INFANTILE PARALYSIS.

Poverty Bay Herald, Volume XLIII, Issue 14051, 22 July 1916, Page 8

INFANTILE PARALYSIS.

QUJ3STION OP TREATMENT. ; WJIEN EXPERT® DIFFER; 11 Questions arising out of the ntu'eh-de-bated problem of treatment of infantile paralysis cases engaged the attention^ of" the Hospital Board for an hour or two last evening. i- ' i ..'•■ , •' A '""preliminary discussion ensued respecting the setting up aiid constitution of the committee appointed at a pre* 7 vious meeting to investigate the results obtained ih ! connection with the Ladies' 1 Massage Society. When the correspond£nce was. being received it was noted that the letter to Dr Scott stated that he ; aa 'honorary medical officer to the — Ladies\ Massa'ge Society, was to act in .conjunction Avith the committee. • ; Tfie chairman, Air Humphreys, stated ths; '? the minute must 'be inaccui'ate/'as'-ffo such intention was in his mind at the -••meeting. ''"■■'■ * ' Sjeyjbi'al' other members concurred. Dr Collins, as mover of the motion, said- that he had fully intended Dr Scott should act with the committee, and there was no misapprehension. Mr Bright remarked, triat he afid others thought Dr Bowleg medical stfp^ erihte^ideiit; - was- referred to. • • • ,»--. * »- Reference was made to the injustice done to Dr Scott in the matter, and after some further discussion "^t was.agreed to forward a letter Of. explanation and regret to- Di- Scott 'On the'sub- •- ject.. ::- '. .'■: ;.'". :V i -': . XX^ \ Mr Jex-Blake remarked that under the circumstances the report 'from tlie committee- should not-* ; be received- )U> 4hat meeting.' ; '.•'"■ Sj ,: '■" ' ~ : ", : The chairman said that they + 'had,'a. report from Dr Scott on the matter also. — The question of considering- the i v epoi"ts was held over until a later /"' stage of ; ' the meetmg. . •' jSJio,ther ', iteih- ; •in the correspondence ind^ided n a letter from the Minister of ; Public Healtjij'- enquiring as to the de: taife*" respecting the app^ucaltion for sub! sidy, on '{ the ''vote for " %h%> Massage Sbgety.'-, . ;'■: -X'fi VA l lengthy letter from the chairinanj'' vdd^^S'T^ff^^tbre^"''';^. infantile^ " paralysis -and 'the subsequent develop; ■■ ni'^n-jba. Tespectirig ;-' 1 * treatment of -. jbaJ^htsA submitted by? the Chairman, tt) :. t^eMVJintsltor fA' ' reply,- r was* "^^-"^n^'s lelfteri'ernb'odied ' tWo letters' 'drgWoteit f lc%T PrsvßeeVe^ itnd Reed, m%iWirs*'of' thi?ho^Ha^^hoi i aTy ifiafi. '-^rf «^ r l V^Xi^^^Vespbhdelhce was as --.&J¥dss : t-: ■„ Ih^he- cOui'seLo'f his letter to^ie . istetrthe ehaii-maivdetyied the outbreak of Wa I htile' ; - paralysis; ti_Mtir ,c4s^Wer© l treate4vatXthe hoSpitlef dur" ing^*eKe • isolatioh' time 'of ( siH; if i!weel?s. Twffity-nine'patiehtßrwere treated rigKt .; ! 'Mtil','¥^6^yy[ :! os : ' pafci^iits, being some of 'tUe^'tmosi^severe; , cases;' still remain, and these' patients' were progressing splendidly* and ultimately Arould regain' norhial use of theif limbs. The hospital treatment had, since ■JS)PJ 'commencemeht , been * one' 'of'' rest, 'ftna.rwas-.^inow, 1 one.' demonstrated '^by; ( '.; Js42sa~ Bevilaqua, and which had the aj^V proval of the department. After the. isolation period three patients left 'tji.e" Irospitab against the ' wish tif^ the tti^toiil staff; but as the hospital had no- power tj keep them, the medical 's^jeritftefid- ; ent— since h« had been with the .Board -—asked each parent to. .bring "their childßen back .from time to • time 1 for treatment/if i^iiired;' X Tnfs : , ,"i^td-"«ot, been done. From themencement of the outbreak, unfoHunaite ; Jy, some of the medical men in the tbwn' were not agreed that the treatment, as carried out by the Board's -meVifttaf -sta^f at. the hospital, was the correct •• one. 'In April last jps 'Scott, formed- '*! 'sdcidty, -of-tedies for ' message" and 'ti-eatmje^hof ; » vinfantile. pai'alys'is, and for -the 'purpose $>iX„ ...their work, permission wasi ; given, v »*»B.vthe use of rooms in tji'e old' -hospital .^/JS^dingß. This treatment had chiefly ""'"'jbeen. massage and battery ; and sohie "splints and, had' appealed to parents;. They > saw something doing against 'the.' Board's treatment of rjest. Up to date '*^ w»s dealing with.