polio in cattle symptoms

Read more. There has been relatively little research with polio, primarily because we don't know how to induce it. Years after you have polio, you may start to have other symptoms. A gradual transition from summer range to lush pasture or the continuation of hay feeding while cattle acclimate or adjust to lush pasture is advised. The correct name is Polioencephalomalacia, commonly called (PEM). GOAT POLIO: Polioencephalomalacia is a metabolic disease with symptoms that are very similar to those of the brain-stem disease Listeriosis (Listeria monocytogenes). Informa Markets, a trading division of Informa PLC. A common name for this disease in sheep and goats is “polio”; however, it has absolutely no relationship with the infectious viral disease found in humans (poliomyelitis). PEM is a pathologic diagnosis and a common end point of several conditions. Because multiple factors are involved in determining the actual risk of developing PEM, these should not be considered as absolute maximal concentrations. Acutely affected animals may have brain swelling with gyral flattening and coning of the cerebellum due to herniation into the foramen magnum. To … Polioencephalomalacia is a common neurologic disease of ruminants. Early symptoms of paralytic polio include high fever, headache, stiffness in the back and neck, asymmetrical weakness of various muscles, sensitivity to touch, difficulty swallowing, muscle pain, loss of superficial and deep reflexes, paresthesia (pins and … This causes rapid problems for the animal. The course in sheep and goats is rapid, and death may occur 24–48 hr after onset of signs; however, the recovery rate can be up to 30% with prompt, aggressive therapy. Feeding Thiamin Not Necessary I've heard of recommendations to feed large amounts of thiamin as a preventative. Despite the polio vaccine’s long ... who in the 1700s determined that milkmaids exposed to the cowpox virus-laden pus of cowpox-infected cattle did not catch ... with polio symptoms. These are: 1-Fever Other toxic or metabolic diseases (eg, acute lead poisoning, sodium toxicosis/water deprivation) can result in PEM as well. Dietary ingredients or water with high sulfur concentration should be avoided or v… The main clinical signs reflect dysfunction of the cerebrum and include wandering, circling, cortical blindness, incoordination, head pressing, recumbency, nystagmus, and seizure activity. PEM symptoms may present itself similarly to listeriosis and even ketosis. Most have surmised it is caused by a virus ... but that is not known with any certainty. Polio can be in an acute form that causes sudden death, or it can trigger staggering and blindness or cause animals to be down. Last full review/revision Aug 2020 | Content last modified Sep 2020. In other words, we don't know what causes it (what triggers the production of the thiamin-destroying enzyme). Corn-based ethanol production has resulted in increased availability of corn byproducts that may vary widely in sulfur content. verify here. The first sign of a problem is generally cattle exhibiting polio symptoms. Symptomatic therapy for convulsions may be necessary. This mystery disease occurs (sporadically) in backgrounding yards during periods of extreme cold. Cause. In polioencephalomalacia, vitamin B1 or thiamin is still synthesized by rumen microorganisms, but for some reason an enzyme that destroys thiamin is also produced. Thiamine is a key chemical in glucose metabolism that, when deficient, is most threatening to neurological activity. Unfortunately, many of these biochemical features of altered thiamine status are inconsistently observed in cases of PEM, and decreased thiamine status has been observed in diseases other than PEM. Tetanus is a fairly common disease occurring in all types of livestock. Cattle with polio display symptoms of listlessness, incoordination and convulsions. Polioencephalomalacia (PEM) was first reported in 1956 and was described as a neurologic disorder of cattle characterized by blindness, ataxia, recumbancy and seizures. Experimentally amprolium-induced polio-encephalomalacia in cattle.pdf. Thiamine inadequacy can be caused by decreased or altered production by rumen microbes (such as high-concentrate feed in feedlot steers) or factors that interfere with the action of thiamine, eg, plant thiaminases or thiamine analogues. Prolonged dry periods will reduce available A and E in pasture forage, a … The actual paralysis is quite characteristic. The initial histologic lesions are necrosis of cerebrocortical neurons. Beneficial effects are usually seen within 24 hours and sometimes sooner; however, if there is no initial improvement, treatment should be continued for ≥3 days. