Reports and papers on epidemic poliomyelitis.

Date:
1912
Catalogue details

Licence: In copyright

Credit: Reports and papers on epidemic poliomyelitis. Source: Wellcome Collection.

    114/180 (page 102)
    of* twins) was apparently quite normal at birth, and the paralysis was first noticed after three or four days. It was then hardly able to stand, so that considerable improvement had taken place between the onset of the disease and Dr. Kentish Wright’s observation of the animal. The farmer who owned the animal stated that he had two other lambs similarly affected during 1910, but they were much worse and died or were slaughtered. He said that cases of “ ricketty ” lambs occurred every year and were frequently to be seen in Melton Market where they were sold to the butchers. He had never heard of an adult sheep being affected and could not say whether there were more cases than usual this year. Pathology. The pathological results obtained in this outbreak cannot be regarded as conclusive. In four cases (42. J. E'., 37. C. S.9 47. L. W. and 54. S.Y.) the cerebro-spinal fluid withdrawn by lumbar puncture was turbid and was found by Dr. Jacob to contain an excess of polynuclear leuco- cytes ; in none of these could the meningococcus be identified; in other cases (30. A. G.9 34. R. G., 35. A. R., 38. P. M. and 57. H. H.)9 * although no microscopical examination was made, it is recorded that the cerebro-spinal fluid so withdrawn was turbid and under high pressure. In three cases of the “paralytic /? type, 9. P. F., 77. D. B. and 78. C. B.9 the blood definitely agglutinated a culture of the meningo- coccus in one hour, in a dilution of 1 in 20, and in a fourth case 27. 0. S., there was some ‘'clumping ” though less definite than in the foregoing. This test is not thought to have much positive value. I have notes of the injection of Flexner’s serum in several cases in which distinct improvement is stated by the medical attendant to have followed the injection. In considering the significance of the improvement, however, allowance should be made for the beneficial effects that might be expected from the relief of pressure on the spinal cord occasioned by the mere withdrawal of fluid. As already mentioned a large number of faucial swabs taken by myself were examined by Dr. Mervyn Gordon with negative results as regards the presence of the meningococcus. Conclusion. Pathological investigation, so far as it was carried out in respect of the 74 cases under consideration, gave no support to the view that any of them were cases of cerebro-spinal fever. The diagnosis of cerebro-spinal fever was strongly upheld in respect of the more severe cases by some of the medical men who attended them. On clinical grounds alone it is not easy to differ- entiate between cerebro-spinal fever and the more severe bulbar or encephalic types of epidemic poliomyelitis. These more severe cases, however, were in many instances closely associated with milder cases of purely “ paralytic ” type, which conformed clinically in all respects to the description of poliomyelitis, and for the reasons above set forth I have no hesitation in concluding that the outbreak was one of epidemic poliomyelitis and not of cerebro-spinal fever.