26 Loc. cit., p. 108.
That the facial should be affected while the other medullary nerves escape probably depends on the more anterior position of its nucleus.
The regression of the original paralysis is characteristic, indeed almost pathognomonic, of the disease. It is on this account that Barlow has proposed the name regressive paralysis.27 This author quotes the case of a boy who at five months was affected with a universal paralysis, even affecting the neck, but entirely recovered except in the extensor longus digitorum of the foot. This improvement constitutes a second apparent convalescence, as deceptive as that which immediately succeeds the pyrexia. Only in rare cases do all the muscles at first paralyzed remain so permanently (Seeligmüller); nor, on the other hand, do all entirely recover (temporary paralysis of Kennedy and Frey). Even when an entire limb appears to be paralyzed, careful examination will usually detect certain muscles that retain their faradic contractility. Thus the order of frequency of paralysis in the different limbs must be distinguished from that observed for different muscles.
27 Brit. Med. Journ., 1882.
Duchenne fils28 and Seeligmüller29 have tabulated, for lists of 62 and 75 cases respectively, the general locality of the permanent paralyses in their order of frequency. The cases of monoplegia are by far the most numerous. Thus in the table quoted below there are 97; in Heine's tables (86 cases), 47; in Sinkler's tables (86 cases), 29—total, 173 from a total of 309, or nearly one-half:
| Duchenne. | Seeligmüller. | Total. | ||
| Left lower extremity | 7 | 27 | 34 | |
| Right lower extremity | 25 | 15 | 40 | |
| Right upper extremity Left upper extremity | 10 | 13 | 9 4 | 23 |
| All four extremities | 5 | 2 | 7 | |
| Both upper extremities | 2 | 1 | 3 | |
| Both lower extremities | 9 | 14 | 23 | |
| Left over and under extremity | 1 | 1 | 2 | |
| Right over and under extremity | 0 | 1 | 1 | |
| Right over and left under extremity | 2 | 1 | 3 | |
| Muscles of trunk and abdomen | 1 | 0 | 1 | |
| 62 | 75 | 137 | ||
This limitation is all the more noteworthy when compared with the frequency of general paralysis at the outset.
28 Archives gén., 1864.
29 Jahrbuch der Kinderheilkunde, N. H. xii. pp. 338-343.
The next peculiarity is the great preponderance of paralysis of the lower over that of the upper extremities. This is noticeable even in the monoplegias. In Sinkler's cases only two of these affected an arm. But in bilateral paralysis the predilection is still more remarkable, paraplegia of the lower extremities being among the most frequent, paraplegia cervicalis the rarest, form of paralysis. This is not because a lesion situated in the cervical spinal cord must interfere with the motor tract going toward the lumbar, and hence nearly always paralyze all four extremities, if any. Because when this does happen the upper extremities alone exhibit the atrophic changes characteristic of anterior poliomyelitis: the lower, though paralyzed, do not atrophy and retain their faradic contractility. Heine denied the existence of paraplegia cervicalis. But in the table of Duchenne-Seeligmüller 3 cases are recorded; Rosenthal30 relates 1; Lockhart Clarke, 1.31 This is the somewhat famous case, described by Clarke as a progressive muscular atrophy, which contributed one of the earlier autopsies.