HEALTH NOTES

Hawera Star, Volume XLVI, 10 December 1926, Page 8

HEALTH NOTES

ACUTE POLIOMYELITIS

DISEASE OF EARLY LIFE. TRANSMISSION AND TREATMENT OF INFANTILE PARALYSIS. (Contributed to the Department of Health.) Acute poliomyelitis is the scientific name of the disease which is commonly known as infantile paralysis, though paralysis actually occurs in a comparatively small proportion of those attacked. Throughout the world from 1880 to the present day over 150 outbreaks of infantile paralysis have been recorded. In recent years there has been a marked increase both in the frequency of the epidemics and in the average of cases recorded in each. Over a period of five years the number of cases per epidemic now average from 300 to 600, and as an exceptional instance New York City reported 8928 cases in 1916 with 2407 deaths. This increase cannot be wholly accounted for by the fact that infantile paralysis is ‘now better known and is therefore more readily recognised and diagnosed as such. A great deal of research work has been undertaken in recent years to establish the origin and nature of this disease, and as a result a considerable addition has been made to our knowledge of the subject, though much remains to be learned. CAUSE AND IMMUNITY. The disease has been definitely shown to be one of those produced by organisms so minute that they will pass through the pores of the finest laboratory filter and remain invisible under the highest-powered microscope available. In this respect it is on all fours with smallpox, measles, mumps, rabies, typhus and yellow fever, which have been under investigation for many years. The disease has been experimentally conveyed to monkeys by inoculation from the spinal cord of a child who had died of the disease. One attack of infantile paralysis confers a high degree of immunity. It lias been shown that the blood serum of those who have recovered from the disease when mixed with the virus renders it harmless. It has also been shown recently that human blood serum from mild or abortive cases when mixed with the virus renders it inert, just as does the serum of typical cases in which paralysis has developed. Hence it was possible during the last epidemic of infantile paralysis in New Zealand for those who had suffered previously from infantile paralysis to donate blood serum for the treatment of active cases with markedly beneficial result to the patients.

Environment and social conditions have littlg bearing upon the appearance of the disease, and it occurs as commonly in sparsely-settled rural districts as in crowded cities. The victims of the disease are almost without exception Tobust children, and the chiTdren of wealthy parents are equally prone to an attack as those of the noorer classes. It is a disease of early life, hv far the greatest majority of cases occurring under the age of 16 years. MODES OF TRANSMISSION. The modern explanation of recurrent epidemics of infantile paralysis and their distinctive features is that it is a very communicable disease, like measles, and much more widespread in the community than would be indicated by the paralytic cases alone. Most eases are mild, escape notice, and leave the individual protected against further attacks. There is thus a liigli degree of acquired immunity except in the young. Only the ocftisional severe cases with paralysis is recognised and diagnosed as infantile paralysis. It is most infectious during the early stage of the disease. We are therefore dealing with a common infection, always present in the community, but which in recent vears. and particularly in the late summer and autumn seasons, is apt to gain an increased virulence. Persons of five years and under 0011tribute approximately 70 per oent. of the cases, and epidemics in any one country tend to recur every three t<o five years, seemingly when a fresh number of susceptible children is- available. Persons under . sixteen years contribute over 90 ner cent, of the cases. There is much evidence to sup--00 rt the opinion that the disease, both in its mild and its severe form, is directly transmissible from norson to person. In addition, healthy carriers, oersons who have been in contact with a case, can carry the virus in the mucous membrane of their noses and throats without suffering any symptoms. These carriers, even if the infection they carry comes from a mild unrecognised ease, mav produce an, attack of -evere tvne if they chance to eonvev the infection to a sufficiently susceptible person. Exhaustive inquiries in many outbreaks have shown evidence against the likelihood of the transmission of the disease b-- insects, or by animals. The data collected from many epidemics do not su—ort the idea that peculiar climatic conditions mav predispose to flic disease and determine an epidemic ps much as the disease appear® t--follow lines of transport rather than to correspond to any definite chin a tie factor.

The weight of present opinion, therefore, inclines to the view that infantile paralysis its exclusively a human disease, and is spread by personal 1 contact, which includes all the usual opportunities. direct or indirect, for the transference of bodv discharges from person to person, having in mind the possibility that the infection may occur through contaminated food. SYMPTOMS. The symptoms may simulate any ol the indefinite illnesses of childhood, and in the presence of an epidemic it w, well lor parents and physicians to treat sick children having fever without a definite proven diagnosis as possible cases of poliomyelitis. Still there is a grouping of symptoms which is very suggestive, the combination of fever, vomiting, constipation, drowsiness, and irritability, especially when combined with headache, a transient flushing of the face, abnormal sweating, or retention of urine is enough to make tentative diagnosis of poliomyelitis. if defined cases are occuring in the vic nity. An onset with one or more remissions is very suggestive ol poliomyelitis. When signs of involvnient of the nerous system supervene the diagnosis is readily made. Paralysis of a group of muscles occurs when its controlling area in the brain or spinal cord is injured or dest roved. TREATMENT.

It behoves all who come in contact with a case of poliomyelitis to strictly carrv out all instructions of the medical attendant and health authorities as to' isolation and the precautionary meaKuros. to bo observed. Ajs- "this i& & <lisease whioh often brings disaster in its

train, no personal precaution can lie too great lo p:event its spread to others. Regarding the tieatment ox individual cases, the importance oi securing medical advice at the earliest oppoi tunity cannot be too greatly stressed. Prompt and expert treatment o■ affected groups of muscles is often efli-c-acious in limiting the extent of paralysis and in bringing about, satisfactory recovery. The best chances ol recoveij from the paralysis .sometimes associated with poliomyelitis is skilful aftercare under the direction oi a physician. Treatment must be prolonged, and is necessarily tedious but often results in remarkable improvement. Ihe benefit of expert treatment has been repeatedly demonstrated at our larger public: hospitals and at King George V. Hospital. Rotorua, where special I acuities exist for dealing with such cases.