THE increase in recurrence and prevalence of encephalitis in sporadic and epidemic form in our state and bordering states is the excuse for this paper, and not that I can add anything of value in detection or treatment, in the etiology or pathology of this disease with may be of value in detection or treatment, in the etiology or pathology of this disease with its complex protean manifestations But discussion may be of value in directing a more critical attention to this diseases that from all reports has been mistaken and treated in many instances for other diseases until within the last six months. Apparently it is not contagious or infectious. Not only sporadic cases., but those occurring during epidemics occur without any one being able to trace or determine the contact.
The very latest report on this disease, as given out by Drs. Leslie. T. Webster and George L. Fite of the Rockefeller Institute for Medical Research, indicates that these investigators have developed a test that differentiates the devastating epidemic of Japan in 1924 from those of Paris, Ill, in the fall of 1933, St. Louis in the fall of 1933e, and New York and Kansas City in the summer of 1933. They claim the type serologically is not the same, nor is it the type as that formerly known as epidemic or lethargic encephalitis. It was from the latter type the disease acquired the name- sleeping sickness. Our State Board uses the term epidemic encephalitis, but why they do with the sporadic cases outnumbering the epidemic is not apparent.
The Board gives out a report showing that in 1932 thirty- one countries in the state reported one or more cases of the disease, with the total for the year being 100 cases. In 1933, fifty-nine countries reported one or more cases with a total of 230. In 1932, Cook and Edgar counties each had twenty -seven cases, August of that year having the largest number of reported cases. In 1933, September led with ninety-five cases reported, October next with fifty-eight cases and August next with twenty-four,showing a strong seasonal influence, through one or more cases were reported in each month of the year. In 1933, the prevalence was greatest in Cook, Madison, St. Clair, Morgan and Macon, while Edgar Co., which experienced in epidemic at Paris in 1932,reported none. With an increase of over 100 as to whether this year will show a subsidence or recrudescence of the disease.
Drs. Webster and Fite make the claim that the virus invades the body through the nose, travelling to the brain along the olfactory nerves, rather than via the blood stream. They also claim they have succeeded in making mice resistant to the disease in seven days, lasting five weeks and possibly longer. So far no results on human cases have been reported, but likely they have made an approach in that direction. They claim that in mice a single injection of one-millionth of a gram brings a high degree of immunity. If an immunizing vaccine results from their investigations, the development of a curative agent will not doubt soon follow.
We know that in in this we have an involvement of the central nervous system, any part of which may be involved, with a preference, however, for the basal ganglia and midbrain. Clinical types are may, with manifestations from extreme nervousness and sometimes convulsions to the deepest lethargy. No age is exempt, but cases in those past middle life seem to carry a much greater hazard. Some who survive the attack later show the effect of the vascular changes and of the generative and destructive effects of the haemorrhagic process, in residuals that may appear early or later, the more severe of which are Parkinsonian states, tremors, and myoclonic and choreiform movements, and in the young at times mental changes with conduct disorders that offer real problems, many requiring institutional treatment and care.
Case I: October 7, 1933, was called to see W..T., aged twenty two years. His mother, a practical nurse, told me her son had been sick two days with symptoms much like influenza. I found him with a temperature of 102.6, pulse 90, quite indifferent but complained of headache and some bodily aching and soreness. Seemed much exhausted at least exertion. No catarrhal symptoms. Mother said he had been in a rundown condition for several months. October 9, the mother reported that he seemed very little if any better and asked me to see him. Found him in much the same condition but with lethargy quite marked. Indifferent about everything.
The following day headache much worse and patient when roused insisted that something was wrong with his brain. Pupils unresponsive. Marked tremor of tongue when protruded. Masked expression of face. Diplopia. Plantar reflex absent. Not having seen a case of encephalitis, but pretty well convinced that that this was one, I reported it as a suspected case to the chairman of the local Board of Health and asked that a state inspector be called to pass on the case. He said one would be in the city next day to investigate a scarlet fever epidemic. Dr. Dorris, of Paris, who had gone through an epidemic the year before, saw the case with me and confirmed the diagnosis.
This case ran an eventful course, fever subsided by the end of the second week, head pains disappeared, strength gradually returned, lethargy disappeared and by the end of the third week he was well on the road to recovery with no residuals. I found on inquiry that he had been in the St. Louis district with an orchestra company but none of the other members of the company had developed the disease. This case was a mild one, yet very distinctive. Late in the case there was low blood pressure and slow pulse that improved under treatment. A mild case that gave no concern.
Case 2: October 8, 1933. Mrs. A., aged sixty , seat word to my office that she had the flu and wanted some medicine Symptoms given-chilliness, aching, weakness. Next day was called to see her after she had a decided chill. Found her in bed, temperature 104, pulse 96, complained of headache and dizziness and unusual weakness. The husband said she had been quite nervous of late the unusual tired, due he thought to the fact she had been caring for two small grandchildren in addition to her usual hurtled duties. Saw her again October 10 in much the same condition ,but with mind confused and marked disorientation, She insisted that the ground was covered with snow, though no snow had fallen.
I reported the next day by DR. Dorris, or Paris. A nurse was placed in charge of the case and the fact that the patient implicitly believed doctors orders were to be observed rendered for care wondered why we brought her bed. At times somnolence was marked. At other times could not sleep and this became so marked that a sedative had to be used by the end of the second week. Pupillary and plantar reflex absent. Girdle and chest pains so oppressive we were apprehensive of respiratory complications.
Tremor of tongue marked. By end of third of third week fever had left. Exhaustion marked a temperature of 96, blood pressure 110, slow pulse. This condition persisted for nearly a week, when gradual improvement began and continued until recovery. No residuals in this case. In six weeks she was doing light housework, and in two months was almost back to normal.
Homoeopathic remedies that suggest themselves-gelsemium, bryonia, arsenicum, strychnia ars., digitalis, kali phos. Hypnotics and sedatives may be required in some cases, but the heavy prescribing of our old school friends is, I fear, more injurious than helpful in many cases. A close adherence to the use of our homoeopathic remedies based on the clinical manifestations of the case, and the attendant symptoms, will, I believe, and lower the mortality rate that in the epidemics reported the last few years had been from 25 to 30 per cent, the highest mortality being in ages past fifty years. Spinal puncture may relieve the intense headache, but according to Beckman the cerebrospinal fluid may be normal, but in some cases there is an increase in globulin and sugar and a slight increase in cell count.
The chief purpose of this paper is to put those who have not had contact with this disease on their guard in questionable cases occurring especially in the late summer and early fall in persons in a run rundown and debilitated condition. In epidemics little trouble will be encountered. In sporadic cases there may be.