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 CHAPTER VIII

Epidemiology

Bergenholtz was the first who observed a true epidemic. He recorded in the Swedish Public Health reports, 18 cases of spinal infantile paralysis which occurred in North Sweden in 1881. In 1887, Oxholm published the first article on this subject; it com- prised five cases of paralysis which appeared almost simulta- neously in a limited district of Norway. Although there is now no doubt of the nature of the five cases, Oxholm seems not to have been quite clear on the point. A small epidemic of 13 cases occurred in the south of France in 1885. Cordier in 1888 pub- lished such details as after the epidemic he was able to collect. Both publications remained unnoticed. Medin's lecture at the Tenth International Congress at Berlin in 1890, upon his obser- vations during the "first epidemic in Stockholm (43, or more cor- rectly 44 cases), convinced everyone that spinal infantile paral- ysis could appear in epidemic form. Subsequently, other reports were made upon groups of cases, but only those described by Medin, 1895 (second epidemic in Stockholm, 21 cases) ; Caver- ley and Macphail, in America, 1894 (126 cases); Leegaard, in Norway, 1899 (54 cases) ; Auerbach, in Frankfort on Main, 1898 (15 cases) ; Buccelli, in Italy, 1897 (17 cases) ; Zappert, in Vienna, 1898 (42 cases) ; Platou, 1904 (20 cases), and Nonne, in Norway (41 cases), 1904, could be called epidemics. Other outbreaks consisted of groups usually of 4 or 5 cases, sometimes more, sometimes less (Brieglieb, Andre, Pierracini, Pasteur, Pleuss, M. Taylor, Buzzard, Biilow-Hansen and Harbitz, New- mark, Packard, Chapin, and others).

No reports give us any explanation of the mode of spread of Heine-Medin's disease. The only noteworthy observation in this respect was Leegaard's. He proved that the disease showed a remarkable relation to highways. But to him, also, the precise mode of diffusion of the disease remained obscure. The current view was expressed in the sentence: "Infantile paralysis is of an