Is The Public Health Law Responsible For The Poliomyelitis Mystery?
Posted: Wed Jan 24, 2007 10:51 am
Is The Public Health Law Responsible For The Poliomyelitis Mystery?
VERY interesting
" If poliomyelitis was not considered to be an infectious contagious
disease a half century ago by outstanding clinicians, we must determine why
it has come to be considered infectious since that time. The answer to this
reversal of thought concerning the nature of this disease is to be found in
the period of medical history between the years 1905 and 1911."
"Chapin5 stated: "there is one aspect of this disease of considerable
interest. Years ago we never thought of contagiousness with reference to
it." Acker stated that he had seen no cases of contagion. "If the disease
is so contagious," he said, "I do not understand why the nurses and mothers
would not have been infected." "
http://www.geocities.com/harpub/scoblaw.htm
Images Of Poliomyelitis
From Archive Of Pediatrics (May, 1951)
Is The Public Health Law
Responsible For
The Poliomyelitis Mystery?
Ralph R. Scobey, M.D.
Syracuse, N.Y.
After 43 years of intensive and expensive research on the virus theory
as cause of poliomyelitis, the failure to explain the disease calls for
reappraisal of the problem. "If there is adequate understanding of
conditions, there is less occasion for guessing," Swayze1 stated concerning
poliomyelitis 41 years ago and this fact is obviously applicable today.
The first and by all means the foremost fact that must be conclusively
established is whether or not poliomyelitis is actually an infectious
contagious disease, as has been commonly assumed and stated in the public
health law. This assumption, it must be admitted, is almost entirely based
on the results of animal experiments rather than on clinical
investigations. Simon flexner2, in 1911, stated: "We have progressed very
far in the management of an infectious disease when we have learned the
portals of egress and ingress of the infectious agent. Such knowledge of
this kind as we possess regarding epidemic poliomyelitis is based wholly on
animal experiments, and hence the degree of application to human beings has
still to be established." Yet, in 1951 -- 40 years later -- nothing is
definitely known regarding the portal of entry into the human body of the
so-called virus of this disease, and conclusive proof that a virus actually
enters the human body under natural circumstances from without is
conspicuously lacking.
The writer3 has found that in the past no less than 200 names have been
applied to poliomyelitis and has pointed out the existence of epidemics of
it years ago. Some of our foremost clinicians of half a century ago made it
known that they had been cognizant of the disease many years before.
Furthermore, many stated that they had not considered it to be infectious
or contagious. At the time that a Report of the Special Committee on
Anterior Poliomyelitis5 was read to the members of the American Orthopedic
Association and the American Pediatric Society, April 28, 1911, the
following comments were made regarding the prevalence of the disease and
its communicability in previous years. Chapin5 stated: "there is one aspect
of this disease of considerable interest. Years ago we never thought of
contagiousness with reference to it." Acker stated that he had seen no
cases of contagion. "If the disease is so contagious," he said, "I do not
understand why the nurses and mothers would not have been infected."
Crandall5 pointed out that he had seen his first cases of poliomyelitis 23
years previously and Morse5 stated that his first cases went back about 17
years, and a diagnosis of rheumatism had often been previously made on
account of the pain. Koplik5 pointed out that today cases are included that
were formerly not recognized as poliomyelitis.
Lovett6 (1911) indicated that poliomyelitis had been known for a long
time to contemporary physicians when he stated: "That infantile paralysis
has existed in the United States for an indefinite time is perfectly
familiar to us from the fact that we all know of adults affected whose
history would reach back fifty years."
In a letter addressed to every children's hospital in this country,
Adams5 asked a certain number of questions, among which was: "Have you ever
had a case of poliomyelitis originate in the hospital, or have you any
evidence that the disease has spread from patients admitted to the
hospital?" As to the disease originating in the hospital, the invariable
reply, he says, was, "No."
Sachs7 (1911) indicates that he was familiar with poliomyelitis before
it was generally realized that it occurs in epidemics and that it was not
generally considered to be infectious. He says: "Many years ago those of us
who were in charge of hospitals and dispensaries had observed the seasonal
occurrences of the malady, the early spring and summer being the periods of
the year in which the onset of the disease had been most commonly observed.
Some ten or fifteen years ago the opinion was hazarded -- among, others by
the writer -- that the disease should be considered one of the infectious
diseases of childhood, but this opinion did not gain a firm foothold until
the epidemic occurrence of the disease in Norway and Sweden in the late
nineties and the early years of this century. Thereafter, a more careful
review of the entire subject showed that earlier epidemics had been
reported in Europe and in America... But we were not fully alive to the
importance of the subject until the epidemic in Greater New York in 1907."
Sachs points out: "Our present knowledge of the possible methods of
contagion is based almost entirely upon the work done in this city at the
Rockefeller Institute." This of course placed reliance on animal
experiments rather than on clinical investigations. Sachs states that
children afflicted with the disease were kept in general hospital wards and
that not a single one of the other inmates of the wards of the hospital was
affected with the disease.
