TREATMENT 
OF 
PARALYSED MUSCLES 
BY 
ELASTIC RELAXATION. 
By JNO. P. VAN BIBBER, SL-ff 
Reprinted from the Transactions of the Medical and Chirurgical Faculty of 
Maryland, April, 1875. 
BALTIMORE: 
INNES & COMPANY, PRINTERS AND BINDERS. 
1875. TJE^E^TIMIIEIIsrT 
OP 
Paralysed Muscles by Elastic Eelaxation. 
At the present time, when a new vigor seems to have been im- 
parted to the study of the nervous system, I deem it peculiarly fit 
to bring to the notice of the Society some observations which have 
lately been made concerning the condition of muscles in various 
forms of paralysis. 
And I do so more willingly, because it is evident to me that the 
morbid conditions of the muscular system have up to this time been 
too little investigated, and I feel convinced that the day is not far 
distant when the nosology of muscular diseases will be very mate- 
rially increased. Taking into consideration the fact that the mus- 
cular tissue constitutes nearly one-half the entire mass of the hu- 
man body, or according to Ranke .45, and that the process of 
nutrition and assimilation is carried on to a great extent in this 
system, we must be impressed with the important influence which, 
either in health or disease, this large mass of tissue exerts upon the 
economy. Indeed, Flint in his Physiology, vol. ii, p. 449, says, 
“that the condition of the muscular system is an almost unfailing 
evidence of the general state of the body.” To show clearly the 
practical importance of the theory which I shall here endeavor to 
develop, I would beg leave to call your attention briefly to the 
anatomy of muscular fibre, in order more intelligently to explain 
the curative action of elastic relaxation applied to paralysed 
muscles. 
According to Flint, voluntary muscles are made up of a great 
number of microscopic fibres called primitive muscular fasci- 
culi. The structure of these fasciculi is complex, but they may be 
divided longitudinally into fibrillse, and transversely into disks, in 
such a manner as to render it doubtful as to what, strictly speak- 
ing, is the ultimate anatomical element of muscular tissue. A 
primitive muscular fasciculus runs the entire length of the muscle, anti varies much in size in different individuals. As a rule they 
are smaller in young persons and females than in adult males. As 
a muscle is better developed, so the fasciculi increase in size, and 
it is probably due to this fact rather than to the formation of any 
new elements, that we have the enlargement of a muscle under con- 
stant exercise. These fasciculi are gathered into bundles and sur- 
rounded bv connective tissue; and a certain aggregation of bundles 
so formed constitutes a muscle. 
The circulation in muscles is very abundant, and the capillary 
vessels are arranged somewhat peculiarly, and are the smallest 
in the whole body. According to Kollike, when distended with 
blood, they are from tsVtt to stW °f an inch in diameter, and 
when empty their diameter is from t° ztujs of an inch. The 
capillaries are distributed to each primitive fasciculus, and their 
long diameter follows the direction of its fibres. 
Now it is evident from this anatomical construction that 
the diameter of these vessels is much influenced by the position 
of the muscle. If it be relaxed, the diameter of the capillaries 
would be greater; if it be stretched to any extent, the diameter 
would be very materially diminished. On the other hand it is 
equally evident that in the contraction of a muscle the circulation 
is also influenced to some degree ; but as that is not of as much im- 
portance in this discussion, it is only mentioned as a fact. 
I would wish to call attention to the fact that a muscle is so 
formed, its fibres and circulation so arranged, that it cannot remain 
in a fixed position, contracted, relaxed, or stretched, for any length 
of time without suffering grave disturbances in its nutrition. 
