Elsewhere I have described the mechanism whereby the ordinary spinal type of poliomyelitis is produced.1 The ordinary forms of monoplegia and paraplegia seen in human beings with this disease can be reproduced experimentally when the virus is introduced into an animal by way of the gastro-intestinal tract.2 The spread in the latter instance is probably along the thoracolumbar outflow of the sympathetic system.3 It has been pointed out likewise that there are good anatomic and physiologic reasons for believing that ordinary spinal poliomyelitis has its origin in the gastro-intestinal tract and that the virus spreads to the spinal cord along the sympathetic nervous system.1 This hypothesis, which explains the production of this type of poliomyelitis, does not, however, explain the mechanism whereby bulbar poliomyelitis is produced.
Isolated nuclear paralysis of the ninth, tenth, eleventh or twelfth nerve is uncommon, but as the virus of poliomyelitis may
TOOMEY JA. POLIOMYELITIS: II. THE BULBAR TYPE. Am J Dis Child. 1935;50(6):1362–1373. doi:10.1001/archpedi.1935.01970120014002
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