HEALTH NOTES.

Otago Witness, Issue 3860, 6 March 1928, Page 9

HEALTH NOTES.

POLIOMYELITIS.

METHOD OF TREATMENT.

(Contributed by 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 b>en 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 micioscope available. In this respect it is on all-fours with the 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 has been shown that the blood serum of those v ho 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 was possible during the last epidemic ot infantile paralysis in New Zealand for those who had suffered previously from intantile paralysis to donate blood serum tor the treatment of active cases with markedly beneficial result to the patients. Environment and social conditions have little 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 disea?e are almost without exception robust children, and the children of wealthy parents are equally prone to attack as those of the poorer classes. It is a disease of early life, by far the greatest majority ot cases occurring under the age ot 1(5 years.

MODES OF TRANSMISSION. /nodern explanation of recurrent epidemics of infantile paralysis and their distinctive features is that it is a very communicable disease, like measles, and is much more widespread in the community than would be indicated by the paralytic cases alone. Most cases are mild, escape notice, and leave the individual protected against further attacks. There is thus a nigh degree of acquired immunity except in the young. Only the occasional severe cases with paralysis are recognised and nosed as infantile paralysis. It is most infectious during the early stage of the disease. Wo 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 viru lence. Persons of five vears and under contribute approximately 70 per cent, of die cans, and epidemics in any one country tend to recur every three to five vears, seemingly when a fresh number of susceptible children is available. Persons under 16 years contribute over 90 per cent, of the cases. There is much evidence to support the opinion that the disease both in its mild and in its severe form is directly transmissible from person to person. In addition, healthy carriers, persons who have lieen 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 case may produce an attack of severe type if they chance to convey the infection to a sufficiently susceptible person.

Exhaustive inquiries in many outbreaks have shown evidence against the likelihood of the transmission of the disease by in sects, or by animals. The data collected from many epidemics do not support the idea that peculiar climatic conditions may predispose to the disease and determine an epidemic in as much as the disease appears to follow lines of transport rather than to correspond to any definite climatic factor. The weight of present opinion, therefore, inclines to the view that infantile paralysis is exclusively a human disease, and is spread by personal contact, which includes all the usual opportunities, direct or indirect, for the transference of body discharges from person to person, having in mind the possibility that the infection may occur through contaminated food. SYMPTOMS. The symptoms may simulate any of the indefinite illnesses of childhood, and in the presence of an epidemic it is well for 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 occurring in the vicinity. An onset "with one or more remissions is very suggestive’ of poliomyelitis. When signs of involvement of the nervous system supervene the diagnosis is readily made. Paralysis of a group of muscles occurs vjrhen dts (controlling ’area in. the brain or spinal cord is injured or destroyed*

TREATMENT,

It behoves alt who come in contact with a case of poliomyelitis to strictly carry out all instructions of the medical attendant and health authorities as to isolation and the precautionary measures to be observed. As this ia a disease which often brings disaster in its train no personal precaution can be too great to prevent its spread to others. Regarding the treatment of individual cases, the importance of securing medical advice at the earliest opportunity cannot lie too greatly stressed. Prompt and expert treatment of affected groups of muscles is often efficacious in limiting the extent of paralysis and in bringing about satisfactory recovery. The best chances of recovery from the paralysis sometimes associated with poliomyelitis is skilful after care under the direction of a physician. Treatment must be prolonged, and is necessarily tedious, but often results in remarkable improvement. The benefit of expert treatment has been repeatedly demonstrated at our larger public hospitals and at King Georgp V Hospital, Rotorua, where special facilities exist for dealing with such cases.