Abstract
GEOGRAPHIC variation in the incidence of poliomyelitis is not well understood and many of the factors involved have not been properly evaluated. A large scale study of two important phases of this problem has recently been reported by Alexander G. Gilliam, Fay M. Hemphill and Jean H. Gerende (Pub. Health Rep. 64:1575 and 1584, 1949). These investigators studied the reported incidence of poliomyelitis in all the 3,095 counties in the United States and analyzed the data chiefly from the standpoint of variations in average annual incidence and the frequency with which epidemics recurred in a given locality. The problem is complicated, as in many other diseases, by lack of a generally available specific diagnostic test. There is usually little question about the manifest cases with paralysis. Abortive and nonparalytic cases, however, constitute a large variable. In any large scale epidemiologic study one is forced to rely on reports of cases as received by the health authority. While there is provision for correcting these reports if subsequent events cause a change in diagnosis it is obvious that in any locality interest and awareness will largely determine the number of cases reported when there is no paralysis. "It appears necessary to emphasize that in most States in this country no distinction is made between paralytic and nonparalytic poliomyelitis in cases officially reported.
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