Poliomyelitis : new facts concerning its etiology, early diagnosis and treatment / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1910
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Licence: In copyright

Credit: Poliomyelitis : new facts concerning its etiology, early diagnosis and treatment / by Tom A. Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    POLIOMYELITIS; NEW FACTS CONCERNING ITS ETIOLOGY, EARLY DIAGNOSIS AND TREATMENT. ent s. By TOM a. WILLIAMS, M.B., CM., Edin., Corresponding Member of the Society de Neurologie de Paris; Neurologist to Epiphany Free Dispensary, etc., WASHINGTON, D. C. Within the last decade, over eight thousand cases of this disease have occurred; and, of these, five thousand were in the United States of America. It is likely that at least a thousand people have been attacked in Pennsylvania alone this year; and in the District of Columbia a committee appointed to study the outbreak there has cognizance of over five hundred cases. Thus, the situation is a serious one; and every new fact bearing upon the disease should be carefully weighed by each of us, until we have found means to prevent the spread of infection or have discovered a method of arresting the invasion before the nerve elements are destroyed. Etiology and Pathology.—The disease is not a primary atrophy of the anterior horn cells from acute toxaemia. It is a constitutional disease due to a living virus which causes an inflammation of the connective tissues of various organs, including the lymph glands and intestinal follicles. It is accompanied too by congestion of the spleen and of the mucous membranes. The meninges are inflamed, and the whole central nervous system is more or less hyperaemic. The destruction, however, vastly preponderates upon the region of distribution of the anterior spinal arteries, which supply tile anterior cornua, the injury to the motor cells in which produces the paralysis. Those cells around which the inflammation is not so severe as to produce more than oedema quickly recover as the invasion ceases; and this accounts for the rapid return of power in some cases. Other cases where return of power is less rapid are accounted for by the reintegration of a destroyed axone the pyramidal cell of which has escaped necrosis. In other cases it is the fibers of the pyramidal tract which are mainly involved as they proceed toward the cells in the cornua, which themselves in part escape. Such a case is charac- terized by exaggerated reflexes and sometimes by Babinskfs toe sign. Still another set of fibers may receive the chief impact; I refer to the rubrospinal fibers, which also pass to the anterior cornua cells, through which they regulate muscular tonus. The loss of their influence leads to hypotonia and tremor, without paralysis so long as the pyramidal cells themselves are not implicated. Of course, the clinical picture may vary in different parts of the body in