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Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS

TRUE/FALSE

1. Events are economic occurrences that require accounting entries.

ANSWER: T

2. The concept of uniformity appears to overlap with consistency.

ANSWER: F

3. Transactions are economic or financial events that are recorded in the firm’s accounts.

ANSWER: T

4. An event, as defined in SFAC No. 6, is “a happening of consequence to an entity.”

ANSWER: T

5. Because events that are internal to the firm are not considered “transactions,” they do not require
entries in the firm’s accounts.

ANSWER: F

6. Relevant circumstances are an important aspect of the uniformity issue.

ANSWER: T

7. Future contingencies that are allocations do not have real information content for financial
statement users.

ANSWER: F

8. Minimizing reported income would not be a motive guiding the selection of accounting methods.

ANSWER: F

9. Environmental conditions are elements beyond managerial control.

ANSWER: T

10. Rigid uniformity has been formulated as an alternative to finite uniformity.

ANSWER: T

11. In accounting, we presume that if rigid uniformity can be attained, it is superior to finite
uniformity.

ANSWER: F

Accounting Theory: 9th edition Page 1 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS

12. Improving comparability may lessen relevance or reliability.

ANSWER: T

13. Rigid uniformity considers relevant circumstances.

ANSWER: F

14. Flexibility is an approach to the uniformity problem.

ANSWER: T

15. Flexibility applies to situations in which there are relevant circumstances and more than one
possible accounting method exists.

ANSWER: F

16. Flexibility is not often used in generally accepted accounting principles.

ANSWER: F

17. Whenever possible, flexibility should be used in formulating accounting policy.

ANSWER: F

18. Finite uniformity should always be used in accounting for complex events.

ANSWER: F

19. Since the 1970s, the SEC appears to have shifted its emphasis toward informative disclosure
rather than protective disclosure.

ANSWER: T

20. Lev advocated restricting disclosures to “good news” items only.

ANSWER: F

21. An organized disclosure policy that includes “bad news” is beneficial to all parties because
uncertainty about the firm is reduced.

ANSWER: T

22. The SEC requires disclose of both retrospective and prospective information in the
Management’s Discussion and Analysis section of the annual report.

ANSWER: T

23. Signalling theory appears to be inconsistent with the advocacy of greater disclosure.

ANSWER: F

Accounting Theory: 9th edition Page 2 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS

24. Management disclosures in the face of a major earnings surprise may take the form of conference
calls with analyst or public announcements via news services.

ANSWER: T

MULTIPLE CHOICE

1. Which of the following is not listed by Fields, Lys, and Vincent as a possible reason underlying
management choice?
a. Minimizing agency cost
b. Comparability
c. Signaling
d. Influencing outside parties

ANSWER: B

2. Which of the following is not a true statement?

a. Comparability refers to accounting for similar transactions similarly and different
circumstances differently.
b. Comparability refers to comparing alternatives in order to make a decision.
c. Comparability is an inherent quality of accounting numbers in the same sense that
relevance and reliability are.
d. Uniformity influences comparability.
ANSWER: C

3. Which of the following is a true statement?

a. Transactions are events that may be either external or internal to an enterprise.
b. Events that are internal to the firm do not require entries in the firm’s accounts.
c. Transactions are economic or financial events that may or may not be recorded in the
firm’s accounts.
d. “Simple events” do not have any significant economic variables that lead to essentially
different recording.
ANSWER: D

4. The term “present magnitudes” refers to:

a. conditions known at the time of an event.
b. conditions known only at a later date.
c. events that will significantly affect the financial statements.
d. none of the above.
ANSWER: A

5. Which of the following terms represents the two general types of relevant circumstances?
a. Present circumstances and future contingencies
b. Present conditions and future contingencies
c. Present magnitudes and future conditions
d. Present magnitudes and future contingencies
ANSWER: D

Accounting Theory: 9th edition Page 3 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS
6. Circumstantial variables are environmental conditions that possess which of the following
qualities?
a. Excessive measurement costs
b. A high degree of verifiability relative to other accounting methods
c. Both a and b
d. None of the above
ANSWER: A

7. Prescribing one method for generally similar transactions even though relevant circumstances
may be present is referred to as:
a. finite uniformity.
b. rigid uniformity.
c. inflexible uniformity.
d. measurable uniformity.
ANSWER: B

8. Which of the following is a true statement?

a. Finite uniformity should be more representationally faithful than rigid uniformity.
b. Finite uniformity should be more verifiable than rigid uniformity.
c. Rigid uniformity is more relevant than finite uniformity.
d. Rigid uniformity can be obtained only at a greater cost that finite uniformity.
ANSWER: A

9. Where rigid uniformity is in effect, the underlying reasons may be attributable to all but which
one of the following factors?
a. A desire for conservatism
b. An inability of the standard-setting organization to determine meaningful relevant
circumstances
c. An attempt to increase representational faithfulness of the measurement
d. Recognition of the fact that an allocation is involved
ANSWER: C

10. Flexibility applies to which of the following situations?

a. Situations in which there are relevant circumstances and more than one possible
accounting method exists.
b. Situations in which there are relevant circumstances but only one possible accounting
method exists.
c. Situations in which there are no observable relevant circumstances and more than one
possible accounting method exists.
d. All of the above.
ANSWER: C

11. Which of the following is not true of accounting allocations?

a. Examples include depreciation and cost of good sold.
b. They are arbitrary.
c. No method can be proved superior to another method.
d. They are not useful in providing financial information.

