It is almost impossible to make the diagnosis during the so called incubation, invasion, or pre-paralytic periods. Thus, we can doubt that the abortive form exists, since it is not diagnosable while the paralysis does not appear. Nevertheless these are the sign of Amoss, difficulty to seat the child because of rigidity or pain in the spine, and in addition to the sign of Kernig, which is no more than the same sign of Amoss, but in the cervical region of the spine. These two clinical signs, along with fever, the syndrome of meningism, or prostration, will solely make us suspect that it could be infantile paralysis. If all this is developed anywhere there is an epidemic, we can have the certainty that all this clinical condition is poliomyelitis.
There will be no doubt in the diagnosis when, at the end of the acute infection, the paralysis of some or all the limbs appears, and if in addition the patient presents apnea, disphagia, accompanied by flaccidity in the paralyzed muscles, with muscular and tendinous relaxation allowing one to carry out by hand the exploration of all types of movements to the affected limbs. Sometimes these movements produce intense pain, but the patients do not offer any muscular resistance to carry them out. And if all this is accompanied by hypo and hyperreflexia, cutaneous and tendinous, we will arrive at the exact diagnosis of poliomyelitis.
As confirmation of the clinical diagnosis, electrical testing, and more specifically the chronaxie test, will give us the certainty of poliomyelitis and it is reported that this can be a good means for the prediction of the future of some specific muscles.
Since electrodiagnosis is a method of personal appreciation, chronaxie indicates the time that characterizes each motor or sensitive excitability. According to facts established by Bourguignon:
Muscles are classified into groups by regions; each region is classified into two antagonistic groups:
The anterior muscles that are simple muscles, and the posterior muscles that are double, are formed by two muscles whose sinews are within the same tendinous sheath.
Extensor muscles have stronger chronaxie being antagonistic of flexor muscles; and in the later, when chronaxie is equal, they are synergic and moderate. All the preceding is established with respect to motor chronaxie. In sensitive chronaxie it has been established that: In each region, the chronaxie of the sensitive nerves innerving the skin is the same as the one of underlying muscles; reflexes are conditioned by sensitive regional motor synchronism, which testifies to reflex location.
Chronaxie helps us to make topographic diagnosis of neuromuscular lesions, and to follow the evolution with instituted treatments but it can probably not help us with diagnosis.
Unfortunately this test is done only when there is paralysis, paresis, or areflexia. As a result, this test cannot be early, and is normally not. Paralyses of the motor muscle of the eye and face occur, and frequently changes in the timbre of the voice. Also there is paralysis of muscles of the abdominal walls and of the sphincters. These last ones are always temporary, but they add to greater accuracy of the diagnosis.
Neuritis, radiculitis, rheumatism, various forms of meningitis, encephalitis and meningo-encephalitis are the disorders that can more easily be confused with poliomyelitis.IS
According to observations made in the USA, 50% of the affected patients recover by themselves, that is to say, they will not be left with sequelae; but if we remark that in this 50% are those classified as abortive, which are very difficult to diagnose, this reduces greatly such a conservative number. Nearly 25% will only have a moderate physical disability, with such good fortune that the patient becomes accustomed to it, and is not aware of such a small motor deficiency. 15% will remain with major disability, and those are affected by a real misnomer called chronic poliomyelitis. They are the ones with the sequelae, the true disabled, or the invalids of infantile paralysis. Finally, a 5 to 10% mortality has been recorded. Children born of mothers who had poliomyelitis during their pregnancy or their childbirth, are always normal. Pregnant women are not more susceptible than other people, although one says that the blood of pregnant women contains a great number of antibodies. The fact that they also respond to infection as other persons do, and that their blood has been tested as a curative means without having been more effective, verifies their susceptibility equal to that of other mortals.
ORTHOPEDIC PHASE OF DEFORMITIES
At least 31% of the infantile paralysis cases are going to remain DISABLED, especially of the inferior extremities.
Muscular flaccidity precedes muscular atrophy. The muscles progressively shrink. The electrical reactions of degeneration (chronaxie) continue to disappear, and with this disappearance comes complete muscular atrophy. Not only do the muscles participate in this atrophy, but bones decrease thickness and length, become fragile, and by this, are exposed to spontaneous fractures. Joints become lax, from lack of resistance of the articular ligaments, and prone to easy luxations. The skin is cold and sometimes cyanosed, and appears stuck to the bone. The nails sustain very visible changes of various kinds. Sometimes the subcutaneous fatty tissue is too abundant and has hypertrophied, which masks the muscular atrophy.
The dangling foot gives the impression that it is always under the influence of gravity, and obeys all outer influences such as finger pressure, manual traction, orthopedic apparatus, etc.
As a rule, paralysis of the extensor muscles, which is the most frequent, places the foot in extension of the leg; the contraction of the posterior muscles of the leg (triceps sural), not compensated for lack of tone of the extensors, causes this position. Talipes valgus foot appears later, making the patient bear the internal edge of the foot on the ground. Talipes varus, where the bearing on the ground is on the external edge, is the vicious position that follows the former in frequency. In both cases, the action of the flexor muscles produces a forced curvature of the sole of the foot, getting the toes closer to the heel. This position disappears with ease when placing the foot on the ground, since without difficulty it can take all the positions given; all the joints have no limits in their movements.
The knee is also dangling, has lateral motion of certain amplitude; the amplitude looks like flexion. In order to walk, the patient, with the hand of the same side, leans on the paralyzed knee, if the lesion is on one side, trying to give it the rigidity needed.
The knee in forced flexion is frequent; seldom in extension, and accordingly rare in the lateral positions: genu valgum (knock knee) or genu varum (bow leg).
