THE NEW DISEASE

New Zealand Times, Volume XLIV, Issue 10290, 27 May 1919, Page 6

THE NEW DISEASE

AUTHOR ISES TO ACT

STATEMENT BY THE HEALTH

MINISTER.

The Health Department has been watching ever since the beginning of tliis month the indications of the new jiisease—lethargic encephalitis—which has recently made 'its appearance in New Zealand, stated the Hon. G- W. Russell, Minister for Public Health, to a “Times” representative yesterday. On May Ist, the district health officer, Wellington (Dr Watt), forwarded a report on the subject to the Chief Health Officer, and on May sth, Dr Chesson, District Health Officer, Christchurch; seat up a report as- to a* case- at Ohoka. It has now been determined to declare tho disease notifiable, and the necessary steps have been taken for that purpose. The department is issuing a bulletin for the information of hospital ' board medical superintendents medical profession generally, containing information front one of tho reports of the British Health Department. The, infectivity of the disease is low. SUSPECTED CASES IN WELLINGTON HOSPITAL.

According to the Healthy Department. there are m the WellingtonHospital two or three oases which are suspected to be lethargic encephalitis. The symptoms are apt to lead to confusion with cerehro-spinal meningitis, and,, in fact, the first cases’ reported were notified as “O.S.fS.,* diagnosis uncertain.” The disease, it would appear, is some relation of poliomyelitis (infantile paralysis), and there is also a possibility that it is first cousin to the mysterious “X” disease which was reported in Australia last year, .if it is not the same sickness. .. .. Dr Watt, .District Health Officer, stated yesterday, that apparently the disease had often been associated witu influenzal outbreaks. The earliest outbreak of which there was any record was about 1712, at Tubingen, in Germany, when it went under tho name of sleeping sickness. After the ISB980 pandemic of influenza, in 1390, there were outbreaks of what was apparently the same disease in Northern Italy and Hungary. The disease was then known as “Nona,” apparently a popular corruption of “coma.” Cases were reported in England last year. "First of all, it was believed to be poisoning, and was called botulismus, as it was thought to be due to the bacillus botulinus, found in pork, sausages, etc. Later inquiry and research showed

that this was not the case, A cable message from America a J 'w«ek.ago, stated that sleeping sickness was prevalent there. There is no record from England of many cases being met with, there now. Being due to a germ,- the sickness is infectious, but no cases have been reported of more tban"oue member of a household being affected;* In England the degree of mortality was not high. SYMPTOMS OF THE DISEASE. Some interesting facts as to the ocjurrenco and forms of the new disease are given in a pamphlet prepared by the Health Department for immediate publication. In Vienna in April, 1917, attention was drawn to the disease, and the following month the same disorder was discussed by tne Pans Academy of Medicine. Professor Mctter there expressed the opinion that the disease was not a form ot acute poliomyelitis. He also quoted gome evidence in support of' this view that the disease occurred at the end of the 17th and beginning of the- 18th century in Germany, and more definite evidence that it occurred in Upper Italy and Hungary in 1890. Very suggestive cases occurred in nearly all the countries of Europe and in the United States in the spring of 1895. From the .data presented by von Economo (Vien.nu)j it is evident that the disease oc-, ' curred in Vienna in the winter of "isie-iyr The first case 'noted in England occurred on February 11th,- 1918, in Bermondsey, and the largest number of. cases in one week was 18, in the last

•week of April. The number of cases declined thereafter, and the epidemic, which’never' attained large proportions, came, at least temporarily, to an end in June. The disease has been made notifiable in England and Wales under the name of “lethargic encephalitis." Early last year the Local Government Board, with the assistance of the Medical Research Committee, instituted clinical and pathological investigations.