ANSWER: D

Accounting Theory: 9th edition Page 4 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS

12. The requirement by SFAS No. 2 that research and development costs be immediately expensed is
an example of:
a. elastic uniformity.
b. finite uniformity.
c. flexible uniformity.
d. rigid uniformity.
ANSWER: D

13. The determination of whether a lease is a capital or operating lease is an example of:
a. elastic uniformity.
b. finite uniformity.
c. flexible uniformity.
d. rigid uniformity.
ANSWER: B

14. The treatment of loss contingencies required in SFAS No. 5 is an example of:
a. elastic uniformity.
b. conservatism.
c. flexible uniformity.
d. rigid uniformity.
ANSWER: B

15. Accounting for inventory and cost of goods sold and for depreciation is an example of:
a. elastic uniformity.
b. finite uniformity.
c. flexibility.
d. rigid uniformity.
ANSWER: C

16. Under which of the following circumstances should rigid uniformity be used?
a. If the event is a not a simple event.
b. If the event is a complex event in which finite uniformity cannot be instituted in a cost-
effective manner.
c. Both a and b.
d. None of the above; rigid uniformity should never by used.
ANSWER: B

17. Under which of the following circumstances should finite uniformity be used?
a. If the event is a simple event.
b. If the event is a complex event in which relevant circumstances cannot be measured and
implemented in a cost-effective manner.
c. If the event is a complex event in which relevant circumstances can be measured and
implemented in a cost-effective manner.
d. Both a and b.
ANSWER: C

Accounting Theory: 9th edition Page 5 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS

18. Which of the following is a true statement?

a. Disclosure is concerned with information in the financial statements as well as information
in the footnotes, management’s discussion and analysis, financial and operating forecasts,
and other supplementary communications.
b. Disclosure is concerned with information in the financial statements only.
c. Disclosure is concerned with information in the footnotes only.
d. Disclosure is concerned with information in the financial statements and all supplementary
communications except financial and operating forecasts.
ANSWER: A

19. SFAC No. 5 defines disclosure as:

a. presentation of information in the financial statements.
b. presentation of information by means other than recognition in the financial statements.
c. recognition of information in the financial statements or footnotes.
d. presentation of information in any source available.
ANSWER: B

20. Protective disclosure and informative disclosure are two types of disclosures as interpreted by
the:
a. FTC.
b. FASB.
c. AICPA.
d. SEC.
ANSWER: D

21. The system of disclosure largely in effect today is called:

a. selective disclosure.
b. conventional disclosure.
c. differential disclosure.
d. standard disclosure.
ANSWER: C

22. The 10-K report filed annually with the SEC is basically aimed toward which of the following
groups?
a. Shareholders
b. Professional financial analysts
c. Management
d. All of the above
ANSWER: B

Accounting Theory: 9th edition Page 6 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS

23. Which of the following describes information overload?

a. The inability of preparers to process and adequately report all the information that should
be provided in financial reports.
b. The inability of auditors to process and adequately attest to all the information that should
be provided in financial reports.
c. The inability of users to process and intelligently use all the information provided in
financial reports.
d. The inability of preparers, auditors, and users to process and adequately utilize all the
information provided in financial reports.
ANSWER: C

24. Which of the following represents the principal theoretical issue underlying quarterly data?
a. Whether an interim period should be viewed as a separate period standing on its own.
b. Whether an interim period report should include balance sheet and cash flow statements.
c. Whether quarterly earnings should be disaggregated by segments in terms of revenues,
profit or loss, and segment assets.
d. Whether interim reports should include income statement data and basic and fully diluted
earnings per share numbers.
ANSWER: A

25. Viewing each interim period as a separate period standing on its own is called:
a. the integral view.
b. the disjointed view.
c. the discrete view.
d. the linked view.
ANSWER: C

26. Which of the following represents the approach to interim reporting favored by APB Opinion No.
28?
a. The integral view
b. Disjointed view
c. The discrete view
d. The linked view
ANSWER: A

27. From a theoretical standpoint, which of the following represents the approach to interim reporting
with the most validity?
a. The integral view
b. The disjointed view
c. The discrete view
d. The linked view
ANSWER: A

Accounting Theory: 9th edition Page 7 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS

28. Which of the following is a provision of SFAS No. 131?

a. Segment liabilities must be reported, but reported segment assets is optional.
b. Reconciliation of segment profit or loss to consolidated profit of loss must be done before
income taxes.
c. A segment is constituted by having 20% or more of combined revenue of all operating
segments.
d. Segment reporting is based on the way management organizes the segments for making
operating decisions and assessing performance.

ANSWER: D

ESSAY

1. How does the concept of uniformity relate to comparability in the accounting literature?

ANSWER:
In the accounting literature, the concept of uniformity appears to overlap with comparability.
According to Sprouse, the term “comparability” is used to mean accounting for similar
transactions similarly and for different circumstances differently. He sees comparability as both
the process of accounting for circumstances in accordance with similarities or differences and the
end result of comparing alternatives in order to make a decision. However, in the text,
comparability is viewed only in the latter context, while uniformity is seen as the concept that
influences comparability. The degree of comparability that users can rely on is directly dependent
on the level of uniformity present in financial statements.

2. What is meant by relevant circumstances? Describe the two types of relevant circumstances.

ANSWER:
Relevant circumstances are economically significant circumstances that can affect broadly
similar events. These economically significant circumstances are general conditions or factors
associated with complex events that are expected to influence the incidence or timing of cash
flows. Relevant circumstances pertain directly to the event being accounted for and influence the
accounting method selected to represent that event. Those conditions known at the time of the
event are referred to as present magnitudes. Factors that can be known only at a later date are
called future contingencies.

3. Discuss the role of management in relevant circumstances.

ANSWER:
Managerial influence has been regarded as an important consideration in terms of allowing
different accounting methods based on relevant circumstances. However, there is a problem in
that the selection of accounting methods might be guided by motives such as:

(1) Maximizing short-run reported income if managerial compensation is based on it

(2) Minimizing short-run reported income if there is fear of governmental intervention

on antitrust grounds

(3) Smoothing income if it is believed that stockholders perceive the firm as having a
lower amount of risk than would be the case if greater fluctuations of earnings were

Accounting Theory: 9th edition Page 8 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS
present

Because management is potentially capable of distorting income measurements, limiting relevant

circumstances to elements beyond managerial control has been suggested.

4. Distinguish between finite uniformity, rigid uniformity, and flexibility. Also, explain when each
is appropriately used.

ANSWER:
Finite uniformity attempts to equate prescribed accounting methods with the relevant
circumstances in generally similar situations. Rigid uniformity means prescribing one method for
generally similar transactions even though relevant circumstances may be present. Finite
uniformity should be more representationally faithful than rigid uniformity, but may be less
verifiable.

