The place of physical treatment in poliomyelitis.

There has been a great deal of. controversial writing and discussion about the type of physical treatment that is best in poliomvelitis and at what stage in the disease this treatment should be started. Some of the stumbling blocks to a scientific approach to the treatment of this disease are that singularly little is actually known about it, little material has been obtained for pathological examination and this in itself is difficult to carry out owing to the inununity of almost all the usual laboratory animals available for experimental work. Added to this the disease has a sinister reputation with the general public who, at least in times of epidemics, clamour for any line of treatment that is reputed to minimize the crippling effects. Unfortunately in some quarters, the public has been encouraged to expect miraculous cures from treatments which have little scientific foundation. Before discussing the place of treatment, we must try to obtain a picture of the pathological processes taking place in the certral nervous system both in the acute stage and during the stage of recovery. Sections from the brain and spinal cord from fatal cases show a lymphocytic infiltration of the affected areas, this being most marked around the motor cells of the anterior horns of the spinal cord. In addition to the pericellular and perivascular infiltration, changes occur irs the motor cells themselves and it is suggested that the earlier ones are reversible, which would account for the degree of spontaneous recovery from paralysis which is so marked a feature of some cases. An alternative and older conception is that oedema is present during the acute stage of the disease and as this is absorbed, so those nonfunctioning nerve cells not actually destroyed gradually return to normal. Despite our ignorance of the actual pathology of the disease there is no doubt that clinically some muscles are permanently paralysed and finally degenerate in whole or part depending on the amount of damage to the controlling motor nerve cells, and others suffer from disuse atrophy while the controlling motor cells are temporarily out of action. It should be remembered that degeneration of a muscle is a very slow process. In addition to the paralysis there is sometimes present in the early stages of the disease a considerable degree of muscle tenderness; spasm is also described by some observers as occurring in both the paralysed muscles and their nonparalysed antagonists in this stage.