The Bridgeport evening farmer., 1916-08-04
THE PROGNOSIS IN
 INFANTILE PARALYSIS
WALTER c. STERN, M. D.

ally or which I know of from personal communication with the attending physician, which can be said to have undergone complete cure. One was case of left facial paralysis in child of 3, and the other a marked weakness of the thigh muscles in a child of 6, the attack being so light as to have been entirely overlooked by the attending physician.
 When complete recovery takes place spontaneously, it is said that the cli- max is reached not later than six weeks from the time of onset.
 Partial recovery of muscle power with a more or less satisfactory recov- cry of function is the universal rule. No case is so bad that there is not some opportunity for improvement and almost all patients with paralysis of the lower extremities can be put on their feet and taught to walk. It 1 has long been taught that, as a rule, the intensity of the paralysis is in pro- portion to the severity of the attack and that the mildest cases recover cas- jest; but this rule is not universally true and the physician must be on his guard not to be misled by the seeming insignificance of the primary paraly- sis, lest, the afflicted muscles be allow ed to o*erstretch and become weaken ed from misuse. I have in mind g. case of personal palsy so mild that the attending physician, a pediatrist of note, suspected coxitis on account of the limp. The consulting orthopedist ruled out coxitis, and as the child was | evidently suffering from rickets, put the child on antirachitic treatment he lot | when I saw the child again, it showed a tendency toward varus and an evil i dent weakness of the peroneal mus 1 cles.
 The prognosis for recovery in a giv- en case depends on many factors, most | of which represent unknowns, and on- | ly one being under the direct control | of the physician. These are: l. The amount of actual perma- nent destruction of the gangiion cells of the anterior horns, or of the brain. | Z. The amount of nerve cell. con- gestion and edema, and neuritis 3. The regenerative and recon structive powers of the nervous sys- tenn.
 | A. The amount of muscle degene- ration and over-stretching Qoss of tone.)
 5. The presence of bone and joint deformities
 6. The curative effect of proper treatment
 ! or vital importance in the prognosis is the carrying out of the proper treat ment to strengthen the weakened muscles. The first factor in this treat ment is>rest, complete rest to the mus cles in the physiologic position of the joint LorenZ. There has been 2. quiet controversy concerning the length of thls absolute rest in bed. Judson at one extreme advised eighteen months. townsend one year, while Lovett in a. recent publication advocated that the children be put on their feet as soon as possible. Against the latter | stand l must protest most earnestly. There is great deal to lose and noth Ing to be gained by a too early re- sumption of walking. It is the an- tllhesls or rest. The day walking is to be resumed by the convalescent is the beginning of a new era It ic the resumption of>the pleasures and actiy- ities of life; and with it's dawn the re- straints of medical discipline, the pre- cepts of the physician and the ideals
 of treatment are alke thrown away The boy longs for his bat and ball and the girl for her Jumping rope and
 dancing, and as soon as possible the normal activities of daily life are at- tempted. It behooves US, therefore
 before allowing such freedom, to weigs carefully the dangers of over exertion against the good of early re- sumption of walking. The graded message and muscle training of the ideal method of treatment can stimu- late the weakened muscles only a few minutes or possibly a few hours a day. But active exercise and walk ing stimulate the unparalyzed and stronger muscles for ten times as long What wonder is it, then. if the patient soon returns with a deformity brought on by the contrac cture of the antago- nists?
 | With rest in bed combined with the use of massage and the interru otefI ] galvanic electricity to keep up the tone and the vitality of the muscle body. resistance exercises and muscle training seeking to open new avenues | of nerve communication for the re-es- tablishment of nerve control and re- covery of neuromuscular strength, we