EPIDEMIC POLIOMYELITIS.
637
bombs, being himself wounded by
the boys at Cheltenham College during the month an explosion later that his house had been of October, 1917. The precise source of the inbombed in his absence, his wife or members - of fection was not definitely determined, but it is family being also hurt. If he were found, quite thought very probable that it was brought to the imprudently we admit, to have failed to insure to college by a returning schoolboy at the conclusion The first of the cases the fullest extent, or to have allowed his insurance of the summer vacation. to lapse, we should certainly feel impelled to sup- had a fatal termination, but the other two port the view, which no doubt he would hold, that recovered. There were ten notifications of poliothe State ought at least to help him to bear his myelitis in Cheltenham town during 1916, but loss. It will be recognised that the case we have apparently no connexion existed between these put forward is not wholly imaginary, and because cases and those at the college in 1917. The publiof it, and others, we sympathise in the abstract cation of these three reports serves, among other with the views put forward by the Committee on things, the useful purpose of reminding medical men that poliomyelitis is liable to occur, sporadiWar Damage. cally or otherwise, in any part of the country, and EPIDEMIC POLIOMYELITIS. that practitioners should be on their guard against IN this country, happily, we have had so far no overlooking mild, abortive, or anomalous cases severe or widespread epidemics of acute poliowhich, if not properly dealt with at once, might myelitis, such, for example, as that which swept diffuse the infection in the locality and give rise to a serious epidemic. Epidemic poliomyelitis is, over the State of New York two years ago, and which, in a population of about 10 ½ millions, as our readers are aware, one of the saddest of attacked no fewer than 13,164 persons, most of diseases, since the tender-aged victims who survive them under 5 years of age, of whom 3331, or about the attack are often left permanently crippled or 25 per cent., died; and among those who recovered deformed. a considerable proportion were left paralysed for ULSTER AND THE MEDICAL NEEDS OF THE life. In England the manifestations of the disease, ARMY. while not uncommon, have hitherto been on a of’ small scale. The total number comparatively AT the first meeting of the Ulster Medical Society cases notified in 1917 was 357, distributed widely for the session 1918-19, held in the Belfast Medical The Institute, when Dr. W. Donnan, as retiring President, over the country in small groups of cases. largest outbreaks in recent years occurred in introduced his successor, Dr. J. Colville, Dr. F. Devon and Cornwall in 1911, and were carefully Goodbody made a strong appeal for doctors for the investigated on behalf of the Local Government front owing to the great necessity for them during Board by Dr. R. J. Reece.! Three localised out- the present Allied offensive. The medical probreaks of epidemic poliomyelitis reported to the fession in Ireland is being strongly pressed for Board during 1917 were made the subject of fully qualified practitioners with the Army, and the special inquiry by medical inspectors. The Queen’s University of Belfast has definitely decided three reports have now been issued together, to hold a special medical degree examination at the along with a prefatory note by Dr. R. J. Reece, end of November, so that there shall be no delay The until the usual degree examinations in March of Assistant Medical Officer to the Board.2 first report is by Dr. A. S. MacNalty and deals with next year. But they have made certain clear an outbreak, comprising 42 cases and 3 deaths, in conditions :the Esher and the Dittons urban district and in the 1. Every candidate before being admitted must sign a. adjoining Epsom rural district, 33 attacks being document that in the case of men they will go to the front, referred to the former and 9 to the latter. Twenty and in the case of women that they will place their services of the cases suffered from definite paralysis, in 12 at the disposal of the War Office. 2. Those candidates who pass must provide evidence of whom, when last seen, the paralysis still per- before their degrees are conferred that they have " signed sisted. The spread of the disease generally was on " with the War Office, otherwise their degrees will be from person to person. Dr. MacNalty in his report forfeited. gives a diagram representing graphically the spread " The possibility of getting young medical men in of the infection and the grouping of the cases. Mild Ireland has been rendered doubtful," says our or so-called "abortive" cases occurred side by side Belfast correspondent, " because there is no with paralytic cases in the same households; such that if a young doctor throws up his guarantee mild cases when unrecognised probably played a practice and goes to the front he will not on not inconsiderable part in diffusing the infection. his return find his patients in the hands of others The first attacks were reported in mid-July and the will not be very keen to give them back." Our outbreak lasted until the end of August. The correspondent proceeds : second report is by Dr. H. A. Macewen and relates The bureaucratic authorities in of the petrolto the occurrence of 11 cases of acute poliomyelitis supply are cutting down the amountscharge of spirit to doctors, in the borough of Cambridge and in its vicinity with the natural result that, in addition to the amounts smaller and often much poorer, the mileage of the during the autumn of 1917. In this instance also being diminished. The consultants and those the malady appears to have been spread by personal cars is being attending the military in hospitals and camps are finding infection. The origin of this local outbreak was that it is impossible to get through work with the difficult to trace, and no connexion between it and a diminished supply of such frequently poor petrol; while men-who would be willing to do the extra work of previous occurrence of the disease could be dis- older doctors, so as to let the latter off to the Navy and younger covered. There was only 1 death among the 11 cases. Army-realise they could not, with their present petrolThe third report is by Dr. J. P. Chandler, and is supply, do the work. What makes it specially aggravating is concerned with an investigation of three cases of that every day civil officers are using petrol, and ambulances are seen running about with, at times, some vegetables or acute anterior poliomyelitis which occurred among clothes (washed or soiled), as the case might be, from one
o6nd being informed
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THE LANCET,
1912, i., 450.
