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It is supposed that most infants and young children get exposed to infection,
and without showing much sign of illness acquire an immunity which is
probably life-long. This type of immunising reaction is thought to be probable
in the case of Lansing (type 2), in which the reaction has only rarely been
severe, and also possible in the two other types. It is not known what proportion
of the population become thus immunised; it may possibly be perhaps
80 per cent. In group 1 (b) infection, the patient—usually a child—has a
rise of temperature for a day or two with a feeling of malaise, sore throat,
and a flushed appearance, and possibly headache and abdominal pain. The
condition is almost indistinguishable from any type of feverish infection, and
might suggest an early sore throat, or a bowel infection. The patient recovers
and has acquired life-long immunity. In group 1 (c) the symptoms are similar,
but more severe, and there is neck stiffness; the patient cannot kiss his knees.
The condition suggests meningitis, or meningismus from any toxic illness;
food poisoning; or acute infection of the kidney or rheumatic fever. The
neck rigidity disappears if the patient is laid face downwards with the head
over the edge of the bed, a sign which distinguishes poliomyelitis from true
meningitis. Again, even with this more severe illness, the patient recovers
and acquires a life-long immunity.
In group 2 (a) the illness can cause paralysis of any muscle of the body,
including the urinary bladder and the diaphragm. In group 2 (b), in additon
to paralysis of skeletal muscles, there occurs paralysis of the muscles of the
throat, voice, and respiration; it is very serious and frequently fatal. For
groups 1 (c), 2 (a) and 2 (b) admission to hospital is necessary and the disease
must be notified. In group 1 (b) the patient should be isolated in bed and if
the doctor suspects a poliomyelitis infection he should notify it.
Preventing Poliomyelitis.
It is reasonably certain that poliomyelitis is acquired by contact with a
case, or with a carrier. Arguments have been advanced for requiring
quarantine of all individuals who have been in contact with the patient up to
four days before the onset of the illness; this would include all persons living
in the same house, contacts outside the family and contacts at the place of
work or school. The period of quarantine for an individual should be 15
days, and for a group even longer. The difficulty with such a policy is that
many people do have contact with patients and carriers without subsequent
harm; and it is not possible to predict who will be victims.
In America, a trial has taken place with various vaccines prepared from
cultures of poliomyelitis virus. Children have been inoculated and the vaccines
appear to be safe and capable of stimulating the production of protective
substances in the blood. The vaccines, however, are not yet ready for universal
use. In another experiment in America, the protective effect of gammaglobulin
has been demonstrated. This substance is a fraction of the globulin
part of human blood. We know that this substance will abort or modify an
attack of measles if injected in the early stages. On the same analogy it was
tried in various towns in the United States where poliomyelitis epidemics were
present during 1951 and 1952. It was shown that less children suffered from
an attack of poliomyelitis when injected with gamma-globulin than in those
injected with an inert substance. However, such a method of prevention is
not at present a practicable method, because gamma-globulin is scarce and
difficult to prepare, and the effect is only temporary.
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