POLIOMYELITIS. Also known as In fantile Paralysis, or Heine Medins Disease. An - acute infectious disease, chiefly involving the spinal cord and its membranes, at times pro gressing into the upper parts of the mid-brain and brain itself. The agent itself has not been definitely isolated (1919) although the disease has been communicated to lower animals (chiefly monkeys) and has been transmitted through a number of generations of these ani mals. It is known that it is a filterable virus of some kind, in some ways behaving like the filterable virus of the disease known as hydro phobia. The mode of ingress is not definitely known, but the naso-pharynx is supposed to carry it. It is a communicable disease and oc curs in epidemic form, some epidemics having almost circled the globe. It is chiefly found in temperate zones, and the epidemics have oc curred chiefly in the summer or autumn, though winter and spring epidemics are known. It is frequently confused with influenza, epidemic lethargic encephalitis and certain forms of cerebro-spinal meningitis. It affects children chiefly, but not exclusively.
The disease often begins with mild respira tory or gastro-intestinal disturbances. There are vague neuralgic pains and headaches, there may be increased irritability to light, sounds and touch and in from 24 to 72 hours certain groups of muscles are partially or completely paralyzed. These paralyses are usually very unequally dis tributed, and whole muscle groups or parts of a muscle are involved. The involuntary struc tures are also at times involved, causing various trophic or vegetative disturbances. The nature of the changes in the spinal cord and meninges are those of an acute infiltrating inflammation in which the blood supply to the cord may be cut off or the inflammatory oedema cause swell ing and pressure upon nerve structures. Thus there results a partial or complete destruction of the nerve structures of the spinal cord which are correlated with muscle function. The large cells of the anterior horns of the spinal cord, which are stations in the pathways for the con duction of motor nerve impulses, seem to bear the brunt of the inflammatory changes, and hence present the most obvious changes which were seen in the old cases. But it must be re membered that the pathology which was de scribed in the older accounts was framed upon the study of the old and long since active cases. The modern study has shown the widespread involvement of the nervous system and also shown that the disease may be traced to other than purely nervous structures, even if the lat ter bear the brunt of the serious left-over de structions. In certain patients the chief de
structions are found in the mid-brain tissues; from these result paralyses of the cranial nerves, particularly of the eye-ball muscles and the muscles of the face.
The course of the disease varies consider ably. As a rule its worst effects are present within the first week of the illness. After this comes the long and tedious stages of recovery which going on slowly at first may improve more rapidly and then a very long period, years it may be, of very slow and gradual improve ment if the proper kind of treatment is pursued.
The treatment is preventive, palliative and restorative. In the preventive treatment great care should be taken not to come in contact with poliomyelitis cases, especially in the early stage& As some of those sick from the disease may have it in a very light form special quarantine measures are desirable for these suspects. All children taken sick during an epidemic should be carefully isolated and contacts with others made as light as possible. In the acute stages of the disease it is not known what may be beneficial. Lumbar puncture helps some, ergot help others, and specific sera are being evolved which may help others. These sera are con stantly being improved and this article can only call attention to this fact and urge the afflicted parents to call upon such wide-awake physicians who would be most likely to be abreast of the times and know what is going on in medicine. In the treatment of the chronic phases great care and detailed attention should be given to conscious muscle training. Electricity, mas sage and other similar types of therapy are usually unavailing. They are for the most part stupid. The sick and partly degenerated muscles must be activated into tonic action through the only kind of stimulus to which the muscles are physiologically accustomed, namely, the conscious wish to perform movements. This type of therapy requires a detailed knowledge of the use of all of the muscles and the correct type of stimulus to bring out its physiological possibilities. The usual type of gymnastic studies or exercises are as a rule as valueless as the massage and the electricity. Consult Jel liffe and White, 'Diseases of the Nervous Sys tem' (3d ed.. 1919).