Nelson Evening Mail TUESDAY, MARCH 10, 1914. "INFANTILE PARALYSIS."

Nelson Evening Mail, Volume XLVIII, Issue XLVIII, 10 March 1914, Page 4

Nelson Evening Mail TUESDAY, MARCH 10, 1914. "INFANTILE PARALYSIS."

THE disease commonly known as infantile paralysis has been causing a,' good ■ deal of discussion throughout the Do-1 minion. A point stressed has been the advisableness of exercising, care ?in regard to the spread of this disease by abortive cases. The Dunedin "Star" has gone fully into the matter, and- it is interesting to follow the main points. During the Swedish epidemic of 1905, in the immediate neighbourhood of well-de- i fined poliomyelitis, and in distinct con-1 nection with it", many patients were dis--1 covered who showed only general symp- j toms of being ill, and presented no. signs of paralysis. Such cases Wick- ] man designated abortive cases. Between them, and the typical, sometimes even fatal cases, air gradations of severity were observed, arM sometimes- several of these gradations could, be seen irr .one family. The picture of the abortive type,.corresponds pretty well with the first'stages of the typical paxalytic cases. The attack is acute and accompanied by fever; headache, and the feeling of illness generally. -There may be stiffness of the neck, in the neck, back,! loins, and limbs: : Extreme drowsiness. has been obserxed, so that the mother states that the child has slept for days. Paiif in the limbs is often very marked, and sometimes the tenderness is so ex-' treire that a mere touch is painful to j the child. Such cases may be confused j with influenza, or the symptoms; may be such as to suggest meningitis. Feelings of sickness, vomiting, and diarrhoea, have-been frequently observed in abor-1 tive cases. Physicians from time to time i have remarked upon the cases"*©f "influenza" and the gastrp-intestinal symp- j toms, which develop in patients 4n the I same neighbourhood -where poliomyslitis I is active. In the light of present-day j knowledge, however, these cases woiild be regarded as abortive forms, of HeineMedin's disease. Since Wickman published his epoch-making, and now classical investigation?, records of, al|ortive 'cases have-accumulated, and-especially in connection with the ~ American epidemic (Lovett, Armstrong, Daviesj and others), and it may therefore He safely asserted that the occurrence of abortive cases during an epidemic is a regular phenomenon. This abortive type as ol great importance, as obviously the extent and spread of the presents an entirely different aspect if we take into consideration not only typical but abortive cases. We, notice with regret that the authorities have made only infantile paralysis or acute poliomyelitis notifiable, thereby excluding the important abortive casesj and all those.foTms of Heine-Medin's disease which do not correspond to the hitherto accepted type. The resulting, statistics .will-suffer a serious loss of value-from-this limitation.

An important point concerning; which the public desire information is the question of the death rate in previous epidemics. The following, table will suffice: — g .-■„• 3§i 3J l v 11 «§ £ ;£| ":»! Sweden 1905; 868 145 16.7 Norway 1905 .577 . 84 ' 14.5 r N Austria 1908 266 29 18.0 E.' Austria 1908 ■ 71 16 22.5 Styria,. ' 1908 433 57 13.6 Arnsberg 1909. 633 78 12.3 Hesse-Nassau 1909 100 16' 16.0 Pomerania . 1909 51 6. 11.7 Hanover v : 1909- 34 7 20.5 The mortality of American epidemics was lower. In the New- York epidemic the mortality was estimated: at 5 per cent, by the Collective Investigation

Committee, who. went into the matter some months after.the event —a method of examination "which compares unfavourably with the immediate personal Continental method. Lovett, in the Massachusetts epidemic of 1907., reported a mortality of 4.7 per cent, and 1908 a mortality of 2.t per cent., but, Emerson, reporting at the same time, in another part of Massachusetts,, gave- the mortality for his district at 7.24 per cent. E. A. Sharp repo'rted on the Buffalo epidemic of 1912,' up to November 1, 310 cases, with 41. deaths, a mortality of 13.2 per cent. It will be seen that the death rate is subject to fluctuations, but one must, remember that errors are apt to creep into such statistics. Fatal cases of Heine-Mediri's disease have been certified as meningitis. Medin and Pierre Marie record such instances. Spieler refers to four cases in the Vienna Children's Hospital which so closely resembles tubercular meningitis that it was some time before HeineMedin's disease was eveh suspected. Again, adult cases of this disease, running a fatal course, have heen certified • asVLandry's paralysis. It is therefore evident, that in any epidemic fatal cases of Heine-Medin's disease may he certified under another heading, and thus lower the recorded-death rate. • It. seems that the danger to life is greatest on the fourth day. of. the disease. -The infective nature of the disease has altered the ideas with regard, to the outlook for the paralysed. A fairly extensive paralysis may completely disappear. Leegard shows in his report that 26.87 per cent of his paralysed cases got quite well. The New .York Collective Investigation Committee, "whose report lies before us, give a> less favourable.; outlook. The "question, may be asked: During what period may we hope for improvement ? Most of,'■ the complete recoveries take place during the first half-year, but cases are reported of r recovery after a much longer period, of paralysis. ' In conclusion, it has been stated that the micro-organism of poliomyelitis has been isolated; • cultivated,- and proved to be the specific germ by Flexner and Naguchi, of the Rockefeller Institute. The results were published in 1913., This is not the-first time the claim-has been made, but the association., of this discovery with'thos^e- good--American names, Flexner and N.aguchi, inspires, one with the hope that, this time the finding will be verified. '<' •