PERSISTENCE OF THE VIRUS OF POLIOMYELITIS IN THE NASOPHARYNX

The virus of poliomyelitis occurs in the nasopharynx of man and monkeys. In man it has been detected by the inoculation test in washings from acute cases, rarely in similar washings from healthy contacts, in the nasopharyngeal tissues obtained from fatal cases in the 1st week of infection, but rarely, if ever, from nasopharyngeal tissues removed surgically at later periods in the course of the disease. In monkeys, also, the virus has been detected in the secretions from acute experimental infections, in the nasopharyngeal tissues derived from early cases, and rarely from cases several weeks or months after recovery from the acute symptoms. The inoculation of tonsils and adenoids obtained from cases of undoubted poliomyelitis either yielded definite results in the form of typical paralysis and histological lesions in the central nervous organs of the monkeys injected, or no symptoms or lesions which could be confounded with poliomyelitis. The indefinite symptoms and atypical lesions described in a certain class of inoculated animals by Kling, Pettersson, and Wernstedt were not encountered in our experiments. The deduction from the experiments reported is to the effect that the virus is regularly present in the nasopharynx in cases of poliomyelitis in the first days of illness, and especially in fatal cases; that it diminishes relatively quickly as the disease progresses, except in rare instances; and that it is unusual for a carrier state to be developed. Hence the period of greatest infectivity of patients would appear to be early in the disease, which is probably the time at which communication of the virus from person to person takes place. Available evidence proves that healthy carriers of the virus occur. We do not, however, possess data which indicate the frequency with which carriage arises. The fact that even after a severe and wide epidemic, such as occurred in the United States in 1916, the disease may virtually disappear within 2 or 3 years, points to the probability that enduring carriers of the active virus, whether healthy or chronic, are of exceptional occurrence.