Simon Flexner8 (1910) stated: "It was not easy to establish in an
individual case precisely how the disease was acquired; it was difficult to
bring evidence that was not at all convincing that this disease was
contagious." L. Emmett Holt8, in discussing Flexner's paper, stated: "Even
five years ago if anyone had suggested that the disease under discussion
was an infectious or contagious one, it would have been looked upon as a
joke."
If poliomyelitis was not considered to be an infectious contagious
disease a half century ago by outstanding clinicians, we must determine why
it has come to be considered infectious since that time. The answer to this
reversal of thought concerning the nature of this disease is to be found in
the period of medical history between the years 1905 and 1911.
Although an extensive epidemic of poliomyelitis had occurred in Vermont
in 1894, that was described by Caverly9, no extensive outbreak of the
disease aroused widespread attention in this country until the 1907
epidemic occurred in New York and Massachusetts. Caverly had stated
emphatically 13 years before: "There was a general absence of infectious
disease as an etiologic factor in this epidemic. The element of contagion
does not enter into the etiology either. I find but a single instance in
which more than one member of a family had the disease and it usually
occurred in families of more than one child and as no efforts were made at
isolation, it was very certain it was non-contagious." Yet, in 1907, and in
subsequent years, every effort was made by the New York City and
Massachusetts Health Departments to show that poliomyelitis was an
infectious, contagious disease. The general attitude at that time appears
to be expressed by Sachs10 when he says: "In general, the epidemic
occurrence of any disease is sufficient to prove its infectious or
contagious character." It is significant to note that at about this same
period in medical history that the infectious and contagious nature of
pellagra was also suspected because it occurred in epidemics and convincing
evidence to prove this contagion concept was presented by the
Thompson-McFadden, Illinois, and Texas Commissions appointed to study the
problem. Harris11 "proved" the disease to be caused by a virus and Tucker12
concluded from clinical and pathological studies that pellagra is a virus
disease. It was, of course, unknown at that time that pellagra is a vitamin
deficiency disease and can occur in extensive epidemics.
In 1907, the insistence that poliomyelitis must be a specific
infectious disease arose chiefly from the fact that an epidemic of the
disease was prevailing. The discovery of the so-called virus of
poliomyelitis had not as yet been announced. Epidemics of poliomyelitis,
designated by other names, had existed before, but as Manning13 (1911)
states: "The tardy recognition of the epidemic character of poliomyelitis
in the last century resulted in a very limited written history or, as we
say, epidemiology of the disease."
The attention in this century of the medical profession and the public
had never been so focused upon a disease as it was upon poliomyelitis
during the epidemic of 1907, as the considerable amount of discussion given
to it in both the public and medical press indicates.
A Collective Investigation committee of the New York Neurological
Society14, with the cooperation of the committee appointed by the Section
on Pediatrics of the New York Academy of Medicine, and the New York Board
of Health, was appointed to investigate this epidemic of 1907.
One of the first steps taken by the committee was to send out return
postals to the physicians of Greater New York and vicinity, inquiring
whether or not the physician in question had seen cases of infantile
paralysis during the summer and autumn of 1907. Inquiry blanks were sent to
those physicians who replied and these contained certain leading questions.
The committee concluded from the returned blanks that poliomyelitis was
infectious but not a contagious disease.
The initiative having been taken in New York, the Massachusetts State
Board of Health15 started an investigation to determine the etiology of
poliomyelitis modeled after the New York investigation. Receptacles were
sent to physicians reporting cases for collection of stools in order to
investigate the gastro-intestinal tract as a possible source of infection
of the disease. This investigation, although producing no bacterial
evidence of its etiology, nevertheless, not only focused the attention of
the medical profession on poliomyelitis as a disease entity but likewise
strongly conveyed the idea that the disease was infectious in nature. An
editorial in the Boston Medical and Surgical Journal16 (Sept. 12, 1907)
points out this fact when it says: "Taking it as a highly probably point
that the disease is due to a specific germ, a circular has been prepared to
be sent out to physicians generally, in which a request is made for such
reports as would do much toward establishing at least the usual
surroundings in which the disease occurs most frequently and thus afford
some idea of the conditions favorable to the development and growth of the
supposed morbific organisms."
For the first time in the United States the attention not only of
physicians but the public as well was focused on a vast scale on
poliomyelitis as a possible infectious contagious disease. Although there
was admittedly no conclusive proof of its contagiousness, the general
attitude at that time is summed by Strauss17 (1911) as follows: "It seems
to us despite the lack of absolute proof, that the best interests of the
community would be conserved by our regarding the disease from a contagious
standpoint."