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. I convinced the owner to delete the thiamin. As they grow, the bacteria produce toxins, which spread along the nerves to the brain and cause the clinical signs of tetanus. Cattle with polio display symptoms of listlessness, incoordination and convulsions. Tetanus is caused by toxins produced by the bacterium Clostridium tetani. The treatment of choice for polioencephalomalacia regardless of cause is thiamine administration at a dosage of 10 mg/kg, three to four times daily, for cattle or small ruminants. Some animals are found dead. Most commonly, decreased thiamine concentration in the diet or high levels of dietary sulfates are the cause of polio in growing and feedlot cattle. In adult ruminants, thiamine is produced by rumen microbes. The legacy of this great resource continues as the Merck Veterinary Manual in the US and Canada and the MSD Manual outside of North America. It affects all ages and both sexes, sometimes as an epidemic in feedlot cattle or sheep. Even if it did work, however, polio is so sporadic I'm not sure it would be economical. Supplementation with thiamine has been recommended for prevention, but is not fully supported by evidence. Ensley says the first clinical sign to watch for is blindness. Although you can get polio at any age, kids under 5 have the highest risk of getting it. In the 1940s, Frederick R. Klenner, MD, had 100% success rate treating polio-like symptoms with intravenous vitamin C. At the same time, in Australia, Sister Kenney successfully used physical therapy with polio victims ... Cattle in Australia were routinely dipped in chemicals, including arsenic. Hydrogen sulfide (H2S) gas, which has the odor of rotten eggs, accumulates in the rumen gas cap. Symptoms are largely neurological in nature, as PEM results first in brain tissue swelling, and then in softening of brain tissue and the growth of brain lesions (it is also called cerebrocortical necrosis [CCN] in cattle and sheep). Goat polio can effect any goat and can be fatal here is what I have learned first hand. Concentrations can be demonstrated with commercially available H2S detection tubes via percutaneous gas sampling. This video is a short synopsis of Polioencephalomalacia or (PEM) in cattle. Head pressing, opisthotonos, and grinding of the teeth may also be seen. Dorsomedial strabismus may develop. Polioencephalomalacia (PEM) is also known as cerebrocortical necrosis (CCN) and is a relatively common nutritional disorder in sheep and goats. At necropsy, macroscopically evident cerebrocortical autofluorescent areas under ultraviolet illumination provide a presumptive diagnosis of PEM. Hi Katie – webmaster here, I also sent you an e-mail. A common name for this disease in sheep and goats is “polio”; however, it has absolutely no relationship with the infectious viral disease found in humans (poliomyelitis). https://www.beefmagazine.com/sites/all/themes/penton_subtheme_beefmagazine/images/logos/footer.png, Polioencephalomalacia is a nutritionally related disorder, commonly referred to simply as "polio." When evaporation occurs, water sulfate concentrations increase. Listeriosis- Signs and symptoms- Depression, fever, staggering, facial paralysis on one side, drooling, abortions, blindness. Recently I have been called out to a number of heifer which had some unusual symptoms and behavior. Today, despite a worldwide effort to wipe out polio, poliovirus continues to affect children and adults in parts of Asia and Africa.The Centers for Disease Control and Prevention (CDC) advises taking precautions to protect yoursel… However, unlike other forms of paralysis, where the affected limbs also lose all sensation in the paralyzed limb, the limbs suffering from polio induced paralysis retain sensation. There are a couple of other diseases that can appear similar, but are caused by infectious agents.Although not discussed in textbooks, consulting veterinarians tell me there is a condition known as the nervous. X Research source Those that do not die quickly are listless and often lethargic, and wander aimlessly around … Low fiber forages and high concentrate diets, producing low levels of volatile fatty acids in the rumen, have been implicated in the epidemiology of polioencephalomalacia. Few laboratories are capable of routinely measuring thiamine content of blood and tissues, transketolase activity, or the thiamine pyrophosphate effect on transketolase. Treatment- HIGH doses of Pen G every 6 hours until all symptoms has disappeared. Polioencephalomalacia (PEM) is an important neurologic disease of ruminants that is seen worldwide. Clinical cases of polio are commonly seen in yearling feedlot cattle. Symptoms appear three to five days after exposure to the virus and include slight fever, headache, sore throat, vomiting, lack of appetite, and a general feeling of illness and discomfort. Polioencephalomalacia is a common neurologic disease of ruminants. Watch for symptoms. Although not discussed in textbooks, consulting veterinarians tell me there is a condition known as the nervous form of coccidiosis. All we know is that it seems to occur primarily in the fall; typically with calves being brought up on high concentrate rations. This