Clinical Concept of Poliomyelitis

EVERY aspect of poliomyelitis has been subjected to intensive study during the last two or three decades, in spite of which the clinician has not been presented with any inescapably sound doctrine regarding its epidemiology and transmission, its precise pathogenesis, or the details of diagnosis and treatment. The clinician, who observes the only animal naturally subject to this disease, must develop his own credo regarding most of the aspects of the human form of the disease including not only the details of management of the affected patient but also the many hypothetic considerations which influence one's judgment during epidemics. This paper is an effort to summarize our own ideas during the observation of more than 1000 cases. We hope later to document certain of our clinical impressions by detailed analysis of this case material. At present, however, we are attempting simply to record the point of view with which we have approached the many inscrutable aspects of this disease. As long as this disease continues unpredictable in course, severity and end result and cannot be made to reproduce in animals the counterpart of epidemic disease in man, purely clinical considerations must have some weight. Reasoning which may be largely inductive may point the way to useful hypotheses. Epidemiology The epidemiology of the disease remains obscure. There has been a tendency to depart from an early theory that the disease spreads by means of direct contact. The abundant occurrence of the virus in the intestinal tract of affected patients has led to the belief that the manner of spread resembled that of the enteric infections.