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38
Annual Report of the London County Council. 1914.
hospital authorities also observed that during the period when so many cases of poliomyelitis were
under treatment, a number of other patients were found to be suffering from herpes zoster, and it
was concluded that there was probably a close relationship between the two diseases ; thus, while in
poliomyelitis the brunt of the attack is borne by the motor neurones, in herpes zoster the neurones
of the posterior root ganglia are affected. It may be assumed, moreover, that other cases occur in which
the injury produced may only be of a temporary or minor character and would not give rise to recognisable
symptoms. For these reasons the number of cases actually notified probably does not represent
the full extent of the prevalence of the disease.
No evidence has been discovered to show that there is any association between the incidence
of poliomyelitis and insanitary conditions. The causes which influence the manifestations of the disease
are to be looked for in other directions. The experimental work of Dr. Simon Flexner, of New York, and
others has demonstrated that both the cause of sickness and its method of spread are at present involved
in obscurity; especially as the virus associated with the disease may be demonstrated in the discharges
of persons apparently healthy. The following quotation may be made from Dr. Flexner's paper.
"We do not possess a generally acceptable theory to account for the epidemic waves of disease. What is
required is an adequate explanation of the initial rise, persistence, and the final fall of the wave as represented
by the varying number of the affected. That mere presence of the microbic causes of the disease
does not suffice to produce epidemics has long been known. It is just the discrepancy between the
occurrence of the microbic cause in sporadic cases of potentially epidemic diseases and the absence of
true epidemics that has led to the formulation of the hypothesis of concomitant causes of v. Pettenkofer
and of Naegeli. While the one supposes a necessary ripening of the microbic agent in the earth as
a pre-requisite, the other invokes the co-operation of a second, though unknown, but subsidiary, microorganism.
The subject has not been rendered essentially more comprehensible by the discovery of the
healthy and chronic carriers of infectious micro-organisms or by the mere ready detection of so-called
abortive cases of infection. Indeed these discoveries only add to the perplexity, since they prove that
potentially infective micro-organisms capable of starting epidemics are more frequently present in our
surroundings than has hitherto been supposed."

During 1914 three cases were notified in London; in only two was the diagnosis confirmed. In one
case the patient lived in Southwark and was employed as a phosphor bronze moulder. On 9th October
he was admitted to Guy's Hospital suffering from a phosphor bronze splinter wound on the eyelid;
an operation Was performed on the following day and the patient died on the 14th October. An inquest
was held and evidence at the post-mortem examination indicated that the case was one of anthrax.
The disease was not traced to the injury to the eye. Investigations into the source of infection were
made, and it was ascertained that the patient's wife was a brush-maker working at home, and that white
and black hair from Russia and China was used in the manufacture of the brushes; the infection was
attributed to this source. In the other case the patient was a pensioned soldier and was employed at
the East India Dock. At the end of December, 1913, he was engaged in unloading hides from a steamer.
He was then said to have had a pimple on his right cheek, which he scratched. On 31st December, 1913,
his face became very swollen and he consulted a doctor, who subsequently advised him to go to hospital.
He was admitted on 6th January, 1914, and was thereupon recognised to be suffering from anthrax.
The patient eventually recovered.
It may be of interest to record a small outbreak of anthrax in the County Borough of Croydon
in December, 1914, which concerned London, inasmuch as two of the patients were admitted into Guy's
Hospital. On 21st December an inquest was opened in the Southwark Coroner's Court into the circumstances
attending the death of a man (C. T.), aged 46 years, who lived at Mitcham and who had been
admitted to Guy's Hospital on the 15th December, where he died two days later. At the adjourned
inquest on the 7th January, 1915, it was found that death was due to external anthrax. Enquiries
were made, and the following facts are available owing to the courtesy of Dr. Veitch Clark, Medical
Officer of Health of the County Borough of Croydon. A small outbreak, in which five persons and a
horse were infected, was brought to light in connection with a firm of wholesale meat vendors in Croydon.
On 12th December, this firm's head slaughterman was found to have a swelling on the jaw. Bacteriological
examinations were conducted on 14th and 15th December with negative result. The patient
was then removed to Croydon General Hospital, where as a result of further bacteriological examination
the bacillus of anthrax.was discovered. The man died on the 15th December. A junior clerk employed by
the firm became seriously ill on the 13th December, and wa6 seen by a doctor on the following day, when he
was at once removed to Guy's Hospital suffering from anthrax. He was probably infected on the
11th or 12th December. After admission to Guy's Hospital favourable progress was made under treats
merit, and the natient, recovered.