The facies (appearance) of paralysis is quite pronounced, and understandable to those acquainted with the various expressions.

Paralysis and its deformities are many. Any part of the nervous system may be involved. The muscles and organs to which the nerves are distributed must become atrophied, and the opposing muscles are rendered rigid and spasmodic. The intellect must be affected, and the countenance becomes an index.

Action or motility must be observed.

Motion--voluntary motion--is lost. The amount of paralysis must be in keeping with the amount of lost power.

Monoplegia is where one limb is paralyzed. Hemiplegia is where one arm and one leg are involved. Where the face of one side and the limb of the opposite side are involved the name of crossed or alternate paralysis is given.

When the two upper or two lower limbs (which is rare) are affected, the name of paraplegia is given. Where the paralysis is confined to less than one limb, or to a part of the extensor, or part of the contractor, muscles of one limb, the paralysis is named partial paralysis.

Where the limb is entirely paralyzed, it is readily recognized; for it is devoid of all motion and cannot defend itself at all. When raised, it falls as dead, if allowed, if burned, it cannot get away from the torture.

Where the paralysis is of a muscle or two, the auxiliary and opposing muscles undertake to do vicarious work. Where this condition is pronounced, deformity must develop; for the muscles which are doing extra work are unduly developed, and those which are paralyzed go into a state of atrophy. The two extremes in a limb cause the limb to be deformed. If the strengthened muscles are extensors, the limb is forcibly extended, and vice versa.

A paralyzed side of the face is smooth. This contrasts very greatly with the opposite side, which is overdrawn and contracted because of losing the counterpoising effect of the paralyzed opposite side.

If the patient attempts to whistle, spit, or put out the tongue, the movements mark the change that has taken place. The movements lack uniformity.

The orbicularis palpebrarum (the muscle that closes the eyelids) is paralyzed when the cause is peripheral (external); but when the lesion is central, this muscle is left intact. When this muscle is paralyzed, the eye remains open, and the dust settling in it is a source of much annoyance as well as discomfort.

Where muscles are relaxed, the paralysis is said to be flabby; the opposite is contracture.

Where there is contracture or rigidity of muscles, the upper extremity hugs the side, while the lower extremity extends. The arms stick to the side; the forearm is bent at a right angle; the hand is flexed and pronated (palm down). The toes of the extended leg are flexed toward the sole.

Contractures may be hysterical or functional; but often they are due to organic change, caused by an inflammatory state brought on from toxin poisoning or a traumatism (injury). Atrophy of the brain, spinal cord, or membranes accompanies or causes paralysis. All permanent lesions end in contracture. The reason for this, as stated before, is overdevelopment of opposing muscles and atrophy of the paralyzed muscles. A time comes, however, when there will be a wasting of even the muscles not paralyzed, because they become so contracted that they have no other movement than that of contraction. The effect is that of inactivity, nutrition fails and the whole limb withers.

Much of this sort of deformity follows infantile paralysis. The disease is central. Where the paralysis is of vital organs, the children die. Where the paralysis is of one extremity, complete, there will be no contractures, hence no deformity. Where the paralysis is partial of one limb, or partial in two limbs, there must be contractures, hence deformities.

Much unnecessary financial burden is placed on the parents of paralyzed children. In many instances the burden is too great, when the end is, or should be, known to the medical adviser. The end of all treatment must be contracture, which means deformity. Possibly the cutting of tendons to correct a very inconvenient or unsightly deformity may be advisable; but if the object is a cure, or holding out a hope of cure, it is cruel to parents to give hope where there is none to be given.

All lesions sooner or later end in contracture, and mean degeneration. Of brain diseases it may be well to mention: inflammation, hydrocephalus, tumors, hemorrhages, traumatism (injury), degeneration, medullary diseases (diseases of the white substance of the brain), myelitis, sclerosis, tabes, and meningitis; for the latter disease has contractures among its symptoms. Indeed, it is reasonable to believe that infantile paralysis is cerebro-spinal meningitis.