. A treatise on nervous and mental diseases, for students and practitioners of medicine. ft side. The paralytie stage. The onset of the paralysis may be sudden orgradual. At first it is usually general, aflecting most of the volun-tary muscles. In the course of tAvo or three days, however, there isa spontaneous recession of the paralysis from most of the muscles^ SPINAL CORD AND MEDULLA OBLONGATA. 213 leaving only certain groups affected. Occasionally the paralysis islimited from the first to certain muscle-groups. Usually there is asecond aud more gradual spontaneous recession of the paralysi
. A treatise on nervous and mental diseases, for students and practitioners of medicine. ft side. The paralytie stage. The onset of the paralysis may be sudden orgradual. At first it is usually general, aflecting most of the volun-tary muscles. In the course of tAvo or three days, however, there isa spontaneous recession of the paralysis from most of the muscles^ SPINAL CORD AND MEDULLA OBLONGATA. 213 leaving only certain groups affected. Occasionally the paralysis islimited from the first to certain muscle-groups. Usually there is asecond aud more gradual spontaneous recession of the paralysis dur-ing several months. In children the most common form of paralysisis monoplegia, most often of a lower extremity. In adults, para-plegia is most common, usually of the lower extremities. Still, itmust be remembered steadily that any of the voluntary muscles maybe affected. But all the muscles of a limb are not, as a rule, equallvimplicated. In the lower extremities, the flexors of the leg, the glutealmuscles, the quadriceps, and the ilio-psoas, are generally spared. In Fig. Photograph of a case of myelitis of the anterior cornua, showing atrophy of theleg type on the left side. the upper extremities it is the forearm and hand muscles that gener-ally remain intact. The paralyzed muscles of the lower extremitiesare usually the tibialis anticus, or the peronei and extensors of the the upper extremities the paralyzed muscles may be the supinatorlongus, biceps, brachialis internus, and deltoid—the so-called upper-arm type of Remak or Erb ; or all the muscles supplied by the radialnerve may be paralyzed, except the supinator longus. Then theserratus anticus may be affected, together with the hinder portionsof the deltoid, the infra-spinatus, and rhomboids. Thus, as will beobserved, of the; five lumbar segments it is usually the fourth andfifth that are the site of disease in these types; aud of the eight 214 NERVOUS DISEASES. ana- cervical segments it is principa
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