Infantile paralysis in Massachusetts during 1910.

  • Massachusetts. State Board of Health
Date:
1911
Catalogue details

Licence: In copyright

Credit: Infantile paralysis in Massachusetts during 1910. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    Prognosis, — A few years ago it was supposed by most persons that practically all cases once paralyzed were to some extent paralyzed for life; but more careful study has shown us a better and more encourag- ing state of affairs. In the cases in Massachusetts in 1909, a group of 150 occurring near Boston was studied in detail, and it was reported that 25, or 16.7 per cent., had wholly recovered inside of three months. This statement was not believed, and the investigators were sent back to review their work. Each one of the children was stripped, and the movements of ankle, knee, hip, shoulder, elbow, wrist and spine were examined. The statement can be definitely made, therefore, that, of this group, 16 per cent, had wholly recovered within three months. The commonest type of final paralysis is an affection of one leg, vary- ing in degree from a slight limp in walking to a condition which requires the use of a brace; if both legs are involved crutches are occasionally also required. In short, a disability from infantile paralysis so great as to prevent an adult from earning his or her own living occurs in a very small number of cases properly treated, but the ultimate condition of neglected cases is frequently distressing. In connection with the question of treatment it is important to con- sider the reasons for this tendency to recovery which are to be found in the pathology of the disease. At the height of the disease there is an extensive perivascular infiltra- tion of the blood vessels of the cord, diminishing their lumen and induc- ing anemia and oedema of the regions of the cord supplied by them. In addition to which there is also infiammatory oedema of the nerve tracts in the white matter, and oedema of the nerve cells in addition to any destructive process which may be going on in neighboring cells. These changes, of course, cause loss of function in the parts affected, expressed as a temporary paralysis which passes away as the perivascular infiltra- tion subsides. This apparently accounts for the improvement of paraly- sis in the early stage of the disease which exists in all non-fatal cases. But the spontaneous improvement in the paralysis of the early history of the disease is no more important than the improvement to be obtained by proper treatment in the chronic stage of the disease, after there is every reason to believe that the temporary perivascular infiltration has subsided, and the reason for this later improvement apparently rests on another pathological basis. Assuming that the phenomena just described have ended, but that permanent destruction of certain motor centers in the spine has occurred, leaving a definite motor paralysis, the ques- tion arises, what reason is there to look for improvement in this. The answer apparently is as follows: —
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