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The pattern of infection in poliomyelitis
PUBLIC
HEALTH
OFFICIAL J O U R N A L O F T H E
SOCIETY OF MEDICAL OFFICERS OF HEALTH Telephone: EUSton 3923
TAVISTOCK HOUSE, TAVISTOCK SQUARE, LONDON, W.C.I
No. 3. Vol. LXVII
Telegrams: Epidauros. Westcent
DECEMBER, 1953 CONTENTS PAGE
EDITORIALS T h e P a t [ v r n o( Inflection in Po!iom~'elitis
.
.
.
.
33
SPECIAL ARTICLES S o m e R e l l m ' t i o n s o n ( ' o l o r d i n a t i o n h! the l t e a l t h Service. B~. ~ C. G a w n e , M.t)., I) c.H.. 1).P.H . . . . . . . . . . . . T h e W o r k , R e c r u i t m e n t a n d T r a i n i n g ~>f H e a l t h Visit~I~. M e m o r a n d l n n b y the C o u n c i l ol the S o c i e t 3
NEWS AND The Annual
Dinner
2~[ 11
REPORTS . . . . . . . . . . . . .
b~
BOOK REVIEW A D i c t i o n a r y of l q i d w i f c r y a n d P u b l i c H e a l t h (G. B. ( ' a r t c r a n d G. H . l)&lds)
1.5
CORRESPONDENCE h~du~;lrial M ed icin e
(W.
N.
Taylor)
PAGh
SOCIETY OF MEDICAL OFFICERS OF HEALTH .
. . . . . .
Io
EI3ITORIAL
T h e Pattern of I n f e c t i o n in P o l i o m y e l i t i s W e are a c c u s t o m e d to receiving wise g u i d a n c e on epidemiological p r o b l e m s f r o m Dr. W. H. Bradley, as was s h o w n b y t h e very large m e e t i n g of m e m b e r s of t h e M e t r o p o l i t a n B r a n c h a n d m a n y o t h e r m e m b e r s of t h e Society w h o a t t e n d e d o n N o v e m b e r l a t h to hear his address ~ o*'fi t h e epidemiology, virology a n d p r e v e n t i o n of poliomyelitis, t h e disease w h i c h t o - d a y p r e s e n t s difficulties of control, t r e a t m e n t a n d m a i n t e n a n c e of p u b l i c m o r a l e quite out of p r o p o r t i o n to its actual incidence. D r . Bradley gave an e n c o u r a g i n g a c c o u n t of the active steps w h i c h t h e M . O . H . can take to control t h e s p r e a d of t h e disease a n d at t h e same time to add, b y careful field investigation a n d r e p o r t i n g , to the g r o w i n g pool of knowledge o n t h e t r a n s m i s s i o n of polio infection. Since 1950, Dr. Bradley has b e e n a convert f r o m t h e p r e v i o u s generally held t h e o r y t h a t t h e poliomyelitis virus is u b i q u i t o u s a n d flares u p in clinical o u t b r e a k s a n d has firmly advocated t h e view t h a t the disease c a n ~pread t h r o u g h a n a r r o w s t r e a m of t h e population.2 T h e latter view has b e e n s u p p o r t e d b y the results of t h e M . R . C . sewers w a b b i n g investigation carried o u t w i t h the collaboration of h e a l t h d e p a r t m e n t s , i n t o t h e n a t i o n a l d i s t r i b u t i o n of t h e virus, a n d b y the detailed accounts of s u c h o u t b r e a k s as t h a t in t h e Isle of W i g h t (1950), G u i l d f o r d (1952), a n d Rye (1952), w h e r e t h e chain of i n f e c t i o n f r o m case to case has b e e n well d e m o n s t r a t e d . M o r e o v e r , as Dr. J. S. L o g a n said in the discussion o n N o v e m b e r l a t h , s p e a k i n g f r o m recent experience at S o u t h e n d , the " n a r r o w s t r e a m " t h e o r y is the only basis for practical control of the s p r e a d of infection. As it h a p p e n e d , an editorial in t h e Lancet of N o v e m b e r 14th, a w h i c h a p p e a r e d o n the day of D r . . B r a d l e y ' s recent address, drew a t t e n t i o n to a r e c e n t s t u d y b y Dr. M e l n i c k a n d L e d i n k o of the section of p r e v e n t i v e m e d i c i n e at Yale U n i v e r s i t y w h i c h leads o u r c o n t e m p o r a r y to suggest a c o u n t e r t h e o r y t h a t t h e r e is a " w i d e s u b t e r r a n e a n c h a n n e l " in w h i c h t h e polio v i r u s flows, to m a k e s u d d e n u p s u r g e s in the f o r m of outbreaks. B u t we feel t h a t the t w o schools .of t h o u g h t can b e reconciled b y t h e c o n c e p t t h a t it is the disease p r o d u c i n g m a n i f e s t a t i o n s of the virus w h i c h m a t t e r a n d t h a t a n t i b o d y levels in samples of t h e p o p u l a t i o n , as was said b y Sir W e l d o n D a l r y m p l e - e h a m p n e y s , s h o u l d b e t a k e n as an i n d i c a t i o n of t h e e p i d e m i c situation b u t n o t as a defensive XSummarised in The Medical Officer, November 21st, 1953,
9% ~50. Some Notes on Poliomyelitis, Bradley, W. H., (1950), Monthly Bull. Min. of Hlth. ~ P.H.L.S., 9, 203. a Sub-clinical Poliomyelitis Infections, Lancet (1953), 2, 1028.
