POLIOMYELITIS (INFANTILE PARALYSIS) I'I.ATK A. Intervertelmd foramen with the periostea! extending into the vertebral canal peeled back. The membranes arc died hack to expose the "ord. A cord segment is removed to show the vascularization of the white and grey matter. (Sen KM me.) PLATE B. Vortical section of the vertebral (anal with the periostea! lininir shown in the upper portion. The dura has boon drawn away slightly. The vortobral ligaments and venous arrangement may be seen. 'In the lover portion the membranes arc drawn aside to expose a seHioii of the eon!. Still lower spinal nerve with the sheath of the dura. POLIOMYELITIS 7 (INFANTILE PARALYSIS) i^DITED BY FTP. MILLARD, D. 0. TORONTO Graduate of the American School of Osteopathy, Kirksville, Missouri. Founder of the National League for the Prevention of Spinal Curvature. Editor of the Journal of National League for the Prevention of Spinal Curvature. Anatomical Artist. Producer of Various Charts; Anatomical Chart of the Spinal and Sympathetic Nerves; Spinal Lesion Charts; The Sympathetic System, Etc., Etc. Originator of the Water-marked Spine in Stationery for Osteopaths. Conductor of Tri- Weekly Clinics for Chronic Cases of Infantile Paralysis. COPYRIGHTED 1918 97 ILLUSTRATIONS 14 FULL PAGE PLATES PRINTED BY JOURNAL PRINTING COMPANY KIRKSVILLE, MISSOURI DEDICATED to the memory of the late Dr. A. T. STILL Founder of the Science of Osteopathy PREFACE In undertaking to publish a book on the subject of Polio- myelitis, the author is aware that this is not the first attempt made along this line. Our medical co-workers have contrib- uted their quota, presenting their side of the subject, and giv- ing their viewpoint regarding causative factors and treat- ment. This is, however, the first attempt to produce a book on this subject from the osteopathic viewpoint. We have as our illustrious guide the late Dr. A. T. Still, originator and founder of the science of Osteopathy. No greater philosopher ever lived, and no greater physician ever served as a benefactor to the human race. His evolution of the therapeutics of adjustment, adjustment of the skeletal tissues, which has already done much to modify medical practice, is practically new to the world. All over this fair land multitudes of people once lame, crippled or bedridden have been restored to health and hap- piness. Dr. Still paved the way for this new method of treat- ing Infantile Paralysis. His reasonings were those of a sane man, a sage, a peer. His contention that the rule of the artery is supreme, and that the moment the circulation to any part of the body is interfered with that moment a diseased or disturbed condition arises or is in the making, is genuine phil- osophy and will stand for all time. Not since the discovery of the circulation of the blood by Harvey has more significant logic been deduced and sub- stantiated. His ideas regarding the invasion of germs and their destructive tendencies thru their toxins acting upon tissues devitalized from obstructed circulation, is no less true, and will go down thru history unchallenged. The cause of Infantile Paralysis will be taken up in the first chapter, and is based upon Dr. Still's reasonings. x POLIOMYELITIS We are indebted to our fellow co-workers for many case reports, and data found in this small volume. To the Osteo- pathic Physician, we wish to give credit for case reports 7 to 36. To Dr. A. G. Walmsley, especial thanks is due for his able collaboration in producing this work. Of assistance rendered in various ways by Dr. Walmsley, aside from the chapters contributed by him, may be mentioned reading the proofs and preparing the comprehensive index found in this volume. We trust the reading of this little book may stimulate others to follow along the lines that Dr. Still gave to the world in the last quarter of the nineteenth century. F. P. MILLABD, D. O. May, 1918. CONTENTS INTRODUCTION A brief outline of the scope of this work 1 CHAPTER I. Poliomyelitis (Infantile Paralysis) Causes 5 Mode of Infection 9 CHAPTER II. Applied Anatomy 11 Lesions Affecting the Blood Supply of Spinal Cord and mem- branes Cervical Lesions 15 Dorsal Lesions 19 Lumbar Lesions 22 Sacral Lesions 23 CHAPTER III. Applied Anatomy continued 25 Lymphatics of Head and Neck CHAPTER IV. Applied Anatomy continued 36 Lymphatics of the Thorax and Abdomen. CHAPTER V. Treatment Part One 43 Acute Cases 48 Treatment Part Two 50 Procedure in Acute Cases 52 Caution 57 CHAPTER VI. Hints to the Public on Infantile Paralysis 60 CHAPTER VII. Infantile Paralysis 65 CHAPTER VIII. Case Reports 81 CHAPTER IX. Osteopathic Treatment Versus Medical Treatment of Infantile Paralysis 149 ILLUSTRATIONS Frontispiece Plates A and B Plate C. Entrance and direction of invading germs 6 Plate D. The vascularization of the spinal cord 14 Plate E. The central nervous system 16 Plate F. The spinal cord and nerves in situ 18 Plate G. Anterior view of the cord and membranes 27 Plate H. Right lateral view of the cord, and the formation of the spinal nerves 29 Plate I. Left lateral view of spinal cord and membranes. . 31 Plate J. Posterior view of spinal cord 33 Plate K. Vascularization of the central nervous system 37 Plate L. Braces and crutches removed by osteopathic measures (author's cases) 44 Plate M. "Intramural" 56 Plate N. The ligamentous bands that hold the spine together, etc. . . 59 Fig. 1. The chest box or thorax : 7 Fig. 2. Spinal pads or bumpers 9 Fig. 3. Vascularization of a section of the spinal cord 10 Fig. 4. Blood supply of the brain and spinal cord 12 Fig. 5. Relative position of the spinal cord to the heart and aorta. . 17 Fig. 6. Back view of the spine 20 Fig. 7. Front view of the spine . . 20 Fig. 8. Square shoulders, even hips etc 21 Fig. 9. The sympathetic nerves 23 Fig. 10. The nerves of the extremities 24 Fig. 11. The brain is well supplied directly from the heart 26 Fig. 12. The circulation to the head .....: 34 Fig. 13. Faint view of the nerves involved in infantile paralysis .... 38 Fig. 14. A perfect spine has no lesions 40 Fig. 15. Enlarged sections from the three regions of the spine 42 Fig. 16. Section of the spine 43 Fig. 17. The spinal cord is a continuation of the brain, 46 Fig. 18. Nerve impulses travel downward from the brain, etc 47 Fig. 19. At birth the spinal cord is almost the length of the spine ... 49 Fig. 20. The circulation in the feet, etc 51 Fig. 21. "Spinal marrow" .53 Fig. 22. A normal spine and normal poise 55 Fig. 23. Vertebrae, spinal pads, spinal cord etc . , 58 ILLUSTRATIONS xm Fig. 24. Spinal curvature 61 Fig. 25. Dr. Florence Gair's sanatorium in Brooklyn 66 Fig. 26. Dr. Gair's collection of braces, casts, etc 67 Fig. 27. Last winter's case (winter 1918) 68 Fig. 28. Paralyzed from chin to toes 69 Fig. 29. Boy age three 70 Fig. 30. Note the improvement as shown in case 31 72 Fig. 31. Same as case 30 73 Fig. 32. "Three ambulance calls had refused to take him, as he was considered too far gone 74 Fig. 33. This boy was practically helpless. 75 Fig. 34. A bad case of talipes t .76 Fig. 35. Bulbar paralysis in right side of face 77 Fig. 36. Same as Fig. 39 79 Fig. 37. She can now stand on her legs again , 80 Fig. 38. Nerve mechanism down thigh, etc 82 Fig. 39. Spinal curvature ease greatly helped 83 Fig. 40. Front view of the pelvis '. 84 Fig. 41. Relationship of the spinal cord to the atlas and sacrum 85 Fig. 42. Hand everted. Lesion at 4th cervical 87 Fig. 43. Back view of the pelvis 89 Fig. 44. Tilted hips and spinal curvature 90 Fig. 45. Lack of symmetry in spinal curvature 91 Fig. 46. Shortening of a leg following infantile paralysis 93 Fig. 47. Brace removed six years after an attack of infantile paralysis 95 Fig. 48. Well developed curvature in a neglected case 96 Fig. 49. Neglected cases 97 Fig. 50. Case restored to normal by osteopathic treatment 99 Fig. 51. Back view of case 50 100 Fig. 52. Brace removed from infantile paralysis case (author's case) . . 101 Fig. 53. Brace removed after two years' use (author's case) 103 Fig. 54. The nerves of the arm 104 Fig. 55. Braces taken off by the score 105 Fig. 56. Plaster paris cast removed from boy aged 3 (author's case) 106 Fig. 57. Curvature weakens the body . . 107 Fig. 58. Difference in length of limbs causes spinal curvature 108 Fig. 59. Level shoulders and hips 109 Fig. 60. Curvature undermines the health 110 Fig. 61. Shortened and withered leg, tilted hips and affected nerves. .111 Fig. 62. Perfectly shaped lungs 113 Fig. 63. The bony framework protects the central nervous system. .114 xiv POLIOMYELITIS Fig. 64. Brace for a girl of seven years 116 Fig. 65. "Hipping out" 117 Fig. 66. The nerve mechanism of the leg 118 Fig. 67. The normal arch of the foot 120 Fig. 68. "Broken arch" 121 Fig. 69. "The spinal column is literally alive with nerves" 122 Fig. 70. The spinal cord and the spinal column 124 Fig. 71. Watch the kidneys in paralysis cases 126 Fig. 72. Back view of Fig. 71 ' 127 Fig. 73. A section of the spine cut in half 129 Fig. 74. The tonsils and Eustachian tubes 131 Fig. 75. The chest is hung onto the spine 133 Fig. 76. The attachment of muscles of spine, shoulder blades, etc. .135 Fig. 77. Bones bound together by ligaments 136 Figs. 78, 79. The normal chest is conical in shape 138 Fig. 80. Framework of the house which we live in 140 Fig. 81. We are shorter at night than in the morning 141 Fig. 82. Nature's method of nourishing the spinal cord, etc 142 INTRODUCTION N PRESENTING the thoughts contained in this book on the subject of infantile paralysis, it has been the de- sire of the author and of his collaborators that this work should not receive the criticism that so frequently is levelled at a one-man production. Having this thought in mind, every effort was directed to the end that this work should have what might be termed a cosmopolitan flavor. The chapters contributed by others than the author, along with the most excellent array of case reports herein contained, are, we believe, a fulfillment of the end aimed at. No one who is interested in the subject of poliomyelitis should fail to read this work. After reading the chapters on Etiology, Applied Anatomy, Treatment, etc., the reader should care- fully study the case reports. It is surprising how, time and again, the physicians submitting the case reports appar- ently, sometimes wittingly, sometimes unwittingly drive home the truth of the statements made in the chapters on Applied Anatomy and Treatment. Among the things that are brought out by the case reports the following deserve special mention: First. Those who have had experience with poliomye- litis are unanimous and emphatic in their contention that the earlier the osteopath gets the case the better. A study of the case reports leaves no doubt that Osteopathy is THE treatment for poliomyelitis in the early stages. The more severe the case and the greater and more urgent the necessity for the ministrations of the osteopath. Second. The symposium of case reports shows beyond a doubt that Osteopathy is the only treatment that offers real hope of improvement or cure in any and all stages of the disease. Whether the case is of a few days' standing or whether years have elapsed since the attack, Osteopathy is the ONLY treatment that has accomplished anything worth while. Third. The average medical man seems, and actually is, almost helpless in treating infantile paralysis. His policy, for the most part, is one of watchful waiting until the acute 2 POLIOMYELITIS stage is past. Then he will make an attempt to overcome the resulting paralysis and deformity. But in this last effort his armamentarium lacks means whereby the desired end may be attained, and it is because of this fact that one is justified in pronouncing the medical treatment of polio- myelitis an abject failure. The drugs administered during the more distressing stages of the disease undoubtedly handi- cap rather than help nature, and fortunate are those polio- myelitis cases who escape drug treatment. Fourth. A reading of the case reports brings out the fact that quite a number of osteopaths who treated infantile paralysis cases were rather timid about undertaking to do so. They had not had experience with the disease and were not sure of what they could do. But they applied themselves diligently to the cases once they had taken charge of them, and in many of these cases the results obtained were vastly more satisfactory than they had expected. Such results could not help making enthusiasts of them, and it will be noted that everyone who submitted case reports, with per- haps one or two exceptions, became highly enthusiastic over the showing Osteopathy made in the treatment of poliomye- litis. Some are so enthusiastic that they unhesitatingly claim that Osteopathy is a specific treatment for the disease if the case is had soon enough. Fifth. Of the various means resorted to to comfort and alleviate the distress of the patient in the acute stage of the disease, we desire to call attention. Poliomyelitis is one of the acute diseases in which the best and most at- tentive nursing are highly necessary. The means applied and the results obtained, as outlined in the case reports, are deserving of careful reading. Sixth. If we may be permitted to express an opinion on one point which we feel is sufficiently evident from the case reports submitted, it is that in many of the cases re- ported the treatment was not continued as long as it should have been. We cannot help feeling that if, in a number of the cases reported, the treatment had been continued six months or a year longer much more would have been ac- complished. A continuance of the treatment can do no harm, and it may do much good. Therefore, why give up while there is the slightest hope of further improvement? INTRODUCTION 3 Seventh. It will be noted that the hospitals of the country were not open to the osteopaths to treat infantile paralysis cases in them. In fact, under the quarantine regulations now in force in the United States and Canada, it is next to impossible for an osteopath to get a case of in- fantile paralysis in the acute stage. The great Rockefeller Institute, the greatest research institute in the United States and perhaps in the world, is controlled by the medical ma- chine. It, through the veto of Dr. Simon Flexner, refused to allow an osteopath to demonstrate what could be done by Osteopathy for the victims of infantile paralysis that were languishing within its walls. In the face of such prejudice in high places, the broad-mindedness of those few M. D.'s who, when they realized they could do nothing for infantile paralysis, referred their patients to osteopaths, stands out in bold relief. If the general public realized what Oste- opathy has done and can do for infantile paralysis in all stages, one cannot help feeling that they would vigorously protest against the domination of the great medical octopus and demand that the victims of infantile paralysis have the right to employ an osteopathic physician if they so desired. May we hope that in the great fight for democracy that is now being waged we will achieve a democracy that will vouchsafe medical freedom to the masses? So far as we are aware, this is the first work on infantile paralysis in which the applied anatomy of the spinal cord is discussed in all its phases. We believe that a study of the applied anatomy of the spinal cord, and of the osteopathic interpretation thereof, cannot fail in being of invaluable help to the practician who may be called upon to treat infantile paralysis or other inflammatory conditions of the spinal cord. Scattered over the country there are thousands of cases of club foot and other deformities of the feet and limbs that have resulted from infantile paralysis. Under proper treat- ment most of these cases can be helped and many of them cured. The osteopathic profession has an orthopedic spec- ialist who, we believe, is second to none, in the person of Dr. George M. Laughlin of Kirksville, Missouri, and it is with pleasure that we refer the reader to the chapter on the treat- ment of deformities by Dr. Laughlin. 4 POLIOMYELITIS But lest the practician be inclined to haste in advising orthopedic measures, not realizing how much may be ac- complished by osteopathic procedure, we would suggest a careful reading of the chapters by Dr. E. Florence Gair. Dr. Gair admits that in many cases showing marked deformity the results obtained surpassed her fondest expectations, and some of these cases were helped in a remarkably short time. The chapters by Dr. Gair cannot fail to encourage and en- thuse those whose experience with such cases has been limited and whose outlook therefore lacks the vision born of ex- perience. The first chapter by Dr. Gair (Chapter Seven) appeared in the August issue of the Osteopathic Magazine. This was the result of a misunderstanding, as it was written especially for this book. A. G. WALMSLEY. CHAPTER I POLIOMYELITIS (INFANTILE PARALYSIS) Causes Practically all agree that Infantile Paralysis is a germ disease, and that the germ gains entrance thru the nasal and oral openings. Undoubtedly the germ is present in many instances within the body. In order that germs may cause destruction of tissue, there must be suitable soil for them to increase and give off their toxic products. Suitable soil will be that found in devitalized tissues when circulation has be- come disturbed. Stasis is produced whenever the circulation has become impeded. There may be a vasomotor disturbance causing a varia- tion in the calibre of the walls of the blood vessels, or there may be direct mechanical blockage at some point along the course of the blood vessels. Osseous lesions may cause vascular disturbance through the various nerve tracts that connect the spinal nerves with the autonomic nervous system. Later on we will discuss this phase of causative principles under the heading of applied anatomy. There is always the possibility of an hereditary diathesis producing a nervous instability that ren- ders the tissues more liable to ataxic conditions. Thus we find an example in certain neurotic subjects and in cases of St. Vitus ' dance, where there seems to be an inherent tendency for some nervous symptom to develop. In the majority of cases w r e have examined and treated we have noted traumatic conditions. We have found one or more spinal or costal lesions more or less directly influencing the vascularization of the membranes of the spinal cord. LESION THEORY. No child is too young to become lesioned if the proper mechanical pressure or torsion has been applied. We have observed in our practice in many cases of instrument-delivered babies one or more cervical lesions. This is common knowledge to the osteopathic physician. We have noted various forms of nervousness develop in early POLIOMYELITIS PLATE C. The arrow indicates the entrance and direction the invading germs follow in infantile paralysis. POLIOMYELITIS 7 life caused by these lesions produced when the child was born. The obstetrician did not realize that in delivering the child with the forceps the cervical tissues were injured and lesions produced. It did not occur to him that the infant's neck should have been carefully examined and if any lesion existed an adjustment made as soon as possible. FIG. 1. The chest box or thorax containing and protecting the heart. We hear the heart-beat through the resonant walls. The nervous system is nourished indi- rectly from the heart. 8 POLIOMYELITIS He did not reason from cause to effect and connect the after symptoms of a nervous phase which endangered the child's life with the early injury. The lesion produced by the torsion at delivery was the beginning of a vascular irregularity and nerve impulse dis- turbance that affected the tone of the membranes surrounding the spinal cord. Another kind of lesion quite commonly found in children is one produced by a fall or twist. Sometimes a child will slip out of the nurse's arms, and while we admit that the bones are soft and not completely formed and ossified, yet we know that lesions have been made in this manner, as clin- cal experience has verified in our everyday practices. A child may not be supported properly on the lap and ma,y throw itself backward suddenly, as most babies do, and that act may lesion the spine and cause pressure upon certain nerve centres, producing such symptoms as marked gastric disturbances, mental irritation or even convulsions and epilepsy. A jealous brother or sister may give the baby a quick push on the head and lesion its neck. There are many ways to lesion the spine of a baby. After a baby begins to walk many are the tumbles out of high chairs, cribs, or off the bed. It may even slip on the staircase and go head over heels down to the floor below. Does it sound unreasonable to state that there is always a possibility of a child lesioning its framework under circum- stances such as we have enumerated above? One of the most marked cases of St Vitus' dance I have treated in my eighteen years of practice was caused by a tumble down stairs. Two adjustments at the fourth cervical restored the child to normal. Suppose this lesion had not been corrected. There is a possibility that nature would have in time overcome the nervous disturbance, but the lesion would still be present, and a certain amount of vascular dis- turbance to the membranes of the spinal cord would continue to be present. If climatic conditions were right and an epidemic of infantile paralysis was spreading over that com- munity, would not this child, with weakened tissues around the cord, have suitable soil for invading germs to harbour and cause destructive work in the spinal cord areas? We are now leading up to the direct cause of at least a number of cases that contract infantile paralysis. POLIOMYELITIS 9 Mode of Infection We have already stated the most commonly accepted theory regarding the entrance of germs into the system, viz., the respiratory and the deglutitory tracts. Food taken into the mouth while being masticated may take up the invading germs and convey them during degluti- FIG. 2. Spinal pads or bumpers. When piled up as shown at the left they equal one quarter of the length of the padded part of the spine. 10 POLIOMYELITIS tion into the stomach. The absorption of food material in the form of chyle will allow the conveying of these germs into the remotest parts of the system. If there already exists a lowered vitality condition of the spinal cord membranes thru one or more lesions, as mentioned above, these germs w T ill find suitable soil in which they will increase in numbers and throw off their toxic products. The static blood in this area is no longer properly oxygenated, and the resistance is so lowered that it is only a matter of a few days until the typical symptoms of infantile paralysis mani- fest themselves, and we find the little patient with fever, nausea and all of the other symptoms so marked in a typical case. FIG. 3. Vascularization of a section of the spinal cord. Note the accessory artery assisting the three spinal arteries. There may or may not be paralysis. The case may be of the abortive type and the circulation may clear up the mem- branes sufficiently that the cord segments will not be invaded to the point of causing destruction in the motor area of the cord. There may be some destruction of the motor cells in the cervical enlargement of the cord, with paralysis of one arm, or the destruction may be so general that not only the cervical enlargement may be affected but the lumbar enlargement as well. We may find that complete paralysis has taken place, and that the invasion has traveled upward and caused bulbar paralysis. It all depends upon the resistance the tissues have against invasion and destruction. CHAPTER 2 APPLIED ANATOMY Lesions Affecting the Blood Supply of Spinal Cord and Membranes The vascularization of the spine includes that of the cord and its membranes. We find the arrangement of the vessels such that one set reinforces another thru anastomoses. The spinal arteries from the vertebral are the longest vessels of their size found in the body. The anterior spinal artery is given off by two branches, one from each of the vertebrals. They unite near the atlas to form one long slender vessel that passes downward under the linea splendis to reach the filum terminale. It is situated in front of the anterior median fissure of the cord and sends out many transverse branches, the anterior media, which divide into the commissural arteries that supply the major part of the grey matter of the cord. This central or centrifugal set is reinforced by spinal branches in the various regions of the spine. In the cervical region the lateral spinal branches of the vertebral, also the ascending cervical branches of the inferior thyroid entering the foramina accompany the anterior and posterior roots of the spinal nerves. In the thoracic region we have the spinal branches of the dorsal divi- sion of the intercostal arteries; in the lumbar region the spinal branches of the lumbar and ilio-lumbar arteries ; while in the sacral region the rami spinalis are from the lateral sacral arteries. These vessels reinforce not only the anterior but the posterior spinal arteries as well. The posterior spinal arteries are two in number, and are also branches of the vertebral arteries given off above the atlas. They follow the spinal cord just back of the posterior nerve roots, and extend down the full length of the cord. The posterior spinal arteries sup- ply the grey matter in part also the white matter in the pos- terior portion of the cord. They are referred to as the cen- tripetal set. 12 POLIOMYELITIS FIG. 4. Blood supply of the brain and spinal cord. Note the spinal arterie? are given off from the vertebrals at the base of the brain and turn downward extending the length of the spinal cord and its membranes. APPLIED ANATOMY 13 The reinforcing arterial branches that follow the nerve roots to the cord supply the dura mater and pia mater and enter the cord segments passing directly toward its centre. This arrangement of vessels makes a centripetal and centrifu- gal group that supply a superficial or peripheral area, also a central and intermediate area. The vessels mentioned above not only supply the cord but the nerve roots, the membranes of the cord and the per- iosteum lining the spinal canal. This indirect method of vascularizing the spinal cord and membranes is interesting to note. In the instance of the spinal arteries proper, that is the anterior and posterior spinal, we note that the blood forced from the heart upward toward the brain is turned backward and downward to follow the spinal vessels. This arrangement checks the arterial pressure, and gravity is given an opportunity to carry the blood to the filum terminale area. The reinforcing arteries are given off from the various arteries mentioned at almost right angles, and in the thoracic region we find first the intercostal branches at almost right angles to the aorta, and then the spinal branches turning backward and inward to enter the foramina to reach the cord. Thus in each instance the visi-a-tergo is lessened and the delicate cord and its membranes are protected from any direct pressure, even though the heart action is accelerated and fever is rampant. The drainage of these areas by the veins is somewhat sim- ilar in arrangement, altho the greatest vascular area is at the posterior surface of the cord. The veins pass out along with the spinal nerves and empty into the larger veins just outside the vertebral column. In the brain we find the circle of Willis checking the blood force and distributing the blood to the various areas of the brain. The membranes covering the brain are well sup- plied by arterial branches that are indirectly given off by the larger branches of the carotids. In congestion of the spinal and cephalic areas the greatest problem is the venous drainage. We have to contend with lesion effects in the way of vasomo- tor disturbances, contracted musculature, overtense tissues and enlarged glands. 