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One must remember that the recovery of an extensively damaged muscle is never complete if some of its representative nerve cells in the spinal cord have been destroyed. Likewise, one may say the future potential strength of the muscle can be measured by the number of representative neurons remaining intact. No one type of treatment is suited to these neuromuscular units that remain. Each case is an individual problem and must be treated as such. The after-care of the poliomyelitis patient in all its phases has not been standardized. Treatment varies from complete physiological rest over prolonged periods to exercises in a medium of warm water as early after the acute attack as the physical status of the patient will allow. There is no positive evidence that one method has a decided advantage over the other. Unfortunately there are no "controls." It is impossible to say what improvement a given individual would have made had he been treated by a different method or methods.

With the completion of the hospital building at Warm Springs in August of 1939, the Medical Department for the first time in the history of the institution was provided with a unit in which every phase of treatment of the poliomyelitis patient could be applied and studied under one roof. The one exception is the work carried on in the main hydrotherapy pool which is located at a convenient distance from the hospital. Patients residing in the hospital for whom hydrotherapy is indicated can be transported to and from the pool in a manner consistent with the care their particular involvement requires. For example, no early convalescent patients are allowed to sit up. They are transported to and from the pool on specially designed frames. The hospital is designed in particular for the treatment of infantile paralysis. It is so arranged and equipped that a maximum number of patients can be thoroughly supervised and cared for with the greatest efficiency. It is possible to have every early convalescent patient seen every day by designated members of the physical therapy department. This makes it possible to detect early deformities, apparatus that might not fit properly, and give attention to the minute details which are so important in the treatment of poliomyelitis. Patients can be carried in their own beds down to a lower level to an appliance shop for fitting of all apparatus and at this one fitting the minor adjustments which are necessary can be made with the least inconvenience and discomfort to the patient.

Prior to the completion of the hospital, all surgery was done in an affiliated hospital some 75 miles distant from Warm Springs. Now there is a complete operating suite in which all operations can be performed under the most favorable conditions, and the postoperative care which is so important can be closely supervised. Physical facilities have been provided whereby all the necessary parts of an orthopedic organization can work in a coordinated manner to give the best care possible for the poliomyelitis patient.

Procedure for Admission of a Patient

AN APPLICATION for the admission of a patient, accompanied by a complete medical case history from the attending physician, should be directed to the office of the Registrar. Thereafter the Chief Surgeon and his staff review the case history and determine the applicant's medical acceptability. If the applicant is acceptable, arrangements are made by the Registrar for the admission of the patient.

Cost of Treatment

Over 50% of the patients are Aid cases, the others paying a moderate rate which does not defray actual cost. (1) There are no patients at Warm Springs from whom any profit is derived.

Railroads extend the courtesy of one-half the regular fare to Aid patients and one person accompanying them. Application for this special rate can be made to the railroad agent from whom the ticket is purchased through a special form furnished by the Registrar.

Generally the cost of medical attention and maintenance, depending somewhat on the type of accommodations, is as follows:

Medical: There is an initial examination of every patient on arrival, comprising three separate functions: a general examination by a physician, muscle examination by a trained physiotherapist, and orthopedic examination by an orthopedic surgeon. The fee is determined by the extent of these examinations, but is usually $25 for all three.

Rates: There are two basic rates for Pay patients, which include medical supervision, physical therapy treatment in the pools, service of all attendants, walking instructions, etc., and complete maintenance. The present rates are $42 per week for patients living in the hospital and infirmary who require full hospital care; and $39 per week for those patients who are ambulatory and need less nursing care. However, such patients are always supervised by a registered nurse.

NOTE: These rates do not include such extra items as orthopedic appliances (braces, shoes, corsets, plaster casts, etc.), surgical fees, use of operating room, and anesthesia.