It is an acute disease characterised by destructive lesions in the grey matter of the spinal chord and brain; there is degeneration of the cells in the anterior horns. There is inflammation of the leptomeninges, particularly over the anterior fissure of the cord. The cerebral and cerebellar cortex, the basal ganglia and brain stem may also be affected.
Paralysis is not an essential feature of Poliomyelitis. The incidence of paralytic cases gives a very erroneous impression of the actual prevalence of this disease. The presence of neutralising antibodies in the blood serum of from 50 to 60 per cent adult population indicates that a large proportion of urban dwellers have suffered from an unrecognised or abortive attack of Poliomyelitis.
The disease is caused by a neurotropic virus which is probably transmitted from person to person through the transfer of the secretions of the nose and throat by droplet infection, by fingers and the common use of articles recently contaminated with these secretions. The virus attaches itself to the olfactory hair, ascends by way of the olfactory nerves and invades the nerve cells with more or less extensive spread from brain to spinal cord. There is another and more probably way of communication of the disease in which infection spreads by mouth by infected milk or water and by insect vectors.
The virus multiplies chiefly in the walls of the pharynx and small intestine. It passes to the central nervous system through the pharyngo-tonsillar or intestinal mucous membrane, travelling along autonomic nerves to the medulla or spinal cord. The infection may pass along parasympathetic fibres in the 7th., 9th., or 10th. Cranial nerves, along sympathetic fibres to the thoraco-lumbar region, and along parasympathetic fibres to the sacral region.
Carriers and unrecognised or abortive cases play a very important part in the spread of this serious disease.
The virus has been isolated from the naso-pharynx during the third week of convalescence. It is excreted in the faeces, and can be detected in the faeces of patients suffering from the paralytic and the common abortive types of the disease. It may be present in the faeces in convalescence for over three months.
The incubation period appear to vary from 5 to 17 days, the average period being from 9 to 12 days. The patient must be promptly and effectively isolated. Children who have been in contact with the patient should be strictly quarantined and kept under medical observation for a period of three weeks from the date of last contact.
Adults may continue their occupation so long as they can avoid mixing with children, but they should avoid all social activities for a period of three weeks from the date of the last contact; kissing or playing with young children must bee strictly forbidden. Where a profession necessitates coming in contact with children (as in the case of nurses and school teachers), even the adults must be quarantined.
If a person coming in contact with a case of Poliomyelitis suffers from a febrile catarrh or other symptoms suggestive of an abortive attack of the disease, he should be strictly isolated till recovery. Children should not sleep together in the same bed, nor use a common handkerchief. They should spend as much time in the open air as possible.
During epidemic prevalence of Poliomyelitis, tonsillectomy operations should be postponed as it has on some occasions transformed a milk sub-clinical poliomyelitic infection into a fatal bulbar type of the disease.
THE ONSET AND COURSE OF THE DISEASE.
The patient is taken ill comparatively suddenly, with headache, malaise, fever, drowsiness, pains in the neck, back and limbs, nausea, vomiting, diarrhoea, and perhaps convulsions. Rigidity of the neck and signs of meningeal irritation develop, and the headache may be very intense. Small and uncontrolled movements of the fingers and hands may be noticeable.
Hyperaesthesia and fear of pain on handling are usually prominent symptoms. Thee prodromal stage may be very short or it may last a day or so. Muscular paralysis is noted about the second or third day. It is usually at its highest at the onset, but in some cases may spread rapidly. The legs are more often affected by paralysis. A maculo- papular eruption is sometimes seen on the affected limb. The bowels are usually constipated. The deep reflexes are generally sluggish or lost, the abdominal reflexes are abolished, but sensation is normal.
Some of the affected muscles recover completely, others partially while some may be permanently paralysed. The affected limbs have a tendency to emaciate, their bones usually do not grow as well as normal, and so there is a shortening of the affected limb as compared with the healthy one.
Prognosis is favourable as to life, though death-rate in an epidemic may be between 10 and 30 per cent. If the superficial and deep reflexes are not lost, the patient may recover completely even if all the four limbs are paralysed. Painful and tender muscles are more likely to recover than insensitive muscles.
Muscles which respond to faradisation usually recover, but if thee reaction of degeneration is present, there are grave chances of permanent paralysis. After a year of the onset of the disease, little improvement may be expected. Most of the improvement may be expected in the earlier weeks or thee first few months of the disease. Mortality is very high when the medulla is affected and in spreading type of infection, death resulting from respiratory paralysis or bronchopneumonia.
Absolute rest and quiet surroundings are essential. Isolation should be strictly enforced and visitors discouraged. The painful limbs should be wrapped in hot dry cotton wool and kept warm by hot water bottles. Great care must be taken to prevent stretching of paralysed muscles. The limbs must be placed in such a position that the affected muscles are relaxed and the maintained by pillows,sand bags and light splints.
Paralysed legs should be kept extended, abducted and rotated in, with the feet kept at right angles to the legs; a small pillow should be kept beneath the knees, and the child kept flat. If the deltoid muscle is paralysed, the arm should be abducted to a right angle with the body. When the respiratory muscles are affected, artificial respiration has to be carried out for prolonged periods by automatic mechanical respirator.
