H.—3l.

APPENDIX B.

ACUTE ANTERIOR POLIOMYELITIS IN NEW ZEALAND. HISTORICAL. Although acute anterior poliomyelitis has been present since early times, it is only within the last sixty years that the occurrence of widespread epidemics has been recorded. There must have been epidemics before that, but it may be that more extensive and more rapid means of communication, with the consequent increased facilities for the dissemination of disease, have radically altered the epidemiological picture of this disease. Only approximately one hundred years ago, in 1840, was the condition isolated as a morbid entity. In that year von Heine described the advanced stage of infection, and fifty years later Medin described the feverish stage of the disease and made a study of its morbid anatomy. Until 1881 poliomyelitis was described simply as a sporadic affection, and more attention was given to the form and specific nature of the lesions than to its epidemiological character. In that year Bergenholtz, as a result of experience of the first recorded epidemic of infantile paralysis, in Sweden, stressed its epidemic character, but it was many years later before the infectious nature of the disease was generally recognized. From this Scandinavian focus the disease spread to other European countries, and in 1894 to America, in which year occurred the Vermont epidemic, the first recorded in that continent. It was in 1894 that New Zealand first experienced an outbreak of poliomyelitis, but cases were known in this country before that date. INCIDENCE IN NEW ZEALAND. Acute poliomyelitis was made a notifiable disease in New Zealand in 1914 on the occurrence of a minor epidemic, chiefly confined to the South Island. Before that date, however, the disease was not unknown in the Dominion. In the New Zealand Medical Journal of 1905, Vol. IV, page 357, is mentioned the case of a girl of eighteen years who suffered from an attack of infantile paralysis when six months old, which would be in 1887-88. Our knowledge of the presence of the disease from that date until 1914 is fragmentary, but the references given below indicate that sporadic cases occurred and that an epidemic was experienced in 1894-95 : — 1890. N.Z. Medical Journal, 1890-91, Vol. IV (old series), page 121. Under the heading " Our Canterbury Letter," and referring to a meeting held in November, 1890, it is stated : " Dr. Pairman, Lyttelton, exhibited a case of infantile paralysis and gave a short history of its progress and treatment from which it appeared that there was a likelihood of ultimate recovery." 1893. N.Z. Medical Journal, 1893, Vol. VI (old series), page 311. Under the heading " Auckland Branch General Meeting, September 13th, 1893," it is stated : " Dr. Lindsay read notes of a case of acute ascending paralysis ending in recovery." 1894. N.Z. Medical Journal, 1896, Vol. IX (old series), page 183. In a letter to the Editor, the late Dr. Robert Fulton, Dunedin, wrote : " Some time ago I communicated with you on the subject of ' infantile paralysis,' a curious outbreak of which was said to have occurred in Wellington. Could you, or any of your readers, give me any information on the subject ? I can find no one in Wellington who has had a case (with the exception of Drs. Anson and Hislop) . . . May I ask any member of the profession who has seen a case of this very unusual and extraordinary disease occurring during the last two years to oblige me by sending a post-card giving a brief note of such case ? I have had it authoritatively stated that no cases occurred in Auckland or Napier, and that practically the North Island escaped the outbreak of 1894. I have notes of cases from Christchurch, Waimate, Dunedin, Milton, Lawrence, Tapanui, Outram, Invercargill. As far as I can gather, no other places were affected." Trans. Australasian Medical Congress, Auckland, 1914, page 30. In his Presidential address Dr. A. C. Purchase made a few remarks regarding the epidemic of infantile paralysis at that time present in Dunedin, and stated : " There was a similar epidemic twenty years ago, when cases appeared from the north to the south of these Islands, twenty-one cases being in Dunedin." 1895. N.Z. Medical Journal, 1895, Vol. VIII (old series), page 128 (April number). Wellington notes : " There is at present a remarkable epidemic of ' infantile paralysis.' One hears of new cases continually, and a large number have been under treatment at the hospital during the past few weeks ..." " Dr. Cleghorne writes that there was an epidemic in Blenheim some years ago, and that most of the patients made fairly good recoveries." Note. —A search of the Wellington Hospital records for the years 1894, 1895, 1896 shows that no cases of " infantile paralysis " were admitted in 1894 or 1896, but that between February and September of 1895 seven cases were admitted with that diagnosis. One boy of thirteen years was admitted with a diagnosis of " paralysis." This boy, a probable case of the disease, was the first of a series admitted (4th February, 1895), and was followed by a second case on the 15th February and a third on the 18th February. The ages shown in the register are : Males, 13 months, 18 months, 3 years, 5 years, 9 years, 13 years ; females : 2 years, 3 years. Three of the cases were admitted in February, two in March, two in April, and one in September. The only other cases admitted that year with a diagnosis of " paralysis " were a female of fifty years of age (June) and two males (forty-nine years and fifty-nine years) in November and December respectively.

72