into effect. The far-reaching possibilities for good or evil dependent upon the judgment of these three men can hardly be overestimated. In accordance with the provisions of the bill, one of these three is the major-general commanding the National Guard of the State. It happens that at this moment this office is held by Major-General John F. O'Ryan, one of the most effective and able officers in the National Guard. The Outlook has had occasion to disagree emphatically with Major-General O'Ryan on matters of National policy; but it has never doubted for a moment either his competency or his devotion to the work which he has undertaken to perform. The bill provided that a second member of the Commission should be chosen by the Board of Regents of the University of the State of New York. Very wisely this Board chose as its representative the President of the University and Commissioner of Education, Dr. John H. Finley. No one who knows Dr. Finley's record will doubt the wisdom and excellence of this choice. The third member of the Commission was to be appointed by the Governor, and Governor Whitman has chosen for the position Dr. George J. Fisher. For twelve years Dr. Fisher has been Secretary of the Physical Department of the International Committee of the Young Men's Christian Association, having supervision of physical training in the United States and Canada and in foreign lands. He is, and has been for ten years, the President of the Physical Directors' Society of North America, and is a Vice-President of a similar organization in Great Britain. He has been extremely active in working out the problems of athletic administration in this country. Dr. Fisher has rendered a large service to the Boy Scouts of America, helping to give the movement wholesome direction in the early days of its organization. He has served. since the beginning as the chairman of its most important committee-the Committee on Badges, Awards, and Scout Requirements, which largely shapes the practical policy of the movement. He is the author of the chapter on "Health and Endurance" in the official "Handbook for Boys of the Boy Scouts of America." The spirit in which Dr. Finley, Dr. Fisher, and Major-General O'Ryan have undertaken their new work is an ample guarantee that, in so far as they are responsible, the phys ical and military training of the boys of the State will be carried on with the utmost social advantage to New York State's future citizens. It is expected that the unprecedented powers granted the Commission will be broadly interpreted. The definition of military training will be made generous enough to include physical and disciplinary training of the most fundamental character. Indeed, it is foreshadowed that much of the military training will be of such a nature as that already given to members of the Boy Scouts of America. It will be used to lay a foundation of physical fitness, mental alertness, and habits of discipline and obedience that should prove a most useful basis for such advanced military training as is now being given at the Plattsburg camps. That Dr. Finley and Dr. Fisher will not be alone in their ambition to make the physical training given by the Commission of intensive social value may be judged from the following statement recently made by Major-General O'Ryan in regard to the experimental training camps, which the Commission intends to conduct during the present summer. The character of the instruction is formulated not for the purpose of attaining perfection in military drill. On the contrary, military drill will be recognized by us merely as a means-one of many means-to be adapted for characterbuilding and the development of physical fitness. The boys are to be taught correct posture and walk, directness of speech, the importance of truth-telling and fair dealing, punctuality, attention to details, thoroughness, courtesy, consideration for the rights of others, the value of co-operative effort under leadership, personal hygiene, sanitation, the value of correct living, the effect of diet on physical fitness and longevity; and they will be rigidly developed by physical exercises. The progress and success of the work of the Military Training Commission is something which we shall follow with intense interest. The New York State law will doubtless be studied carefully by legislators and students of public welfare throughout the country. It is unfortunate that New York, the pioneer State to enact legislation of this kind, did not produce a more carefully formulated measure for the attention of her sister States; but we are sure that in the progress of the work under Dr. Finley, Dr. Fisher, and Major-General O'Ryan there will be much information which can be gleaned to the profit of the country as a whole. ERIOUS as the present epidemic of infantile paralysis in New York and its environs is, it is not something new; the knowledge about the disease is greater, and the forces fighting it are better organized, than ever before. The outlook, therefore, should not be regarded as discouraging." This is the conclusion which Dr. Simon Flexner, the greatest American authority on infantile paralysis, and one of the greatest authorities in the world on infectious diseases, reached in remarkable paper read on Thursday, July 13, before the New York Academy of Medicine. Dr. Simon Flexner (whose portrait appears on another page) is a native of Louisville, Kentucky. His younger brother, Abraham, is well known as an educational expert. Simon Flexner received his medical degree at the University of Louisville, and became a graduate student at Johns Hopkins and at the Universities of Strassburg and Berlin. He has received the degree of Doctor of Science from Harvard, Yale, Princeton, and Johns Hopkins. After occupying several prominent medical positions, he became, in 1903, the Director of the Laboratories of the Rockefeller Institute for Medical Research in New York City. His achievements have been invaluable contributions to the progress of medical science, and consequently to the welfare of his fellow-men. Epidemics of other diseases are often more widespread than this epidemic of infantile paralysis is or threatens to be. The reason why infantile paralysis is especially feared is not so much because of its prevalence as because of the consequences of the disease and of the mystery that has been attached to the way it is spread. Such a paper as Dr. Flexner's ought to be very widely read, not only by physicians, but by others. Such knowledge as he gives very clearly and simply is one of the best preventives of panic because it replaces the fear of ignorance with information as to what can be done. Some of the facts concerning this disease (which medical scientists call acute anterior poliomyelitis) were reported in The Outlook for July 12. Such facts were: that the disease is