A Record of Some Cases of Epidemic Paralysis Occurring in Hampshire
Authors: G. F. England
Journal: BMJ (1911)

I NEDICLL JOURNAL 19 9 cases were notified.Assuming the preventive measures were efficacious, it is interesting to consider which was most likely to be efficiently performed.Flies still swarmed after the epidemic ceased.The spraying of " contacts," although advocated, was not super- vised and could not be insisted on.The probability is that this measure was neglected in many instances, and cannot be reckoned as a potent factor in staying the spread of infection.Isolation was observed as far as possible.But in many instances parents refused to send their children to the isolation hospital, only four patients being admitted.The only measure thoroughly and regularly performied was watering the streets with antiseptics, and in this way rendering the dust innocuous.The evidence from this epidemic, therefore, would appear to support the view that dust infection is an important factor in spreading the disease.Clinical SymptoMs.The symptoms differed in no material respect from those already published in the BRITISH MEDICAL JOURNAL of November 4th, as typical of the epidemics in Cornwall, Huntingdon and Devonshire.In the majority of cases gastro-intestinal trouble either preceded or accompanied the attack.In one instance amongst my own cases the illness was preceded by tonsillitis.Headache, pain at the back of the neck, furred tongue, vomiting, usually constipation, with some fever, marked the onset of the disease.In bad cases muscular twitching and convulsions occurred, also retraction of the head and spinal rigidity.Paralysis of one or more limbs supervened in from two to three days.Kernig's sign was present in 75 per cent. of the cases.Reflexes were usually abolished with the onset of paralysis.Retention of urine occurred in 10 per cent. of the cases.Pain and tenderness was usually present in the paralysed limbs.In some cases hyperaesthesia was very marked.The paralysis in the majority of instances appears to be permanent.Bacter*iology.In several cases the spinal fluid was examined, and Dr. Heath, county medical officer of health, has obtained some interesting results, which will be published in due course.Dr. Alice Taylor also worked at the bacteriology of the (lisease, and her results appeared to confirm those of Dr. Heath. Treatment.Various drugs were tried, including urotropine, but the course of the disease appeared to be uninfluenced.No doubt with the isolation of the specific organism, and preparation of a vaccine, better results will be obtained. NOTES OF CASES.H. D., aged 19.On August 10th suffered from tonsillitis, wvhich passed off in a few (lays.On August 19th complained of headache, especially at the back of the neck, vomiting, and pains in limbs and back.Temperature 1000.Tongue furred; constipation present.August 21st, paralysis of left arm and leg.Kernig's sign present-paralysis of left arm severe.At the present time, three-and-a-half months from onset, has not recovered full use of arm, and is still slightly lame.C. O., aged 5, commenced August 19th.;Much pain in back of head and down the spinie.Retraction of head and spinal rigidity very marked-some twitchings of muscles during sleep.Kernig's sign present; reflexes abolished.Hyperaesthesia of paralysed limbs.The case is interesting, as, although cerebro- spinal symptoms were well marked, examination failed to confirm the diagnosis of cerebro-spinal fever.Patient died of bronchopneumonia after one month's illness.Mrs. B., aged 40, taken ill September 14th, and moved into hospital.Paralysed in both legs-very complete; no hyperaesthesia.Kernig's sign absent; reflexes absent; temperature from 1000 to 190O.Retention of urine for ten days.She died after three weeks' illness from bronchitis and heart failure.Examination of spinal fluid was negative, as far as cerebro- spinal fever was concerned.This patient was certain she con- tracted the disease from one of her children, whom she said was ill a week before she was, with vomiting and headache.Trhe child was not attended by a doctor, and when seen later showed no paralysis, but this may have been an abortive case.F. R.. aged 4. Commenced with vomiting and headache, and pain in the back, on September 4th.Paralysis of both legs.Kernig's sign present; hyperaesthesia present; constipated.Reflexes absent.Paralysis very complete.At present time there is some slight return of power in the flexors.Ex- amination of spinal.fluid negative as regards cerebro-spinal fever.S. C., aged 5. Seen Septemb)er 14th.Left leg paralysed.Had had slight attack of headache, pain in back of neck, anld v-olniting three days previously.Doctor only called in when paUralysis noticedl.Uninterrupted recovery.Cerebro-spinal fluid negative.