In May 1910, a joint committee was appointed by the American Orthopedic
Association and the American Pediatric Society to communicate to state
Boards of Health and other health authorities with regard to anterior
poliomyelitis. circulars were sent to the medical journals and letters to
the health commissioners of each state and to each provincial health
officer of Canada. These letters urged the physicians and health
authorities to study and quarantine the disease, and the journals gave
publicity to most of these circulars. The letters to the health officers
requested them to take notice of the serious character of the epidemics,
the spread of the disease and its contagious nature, and asked them to make
the disease reportable and to undertake a field study of epidemics.
By that time poliomyelitis had been made a reportable disease in 23
states and in Ontario and British Columbia. The committee recommended that
the disease be made reportable in all states. It recommended further that
all cases be quarantined, sputum, urine and feces be disinfected, and the
same rigid precautions adopted as in scarlet fever.
[Map of U.S. (1910) omitted]
In the same year (1910), Swayze1, Professor of Obstetrics and Dean of
the Medico-Chirugical College of Philadelphia, stated that he had received
a printed official postal from the Department of Health, over the signature
of the Chief Medical Inspector, commanding that he make immediate report of
each and every case of anterior poliomyelitis occurring in his practice in
the same manner that other communicable diseases are reported to the health
authorities. "This arbitrary demand cited infantile paralysis as a
contagious affection although bacterial research failed to back up the
assumption." In substance, Swayze's reply to the Chief Inspector declined
to accept the theory of contagion. In response he received an official
envelope containing a duplicate card desiring reports "in the same manner
as other communicable disease" and hoped it was satisfactory. Swayze
replied to the effect that the conclusion of contagion was not satisfactory
and the incident was closed. In his article, "The Infantile Paralysis
Muddle," in which this exchange of correspondence appears, Swayze offers
evidence that poliomyelitis is simply solar heat prostration. This
concept18 had been considered before and after that time to explain certain
cases of this disease. The lesson to be learned from Swayze's insistence
that infantile paralysis is not a contagious disease is that, nevertheless
according to the law, it is a contagious disease, and that it is illegal to
consider it otherwise. The law, clinical observations to the contrary, has
to be considered. Poliomyelitis is unique in that it is the only disease in
the history of medicine in which a theory, and not an established fact as
to its cause, has become incorporated into the public health law. [Note: In
1996, Duesberg wrote, "AIDS is the first disease whose cause was proclaimed
at a governmental press conference." and "AIDS is the first disease of
consensus, in a time when science has degenerated to consensus." (Inventing
The AIDS Virus)]
The year 1910 also showed other intensive efforts not only to gather
information regarding poliomyelitis but to imply that it was an infectious
contagious disease. The Massachusetts State Board of Health sent out
several hundred letters of inquiry to state boards of health, to officers
of state medical societies and to prominent physicians in various parts of
this country, its dependencies, and Canada.
Statistics reported by Lovett6 (1911) show the results of this survey.
A map of the United States (Fig. 1), on which is marked the number of cases
for 1910, showed a total of 8,700 cases. These were the cases of
poliomyelitis that were officially reported, in some cases estimated, but
this estimate was a poor criterion by which to judge the total number that
had occurred during the year. In half of the states the disease was not as
yet reportable; in the states where the disease was reportable, many cases
were either unrecognized or unreported when recognized; in other states the
alertness of physicians is evident from the number reported. A study of the
map, however, shows the widespread and general distribution of the disease
after the attention of physicians had been called to it. Obviously
poliomyelitis had not spread to the various states indicated. It is equally
obvious that diseases which had doubtless been designated by other names in
the past were now being reported as poliomyelitis. The known existence of
cases of a paralyzing disease such as poliomyelitis, might excite public
panic and this understanding may have deferred physicians from making known
the prevalence of such cases in the past.
If one takes into consideration the evidence that in 1910 there were
officially reported cases of poliomyelitis in the United States in only one
half of the states, and that early, mild, or nonparalytic cases that are
not reported were not considered to be this disease at that time, it is
fair to assume that extensive epidemics existed then and perhaps as great
as those of today. To continue the assumption, we may conclude that the
incidence of poliomyelitis may not have increased after all, as is commonly
supposed.
Collins19 (1910) made a plea in a paper read before the Association of
American Physicians on May 2, 1910, that poliomyelitis be made a reportable
quarantinable disease. He based his arguments of contagiousness on the
prevalence of epidemics of this disease and on circumstantial evidence. He
stated in regard to the so-called poliomyelitis virus: "From a study of the
disease clinically, no information has been obtained as to how the virus
gains entrance into the system." This point has not been conclusively
established even at this date, 41 years later, despite intensive research.
On May 30, 1910, the Academy of Medicine of Paris, France20, appointed
a commission to discuss the expediency of classifying poliomyelitis, or
infantile paralysis, among the diseases in which notification is
obligatory. The commission reported to the Academy at its meeting on July
11, 1910, that the disease was first made notifiable in Sweden and Norway
in 1905, and that similar action had been taken by many of the North
American and Australian states, and throughout the German Empire. The
commission, therefore, recommended compulsory notification of poliomyelitis
in France, quarantine of suspects, patients and convalescents, and
subsequent disinfection of premises. These recommendations were adopted.
