What is Poliomyelitis?
Poliomyelitis is a severe nervous system disease that was once responsible for an astonishing number of deaths and an even greater number of cases of paralysis, is now seen much less frequently. In fact, with the wide use of Sabin vaccine in infancy, it is now rare to see it at all, and many younger doctors may not see one case in their professional lifetime. The Salk vaccine was introduced to the Western world in the mid-1950s, and from that moment on, there has been a dramatic decline in cases.
However, this does not mean the insidious viral infection is not still in existence. In countries where active vaccination campaigns have not been carried out and maintained up to date, it is still a common disease, and large areas of the Third World still suffer from it. Statistics for Australia and New Zealand have recorded no cases or deaths attributable to polio since 1986. This is a very different picture from that of the high figures of a few decades ago.
The disease tended to attack mainly the young, especially those in the second and third years of life, but over the past fifty years it has seemed to attack adults too. Any time of the year could see its occurrence, but it favored the hot summer months.
Polio is produced by a very small virus measuring, thirty micro microns, and is one of the smallest detectable under the most powerful microscopes. In an unimmunized community, the virus may live in the pharynx of many without causing symptoms, and these people may act as carriers in times of epidemics.
Exactly how the virus is transmitted is not known. It is believed that droplet infection from infected persons is important. This means that during coughing and sneezing, tiny moisture particles are projected from a person harboring the virus in the throat. This may be inhaled by a person in the immediate vicinity, and so the infection is transmitted.
Transmission of fecal material by flies also seems to play a part. The disease appeared to be more common in patients who had undergone tonsillectomy, and for this reason, the mass removal of tonsils, particularly in children, fell into disfavor when this was discovered in the pre-vaccination era. Incidentally, this idea is still current, and today there are few reasons for enthusiastically removing tonsils in children. The virus may be collected, isolated and identified by the pathologist from washings from the throat, and from pharyngeal swabs and also from fecal samples taken for several days before and just after symptoms set in.
The virus attacks the brain and spinal cord, permanently destroying the cells. Irreversible muscle paralysis occurs and, in about ten percent of these cases, death takes place. Symptoms are often minimal. There may be a slight fever; tremor of the limbs may accompany any sustained effort, then paralysis may suddenly occur. Often there is no previous indication of any serious illness, especially in infants.
It is most unlikely that poliomyelitis will be encountered by persons living in Western countries where active immunization has been carried out along the recommended lines. In the early stages, influenza like illness may occur, with headache, backache, neck stiffness, nausea and vomiting. It is similar in nature to viral meningitis and, indeed, on clinical grounds they may be indistinguishable. The patient may run an elevated temperature for about a week.
Symptoms will vary according to the part of the brain or spinal cord which is affected. Therefore, it may range from parts of the face and head, to the trunk, or limbs. If the respiratory muscles are involved, breathing becomes increasingly difficult. During pyrexia (the period of elevated temperature), paralysis may occur, or there may be general or specific muscle weakness.
In the rare event of this disease being diagnosed, the patient must be under the care of a competent physician and in a hospital where full facilities for accurate diagnosis and therapy are available. The disease will be treated as a serious contagious illness where special precautions are taken to prevent spread, and in the early stages absolute bed rest is essential for the patient to prevent the onset of paralysis. Facilities for respiratory management are essential, for many deaths occurred when paralysis of the respiratory mechanism took place.
The early stages of treatment are aimed at keeping the patient alive, nourished and hydrated. Respiratory failure, if it is destined to happen, usually takes place in the first two to three days, and often there are warning signs that paralysis of the muscles of respiration is taking place so appropriate steps can be taken.
Muscle weakness or paralysis must be treated by nursing the affected parts in their physiological positions. This will help prevent, or at least reduce the risk of permanent contractures and loss of movement if and when the muscles start to regain power and function.
The important anterior horn cells of the nervous system are the ones affected and, depending on the severity of infection and destruction, various degrees of return to function may take place. The picture is variable. Actually, the number of people affected is a great deal more than those who go on to the production of symptoms or the exhibition of paralysis. The essence of treatment is careful nursing by professionals experienced in this field. Specialized care affords the patient a better chance of recovery.
The chance of polio occurring today is minimal, but this should not prevent parents from making certain their babies and infants are adequately protected early in life. Vaccine is readily available in the Western world, and its use is imperative. Today, with the incidence of polio now largely historical, young mothers are unaware of the terrifying picture it presented, and may become negligent. Such an attitude is extremely dangerous. Polio immunization must be carried out as an automatic part of baby care, and reinforcing boosters given regularly.
Serious cases were treated in hospital and there was full back up support to gain life. Milder cases were often gated at home. A variety of different methods were used, once the disease had brought about its havoc, practical therapy became of much use. Various forms of bed rest, heat (the famous meter Kenny method), physiotherapy, artificial mechanical respiration, all had their place. However the ace treatment is to prevent it from happening. The continued widespread use of polio immunization is the only present guarantee for this.