The treatment of infantile paralysis / by Oskar Vulpius ; translated by A. H. Todd.

  • Vulpius, Oscar, 1867-1936.
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of infantile paralysis / by Oskar Vulpius ; translated by A. H. Todd. Source: Wellcome Collection.

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    These signs of sensory disturbance are more frequent than was at one time recognized, but motor symptoms are quite the exception ; convulsions are rare, and usually occur only in cases of encephalitis. In many epidemics gastro-intestinal symptoms are a prominent feature at the beginning of the attack, occurring in perhaps 90 per cent, of the cases. Vomiting is very frequent, but is never protracted or severe. Severe diarrhoea occurs in two-thirds of the cases, with foul-smelling green stools, and may so dominate the clinical picture that a diagnosis of simple epidemic gastro-intestinal catarrh is made. Constipation sometimes follows, but this is infrequent. It has been noted of late in several epidemics that whilst whole families may suffer from diarrhoea, certain members only show signs of paralysis later on, so that one is disposed to regard the affection of the others as an abortive form of the disease. In other epidemics feverish sore throat and bronchitis usher in the attack. Now and again, but not often, bladder symptoms appear during the pyrexial stage, and the commonest is retention of urine, requiring the use of the catheter for its relief. The fluid obtained by lumbar puncture is under increased pressure, and contains an increased amount of albumin—up to double the normal quantity (Eichelberg), and a deficiency of lymphocytes. Paralytic Stage.—The temperature now rises slightly, and the stage of paralysis sets in. In severe cases it is discovered after the alarming initial symptoms have subsided. In other cases, no less severe, the onset is quite mild, and may even pass unnoticed. The child is put to bed bright and, apparently, perfectly well, and next morning, to the consternation of the relatives, the paralysis is discovered. It has been observed in a certain number of carefully recorded cases that slight motor weakness and a tendency to fatigue are present during the earliest febrile stage of the disease, and these symptoms may either remain stationary, slowly fade away, or advance to the stage of complete paralysis. It is not improbable that this early stage is often missed, so that an acute onset is erroneously ascribed to the illness. The disease almost invariably remains confined to the motor system, and in uncomplicated poliomyelitis is a flaccid paralysis. It usually advances with great rapidity, so that its full extent becomes obvious within a few hours, but in exceptional instances it continues to spread during the next day, or even for several weeks (Wickmann, Förster). This initial spread of the disease varies considerably in degree, but may be serious. There may be complete loss of power in both legs, in the arms as well, or even in the muscles of the back, neck, and abdomen, and the child lies helpless and immobile. Passive movements cause obvious indications of pain. Incontinence of urine is sometimes seen. If the intercostal muscles and the diaphragm are partly or completely paralyzed, severe dyspnoea