\ls' tcaseg, 'seme pCa' serious nalture. On M&ffilK: Dr Scott, oh "Behalf of his 'sociel^/'ap;-, pealed to the Board for £56 lis 'for expenses-* incurred, and for a further. £129, estimated to be their current ■expensesofor^hj After settifig put 4he Bbai'd's' • Becisfon on the subject,' it' was added that if in the opinion, pf '.the' Board iitip ' t'epoi'ts of the comittittee^ wer^'-favorablej; it would mean that the Minister's sanction would be required fdr.tlFe £56; and further payments? frbhT time to time. The chairman two letters of protest fi'om members of - the honorary staff. Consideiing the gresatf-/ difficulty of laymen in judging whetheV the society's treatment was cor-* reef 6v not, the .chairman urged', the : necessity of sendibg an expert -to report to the Boardj' so'as to settle the matter in the mf&r^esfcsv ** of all con- . e'erned. __ -■' „.-.. """^'^ i, . • • '■ > Dr. Reeve wrote as foffofrsTT— "Dear Bir,-r-If the . newspaper r i etK>rti*s£^ yoUr last "meeting is coiTect'^ouin^Bdird parsed a resolution which;! -fifui^eg '^tny jposHSon and that of other nfM'bera of the. h^fspita^ medical stai| very, difficult. I • refer to .tlie resoliHton* I deciding ix> l>ay tlje expenses of the Massage, fjocjety. _By so d,?^ 1 ]? tfie ifi; giv- ' - ing "'official recognition^ .to ; a society which ;.was jcalled into being' for the)express- purpose of caiTt-ying.' oift V ; t^^|t^ ; ment in direct opposition iJo v %hat'. I t'a's v ed' by your niedical officers at the hospital. The treatment for infantile paralysis provided? at the hospital, you^ ai'e aware, is that of rest, the use .o£spfin6s and, afl, no long massage. This treatment was '.'adopted by your medical 'officers ag being the^latest modern treatment recommended by eminent, special- ' ists in the disease. ') "The <^yerhni;eht -.:' has: gone to the expense and trouble 'of 1 - an' expert, Nurse Bevilaqua, to' the: different centres, to teach this same treatment, .and as the ;> results bf.-her work at tlie -four centres at least the "public 'hospitals aban^nW the! old rriejftioxl/'and have adopted ;, treatftiehfc • wfiicF lias '• been used : b^r '•? tftit 1 ' holpital f tjtoto thoj^rst ; n.ot in^all-iST ae'talls,'^but •in V- its general principles :bf : rest . and $Ke„ prevention ,. of opntractjons; • v J^urse ;Be^ilaqua,. iquptjng Drs Jones and/ Mc-. KsSD7.ie,. .tjie eminent' specialists,' 'utterly .;• -condemns the , 6 'b f f mas^fe 'and" elec-' "-; trioity for 'pltralySed mugcles.' 'Further, 1 B^itbtics im tHe "text^'bbolcs shdAV J^hat „-under,. -under, the use bf massage'-ahd .e'ljslctricity . - /75 k per eent^of the :cas<ie rern^h 'crippled. "-Our own statistics lehpjy, 3ifter.\ only a few months, a far better result t|jan that, and every WeeK lirihgs an inrprpyement in the figufei'/F^etrtWily, rthink, we shall havbrless - thah'-five per cent, of failure insteaoV/of 75 per r cent. '■ No one will q^iestion*the good interijtip'ns I of the Massage Society, but it must' be . ' remembered that .devotion cannot' take the place of skill and trainingi o . U-h'e HibSpllial Board, l therefore, appears 0 me to ba in «n. illogical positiptti' It jfrpppses '..to continue the treatment at the hospital advocated by its medical officers and Government expert, and af the same time to finance a society tyhich is 'carrying 'but the opposite- line of treatment on the patients as soon as they leave the hospital. There is. another .principle' involved in irtns atitipn Of the Board which iis a g;fave s one'. ?^ I X understand fropi the newspaper that^ the^^ard^proposes'to setilp' ; a < lh;y <sr6irti> mittee to supervise the work of the Massage Society, to decide whether its I 4ireatment is good or not. It seesms to j melihat this is 'surely not a matter in vrhi^i a layman \ can pretend to ' Have Jhe* "training and knowledge to enable' him to judge, and that the^Bpard '<can

