4. Apoplexy Treatment of the After - Results

We consider it specially important that the public should be rendered intelligent respecting this part of the treatment of this disease, as a large share of the cases of paralysis of long standing might have been cured quite rapidly if the proper treatment had been applied at the proper time. No active measures should be employed so long as there are evidences of irritation of the brain or danger from inflammation. By the end of two or three weeks, however, if the patient still remains paralyzed, systematic efforts should be begun, to enable him, so far as possible, to regain the use of his limbs and to prevent deformity. These measures consist, at first, in daily bending and manipulation of the affected limbs. All the joints should be moved to prevent stiffening, and the limbs should be manipulated thoroughly so as to secure a vigorous circulation. Movements described in the section devoted to "Medical Gymnastics," are particularly adapted to these cases. It is also important that the patient should be required to move his limbs by his own effort as much as possible without too great fatigue. If he is unable to do this, he should be required to make an effort to perform the motion given to the limb by the attendant. The effect will be much the same as if he moved the limb himself with a little help, though he really takes no part in it. This point is quite an important one, as, in many cases, the patient remains paralyzed after the nervous connection which has been interrupted is fully restored, simply from want of voluntary control which has been lost through the long disuse of the affected part. The only way in which this difficulty can be overcome is by the plan suggested. The movements should be applied only five or ten minutes each day at first, but can be gradually increased to fifteen or twenty minutes twice a day.

Electricity is an invaluable remedy in the treatment of paralysis. By means of this agent the paralyzed muscles may be made to contract the same as though controlled by the will. Electricity may be applied in various ways. The mast effective inodes of application, however, are general and local faradization. Most of the paralyzed muscles may be made to contract by passing rapidly over them a large sponge electrode, using a current sufficiently strong to produce slight pain or contraction of the muscles. In some cases, however, it is necessary to apply the electric current in a more precise manner by local faradization. This is particularly necessary in a case of long standing in which the muscles do not easily respond to the stimulation of the electricity. In these cases, one pole of the battery should be placed in the foot bath in which the feet are also placed, while the other is applied successively to the various points indicated by dots in Figs. 319 and 320. The nerves which control the various muscles of the body are most easily affected at these points. In some cases of paralysis of very long standing, the muscles will not respond to the faradic current until after a more or less prolonged course of treatment. Electricity may also be administered with great advantage by means of the electrothermal and the electro-vapor baths. When there is a great loss of sensation, it is sometimes necessary to apply electricity by means of a wire brush passed over the skin after it has been thoroughly dried.

Mechanical movements of various sorts, or movements administered by machinery, are in many cases very useful. Baths of various kinds are also of very great advantage, especially daily sponging of the body with tepid water or salt and water. Sponging of the surface of the affected parts with water as hot as can be borne is a very excellent means of restoring lost sensibility. Alternate hot and cold nibbing, employing extremes of temperature as great as can be borne without discomfort, is also a very useful measure. The application of fomentations daily, or every other day, and daily manipulation or kneading of the bowels, is a very good means of restoring the activity of the intestinal canal and relieving constipation. When the skin is dry, inunction with vaseline should be employed two or three times a week. Every possible means should be employed to improve the patient's general nutrition. The diet should be nourishing and unstimulating. The less animal fats and condiments that are taken the better. The patient should be got out into the open air and sunshine as -much as possible, and, when practicable, should be given daily sun-baths. Notwithstanding the employment of all the most approved remedial agencies, the most of cases will improve very slowly. Some will make very little improvement. A few will be restored to perfect health, but all, or at least nearly all, eases may be benefited more or less. Even though little improvement should be seen for several weeks, or even months, treatment should be patiently continued with unrelaxing thoroughness, as most remarkable results have often been obtained even when all efforts have seemed to be fruitless for several months. We have treated many cases of paralysis, and have sometimes seen patients recover in a few weeks, while other cases have required as many months to accomplish even a small amount of improvement.

Fig. 319. Showing points at which electricity should be applied to affect special nerves and muscles.Fig. 320. Showing points at which electricity should be applied to affect special nerves and muscles.

Figs. 319 And 320, showing points at which electricity should be applied to affect special nerves and muscles.