ON THE SUCCESSFUL TREATMENT 
OF SOME FORMS 
OF 
PERIPHERAL PARALYSIS 
By JOHN VAN BIBBER, M. D. 
Reprinted from the Transactions of the Medical and Chirurgical Faculty of 
Maryland, April, 1876. 
BALTIMORE: 
INNES & COMPANY, PRINTERS AND BINDERS. 
1876. The Successful Treatment pf Some Forms 
of Peripheral Paralysis. 
JOHN VAN BIBBER, M. D. 
In the paper which I had the honor to present to this Society 
last year, I called attention to certain views concerning a new 
treatment for some forms of peripheral paralysis. Since that 
time I have had the opportunity of making further observations, 
which have convinced me more fully of the truth and accuracy of 
an opinion that was then only imperfectly substantiated by prac- 
tical results. 
When last year it was stated that too often the muscular ele- 
ment of paralysis was entirely neglected, I did not then suppose 
that the subject was of such vast importance as a larger experience 
has proved it to be. And when to-day it is stated positively, and 
with assurance, that the investigations into the condition of para- 
lyzed muscles are destined to become one of the chief advances 
in medical science, there are many who will be surprised at the 
bold position that I have taken. But it should be remembered 
that the various lesions of the nervous system have only of late 
years been brought into prominence, and that the more general 
recognition of specialties has brought under enthusiastic observa- 
tion a much larger number of cases. Thus great interest has 
been aroused in this heretofore unsatisfactory field of medical 
science; and by superior means of diagnosis, increased pathological 
knowledge, and by vivisections to establish physiological truths, 
many advances have already been made, and much progress is 
promised in the future. 
The Dispensary for Nervous Diseases at the Washington Hos- 
pital has presented to my care a very large proportion of peri- 2 
pheral paralyses among the patients applying for relief, and it has 
been a source of great gratification to observe the results that 
have followed the special plan of treatment adopted for such cases. 
It is to this subject that I wish now to call your attention; and 
I think it would be more acceptable to this Society for me to give 
the results of my own views and deductions concerning this 
morbid condition, rather than to follow the questionable fashion 
of the day, and present to your consideration long extracts from 
various authors and authorities. 
In order at once to command your attention, I may say that in 
no department of medicine are the results of treatment so apparent 
and interesting as in the progress and recovery of peripheral 
paralyses. For in this condition you have a distinct nerve-injury 
and a separate group of muscles deprived of power, and in the 
slow return of natural functions we have an opportunity for satis- 
factory and intelligent observation that is rarely afforded us in 
medical practice. 
Although the optic nerve is the only nerve-tissue we can see 
either in health or disease without doing violence to the body, yet 
in the muscles to which various nerves are distributed we have a 
beautiful index, a gauge to judge of their actual state, an excel- 
lent medium of information to tell of their strength, their action, 
and probable morbid condition. Injuries to the facial, the cir- 
cumflex, and the musculo-spiral nerves fully substantiate the truth 
of this assertion ; for any violence to these filaments branching out 
from great nerve-centres, leaves in bold prominence a certain 
number of muscular fibres which refuse to act, which lose their 
animal heat, and which finally degenerate and atrophy. What 
is true of these nerves is of course equally applicable to others, 
though on account of their exposed position the three first men- 
tioned are most frequently brought to the notice of the profession. 
This fact of local paralysis refers to all nerves which some- 
where in their distribution may be reached by various accidents, 
such as violence, cold, or toxic influence, and thus be rendered 
incapable of conveying that necessary impression to the muscles 
which determines their contraction. 
When any number of muscular fibres, by any of these acci- 
dents, lose their connection with the will, and can no longer per- 3 
form their natural functions, certain changes go on in their sub- 
stance wdiich are at once interesting and instructive. The loss of 
motion, although the most prominent, is not by any means the 
only important alteration that goes on in the muscular tissues after 
the nervous influence is cut off or impeded. The sudden change 
from the motions and contractions of health to the immobility 
and helplessness of paralysis, must produce many disturbances 
besides the loss of power in both nerve and muscle. But the 
immediate difference made in the circulation of a paralyzed muscle 
is the main factor that determines its degeneration. For, taking 
into consideration the anatomy of muscular fibre, we cannot fail to 
be impressed with the idea that motion is necessary for the due 
performance of its nutrition, and that any prolonged quiescence, 
or any stretched and forced condition of this tissue, would be fol- 
lowed by loss of animal heat and consequent atrophy. The 
diameter of the blood-vessels being varied with every contraction of 
the muscles, it is but reasonable to suppose that the element of posi- 
tion is much more important than has heretofore been considered. 
