Table of Contents • I. Poliomyelitis, Treatment, and Prevention Prior to 1955 • A. Poliovirus and Poliomyelitis • B. The Endemic Phase (Antiquity to ~1880) • C. Epidemic Emergence (1880-1920) • D. The Epidemic Phase (1920-1955) • E. The Path to a Vaccine • II. The Arrival of the Salk Polio Vaccine: Documents, April-July 1955 • III. Postscript - Polio Prevention after Jonas Salk • IV. Bibliography and Resources • V. Student Assignments • VI. Catalogue of Sources

Section I: Poliomyelitis, Treatment, and Prevention Prior to 1955

C. Epidemic Emergence (1880-1920)

What is widely regarded as the first polio epidemic occurred in Scandinavia around 1881, followed by another in a small town in France in 1885.^1-2 In the summer of 1887, the world's first major polio epidemic struck Stockholm, Sweden; 44 cases developed in a city that usually saw only one or two a year. The physician Karl Oskar Medin studied the outbreak and noted the three phases of the disease. In honor of his discoveries and the earlier work of the German doctor Jacob Heine, polio was called Heine-Medin Disease for a number of years.

A student of Medin's, Ivar Wickam, confirmed with data from the Scandinavian epidemic of 1905 (over 1,000 cases) that Medin's hypothesis of different forms of the disease was correct. He also determined that polio is highly contagious and that even the mild cases should be considered severe, as they too are infectious. Three years after the epidemic, scientists Karl Landsteiner (best known for identifying the different blood types) and Erwin Popper determined that a virus caused the disease. They showed this by injecting a monkey with fluid from the neural tissue of a deceased polio victim. During this period of discovery, epidemics increased in frequency and intensity and moved out of Sweden to other places in Europe and, eventually, across the Atlantic to the Americas.

The first documented polio epidemic in the United States took place in Vermont in 1894, an outbreak of 132 cases. Epidemics spread to different cities and towns around the country, primarily during the summer months. The 1916 epidemic was particularly severe, as New York City alone had 9,000 cases and the local government felt so threatened that they locked down the city. Children were not allowed to travel out of the city (later they could leave if they had a signed "health pass"), and police were stationed at every entrance to deny visitors entry. The government did its best with its limited knowledge based on the nascent germ theory of disease, launching mass efforts to clean city streets, quarantine patients, and educate the public. In early July, animals were destroyed at a rate of 300 to 450 a day,³ and in September, legislators postponed the opening of schools. The epidemic did not wane until October.⁴

Living with polio during epidemic emergence (1880-1920)
Physicians sought new methods of treatment during this time with little success, especially because scientists and doctors still did not understand with precision how the disease was spread. Many physicians felt helpless as they watched their previously healthy and active young patients lose the ability to walk or breathe within only a few days.

During this time some hospitals and physicians began to use 'Convalescent Serum Therapy,' which was first recommended by French scientist Arnold Netter in 1915.⁵ The serum was made from the blood of people and monkeys who had recovered from polio and remained the treatment of choice during the 1916 epidemic and throughout the 1920s. Doctors quickly encountered problems with determining the actual effectiveness of the serum, however. Despite multiple attempts, a good study was not released until 1935 because it was ethically difficult to deny patients treatment, making it impossible to establish adequate control groups. In the absence of other treatments, it was used until 1935, even as doubts over its effectiveness grew, doubts which were eventually confirmed.⁶

Physicians also began immobilizing limbs affected by polio in plaster casts or other apparatuses to restrict muscle movement. Experts at the time believed that the stronger, unaffected muscles pulled on the weakened or paralyzed muscles to create the characteristic poliomyelitis deformities. Straightening the limb was thought to 'correct' for this, leading to the presence of countless pulleys in hospital polio wards.7 Physicians later discovered that immobilization hindered recovery because disuse of limbs made weakened muscles that much weaker.

Continue to The Epidemic Phase (1920-1955)

¹ Paul 74.
² Paul 75.
³ Gold, Tony. A Summer Plauge: Polio and Its Survivors. New Haven: Yale UP, 1995. 8.
⁴ Gold 25.
⁵ Paul 190.
⁶ Paul 198.
⁷ Paul 222.