N o IlCES AnnlJM G c m ' z a l Mc('tin~, with R e p o r t s of the C o u n c i l , E d i t o r of PUBLIC HI!AI.1H . . . . . . . . Balance Sheet and Income and Expenditure Account Metropolitan Branch . . . . . . REPORIN ( ' o u n c i i Meeting E:ts, A n g ] i a n B r a n c h . . . . . . Home Counties Branch . . . . . Midland Branch ,. North-XVestern B r a n c h . . . . . . Tuberculosis Group . . . . . . ()I, EICIAL N() riCES U i t y of C o v e n t r y E C . . . . .
.
l i o n . "lr(,.*~.l(.r . .
and l(i ls 511
. . . .. .
51 51 51 54 5(; 51;
.
2,1;
.
. .
factor against the m o r e v i r u l e n t f o r m s of the infection. W h i l s t these difficult virological p r o b l e m s are still b e i n g s t u d i e d a n d evaluated, D r . Bradley's g u i d a n c e on " outb r e a k c o n t r o l , " b a s e d o n t h e practical experience in this c o u n t r y , is obviously s o u n d and will r e m a i n so even w h e n t h e additional w e a p o n of i m m u n i s a t i o n is p r o v e d a n d fully available.
REFRESHER
COURSE FOR SCHOOL OFFICERS
MEDICAL
The School Health Services Group ot the Society is arranging a Refresher Course for School Medical Officers who have recently joined the School Health Service f r o m J a n u a r y 22nd to 24th, 1954. I t is to be held at the ~Vansfeli Residential College, Essex, and residential accommodation is available at the College, b u t is limited to 35 members. The fee for the Course will be four guineas inclusive of residential accommodation. The provisional programme is as f o l l o w s : Friday, .January 22rid 7 p.m. Supper. 8 p.m. Introductiorn to the Course, from the Course Tutor. 8.2o p.m. Film "" Moving and Growing.'" 9.I 5 p.m. Discussion. Saturday, January 23rd 9.3o a.m. Physical Standards and Their Assessment. Lecturer: Dr. I. Gordon (M.O.H., tlford M.B.). lO.3O a.m. DiscusSion. I1.15 a.m. The School Health Services in the U.S.A. Lecturer: Dr. Peter Henderson (Principal Medical Officer, Ministry of Education) 9 12.15 p.m. Discussion 9 5 p.nl. Physical Education and the School Medical Officer. Lecturer: Miss R u t h Foster (Staff Inspector, Physical Education, Ministry of Education). Sunday, January 24th io a.m. B C . G . and the School Leaver. Lecturer: Dr. T. M. Pollock (Medical Research Council). 11.3o a.m. The Disturbed Adolescent in School. Lecturer: Dr. G. S Prince. 2.30 p.m. Summing Up by the Course Tutor. AppIication has been made to the Ministry of Education for authority for t h e payment of the necessary expenses. Nolninations should be sent as soon as possible to the Administrative Officer, Society of M.O.H., Tavistock House, Tavistock Square, I~.mdon, W.C.~. "" Vaseline."--The Chesebrough Manufacturing Company, Ltd., of Victoria Road, London, N.W.Io. have written to point out t h a t the word " Vaseline," used in the article on " Skin Affections of the School Child " in our October issue (p. 6) with .reference to the t r e a t m e n t of impetigo, is the trade mark name distinguishing their preparation of petroleum jelly! and not a descriptive word for petroleum jelly in general.
