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The summer was a rather anxious one where poliomyelitis was concerned. Vaccination has
dramatically reduced incidence, but has not been as extensive as we would like, and it has been necessary
to keep on the alert for sporadic cases. In August a case of paralytic poliomyelitis was reported in
another borough. He had been in contact the previous month with a man in Haringey who, about that
time, had had symptoms suggestive of the disease. Investigation of this man failed to show any evidence
of poliomyelitis, and it was eventually concluded that he was probably not the source of the infection.
A family elsewhere in this borough had been in contact with the case. They were given oral vaccine
by their general practitioner in order to counteract the possible natural infection, and they were kept
under close surveillance throughout the incubation period, during which none of them became ill.
Later in August, a railway station foreman employed in another part of London was admitted to
hospital with paralytic poliomyelitis. This was due to the same kind of virus, type 2, as in the case
just mentioned but no connection could be established. The difficulties in tracing the cause of his
infection can be appreciated when it is realised that his duties involved ticket collecting, and must have
brought him into close proximity to thousands of people. Known contacts were followed up immediately
and given the oral vaccine. There were no further cases. The patient, who had not been vaccinated
against poliomyelitis, recovered, although there was some residual paralysis.
It wasdistressing to learn during the year of the death in Ghana from acute poliomyelitis of a young
woman from Haringey.
One tends to think only of exotic infections like smallpox, cholera and yellow fever when being
inoculated before going overseas, and it is perhaps not surprising that poliomyelitis is overlooked.
One can nevertheless pick up heavy doses of the virus, especially in tropical countries, and poliomyelitis
vaccination is well worth having in these circumstances. It would be better still if everyone under the
age of forty were protected. It is not enough to have stopped the fierce epidemics which used to rage
like forest fires, when they are still liable to smoulder underground and burst out in unexpected places.
It's safer to be flameproofed.
Typhoid
The department investigated a number of Haringey residents who were at various times contacts of
typhoid cases in other boroughs. These were all negative. Only one person living in Haringey actually
had the disease. The evidence suggested that the infection had taken place in a cafe in a neighbouring
borough, but intensive follow-up there failed to reveal the source. Similar investigations into family
contacts and local shops patronised by the affected individual also proved negative Thepatient made a
satisfactory recovery, but the origin of the disease remains a mystery.
Dysentery
A mild, common form of this infection - that caused by Shigella sonnei - continued to be a problem.
An outbreak occurred at a school, and there were cases at two day nurseries. Some children and staff
were excluded.
Although there was an instance of a grocery shop assistant being excluded from work because of
this infection, it is not usually transmitted by food. Contact is the normal mode of spread, frequently
among children. Control is difficult because there are many symptomless carriers, but if these are
identified and excluded, the institution concerned may be paralysed for weeks or months due to the
persistence of the organism, while the victims are usually in excellent health. Hence, considerable
nicety of judgement is required from the Medical Officer of Health, who has to bear in mind on the one
hand the widespread nature of the disease - each outbreak probably indicating a large reservoir in the
local population - and on the other, its occasional tendency to manifest itself in vicious attacks. Since
the organism isresistant to most antibiotics, this remains one of the most intractable problems in public
health today. Higher standards in toilet hygiene would do much to confine it.
Smallpox
There was no case in Haringey, though it could be said that the tail of the variola minor outbreak
in the early summer in the Midlands and Wales brushed us lightly. A family of five people stayed on a
campsite in Dorset where a child from Wales was suffering from the disease, at that time unrecognised.
It was difficult to say whether there had been any contact, but the family was vaccinated and examined
daily during the incubation period.
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