Poliomyelitis

“ We have learned that acute poliomyelitis is much more protean in its manifestations than was formerly taught. So variable has it shown itself, that even clinicians of wide experience doubt the identity of epidemic infantile paralysis with the classical malady in which only sporadic cases appeared.
Wickman has suggested that all forms of disease arising from the same virus as acute poliomyelitis should be grouped under the one term—Heine-Medin's Disease. ”

“ Landsteiner and Popper were the first successfully to infect monkeys. From the work of Flexner and Lewis, Landsteiner and Prasek, Knöpfelmacher, Leiner and Von Wiesner, Römer, Römer and Joseph, Levaditi and Landsteiner, Netter and Levaditi, and others, we must conclude that the cause of acute poliomyelitis does not belong to the class of the common bacteria, but is a filterable virus, and is present in the spinal cord. ”

“ Celebrated writers have even stated that acute poliomyelitis does not occur in adults. But the statistics of Wickman and Leegaard, however, show that adults are by no means immune. Fr. Schultze, Rissler, Taylor, van Gehuchten, Wickman and others had already by pathologic anatomic examinations proved that the disease affects adults. Wickman saw a man of 46 years suffering from a typical attack, while his nine children living in the same house with him remained unaffected. It is possible that conditions change from epidemic to epidemic, so that the frequency of attacks upon adults varies. ”

“ Poliomyelitis is most prevalent during the warm months, even when it is not epidemic. Under the same [Pg 87] conditions of temperature, rainfall, humidity, cloudiness, sunshine, wind, dust, etc., the outbreak will progress in one part of the city and subside in another. The course of the epidemic is not materially modified by weather conditions. No age, no sex, or race is exempt; the incidence is greater under five years of age, and the blonde children appear to be especially susceptible, while the colored race are rarely attacked, and the strongest children seem to be the greatest sufferers. ”

“ In poliomyelitis the disease may come on with diarrhœa and fever; often it comes on with vomiting and pain. The patellar reflex is retained, often exaggerated, and rarely lost, in hysteria, while it is usually lost in poliomyelitis. Electro-muscular contractility is often normal in hysterical paralysis, although it is sometimes slightly diminished quantitatively to both faradism and galvanism: the various muscles of one limb respond about equally to electricity: there are no reactions of degeneration in hysterical paralysis as in poliomyelitis. ”

“ The prominent symptoms in the muscular system—viz. paralysis, atrophy, the degenerative reaction—are the same in both. It may be remarked, however, that in multiple neuritis the paralysis is more generally diffused over the muscles of the affected limbs, while in poliomyelitis it is more confined to the areas of distribution of particular nerve-branches. Pain is common to the beginning of both diseases, but it generally passes off more quickly and completely in poliomyelitis. The persistent hyperæsthesia of the muscles is wanting in poliomyelitis. ”

“ These features are, however, negligible factors in monkeys in which a minimal dose suffices to produce the disease. It seems to me, with so many contradictory statements about poliomyelitis in rabbits, that until we have further information only monkeys should be used for clinical research purposes, for failure to reproduce the disease by inoculation is in them exceptional. ”

“ Anterior poliomyelitis is the lesion underlying what was formerly known as infantile paralysis—a name to be avoided, because the condition is not confined to infants and it is not the only form of paralysis met with in young children. Anterior poliomyelitis is characterised by an illness attended with fever, in which the child is found to have lost the power of one, less frequently of both lower extremities ”

“ Here we may be assisted by remembering that while in poliomyelitis sensation is intact, in nerve-injury it is almost always affected in a greater or less degree, although it may have been recognizable but for a short time. In lead paralysis we also have the degenerative reaction, but whether the seat of lesion in that affection is central or peripheral is an undecided question. ”

“ Not only is there an increase in certain other diseases following influenza outbreaks, genetically related, as we have seen, but also some observers, particularly Crookshank, believe that previous to epidemic influenza prevalences there occurs an increase in the incidence of other entirely unrelated infectious diseases, such as poliomyelitis. This theory of simultaneous increase in invasiveness of many apparently unrelated germs is comparatively new and will probably receive deep consideration in the future. ”

“ Scientific technology and medical research have given us many new tools to help in the essential tasks of preventing illness or conditions which can cripple. Thanks to vaccines which have been developed in recent decades, poliomyelitis is no longer the widespread crippler it once was. Children can now be protected against measles and the risk of death or brain damage resulting from this disease. Immunization against rubella not only protects young children, but also protects pregnant women from contracting the disease and risking the mental health of their unborn children. ”

“ The disease may be localized in certain organs because only in these do the bacteria find favorable conditions for growth. In spite of a high general resistance to infection the lesions in chronic glanders are most marked in the muscles, those of poliomyelitis in the spinal cord. There are few bacterial diseases which are localized in the blood, but many of the diseases caused by protozoa have this localization. In every infection some organisms enter the blood, which acts as a carrier and deposits them in the organs. ”

“ Such an individual may be a greater source of infection than one with the disease, because there is no suspicion of danger. The organisms which thus grow on the surfaces have in some cases been shown to be of diminished virulence, but in others have full pathogenic power. Such passive carriers of infection have been found for a number of diseases, as cerebro-spinal meningitis, diphtheria, poliomyelitis and cholera. In all these cases the organisms are most frequently found in those individuals who have been exposed to infection as members of a family in which there have been cases of disease. ”

