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an increase in epidemics in Europe, though their distribution has been patchy. The disease has been
notifiable in England since 1912, but there has been no epidemic comparable to that of 1947. The incidence
was about the same as in the United States epidemic of 1916, but much less than in the 1941 epidemic
in Norway and Sweden or in the 1944 epidemic in Switzerland. With the development of the disease
to epidemic proportions the age incidence has altered. Originally the disease occurred chiefly in young
children—hence the name infantile paralysis—but in recent years an increasing proportion of adolescents
and young adults have been affected. Accompanying this age incidence change there has been a change
in the type of disease resulting in an increase of non-paralytic cases. Poliomyelitis has been reported
from all parts of the world, but a peculiar feature is that epidemics appear and recur in countries where
sanitation and hygiene are at a high level. Though the virus can be demonstrated in the excreta of patients
and contacts there is no sound evidence to warrant considering the disease to be transmitted by water,
food or flies. The disease is thought to spread by person-to-person contact, but in what way is still unknown.
The current view is that for every person showing clinical signs of the disease many are infected, but show
few or no symptons. Doctor Horstmann of Yale University summarised the position as follows in the
Lancet early in 1948:—" In spite of all the information collected by many investigators in many lands,
we still cannot say why poliomyelitis suddenly became epidemic almost sixty years ago, why it is increasing
rather than decreasing like other infectious diseases, why it is a summer disease with a preference for certain
lands, how it is spread, or how it may be prevented."
During an epidemic crowding should be avoided as far as possible because as far as is known personto-person
contact is the chief mode of spread. The virus has been found in excreta therefore food should
be protected from flies, bathing avoided in rivers or streams subject to pollution and hands washed as
necessary to prevent contamination of food. Any danger in a swimming bath where the water is filtered
and adequately chlorinated would most likely arise from spitting, etc., by the users especially if the bath
is allowed to be overcrowded.
The early symptoms of the disease are similar to those of any febrile disease and doctors are encouraged
to arrange admission to hospital as soon as there is any sign of involvement of the nervous system
or other signs raising a suspicion that the illness might be poliomyelitis. Something of the difficulty in tracing
the origin and spread of this disease is shown by the following:—
In a house occupied by 6 adults and 7 children under the age of 16 years illness occurred as under:—
A. aged 17 years—headache on 15/8/48; vomiting on 16/8/48, seen by doctor; vomiting and weakness of
legs 17/8/48; sent to hospital on 18/8/48 and diagnosis of polioencephalitis confirmed;
made a complete recovery.
B. aged 5 years—headache and feeling sick 17/8/48; not seen by doctor; full recovery after 3 days.
C. aged 11 years—headache and vomiting 18/8/48; not seen by doctor; full recovery after 3 days in bed.
D. aged 4 years—headache and backache 20/8/48; not seen by doctor; full recovery next day.
E. aged 9 years—headache and sickness 21/8/48; not seen by doctor; full recovery after 2 days in bed.
F. aged 16 years—headache and sickness 21/8/48; doctor suspected food poisoning; full recovery in 2 days.
G. aged 26 years—headache, sickness and " tightness of spine " 21/8/48; doctor suspected food poisoning;
full recovery and back at work in 3 days.
H. aged 25 years—headache and vomiting 22/8/48; returned to work 24/8/48; recurrence of symptoms
25/8/48; doctor attended; full recovery and resumed work on 30/8/48.
The remaining 2 adults and 3 children had no symptoms.
Enquiries in the neighbourhood revealed that immediately prior to and during the period covered
by the illnesses of A. to H. a number of adults and children had been unwell. The symptoms were vague
and had passed off in 24 to 48 hours. In most cases the dates of the illness could not be recalled with
accuracy.
The most careful enquiries failed to reveal any article of food which was consumed only by the sufferers.
The 5 persons who escaped in the first house had consumed the same food as the 8 persons who
were ill. It is impossible to state whether A. was an isolated case of polioencephalitis or the only one of
a group of persons infected by the virus who developed evidence of involvement of the nervous system.
The diagnosis was confirmed in 29 out of the 37 cases notified during the year. One case, a patient
in West Middlesex Hospital, was not a resident of the Borough. Of the 28 Borough cases 2 died. 16 made
a complete recovery and the remaining 10 were transferred to orthopaedic hospitals and clinics for treatment
of the residual paralysis. In one household 2 cases occurred but the other cases occurred singly.
No closure of schools, swimming baths, children's cinema, etc., with a view to controlling the spread
of infection was carried out.
Typhoid and Paratyphoid Fevers.—No case of typhoid fever but 3 cases of paratyphoid fever
were notified during 1948. The source of infection of these cases was not traced.
Dysentery.—Five cases of dysentery were notified during the year. Investigation failed to reveal
the source of infection or any connection between the cases.

The number of cases of tuberculosis on the Borough register at 31st December, 1948, was 774.
Ophthalmia Neonatorum.—No case of this infection of the eyes of young babies was reported
during the year.
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