NEW DISEASE REPORTED.

Manawatu Herald, Volume XLI, Issue 1983, 29 May 1919, Page 4

NEW DISEASE REPORTED.

AFFECTION OF. THE BRAIN. SEVERAL AUCKLAND CASES. DESCRIPTION OF SYMPTOMS. A new disease, chiefly affecting the brain, has made its appearance in Auckland, and several cases are reported to have occurred. Its technical name is lethargic encephalitis. The illness was present in England in epidemic form from February to June, 1018, and the suggestion was made when the earliest eases were reported that they were examples of botulism, but investigations afforded no bacteriological evidence of botulism, and gave no support to the association of the outbreak with infection from food.

The epidemic in England never attained large proportions, and at present there is not a great deal of evidence available dealing with the disease. From the experience gained in England, it is recognised to be an acute affection, due to a specific virus, which probably finds its way through the nose like acute anterior poliomyelitis —infantile paralysis—and which, like it, has a special affinity for the nervous sytem, though for different areas and elements. It is stated that Professor Alarinesco, of Bucharest, who more than 10 years ago studied and described.botulism, is of the opinion that symptoms accompanying lethargic encephalitis present a striking resemblance to those of “sleeping sickness.” CASES IN AUCKLAND HOSPITAL, , Giving evidence at an inquest at Auckland last week, Dr. C. E. Maguire, medical superintendent of the Auckland Hospital, said the patient, a married man, 38 years of age, was suffering from lethargic encephalitis. Several such eases had been treated in the Auckland Ilospotal. The disease appeared in epidemics, but was not in itself epidemic. In the case under investigation, death occurred while the patient was under an anaesthetic, administered to permit a minor operation necessary to elucidate the diagnosis, and also as a means of treatment. The actual cause of death was respiratory failure. Another case has been reported by a private practitioner. SYMPTOMS OF THE DISEASE. Lethargic encephalitis has been described as a general infectious disease, characterised by manifestations originating in the centra! nervous system, of which the most frequent arc progressive lethargy and stupor. Usually the first symptom is simple catarrhal conjunctivitis. In a smaller number of eases of those which oeeurred in England, tonsilitis, sore throat, and bronchial catarrh were observed, but the most salient symptom was progressive lethargy, it might he ushered in by a fainting attack, but the onset is more often gradual. The patient generally becomes dazed or stupid, is inclined to sleep a great deal, and to be drowsy by day. In marked cases the lethargy is accompanied by heaviness of (lie eyelids, pain in the eyes, and blurred vision. Headache is common, and giddiness is a highly characteristic early symptom. The patient may exhibit a highly emotional state, and symptoms which may be labelled hysterical. In other instances the mental depression is so great that melancholia might he suspected. The severest eases lie like a log in bed, in a state of catalepsy. Delirium, usually nocturnal, is not uncommon. During the time of the epidemic in England, among 108 eases 37 deaths were recorded. QUESTION OF AFTER-EFFECTS. There is little evidence regarding after-effects, hut among the epidemic eases in England certain manifestations persisted after the expiration of three months from the date of onset. Among these were an alteration of the mental condition, "persistent cranial nerve palsy, and the appearance of paralysis, apparently of spinal cord origin. The resemblance between encephalitis and the rare eases of the cerebral form of infantile paralysis is very close, and it seems probable that some of the eases reported in England and elsewhere in the past as ccrebro-spinallpuliomyelitis may have been eases of the new disease. There are clinical indications that in the epidemic in England last year both polomyelitis and lethargic encephalitis occurred, but not in association with each other. It is believed that convalescence will last for six months after the beginning of an illness. Lethargic encephalitis was made a notifiable disease by the Local Government Board in England. The advantages of notification as the fundamental step in the elucidation of the problems of infections disease in general appear now to have been fully recognised, and with informal ion of the occurrence of cases at their disposal, the authorities will be able to co-ordinate in research, and the discovery of the cause of the disease will be advanced. In New Zealand lethargic encephalitis is not a notifiable infections disease, but it is the opinion among medical men that it should be included in the list of diseases under the Public Health Act, especially in view of the fact that several cases have already occurred.