oilier act ill sitch Matters after coiißultilig with its medical advisers. Any other Gourse would be unworkablo in tho interests of public health. Laymen cannot on matters requiring expert knowledge. During my three • years of office the. relations between tlie Board and myself have been of tlie pleasantest, but the position is impossible" if the Board does imt uphold its medical officers. We are responsible for the treatment given at the hospital and have- a right to expect their loyal support. I feel sure, from my past experience of the Board that they have not realised the reflection cast upon their officers by their action. But if the hospital is served by medical officers who give their best in the interests of the liospital, they have the right to expect the Board to consult them iu matters concerning' tile proposed treatment of the patients and to uphold their decision as medical men. I would suggest "that the Board reconsider its decision regarding the paynlent,:tp the Massage 'Society, and that a. cprttmit'toei bo set up to discuss tlie matter of outside treatment of, infantile paralysis, consisting of tho active medical staff of tho hospital and the Hospital Board." - t vDi'.' .- Reid . wrote : — "Dear Sir, — I understand the Cook Hospital Board have J decided to mortetai-ily assist a class for the' treatment of infantile paralysis by massage. Whilst recognising that my position as an honorary surgeon to the public hospital entitles mo to no voice" in the expenditure of 'the Board's funds, I nevertheless feel it encumbent on me as a professional officer of the Board to protest against the subsidising of a society whose work I believe is not in accordance with the niost modern scientific teaching. For many years past cases of infantile paralysis have been treated by massage and electricity. The deplorable deformities frequently follqwing tliese measures havo led recently to a review of the rationale of | the.treatment of the disease. As a result' the %time-lioriored methods have been discarded not only " as useless but as harmful, it .being recognised that cases apparently improved under their employment" were such as would have recovered 'Under any circumstances. The most modern authorities agree that tho great essential in the treatment of the disease is rest, together with the application, of splints for the prevention of deformity and ultimately controlled mov^hients of'the aflfect'ed limbs' carried out largely by. tho patients themselves. Tjtoiytlliiig iiiJ the ;riatu're' of rubbing is to be deplored as beihg calculated io produc.e" distortion. " Nor "aire the reasons underlying the modem method unintelligible to ; the nbn'-professional mind. All. are agreed <as to the necessity of rest in imfammatory conditions bo they as simple as an inflamed finger or as 1 serious as an inflamed appendix. In infantile paralysis, where tho inflammatory :process lis" in; the' delicate lierve tissue governing,, the muscle ; how -infiniteiy riidrV important' & rest. In regard to what. I gather, is. a further proposal of youfc Board, riamely, that a committee of Board members adjudicate on the results of treatment in" 'these cases, 1 would, point out the . extreme difficulty . laymen would have in the interpretation of .therapeutic and in . the decision of a question which has until recently been the subject of professional controversy. In conclusion, might 1 • sflggest' (to the members^ of the Board that they consider the question of pending 'their financial aid to the carrying out of a form of treatment which must soon, if not ' now, be regarded ;as. traditional." DV Collins urged that it was in the interests of the patients and the public that the letters should" be handed to the press! , The chairman remarked that the Board Was in open meeting, and the letters' would be available in the ordinary, course.' He did not know whether the letter he forwarded to the Minister met with their approval. \ Di* Collins said that he did not desire to the. chairman's letter, which was open to severe criticism, but it placed the Board in an unfortunate position. ' It was advisable when such debatable matters cropped up that the matter should be referred to the Board. • Mr Jex-Blake remarked that the cnairmaA had mentioned the receipt ot the Minister's enquiry, and that he intended to reply at; length, ; in' which ho (the sjieaker) concurred. Dr Collins declared that practically no treatment was being accorded to tho children who were leaving the hospital, arid' it was then the Volunteer Association was formed. The Association was not started in any "antagdiiism to the hospital, but because there was -practi,cally