14 POLIOMYELITIS PLATE D. The vascularization of the spinal cord- APPLIED ANATOMY 15 Cervical Lesions In the cervical region the variety of lesions is numerous. The lesioned atlas may disturb the superior cervical ganglion, with its many branches going to the carotid vessels, both in the cervical region and in the cephalic. This ganglion com- municates with three principal cranial nerves almost directly and with others indirectly. The vascularization of the brain and membranes covering it depends normally chiefly upon undisturbed impulses from the vasomotor centres in the up- per thoracic area. If the preganglionic nerve tracts are inter- fered with the communication with the postganglionic in the superior ganglion of the sympathetic will be disturbed. An atlas lesion may also affect the first and second spinal nerves and likewise cause contraction of the muscles and tissues con- trolled and supplied by them. The vagus nerve receives a branch from the superior cervical ganglion and the distribu- tion of the vagus is so far-reaching that a lesioned atlas may cause functional or organic effects in one or more of the dis- tributing centres of this nerve. The low r ered tissue vitality found where there is impeded circulation to the spinal cord and membranes will allow invading germs to destroy tissues that otherwise would resist their attacks if the vascular areas were normal. The venous stasis from contractured musculature will remain as such unless the cause is removed. Any lesion found in the cervical region or other regions w T ill lower spinal cord re- sistance. The spinal nerve cells, nerve roots, etc., are nour- ished by these spinal arteries, and they must not be com- pressed or their vasomotor control interfered with if we are to expect normal tone and perfect impulses. The vertebral artery threads its way through the upper six transverse processes of the vertebrae. Any malalign- ment of any of these vertebrae will affect the circulation in the spinal branches of this artery on either side. The other arteries in this region contributing spinal arterial branches will also be affected by any cervical lesion or lesions. If a lesion exists in the axis or any other cervical vertebra w r e find a corresponding irritation or disturbed nerve impulses to the muscles supplied by the various nerves. If the third and fourth are in lesion the diaphragm may be 16 POLIOMYELITIS PLATE E. The central nervous system. APPLIED ANATOMY 17 involved thru the phrenics. This will add to the seriousness of matters when an attack of paralysis is lowering the cord resistance during the febrile stage. The cervical enlarge- ment of the cord is one of the most common areas attacked in infantile paralysis. The branches of the cervical nerves forming the brachial plexus may lose their motor control and the deltoid and other muscles of the shoulder and arm FIG. 5. The dotted line indicates the relative position of the spinal cord to the heart and aorta. become helpless. Lesions in this region of the cord will al- low a disturbed vascularization to progress more rapidly because the vasomotor tone is lowered. Nature is not able to clear up and throw off the congestion as rapidly. Con- gestion and stasis will fail to clear up to the same extent as in that state where no lesions exist. The greatest amount of 18 POLIOMYELITIS PLATE F. The spinal cord and nerves in situ. APPLIED ANATOMY 19 congestion in the cord and membranes will be found where the most marked lesions exist. The exciting factor men- tioned in Chapter One under the head of causes applies to the lesion effects we are discussing. Cervical lesions may cause contraction of the scaleni muscles and draw upward the first and second ribs to which these muscles are attached. Over the first rib we note the subclavian vessels passing. The upward drawing of the first rib will interfere and carry up the vessels lying in close approximation. The artery may not be compressed, but the vein with its thinner walls, may be, and venous stasis in the arm will result. The vasomotors will likewise be disturbed in the brachial plexus of nerves, and we will find the arm and hand cold and lifeless. The motor, vasomotor and trophic nerves are alike affected, partially thru the lesioned areas as well as thru the pathological state of the cord cells. We have all noted the disturbances to these various nerves in cases where cervical lesions existed aside from any poliomyelitic state. We find one or more fingers partially numb, the hand sometimes quite helpless, as in writer's cramp and wrist-drop. In a milder way there may be lowered nerve tone and vascular effects thru the vasomotors in cases free from paralytic symptoms. Add to this condition an attack of poliomyelitis and obviously we see the lessened chance the patient has to over- come a condition that is complicated by lesion effects and cord cell destruction. If an attack of poliomyelitis comes to one with lesion? already existing and lowered tissue resistance, the chances for a more marked paralysis condition are multiplied The child that fell or in some manner produced a lesion thru torsion is the child that is more apt to have greater de- struction of the motor cells when attacked by poliomyelitis. Dorsal Lesions In the thoracic area, as in the cervical, we have a somewhat similar proposition. Although the spinal cord in the greater part of this region is small in size and the vertebrae likewise, yet we find in this region some of the most important vaso- motor centres. It is in this region that we note the presence of grey rami. The cervical nerves have white rami only. This 20 POLIOMYELITIS double communication with the autonomic nervous system makes this region significant in the way of vasomotor im- pulses to the various organs of the chest and abdomen. We have already mentioned the upper thoracic vaso- motor connection with the head, neck, shoulders and arms. FIG. 6. Back view of the spine. Notice the outline of the outside tips, and the inner line corresponding with the articular or joint surfaces. FIG. 7. Front view of the spine. The inner line follows the bodies of the sections. APPLIED ANATOMY 21 We will now consider the great outflow of vasomotor im- pulses to the semilunar ganglia and coeliac plexus thru the splanchnics. The systemic arteries have an arrangement of vasomotors different to that found in the mesenteric vessels of the abdomen. On the one hand, we find the preganglionic fibres terminating in the sympathetic ganglia, and the post- ganglionic fibres carrying on the impulses to the walls of the vessels. In the mesenteric vessels we find the preganglionic fibres have passed to and thru the sympathetic ganglia, and on to the mesenteric ganglia where the postganglionic fibres convey the impulses to regulate the abdominal vessels in the bowels. Lesions found in the thoracic vertebrae are no less important than those found in the costal area. The sympa- thetic ganglia from the first thoracic down are in close prox- imity to the heads of the ribs. The subluxation of the first FIG. 8. Square shoulders, even* hips, and^a spine free from curvature insures normal freedom of circulation and of nerves. 22 POLIOMYELITIS rib may cause disturbance in the stellate ganglion and like- wise cause a vasomotor effect to the blood vessel walls in that region. The lesions found in any costal subluxation in each instance will disturb the corresponding ganglia found in re- lation to the head of that rib. If in the splanchnic area, the disturbance will be marked, as the splanchnics convey vaso- motors to the important organs in the region of the coeliac plexus. Costal lesions not only disturb the vasomotors but affect the intercostal vessels, nerves and muscles. Here again we will note that these lesions will interfere with the spinal vessel branches supplying that area of the spinal cord and its membranes. Costal lesions may affect the diaphragm in the region where that dome-shaped muscle attaches itself to the inner thoracic walls. The passing of the splanchnic nerves thru the crura of the diaphragm may be disturbed by thoracic and lumbar lesions as well as costal. The aorta may be compressed as it passes thru the opening, for it is in relation to the fibrous por- tion of the diaphragm. The cardiac nerves found in the cervical and upper thoracic may, if lesions exist, cause ir- regularity of heart action. Lumbar Lesions In the lumbar portion of the spinal canal we find reinforc- ing arteries helping to supply the nerves and their coverings that go to supply the lower extremity. While all these nerves are given off from the lumbar enlargement of the cord above the second lumbar vertebra, yet these nerves must receive a blood supply to be properly nourished. The membranes of the cord extend below the cord and protect these nerves until they are all finally given off and pass out of the foramina in this and the sacral region. The lumbar nerves, if interfered with by lumbar or lumbo-sacral lesions, will lose their tone, and a lowered re- sistance of the muscles and tissues of the limbs will result. The renal plexus will be affected by upper lumbar lesions and the pelvic organs and vessels will become congested if lesions are present in this region. The paralysis found in the bladder and bowels may be aggravated by the presence of osseous lesions. APPLIED ANATOMY 23 The additional cord segment pathology, whether con- gestion alone or cell deterioration or partial destruction is found, will be harder to clear up if the vasomotor tone is already impaired. Sacral Lesions The sacrum is wedged between the innominates, and upon it rests the spinal column. It is common to note a sacro-iliac lesion, and we find with the rotation of the in- nominate upon the sacrum a corresponding difference in the length of the legs. The sciatic nerve leaving thru the notch in the ischium may become irritated in a lesion of this nature. Sciatica is commonly found when the innomi- nate is rotated. The sciatic nerve conveys a variety of im- pulses vasomotor, motor, trophic, etc. This nerve is also FIG. 9. The sympathetic nerves that supply the various organs are connected \\ith 1 the spinal nerves that pass out from the spinal cord between the vertebrae. 24 POLIOMYELITIS well vascularized. The lesion mentioned above may not only cause sciatica, but cold feet, muscular atrophy, swelling of the ankles, and many other symptoms. Add to this condition an attack of infantile paralysis and we have a complication that will be almost impossible to clear up unless the proper adjustments are made. Thus we see the importance of making careful examina- tions of children's spines, ribs, hips and every part of the framework in order that normal impulses may be maintained, and when an epidemic of infantile paralysis attacks the chil- dren they will at least have good circulation and freedom from nerve pressure to withstand the invasion of toxins that takes place. Their chance of throwing off the disease and clearing up the congestion will be far greater if nature can use all her forces to combat the disease. FIG. 10. Most attacks of infantile paralysis affect one or more of the extremities. The nerves involved are outlined on the figures. CHAPTER 3 APPLIED ANATOMY Continued Lymphatics of the Head and Neck We have already mentioned that the most direct area of infection in infantile paralysis is through the membranes of the nose and throat. The virus gains entrance during respiration and deglutition. We have also referred to the mode of infection through the alimentary tract. The virus is carried along with the bolus of food and enters the stomach. During the process of digestion it is conveyed to the intestinal tract and the system takes up the virus and its poisons by way of the lacteals and blood channels. A more direct infection of the central nervous system may take place thru the lymphatics of the head and neck. The membranes of the nose, naso-pharyngeal region and mouth are rich in lymphoid tissue. The close connection between the lymphatic tissues of these areas and those found in the head and neck allow a conveyance of the virus to the membranes of the brain and spinal cord. The openings for communication are numerous and the paths for the convey- ance of infection are closely connected. The superficial and deep lymphatic vessels and nodes found in the neck and throat allow of ready communication and transmission of the micro-organisms and their toxic products. The central nervous system may be almost directly invaded by the virus found in the membranes and lymphatics of the naso-pharyn- geal region. Once the virus reaches the membranes pro- tecting the central nervous system the upward invasion to the brain from the cervical region is readily accomplished. The cerebro-spinal fluid surrounding the cord also sup- plies the area around the brain. There is a communication between the cord and brain, as the same coverings that sur- round the cord are continuous with those covering the brain. One of the most noticeable symptoms in an acute case of infantile paralysis is headache. There is also pain in the neck. The temperature increases in a typical case until it 26 POLIOMYELITIS reaches 103 or a trifle more. The congestion in the head and neck is marked. The neck seems swollen; the lymph nodes are enlarged and indurated. The lymphatics are in- volved as well as the blood vessels. The lymphatics have carried the virus to the hidden membranes of the central nervous system. The invasion may have taken the route found in the infundibular region and the cephalic membranes first be- come infected. The virus in this case must needs travel FIG. 11A. The brain is well supplied directly from the heart. FIG. 11B. Lymphatics of the neck. APPLIED ANATOMY 27 PLATE G. Anterior view of the cord and membranes. 1. Posterior horn; 2. Anterior horn; 3. Spinal nerve with covering; 4. Dura mater; 5. Turned back; 6. Spinal cord bared; 7. Arachnoid; 8. Anterior nerve roots: 9, 10, (top no.) Lat. sur- face of cord. 28 POLIOMYELITIS downward in the central nervous system if the case is one that is not abortive in type. General infection of the cord may or may not take place. The cephalic membrane in- volvement may be sufficient to cause a bulbar paralysis which will eventually affect all points below and prove fatal in nature if sufficient destruction takes place. Again, it is the amount of resistance the tissues have that will determine the extent of the destruction in the nerve cells. The lym- phatic engorgement will depend upon the lack of freedom of circulation and the quality of the blood and lymph. The nodules will indurate in proportion to the amount of blockage. The more regular the circulation the better the oxygenation of the blood will be, and good blood, well areated, is the best of germicides. The phagocytes lose their potency in proportion to the amount of devitalized tissues they have to work in. The extreme amount of congestion in the head and neck is due in part not to the virulence of the virus as much as to the amount of obstruction found in relation to the blood ves- sels and lymph channels. The nodal induration is much more rapid when the blood circulation is impeded. The feverish condition of the head and the tendency for the head to draw backward is not so much a question of the effects of the virus and its toxins as it is the effect upon the nerve centres thru congestion by obstructed blood and lymph channels. The involvement of the lymphatics is due in the first place to the more ready infection and conveyance of the virus by the fact that the tissues in which these vessels are found were devitalized by obstructed or impeded circulation. The normal tissues in the pharyngeal and nasal regions of a child will not harbor nor convey to the same extent the virus as in the case of a child in which adenoid growths and diseased tonsils are found. The child with polypi and con- gested turbinate processes will likewise harbor germs and propagate them in a soil that is suitable for germ development thru obstructed lymph and blood channels. The cause of this static condition in the sinuses of the head and the membranes lining these as well as lining the pharyngeal region may be due to a variety of leisons. There is always a possibility of hereditary weakening or diathesis APPLIED ANATOMY PLATE H. Right lateral view of cord, and the formation of spinal nerves. 1. Anterior horn; 2. Posterior horn; 3. Anterior median fissure; 4. Posterior spinal nerve roots; 5. Lagamentum denticulatum ; 6 and 8. Dura Mater; 7. Posterior ganglion. 30 POLIOMYELITIS with nervous instability, but we will discuss here the cause in which osseous lesions play the role of primary factors. The drainage of the lymphatics of the head and neck is quite the same in both sides. Below the neck and for the rest of the body we find a vastly different proposition. The lymphatics of both sides of the head and neck tend to pass downward to a common collecting centre to empty into the subclavian veins. The superficial communicate with the deep, and the lymphatics of one side communicate in some instances with those of the opposite side. Normally the nodes are not over-sensitive unless pressed upon. Induration is pathological if found to any extent. The same rule that governs the freedom of circulation of blood is more or less applicable to that of the lymph channels. Lesions that con- tract muscular tissue will obstruct lymph channels the same as they will obstruct the blood vessels. Not all lymphatics have vasomotors supplying them, it is true, but there are other ways of obstructing the flow of lymph and blood than thru the vasomotor nerves. The lesions mentioned under the heading of "cervical" in the last chapter are applicable to the lymph channels as well as to the blood vessels. The lesions that produce a congested condition of the tonsils will invariably affect the lymphatics that are so abundant in this region. The lymphatic tissues that form the outer and inner defences of the naso-pharyngeal region suffer ob- struction and nodular enlargement whenever there is venous stasis. The involvement of the membranes of the sinuses of the head are either secondarily or simultaneously affected thru a vascular disturbance in the vault of the pharynx and the region of the nose. The congestion found in the membranes protecting the central nervous system are the effects of lymph and blood vessel obstruction thru a lesion of some nature osseous or otherwise. Before congestion there must be obstruction, and before invasion and toxic poisoning from virus there must be a suitable soil or else the tissues would produce an abortive condition. Thus we see first, last and -always the greatest preventa- tive measure in infection of any nature will be the mainte- nance of normal circulation both in the lymph channels and APPLIED ANATOMY 31 PLATE I. Left lateral view of spinal cord and membranes. 32 POLIOMYELITIS in the blood vessels. This accounts for the numerous cases of the abortive type of infantile paralysis, and also the noted fact that in many instances only one or possibly two in a family of several children contract the contagion; the others go along uninfected. Fortunately, the microorganism of infantile paralysis does not attack children as numerically as the germs that are connected with some of the other and more common diseases. In scarlet fever, measles, whooping cough, etc., there seems to be a condition that makes the contagion spread with a more decided virulence. It is not uncommon to see these children's diseases go right thru a family. In infantile paralysis the central nervous system is di- rectly involved, and the child who due to lowered tissue resistance from spinal lesions and other conditions furnishes the most suitable tissue soil is the one that will be the victim. The others may have the germs in their mucous membranes, but the soil is not favorable to infection and they will have simply an abortive type or will not be affected in the least. The obstruction of the lymphatics may be due to a secondary condition. The presence of stasis in the region of the tonsils may be somewhat chronic in nature. There may be repeated attacks of tonsilitis which may last only a day or two. The disturbance may be almost w r holly va? cular. Should the obstruction persist and the lymph nodes become enlarged there will be a lymphatic involvement that will tend to complicate matters. Infection will be a natural sequence. The correction of an atlas or axis lesion that will remove any disturbance to the superior cervical ganglion with its postganglionic fibres that control the vasomotors to that region where stasis has been present will re-establish normal lymph flow. Lymphatic involvement may be secondary to avaso- motor disturbance to the blood vessels in the same region where congestion exists. The hyoid bone slightly misplaced will put tension upon one set of the muscles attached to it and cause not only venous stasis but a blocking of the lymph channels, and as a result we will note nodular enlargement in the lymphatic chains. The enlargement of the nodes in the region of the mastoid may be due to an obstruction of the lymphatic channels in the region of the clavicle. The back- APPLIED ANATOMY 33 PLATE J. Posterior view of spinal cord. 34 POLIOMYELITIS ward luxation of the clavicle with a subluxated first rib may obstruct the drainage of the lymph into the subclavian veins. The middle cervical ganglion may be involved and we may have a thyroid disturbance as well as cardiac irregulari- ty thru a cervical lesion. This may in turn cause pressure by thyroid enlargement upon the lymph channels and produce toxic poisoning of the membranes and tissues in the throat , head and central nervous system. FIG. 12. The circulation to the head. The veins returning the blood are not shown, but parallel the arteries. Note the formation of the spinal artery. APPLIED ANATOMY 35 The presence of an aneurysm may, thru mechanical pressure, cause a greater disturbance than any single osseous lesion. A cervical rib may cause irritation of the brachial plexus and the sympathetic system that will not be relieved until surgical measures are used. Not all disturbances are from osseous lesions in the way of vertebral rotations or sub- luxations, and not all disturbances are from local interfer- ences. The lymph channels may be affected and infected through disorders in the axillary and mammary region, or even lower down. There is a communication between the lymph channels of the thorax and cervical region back of the clavicles. That is why no diagnosis is complete that does not include a complete systemic survey in each instance. The high temperature of a child or an adult may be lowered by a single adjustment in the upper thoracic, or a similar effect may be brought about through the correction of a cervical lesion. The idea is to determine the exciting cause, if from a lesion, and correct the irregularity if it is at all possible to do so. CHAPTER 4 APPLIED ANATOMY Continued Lymphatics of the Thorax and Abdomen Infection almost invariably complicates the lymphatic system. We are prone to think only of the veins convey ing- impure blood and producing congestion and stasis, but we must remember always that the lymph channels are the conveyors of toxic products, and blockage in a node or num- ber of nodes will affect the elimination or retard the dis- semination of toxic products. There is a possibility of the virus found in infantile paralysis cases entering thru the bronchial tubes and in- fecting the tissues in relation to the roots of the lungs. Dust particles include, germs, and their entrance via the bron- chioles may cause infection and enlargement of the lymph nodes in that area. There is a possibility of the virus or microorganisms of infantile paralysis lodging and becoming scattered thru the lymphatics in the thoracic region in relation to the bron- chial terminations. Around the cord the pia mater and arachnoid harbor lymph spaces. These spaces are in communication with the vessels, and it is through them infection enters the cord substance. In the abdomen below the diaphragm the cisterni chyli is located. Into this receptum the intestinal lymphatic drainage enters and the beginning of the thoracic duct is found. This duct collects from the abdominal viscera and pierces the diaphragm in relation to the aorta. The lacteals carry away the chyle absorbed from the small intestines and convey the substance to the thoracic duct that passes upwards to empty into the subclavian vein on the left side. The peritoneum is a lymphatic sac in one respect. The amount of absorption that takes place in the peritoneum is great. The food taken into the stomach containing the micro- organisms of infantile paralysis are readily absorbed by the lymph channels and conveyed to the blood circulation. APPLIED ANATOMY 37 PLATE K. Vascularization of the central nervous system. 38 POLIOMYELITIS The possibilities of mixed infection is worthy of consid- eration. If a lymph channel is already infected by other germs, it is in no condition to combat the virus of infantile paralysis should it be absorbed. The lymphatic system is in danger of blockage and slug- gishness the same as the vascular system. The normality of the nodes and channels of the lymphatic system will depend to a great extent upon the condition of the blood vessels and the tone of their walls. If we find stasis in the mesenteric FIG. 13. Faint view of the nerves involved in infantile paralysis. blood vessels w r e are likely to find nodular enlargement of the lymphatic system. The numerous nodes found in the mesentery and along the vessels of the bowels are normal only so long as the blood stream to and from the abdominal viscera is normal. A diseased organ is one that has a dis- turbed circulation regardless of the cause. If an organ is functioning abnormally we invariably find its vascular sup- ply disturbed. If an organ is mechanically interfered with we also find the circulation to that organ affected. The APPLIED ANATOMY 39 cause being removed, the circulation may once more be re- established. The infection of an organ is through its vascular chan- nels, either the blood or the lymph. The better the circula- tion the less chance of germ invasion. The more perfect the assimilative mechanism the less liable the virus will be to be disseminated and propagated. Lymph spaces are found around the cord in all regions. The vascularization of the cord is complete at every segment. The entrance of germs at any point is possible. The nor- mality of the lymph spaces in relation to the pia mater will depend to a great extent upon the normality of the vascular system in relation to the cord and its membranes. If there exist lesions at any point along the length of the cord we at once find a lowered tissue resistance to that area of the cord. There may be a trophic disturbance or a vasomotor insta- bility to the vessel walls, or w r e may find stasis from a con- tractured musculature that will block the lymph spaces. In any of these conditions the tissue vitality will be under- mined and invasion is more apt to take place. In the thoracic region we may find costal lesions as well as vertebral. The relation of the intercostal vessels to the ribs may in a costal subluxation so disturb the sympathetic ganglia that the tissues around the foramina become irritated, and this will extend into the cord thru the blood channels. The blockage of one vessel to the cord and membranes may so lower the nerve and cell integrity that a cord segment will become readily infected by the virus. Remember that the cord segments and their cells must be kept at a certain tone from a vascular standpoint or else the cells will not functionate normally. In the ventral por- tion of the grey matter of the cord the motor cells send forth their efferent impulses, and the muscular tone of the limbs will depend upon the normality of these impulses for their strength and motion. The lowered tone thru disturbed vascularization plus the invasion of the virus or its toxins even in a mild or abortive case will cause a disturbance to the efferent tracts in proportion to the degree in which the cells resist the attack. 40 POLIOMYELITIS In the more severe cases of infantile paralysis, where exudation accompanies congestion, we note a marked de- struction of the motor area. If the spinal arteries and veins are obstructed to any extent the lymph spaces are occluded, and nature's effort to clear the condition is sorely handicapped. Thus we see the prime importance of keeping a child's spinal tissues up to a normal point so that should the virus gain entrance to the body there will not be lowered tissue resistance in the region of the central nervous system. The region of the diaphragm, with its many openings for the passing of nerves, vessels, tubes, etc., is of interest. The presence of lower rib lesions or vertebral misplacements may so affect the attachments of the diaphragm and its crura FIG. 14. A perfect spine has no lesions. Every section moves without a " hitch . Notice the spinal cord does not extend the full length of the spinal column. APPLIED ANATOMY 41 that the openings found in its central tendon and in the region in relation to the vertebral column may cause undue pressure or obstruction to these various tubes, vessels and nerves. The veins and thoracic duct are passing upward; the nerves, aorta and esophagus are going downward. All have their functions and any minor obstruction may cause a systemic disturbance. The thoracic duct has a few valves to prevent back- ward flow. It is a long tube, and gravity is against it the same as in the saphenous veins. This duct has its vascular supply and nerve tone, although it has not the marked mus- cular tissue within its walls that is found in the blood vessel walls. The thoracic duct is a great collecting system, and the flow of lymph must be emptied into the veins as regu- larly as possible. From the fact that the lymphatic system has to deal with toxic products, we must at all times determine the condition of this duct and see that no lesion exists that will in any way affect its walls or its conveying properties. The cisterni chyli is located in front of the second and third lumbar vertebrae. Lesions that are found at this region or even higher, including lower costal, may have a marked effect upon the receptive properties of this collecting system. The drainage of the mesenteric nodes into this cistern will depend upon the normality of the blood vessel circula- tion. The presence of obstipation with poor peristaltic action, the finding of adhesions or the noting of growths and thickening of the tissues, all have a bearing upon the lymphatic system. Splanchnoptosic conditions will affect drainage and obstruct the lymph channels. This will lower the general tone of the tissues. In children colic, convul- sions and constipation will lower the vitality. The tissues of the entire body in the child are not only growing, but must be sustained in the way of complete nour- ishment as well. In the adult the growth is complete and sustenance alone is required. The activity of a child is much greater than in the adult as a rule. The resiliency of the tissues is greater, and its bones are not as yet com- pletely ossified. It takes up shock better than an adult, and the nerves do not seem to suffer from accidents as do those of the adult. 42 POLIOMYELITIS The common point of tissue irritability is when we find a lesion from a fall or strain. The disturbance to the vessels and nerves, unless the proper adjustment is made, will con- tinue to lower tissue resistance thru nerve irritation. If the sympathetic chain is involved thru its connection with the spinal nerves, the vasomotors will suffer from impeded cir- culation, and the impulses will become irregular. The spine of a child from the time it is born must be inspected if we wish to keep it free from lesions and scoliosis. Some children grow up with almost perfectly aligned spines, while others, thru traumatism, suffer irregularities that ad- justment alone will rectify. FIG. 15. The enlarged sections from the three regions of the spine, show the different shapes peculiar to each region. The spinal nerves pass through the openings back of the solid parts, or bodies, of the vertebrae. CHAPTER 5 TREATMENT Part I To outline a specific course to pursue in treating In- fantile Parah'sis is not as easy a matter as one might presume. In the first place, we must be cognizant of the fact that no two doctors have the same viewpoint. One physician may be partial to accessories, such as hydrotherapy measures, while another may be inclined to emphasize thermostatic agencies. Osteopathic physicians are agreed that in order to get the best results in these cases, we must stick to ten-finger Osteopathy. That measure alone will get the best results, and we must remove the vertebral lesions if one or more lesions are present. The Old Doctor's principles are true and tried, and if we deviate from them we are not going to secure the best results. Few cases, if any, of infantile paralysis are without one or more specific spinal lesions. In practice we have yet to find a case without a specific spinal or rib lesion. In our clinic, now well into its second year, we average fifteen a day three times a week, and one-half of these are infantile paralysis cases in the chronic stage. Dr. Gair, in FIG. 16. Section of the spine. A vertebra with the spinal cord and its mem- branes. The small cut to the left is an enlarged section of the cord. Lymph spaces are found in this area. 44 POLIOMYELITIS PLATE L. Braces and crutches removed by osteopathic methods (Author's cases). TREATMENT 45 her famous Brooklyn clinic, treats thirty and forty a day, and a goodly percentage of them are infantile paralysis cases. Strange to say, some of our osteopaths have not secured good results from treating these cases. We frankly admit that until a very few years ago we did not get good results. We now know why. We did not have the proper vision. We did not grasp the principles laid down by the Old Doctor. We were not sufficiently specific. Our technique was not right. We do not and did not blame Osteopathy. We knew that we were not following along the right path. Now we love to handle these cases, and we get good results. Whether it is a recent or a chronic case, the results are in proportion to the time that has lapsed since the attack and the seriousness of the disease at that time. There is only one royal road in handling these cases, and that is specific adjustment. Five minutes' time is sufficiently long in treating a patient, and sometimes too long. Ten or twelve of these cases an hour is a moderate record. But when you treat them don't start any massage work. That is not our work. We are too skilled to waste time in giving massage. Start in and move every spinal joint. That takes only about two minutes. Spring the sacro-iliac articulations just enough to get motion. Then give a specific cervical treatment. Do not stop to relax mus- cles in a child. Adjust as rapidly as possible. Make every spinal joint yield to motion. Spend only one minute, or possibly two, on the cervical vertebrae. So far, we have consumed four minutes. The last minute we loosen up the wrist or ankle, according to the extremities that are involved. We think this general outline of treatment for chronic cases will be approved by those who have been getting the best results. Drs. Gair, De Tienne, Bernard, Green, Bush, etc., will bear me out in these statements. Regarding home treatment, the parent or guardian should be instructed in giving massage and systematic exercises. Dr. Bush has pos- sibly given this phase more attention than any other osteo- path. It is quite necessary to have our specific work followed up by these home accessories in chronic cases. Usually a mother will give her child any amount of home drill and massage. As already stated, massage and exercise alone will sel- dom cure a chronic case. It is the specific work that counts. 