The other patient, seen in 1897, was a rancher from New Mexico, thirty-three years old, who had led an active, hard-working, much-exposed life, but had been perfectly well until 1891, when he was said to have had an attack of spinal meningitis, from which he recovered very slowly.  Four years later he noticed numbness of feet and weakness of legs, great enough to make it hard for him to get a leg over his horse.  Some pains were felt in the limbs, and a constriction about the chest and abdomen, which had steadily increased in severity.  Sharp attacks left distinct bruise-marks at the seat of pain each time.  Could not empty bladder.  Gait feeble, spastic, and paralytic, could not mount steps at all or stand without aid, sway very great.  Knee-jerks and muscle-jerks increased, especially on left; ankle-clonus; very slight loss of touch-acuity in lower half of body.  Eyes:  muscles and eye-grounds negative; pupils equal and active.  Bladder could not be emptied; cystitis.  Ordered rest, massage, electricity, and full doses of iodide in skimmed milk.  In this way he was able to take without distress or indigestion amounts as large as four hundred and forty grains a day.  When education in balance, etc., was begun he could not walk without aid, or more than a few steps in any way.  In three months from the time he went to bed he walked out-of-doors alone with no stick, and in five months went back to work.  The bladder did not improve much until after regular washing out and intravesical galvanism were used, with full doses of strychnia.  He was soon able to empty the organ twice a day, and since leaving the hospital writes that it gives him very little annoyance, though as a measure of precaution he uses a catheter once daily.  His pains have entirely disappeared, and he is daily on horseback for many hours.

In spastic paralysis, whether in the slowly-developing forms in which it is seen in adults, due sometimes to multiple sclerosis, sometimes to brain tumor, sometimes following upon a transverse myelitis, or in the central paraplegia or diplegia of “birth-palsies,” some very fortunate results have followed the careful application of the principles of treatment already described.  Absolute confinement to bed is seldom required or in adults desirable, though exercise should be carefully limited to an amount which can be taken without fatigue, and some hours’ rest lying down is usually advantageous.

Assuming that the necessary treatment for the disease originating the paralysis is to be carried on in the ordinary way, I will only describe the special forms and methods of exercise I have found serviceable.  Whatever the cause, this will be much the same, though in birth-palsies the teaching may have to include groups of muscles and instruction in the co-ordination of actions which are not affected in adult subjects.