Movement seems to be absolutely necessary for the healthy 
development of muscle, and hence we can readily infer that a 
certain amount of motion is essential for the well-being of the 
component parts of this tissue. Even a perfectly relaxed position, 
with the antagonistic muscles acting normally, I do not think 
could long be sustained without some interference to the circula- 
tion. If then a healthy muscle depends to such an extent upon 
movement for the integrity of its condition, we can easily imagine 
that the loss of motion of paralysed muscles is not an unimportant 
factor in their degeneration. 3 
Therefore in some forms of paralysis, when a muscle, or group of 
muscles, is forced by its antagonists into an abnormal and compara- 
tively fixed position, Tdo not think that treatment wise or efficient 
which only endeavors to cure the nervous lesion, or at best totally 
neglects the nnphysiological condition of these paralysed muscles. 
For in such a case of paralysis, we not only have the muscles in- 
capable of receiving the influence of the will, but not being cap- 
able of motion or contraction, they are injured, first, by the fibres 
themselves being intensely stretched; second, by the circula- 
tion being undoubtedly interfered with ; third, by the commen- 
cing atrophy or degeneration which must accompany any continued 
diminution of the circulation. 
To recapitulate the various disadvantages under which a muscle 
so affected is placed, I would say, first, the loss of the nervous in- 
fluence of the will ; second, the inactivity of the muscular fibre ; 
third, its stretched and elongated position ; fourth, the contraction 
of the blood vessels, and consequent anaemia and loss of temper- 
ature. 
Heretofore, too little attention has been given to the treat- 
ment of the muscles themselves in some of the more curable 
forms of paralysis, and I refer with some pride to an article 
in the New York Medical Journal, May 1874—that pro- 
posed a plan of treatment, which if not entirely new, at 
least brought forward some new arguments and considerations in 
regard to a closer investigation of the condition of paralysed muscles. 
Before attempting to call attention to the injurious way in which such 
stretchingof the muscle mayaffectthe ultimate distribution of nerve- 
fibre, I will endeavor to show how the elastic relaxation of paralysed 
muscles will better their condition and promote recovery. 
In the article before referred to, in alluding to the use of an artifi- 
cial extensor muscle in a case of lead paralysis, I gave the following 
opinion of its advantages and usefulness : u Perfect relaxation of 
muscle by mechanical means would not, I am confident, accomplish 
the results I have seen from the use of this instrument, and at the 
same time would not give to the patient as useful a hand. For 
here, without having power in the extensor group, we simulate, 
as nearly as possible, nature herself; and in the daily uses of the arm, by alternate relaxation and contraction, we bring the muscles 
as near their normal movements as the deformity will allow. And 
I would place great emphasis upon this point, that in these 
changes of position we have changes in circulation ; that when the 
muscle is intensely stretched, the capillary vessels are pressed 
upon and their calibre reduced; while on the other hand, in a 
relaxed Condition of the muscle, nutrition can go on with less in- 
terference. Certainly in health, only by movement and exercise 
can we produce developed muscle. Therefore, when the power of 
motion is lost, when paralysis has deprived any muscle of an 
element so important to them in their normal state, we should, in 
our treatment, endeavor to imitate their natural action as the 
surest means of bringing about recuperation.” 
The first example which will be brought forward as a success- 
ful proof of the efficacy of this treatment, is a case of Ptosis that 
came under my observation at the New York Eye and Ear 
Institute. The patient had been under treatment for some 
weeks, but the paralysis was not in the least improved. My 
friend, Dr. John J. Mason, of the Department for Nervous 
Diseases of the Institution, had tried as efficiently as possible' the 
effect of faradization, with no result whatever. It occurred to me 
that if the stretched fibres of the Levator palpabrae superioris could 
be relaxed, and the lid kept up by an artificial levator muscle, that 
a great step would be made towards his recovery. Accordingly, a 
thin and elastic ribbon of India rubber was attached to the upper 
lid, at the highest point of its convexity, and as near to the lashes 
as possible, by means of minute strips of court-plaster, which, 
when dry, were painted over with collodion. The lid was then 
drawn up by this muscle to a natural position, and the ribbon 
attached by the same means to the forehead just above the eyebrow. 
Conrad McEroe, aged forty-three, carver in a restaurant, stands 
much over hot dishes in carving and is exposed to draughts. 
