INFECTIVE DISEASES: POLIOMYELITIS OR INFANTILE PARALYSIS

For many years infantile paralysis has been the most feared of all the crippling diseases that affect mankind. The year 1955 marked the turning point toward elimination of infantile paralysis as a threat, just as typhoid fever and smallpox have been eliminated. This has resulted from the work of the National Foundation for Infantile Paralysis, which began raising funds for research on this disease in 1937. Up to that time the suspicion prevailed that this disease was caused by a virus, but the virus was not isolated. Today the viruses – there are several of them – have been isolated and grown in pure form outside the human body. For this work Enders and his associates received the Nobel Prize. When the virus could be grown outside the human body on monkey kidneys in pure form, the preparation of a vaccine was attempted by Dr. Jonas Salk and early experimentation indicated that the inoculation of a mixture of killed viruses would produce in a child resistance against infection with this disease. After pilot experiments a vast experiment was undertaken under the auspices of the National Foundation for Infantile Paralysis in which great numbers of children were inoculated and compared with a similar number who did not receive the inoculation. Once this effective experiment was reported on April 12, 1955, at Ann Arbor, Michigan, the vaccine was made available by various manufacturers throughout the United States. Subsequently the research of Dr. Albert Sabin resulted in the development of a vaccine made of living attenuated viruses of infantile paralysis. Both the Salk and Sabin vaccines are now available for protection. The number of cases of poliomyelitis in the United States decreased from a high of over 57,879 cases in 1952 to less than a thousand in 1962.
For many years, mild, non-paralytic cases of infantile paralysis have been cared for suitably in the home. Unquestionably, however, the patient who has paralysis is far better off in the hospital than at home. In the hospital modern methods of treatment with hot packs, control of distortion due to weakened muscles, encouragement of recovery after paralysis and, particularly, the use of the respirator are made available. These may mean the difference between life and death.
Not much seems to be gained by isolating every patient with infantile paralysis. Such patients can be cared for in general hospitals as well as in hospitals devoted exclusively to infectious diseases.
Since the virus of infantile paralysis seems to be spread by excretions from the bowel, the excretions of patients should be considered infectious and should be disposed of with precautions that they do not spread contamination. Little seems to be gained by adding antiseptic substances to the excretions but disposal of the material in a suitable toilet and thorough cleansing of vessels, such as bedpans, are important.
Because infantile paralysis is so widespread, particularly in the non-paralytic form, any disease with fever occurring in children and young adults in the summertime must be regarded with suspicion, particularly in times of epidemic. A competent doctor can diagnose the disease, and suitable care during the early stages is significant. Far too often patients in the early stages are submitted to pulling, manipulation, rubbing, and all sorts of energetic treatments which are likely to do more harm than good.
As soon as there is a question that the patient may have poliomyelitis, bed-rest is important. The patient without paralysis must be confined to bed for at least three or four days after the temperature has returned to normal.
Most orthopedic specialists recommend the firm, hard bed from the beginning. The muscle tightness and paralysis can be helped by a suitable bed. The bed should be fitted with a foot-board which is placed several inches beyond the mattress and allows room for pressure by the heels or toes of the patient when the patient lies on the back or on the stomach. This foot-board also protects the legs from the pressure of bed clothing and gives opportunity to avoid muscle weakness by such use as can be made of the limbs. If the legs are weak, the knees are usually supported in a slightly relaxed position.
Since poliomyelitis is such a frightening disease, the doctor must do everything that he can to prevent fear and terror on the part of the infected child or of the parents. Early in the disease the whole family must be adjusted to the fact that there is a medical problem. Such attention given early in the condition is likely to avoid nervous and psychotic disturbances at a later date.
In the early stages, infantile paralysis is treated exactly as one would treat other infectious diseases, like measles, scarlet fever, or whooping cough. The treatment is usually rest in bed with a light diet but particularly with good nursing care.
During the early stages of inflammation, the patient must be provided with relief from pain. The use of moist heat is now considered most effective, including the application of hot baths for small children or for older ones, and the hot packs applied for thirty-minute periods every four to six hours. The extreme ritual developed by recent techniques is not absolutely necessary. If patients revolt against hot packs, they should be discontinued.
*19/318/5*