Therefore it has been my endeavor during the last year to ob- 
serve closely all cases of paralysis that have come under my care, 
with the view of ascertaining, if possible, the exact value of arti- 
ficial motion in the treatment of paralyzed muscles. In a 
former paper on this subject, attention was called to the physio- 
logical arguments in favor of this theory; and after referring to 
the anatomy of muscular fibre, I advocated the plan of elastic 
relaxation, in the following words :—“ In some forms of paralysis, 
when a muscle or group of muscles is forced by its antagonists 
into an abnormal and comparatively fixed position, I do not con- 
sider that treatment wise or efficient which only endeavors to cure 
the nervous lesion, or at best totally neglects the unphysiological 
condition of those paralyzed muscles. For in such a case of 
paralysis, we have not only the muscles incapable of receiving the in- 
fluence of the will, but not being capable of motion or contrac- 
tion, they are injured—first, by the fibres themselves being in- 
tensely stretched; second, by the circulation being undoubtedly in- 
terfered with ; third, by the commencing atrophy and degeneration 
which must accompany any continued diminution of the circulation.” 
It is not wi thout some regret that I refrain from entering more 4 
fully into the discussion of this plan of treatment, for it is evident 
that there are many points in regard to it unappreciated by the 
profession at large. But it will probably be wiser to appeal to 
results rather than to theories, and to defer any more lengthy 
discussion until a larger success has proved the efficacy and im- 
portance of the measures that will be here recommended. 
Since in peripheral paralysis the patient is not affected by any 
organic trouble, and possesses every member or part in the enjoy- 
ment of life and health, save one, the better treatment of such a 
morbid condition is certainly an object to labor for and attain. 
Whether it has been in my power to improve the means at our 
command for this purpose, the cases which will now be related can 
best show, for they are among the first, as well as the most promi- 
nent results that have fallen under my observation. 
A clerk, 24 years of age, came under my care in August, 1874, 
for the treatment of a paralysis of the extensor muscles of the 
forearm. This condition had come on suddenly after sleeping in a 
tent at the sea-shore, about two weeks before he consulted me. 
There was total paralysis of the whole extensor group, including 
the supinator longus, and the temperature of that surface was 
appreciably diminished. His hand presented the characteristic 
position known as “ wrist drop,” and under ordinary treatment he 
would have suffered the inconvenience and disadvantage of having 
his hand in that stretched position for some length of time. But by 
the aid of an elastic extensor muscle, made such as I first described 
in N. Y. Medical Journal, May, 1874, this complication was entirely 
overcome, the whole group was retained in a more natural position, 
and its nutrition stimulated by motions as nearly normal as artificial 
means could produce. Vigorous massage was recommended, and 
the application of electricity was not neglected. The case went on 
to rapid recovery, and by the end of September, or six weeks after 
the commencement of treatment, he was able to write, and to com- 
mand his extensor muscles to their various uses. 
I place in juxtaposition to this case a patient, Heinrich Speikel- 
man, laborer, age 30, who was treated at the Washington Dispensary 
for the same condition, and in whose treatment I did not avail my- 
self of the elastic relaxation. The result showed the areat in- 
c5 5 
fiuence of the elastic muscle in promoting recovery; for although 
he was given the advantage of advice about placing his hand in 
the best positions, and of efficient treatment by massage and 
electricity, his paralysis was of much longer duration than the case 
referred to above. Two or three months is the average duration 
of a case of this kind, and the good results observed in the case of the 
first patient were entirely due to the new treatment I was enabled 
to pursue. 
The next form of peripheral paralysis to which I shall call your 
attention, is one that could not be brought under the advantage 
of elastic relaxation, and was therefore treated by positions which 
would give the paralyzed muscles the best motions and the greatest 
amount of relaxation. 