Reports to the Local Government Board on Public Health and Medical Subjects (New Series, No. 120). Further Reports and Papers on Epidemic Poliomyelitis. H.M. Stationery Office. Pp. 27. Price 1s. net.
military hospital to another. The whole train service is so greatly restricted that it is of little use to doctors. Owing to the inadequate supply of doctors the Dublin corporation has demanded the release of several medical been deported and interned."
men
who have
638
TUBERCULOSIS IN FRANCE.
Professor Gunn then described the adaptation of some of the
TUBERCULOSIS IN FRANCE.
found useful in the United States to the conditions in Five different methods have been employed:e France. exhibits, posters, pamphlets, and public newspapers, 1’he Return of the Tuberculosis Interné1. A series of articles prepared by the educameetings. are from CIVILIAN prisoners being repatriated Germanyitional division of the Commission have been printed in through Switzerland in increasing numbers. One of our36 newspapers, explaining the origin of tuberculosis, the French correspondents writes that something like 1000-1300 ways in which it can be cured, and the French newspapers are arriving daily at Evian, and of these about 1 per are rapidly coming to realise their great opportunity of cent. are found to be tuberculous, their condition being a public health education. 2. The travelling exhibit emphasises of the insufficient defective and food, hygiene, product the main facts about tuberculosis by means of wall charts. of circumstances captivity. To ensure sufficient and imme-There are also models of a dispensary, an out-of-doors diate care for theseunfortunates the Minister of the Interior and a kinema with films. The exhibit, has set up machinery at Evian for weeding out the tuber-sleeping-porch, which is carried on a truck from town to town, is in culous patients on their arrival, with a view to classification of a directress and has a personnel of chauffeur, and treatment appropriate to each several case. A rapid charge moving picture operator, two lecturers, and an advance into three is made : the separation categories (1) grave forms, There are now three such exhibits in operation and which are sent to special hospitals; (2) the suspects, who agent. within a few months the number will be increased to six. are reserved for careful examination ; (3) those found unhave already traversed the departments of Eure-et-Loir, affected, who are then allowed to continue their journey. They Loir-et-Cher, Indre-et-Loire, Cher, Allier, Ille-et-Vilaine, The hospital of suspects includes 180 beds, and to it Cotes-du-Nord et Loire-Inferieure. 3. Conis attached a hostel for healthy children, where sufficient Finistere, ferences the exhibition have been held in comisolation is obtained without complete separation from their munities preceding of 3000 or more persons, the audiences in many possibly infective parents. At the end of 10 days’ observation instances numbering 50 per cent. of the population. the patient then recognised as non-tuberculous is allowed sessions have been arranged for school children, to proceed. Those found to be tuberculous are classified as Special who attend with their teachers, as well as conferences for follows : (1) advanced or rapid lesions, needing rest in bed ; mothers and meetings in factories. 4. Moving pictures on (2) old cicatrised lesions with good general condition; health subjects form an important part of the programme. (3) cases presenting some active symptoms, but whose Some of the films are scientific presentations of disease; lesions are slight and closed ; (4) cases with open lesions others are animated cartoons on health. The meetings are and therefore infective, but with a prospect of cure. are put on the walls advertised ; many thoroughly posters The men are generally alone, the women more often and the local newspapers carry notices. 