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in the Borough, as a result of which it appeared that 6 children in all had contracted
poliomyelitis within 22 days of immunisation. Telephone conversations to my colleagues, the
Medical Officers of Health in other Boroughs in London, showed that similar instances were
occurring elsewhere. The combined vaccine was withdrawn during the epidemic. Further
investigations were carried out in which I had the help of every Medical Officer of Health in
London. At that time there had been 359 cases of poliomyelitis in London, and 182 of the
patients were under 5 years of age. 30 had developed poliomyelitis within 4 weeks of being
immunised against diphtheria and/or whooping cough, paralysis affecting the limb of injection.
In 21 cases a combined vaccine had been used, in 8 cases a vaccine protecting from diphtheria
alone. In one case the vaccine was against whooping cough.
Since I prepared the report on this subject similar occurrences have been reported from
Australia, and an association between inoculation and the paralysis of poliomyelitis has been
accepted. There is no suggestion that vaccine causes infantile paralysis. All that can be said
is that it can activate paralysis in children carrying the virus of the disease. It must not be
thought for one moment that immunisation alone can cause this event. It can result from
injections of any description and from minor surgical operations such as the removal of tonsils
and adenoids, removal of teeth, and the like. I have had one serious case following upon an
operation for appendicitis. It is customary to cease operations for removal of tonsils and
adenoids during the period of a poliomyelitis epidemic, and minor operations might well be
postponed unless they are of urgent necessity.
Should poliomyelitis unfortunately occur again in this country the postponement of
immunisation might well be considered in an area where the disease is existing in epidemic
form, but such postponement should most definitely be temporary and it would be a tragedy
if such temporary postponement led parents to deprive their children of the very definite
advantage which can be given to them by protection from diphtheria. In this respect I would
call attention to the fact that in the whole of St. Pancras during 1949 there were only two
confirmed cases of diphtheria. The public has naturally shown much concern as to the
co-relation between injection and paralysis. It must be remembered, however, that the cases
that have occurred are few, that the possibility has always been recognised, and that it is not
so very long since, in the absence of immunisation against diphtheria 3,000 children were
dying from diphtheria every year in England and Wales. In the worst epidemic of poliomyelitis
that has occurred in this country, which was in 1947, the total number of persons who died
was about 688. That the public should understand the situation is right. Truth is valuable
even at high price, possibly at any price, but a sense of proportion is essential and can be
expected from a well informed, understanding, public. It is hoped that the co-relation between
local stimulus and paralysis as indicated by the work carried out in St. Pancras with the help
of the Medical Officers of Health of London may show a line of research into the causation of
this disease which may lead in due course to its prevention. All information concerning
poliomyelitis, about which so little is yet known, must ultimately be of advantage.
Smallpox.
Since July 1948 vaccination against smallpox has not been compulsory in this country
and I think a time has come when we are entitled to consider the results of this new policy.
In the year 1947, when vaccination was compulsory, 68.7 per cent, of the children normally
resident in this Borough were vaccinated within a few months of birth. What the figure is for
1949 I do not know, but by and large throughout the country the percentage of vaccinated
children has dropped to 18-20 per cent., and I have seen nothing to indicate that the figure
is any better in the Borough of St. Pancras. The risk of smallpox, however, is still present.