ABSTRACT
Anterior poliomyelitis, or infantile paralysis as it is commonly called, has a number of clinical forms. These are not entirely distinct and they are frequently combined so that the defects of different patients may vary considerably, so much so that the symptoms of two patients may lead an observer to believe that there are two or more diseases. Lovett has given an excellent account of the various forms, both simple and combined. The most simple of the various classifications is that by Peabody, Draper and Cochez. They have grouped the cases into three classes. The abortive form is one in which the infection has produced no marked symptoms beyond that of the initial fever and its accompanying delirium etc., and in which the paralyses, if they exist, are so slight that they escape all but the most careful examination. The cerebral cases, in which some nerve elements in the brain are involved and in which the toxic or infective agent acts upon those neurones to bring about a condition of cerebral paralysis like other cerebral paralyses, in children or in adults, due to hemorrhage or to other accidents. The third group is the spinal group in which the lower motor nerve elements are involved, the paralyses being due to destruction of 132cells in the mid-brain or the medulla oblongata, and especially in the spinal cord. It is this last type which is most common. It is considered to be typical of poliomyelitis, and it will chiefly concern us here. Although in poliomyelitis of the usual, or flaccid, forms the main manifestations are those of paralysis, it is not unusual to find that the patient also complains of pains and tenderness over considerable areas. These symptoms are pathologically to be associated with interferences with parts of the afferent or sensory fibers or cells in the spinal cord. It would be almost unthinkable to believe that, with the extensive destructions which sometimes take place in the gray matter of the spinal cord, some of the afferent conducting fibers and some of the intercalated cells should not also be seriously affected or destroyed. Although in many cases there are sensory disturbances we are more concerned with paralytic conditions that follow the destructive lesions in poliomyelitis. We are also chiefly concerned with the re-education procedures that must be directed to the overcoming of, or to the compensation for, the paralyses.
