Evening journal., 1916-08-24
Noted Physician Discusses
Paralysis and Its Treatment


way. but has led to a rapid advance
IN our knowledge of the affection anC
its treatment. Owing to the fact oi
the prevalence OF the disease, espe-
cially in our eastern cities, the hor.
ror and fear that it has excited in
the minds of the medical profession
and the laity itself the textbook en-
titled "The Treatment OF lnfantile
Paralysis" by Dr. Robert w. Lovett
Boston. is Of peculiar interest. In this
book DIR. Lovett embraces the follow
ing chapters.
First Pathology; Symptoms and
Types. Diagnosis and PrognoSis.
A General Infection.
Regarding the pathology, intantilf
paralysis Il a general infection, the re-
suits of which are most marked IN the
nervous system. u seems probable that
tho infection enters the body from The
,ippcr air passages. but once entered II
evidently docs its damage by means oi
circulating i'm the blood stream, causing
direct pressure ON the nerve cells by
means of hemorrhage, edema and eXu
date. to which must be- added the con
dition termed anemia, following the con
sfriction of the blood vessels, and IN nd
dition TO this maybe the direct poison
Gus action Of the virus itself on the
nerve cells. On account Of this pres
aure and anemia the nerve cells dage7
crate and If the hemorrhage eXudas,
and the other products are absorbed
soon enough the cells may recover frnc
tion. but il the unfavorahle condition.
have been prolonged or arc excessive tn'
nerve cells may 60 on 10 complete de
generation.
The symptoms in the acute stage 81
those Of any acute infection gastro.in
testinal symptoms predominato--tever
vomiting. diarrhoea infrequently, whit
In other symptoms referable 10 th'
uprer air passage are the most marked
But the symptoms most commonly pres
cnt are sweating, marked nervous irri
liability and general hyperesthesia lgen
eral sensitivenessl. The above symp
toms being present in many instance
before the onset Of the paralysis, bu
they are not at all constant.
Tho classification.
I'm general We may say concernine
the classification that they are OF
three types: (a) the abortive. (b) tho
cerebral. (c) the hulbo-spinal group
but VIC shall Immediately pass over
these classifcations TO our medical
brethren.
The diagnosis OF infantile paralysis
rarely Is made before the appear
ance OF the paralysis. The appear.
ance of symptoms OF a sudden i'll
ness in young child. especially II
a region where the disease prevails
Is always suspicious. particularly I
accompanied by sweating. irritahilitl
and hyperesthesia. other symptoms
that are to be looked for are inter
ferences with the urinary and feca
output. When the paralysis has o.
Cured. which It usually does within
twelve hours. the diagnosis as rul
presents little difficulties.
The PrOgnOsis.
The prognosis as to life itself froi
the age OF ten years and upward
that the patient Is likely 10 die
The acute attack when IL does occu
& is usually from involvement OF IN
muscles or centers of breathing. an
is most common on the fourth an
NTH day. and is unlikely after IN
seventh day. The prOgnosis as {
function is 10 be spoken OF with grea
reserve: on the whole, Il may be sal
that severe onset Is more favor
able than a mild one. Through tn
FIRST week after the onset the sever
csi cases show but little return @
power. tenderness Is severe and last
a long time, and the paralysis
widespread. In cases in which a
the end OF two months there has bee
hut little gain. the outlook is not en-
couraging for very good function; !
q general way il may be stated this
the prognosis is better in the frs
yea~ than later. and the more volur
tary power shown by the affecte
muscles. the better the outlook Il
sucn muscles.
II must be remembered that tot
PARALYSIS Is less common than pa
fial and that the problem of strengt
ening weakened muscles by ther
poutic measures has made gre
strides In late years, most untreat'
cases or badly treated cases are cap
bic OF marked or great improveme
bf treatment A really bedriddC
case of infantile paralysis should
most never occur. Deiormities m'
have TO be removed and apparatl
furnished TO trunk and legs. but
comotion practically is always pos
BILE: prOgnosis as to shortening II
nuently will be expected from Il
surgeon. The important fact TO 7
member in this aspect of the pro
nosis is that the amount of shOrte
ing is not necessarily proportiona
to the degree Of the paralysis. TT
shortening is due TO the fact th
the leg or arm grows more slow
than the other. In muscles which r
main totally paralyzed TO attempts
voluntary contraction. at the end
three months the outlook for the 7
covery OF any marked degree
function Is not good, hut neither
the situation hopeless.
Cites Two Cases.
Two classes OF cases probably a
not much affected by treatment. Firs
Those where the affection is so seye
that Il has left behind an eXtensi'
paralysis. Second: Those which won
have recovered without any treatme
whatsoever
In the seconL chapter of this boz
Doctor Loyett embraces the treatme
of this condition: First The tres
ment of the acute phase. Second: TT
treatment of the convalescent phas
Third; The treatment Of the chron
phase. Fourth The operative tres
ment TO improve functions. Fiftl
Muscle training Sixth The spril