Rigid uniformity can improve comparability in situations where representational faithfulness is

not the goal. However, improving comparability may destroy or weaken relevance or reliability.
The presumption is that if finite uniformity can be attained, it is superior to rigid uniformity from
the standpoint of usefulness in decision-making or performance evaluation. However, meaningful
finite uniformity could be obtained only at a greater cost than rigid uniformity, so the advantage
is merely relative and depends on marginal benefits and costs.

Flexibility applies to situations in which there are no discernible relevant circumstances but more
than one possible accounting method exists, any of which may be selected at the firm’s
discretion.

Wherever possible, flexibility should be eliminated. If it is possible to discern relevant

circumstances and they can be measured and implemented in a cost-effective manner, finite
uniformity should be implemented. If the event category is either a simple event or a complex
event in which finite uniformity cannot be instituted in a cost-effective manner, rigid uniformity
should be employed.

6. What is meant by differential disclosure? Identify the three differential disclosure proposals
discussed in the text.

ANSWER:
Differential disclosure as it is in effect today refers to the fact that the 10-K and 10-Q reports
filed annually and quarterly by management with SEC are basically aimed toward professional
financial analysts. They are more detailed and technical than the annual report going to
shareholders. Three additional differential disclosure proposals include:

(1) Small firms versus larger firms: The FASB specifically considers implications of
disclosures for smaller firms with the express purpose of requiring disclose only
where they are relevant and cost effective.

(2) Summary annual reports (SAR): These reports are condensed financial statements
that omit or boil down much of the detail contained in the body of the traditional
audited financial statement and are a new development in disclosures. Management
discussion and analysis, on the other hand, is generally more expansive. The SAR
is intended to replace the traditional corporate annual report and to be more
understandable. The wide use of SARs would be a revolutionary development in

Accounting Theory: 9th edition Page 9 of 10

Chapter 9—UNIFORMITY AND DISCLOSURE: SOME POLICY-MAKING DIRECTIONS
financial reporting.

(3) SEC attempts to streamline annual reports: The SEC has proposed that financial
statements in annual reports be streamlined by reducing the number of footnotes.
This proposal was abandoned shortly after it was introduced because investors
thought they were being deprived of important information.

7. What is Regulation FD, and how does it relate to the disclosure of information?

ANSWER:
The SEC passed Regulation FD in August 2000 in an attempt to prevent the leaking of important
information to favored financial analysts prior to announcing it to the general public. It attempts
to eliminate selective disclosure in terms of conveying information to financial analysts and the
general public. The elimination of selective disclosure is complementary to efforts to increase the
level of disclosure to the public.

8. How has the FASB (and the SEC) addressed the contention that small firms incur
significantly higher costs than large ones in carrying out complex accounting standards or
disclosure requirements?

ANSWER:
The FASB specifically considers implications of disclosures for smaller firms with the express
purpose of requiring disclosures only where they are relevant and cost effective. The FASB
established a Small Business Advisory Committee of the Financial Accounting Standards
Advisory Council for facilitating communication concerning financial reporting for both small
enterprises and small public accounting firms.

Accounting Theory: 9th edition Page 10 of 10

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cerebral paralysis without causing the remarkable coldness
characteristic of anterior poliomyelitis.

The atrophy of the blood-vessels is not always confined to the

terminal twigs. The entire iliac artery, and even the lower part of the
aorta, have been found markedly diminished in calibre.55 This
shrinkage is unaccompanied by any change in the walls of the blood-
vessels: it is a simple arrest of development. It strikingly illustrates
the dependence of the blood-vessels on the vascular demands of
the tissues they are destined to supply.
55 Charcot and Joffroy, Archives de Phys., 1870, case by Séguin, loc. cit., p. 9.

The changes which take place in the electrical reactions of the

paralyzed limbs rank in importance with their paralysis and their
atrophy. They serve to establish the diagnosis, to decide, to a large
extent, the prognosis, and to measure the degree of nervo-muscular
degeneration.

It is well known that the early diminution, and even entire loss, of
faradic contractility was first emphasized by Duchenne as
pathognomonic of infantile spinal paralysis. Contractility is
diminished in from three to five days after the occurrence of the
paralysis, and by the end of a week is completely lost in those
muscles in which the paralysis is to be permanent. The muscles
which recover spontaneously during the period of early regression
recover their faradic with their voluntary contractility. In others,
persistently but less profoundly paralyzed and susceptible of cure,
the faradic contractility remains simply diminished and in unequal
degrees. Progress to recovery under treatment is usually marked by
progressive increase in the faradic response; but sometimes the
power of voluntary contraction is fully regained, while the faradic
response is still permanently lessened. The loss of faradic
contractility is more complete and permanent in muscles irretrievably
paralyzed by anterior poliomyelitis than in any other disease. These
laws have been generally accepted by late observers.56
 56 Simon disputes their validity, and declares that the importance of electricity in the
diagnosis of spinal paralysis may easily be exaggerated (Union médicale, 7, 28, p.
942, 1879).

In 1868, Salomon discovered that muscles in which faradic

contractility had been completely lost were nevertheless capable of
contracting under the stimulus of galvanism—that this contraction is
exaggerated, and sometimes occurs at the opening as well as at the
closing of the circuit.57 The author remarks that the persistence of
galvanic reaction after the complete loss of faradic contractility is
completely analogous to an observation of Brucke's on muscles
poisoned by woorara,58 where the intramuscular termination of the
nerve is paralyzed. It is to be inferred, therefore, in both cases that
the muscular contraction results from direct irritation of the muscle,
and implies the entire loss of influence from the nerve.
57 Jahrb. f. Kinderheilkunde, N. F. i., 1868. According to Erb (loc. cit., p. 984) and to
Ross (loc. cit., p. 111), Salomon was the first to make this observation. Seguin,
however, attributes priority to Lobb (Lond. Med. Times and Gaz., 1863), to Hammond
(New York Med. Journal, 1865), and to J. Netten Radcliffe between 1863 and 1865.
These dates precede that of the publication of Salomon's paper, but the latter seems
to have been written without knowledge of earlier observations. (See also Onimus,
Soc. de Biol., 1878, who argues that muscle-termination of nerve is partly destroyed.)

