Price of Poliomyelitis

The risk of permanent paralysis is the predominant feature of poliomyelitis, and the dread of disability has profoundly affected society's attitude to the disease. In the broad medical context of disease in society, acute poliomyelitis is comparatively uncommon. Pneumonia causes over twenty times the number of premature deaths, even though premature deaths from pneumonia are less than a fifth the number twenty-five years ago. The risk of a young adult contracting respiratory tuberculosis was more than ten times greater than his risk of contracting acute poliomyelitis even during the years when the incidence of poliomyelitis was at its height. The magnitude of the impact of paralytic poliomyelitis on an individual over-shadows all other aspects of the illness. Unlike other dangerous illnesses, the victims of poliomyelitis live on, many of them permanently damaged. The number of disabled grows larger year by year. The disease becomes a social rather than a medical problem, one which is far greater than its annual incidence indicates. There is a popular impression that poliomyelitis is a disease of modern civilisation, but there is evidence to suggest that it existed as long ago as the time of the Pharoahs. The first clinical description was published in 1789 by the London physician Michael Underwood. He observed that "it is not a common disorder, and seems to occur seldomer in London than in other parts. It seems to arise from debility, and usually attacks children previously reduced by fever; seldom those under one, or more than four or five years old". A fuller and better known description of the late effects of poliomyelitis was published in 1840 by the German bone setter, Dr. Jacob Heine. The hygiene and sanitation of modern society indirectly inhibited the growth and development of immunity in communities, leading to a change in the epidemic character of poliomyelitis, deepening its impact. In 1881, a sudden outbreak occurred in the small town of Umea, in the far north of Sweden. Six years later a larger outbreak occurred in Stockholm; during the first half of the century large epidemics occurred in most advanced communities of the world—particularly in the United States. Poliomyelitis was made notifiable in England and Wales in 1912. At this time, because of the problems of recognising and diagnosing the disease it is very doubtful whether the number of cases reported represented the true incidence of the disease. There is evidence which suggests that an epidemic occurred during the years immediately before the first world war. For the next 35 years notification of cases tended slowly to rise, but rarely exceeded 1,000 in any one year. In 1947 the pattern changed dramatically. In that year almost 8,000 cases were notified, a number nearly five times greater than any previously recorded. The next ten years saw repeated recurrence of similar outbreaks. Between 1947 and 1958 over 50,000 persons contracted the disease, of whom probably 32,000 showed some degree of paralysis. Deaths averaged 330 a year; the majority of the victims were young adults. Vaccination started on a very small scale in 1956. An intensive campaign was launched in 1958. From the non-notifications of the disease declined rapidly and in 1962 numbered less than one tenth the number in the epidemic years. The polio vaccination campaign makes it possible that by the end of the 1960's poliomyelitis will become even more rare than diphtheria. The immediate medical problem of preventing poliomyelitis is nearly solved. But even so, there will remain the legacy of the epidemic years, the residual social problem of the large number of victims permanently disabled by the disease. There is a danger that when the risk of the disease is eliminated the problems of the disabled maybe forgotten. Society soon neglects diseases once they are conquered.