: A THE PENINSULAR JOURNAL OF MEDICINE. JANUARY, 1876. Original Communications. A CLINICAL LECTURE ON PARESIS, OR FAILURE OF MUSCULAR POWER. Delivered December 22, 1875, at the State Hospital, connected with the Department of Medicine and Surgery, of the University of Michigan, by A. B. PALMER, M. D., Professor of Pathol ogy and Practice of Medicine. GENTLEMEN-Since commencing this course of clinical lectures seven cases have presented themselves where a loss of muscular power in a greater or less number of parts of the body, and with greater or less completeness, was among the prominent symptoms. Case 1, was that of A. B., a farmer from Wayne Co., aged 66 years, who had had two years ago, as he said "spinal meningitis," from which, or its effects, he had not completely recovered. Two months before he visited us he was attacked with hemorrhage from the stomach, vomiting blood several times in free quantity, from which he was so much reduced in general strength that he was confined to his bed for some time, but at length was able to be up a part of the time. One week before we saw him here, there was marked loss of power in his lower extremities, together with some impairment of sensation, notwithstanding his general strength had improved; and this paresis was so great that he could with difficulty stand, and with more difficulty walk. He was exceedingly pale-the prolabia colorless and his ears bloodless, indicating extreme anæmia. You will remember I attributed this loss of power in the muscles of his lower limbs (more likely to occur here than elsewhere from this cause) chiefly to the loss of blood and the consequent anæmia; this effect being influenced by the patient's age, and probably also by impairment of the spinal cord by the meningeal inflammation two years before. We found no clear evidence of present organic disease of the stomach, though the hemorrhage suggested cancer or ulcer. And you will recollect that he was directed to take a nourishing diet, easily digested; to dress warmly, and to take a drachm of the elixir of the phosphate of iron, quinine and strychnine, three times a day. Case 2, was that of a young man who had suffered from paralysis of one lower extremity from his infancy. He was examined hastily. But little encouragement could be given as to the results of treatment. We did not see him a second time, and I have not preserved any notes of the case. The original lesion in reach of remedies, and Such cases are sufficiently common. the nerve centre is often beyond the when continuing so long as in this case, the muscles become wasted or are undeveloped, are often degenerated and contracted and the restoration to a healthy state is out of the question. Case 3, was that of L. D. S., of Calhoun Co.; a farmer, married, age 38. He reported himself as having had "enlargement of the liver" fifteen years ago, and "typhoid fever" nine years ago, since which his health has been seriously impaired. You will remember our inquiry as to the particular symptoms of this "fever" did not make clear the correctness of that diagnosis, as he could not remember that he then had diarrhoea, distension of the abdomen, deafness or nose-bleed, and his hair did not fall out afterwards. Since that sickness, whatever it was, he had suffered from what he called "rheumatism" in his lower limbs, hips and back; he walked with great difficulty and by the aid of a cane; the muscles of his limbs were much wasted; but the history and present appearances indicated sciatica rather than rheumatism, this having become chronic, resulting in the loss of power from impairment of nerves and muscles. You will remember his countenance and whole appearance indicated great debility and depression; that notwithstanding his general anæmia his tongue was red and glossy; that he was directed to discontinue the whisky which he had been taking in regular, but not what is usually considered excessive quantitiesonly in such cases as had been prescribed for him by a physician as a tonic;" that he was directed to take the elixir of phos. of iron, quinine and strychnine, and that he appeared in four weeks after, looking and feeling much better, his color having improving decidedly, his pain diminished and his power of locomotion moderately increased. He was advised to continue the former prescription and to visit us again. Case 4, was that of D. S., age 60, cabinet maker; of short stature, of correct habits with the exception of the free use of tobacco, and a not altogether moderate use of coffee and tea. Six weeks before his appearance at the clinic, after a breakfast which was freer and more enjoyed than usual, he was taken suddenly with a severe pain in the head, but went to his business, when in an hour or so after, he fell from his chair and was brought home insensible, with a flushed face and slow, laboring pulse. He gradually returned to consciousness, but was drowsy and confused in mind, and was soon discovered to have partially lost the power