58 “Ueber den Einfluss der Stromes dauer auf die Elektrische Bewegung der
Muskeln,” Sitzber. d. k. Akad. d. Wissensch. in Wien, 1867, Bd. lxi., quoted by
Salomon, loc. cit., p. 388.

Erb has greatly extended these observations, and shown that the
galvanic reactions of paralyzed muscles indicate their structural
degeneration, and are identical with those observed after section of
a peripheric nerve. There are three characteristic peculiarities in the
contractions thus obtained: 1st, they are slow, tonic, long drawn out;
2d, they are more painful than in normal muscles submitted to an
equal amount of electricity; 3d, in complete degeneration the
contraction obtained at anode closure equals or exceeds in intensity
that excited by cathode closure [AnSZ = or > KSZ]. The excitability of
the muscle to the galvanic current remains increased for several
months, then gradually diminishes, and finally falls below normal.
The qualitative alterations persist somewhat longer: finally, the
muscle fails altogether to contract.

Spinal paralysis differs markedly from progressive muscular atrophy

in the absence of constant correlation between the degree of
paralysis or atrophy and of electrical changes.

The last positive symptom to be noted in the paralytic stage of

infantile paralysis is the diminution and ultimate loss of reflex
excitability. This is correlative in time and extent with the loss of
faradic contractility. This seems to be an exception to the usual rule,
which associates loss of tendon reflex with lesion of the posterior
columns or nerve-roots. This is a proof that interruption of the reflex
arc at any point suffices to abolish the tendon phenomena.59
59 Buzzard tested the tendon reflex in the zygomaticus major in a patient in whom the
sensory branch of the fifth nerve had been stretched, and therefore, to a certain
extent insulted. The reflex response was decidedly lower than on the opposite side
(Lancet, Nov. 27, 1880).

Negative Symptoms.—The negative symptoms of atrophic paralysis

are as important for the diagnosis and pathogeny as are the positive
characters, which have now been sufficiently detailed. The absence
of decubitus or other nutritive lesions of the skin has been already
mentioned. The absence of anæsthesia, or, as a rule, of any marked
degree of hyperæsthesia, is most important as indicating immunity of
the sensory tracts in the cord. Some diffused hyperæsthesia is
sometimes noted during the febrile stage: pain is by no means rare
in adults. But in children this is altogether absent, or else slight and
transitory. On the other hand, the complete preservation of sensibility
constitutes, in children, a serious obstacle to electrical investigation.

After subsidence of the cerebral symptoms, if any, of the initial stage,

the functions of the brain are always intact60 and the disposition of
the children apt to be remarkably lively. The general health is often
remarkable for its vigor. The worst, because the most neglected,
cases are naturally most often seen among the poor: the ranks of
professional beggars are largely recruited from among the victims of
infantile paralysis.
60 Practically, it may often be of importance for the physician to ascertain that an
intellectual enfeeblement, or even idiocy, existing at the time of examination had
preceded the onset of the paralysis by months or years.

The chronic stage is marked by the development of a new set of

symptoms—contractions of certain muscles surrounding one or more
joints and deformed positions of the limbs. These symptoms do not
always appear. If all the muscles surrounding a joint are completely
paralyzed and extensively atrophied, and if no weight is imposed on
the limb by the action of a non-paralyzed upper segment, and if the
paralyzed segment be so supported that its own weight does not
approximate the insertion-points of muscles, and thus cause their
passive retraction, then there is no deformity, but a dangling limb, a
membre de Polichinelle.

Laborde states that contractions appeared at the earliest about two

months after the paralysis. Seeligmüller, however, has seen pes
equinus and pes calcaneus develop in four weeks. The date is partly,
at least, determined by the time at which the children try to walk or
otherwise to use the paralyzed limbs; and the deformities are very
much more marked in the lower extremities, proportioned to the
much greater weight which they are obliged to sustain.

All varieties of club-foot, and most frequently equino-varus, knock-

knees, rigid flexions at the knee and hip, cyphosis, lordosis, and
colossal scoliosis may develop as manifold consequences of
atrophic paralysis. That subluxation of the humerus and the claw-
hand may occur in the upper extremities has already been
mentioned.

In Seeligmüller's 75 cases, 53, or 71 per cent., exhibited some kind

of deformity. Among these, 43, or 56 per cent., were of the foot; 6
were cases of subluxated humeri; 5, easily-reducible luxation of the
fingers.
The following table contains a summary of the deformities observed
as a consequence of atrophic paralysis. They are distinguishable
from congenital deformities dependent on altered relations of
articular surfaces through defective development61 by being easily
reducible. This remark especially applies to paralytic club-foot:

Equinus.
Equino-varus (varus hardly ever alone).
Foot. Calcaneus.
Calcaneo-valgus.
Valgus.
Genu-recurvation.
Knee. Genu-incurvation.
Permanent flexion.
Luxation.
Hip. Permanent flexion.
Permanent adduction.
Flexion fingers or wrist (rare).
Hand. Extension of wrist.
Claw-hand.
Elbow. No deformity (Seeligmüller).
Shoulder. Subluxation humeri.
Dorsal scoliosis.
Lateral incurvation lumbar region.
Trunk. Cyphosis.
Lordosis with backward projection of shoulders.
Lordosis without backward projection of shoulders.

61 Volkmann's Handbuch, Billroth und Pitha.

Mechanism of Deformities.—From what has been said on the cases

in which deformities are absent it is evident that one at least of three
conditions are required for their production: the paralysis must be
unequally distributed in the muscles surrounding a joint; pressure
must be exerted by the weight of the body or traction by the weight
of the limb; effort must be made to utilize the maimed part of the limb
by means of other parts, or even by the muscles of the trunk.
The share taken by these different factors in the production of
deformities has been differently estimated by different observers.
The French surgeon Delpech was the first to explain the
phenomenon on the theory of muscular antagonism. The same
theory has been most minutely elaborated by Duchenne.62 According
to it, the intact or less paralyzed muscles, in virtue of their tonus,
constantly tend to draw the segment of the limb on which they act in
a direction opposed to that in which it should be drawn by the
paralyzed muscles. Since this action is unantagonized, its influence
persists; the insertion-points of the contracting muscle being
permanently approximated, the nutrition of the muscle is modified: it
grows shorter (adapted atrophy). There results finally shortening and
retraction of the muscles on one side of the joint, over-stretching of
those on the other.
62 De l'Électrisation localisée, 1861.

