INFANTILE PARALYSIS.

Manawatu Herald, Volume XXXVI, Issue 1221, 17 March 1914, Page 4

INFANTILE PARALYSIS.

DESCRIPTION OF THE DISEASE. A Christchurch medical man, discussing infantile paralysis, which has now been declared notifiable, said that he knew of seven cases in Christchurch, and that ali doctors would approve oi the action taken by the Department. It was specially necessary to be alert, he added, because the medical profession knew nothing of the origin of the disease, and very little of the proper treatment. It sometimes took the form of an epidemic. There had been several epidemics in other countries. The great Swedish epidemic ot 1911 began in the early spring. In July there were 179 cases, in August 893, in September 1067. in October 473, in November 235, out of a total of 3540 cases ; and the epidemic had not ceased to spread early in 1912. Town and country were equally affected. No comraou source ot infection could be found, and an authority believed that the origin of this epidemic ultimately was connected with, and to be sought for i j the previous epidemic in 1905, when 1000 cases were reported. According to one authority, he said, the most striking fealuie ot the disease was the frequency with which it affected young childreu. It occurred six times more frequently in the first ten years than in the remainder of life. It had been attributed to cold and to fall, but there were many facts in favour of its being of an infective nature. It had occurred during convalescence from acute diseases, immediately after attacks believed to he influenza. EARLY SYMPTOMS. The onset of the illness often was sudden, but the paralysis was not generally noticed for one, two or three days. The early symptoms consisted of feverishness, or convulsions, or severe pains, either general or localised to the limb or limbs that were afterwards paralysed. Both pains and feverishness often were present together, and the pain might persist some days. The way in which the paralysis itself began also was very variable ; it might show itself in one limb, and within two or three days affect others ; on the other hand, sometimes three or four limbs were paralysed at first, and recovery rapidly took place in one or two, leaving the other permanently affected ; finally, in other cases, certain limbs were affected from the firs;, and remained so. A child, aged four years and a half, was sick one day, feverish with headache the next two days and became paralysed in all four limbs on the fourth day. Three months later, paralysis of both arms and weakness ot the right leg remained. Another child, fifteen months old, was taken rather suddenly ill one day, and appeared to have something wrong with the hip. She was feverish for three days, and then the left leg was found to be painful and paralysed. The pain subsided in ten days, but the paralysis persisted. TREATMENT OE THE DISEASEThe tame authority, dealing with treatment, stated that in the early stage, before the paralysis had develops d, attempts might be made to reduce the fever, but the treatment must be mainly expectant. When the paralysis had declared itself, the patient, already in bed, might be placed in the prone or lateral position and ice bags might be applied to the spine. Ergoliu in doses of i-6th to a )<2 grain lor children and from one to two grains for adults, twice daily and belladonna, in doses of i*2oth to i-i6th grain to the ex-

tract, according to the age of the child, had been recommended. The patient would be greatly benefited after the first few weeks, by the use of tonics, such as iron iodide and phosphate small doses of arsenic or strychnine and cod liver oil. At this time also the local treatment cf the atrophied muscles become important and electricity to those muscles which were still susceptible to it, and galviuism to others, should be applied. Massage was also important in promoting the circulation of the limb. Deformities in the affected limb must be prevented, as far as possible, by position and passive movement. Mechanical supports and in some cases the division 0! tendons, might be necessary. A paralysed muscle which was unduly stretched by the weight of the limb, or by over-action of Its antagonists, might be aided by fixing the limb for long periods of lime in order to prevent that. Some assistance also had been gained by dividing the tendon of a paralysed musAa and grafting it on to the adjacent tendon of a healthy muscle. The most distressing cases were those which came under the notice of the physician six, eight or twelve months after the onset of the paralysis, when one leg or one arm or both legs were placid and had little or no motion. It in a case in which the paralysis had lasted for six or eight mouths no observable improvement look place in the next six mouths with thorough and systematic treatment little or no hope could be entertained of further change. PARTIAL PARALYSIS. Several bacteriologists have staled recently that they have isolated a germ, and by means of injecting the poison into monkeys have produced the same disease. The part principally affected is the spinal cord, especially where the nerves supplying the muscles are given off. In a child, as a rule, it involves the paralysis of one or both the lower limbs. All the muscles of the limb do not become paralysed, but only certain muscles controlled by particular nerves. The paralysis is always flaccid, and the patient cannot move the affected limb freely, though total inability to move it does not occur. It amounts, in the popular acceptation, to partial paralysis. Sometimes (though instances are rare) there may be weakness or paralysis of the abdominal and chest muscles, producing inability to sit up or stand properly. Not only does the disease induce atrophy of the muscles in the parts affected, but also of the bones, so that after a lime the affected limb will be found not to have grown to the same extent as the healthy member. In auults the disease may appear in the same way as in children, but it has a tendency to involve two or three limbs, and may involve both legs and both arms. The course of the disease in both cases is chronic, and with the ex- ■ of the improvement of the paralysis in the fi.st few weeks, mere is no recovery ot the lunations of the part affected. PREVENTIVE TREATMENT. As nothing very definite is yet known as to the manner in which the disease is produced, preventive treatment is difficult to carry out, but it is suggested that parents should take the same care of their children as they do in respect to other infectious diseases. Tramcars, theatres, and other places where by reason of the close aggregation o! people contagion is a comparatively simple matter, should be avoided as much as possible. The acute onset of the disease is olteu regarded lightly, and nothing done till the paralysis

has developed. It is, of course, well to call in a doctor as early as possible. The only hope of recovering paitial function is the application of massage and electricity to the affected muscles after the first few weeks. This must be continued for a long time. Lately work has been done at Home by specialists in deformities which inspires the hope that in the near future the disease will be treated with greater success than has been possible in the past. The treatment that has now been tried consists of the transplanting of the tendons of healthy muscles to the muscles affected by the disease. Treatment of this character has already been carried out.