INFANTILE PARALYSIS

Evening Post, Volume CIX, Issue 148, 26 June 1925, Page 14

INFANTILE PARALYSIS

A MODERN SCOURGE

HOW TO RECOGNISE THE

■ DISEASE

MARKED PREFERENCE FOR

CHILDREN.

Though the term "infantile paralysis" is really .-.a.-.misnomer, it is a. very convenient one, and more often used than the correct title, " acute anterior poliomyelitis." The disese has been known for about 150 years, though only properly described during the last, twenty : years.; At first only odd cases here and there occurred—i.e., it was sporadic, but since the . 20th century epidemics have occurred in many countries, and they seem to be increasing both in the number of cases and in virulence; witness the recent epidemic in Now Zealand, where .in the laßt six months there have been over 1000 cases, with a mortality'of I about 13 per cent. Though not very prevalent in Victoria, already during 1925 there have been five times the number..,of cases 'notified compared. with the whole -of last year, Bays: " Stethoscope " in the Melbourne "Argus." .Anterior polio-mjelitis may attack adults^ and paralysis .may occur in children from other causes, yet the vast majority of paralyses found: in children is due to. this disease, so that the title " infantile paralysis "will be used.- ; ; '"" ' "'■ : It is an infectious disease, Avhich shows a marked preference for young children ; 85 per,cent, of all cases being in children . under .five years of age—the first three years- seem to be the most danger-; ous r. The incidence, gradually,: falls with increasing age,; and.-the disease is: unknown ; after 40. Epidemics usually ; . occur, in the late summer and autumn months,' and as this corresponds with the period ■■ of maximum "prevalence: ;of the. housefly; this pest has also been blamed for_ conveying-infantile, paralysis as -well as typhoid, diphtheria, 'etc;. ': However, present-day authorities give, the" fly a verdict of,:" not proven ' for. this disease,, though: quite possibly :it i.plays' a part in' infecbing ■' food.; / _Mosquitoes, fleas, bugs,'etc., have ( beeri'-found','not guilty,"/.and the real culprit in:spreading the disease seems .to be man himself. The possibility of! blood-sucking flies,: such; as the:'horse.; or .-.stable .fly, being .'responsible, has. been denied—chiefly";on experimental.grounds,.which"..,; showed that a large amount, of blooE taken from an acute case.Had to be injected to infect > monkey, compared, for example, with the smaller amount of infected nasal/se- : creHon;'".:-'.-..--';..',.,-.'', v '■-■•'■-■.- /;' •■.■".. ..-'; .-■ ■■' ' y '/vGAUSES OF JNFECTION. »;;'■>? , 'Infection -i 1; is caused -by ■ very.; .minute micro-organisms, arid their virus can pass through-the finest porcelain filters.' This;-.virus,, is found' .in, the nose -and throat of patients, and "also in the nervous . where-' its & harmful effects are''chiefly-' noticed. 1 It is vvery. resistant to'heat and disinfectants, compared with other'diseases,', 'and it has- ;onlyi::been found -possible to infect man and -monkeysj'with, this disease.'v The secretions .' .>m ii the nose . and .throat of • infected .;;;:|<;sers,.or people actually suffering from the , complaint,' are regarded as the. usual methods oT propagating infantile paralysis. The actual microbe possibly lives in the nose andythroat; but its .poison acts ,priricipally';on thevsmaller blood ves-' sels,' particularly ■in nervous system, arid, also ;on; the; nerve: cells. themselves., This. % latter'; statement :is ; denied; by> some authorities, who: state that the changes founds in: v the 'nerve - cells are. I;brought about; by pressure;, of '.inflammatory .■-.' pro-. ductSjVand haemorrhages,;and;round cell .infiltration. ..vlh'-.either .'.case l : he. grey matter.- of the ibrain and spinal cord, particularly the latter, and especially: its anterior*! and more vascular-part, "show extensive inflammatory changes .wheni examined post-mortem, and the spinal fluid shows ■; similar changes when examined during life by. lumbar puncture—indeed this_ is.the only reliable method of .diagnosing cases in-theirjearly Btages. ; The nerve cells so surrounded-may die,: thus, causing secondary "degeneration 'in 'the nerves, and giving.-rise to the characteristic muscular .paralysis.:v!. -.}.'■ '■■ '„'.■;. '' : t |■'.-' '^ -V._ FIRST ; SYMPTOMS.V : y ;- : 1 Infantile paralysis seems to attack all Masses of ; children, very often those who i are apparently healthy, and. mild attacks ■• often pjass ;unnoticed:.or tiridiaghosed at i the.:time,:'and\itis only: when paralysis; ■'is noticed that : the .true '.> state ,of .things' is thought of. : . Very mild cases' where. | no paralysis develops pass quite Tinnoticjed, and some authorities state, that such leases may be four times as numerous I as the diagnosed and reported' ones, so! that,the true figures, hi an epidemic would: be about five times the recorded numbers. , In a typical case, a previous-' ly; healthy child becomes out of sorts, .feverish ;'■with -a temperature of lOldeg.or 102deg. . Fahr'., '.may. have;digestive, symptoms, such as vomiting or diar- • rhoea, or convulsions with some stiffness of the neck, so that; there is resistance and pain when the head is bent. 'This latter is the only, symptom which might suggest nervous trouble, but usually the child might 1 have eaten something that' disagreed with it or be sickening for. any other disease, so that; unless there 1 is a known epidemic present, infantile paralysis will not be thought of, and, even if it is, -the only way the doctor can diagnose it _with any certainty at,, this early stage is by lumbar puncture and a pathological report on the spinal fluid. If! the child be old enough it may complain of pains in the muscles, particularly the legs, and .will be unwilling to move them. The limbs may be tender on being, handled, but usually the child is.so irritable that nothing' definite can be made out; until the acute constitutional symptoms subside, which usually happens in a day or two. The child may now be found to have lost the power o£ one of his limbs, no longer runs about and cries if handled or, moved. .This is usually the first indication of anything being seriously wrong, and medical* advice is. not thought of until this occurs When seen a week or two after the acute attack has subsided, the affected flmv.v~ USU l ai ly ' ■ •? le S-win be , soft and flabby, colder than the other, with mottied, skin, and the muscles will commence Mo waste. If the child is, not carefully attended to the wasting increases,joint changes and various bony deformities wil occun Eepair usually begins about the second or third week and may continue until the end of twelve' 11-o twenty-four months; usually after six months ( -careful treatmc-nt there will bo \ftiy little, further natural improvement and recourse must lie had to the surK«o., I'rovided the patient survives 1-HR hist week,;or once the acute sta^e is over, there is -very little risk to life, tlio .mortality varying from 5 to SO pelcent, m d.ttorent epidemics. The outhPvp°? r?S fl«ls complete health is poor, theie is loss of function .i,, .about hal -he pases though the degree varies. 0 c leg is affected ,„ 50 to 60 per cent, of rases; 30 per cen t. have two limbs, and o per cent, have all four limbs involved TREATMENT BY SERUM. . Treatment, is ,mosl .effective ]V the early.-stages before there are symptoms of.-paralysis, and .the only treatment known.to have auy curative value m in.