From this beginning in the period of medical history from 1905 to 1911,
poliomyelitis eventually has become throughout the world not only
reportable, but according to the law, an infectious contagious disease.
From the time that compulsory reporting of poliomyelitis was adopted as a
public health measure in certain localities up until the present time when
such reporting is universal, the implication that poliomyelitis is an
infectious contagious disease has been included in the public health law.
If it had been made reportable only and no suggestion as to its possible
etiology had been implied in the law, unlimited research would have
undoubtedly been carried out during the last half century and the mystery
surrounding the disease would probably have been solved.
COMMENT
Although poliomyelitis is legally a contagious disease, which implies
that it is caused by a germ or virus, every attempt has failed conclusively
to prove this mandatory requirement of the public health law. The manifest
truth that we must take into consideration is that progress in
poliomyelitis investigations has been impeded by this prematurely
formulated public health law. Hoyne21 (1951) recently summed up our
cumulative knowledge of poliomyelitis since it was made a reportable
contagious disease as follows: "Notwithstanding the intensive studies of
investigators, very little information of practical value has been added to
our knowledge of poliomyelitis during the past forty years."
Hoyne points out, as others have also indicated, the rarity for a
patient to give a history of exposure to a known case of poliomyelitis; the
prevalence of epidemics of this disease in the summer, whereas nearly all
common acute infectious diseases occur in seasons when life is principally
within doors and schools are in session; the warm weather prevalence which
is unusual for a communicable disease; and the inability to prevent
poliomyelitis according to the standards employed in preventing known
infectious diseases. He then makes the startling revelation that the
etiologic agent of the disease is still unknown.
Unlimited poliomyelitis research ceased abruptly when this disease was
legally made a communicable disease. However, definite progress toward a
solution to the problem was being made before the public health law made
poliomyelitis a germ or virus disease. For example, it was reported by
toxicologists and bacteriologists that poliomyelitis could be produced both
by organic and inorganic poisons as well as by bacterial toxins. The
relationship of this disease to beriberi was also being given
consideration. However, these investigations lost support when a germ or
virus came to be considered by some to be the full and final answer to the
problem. Funds for poliomyelitis research were from then on designated for
the investigation of the infectious theory only.
Nevertheless, there are today many investigators who have strong
evidence contradicting the infectious theory. Vitamin and mineral
deficiency, poison, allergy and other theories are being presented to
explain the mystery, but these men, because of the public health law and
the limited ability to obtain funds or cooperation from any source cannot
work freely on the problem of cause of poliomyelitis.
What Louis Bromfield22 states about research in agriculture in his
book, "Out of the Earth," could obviously apply to poliomyelitis
investigations if unlimited research were encouraged. He says: "In the long
history of mankind, the tiniest observation or speculation of the most
humble men (and all really great men are humble in the face of Nature) has
sometimes led to vast and dynamic discoveries of the utmost importance to
man. Many of the greatest contributions to agriculture in our time have not
come from the billion dollar Department of Agriculture nor from the
countless Colleges of Agriculture but from a county agent or a farmer who
had the power to observe, the imagination to speculate and the logic to
deduce a process from which vast benefits have developed. ... [sic] Each
day brings forth some new discovery which completely pulls the carpet from
under theories which in the past were accepted as facts. It is not
impossible that many accredited theories of today may join the exploded
superstitions of yesterday." Bromfield points out that circumstances and an
apparently impregnable chain of circumstance threw the investigator off the
real track. Although he indicates that the pendulum has not infrequently
swung in agriculture from one theory to another than provided the full and
final answer to the problem, however, in poliomyelitis investigations it
has been impossible for the pendulum to move perceptibly because of the
public health law.
The mother, general practitioner, country doctor and clinician have all
made important observations during epidemics of poliomyelitis and have
formulated their own theories regarding the cause of the disease. However,
they have been unable to have these observations seriously considered,
especially when they have disagreed with the orthodox concept of the cause
of the disease. This situation is admittedly unfortunate since our
fundamental knowledge of the disease, as incorporated in the public health
law, has originated form laboratory workers experimenting on animals that
are not naturally susceptible to poliomyelitis. Jelliffe23, 32 years ago,
cautioned: "The purity of laboratory experimentation is rarely repeated in
nature."
Shaw and Thelander24 (1949) emphasize these facts when they state: "The
clinician has not been presented with any sound doctrine regarding its
epidemiology and transmission, its precise pathogenesis, or the details of
diagnosis and treatment. The clinician who observes the only animal
naturally subject to this disease, must develop his own credo regarding
most of the aspects of the human form of the disease including not only
details of management of the affected patient but also the many hypothetic
considerations which influence one's judgment during epidemics."