HEALTH
OFFICIAL J O U R N A L O F T H E
SOCIETY OF MEDICAL OFFICERS OF HEALTH Telephone: EUSton 3923
TAVISTOCK HOUSE, TAVISTOCK SQUARE, LONDON, W.C.I
No. 3. Vol. LXVII
Telegrams: Epidauros. Westcent
DECEMBER, 1953 CONTENTS PAGE
EDITORIALS T h e P a t [ v r n o( Inflection in Po!iom~'elitis
.
.
.
.
33
SPECIAL ARTICLES S o m e R e l l m ' t i o n s o n ( ' o l o r d i n a t i o n h! the l t e a l t h Service. B~. ~ C. G a w n e , M.t)., I) c.H.. 1).P.H . . . . . . . . . . . . T h e W o r k , R e c r u i t m e n t a n d T r a i n i n g ~>f H e a l t h Visit~I~. M e m o r a n d l n n b y the C o u n c i l ol the S o c i e t 3
NEWS AND The Annual
Dinner
2~[ 11
REPORTS . . . . . . . . . . . . .
b~
BOOK REVIEW A D i c t i o n a r y of l q i d w i f c r y a n d P u b l i c H e a l t h (G. B. ( ' a r t c r a n d G. H . l)&lds)
1.5
CORRESPONDENCE h~du~;lrial M ed icin e
(W.
N.
Taylor)
PAGh
SOCIETY OF MEDICAL OFFICERS OF HEALTH .
. . . . . .
Io
EI3ITORIAL
T h e Pattern of I n f e c t i o n in P o l i o m y e l i t i s W e are a c c u s t o m e d to receiving wise g u i d a n c e on epidemiological p r o b l e m s f r o m Dr. W. H. Bradley, as was s h o w n b y t h e very large m e e t i n g of m e m b e r s of t h e M e t r o p o l i t a n B r a n c h a n d m a n y o t h e r m e m b e r s of t h e Society w h o a t t e n d e d o n N o v e m b e r l a t h to hear his address ~ o*'fi t h e epidemiology, virology a n d p r e v e n t i o n of poliomyelitis, t h e disease w h i c h t o - d a y p r e s e n t s difficulties of control, t r e a t m e n t a n d m a i n t e n a n c e of p u b l i c m o r a l e quite out of p r o p o r t i o n to its actual incidence. D r . Bradley gave an e n c o u r a g i n g a c c o u n t of the active steps w h i c h t h e M . O . H . can take to control t h e s p r e a d of t h e disease a n d at t h e same time to add, b y careful field investigation a n d r e p o r t i n g , to the g r o w i n g pool of knowledge o n t h e t r a n s m i s s i o n of polio infection. Since 1950, Dr. Bradley has b e e n a convert f r o m t h e p r e v i o u s generally held t h e o r y t h a t t h e poliomyelitis virus is u b i q u i t o u s a n d flares u p in clinical o u t b r e a k s a n d has firmly advocated t h e view t h a t the disease c a n ~pread t h r o u g h a n a r r o w s t r e a m of t h e population.2 T h e latter view has b e e n s u p p o r t e d b y the results of t h e M . R . C . sewers w a b b i n g investigation carried o u t w i t h the collaboration of h e a l t h d e p a r t m e n t s , i n t o t h e n a t i o n a l d i s t r i b u t i o n of t h e virus, a n d b y the detailed accounts of s u c h o u t b r e a k s as t h a t in t h e Isle of W i g h t (1950), G u i l d f o r d (1952), a n d Rye (1952), w h e r e t h e chain of i n f e c t i o n f r o m case to case has b e e n well d e m o n s t r a t e d . M o r e o v e r , as Dr. J. S. L o g a n said in the discussion o n N o v e m b e r l a t h , s p e a k i n g f r o m recent experience at S o u t h e n d , the " n a r r o w s t r e a m " t h e o r y is the only basis for practical control of the s p r e a d of infection. As it h a p p e n e d , an editorial in t h e Lancet of N o v e m b e r 14th, a w h i c h a p p e a r e d o n the day of D r . . B r a d l e y ' s recent address, drew a t t e n t i o n to a r e c e n t s t u d y b y Dr. M e l n i c k a n d L e d i n k o of the section of p r e v e n t i v e m e d i c i n e at Yale U n i v e r s i t y w h i c h leads o u r c o n t e m p o r a r y to suggest a c o u n t e r t h e o r y t h a t t h e r e is a " w i d e s u b t e r r a n e a n c h a n n e l " in w h i c h t h e polio v i r u s flows, to m a k e s u d d e n u p s u r g e s in the f o r m of outbreaks. B u t we feel t h a t the t w o schools .of t h o u g h t can b e reconciled b y t h e c o n c e p t t h a t it is the disease p r o d u c i n g m a n i f e s t a t i o n s of the virus w h i c h m a t t e r a n d t h a t a n t i b o d y levels in samples of t h e p o p u l a t i o n , as was said b y Sir W e l d o n D a l r y m p l e - e h a m p n e y s , s h o u l d b e t a k e n as an i n d i c a t i o n of t h e e p i d e m i c situation b u t n o t as a defensive XSummarised in The Medical Officer, November 21st, 1953,
9% ~50. Some Notes on Poliomyelitis, Bradley, W. H., (1950), Monthly Bull. Min. of Hlth. ~ P.H.L.S., 9, 203. a Sub-clinical Poliomyelitis Infections, Lancet (1953), 2, 1028.
