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85
The following is a summary of the work in visiting infectious
diseases carried out during the year which is in addition to the visits
paid by the sanitary inspectors referred to in table 24. :—

Poliomyelitis
1953 was a bad year as far as the incidence of poliomyelitis was
concerned. 52 cases were confirmed, this being the highest number
since the peak year of 1947 when there were 76 cases. Of the 52 cases,
35 were paralytic and 17 non-paralytic. 25 of them were in the west
division, 14 in the north and 13 in the south. 22 were males and 30
females, of whom 3 were known to be pregnant, one of these aborting.
Of the 52, 3 were under one year of age, 13 between one and five,
21 between 5 and 15, 10 between 15 and 25 and 5 between 25 and 45.
As far as our own records go (these possibly being incomplete), 8 of the
cases were of the bulbar type (paralysis of a nerve in the brain); there
were 2 deaths, 22 cases made a complete recovery, 13 had severe
paralysis and 13 had moderate or mild paralysis; 2 were untraced.
There has been a tendency in recent years for poliomyelitis to show
itself more and more in local outbreaks, such as in a family, a school,
or a hospital, whereas some years ago this method of spread seemed to
be the exception. It is likely that there are several strains of the various
types of virus (three types are wellknown at present) and it is possible
that the infecting strain now is different to that of some years back.
Much has been said recently as to whether virulent paralytic infection
is more likely to spread from case to case (the socalled " narrow stream ")
or whether there is more usually a mild infection affecting large numbers
of people with only a very small proportion of them showing definite
signs of poliomyelitis or paralysis. Clearly, if one or other of these
theories were proved to be correct, the administrative measures required
in attempting to control the disease would be very different. Thus on
the narrow-stream hypothesis, early diagnosis of a case with rigorous
control or partial quarantine of contacts, should in theory prevent
spread just as it seems to do in practice where smallpox is concerned;
while with the other theory of widespread infection little if any benefit