46 POLIOMYELITIS As soon as we get away from Dr. Still's teachings we are going to fail in getting the best results. Regarding the frequency of any specific lesion, we are unable to state what particular lesion or lesions are most often found. Sufficient is it to make a careful examina- tion, to determine the number and nature of the lesions, and then proceed to correct them. That is genuine Osteopathy. FIG. 17. The spinal cord is a continuation of the brain. "Find it, fix it and leave it alone." Five minutes of thor- ough and specific spinal adjustment is worth hours of mas- sage or even muscle manipulation. There may be an acceleration of the blood flow after a thorough muscle relaxation, but the extremities will grow cold a few minutes after you are through. Give a good spinal adjustment from the atlas to the coccyx, and note the warmth come back to the livid muscles and the disappear- ance of the flaccidity and the regaining of tone in the muscles. Muscular atrophy will disappear, and the limbs will once TREATMENT 47 more round out. The bones will start to lengthen, and the short ones, if the discrepancy is not marked, will catch up in growth with those that are normal. This can only be done by treating the nerve centres, those centres which have to do with motion and tissue development, the motor, trophic, secretory and vaso-motor centres. FIG. 18. Nerve impulses travel downward from the brain through the spinal cord to the feet. Paralysis may involve a part or all of a tract. If the case is well advanced, that is, chronic in nature, and the motor cells have been destroyed to a great degree, we must bring into play the remaining cells of the cord seg- ments that will co-ordinate and carry on the reflex arcs. The viscero-motor and viscero-sensory reflexes must be re- established as far as possible, so that normal tissue tone will again be regained and the reflex arcs work in accordance with physiological principles. Every cord segment, especially the cervical and lumbar enlargements, must be constantly bathed with good rich 48 POLIOMYELITIS blood. We must get good vaso-motor action, as that alone will restore the circulation to all of the tissues. If the slight- est subluxation, costal or spinal, exists, we cannot expect good results until adjustment is made. It is quite unnecessary to tell fellow practitioners how to make corrections. We simply w r ant to admonish them to be careful to trace out these lesions and to be specific in making adjustments. The outline of treatment thus far is general, we admit, but we have earnestly sought to emphasize the keynote of Osteopathy as applied to not only these cases, but all cases treated by our own peculiar method. Acute Cases The treatment given in acute cases is unique. We know r that the " regulars, " so called, state that cases of infantile paralysis should not be treated or massaged for several weeks. Just here we leave the trail and turn to the right. True it is that we have been handicapped in securing acute cases, especially since the last great epidemic in 1916. But there have been quite a number treated osteopathically in the acute stage, as you will see in reading the case reports contained in this book, and the results have been most satis- factory. We thoroughly believe that fifty per cent, of the cases now on crutches and braces, with their withered limbs, would be in an almost perfect condition physically if they had received osteopathic treatment from the very first. The treatment may not have necessarily taken more than a few moments, but a simple adjustment, or even inhi- bition, might have prevented the disastrous condition that resulted by following the medical theory that they should be left alone. When these cases are left alone the motor cells literally burn up and are destroyed. The osteopath is fitted by training to handle spinal cases, and just such cases as these. Who should dictate just when spinal treatment should be applied in these cases : the osteopathic doctor, who is versed in this particular method, or the medical doctor, who is not familiar with spinal adjust- ment either from a standpoint of etiology or from a standpoint of physiological reaction? It is the work of a spinal special- TREATMENT 49 ist, who is familiar with the control of the circulation by stimulation and inhibition of the nerve centers. Case after case has been recorded where osteopathic measures had been instituted from the first in acute cases, and almost invariably the results have been all that could be expected. The congested cord must be relieved. The circulation must be equalized, and how else could it be accomplished save through the scientific application of nerve centre treat- ment. We will grant that the medicos are right in saying that massage is contraindicated, but Osteopathy is not mas- FIG. 19. At birth the spinal cord is almost the length of the spine. It grad- ually shortens, apparently, as the spine outgrows it until at about three the cord is at a level of the second lumbar vertebrae. sage. Leave it to those who know how to equalize circula- tion, and you will get the best results. We have given this phase particular attention and know whereof we speak. The wrecks all over the land following each epidemic are proof enough that the proper treatment was not given in the acute stage. Thousands of children and grown-ups, following the recent and far past epidemics, are living examples of the fallacy of the old method of doing nothing. No specific serum has been found that will cure these cases in the acute stage. Under the shadow of the best 50 POLIOMYELITIS equipped laboratories known to medicine, the last great epi- demic had its sway, and yet look at the cripples^ New York is full of them. Dr. Gair and others are now restoring their withered limbs by the hundreds, even at this late stage of chronicity. The majority would never have become cripples if osteopathic methods had been instituted from the beginning. We have tried to present this matter in the true light, and we only trust that parents will become sufficiently in- formed so that should another epidemic sweep this country in a few years the children will be spared from becoming helpless cripples, or going about on braces and crutches. TREATMENT Part II A. G. WALMSLEY, D. O. In Part One Dr. Millard has emphasized the vertebral lesion as a causative factor in poliomyelitis by devoting his remarks on treatment to the necessity of correcting all spinal lesions as soon as it is possible to do so. Before passing to the discussion of other phases of treat- ment, we wish to express our hearty agreement with what has been said regarding spinal lesions and spinal treatment. There is no doubt that the splendid record made by osteo- paths in treating poliomyelitis in the acute, subacute and chronic stages is due in large part to the application of the principles discovered by the founder of Osteopathy. There- fore, our discussions of the treatment of this disease must have as their center or touchstone the principles enunciated by Dr. A. T. Still. But having emphasized the prime importance of the application of those measures peculiar to the science and practice of Osteopathy namely, spinal adjustment in the treatment of poliomyelitis, it does not follow that the treat- ment of the disease ends there. Indeed, we are cognizant of the fact that it does not always even begin there. In some acute cases of poliomyelitis the tissues are so exceed- ingly sensitive, especially the spinal tissues, that the patient TREATMENT 51 will not tolerate being touched, and will cry out if he thinks his physician or his nurse is going to touch his spine. It is at once apparent that in such cases the hypersensitive con- dition of the spinal tissues must be relieved before the osteopath can adjust spinal lesions. It is fitting that we should mention at this point that parents do not and some of them will not see how an osteopath can manage these very sensitive cases, and most M. D.'s hold up their hands in horror at the thought of an osteopath being called to see such cases. But what does the FIG. 20. The circulation in the feet is supplied by the far away heart, small arteries, etc. Small arteries enter the long bones through little openings, and keep them well nourished. 52 POLIOMYELITIS average M. D. do in such cases? For the most part, his policy is one of hands off. The disease is allowed to burn it- self out, and in many cases it takes the patient with it; and when it does not kill the patient it very often leaves him a hopeless wreck. It is true that the M. D. resorts to internal medication and to the use of sera, but the effects of such treatment are so far from satisfactory that he cannot and (if honest with himself) does not look with any degree of hope for tangible results. If one may judge from the host of children with withered limbs and misshapen bodies who have passed through the hands of the medical profession in recent years, one cannot but adjudge the medical treatment of poliomyelitis a failure. In the face of these failures, one may be permitted to ask: Why should the medical profession say this should not be done; that should not be done, etc., etc.? We are unalterably opposed to this do nothing policy. We believe that so much can be done in the early stages of poliomyelitis by intelligent handling that we are encouraged to set down our views of the matter in the sincere hope that they may prove of help to others in the treatment of this disease. Procedure in Acute Cases For the guidance of the physician we will outline what we consider sane and logical procedure in acute poliomyelitis. FIRST Isolate the case. In doing this the patient should be put in the. quietest, most cheerful and if in the hot weather in the coolest room in the house. SECOND Keep people out of the room; none but the nurse should be with the patient. THIRD Stop all food. When we say all food, we mean ALL. This, as well as some of the other things we will sug- gest, should be done in all acute infectious diseases. In the acute diseases the gastrointestinal tract is utterly unable to carry on the digestive functions, and the ingestion of food not only places an added handicap upon nature in her efforts to clean house, but it also prolongs the disease and makes more probable troublesome sequelae. Food should be with- held until the temperature is down to 100 F. or lower. When the temperature is down to 100 F. or lower, and if the pain and sensitiveness have practically subsided, feeding may be TREATMENT 53 commenced by giving fruit juices for a day or two; then fresh fruit such as berries, cherries, oranges, peaches, or baked apple may be given. After a day or two of this the heavier foods may gradually be introduced. FOURTH In acute poliomyelitis, as in all fevers, the patient should be given plenty of water to drink. It is better to give a little at a time and give it often. Water to the fevered patient is both food and drink. It literally helps to drown the fires that are raging within and it pro- motes elimination. FIG. 21. "Spinal marrow" is really the spinal cord, with its three coats, as shown in the small section to the right. The cord seen from the side view is curved to conform with the shape of the spine which encloses it. FIFTH In many of the acute cases the spine is so sensi- tive that at first not much can be done in the way of handling it. When we encounter such cases, shall we throw up our hands and say that nothing can be done; that we must wait until the patient has improved and is less sensitive to the touch before attempting spinal adjustment? Not so! We should rather do all that may be done to get the patient in such condition that osteopathic measures may be applied. We believe that the best way to accomplish this is by hydro- therapeutic measures. A few osteopaths advocate placing the patient in a bath at body temperature or a little higher, 54 POLIOMYELITIS and keeping him there for fifteen or twenty minutes, this to be repeated every two or three hours until contraindicated. While we believe in the merits of this procedure, we are of the opinion that hot compresses applied to the spine and to other very sensitive parts will answer the purpose as well in most cases and better in some cases. The compresses do not require that the patient be handled as much as in putting him in the bath, and this in an important consideration. In applying the compresses turn the patient face down upon the bed. Place one or two cushions under the abdomen. This will support the body and will slightly arch the spine. It is claimed that in the prone posture the spinal vessels drain more readily, so in placing the patient in this position to apply the compresses we are accomplishing a two-fold purpose. The compresses should be applied to the entire length of the spinal column, but special attention should be given to the more sensitive areas. Light compresses should be used at first because even the weight of a light compress may not be well borne by the patient. The first two or three compresses should be warm in order to accustom the patient to them. After that they may be put on quite hot but not hot enough to burn the patient. They should be wrung out so that water w r ill not drip from them. The application of the hot compresses may be con- tinued for one-half to three-quarters of an hour. This pro- cedure should be repeated in two or three hours if the patient becomes restless. It is claimed by some osteopaths that when the patient has a very high fever cool or cold compresses are more effective than hot compresses. In such cases it might be well to try cold compresses. The com- presses help to bring about relaxation of the tense ligaments and muscles and thus promote drainage from the spinal cord. The compresses do more than this; they not only largely, sometimes entirely, overcome the painful, sensitive condition of the spinal tissues, but they also have a decidedly soothing effect on the nerves of the patient and as a result the patient is enabled to rest and conserve his energies; whereas, he had been unable to rest and his resistance was being rapidly de- pleted. We are of the opinion that not many applications of the compresses will be necessary before the osteopath will be able to do gentle corrective work to the spine. TREATMENT 55 SIXTH Irrigate the colon with copious saline enemas. This should be done as early as possible. It has been noted by most of the osteopaths who have treated acute polio- myelitis that not only is there a decided involvement of the digestive tract, but that the fecal discharges are very of- fensive. The sooner the colon is rid of the offending mater- ial the sooner will the fever abate and the other symptoms subside. FIG. 22. A normal spine is usually found in a person with a normal poise. At first the colon should be flushed at least twice a day. In some of the more severe cases the colon should be flushed every five or six hours for the first day or two. Later once a day will do, and this should be continued so long as the patient is bedfast. When the patient begins to take solid food the bowels should be closely watched until normal action is restored. 56 POLIOMYELITIS PLATE M. "Intramural" (within the walls). 1. Dura Mater; 2, 3, and 4. Per- iosteal lining; 5. Posterior ganglion; 6. Anterior nerve roots; 7. Anterior horn; 8. Pos- terior horn; 9. Anterior median fissure; 10. Union of anterior and posterior spinal nerve roots. 11. Ligamentum denticulatum; 12. Spinous process; 13. Ligament; 14. Body of vertebrae; 15. Disc between vertebrae. TREATMENT 57 SEVENTH Close attention should be given to the nose and throat, especially where there is profuse discharge from the mucous surfaces of these parts. The nose and throat should be kept as clean as possible without undue annoy- ance to the patient. The excretions from these parts should be carefully sterilized. EIGHTH In poliomyelitis as in any of the acute dis- eases, it will be found that the feet are cold even though the patient is in a high fever. This is true even in the hottest weather in summer. A hot water bottle should be placed in the bed but it should not be allowed to come in contact with the feet if it is very hot lest it burn them. Caution If the patient makes phenomenal progress, do not cease watchful care too soon. Relapses have occurred where the patient was allowed too much exercise, too much food and too much excitement when it was thought all danger was past. In cases that at first show only slight paralysis and that to all appearances are mild cases, it is well to be as watchful and as rigid in the regime outlined as with the more severe cases. The only safe plan to follow is to treat all cases of poliomyelitis as though they were severe cases. When the acute stage is past and convalescence is pro- gressing favorably, it is still imperative that great care be exercised. The osteopath may sometimes wonder why a paralyzed part is not making better progress under treatment, and may be inclined to chide himself or his science; whereas, if he would inquire into the case he would find that the patient was having too much exercise and too much excite- ment. This will not do. Rest and quiet are indicated if the patient is to make a satisfactory recovery a recovery that leaves no withered limbs nor constitutional weakness. In cases in which the paralyzed limb or limbs have not made complete recovery within a few months from the onset of the disease, the osteopath sometimes questions the advisa- bility of continuing treatment. We believe that in most cases there should be no question whatever as to the wisdom of continuing treatment. 58 POLIOMYELITIS Cases will sometimes reach a point where it would seem that all has been done that may be done, but unless complete recovery has taken place the parents should be encouraged to continue the treatment for some months. Not infre- quently when this course is pursued one, two or three months the patient's condition shows a decided improvement as compared with the condition when it was thought improve- ment had come to a standstill. Furthermore, the osteopath should not base his conclusions as to the wisdom of continu- ing treatment solely on the condition of the parts paralyzed. T0 Ktwtf* w"n ll"Tlf Scrnoitt FIG. 23. The spine is made up of sections called vertebrae. Between the verte- brae pads are placed to cushion the spine. Within the spinal column the spinal cord is found. The cord has three coats. A cross section is shown with a darkened center. Part of this center is the motor area that controls the muscles and is found damaged in infantile paralysis. In a child whose general health and constitutional condition was much below par prior to the onset of an attack of polio- myelitis, it is to be expected that nature will devote some at- tention to rehabilitating said constitutional condition, and in the circumstances she can not give all her energies to re- storing the affected limbs. Even though a case has apparently come to a standstill as far as progress with the affected limbs is concerned, we be- TREATMENT 59 lieve it unwise to discontinue treatment for some months later. So much more has been accomplished for many of these cases than the osteopath thought could be accomplished that it is well to give the patient and the treatment the bene- fit of any doubt that may exist as to the advisability of con- tinuing treatment. 1R '.*, m PLATE N. The ligamentous bands that hold the spine together and fasten the ribs onto the vertebrae. The drawing to the left shows them removed from the bones. CHAPTER 6 Hints to the Public on Infantile Paralysis A. G. WALMSLEY, D. O. The epidemics of infantile paralysis that the United States and Canada have witnessed in the last decade or so have made this disease appear among the dread possibilities of each summer and early autumn season. In addition to the epidemics that have been of sufficient severity to attract attention, each year witnesses sporadic or scattered cases throughout parts of the country not included in the epidemic areas. The general public has grasped certain facts in connection with infantile paralysis more readily than is the case with most diseases. This would seem to be due to the nature of the disease; to the fact that in so many cases it leaves one or more extremities shrunken and lacking normal usefulness. And this again emphasies the fact that perhaps no form of illness or incapacity attracts the public eye to the extent that does physical deformity and inability to use one's body or parts of it. But from the standpoint of the public, several questions present themselves : What are we to do? Can anything be done to prevent my children becoming victims of infantile paralysis? If they should come down with the disease, what is the best thing to do? Prevention should be the watchword of all intelligent lay- men as well as of progressive physicians. But in order to pre- vent the development of any disease we must have some grasp of the conditions that favor or make for its development. Infantile paralysis is classed with the infectious diseases. The invading germs, it is claimed, find entrance to the body through the mucosa of the nasal tract. Medical literature, in discussing the cause of infantile paralysis, gives practically no space to any other factors as operating to cause this disease , holding that it is due solely to germs. With this view we must take issue. Observation and experience have shown that a number of things predispose to and favor the develop- ment of infantile paralysis aside altogether from the part HINTS TO THE PUBLIC 61 germs may play. For example, in many of the children who come down with the disease there is a distinct history of a fall or injury in which the spine is affected, this dating from a few days to a few weeks prior to the onset of the trouble. On examination of such cases it has not been difficult to discover spinal irregularities that w r ould result from such accidents as mentioned. Anything that will inter- fere with the normal relationship of the bones forming the spinal column will favor the development of infantile paraly- sis, because the blood supply to the spinal cord and to FIG. 24. When dressed up a curvature is not always noticed by the casual observer. The outline of the spine to the left, is also a front view and tells the tale. Notice the drop in the right shoulder. certain cells of the cord, which cells are affected in infantile paralysis is interfered with; drainage from the cord is particularly interfered with where the spine has been strained or injured, because even a slight injury causes the muscles to contract, and this through pressure on the vessels impairs drainage from the spinal cord. Where drainage from the spinal cord is impaired the poisons contained in de-oxygen- ated or venous blood are not removed and their presence lowers the vitality of the tissues and favors the onset of inflammatory conditions. 62 POLIOMYELITIS Those members of the ostebpathic profession who have studied carefully both the acute and later stages of infantile paralysis have been impressed by the fact that almost invariably there is a derangement of the alimentary tract coincident with the disease. Not only is there a loss of desire for food, but when the colon is flushed the stools are of an exceedingly offensive nature. Is it unreasonable, then, to assume that a filthy intestinal tract lowers the resistance of the body and favors the development of the disease? We aver that it is not. And the very fact that colon flushing early in the disease lowers the temperature and conduces to the general comfort of the patient seems sufficient evidence that the contained filth played a part in causing the disease. But why do so many children as well as adults have filthy intestinal tracts, and why are so many taken down with intestinal diseases in the summer months? Because there is no season of the year when the digestive tract is bombarded with such a quantity and such a variety of "eats" as in the summer and early autumn months. At this season we not only have the usual staples as meat, potatoes, bread and butter, milk, cream, pie, cake, puddings, etc., but we also have fresh vegetables of all kinds, and also a wide range of fresh fruits. Added to this list we have fruit, pickles, jams, etc., etc., that mother is putting up for winter. And super- added to the above we are confronted with ice cream, sodas, soft drinks and candy, candy, candy at every turn. Weigh the fact that owing to the heat of summer the body's resistance is lowered; also weigh the fact that we do not require the same quantities of heat producing foods such as fats, sweets, etc., in the hot weather as in winter; and further, weigh the fact that pathological fermentation takes place more readily within the body, just as foods, fruits and vegetables ferment or spoil more readily in our cellars or re- frigerators in the summer months than in cold weather. When these facts are duly weighed and the added fact that at no time of the year is the alimentary tract invited to sample such a wide variety of consumables, is it any wonder that nature so often rebels? The mere recounting of these things should be sufficient hint to the wise to practice moderation. Cut down on the heavy foods in summer; eat more fresh fruits and fresh vege- tables. Do not allow your children to be constantly guzzling HINTS TO THE PUBLIC 63 ice cream and soft drinks and eating candy. Never mind if some wiseacre says that "ice cream is good," or this or that is good. Many a thing the constituent parts of which are good is not in itself good, and this is true of ice cream, soft drinks and candy in hot weather; a little is all right, but none but the strongest can take these things daily without court- ing trouble. It has been remarked by many in the profession that an attack of infantile paralysis was preceded by unusual activity on the part of the victim. The writer frequently has had parents call attention to this fact and cite it as proof that "Willie was unusually well just before the attack." How are we to interpret this picture of unusual activity and in- fantile paralysis following soon after? If we will associate a few simple facts, facts with which any layman is familiar, we should find a solution to our question. Is it necessary to call attention to the fact that the average child wears as little clothing as possible in the summer? The child, even in hot weather, is irrepressible; he will romp and play until tired out. When tired what does he do? He lies on the cool grass or in any cool place he can find. And w r hat, under such conditions, so often hap- pens? The muscles of the back contract and the back feels stiff. If we have this condition plus a deranged intestinal tract as outlined above, we have ideal conditions for the de- velopment of infantile paralysis. The contracted muscles of the back interfere with circulation to the spinal cord and especially with drainage from the cord, and favor the devel- opment of infantile paralysis. The writer has seen quite a number of cases in which the picture presented tallied in every respect. When we consider that the spinal cord of the child is not fully developed and therefore has not the resist- ance of that of the adult, are not the conditions enumerated sufficient to overtax it and cause trouble, and to do so with- out the introduction into the system of germs? And if disease germs are introduced into tissues thus weakened they find them an easy prey. Parents should know that body resistance is much lowered when the weather is hot and humid. Hot weather in itself is not so bad, but when it is both hot and humid for weeks at a time there invariably is an increase in children's diseases, and particularly in those diseases in which the ali- mentary tract is involved. 