site complies with the HONcode standard for trustworthy health information: Treatment consists of intravenous injection of thiamin and glucose. Cortical spongiosis is sometimes present in the early phases of the acute form. … Which of the following conditions can also cause laryngeal paralysis? Had we left thiamin in the ration, obviously we would think it was working. As the disease progresses, there is cortical blindness with a diminished menace response and unaltered palpebral and pupillary responses. If your lamb bumps into things that it ordinarily would see and avoid, he may be showing signs of blindness. This condition, which affects more than half of all people who contract polio, is known to cause a number of unpleasant (though far less fatal) symptoms such as … True polio is caused by an induced thiamin or vitamin B1 deficiency. Paralytic polio symptoms: Although paralytic polio symptoms mimic the nonparalytic polio symptoms for about a week, increasing symptoms of severe muscle aches and spasms, loss of reflexes, and flaccid paralysis (limbs become floppy) begin to develop. Clinical diagnosis is often difficult and suspected based on the combination of neurologic signs, elimination of other diagnoses, and response to thiamine administration. It is an infrequent but frustrating malady that usually begins occurring about this time of year. Symptom #2: Stiffness of the Arms and Legs. Polio due to sulfur toxicity is usually seen at least one to three weeks after first starting animals on a … Maybe there are more ways to cause polio symptoms, like there are several ways to achieve a headache, maybe DDT was just one of the many ways a person developed polio like symptoms. Symptoms: Cattle with acute acidosis may go into shock and die suddenly due to a result of overwhelming increase in acidity in the rumen. The disease’s incubation period varies with the amount of ingested toxin, with individual susceptibility, and may last from days to weeks. All rights reserved. Since the brain controls nearly all bodily functions, adequate thiamine levels in the brain are of critical i… One of my clients used to say, "It doesn't cost but a couple of hundred dollars a month more to get a really good man ... and he'll easily save you that much in reduced equipment damage." A disorder called polio (polioencephalomalacia) commonly develops in malnourished, thin cattle that have been grazing poor pastures low in protein, consuming high levels of sulfate in grass and water and then are brought into dry-lot confinement and fed large amounts of grain concentrates or grain silages without adequate roughage. 2. If the problem can be associated with a high sulfur intake, all possible sources of sulfur, including water, should be analyzed and the total sulfur concentration of the consumed dry matter estimated. He is the sweetest thing and it is breaking our hearts. Polio kan skada ryggmärgen och orsaka förlamning. The cause was Polio, and I have seen in sheep on feed but not very often in range cattle. In particular, vitamin A and E can be common causes of lost profit, secondary to limitations of reproductive and growth potential. The latter microorganism proliferates under conditions of high grain intake. Overall, there is not a linear relation among the presence of ruminal and fecal thiaminase, decreased concentrations of tissue and blood thiamine, and development of disease. Polio: It is a disease of the central nervous system. They can either destroy thiamine or form antimetabolites that interfere with thiamine function. Please confirm that you are a health care professional. True polioencephalomalacia, on the other hand, has a known cause. Signs Of Polio Veterinary pathologists can readily identify classic nutritional polioencephalomalacia by examining brain tissue. Feeding high-grain diets to ruminants can predispose them to polio because it slows thiamine production in the rumen and increases mechanisms that degrade thiamine produced in the rumen. This is due to toxic levels of sulfur within the animal causing brain swelling, which damages neurons, including the optic nerves. Wet distillers grains plus solubles have been shown to have sulfur content ranging from 0.44%–1.74% sulfur as dry matter. Most feedlot veterinarians will routinely instruct feedlot "doctors" in how to treat polio, and likewise thiamin and glucose will be kept on hand. Those with a longer duration of acute signs have poorer responses to therapy and higher mortality. Because this is a deficiency of a vitamin it is NOT contagious. The first sign of the disease is blindness. Animals with the subacute form initially separate from the group, stop eating, and display twitches of the ears and face. Goat polio is usually seen in goats raised under intensive management conditions and/or usually in kids. Polioencephalomalacia (PEM), also referred to as cerebrocortical necrosis (CCN), is a neurological disease seen in ruminants that is caused by multiple factors, one