A visit to poliomyelitis centres in U.S.A

Aging in polio

For a disease that was "conquered" some 40 years ago with the onset of effective vaccination, the issues of long-term survivors of paralytic polio as they age continue to present challenges to rehabilitation specialists. Aging with polio is a definition of PPS. There are over a million patients with PPS in the United States. Management has to include the appropriate use of exercises, appropriate bracing and support, and, in the case of bulbar and respiratory symptoms, the appropriate use of speech therapy services and ventilatory support. There are no prospective randomized trials studying the treatment of weakness and fatigue in PPS. Pharmacologic interventions are limited at this time but include anticholinergics for muscle weakness and dopaminergic agents or amantadine to control central fatigue. The pathophysiology of aging with polio is consistent with neuronal loss and denervation lying at the heart of the developing disorder, whereas the central nervous system components of the fatigue syndrome may be related to central changes with neuronal loss in the basal ganglia and reticular-activating system. Many of the survivors of the polio epidemics are in their later retirement years, and their needs will increase as they have other disabilities due to natural aging. Sensitivity to some of the special issues in PPS may help to avoid complications. Polio is an active infection in the third world. Although great strides have been made, the disease is endemic in eight nations and is threatening to spread. The lessons learned in treating PPS now will be useful in years to come as these individuals age and manifest PPS in the future.

A state secret: the closely guarded report of a hospital inquiry

Two hundred years ago, Cork Street Fever Hospital was built by charitable subscription. Seven years after becoming a public-private partnership in 1937, its administration was subjected to a Sworn Inquiry. Why the Inquiry was held and why the Inspector's Report was never published are the questions addressed in this paper.

Clinical observations on acute poliomyelitis

During the years of the polio epidemics, most patients with the poliovirus had little or no paralysis. In those with paralytic polio, the extent of involvement of the anterior horn cells was often underestimated. Thus, patients with post-polio syndrome now often report that a limb was uninvolved; however, the original record will show clear evidence of initial paralysis that improved so that the patient no longer recognized the weakness. The epidemics were associated with great anxiety involving the patients, their families and all of society. Treatment was for the most part ineffective and was sometimes confused or inappropriate. Patients developed coping techniques that have been singularly useful and effective. These coping techniques often include strategies that require maximal athletic development of little-used muscles. The coping techniques developed by post-polio patients would be of great benefit to patients with other forms of disability. Review of the medical histories, biographies, and autobiographies of patients who had severe disability because of poliomyelitis reveals that they adopted firm convictions about their disease and their recovery. We must be aware of these convictions if we are to treat their later disabilities. These convictions include the belief that their condition can only improve, that their improvement is related primarily to the willingness of the patient to engage in exercise, and that improvement is more a thing of the spirit than of medication. Associated with this conviction is denial--often concurred with by the family--of the extent of the disability. Furthermore, the confusion of physicians that patients witnessed during the great epidemics suggests to patients that physicians can be of little help to them now. Convictions that were invaluable to patients who were young and vigorous become a liability when aging and progressive weakness supervene. Patients who had adapted to muscle weakness through great physical and emotional effort are unable to continue functions they had regained. However, such patients cannot accept that they do not continue to improve. Some become depressed, but this is unusual.