64 POLIOMYELITIS During the epidemic of infantile paralysis in and about New York in the summer of 1916 the weather was exceedingly hot and humid for weeks, and it is worthy of note that as soon as it began to cool slightly and the atmosphere became drier and clearer the number of cases reported at once showed a marked falling off. In such weather parents should pay close attention to the intestinal tracts of their children, both in the matter of food taken and in the matter of keeping the bowels clean. Children should not be permitted to play to the point of physical exhaustion, and they should be kept in- doors and at rest for an hour or two in the heat of the day, and especially following the mid-day meal. Finally, if children are taken down and infantile par- alysis is suspected or a positive diagnosis is made, the vital question is : What should be done? Osteopathy has proved the most successful treatment to date for infantile paralysis in both the acute and chronic stages. In fact, it is the only known treatment that is able to cope successfully with this disease. If the child is so ill that it apparently can not be touched, do not be afraid to call an osteopath. If a preju- diced M. D. says that the osteopath "will ruin your child," that it "will surely die if an osteopath treats it," etc., etc., do not be deterred. The osteopath is the one to say when osteopathic procedure is indicated and when not. If the average M. D. were asked when osteopathic measures were indicated in any condition he would almost always say never. Why, then, should the public expect a man who is prejudiced against all forms" of treatment but his own to recommend Osteopathy for infantile paralysis or for anything else? The medical profession is very dogmatic as to what should and what should not be done during the acute stage of infantile paralysis, and one can but wonder at their colossal conceit when one contemplates their record of failure abject failure in treating this disease. The osteopath realizes that he does not know all that is to be known about infantile paralysis, but he has demonstrated that his treatment will will do more for it than anything else will do. And what is more, it has been fully, indisputably proven that the earlier the osteopath gets the case the better are the chances for complete recovery of the use of paralyzed parts after the acute phase of the disease subsides. CHAPTER 7 INFANTILE PARALYSIS E. FLORENCE GAIR, D. O., Brooklyn, N. Y. While a student at the American School of Osteopathy I became greatly interested in the treatment of Infantile Paralysis, and I decided then to make it as far as possible a specialty, or my hobby, and try out everything, no matter how longstanding or how bad ! In the class room I had been told not to consider a case after two years from the attack and to seldom give prognosis for a cure after six months. I started my clinical work in the Fall of '11 after grad- uation in June. My first case was a "dope" case I had to put in the ward of a private sanitarium, as no hospitals are open in New York City to osteopathic physicians. While treating this case another woman in the ward told me of an infantile paralysis case just dismissed from Rockefeller Insti- tute as a hopeless cripple, and asked me would I take it? In this case the left leg hadn't a muscle that reacted to stimuli; it hung limp from the thigh down. I got excellent results in a short time; and during my absence at Christmas time, when I went on to take a Post-graduate course at the American School of Osteopathy, the Rockefeller Institute sent for my case, not knowing it was under my care. The child's walking amazed them greatly. Several doctors and nurses gave a thorough examination with all the tests. I was asked on my return to call, which I did, and Dr. Draper and I had a long talk and thoroughly discussed medical versus osteopathic treatment for this disease. As he was in charge of the w r ard for infantile paralysis he took me thru and showed me his cases. One case, the last, was being left entirely to nature's course, to see the result. I begged him to take findings, then let me treat, and go back again in half an hour and again take findings, and see what Osteopathy would do for such a case. Then I proposed to him that I would give so much time there and we would each take a certain number of cases and see results, or else he would send me cases after his examinations and keep in touch with each 66 POLIOMYELITIS case every month. I believe fully had he been free he would have complied with any of these suggestions. But Dr. Flexner was in charge over him, and there was the barred door. So this was my first and last visit to the Institute, and I fully realized how little such an institute is out for an all- round investigation. It must come only within certain prescribed centres. How wrong this is, only the unpreju- diced investigator knows. This first case, however, brought me any number my first year, for an uncle of the child was a barber in Harlem, FIG. 25. Dr. Florence Gair's sanatorium in Brooklyn. Dr. Gair has the largest infantile paralysis osteopathic clinic known. and he spread the news broadcast. The little girl's father was a fireman, and he likewise spread the good news, so that I had over 50 my first winter. One was a young Jewess of thirteen who had been in double braces for twelve years, her feet in plaster off and on for the past two years. They were swollen, misshapen and horribly discolored from impaired circulation. She had such a bad lumbar curve from sec- ondary contractures of her legs that she walked with but- tocks swung out and to the right, shortening her stature INFANTILE PARALYSIS 67 Considerably. I treated the case twice a week all winter, with very gratifying results. The curvature straightened, and the secondary contractures left the limbs, the feet be- came shapely; the swelling all disappeared as the circulation was restored; and today she walks thirty to forty blocks without tiring. The first time I insisted on her discarding her braces she could only go a few steps at a time and sit FIG. 26. Dr. Gair's collection of braces, casts, etc., removed from infantile paralysis cases during the past few months. Had she started saving them from the first, she would not be able to put them in one cart load. down and rest. She could hardly reach the car in front of my door, and had to rest on the curbstone. I didn't get her for treatment after the first winter, as she felt she was cured. The right leg had had a ham-string tenotomy per- formed, which left it contracted, so never was as good as the left leg. It is such a mistake to do these operations before treating the case and watching for nature's restorations first. 68 POLIOMYELITIS There is time enough later to resort to the knife, plaster and braces. This is the great mistake in medical treatment ; the end procedures are resorted to in the beginning instead of as a last resort, and WHEN is THE LAST RESORT? I was greatly interested in a case in my neighborhood which was stricken in the '80's. All the doctors gave up the case, but the mother never lost hope. She massaged and worked hard over those four crippled limbs and back. It FIG. 27. Last winter's case. Back of both legs atrophied now, almost com- pletely restored (case from 1916 epidemic). was two years before the arms were of use ; it was four years before the legs returned; and eight years before the child really walked. But today she is the mother of four chil- dren, runs her own auto, skates and dances. It shows that nature needs both time and, in many cases, assistance, to do her work, and we often give up too soon. This case gave me much food for thought, with this result : in my seven years of INFANTILE PARALYSIS 69 practice I have never resorted to an operation or employed a brace. In the bad spinal cases I use a boned corset for support if the spine is weak, while the child is learning to walk. I have the mothers massage and rub hot oil into the affected limbs and spinal muscles if they have the time, hot salt baths and exercises against resistance at first, then overhead bars and gymnastic work, acco rding to the case. FIG. 28. (1916 epidemic) Treated last winter. Paralyzed from chin to toes. All spinal muscles weakened, as well as both arms and legs. Fine results, as you see by picture. FIG. 33. This winter I took a young lad of eleven braced most up to his chin for weakness in spine and legs even a worse cripple than my Jewish girl I mentioned. He'd had the attack in infancy. His back was badly deformed with a mean double curve. To make this worse, his right thigh was so badly contracted and flexed that he couldn't sit up, and muscles atrophied. The first day I examined the case 70 POLIOMYELITIS it looked so helpless I was going to dismiss it, but the child begged so pitifully and said he knew he'd be cured if I'd just treat him. I told the father he might carry him to me for the Sunday clinic and I'd try him out, but to be sure to keep off the braces. He came the latter part of January, and owing to the inclement weather of this winter made many skips. Still, he is walking today on one crutch; both legs are on the floor; and the spine has lengthened out several FIG. 29. Boy age 3. Same boy as in Fig. 36, taken one year later. inches. He sits up nicely now as well. The atrophy re- mains, but the contractures have all disappeared from feet and limbs. All he says now is, " Didn't I tell you so? I knew I'd get well under the right treatment." It shows me how little we can prognosticate in these difficult long-stand- ing cases. I find nature responds so quickly, and so unex- pectedly, to the touch of the right button. Our motto: "Find it, fix it, leave it alone:" How fittingly it works with nature! INFANTILE PARALYSIS 71 This week, (last week of April, 1918), I had a two-year- old baby who had been under a chiro for months. He had failed to touch the right button and remove a bad pelvic twist on the lumbar. This had caused marked contracture of the right leg. The external muscles (the thigh rotators) had twisted the thigh and the post-tibial group, with Achilles tendon, had made the foot contract to bring the sole upper- most. After reducing the lumbar lesion Wednesday, the rotators of the thigh gave w T ay, and the leg went down to normal position. After stretching the foot muscles I bound them in adhesive plaster I found this morning, three days later, a marked improvement. The foot stayed placed normally on the table w r ith thighs flexed. No atrophy being present, I hope to get nice results in a few weeks in this case. I examined a bulbar case this week I had treated last winter. I got it two years after attack. You cannot find a trace of muscle defect. The treatment resulted in a com- plete cure. *' As my practice is entirely confined to clinical office work, I have taken very few acute cases. In such a work as mine one must limit one's endeavors. My earliest infant paralysis case, a boy of three years, was seen by me on the fourth day of the attack. Three baby specialists had seen the case, and had agreed that nothing more could be done save to leave the limbs swathed in cotton batting, keep the child warm in bed on his back, per- fectly quiet, and in six weeks bring him for electrical treat- ment at the office. The mother, hearing of my work, rang me up to ask what I thought. I told her NOW was the time to establish the cure, the sooner the better. I'd undertake the case, if I might have full charge and she would promise no inter- ference. When I saw the child that morning he was lying a helpless mass in bed paralysis complete on right side, including the face, with loss of speech, the right side of the mouth sagging and drooling saliva. I prepared a three-quart enema, and with my metal sigmoid colon tube I administered a good cleansing of the colon. The odor from the bowel was a stench, showing how necessary it is to thoroughly cleanse the tract, and this medi- cine will never accomplish. Then I examined him for lesions 72 POLIOMYELITIS and corrected those I found in lumbar, dorsal and cervical regions of the spine. This took about ten minutes. I had the boy put back to bed. I told the mother to turn him on his face, and let the spinal cord get drainage, which would rest him, to keep him warm in bed, give plenty of water, but just a liquid diet. She could rub the affected limbs with hot olive oil, but not for more than fifteen minutes, and also massage his back muscles. I 'phoned next morning and heard the good news that the arm was moving and speech returning, so I skipped that FIG. 30. The description of this case in the text is most interesting. Note the improvement as shown in case 31. day and went the following afternoon. I found motion was coming back to the leg. I administered the same treat- ment as first day and found the bowels in much better condi- tion. On my next visit the following day I found full motion restored to both limbs and speech nicely returning. What was my surprise on the fifth day to find him so lively that I couldn't catch him on the bed to treat him. He ran in every direction. INFANTILE PARALYSIS 73 It was a balmy, sunshiny spring day, so I told the moth- er to take him out at noon each day. This case doesn't show a trace of the disease to-day. Here is an interesting feature : He caught cold in the next ten days, and had a relapse with loss of speech and the use of the right arm. I sent him to Dr. DeTienne for these treatments. He soon had him well again. The M. D. formerly in charge had rung up to learn how the boy was doing. On hearing of his improvement, and that Dr. Gair was in charge, he told the mother to have a care, as in two or three weeks the after effects would be worse. FIG. 31. Same as case 30, taken a few weeks later. It was hypnotism. I wasn't a " regular" practitioner. I had no diplomas. I was just a quack. The mother was frantic and rang me up to tell me. My next earliest case was brought to me from a City Hospital after a three weeks' stay. (Both these cases were before the 1916 epidemic, else I couldn't have seen them for from six to eight weeks.) This child was in a frightful con- dition. The nurse had left a water bag which was too hot on the loin, with a resulting blister which became infected. It was a nasty big oozing sore when I saw it. The child was also infected with a nasty coryza. Her stools were run- 74 POLIOMYELITIS ning blood and both ears pus, besides the paralysis. It was a nasty case to handle. In two weeks I had her walking the length of my treat- ment table after pennies. The bloody stools ceased after the first enema, cleansing the colon and reducing the lumbar lesions, putting an end to that trouble. One ear cleared up in a few days, the other ran pus for over two weeks. The healing of the sore was likewise of long duration. This child made a nice recovery by the end of that winter. FIG. 32. "Three ambulance calls had refused to take him, as he was consid- ered too far gone." He now rides his velocipede for hours. I lost track of these cases, as the poor move about so much from one spot to another, and I haven't seen this one since. The winter following our epidemic brought me over one hundred and seventeen cases. I was in Seattle during that summer. From October onward cases in all stages of the disease kept coming in. It was very interesting to watch the pro- gress of the different cases. Some showed no signs of improve- ment for six months. I wondered how the parents kept up INFANTILE PARALYSIS 75 their courage, but it was only through seeing the improvement in the others and hoping that their child in the end would get well. One little fellow was brought to me early in the fall. Three ambulance calls had refused to take him, as he was considered too far gone. He was in a pitiful plight, stools running blood, rectum paralyzed and protruding, bad leg and spinal paralysis, with a horrible coryza. To show what a nice recovery he made, I have taken his picture. He can run about now on his velocipede for hours. Fig. 32. FIG. 33. This boy had an attack of infantile paralysis when a baby and was practically helpless when taken and restored to the condition as shown in the picture. One child, not three years old, was brought on a stretch- er. Spine too weak to sit up, legs both paralyzed, also right arm. I had her walking nicely in three treatments. This was a perfect case. Since then she broke her arm and had wrist drop. I was fortunately able to correct this deformity as well. I am still treating a little boy of three. The home town physician said he must be operated on at once. The right abdominal muscles were paralyzed, and the stomach pro- truded out like a small balloon. The child's right leg and arm were affected, and the spinal muscles too weak to give 76 POLIOMYELITIS support. Today he is walking, the leg muscles firm, the atrophy keeps decreasing and he has two nice shapely limbs. The arm is perfect, the spine is still a little weak, and to pre- vent a curvature I have him in a boned corset. The ab- dominal muscles have gradually regained their tone, so that there is is now no protrusion. In another year the spine, I hope, will be strong and able to do its work. FIG. 34. Most deformed case of talipes I have seen. Foot flexed on shaft of tibia. Heel and metatarsals meeting. Complete muscular atrophy of plantar mus- cles. Boy now skates with rollers and on the ice. I am still getting cases from the 1916 epidemic, that had received the medical treatment for two years. It is sur- prising to see the quick results which can be attained in these later cases. I immediately take off the braces and sometimes wonder what would indicate their use in cases of babies not yet walking. The improvement that comes from reducing a spinal lesion and giving the limb the normal blood and nerve sup- INFANTILE PARALYSIS 77 ply is often astonishing. A flabby useless limb will tone up in less than a month's time. Sometimes the improve- ment which is the result of treatment seems hardly credible. It only goes to show how responsive nature is, if we only touch the right button, assist, and not hinder. Sometimes I do not see a case for a year or two after the treatments, and the improvement is gratifying. Many bulbar type cases have been coming in of late to let me see FIG. 35. Bulbar paralysis on right side of face. Complete restoration. Right arm a trifle weak at deltoid yet. the cure. You can't find any lack of tonicity. Both sides of the face are normally balanced. This means more to a girl than to a boy, as the boy's deformity can be later cov- ered up with a beard or moustache. Some of these cases w r ere of four or five years' standing before they were referred to me, this making the cure all the more interesting from the standpoint of the duration of the paralysis. 78 POLIOMYELITIS My quickest recovery was the case of a child of three, Fig. 30. A week before the attack she had fallen down the cellar stairs. It was Sunday and the mother had returned from Sunday School. She noticed a sort of weakness in the child's limb, with a sudden giving way. Finding the child had lost all use of the lower limbs, she quickly prepared a hot foot tub, with mustard added, into which she put the child while she ran for a doctor. The child, for the next three months was confined to bed, couldn't sit up, and screamed so much with pain that narcotics had to be administered. The mother took her child everywhere, seeking a cure. Nine surgeons at the Long Island College Hospital advised an operation for the hip joint. In the mean- time the mother heard of me at her office, and next morning sent the child to my clinic, with a young girl who cared for it in the mother's absence. I adjusted a fourth and fifth lumbar. The child sat up and ate her evening meal for the first time since the attack, and had no further trouble. It was an overnight cure. The M. D.'s termed it a case of hypnosis and told the mother that the child's condition would be worse when the effects wore off. She has only a slight ptosis of left eyelid, which is hardly noticeable. The leg doesn't show a trace of the disease, Fig. 31. In getting my histories, many of my more rapid cures give direct histories of falls. On correcting the resultant lesion, the limb was quickly restored to use. Most of my cases from the 1916 epidemic are now walk- ing nicely. Some get well quicker than others. One never can tell, on examining a case, how it will turn out. The one you least expect results from often proves the best cure, and vice versa. The greatest trouble is, we give up too soon; we are too easily discouraged. My greatest annoyance is interference by the visiting medical nurse with the weak parent. She returns them to medical procedure, they go back to the brace, to the cast, or to surgical interference and the poor child must suffer! The only thing I resort to is an ankle corset and a boned waist for the weak spine. This can be taken off during ex- ercise and at night. I like elastic sides to give play for the ribs. INFANTILE PARALYSIS 79 I encourage mental effort in all exercise; that must be secured. Therefore, exercises against resistance are the best. I keep the child creeping as long as possible while the spine remains weak, and encourage chinning, and work on horizontal bar for muscle development. Swimming also is fine it brings all the muscles into play likewise the Kiddie Kar, the tricycle and velocipede, for lower limbs. I don't like mechanical electrical machines for training, for this does FIG. 36. Same case as Fig. 29. Boy two years old when this picture was taken. Boy at left had legs, arms and back paralyzed. He now wears a little corset, but walks nicely. not bring the cells into the same stimulus as personal mental effort in the training. I tell most of the children they can all walk if they only want to hard enough, and not to give up too soon and become lazy. My reason for objecting to the cast and the brace is this: the disease includes the motor and the nutritional nerves. As soon as you place a limb in plaster you decrease 80 POLIOMYELITIS the circulation to the part and increase the atrophy, and you don't get the desired results. The brace does the same thing. It is heavy for the weak limb, nearly always makes deformities of the feet, enlarges the ankle bone, and causes nasty sores and always atrophy and muscular weakness. Osteopathy immediately goes to the centre of the trouble, reduces the lesions, giving the impaired limb a better nerve and blood supply, reducing the contractures of old cases, and preventing them in the recent. It is the only logical, sensible, curative treatment for this disease. FIG. 37. She can now stand on her lees again. I expect a complete cure. CHAPTER 8 CASE REPORTS L. J. BINGHAM, D. O., Ithaca, N. Y. Case 1. Infantile paralysis in a boy 10 years old; called October 16. 1915, on the sixth day after initial attack. Patient contracted the dis- ease in the country on a hot October day after drawing a hand-sled up and down the road and other strenuous exercises causing extreme fatigue. Case reported high temperature during the first six days; temperature subsided just before I was called. I found the following picture: Both legs paralyzed, left one slightly worse than the right. Patient was unable to lift either leg. There were symptoms of extensive inflamation of the spinal cord and its coverings, with typical opisthotonos simulating spinal meningitis. There was pain in the legs, the back muscles and the back of the neck, and marked tenderness along the whole spine. The patient was constipated, with a furred tongue and poor appetite. The bony lesions present were a twisted fifth lumbar vertebra, and upper cervical lesions, thus making a block of the circulation at both ends of the spinal cord. There was a twisted pelvis, slight curvature, and an irregular alignment of ribs and vertebrae at points all along the back. His teeth were bad. Mus- cles were rigid along the whole spine. Previous to the attack the child had been notional about eating; parents indulged him with sweet foods and things he liked. Patient responded rapidly to treatment from the first. The diet was regulated, constipation relieved by enemata, and the lesions reduced as rapidly as possible. Treatment was given twice a day at first, diminishing until finally he was taking only one treatment a week, until May 13, 1916, when the patient was discharged in good condition. He apparently has as good use of his limbs in every respect as he ever did. Case 2. On the 19th of October, 1916, I was called twenty miles in the country to see a brother and sister of seven and nine, respectively. These children had been constant companions of a neighboring child that died of infantile paralysis about a week previous. Both children came down with the attack the day before I was called. There was a tempera- ture of 102, together with the usual characteristic sumptoms of an acute attack of infantile paralysis, but the paralysis had not yet manifested itself I will describe how I handled these cases and thereby give my methods of treating infantile paralysis. I ordered the mother to discontinue all food, excepting fruit juices, all the water they could drink and concentrat- 82 POLIOMYELITIS ed vegetable broth as long as the temparature lasted. The broth was prepared by grinding equal amounts of several vegetables through a food- cutter and boiling this pulp for three hours, afterwards straining out the pulp and allowing the child to drink the broth. I ordered an enema morning and night, a cold compress about the neck, and a daily hot bath. In cases where there is evidence of inflamation along the spinal cord, a cold, wet towel is put over the area and kept on until the pain and inflalmation subsides; rest in bed and treatments two or three times a day as long as the febrile stage lasts. FIG. 38. Nerve mechanism down thigh disturbed through a twisted pelvis and slight spinal curvature. CASE REPORTS 83 There were well-defined lesions in the pelvic and cervical regions. The boy had a slight curvature. I corrected these lesions as best I could on the first day. I stayed several hours and treated two or three times before I left. The mother followed my instructions carefully for a week before she gave any solid food. The little girl came through without any signs of paralysis. The boy had a slight paralysis of one leg and there was some paralysis of the chest muscles which interfered somewhat with breathing. On account of the quarantine laws and the great distance from town, it was several weeks before I got to treat the boy again. On the 4th of De- cember the child was brought to Ithaca and they stayed several days. He FIG. 39. This case has improved under treatment so remarkably that the curva- ture has been almost eradicated. then had a slight limp and his curvature was increased and it was difficult for him to take a full breath. I treated him three times on successive days. Later, he was brought in at intervals of a few weeks apart, until I had given the child seven treatments. This case made rapid improve- ment, the limp disappeared and the breathing and curvature improved. The last time I saw the case I could -not detect any muscle deficiency and the boy seemed to be as vigorous as before the attack. I attribute the comparatively mild effect on these two children to the fact that I saw the cases early and gave the corrective treatment and ob- 84 POLIOMYELITIS tained the cooperation of the mother in dieting and nursing the patients. I believe it is of utmost importance that food be withheld from infantile paralysis patients during the temperature stage and that every effort be made to eliminate and stop the production of toxins. Cold compresses placed over the areas of the cord involved are a great benefit. In addition to correcting the bony lesions, gentle, general relaxing treatment to keep down the nervous irritation, aid the circulation, and to promote elimina- tion is indicated. I believe osteopathy is a specific for infantile paralysis if it is applied properly and early enough. Properly graded exercises are important in helping to regenerate muscles and restore their function dur- ing the later stages of treatment. N. GAYLORD HUSK, D. O., Bradford, Pennsylvania Case 3. Boy age four. Arm and leg paralyzed, unable to sit up alone. This case was in the hospital for a time under medical treatment but was brought home as hopeless, the physicians saying nothing further could be done. Under osteopathic treatment he began to improve at once and continued to improve steadily. The leg has been restored to normal, FIG. 40. Front view of the pelvis, also outlines of the innominate bone when lesioned. and the arm has only a slight impariment of function when raising it above the head, but in time use and growth will rectify this slight defect. Fifty treatments were given. Case 4. Boy aged two. Leg nearly helpless, could not stand or walk on it, only slight motion of foot. Previous to the attack the patient walked normally. After a few treatments improvement was noticed. At first there was marked atrophy but this is greatly improved. This boy can now walk with but a slight "swing" to the foot. This case has had fifty-one treatments to date two treatments a week and is still under treatment. I am confident this case will be restored to normal. CASE REPORTS 85 L. M. BUSH, D. O., Jersey City, N. J. Case 5. A. C., aged 9 months; date of first treatment June 1, 1916. Previous history, bronchial pneumonia in January, not well since. No history of fall obtainable. Four brothers and sisters, none took the dis- ease though exposed. Present illness : About May 7 child indisposed and slightly feverish, continued irritable for two or three days before it was noticed that child did not move limbs. M. D. called and case diagnosed infantile paralysis but merely kept under observation. No particular medical treatment begun and parents became impatient and brought child to me. Examination showed both limbs flaccid and completely paralyzed, no reflexes, sensation to pain normal but no movement even of toes when foot was pinched or tickled. Too young to test control of blad- der or bowels. General appearance irritable, cried when limbs were moved or when they were washed or manipulated, face pale and thin, no fever, arms normal. Spinal lesions. Second, third and fourth lumbar vertebra apparent- ly posterior and ligaments tense at this area. FIG. 41. Relationship of the spinal cord to the atlas and sacrum. The cord does not extend as far down as the sacrum, but spinal nerves pass through it as through a sieve. 