Though an ancient illness, poliomyelitis, or polio, became a significant epidemic disease only with the beginning of the twentieth century. The reasons are complex. Ironically, however, changes in the epidemiological pattern of polio had much to do with improvements in public health during the early years of that century. Polio was primarily a childhood disease; the relatively few who developed paralysis were generally young children, as reflected in a name often used for the illness: infantile paralysis. Though the likely viral etiology of the disease was demonstrated by the Austrian physician Karl Landsteiner in the first decade of the twentieth century, the mechanism for spread of the disease as well as the extent of inapparent infections remained obscure. Answers to such questions would come only in the 1930’s, as better methods for study of the virus as well as improved methods of diagnosis became available.
As is true for many viral diseases, the age of infection played a critical role in the severity of the disease. Young children were initially provided a measure of protection by antibodies obtained from their mothers, either in utero or through colostrum if the child was nursed. Relative resistance to the infection often remained through early years of growth. The result was that exposure to the virus at a young age generally resulted in an inapparent infection, providing lifelong immunity to the child without development of any obvious symptoms. Probably 95 to 99 percent of natural infections fell into this category, and as long as the virus remained present in the human environment, a consequence of poor public health policies, this did not change.
Changes in public health practices, including improvements in the quality of the water supply for most major cities, decreased the likelihood of early childhood exposure to the virus. Beginning with the second decade of the twentieth century, children were older when first exposed to the virus. Early resistance to infection had largely disappeared, and polio appeared with a vengeance. The first major epidemic in the United States appeared in 1916, initially in New York City, but the outbreak subsequently spread across the country. At least thirty thousand persons developed some level of paralysis, with a mortality rate approaching 25 percent. In subsequent years, the numbers of cases abated somewhat and were accompanied by changes in the age distribution as well. Whereas most cases of polio in 1916 were in children under the age of four, epidemics in later years affected older children.
While sporadic epidemics continued to appear on a yearly basis, major outbreaks began in the early 1940’s and continued until development of the Salk and Sabin vaccines in the 1950’s. As noted by the author, between 1944 and 1955, the last year for a major epidemic, nearly 416,000 cases of polio were reported. While other epidemic diseases such as tuberculosis, whooping cough, and scarlet fever actually affected larger numbers of children, the nature of polio, particularly the onset of (often permanent) paralysis, lent itself to a fear among the population which went far beyond specific numbers. Polio season, the summer months, was a time of dread, and numbers published in the newspapers reinforced widespread fears among the populace.
This is not to say research into preventing the disease or dealing with its aftermath was neglected. In 1938, the National Foundation for Infantile Paralysis, under the direction of President Franklin Roosevelt and headed by his lawyer and friend Basil O’Conner, was established, both to fund research into the disease and to provide funds for hospitals and private citizens. Purchases of equipment such as the “iron lung” to keep patients alive and braces or tractions to enable victims to return to society were largely funded by the organization. A yearly “March of Dimes” was established, both to provide a means to obtain funding and to allow private citizens to feel they personally were involved in fighting the disease. Roosevelt, of course, was a polio survivor, and though the public rarely saw the extent of his paralysis, he remained a role model in demonstrating that even polio could not deter a person determined to live an active life.
In Living with Polio, author Daniel J. Wilson, himself a polio survivor, taps into the fear that existed throughout the American population. The...
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