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During the two months period from July 23 to Sept. 20, 1938, twenty cases of poliomyelitis occurred in the city of Niagara Falls. However, one of the cases occurred in a resident of an adjoining town who was a frequent visitor to Niagara Falls and had had a tonsillectomy performed in that city fourteen days before the onset of poliomyelitis. There was an unusually low incidence of poliomyelitis in New York State during 1938 and the epidemic character of the series of cases in Niagara Falls is shown clearly by a comparison of attack rates in that city with attack rates in the state as a whole and in adjoining areas (table 1). The most striking features of this outbreak were the large proportion of cases in which bulbar involvement was observed and the high fatality rate. In thirteen of the twenty cases definite bulbar paralysis was observed and twelve
STEBBINS EL, GILLICK EE, INGRAHAM HS. AN EPIDEMIC OF POLIOMYELITISIN WHICH BULBAR PARALYSIS OCCURED WITH UNUSUAL FREQUENCY. JAMA. 1939;113(17):1559-1561. doi:10.1001/jama.1939.02800420033007