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The Peripheral Spread of Poliomyelitis Through Rural and Urban Areas: Observations from a Recent Epidemic *

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THE PERIPHERAL SPREAD OF POLIOMYELITIS THROUGH RURAL AND URBAN AREAS: OBSERVATIONS FROM A RECENT EPIDEMIC* JOHN RI PAUL Early in the summer of 1944 an epidemic of poliomyelitis began in Tioga County in North Central Pennsylvania, close to the New York State border (see Fig. 1). This epidemic soon grew to sizable pro- portions, spreading peripherally to involve adjacent counties in both states. The part of the outbreak which involved New York State has already been described at some length in a valuable report by Conway and Bigwood.4 Their experience covered 591 cases. It is my purpose to include the Pennsylvania experience in my report, and to limit my discussion of this bi-state outbreak essentially to two features, namely, a description of the manner in which the cases spread within the epidemic area; and the age groups attacked within rural and urban sites. Within the whole epidemic area arbitrarily chosen for this study, and shown in subsequent maps, the cases numbered close to 1,000 in a population estimated to be about 340,000 (a rate considerably higher than 2 per 1,000). High rates again persisted in this same general area during the following summer of 1945; in fact this severe epidemic almost seemed to pick up in 1945 where it had left off the previous From the Section of Preventive Medicine, Yale University School of Medicine. Aided by a grant from the National Foundation for Infantile Paralysis, Inc. Most of the New York State data were collected through the District Health Office at Hornell, New York, by Dr. D. E. Bigwood, under the direction of Dr. John A. Conway. The assistance of these two physicians during the author's stay in the epidemic area in August, 1944 is gratefully acknowledged. Dr. James E. Perkins, Director, Bureau of Preventable Diseases, New York State Department of Health, also assisted in making this study possible. Many of the data from Pennsylvania were gathered by Dr. Merl G. Colvin, Health Officer of Lycoming Co., and of Williamsport, Pa. Dr. H. A. Wen

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