Poliomyelitis (Heine-Medin disease).

Poliomyelitis (Heine-Medin disease) T he recent death of FC Robbins 1 , Nobel laureate and pioneer worker who cultivated the poliomyelitis virus, prompts this note. Poliomyelitis pre-dates recorded history. 2 Biblical descriptions of the lame and crippled lack sufficient detail for diagnosis. However, a funereal stele of the priest Ruma from the 19th Egyptian dynasty shows shortening and marked wasting of his right leg; he walks on his toes and uses a stick 3 ; this has been attributed to poliomyelitis. 4 Frequent 18th century epidemics allowed a British doctor, Michael Underwood, to describe poliomyelitis as an entity in 1789, referring to a ''debility of the lower extremities in children'' 5 John Badham described an acute paralysis suggestive of poliomyelitis in four children in 1835. 6 Little more was written until Jacob von Heine published a 78 page monograph in 1840, which recognised poliomyelitis as a disease entity (Heine also portrayed congenital spastic diplegia, later elaborated by Little in 1841). He separated the disease from other forms of paralysis and termed it infantile spinal paralysis. 7 He described the residual deformities, and suspected a cord lesion. Heine was a German orthopaedist, born 16 April 1800 at Lauterbach. His family had a long tradition of bonesetting. Two years after graduation at Würzburg in 1827 and postgraduate work, he left Würzburg; the government elected him to organise an orthopaedic clinic in Cannstatt, which attracted patients from all over Europe. He died on 12 November 1879. However, the limited prevailing medical knowledge prevented an understanding of the infectious nature of poliomyelitis. For example, a major epidemic in Vermont during 1894 was attributed to ''overheating, chilling, trauma, fatigue, and illnesses such as typhoid, whooping cough, and pneumonia''. The pathology too was unknown until Duchenne in 1855, then Charcot and Joffroy, first located the atrophy in the anterior horns of the spinal grey matter. 8 They ascribed it to ''an irritation that suddenly seizes a large number of cells in the anterior horn and makes them loose their function''. And, Erb reflected this when he coined the term ''acute anterior poliomyelitis'' in 1875. Usually named sporadic infantile paralysis, the Swedish Oskar Medin in 1890 reported its occurrence in epidemic form. Hence arose the eponym Heine-Medin disease. Prevention When in 1910 Levaditi and Landsteiner mixed live polio-myelitis virus with convalescent monkey serum, it failed to produce paralysis when injected into healthy monkeys; but this promising method …