who have had the disease. Even though they have had it many years before, their. blood sei-um contains immune bodies. Immune horse scrum has been stated to give good results, but at present the details are insufficient, and our own serum laboratories 'do not prepare any. Some authorities have quoted figures showing that serum treatment given during the first few days of the acute attack was completely curative, i.e., no paralysis developed, and that given in the first week or so it had a decidedly beneficial action. Apart from this, drugs seem quite useless, beyond helping the natural resisting powers of the body. Lumbar puncture, besides being a most import-ant test for the disease, is also good treatment, as it relieves the increased pressure of the spinal fluid. The next most important treatment during the acute stage is rest. The affected limbs should be kept warm in cotton wool, and if necessary bandaged, or even put in plaster of paris splints to keep them in a good position. After the first few weeks, when all pain has, disappeared, gentle massage, with or without mild electrical treatment, must be persevered in; but active movement on the patient's part is forbidden. ' ,; . This is the most trying time for everyone concerned—the patient feels he can use his limb, his parents think he ought to be allowed to do so, and the doctor knows that if he gives way the case may end-.in disaster, "or in any case harm will/be done and cure delayed; in fact, this _ is the time he may consider it adTusable to use splints if he has nof already done so. Gradually under careful supervision the muscles may recover some or all. of their power, but generally the result is never perfect, and some muscukr weakness remains permanently,. However, one consolation is that f eVfu- P, aralysis is>esent at the end of the third or fourth week is the worst that may. be anticipated, as it is very exceptional for any further, extension Mo occur after; that time, while a'decided' improvement :is not only, possible, but probable. If carefully treated by massage, and electrical stimulation if necessary, improvement after eighteen months is. possible,, but_not probable, but. careful treatment will have prevented' defor- ™! ?£ r'J* i? 0 ' to^er improvement oc curs medically, then by suitable surgicar methods, such as tendon and nerve transVhntmg, recovery -will be encouraged, an Q £ If r?>efnl,limb-wiU result. g .Schools -do nof seem to spread the disease and general medical opinion appears to be that isolation of each case as it occurs is'airthat is necessary^ paying particular attention to fly destructwn and ; ,prevention. The most probS ientsr^° f illfr tion are conv^^ falikelv P toy Kng f °r an«seP«° treatment such nJnW / ,mT3ch. use rendering sucn. people free from inf ectivity ; ''■.■