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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    motor ataxia, infantile paralysis, and tetanus, and, doubtless, along with them, many less formidable affections. The symptoms presented by our patient were very peculiar, combining, as they did, evidences oi excess with evidences of defect of function. For while there was feeling of numbness in the affected parts, there was also hyperassthesia; and while there was want of motor power, the muscles jerked on the slightest irri- tation. The whole history indicated that the case must, like the last, be referred to the functional group; but, in the present state of our knowledge, it would be unsatisfactory to speculate as to the actual condition of the nervous system. Certainly the results of the treatment were very satisfactory, and of con- siderable practical interest. There seemed distinct enough indi- cations for the employment of ergot, in accordance with the rules laid down by Brown-Sdquard.^ He says—Ia-^, Ergot must be employed in paraplegia in cases attended with irritation of motor, sensitive, or vasomotor nerves, viz., in congestion or inflammation of the spinal cord, or its meninges. 2<^, Ergot must be avoided as an agent only able to increase the paralysis in cases of paraplegia without symptoms of irritation, such as cases of reflex paraplegia, or of non-inflammatory softening of the spinal cord. With such signs of irritation as our patient presented, one would certainly have concluded, according to these rules, that the ergot should have been useful. But it proved quite otherwise; and, after a few doses, had to be discontinued, as it was manifestly proving injurious. Turning, again, to the rules laid down by the same dis- tinguished authority for the use of strychnia, it appears that that remedy should have been most unsuitable. For strychnia, says he, should, 1st, be employed in those cases of paraplegia in which there is no sign of irritation or of increase of the vital properties of the spinal cord, such as cases of reflex paraplegia and white softening. 2d, It ought to be avoided as a most dangerous poison in those cases of paraplegia in which there are signs of congestion or inflammation of the spinal cord or its membranes. In these cases strychnia can only increase the cause of the paralysis. In our case therefore this remedy might have seeniedf contra- indicated. But experience shows that ergot of rye and-'the pre- preparations of nux vomica suit opposite classes of ca^s,- and'it was therefore right to try the latter when the former h^d'aggravated the symptoms. Its beneficial effects were alike 'powerful ariiJ speedy, and the result shows that strychnia may prove ^eminently beneficial, even in some cases where irritative symptoms^exist.'^ ' * Paralysis of the Lower Extremities, p. 111. i*^'v-.''* EDINBUROn: PRINTED Br OLIVElt AND BOYD.