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EW YORK, last summer, passed through one of the worst, if not the worst, epidemic of infantile paralysis that ever visited the United States. The disease not only kills its victims, but those who survive are often left invalids or cripples for the remainder of their lives. The history of previous epidemics shows that they progress in a wave like manner, and this feature is what prompts this article.

What can be done to prevent an epidemic of infantile paralysis? The following outline may help

1st-Education of the public. 2nd-Energetic active local health of

ficials.

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3rd-Co-operation of citizens, physicians, and health officials in every c munity.

4th-Further research work as to source, methods of transmission, preventive and curative treatment.

The educational phase should supply authentic information in a simple manner as to the source, prevalence, and the early symptoms that should excite suspicion of the laity, as to possible infantile paralysis infection.

Specific Organism-A micro-organism has been isolated by independent investigators in Chicago and in New York. The general conclusion arrived at is that this organism either is a secondary invader, which in cultures may be more or less closely associated with the independent virus of poliomyelitis, or it is itself the cause of poliomyelitis and capable of existing in filterable and nonfilterable forms.

Transmission-The disease is transmitted in all probability by the secretions and excretions of the patient dried

or otherwise coming in contact with the nasal passage or throat of susceptible persons. Coughing, sneezing, spitting and contamination by intestinal discharges are undoubted methods of spreading the disease. The virus endures for considerable time outside the body making a disinfection necessary, of infected persons, premises, and material.

The bite of the stable fly or insects such as lice or bed bugs have not been proven to be means of contagion. The role of the blue bottle, or green fly as a possible source of contagion has been strongly suggested. The identity between poliomyelitis and paralytic infection in fowls and lower animals denied by Flexner, but investigations by Saunders point to the accidental ingestion of infected larvae of the green fly as a possible source of the disease.

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Of those who survive, a part make complete recoveries, the remainder, and unfortunately not a small number suffer some degree of permanent crippling.

Activities by Health Officials

Dr. Flexner says protection to the public can best be secured through the discovery and isolation of those ill of the disease, and the sanitary control of those persons who have associated with the sick whose business calls them away from home. Both these conditions can be secured without too great interference with the comforts and rights of individuals.

The essential facts upon which preventive measures rest are:

1-Infantile paralysis is contagious. 2-The convalescent may be a carrier for weeks or months.

3-Healthy persons exposed to infection may be carriers by harboring the organism in their throats and nasal passages for a long period of time.

4-The infectious material comes largely from the nose and throat. May also be found in the intestinal passages and may be present in urine and sweat. 5-Children are particularly susceptibut adults are not necessarily immune.

ble;

6-Infection probably takes place through the mucous membranes of the nose and throat.

7-The exact means of treatment is uncertain.

With the above information it is desirable that health officers establish a rigid quarantine, or better still, hospitalization of all persons suffering from the disease.

There should also be quarantine and rigid observation of all persons who

have been in contact with patients suffering from the disease.

There should be careful destruction of all discharges of affected persons, and of all things contaminated by discharges.

After the death, removal, or recovery of the patient, the premises should be thoroughly cleaned and disinfected.

Health authorities should take the necessary steps to prevent and avoid dust of every kind in a community where infantile paralysis prevails. The streets should be oiled or sprinkled; in infected homes, no dry sweeping or dry dusting should be allowed; the carpets and rugs should be cleaned and not beaten; the public should be warned that convalescent patients may carry virus for uncertain periods. There should be a general community cleanup. All manure or decomposable material should be removed, thus waging an effective war against flies.

Flytraps should be generally used. All houses should be securely screened. This is especially important on premises in which the sick reside.

Domestic animals and pets should be kept on the owner's premises, and such animals, if found on infected premises, should be destroyed,

Children should not be permitted to come in contact with other children unnecessarily if infantile paralysis is present in the community.

The public should be advised of the danger of using public drinking cups or articles which may come in contact with the secretions of the nose and throat of a carrier person.

During the prevalence of infantile paralysis, adults should not kiss children, and children should not be permitted to kiss one another.

All persons should cover the mouth when sneezing and coughing.

The same handkerchief should not be used for two or more children.

After caring for the nose or throat of the child, the hands of the parent or nurse, and all implements or articles used, should be cleansed before caring for another child.

All food supply should be carefully protected from flies during their manufacture, sale and delivery.

The mouth, throat, and nasal passages should be kept in a clean and healthy condition. This can best be accomplished under advice of the family physician.

Whatever is used for prophylactic measures should be individual.

In the event of danger from outside sources, the local health department should inaugurate a system of medical inspection on incoming trains and boats from the infected localities.

