Encephalitis

A classic treatise on one of the worst infectious diseases, sleeping sickness, last week came from the U.S.'s No. 1 encephalitis specialist, Dr. Josephine Bicknell Neal of New York City's Health Department. Encephalitis swept the U.S. in the wake of the influenza epidemic of 1918. What World War II has in store no one can tell, but Dr. Neal and other experts* fill this book with everything they know about this dread malady (Encephalitis ; Grune & Stratton; $6.75).

Cripples and Criminals. Encephalitis is a convenient name for a class of diseases which attack the grey and white matter of the brain. What causes infection is a mystery, although doctors suspect a filterable virus. In the U.S. two forms of encephalitis have been discovered: 1) equine encephalitis, a horse disease, which may be transmitted to human beings by mosquitoes; 2) St. Louis encephalitis, named after the epidemics which raged in St. Louis in 1933 and again in 1937. Although they first appeared together, flu has no direct connection with encephalitis; it may, of course, weaken resistance to the nerve disease.

Encephalitis may attack anyone from the newborn to the octogenarian. About a third of the victims of epidemic encephalitis die; another third are crippled by all sorts of nervous disorders, the remainder seem to recover. But they cannot tell what is in store for them, for the disease continues to smolder for many years, often destroying brain tissue, producing startling changes in personality.

Bright, healthy children may be transformed into incorrigible delinquents. Adults do not change so radically, but may develop a typical masklike expression, trembling hands, a stiff, rigid body. Some are drowsy all the time; others cannot sleep. Strangely enough, victims do not necessarily lose athletic skill. Said Dr. Neal: "I have seen patients bedridden by day who were able to walk and even dance during the night. . . . One patient could pitch a ball with speed and accuracy, whereas the spasticity [jerkiness] and tremor of his right arm interfered with his carrying out the more simple acts of everyday life."

Help from Horses. One way to protect human beings from one type of encephalitis is to eliminate the disease in horses.

Dr. Neal has great hope that equine encephalitis may soon be controlled by a powerful new vaccine. In 1938 there were 185,000 cases of encephalitis in the country's 15,000,000 horses. Some of them drooped, yawned, leaned against fences; others had convulsions, staggered. In 1939 3,000,000 horses were vaccinated; the total number of cases dropped to 8,000.

A similar vaccine has been developed to protect human beings from this form of the disease.

Although there is no preventive vaccine for epidemic encephalitis, laboratory workers all over the U.S. are trying to perfect one. Meanwhile, new treatments have been devised for the disease once it takes hold. During the past eleven years in the Neurological Institute, with grants from the William J. Matheson Commission for Encephalitis Research, Dr. Neal has cared for over 700 encephalitis victims, has found the following measures effective: > In the early stages, sedatives, good food and rest are vital. Convalescence, said Dr. Neal, must last from six months to a year.

> A vaccine made from the herpes virus (allied to the fever blister and shingles virus) helps to prevent severe nervous degeneration if given over a period of several months. Dr. Neal has tried the vaccine on many patients, with apparently good result.

> A remarkable drug for holding down chronic symptoms is Bulgarian belladonna, steeped in white wine. (An American substitute is now available.) In many cases the drug relieves insomnia, helps build up strength, improves speech.

* Drs. Lauretta Bender, Helen Harrington, Ralph S. Muckenfuss, Tracy Jackson Putnam, Albert A. Rosner, Lewis D. Stevenson, Hubert S. Howe.

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