Duchenne used to illustrate this theory by means of a skeleton

supplied with artificial muscles, whose successive section would
cause the appearance of the corresponding deformity. Werner63 first
protested against this theory, and the protest has been further
developed and a different theory built up through the efforts of
Hueter64 and Volkmann.65 The latter observes that the muscles and
ligaments surrounding a joint normally receive a large amount of the
weight falling upon its articular surfaces. Removal of this elastic
resistance exposes these surfaces to the full force of the pressure,
and thence to almost certain danger of deformity—a danger,
therefore, always incurred after paralysis of the muscles. Thus, the
weight of the body, pressing, unresisted, on the arch of the foot, is
able to displace the bones of the arch from their normal relations and
completely flatten the arch.
63 Reform der Orthopædie, 1845.

64 Gelenkkrankheiten.

65 Sammlung klin. Vort., No. 1.

A position of ease is that in which the movement of the joint has
been pushed as far as possible until limited by the passive
resistance of the ligaments or the conformation of the articular
surfaces. The weight of the body must then be so placed that the line
of gravity falls on the side of the open angle, while the limiting bands
stretch across the base. Thus, a tired man sits with a curved back;
the muscles which may extend the spinal column in a straight line
are relaxed; the column falls forward until arrested by the anterior
vertebral ligaments. Thus, in standing at ease the thigh presses
against the leg, so as to form a wide angle open anteriorly. When the
quadriceps extensor is paralyzed, this position is inevitable and
exaggerated, since the force which might counteract it, contraction of
the thigh extensor, has been removed.

Formerly, the rôle of muscles in this elastic resistance was under-

estimated and that of ligaments exaggerated.

CRITICISM OF THE THEORY OF MUSCULAR ANTAGONISM.—Three

considerations have been urged in objection to the theory of
muscular antagonism: First, deformities may develop even in limbs
totally paralyzed, provided these limbs be subjected to weight and
pressure. Pes equinus, the most common form of paralytic club-foot,
develops with total paralysis of the muscles of the leg where the
child does not walk, but is carried on the arms of a nurse with its foot
dangling. The part of the foot anterior to the ankle-joint being longer
and heavier than that behind, the point falls; the tendo Achillis is
passively shortened, and by nutritive adaptation to this position may
become permanently retracted. Long persistence in this position
accustoms the dorsal surface of the bones to a less degree of
pressure than the plantar surface: as a consequence, the growth of
the bone becomes more active above, while it is arrested below; the
arch of the foot is increased until the sole is curved into a deep
hollow; and the plantar aponeurosis is correspondingly shortened.

Volkmann relates a case where this same deformity appeared

without the least paralysis, but simply from prolonged passive
extension of the feet in bed. The patient was an adult, and suffered
from a severe typhoid with a double relapse. After recovering from
the fever a year of orthopædic treatment was required to restore the
feet to their normal position.

The second objection is the absence of any proof of such constant

tonus in the muscles as may be sufficiently powerful to determine the
position of a limb. Such tonus exists in the involuntary muscles,
especially in those of the blood-vessels, but there is no evidence that
it exists in the voluntary muscles. To this Seeligmüller has replied by
admitting the objection to the theory as thus proposed, but
substituting the more plausible influence of repeated contractions on
the part of the non-paralyzed muscles. Each contraction draws the
limb in a certain direction, and there it tends to remain, because
there is nothing to antagonize the force which it has obeyed.

The third objection is that examination of individual cases not

infrequently shows displacements in directions opposed to that
which should be determined by muscular antagonism. Volkmann has
especially illustrated the latter assertion by the mechanism of genu-
recurvation. In paralysis of the quadriceps extensor of the tibia the
weight of the body is exercised, not merely from above downward,
but from without inward, falling, therefore, on the inner malleolus. It
thus tends to press the anterior part of the foot outward,66 and a
valgus finally complicates the calcaneus. Seeligmüller, however,
quotes two cases of pes calcaneus developed in children who had
never walked: in one paralysis of the sural muscles had occurred at
the age of four weeks, and the other case was observed at the age
of fourteen weeks. Seeligmüller remarks that only early examination
of the faradic contractility of a group of paralyzed muscles can
decide whether any among them preponderate during a time
sufficient to fix the limb in a vicious position. Thus in one case of pes
calcaneus he found two years after the occurrence of the paralysis
that some contractility still persisted in the dorsal flexors, but six
months later this had quite disappeared. Had the examination then
been made for the first time when all the muscles were equally
paralyzed, it would have seemed impossible to explain the deformity
by muscular antagonism.
 66 Sayre asserts that lateral rotation cannot take place at the ankle-joint, but at the
medio-tarsal articulation. Hueter also refers pes varus and pes valgus to the talo-
tarsal articulation.

RELATION OF WEIGHT AND MUSCULAR FORCES.—The influences of

weight and of muscular action sometimes concur, sometimes are
opposed to each other. Thus, the weight of the foot alone always
tends to produce equino-varus; it acts therefore to intensify the
action of the sural muscles when the anterior tibial are paralyzed, but
to diminish the influence of paralysis of the gastrocnemius when the
foot is being drawn into dorsal flexion. Hence one reason for the
comparative rarity of pes calcaneus.

Paralytic deformities at the hip and knee are much rarer than those
of the foot. At the hip this immunity is partly due to the relative rarity
of paralysis in the muscles surrounding the joint—still more to the
fact that the weight of the limb tends to correct excessive flexions.
These are therefore more likely to occur in children allowed to
remain in bed than in those who are encouraged to walk by means
of suitable apparatus. The use of crutches, however, favors the
development of deformity, because, since with paralysis of the thigh-
or leg-muscles pes equinus nearly always exists, the thigh is unduly
lengthened. To palliate this inconvenience the patient instinctively
flexes the knee or hip, or both, and the position tends to become
permanent.

