Epidemic infantile paralysis (Heine-Medin disease) / Tr. by H. Ridley Prentice.

  • Römer, Paul Heinrich, 1876-
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Epidemic infantile paralysis (Heine-Medin disease) / Tr. by H. Ridley Prentice. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    only slight general symptoms of fever which may be overlooked; the child goes to bed apparently healthy and is found paralysed in the morning. This mild type of onset is the more common form and often leads both the doctor and the parents to take too hopeful a view of the illness. The danger to life in such cases is very slight, but there is no doubt that in the more violent cases the child is in considerable danger, although no directly fatal case has come to my knowledge. The convulsions are limited to a single attack in most cases, but rarely the initial attack is followed by several minor paroxysms. After the convulsions the child lies quiet, pale and exhausted, looking about the room as if just awakened from a sleep—[in the First Edition Heine writes paralysis suspendit convulsiones] and it appears to the parents as if convalescence will be rapid until they find on lift- ing the child that it is paralysed. The lower extremities are most frequently affected; often in conjunction with the muscles of the trunk, so that the patient not only loses the power of walking, but even of sitting up and of holding up the head. Frequently one leg is affected, but without the corresponding arm, as in the hemiplegic type of the disease; a few separate muscles may be affected in each leg. In the rarest cases one arm and shoulder being affected the limb hangs by the side, while the lower extremities remain quite untouched. The bladder and rectum are some- times weakened for a time, but never permanently affected. With the occurrence of paralysis the first stage of the disease is finished and it passes into its second stage. This description, in my opinion, is still worth recalling in the light of our subsequent knowledge. It is true that Heine depicts the acute stage mainly from facts obtained from the history of the cases, but this scarcely diminishes the value of his state- ment, as the obtaining of a good history is one of the most important parts of clinical examination and is an art in itself which is by no means understood by everybody. Eduard Miiller has lately called attention to the great importance of a good history in just these cases; further, the doctor rarely has an opportunity of observing the acute stage of the disease, except during an epidemic. Even as late as the year 1878, we find Seeligmuller com- plaining that there was but one description of the acute stage in the literature, that written by Dr. Ehrenhaus, an assistant of Dr. Henoch. Heine may be considered the founder of the symptomatology of both the acute and chronic stages of the disease. Following on a short communication to the Society for the Study of Natural History at Freiburg, in 1838, his first monograph appeared in 1840. In this he describes fourteen cases of paraplegia, seven cases of hemiplegia, which term he uses to connote paralysis of one extremity, i.e., cases which we should-call monoplegia, and six cases of partial paralysis. In the same monograph he describes four cases of paralysis due to cerebral lesion, which he differentiates sharply from the rest by laying stress on the spastic nature of the paralysis; he thus lays the foundation of his classification of the paralyses according to their spastic or non-spastic character, which classification has been adhered to down to the present day. The