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London hospital (the eighth) on November 2nd. He was there thought at
first to be a ? case of polioencephalitis (although this health authority was
not communicated with) but was subsequently thought to be a case of cerebellar
encephalitis. It seems probable that the causal virus of this and the other
boy may have been one and the same. A fortnight later, on December 2nd,
the last case was reported. This was a girl, aged 2, who had apparently been
ill for nearly four weeks before admission to hospital.
There were therefore in all, 12 cases or probable cases of poliomyelitis,
and five other cases at one time suspected but subsequently exonerated.
In this group of cases the first two at the first school, occurring on
September 3rd, were probably infected by a healthy carrier at the school while
the third, occurring on September 30th, was probably infected either by the
same carrier or another child who had been infected. Two cases occurred in
the same house, the first with onset on October 8th and removal to hospital
on the 14th, the second with onset on October 13th. Two other cases occurred
in the same class of the same school; there was a gap of 16 days between
the last school attendance of the first and the onset of the second ; infection
may therefore have been through an undiscovered third person rather than
from case-to-case contact. An exhaustive enquiry failed to connect these with
any earlier case.
Further, the cases as a whole were fairly well spread out over the district,
five in the north, two in the middle, and five in the south.
In spite of the increased incidence of the disease over the whole of this
part of Middlesex the actual paths of infection could not be traced. This rather
indicates that there were several abortive unrecognised cases in the locality.
As far as administrative control is concerned, isolation of the cases is advisable,
especially for young children, but probably the most effctive mode of control
is the close supervision of contacts. The Ministry of Health is against closing
schools, and in any case even abortive attacks are usually of definite onset
and the child affected stays away from school either that day or the next,
thus, by its absence, calling the investigator's attention to itself. It is obviously
impossible to ensure that children of a closed school-class are kept at home.
When only a few children are affected, such as school-contacts in the same
home, or particular school friends of the patient, the parents can usually be
persuaded to keep the child away from other children for at any rate the first
part (which is probably the most dangerous part) of the recommended three
weeks. With regard to other school children all that can be done is for the
health visitor immediatelv to visit absentees in order that if the reason for
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