No syphilitic history, paralysis of lev. palp. sup. and rectus sup. 
Ptosis, probably of rheumatic origin, or in other words “ coup 
de vent.” Has been treated for three weeks by electricity, and 
hydrarg. bi-chloride and potass, iodide, with no success. The first artificial muscle applied, remained on five days. The patient 
showed decided improvement. The next muscle remained on ten 
days, and the next three days. At each examination he was found 
to be improved, and after eighteen days of treatment it was found 
that his eye would remain two-thirds open, and that he could close 
the eye and open it to that extent an indefinite number of times. 
It was, however, thought best to apply it again, and by this 
means and the aid of electricity the affected muscle was soon 
entirely restored. 
I had the pleasure of showing this case to the Society of Neuro- 
logy and Electrology of New York, and also mentioned it in the 
article before alluded to, in the following words : “ The patient ex- 
periences much comfort from the appliance, as, the recti muscles 
being but slightly involved, he is rarely troubled with diplopia. 
The elasticity of the rubber allows the patient to close the eyes, 
but upon ceasing muscular effort the eye is again opened.” 
In this case the artificial levator had not only to overcome the an- 
tagonism of the orbicularis,but also the counteracting force of grav- 
ity, for the upper eye-lid of an adult is of some appreciable weight. 
I look upon this as a type case, for it had long resisted the treat- 
ment of electricity, and it was only after prolonged relaxation and 
weeks of artificial motion that the fibres of this muscle were able 
to resume their natural functions. 
The case of lead paralysis in which l first used the artificial ex- 
tensor muscle was also a very instructive one, showing the value 
of this treatment when all others had failed. 
Frank Fitzimmons, age 45, painter; blue line on gums, and lead 
cachexia well marked. Has had colic, and paralysis of extensors 
has lasted eight months. Prognosis bad. Has not improved at all 
under constant electrical treatment. Extensors are entirely useless ; 
and flexors, when motion is attempted, bend the hand at a right 
angle with the forearm. The temperature of the extensor surface 
of the arm is perceptibly diminished. The elastic relaxation was 
applied as I have described it in JSf. Y. Med. Journal, May, 1874, 
forming a very useful and efficient extensor muscle. He continued 
to wear this apparatus for about 3 months, and at the time of my 
leaving New York was able to resume light work, having full power over the extensors of the wrist, but not having yet fully re- 
covered the use of the extensors of the fingers. I should not 
neglect to say that during this time the treatment by electricity was 
continued; but as he had so long resisted that treatment, and re- 
ceived no benefit from its use alone, I think his recovery may be 
truthfully attributed to the curative action of the elastic relaxation. 
Dr. Detmold, New York Med. Journal, May, 1873, published a 
case of facial paralysis treated by an apparatus which, though it re- 
laxed the muscles, was not elastic, and which was thought to have 
a curative effect on account of the current of electricity that passed 
continually through it. It consisted of two different metals, made 
in the form of a double hook, one end to pass behind the ear and 
the other into the angle of the mouth. The hook behind the ear 
was armed with a small sponge, which was kept moist with dilute 
vinegar, and the one in the mouth obtained its moisture from 
the saliva. This instrument was tested by a galvanometer and a 
perceptible current found to be generated by it. Dr. Detmold, in 
his article, questions whether it was the electricity or the relaxa- 
tion that benefited this case so much. 
I am inclined to believe it was entirely due to the relax- 
ation, although it lacked the most important element of 
elasticity. A small hook to hold up the angle of the mouth, 
attached by a band of rubber around the ear, is a much more 
effective apparatus; and it was tried several times at Dr. 
Seguin’s clinic, and also at the Bellevue, but with what result I 
am unprepared to say. Dr. Detmold was kind enough to say in 
New York Academy of Medicine, that he thought the elastic 
apparatus would accomplish much more than the one he had first 
devised. 
I will now come to the consideration of the nervous element of 
the treatment proposed and carried out in the cases just related. 
