Poliomyelitis
Authors: W. R. Russell
Journal: BMJ (1947)

ACUTE POLIOMYELITISMEDICAL JOUNAL 023 made until 48 hours after his admission ; during this period he was nursed without precautions.Nurse B. C. nursed him from the day of his admission (July 21) to July 25.Three days later she had a dental extraction but was well until the 29th, when she complained of pain behind the sternum and of a slight aching pain in the left wrist.On July 31 the headache was marked temperature 100°F.(37.80 C.); cerebrospinal fluid: 18 lymphocytes and 1 polymorph pem c.mm.; protein, 30 mg. per 100 ml.Slight weakness of extensors of wrist and fingers of left hand was noted on Aug. 1.Nothing is known of th; factors that render a person susceptible to an attack of poliomyelitis.The concept that immunity to the disease is conferred in childhood by a subinfective dose of the virus is not entirely borne out by recent facts (Van Riper, 1947).Sabin (1947) has pointed out that there is evidence to suggest that there may be no relationship between an attack of the disease or the passing of an epidemic through a community and the appearance of a neutralizing antibody as tested for against a single standard strain of virus, and occasionally even against some more recently isolated strains.Burnet and Jackson (1939) have stated that poliomyelitis antibody is not a result of exposure to or infection by the virus of epidemic poliomyelitis.During the past quarter-century there has been a definite rise in the age incidence of the disease in all poliomyelitis countries.Furthermore, the disease and the mortality rate have both been more severe in adolescence and in adults than in children.Such information as is available about the recent epidemic in this country would seem to confirm this tendency.One of our cases-a doctor's wife-apparently passed the infection to her brother-in-law, aged 30, but failed to infect her own two children, with whom she was in much closer contact.despite the fact that one, aged 3, had had a dental extraction during the time she showed prodromal symptoms and the other child, aged 5, had had a tonsillectomy a few days before.Two of our cases gave a previous history of close contact with poliomyelitis in the early febrile and paralytic stages of the disease, yet both cases remained well at that time but contracted the disease in the recent epidemic.Case 23.-Mrs.C., aged 21.During September, 1938, when 12 years of age, she was on holiday and sharing a bed with her sister.The sister developed headache, high temperature, and general malaise, followed by severe paralysis of her right leg.A diagnosis of poliomyelitis was made.Mrs. C. continued to share her sister's bed until the latter was removed to hospital.She herself remained perfectly well, but contracted a mild attack of poliomyelitis on Sept. 2, 1947.Case 28.-Captain R. P., aged 32.In 1945 in Washington.U.S.A., he shared a room with another man, aged 28, who developed headache, aching all over, and stiff neck, followed by paralysis of the small muscles of his right hand.He was removed to hospital as a case of acute poliomyelitis.For two days he was fed and cared for by Captain R. P., who remained well at that time but contracted polio-encephalitis on Aug. 21, 1947.Thus it would seem that if a child or an adult is exposed to the virus and does not develop paralysis, immunity either may not occur or may be short-lived.Judging by recent reports, second attacks of the disease are not so rare as were formerly supposed.In Alves and Pugh's (1947) case eight and a half years elapsed between the attacks.The three examples recently reported by Lipscomb (1947) concerned officers in India.In one of these the second attack occurred within six months of the first.A similar short interval was recorded by Cunningham (1947).Variations in the strains and virulence of the virus may in part explain second attacks of poliomyelitis, although it is possible that unknown factors underlying susceptibility may be of equal importance.Summary Symptomatology in 54 cases of acute poliomyelitis is dis- cussed-24 of the cases belonged to the non-paralytic form.There were no deaths.Several case histories are given, including an example of a rare ocular complication (opsoclonia), as well as an unusual case of bulbar paralysis successfully treated by tracheotomy.Attention is drawn to certain atypical features in the cerebro- spinal fluid.In nearly one-third of the proved cases contact histories suggested the probability of an abortive attack of the disease in other members of the family or in friends.In this country the virus of acute poliomyelitis should now be regarded as the usual cause of a benign type of lymphocytic meningitis and of a brain-stem encephalitis accompanied by meningitis.A brief reference is made to the problem of immunity.