Prognosis.—This varies widely in indi vidual instances, the variation being de pendent chiefly upon the etiology, al though the severity of symptoms is also a factor. Myelitis due to causes which are removable by surgical procedure—as, for example, compression from trauma, tumor, or vertebral disease—may occa sionally be completely cured. Syphilitic myelitis offers a distinctly better prog nosis than the non-syphilitic, although even here an opinion as to the outcome should always be extremely guarded and never positive at first, especially as re gards permanent disability. Immediate danger as regards life is greatest in mye litis due to or following the infectious fevers, sepsis, and severe injury. The duration of the disease is equally in definite; a subacute myelitis may pass into a chronic, slowly progressive form, the gradual development of symptoms extending over a period of many months or years. The inflammation may sub side after a varying length of time and be followed by a necrosis or sclerosis which is limited by the preceding inflammation, the patient being left with a paralysis which remains permanently stationary. The process may stop and remain station ary for some time and then start up again, some slight additional cause re lighting the fire in a locality predisposed by previous disease. The severity of the trophic symptoms is quite reliable as a guide in determining the immediate dan ger to life, deep and extensive bed-sores being invariably of ill omen. Severe bladder symptoms are also of evil sig nificance.
Treatment.—Absolute rest in bed is essential in all cases; at first counter-irri tation should be employed, with extreme caution, however, on account of the dan ger of inducing bed-sores. A water-bed is often advisable from the first to prevent this complication. The catheter should be employed also with extreme antiseptic and mechanical precaution. Pain should be relieved by opiates when necessary, but in minimum doses. The details of treatment vary with the cause. In syph ilitic myelitis no time should be lost; the patient should be put at once upon full and rapidly increasing doses of potas sium iodide. The dose to begin should be at least 25 drops of the saturated solu tion. The salt should be pure and the vehicle should be changed every few days—water, milk, Vichy, Apollinaris. Geisshtibler water, or plain carbonated water may be employed in turn. The dose should be progressively diluted more and more, as it is increased. Should iodism develop, double the dose if less than 40 drops or grains; if over 100, reduce it one-half and rapidly increase to a dose beyond that at which iodism occurred. The maximum daily amount is to be determined by the effect on the disease, but it is rarely necessary to give more than 600 or SOO grains daily. Mer cury is superior to the iodide only when primary syphilis has immediately or at least recently preceded the myelitis. When the disease results from trauma or is due to tumor, abscess, or disease of the vertebra, the question of operative in terference should always be considered and decided promptly in order to pre vent extension and secondary softening.
Symptomatic relief may often be ob tained by appropriate operative proced ure, and this is true even in tuberculous myelitis, where lumbar puncture with drainage at times greatly alleviates the patient's distress. In myelitis due to in fection there is no specific drug or plan of treatment. Sodii salicylatis, small doses of mercury, or full doses of iron may be given in addition to the familiar local measures during the acute stage.
For the chronic disease we may expect a certain amount of benefit from galva dism and massage. The details of the electrical treatment will vary with the locality affected (see POLIOMYELITIS). Silver, arsenic, gold, phosphorus, and ergot are all mentioned as therapeutic resources, but there is little, if any, evi dence of specific benefit from either. A tentative course of treatment with potas sium iodide should be given in all chronic cases.
Poliomyelitis. .
Synonyms. — Infantile spinal paral ysis; myelitis of the anterior horns; acute atrophic paralysis; essential paralysis of children; West's morning paralysis.
Definition.—A purely motor paralysis of flaccid type, occurring usually in young children, the paralysis being followed by rapidly developing atrophy, with degen erative electrical reactions in the affected muscles. An acute, a subacute, and a chronic form are recognized, the last be ing the variety commonly observed in adults.
Symptoms. — An attack of acute in , fantile spinal paralysis is, as a rule, un attended with prodromata. The disease begins abruptly, usually with some fever, the essential significance of which is rarely understood at this stage. The tem perature may be only slightly elevated (1 to 3 degrees), the range being higher and the fever more prolonged, the older the child. There may be slight digestive dis orders,—such as vomiting and diarrhoea, —slight headache, and in some instances the patient may complain of pain in the back and limbs. These general symp toms vary in intensity with the tempera ture. In about one-fourth of all cases the onset of the disease may be marked by a convulsive seizure. The younger the patient and the higher the temperature, the more likelihood is there of convul sions, which, however, are rarely repeated more than once or twice. After a few days —usually two or three, rarely more than ten—the fever and general disturbance subside, and not until then, usually, is the true nature of the illness made evi dent by the discovery of a flaccid motor paralysis, which may at first affect all of the extremities as well as the trunk-mus cles. If suspected and sought for, how ever, the paralysis may often be detected during the febrile stage. Within a week or two the general paralysis clears away, leaving a residual paralysis limited to one or more limbs, or, it may be, to a single muscle or group of muscles. Such groups are invariably of muscles of associated function. The lower limbs are rather more frequently affected than the arms. A paraplegic distribution is common, a hemiplegic distribution exceedingly rare.