Cases of paraplegia / by T. Grainger Stewart.

  • Stewart Thomas Grainger, Sir, 1837-1900.
Date:
1876
Catalogue details

Licence: Public Domain Mark

Credit: Cases of paraplegia / by T. Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    very severe. There was a cold feeling in the legs, particularly the right, and some formication in the back of the trunk. Sensi- bility to touch, temperature, tickling, and pain was greatly im- paired in the rigiit leg, though it was natural in the left. The muscular sense was greatly impaired in the left leg, though natural in the right. He was unable either to walk or to stand, and even in bed, while the right leg could be moved about with some freedom, the left was totally paralyzed. It was clear that there was more disease than formerly, that mere pressure would no longer account for the phenomena, which must be due to local changes in the cord; but as these grave changes were due to the causes which were active during the former illness, the same treat- ment was adopted, and it was followed with like good results. In August the girdle pain had disappeared from one side, and the paralysis was much diminished. It was found that on the left side, the side affected with motor paralysis, the sensibility of the skin of the abdomen, up to the level of the umbilicus, was un- naturally acute. The patient continued to improve during the succeeding months, and in January left the Infirmary cured. He is at present employed as a sailor in the Baltic trade. It is just a hundred years since Percivall Pott' described, with great accuracy, the form of disease of the vertebra3 from which this patient sutfered, and the form of paraplegia which it is apt to induce. It is now^ known that Pott's disease may originate either in a strumous affection of the bodies of the vertebrae or in disease of the articular structures, and that in whichever seat it may commence, there is ultimately crumbling down of the bone, resulting in the formation of an acute curvature, and perhaps abscess. I am in- clined to think, considering the patient's age, his constitution, and occupation, the absence of suppuration, the presence of nocturnal exacerbations of pain, and the subsequent progress of the case, that the disease originated in the cartilages. Pott^ recognised the great features of this kind of paraplegia. He says,— It should be observed that, notwithstanding the lower limbs be rendered almost or totally useless, yet there are some essential circumstances in W'hich this affection differs from a com- mon nervous palsy, when legs and thighs are rendered unfit for the purposes of locomotion, and do also lose much of their natural sensibility; but, notwithstanding this, they have neither the flabby feel which a truly paralytic limb has, nor have they that seeming looseness at the joints, nor that total incapacity of resistance which allows the latter to be twisted up in almost all directions. On the contrary, the joints have frequently a considerable degree of stiff- ' Remarks on that kind of palsy of the lower limbs, which is frequently found to accompany a curvature of the spine, and is supposed to be caused by it.^ The Chirurgical Works of Percivall Pott, F.li.S., vol. iii. p. 393. - See Leyden, Ruckenmarks' Krankheiten, vol. i. p. 217. Shaw, in Holmes's bysfem of Surgery, 2d edit., vol. iv. p. 103.' 3 Op. cit., p. 400.