Paralysis Following Poisoning by a New Organic Phosphorus Insecticide (Mipafox)

The disease resembles a non-icteric form -of Weil's disease and may prove to be caused by a leptospire. Its prevalence along river banks and estuaries in North Korea during autumn months, the presence of a suitable rodent carrier in vast numbers, and its general clinical course, with special emphasis upon renal involvement, are all sugges- tive of such an infection despite the absence of positive proof by laboratory demonstration. Weil's disease has a case mortality of 3% for the age group 16-30 (Broom, 1951), our mortality was 1 in 40 (2.5%), but diagnosis was possibly made more often in milder cases owing to its epidemic quality. All agglutination tests for leptospirosis were negative. As renal failure in this disease follows a period of hypotension it may be due to anoxia, which Darmady and his colleagues (1944) suggest is the causative mechanism in Weil's disease; the pathological picture of the kidney is one of cortical pallor and medullary hyper- aemia, suggesting an alteration in the distribution of blood flow in the kidney which may short-circuit the glomeruli, as has been shown in rabbits by Trueta et al. (1947). Paralysis of the sympathetic nerves by high spinal anaesthesia was not attempted in our cases.