After the temperature has been normal for several days and all muscle tenderness has disappeared, plaster cases and splints should be applied under the guidance of an orthopaedic surgeon whose supervision is in fact desirable from the very onset of paralysis. After three or four weeks, the affected limbs should be given daily gently massage and passive movements, and the local application of radiant heat. Message and electrical treatment should not be given during the period of active infection. Discharges from nose and throat must be carefully collected on rags or paper handkerchiefs which should be burnt at once; urine and stool must be disinfected.
Much that has been said about this disease in the old school literature is of value only in understanding the nature of the disease and din indicating methods of preventing spread, But so far as the preventive treatment is concerned, or regarding the actual treatment of the disease, much help is not offered. My humble experience goes to show that the severity of the disease has been worse where suppressive treatment like administration of quinine was started from the very beginning under the misapprehension of Malaria.
Where from the very onset of fever the indicated homoeopathic remedy has been given, the whole aspect of the disease has been very much modified, and often the disease has been aborted, It is in this aborting or nipping in the bud of diseases that Homoeopathy has won its greatest laurels, and Poliomyelitis furnishes a good illustration of this aspect of Homoeopathy.
Dr George Royal holds that Aconite, Belladonna and Gelsemium will be the indicated remedies for the first stage in 95 percent cases. It is seldom that the physician sees the patient early enough to use ACONITE, but if the sudden onset, high fever, rapid pulse, characteristic restlessness. anxiety and thirst be present, Aconite would do a lot to cut down the violence of the attack.
GELSEMIUM, according to Dr Royal is the leading remedy for this disease, having a marked affinity for the cells of the motor nerves, producing first congestion, and later destruction, causing paralysis. It nicely covers the symptoms of drowsiness, flushed face, sneezing, irritation in nose and throat, and watery discharges from the nose, in addition to the high fever. The onset is not a sudden as with Aconite and Belladonna.
BELLADONNA.If the onset be rapid, with high fever, throbbing carotids, red face and eyes, dryness of eyes, nose and throat (opposite of Gelsemium), severe throbbing headache, with aggravation of the patients condition by touch, jar, motion and noise, it does not take long to discover that Belladonna is the simillimum.
RHUS TOX. When getting wet or exposure to dampness is the exciting cause, Rhus tox should not be forgotten. It is a much praised remedy for paralysis of the lower extremities in acute as well as chronic cases. Marked pain and restlessness would be important indications.
DULCAMARA is in many respects similar to Rhus tox, though not so suitable in chronic cases.
On the whole, the remedies most commonly indicated in thee EARLY STAGES may be from amongst; Acon; Apis; Ars; Bell; Bry; Caust; Cocculus; Dulc ? GELSEMIUM; Lach; Merc. sol; Natr Mur; Natr Sulph; Nux Vom; OPIUM; PHOS; Rhus tox; Sulphur.
WHEN THE DISEASE HAS PASSED THE ACUTE STAGE, and ultimated in chronic paralysis, the remedies to be specially looked into are : Alum ; Amm-m ? Bar Carb ; Bar Mur ; calc ; Cause ; Natr Carb ; Natr Mur ; PHOS ; Pic-ac ? PLUM ; Silic ; Sulph.
PLUMBUM has been very much extolled for the later stages, and indications for it should be closely examined. The symptomatology of Plumbum strikingly reveals a general paralytic state, preceded by sluggishness and paresis; the symptoms develop slowly and insidiously. Progressive muscular atrophy (Chronic Anterior Poliomyelitis); progressive paralysis. Paralysed or painful parts wither.
There is paralysis of both extensors and flexors, but especially of extensors where it begins, giving us the wrist- drop. It has an elective affinity for the upper extremities, and Bayes has gone so far as to say that he has not seen any beneficial results from it in paralysis of lower extremities. Paralysis may be preceded by tremor. Constipation with hard lumpy stools may be a high ranking symptom. Retention or suppression of urine may be present.
PHOSPHORUS (according to Dr George Royal) is called for as it has an elective affinity for the brain and nerves, and causes destruction (fatty degeneration) of those tissues. If and when the symptoms agree.
ALUMINA has paralysis of the lower extremities, especially of spinal origin. Constipation requiring much straining to pass even a soft stool ; formication of limbs ; patient brushes his face as if trying to remove a cobweb.
Finally, a mention must be made of LATHYRUS SATIVA which presents such a striking picture of typical Infantile Paralysis :symptomatically, pathologically and clinically” as to justify presuming it to be a most effective PROPHYLACTIC against the disease.
Dr A H Grimmer claims that clinical application of this remedy as a prophylactic in many thousand cases over a period of thirty years in many epidemics has registered hundred per cent success. He mentions it for “the acute infective and toxic forms of paralysis including infantile”, and also puts if in a group of about fifty remedies frequently found indicated for paralytic states in general.
R. S. Rastogi,
Note :- Singly underlining indicates italicised type. Double underlining indicates thick bold type.