N o IlCES AnnlJM G c m ' z a l Mc('tin~, with R e p o r t s of the C o u n c i l , E d i t o r of PUBLIC HI!AI.1H . . . . . . . . Balance Sheet and Income and Expenditure Account Metropolitan Branch . . . . . . REPORIN ( ' o u n c i i Meeting E:ts, A n g ] i a n B r a n c h . . . . . . Home Counties Branch . . . . . Midland Branch ,. North-XVestern B r a n c h . . . . . . Tuberculosis Group . . . . . . ()I, EICIAL N() riCES U i t y of C o v e n t r y E C . . . . .
.
l i o n . "lr(,.*~.l(.r . .
and l(i ls 511
. . . .. .
51 51 51 54 5(; 51;
.
2,1;
.
. .
factor against the m o r e v i r u l e n t f o r m s of the infection. W h i l s t these difficult virological p r o b l e m s are still b e i n g s t u d i e d a n d evaluated, D r . Bradley's g u i d a n c e on " outb r e a k c o n t r o l , " b a s e d o n t h e practical experience in this c o u n t r y , is obviously s o u n d and will r e m a i n so even w h e n t h e additional w e a p o n of i m m u n i s a t i o n is p r o v e d a n d fully available.
REFRESHER
COURSE FOR SCHOOL OFFICERS
MEDICAL
The School Health Services Group ot the Society is arranging a Refresher Course for School Medical Officers who have recently joined the School Health Service f r o m J a n u a r y 22nd to 24th, 1954. I t is to be held at the ~Vansfeli Residential College, Essex, and residential accommodation is available at the College, b u t is limited to 35 members. The fee for the Course will be four guineas inclusive of residential accommodation. The provisional programme is as f o l l o w s : Friday, .January 22rid 7 p.m. Supper. 8 p.m. Introductiorn to the Course, from the Course Tutor. 8.2o p.m. Film "" Moving and Growing.'" 9.I 5 p.m. Discussion. Saturday, January 23rd 9.3o a.m. Physical Standards and Their Assessment. Lecturer: Dr. I. Gordon (M.O.H., tlford M.B.). lO.3O a.m. DiscusSion. I1.15 a.m. The School Health Services in the U.S.A. Lecturer: Dr. Peter Henderson (Principal Medical Officer, Ministry of Education) 9 12.15 p.m. Discussion 9 5 p.nl. Physical Education and the School Medical Officer. Lecturer: Miss R u t h Foster (Staff Inspector, Physical Education, Ministry of Education). Sunday, January 24th io a.m. B C . G . and the School Leaver. Lecturer: Dr. T. M. Pollock (Medical Research Council). 11.3o a.m. The Disturbed Adolescent in School. Lecturer: Dr. G. S Prince. 2.30 p.m. Summing Up by the Course Tutor. AppIication has been made to the Ministry of Education for authority for t h e payment of the necessary expenses. Nolninations should be sent as soon as possible to the Administrative Officer, Society of M.O.H., Tavistock House, Tavistock Square, I~.mdon, W.C.~. "" Vaseline."--The Chesebrough Manufacturing Company, Ltd., of Victoria Road, London, N.W.Io. have written to point out t h a t the word " Vaseline," used in the article on " Skin Affections of the School Child " in our October issue (p. 6) with .reference to the t r e a t m e n t of impetigo, is the trade mark name distinguishing their preparation of petroleum jelly! and not a descriptive word for petroleum jelly in general.