POLIOMYELITIS

[摘要] There is presented an analysis of the cases of poliomyelitis admitted to Children's Hospital, San Francisco, during a six year period in an effort to correlate this material with certain deductions regarding course, nature and the factors which affect the outcome.This series does not constitute a completely valid cross section of northern California epidemics because the admissions were modified by age, economic status, by a somewhat higher proportion of females, and by the fact that, in general, more severe cases were referred to this hospital from outlying districts.In addition to the physical traumatic factors which are generally admitted to be important in precipitating paralytic poliomyelitis, some evidence is introduced that systemic infections of unrelated etiology may provide a traumatic factor of comparable significance.In the biphasic febrile course of poliomyelitis the initial period of fever is rarely a matter of hospital observation and proof is usually completely lacking that this initial fever is certainly due to poliomyelitis virus. This preliminary rise in temperature may very well be due to other infectious agents which serve to precipitate the onset of poliomyelitis.There is much to indicate the considerable ubiquity of poliomyelitis virus among a population during an epidemic. In the absence of great exposure dosage, entrance of the virus into the body may frequently produce inapparent and completely latent infection which may be converted into active disease only by a variety of factors, including unrelated infections, which increase momentarily the susceptibility of the central nervous system of the host.The value of pooled irradiated human plasma in therapy is admittedly not very great but seems to have a certain value. Statistical demonstration in support of this is almost impossible because of the fact that a weakly effective agent is applied in the treatment of an infection which has an extremely variable outcome.This measure of treatment may displace the spectrum of outcome favorably without there being a great contrast in the statistical comparison of paralytic or nonparalytic outcome.Nonparalytic poliomyelitis is generally believed to be of frequent occurrence. Unquestionably this is more frequent with the inclusion of patients in which the diagnosis is based on minimal and unconvincing evidence. If the diagnosis is restricted to those cases with very definite clinical and laboratory findings, only a small proportion will completely escape paralysis though this paralysis may be minimal, may be detected only by careful and repeated examination, and may disappear entirely before the end of the two week period of hospitalization.

[学科分类] 儿科学