“ The evidence at hand to date indicates that acute anterior poliomyelitis, or infantile paralysis, is transmitted by contact with infected persons. Under certain conditions insects may be agents in spreading the disease, but their rôle is a subordinate one. [Pg 246]
Pellagra
Pellagra is an endemic and epidemic disease characterized by a peculiar eruption or erythema of the skin (figs 144 and 145) , digestive disturbances and nervous trouble. Insanity is a common result, rather than a precursor of the disease. The manifestations of pellagra are periodic and its duration indeterminate. ”

“ Cases are every now and again met with in which serious organic disease (myelitis and poliomyelitis, anterior, acute, for example) is said to be hysterical. Mistakes of this description are often due to the fact that serious organic disease is frequently associated with the general symptoms and signs of hysteria; it is, in fact, essential to remember that all cases of paraplegia occurring in hysterical patients are not necessarily functional—i.e. ”

“ It was formerly accepted that a muscle which exhibits the reaction of degeneration is incapable of recovery, but observation has shown that this is not the case. Complete destruction of the motor cells in the anterior horn of grey matter as a result of poliomyelitis is now known to be exceptional; as a matter of fact, damage to the nerve cells is usually capable of being repaired. The muscles governed by these cells may appear to be completely paralysed, but with appropriate treatment their functional activity can be restored. ”

“ By the President of the United States of America
A Proclamation
One of the greatest challenges to mankind always has been eradicating the presence of debilitating disease. Until just thirty years ago poliomyelitis occurred in the United States and throughout the world in epidemic proportions, striking tens of thousands and killing thousands in our own country each year.
Dr. Jonas E. Salk changed all that. This year we observe the 30th anniversary of the licensing and manufacturing of the vaccine discovered by this great American. Even before another successful vaccine was discovered, Dr. ”

“ Even to drying, the virus is most resistant. The experiments of Leiner and von Wiesner show, however, that if the virus be allowed to dry in thin layers of infected tissues, if it be allowed to desiccate therefore under conditions which approximate to actual experience, it rapidly decreases in virulence. The poison is more sensitive to high than to low temperatures. ”

“ Thus, Flexner and Lewis—who have done most work in this field—failed in numerous experiments to cause the disease by intracerebral inoculation of guinea pigs, rabbits, horses, calves, goats, pigs, sheep, rats, mice, dogs, and cats. Most observers have found animals other than monkeys to be refractory, But Krause and Meinecke, also Lentz and Huntemuller, have reported as many successful transmissions in rabbits by inoculation through the blood stream, as in monkeys by intraspinal inoculation. Insignificant pathologic-anatomic changes were found in the spinal cord of the rabbits. ”

“ The pathologic-anatomic picture—apart from the results of Leiner and von Wiesner—corresponds with that which we find in man. The most important results yielded by experimental investigation are, however, those which relate to etiology and pathogenesis. ”

“ Probably the most enduring immunity is in smallpox, although cases are known of two and even three attacks; the immunity is high in scarlet fever, measles, mumps and typhoid fever. The immunity from diphtheria is short, and in pneumonia, although there must be a temporary immunity, future susceptibility to the disease is probably increased. In certain cases the immunity is only local; the focus of disease heals because the tissue there has evolved means of protection from the parasite, but if any other part of the body be infected, the disease pursues the usual course. ”

“ In general, susceptibility is increased in the young; young animals can be successfully inoculated with diseases to which the adults of the species are immune, and certain human diseases, such as scarlet fever, measles and whooping cough, seem to be the prerogatives of the child. It must be remembered, however, that one attack of these diseases confers a strong and lasting immunity and children represent a raw material unprotected by previous disease. Where measles has been introduced into an island population for the first time, all ages seem equally susceptible. ”

“ A second attack of small-pox is very rare, of scarlet fever less uncommon, of diphtheria common. In erysipelas, influenza, pneumonia, and rheumatic fever, second or even more numerous attacks are common.
Immunity against an infective disease may be natural, but is more often acquired by an attack of the disease in question. This latter immunity is active, and is due to the formation in the tissues of the immunised person or animal of substances produced by the reaction of these tissues to the stimulus of the contagium. ”

“ If any sign or symptom of polio is present, the affected person should be hospitalized immediately. Hospitals have many special forms of equipment which are necessary in treatment. Trained nursing care is essential. Should paralysis appear, special measures are necessary to prevent or lessen deformity and to begin the rebuilding of the affected parts of the body. No clearly reliable specific drug is available as yet which will cure polio, but gamma globulin appears to give some degree of protection for several weeks against the paralysis stage of the disease. ”

“ The discovery of the immediate cause of the various infective diseases, as measles, scarlatina, variola, cholera, dysentery, mumps, whooping cough, cerebro-spinal meningitis, and numerous other epidemic and endemic affections, still remains a question for the future. The constant association of microbia with any or all of such diseases is but one fact in connection with them, and such a discovery is to be regarded merely as a step forward, to be followed by others, each of which represents not only an advance, but confirms the position attained. ”

“ You can immunize a guinea-pig or a patient to almost anything now-a-days by giving him minute doses gradually increased but the immunity passes off quite rapidly when the treatment is stopped. We have still something to learn from Nature in this respect. Nature can give us one dose of yellow-fever or scarlet-fever or small-pox or measles and make us immune for life but your artificially produced immunity may last for a few weeks or months only. Our closest imitation of natural immunity is vaccination [Pg 93] against small-pox. Here we produce an actual disease, cow-pox ”

“ The period of infection is very doubtful. It may be greatly prolonged by complications. This is especially true of small-pox, diphtheria, typhoid and scarlet fevers. The period during which a disease may be infectious cannot be stated definitely. It varies with different diseases, and must be determined according to the symptoms and character of the case. Measles, chicken-pox, and mumps lose the direct power of infection very early, and the infective principle does not remain active for a long period in the room in which the patient has been ill. ”