of which is thiamine depletion in the body. Older cattle are less susceptible and recovery is more common in the older age group of cattle. Dietary supplementation of thiamine at 3–10 mg/kg feed has been recommended for prevention, but the efficacy of this approach has not been carefully evaluated. PEM has been associated with the use of these types of byproducts as feed ingredients. The first sign of a problem is generally cattle exhibiting polio symptoms. Preruminant animals depend on dietary thiamine. The first dose is administered slowly IV; otherwise, the animal may collapse. Polioencephalomalacia (PEM) was first reported in 1956 and was described as a neurologic disorder of cattle characterized by blindness, ataxia, recumbancy and seizures. We do not control or have responsibility for the content of any third-party site. There are two forms of polio: 1. It is also known as abortive polio. The CNS, by virtue of its dependence on a high and uninterrupted level of energy production, is likely to be significantly affected by energy deprivation. Characteristic histologic lesions are confirmatory. The neurons are shrunken and have homogeneous, eosinophilic cytoplasm. It occurs in outbreaks or in individual animals. Cause. Thiaminase I, produced by Bacillus thiaminolyticus and Clostridium sporogenes, and thiaminase II, produced by B aneurinolyticus, catalyze the cleavage of thiamine. Fortunately, treatment is simple and results in rapid recovery. I have also been aware of attempts to administer large amount of thiamin as a therapeutic means to overcome polio, but to my knowledge they have been failures. There are a couple of other diseases that can appear similar, but are caused by infectious agents.Although not discussed in textbooks, consulting veterinarians tell me there is a condition … Symptom #2: Stiffness of the Arms and Legs. Ensley says the first clinical sign to watch for is blindness. In cattle, polioencephalomalacia is an occasional finding, but can occur in outbreaks. More correctly, rumen microorganisms synthesize B vitamins and the host animal absorbs them for their own use. The subacute form of PEM is frequently followed by recovery with only minor neurologic impairment. INTRODUCTION. This occurs in 2 out of 100 people. Death may occur within a few hours after onset of the disease. A variety of sulfur sources can result in excessive sulfur intake, including water, feed ingredients, and forage. Clinical signs include head pressing, blindness, convulsions, nystagmus, dorsomedial strabismus, and recumbency. In the absence of oxygen the bacteria multiply and produce a local infection. Many cattle adapt adequately to sulfur intake levels greater than the maximal tolerable level, although negative effects on performance may occur. A beneficial response to thiamine therapy by PEM-affected animals is sometimes considered evidence of thiamine inadequacy. Tetanus is caused by toxins produced by the bacterium Clostridium tetani. Pastured animals can develop PEM, but animals on high-concentrate diets are at higher risk, as are cattle exposed to high levels of sulfur, whether in water, feed (rations with byproducts of corn or beets processing), or a combination. A neurologic disorder diagnosed in Australia has been associated with the Nardoo fern (Marsilea drummondii), which may contain high levels of a thiaminase I enzyme. This year I am getting reports all over Eddy County. Treatment of PEM is symptomatic and includes administration of thiamine, Dexamethasone may help reduce cerebral edema. These include turnips, rape, mustard, and oil seed meals. Lead poisoning may also produce the symptoms of PEM, and can be detected by sampling blood lead levels. Polioencephalomalacia is a neurologic disease that affects young ruminants and pseudoruminants. Polio. Symptoms: Depression, cough, breathing problems, high fever and loss of appetite. Although PEM has been produced experimentally by feeding high doses of extracts of such plants, field cases are uncommon, because these plants are unpalatable. Polioencephalomalacia may be acute or subacute. Despite the polio vaccine’s long ... who in the 1700s determined that milkmaids exposed to the cowpox virus-laden pus of cowpox-infected cattle did not catch smallpox. There is also apparently another similar malady that to my knowledge has never been identified. The basis of sulfur-related PEM appears to be the production of excessive ruminal sulfide due to the ruminal microbial reduction of ingested sulfur. This may occur in patients with paralytic polio as well; however, if you are struggling with the non-paralytic variety then these symptoms won’t get much worse. Listeriosis is an infectious disease caused by a bacterium, Listeria monocytogenes.It is a zoonotic disease. Animals may show ataxia and sometimes a hypermetric gait. Polioencephalomalacia is a nutritionally related disorder, commonly referred to simply as "polio." Encephalitis or meningoencephalitis in adult ruminants