80 



SCIENCE 



[N. S. Vol. XLIV. No. 1125 



fly is to be incriminated as a carrier of in- 

 fection is doubtful; but we already know 

 enough to wish to exclude from the sick, 

 and hence from menacing the well, all ob- 

 jectionable household insects. 



Food exposed to sale may become con- 

 taminated by flies or from fingers which 

 have been in contact with secretions con- 

 taining the virus; hence food should not 

 be exposed in shops and no person in at- 

 tendance upon a- case of infantile paralysis 

 should be permitted to handle food for sale 

 to the general public. 



4. Protection to the public can be best 

 secured through the discovery and isola- 

 tion of those ill of the disease, and the sani- 

 tary control of those persons who have as- 

 sociated with the sick and whose business 

 calls them away from home. Both these 

 conditions can be secured without too great 

 interference with the comforts and the 

 rights of individuals. 



In the first place where homes are not 

 suited to the care of the ill so that other 

 children in the same or adjacent families 

 are exposed, the parent should consent to 

 removal to hospital in the interest of the 

 sick child itself, as well as in the interest of 

 other children. But this removal or care 

 must include not only the frankly par- 

 alyzed cases, but also the other forms of 

 the disease. In the event of doubtful diag- 

 nosis, the aid of the laboratory is to be 

 sought since even in the mildest cases 

 changes will be detected in the cerebro- 

 spinal fluid removed by lumbar puncture. 

 If the effort is to be made to control the 

 disease by isolation and segregation of the 

 ill, then these means must be made as in- 

 clusive as possible. It is obvious that in 

 certain homes isolation can be carried out 

 as effectively as in hospitals. 



But what has been said of the small inci- 

 dence of cases of the disease among the hos- 

 pital personnel and those with whom they 



come into contact, indicates the extent to 

 which personal care of the body by adults 

 and responsible people can diminish the 

 menace which those accidentally or un- 

 avoidably in contact with the ill are to the 

 community. Care exercised not to scatter 

 the secretions of the nose and throat by 

 spitting, coughing and sneezing, the free 

 use of clean handkerchiefs, cleanliness in 

 habits affecting especially the hands and 

 face, changes of clothes, etc., should all 

 serve to diminish this danger. 



In the end, the early detection and isola- 

 tion of the cases of infantile paralysis in all 

 of its forms, with the attendant control of 

 the households from which they come, will 

 have to be relied upon as the chief measure 

 of staying the progress of the epidemic. 



5. The degree of susceptibility of chil- 

 dren and other members of the community 

 to infantile paralysis is relatively small 

 and is definitely lower than to such com- 

 municable diseases as measles, scarlet fever, 

 and diphtheria. This fact in itself consti- 

 tutes a measure of control; and while it 

 does not justify the abatement of any prac- 

 ticable means which may be employed to 

 limit and suppress the epidemic, it should 

 tend to prevent a state of over-anxiety and 

 panic from taking hold of the community. 



6. A percentage of persons, children 

 particularly, die during the acute stage of 

 the disease. This percentage varies from 

 five in certain severe epidemics to twenty 

 in others. The average death rate of many 

 epidemics has been below 10 per cent. A 

 reported high death rate may not be actual, 

 but only apparent, since in every instance 

 the death will be recorded, while many 

 cases which recover may not be reported 

 at all to the authorities. In the present 

 instance it is too early in the course of the 

 epidemic to calculate the death rate, which 

 may prove to be considerably lower than 

 it now seems to be. 



