The treatment of infantile paralysis / by Robert W. Lovett.

  • Lovett, Robert W. (Robert Williamson), 1859-1924.
Date:
[1916], ©1916
Catalogue details

Licence: Public Domain Mark

Credit: The treatment of infantile paralysis / by Robert W. Lovett. Source: Wellcome Collection.

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    With this increased incidence of the disease there has come a new and better knowledge of its pathology, and especially of its treatment, which will be considered here. JBut as any sound treatment must be based on pathological data, it becomes important first to consider very briefly the pathology, in so far as it bears on treatment. PATHOLOGY1 Infantile paralysis is a general infection, the results of which are most marked in the nervous system. In the nervous sys¬ tem at autopsy the meninges are found to be edematous and injected and there is a slight increase in the amount of cerebro¬ spinal fluid. The brain and cord are edematous, and this is especially noticeable in the gray matter of the cord, which is darker than normal and often projects above the cut surface. Minute hemorrhages can generally be distinguished. It seems probable that the infection enters the body from the upper respiratory tract, but once entered it evidently does its damage by means of circulating in the blood-stream. The first change in the pathological process is an acute insterstitial men¬ ingitis, usually most marked on the anterior surface of the spinal cord. In the cord itself there occurs a hyperemia, and a collection of small round cells in the lymph spaces sur¬ rounding the vessels. In many places the cells are so numerous that they press on the lumen of the vessel and exert a mechanical effect in obstructing the circulation. Minute or extensive hemorrhages occur, and there is an extensive edema. These three factors, cellular exudate, hemorrhages and edema, appear to be the primary reaction of .the nervous system to the virus of infantile paralysis. Because the virus reaches the nervous system through the blood-stream, the cervical and lumbar enlargements of the cord are most often affected, and the anterior horns more often than the posterior or the white matter, because in these regions the blood-supply is most 1 This pathological information has been largely taken from the monograph of Peabody, Draper and Dochez. Rockefeller Institute, New York, 1912 and from the article by Flexner, Clark and Amoss, “jour, of Exp. Med.,” 1914, No. 2.