POLIOMYELITIS.
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.