INFANTILE PARALYSIS.

Sun (Christchurch), Volume I, Issue 41, 25 March 1914, Page 5

INFANTILE PARALYSIS.

ITS CAUSES AND EFFECTS. The epidemic of infantile paralysis formed the subject of two reports considered by the North Canterbury Hospital and Charitable Aid Board this morning. One was from Dr F. L. Scott, medical superintendent of the Christchurch Hospital, who stated that none of the infantile paralysis patients in the hospital had lihe 1 disease in a severe form, and they all felt very well exeept one child, whose temperature was raised. Any possible deformity was being guarded against by the use of appropriate splints, but there was almost certain to be some permanent damage to the affected limb due to the paralysis. At the request of the Public Health Committee of the board, Dr P. C. Fenwick provided a report on the epidemic. He stated: —

"This disease, which appears usually in the early autumn, attacks children in the great majority of cases, although adults are by no means exempt. The cause is now accepted to be an ultramicroscopic germ that causes inflammation in the nerve cells of the spinal cord, and by destruction of these cells causes a paralysis of various muscles. The method of entry of these germs into the body is via the nose, throat, or intestine. The sources of infection are still untraced, but it is believed that infection may be carried by apparently healthy people who have been in attendance upon the sick, by animals, by biting flies,' or by infected food. The illness at its onset is often mistaken for an attack of influenza, as it begins with feverishness, often . accompanied with headache and pain in the limbs, sometimes with vomiting or diarrhoea. A few days after this onset, the child is found to be paralysed in one or more limbs. In nearly every case the child is left with some paralysis and some deformity, due to contractures in the affected limb.

"In 1911-1912, a severe epidemic occurred in Sweden, in which nearly 4000 children were attacked. From experience gained in this epidemic, certain facts were learned which are valuable in helping us to minimise the risk of this present outbreak. The virus was found on the lining membrane of the nose, throat, and intestine of the sick children. It was detected pn handkerchiefs, used by the children. The virus was still present in the bodies of the children six months after the onset of their illness. It was found in the bodies of adults who had not shown any symptoms of tke disease. It was most virulent during the first fortnight of the disease. The degree of -virulence was ascertained by injection into monkeys, who are very susceptible to this disease. Investigation showed that ' a number of apparently healthy people were carrying the disease, and it is stated that the carriers were more numerous than sick children in the proportion of at least four or five to one.' Dr Kling, of Stockholm, states that he believes that the great majority of adults and many children may be infected by the -virus without evil effects, whether the paralysis follows depending upon the resistance of the child. Undoubtedly many adults are attacked during an epidemic, but do not suffer from paralysis, the reason being that the resistance of an adult is probably higher than that of a child, or else the adult has been ' immunised' during childhood.

"From the above-mentioned facts we can deduce:—That the nose, throat, and intestine are the ports of entry of the virus, and should be protected by frequent disinfections. That long after the child has passed through the aeute (the feverish) stage of the disease, the virus is still present in the body, and the child may innoeently act a* a carrier of the disease. That contacts (parents, nurses, etc.) may act as carriers. That clothes and discharges are probably infectious. That at least 14 days' quarantine is necessary. That anything that tends to lower the vital lesistance of a child should be care fully avoided. Fatigue, excitement, mental overwork, are all factors which lower resistance, and I cannot help b'e lieving that if parents \#ould be careful to keep their children from overwork, over-study, and over-excitement during the time that any epidemic is prevalent, many cases would escape simply because their vital resistance would be high, instead of artificially depressed. "At the risk of incurring censure, I sugg'est that overcrowding in trams, picture shows, and picnics, is a vital factor in frhe spread of any disease. To date 20 cases of infantile paralysis have been reported in this district. With the permission of the board a set of questions was drawn up by Dr Blackmore i and myself for the use of the Health Inspectors, who were asked to obtain answers from each house in which th« disease had occurred. The object was to see if any factor recurred frequently, such as unhealthy surreundings, contact with another sick person, presence of flies or vermin. I would draw the attention of the board to the excellent work done by the Inspectors and the great care they-have taken to find any possible cause of infection. "The average age of the patient, with the exception of two young adults, is five and a-half years. Out of the 20 cases, a brother and sister were attacked in two instances. With reference to the period of incubation, one case was attacked six days and one eight days after the brother had fallen "The question of undue fatigue was asked in each case, and in six instances the parents gave the information that the patient had been over-exerted some days previous to the onset of the illness. "Dr Scott, whose report was handed to the committee last week, stated that the disease is of a mild type, but even if this was the case in all the patients, it must be remembered that the mildest case may be handicapped through life by some paralysis. "I am not aware if it is due to the Public Health Committee's action that infantile paralysis has been made a notifiable disease. It is certainly a very wise step on the part of the Health Department, but I hope this is not to mark the limit of their activity. A disease which cripples a proportion of the population for life is one that should surely be regarded with the utmost horror, and at least as much trouble should be taken to prevent its* spread as that lavished on a smallpox epidemic." When the report came up for discussion, Dr Fenwick remarked that there had been one epidemic already, and it was spreading to the north. It was possible that next autumn there would be another. With the idea of finding out whether there was any factor which occurred in all cases, a set of questions ; had been drawn up, and, thanks to the I good work of the inspectors, they had | answers to all the questions for .ever.y case which had occurred in Christ : church. Personally, he would shut up i

every picture show at the time of such an epidemic. A member: What of the churches? Dr Fenwick: I'd shut them, too. I'd rather have a heathen child than a paralysed one. Dr T. H. A. Valintine ; InspectorGeneral of Hospitals, who was present, said he considered the board was very much indebted to Dr Fenwick for his valuable -report. It was most opportune. Eecently the department had issued to its. officers circulars regarding the disease. Unfortunately, the cause of the disease was absolutely obscure. There had been cases in various hospitals, but only lately had the epidemic assumed large proportions. Cases had been reported as far north on the west coast as Taranaki, and there were cases in the Auckland Hospital. The epidemic was pretty general, but the department's inspectors were doing what they could to limit the disease, on lines such as indicated by Dr Fenwick. One feature of the present epidemic was the very large proportion of adults affected, which was rather unusual. There was another important feature. Only this morning he had received reports which showed that, contrary to previous experience of such epidemics, some cases had recovered. These reports, from Dunedin and other places, showed that some cases of this disease Had.*taade complete recoveries, a very remarkable fact when it was remembered that hitherto cases of recovery had been almost unknown. The present epidemic was of greater importance than many others the Dominion had had, even than the smallpox epidemic. Dr Fenwick: This is the-first time we have heard of any recoveries, and it is more hopeful. The chairman thanked Dr Fenwick for his valuable report.