Polio

POLIO

Polio Epidemics and Public Health

In the 1940s poliomyelitis (also known as infantile paralysis or polio) epidemics continued to be a scourge. Young children were the most susceptible to this virus-borne disease. Parents were terrified when their youngsters complained of headaches, sore throats, and fever, fearing these symptoms foretold the onset of the dreaded disease. Most instances of contact with the viruses resulted in only mild symptoms and complete recovery in one to three days. But if polio invaded the nervous system, about 25 percent of the patients suffered mild disabilities, and another 25 percent sustained severe permanent disability, such as paralysis of the arms and legs. If paralysis developed in the muscles of their throats, death from polio became a terrifying possibility.

Summer Epidemics

In addition to being the most susceptible, children were also the most effective spreaders of this highly communicable disease. Summer epidemics caused the closing of swimming pools and playgrounds and the virtual imprisonment of restless children indoors as the nation came under siege from polio viruses. Polio was not the most prevalent disease at the time, but it was deeply feared as the leading crippler of children, and more children died of polio than of any other infectious disease.

The Cost of Sanitation

Ironically, some scientists now believe that the public-health and sanitation movements contributed to these terrible epidemics. Before the advent of better sanitary conditions, children became infected with polio at an early age, when the disease tended to be nearly harmless and invisible, and they would then have lifelong immunity to it. Better sanitary conditions meant polio now struck many more children and adults later in their lives. Even Franklin D. Roosevelt, the U.S. president at the beginning of the decade, had been a polio sufferer. He had contracted the disease as a young adult, and although he kept it successfully hidden from most of his countrymen, Roosevelt needed iron braces and crutches to lock his paralyzed legs in place. During the 1940s the problem of adult infection grew. In 1949 the U.S. Public Health Service published figures showing the shift: in 1916, 95 percent of the cases were children nine or under; in 1947 the figure fell to 52 percent. But the distribution of victims in the age group ten to nineteen rose from 3 percent in 1916 to 38 percent in 1947.

Military Significance

Before the outbreak of World War II polio did not seem to be a disease that would be significant for the military. The shifting of the age distribution of cases, however, caused a totally unsuspected problem for the troops. Polio swept through the ranks of the military, especially those stationed in tropical areas. Age-specific immunity existed among the indigenous populations in tropical areas, but they passed the disease to the unprotected troops. Poliomyelitis was added to the list of dysentery, hepatitis, and other acute viral and parasitic infections creating problems for the armed forces.

Medical Treatment

The total number of polio cases in the country continued to grow after the war. By decade's end case incidence in the United States was over thirty thousand per year. In 1943 studies with monkeys indicated gamma globulin, a blood derivative, protected them against an experimental inoculation of poliovirus. Because of the war, no field trial could be conducted to test whether gamma globulin would have the same protective effect against polio in humans. The only preventive measures lay in the realm of public health—sanitation, isolation, and quarantine. No cure was known. Treatment consisted of mechanical devices such as the iron lung to aid respiration and orthopedic and rehabilitative measures. Such figures as Sister Elizabeth Kenny, who successfully challenged the medical orthodoxy in its theories of the aftercare of paralytic polio, became notorious during the decade.

Poliovirus in Tissue Culture

The names Jonas Salk and Albert Sabin, developers in the 1950s of the vaccines used today, are the ones most often associated with the battle and conquest over polio. But in the 1940s Dr. John F. Enders, a Harvard virologist, managed to produce the poliovirus in test tubes, which meant that the incredibly expensive and relatively unproductive method of producing it in monkey spinal columns could now be bypassed. An enormous amount of virus in some form, either dead or greatly weakened, was needed before widespread production of a vaccine could begin. For his development of the test-tube technique that would lead to the manufacture of poliovirus Enders was awarded a Nobel Prize in 1954.

Sources:

Roderick E. McGrew, Encyclopedia of Medical History (New York: McGraw-Hill, 1985), p. 275;

John R. Paul, A History of Poliomyelitis (New Haven: Yale University Press, 1971), pp. 346-356;

Rick Smolan, Phillip Moffit, Robert Coles, and Richard Fiaste, Medicine's Great Journey. One Hundred Years of Healing (Boston: Little, Brown, 1992), pp. 29-30.