Henry Berger, age 30, applied to the Washington Dispensary, 
March 1st, 1875. Reports that four and a half months ago, fell 
from aloft on shipboard, striking his right shoulder with great 
violence. He suffered intense pain, and noticed immediately an 
entire loss of power in the muscles of the shoulder joint. He says 
he was treated for a dislocation. Now, four and a half months 
after this accident he has marked atrophy of the deltoid, the 
supra and infra spinati muscles, and the pectoralis major, the latter 
probably from disuse. The seat of injury in this case was clearly 
in the upper trunk of the brachial plexus, before it divides into its 
three cords, involving the ext. ant. thoracic, the supra-scapular 
and circumflex nerves. The paralysis was complete, and as it was 
impossible to devise any means of mechanically relaxing the fibres 
of the atrophied muscles, he was advised to hold his hand behind 
his head during the day at various intervals, and to sleep with his 
arm in that position at night. I do not think that persistent 
massage or electricity, or subcutaneous injections of strychnia, would 
have been of much avail, had not the element of position received a 
large share of consideration. In three months this patient had im- 
proved so much that he was able to go to sea, and upon his return 
to the dispensary his paralysis had entirely recovered. 
I will now call your attention to another example of extensor 
paralysis, differing from the others in origin, intensity and duration. 
A mechanic, age 19, came under my care for the relief of a paralysis 
which followed a fracture of the bones of the forearm. Upon 6 
inquiry, I found that the splint had been worn for thirteen weeks, 
and that it had pressed painfully upon the arm about the region of 
the musculo-spiral nerve. To this fact I ascribed the paralysis 
and total atrophy of the extensor group, which had commenced 
three years before, and now rendered his hand almost entirely use- 
less. It would be impossible to give a correct idea of the atrophy" 
in this case without exposing myself to the charge of exaggeration. 
On the surface of the radius, which was peculiarly curved from the 
fracture, there was not the slightest appearance of muscular tissue, 
the skin being tightly drawn over the bone, and apparently adhe- 
rent to it. There was not the least reaction to either current of 
electricity7, and altogether the case presented a very unpromising 
appearance. However, the elastic extensor muscle was applied, 
and the patient was instructed about the manipulations to be per- 
sistently employed. Both faradic and constant currents were 
used in his treatment. He has now been under my observation 
for six months, and I have been surprised at the rapid progress 
of his recovery. Even the extensor com. dig. can perform its 
functions, and the extensors of the wrist and the supinator muscles 
act well. Quite a mass of muscular tissue has been developed 
where before the arm was entirely atrophied. It is interesting and 
instructive to note that the muscles of the thumb, which could not 
be brought under the influence of the artificial muscle by the 
present apparatus, have improved to a very slight extent, although 
the circulation of that part has been much increased by the treat- 
ment. This young man has now a very useful hand, and I look 
upon his case as my best argument in favor of the plan of treat- 
ment that has been of such signal benefit to him. 
In the paper submitted to the Society last year I referred to a 
modification of Dr. Detmold’s apparatus for facial paralysis. Since 
that time I have had occasion to notice its advantages particularly 
in the case of a girl, 9 years of age, who was placed under my care 
for facial paralysis. This condition had come on suddenly three 
weeks before she consulted me, and at that time the paralysis was 
complete, including even the occipito-frontalis muscle. The rubber 
band and hook were applied June 13, and she also received 
the usual treatment for such cases. By July 15th all the muscles 
were much' improved, except the lower fibres of the orbicularis. 7 
She continued to wear the apparatus until July 25th, when it was 
found that the muscles had resumed their normal condition, and 
the appearance of her countenance was again natural and expressive. 
I have three other cases of facial paralysis now under my obser- 
vation, and I am confident that their treatment will be much aided 
by the use of this apparatus. One patient has suffered from this 
condition for seven years; and though there is no atrophy, I shall 
consider its successful treatment almost as remarkable as the case 
of extensor paralysis related in this paper. 
Paralysis of the levator palpebree superioris offers an excellent 
opportunity of testing the utility of an elastic muscle, and I refer 
with some satisfaction to the case, reported last year, which, as 
far as I know, was the first application of this curative method. 
The patient was relieved of a very persistent ptosis which had 
proved beyond the reach of other remedies, and the muscle re- 
covered rapidly under the use of this mechanical means. 
I have thus brought to your notice those forms of peripheral 
paralysis which most frequently occur, and have proposed a treat- 
ment for them that can claim the advantage of a good theory and 
the sanction of a successful practice. 
Allow me to hope that these few remarks, illustrated by such 
highly instructive cases, may increase your interest in paralyzed 
conditions, and impress you with the truth and accuracy of the 
important facts which I have had the honor to submit to your 
consideration.