When the flexion is rigid and extension becomes impossible, the

gastrocnemii are relaxed until they lose their power of tension, and
thence of fixing or raising the heel. Further, as by the flexion the limb
is moved in front of the body, it is necessary to project the body
forward again over the support. Hence a lordosis is developed, to be
distinguished from that caused by paralysis of the vertebral
extensors (a) by the rigid flexion of the thigh; (b) by the facility with
which the patient can extend the back as soon as he is placed in a
sitting position.

Although the quadriceps extensor is so frequently paralyzed, rigid

flexion at the knee—such as on the theory of muscular antagonism
might be expected from the action of the hamstring muscles—is very
rare. As already observed, it occurs, if at all, in neglected children
allowed to lie or sit with the leg partly flexed. In those who attempt to
walk the leg is not flexed, but forced into hyper-extension by the
following mechanism: The muscles inserted on the upper part of the
thigh swing the leg forward like a passive support. Afterward the
body bends forward over the support, and its weight, pressing from
above downward and from before backward, and pressing the
articular surfaces of the joint together, forces the head of the tibia
backward until the movement is checked by the posterior ligaments.
The deformity is the same whether the quadriceps or one or all the
muscles surrounding a joint are paralyzed (Volkmann).

DISLOCATIONS.—Dangling limbs are, however, much more frequently

the consequence of total paralysis, with extraordinary relaxation of
the ligaments of the joint permitting dislocation. Reclus67 has
published several such cases. Verneuil has even suggested that
congenital luxation of the hip-joint always depends on an intra-
uterine spinal paralysis.68<
67 Revue mensuelle de Méd. et de Chir., Mars, 1878.

68 Quoted from Seeligmüller.

In the upper extremities rigid contractions are much less frequent,

even in proportion to the number of paralyses. Seeligmüller has seen
five cases of reducible flexion of the fingers, and one of permanent
extension of the wrist and fingers, associated with paralysis of all the
flexors. In this case, if the arms were so suspended that the hand
hung freely, its weight gradually overcame the action of the
extensors and the fingers fell into flexion. Upon any attempt at
exertion the hyperextension was reproduced.

DEFORMITIES OF THE TRUNK.—Scoliosis will be caused when, with

unilateral paralysis of the extensors of the vertical column, the lower
part of the trunk is drawn to the non-paralyzed side, and the upper
half is bent over the paralyzed side in order to restore the balance. In
bilateral paralysis of the extensors both shoulders are projected
backward, so that a plumb-line dropped from between them falls
behind the sacrum, and lordosis is developed, although the lumbar
column is not projected forward. The same form of lordosis occurs
when the glutæi are paralyzed. When, however, the abdominal
muscles are paralyzed, the lumbar column is really projected
forward, and then a plumb-line dropped from the shoulders passes
over the sacrum.69
69 Duchenne, loc. cit., 1861.

PARALYSIS OF THE ABDOMINAL MUSCLES.—Unilateral paralysis of the

extensors of the back is often difficult to detect in young children.
Seeligmüller recommends that the child be laid across the mother's
knees and told to move the trunk from one side to the other while the
pelvis is held firm. If too young to obey the direction, the movement
can be excited by pricking or by electric irritation. It will be seen that
the trunk can be turned only to one side.

In these paralyses of the trunk it is clear that the deformity does not
develop under the influence of muscular antagonism alone, but only
when the non-paralyzed muscles attempt to sustain the
superincumbent weight of the body or a portion of it.

SUMMARY OF MECHANISMS OF THE DEFORMITIES.—We may indeed

conclude, as stated at the beginning, that this complex etiology
exists in almost all cases. When the limb is at rest in bed or the
weight of the body is transferred to crutches, then repeated
contraction of the flexus will suffice to bring the limb into a vicious
position (contraction at knee- and hip-joint). When the foot or hand
hangs unsupported, its weight is sufficient to cause deformity, even
when all the muscles are paralyzed, and sometimes in opposition to
the direction of intact muscles. Thus the weight which is passively
borne by the limb, and the efforts of intact muscles to effect the
function of the limb in spite of the paralysis, both concur in the
production of the deformity.

ANATOMICAL LESIONS.—The theory of the anatomical basis of infantile

paralysis constitutes one of the most interesting portions of its
history. It is indeed one of the most instructive chapters of modern
pathology from the rapidity with which in a short time precise
knowledge has accumulated, and for the degree in which this has
revolutionized previous ideas.

Autopsies.—Until 1863 only five autopsies had been made upon

persons affected with infantile paralysis.70 As the disease was never,
of itself, fatal, opportunity for pathological investigation did not
present itself, while attention was still vividly attracted to the
paralysis. When this had become a chronic infirmity, and patients
had succumbed to intercurrent disease, the opportunity must have
occurred, but was not then utilized.
70 I believe the first list of modern autopsies was made by myself in a paper read
before the New York County Medical Society, Dec. 22, 1873. The paper was not
published until May, 1874, and in the mean time Seguin's lecture on “Infantile
Paralysis” was published in the N. Y. Med. Record, Jan. 15, 1874, with a tabulated list
of 25 autopsies, necessarily almost identical with mv own—cases 9 and 10 are really
identical. A case by Roth is included; 4 negative autopsies are omitted. In 1880,
Seeligmüller, in his elaborate essay in Gerhardt's Handbuch, published a list of 32
cases, including the above, and adding to them the following: Case by Müller, 1871; 4
cases by Leyden, 1875 (Arch. de Psych.); 1 case by Raymond, 1874 (Gaz. méd. de
Paris); 1 case by Demme, 1876 (B. med. Bericht über das Jennerischt Kinderspital zu
Bern); 1 case by Eisenlohr, 1876 (Tageblatt des Hamburger Naturforscher
Versammlung); 1 case by Schultze, 1877 (Virch. Arch., Bd. lviii.).

