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could be produced administratively, except possibly by some quarantining
in the early days of the season. It is quite likely that both hypotheses
have the truth in them, and in fact different strains of the virus may act
in different ways so that both methods of spread may be going on at the
same time in the same place. Therefore it is proposed in future to
take, where practicable, more intensive measures of surveillance or
quarantine of close contacts of cases, provided that we get to know of
the cases at an early enough date. In 1953 there were three well-defined
groups of cases, the first early in the season at a local hospital, the
second at a residential nursery, and the third in the late autumn at a
school.
Poliomyelitis has been endemic in London with a fairly high
incidence for seven years now and a brief review of the experience in this
borough during those seven years may be of interest. Table 45 shows the
number of possible cases intimated to the department, the number of
such cases removed to hospital, the number of such cases finally
confirmed as suffering from poliomyelitis and the percentage of confirmed
cases of the total intimated cases.

It will be seen that over the seven-year period somewhat less than
half of those intimated to the department had subsequently been
confirmed, but this figure has tended to rise in recent years, presumably
as a result of the disease being better diagnosed in the early stages, and
in 1953 nearly two-thirds of the cases intimated were subsequently
confirmed. Table 46 gives other information comparing the disease
in the seven different years.