Diphtheritic paralysis / by J.D. Rolleston.

  • Rolleston, John Davy, 1873-1946.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Diphtheritic paralysis / by J.D. Rolleston. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    u t Reprinted from Archives of Pediatrics, May E. B. Treat & Co., Publishers, 241-243 W. 23d St DIPPITHERITIC PARALYSIS BY J. D. ROLLESTON, M.D., Assistant Medical Ofllcer, Grove Hospital, London, En' During the last ten years I have been in the habit notes of all the cases of diphtheria that have been under my care, so that I have now the records of 2,300 completed cases. Observations on the occurrence of paralysis among my cases have been published by me from time to time,* but, as it is now nearly four years since the figures of my last series consisting of 1,500 cases appeared, the following remarks may be of interest: A comparison of the following figures with those given in my earlier papers will show that as a result of the observations hav- ing been carried out by a single individual, there is not the wide discrepancy between the results obtained which is likely to take place in a collective investigation. The opportunities for observing the onset of paralysis were exceptionally favorable, as no children admitted with diphtheria were discharged before the end of the sixth week. It is most exceptional for paralysis to develop after that date, except in cases which have shown previous signs of nervous involvement. Frequency.—Of the 2,300 cases, 477, or 20.7 per cent., showed some form of paralysis; 184 were severe and 85 were fatal. In each series of 100 the percentage of paralysis cases was never less than 10 or more than 31. The much lower figures of other observers, e.g., ii per cent., noted by Sanne among 1,382 cases of diphtheria, and 9 per cent, by the collective investigation of the American Pediatric Society, are possibly due to several mild forms of palsy, especially nasal voice or cycloplegia having been overlooked. Character of Initial Attack.—It has been my invariable practice, directly the throat has become free of membrane, to classify the case in one of six classes, the names of which are given in the following table. By this method one is enabled to determine the relation of the initial angina to the frequency and severity of the subsequent paralysis. The table clearly shows * Practitioner, 1904. Vol. I.XXIII., p. 014, and 1909, Vol. LXXXII., p. 110; Revieio of Ncurolofiy, 1900, Vol. IV., p. 008; Lancet, 1900, Vol. II., p. 322, and 1908, Vol. II., p. 261.