There are few diseases of early life that present
so many interesting problems as does Anterior Poliomyelitis, and there are still fewer in which our knowledge
As to causation and prevention has made so little advance in spite of the many and thorough investigations
which have been made into the spontaneous disease in the
human subject.It was not until comparatively recently that the
association was noted between the obscure early symptoms
of this disease, and the flagrant resultant paralysis.
Poliomyelitis, seven years ago, was not definitely classed as an infectious disease: and it is only within the
last few years that extensive research has been made into the pathology and cause of this important scourge to
infant life.Unfortunately, there is little in the early febrile
stage to distinguish this, from the many other feverish
attacks so common during childhood, and it is only when
the devastating paralysis supervenes that the true nature of the complaint is made evident. As a result of
this, the disease - except in epidemic form, when the
profession is exceptionally alert to the possibility of
infection - is rarely diagnosed in the early stages;
and therefore the practitioner's efforts are mainly
palliative.The child is crippled, and in order that everything may be done to prevent or lessen deformity, the case is
transferred from the physician to the orthopaedic surgeon. In consequence, the medical aspect of such case
has beer apt to be overlooked. Within the last few
ears, however, progress has been rapid; epidemics have
been prevalent, and skilled observers have studied
every aspect of the affliction. Foremost in the field
we find Wickman, M ller and Flexner, to whom we are indebted for much of our present knowledge. The disease
has been produced experimentally in monkeys, and it has
been found that in these animals, the clinical results
and pathological findings correspond with great accuracy to those found in man. Attempts to transmit poliomyelitis to other animals have been unsuccessful.The preliminary fever has been conclusively proved'
to be the first expression of the disease, and should an
effective treatment be discovered in the future, it is
to this pre -paralytic stage that our efforts must be
directed. We at present possess no such remedy.As we have just seen it is of great importance to
the patient that we diagnose his case early, but an
early recognition of poliomyelitis must be encouraged
for another reason.It has been proved beyond doubt that the dise ;se is
of an infective nature, and consequently any attempt at
isolation should be commenced in this stage: if this
quarantine be rigorously carried out, much distress and
suffering may be averted.There is also a certain class of case which causes
much confusion, and is of great danger to the community
at large. This is the abortive type of the disease,
when the patient never develops paralysis at all, but is
just as contagious to his neighbours as if he did so.We are unable to state in what proportion these
abortive cases occur, for they are rarely diagnosed except in epidemics and then only with absolute certainty
if the neutralisation test be resorted to, a proceeding
which is not often practicable.The literature on this fascinating disease is
normous, and in the following pages a brief attempt will
e made tt ree¡ee,our present knowledge on the subject,
and to give special attention to its clinical and experiental aspects. Several cases which have been under
he author's care are detailed at length towards the end
of this exposition.One case being of exceptional value, as the disease
roved fatal and at the post mortem the cord was removed and sections of this were cut. Microphotographs
of the most interesting of these are reproduced.Another case of some rarity is that of a man, aged 22
years, proving that the disease is by no means limited
to the very young, as was formerly believed.NOMENCLATURE:
This affection has at various times had many names,
and perhaps a list of the most important would be of
interest. These include; -1. Essential paralysis of children. Rileict and
Barthez, 1853.
2. Infantile spinal paralysis, Heine, 186x.
3. Myogenic paralysis. Bouchert, 1862.
4. Anterior spinal paralysis. Cornil, /863.
5. Atrophic fatty paralysis of children.Duchenne, 1864.
6. Acute anterior poliomyelitis. Schultze, 1876.
7. Polioencephalomeningo myelitis. Cadwalder, 1908.
8. Epidemic paralysis. Ball, 1909.
9. Acute epidemic paralysis. Krause, 19e9.The names that survive today and are in common use,
re- Heine' s - Infantile Spinal Paralysis, and Schultze' s cute Anterior Poliomyelitis
