Definition.—Anterior poliomyelitis is an inflammation of the anterior horn, occurring most frequently in children under three or four years of age, though occasionally found in adults, and characterized by paralysis of one or more of the extremities, followed by atrophy of the muscles, but without loss of sensation.
Etiology.—The exciting cause is unknown; it usually occurs in children under three or four years of age, sex having no influence. Dentition, cold, injuries, mental or physical exertion, menstrual suppression, sexual excesses, syphilis, and various dissipations have been regarded by various writers as possible causes, though, most likely, the only influence they exert is predisposing, by lowering the vitality. It occurs most frequently during the summer months.
It may be epidemic in character. Dr. Caverly reporting one hundred and twenty-six cases in Otter Creek Valley, Vermont, during the summer of 1894. Other epidemics have been reported in Norway, Sweden, and in various parts of Europe and America. These epidemics suggest the lesion to be the result of microorganisms.
Pathology.—The chief lesion is an acute hemorrhagic focal myelitis in the cervical or lumbar enlargement, and is generally unilateral. There is congestion, followed by degeneration of the motor cells of the anterior horn. During the early stage, there is infiltration of leukocytes, blood-cells, and small round cells, into the gray matter about the motor cells. This is followed later by a growth of sclerotic tissue. Since the anterior motor cells preside over the nutrition of the anterior nerves and the muscles of which they are distributed, granular or fatty degeneration and atrophy of the nerve and muscles follow the destruction of the motor cells, and, as a result, the affected limb or part has an imperfect growth, becomes cyanotic, and frequently has a lower temperature.
Symptoms.—The disease generally begins abruptly with chills and convulsions, followed by fever, the temperature reaching 102° and 103°. There may be pain in the head, back, and limbs, twitching of the muscles, vomiting, and diarrhea.
In twenty-four or forty-eight hours, paralysis appears, the location of which depends upon the situation of the lesion. The legs are more frequently affected than the arms, about four to one. The type is generally paraplegic.
In some cases the child goes to bed in his usual good health, to awaken in the morning with paralysis. The paralysis reaches its fullest extent the first week, remains stationary from two to eight or ten weeks, when improvement begins, the last muscle affected being the first to show improvement. In a few weeks, however, what seemed an encouraging condition, ceases, and permanent paralysis results.
The muscles of the paralyzed limb soon atrophy, the circulation is impaired, the limb becomes cold, blue, and the muscles flabby. As a result of impaired nutrition in the bone, permanent shortening of the limb occurs. The reflexes, both superficial and deep, are lost.
Diagnosis.—The diagnosis, after the first few days, is not difficult, the inability to use the affected limb, together with atrophy of the muscles, renders the diagnosis plain.
Prognosis.—The prognosis is favorable as to life, and though some improvement always takes place, permanent paralysis in arm or leg generally remains. When the muscles respond early in the disease to the faradic current, recovery is likely to take place. The prognosis is more favorable where the disease begins as an acute fever, than where it comes on suddenly during the night, the child having been previously in good health.
Treatment.—In the acute febrile stage, the special sedatives, frequent sponging of the patient, and absolute rest in bed, will give the best results. Later such hygienic and dietetic measures as will best improve the general condition should be carried out.
Nux vomica and strychnia will be useful after the acute symptoms have subsided. Ergot has been recommended in the early stage of paralysis.
The affected parts should be carefully massaged two or three times a day, and the faradic current applied daily to such muscles as respond, and the galvanic current to the paralyzed group.
Orthopedic appliances may assist materially in deformities of the limbs.