Principles of the treatment of infantile paralysis / Robert W. Lovett.

  • Robert W. Lovett
Date:
1914
Catalogue details

Licence: In copyright

Credit: Principles of the treatment of infantile paralysis / Robert W. Lovett. 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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    may be formulated that on the whole very severe attacks are most often accompanied by severe paralysis and slighter attacks by more moderate and slighter forms.1 Two hundred and thirty-four cases of paralysis occur- ring in Massachusetts in 1907 were investigated in 1911 by a competent orthopedic surgeon.2 Seeing as many of the patients as could be traced, he found that 25 per cent, had wholly rocovered without regard to whether they had or had not been treated, and, moreover, that the analysis of the early history of these cases showed them to be average cases and that they could not in the early stage have been picked as cases in which the patients were especially likely to recover. All of this goes to confirm the statement that the out- come of the case is not wholly determined by the treat- ment received, a point which parents are slow to grasp. TREATMENT OF THE TENDER CONVALESCENT PHASE Any rigid division of the disease into stages is mis- leading and out of accord with facts, because one stage melts into another so gradually that a dividing line is impossible. Still there are different aspects of the affec- tion, which have been spoken of here as phases. Following the subsidence of fever the patient is gen- erally paralyzed in one or more limbs, tender to the touch and on motion, somewhat prostrated, and generally shows the results of a general infection. The latter, however, is soon recovered from, although in the severer cases the patient is generally below par for some time. This is the period when spontaneous improvement will begin, and the family may be assured that improvement which they can see will occur in a few weeks. It is generally difficult to make the family and the practi- tioner who has not had much experience in the disease understand that the best treatment at this stage is to let the patient alone except for preventing contraction of the Achilles tendon, which may occur to a troublesome extent in the first two or three weeks. So long as tenderness lasts it may be accepted as evi- dence of the existence of some degree of active myelitis around the motor and especially the sensory centers of the cord. Under these condition it seems unphysiologic to stimulate by passive movements, massage or electricity 1. Lovett, Robert W., and Lucas, W. P. : Infantile Paralysis, a Study of 6.35 Cases. The Journal A. M. A., Nov. 14, 1908, p. 1677. 2. Wood, B. E.: Boston Med. and Surg\ Jour., Oct. 5, 1911.