Shaw and Thelander indicate in the above statement that poliomyelitis
is entirely out of the hands of the clinician, a fact that Sachs25, 41
years before, had also intimated.
At one time or another the classical dietary deficiency diseases,
beriberi and pellagra, and even sunstroke, have been considered to be
communicable infectious diseases. If by law any one, or all of these
diseases, had been made a reportable communicable disease, it is obvious
that today it would legally be a germ disease and a search for the
causative germ might still be in progress. If beriberi and pellagra had
been made reportable communicable diseases, it is conceivable that the
epochal studies on vitamins by Funk and subsequent workers could have been
ignored in the search for the infectious agent as the etiological factor in
these diseases. The progress of medicine would have been seriously retarded.
Yet, in poliomyelitis investigations the continued attempts --
unsuccessful to date -- to show a so-called virus enters the human body
under natural circumstances to cause the disease go on over the objections
of those who maintain that the so-called virus is not the cause of the
disease but rather an endogenous product arising secondary to poisoning,
vitamin or mineral deficiency, etc. and despite the protests of the public
who demand that all possible causes of poliomyelitis be investigated.
A virus theory has been considered as an etiological factor in relation
to other diseases, notably cancer26, and convincing evidence has been
presented to support this hypothesis. Nevertheless, research goes on in
this study of cancer cause along many lines of investigation which include
the virus theory rather than on virus studies only, excluding other
theories, as in the investigation of poliomyelitis. If, however, cancer
were incorporated in the public health law as a reportable communicable
disease as a result of these studies, it is obvious that unlimited research
would cease and that those who maintained noninfectious theories to explain
the cause of the disease would neither be able to obtain funds for
extensive research nor cooperation for investigating their ideas.
The time is long past due for careful reappraisal of the poliomyelitis
problem and for many capable workers with various opinions regarding the
cause of the disease to be given the opportunity to work and the funds with
which to work. The implications of the public health law that poliomyelitis
is an infectious communicable disease must be reconsidered if progress is
to be made.
[Summary omitted]
REFERENCES
1. Swayze, G.B.H.: M. Times, 38:321-325, Nov. 1910.
2. Flexner, Simon: Trans. Am. Pediat. Soc., 23:210-216, 1911.
3. Scobey, R.R.: Arch. Pediat., 67:29-46, Jan. 1950.
4. Scobey, R.R.: Arch. Pediat., 67:400-430, Sept. 1950: 462-482, Oct.
1950.
5. Report of Special Committee on Anterior Poliomyelitis: Trans. Am.
Pediat. Soc., 23:223-228, 1911.
6. Lovett, R.W.: Trans. Am. Pediat. Soc., 23:175-185, 1911.
7.. Sachs, B.: Am. J. Obst. & Gynec., 63: 703-710, April 1911
8. Flexner, Simon: Trans. M. Rec., 78:924-926, Nov. 19, 1910.
9. Caverly, C.S.: Yale Med. J., 1: 1, 1894.
10. Sachs, B.: Am. J. Obst. & Gynec., 63: 703-710, April 1911
11. Harris, W.M.: J.A.M.A., 60: 1948-1950, June 21, 1913.
12. Tucker, B.: in S. Harris, Clinical Pellagra, p. 83, 1941.
13. Manning, J.V.: Am. J. Obst. & Gynec., 63: 723-725, April 1911.
14. Report of Collective Investigative committee: J. Nerve. & Ment.
Dis., 36:619-625, Oct. 1909.
15. Lovett, R.W.: J. Nerv. & Ment. Dis., 36: 681-684, Nov., 1909.
16. Editorial: Boston M. & S. J., 157:375, Sept., 12, 1907.
17. Strauss, L.: Am. J. Obstr. & Gynec., 63:711-723, April, 1911.
18. Scobey, R.R.: Arch. Pediat., 67:29-46, Jan. 1950.
19. Collins, J.: J.A.M.A., 54: 1925-1928, June 11, 1910.
20. Editorial: Boston M. & S. J., 165:707, Nov., 2, 1911.
21. Hoyne, A.L.: M. Clin. North American Chicago Number, pg. 175-188,
Jan. 1951.
22. Bromfield, Louis: Out of the Earth, pp. 5, 43-45, 1950.
23. Jelliffe, S.E.: J. Nerve. & Ment. Dis., 49:522, May 1919.
24. Shaw, E.B. and Thelander: H.E.: Pediatrics, 4:277-286, Sept. 1949.
25. Sachs, E.: M. Rec., 78:925, Nov. 19, 1910.
26. Fox, J. DeWitt: M. Ann. Dist. Columbia, Feb. 1951.
VERY interesting
" If poliomyelitis was not considered to be an infectious contagious
disease a half century ago by outstanding clinicians, we must determine why
it has come to be considered infectious since that time. The answer to this
reversal of thought concerning the nature of this disease is to be found in
the period of medical history between the years 1905 and 1911."