5. The Commission accompanied by children whose health is not always the has prepared a large variety of brochures in order that the same as that of the mother, who does not wish to be sepaattending its meetings may have something to take rated from them. Four possibilities have to be considered : people home and study at leisure. The booklets are illustrated by (a) infective mother with infective child ; (b) infective French artists, and a million and a half copies have already smother with non-infective child ; (c) non-infective mother been distributed." with non-infective child ; (d) non-infective mother with Professor Gunn has found that the French people are infective child ; the last a very rare category. Among the to know the facts about tuberculosis, and he has had glad the ,non-infective children it is necessary to define : (1) the and cooperation of the pr6fets and maires. hearty help .healthy; (2) the anaemic, debilitated, and the subjects many of whom have acted as chairmen at the meetings . of tuberculous glands ; (3) those with tubercle of bone: arranged by the Commission. or joint. To meet the needs of these various classes there has been established a hospital of 56 beds in the neighbourhood for grave cases, men and women, ROYAL COLLEGE OF PHYSICIANS OF - tiheir children being placed in a neighbouring hostel. Curable LONDON. tuberculous cases are sent into other establishments, the men to sanitary stations in the interior, where they join the discharged soldiers. Several establishments for women are Meeting of Comitia. available according to the gravity of their case. At the AN ordinary Comitia of the Royal College of Physicians of village of Monnetier-Mornex a hospital of 125 beds has been London was held on Oct. 31st, Dr. NORMAN MOORE, the set up at 800 metres above sea-level, a house of 30 beds for President, occupying the chair. infective women, a hostel with 45 beds for healthy The following candidates having passed the required children, and a house of 30 beds for infective children. The examination were admitted as Members of the College : Dr. Hospital of Ste. Eugénie, near Lyons, with 140 beds set up J. C. Matthews, Dr. S. A. Moore, and Mr. H. J. Orr-Ewing. by the American Red Cross, also receives tuberculous Licences to practise physic were granted to 93 candidates . women. Children with tubercle of bone or glands are sent who had conformed to the by-laws and regulations and had to marine hospitals. Finally, the departmental committees the required examinations. passed of assistance for the military cases of tubercle are setting Certain College officers and examiners gave their faith to .their vast organisation of regional sanatoriums at the the College. ,disposal of the returned civilian. The following communications were received :— 1. The Secretary of the Royal College of Surgeons, dated Propaganda Wog-k in France. At the recent annual meeting of the National Association July 26th and Oct. lltb, reporting proceedings of the Council -for the Prevention of Consumption, held in London, an inform- of that College on July 25th and Oct. 10th respectively. Note.-A supplementary letter states that at the meeting of the ing address was given by Professor Selskar M. Gunn, Asso- ciate Director of the Commission for the Prevention of Council on July 25th it was decided(a) "To omit the names of universities in Germany and Austria.Tuberculosis in France. His main theme was the need Hungary from the list of hospitals and schools of medicine and surgery for popular education in tuberculosis, as illustrated by the publishedin the College Calendar as the places from which certificates work of the Commission in France. " No matter how of the professional education of candidates for the Membership and Fellowship will be received by the College for the year commencing thorough is the medical care of the population," the 1st of August, 1918." Professor Gunn said, "provision for the sick and a (b) " That the desirability of also omitting these universities front the list of the Conjoint Examining Board should be brought campaign against tuberculosis cannot secure complete published results until each individual has been taught the funda- under the consideration of the Committee of Management." mental facts of correct and healthy living and follows the This was referred to the Committee of Management. 2. Dr. Guy Wood, dated Oct. 7th, asking that the Memberteachings. In the last analysis the prevention and the eventual elimination of tuberculosis are a matter of sane ship, which he resigned in 1900, may now be restored to living, of following the most simple physiological laws of him.-This was agreed to for the first time, on the proposition ,health, good food, adequate rest, proper exercise, and of the SENIOR CENSOR. fresh air. At present these facts are the property The SENIOR CENSOR proposed, and it was resolved, that of a limited number of. persons in the community. the Licence of the College which was withdrawn from Mr. It is essential, if tuberculosis is to be conquered, that William Dutton Akers in January, 1912, be now restored. - the scientific knowledge of the few be given to all. to him.
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