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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    of the virus of poliomyelitis. Their researches will be fully reported in Folia Neurobiologica, and along with the report of the Washington Committee. Early Diagnosis.—The earliest symptoms are usually one or more of the following: great weakness with apathy or irritability, sometimes including photophobia; sometimes slight coryza; marked insomnia is often present,2 and this in a child without fever or intestinal trouble should excite suspicion. When this is followed by great weakness, and restlessness later occurs, suspicion is still stronger, and, when profuse perspiration begins without a very high fever, I believe that the diagnosis should be made, more especially if any reflexes have diminished or Kernig’s sign occurs. Cases of poliomyelitis have often been called rheumatism. This is on account of the severe pain and great tenderness which occur when the meninges are much inflamed. The distinction, however, is quite easy; for in acute rheumatism the joints themselves are inflamed, and hence are hot, red and swollen; whereas in poliomyelitis there is no special heat, redness or swelling of the joints or limbs. Besides, there is always a modification of the reflexes in poliomyelitis, and as soon as the horn cells of any segment are invaded the reflex arising in that segment is first diminished and later sup- pressed, often several hours before paralysis occurs. When the attack is mainly on the pyramidal fibers, either in the affected segment or high up in the cord, the reflexes may be exaggerated in that part of the body supplied by those fibers. Again, before the meningeal inflammation has extended to the cord, there may be for a time an exaggeration of reflex activity. Diagnosis from Cerebrospinal Meningitis due to the Diplococcus Intra- cellularis. The Cerebrospinal Fluid.—In cases where restlessness and hyper- sensitivity usher in the illness this diagnosis is sometimes impossible, and, rather than lose valuable time in awaiting further symptoms, the meninges should be punctured and the fluid examined. Only in that way can we be sure of saving the child without damage, if it is the meningococcus which is at work. But, even in poliomyelitis, a lumbar puncture is rather an advantage than otherwise, for it relieves the pressure within the cerebrospinal sac, and probably diminishes congestion of inflamed structures. Examination of this fluid, too, may afford information, according to Flexner, there usually being a marked lymphocytosis in monkeys, the proportions being: polynuclears 40 per cent., lymphocytes 40 per cent., large mononuclears 15 per cent., eosinophiles 5 per cent.; while the blood-count was polynuclears 60 per cent., mononuclears 25 per cent., lymphocytes 12 per cent., eosinophiles 3 per cent., occurring with a distinct leucopgenia. This diminution of white corpuscles did not disappear until the acute stage of the disease subsided. It will be noted that these findings are different from those revealed by the more thorough examination in human beings by the Washington Committee. Inoculation of a monkey with cerebrospinal fluid from an abortive case may be used for diagnosis of a dangerous carrier. Vomiting is often an early symptom, and headache is the rule. Rigidity of the neck and Kemig’s sign are most marked in the meningeal 2 Ph. Roy, Washington Committee.