THE EPIDEMIC

Evening Post, Volume CIX, Issue 93, 22 April 1925, Page 9

THE EPIDEMIC

TREATMENT OF INFANTILE

PARALYSIS

EXPERIENCE AT WELLINGTON

HOSPITAL

ADDRESS BY DR. W. S. ROBERTSON.

Dr. W. S. Robertson, orthopedic surgeorc, Wellington Hospital,, who has had wide experience in dealing with infantile paralysis, and whose success in treating these cases at tho hospital is acknowledged by the profession, delivered an address op infantile paralysis at tho Red Cross Rooms last evening. The Hon. Dr. Collies, M.L.C., presided. This disease, said Dr. Robertson, has affected mankind for centuries. A mummy from Egypt had been described as having typical appearances of an attack. Another authority named Jonathan's son as having been affected; and all througn the centuries up to recent/ times there had been cases quoted in! literature which must have been cases of infantile paralysis. Since 1900_ the disease had been, and was now being, very exhaustively studied from every aspect. About 150 epidemics had been recorded. The disease was an acute infectious disease, the cause being an ultramicroscopic something, probably organisms so minute that they could pass through the finest filter and remain invisible under the highest-powered microscope. The organisms of some other infectious diseases, notably mumps and measles, had not yet been isolated, and came under the samp ultra-microscopic class. DEFINITELY CONTAGIOUS. The causative organism, whatever it ■was, produced a virus, which had been isolated by special culture methods in the form of globoid bodies, which were probably colonies or clumps of the organism. Tho virus, when injected into the brain of the ape, caused typical symptoms of the disease.. An attack usually conferred immunity, but rarely ■ second attacks did occur. The disease was not highly infectious, but was definitely contagious, being carried and transferred from, person to person by direct contact, and by indirect contact by nasal, salivary, and bowel discharges. Density of population -was not a decisive factor, nor was the seasonal incidence, for though most epidemics occurred in the ■warm months of late summer and early autumn, epidemics had been reported in the middle of ■winter. In Dr. Robertson's opinion, exposure to the sun's hot rays was a decisive predisposing cause. MANY MILD OASES. The age-incidence was from 1 to 5 years of age. Intra-uterine cases had been reported, and even the age. of 60 ■was not immune. As a lule, the older the ohild the worse -was tho type of case—the death rate among children about 10 being comparatively high. The human incubation • period was one to five days. Most cases were mild, and escaped notice, tha comparatively ■ occasional case which developed typical symptoms only being recognised. In this way the whole infantile comnrcmity was probably affected, the large majority being protected by a natural or quickly-ac-quired immunity—these cases, however, being all capable of passing on the infection to contacts, the disease then spreading_ along lines of • transport. Sporadic cases were regularly cropping up in between epidemics, -which came every three to five years, but these epidemics unfortunately appeared to be getting more extensive with every appearance.. NATURE OF TTTE; DISEASE. : The disease -was due.to an acute inflammation involving the meninges and substance of all parts of the central "nervous system, giving rise to congestion, infiltration, and oedema of the tissue; the process - extending by following the vessels from the periphery to the interior* of the cord. By~ reason of its rich blood supply, the grey matter of the anterior horns bore the brunt of the hyperaemia and oedema, with permanent destruction of some of the motor cells and temporary congestive choking out of action of others. On account of the extensive oedema and hyperaemia being in excess of the actual infiltrative destruction, the functional loss was much in excess of the permanent paralysis—hence' the widespread paralysis in the early stages, and the marked degree of recovery of function possible. There were various types of the disease according to whichever part of the central nervous system was involved. The main types were: (1) Abortive, (2) mcningeal, (3),' encephalitic, (4) dromedary, spinal. Dr. Robertson then described in detail the preliminary symptoms of the disease. . . TREATMENT. Treatment consisted of: I.—lmmediate recumbency* 2-—Diagnotic examination of the spinal fluid, which always showed an increase of the cell elements in tho early stages. 3.—Administration of blood serum from a two to four months' convalescent case either into the spinal canal or into the vein. The serum was useless if paralysis had appeared prior to its administration, hence the need of getting these cases in the pre-paralytic stage] and preventing the paralysis from appearing. Some cases undoubtedly cleared up without specific treatment, but, just as certainly convalescent serum had prevented many cases from becoming paralysed; and as there was no saying that any given case was going to be abortive or was going to be paralytic, universal use of sernm was urged. There ■were no harmful results from correct administration. 4.—General nursing, fever diet, aperient if necessary, symptomatic treatment for pain, etc. SPLINTING AND PLASTER BEDS.. s.—lmmediate splinting of legs by long light bed boots in position of rest for ankles and knees, the splints being again protected from rotating by sandbags. ■Spinal plaster beds, including feet and arms and head, if necessary, for all children under 3 years were indicated. If the arms were tender or painful they should be elevated into 90deg abduction position by propping up on pillows .r> slinging to head of bedi. Any existing paralysis should be treated in the sWe way by immediate light-splinting in the approved position of physiological rest for the affected muscles. Potation of thigh <-vnd leg on the trunk is to be especially guarded against, by means of sandbars or by use of plaster spinal bed. In the early stages of the disease, the weakness and paralysis are of insidious onset, and may easily be overlooked for somo time, hence the importance of immediate routine splinting of all cases. In view of the fact also that the spinal and ab-

dominal muscles may be involved, the cases should be nursed on firm mattresses, placed on fracture boards. 6-—The patients should be disturbed as littlo as possible, and handled only when necessary for sanitary purposes. -- EXTREME GENTLENESS. More than extreme gentleness is necessary in handling. The limbs are removed from the splints daily, kept supported in position of the splinting, and gently rubbed with methylated spirit and powdered, to prevent splint sores. The back is similarly treated. Hot baths, with both splints applied, had proved of immense benefit To recapitulate, a plaster bed was the ideal, from the following points of view:—(a) ! Diminution of pain, from the supported relaxation of the whole body, preventing pain caused by restless movements of limbs, etc. The manner in which a very irritable, curled up, tender child settled down in its plaster bed, going off to sleep in comfort, was most striking; (b) the limbs and back were in the desired protected position should any paresis supervene; (c) the child need not be disturbed for sanitary purposes. MASSAGE. | Dr. Robertson held that immediate splinting diminished the degree of oncoming weakness or paresis in a giveri limb.-. It prevented contraction of opposing unaffected groups of muscles, and it shortened the recovery time of weakened muscles. Tentative re-educative mea- ; sures should be commenced by the n edical officer in charge as early as the tenth day, provided there were no contra-indi-cations. At the end of three weeks the cases were handed over to masseurs to continue the same treatment. Massage was not employed for two months, nor should electrical treatment bo used before three months at least, and then in selected cases only. UNREMTTTTNG ATTENTION- HOPE OF RECOVERY. The hope of recovery lay in re-ednca- ■ ting by means of the patient's own consciousness those nerve cells that had been temporarily choked out of action. When convalescent, the patient was' brought to the sitting-up position by means of graduated rises on a bed back rest. When ready for walking, weak or paralytic muscles and limbs were protected by various walking orthopedic appliances. There was no limit to the improvement possible within 12 months. No improvement in two to three years called for operative measures in the way of muscle transplants, etc., Infinite patience and unremitting attention was needed by , parents and attendants ior years.