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Antistreptococcus Serum in Accute Poliomyelitis
Published in Minnesota Medicine, Vol. 23, March 1940, as “Further Results in Treatment of Acute Poliomyelitis with Antistreptocuccus Serum (1928-1937).” Republished in The Journal of the American Medical Association, June 1, 1940, pp. 2253-2254.
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Rosenow compares the results obtained in the treatment of 221 patients with acute poliomyelitis receiving antistreptococcus serum since 1928 under his supervision or under the supervision of physicians to whom he sent the serum and the effects of the disease among 116 similar patients living under comparable conditions who did not receive the serum. The initial symptoms in the group in which serum was administered were somewhat more severe than the initial symptoms in the control group. The results are contrasted on the basis of mortality and residual paralysis. Of the patients who received the serum ten died, whereas twenty-three of the control patients died. Of the 211 patients who received serum and who survived 161 recovered without having residual paralysis, twenty-nine had slight paralysis, fourteen had moderate residual paralysis and only seven (3.3 per cent) had severe residual paralysis. Of the ninety-three control patients who survived, only thirty-four did not have residual paralysis, ten had slight paralysis, seventeen had moderate paralysis and thirty-two (34.4 per cent) severe paralysis. The number of injections and the total amount of serum administered were recorded for 188 patients; a total of 508 injections was administered, representing 7,670 cc., or an average of about 15 cc. at each injection, and 40 cc. for each patient. The amount of serum administered per patient ranged from 10 to. 200 cc. Only one person had an immediate severe reaction to the serum, three a moderate reaction, three a slight reaction and 146 no immediate reaction. Six patients had severe late reactions, fifteen moderate reactions, twelve slight reactions and 120 no late reaction. Of the ten patients who died in the serum group, all had marked paralysis before the serum was administered.
Of the seven patients to whom serum was administered and who recovered with severe residual paralysis, five had severe paralysis before treatment with serum was instituted and two had moderate paralysis. In only one instance was the first injection made as early as the second day after the onset of symptoms. Of the twenty-nine patients who had slight residual paralysis after treatment, twenty-one had a severe degree of paralysis and two did not have any paralysis at the time of the first injection of serum. Of the 161 patients who eventually recovered without residual paralysis 106 did not have paralysis, eight had slight paralysis, six had moderate paralysis and
forty-one had severe paralysis at the time of the first injection of serum. The degree of residual paralysis was in direct proportion to the duration of the disease before the administration of the serum. Thus, among those patients who recovered with severe residual paralysis the average duration of the disease was 4.3 days, among those with moderate residual paralysis it was 4.7 days, among those with slight residual paralysis it was 3.5 days and among those with no residual paralysis it was 2.3 days. The much lower mortality (4.5 per cent) and incidence of severe residual paralysis (3.3 per cent) of the patients given serum in comparison with the mortality (19.8 per cent) and incidence (34.4 per cent) of severe residual paralysis of the controls seem directly attributable to the action of the antistreptococcus serum. Restless, nervous children often fell asleep soon after receiving the first injection of serum. Headache and pain in the involved extremity or part often were lessened or relieved. The temperature, especially among patients in the preparalytic stages, rapidly fell to normal, usually after an initial transient elevation. Progressive paralysis often was seemingly arrested. Restoration of muscle function was more rapid among patients who received serum. These favorable results, obtained since 1928, are in strict accord with those previously reported.