=Poliomyelitis—Infantile Paralysis.=—This disease occurs in all
countries and was recognized more than a hundred years ago. The first
of the great epidemics appeared in 1905, and it was then proved that
the malady is a contagious disease. Peculiar facts connected with
previous epidemics of poliomyelitis have made it appear possible that
the disease when not spread directly from one person to another,
like the most acute infectious diseases, may be dependent upon some
intermediate agent, or perhaps upon some other host, or a living
reservoir, or upon the combination of the two. If the disease is
communicated by human contact, mild cases, abortive cases, and
convalescents may carry the germs for years. A normal carrier is an
individual who is not suffering from the disease and may carry the
germs and transmit them to another without being the least suspected.
Laboratory experiments would seem to show that the disease is passed
directly from one affected human individual to another through
immediate contact involving the transfer of the virus from the first
person to the nasal passages of the second, and spread through the
agency of dust or by various other means, a population other than
human, one acting as an undercurrent and influencing the progress
of the epidemic. There seems to be no relation between the sanitary
conditions and the incidence of cases. Poliomyelitis is most prevalent
during the warm months, even when it is not epidemic. Under the same
conditions of temperature, rainfall, humidity, cloudiness, sunshine,
wind, dust, etc., the outbreak will progress in one part of the city
and subside in another. The course of the epidemic is not materially
modified by weather conditions. No age, no sex, or race is exempt; the
incidence is greater under five years of age, and the blonde children
appear to be especially susceptible, while the colored race are rarely
attacked, and the strongest children seem to be the greatest sufferers.
That this disease can and often does end fatally has been clearly
shown by the history of the past epidemics, and it has been frequently
demonstrated by clinicians in various parts of the world that complete
recovery from paralysis is not only possible but it is by no means
uncommon.
=Summary Results from Public School Reports.=—1. A large number of
children with poliomyelitis show pathologic conditions of the nose and
throat, either diseased and hypertrophied tonsils and adenoids, or both.
2. A large number show marked hyperemia of the nasopharynx and throat,
often resembling a scarlet or streptococcus throat.
3. Only a small percentage of cases previously operated for tonsils
and adenoids were found to be affected with the disease, and in this
group of cases the percentage of recovery was very much higher than
in unoperated cases. The number of cases in this group is, of course,
rather small to draw from it any definite conclusion, but it is at
least suggestive. In another investigation of 1404 children in the
public schools, made to determine whether any of them whose tonsils
had been removed had been ill with poliomyelitis during the recent
epidemic, a similar result was obtained. Of the 1404 children whose
tonsils had been operated upon not one developed poliomyelitis during
this epidemic, although in 18 instances cases developed in the family,
and in 93 instances cases developed in the same house.
Poliomyelitis defined: _Polio_ (gray), _myel_ (marrow), _itis_
(inflammation), meaning inflammation of the gray matter of the spinal
cord.
=Pathology= of the disease: Infantile paralysis is a general infection,
with lesions most marked in the central nervous system. Clinical
manifestations exhibit a wide-spread and scattered motor paralysis or
weakening. The large majority of all cases are of the central nervous
system, but there are variations in which the symptoms are not of the
usual kind.
=Classification.=—1. _Non-paralytic or Abortive Type._—These are
cases in which the nerve-cells are not sufficiently injured to
produce paralysis; and those classed as meningitis cases, tuberculous
meningitis without motor disturbances, often called encephalitic; in
these cases the motor cortical areas are not involved, but there is
evidence of disturbance of the sensorium.
2. _Ataxic Type._—Here the motor cells are evidently not involved, but
there is a lack of co-ordination—ataxia, nystagmus.
3. _Cortical Type._—The upper motor neuron is here affected, with
resulting spastic paralysis.
