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household and the fact that hospital staffs are not particularly
prone to the disease. Unfortunately we are still floundering in
the dark as to possible foci of infection and although many
ingenious theories have been advanced, I still adhere, in the
present state of our knowledge, to the view that human carriers
are the most likely source of infection. Before leaving the
subject, a word should be added about immunity. At present
we have no test to determine whether or not an individual is
susceptible to infantile paralysis. It may well be that the
majority of people have a natural immunity to the disease, which
could explain why only one person in a household is usually
affected, but if this is so, the increased number of cases in the
community of recent years can only be explained by the fact
that there are more foci of infection now than there were
formerly. This might well be the case, with the increased intercontinental
travel of modern days, by means of which healthy
carriers could import the disease into this country from other
countries where it is endemic.
From the above remarks it will be clear that, although the
problem of anterior poliomyelitis is as yet unsolved, there are
lines of approach which it is hoped will bring forth fruit in the
not too distant future.
Smallpox.
This disease is no longer endemic in the British Isles but
owing to the speed of modern travel there is always the risk of
its being imported into this country. It is perfectly possible for
a person to be a contact of smallpox, for example in India, to
fly to this country and to develop the first signs of illness after
being here for several days.
If such a sequence of events happened and the patient has
been in addition partially immune to smallpox, he might well be
insufficiently ill to consult a doctor. In such circumstances, the
disease could be spread to a large number of persons before its
presence had been suspected, particularly if the population as a
whole were not immune. In view of this it will be clear that
constant vigilance is necessary on the part of all concerned, if
the importation of smallpox on a big scale is to be avoided,
every day's delay in the control of movement of a case increases
the danger of an epidemic. As the Council are aware, there were
two or three instances of smallpox being brought into this
country during the past year, but they must all be considered
to have been very well controlled.
In view of this ever present potential risk it is the practice
of the department to urge the necessity for frequent vaccination
of all those members of the staff who would be especially exposed