To this list we may now add 3 cases by Turner, Humphrey, Taylor, 1881 (Path. Trans.
London); 2 cases by Dejerine, 1878 (Progrès méd.), giving a total of 37 cases with
detailed histories and autopsies.

The first cases affording autopsies in which the spinal cord was
thoroughly investigated, belonged, however, precisely to this class of
extremely chronic lesions, which should be regarded as showing
rather the results of the morbid process than that process itself.
Omission to observe this distinction has been the occasion of
several misinterpretations of the pathological appearances.
Premature Theories.—In the entire absence of evidence it is a little
remarkable that such high authorities as Rilliet and Barthez,71
West,72 Vogel,73 Eulenburg,74 should have pronounced dogmatically
that the disease was essential—i.e. unaccompanied by any
structural lesion whatever; and that Bouchut,75 on the strength of
most incomplete examination, should have built up a theory of
myogenic paralysis. It is still more remarkable, after the published
autopsies of Rinecker,76 Laborde,77 Cornil,78 Prévost,79 Charcot and
Joffroy,80 Parrot and Joffroy,81 Vulpian,82 Roger and Damaschino,83
that Politzer in 1866,84 Brown in 1871,85 Barwell in 1872,86 Kétli,87
Adams in 1873,88 should still adhere to this doctrine. They are,
however, entirely in the minority, and all recent monographs and
works published with a view to presenting the state of science
assume the spinal nature of infantile paralysis to be established
beyond possibility of controversy.89
71 Traité des Maladies des Enfants.

72 Diseases of Children, Am. ed., 1860.

73 Diseases of Children, trans. from 4th ed., 1870.

74 Arch. Virchow, Bd. xvii. 1859.

75 Deutsche Klinik, 1863.

76 Gaz. méd., 1864, Soc. de Biol., 1864.

77 De la Paralysie de l'Enfance.

78 Gaz. méd., 1866, Soc. de Biol., 1866.

79 Arch. de Phys., 1870, p. 134.

80 Ibid., p. 310.

81 Ibid., p. 316.
 82 Bouchut is said by Simon (loc. cit.) to be alone in his theory; Kétli, however, agrees
with him. Eulenburg, in 1872, in his systematic treatise, assigns a central origin to
infantile paralysis, but offers no opinion in regard to its nature.

83 Gaz. méd., 1871.

84 Jahrbuch für Kinderkrankheiten, 1866.

85 Compend. für Kinderkrank., p. 161.

86 Lancet, 1872.

87 Jahrbuch für Kinderkrank., 1873.

88 Treatise on Club-foot.

89 See Seguin, loc. cit., 1874; Erb, Ziemssen's Handbuch, Bd. xi.; Seeligmüller,
Gerhardt's Handbuch der Kinderkrankheiten; Ross, Treatise on Diseases of Nervous
System, vol. ii.; Hammond, Diseases of Nervous System, 6th ed., 1881, etc. etc.

The following table contains a summary of the seven autopsies in

which the spinal cord is said to have been examined with negative
results. Of these, the only really important case is the third, in which
a microscopic examination, made by so competent an histologist as
Robin, was said to have discovered no lesion of the cord.

The foregoing autopsies may be tabulated as follows:

 TABLE I.—NEGATIVE AUTOPSIES.
Name of
Age at Age at Reference
Author Nature of Limbs Electric Appearances
No. Year. time of time of in
and Symptoms. Paralyzed. Reaction. at Autopsy.
Paralysis. Autopsy. Literature.
Patient.
Gaz. méd.
1850
Rilliet and de Paris,
1 or ? ? ? l. o. ? Negative.
Barthez. 1850 (or
'51?
'51?) p. 681.
1850
Rilliet and
2 or ? ? ? b. u. ? Negative. Ibid.
Barthez.
'51?
Bouchut
and Suddenly Negative Union méd.,
3 1867 Robin. 1½ 3 after 3 both u. micro- 1867, No.
(Angélique days' fever. scopically. 130, p. 187.
Lermain).
Treatise on
4 1873 Adams. — — — — — Negative. Club-foot, p.
—.
Jahrb.
Elischer
5 1873 — — — — — Negative. Kinderheilk.,
and Kétli.
1873.
Elischer
6 1873 — — — — — Negative. Ibid.
and Kétli.

Heine, in the absence of autopsies, but arguing from clinical symptoms

alone, already inferred the existence of a spinal lesion as cause of the
paralysis, and believed that it consisted in congestion, or even in
hemorrhagic exudation, capillary or massive, which should compress the
cord and result in partial atrophy. The same opinion is advanced in 1844
by Brunnière,90 also by Vogt,91 in 1868 by Salomon92 and Radcliffe.93 The
autopsies contained in the following table, in all of which vascular lesions
are prominent, might be invoked in support of this view:

TABLE II.—AUTOPSIES SHOWING VASCULAR LESIONS OF CORD.

Name of Age at Age at Reference
Nature of Limbs Electric Appearances
No. Year. Author and time of time of in
Symptoms. Paralyzed. Reaction. at Autopsy.
Patient. Paralysis. Autopsy. Literature.
 7 1829 Klein. 5 5 Persistent l. o. ? Congestion of Quoted by
cerebral pia around Heine.
symptoms. roots of left
brachial
plexus.
Chronic
8 1855 Brund. 1 5 Meningitis? r. u. ? spinal klepto-
meningitis.
Encysted clot Journ.
in left ant. Psych.
9 — Hammond. 4 yrs. stand. — l. u. ?
column, lower Medicine,
dorsal cord. 1867.

90 Krankheiten des Gehirns und Ruckenmarkes.

91 Lahmung der Kinder, p. —.

92 Jahrb. f. Kinderheilk., 1865.

93 Reynolds's Syst. of Medicine.

The first really modern autopsy, that made by Cornil in 1863, agrees with
the two earliest on record in disclosing only an atrophy of the cord. Some
of the other cases, contained in Table III., note in addition sclerosis of the
lateral columns.

In all the remaining autopsies on record are noted atrophy of the anterior
gray cornua and more or less extensive destruction of the ganglionic
cells.

