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158
1913]
It has been noticed by Gatsberg, who investigated the first epidemic in
Norway (July to October, 1899) that the infection of poliomyelitis spreads
along the line of traffic. This may 'be so in rural districts, although the
statement is hardly borne out in a large community like Islington, for nearly
all the cases have occurred in streets which are not on the main lines of
traffic, although possibly some of them are more or less adjacent to them. It
has also been found that attacks usually occur in groups; but, again, in
Islington this can hardly be said to have been the case, unless those in Milton
Grove, Landseer Road, Cottenham Road, Thorpedale Road, Fairbridge Road,
may be said to be grouped together, yet the distance from one to the other is
in no case, with one exception, less than a quarter of a mile, while in one
instance there is a railway cutting between two of them, viz., between that
at Fairbridge Road and Cottenham Road. It is possible, however, that there
may have been some central source, but it could not be ascertained.
Sanitary Circumstances.—As a rule, the premises in which the cases of
poliomyelitis occurred were in a fair sanitary state, although in one or two
homes the conditions might have been better; and in only two instances were
vermin noticed to be present.
Infection.—It is a noticeable fact that in no instance has more than one
case of the disease occurred in the same family, or, indeed, in the same house,
although in several homes there were young children living in the family
whom one might reasonably have expected to have been attacked if the disease
were very virulent.
Steps Taken to Verify the Diagnosis.—No special steps were taken to
verify the diagnoses by the examination of the cerebro-spinal fluid, owing to
the great difficulty in obtaining it; but inasmuch as all the cases of poliomyelitis
except one were treated as indoor or outdoor patients at a hospital,
it was assumed that the diagnoses were correct, and all the more readily
because, as already stated, the attendant physicians very kindly filled in the
inquiry forms so far as they related to the clinical aspect of the cases. In any
circumstance the examination of the cerebro-spinal fluid of the patients could
at best only give negative results.
Measures Adopted for Checking the Spread of the Disease.—In every
instance, when a notification was received, an Inspector called on the parents