Acute Poliomyelitis Treated with Thermal Antibody

Twenty consecutive cases of acute poliomyelitis were treated during the 1946 season with thermal poliomyelitis antibody.

The table shows the important details concerning each patient. In this series the first case had its onset in July and the last case in November. The ages varied from 2½ years to 16 years. Fourteen of the patients were boys and six were girls. Fever was present at the onset in all the cases. Stiffened neck and back was constant at the onset and a positive Brudzinski sign was obtained in each case. Vomiting and nausea occurred at the onset in five patients. Paralysis or weakness was evident when first seen in seven of the cases. Case 16 was the only patient that developed more paralysis after the administration of the thermal antibody. The reaction which occurred with this patient several hours after the injection of the antibody was probably due to the low pH of the antibody which since then has been brought to between 6.0 and 6.5. It was during this reaction that more paralysis developed. After the reaction subsided, as indicated by normal temperature, no further weakness or paralysis occurred, instead a very slow, gradual return of muscular activity took place. The other six patients in this group with paralysis or weakness, after having received the thermal antibody did not develop weakness or paralysis.

Of the whole series of twenty patients, five either had difficulty in swallowing or could not swallow. Two of these belong to the preparalytic group since they had difficulty in swallowing, but could swallow. This difficulty disappeared by the second day in case 1, and in case 20 by the fifth day after receiving the thermal antibody. The three patients that could not swallow received temporarily nothing by mouth, and in one to five days after receiving the thermal antibody were again able to swallow.

The right arm was weak in two cases, the left arm in one case; and paralyzed in one case. In one patient the right leg was weak, and in one it was paralyzed; in one the left leg was weak and in two it was paralyzed. In one case the abdominal muscles were paralyzed. In three patients the intercostal muscles were weak or paralyzed.

Thirteen of the patients in this series were preparalytic. No muscular weakness or paralysis was present. However, four of these patients had painful muscles, involving extremities in three cases, and muscles of swallowing in the fourth. Lost or absent reflexes were observed in ten of these patients. None of the preparalytic patients developed any developed any muscular 

The spinal fluid cell count varied from 0 to 172. In three patients the number of cells were over 100, two being preparalytic with lost reflexes and one with paralysis; in ten cases the cell counts were between 10 and 100, five of these had definite weakness or paralysis, the other five were preparalytic and had lost reflexes. Seven patients had cell counts less than 10, of these one could not swallow, one had difficulty in swallowing, and five had painful muscles and absent reflexes.

The thermal poliomyelitis antibody was given intramuscularly into the lateral aspect of the thigh in all twenty cases. The amount varied from 15 cc. to 40 cc. Eight patients received 15 cc. each, two received 20 cc. each, one received 25 cc., eight received 30 cc., and one received 40 cc. The dose varied with the severity of the illness and somewhat with the size of the patient. Only one patient, case 16, had a very painful local reaction accompanied by a generalized reaction with a fever up to 104 R. which gradually subsided after four days to a normal temperature. Seventeen patients had only a local reaction of pain, slight to moderate, which did not develop a local redness, and two patients had no reaction or pain.

Improvements noted were: that of the patients with difficulty in swallowing, case 1 could swallow normally in twenty-four hours; case 14 could swallow satisfactorily within three days after the first dose and twenty-four hours after the second dose of thermal antibody; case 16 could swallow normally again on the fifth day after receiving the antibody; case 19 could swallow normally two days after the antibody was given; and case 20 could swallow again five days after receiving the thermal antibody. Of those patients with respiratory difficulties none needed the respirator; case 14 could use his intercostal muscles to some extent within twenty-four hours after receiving the thermal antibody; case 16 could use his intercostal muscles much better on the fifth day after receiving the antibody; case 19 showed improvement in the use of his intercostal muscles in forty-eight hours and was breathing normally in five days after receiving· the thermal antibody. Those with painful muscles: case 1, the pain in his right arm disappeared on the third day after receiving the antibody; case 5, the pain in the left arm disappeared six days after the thermal antibody was given. Cases 7 and 10, the pain in the left leg was gone in four days and five days, respectively, after receiving the antibody.

During this season untreated cases of acute poliomyelitis already having paralysis did develop more paralysis. Some untreated patients in the preparalytic stage and with hyperasthetic muscles after a few days developed paralysis. Other patients with paralysis already present and treated with convalescent poliomyelitis serum continued to develop more paralysis and several died.

None of the patients treated with the thermal poliomyelitis antibody died, and only one patient, case 16, developed more paralysis after receiving this treatment. The remaining 19 cases were free from pain sooner and moving about actively in a short period of time.

The poliomyelitis thermal antibody was prepared by Dr. E. C. Rosenow who kindly supplied the amount needed for the twenty patients. In the preparation of this artificial antibody, Dr. Rosenow states that “it has been found that as the bacteria (streptococci isolated from cases of poliomyelitis) disintegrate in NaCl solution suspension on application of heat in the autoclave, the toxic components are destroyed–and substances resembling antibodies become demonstrable in the supernatant NaCl solution. Optimum yields of ‘antibody’ are best obtained by autoclaving suspensions in NaCl solution for 96 hours, and for one to three hours at pH of 2.0 to 4.0 after adding 1.5 per cent of hydrogen peroxide, and at 100° C. for one hour in oxygen under 2000 pounds pressure per square inch.

“The solutions of ‘antibody’ used in treatment were prepared by autoclaving suspensions in isotonic NaCl solution containing 20 billion streptococci per cubic centimeter isolated in studies of poliomyelitis for 96 hours without hydrogen peroxide, and 10 billion per cubic centimeter for one to three hours after adding 1.5 per cent hydrogen peroxide. Both types contained the antibody and residual largely detoxified antigen from 5 billion streptococci per cubic centimeter. The streptococci had been preserved prior to the preparation of antibody in very dense suspensions of glycerine 2 parts and saturated NaCl solution 1 part.”

In conclusion: This thermal antibody for acute poliomyelitis contains no horse serum, and delayed reactions did not occur. With the pH adjusted to between 6.0 and 6.5 this artificial antibody caused small local reactions and in some cases no reactions. This antibody would seem to have curative effects in poliomyelitis and in returning the patient to normal activity in a relatively short space of time.

 

References:

1. Rosenow. E. C.: “The Production in vitro of Substances Resembling Antibodies from Bacteria.” Jour. of Inf. Dis., 1945, 76, pp. 163-178.
2. “Studies on the Nature of Antibodies Produced in vitro from Bacteria with Hydrogen Peroxide and Heat.” Jour. of Imm., 1947, 55, pp. 219-232.
3. “A Study of the 1946 Poliomyelitis Epidemic by New Bacteriologic Methods.” Journal-Lancet, July, 1948, pp. 265-277.