A treatise on orthopedic surgery . plegia, are weakness,awkwardness, and a stumbling, shambling gait. The symp-toms usually increase rapidly until paralysis of motion is com-plete. At this stage the patella tendon reflex is increased, andankle-clonus is often present. As a rule, both limbs are affectedin equal degree, but occasionally paralysis of one may be morecomplete or may precede that of the other, and in the stage ofrecovery power may return more rapidly on one side than onthe other. The limbs in the early stage of the paralysis mayappear limp and powerless, but when the patient is move
A treatise on orthopedic surgery . plegia, are weakness,awkwardness, and a stumbling, shambling gait. The symp-toms usually increase rapidly until paralysis of motion is com-plete. At this stage the patella tendon reflex is increased, andankle-clonus is often present. As a rule, both limbs are affectedin equal degree, but occasionally paralysis of one may be morecomplete or may precede that of the other, and in the stage ofrecovery power may return more rapidly on one side than onthe other. The limbs in the early stage of the paralysis mayappear limp and powerless, but when the patient is moved orwhen the reflexes are stimulated the peculiar spastic rigidity orstiffness appears. 120 OBTEOPEDIC SUEGEBY. As a rule, the stiffness increases with the duration of the dis-ease, and spastic contractions are often present; thus, the thighsmay be aj^proximated, the knees flexed, and the feet contractions indicate, as a rule, permanent damageto the cord, and in such cases complete recovery is unusual. Fig. Potts paraplegia before the stage of deformity. The apparatus used in thetreatment of this case is shown in Fig. 47. Sensation is not affected ordinarily, but in the more severe orprolonged cases it may be impaired or lost. Sensation was re-tained throughout in 24 of the 40 cases reported by Shaffer. In the cases of partial j^aralysis control of the bladder may beretained, but usually there is incontinence. As the bladder fillsthe reflex centre is excited, and it empties itself. The control of the sphincter ani is less often or less noticeablyaffected. As the paralysis is the result in many instances of active or ofadvancing disease its onset may be preceded by discomfort orpain. Thus, noticeable discomfort attended by an exaggerationof the patella tendon reflex may be considered as an indicationfor enforced rest of the individual, although increased activityof the reflexes is not uncommon during the progressive stage ofthe disease without apparent i
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