. POLIOMY ELITIS Poliomyelitis is an acute inflammation of the spinal cord which chiefly attacks the distribution of the anterior central artery (Kadyi) in the gray matter of the anterior horn. The term poliomyelitis which was introduced by Kusernaul is therefore quite appropriate i.s.o.hos, gray), but it does not imply a sharp distinction from myelitis (see below).
The investigators of poliomyelitis had to overcome two great obstacles before they arrived at the above correct recognition of the pathology of the disease. The spinal nature of the disease, first poetu lated by IIeine in 1840 and later by Duchenne, was for a time called in question and the disease was described uncler the name of "essential infantile paralysis" (Barthez and Rilliet). Later, Nvhen Charcot, Joffroy and others had positively demonstrated changes in the spinal cord, it was supposed that poliomyelitis depended on a primary disease of the ganglion cells leading to atrophy, without any other disease of the spinal marrow This theory, which was based on the post-mortem findings in a ease of poliomyelitis of some duration, suf fered a severe shock when acute inflammatory changes in the spinal marrow were demonstrated (by Roger, Damaschino and Roth) in chil dren who had died early in the disease; nevertheless, Charcoes concept ion of a primary disease of the ganglion cells has many adherents even at the present day Risler and von Kahlden) and, up to a certain point, Ltivegren). :Most of the more recent investigators (Goldscheider, Red lich, :-.;iemerling, Pierre Marie, Neurath), however, have expressed themselves in favor of an inflammatory nature of poliomyelitis and at the present time the discussion on this point—whether the disease is exclusively inflammatory—is practically confined to a controversy on the general problems of inflammation.
Recent cases of poliomyelitis exhibit post mortem all the signs of acute inflammation (hypermia, increase in the number of blood vessels, cedema, small cell infiltration, cloudy swelling of the ganglion cells, degeneration of the nervous elements and, ultimately, central softening) in the anterior horn. The inflammation is not limited to the gray
matter but extends also to adjoining portions of the white substance. Extensive segments of the spinal cord are often involved in the inflatn matory process; even the tnedulla oblongata may be attacked (Red lich). Localization of the lesions in the cervical and lumbar portions of the cord is characteristic of this form of inflammation of the spinal cord. In old cases the anterior horn on the dis eased side is distinctly narrowed; the ganglion cells and fibres are atro phied or sometimes com pletely destroyed; and microscopically the ves sels are often seen to be surrounded by the re mains of inflammation.
Numerous bacterio logic examinations have been made in poliomy elitis with the aid of lum bar puncture (Schultze, Biilow, Hanson, Harbitz, Dethloff and others). In most of the eases a diplo coccus was found resem bling that which causes cerebrospinal meningitis. Some French investiga tors have succeeded in artificially producing clinical pictures resem bling poliomyelitis by injecting various bac terial cultures.
A number of external injuries were formerly in cluded among the causes of poliomyelitis. Seelig mailer holds cold, infectious diseases, trau matism, muscular over exertion, dentition, psychic disturbances and heredity responsible for the development of poliomyelitis. But while all these may occasionally be contributory causes, the infectious diseases alone have any significance; for they frequently precede poliomyelitis so directly that the relation cannot be regarded as a mere accident. It must not be forgotten with regard to the significance of the history that the attending physician not infre quently mistakes the initial stage of poliomyelitis, when it is accom panied by fever, for some other disease and later, when he recognizes the extent of the poliomyelitis, is inclined to inform the parents that the paralysis is the. result of the primary disease.