INFECTIVE DISEASES: POLIOMYELITIS OR INFANTILE PARALYSISFor many years infantile paralysis has been the most feared of all the crippling diseases that affect mankind. The year 1955 marked the turning point toward elimination of infantile paralysis as a threat, just as typhoid fever and smallpox have been eliminated. This has resulted from the work of the National Foundation for Infantile Paralysis, which began raising funds for research on this disease in 1937. Up to that time the suspicion prevailed that this disease was caused by a virus, but the virus was not isolated. Today the viruses – there are several of them – have been isolated and grown in pure form outside the human body. For this work Enders and his associates received the Nobel Prize. When the virus could be grown outside the human body on monkey kidneys in pure form, the preparation of a vaccine was attempted by Dr. Jonas Salk and early experimentation indicated that the inoculation of a mixture of killed viruses would produce in a child resistance against infection with this disease. After pilot experiments a vast experiment was undertaken under the auspices of the National Foundation for Infantile Paralysis in which great numbers of children were inoculated and compared with a similar number who did not receive the inoculation. Once this effective experiment was reported on April 12, 1955, at Ann Arbor, Michigan, the vaccine was made available by various manufacturers throughout the United States. Subsequently the research of Dr. Albert Sabin resulted in the development of a vaccine made of living attenuated viruses of infantile paralysis. Both the Salk and Sabin vaccines are now available for protection. The number of cases of poliomyelitis in the United States decreased from a high of over 57,879 cases in 1952 to less than a thousand in 1962.For many years, mild, non-paralytic cases of infantile paralysis have been cared for suitably in the home. Unquestionably, however, the patient who has paralysis is far better off in the hospital than at home. In the hospital modern methods of treatment with hot packs, control of distortion due to weakened muscles, encouragement of recovery after paralysis and, particularly, the use of the respirator are made available. These may mean the difference between life and death.Not much seems to be gained by isolating every patient with infantile paralysis. Such patients can be cared for in general hospitals as well as in hospitals devoted exclusively to infectious diseases.Since the virus of infantile paralysis seems to be spread by excretions from the bowel, the excretions of patients should be considered infectious and should be disposed of with precautions that they do not spread contamination. Little seems to be gained by adding antiseptic substances to the excretions but disposal of the material in a suitable toilet and thorough cleansing of vessels, such as bedpans, are important.Because infantile paralysis is so widespread, particularly in the non-paralytic form, any disease with fever occurring in children and young adults in the summertime must be regarded with suspicion, particularly in times of epidemic. A competent doctor can diagnose the disease, and suitable care during the early stages is significant. Far too often patients in the early stages are submitted to pulling, manipulation, rubbing, and all sorts of energetic treatments which are likely to do more harm than good.As soon as there is a question that the patient may have poliomyelitis, bed-rest is important. The patient without paralysis must be confined to bed for at least three or four days after the temperature has returned to normal.Most orthopedic specialists recommend the firm, hard bed from the beginning. The muscle tightness and paralysis can be helped by a suitable bed. The bed should be fitted with a foot-board which is placed several inches beyond the mattress and allows room for pressure by the heels or toes of the patient when the patient lies on the back or on the stomach. This foot-board also protects the legs from the pressure of bed clothing and gives opportunity to avoid muscle weakness by such use as can be made of the limbs. If the legs are weak, the knees are usually supported in a slightly relaxed position.Since poliomyelitis is such a frightening disease, the doctor must do everything that he can to prevent fear and terror on the part of the infected child or of the parents. Early in the disease the whole family must be adjusted to the fact that there is a medical problem. Such attention given early in the condition is likely to avoid nervous and psychotic disturbances at a later date.In the early stages, infantile paralysis is treated exactly as one would treat other infectious diseases, like measles, scarlet fever, or whooping cough. The treatment is usually rest in bed with a light diet but particularly with good nursing care.During the early stages of inflammation, the patient must be provided with relief from pain. The use of moist heat is now considered most effective, including the application of hot baths for small children or for older ones, and the hot packs applied for thirty-minute periods every four to six hours. The extreme ritual developed by recent techniques is not absolutely necessary. If patients revolt against hot packs, they should be discontinued.*19/318/5*

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