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at about that level for a month, the outbreak declined sharply to virtual
extinction by the end of the year. This is the greatest invasion to
which this country has been subjected. The question now is whether
the general incidence will not be at a consistently higher level than it
has been hitherto and whether the country will not from now on be
subject to periodical invasion.
The first case in the district which occurred in the period covered
by the general attack of the country was a female of thirty who
succumbed on the 30th June, dying a few days later. The next case
was a child of five whose onset was the 10th July, and who suffered from
a severe attack. Three more patients were notified in July, but in
two of these the illness proved not to be poliomyelitis. A three weeks'
interval of freedom was followed by seven cases with onsets between
the 6th and 14th August. After a further interval of a week two cases
were notified in the last week of August. In the same month another
eight cases who were notified were found later not to be suffering from
poliomyelitis. Ten confirmed cases occurred evenly distributed throughout
September during which time another eight notifications were
received of patients in whom the diagnosis was not confirmed. Quite
a number of those diagnosed at this time as sufferers were abortive
cases, in whom the diagnosis could be confirmed only as the result of
laboratory findings. There was in many nothing clinically to differentiate
them from those other cases who were later considered not to be affected.
Of the eight cases notified in October four proved to be poliomyelitis.
After an interval of freedom of three weeks the last two cases were
notified in the second week of November. Over the period of nineteen
weeks in all fifty-five notifications were received ; in twenty-five of
these the diagnosis was not confirmed, leaving thirty actual cases.
The first few patients were admitted to general hospitals, but when
the disease became more prevalent virtually all cases were removed
to isolation hospitals. No difficulty was experienced in arranging these
admissions. The more severe cases were not discharged to their
homes, but were transferred to an orthopaedic hospital. Towards the
end of the outbreak difficulty was experienced in finding this accommodation
with the result that there was delay in the transfer of some
of the patients.
The clinical type of illness varied from the one sufficiently severe
to terminate fatally to those abortive cases which did not pass from the
stage of the early acute illness and at no stage developed any paralysis.
Males were more commonly affected than females, 18 to 12 cases.
The age and sex group most affected was the male, 5 to 10 with seven
cases. Though the disease is known as infantile paralysis, those of
higher ages are so far from being exempt that the next most commonly
affected group was that of males of 30 to 35 with five cases. In fact
of the thirty cases fourteen were amongst those over 15 years of age.
The commonest illnesses of those notified but not suffering from
poliomyelitis were streptococcal tonsillitis 4 cases, pneumonia 4 cases
and influenza 2 cases.
There was no apparent connection between the cases which occurred
in different parts of the district amongst those of different ages. At
least two cases probably contracted the infection outside the district.