Apoplexy, Tabes

APOPLEXY.
Experience shows that even old cases of paralysis are very often improved, and sometimes completely cured, by mechanotherapy. Its advantages consist in being able to work upon the entire nerve-system as soon as the least activity is apparent in the affected side. The massage is used at first to irritate the nerves and to increase nutrition. It will always be of some benefit, provided the system has power to react. In treating a case of paralysis the operator should remember two special points:
1. Find out which muscles are affected and treat them and their nerve-supplies with massage.
2. Overcome the contraction of the antagonists by movements, or if necessary by braces.
Where there is active power in the affected side, use, in connection with the massage, the following movements (for instance, for the right side):
1. S. rotation of arms.
2. Half L. rotation of legs.
3. S. rotation of right shoulder.
4. Flexion and extension of right leg.
5. Depression and elevation of right arm.
6. Pressing and shaking of right leg.
7. Pressing and shaking of right arm.
8. Percussion of back.

It is generally the best plan not to start the massage until three weeks after the stroke. The operator should remember to always select such manipulations and movements as will prevent a rush of blood to the cerebrum. Paralysis from accident, gout or rheumatism, is very often treated by massage, the result depending upon the condition of the affected nerves. When caused by poison, mechanotherapy is recommended principally as a stimulating remedy, when the patient is convalescent. In paralysis from lead-poisoning massage is an excellent remedy. The necessity of a knowledge of anatomy on the part of the operator is more apparent in treating cases of paralysis than any others. Careful attention should be paid to the facial muscles if required. In a Swedish journal is recorded a case of an eighteen-year-old patient paralyzed in one leg from childhood. He was treated twice daily for three consecutive years by thorough massage and movements, and at the age of twenty-one his leg was restored to its natural size and strength. It is astonishing what the inunction of cod-liver oil in connection with the massage will do in some cases of infantile paralysis.

TABES.
Apply massage of the back in connection with pressing. Massage of the abdomen, with pressing above the bladder and pressing and shaking of the extremities, are frequently used. Some authors recommend extension of the legs, pulling of the legs and beating of the sacrum. The movements should be refreshing and invigorating and great care should be taken not to overexert the patient. A rest in bed for six weeks with intelligently applied massage and inunctions, if indicated, have given the most satisfactory results in the author's experience, including some fifty cases. Of all movements recommended by the authors on mechanotherapeutics in the treatment of locomotor ataxia none equals the pulling of the legs. Place the patient perfectly flat on his back without head-rest; grasp with one hand around the ankle, with the other firmly above the knee - pulling downward slowly without jerking. Carefully and properly applied, this simple movement will often relieve the most agonizing ataxic pains.

As trained nurses are often requested by the attending physician to inunct a patient with blue ointment in this affection, and as the author has seen several cases in which the "inunction" consisted of merely placing the prescribed quantity in the groin or axilla, he considers it proper to here give the correct method of inunction as recommended by Dr. Sigmund. The patient should, if possible, take a hot bath as a preparation. If that, for some reason, be impossible, it becomes the operator's duty to wash the part to be inuncted, either with soap and warm water or with alcohol and water, to dissolve the fat in the pores. The ointment should be worked in with moderate friction by the palm of the hand : on the first day on the inside of the legs; on the second day on the inside of the thighs; on the third day on the sides of the trunk; on the fourth day on the back; on the fifth day on the inside of the arms ; on the sixth day commence a new series. In twenty to thirty minutes the seance is completed.

The operator should wear a glove to protect himself from absorbing the drug. In the friction it is best to try to describe a figure eight, unless the parts are heavily covered with hair - then work in a circle. If the patient desires to conceal the fact that he is taking the inunction, wash the parts worked upon and remove every trace of the proceeding. The best result will be accomplished if the drug is allowed to remain on the skin to be gradually rubbed in by the clothing. Three hot baths a week are generally recommended. The new preparation " Mercury-Vasogen" is now generally used for inunction and it is far superior to the blue ointment as it works in so much quicker and does not leave a disagreeable odor. Besides it has been the author's experience that it does not produce any skin-affections, while the blue ointment is very apt to cause not only local irritations of the parts inuncted, but also eczema and erythema.