(INFANTILE PARALYSIS)
=Definition.=—An acute infectious disease occurring most commonly in
young children, characterized by paralysis, rapid wasting of certain
muscles, and fever. It is an acute myelitis that affects the anterior
horns of the cord. There are no sensory symptoms.
=Etiology.=—It usually occurs in children under ten years of age,
and the majority of cases occur before the fourth year. It is more
common in summer than in winter. The infection seems to gain entrance
through the nasal mucous membrane. Traumatism, exposure to cold and
overexertion, are probably predisposing causes. It has occurred in
severe epidemic form.
=Morbid Anatomy.=—The disease is most frequently seen in either the
lumbar or cervical enlargement and is usually unilateral, though there
is considerable variation in the extent of the lesions. In very early
cases, the condition of acute hemorrhagic myelitis, with degeneration
and rapid destruction of the large ganglion cells, has been found. In
older lesions the anterior cornu in the affected region is atrophied
and there is destruction of the multipolar ganglion cells. The
anterior nerve roots are atrophied, the muscles are wasted and undergo
a fatty and sclerotic change.
=Symptoms.=—The child may have a slight fever, malaise, muscular
twitching, headache, some rigidity of the neck, and sometimes vomiting.
This may last a day or several days or only a few hours, when paralysis
sets in abruptly. The =paralysis= is rarely complete and groups of
muscles only may be affected. As a rule, the paralysis comes on
abruptly, but it may come on slowly, taking several days to develop.
In a few weeks, atrophy sets in and the limb becomes flaccid, soft and
wasted. The paralysis remains stationary for a time when improvement
takes place, but complete recovery is rare. Sometimes the growth of the
bone of the affected limb is impaired. Usually there are no sensory
disturbances and the bladder and rectum are not affected. The condition
of the reflexes is dependent upon the extent of involvement of the
cornual cells. Occasionally the bulbar muscles are affected.
=Diagnosis.=—This is not difficult except in the early stages. Careful
study of the case is commonly all that is necessary. Landry’s paralysis
and peripheral neuritis are to be differentiated.
=Prognosis.=—Complete recovery is rare. Improvement is the rule.
Ivie[128] tabulates sixteen cases, all showing good results. W. B.
Davis[129] reports a case cured by six months treatment and still well
after three years. T. M. King[129] one case cured and one greatly
benefited and A. S. Craig[129] one much helped. Florence Gair, F. P.
Millard, A. G. Walmsley and others report gratifying results in many
cases.
=Treatment.=—In the treatment of chronic cases, F. P. Millard[130]
says “Five minutes’ time is sufficiently long in treating a patient,
and sometimes too long. * * * Start in and move every spinal joint.
That takes about two minutes. Spring the sacro-iliac articulations
just enough to get motion. Then give a specific cervical treatment. Do
not stop to relax muscles in a child. Adjust as rapidly as possible.
Make every spinal joint yield to motion. Spend only one minute, or
possibly two, on the cervical vertebræ. So far we have consumed four
minutes. The last minute we loosen up the wrist or ankle, according
to the extremities that are involved.” This outline has been followed
with gratifying success by Gair, Green, Bush and others in many
chronic cases. The procedure in acute cases is condensed from A. G.
Walmsley[130]: “Isolate, keep cool and absolutely quiet. Stop all food
until the temperature drops to 100° F. or lower and until the pain
subsides when fruit juices may be given followed by heavier foods. Give
patient all the water he will drink. Where the spine is sensitive, and
it will be in many, use hot fomentations until a specific treatment can
be given. If the fever is running high cool compresses will be grateful
and help reduce temperature. Irrigate the colon twice daily with saline
water. Do this first thing when called. Later once daily will do and
then discontinue. Look carefully to the nose and throat and wash with
saline or boracic solution. Keep feet warm as they may be cold even
with high fever. Treat the case over a long period. See that he does
not overdo and observe all dietetic and hygienic measures.” Both these
men lay great stress on the importance of specific adjustments and
massage of muscle tissue has little place in their treatment. This,
with drill at home can be attended to by the mother.
Ivie[131], among other good ideas on treatment, gives the following:
“May I suggest that when such severe results (the acute stage) follow
a slight infection, that we may expect to find a lesion located at
such a point as will interfere with one or more of the anterior root
arteries which join and supply the anterior spinal plexuses. As there
are only five or ten of the anterior root arteries (Dana), the lesions
affecting them can be located throughout a wide range of the spine. In
a great many cases we find that the correction of lesions well up in
the dorsal and even in the cervical region have increased the amount
of the improvement well beyond that received in the correction of the
lumbar lesions alone. To =promote resolution=, correct the lesions,
both muscular and bony, and relax the muscles of the spine daily; move
every vertebra to the limit of all its possible motions; use flexion,
extension, rotation, and lateral flexion at least once every day for at
least a week; and help to overcome stasis by keeping the child off its
back, turning it from side to side, and letting it lie on its stomach
as much as possible. The limb, to be kept in its best condition, should
be kept warm; treated gently; held in a natural position by the use of
sand bags and clothes cradle, thus beginning early the =prevention= of
deformity; the paralyzed muscles should not be kept on a stretch, as
that will retard any possible improvement; stimulating rubs and baths
should be given frequently.” In the =chronic stage= he advocates: “Now
that the nerve cells have been given a chance to regenerate (removal of
lesions), the best thing to do is to force them to work if possible. To
do this, the so-called resistance exercises or educational movements
are to be strongly recommended; the idea being to place the limb in a
given position and then ask the child to fix all its attention on the
limb and to earnestly attempt to hold it there while you move it, or to
keep making the attempt while you move the limb through its whole range
of motion in that direction. These movements should be so calculated
that the resistance of the child will exercise the group of muscles
affected. The mother or nurse can give these exercises every night on
going to bed.”