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diphtheria ; general muscular weakness long before the parah'sis intervenes, the peculiar selec- tion of aft'ecting at first the muscles of the neck and throat with a rather slow time of progression in contradistinction to the usual quick involvement in anterior poliomyelitis. 8. Scurvy : In which diagnosis, as a rule, the age of the patient is to field of green slot machine be considered, the paralysis is only apparent and not actual, its cause being the disinclination to move the limbs for fear of the pain and. tenderness in them. Look for the blue gum line. History of too much carbohydrate food, etc. 9. Erb's paralysis : This field of green 2 being a birth palsy it would probably have a history of being noticed a few hours or days after birth. There is local anaes- thesia in the distribution of the circumflex nerve. The posture of the arm is also characteristic. Prognosis: The prognosis as to life is usually play field of green very good in the simple spinal form of the disease. In the types where it extends up to the brain proper and involves the higher centres your patient will probably die. Recovery even then, however, may take place in a few cases. Therefore be guarded in what you have to say. So far as I can ascertain •the mortality is about from five to ten per cent. The amount of permanent damage is usually verv much less than the primary paralysis. The ultimate re- sult will depend upon the amount of permanent in- jury sustained by the various nerve centres and their constituent parts, plus the amount of good care and proper treatment received during the long stage of field of green slot games convalescence. During the acute stage of the disease a halt in the advance of field of green slot the paralysis, from twenty-four hours to thirty field of green casino hours, usually in- dicates its maximum intensity or extent has been reached. Estimates as to permanence of the paraly- sis during the subacute stage is generally computed as follows : Loss of faradaic irritability at once in the aflFccted parts usually means permanent paraly- sis. Gradual recovery up to a certain point may be expected when the faradaic irritability is lost later. The later it is lost the better the chance for recov- ery. The reaction of degeneration is another way of estimating the permanent damage. About a week after the initial paralysis, the faradaic current reaction in the muscles and nerves directly depend- ent upon the diseased area of the cord is lessened and soon lost. If the faradaic current is retained or merely diminished, the chances are good for ulti- mate recovery. The muscles which have lost their faradaic contractibilitv mav still be made to act to April 15. 191 ■•] STEIXHARDT: AXTERIOR POLIOENCEPHALITIS. 725 the galvanic current. In normal muscles the reac- tion is ijreatest at the closing of the negative pole. In paralyzed muscles the reaction is slower, requires greater stimulation, and the contraction is greater at the closing of the positive pole. This is the re- action of degeneration. The muscles showing this phenomena are those in which a permanent defici- ency may be expected. Remember that while your treatment is not going to aflect those parts of the nervous system which have been entirely destroyed, your prognosis can be made better or worse by the kind of care you are going to give your patient for the conservation of what is only partly destroyed or temporarily crippled. Also on your skill in not allowing contractures, deformities, and other dis- abilities to develop. Remember, also, that constant, steady, and untiring efforts extended over from two to three years may also work wonders in ap- parently hopeless cases. Prophylaxis: Before discussing the treatment of this disease it would be advisable to say a few words regarding what can be done to prevent the spread of it. We cannot say much with certainty, but still there are a few things which seem sensible in view of our present limited knowledge. Every sus- picious case should be quarantined the same as a suspected case of any other contagious disease. If proved a true case the quarantine should be main- tained for from three weeks to six weeks. Cer- tainly during the entire acute stage. To disinfect the urine hexamethylenamine should be given. It may also influence the course field of green slot review of the infection. The .stools should be treated as in typhoid fever. The nasal passages and their secretions should be care- fully treated with antiseptics. Paper handkerchiefs, which can be immediately burned, are to be recom- mended for use to receive the nasal secretions. The bedding and bed garments of the patient should be boiled as also his eating and drinking utensils. Toys, books, and other things handled by the pa- tient should be antiseptically treated. The doctor in calling on the patient should wear a gown and cap. such as are worn when attending any other con- tagious disease. The hands and face should be thoroughly cleaned when the visit is over. These same rules apply to the attendant of the patient. Other families with children in the neighborhood should be warned of the presence of the disease and instructed to stay away from that particular house where the disease has made its appearance, and that house should be most thoroughly disinfected after the acute stage of the disease has passed. In the vicinity a regime of daily cleaning of the nasal passages with first a strong antiseptic solution and continuing with a milder one should be at once in- stituted. Children known to have been in intimate contact with the patient should be given in adrlition a mild course of hexamethylenamine for several days and also a thorough catharsis. General prophylactic measures would be to caution against injudicious ex- posure to the extreme heat of the summer sun dur- ing that time of the year, overfatigue, ice cold baths when overheated, and drinks of a like kind. • Lying on the cold ground after a heating exertion is not advisable. .\11 of these things assist in lowering the normal body resistance. We can also advise parents to S(c that their children are fed food suited to their age, need, and development, and that they get this food at proper times and are not allowed to eat "any old thing at any old time." Insist on proper regulation of the bowels — at least one good move- ment a day is an absolute necessity. Children in whose families the acute disease exists should be excluded from school. Treatment: There being no specific early treat- ment of this disease so far as medication goes, the literatr.re abounds with suggestions as to what should be used in the early stages. Perhaps with our better understanding of the pathology of this disease many of these proposed medications will be shown to be useless and maybe harmful. You have to fight the symptoms as they appear and as indica- tions for treatment show themselves. The adminis- tration of hexamethylenamine to suspicious cases should certainly be an advisable measure and one calculated to limit probably the spread of the pro- cess if it is present. Also thorough cleansing of the nasal passages must be instituted in view of recent discoveries. An icebag to the head may help some in cases where the brain seems to be in- volved. It is very doubtful if counterirritations to the spinal column assist in any way to control or limit the course of the disease. Catharsis is cer- tainly indicated — calomel or castor oil — as it is in almost any acute infection. A clean gastrointestinal tract always helps in the treatment of disease. The usual light diet given to a sick child confined to bed should be instituted at once. Nerve sedatives

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