Children arriving from infected territories should be kept under observation until it is known that they are no longer possible sources of danger.

The prompt hospitalization of all cases that do occur.

The locating and watching of all persons who have been in contact with cases and the quarantining for a period

fections of any kind, and should, on the slightest provocation, call in their family physician for intelligent and careful examination and observation.

The physician should treat all cases that are doubtful as possible sources of infection, and should report the case at once to the health department, either as a "suspect" or a "case." If in doubt as to the diagnosis he should not hesitate to call in competent assistants.

The health officials should, at once, take all steps that are recognized as being desirous or necessary to isolate and make safe any case that develops, or any suspect until diagnosis is determined.

By means of this close relationship between the parent, the child, the physician, and the health officials, everything that is possible to prevent or control

of ten days of all children who have been thus exposed.

Every suspect case should be investigated, and isolation and quarantine instituted until a positive diagnosis is made.

The community should record every acute illness as a possible source of danger, and should refrain from visiting until the nature of the disease is determined.

Co-operation

The end results of any community welfare movement depend upon the degree in which the community helps itself, and in the protection against infantile paralysis, it is absolutely essential that citizens, physicians, and health officers work hand in hand.

The parents of children should be alive to the slightest indisposition or early symptoms of possible acute in

an epidemic of infantile paralysis is performed.

Research

Inasmuch as the definite organism that causes the infection has not been positively found as yet, it is plain to be seen that further research work in this disease is desirable, for it is only when the active agent and its characteristics have been studied that scientific measures for elimination and cure of a disease can be established. Hence, it is highly desirable that all communities, so far as possible, would lend their aid in further study, and ascertain as quickly as possible all the necessary information that would place this disease in the class of conquered infections, as yellow fever, malaria, syphilis, etc. When this is accomplished, the dread will have been removed.

W

E have a case for you, Big Sister." Big Sister's interest in juvenile delinquents was well known and special cases were always handed over to her by agents of the Children's Court. "It is a case of improper guardianship and we would like you to investigate it."

Big Sister boarded a car marked Woodlawn, and after twenty minutes' ride alighted at the street where her "special case" lived. A large coal yard, with offices, stables, some fine dogs and many cats (she was later informed they were to keep rats from eating the grain) and a little hut set far in the back, was the home and surroundings of Elsie, Olga and Eddie Trobert, the children in the case.

The door was opened by Eddie, and when Big Sister stated that she had come to pay them a friendly visit she was admitted. Three bare rooms were revealed, in which there were a few sleeping cots, a kitchen table and kitchen stove. Not a picture, not a curtain, not one of the things that make home a happy place to be in. The fire had gone out, it was a dreary cold day in January, and there was nothing for the children to eat. Mrs. Trobert was out scrubbing. She had been left a widow with seven children, the youngest four months old and the eldest eleven years. Four had been placed in institutions, but Elsie, Olga and Eddie had been left with their mother. Mr. Trobert had not been a citizen and so there was no widow's pension for Mrs. Trobert and her little children.

Big Sister soon had the children building a fire, washing the dishes and sweeping the floors. Elsie was so pretty, with blue eyes and golden hair, and since she was the eldest she mothered Olga and Eddie. Eddie said to Big Sister, “You

have gold in your tooth," and Big Sister, never loath to drive home a lesson, told him it was because she had not brushed her teeth well when she was a little girl. Eddie said, "Gold isn't nice, is it? It makes you talk so different. It makes you talk German!" Soon there was a nice fire and something to eat being prepared and the children and Big Sister were fast becoming the best of friends, telling one another all sorts of confidences.

Later Mrs. Trobert returned from work. She told Big Sister that she received rent, coal and wood free for living on the premises and that she acted as care-taker at night and on Sundays. She did not understand the charge of improper guardianship against her, for she said she was a good mother, had to work hard every day to support her children whom she loved dearly, and if they were all taken from her she would not have a thing to live for. When Big Sister explained to her that the court regarded the place unsafe for the children, because they had no one to care for them all day, and that there were men of evil character about the place who were a danger to the children, Mrs. Trobert wept bitterly and said it was such a help to her not to be obliged to pay rent. Big Sister cheered her as best she could and promised to see her on the day her case would come before the judge.

Court day arrived and with it, Eddie, Olga, and Elsie and Mrs. Trobert. The special agent for the Society of Prevention of Cruelty to Children stated the

case.

The kindest judge in the Children's Court turned to Big Sister and asked her what she knew of the Trobert family. Big Sister was happy to state that the children were her little friends, that their mother had been left with a large