Reports and papers on epidemic poliomyelitis.

Date:
1912
Catalogue details

Licence: In copyright

Credit: Reports and papers on epidemic poliomyelitis. Source: Wellcome Collection.

    23/180 page 17
    The cases under review furnish the following considerations :— Date of onset.—The dates in the column in the table giving the date of the onset in each case records as nearly as possible the day on which each of the cases was found to be ill. It was difficult to determine in many cases whether acute attacks were preceded by prodromata or for how long the patient was manifestly ill before acute symptoms were noticed. In some few cases there appeared to have been no prodromata. The temperature of the patients was not always taken ; the majority of the attacks were certainly accompanied by fever in the earlier stages. The temperature of the patients where the information is available seems seldom to have risen above 102*5 Fab. High fever was rarely observed. Headache.—In 120 cases of which I have definite information, 114 suffered from headache ; and in 6 cases, it is said, there was no headache. This symptom may exist in the case of infants who cannot talk, when it is difficult to make certain of its presence. Vomiting.—Vomiting when it occurred was one of the first signs of the onset. It rarely persisted after the acute attack had culminated, generally subsiding with the initial symptoms. In 120 cases of which there is definite information, vomiting occurred in 79 cases ; it was absent in 41, but in a few of these cases “ nausea ” is recorded. In 34 cases there is no record. Twitching or convulsions.—There were two cases in young children where convulsions occurred at the commencement of an attack, and in one of them “ convulsions ” occurred at intervals throughout the whole of one day. Twitching of a muscle or group of muscles occurred in 34 cases, and is recorded as absent iu 40. No mention is made of the condition in 80 cases. Twitching of the muscles of the face, especially of the muscles round the mouth, was observed in several cases ; and in two cases there was persistent sniffing, independent of any catarrhal symptoms of the nasal passages. Delirium.—Was comparatively rare. It only occurred in severe cases and in those which showed meningeal symptoms. As a rule the sensorium remained quite clear, and even in fatal cases the patients were conscious to within a few minutes of death. “Delirium” is recorded as being present in 21 cases, and as absent in 52. No mention is made of this condition in 81 cases. Hypercesthesia.—In 41 cases definite pains in groups of muscles or limbs, &c., are recorded ; in 14 cases hyperaesthesia is said to have been present, but no details are furnished. In 81 cases there is no record ; but it is possible that amoDg these cases the condition may have been present, for in a large number of cases there was tenderness to the touch, and young children would scream on being moved. Extra sensitiveness to touch or to movement was definitely stated to be absent in 16 cases ; and certain patients developed paralysis without apparently experiencing any pain. Anaesthesia.—In only two cases is loss of sensation recorded ; in one case “ almost complete anaesthesia ” (Case 102), and in the other “ complete loss of sensation lower third of flexor surface, and one-half extensor surface of the right arm ” (Case 18). Irritability of temper is recorded as being present in 47 cases and as absent in 17. There is no record in 90 cases. When present the children were fretful and peevish, and resented being disturbed in any way. Drowsiness.—This sign was a most marked one in the cases I saw. The patients appeared to sleep, and if aroused were irritable and cross, and wishful to be allowed to sleep again, and if left alone would “ instantly go to sleep.” This condition even in severe cases was markedly different from coma, the patients could always be roused and their minds were quite clear. In case 21, a man aged 42, this sign lasted for three days ; at intervals he was awakened to take food, and he dropped off to sleep immediately after eating. It was observed that in children one of the earliest signs was that the child “ lay about and slept.” 21588 B
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