86 POLIOMYELITIS Treatment. Gentle relaxation of lumbar region with strong flexion and extension and stretching same; flexion, extension and rotation of thighs to obtain free motion or sacro-iliac synchondroses and correct les- ions; flexion and extension of knee and ankle joints to prevent anylosis or fibrosis and some manipulation of the muscles of the limbs to keep up cir- culation. After a week the child began to move the toes on one foot; in two weeks could move ankle and toes of other foot. In four weeks was able to flex legs and thighs weekly. I instructed the mother to exercise the limbs frequently and offer some resistance to movements of the child. In six weeks child could kick quite vigorously and move the foot almost normally. In ten weeks tests showed that there was full return of normal muscular action, though muscles were still weak. Child continued to gain strength and started to walk at eighteen months. Child also gained five pounds in first ten weeks' treatment. There are no signs of the par- alysis at present. Case 6. D. H., age 4 years, male, August 1916. Previous history. Had been playing with two children in same block who had been attacked with infantile paralysis the previous week. Weather hot and very humid (see note below). Present illness. Child appeared tired, cross and restless, and parents were worried because other cases of paralysis had started the same way. Sent for me as a precaution as this was in the midst of the big epidemic. Saw child at 9 p. m., fever of 103, restless and irritable, but no intestinal or other trouble to account for the fever. No paralysis yet. Gave treat- ment paying special attention to lumbar region of spine : there was a mark- ed rotation of the 12th dorsal vertebra on the 1st lumbar. I also manip- ulated the limbs to stimulate reaction. Visited child following morning at 8 a. m., fever 102, still restless no appetite, but no symptoms otherwise to account for fever; bowels moving but lost control of bladder. No other signs of paralysis. Treated similar to previous time. Saw child again at 8 p. m. and found temperature 100^, child seeming better but still no control of bladder. Treated twice next day and temperature normal by night. Treated following day and child felt and acted fairly normal except for paralysis of bladder. Continued treatment for three weeks be- fore child regained control of bladder. In this case only paralysis was of bladder but due to the history of exposure and manner of onset I feel sure it was a typical case of infantile paralysis, and I mention it particularly because I was called probably at the very onset of the fever (mother said he seemed to have none two hours before when she put him in bed) and the frequent treatments broke up the attack as an attack of pneumonia is frequently aborted. The paralysis of the bladder would seem to fur- CASE REPORTS 87 ther clinch the diagnosis. I did not call in consultation as the scare was so great I knew the family would be quarantined and the child removed where I could not treat him, to an isolation hospital. I had the family observe strict quarantine rules, however. NOTE. In watching the epidemic of 1916 here, I found one point that seemed to throw more light on the cause of infantile paralysis than any other. This was borne out later by weather bureau reports. The number of cases varied directly with the humidity and not with the heat. It was worse in seacoast towns where the humidity was greatest. The epidemic began to wane the first part of August when the weather became clear, though still very hot, and by the first of September there were few new FIG. 42. Hand everted. Lesion at 4th cervical. Case cured by osteopathic adjustment. cases, though it was still hot. That year there was a great deal of cloudy weather during the late spring and early summer here and even plant life acted in a peculiar manner, as lettuce rotted in the fields, beginning at the core; many other vegetables did the same and I laid it to the lack of sun- shine and continued humidity, as when the weather cleared about the end of the first week of August both the paralysis and this condition of the vegetable kingdom righted themselves. Another point of possible value : My own opinion is, that if a germ is the immediate exciting cause of infantile paralysis it is a widespread organism like the pneumococcus and present in most subjects all the time; 88 POLIOMYELITIS that it starts the general infection, just as the pneumococcus, when through general or local causes the resistance of the individual is lowered. Chil- dren being the weaker and less matured would be more susceptible because such general causes as humidity and excessive heat would reduce their resistance faster than it would that of adults. In several cases I have found a history of falls and believe this to be predisposing, allowing the infection to get a start. In practically every case I have had there have been other children in the family and none got it. I believe the above theory explains the cases where more than one in a family have been infected, and that it is not by direct infection. REGINALD PLATT, D. O. Minneapolis, Minn. Case 7. In 1910 there were four cases of infantile paralysis among students at Princeton University that were admitted to the University Infirmary during the month of October. Two of these ran a very short course and were fatal, the diagnosis not being made until autopsy. Dr. Simon Flexner and some pathologists from Johns Hopkins were in consul- tation and made the final diagnosis. Two other cases dragged along, one under treatment as typhoid for some time, was taken home and the last I heard, rather indirectly, was that while he lived he was so badly crippled that his return to the university was given up. The fourth was diag- nosed as infantile paralysis, taken home and did not return. At the opening of college at mid September, one of the students came to me for treatment for constipation and some trouble with his heart. He started in to take treatment twice a week. On the first of Novem- ber he came for treatment and complained of feeling out of sorts. He had had a bad night and felt nauseated all the time. Had never vomited in his life, but felt now that vomitimg would relieve him. Upon exam- ination of the spine, I found the musculature of the splanchnic region acutely contractured and very sensitive, with increased rigidity of the vertebral column. He had tried to eat breakfast but could not. Com- plained of chilliness, and showed temperature of 100.5 degrees. I gave him a thoro general treatment, specializing a little on neck and splanchnic regions, sent him to bed with instructions to eat nothing, drink a glass of water every hour and apply hot water bottle to the splanchnic portion of the spine. I kept him in bed for two days and treated him daily for four days, at the end of which time he seemed normal. Nausea left on the third day, after which the appetite returned and I concluded that the case had been a simple indigestion. CASE REPORTS 89 The following Monday, November 7, he came to my office to obtain an excuse to talk to the Dean. I wrote the excuse and as he was leaving the room he remarked: "What do you suppose is the matter with my right leg? It doesn't work right." I made an examination and found that the calf muscles of the right leg were partially paralyzed. He lacked the power to raise the heel from the floor while walking. There was a difference in the tonicity and temperature of the two legb. The short flexors seemed to be somewhat affected, but not to the same degree. This paralytic condition, together with the other known cases in the infirmary, led me to suspect that this might have been a similar case. The more I thought of it, the more the idea grew upon me. On November 16, I took the patient to the office of a medical doctor, who had a good electrical apparatus and asked him to make the tests for the R. D., and after doing so he gave it as his opinion that it was a case of infantile paralysis. Short- ly after this the uncle of the patient told him to go to another medical doctor, who was a particular friend of the uncle, and have him make the FIG. 43. Back view of the pelvis. Relaxed muscles and ligaments in infantile paralysis sometimes allow this condition to occur. Spinal curvature is the result. electrical test (This second medical doctor was very bitter against the osteopaths.) After making the test he made the remark: "I guess there is no doubt that you had infantile paralysis, but it must have been a mighty light case." I treated the case regularly three times a week, until the college closed in June, and at that time there was very little difference in the power of the two legs. The one affected would tire more quickly than the other. When he came back to college in September, there was so little difference that only on a rather severe test was it noticeable. I reported the case to the State Board of Health as infantile paralysis. Now as to the conclusions : I believe the case to have been infantile paralysis, but a light case. There were at least two factors that in my opinion contributed to the mildness. 1 . The few treatments received prior to the infection were directed to the area involved in the usual cases and, no doubt, had the effect of raising the resistance. 90 POLIOMYELITIS 2. He was under treatment from the very first symptom of any trouble, said treatment being directed specifically to the anatomical lesions present. The absolute rest given the alimentary tract with copious water drinking, favored elimination. Another factor that was probably as powerful as any other was the freedom of both physician and patient from the dread which a diagnosis of infantile paralysis would very likely have inspired. I think that if we osteopaths could only lose sight of the disease as an entity, and get away from the dire prognoses which are based on drug therapy, we would take an immense stride forward. Instead of treating the disease, treat the patient, and give him a chance to live. What might have been the outcome of the above case if I had been handicapped with a diagnosis of infantile paralysis during the acute stage, is hard to imagine. I was fresh from college and well filled with the ordinary med- FIG. 44. Curvature is always accompanied by tilted hips. ical teachings, and just as liable to be swamped with a mere name as another. I have often thought since that the failure to make a diagno- sis was the luckiest thing that ever happened to that patient. I have often heard osteopaths caution against manipulating the spinal tissues while they are so sensitive in the acute stage of infantile paralysis. Fear of exciting or increasing spinal irritation was the reason advanced. In almost all of these cases the pathology of the nervous system develops very early, while the acute symptoms are at their height. This stage sometimes only lasts a few hours, in which time disastrous results have been wrought in nerve tissue. After the acute stage is over the return of function seems to vary directly with the time that elapses before osteo- pathic treatment is instituted. The longer the elapsed time, the slower the improvement and the less of it. From this I conclude that treatment CASE REPORTS 91 during the acute stage is especially indicated, as in that stage the path- ology is developing. If we can resolve a certain amount of pathology, after its establishment, by our treatment, directed to improve the circu- lation to the cord tissue, why should not similar treatment have been a greater benefit when given at the time when the pathology is in the initiatory stage? The congestion of the cord in the early stage of infantile paralysis can be compared to the congestion of the lungs at the beginning of a lobar pneumonia. In the latter instance there is plenty of good evidence that ostcopathic treatment will reduce the congestion and normalize the cir- culation in the lungs in a very short time. (I have seen it done in less than half an hour.) If the congestion progresses to consolidation we are confronted with a pathology different in nature, and the resolution re- quires more time. Still, osteopathic treatment will resolve the consolida- FIG. 45. Spinal curvature not only produces lack of symmetry, but interferes with organs and tissues. tion more quickly than any other method. The pathology of infantile paralysis practically is much like that of pneumonia, viz: an intense con- gestion followed soon by a degeneration of vessels and consequent forma- tion of hemorrhagic foci thruout the affected portions of the cord tissue. We all know what a clot means in nervous tissue. We all know that the rule is that, no matter how soon treatment is instituted to resolve the clot, the restortation of function is never complete. Why, then, should we hesitate to attempt the resolution of the initial congestion before the clots are formed? In the lungs we have the freest anastomosis in the body; this is an immense aid in the resolution of the clot in pneumonia and is the anatomic reason why a complete restoration of function is had in the usual recovery of pneumonia. In the grey matter of the nervous sys- 92 POLIOMYELITIS tern we have the least free anastomosis of the arterial circulation; hence the lasting loss of function following a clot in this locality. Everything points to thoro osteopathic treatment in the earliest stages of all acute diseases, and infantile paralysis would seem to be no exception to this rule. The idea of waiting until the acute stage is over for fear of producing more irritation, seems like hesitating to drive a mad dog away from biting a baby, because the dog might not like to leave. W. A. WOOD, D. O., Centralia, Illinois. Case 8. I have only had the opportunity of treating one acute case of poliomyelitis. In November, 1912, there were two cases in a small town in adjoining houses, one patient 3 and one 4 years old. I was called to see the four-year-old and a very prominent M. D. to see the other. We each examined and consulted together on both cases. He said there was very little could be done for them. I treated the four-year-old and he treated the other one. The doctor made very light of me when I gave him my prognosis. The result now is that the case I treated osteopath- ically is almost as sound as before. Having been affected in both legs the right leg was worse than the left. She still has a very slight limp, hardly perceptible to one not especially looking for it, with no atrophy of muscles. The M. D. finally gave the other case up as hopeless; told the mother it would always remain paralyzed, which it has, so far, with the muscles bad- ly atrophied. I lay my success in this case to the spinal treatment during the fever stage, which assisted in reducing inflammation. LYNETTE BARTON, D. O., Bartlesville, Oklahoma. Cases 9-10. Several cases of infantile paralysis came under my care in the year 1913. Most of them came in the month of June. Without referring to my books, I recall thirteen cases. Probably there were two or three more that I have forgotten. One case, a girl aged four, died. She had been treated with great severity by a chiropractor previous to my visit. Otherwise I think she might have recovered. The majority of these cases were referred to me by medical doctors thru the influence of an M. D. who had opportunity to observe the progress of a similar case of his own that had been brought to me over his protest. Of these thirteen cases, seven were mild. Four of the seven were turned over to me as soon as the fever left and these four show no evidence of the paralysis to the untrained observer. Of these four the minimum of treatment administered CASE REPORTS 93 to one patient was six treatments. The maximum to one patient was twenty-four treatments. The other three of the seven mild cases were brought to me at periods varying from three to six weeks after the onset. One, a boy four years old, had never entirely lost the ability to walk. These show slight atrophy of muscles and to a slight degree characteristic gait. No shortening. No contractures. No curvatures. One severe case where I was called early shows less evidence of the disease than the milder ones that came under treatment late. In three of these thirteen cases the lesion was in the cervical enlarge- ment. It is difficult to get babies to submit to neck treatment. These were more severe than most of those showing lumbar cord infec- tion, and results of treatment were not so good. One girl of 1 1 a terrible case was able to attend school the follow- ing year. She shows few signs of the disease, but her arms are weak and FIG. 46. The shortening of a leg following an attack of infantile paralysis pro- duces curvature and a weakened organism. she has to wear a brace to prevent curvature. I got her early. The other two were six weeks late. The cases ranged in age from 13 months to 1 1 years. The youngest of them all a Polish baby whose parents could not talk to me without an interpreter showed consideralbe atrophy of the gluteal muscles of the affected side after four or five treaments. Both sides were alike when treatment was concluded. This nearly always occurred in the cases that came to me early. The Polish baby was the one that received twenty-four treatments and the parents wanted me to publish the cure in the daily papers and give their names as references. Treatment : During the period of fever, ice packs to spine or ice water sponging. Ice cap to head. Extremely gentle inhibition treatment to spine for short period, once or twice daily. In all cases massage of painful limb, gently given for short periods, with olive oil, witch hazel and al- cohol equal parts. 94 POLIOMYELITIS I never treat a case of infantile paralysis long at a time. After the fever is past, but while the spine is still sensitive, I use gentleness in hand- ling. When the sensitiveness has vanished I treat vigorously, but never long at a time. I use a vibrator close under the heel on the sole of foot of the affected limb. This gets vibration on the long bones and attached muscles and constitutes about the only local treatment given limb. I do not use the vibrator on the back. I instruct the mother to rub the affected limb for three minutes twice daily with a compound of olive oil, witch hazel and alcohol, and to sponge the spine, limb and ankle once daily with cold salt water. Things to guard against: Over-treatment and electrical treatment. Medical doctors are liable to insist upon both. I have never seen any- thing but harm result from either,altho this may or may not be permanent. I advise osteopathic treatment for infantile paralysis without delay. In the beginning of the disease two weeks' time is so important. I treat three times a week the first month. After that semi-weekly. In the cases I have described only one took as much treatment as I thought advisable. Most of the chronic cases that come late for treatment should have from four to six months' treatment. Rest four months and take three more. Then two months' treatment twice a year for a few years. Only one of these children has ever needed leg braces. HARRY W. GAMBLE, D. O., Missouri Valley, Iowa. Case 11. One case I carried thru the acute stage was a few years ago. I made an early drive, eight miles on Saturday, and found a boy in an alarming condition. His father asked me to take the case and stay on the job as long as life was left and that I thought I could do good. This was a very malignant type and I was greatly worried, along with all the fam- ily. Father at noon told me they were satisfied that I had held my own which the medical doctor could not do, but if I wished help from Omaha, Sioux City or Council Bluffs, he would be glad to wire for it. I told him I felt I was doing all a D. O. could do, and wanted no help of that kind, tho I wished some one to share the responsibility with me, as I feared death soon in the case. I did not wish to call an M. D., for fear he would wish to dope for this or that, and I expected no advantage from such a course. They were satisfied with my work, the father only wished to show willingness to get more help if I needed it. Ice water compresses to spine, with thoro, frequent treatment to the entire spine thruout the day and much of the night, showed decided results before midnight; coma CASE REPORTS 95 and delirium, with respiration that discounted Cheyne-Stokes type. Results showed osteopathy could deliver the goods. The boy had not been very strong and active, but paralysis of feet and legs re- sponded daily very fast; and nutrition and motion were soon perfectly re- stored. I stayed all day Saturday, from before daybreak, until about 2 a. m. Sunday, when I got four hours sleep and the boy got quite a little rest at this time, then, getting worse again, they awakened me, when I got back on the job and worked almost constantly: I would treat the cervi- cals for opisthotonos and delirium; fever not very high; massaged legs after treating spine thoroly, as they were cold and seemed lifeless; one arm slightly involved ; worked all the time, as ice packs to spine and head did good when I did not treat. By Sunday noon he seemed like another person. It was phenomenal how he responded, and after dinner I went FIG. 47. Brace removed six years after an attack of infantile paralysis. home and returned daily for a week, then alternate days a few times, and he was cured, no evidence whatever of the paralysis. I have carried but two cases of infantile paralysis thru the acute stage, but have had several others under my care after convalescence, to deal with the paralytic conditions. None need have misgivings but that osteopathy can and does deliver the goods even in this terrible malady. The first case I had about ten years ago, after paralysis involving both legs in boy ten years of age had discouraged the M. D. in charge the first few days, who advised that there was little hope of his ever walking even if the patient lived, and he advised osteopathy. I went to examine and prognose the case, and was given full charge of the patient Both legs totally paralyzed; treatment daily, almost entirely to spine. Restored one leg to perfect use, and the other leg gained slowly but surely for six months. Later I treated but once weekly. Not a toe could be moved, 96 POLIOMYELITIS bowels and bladder but slightly involved. When the boy quit he was in better health than ever, and can now skate, or ride a bike very decently, tho considerable atrophy still exists, and he walks with considerable swing and limp. His brother is one of nine from this community now at A. S. O. I have been called in to play second-fiddle in two cases, both very low for a week before they called me, reaching the unconcsious stage and apparently completely paralyzed, one girl age ten, they gave brandy to, internally, externally, and eternally, but I could not agree with such pro- cedure. Heart about 160, etc., and I only treated her twice during the first day, she dying that night. Cases 12-13. Two other cases that I stuttered about the diagnosis of, but decided finally were cerebro-spinal meningitis, recovered fully. FIG. 48. Well developed curvature in a neglected case. The last one, boy, nine years old, had a homeopath and allopath, and was surely dying, had he contiuued down the path. He called for the osteo- path, both in delirium and when conscious, as I had pulled his chum thru a year ago when given up to die with rheumatism of heart. His parents could not have faith in osteopathy when both M. D.'s could not control the case, and they feared poliomyelitis, so they thought they could not let him die without granting him his dying wish for treatment. Bunting, nothing gives me the gratification and downright joy, not to add respect for our profession, that results such as this case showed. Every treatment showed decided gain ; so, in a few days, he was out of danger. It is so closely related to poliomyelitis that, when congestion can be so wonderfully controlled in meningitis of one kind, it assures me equal- ly wonderful results can be had in any other. The destruction of any area CASE REPORTS 97 must make allowances for results expected. Of course there is very much that I don't know in the disease you ask light on, but I have given you some hints that may serve you. Pure ten-fingered osteopathy is the only type found in this community, thank God. Am heart sick after just reading reports that there is so much damnable doping by pseudo D. O.'s going on. I'd hang or ostracize every mixer in the ranks and refuse license to every such person. Drugging is rotten enough in the hands of the best M. D. 's. J. W. PAY, D. O., Milbank, S. D. Cases 14-15. Four years ago an epidemic passed this way and it was my fortune to have seven cases to care for. These varied from the FIG. 49. Neglected cases. first stages to paralysis of several months' standing. The cases that I had from the beginning made the best showing and there is not one of them but what is walking today. The two cases that came to me later, after re- ceiving the regular medical treatment, show good results, all improving greatly under treatment. But one of these cases will be crippled in one leg, as the destruction of tissue had gone too far before the case came to me. A typical case in a two-year-old boy made a complete recovery in three weeks' time. The lower limbs were affected in this case. The case of a four-year-old girl, where the arm on the right side and both lower limbs were affected, recovered completely in three months. 98 POLIOMYELITIS In the seven cases treated all have been restored except the one case mentioned, and all show normal conditions: so I should say osteopathy is the successful treatment. I realize seven cases is not sufficient experience to base much of a conclusion upon, yet to me it shows that we are able to do immeasurably more for for these cases than the old-time treatment. MARGARET E. SCHRAMM, D. O., Chicago, Illinois Case 16. I have had a typical case of infantile paralysis, which I cured in two months' time. Osteopathy's success was stupendous! Three medical doctors had given up the case as hopeless before I took it. Osteo- pathy was employed as a last resort. My little patient's mother took care of her baby in the most intelligent and conscientious manner, with- out which all osteopathic treatments must have come to naught. Three years ago I was called to attend a baby girl nine months of age. She had been a healthy, normal and mentally bright baby before being stricken. When I first saw her both of her lower limbs and one arm were paralyzed ; flexor and adductor muscles were contractured ; her eyes were of a leaden hue and her temperature was subnormal. Was a bottle-fed infant. I was properly frightened at the sight of a child so nearly dead ; however, I was determined to give osteopathy the usual good try out. The first time I treated the baby w&s late at night. That was on the first day of the month. The next day I treated her twice (early and late) ; after that once a day up to the 7th of the month, when I began to treat every other day. My first treatments lasted four minutes and were directed to the spine only (greatest tension in upper dorsal area). Gradually the treatments were made more general, lasting about ten minutes. My little patient got her first ten treatments at home and then sixteen treatments more at the office a few blocks from her home. Twenty-six treatments did the work. All the functions of her body have been restored and the child has en joyed perfect health ever since. The only adjunct to osteo- pathy employed was a tepid bath daily, followed by an olive oil rub and the taking of half a teaspoonful of olive oil daily. We had no trouble with the bowels of the patient. We did not dress the baby after her bath, but wrapped her in a soft flannel blanket and let her take her morning's nap. After the nap she was dressed and taken for an outing. This happened in early autumn, but the outings were adhered to rigidly. When I first treated the baby she cried violently and fought against it with all her might; that ma/le me think that I was hurting her; however, a little incident proved to me that pain was not the cause of her rebellion. CASE REPORTS 99 The baby's mother found it necessary to leave her charge for a week in order to recuperate her strength. The child was left in the care of a stranger. I called at the house again because it simplified matters for the nurse. When I came to treat the little one (this was probably at the end of the first month) she was delighted to see me, because she knew me bet- ter than her nurse. From then on her treatments seemed to be pleasant or even entertaining to her. We have been friends ever since. No doubt i lit- baby had been spoiled in spite of all efforts on the part of the mother to control the situation. The little one had developed a habit of being awake at night and to sleep, whenever she did sleep, in the daytime. She FIG. 50. Case restored to normal by osteopathic treatment. overcame this habit in six weeks. It must be considered that the child suffered desperately for three months before I took the case, passing thru all the stages of the disease. A. J. BROWN, D. O., San Antonio, Texas Case 17. History of case of infantile paralysis, November, 1913. Children of Mr. and Mrs. Persons, Bay City, Texas. Girl, aged 3 years, stricken on Wednesday, died on Sunday. The boy, aged 20 months, was stricken the following Wednesday. The fever lasted about a week, result- ing in complete paralysis, even to all muscles of the neck and to the upper eyelids. The child was taken to the leading physicians in Houston and 100 POLIOMYELITIS San Antonio, but no hope of recovery was given by them. The child was brought to me about two weeks after being stricken. I gave him daily treatments with the following results: After the second treatment, nor- mal movement of the bowels and kidneys. End of first week, eye and neck improvement well marked. Second week marked improvement in all the limbs; third week, could turn and roll over on bed; fourth week, could stand on feet with a little help, and from that on improvement was fast until complete recovery was effected. I treated him daily from Nov. 20 to Jan. 31, giving sixty-five treatments in all. I understand that his health has been even better since recovery than before the attack. FIG. 51. Back view of case 50. The treatment I gave daily was to spearate each vertebra, move both sidewise and apart so as to give free circulation to the cord and take out all contractions of spinal muscles. Gentle treatment of abdomen and loosening of the muscles of the limbs along the course of the blood vessels and nerves. I have had altogether about twenty cases of infantile paralysis and very good results in all ; but the results were more marked in this case, due no doubt to getting the case so soon after the fever. If we could vi these cases at the first we could save 90 per cent in my opinion. CASE REPORTS 101 HARRY VAN DORAN, D. O., Elizabeth, N. J. Case 18. Aug. 8, 1916. Patient, Lee Maclnnis, age 5 years, male. Address, 33 Montgomery St., Newark, N. J. History of present illness: Child arose in the morning without apparent illness; an hour later com- plained of pain in the abdomen and in the muscles of the ulnar portion of t lie forearm and hand, left side. When I arrived at 1 :30 p. m. the above symptoms were present and there was tenderness over the deltoid, ten- derness and pain on slight pressure in first to sixth dorsal area, right uni- FIG. 52. Brace removed from infantile case (author's case). lateral first and sixth dorsal, both slightly posterior, and rotated fourth cervical. Temperature, 103 F. I found out that the child's aunt had been holding a child in her arms, the child being sick then, and a day later the case was diagnosed as acute anterior poliomyelitis, but without being aware of this she also held Lee Maclnnis. There was also a case of anter- ior poliomyelitis in the house next door, 31 Montgomery street. Treat- ment : I first manipulated in area affected, then adjusted to correct all lesions, gave an enema of two quarts of tepid water and salt solution. Full pack, using cold epsom salt solution. Repeated the above, or por- 102 POLIOMYELITIS tions of the above treatment, as the case indicated. After the cold full pack the temperature dropped to 101 F. I remained with the patient till 5:30, when the temperature was 100 4-10 F. Aug. 9, 9 a. m. Tem- perature normal, muscular pains absent. Diagnosis Anterior poliomyelitis, abortive type. Addendum: I know of other osteopaths who have treated cases of infantile paralysis in the acute stages. I have found that all acute con- tagious diseases respond quicker to osteopathic treatment than to the medical. We osteopathic physicians have not had the opportuinty to take care of an epidemic because all health boards are composed of or controlled by the M. D.'s. L. M. BUSH, D. O., Jersey City, N. J. Case 19. A. C., age 9 months; male. Previous history, pneumonia January , 1916, lost 2 pounds from 16 to 14 pounds; continued to lose gradually until May, at that tune weighing 12 pounds. Onset present illness about May 7, 1916; out of sorts a few days previously and slight fever. May 7 it was noticed he did not move his limbs. M. D. summoned paid little serious attention to case until a week or two later he pronounced it infantile paralysis and left a little medicine. May 27 case brought to my office with both limbs entirely paralyzed from the hips down. Could not even move his toes. Temperature 99 3-5, pulse 120, considerable rash on skin of whole body. Had been fed on Eskay's food, so I changed to modified milk formula and treated three times a week. Lesions 12 D, first and second lumbar posterior, making quite a lump. Whole lumbar spine was stiff. I treated specifically these lesions; also used pressure along the sciatic nerve to stimulate and keep them from degenerating. The baby could move his toes in a week, draw up his limb in two weeks and kick off the covers in a month. Discharged Aug. 7, no paralysis gained 3 3-4 pounds and perefctly healthy. MARY D. MORGAN, D. O., McMinnville, Tenn. Case 20. Dr. Mary D. Morgan tells of an interesting acute exper- ience which she believes was anterior poliomyelitis, but diagnosis is not sure. Three years ago I was called to see a little girl 5 years old, who was very ill. I had been their family physician for several years. I did not hazard a diagnosis at the time of the acute illness but afterwards conclud- ed it was infantile paralysis. I gave all my time to the thought of what CASE REPORTS 103 was to be done for her while she was so terribly ill. The mother and I sponged her off and I treated the neck gently and on down the spine until all tension was removed. The fever fell several degrees, she quieted down, dozing off to sleep. The fever was very high. Sometimes she was delirious, complaining much of back and limbs. This lasted for a week. We watched over her day and night, doing all that could be done. The fever gradually subsided; by the fifth day she slept more naturally. She complained of numbness in the limbs. I directed my treatment more to restoring the circulation to the limbs. As she gained strength this numb feeling left and she learned to walk as before. It was, indeed, a hard fight. I am doing all I can in my humble way for the people, and to convert them to Osteopathy. FIG. 53. Brace removed after two years' use (author's case). 