"Chapin5 stated: "there is one aspect of this disease of considerable
interest. Years ago we never thought of contagiousness with reference to
it." Acker stated that he had seen no cases of contagion. "If the disease
is so contagious," he said, "I do not understand why the nurses and mothers
would not have been infected." "
http://www.geocities.com/harpub/scoblaw.htm
Images Of Poliomyelitis
From Archive Of Pediatrics (May, 1951)
Is The Public Health Law
Responsible For
The Poliomyelitis Mystery?
Ralph R. Scobey, M.D.
Syracuse, N.Y.
After 43 years of intensive and expensive research on the virus theory
as cause of poliomyelitis, the failure to explain the disease calls for
reappraisal of the problem. "If there is adequate understanding of
conditions, there is less occasion for guessing," Swayze1 stated concerning
poliomyelitis 41 years ago and this fact is obviously applicable today.
The first and by all means the foremost fact that must be conclusively
established is whether or not poliomyelitis is actually an infectious
contagious disease, as has been commonly assumed and stated in the public
health law. This assumption, it must be admitted, is almost entirely based
on the results of animal experiments rather than on clinical
investigations. Simon flexner2, in 1911, stated: "We have progressed very
far in the management of an infectious disease when we have learned the
portals of egress and ingress of the infectious agent. Such knowledge of
this kind as we possess regarding epidemic poliomyelitis is based wholly on
animal experiments, and hence the degree of application to human beings has
still to be established." Yet, in 1951 -- 40 years later -- nothing is
definitely known regarding the portal of entry into the human body of the
so-called virus of this disease, and conclusive proof that a virus actually
enters the human body under natural circumstances from without is
conspicuously lacking.
The writer3 has found that in the past no less than 200 names have been
applied to poliomyelitis and has pointed out the existence of epidemics of
it years ago. Some of our foremost clinicians of half a century ago made it
known that they had been cognizant of the disease many years before.
Furthermore, many stated that they had not considered it to be infectious
or contagious. At the time that a Report of the Special Committee on
Anterior Poliomyelitis5 was read to the members of the American Orthopedic
Association and the American Pediatric Society, April 28, 1911, the
following comments were made regarding the prevalence of the disease and
its communicability in previous years. Chapin5 stated: "there is one aspect
of this disease of considerable interest. Years ago we never thought of
contagiousness with reference to it." Acker stated that he had seen no
cases of contagion. "If the disease is so contagious," he said, "I do not
understand why the nurses and mothers would not have been infected."
Crandall5 pointed out that he had seen his first cases of poliomyelitis 23
years previously and Morse5 stated that his first cases went back about 17
years, and a diagnosis of rheumatism had often been previously made on
account of the pain. Koplik5 pointed out that today cases are included that
were formerly not recognized as poliomyelitis.
Lovett6 (1911) indicated that poliomyelitis had been known for a long
time to contemporary physicians when he stated: "That infantile paralysis
has existed in the United States for an indefinite time is perfectly
familiar to us from the fact that we all know of adults affected whose
history would reach back fifty years."
In a letter addressed to every children's hospital in this country,
Adams5 asked a certain number of questions, among which was: "Have you ever
had a case of poliomyelitis originate in the hospital, or have you any
evidence that the disease has spread from patients admitted to the
hospital?" As to the disease originating in the hospital, the invariable
reply, he says, was, "No."
Sachs7 (1911) indicates that he was familiar with poliomyelitis before
it was generally realized that it occurs in epidemics and that it was not
generally considered to be infectious. He says: "Many years ago those of us
who were in charge of hospitals and dispensaries had observed the seasonal
occurrences of the malady, the early spring and summer being the periods of
the year in which the onset of the disease had been most commonly observed.
Some ten or fifteen years ago the opinion was hazarded -- among, others by
the writer -- that the disease should be considered one of the infectious
diseases of childhood, but this opinion did not gain a firm foothold until
the epidemic occurrence of the disease in Norway and Sweden in the late
nineties and the early years of this century. Thereafter, a more careful
review of the entire subject showed that earlier epidemics had been
reported in Europe and in America... But we were not fully alive to the
importance of the subject until the epidemic in Greater New York in 1907."
Sachs points out: "Our present knowledge of the possible methods of
contagion is based almost entirely upon the work done in this city at the
Rockefeller Institute." This of course placed reliance on animal
experiments rather than on clinical investigations. Sachs states that
children afflicted with the disease were kept in general hospital wards and
that not a single one of the other inmates of the wards of the hospital was
affected with the disease.
Simon Flexner8 (1910) stated: "It was not easy to establish in an
individual case precisely how the disease was acquired; it was difficult to
bring evidence that was not at all convincing that this disease was
contagious." L. Emmett Holt8, in discussing Flexner's paper, stated: "Even
five years ago if anyone had suggested that the disease under discussion
was an infectious or contagious one, it would have been looked upon as a
joke."