In a certain number of cases the atrophy seemed to be the unique lesion.

But it never was confined to the ganglionic cells, but included the
reticulum of gray fibres in which these were imbedded, and which was
replaced by a reticulum of connective tissue. These cases were all
examined many years after the occurrence of the paralysis.

TABLE III.—AUTOPSIES SHOWING ATROPHY OR SCLEROSIS OF WHITE COLUMNS

OR ROOTS.
No. Year. Name of Age at Age at Nature of Limbs Electric Appearance Reference
Author time of time of Symptoms. Paralyzed. Reaction. at Autopsy. in
 and Paralysis. Autopsy. Literature.
Patient.
Atrophy of
cord from
below 8th Quoted by
10 1825 Hutin. 7 49 Convulsions. b. u. ? dorsal nerve Heine, p.
to thickness 151.
pencil, and
of nerves.
Atrophy and
brown
discol. of Anat. et
ant. roots of Phys. du
11 1842 Lunget. ? 8 ? r. u. ? lumbar and Syst.
sacral nerveux, i.
nerves p. 358.
going to
sciatic.
Deutsche
Klinik,
1863, Jan.
3.

Atrophy of
Reckling- Seel. says
12 1863 ? ? ? b. u. ? ant.-lateral
hausen. also
columns.
atrophy of
cells;
Seguin and
J.,
tubercles.
13 1863 Cornil. 2 49 ? b. u. ? Atrophy Soc. de
antero- Biol.,
lateral Comptes
columns. Rendus,
1863.
Seeligmüller
says also Infiltration
atrophy of of gray and
ganglion- white
 cells, as if corpuscles,
quoting with
Charcot. abundant
amyloid
corpuscles,
especially
in anterior
gray
cornua.
These
through
entire
extent of
cord—cells
—intact.
Paraplegia,
but walks
by muscles
of thigh and
pelvis; leg
and foot
atrophied.
Atrophy
Laborde,
antero-
De la
lateral
Laborde Paralysie
columns;
14 1864 and 1 2 ? all four. noted. de
nerve-fibres
Bouvier. l'Enfance,
atrophied
pp. 109-
and
119.
varicose.
Sclerosis of
ant.-lateral
columns.
Laborde Laborde,
15 1864 and ⅔ 2 ? b. u. ? Ganglion- loc. cit., p.
Cornil. cells 104.
normal;
sciatic
neuritis.
The first group is contained in the following table:

TABLE IV.—AUTOPSIES SHOWING ATROPHY OF THE ANTERIOR CORNUA AND

GANGLION-CELLS.
Name of Age at Age at
Nature of Limbs Reference in
No. Year. Author and time of time of Result of Autopsy.
Symptoms. Paralyzed. Literature.
Patient. Paralysis. Autopsy.
Comptes
Atrophy of left
Rendus,
anterior cornu,
16 1866 Prévost. ? 78 ? L. u. Soc. Biol.,
especially of
Gaz. méd.,
ganglion-cells.
1866.
Atrophy of cells ant.
Charcot All esp. l. Archives de
17 1870 7 32 Sudden. horns and ant.
and Joffroy. u. Phys., 1870.
lateral columns.
Atrophy and partial
Parrot and sclerosis of anterior
18 1870 — 3 Unknown. B. l.
Joffroy. cornua and ant. lat.
columns.
Atrophy of
Archives
ganglion-cells,
19 1870 Vulpian. ? 66 ? L. l. Physiol.,
sclerosis of antero-
1870.
lateral columns.
Quoted by
Atrophy of
Seeligmüller,
Fall from ganglion-cells ant.
20 1871 Müller. 4 34 L. lower. Gerhardt's
bed. cornua; sclerosis of
Handbuch,
anterior roots.
Tabeln.
Petitfils,
Atrophy of external Thesis on
group cells in ant. Atrophie
Lancereaux
21 1873 2 18 ? L. upper. cornua; general aigue des
and Pierret.
atrophy of left half Cellules
of lumbar cord. motrices,
1873, p. 33.
Atrophy of
Gaz. méd de
ganglion-cells in
22 1875 Raymond. ? 75 ? R. arm. Paris, No.
right ant. horn cerv.
19, 1875.
region.
 23 1879 Taylor. 1½ 3 3 days' L. leg. Atrophy of left ant. Trans. Path.
fever. cornua; Soc.
disappearance of London,
ganglion-cells; no 1879.
lesion in white
column.
Atrophy of ant. horn
R. foot
right side; atrophy Arch. Phys.,
24 1875 Dejerine. — — — (congenital
external group of 1874.
equinus).
motor-cells.
Atrophy of left half
lumbar cord; Trans. Path.
disappearance of Soc.
25 1879 Humphreys. 1½ 3½ ? L. leg.
medial group cells London,
both sides; antero- 1879.
lateral on left side.

In the remaining cases the ganglion-cells of the anterior cornua had also
disappeared; but in addition to this atrophy excited distinct evidence of
more or less extensive inflammation. This table includes one case of
autopsy at two months (Roger's); one at six weeks after paralysis
(Turner's).

TABLE V.—AUTOPSIES SHOWING EVIDENCE OF MYELITIS, TO WHICH THE ATROPHY

OF THE GANGLION-CELLS WAS CONSECUTIVE.
Name of Age at Age at
Nature of Limbs Appearance at Reference in
No. Year. Author and time of time of
Symptoms. Paralyzed. Autopsy. Literature.
Patient. Paralysis. Autopsy.
Granular
Quoted by
R. arm, R. pigmentation
26 1866 Echeverria. 3 10 Fever. Seguin, loc.
leg. anterior cornua,
cit.
diffuse myelitis.
Febrile
27 1866 Echeverria. 2 2½ Both legs. Ibid. Ibid.
diarrhœa.
28 1871 Roger and 15/6 2 Scarlatina L. arm, Foci of softening Gaz. méd.
Damaschino. with then both throughout cord. de Paris,
second legs. Atrophy ganglion- 1871.
attack. cells and nerve-
fibres. Dilatation,