104 POLIOMYELITIS T. M. KING D. O., Springfield, Mo. Cases 21-22. About eleven years ago a 3-year-old child was afflicted with anterior poliomyelitis and had the usual symptoms, as I remember, without having a record of the case to refer to, and in addition a history of a fall previously. I was called on the case three weeks after paralysis had occurred and found both lower limbs totally paralyzed. She was unable to move a muscle below her waist. The only lesion found was a posterior condition of the fourth dorsal. In six weeks' treatment the child made a complete recovery. Another case was stricken in the month of August with the usual history, vomiting, high fever, headache; and on the third day the right FIG. 54. The nerves pass down the arm from the spinal cord. The flaccid and atrophied muscles in infantile paralysis cases are restored by treating the spinal cord centres. Osteopathy affords speedy relief in these cases. leg was paralyzed. When I first saw her the following December she had but little use of the limb and was unable to support her weight on it. During three months' treatment she improved sufficiently to walk with- out support. I have no doubt she improved much more, for I referred her to an osteopath in Kansas, as they were leaving Springfield, but I lost track of the case. I have treated other cases, but have had very little success in any case that was of more than one year's duration. I realize these are very unsatisfactory reports and I cite them only for the encouragement they may lend to others who come in contact with this dread disease. By all means get the cases early if possible. CASE REPORTS 105 W. W. HOWARD, D. O., Medford, Ore. Case 23. In September, 1913, two children, boy and girl, were stricken with anterior-poliomyelitis at the same time. They were about the same age. The boy, 2 years old, came down with the disease on Monday. I was called and began to treat him the following Sunday. First he was taken to a very fine M. D. and surgeon, who diagnosed it as infantile paralysis and said he would never walk. The right leg was para- lyzed. In two weeks he began to try to stand. I treated him ten months. Result : Complete recovery, both as to size and strength of leg. FIG. 55. Braces have been taken off by the score through osteopathic measures. The little girl is still in bed, helpless. They have had her. up and down the coast to different specialists with no results. They never took her to an osteopath. They were told of my success, but for some reason would not try Osteopathy. (I was told because of prejudice against any system that was non-drug.) I was also told that both children had been affected to about the same degree. But of this detail I cannot vouch. K. T. VYVERBERG, D. O., Lafayette, Ind. Case 24. I want to relate my experience with a case of infantile paralysis I treated that made a complete recovery. Boy, five years old, became paralyzed early part of July, 1912. Called to see him four or five weeks later. Medical treatment up to that time. Entirely help- less when I first saw him. Both legs equally affected, arms slightly, all back muscles, and muscles of neck; could not raise his head from bed. Suffered considerable pain. Spine contracted and very sensitive. Re- flexes gone. Commenced light, gentle, general treatments daily for about seven days. Hot fomentation to back daily; also instructed mother to nil) legs and arms and back lightly once or twice daily. We noticed 106 POLIOMYELITIS considerable improvement at end of first week. Treatment every other day for about two months. Then twice a week for a while. Then once a week for some time. Had boy under my care for about a year, at the end of which time I pronounced him well. His entire muscular system is now as strong as any boy of his age. His endurance is good. The knee reflexes have not returned, but possibly may in time. We must get these cases early to get the best results. The parents of the little boy think that osteopathic treatment can perform miracles, as their first FIG. 56. Plaster paris cast removed from boy aged 3 (author's case). doctor told them that their child would probably be helpless the rest of his life. I treated a number of other cases that were brought to me after dis- ease had been standing a year or longer. I found that I could not im- prove them very much, except possibly their general health. I. L. JAMES, D. O., Springfield, Mo. Case 25. In July 1913, we had about fifteen cases of infantile par- alysis in Springfield. On July 3rd I was called to see a little boy about three years old, and on arriving at the house was given the history of the case, and was told that the child had been under the care of the family physician. On June 30th the child was taken suddenly ill with nausea, vomiting, malaise, and temperature running up to 103. The medical man diag- nosed the case as acute indigestion, and when he was called again, three days later, found the legs of his patient both completely paralyzed. His diagnosis was then given as infantile paralysis, and he told the parents CASE REPORTS 107 that there was very little that he could do, merely leaving a tonic, and instructing them to give him warm baths every day. He further told them that the condition that the boy would be in a year from that time would be his permanent condition for life. After making an examination I was satisfied that the medical man's diagnosis was correct, and in response to the questions of the parents told them I was confident that Osteopathy could effect a cure, as I had been able to secure the case in its early stages, and our experience had shown that in most cases of this kind we were able to secure wonderful results, particularly when the case was received in the early stages of the disease. FIG. 57. Curvature weakens the body and causes nervous instability. The case was given me, and I went to work. I visited the child once a day, giving him osteopathic treatment and instructing the mother to give him warm baths each day. As before stated, at the begin- ning of the treatment both limbs were completely paralyzed. At the end of three treatments the child was able to crawl around on the floor, and after about ten treatments was able to walk by being supported. From that time on recovery was rapid, but I continued the treatments until forty-four had been given. I see this child frequently, and will say that he is as healthy, strong and active as any normal child, and shows no signs of muscular weakness or atrophy in his lower limbs. I had this case before our local osteopathic association, and the doctors were all delighted with the results obtained. BERNARD S. MCMAHAN, D. O., Washington, D. C. Case 26. Child, age 3 years; six weeks previous to treatment she lost use of right limb ; had walked normally for age previously. Muscles 108 POLIOMYELITIS just beginning to lose tone. After six weeks' treatment she regained use of limb very materially. Stopped treatment on account of moving, but the improvement continued and nearly a year later I learned there was no trace of the disease. RALPH D. HEAD, D. O., Pittsfield, Mass. Case 27. Girl, 4 years of age, attack came on in the usual manner. For four weeks was under the care of an orthopedic man without results. The legs were paralyzed and during that time there was absolutely no im- provement. The M. D. was discharged and I was called at the fifth week. Both legs absolutely paralyzed. Muscles of right leg very flaccid and less tone than left. Treatment was as follows: Twice a day FIG. 58. The curvature found in a spine is usually in proportion to the difference in the length of the limbs. the mother (who by the way, is a trained nurse, and can therefore carry out instructions intelligently) gave the child a hot bath, with a handful of mustard in water. The child was given a thorough massage of the muscles three times a day. The limbs are at all times kept warm. To accomplish this I keep woolen underwear on the child and at first used in addition flannel cloths to wrap around legs. Specific osteopathic treat- ment has been given to loosen up the lumbar region, which in this case 1 was very stiff and rigid. There were no obvious structural changes. Prescribed resisting exercises which would bring into play all muscles of thigh and leg. Let me say that this latter has got to be done very slowly CASE REPORTS 109 and patiently and must be persisted in. It must not at any one time be r;ii Tied to the point of fatigue, but be done enough times so that at the end of day the child will have had practically all the exercise it can stand and be comfortably tired. Great care must be exercised to see that the muscles which present the most marked symptoms of paralysis shall re- ceive their resisting exercises or else the child will be over-developed in one set and an opposing group will be so weak that it results in con- tiacturcs and deformities. Result, after four weeks of treatment, the child can now use legs in most all of their normal movements with the exception of extending legs on thighs. I might add in treatment, that I do not let the child get on to her feet as yet, depending entirely upon the exercises to strengthen her limbs. These cases are not for the hurried or three minute osteopaths. On the contrary, they must be studied carefully and intelligently. The care of the child by nurse or parents is of the greatest importance, and unless you can have their faithful following out of your instructions you are only half accomplishing what might be done. Louis E. WYCKOFF, D. O., Los Angeles, Calif. Cases 28-29. We had an epidemic in July, 1912, in which I had exper- ience with two cases of recent infection, but not during acute symptoms and not until after fever had subsided. So I cannot say anything about FIG. 59. Level shoulders and hips are usually found where no spinal curvature exists. the results of osteopathic treatment during the acute stage. I was called in each case about a week after the fever abated. One, a boy of 16, had paralysis of the leg, arm and face, and I suc- (((< led in overcoming all but the paralysis in one leg. The other, a baby of two years, had been left with facial paralysis. This was entirely corrected. 110 POLIOMYELITIS One thing I feel quite positive of is that it is infectious, but not actively contagious. Both of these cases came in contact with children up until quarantined and not one case was traceable to them, nor was there any in their respective neighborhoods. I believe that Osteopathy will show best results in all these cases, early or late. Practitioners cannot be too careful in asepsis and hygiene, because I know danger from infection is great. We know a young physician who is a hopeless cripple from contracting this disease from a case. C. L. NELSON, D. O., Logansport, Ind. Case 30. I wish to call your attention to the epidemic of anterior poliomyelitis that passed over this country in 1909 and 1910, since which time I've had under treatment with varying success at least twenty-five cases, and have seen even a larger number of chronic cases leave my office because I would not encourage them to expect speedy and com- plete recovery. FIG. 60. Curvature undermines the health. During this wave of which I speak I was not privileged to see any of the cases in the active or acute stage, and of the fifty or more cases, of which I knew, reported as such, I think but four resulted fatally. My cases have ranged in age from 2 years to 30 years and from a slight damage to one hand to complete paralysis of hand and arm and a com- plete paralysis. Of twenty-one cases, fifteen were female. The great- est obstacle in treatment of these chronic cases is to get the parents to be persistent to stay with the treatment for two or three years, or during the growth and development of the child, but where I've been able to have them realize the situation I've had results that were very satis- factory to them as well as to myself. Another obstacle in our treatment is the lack of knowledge of the pathology of the disease. It is recog- nized as infectious and contagious, but of all the cases in this county I CASE REPORTS 111 know of but two families where there was more than one case, and this in face of the fact that many of them were not recognized and correctly diagnosed in their earlier stages and no quarantine or preventable meas- ures were adopted. Am sorry to confess I've never kept case reports in any of these cases, but as I look over my list I recall each of them and their damage and history. Could write for each of them quite a complete outline. One peculiar thing I've noted is that the damage is not always in proportion to the severity of the acute attack in other words, cases that were badly damaged were reported as having had but a few hours or a day or two of illness, while cases with slight damage were reported as having had a most serious illness. ALICE N. WILLARD, D. O, Norfolk, Va. Case 31. Two young naval officers on board ship worked all day in the bilgewater. That night they were off duty, on shore together. Both were taken with infantile paralysis and treated by the naval hos- pital physicians. One of them had no other treatment and when last heard from was still in a wheel chair. The other "lived up to the light, " as it was shown him. He had massage and later when hearing the good news of Osteopathy came to us for treatment. He improved rapidly and when called away on duty had only a very slight limp. FIG. 61. Infantile paralysis deforms the little ones unless they are properly treated. The shortened and withered leg, the tilted hips, and the affected nerves are shown. 112 POLIOMYELITIS It has been my good fortune to have had the opportunity of watching closely the cases of two boys. At the opening of a country school two boys drank freely of the water from a well that had not been cleaned out since the year before. Both were taken with infantile paralysis and treated by the same M. D., with the usual results. The one having no other treatment has made no progress toward recovery, remaining about the same. The other was brought to me for treatment and is now perfectly well, feeling only a slight weakness in the right leg when stepping up. As I treated this case myself alone I had a good opportunity to study it. My husband, the late Dr. William D. Willard, had wonderful suc- cess in infantile paralysis, having treated some children at the same time the M. D.'s were treating others during an epidemic. His cases recovered without the serious results that the others experienced. I am sorry that I cannot give you the details in these cases also. E. C. HIATT, D. O., Payette, Idaho Case 32. The one case of infantile paralysis (in a boy of 5), which I have treated, came with a history of a fall out of the back of a wagon on to the head; and as the facial muscles were the first to show paralysis the diagnosis was uncertain. The arms were not affected, but the left side of the face and both legs were almost completely paralyzed. It was several days before there was much prostration. After nearly two months he began to walk again. Gentle and thorough relaxation of all spinal musculature I regarded as an important part of the treatment. Medical books to which I have access say nothing about the facial mus- cles as likely to be involved in this disease; but I remembered that Dr. Laughlin had mentioned that they were sometimes affected, and that helped form my conclusions, until Dr. Gerdine confirmed the diagnosis fully. For a long time the child walked with a limp and the mouth was drawn around to the right side, but now, after a year, there is very little evidence of his trouble to be found. C. A. BLACK, D. O., Lima, Ohio Case 33. A prominent medical doctor in Lima, Ohio, claimed that little Helen Watkins would always be a cripple, following an attack of infantile paralysis. After such a prognosis the mother became discour- aged and was advised by a friend to try Osteopathy. The patient has CASE REPORTS 113 completely recovered from paralysis of the entire right side in three months' treatment, with no deformity. The patient is 4 years old and condition is believed to have been caused from a fall down cellar stairs. Her sixth, seventh and eighth dorsal were rotated to right with very marked lesions and rigidity. Right innominate was posterior, causing considerable difference in the length of legs. There have been five cases of infantile paralysis in Lima thus far; one case died, three were left with deformity and one case entirely cured. EUGENE PITTS, D. O., Bloomington, 111. Case 34. I could not write a scientific case report to save my soul, but I have had many cases of infantile paralysis and as they vary in vio- lence so greatly it would be necessary to keep strict case reports on every case to give definite conclusions. But generally speaking, I have decided FIG. 62. The lungs are more perfectly shaped when no spinal curvature is present. lesions at the atlas, 3 C., 11 and 12 D., and 3 and 4, lumbar, to be the cause of the disease, and I have never known of a single death from this disease in this town in nearly sixteen years of practice where a D. O. was called in in any reasonable time. I remember the case of Sylvia Green, 3 years old, who was stricken five years ago last March, and was delirious when I arrived, but after three hours' osteopathic work, with high enemas, and hot baths, was restored to consciousness and made a complete recovery. Sylvia is now a little past 8 and is going to country school every day and is a perfectly healthy child. T. OREN WATSON, D. O., Seattle, Wash. Case 35. My youngest sister was stricken with the sporadic type of this malady eighteen years ago at the age of eleven months. This gave 114 POLIOMYELITIS me an opportunity to watch the case and its handling by the best medical doctors in our locality, which was in an Eastern State. The child had the usual apparent light cold, but on the morning of the third day of her supposed cold the right leg hung limp. She was im- mediately taken to the best medical men available, but they were all at a loss to know what was wrong. They advised the use of a battery, which caused the baby to scream with pain throughout the treatment, but out- side of that she was cheerful and happy. During the electrical treat- ment the little thing would reach down and try to pull the helpless limb away from its tormentors. This treatment was continued for a while, with no help. The case was then taken from one medical doctor to FIG. 63. The bony framework protects the central nervous system. another for seven months with many diagnoses, none of which were cor- rect. The prognosis was always hopeless. About this time an osteo- pathic physician was engaged who succeeded in giving her some use of the limb, but just what groups of muscles were again brought into action I cannot say, as my knowledge of anatomy in those days was somewhat limited. I have forgotten just what actions she regained, but mother advises that she took two steps after a month's osteopathic care. Then she fell ill with cholera infantum and died in seven days, as mother thought she was too sick to take to the osteopaths, who were twenty miles away. She called in the medical men again for this latter com- plaint, under whose care she passed away. I have since cured many CASE REPORTS 115 cases of acute diarrhea in both old and young with -no failures, and if I had known as much then as now, or if mother had taken sister back to the osteopaths for the complaint that proved fatal, we might have had her with us yet. In later years, while I was in training for my profession, this disease (infantile paralysis) came under my consideration. Im- mediately I diagnosed my sister's case, and this, I am sure, was the first correct diagnosis. The disease under consideration was first discovered in 1840 in Europe, where it is quite prevalent yet and they still have frequent epidemics. There have been a few epidemics in the United States, also in Aus- tralia. There was an epidemic in Los Angeles a few years ago. This is the location of my Alma Mater and they naturally handled a number of cases the in the college clinic, with uniformly good results when taken in time. As you know, the specific organism causing the disease has not been discovered and probably will not be until our microscopes are made much stronger than now, as it passes through the finest porcelain filters very readily. The organism seems to thrive in the secretions of the nose, from which secretions of a monkey suffering with the disease it is possible to transmit it by inoculation to other monkeys for several months. The undiscovered cause, be it a germ or what not, seems to attack first the endothelial cells lining the terminal arteries of the central nervous system and most frequently the anterior spinal branches of the lumbar enlargement in the spinal cord, in which are located the nerve cell bodies of the nerves that supply the muscles of the lower extremities. This causes an immediate inflammation and round cell infiltration around the artery in which is located the nidus of infection. The severe acute inflammation with the attendant swelling and other phenomena cuts off the circulation to and crowds the anterior horn cells to such an extent that they undergo cloudy swelling, and if not relieved, degeneration. This seems to be the primary lesion and there are such lesions for each group of paralyzed muscles. They probably all start about the same time. In the cases that prove fatal one of these primary lesions involves the medulla oblongata or later spreads to it from the cervical enlargement, invading the upper .vegetative centers or the nucleus of origin of the pneumogastric nerve. There are many secondary foci for the infection in various terminal arteries of the nervous system, but before these become as formidable as the primary lesion the patient, in favorable cases, has developed a reaction and the increased leucocytes keep down these secondary lesions. 116 POLIOMYELITIS The lymphoid tissue, which forms the white blood cells or leucocytes,, whose business it is to fight all infections, increases very materially throughout the body, thus showing that the organism which causes the disease is circulating in the body fluids and exciting the protective reaction known as leucocytosis. After the patient overcomes the infection the spinal cord shrinks and the anterior roots decrease in size at the point or points of the primary lesions due to the death of the nerve cell bodies in the former and their fibers in the latter. FIG. 64. From a girl of 7 years. Symptoms. The incubation period lasts about five days, during which the patient has headaches, pains and stiffness of the limbs with a fever running from 100 to 102. Following this the paralysis appears, usually of one leg, but may be one arm, both arms or one leg and one arm or any other combination of these. The paralyzed member is not anes- thetic because the sensory nerve cell bodies, as you know, are not located in the spinal cord, but in the posterior root ganglia of the spinal cord. The limb is not painful unless injured or stimulated by heat, electricity or otherwise. In a few weeks the paralyzed muscles begin to show a disuse atrophy. CASE REPORTS 117 Prognosis. If the case is properly managed from the beginning so as to limit the damage done until the body cells have a chance to overcome the invading organism, T consider the prognosis good for an ultimate re- covery with little or no muscular loss. However, if the primary lesion involves the medulla oblongata the prognosis, I think, would be wholly bad, no matter what treatment given. General Management. Two nurses should be put on the case at the beginning, with nothing W do but look after the patient night and day. FIG. 65. "Hipping out" accompanies scoliosis; a poor physical start in life for a child. The patient should be kept lying face down on a feather pillow with the body and hence the spinal canal sloping upward toward the head, so as to give the return blood flow the best opportunity to get away from the congested area, thus lessening the congestion and destruction of nerve cells in the primary lesions. The gentle upward slope of the body and spinal cord tends to keep the primary lesions from spreading toward the brain stem. The child under no circumstances should be picked up and fondled by loving mothers or other persons, as this bends and twists the back and greatly aggravates the already severe inflammation, causing it to spread and involve more of the nervous tissue. The patient suffers no pain 118 POLIOMYELITIS as a result of the handling and the mother, not knowing the condition existing in the spinal canal, thinks that it does no harm to handle the child. Treatment. The only treatment needed in the acute stage is gentle intermittent pressure lasting for five minutes on the erector spinse muscle mass over the involved portion of the spinal cord, as indicated by the paralyzed muscles. This will drive the blood out of the tissues sur- rounding the primary lesion toward the heart; this in turn will drain the excess of blood from the cord through the small veins passing through the intervertebral foramina, relieving the congestion and inflammation in the spinal canal. These treatments should be given every hour, I FIG. 66. The nerve mechanism of the leg. night and day, when the patient is awake. This can be given by the nurses under the direction of an osteopathic physician. This form of treatment should be kept up for at least four weeks and six weeks would be better. After that treatment should be given to stimulate the circu- lation of the blood and nerve -force through the spinal cord and the paralyzed muscles. This will hasten the growth of the nerve cell pro- cesses of the injured, but not destroyed nerve cells, and help them to re- establish their connections with the paralyzed muscles. The passive exercise of the limbs will prevent some of the wasting until such time as the nerve cell damage can be repaired. Quarantine. Each case should be strictly quarantined and no one except the nurses and the physician should see the patient. All dis- CASE REPORTS 119 charges from the mouth and nose should be burned right in the room if possible and all other excreta should be thoroughly disinfected before leaving the room. All linen and clothing should be soaked in strong soapsuds of the two per cent mercurid iodide germicidal soap for several hours before leaving the room. The physician should make an entire change of clothing and put on garments covering every portion of his person completely, using a respi- rator wet with soap suds of the above-mentioned soap, and before leav- ing the room this clothing should, while yet on the physician, be thor- oughly sprayed by the nurse with the strong soapsuds, when he should retire to another room and remove the wet garments, dropping them into strong soapsuds again. These to be boiled without removing from the soapsuds then hung out to dry and be ready for the next visit. The nurses should care for themselves in the same way. U. G. LITTELL, D. 0., Santa Ana, Calif. Case 36. A. C., girl, age 4 years. Under M. D. care first week. Diagnosed sciatica. I was called Nov. 15, 1911, the 8th day of the disease. I found the left leg in a state of flaccid paralysis and the little patient suffering from nocturnal paroxysms of pain, accompanied by intense itching all over the paralyzed limb. The pain recurring about every hour. I gave treatment every hour the first night, and with increasing intervals, for eight nights. Then three times per week to Nov. 29, then twice a week to Jan. 22, 1912. Result: patient walked with crutches about a month, then laid them aside with fair use of the limb. At present, after six and one-half years, the affected limb is slightly shorter and considerably smaller than the other, showing that certain trophic nerve centers in the cord were disabled. Treatment in this case was directed to the relaxation of tense spinal tissues and encouraging elimination, with passive movements, at first, and later active resistive movements of the affected part. Case 37. A. M., male, age 18 years. As in Case No. 36 this patient came under my care a week after initial fever appeared. I found an oversized young man weighing 200 pounds, with partial paralysis of the right arm and the left leg. Initial symptoms were described as a "grippy cold. " Here I found tension and tenderness from occiput to sacrum. Treatment was given twice daily for six days, then once a day for twelve days, when with slight 120 POLIOMYELITIS improvement, he was taken to another city. Later he was placed under the care of another osteopath and made a complete recovery in about a year from date of initial attack. Case 38. M. H., male, 6 years old. Had classical symptoms of anterior poliomyelitis with complete right-sided paralysis when one year old. When brought to me he had fully recovered the use of the leg but the wrist was flexed at a right angle and the fingers flexed to the palm. He had never used the right hand. The mother stated that when he was asleep the wrist and fingers would straighten out. In this case the first dorsal vertebra was lateral to the right. This was easily corrected. Treatment twice a week for seven weeks with gradual improvement. I used a splint to keep the wrist in extension between treatments. J. P. FOGARTY, D. O., Michigan City, Ind. Case 39. Dorothy Thornton, Michigan City, Ind., age 5. Family history good. Previous history of child, unusually good health. Present illness: Following a three weeks' stay in the hospital for what was diag- nosed as acute poliomyelitis, the child was brought to me with a flaccid paralysis in the anterior tibial and peroneal group of muscles in one leg. When first seen by the family physician, was said to have fever, pain in the neck and spine with head drawn back (opisthotonos), followed by paralysis. t FIG. 67. The normal arch of a foot is wonderful in construction and arrangement. The black line is the large nerve that supplies the muscles in the sole of the foot. Infantile paralysis weakens the arch. CASE REPORTS 121 The child was treated daily for about one month with a general spinal treatment and manipulation of the leg. Later, twice or three times per week for 7 or 8 months. During the first month treatments were given very light but general, later on more specific and heavier. There was a gradual improvement from the first and by the seventh or eighth month had completely recovered and had a normal gait. This particular case would seem to show that a complete cure is possible when osteopathic treatment is started early and kept up. I consider this rather a light attack, although the child was said to have been quite ill at first. A. G. WALMSLEY, D. O., Peterborough, Ont., Can. Case 40. Girl, aged five. This case first came under my notice October 26, 1917. The history is as follows: Some five weeks previously the mother of the child found one morning that the child was unable to raise up or to turn over in bed, and would not allow any one to touch her about the trunk or lower limbs because of the pain resulting therefrom. An M. D. was called, who after examining the case pronounced it hip disease. The prognosis was grave; he said that the child might not even live, and that if she did she would be a cripple. In the week immediately following, the child improved slightly, its mother being able to handle it somewhat, but it was still confined to bed. At the expiration of two FIG. 68. "Broken arch." The arrow indicates one joint that is opened up. Notice the heel-bone sprung backwards. Compare with Fig. 67 and note how much nearer the floor the arch is at point of arrow. The nerve was left out to show the better the sprung joint. 