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ANTERIOR POLIOMYELITIS: A Study of the Acute Stage with Special Reference to the Early Diagnosis and Treatment.

DIVELEY, REX L.
The Journal of Bone & Joint Surgery: January 1929
Archive: PDF Only

From the study of this and the other recently reported epidemics of anterior poliomyelitis, the following conclusions seem justifiable:

1. An earlier diagnosis should be made and more specific treatment instituted during the acute or febrile stage.

2. Early and repeated spinal drainage followed by antipoliomyelitic or immunized horse serum is the most important factor in the early treatment.

3. More care and supervision should be given to the treatment of these patients during the second, or convalescent, stage.

4. Seventy-eight per cent. of these cases showed good recovery from paralysis when proper treatment was carried out during the first and second stages of this disease, against twenty per cent. of recovery when poor treatment was given.

5. If the cases are carefully treated and are under close supervision during the first and second stages, ninety per cent. of the deformities which we now see can be prevented.

From the study of this brief series of cases, the following conclusions seem justifiable:

1. The cases treated with Rosenow serum showed a more rapid recovery, and the paralysis was not so profound and extensive as in the untreated cases.

2. The effect of spinal drainage on the acute symptoms was almost phenomenal, the symptoms disappearing for the most part a very short time after the drainage and only appearing when the spinal pressure again was raised above normal.

3. The death rate in the treated series was much smaller than in the untreated cases.

4. There was a glycosuria and hyperglycemia in a large percentage of the reported cases, thus substantiating the point that several men have made, that this infection has some effect on the carbohydrate metabolism, which is probably an inflammation of the pituitary bodies.

5. The ideal treatment for acute anterior poliomyelitis seems to be: (1) strict isolation; (2) early and repeated spinal drainage to keep the abnormal intraspinal pressure down; (3) serum, either human serum or immunized horse serum of Rosenow, given directly after the spinal drainage, either intramuscularly or intravenously, depending upon the symptoms; (4) general hygienic medical treatment.

From the foregoing experiments, the following conclusions seem justifiable:

1. Human convalescent poliomyelitic serum and antistreptococcic poliomyelitic serum of Rosenow are capable of neutralizing the virus of poliomyelitis. These experiments would tend to demonstrate, however, that the neutralization is more complete with the human convalescent serum. [SEE THE FIG. 6, 7, 8, 9, 10, 11 AND 12 IN SOURCE PDF]

2. Monkeys can be immunized against an active virus of poliomyelitis by human convalescent poliomyelitic serum, and antistreptococcic poliomyelitic serum of Rosenow. It will be noted, however, that the immunization is much more complete where human convalescent serum is used. Immunization of monkeys with this method is short-lived and does not last over a six-months' period.

3. Human convalescent serum and antistreptococcic poliomyelitic serum of Rosenow are both highly specific in the treatment of acute infantile paralysis. These experiments would tend to prove that the convalescent serum is the more potent. It will also be noted that much better results were obtained where the serum was given early, although recovery is noted when serum treatment was started forty-eight hours after the appearance of definite paralysis.

(C) 1929 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.

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