nothing being done. The new treatment was carried out lifter- the appointment of the present medical superintendent, and it was aIT very well these protests coming in at a late hour. >Mr Ken viray said he did not want any impression to be conveyed to the press that there had been any inattention at the hospital, either, on tlie part bf tho doctor, the matron, or the nursing stall. When the new medical superintendent arrived,' ;• Dr Bowie having 'been associated wjth Dr Jones,' had taken up r the treatment on the more modern lines. =- At this stage the chairman remarked that as the matter was a .professional one he questioned whether tho discussion should proceed. Subsequently Dr Collins moved that the discussion on the report be held over until the committee had met in conjunction with the honorary medical officer in charge of the class. Mr Jex-Blake, in seconding, said lie wished to dissent from a section of the report which he had not noticed when he. went through it originally. 'After 'considerable discussion as to what procedure should be adopted, it was" decided to grant" permission^ ior the report to be withdrawn. < A report- was also received from Dr Scott on the result of the treatment of the patients in question') and the Board decided to forward, an extiuct from the same to the Minister for his information. , v ' ' •Dr. Chas. F. Scott, hon. medical officer and acting-secretary of the 'Ladies' Massage Society, has forwarded ■■ for publication a .copy af th* letter seat : to tho Hospital Board, • which reads, as follows: — "I am desired by' the committee of the above society to report to you on the prdgress elf patients Minder treatment. Of 'the 'ls 'cases originally under the society.'s care, all but four, with the exception, of trivial minor incapacities, are practically cured,- and [biily, require a bi-weekly,:-and some only a weekly, supervision! The four cases ■remaining for continuous treatment I beg to report on as follows : " (a) A lad, 19 .years of -age, originally completely paralyse^ in both legs, with no movement of any kind, is now daily using his muscles, with increasing power «of movemmmmmmmmmmmmmmmmmmmmmmmmmmmmm^mmmmmmmam

ments'' in both legs. Special walkings splints are on cvJor fov him, and I hope j to have him on his crutches very shortly, ; although- he will certainly be' a ver^V.loug time- before*— if ever-r-he , walks- -without lliein. b) Child oompletely paralysed in ■both logs, one arm and tlie back,. at the_ outset of treatment; by- tho society, has now completely recovered tho use of the ;um and both legs, and the back, whilst well on the way to complcite recovery, will require further attention, (c) Child with originally .complete-. paralysis of one , leg; al. the- movements are' hero almost completely „r ecovered; and a i daily v imprdvcimeht is manifested -in the initial teaching" 'over again of the-act-of'--talk-ing; a special walking splint is on order. (df A very young -infant with originally complete paralysis of one arm; recovery has so i'aa- taken place d: all" muscles of the lingers, wrist and forearm, but the deltoid muscle which raises the upper arm has, so far, failed to respond;'- Tire case is only able to attend irregularly; and ought to be returned to hospital for continuous -treatment;- Al though- this has been .repeatedly pointed, out the mother, she refuses .to -part- with, h&r 1 i ttle . ono' : for such an exrfe'nded - titoe as the"" process involves. Tlie members, of the society (and the patieritsj ,; 'express considerable gratification- at the highly sU-tis.fati.tory results, obtained, .and t'eel that ""tlie. " Board -flnll johi with them wlich avo' aiinounco to you that thegi'aiits of inoriiey towards our expenses, whicll will' carry lis to> tho end of^August; will be all sufficient, provided that the cost ( price J of spWaf spliiitsf/ esthwated tit' '£lo, ' bo* ! added':''t>"your' Board's Origijial sum. In making up the estimates these were «BaaaraßMU)w_aaßflaaaßaMnaßHHßaaaaßMßHMaßH

inadvertently" omitted. Beyond this, the society' will continue to treat its members' labors-, which will consequently relieve your Board of any further expenditure Or responsibility." cases at practically the expense of its a— i —«— — — if i __.