122 POLIOMYELITIS weeks the doctor in attendance asked for consultation, and the consulting physician concurred in the diagnosis and the prognosis of his colleague. Three weeks later, or five weeks from the onset of the trouble, the child was brought to my office; the mother carried the child upstairs and sat her down on the office floor, the child not yet being able to stand, and of course it could not walk. Before examining the child I inquired carefully into the history of the case. As soon as the mother mentioned hip dis- ease I naturally was on the alert, realizing that hip disease is not a dis- ease to be trifled with. The history brought out two very interesting points, namely: First, two days before the onset of the disease the child while playing in the yard climbed a ladder to a height of some four or five feet and from this position fell to the ground. Second, this child is inordinately fond of meat, and at some meals will eat nothing FIG. 69. "The spinal column is literally alive with nerves." else if it can get all the meat it wants. It so happened that at this time the mother of the child was spending considerable time with the neigh- bor next door whose husband was on his death bed, and the child was with her the greater part of the time. While there the neighbor's daugh- ter indulged the child's appetite for meat. That the toxic state produced by overeating, and especially of meat, lowered the child's resistance and made it more susceptible to the paralytic condition that ensued, seems a reasonable hypothesis. Examination. My first thought on examining the child was to confirm or disprove the diagnosis of hip disease. This was not a difficult matter, and in a few minutes I was able to assure the mother that the child had not hip disease. She then asked me: "Well Doctor, what's the matter?" I answered: " Your child has infantile paralysis. " Her CASE REPORTS 123 next query was: "Can anything be done for her?" And I assured her the child could be greatly helped and in all probability cured. Contin- uing with the examination, I found slightly rotated third and fourth lumbar vertebrae and a very tense condition of the lumbar group of mus- cles and some involvement of the muscles higher up in the spine. The child was still quite tender and made quite a fuss during treat- ment, but after each treatment this tenderness was less noticeable and in a few days had entirely disappeared. After five treatments the child was able to walk by taking hold of chairs or tables, and from this time on the improvement was rapid. I treated the child three times a week for five weeks, and twice a week for three weeks following. By this time she was walking very well but would tire easily. I urged the mother to continue bringing the child once or twice a week for a time until it would be fully recovered, but for some reason unknown to me she discontinued. The first week in May, or about four months since I last saw the child, the mother brought her to my office to show me how well she was. In- quiry revealed the fact that while the child is walking well and in good gen- eral health, she still tires more readily than before the attack I again urged the mother to bring her back, but she has not yet done so. After I had been treating this case some six weeks, and the child had made the splendid progress referred to, the child missed one week (luring which she was not brought for treatment. When the mother brought her back I wanted to know why the child had missed coming the previous week, and the mother informed me that she had been next door nursing the neighbor mentioned above and could not bring the child. The mother then went on to tell me that the child had had another very sick turn and that she thought it was going to have another attack similar to the one that prostrated her before. Inquiry brought out the fact that the neighbor's daughter had again been indulging the child with all the meat she would eat, and added to this some candy. This was a sporadic case of poliomyelitis, there being no others in the city to my knowledge at that tune, and I feel no hesitation in saying that the causative factors in this case were the toxic state due to wrong food and over-eating, and the effects of the spinal injury resulting from the fall. Some four weeks after I began treating the child, the M. D. who was called in consultation by the physician in charge, saw the little girl play- ing about in a neighbor's house and the neighbor and the mother of the child had much difficulty in convincing him that this was the child he and his colleague said might not live, and that if she did live would be a cripple. 124 POLIOMYELITIS M. E. CHURCH, D. O., Calgary, Alberta, Can. Cases 41-42. On July 10, 1916, I got a hurry call to come and see a couple of boys that were unable to get up. They had been sick in bed for only a day and two nights, but had not been feeling extra well however before this, which was just after their arrival in Calgary. School closed the last of June, and the mother and three boys, 3^, 8 and 9 years respectively, together with their mother, left University Place, Edmonton, to visit some relations in the country, and then to come to Calgary to spend a while with Mrs. Johnson's mother, the boys' grand- mother. While in the country the boys played hard, as only boys can,, had lots of good things to eat, lots of milk to drink; in fact, their father runs the dairy of the Alberta University at Edmonton. On the train FIG. 70. The white tract within the sectioned spinal column is the spinal cord with its three surrounding membranes. Notice the cord extends only down as far as the small of the back. Between the spinal bones or vertebrae the spinal nerves pass out to supply the muscles and organs of the body. CASE REPORTS 125 coming down they had some ice cream cones and drank of the water on the train quite freely. As the case history showed, they had been in Calgary but four days, neither of the patients, the two older boys, felt extra well after their arrival, but had not complained to their mother until the night preceding the night I was called, and then it was simply that their legs were weak. The mother thought it might have been from playing too hard that they were sore and stiff, and had them stay in bed the day before. In fact, they tried to get up and couldn't. On arrival at the home I found the two boys in one bed suffering from an inability, as they expressed it, of drawing their legs up and straighten- ing them down. This was particularly true of the right leg of the older boy, and the younger boy (aged 8) was similar except not so bad; the younger boy's face showed signs of slight paralysis on the right side, which had not completely recovered at the end of two months. The boys were extremely nervous and irritable and complained of the back hurting. Having made the usual tests carefully, reflexes, etc., I turned them one at a time on their faces and gently manipulated the spine. The whole plan of treatment was for improved circulation to and from the cord; I then treated the neck gently, also carefully manipu- lated the musculature of the legs. The boys were refreshed from the first, and to make a long story short, I called twice a day at first; at the end of two weeks the boys were sitting up, able to draw the legs around, and were putting their weight on in three weeks and were taken to their home in a little over a month. The picture shows them standing on the veranda at two months, and shortly after this they entered school. I often hear from them, they are both well and as strong as if nothing had ever happened to them. I might say the younger boy, who seemed to have a predominance of the Bulbo-Spinal type, improved on his feet the quicker for the involvement was less in the area of the cord where the nerves to the limbs were af- fected. The facial paralysis cleared up slowly. I will now mention the fight we had with the Health Officer, who would not call and see the cases at first, and said the injection of spinal fluid into a monkey was necessary before a positive diagnosis could be made. To nip this in the bud, I wired New York, and got a reply saying that inoculation was not necessary in well-marked cases. My diagnosis was also sustained by the Health Officer of Edmonton, and admitted to by the Health Officer here later, after he lost his "swelled head" and was called down by a couple of the newspapers. I honestly believe from these two acute cases and a number of chronic cases I have treated, that there is no treatment that can begin to com- pare with Osteopathy in the treatment of acute or chronic poliomyelitis. 126 POLIOMYELITIS The boy of three and one-half years did not show a symptom of poliomyelitis, and he was with the other boys constantly until their con- dition was diagnosed. W. J. CONNER, D. O., Kansas City, Mo. Case 43. Boy about five years old. Examined 1908. He was brought to my office paralyzed from the neck down. He could not work a muscle in arms or legs. Bladder and bowels also paralyzed. This condition had existed for about ten days. Upon careful examination it seemed a hopeless case. I decided to call counsel; Drs. Cornelia Walker and Irene Harwood also pro- nounced it a difficult case. We decided that osteopathic measures offered the only hope of restoring the patient, and with that feeling I undertook to handle the case. Tenderness of the cervical tissues, without any specific lesion was noted. A relaxing treatment was given, with the object of accelerating the circulation to the cord in the cervical region. He was given all the oranges he wanted to eat. In one month's time he was sent home with the use of all his muscles. At home he made FIG. 71. Watch the kidneys in paralysis cases. A curvature will weaken them. CASE REPORTS 127 a perfect recovery. I followed the case for several years and he is now as perfect as though he had never been affected. Case 44. Baby two years old developed the usual symptoms of infantile paralysis. On the third day both legs were paralyzed. It proved to be a mild case, as six treatments directed towards clearing the circulation to the lower dorsal and upper lumbar region restored the case to normal. During my practice I have received for treatment twelve cases, and every one made perfect recoveries under the same treatment as indicated above. In order to get the best results, you must get the case within a week or two after the initial symptoms. The sooner the better. I have never been more than a month curing any case. Many are the cases I have treated during the chronic stage of the disease, but never have had the same results as when treated in the acute stage. Fio. 72. Back view of Fig. 71. 1 2S POLIOMYELITIS H. W. GAMBLE, D. O., Missouri Valley, la. Case 45. Last August there occurred four cases of infantile paraly- sis in this town within three days' time, within a radius of a half mile distance. The youngest was six months old, the oldest was five years. Across the street from the latter, the same week, a lad seventeen years of age was stricken with an unusual train of symptoms which the two con- sulting M. D.'s finally pronounced brain fever but had many character- istic symptoms of I. P. and might as well have been^so diagnosed A week later a girl age 22 years living sixteen miles from here was attacked with infantile paralysis; no other cases in this com- munity developed that I know of, and all of the above came into our care soon after they were diagnosed (but diagnosis was never made until after paralysis was established). There seemed no possibility of a com- mon infection or exposure to such. But one case was quarantined by the attending physicians and it was more isolated than the rest. Two cases permitted a number of other children to become exposed but no other cases resulted. One case was taken much the same, almost identically, the family claimed, as a little brother two weeks later whom I treated from the out- set and in three days he was well, with no paralysis developing; the family feels Osteopathy prevented serious results as followed the case under medical treatment before they called the osteopath. Climatic conditions in the above little epidemic seemed to have much to do with its presence. It was dry and dusty. During the past eighteen years we have had probably more than an average acute prac- tice in our field, and have had many cases to treat, most of them coming to us some months or years after paralysis is established. Our treat- ment for the chronic conditions has been probably the average, and results ditto. It has been our practice to treat the chronic cases more strongly and less frequently then the acute, otherwise it has varied less than it appears to with some D. O's. These cases all presented much the same history and symptoms, only in varying degrees of intensity, digestive disturbances predominating and most of them were treated accordingly by the M. D.'s; i. e. for above symptoms, as infantile paralysis was not suspected in any until paralysis intervened. F. E., age 3 years was most seriously afflicted, though in apparently good health previously. Family history rather bad, father's habits bad, mother's health poor. Two medical doctors handled the case for about three weeks when they advised the family to try Osteopathy. The right arm, back and legs were paralyzed, though had a trifle use of the hand. No motion in either leg or foot and back muscles paralyzed also. Very fretful and CASE REPORTS 129 nervous, had to be turned every few minutes night and day for the first month of illness. Stomach, bowels and kidneys, all in bad condition, air hunger and dyspnoea pronounced the first week of treatment. Medi- cation had been modest but took scarcely any after starting treatment, and discontinued in a week. Hyperesthesia most pronounced thruout the spinal area, with no portion more affected than the other. Con- traction of soft tissues less than would be found in most any other acute illness of same severity. Treated daily for two weeks, thrice weekly for two weeks, then twice weekly from October 1, 1917 to date April 1, 1918. Treatment was very gentle; slow, relaxing and inhibitory throughout the spinal area. General conditions unproved from the first treatment. The child was turned on either side and as hyperesthesia was relieved the treatment was increased to comfortable toleration. Both legs were FIG. 73. A section of the spine cut in half to show the groove for the spinal cord. The three spots indicate the openings where the spinal nerves pass out. No- tice the network of ligaments or bands that bind the vertebrae together. very tender also, and gentle treatment was given them every time. With- in less than a month the arm was in apparently perfect condition, the back and hips began to get some strength, and in about six weeks he could sit propped up in bed. Sleep improved every treatment and within a couple of weeks was sleeping normally, though had to be turned often the first ten days or two weeks; each treatment made his rest longer be- tween being turned until he could sleep all night long and could turn himself after couple of months' treatment. His general health by that time was almost perfect. It was about four months until he could sit unsupported on the table, and until he could take a very thorough treat- ment of any strength, while at present he is taking a very strong treat- ment. The right leg has been the worst, and atrophy more pronounced. He can crawl on the floor and onto the couch and turn a somersault. Wiggles the toes and foot slightly of left leg, but only faintest indication 130 POLIOMYELITIS of motion in the right foot. Improvement still continues but is some slower than at first, as was expected. Case 46. D. D., age 5 years. Taken with what was diagnosed as autointoxication. Left arm and leg were affected the third day, the arm but slightly, and the leg more severely. M. D. thought she had made good recovery, and said he would call up on 'phone, though he thought further calls unnecessary. Family became alarmed at the paralytic con- dition so thought of Osteopathy. I pronounced it infantile paralysis, and told them to isolate the case. Recovery of all trouble seemed good save for paralysis. Muscular atrophy developed in the leg, of half an inch, measured 3 inches above patella; cervical hyperesthesia most pronounced. Treatment daily for ten days, then alternate days for two weeks, then twice weekly for six weeks. The arm became normal within ten days, the leg and back improved steadily so could stand on both feet inside two weeks, could walk in three weeks; eversion of foot, and foot drop was overcome in six weeks and discontinued treatment thinking the child cured. I urged them to bring her once weekly for two months longer, but they hated to part with "der gelt," and thus economized. Case was generally considered cured by others, though I told them it was not yet complete, for when tired from overstrain at play the limp is quite apparent. They took the child to the family doctor to show them her cured condition, but he grunted that "she only had a slight touch of it," notwithstanding she could not sit alone nor stand alone when he ceased visits. Case 47. P. L., age 4 months, also pronounced autointoxication. Family doctor only made a couple of calls, did not consider the babe was in a serious condition, and it seemed to be well, though parents noted it failed to move one leg. The father stopped me in the road one day a couple of weeks after the doctor quit the case, though they had gone to his office telling them they feared infantile paralysis. He scouted the idea; but I told the father I was satisfied it was infantile paralysis. He asked me if I could help it, and I assured him that the results generally were good, but urged early treatment which he promised to start at once. Opposition pre- vented for some time, so it was over a month from onset until they brought the baby to me. Atrophy of the right leg was most pronounced, half an inch at the calf and 3-4 inch two inches above patella. Tho child had appeared most robust, it has had chronic constipation, kidney and stomach trouble. Hyperesthesia localized at the lumbar enlargement. CASE REPORTS 131 Treatment given to the dorsal and lumbar areas thrice weekly for one month, then twice weekly for five months. Recovery was slower than those cases taking treatment earlier. Muscular atrophy not entirely overcome but much improved, can use the leg considerably and bears weight upon it now. Constipation has been most obstinate indeed. Expected it to improve with little attention to it but got no improvement FIG. 74. The tonsils are located in the region of the Eustachian tubes that connect the back of the throat with the middle ear. Each tonsil is supplied with at least four arteries. Good drainage prevents congestion, and sometimes partial deaf- ness. Keeping the tonsils normal helps to prevent the entrance of germs. 132 POLIOMYELITIS until I gave it more direct treatment, and now the general health is the best it ever had. The furnace allows the home to be very drafty, and many severe colds have hindered more rapid recovery. I expect the child to walk, though there will likely be some limp. Case 48. E. H., age 3 years. Attended by same physician who advised Osteopathy in first case. He did not give diagnosis, but said the spine was affected and thought Osteopathy would help it. The child's neck, shoulders, left arm and leg were badly involved ; he could not sit up so was carried to our office. He had been attacked two weeks previously and they supposed it was stomach and bowel trouble with slight fever. In the cervical and lumbar enlargements there was pronounced hyperesthesia. Very gentle but thorough treatment to entire spine given daily for ten days, then thrice weekly for one month, then twice weekly for two months. Sleep during or following treatment almost invariably followed, as in nearly every case treated. Improvement noted from the first, and treatment gave improvement in general health as is usual. Kidneys of most cases seem to be in poor condition and improve greatly with treat- ment. Ninety-five per cent, of the treatment is to the spinal area and I rely upon spinal treatment for practically all results. The arm was first to recover, then the back, then the leg and finally the neck so patient could at last hold the head up. Three months' treat- ment made practically perfect recovery from every trace of paralysis, and general health best ever enjoyed. Case 49. G. E., age 22 years, living sixteen miles from here, taken ill soon after the above cases. M. D. from her nearest town did not attempt to name the disease; no one thought it was of any importance. The M. D. did not have to make but one or two calls, fever but a trace, and recovery seemed O. K. after couple days confinement to bed; but the left arm and leg did not act right, so they drove in to see me a few days later. I used a meat auger and Presbyterian corkscrew for a long time to get a history of the case. They acted as though they were in a den of thieves, but had no better place to go, and refused to give symptoms and history I wished; I finally told her I could not make out any thing but infantile paralysis from her reluctant story. I advised her to remain close to town with friends and have frequent treatment. After remain- ing all night with their friends they drove home the following day. She was again taken much as before and the doctor asked for consultation, when they told him they had been here and I pronounced it infantile paralysis. They quarantined the case after the other doctor got there, CASE REPORTS 133 she being some worse than the first time, this attack lasting a week, and the paralysis being more pronounced. Roads and weather prevented her return for treatment until March 1st, when she took three times weekly when possible. The right leg did not seem atrophied, and she only complained of sort of stiffness and weakness in that ankle. The atrophy in the arm and leg improved as did function until the left leg seemed normal in nutrition. While the right leg did not improve in size, its function did improve considerably; it still shows atrophied con- dition which was not suspected at first. This is unusual, I believe. Fifteen treatments have been given altogether with improvement suffi 7 cient for her to dispense with housekeeper's services, and she handles the home duties very nicely. Can get the arm up to the head quite well now, walks with but little limp, increased in weight 7 pounds, though she claimed good health at the time she began treatment. Treat- ment will be continued for some time to come, with less frequency, and with expectations of further gain. FIG. 75. The chest is hung onto the spine, and fastened together at the front by the breast-bone. As we breathe this cage of ribs and muscles moves upward and (( ive without correct attention. We must, in order to assist nature in overcoming any disease, see what nature's method of fighting this disease is, and aim to assist in just FIG. 81. We are shorter at night than in the morning, and we are shorter if we stoop, as in round shoulders. The arrow points to the pads between each section of the spine. the line nature is trying to act. The germs gain access through the nasal mucosa and spread all over the body. More than a thousand people are exposed to every one who is susceptible enough to suffer noticeably from the disease. Nearly all tissues of the body are immune from attacks of the germs and readily overcome them. Thus these tissues easily manufacture enough antitoxin to kill the germs, and if the circulation to every cell of the body is perfect this antitoxin is carried to every cell and the germs eradicated. The nerve tissue is the only kind that may need help and if any particular part of the nerve tissue is specially weak- ened, the germs at that point grow more virulent and their toxin tend to destroy the helpless nerve cells. We know that nerve cells that are actively functioning can put up a strong fight; but the quiescent ones are much more likely to succumb. It is, therefore, the duty of the physi- cian and nurse to allow the nerve cells to have all the needed physiologi- 142 POLIOMYELITIS cal stimulation that muscular activity can give them. Not only should the circulation through the nerve tissue be kept as perfect as possible; but we should be sure that the antitoxin, which every other tissue of the body manufactures, is carried promptly into the circulation and thus brought to the needy nerve tissue. As soon as the disease is recognized, if the bowels are constipated they should be well cleansed with enemas, and treatment begun. During the acute stage, the child should be put into a bath at tem- perature of about 103 to 105 degrees. The heat helps to relax the con- tractured muscles. While in the bath, massage should be given to thor- oughly stimulate the venous and lymphatic circulation, so the antitoxin made by the body cells can be utilized where needed, and the toxin from FIG. 82. Nature's method of nourishing the spinal cord, its membranes and the spinal sections called vertebrae. The artery sends a branch into the opening where the spinal nerve comes out. Any irregularity of the spinal column, such as a curvature, will interfere indirectly with the artery and nerve, also a vein that passes out to convey away the impure blood. Each spinal segment must be nourished prop- erly or else the nerves suffer. the disease germs disseminated over the body, to more fully stimulate the manufacture of antitoxin by the stronger tissues. Every muscle, as far as possible, should be exercised passively while child is in the bath, so that the nerve cells of each muscle will have the reflex stimulation of muscle activity. The bath and treatment should last ten minutes or more and be repeated about every two hours, or even oftener, as the case requires. Careful stretching of the spinal column should be attended to to force and free the circulation through the affected part. If the circulation is kept as free as needed through the cord, the accumulation of white blood cells, that by pressure often occlude the blood vessels, will not be CASE REPORTS 143 likely to take place. This one thing is most essential. Light manual vibration correctly used over the affected area between the times for the baths and treatment will also help to this end and relieve the patient very decidedly. This scheme of treatment should continue during the whole twenty- four hours of each day during acute stage. It is during the quiet hours of night, while the patient is more quiet than usual, that damage is most liable to be done. Do not let the child lie on his back; turn him over as often as he desires. The limb or limbs paralyzed, or threatened, should be frequently moved for the sake of the reflex effect on the nerve centers. After the acute stage is over treatment should be continued until the body is in the best possible shape. Where the muscles are atrophied a few weeks after treatment, it is good evidence that the nerve cells gov- erning those muscles are either dead or very weak. Other nerve cells may act on those muscles but the dead cells cannot be regenerated by any means at our command. The weakened muscles can be strength- ened by special exercises designed for each case. Surgery is sometimes indicated. Susceptibility seems greatest during the second and third years of life. The youngest patient I have known was eleven months, and the oldest nearly seventy years. In experiments on monkeys, practically every monkey was susceptible by inoculation, but I have seen no report of any monkey taking the infection in a natural manner. It was proved that immunity as a rule resulted from once having had the disease. M. D. Commends Osteopathtc Treatment It is a great satisfaction to the Osteopathic Magazine to be able to present to its readers a report by F. Fisher, B. A., M. D., of Curling, Newfoundland, on his experience last year with three cases of poliomye- litis (infantile paralysis) in which he gives frank credit to the treatment of an osteopathic physician. Statements of this character from medical practitioners are so rare that they have a really unique interest. Referring to the cases of Frank Meaney , 7 years old ; Gordon Meaney , 5 years old, and their sister, May, 11 months old, Dr. Fisher says, in a statement that was read at the annual convention of the American Os- teopathic Association in Boston the first week in July: "At first I thought I had a case of cerebro-spinal meningitis. When paralysis developed and muscles began to show wasting, together with absence of deep reflexes and acute onset, the malady impressed itself upon me as cases of anterior poliomyelitis. 