If poliomyelitis was not considered to be an infectious contagious
disease a half century ago by outstanding clinicians, we must determine why
it has come to be considered infectious since that time. The answer to this
reversal of thought concerning the nature of this disease is to be found in
the period of medical history between the years 1905 and 1911.
Although an extensive epidemic of poliomyelitis had occurred in Vermont
in 1894, that was described by Caverly9, no extensive outbreak of the
disease aroused widespread attention in this country until the 1907
epidemic occurred in New York and Massachusetts. Caverly had stated
emphatically 13 years before: "There was a general absence of infectious
disease as an etiologic factor in this epidemic. The element of contagion
does not enter into the etiology either. I find but a single instance in
which more than one member of a family had the disease and it usually
occurred in families of more than one child and as no efforts were made at
isolation, it was very certain it was non-contagious." Yet, in 1907, and in
subsequent years, every effort was made by the New York City and
Massachusetts Health Departments to show that poliomyelitis was an
infectious, contagious disease. The general attitude at that time appears
to be expressed by Sachs10 when he says: "In general, the epidemic
occurrence of any disease is sufficient to prove its infectious or
contagious character." It is significant to note that at about this same
period in medical history that the infectious and contagious nature of
pellagra was also suspected because it occurred in epidemics and convincing
evidence to prove this contagion concept was presented by the
Thompson-McFadden, Illinois, and Texas Commissions appointed to study the
problem. Harris11 "proved" the disease to be caused by a virus and Tucker12
concluded from clinical and pathological studies that pellagra is a virus
disease. It was, of course, unknown at that time that pellagra is a vitamin
deficiency disease and can occur in extensive epidemics.
In 1907, the insistence that poliomyelitis must be a specific
infectious disease arose chiefly from the fact that an epidemic of the
disease was prevailing. The discovery of the so-called virus of
poliomyelitis had not as yet been announced. Epidemics of poliomyelitis,
designated by other names, had existed before, but as Manning13 (1911)
states: "The tardy recognition of the epidemic character of poliomyelitis
in the last century resulted in a very limited written history or, as we
say, epidemiology of the disease."
The attention in this century of the medical profession and the public
had never been so focused upon a disease as it was upon poliomyelitis
during the epidemic of 1907, as the considerable amount of discussion given
to it in both the public and medical press indicates.
A Collective Investigation committee of the New York Neurological
Society14, with the cooperation of the committee appointed by the Section
on Pediatrics of the New York Academy of Medicine, and the New York Board
of Health, was appointed to investigate this epidemic of 1907.
One of the first steps taken by the committee was to send out return
postals to the physicians of Greater New York and vicinity, inquiring
whether or not the physician in question had seen cases of infantile
paralysis during the summer and autumn of 1907. Inquiry blanks were sent to
those physicians who replied and these contained certain leading questions.
The committee concluded from the returned blanks that poliomyelitis was
infectious but not a contagious disease.
The initiative having been taken in New York, the Massachusetts State
Board of Health15 started an investigation to determine the etiology of
poliomyelitis modeled after the New York investigation. Receptacles were
sent to physicians reporting cases for collection of stools in order to
investigate the gastro-intestinal tract as a possible source of infection
of the disease. This investigation, although producing no bacterial
evidence of its etiology, nevertheless, not only focused the attention of
the medical profession on poliomyelitis as a disease entity but likewise
strongly conveyed the idea that the disease was infectious in nature. An
editorial in the Boston Medical and Surgical Journal16 (Sept. 12, 1907)
points out this fact when it says: "Taking it as a highly probably point
that the disease is due to a specific germ, a circular has been prepared to
be sent out to physicians generally, in which a request is made for such
reports as would do much toward establishing at least the usual
surroundings in which the disease occurs most frequently and thus afford
some idea of the conditions favorable to the development and growth of the
supposed morbific organisms."
For the first time in the United States the attention not only of
physicians but the public as well was focused on a vast scale on
poliomyelitis as a possible infectious contagious disease. Although there
was admittedly no conclusive proof of its contagiousness, the general
attitude at that time is summed by Strauss17 (1911) as follows: "It seems
to us despite the lack of absolute proof, that the best interests of the
community would be conserved by our regarding the disease from a contagious
standpoint."
In May 1910, a joint committee was appointed by the American Orthopedic
Association and the American Pediatric Society to communicate to state
Boards of Health and other health authorities with regard to anterior
poliomyelitis. circulars were sent to the medical journals and letters to
the health commissioners of each state and to each provincial health
officer of Canada. These letters urged the physicians and health
authorities to study and quarantine the disease, and the journals gave
publicity to most of these circulars. The letters to the health officers
requested them to take notice of the serious character of the epidemics,
the spread of the disease and its contagious nature, and asked them to make
the disease reportable and to undertake a field study of epidemics.