is the most frequently recognizsd form. Water consumption by cattle is temperature dependent and increases greatly at high temperatures, leading to increased sulfur intake due to concurrent increases in water consumption and sulfate concentrations in water. Suspected based on clinical signs and response to thiamine; confirmed by necropsy. Polioencephalomalacia (PEM) or cerebrocortical necrosis is a neurologic disease of ruminants characterized by necrosis of cerebral cortex (Loew et al., 1969; Summers et al., 1995).PEM affects young ruminants, usually 2 to 7 months/sheep and from weaning at 6 to 18 months/cattle. Polio is a contagious viral illness that in its most severe form causes nerve injury leading to paralysis, difficulty breathing and sometimes death.In the U.S., the last case of naturally occurring polio was in 1979. A disorder called polio (polioencephalomalacia) commonly develops in malnourished, thin cattle that have been grazing poor pastures low in protein, consuming high levels of sulfate in grass and water, and then are brought into dry lot confinement and fed large amounts of grain concentrates or grain silages without adequate roughage. It is an infrequent but frustrating malady that usually begins occurring about this time of year. Number 8860726. The Merck Veterinary Manual was first published in 1955 as a service to the community. Animals most commonly affected are calves of 6-18 months of age. Copyright © 2021. Assessment of thiamine status is difficult, and results should be interpreted with caution. Deficiencies of vitamins A, D, K, E and thiamin can cause severe limitations in beef production. The time between infection and disease can be very short (two … Polio in Cattle can be Caused by Sulfur Toxicity. Consider your mindset for 2021 and beyond, Cattlemen's Update to examine market, production, research, 7 ag stories you might have missed this week - Jan. 8, 2021, Ag groups file additional comments on FMD vaccine, Nufarm announces Grassmanship Scholarships. The maximal tolerated concentration of sulfur for cattle and sheep depends on the type of diet. Antemortem confirmation of a diagnosis of Polioencephalomalacia is difficult. Most people with polio don't have any symptoms and won't know they're infected. At first, … Polio is most common in rapidly growing cattle fed a high-concentrate diet because this class of animals are more likely to encounter risk factors that lead to decreased thiamine activity. I say this because I had wondered that same thing, still being on the fence w vaccines, it seemed that polio existed before, after and outside of DDT. Thiaminases can be produced by gut bacteria or ingested as preformed plant products. To prevent permanent brain damage, producers should call in a veterinarian for treatment immediately within 12 hours if they are treated early in the course of disease and do not have brain necrosis. It briefly discusses clinical signs, necropsy findings, causes, and a Bovine Diet. Usually, affected sheep or cattle display signs for 1–6 days before dying. Although nonreduced forms of sulfur, such as sulfate and elemental sulfur, are relatively nontoxic, H2S and its various ionic forms are highly toxic substances that interfere with cellular energy metabolism. There are a couple of other diseases that can appear similar, but are caused by infectious agents. When the problem could be associated with high sulfur intake, all possible sources of sulfur, including water, should be analyzed and the total sulfur concentration of the consumed dry matter estimated. Diagnosis is suspected based on signs and response to thiamine administration. Cruciferous plants normally synthesize sulfur-rich products and serve as important sources of excess sulfur. Usually, people suffering from this disease variant don’t even suspect they have polio because it generates symptoms similar to the common flu. Animals that survive the acute form or advanced subacute form often manifest significant neurologic impairment that necessitates culling. Polioencephalomalacia is a thiamine-responsive disease of ruminants. Thiamin must be injected (intravenous) to bypass the enzyme in the rumen. Demonstration of clinical improvement after thiamine therapy is not adequate evidence for a specific diagnosis. Veterinarians I have worked with tell me that this mystery disease I have described leaves no identifiable pathology. ... Polioencephalomalacia (not related to the paralyzing human version of polio) is also a concern for cattle that have had acidosis. GOAT POLIO: Polioencephalomalacia is a metabolic disease with symptoms that are very similar to those of the brain-stem disease Listeriosis (Listeria monocytogenes). Polio, polioencephalomalacia, is a disease caused by a deficiency of thiamine and is seen most commonly in lambs on high grain diets. For diets ≥45% forage, the maximal tolerable level of total sulfur is 0.5% dry matter. This enzyme is produced in quantities so massive that they overwhelm