caused by a very minute organism which lodges first in the nose and throat, that it may thus be carried about by people who are well or by people who are so slightly ill that the disease is not recognized; that little children are more susceptible than adults, though no one who has never had the disease is necessarily immune; and that those who are crippled by the disease may in many cases be helped by proper treatment. Some further information about the disease we summarize from Dr. Flexner's address. It is doubtful whether the stable fly, which has been accused of drawing the blood of infected persons and then infecting others by its bite, does really convey the disease in this way. The usual means by which the virus of the disease escapes from the sick is by way of the nose and throat and the intestines. It is thus readily distributed by coughing, sneezing, kissing, and by means of fingers and articles contaminated by secretions and intestinal discharges. When such secretions are dry, some disease germs die. Not so, however, the germs of infantile paralysis. So dust, composed in part of these dried secretions, may be a source of infection. The virus, however, is readily destroyed by exposure to sunlight. Though blood-sucking insects are not proved to transfer it with the blood of their victims, they may, like other insects, carry it about on their bodies. The paralytic diseases to which certain animals are subject are quite different from infantile paralysis; but domestic animals can be the means of conveying the secretions if they are allowed to be contaminated by them. The virus can be carried for several weeks in the mucous membrane. The longest period after inoculation in which the virus has been detected in the nose and throat of monkeys is six months, and in one case it has been detected in the mucous membranes of a human being after five months. The virus, however, tends not to persist in the body longer than four or five weeks except in the unusual instances of chronic carriers. One attack confers immunity. The substances in the blood that make a person immune have been found twenty. years or even longer after recovery from infantile paralysis. A mild attack confers immunity just as a severe one does. In the case of such diseases one might naturally expect a serum to be discovered which could be used to create artificially this immunity when injected into the blood, as in the case of diphtheria, for instance; or a vaccine that would cause the blood of a well person to The create its own immunizing substances. trouble, as far as vaccination is concerned, is that no vaccine has been developed for this disease which is uniform and safe, as is the vaccine for typhoid fever, for example, or for smallpox. And as regards, the use of serum, there are only two sources from which an effective serum has been obtained-human serum and monkey serum; and of course there is no way by which a general supply of human serum can be obtained, while, the monkey "is not a practicable animal from which to obtain supplies." Efforts for drug treatment have been so far only partially successful with monkeys, and have not yet reached a stage where they can be applied to human beings. From these facts certain practical applications can be made. 1. Not only those who are sick, but those who are attendants on or associates of the sick, are suspect. Isolation of the patient is essential; but the fact that infantile paralysis is very rarely communicated to other persons in general hospitals shows that the spread of it is readily controlled under properly supervised sanitary conditions. 2. During the epidemic people should be especially careful about sneezing and coughing. An epidemic can thus be greatly restricted by habits of self-denial and cleanliness. As children are the principal sufferers, the fingers of those who attend children may become contaminated by wiping away secretions from a child's nose and mouth; so where a mother waits on a sick child and also attends on other children the conditions are not likely to be as safe as they are in a hospital. 3. As flies can become contaminated, they should be excluded from the sick, and hence from menacing the well. Food should therefore not be exposed in shops, and should not be handled by people who are attending upon a case of infantile paralysis. 4. Protection to the public can best be secured by discovering and isolating those who are ill and by the control of those who have associated with the ill. In some homes isolation can be carried out effectively, but in other homes where cases occur the patients should be removed to a hospital. In case of doubtful diagnosis, the aid of the laboratory should be sought, for in the mildest cases there is a change that can be seen in the cerebrospinal fluid. Personal care of the body has a great deal to do with preventing the spread of the disease. "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." 5. The susceptibility of children and others to infantile paralysis is less than to measles, scarlet fever, and diphtheria. This fact should tend to prevent a state of panic and should lend encouragement to measuies for the control of the disease. 6. A reported high death rate may not be real, because, while every death is reported, mild cases may not be. It is too early to tell what the death rate in this epidemic is. 7. The number of those who survive without any crippling is larger than many suppose. To a large extent a great many other cases may recover from paralysis, in many of the permanently paralyzed the paralysis may be so slight as not seriously to hamper the ordinary life activities, and in still other cases it may be relieved or minimized. Only a very small number of the attacked are left severely or helplessly crippled. Recovery on the part of those who do recover is necessarily slow. In some cases the recovery extends over months, and even years. Not since 1907 has the country, the State of New York, or the city of New York been wholly free from the disease. It varies in intensity in different years. Experiments have shown that the virus,of the disease can be intensified, but that after a while it refuses to be intensified and begins to lose its virulence. This corresponds to the rise and fall in the number and severity of cases in the course of an epidemic. The disease has been epidemic before and has been brought under control. More is known about it than ever before. A great deal of this advice of Dr. Flexner's is, of course, applicable to any case of contagious disease. More and more the public is learning the value of cleanliness and personal hygiene. The public also is learning more and more of what has been accomplished by scientific medicine, and what can be gained by observing strictly the regulations of public health authorities. All this is particularly applicable now. |