Epidemic infantile paralysis (Heine-Medin disease)... / transl. by H. Ridley Prentice.

  • Römer, Paul H.
Date:
1913
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Licence: In copyright

Credit: Epidemic infantile paralysis (Heine-Medin disease)... / transl. by H. Ridley Prentice. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    out, that of Jakob v. Heine. It is to his credit that he isolated a type of flaccid atrophic paralysis from the chaos of the multitudinous forms of paralysis affecting children. He chose the name Spinal Infantile Paralysis because of the supposed site of the lesion. His excellent description remained for years the basis of all the accounts of the disease in the text-books, and for a long time, with the exception of the discovery of the changes in the electrical reactions by Duchenne and Erb, no important addition was made to it by other observers. It was not until the occurrence of the great Swedish epidemics that Medin and Wickman discovered that the disease Spinal Infantile Paralysis was only the common symptom-complex produced by a disease which more rarely appeared in a bulbar, cerebral, polyneuritic, ataxic, meningitic or abortive form, or as Landry's paralysis. Owing to the length of time which had elapsed, during which the disease had been con- sidered as a fully described entity, the many-sided picture of the disease drawn by the Swedish atithors was surprising and novel. Many considered that the disease so described had nothing to do with Heine's disease, while others fell back upon the hypothesis that the disease had changed in the manner of its manifestation. As a matter of fact, the only change which had taken place was in the extent of our knowledge. It is necessary to recognize this important fact in estimating the value of the contributions of the Swedish investigators. Their results have been confirmed by all the painstaking work which has been done in the more frequent epidemics of later years. Pathological and anatomical investigations have advanced pan passu with the clinical, in this as in other departments of medicine. Heine placed the lesion in the spinal cord on theoretical grounds; the proof of the existence of an organic lesion was furnished later by microscopical investigation at the hands particularly of French authors (Prevost and Vulpian, Charcot and Joffroy, Roger and Damaschino), who called attention to the most important change of all, the atrophy of the ganglion cells. The French authors also pointed out the importance of the interstitial changes which occurred in the cord. Subsequently, pathological discussion raged round the question whether the parts primarily affected were the ganglion cells, as maintained by Charcot, or the supporting structures of the cord. It cannot be said even at the present day that this question has been decided finally one way or another. But the researches of Rissler in acute cases have enabled us to say definitely that the disease consists in a disseminated, infiltrative, inflamma- tory process, which may attack any portion of the central nervous system, but which shows a predilection for the spinal grey matter. Wickman particularly not only confirmed and extended our know- ledge of the actual, demonstrable, pathological changes, but threw new light upon the question of the pathogenesis of the disease. Recent experimtents with animals appear to be leading to a still more clear conception of the pathology and pathogenesis of Heine- Medin disease.