of his left side. Since then he had been gradually improving, his mind becoming more clear, and the "weakness," as he expressed it, of the left side diminishing. The diagnosis which many of you attempted to make, with varying success, was decided to be cerebral hemorrhage-the partial hemiplegia being a result of that pathological lesion. This opinion was strengthened by finding the heart hypertrophied, though without apparent valvular lesions-for in this condition the blood is more likely to be thrown to the head with sufficient force to rupture weakened vessels. He was prescribed iodide of potassium in five grain doses three times a day, with a view of promoting the absorption of the clot and inflammatory exudates about it, which condition was presumed to be present. At subsequent visits his symptoms were found to be gradually abating. Care and moderation were enjoined, as in such cases there is a liability to subsequent attacks. Case 5, was that of S. T., farmer, age 73. For the last sixteen years this patient has been unable to work, and has walked with a crutch or cane. He had at first suffered much pain, and since at different times, with feelings of numbness, though having but little pain now and for months past. A variety of treatment had been used at different times, including galvanism, with but little apparent effect. The history and present condition justified the diagnosis of sciatica and its results, rheumatism and rheumatoid arthritis being excluded. As Mr. T.'s general health was good, the pain in his limbs not now considerable, though there were some disagreeable, numb sensations, especially in one heel, but all being the result of former rather than present active diseased processes, age now adding its influence to the other conditions; hygienic measures without medicines were advised. Case 6. Mrs. P., widow, age 55, from Davisburg, Michigan. This lady had never been very strong. When she was nineteen years old she had "brain fever," which affected her severely. Her speech and movements were impaired, and her memory so affected that she was obliged to learn to read and write a second time, and she has never since had complete control over her muscles, the left side being more affected than the right. During the last few weeks her symptoms have became markedly Her speech is thick and the loss of power in her hands has been progressing. She was accompanied by her physician, who had been in charge of her case only since the recent advancement of her symptoms had occurred, and who had prescribed some alteratives and tonics. more severe. The diagnosis was impairment of brain and nerve tissue, especially of the motor tract by the inflammation thirty-six years ago, now added to by the failure of nutrient and general power as age advances. She was advised iodide of potassium in five grain doses, three times a day for a few weeks, and then the trial of tonics; regulating the general functions, and meeting any other conditions which may require correcting. The prognosis could not be considered encouraging, as too cure, though some improvement is possible. Case 7. George C., a farmer, age 61; residence, Vermontville, Michigan. The constitution and general health of this gentleman have been good, his habits correct; rather robust in size and form. He "strained" himself by lifting, some sixteen years ago, but recovered completely in the course of two years. In his younger days he had occasional "blind spells," followed by severe headache, etc., (probably migraine), but has had nothing of this for years past. This patient was brought from the hospital into the amphitheatre with his bed, upon a stretcher, he being entirely helpless, the muscles of the upper and lower extremities being alike affected, though, as you saw, he could draw up feebly his left leg and could raise his left hand nearly to his head. You noticed that the little finger of each hand was rigidly flexed, that each forearm was held quite firmly at about a right angle with the arm, that the wrists were stiff, and that passively bending any of these parts produced pain. The lower limbs, though no more under the control of the will than the upper, have not this rigidity—the muscles being flabby and relaxed. The tongue was protruded readily and in a direct line; the voice was unimpaired, the intelligence perfect, the face symmetrical; mastication and digestion were uninjured so far as muscular action was concerned; in short, all the parts supplied by nerves directly from the brain retained their functions, while all those supplied by nerves from below the cervical vertebræ had their motor functions greatly impaired or entirely lost. The motion of the diaphragm and other respiratory muscles was comparatively intact, as the nervous supply of these muscles is not so dependent upon the spinal cord. The patient informed us that he had occasional chills followed by flushes of fever. His pulse, when he was quiet, was 70; respiration about normal in fre |