As a result of the poor positions of the lower limbs, surely and gradually the hip, the spine, the whole thorax become deformed, which sometimes causes a pronounced protruding of the floating ribs.
Scolioses (lateral deviations of the spine) are generally towards the paralyzed side; they are all compensations caused by lesions of the paralyzed limbs.
One subject of extreme interest, which so far has not been given any importance, is the Paralysis of the abdominal muscles. When the child makes an effort with the abdomen, a great projection the size of a fistforms, contrasting with the healthy side. It is almost always a single side, and this side is in opposition to the paralyzed lower limb (crossed paralysis). We have had the occasion to observe children with abdominal paralysis of both sides, accompanied by paralysis of intestinal peristalsis and paralysis of the bladder muscles. This clinical condition is sometimes amazing, because there is fecal matter and urine retention, that does not have anything to do with the paralysis of both sphincters. In the first days of the onset, it is observed in some patients and then disappears by itself.
Paralyses of the abdominal muscles give the impression of very large hernias; only comparison and study of many similar cases can give us an indication of the true origin.
Digestive disorders are accompanied by paralysis symptoms and this is one of the best means to clarify the diagnosis, since it is known that hernias of the abdominal wall do not bring constant digestion disorders. The pains produced by hernias are very characteristic; on the other hand they help the intestine move, facilitating digestion. Choosing the food, and mainly making the causal treatment (etiologic), that is to say, attacking the infection in the spinal medulla, this is one of the symptoms that quickly disappears.
The deformities must be very heartbreaking, since they force almost all patients to use crutches, or grievous apparatus and considerably limit their activities, not only physical, but also mental. They make them fall, little by little, into true psychosis; the individual is ready to contract an endless number of various other diseases.
The degeneration reaction (electrical examination, chronaxie) gives valuable data for the prognosis. When there is contractibility with faradic currents, as weak as it may be, and it persists for some weeks, it is very probable that those muscles will recover all their functions. On the contrary, if there is no contraction to the currents, from the beginning and this lack of contraction persists, there will be no recovery, not even partial, of the affected muscles. Generally, the recovery we are speaking about occurs within the period of 4 or more months; all these improvements are spontaneous, without the intervention of classic medicine.
CLASSICAL TREATMENT OF INFANTILE PARALYSIS
During the period of invasion, that is to say, the pre-paralytic period, the disease in general is treated in very different ways, and they are all good. It presents the complete picture of an indefinite infectious disease and for this reason the prescribed medications are: sulfas, penicillin, streptomycin, antibiotics in general, colloidal metals, Urotropin, and an extremely wide range of all anti-infectious medications used before and now. Unfortunately, and in spite of all the medications administered, the disease will continue, serious or not, developing the sequelae already mentioned in these chapters.
When the patient is already in the paralysis period, there are also a variety of medications, each more useless than the other, to prevent the evolution of the disease: the serums of convalescents, of pregnant women, of individuals living with patients, and vaccinations of various types, etc.
The last antibiotics already placed within reach of the public, Chloromycetin and Aureomycin, these and all the others are, so far, completely inactive, because they cannot even be called symptomatic medications. Nothing modifies the evolution of this disease favorably.
Curare and its derivatives, vitamins, Prostigmin, etc., are just so many other ineffective medicines.
The recommendation from the North American doctors, to immobilize the patients, is simply disastrous, because with time the patients become ankylosed in the immobilized joints, and therefore, in addition to all the consequences of polio, ankylosis is added. Generally, there is no remedy, in spite of all the operations in vogue. The deviations, the disarticulations, the atrophies and all the sequelae of the disease come as a result of the medullar lesions, and we do not have to see immobility from these lesions. Of course, when it is not known how they can be cured, the blame is placed on the fact that the disease evolves more or less severely, attributing the deviations to the movements.
The disability can be physical or mental, or both; physical disability is the only, or almost the only, disability remaining to patients of infantile paralysis.
From patients with slight incapacities, only noticed by relatives, to the crippled who remain bound for life, forced to stay in bed, these constitute the disabled by poliomyelitis.
The uneven situation with respect to motor functions for these individuals can cause in them a mental state, which little by little becomes, and ends up as a certain mental abnormality that can well be classified as mental incompetence. The insecurity in all movements or the absolute lack of them, a major symptom, transforms them into distrustful, fearful, unstable, etc. But in the great majority, by themselves or with the assistance of relatives, generally these disabled people are normal individuals from the mental point of view, or excel in their environment. Between the disabled, we must distinguish several groups among the various disorders: those who have small visual defects, auditory, or of some other senses of little importance. There are cases whose defects are mainly psychological, mental debility, or precocious. These, luckily either do not realize their situation, or they do not grant much importance to it; they suffer the least in their state. Cases with neurological or psychogenic lesions, like the encephalitics, epileptics, etc., behavior patients, who could be classified among the mental cases, but which now we have made a special division of these disabled. And finally the orthopedic cases, which is mainly where are placed those disabled by poliomyelitis.
NINE CLINICAL HISTORIES
From 1941, since we have begun to examine the first patient, who is in perfect condition of health to date, we have treated nearly one thousand children. The results are: within the first days of the onset of the paralysis, there is a 95% cure (without leaving any sequelae), when 5% improved, with some traces of the disease remaining. The time of treatment is very variable, from 20 to 180 days. The accidents are controllable. We can say that there has not been one single death attributed directly to the application of this therapy. From the less obvious to the most serious cases, they all responded favorably.
In the chronic states, or properly speaking, in the disabled, this therapy continues to give better results than those observed with all the other therapies in use today. In these states almost all the medications change, but the system remains the same.
Outside the intercurrent diseases that have been taken care of according to the canons common in therapeutics, no other therapy had previously helped in any acute case.
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