Poliomyelitis and the Neurologists: The View from England, 1896- 1966

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Abstract
Bulletin of the History of Medicine 71.2 (1997) 249-272 In 1907, following one of the earliest poliomyelitis outbreaks in New York City, the New York Neurological Society set up a poliomyelitis committee with a view to studying and illuminating the behavior of this newly epidemic disease. The neurologists' interest in polio was of long standing, dating from the orthopedic surgeon Jacob von Heine's conclusion, in 1860, that the symptoms of infant paralysis pointed to "an affection of the central nervous system, namely the spinal cord." Ten years later, Heine's deduction had been confirmed by the researches of Jean-Martin Charcot (1825-93), who demonstrated the destruction of the grey matter of the anterior horns of the spinal cord (within which the motor impulses arise and are transmitted) in cases of infant paralysis. This demonstration of the pathology of the disease placed it firmly within the concerns of neurology, where it remained until polio arrived as a major epidemic problem. In America, according to John R. Paul, the New York Neurological Society's committee marked "almost the last time that neurologists as a professional body were to assume a position of dominance with respect to poliomyelitis." In 1909 Karl Landsteiner and his colleagues announced their discovery of the virus of poliomyelitis, and in the following year, Simon Flexner, director of the Rockefeller Institute for Medical Research, threw the resources of his well-funded and scientifically distinguished institution into the problem of polio. Thereafter the disease was taken over by "virologists, internists, pediatricians, orthopedists, specialists in physical medicine, and public health officials." Although it took more than forty years for the efforts of America's multiple medical specialists to resolve the problem of poliomyelitis, their involvement with the disease demonstrated very clearly its exceptional nature as an illness that required a high level of medical teamwork, both in its therapeutic and in its public health aspects. The American experience of poliomyelitis overshadowed that of other Western countries in the decades to 1950. It was America that suffered the most spectacular epidemics -- notably that in New York in 1916, in which some 2,400 people died. It was in the United States that public concern over the disease reached its highest peak, and that decades of laborious experimental research culminated in the development of Jonas Salk's vaccine against the disease in the early 1950s. America had its own dramatic national figurehead for polio in President Franklin Roosevelt, himself crippled by the disease. The known history of poliomyelitis, both social and scientific, belongs largely to America. By contrast, the countries of Western Europe, with the single exception of Denmark, escaped the devastation wrought by major epidemics of the disease until after World War II. Yet Europe did not remain untouched by the disease. The English experience of poliomyelitis, for example, has been described in a recent study as negligible: "Everything to do with polio in Britain -- not least the disease itself -- was on a minor scale." Despite "incipient panic" with the first big epidemic in 1947, the country's response to polio is described as "phlegmatic" compared with that of New York in 1916, probably because of the more advanced state of knowledge available through American research. While the assessment of England's polio problem as minor is perfectly fair -- there was an average of only 680 cases a year in the 1920s -- this picture overestimates the extent to which response to the 1947 epidemic was tempered by more advanced knowledge. Although English medical observers kept up with American poliomyelitis research, and avidly reported developments in the medical journals, such knowledge had not by 1947 led to any significant advances in prevention, treatment, or cure. As the Ministry of Health's senior medical officer, W. H. Bradley, observed in 1948, the problem of polio the world over was one of "ignorance, impotence and insecurity." In fact, the British response to polio in 1947 was tempered far more by some fifty years of persistent, relatively low-key experience of polio and polio-alarms than by all the labors in all the laboratories of America. Beginning in the 1890s, a small number of British clinicians had maintained a close interest in...

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