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Poliomyelitis
and polioencephalitis
20
In 1949 poliomyelitis once more became epidemic. During the year 668 cases
occurred (corrected notifications) and there were 50 deaths giving a crude case
mortality of 7.4 per cent. In the 1947 outbreak there were 702 cases and 49 deaths
so that the two outbreaks are of almost equal magnitude and severity. The effect
of the 1947 outbreak in immunising to some extent the population then living was
seen in 1949 in a much younger age distribution of cases (55.3 per cent. of cases
were of infants under 5 years of age compared with 27.9 per cent. in 1947) and
in the changed geographical distribution of cases. Many areas which had heavy
incidence in 1947 had only light incidence in 1949 and vice versa. A full account
of the outbreak has been published.*
The following account of an outbreak at the Ladywell Nursery is of interest
The first outbreak occurred on the ground floor of Block B containing about
twenty-six children. The first indication of infection occurred on 1st July when a
small boy, R.C., complained of a sore throat. He made a normal recovery in a
few days.
On 2nd July another child, R., was transferred to hospital with measles and
a domestic assistant, J., who worked in the block reported ill with tonsillitis. The
following day a nursery assistant, H., reported a sore throat and a child aged two,
K.G., was found to have a temperature in the morning without apparent cause.
In the evening it was normal but there was again some slight pyrexia the next day.
He vomited once but his temperature appeared to be normal until 8th July when
he was noted to have a slight stiffness of the neck. The following day he was transferred
to hospital as a case of poliomyelitis. On 6th July, a child M.F., aged nineteen
months, was unable to walk and had slight pyrexia. On 9th July she was
transferred to hospital as a case of poliomyelitis. In both these cases the diagnosis
was confirmed. Although most of the staff live in Lewisham where poliomyelitis
had been present since June no outside contact was established.
No further cases occurred until September when a part-time staff nurse L.,
working on the upper floor of another block P complained of headache, sore throat
and a stiff neck on September 19th. No paralysis occurred but she may have suffered
an abortive attack. On 21st September a child, R.G., on the Ground floor of block
P was noted to be reluctant to walk, to refuse food and to be generally miserable.
He was diagnosed as suffering from poliomyelitis and transferred to hospital. The
following day a child, M.O'R., on the upper floor of the block was noted to have
suddenly developed paralysis of the left leg. She was admitted to hospital and
the diagnosis of poliomyelitis confirmed. It is stated that about a week previously,
16th September, this child had had a mild bout of pyrexia and had vomited, an
incident which may be taken to represent the first phase of a double-phase attack.
On 23rd September, the child in the adjoining bed, B.H., was transferred to hospital
paralysis of the left leg having been noted. The diagnosis was confirmed, but in his
case there was no history of a previous febrile attack.
Even if it is assumed that the staff nurse actually suffered from an abortive
attack of poliomyelitis, she can hardly have originated the outbreak, since her
illness ante-dated an overt confirmed case by only a few days and occurred three
days later than the first phase of M.O'R's attack. It was noted that an assistant
nurse, E., who also worked on the upper floor, had been off duty for two weeks from
5th September. It was stated that she complained of sore throat, headache and stiff
neck and had also vomited, but that her doctor made no suggestion of poliomyelitis
and treated her as a case of upper respiratory infection. It is possible that she may
have been an abortive case of poliomyelitis and was the starting point of this small epidemic.
There was no history of contact between any of the above cases and a known case
of the disease outside the institution, nor that any of the staff of the nursery had come in
contact with a case of poliomyelitis before the outbreak of this epidemic.
* Breen, G. E. and Benjamin, 13. (1950) B.M.J, ii 1473