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ANTERIOR POLIOMYELITIS:- Twenty-nine acute cases were diagnosed
within the Borough between May and December 1947, Eight of
these were abortive, and recovered without paralysis. Nineteen
suffered from paralysis. Two died. Of the nineteen paralysed
cases; five have recovered completely. Nine have slight residual
weakness of one limb. Two have partial loss of function of one
limbc Three are seriously disabled. Thus of the twenty-nine
cases, twenty-two have recovered without serious disability, a
satisfactory result which can be attributed to the excellent
primary treatment given at Cuddington Isolation Hospital and
subsequently in the orthopaedic departments of St. Helier Hospital
and Sutton and Cheam Hospital, and which holds out the hope of
considerable improvement in the more severe cases still under
treatment.

The principal focus of infection was in Sutton. It is
probable that infection was introduced into this area early in
July by an ambulant case in the early phase of illness. Fourteen
cases occurred within the area of a square mile. Other smaller
foci of infection were in an institution (5 cases) in the SouthWost
Ward (5 eases) in the North Ward (2 cases) and in the Northwest
Ward (2 cases). The group of cases in the Sutton area
showed well defined circumferential spread, an unexplained feature
of Poliomyelitis. Only in two instances were two cases diagnosed
in one family. In general it was the exception for direct
contacts of cases to fall ill with the disease. Only in two
instances were two families affected in the same street. The
sequence of infection was seldom ordered by association between
families or proximity of dwellings. Bad housing or overcrowding
did not appear to attract infection. Infection could not be
traced to cinemas or swimming baths or crowded assemblies. No
common infecting food factor was apparent. Where two oases did
occur in one family it was the result of exceptionally close
contact.
The relative freedom from infection of direct contacts of
cases suggests either that the dose of infection to produce the
disease is very high, or that highly susceptible people are
relatively few. It is possible that direct contacts who do not
fall ill with the disease become potent carriers of infection,
and set up a chain of infection through contact with other
non-susceptibles until a highly susceptable person is encountered,
It is known that the virus lies in the nasopharynx and in the
bowel of infected persons, and the chain of contact infection may
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