PARALYSIS.

Hawera Star, Volume XLVIII, 12 July 1924, Page 15

PARALYSIS.

SPASTIC TYPE. BRILLIANT OPERATIONS. Remarkable operations have been performed in Sydney by Dr Norman D. Royle for the treatment of spastic paralysis. The results of these have exceeded all expectations (reports the Sydney Herald). The first patient, who before being operated upon was unable to walk laterally or backwards, was able to. do so 14 days after treatment, and also to balance on his defective limb. After 24 days lie could even ascend stairs. Another soldier wffio was treated suffered from a gunshot wound in the vertex of the skull, which lie received in 1916. He was paralysed in both limbs, the left limb wrnrse than the fight. The patient was unable to balance, and could only move by dragging himself along. This man could balance himself four weeks after his operation, and at the present time, can stand up for nearly a half-hour unaided.

A little schoolgirl, 10 years old, was also operated upon. She had a onesided spastic paralysis since birth, or suffered from a spastic hemiplegia. After receiving surgical attention the child was able to use the upper limb for almost any action. She could feed herself, and also write legibly. A man who.had. a paralysis of an ripper limb was also operated upon. When asked to raise or lower the arm before treatment all he could do was to make his upper limb more rigid, and cause a coarse tremor' to appear. He has benefited considerably as a result of the operation, and now 7 he can move his arm quite freely. A girl of 19 years of age, rvho was unable to walk backwards, otherwise she would fall, could move in any direction a short time after the operation, and balance en either limb. The most spectacular case of all is that of a young boy under the care of the State Children’s Welfare Department. This boy had no voluntary control of his lower limbs, w 7 as 16 years .of- age, and had never Avalked. To relieve his condition many operations had previously been performed upon him, but none was successful. Seven days after his operation he regained poAver in the paralysed limbs, and. tAvo weeks after being treated. Avas able to stand by his bed. In 18 days folloAving the operation lie could Avalk the entire length of the hospital Avard. Dr Royle describes his’ease as one of spastic paraplegia. A. cinematograph film exhibited bv Dr Royle at the University on.‘Friday evening depicted this youth AA'alking around a garden, Avith his hands' in his pockets, about 12 Aveeks after he left hospital. The change Avrouglit in his condition Avas truly astonishing. Many of these patients also ,suffer acutely from chilblains, and the remarkable thing is that these do not trouble them after the operation.

: The facts A,vhich have been referred tb in detail above Avere mentioned by Dr Nonnan Royle in the course of a lecture which he delh 7 ered at the University last Friday eA 7 ening before the Sydney Uni\ 7 ersity Medical Society, on “ A NeAv Operative Procedure in the Treatment of the Spastic Paralysis,” ih Avhich he. outlined his new 7 method of treating spastic paralysis.

He dreAv attention to the fact that as far back as six years ago he had published in the Medical Journal of Australia his first experimental observation, and that Avas in connection with the abnormal movements of muscles in spastic paralysis. It may be said in passing 'that the muscles themselves in spastic paralysis ate not actually affected by disease, but that the abnormal condition is in the neiwous system. In ordinary circumstances if an indiA 7 idual Avishes to perform such a movement as bending his elboAV, the muscles Avhich are responsible for extending the elboiv automatically relax, and alloAv the moA 7ement to proceed smoothly and evenly, without obstruction. In spastic paralysis, hoAveA 7 er, AA-hat Dr Royle found A\ 7 as that the movement of bending the elboAV Avas Obstructed, simply because the muscles which straightened the elbow failed to relax. This meant that in spastic paralysis there Avas a failure of the principle of reciprocal innervation, as defined by the famous physiologist, Sir Sharles Scott Sherrington, Wayhflete, professor of physiology at Oxford University.

Dr Royle pointed out that for many years it has been known that the ordinary voluntary muscles had two sets of nerves, and while the function of one set was well known as a result of Sherrington's work, the function of the other set or sympathetic nerves had newer been clearly defined. Dr Royle thought of the possibility of relating the undetermined function of the sympathetic nerves to the abnormal condition presented in spastic paralysis. During the year 1922, while engaged upon an investigation of another type of paralysis he made a series of attempts to bring about spastic paralysis in animals with a view subsequently to seeking a cure for the condition. These experiments, however, proved to be unsuccessful, and it was not until March, 1923, that- he renewed' his investigations.

When Professor John Hunter, of Sydney University, returned from his trip abroad, lie brought back with him a preparation of muscle made from a python, in which these sympathetic nerves were clearly demonstrated. This induced Dr Royle to continue his investigations, and lie undertook another series of experiments, which he conducted with the assistance of Professor Hunter, in a consultative capacity. These experiments were carried out on animals iii various conditions resembling the diseases which cause spastic, paralysis, and it was observed that in each ease the removal of the sympathetic nerve caused a definite change in the action of the muscles. In the normal animal the removal of the sympathetic. nerves, did not interfere with the animal’s ability to control its limbs, nor did it in any way affect the power of the muscles deprived of the sympathetic nerve supply. But the difference that was'noted was that it was not as easy for the animal to maintain the limb in a. definite, position without voluntary action, and in those animals whose condition was made to resemble that seen in certain spinal diseases the ri"lit lower limb was held in a beat position, but the left lower limb, from which the sympathetic nerve had been removed would live in a position determined by gravity. In the third class of experiments the sympathetic nerves were removed in the first place, and a type of paralysis was induced at different intervals after the removal of the sympathetic nerves. Then it was noticed that the paralysis did not affect the left lower limb from which the sympathetic, nerve had bden taken to the same extent as the right, lower limb. It. was, for example, much easier to move the left lower limb passively than the right. “These experiments,” said Dr Royle, “indicated that the sympathetic nerve (lid have an important function, that

function being to enable an animal to maintain a position or to hold a muscle in a certain state of control without having to be continually thinking about it. Furthermore, they showed that the rigidity noted in many patients might possibly be very much reduced by removing certain parts of the sympathetic, nerve. ” Dr Royle said that, many of these results had been, obtained by other investigators, but the same consistency in results had not been evident, and'the difficulty that, confronted him was just how to apply the results of his experimental work to human patients He declared that the whole of the experimental work was undertaken on account of two returned soldiers, suffering from gunshot wounds in the brain and it was the wonderful enthusiasm and unselfishness of one of these patients that ultimately led to the first operation being performed. During the course of the lecture Dr Royle paid a tribute to the way in which so many of the wounded men were prepared to undergo any operations in the hope of something being discovered that would confer a lasting benefit upon suffering humanity. The case of one who told the surgeon just prior to the operation to go right, ahead and find out all you can ” was typical of the sacrifice all of these men were ready to make in tile interests of others. The operations that Jn Royle described were also illustrated bv some magnificent dissections that had been done in the anatomv department of .Sydney University by Dr 1. K. Potts. According to Dr Rovle, these dissections represent the finest thmgs of their kind that have ever been prepared, and the drawings made from tlie.ni were far superior to any similar ones that have ever appeared in any anatomical text book. At the conclusion of the lecture. Dr Royle drew attention to the fact that his research work had involved much co-operation, and he tendered his thanks to Professor Hunter. Dr John W. Hoets, and Dr. Lipscomb.