144 POLIOMYELITIS "Two days before the death of the second child I was fortunate in securing the services of Dr. Philip Holliday, an osteopathic physician of Montreal fortunate as regards diagnosis and more so respecting treat- ment. Realizing the great and lasting benefit given some patients of mine I had him treat two months previous, I gladly gave Dr. Holliday a free hand in the treatment of these cases of infantile paralysis. I was interested to see how he could, by his manipulative method, relieve con- gestion of the brain and spinal cord. "That he did so relieve pressure was proved by the fact that while the child was in a state of convulsions he would administer his treatment but a very short time when the convulsions would cease, and the little boy would be able actually to recognize his own parents. This occurred not only once, but if I remember rightly some half dozen times. It seemed to me that, had Dr. Holliday been two days earlier, he could have saved this child's life also. His treatment in the cases of the oldest boy and the baby was most effective. In the case of the brother it restored his right leg to normal condition, and I believe arrested the disease in the left. The little sister shows no ill effects whatever of the paralysis of the arm, and the boy, apart from a slight limp, which is weekly improving, is able to move freely about and play again with his companions. " Club Foot Follows Infantile Paralysis GEO. M. LAUGHLIN, D. O., Orthopedic Surgeon This is a case of acquired club foot due to infantile paralysis. The patient is 22 years of age. She gives the following history: When two years old, she had an attack of infantile paralysis, and she recovered from the attack, except she has paralysis in the left leg and foot. In the beginning there was paralysis of both legs and involve- ment of one or both arms, although eventually recovery was complete except in the left leg. This case presents some very interesting features because there is a deformity here which would persist unless certain things are done. This case will respond to Orthopedic treatment. She says that an operation was performed about six years ago, which operation is what we would ordinarily do for dividing the plantar fascia or the tendo Achilles. She wears a brace to hold the foot normal, or as nearly normal as it will go. Here is the brace this patient wears. It is cumbersome. You see it is heavy; she is troubled in putting it on and taking it off. She walks poorly with this brace because the tendo Achilles is too short. She walks on her toe in advancing. CASE REPORTS 145 I will not discuss in this case the treatment for infantile paralysis, that is its cause, symptoms, and treatment for the acute stage. Here is a case that has long since passed the acute stage and is characterized by paralysis of certain muscles which has resulted in a definite deformity and can only be corrected by certain definite methods of treatment. In order to determine what might be done, we have to take into consideration the muscles of the thigh, back and buttocks and see to what extent the mus- cles are paralyzed. If the muscles of the legs, thighs and buttocks are com- pletely paralyzed nothing can be done. If only certain groups of muscles are paralyzed, and other muscles remain in nearly normal strength, we can do certain things which will eliminate the necessity of wearing ap- paratus and which will at the same time permanently correct the de- formity. In looking over this case, I find no paralysis of the spinal muscles. Both gluteal muscles are about the same. There is strength in the gluteal muscles on the left side. If the gluteal muscles are paralyzed, they would be very poor. The body would protrude when weight is put upon the muscle. You can see that as I step on my right leg and the left is off of the floor, I stand erect. If the left muscle was paralyzed, the body would protrude. Now I will next test the flexors and extensors of the thigh. In order to do that, I will have her sit up. Now I will have the patient ex- tend her leg. See, she can extend the leg. Now with the leg extended, I will see if I can push it down. See, I can hardly push it down. We know she has got strength in the quadriceps extensor. When it is para- lyzed, the patient will walk putting the foot down carefully, and unless there is the proper balance, the patient will go down because the quad- riceps extensor is not strong enough to maintain the leg in proper posi- tion. Now I shall test the hamstrings. I will have the patient draw her leg back and see if I can straighten it. See, the hamstrings are normal. So the flexors and extensors are normal. Next, we come to the foot and the leg. Now you can see she has talipes equina varus. Talipes is due to contraction of the tendo Achilles. You will notice the foot turns in. That is due to some contraction of the tibialis anticus, which remains good, and to paralysis of the peroneal muscles. The tibialis anticus is not sufficiently opposed to keep the foot in normal position. It is not only a flexor muscle but turns in (inverts) the foot as well. She can flex the foot normally. She can riot flex the foot out (evert) as the peroneal muscles are paralyzed. She has a good gastrocnemius, fairly good tibialis anticus, but the peroneal is paralyzed. 146 POLIOMYELITIS There are two operations for this. First, I will mention one. There is one operation which will give this patient a good foot. You know treatment won't do it, for she has had the condition too long. Where some of the muscles are paralyzed and some are healthy, we figure out a plan whereby we can transpose a healthy muscle. Where the tendon transplantation is indicated, you have to have some good muscles. We can transpose the tibialis anticus from the inside to a little past the middle of the foot. The tendon is inserted into the bone by dividing the periosteum and making a groove in the bone so the tendon will lay in there. Of course, I will flex the foot around a little over-corrected be- fore planting the tendon. I will then apply a cast and a suitable sup- port. If the support is not worn long enough, it may come loose. Slit- ting the tendo Achilles, we can flex the foot up and there is no danger of secondary contraction. If it is divided across, it will go together again and contract. Make an incision down the tendo Achilles and splice it, and we don't get a secondary contraction. Having transposed the tibialis anticus from the inside to the outside of the foot, she should be able to flex and extend the foot, and should be able to go about without a brace. Suppose she did not have a good tibialis anticus or had very little power of contraction but had a good flexor of the great toe. I could take that just the same. Taking off the tendon of the great toe, pulling it up and passing it down outside the foot it would be good. What else could I do? I could fix the ankle. I would go into the joint here and ankylose it by taking off the cartilage of the astragalus and tibia and getting fusion of the bones. Notes on Infantile Paralysis Cases EVELYN R. BUSH, D. O., Louisville, Ky. "Many cases of paralysis have been restored to comparative effi- ciency by Osteopathy, after all other methods failed, " said Dr. Bush. "I will not enter needlessly into anatomical or pathological findings, but at once take you into the realms of re-education of muscles, where long and unusual experience has furnished me with interesting and won- derful data. "The technique to be pursued in the re-education of muscles in paralysis is a subject upon which practically no literature has been written. "We have not enough osteopathic physicians to meet the demands for osteopathic work, hence they have so little time for writing, while the physicians of other schools have so little constructive treatment, as yet, to give to the world on the subject. CASE REPORTS 147 "A detailed account cannot be given at this time, of our various methods of ascertaining the loss or impairment of power of individual muscles or groups of muscles. A knowledge of the origin and insertion, nerve supply and normal action of a muscle or group of muscles, gives the ability to work out according to the type of individual under treat- ment, the series of tests or experiments necessary to gain the desired in- formation. "While we are cautious to be accurate in our physical findings, we recognize the unlimited importance of our mental findings. One of our important duties is to secure the best mental atmosphere, for without it our work will be far less rapid. "There is more or less fear present in the mind of every paralytic case. This must be eradicated at the earliest possible moment. The physiological effect of fear in these cases receives all too little attention within our ranks. "It is of paramount importance to see what is the stage of develop- ment of the will of the individual. What the steam is to the engine, so the will is to the paralytic an absolute necessity." "The physiological power of 'interest' is as yet an unknown subject in connection with these cases. It has been said, 'If a man expended the same amount of muscular exertion sawing wood, which he does climbing rocks and wading streams after trout, he would faint dead away.' But interest is the soul of will. Therefore, see that you have the patient's interest. There is nothing more deplorable than the pathetic look in the faces of most of the paralyzed patients and their relatives. Why? Not the disease itself, for you know running down the category of dis- eases there are many, many diseases worse than paralysis. Why? I answer because of the discouraging words humanity was accustomed to use relative to paralysis before Dr. Still gave Osteopathy to the world Helpless, hopeless, incurable cripple! Words! enduring words! How they sink into the mind and what havoc is wrought by them! CHAPTER 9 Osteopathic Treatment Versus Medical Treatment of Infantile Paralysis E. FLORENCE GAIR, D. O., Brooklyn, N. Y. Since I have explained my objection to the use of the case and the brace (they both retard and hinder nature in her effort to re-establish normal physiological functioning to the affected parts by impeding the circulation), in like manner I will try to explain why I object to the medical regime in handling this disease. Infantile paralysis is not like an acute tubercular in- fection to a bony part that at once requires rest and immo- bility to the affected area; instead, this is a disease that urges the quickest ridding in the system of the toxemia being formed and this at the earliest moment. In all acute diseases we osteopathic physicians work with the idea of helping nature to regain her own balance to do the work; we therefore free up the circulation wherever impeded, and likewise the nervous system, thus permitting the cells to regain their normal tone throughout. We help the system to eliminate the toxins being formed by improv- ing the action of the skin, the kidneys and the bowels. I believe had every case been given the following treatment many a life might have been saved and many a limb regained its functioning. As the disease generally starts with a mu- cous infection in the head I employ a gargle of hot water and vinegar a tablespoonful to a half-glass this cuts the phlegm and cleanses the membrane, then I have the nos- trils rinsed with a mild antiseptic very mild though fol- lowed by an oil spray or melted white vaseline. This spray- ing and gargling can be done every few hours. The infec- tion passes down the mucous membrane to the bowels, therefore a thorough cleansing with water no medicine yet ever cleansed the colon it merely makes a centre clearing, leaving the accumulation around the colon wall. This water bath to the colon greatly helps in diluting the toxemia. I use a cup of steeped strained flaxseed for bad cases, or oils; 150 POLIOMYELITIS milk of magnesia is excellent, or bi-carbonate of soda, or anything of that nature that will not injure the mucous mem- brane. I always use the Cole's Metal Sigmoid irrigator it is so easily inserted and stays when it is put at the mouth of the descending colon. I can then use as much water as I feel I need with no expelling or displacement of the tube on the evacuation of the fluid contents. The rubber tube must be reinserted at every expulsion of water and must cause an irritation in the end of the mucous membrane if continually reinserted. The wash out is never so quickly done or so thorough. I follow up the irrigation with a hot bath from which, undried, I wrap the child in a blanket and put him to bed with hot water bottles to get well bathed in perspiration. If the fever does not abate compresses around the abdomen are used. Later a good massage with hot oils and a little alcohol. This frictional rubbing helps to rid the muscle toxins, and so helps the nervous tone. Noth- ing is given to eat, but all the water, hot or cold, the child will drink with a fruit juice added, preferably lemon without sugar, the first day. This helps to keep up the dilution of the toxins by eliminating through the kidneys. Every mother that attends my clinics is taught this procedure in handling a fever. It gives them confidence and keeps them from that panicky feeling as soon as a child looks ailing. In the recent epidemic of "Flu" I did not lose a single case. I simply instructed each parent what to do, and when able the patient came to me for treatment. No complica- tions set in, and no after results. What is it but just com- mon sense, and had this method been instituted in the army many a boy might have been saved. Many a disease can be readily checked at the outset by this rational method of handling, as most children's diseases either start with a cold in the head or an upset intestinal tract. It is the common- sense method. The medical treatment for infantile paralysis was rest and a cathartic a rest of a six weeks' period and then electric treatment or massage. In the meantime the tox- emia has overwhelmed the cells in the spinal column. The only sane feature of their treatment was that of massage. Those children who had that, were best off for it helped na- ture most but even in those cases, WHEN DEFINITE BONY LESIONS PERSISTED that limb was cut off from its normal OSTEOPATHIC TREATMENT vs MEDICAL TREATMENT 151 blood and nerve supply and could not regain its tone, and that is why such astounding results take place under osteo- pathic care. The lesions are reduced permitting normal stimuli of nerves and blood flow through the limb. Lately I had a twelve-year old boy brought me from a medical hospital where he had been treated since 1916. They had kept him on a Bradford frame for a WEAK BACK. The condition was pitiful. He was stiff as a board all over and very painful to the touch, a bad lumbar curve had form- FIGS. 83-84. A complete right side paralysis with loss of speech cured in four treat- ments. Boy today is in perfect condition. (See Chapter 7, p. 71.) ed, and a resulting compensating one above, the limbs in contraction, skin so harsh and badly nourished. In a few weeks I revolutionized him. He comes in smiling, the fam- ily are so happy for they begin to see hope for recovery. The special curves are gradually disappearing. The con- tractures are giving way, the skin is improving, and the boy is happy. An uncle brings him Sunday and a young boy for the Wednesday treatment. What the resultant effects would have been had the Bradford frame been em- 152 POLIOMYELITIS ployed much longer is easy to conjecture. Yet these poor people paid $3.00 per week for two years for WHAT? Another case similar a twelve year old boy had been left in a hospital. Last June the parents brought him to me. They took him home for they saw him getting worse instead of better. The mother had a good supply of common sense and began massage and muscle exercise. I gave three treat- ments before I left for the summer and this September on my return I was indeed happy with the change. The father picked up a Ford car for $50.00, which he repaired, and the boy has had good airing since. He is certainly progressing each month, and yet these cases seem so pathetically hope- less when you first see them. This fall I had the good fortune to get a baby stricken this September. The case was never diagnosed Infantile Paralysis, but the mother kept noticing how unstable the child was when walking, how it would drop suddenly after a few steps; I told her that without a doubt it was a case of poliomyelitis. The limbs toned up into firm hard flesh and the baby walked nicely after three treatments. One of my girls who came to me two years ago with weak ankles she couldn't then walk two blocks without fatigue hiked seven miles this summer. Her case is one from infancy. I always feel proud of results from these long standing cases, and I am still wondering how that mus- cle tone and strength of limb is obtained after all these years. How do we do it? Do we establish new pathways for a nerve cell that dies? Is it resuscitated? Or do we get other nerves to take up the functioning of the dead nerve? These cases get better and better each year. Nature abhors a vacuum. It is the mutual effort I believe. It is the energy and mental stimulus of those treating the disease imparted to the child's. The more mental effort and energy the child uses the better the child gets. Each year I treat this dis- ease I feel more and more the wonderful something we each possess that is at our call if we only understand. The Lord helps those who help themselves. Nature has within her resources unlimited processes, but one must go along with her and not against her. She needs our assistance both mental and physical. OSTEOPATHIC TREATMENT vs MEDICAL TREATMENT 153 I notice in my work that the mothers who never say die, who won't give up a case, accomplish wonders in this disease. It is truly remarkable what some of these mothers accomplish. I have one mother in mind. She took a help- less boy of three from the hospital in a pitiful condition the last doctor gave her no hope told her the case was hopeless. She never knew how she pushed the baby home she was so dazed. When she came to herself she determined she would not give her boy up. She started in massage and muscle exercises, she made up all sorts of exercises. It was remark- able the change in six months, and since bringing him to me the reconstructive progress has been steadily going onward. I never forget to instil into these patients, never to give up, to keep on and on, till each year brings the child nearer perfection. November, 1918. FIG. 85. Author's case of infantile paralysis now completely restored. For three years I have been raising rabbits to give my clinic cases, and with good results. I find that the rabbits absorb their interest and in their effort to catch them, they forget their affliction and exert every ounce of energy possible to capture them. This exercises the muscles. INDEX Page A hard fight in some cases (case 20) 102 A careful history is to be commended (case 18) 101 A case practically cured after twelve years 66 A quick recovery 78 Abortive type of infantile paralysis 32 Abortive type of infantile paralysis (case 18) 101 Accidents to babies in arms 8 Accidents a factor in causing infantile paralysis 61 Acute cases 48 Adenoids lower resistance of respiratory membranes to infection .... 28 Adjustment lowers temperature 35 Adjust rapidly in children 45 All acute contagious diseases respond more quickly to osteopathic treatment than to medical treatment (case 18) 102 Alimentary tract is always deranged in infantile paralysis 62 Ankle corset 78 Aneurysm its effects 35 Another M. D. mistaken in diagnosis 143 Another nine months' baby cured (case 19) 102 Anterior horn cell lesions 115 Aorta may be compressed by diaphragm 22 Applied anatomy 11, 36 Arrangement of vasomotors of abdomen 21 Arterial anastomosis not free in grey matter of spinal cord 92 Atmospheric conditions seemed to play a part. . 128 Atrophy from wearing brace 80 Atlas lesion 32 Attack can be aborted 86 Attack followed hard play (cases 41, 42) 124 Autointoxication, was M. D.'s diagnosis (cases 46, 47) 130 Avoid physical exhaustion 64 Axis lesion 32 Back muscles contract 63 Backward drawing of head 28 Be sure and adjust lesions 35 Better health often follows in infantile paralysis patients who have been treated osteopathically 100 Bladder and bowels paralyzed (case 43) 126 Bladder control lost , \ ;. 86 Blood supply of spinal cord 11 INDEX 155 Body's resistance lowered in hot months 62 Boned waist for weak spine 78 Bony lesions must be adjusted 150 Boy had homeopath and allopath,but begged for osteopath (cases 12, 13) 96 Brandy given by medical doctor 96 Braces taken off immediately 76 Bulbar paralysis 28 Bulbar paralysis cured 71 Bulbar paralysis cured after five years 77 Can infantile paralysis be prevented? 60 Can babies be treated osteopathically, is often asked. See case 16. .. 99 Case considered hopeless by medical doctors (case 16) 98 Case Reports begin 81 Causes 5 Caution 57 Central nervous system is directly involved in infantile paralysis 32 Cervical enlargement of spinal cord most of ten attacked in poliomyelitis 17 Cervical lesions 15 Cervical rib 35 Child begged to be treated 69 Child fell from ladder 122 Child walked after three treatments 75 Children are irrepressible 63 Cheyne-Stokes respiration 95 Clinic Cases 43 Coeliac plexus 21 Cold feet 24 Cole's Metal Sigmoid Irrigator recommended 150 Congestion of head and neck 26 Contracted musculature 13 Cord cell tonicity necessary to normal functioning 39 Cold compresses 54 Cold pack gave good results, (case 18) 101 Colossal conceit 64 Contracted muscles of the back 63 Cold compresses about the neck 82 Cord circulation blocked at both ends 81 Coma and delirium 95 Congestion of cord compared to congestion of lungs in early lobar pneumonia 91 Convulsions ceased under osteopathic treatment 144 Cure possible when treatment is kept up (case 39) 121 156 POLIOMYELITIS Cured after two years in hospital under medical treatment 151 Daily hot bath 82 Damage to tissues during night while child is quiet 143 Developed after extreme fatigue 81 Diagnosed as sciatica by M. D. (case 36) . . 119 Diagnosed as a "grippy cold" (case 37) 119 Diagnosed as hip disease (case 40) 121 Diagnosis in the early stage not always easy 88 Diaphragm 15 Diaphragmatic pressure on nerves, vessels, tubes, etc., passing through its openings 40 Diet should be restricted 136 Diseased organs always have disturbed circulation 38 Diseased tonsils favor infection 28 Discovered in Europe in 1840 115 Do not be afraid to call an osteopath 64 Don't give up too soon 78 Drainage of spinal veins 13 Drainage of spinal vessels better in prone posture 54 Dr. Gair begged for a chance to help infantile paralysis victims 66 Dr. Gair had fifty cases first winter 66 Early cases make the best showing (cases 14, 15) 97 Early treatment by osteopath advised 71 Ears sometimes involved 74 Eat less heat producing food in summer 62 Eats galore 62 Effect of lesions on lymphatics 30 Effects of costal lesions 22 Effects of muscular activity -. 63 Efferent impulses 39 Electrical treatment in acute stage not well borne (case 35) 114 Eliminate the "mixers" 97 Emphasize necessity of early treatment regardless of the severity of the case 93 Enemata necessary in acute cases 71 Even the slightest subluxation must be corrected 48 Examination of spine is important 24 Exercises in later convalescence 69 Exercises help in later stages 84 Extremities involved must receive attention 45 Extreme hyperemia and capillary pulse 140 Falls, tumbles 8 INDEX 157 Fear is prejudicial to making best progress 90 Fecal discharges of infantile paralysis cases very offensive 55 Feeding in infantile paralysis 52 Fell out of wagon on head (case 32) 113 Feverish condition of head 28 First rib lesion 34 Flux in some cases 74 Food a vehicle of infection 9 Frequent colon flushings indicated in acute cases 55 Fruit juices and water during fever 150 Gargle of hot water and vinegar 149 General management 117 Getting cases after two years of medical treatment 76 Give close attention to mucous surfaces of nose and throat 57 Got worse, instead of better 152 Had disease at age of one year; never used right hand after (case 38) . . 120 Had attack while broken arm was in a case (cast 55) 139 Headache a symptom in infantile paralysis 25 Hernmorhagic foci in affected portion of core tissues 91 Hints to the Public on Infantile Paralysis 60 History of falls in many cases 78 History of falls 88 History of a fall, previous to attack (cases 21, 22) 104 How long should cases be treated 58 Hospitals of New York closed to osteopaths 65 Hot bath recommended 142 Hot compression very sensitive cases 54 Hot compresses promote drainage 54 Hot, humid weather favors the development of infantile paralysis. ... 63 Hydrotherapy 53 Hyperesthesia pronounced 129 Hypnotism, said the medical doctors 78 Ice packs used 95 Indurated lymph nodes due to impeded circulation 28 Infantile paralysis not as general in families as other infectious dis- eases, such as scarlet fever, measles, whooping cough, etc 32 Infantile Paralysis E. Florence Gair, D. 65 Infantile paralysis epidemic in New York, summer 1916 64 Infection enters cord substance through lymph spaces between pia- mater and arachnoid 36 Infection thru lacteals and blood channels 25 Infection thru lymphatics of head and neck 25 158 POLIOMYELITIS Infectious, but not contagious an opinion (cases 28, 29) 110 Improvement continued after quitting treatment (case 26) 107 Improvement slow in some chronic cases 74 Improvement soon noticed 84 Inoculation not necessary in well-marked cases 125 Intelligent nursing an important factor (case 16) 98 Intelligent nursing of great value (case 27) 108 Interference by visiting medical nurse 78 Intestinal diseases more frequent in hot weather 63 Instrument-deli vered babies 5 Irrigate the colon 55 Irritability marked in many cases 86 Judgment quite as essential as skill 135 Just and unbiased, was this M. D 144 Keep patient's feet warm 57 Kiddie kar, the tricycle and velocipede good for lower limbs 79 Know nature's method of fighting disease 141 Leg brace seldom necessary (cases 9, 10) 94 Lesion of clavicle 34 Lesion of hyoid bone 32 Lesion theory 5 Lesions present 82 Liquid diet 72 Lumbar lesion 22 Lymph nodes of neck enlarged 26 Lymphatics of the head and neck 25, 30 Lymphatics of thorax and abdomen 36 Many bulbar paralysis cases cured 77 Many infantile paralysis victims give a history of being very active . . 63 Maternal persistence rewarded (a case from the 80's) 68 Mechanical, electrical machines not advised 79 M. D. admits osteopathic treatment was most effective 144 M. D. commends osteopathic treatment 143 M. D. thought Osteopathy would help (case 48) 132 Medical octopus 65 Medical doctor advised Osteopathy 95 Medical doctors disparage results obtained by Osteopathy 78 Medical prognoses at sea case 23, page 105; case 25 107 Medical treatment a failure 52 Medical treatment of infantile paralysis 150 Medical treatment unsatisfactory 149 Mental effort on part of patient necessary to secure best results 79 INDEX 159 Mixed infection 3g Mode of infection 9 Moderation necessary 62 Motor, vasomotor and trophic impulses affected by ligamentous and osseous lesions 19 Much cloudy weather in 1916 which affected atmospheric conditions 87 Muscular atrophy 24 Nature will do wonders if assisted 67 Nature must not be handicapped 24 Nature must rehabilitate 58 Nerve irritation lowers tissue resistance 42 Never say die 153 Nine months baby cured after suffering from disease three months case 16 98 Ninety per cent could be cured, says osteopath (case 17) 100 No specific serum has been found 49 No wonder nature rebels 62 Normal circulation the greatest preventative 30 Normal pharyngeal and nasal tissues more resistant to infection 28 Nostrils require attention 149 Notional about food 81 Nutrition impaired by wearing casts and braces 79 Objection to treatment on part of infants does not prove that the treat- ment hurts (case 16) 99 Obstipation 41 Oil spray for nose 149 One case left entirely to nature as an experiment by Rockefeller Insti- tute authorities 65 Only case, though others exposed 85 " Operate, " said the home town physician 75 Opisthotonos 81 Organs become infected through their vascular channels the blood and the lymph 39 Organism causing the disease circulates in the body fluids 116 Orthopedic surgery 145 Osteopath should get case early 64 Osteopathy in acute cases 49 Osteopathy is the natural treatment for infantile paralysis 64 Osteopathy goes to centre of trouble -80 Osteopathy the only logical, sensible, curative treatment 80 Osteopathy specific if applied early -84 Osteopathic treatment in the acute stage is especially indicated 90 1GO POLIOMYELITIS Osteopathic treatment, versus medical treatment (case 8) 92 Osteopathic results versus medical results (case 23) 105 Osteopathic and medical results compared (case 31) Ill, 112 Osteopathy won after three medical doctors gave up case (case 16) . .98 Osteopathy is usually the last resort (case 17) 100 Paralysis due. to fall down stairs (case 33) 113 Paralysis of bladder and bowels 22 Parents not persistent enough (case 30) 110 Parents must have courage 74 Patient must be guarded in convalescent stage 57 Paths of conveyance of virus to membranes of brain and spinal cord . . 25 Pathology changes as case progresses 91 Pathological fermentation takes place more readily in summer 62 Pathological state of spinal cord develops early in the acute stage .... 90 Phenomenal results in some cases 71 Physician contracted infection (cases 28, 29) 110 Physician sometimes has to be nurse (case 34) 113 Plant life affected in summer of 1916 87 Poliomyelitis more severe in children whose spines have lesions 19 Policy of medical doctors is, hands off 52 Predisposing causes 60 Preganglionic and postganglionic nerve fibers 21 Prevention the watchword 60 Procedure in acute cases 52 Prognosis 117 Prognosis difficult in long-standing cases 70 Prognosis grave, said the M. D. (case 40) 121 Prolonged period of treatment often necessary. . . 94 Pronounced coryza in some severe cases 75 Proper vision 45 Quick ridding of toxins necessary 149 Rapid response, though child had not been strong 95 Reaction of muscles and muscle tone are of first importance in diag- nosing cases not well defined 89 Recovery complete 73 Regeneration of dead cells impossible 91 Relapses 57 Relapses sometimes occur 73 Remove the lesion 43 Renal plexus 22 Rest and quiet indicated in convalescence 57 Restless.. . 86 INDEX 161 Resistance exercises help (case 27) 108 Resistance exercises best 79 Resort to surgery, plaster casts, braces only when everything else has failed 67 Resolution of initial congestion, by osteopathic treatment, is logical course to pursue 91 Results all that could be desired (case 24) 105 Rib lesions 22 Rockefeller Institute is controlled by the great medical octopus 65 Rockefeller Institute fails 65 Rockefeller Institute a biased investigator 65 Rub limbs with hot olive oil 72 Sacral lesions 23 Sciatica 23 Seeks a cool place 63 Semilunar ganglia 21 Sensitive spines 53 Severe treatment contra-indicated (cases 9, 10) 92 She couldn't walk two blocks now cured 152 Short treatment indicated 94 Shrunken limbs 60 Simulated spinal meningitis 81 Significance of grey rami of dorsal spinal nerves 19 Six out of seven cases restored to normal (cases 14, 15) 98 Soldiers with " flu " might have been saved 150 Specific adjustment 45 Specialists said nothing could be done 71 Soothing effect of hot compresses 54 Spoiled babies make it difficult for the physician (case 16) 99 Spinal cord of the child is not fully developed 63 Splanchnic nerves 22 Spinal nerve cells nerve roots 15 Stick to Dr. Still's teaching 46 Stools very offensive 62 Susceptibility 143 Symptoms 116 Symptoms of case eight 92 Symptoms different in cerebral cases 141 Sympathetic ganglia 21 Static blood a predisposing cause 10 St. Vitus' Dance due to trauma 8 Temperature 25 162 POLIOMYELITIS "Ten-finger" Osteopathy 43 "Ten-fingered" Osteopathy does the work 97 Tepid bath and olive oil rub (case 16) 98 The medicos do not want an all-round investigation 65 The number of cases during 1916 epidemic varied with the humidity . . 87 The osteopath works with nature 149 Things to guard against 94 Thoracic duct a great collecting system 41 Totally paralyzed from waist down, child made complete recovery in six weeks' treatment 104 Trauma 7 Treatment Part One 43 Treat the patient, not the disease 90 Treated twice a day at first 81 Treatment gentle relaxation, strong flexion and extension of spine . . 86 Treatment raises resistance 89 Treatment in severe cases 93 Treatment of deformities resulting from infantile paralysis 145 Trouble with Health Officer 125 Turn on face to let spinal cord get drainage 72 Typhoid fever was suspected (case 50) 134 Undried, wrap child in blanket 150 Use of hot bath 107, 142 Value of rest to alimentary tract 90 Vegetable broth 82 Venous stasis precedes nodular enlargement 38 Vertebra artery 15 Vigorous treatment when sensitiveness of spine is overcome 94 Vision 45 Vomiting, high fever, headache 104 Water to fevered patient 53 Weakened tissues an easy prey to toxins 63 Wearing brace causes deformity of foot 80 What is the best thing for the public to do in infantile paralysis 60 What should be done 64 When convalescence begins watch the bowels 55 Where does treatment of acute cases begin 51 Why have filthy intestinal tracts 62 Why put braces on babies not yet walking 76 Withhold foot during temperature stage 81 Wrist-drop cured 75 Youngest patient and oldest patient I have known 143 Date Due PRINTED IN U.S.*. CAT. NO. 24 161 A 000 421 815 2 WC555 M61*5p 1918 Millard, Frederick P. Poliomyelitis MEDICAL SCIENCES LIBRARY UNIVERSITY OF CALIFORNIA, IRVINE IRVINE, CALIFORNIA 92664