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Main article: Poliomyelitis
The history of poliomyelitis (polio) infections extends into prehistory. Although major polio epidemics were unknown before the 20th century, the disease has caused paralysis and death for much of human history. Over millennia, polio survived quietly as an endemic pathogen until the 1880s when major epidemics began to occur in Europe; soon after, widespread epidemics appeared in the United States. By 1910, frequent epidemics became regular events throughout the developed world, primarily in cities during the summer months. At its peak in the 1940s and 1950s, polio would paralyze or kill over half a million people worldwide every year.
The fear and the collective response to these epidemics would give rise to extraordinary public reaction and mobilization; spurring the development of new methods to prevent and treat the disease, and revolutionizing medical philanthropy. Although the development of two polio vaccines has eradicated poliomyelitis in all but four countries, the legacy of poliomyelitis remains, in the development of modern rehabilitation therapy, and in the rise of disability rights movements worldwide.
Early history
Ancient Egyptian paintings and carvings depict otherwise healthy people with withered limbs, and children walking with canes at a young age. It is theorized that the Roman Emperor Claudius was stricken as a child, and this caused him to walk with a limp for the rest of his life. Perhaps the earliest recorded case of poliomyelitis is that of Sir Walter Scott. In 1773 Scott was said to have developed "a severe teething fever which deprived him of the power of his right leg." At the time, polio was not known to medicine. A retrospective diagnosis of polio is considered to be strong due to the detailed account Scott made.
The symptoms of poliomyelitis have been described by many names. In the early nineteenth century the disease was known variously as: Dental Paralysis, Infantile Spinal Paralysis, Essential Paralysis of Children, Regressive Paralysis, Myelitis of the Anterior Horns, Tephromyelitis (from the Greek tephros , meaning "ash-gray") and Paralysis of the Morning. In 1789 the first clinical description of poliomyelitis was provided by the British physician Michael Underwood—he refers to polio as “a debility of the lower extremities". The first medical report on poliomyelitis was by Jakob Heine, in 1840; he called the disease Lähmungszastände der unteren Extremitäten . Karl Oskar Medin was the first to empirically study a poliomyelitis epidemic in 1890. This work, and the prior classification by Heine, led to the disease being known as Heine-Medin disease .
Epidemics
Major polio epidemics were unknown before the 20th century; localized paralytic polio epidemics began to appear in Europe and the United States around 1900. The first report of multiple polio cases was published in 1843 and described an 1841 outbreak in Louisiana. A fifty-year gap occurs before the next U.S. report—a cluster of 26 cases in Boston in 1893. The first recognized U.S. polio epidemic occurred the following year in Vermont with 132 total cases (18 deaths), including several cases in adults. Numerous epidemics of varying magnitude began to appear throughout the country; by 1907 approximately 2,500 cases of poliomyelitis were reported in New York City.
On Saturday, June 17, 1916 an official announcement of the existence of an epidemic polio infection was made in Brooklyn, New York. That year, there would be over 27,000 cases and more than 6,000 deaths due to polio in the United States, with over 2,000 deaths in New York City alone. The names and addresses of individuals with confirmed polio cases were published daily in the press, their houses were identified with placards, and their families were quarantined. The 1916 epidemic caused widespread panic and thousands fled the city to nearby mountain resorts; movie theaters were closed, meetings were canceled, public gatherings were almost nonexistent, and children were warned not to drink from water fountains, and told to avoid amusement parks, swimming pools, and beaches. From 1916 onward, a polio epidemic appeared each summer in at least one part of the country, with the most serious occurring in the 1940s and 1950s.
Prior to the 20th century polio infections were rarely seen in infants before 6 months of age and most cases occurred in children 6 months to 4 years of age. Young children who contract polio generally suffer only mild symptoms, but as a result they become permanently immune to the disease. In developed countries during the late 19th and early 20th centuries, improvements were being made in community sanitation, including improved sewage disposal and clean water supplies. Better hygiene meant that infants and young children had fewer opportunities to encounter and develop immunity to polio. Exposure to poliovirus was therefore delayed until late childhood or adult life, when it was more likely to take the paralytic form.
In children, paralysis due to polio occurs in 1/1000 cases, while in adults, paralysis occurs in 1/75 cases. By 1950, the peak age incidence of paralytic poliomyelitis in the United States had shifted from infants to children aged 5 to 9 years; about one-third of the cases were reported in persons over 15 years of age. Accordingly, the rate of paralysis and death due to polio infection also increased during this time. In the United States, the 1952 polio epidemic would be the worst outbreak in the nation's history. Of the nearly 58,000 cases reported that year 3,145 died and 21,269 were left with mild to disabling paralysis.
Historical treatments
In the early 20th century—in the absence of proven treatments—a number of odd and potentially dangerous polio treatments were suggested. In John Haven Emerson's A Monograph on the Epidemic of Poliomyelitis (Infantile Paralysis) in New York City in 1916 one suggested remedy reads:
Following the 1916 epidemics and having experienced little success in treating polio patients, researchers set out to find new and better treatments for the disease. Between 1917 and the early 1950s several therapies were explored in an effort to prevent deformities including hydrotherapy and electrotherapy. In 1935 Claus Jungeblut reported that vitamin C treatment enhanced resistance to poliomyelitis in monkeys. However follow up experiments reported by Albert Sabin and Jungeblut himself were unable to confirm the initially promising results. Later, Fred Klenner published his own clinical experience with vitamin C in the treatment of polio, however his work was not well received and no large clinical trials were ever performed.
Surgical treatments such as nerve grafting, tendon lengthening, tendon transfers, and limb lengthening and shortening were used extensively during this time. Patients with residual paralysis were treated with braces and taught to compensate for lost function with the help of calipers, crutches and wheelchairs. The use of devices such as rigid braces and body casts, which tended to cause muscle atrophy due to the limited movement of the user, were also touted as effective treatments. Massage and passive motion exercises were also used to treat polio victims. Most of these treatments proved to be of little therapeutic value, however several effective supportive measures for the treatment of polio did emerge during these decades including the iron lung, an anti-polio antibody serum, and a treatment regimen developed by Sister Elizabeth Kenny.
Iron lung
The first iron lung used in the treatment of polio victims was invented by Philip Drinker, Louis Agassiz Shaw, and James Wilson at Harvard, and tested October 12, 1928 at Children’s Hospital, Boston. The original Drinker iron lung was powered by an electric motor attached to two vacuum cleaners, and worked by changing the pressure inside the machine. When the pressure is lowered, the chest cavity expands, trying to fill this partial vacuum. When the pressure is raised the chest cavity contracts. This expansion and contraction mimics the physiology of normal breathing. The design of the iron lung was subsequently improved by using a bellows attached directly to the machine, and John Haven Emerson modified the design to make production less expensive. The Emerson Iron Lung was produced until 1970. Other respiratory aids, such as the “rocking bed" were used in patients with less critical breathing difficulties.
During the polio epidemics, the iron lung saved many thousands of lives, but the machine was large, cumbersome and very expensive: in the 1930s, an iron lung cost about $1,500 - about the same price as the average home. The cost of running the machine was also prohibitive, as patients were encased in the metal chambers for months, years and sometimes for life: even with an iron lung the fatality rate for patients with bulbar polio exceeded 90%.
These drawbacks led to the development of more modern positive-pressure ventilators and the use of positive-pressure ventilation by tracheostomy. Positive pressure ventilators reduced mortality in bulbar patients from 90% to 20%. In the Copenhagen epidemic of 1952, large numbers of patients were vent
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