A reference hand-book for nurses

by Amanda K. Beck

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.