CHAPTER VII
Prognosis
When we speak of the prognosis of Heine-Medin's disease we must, more than in most other diseases, distinguish between the prognosis quoad vitam and the prognosis quoad valetudinem completam. That infantile paralysis never or hardly ever ran a fatal course, and that permanent paralysis always ensued, had formerly the weight of a dogma. Medin and Rissler proved that infantile paralysis could end fatally. Wickman later showed that, under certain conditions, the prognosis quoad vitam ought to be guarded; that a high mortality might prevail; and that the disease was more fatal to adults than to children. The Swedish epidemic of 1905 demonstrated further that the prognosis quoad valetudinem completam is more favorable than was credited formerly.
The mortality fluctuates considerably, not only in different centers of the same epidemic, but even at the various points of a single center. In one small epidemic area of 26 cases, Wickman found a mortality of 42.3 per cent.; in another, of 41 cases, the death rate was only 10 per cent.
The general aspect of an epidemic varies materially according as the abortive cases are estimated or not; and even when they are estimated, it changes according to the thoroughness with which the estimation is made.
The following table shows the figures accessible to me from European epidemics.
I reported altogether 1,025 cases with 125 deaths; 868 cases showed paralysis; 157 were abortive. For the sake of comparison with other epidemics and because the actual number of abortive cases was far in excess of those I reported, I have calculated the mortality with reference only to the 868 cases of paralysis. I have omitted the deaths which occurred after two weeks, for then the fatal termination always arose from a complication such as pneumonia developing in consequence of the paralysis. Fourteen deaths were thus excluded; one hundred and forty-five remained and are inserted in the table.
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