normal thiamin production, which causes the animal to become paralyzed. The condition, caused by a virus, is extremely contagious and can lead to a number of debilitating symptoms and, if untreated, be fatal. It's rare nowadays because it can be prevented with vaccination. Most of the late symptoms appeared gradually (median time 45 years after onset of polio). In addition to high sulfur, polio also can be caused by things … Polio. Thiamine (vitamin B1) is produced naturally in the rumen of sheep on a normal diet. Byproducts of corn, sugar cane, and sugar beet processing commonly have a high sulfur content, apparently due to the addition of sulfur-containing acidifying agents. POLIO IN CATTLE AND SHEEP . After recovery they can develop post-polio syndrome years later as adults, causing weakness or paralysis. To date, only nominal instances of polio have occurred. Polio is a virus that spreads easily between people who aren't vaccinated. The amount of thiamin enzyme produced is so great that it has destroyed virtually every amount that has been administered (orally). The pattern of clinical signs should arouse suspicion of polioencephalomalacia. In the less severe cases, cattle with polio show head-pressing and remain stationary for several hours or a few days and will show anorexia. Certain weeds, including Canada thistle (Cirsium arvense), kochia (Kochia scoparia), and lambsquarter (Chenopodium spp), can accumulate sulfate in high concentration. The hands-off approach changed once reports surfaced that children who had received Salk’s vaccine were in the hospital, with polio symptoms. However, I am not aware of any research supporting that idea. As a general rule, ruminants can synthesize their own B vitamins. Slight yellowish discoloration of the affected cortical tissue may be present. Polio is a medical condition that’s also referred to as poliomyelitis and infantile paralysis. The byproducts can have enough sulfur to cause polio in cattle. The head is held in an elevated position. Another symptom of non-paralytic polio is stiffness of the arms and legs. This video is a short synopsis of Polioencephalomalacia or (PEM) in cattle. The severity of the paralysis depends on the region of the spinal cord which was under attack, which means that instead of being symmetrical paralysis, a person may suffer from paralysis one side, … This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. 1cc per 10-20lbs. Although the etiology is usually unknown, trauma and neoplasia can cause laryngeal paralysis. The primary cause of polio in sheep is thiamine deficiency, or a disturbance in how the body uses thiamine. Paralytic polio leads to paralysis in the spinal cord (spinal polio), brainstem (bulbar polio), or both (bulbospinal polio). Alfalfa, by virtue of its high protein and sulfur-containing amino acid content, can serve as a significant source of sulfur. Goats and other ruminants are dependent on Thiamine in the rumen which metabolizes glucose into carbohydrates. Treatment: Antibiotics are available to treat this disease, consult the veterinarian as soon as you observe above symptoms. The animal (usually a 400- to 600-lb. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. Beef Magazine is part of the Informa Markets Division of Informa PLC. The brains of acutely affected animals may also have autofluorescent bands of necrotic cerebral cortex evident on meningeal and cut surfaces of the brain when viewed with ultraviolet illumination. Cases of PEM can be successfully treated if detected early in the disease course, making recognition of early symptoms a critical issue for sheep and goat producers. The main clinical signs reflect dysfunction of the cerebrum and include wandering, circling, cortical blindness, incoordination, head pressing, recumbency, nystagmus, and seizure activity. This bacterium is found in the soil and the guts of animals and humans. Polio är en virussjukdom som sprids med avföringen och förorenat vatten. Polio-encephalomalacia. Symptoms: Cattle with acute acidosis may go into shock and die suddenly due to a result of overwhelming increase in acidity in the rumen. At later stages, the affected cortical tissue undergoes cavitation as macrophages infiltrate and necrotic tissue is removed. The most common cause of PEM is thiamine deficiency. The micropathologic description was a … However, sudden death can also occur only 12–48 hours after introduction into a paddock. Cattle with polio, regardless of the cause, may have aimless wandering, indications of blindness, head-pressing, stumbling, circling, muscle tremors and possibly convulsions. Watch for symptoms. Vessel cells undergo hypertrophy and hyperplasia. Polio infected people whose muscles are affected mostly die because it affects their breathing. In this case, a little extra money to hire conscientious cowboys can save several times as much in unnecessary (and probably ineffective) thiamin.

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