The treatment of infantile paralysis / by Oskar Vulpius ; translated by A. H. Todd.

  • Oscar Vulpius
Date:
1912
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of infantile paralysis / by Oskar Vulpius ; translated by A. H. Todd. Source: Wellcome Collection.

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    different extremities and parts of the extremities, and to the indications for the operation, in preference to muscle and tendon operations. When is the proper time to perform the operation ? The tendency of the leading authorities on the subject is to shorten the delay, although it has been found by experience that recovery may take place after ten years or more. Our object, however, is not the performance of an experiment, or the restoration to the injured muscle of a feeble power of contraction or electrical excitability, but the production of a really useful muscle, so that long delay is to be deprecated. Within the first six months after the onset of the attack of paralysis, we can tell which muscles are completely destroyed, and which are capable of further improvement: any time within the next six months, up to the next twenty, the condition of the muscles will remain so far constant that no further change in the plan of treatment need be contemplated. It may be remembered, too, in de¬ ciding upon the operation, that it causes hardly any disturbance, so that if it does not succeed, some other method, such as a tendon operation, can always be performed later on. The longer the operation is postponed, the more extensive becomes the degeneration of the nerve and its end organ, the more do the very atrophic muscle and the weakened joint capsule become overstretched, and the prospects of success become diminished. I think it is well, therefore, to resort to neuroplasty about six months after the onset of the illness, if the conditions are such as to suggest this as a suitable mode of treatment. The operation may be performed later on, however, even if it be not the time of election, in patients who only present them¬ selves for treatment after some time. It has been stated that the first three years are the most favourable, and that afterwards the chances be¬ come less ; our experience in this direction, however, is so scanty that such opinions must be based more upon conjecture than upon actual knowledge. On the other hand, I think that it is not well to operate sooner than I have said. Spitzy, in his earlier work, said that he thought the operation was indicated if, four to six weeks after the onset of symptoms, the reaction to electricity was growing weaker, thus indicating that the destruction of muscle and nerve was progressing. He adds—and with good reason—that there is an objection to this method, in that success might follow even if the operation had not been performed, and he compares the problem to that of surgical interference in appendicitis. This, however, is not quite on a par, for the question of saving life is there of paramount importance. I am of opinion that we should only undertake cases within the three months’ limit under very exceptional circumstances, when there is a special indication for surgical interference. Otherwise, it is difficult to estimate the value of the operation perse, as well as in comparison with other methods. Accurate judgment of cases is a matter of experience.
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