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36
wasting of the parts affected, without loss of sensation or affection of sphincters.
Although adult cases do occur from time to time, attacks after six years of age are
rare, by far the greater number occur during the first three years of life, the period of
greatest susceptibility, however, being during the second year.
The disease, which is a seasonal one, invariably reaches its maximum in August,
and is least evident in January and November. It would appear, therefore, that the
period of onset corresponds with the month of greatest heat.
The relation of the disease to acute specific fevers is one of extreme importance.
It has been observed to follow Scarlet Fever, Measles, Whooping Cough, Typhoid
Fever, Pneumonia, Diphtheria and Malaria, and this relationship has been too frequent
to allow of doubt that there is some significance in the connection.
That the disease is epidemic and infectious has been definitely established, well
marked epidemics having been reported in various counties and in parts of the country
which at other times have been particularly free from the malady.
The onset of the disease, which is of the nature of paralysis, is sudden. Sometimes
the patient goes to bed well and wakes at night in great pain. Movement of the
affected limb or back is restricted, the temperature is raised, vomiting may occur, there
is general malaise, and the outbreak may even be attended by convulsions.
A more common symptom is that the child is taken ill with slight feverish
symptoms, headache, vomiting, diarrhoea and pains in the back, and after a day or two
in bed as a result of this general malaise, it will be noticed that one or more limbs are
paralysed.
The acute onset, the loss of power, and the flaccidity of the limb without any
disturbance of sensation are, as a rule, sufficient to make the diagnosis clear, but in
some cases difficulty has arisen in differentiating between this disease and Cerebro-spinal
Meningitis.
Until recent years very little attention has been given to Epidemic Cerebro-spinal
Meningitis, and even less to Polio-myelitis, and as there would appear to be some
similarity between the two diseases, it is obviously desirable that they should both be
subject to the same discipline as far as public health is concerned. Cerebro-spinal
Meningitis referred to on page 23, was placed upon the list of notifiable diseases in
March, 1907, and it is clear that the non-notification of Polio-myelitis, which at times
resembles Cerebro-spinal Meningitis, discounts the value of the notification of the
latter.
The preventive measures in operation in regard to Small-pox and Epidemic
Cerebro-spinal Meningitis have been adopted in connection with those of Polio-myelitis.
The information obtained by your Officers is communicated to the London County
Council on an approved form, copies of which are then transmitted to all the Metropolitan
Borough Councils for the scrutiny of their Medical Officers of Health, who, if
they are able to detect any direct or indirect connection with their districts, can
immediately set the necessary machinery in motion with a view to eliminating a possible
means of infection which might have otherwise passed unnoticed.