As to Infantile Paralysis by Daniel H. Kress, M. D.

Pacific Press Publishing Association · Mountain View, California · Sep 12, 1916

FromSigns of the Times, Vol. 43, No. 36.

As to Infantile Paralysis

By Daniel H. Kress, M. D.

Interesting Facts as to Cause, Cure, and Prevention

By Daniel H. Kress, M. D.

No country has suffered more severely of infantile paralysis during the last few years than has the United States. Out of 8,000 cases reported between 1905 and 1909, 5,500 occurred in the United States. More than half of these were in Greater New York. In the year 1909, 569 deaths were reported in the registration area of the United States. During the present epidemic, already over 3,000 cases have been reported, and over 600 deaths in New York alone.

In the New York epidemic of 1907, over ninety per cent of the cases reported were children under six years of age; and ninety-nine per cent of the children affected during the present epidemic have been born since the former epidemic. There is only an occasional adult to be found with the disease. In an epidemic in Buffalo, New York, in 1912, no cases were reported among persons above the age of twenty-four, though they constituted nearly half the total population. Yet in an epidemic that occurred in Sweden in 1905, only forty per cent were in children under six years, and ten per cent of the cases were in adults. In the year 1910, in the Island of Nauru, out of 700 cases, the majority were adults.

No doubt there is a reason for the difference in epidemics, of which fuller knowledge of local conditions might furnish explanation. The mortality varies with age. The Massachusetts State Board of Health found the mortality to be as follows: In cases less than one year old, sixteen per cent; from one to ten years, four per cent; and over ten years, twenty per cent. During the present epidemic, the mortality has thus far been over twenty per cent. A sad thing about the record is that only seven per cent of those who survive make complete recovery, and the rest are left more or less maimed for life.

In every epidemic of infantile paralysis, there are cases of a mild type not recognized by friends nor diagnosed by physicians. Practically the only cases that are reported are those in which a certain amount of paralysis has taken place. The symptoms present in these mild cases are common to nearly all febrile diseases. In a few days, the patient makes an apparent recovery. Abortive cases of this kind do more to spread the disease than do those correctly diagnosed. When one child in a family develops paralysis, he may have been infected by another that had only a little digestive disturbance and fever for a few days. This emphasizes the importance, during an epidemic of this character, of parents' calling a physician when the first symptoms of the disease appear.

The degree of susceptibility of children to infantile paralysis is probably less than to scarlet fever, diphtheria, or measles. The mortality is not so great as is that in some diseases about which there is felt very little alarm,—for instance, summer diarrhea among children. During the epidemic, 600 deaths from this disease have been reported among children; but diarrhea diseases carried off a greater number in the same time.

Infantile paralysis is communicated in much the same manner as these diarrheal diseases. The germ, or virus, enters the body chiefly by way of the mouth, the nose, and the throat. The mouth smeared with food substances favoring germ growth becomes a base for their cultivation, and they may also multiply in the intestines. From this base, they may penetrate the mucous membrane, and finding access to the lymphatic channels, pass through to the spinal cord and the brain, their principal seat of operation. This is believed to be the most usual method of entry.

Method of Infection

AFTER infection, as in other germ diseases, there is a period of incubation. In this case, from two to fourteen days must elapse before symptoms of the disease appear. The virus is always present in the secretions of the nose and throat of those having the disease, and for fully six weeks after recovery. Hence it may be readily distributed by coughing, sneezing, or kissing, or through the handshake, eating out of the same spoon, or by ordinary contact.

As the disease principally attacks the young, the hands of the fond mother readily become contaminated. Then in preparing food or in actual contact with other members of the family, she may convey the germs from the sick to the well. Adults who have been exposed may harbor the germs in mouth and throat, even though no symptoms of disease develop. The domestic fly may carry infection from the sick to the healthy, either directly or through food infected by it.

The fact that the fly is tolerated by children more than by grown-ups may afford one explanation of why the disease is more prevalent among children. Children are also less careful in regard to what enters the mouth. Putting the fingers into the mouth or the nose, a practice common among children, is likely to introduce infection. Their playthings also are a medium by which germs are conveyed to the mouth from the dust of the floor.

Symptoms of the Disease

THE onset of the disease is usually sudden, but symptoms vary considerably. Generally there is fever, headache, a feeling of weakness, nausea, vomiting, and sometimes diarrhea. The child is likely to be irritable and drowsy. Localized pain in the back of the neck, sometimes extending down the spine, may be experienced. However, to make a diagnosis from these symptoms is difficult, and hence many cases are overlooked even by physicians. After the onset of paralysis, the diagnosis offers no difficulty. In the case of a little child that came under my observation some years ago, the temperature in the evening reached a little over 101 degrees Fahrenheit. Some digestive disturbance, restlessness, et cetera, were present.

As there were no other cases in the community at the time, I had no thought that the case was one of infantile paralysis. In the morning, the fever was down, but the little patient was unable to get out of bed, the lower extremities being paralyzed. It was then not difficult to determine the nature of the trouble; but had paralysis not developed, no one would have suspected the identity of the disease. In four weeks' time, the little girl made an almost complete recovery.

Treatment and Recovery

THE recovery depends upon the extent and location of the injury sustained by the spinal motor centers. If destruction is complete, the paralysis will be permanent, no matter how well the treatment may be adapted to the case. If the destruction involves the centers that control respiration or the heart action, death results.

During the acute stage, complete rest is required. There is danger in doing too much for the patient. To see little ones lying in bed, and do nothing for them, seems hard; but as a rule, it is best merely to keep them comfortable.

Treatment should be continued for months after the acute stage has passed. Progress in recovery is usually rapid during the first few weeks. After the fourth month, little further improvement may be expected in most of the cases; but there are exceptional cases which, under suitable treatment, continue to improve for months. Doubtless better results might have been obtained by careful treatment. Out of 754 cases in the 1907 epidemic in New York, only 53 made complete or almost complete recovery.

Money spent for patent medicines is worse than thrown away. Warm baths, fomentations to the spine, alternating hot and cold to the spine, massage to the limbs, and electricity will accomplish more than any other treatments. In fact, these are the only treatments of real value.

Thrives in the Darkness

LIKE other ger. diseases, infantile paralysis is a "pestilence that walketh in darkness." Sunlight is destructive to the virus. As a precautionary measure, it is well to

admit sunlight and air freely into living rooms. Moldy, damp, sunless rooms were condemned by the law of Moses as unfit to live in, and such rooms are the most favorable places for the cultivation of germs.

Care should be taken to keep the hands always clean. Especially before eating should they be washed with soap and water. The dirt should be removed from under the nails with a brush and then with a towel. The hands come in touch with many objects during the day, such as door knobs, and hanging straps in street cars. By hand-shaking, infection is frequently carried from hand to hand. Kissing by lips touching lips should be avoided. The rubbing of noses, as practiced among the natives of New Zealand, may be less objectionable.

Great care should be taken to keep the mouth and the throat clean by the use of toothbrush and gargles after each meal. Remnants of food, especially animal products, such as meats, milk, and butter, which encourage the growth of germs of disease, should be removed after each meal, and again before retiring. Not only should the teeth be brushed, but the tongue and the roof of the mouth should be scrubbed. While little is as yet known by science of this disease, these things are effective to prevent its spread.