Page:Acute Poliomyelitis.djvu/64

52 Paresis of the trunk muscles always accompanied severe paralysis of the lower extremities, but was usually transient. Zappert calls attention to the fact that in his experience the left side was surprisingly more often attacked than the right (arm palsies—8 right, 16 left; leg palsies—29 right, 38 left; hemiplegia—8 right, 14 left). During the New York epidemic, 29 left, 21 right arm palsies; 171 left, 120 right leg palsies, and 15 left and 16 right hemiplegias were reported. I myself found 34 left, and 24 right arm palsies; 61 left, 60 right leg palsies and 9 left, and 23 right hemiplegias. Leegaard gives the following figures: Arms, 21 right, 21 left; legs, 56 right, 44 left; hemiplegia, 7 right, 8 left.

It is evident that every part of the spinal cord may be attacked in this affection. Clinically, the disease occasionally seems to be confined to a circumscribed area. The great variability of the paralysis is obvious not only when the whole body is attacked, but also in infections involving single limbs. In the extremities, even during the first period, when the paralysis is of greatest intensity and extent, accurate observation seldom reveals a complete monoplegia or paraplegia. Even when the whole leg lies motionless, the toes may still be capable of movement which, however, is more weak or less free than normal. An analogous condition occurs not rarely in the arm. After some time has elapsed, the unequal distribution of the paralysis is more evident. Although a great variety of combinations of paralysis may develop, certain types appear more often than others. In the leg, the peroneal group and certain muscles of the thigh—in my experience the quadriceps femoris especially—tend to be implicated. Although the paralysis seems to be localized to these muscles, others are to some degree affected also. Lovett and Lucas showed that in not less than 355 out of 478 cases in which the legs were implicated, the quadriceps either alone or in combination with other muscles was affected. Next in frequency to the quadriceps, comes the tibialis anticus, which is oftener attacked than the peroneal group. Of the flexors of the thigh, the mesial muscles are more frequently paralyzed than the lateral. In the upper extremity, an analogous condition exists; i. e., in frequency and distinctness, paralysis of the deltoid and of the upper arm preponderates (E. Remak).

Sometimes the motor disturbances assume the form of an