Tho following data are abstracted

from a review of the Government re-

port published in a recent number, ol tho “British Medical-. Journal” : —The disease is an acute affection due to-a specific virus, which, like that of acute anterior poliomyelitis, probably-.* finds entrance through the naso-pharynx, and which, like it, has a special affinity for the nervous system, though for different areas and elements.* .Pathologically, lethargic encephalitis-belongs to the class of polio-encephalitic diseases which are inflammatory in nature. Bacteriological investigations did .not yield any positive results. Clinically the dscase is a general infectious disease, characterised by manifestations originating in tho central nervous system, of which the most frequent and characteristic are progressive lethargy or stupor and lesion in or about tho nuclei of the third pair of cranial nerves. There seems to be little doubt that there is always a certain amount of fever in .an early stage, although occasionally it may not he observed for several days after the onset of symptoms. Usually tho first symptom is simple catarrhal conjunctivitis, and in V'-smaller number of cases tonsilitis, simple sore throat, end bronchial catarrhs were observed. hut tho salient sraptom observed in 80 per’cent: of the cases at this stage was progressive lethargy. It might be ushered, m suddenly by a fainting attack or fit, but thE onset was more often gradual. The patient became dazed or stupid, slept a great deal, and was drowsy’by day. In marked cases the lethargy was accompanied by heaviness of the eyelids, pain in tho_ eyes, blurred vision, and photophobia, and, in a wellmarked case, gradually passed into Etnoor. Headache was common, and giddiness was a highly characteristic early symptom, and in some cases was accompanied by diplopia. Mental hebitudo was often associated with a highly emotional state, and tho patient might exhibit, without apparent cause, symptoms which might bo labelled hvsterical. In other instances the mental depression was so great that melancholia was suspected. After this prodromal period, if it occurs, the symptoms of a general infections disease became manifest, the

febrile reaction has already boon mentioned,. The patient lies in bed on the back, often unable to make any voluntary movement on account of great muscular weakness; tho face is quite expressionless and masklike, and there may bo definite double facial paralysis. The severest cases lie like a log in bed, resembling a waxen image in tho lack of expression and mobility, and .this may be accompanied- by* - catalepsy. Tho patient is in a condition of stupor, although true sleep is often not obtained. Delirium, usually nocturnal, is not uncommon, and, in addition to the muscular trouble, there is distinct rigidity in a considerable proportion of cases. Tho voice becomes, nasal and monotonous, sentences arc uttered very slowly and words slurred into on© another. Occasionally. however, once started to speak, ’the patient chatters sentences with so great rapidity that ho is often unintelligible. Among I(38 cases, 37 deaths were recorded. The duration of the stupor is very variable; occasionally it lasts two to three days, more often two to five weeks, and in one case, which eventually recovered, it continued for eight weeks. It is too soon to speak positively of after-effects, but certain manifestations have persisted after the expiration of three months from tho date of onset; these are an alteration in the mental condition, persistent crania! nerve palsy, tho appearance of paralysis (apparently of spinal-cord origin) and athetosis.

■ With regard to treatment, no specific method has been devised, and the best that can be done is to put the patient to bed and provide him with good nursing; cold sponging is often beneficial "during the pyrexia! period, and tends to diminish the deliriurfi. In many instances, transient or permanent relief, with diminution of stupor, followed the withdrawal of cerebro-spinal fluid by lumbar puncture, especially when the fluid was under pressure. For the pain, numbness, and tingling of tho limbs warmth is the best remedy, and the bed-clothes-should bo-raised on frames. Constipation is obstinate, and often difficult to overcome, except by oneraata, follpiyed ..by such drugs as liquid paraffin or jxhenolphthalein. No hypnotics and no morphine or_ other preparation of opium should be given, and Dr. MacNalty deprecates the administration of hexamin in largo and repeated doses: if it is prescribed the urine should be carefully watched for albumin. Daily cleansing of _tKe mouth and antiseptic treatment should he carried out,_ and respiratory complications systematically looked for. Finally, tho patient should be given to understand that his convalescence will last for at least six months after the beginning of the illness.