4. _Ordinary Spinal or Subcortical Type._—Here the lower motor neuron
is affected, with resulting flaccid paralysis; a manifestation of
poliomyelitis difficult to classify is blindness. The most important
symptoms of the disease may be described under the _non-paralytic_ or
_abortive_ cases and those of _ordinary spinal form_.
=Symptoms of Onset.=—There is no typical onset for this disease. It
is believed that there is an interval of from a few days to two weeks
between the time of exposure and the appearance of symptoms. No one
symptom or group of symptoms will always be found to identify it
before the paralysis is apparent. Fever is the most constant of all
symptoms; it varies a great deal; there may be much or there may be
little. Vomiting occurs quite frequently, and in a child old enough to
talk headache may be complained of. Sometimes there is considerable
pain in the back. The child is often very drowsy and desires to be
alone. Movements of any kind seem to cause pain, and muscle tenderness
is plainly evident. Marked irritability and sweating are also often
prominent features. Such symptoms may all appear suddenly following a
day of great activity and good health. These symptoms may continue for
from two to four days, when it is noticed that the child is unable to
move a hand, an arm, a foot, or a leg. There may merely be a paralysis
of one side of the face or only weakness in an arm or leg. In some mild
cases it is occasionally hard to convince parents of the true nature
of the disease. In some instances the first knowledge of a child’s
indisposition is the discovery that it cannot walk or has difficulty in
using an arm. Cases of this character are often attributed to “catching
cold,” to going in bathing for too long, or perhaps a fall.
In the majority of cases temperature is down to normal within a week
and there is seldom an extension of the paralysis after that time. In
most instances all the paralysis which is going to occur is present at
the time it is first noticed.
Within two weeks all the tenderness has usually left the muscles, which
are now found to be soft and flabby from lack of use. No matter what
extremity may be affected by the paralysis, there is one condition
which is nearly always present in these cases. If the child’s shoulders
are raised up from the bed, the head drops back almost as if on a
string. The child is unable to keep its head in a line with the body,
and if the head is raised and forcibly bent forward so as to cause the
chin to touch the chest, marked pain results.
=Treatment.=—By the end of three weeks in favorable cases there may be
some motion obtained by the patient in the limb which was paralyzed,
or there may be evidence of threatened deformity. It is at this time
and in the weeks and months to follow that so much depends upon
treatment. The muscles of a leg or arm may waste away so as to make
them useless if not promptly cared for. If contractions of muscles
are not prevented, a club-foot, toe-drop, or some similar deformity
may develop. _Such deformities may be hastened by the pressure of
the bed-clothes._ At times it is well to put a wire cradle over the
affected limbs. Well-padded splints seem to take the strain from
unaffected muscles.
By some wonderful adaptation of nature there is a great effort to make
other nerve channels take up the work of the destroyed cells, and
hence the value of keeping the muscles artificially active by the use
of massage and mild electric treatment. This treatment should be used
early in the case, and then only with the advice and supervision of a
competent physician.
The destruction of nerve-cells in the segment of the spinal cord is
sometimes so extreme that a total paralysis of one or more extremities
follows. This is a grave shock to the growing child, and it may be
that all growth of that member will stop. The long bones will not
lengthen. If one group of muscles remain active and unopposed in their
action, deformity will follow. These deformities can be corrected by
the orthopedic surgeon, and can usually be checked if the physician’s
advice is sought.
_Serum Treatment._—The serum injections were given even as long as
thirty years ago. Intraspinal injection of an immune serum is effective
when introduced in the preparalytic stage.
_Prophylaxis._—The _virus_ or germ of _poliomyelitis_ is found _in the
nose, the mouth, and intestinal tract_ (it is also found in various
other parts of the body). As house-flies may carry the virus after
crawling over the person suffering from the disease, all insects are a
dangerous asset to any household. Disinfection of secreta and excreta
should be carried out. The mouth and nose should be disinfected.
=Quarantine= should be rigidly enforced, and all the necessary
precautions taken to prevent the spread of a contagious, infectious
disease.