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EDITOR'S NOTE -- We should like to see a satisfactory answer to Dr. Freiberg's question from an economic point of view. We believe the time must come when society will arrange that every person suffering from the after effects of poliomyelitis will be systematically placed in some occupation which will make the maximum use of his abilities compatible with the maximum of recovery. Two ends would be served -- society would gain by the human energy reclaimed; the recovery of the individual would be hastened rather than curtailed by the fully useful activity.

So much has been said and written concerning Poliomyelitis, or Infantile Paralysis, during the past two decades that the reading layman is pretty well informed regarding its general characteristics. He knows quite well that it is regarded as an acute infectious disease, that there is still doubt as to the manner of its transmission and contagiousness. Many persons know that the disease is one which produces its permanent disabling effects by reason of damage to the spinal cord but many are still unclear on this point; they look to the paralyzed limb as the seat of the disease and, therefore, they hope for miraculous and impossible help from treatment directed to the limb. Those who are well informed know that the true seat of the damage is in the spinal cord and that after the acute and often prostrating phase of the illness is past there is a period during which nature is able to bring about much repair at the site of the disease in the spinal cord, in the great majority of cases at least. However, not a few of even this group do not realize that medical science has thus far not enabled us either to limit the extent of the damage in the cord, or to definitely influence the degree to which repair in the spinal cord is to proceed. We do know that after a certain period, whose outside limit is assumed to be two years, no further repair in the cord may be expected. During the period of repair certain muscles are receiving no nerve impulses to make them act. Being unable to resist by contracting, as a normal muscle would do, they are subject to damage by various influences such as overstretching, unless we protect them. Unless they are so protected, when nerve impulses again come to them because of the repair which has taken place in the nerve centers in the spinal cord, the muscles will have so deteriorated that they can not respond by action. This deterioration may be so great as to be beyond recovery; most often it is not, if the proper things are done.

We may liken the situation to that of a system of electric bells which are worked by a central battery. If the battery is out of order, they will not ring. If, pending the repair or replacement of the battery, we permit the bells themselves to be damaged, when the battery is again in order the bells will fail to operate until they have been looked after. In this simile, the battery represents the spinal cord nerve centers, the wires are like the nerves which bring nerve impulses (or electric current) to the bells which we have likened to the muscles. Every intelligent person knows to what extent the muscles of an otherwise normal person deteriorate and weaken by lack of use, or exercise. But we also know that if the individual be otherwise normal, these weak muscles can be made again strong by well directed exercise. We also know that if such a weakened muscle, or set of muscles, be over-worked it becomes degenerated. It becomes not stronger, but weaker and our purpose is defeated. On the other hand, it is well understood that by means of judiciously controlled exercise, which we speak of commonly as "training" or gymnastics, muscles may be brought to a degree of strength which is much greater than usual. We have here only to think of the bulging muscles of the trained athlete; not, indeed, that such bulges are to be desired but rather as an example of the extent to which strength and even volume of muscle may be cultivated.

It is easy to imagine how important all of these considerations become when we have to deal with muscles which are weakened by paralysis in any conceivable degree; the muscle may have 90% of its proper strength or it may have 20%. But whatever it has should be conserved and carefully built up to the maximum which is possible. Here lies the virtue of exercise under warm water. The buoyancy of the water makes it possible for a trained person to control the exercise to a marvelous extent and to apportion it alike for the weakest muscle as well as the one which has perceptibly grown strong. It greatly facilitates the task of working quite weak muscles in combination with such as are much stronger, as no other method can approximate. If, at the same time that such suitable method of "physiotherapy" is being employed the weakened muscles are protected from becoming overstretched by means of suitable splints or braces and by regulating the patient activities, we may hope to bring him towards maximum degree of recovery.