In paralysis of all kinds, heretofore, we have looked almost en- 
tirely to the lesion existing either in the nerve-centres, or in the 
course of the nerve some distance from its distribution to the 
affected muscles. Of course for purposes of diagnosis this is not 
only important.but necessary ; yet I would wish to show that no 
treatment should be governed by this idea alone, but that we must take into consideration the paralysed muscles, and give them some 
share of attention. 
The intimate anatomical relation existing between the ulti- 
mate nerve filaments and the muscular fibrillre, is not only 
a strong argument for giving our treatment a local character, 
but it is a physiological fact which if overlooked would tend to 
retard beyond measure the recovery of the paralysed muscles. If 
it can be shown that a nerve, besides the nutrition that it has from 
the circulation in its course, derives a separate and distinct source 
of nourishment from its distribution to the muscular fibre, it will 
be evident that any effort to better the condition of the muscles 
would be followed by corresponding improvement in the distal 
portion of the nerve. In a grave central lesion, as we could hardly 
hope to effect any permanent relief, such endeavor would be of no 
avail. But in many cases of paralysis, especially such as I have 
related, I think the theory is one which should prove itself suc- 
cessful in practice. 
The termination of the ultimate filaments of nerves in the 
fibres of muscular tissue is a subject that has given rise to 
much discussion. But whatever may be the explanation of 
the question, this fact is beyond all doubt, that the nerve-tissue 
and muscle-fibre are very closely and intimately connected, and 
that the nutrition of both these tissues as they merge into one 
another is probably carried on by the same blood-vessels. 
In fact, it has been demonstrated by experiment, that if a nerve be 
cut some distance from its termination in a muscle, and its irritability 
exhausted, it will first show signs of returning irritability nearest 
its distal extremity. Herrman experimented upon the sciatic nerve 
of a dog, which he exposed high, and cut, and exhausted its irrita- 
bility. The distal portion of the sciatic being separated from the 
remainder of the nerve, and entirely cut off from the spinal sys- 
tem, could receive no recuperative power from that source. Yet it 
was found after a time to have regained its irritability, and percep- 
tibly in a greater degree nearest its distal extremity. The inter- 
esting question as to how this nerve was able to resume for a time 
its normal condition, and to give rise to natural phenomena, can 
only be answered by admitting that, after being exhausted and ren- 
dered completely incapable of reacting to the usual stimuli, it has recovered and been nourished from its distal extremity—whether 
through its ultimate connection with muscular fibre, or through a 
grosser circulation which exists between the muscular and nerve 
tissues. 
If the inference drawn from this experiment be true, the 
local treatment of paralysis has been heretofore too much ne- 
glected, and a new method must be introduced, and a new hope 
inspired concerning the ultimate recovery of many forms of 
paralysis. 
It is then a fallacious idea to think because the inner- 
vation of a muscle is cut off, that we should, therefore, wait 
until that necessary influence has been re-established before we 
can do anything to better the condition of the muscular fibre. 
Hence, I believe that in all forms of peripheral paralysis, from 
injury,cold, toxic influence, and the like, where not being able to 
restore the nerve to its normal condition, if we can by mechanical 
means give the affected muscles, as nearly as possible, their natural 
motions, we prevent any further degeneration in the muscles, 
and actually improve the condition of the nerve or nerves. 
There are two results to be derived from the course of treatment 
advised in this paper : first, the muscular fibre is improved, and 
its condition rendered more natural ; second, through the improve- 
ment of the muscles, the distal extremities of the nerves are 
affected favorably; and finally, the whole part is placed in the best 
hygienic condition to receive the influence of the will, as soon as 
the lesion should commence to disappear. 
It is to be hoped, that as more attention is drawn to this method of 
treatment, closer investigation in regard to the muscular system 
will be invited, and that the principles advocated in this paper, 
heretofore totally neglected, will prove our best means of relieving 
many forms of paralysis.