The treatment of poliomyelitis is quite different in the three stages of the disease.
If the physician is so fortunate as to see and recognize a case in the initial stage—which is very rare—he will have to content himself with general antipyretic and sedative measures (see treatment of encephalitis). Rest in bed, the application of ice bags to the vertebral column, free catharsis and, in older children, leeches would constitute the treatment. Lumbar puncture is to be recommended during these stages because, aside from the diagnostic results, it has a favorable effect on the inflam mation by relieving pressure and possibly by removing bacterial poisons.
At the beginning of the stage of initial paralysis—the period when the physician usually sees the patient for the flist time—it has long been customary to adopt a diaphoretic line of treatment, salicylates, aspirin, hot tea. It cannot be said that the improvement that occurs during this time can be attributed to the treatment. On the other hand, electricity and massage are of great value in this stage of poliomyelitis.
It is well to begin electric treatment about two weeks after the onset of the disease, keeping it up for many months, or even a year, three or four times a week. There are few organic palsies in the treatment of which patience and perseverance are so imperatively demanded FIS in poliomyelitis, and it is very probable that improvement in muscles that are completely paralyzed is hastened by electric treatment. The active pole, the cathode, of the galvanic current is used, and an attempt is made to produce a muscular contraction by interrupting the current. Especially devised electrodes are used for this purpose. Cathodal galvanization can alsO be effected by passing a current which produces twitching contractions over the paralyzed group of muscles. In this method of electric treatment the strength of the current is gradually increased and again diminished. If the muscles respond to the faradic current, the latter may be employed with the aid of a wandering electrode (for instance a faradic coil). If it is desired to produce a powerful effect, labile galvanofaraclization, using both kinds of current, should be tried Next to electricity massage is of great importance in this stage of the disease, only however, when it is done by a practised hand and with accurate knowledge of the paralyzed muscles.
Warm baths are to be considered as an auxiliary measure and should precede passive movements and massage. Bathing cures ith aerate
thermal waters, warm saline or natural carbonated waters are useful during the summer, when the electric treatment is interrupted.
'When the physician has become convinced that no improvement is to be expected by electricity or massage, orthopedic treatment is indi cated. 'While this belongs to the stage of permanent paralysis, the ground may be prepared during the period of repair and the tendency to contracture may be combated by forbidding. certain forced attitudes, anti by the application of dressings and orthopedic apparatus. If con tractures have already developed, various measures such as tenotomy, fixation of flail joints (arthrodesis), and various orthopedic apparatus are indicated in order to increase the functional power of the paralyzed extremities. The various apparatus devised by Hessing and Hoffa deservedly enjoy a wide popularity. A purely symptomatic and com mendable surgical treatment consists in the transplantation of tendons after Nicoladoni. It is based on the principle of uniting the tendon of a paralyzed muscle to that of an adjoining healthy muscle. Only a part of the tendon of the healthy muscle is split off and attached to the para lyzed muscle so as not to destroy the function of the former. The close proximity of healthy and paralyzed muscles is indispensable for the application of this treatment and as this condition is satisfied in polio myelitis more than in any other disease, it is here that the method has been chiefly developed. It is needless to say that the first requisite for the success of this operation is an accurate functional and electrical examination of the muscles to he operated upon, which alone enables the surgeon to map out his plan of procedure and this operation is quite difficult; after the muscles have been exposed, the difference in color and elasticity between the healthy and diseased muscles is of some importance. The best application of the method is found in partial palsies of the leg or of tbe arm. The results of this operation arc very favorable (Lange, J. Wolff, Krause, Vulpitts, and others). For the details of the technic, which has been carefully elaborated (for example, length ening of the tendons with silk sutures, attachment of a transplanted tendon at the point of insertion of the paralyzed muscle) the reader is referred to Vulpius, Die Sehnenfiberpflanzung, Leipzig, 1902.