By that time poliomyelitis had been made a reportable disease in 23
states and in Ontario and British Columbia. The committee recommended that
the disease be made reportable in all states. It recommended further that
all cases be quarantined, sputum, urine and feces be disinfected, and the
same rigid precautions adopted as in scarlet fever.
[Map of U.S. (1910) omitted]
In the same year (1910), Swayze1, Professor of Obstetrics and Dean of
the Medico-Chirugical College of Philadelphia, stated that he had received
a printed official postal from the Department of Health, over the signature
of the Chief Medical Inspector, commanding that he make immediate report of
each and every case of anterior poliomyelitis occurring in his practice in
the same manner that other communicable diseases are reported to the health
authorities. "This arbitrary demand cited infantile paralysis as a
contagious affection although bacterial research failed to back up the
assumption." In substance, Swayze's reply to the Chief Inspector declined
to accept the theory of contagion. In response he received an official
envelope containing a duplicate card desiring reports "in the same manner
as other communicable disease" and hoped it was satisfactory. Swayze
replied to the effect that the conclusion of contagion was not satisfactory
and the incident was closed. In his article, "The Infantile Paralysis
Muddle," in which this exchange of correspondence appears, Swayze offers
evidence that poliomyelitis is simply solar heat prostration. This
concept18 had been considered before and after that time to explain certain
cases of this disease. The lesson to be learned from Swayze's insistence
that infantile paralysis is not a contagious disease is that, nevertheless
according to the law, it is a contagious disease, and that it is illegal to
consider it otherwise. The law, clinical observations to the contrary, has
to be considered. Poliomyelitis is unique in that it is the only disease in
the history of medicine in which a theory, and not an established fact as
to its cause, has become incorporated into the public health law. [Note: In
1996, Duesberg wrote, "AIDS is the first disease whose cause was proclaimed
at a governmental press conference." and "AIDS is the first disease of
consensus, in a time when science has degenerated to consensus." (Inventing
The AIDS Virus)]
The year 1910 also showed other intensive efforts not only to gather
information regarding poliomyelitis but to imply that it was an infectious
contagious disease. The Massachusetts State Board of Health sent out
several hundred letters of inquiry to state boards of health, to officers
of state medical societies and to prominent physicians in various parts of
this country, its dependencies, and Canada.
Statistics reported by Lovett6 (1911) show the results of this survey.
A map of the United States (Fig. 1), on which is marked the number of cases
for 1910, showed a total of 8,700 cases. These were the cases of
poliomyelitis that were officially reported, in some cases estimated, but
this estimate was a poor criterion by which to judge the total number that
had occurred during the year. In half of the states the disease was not as
yet reportable; in the states where the disease was reportable, many cases
were either unrecognized or unreported when recognized; in other states the
alertness of physicians is evident from the number reported. A study of the
map, however, shows the widespread and general distribution of the disease
after the attention of physicians had been called to it. Obviously
poliomyelitis had not spread to the various states indicated. It is equally
obvious that diseases which had doubtless been designated by other names in
the past were now being reported as poliomyelitis. The known existence of
cases of a paralyzing disease such as poliomyelitis, might excite public
panic and this understanding may have deferred physicians from making known
the prevalence of such cases in the past.
If one takes into consideration the evidence that in 1910 there were
officially reported cases of poliomyelitis in the United States in only one
half of the states, and that early, mild, or nonparalytic cases that are
not reported were not considered to be this disease at that time, it is
fair to assume that extensive epidemics existed then and perhaps as great
as those of today. To continue the assumption, we may conclude that the
incidence of poliomyelitis may not have increased after all, as is commonly
supposed.
Collins19 (1910) made a plea in a paper read before the Association of
American Physicians on May 2, 1910, that poliomyelitis be made a reportable
quarantinable disease. He based his arguments of contagiousness on the
prevalence of epidemics of this disease and on circumstantial evidence. He
stated in regard to the so-called poliomyelitis virus: "From a study of the
disease clinically, no information has been obtained as to how the virus
gains entrance into the system." This point has not been conclusively
established even at this date, 41 years later, despite intensive research.
On May 30, 1910, the Academy of Medicine of Paris, France20, appointed
a commission to discuss the expediency of classifying poliomyelitis, or
infantile paralysis, among the diseases in which notification is
obligatory. The commission reported to the Academy at its meeting on July
11, 1910, that the disease was first made notifiable in Sweden and Norway
in 1905, and that similar action had been taken by many of the North
American and Australian states, and throughout the German Empire. The
commission, therefore, recommended compulsory notification of poliomyelitis
in France, quarantine of suspects, patients and convalescents, and
subsequent disinfection of premises. These recommendations were adopted.
From this beginning in the period of medical history from 1905 to 1911,
poliomyelitis eventually has become throughout the world not only
reportable, but according to the law, an infectious contagious disease.
From the time that compulsory reporting of poliomyelitis was adopted as a
public health measure in certain localities up until the present time when
such reporting is universal, the implication that poliomyelitis is an
infectious contagious disease has been included in the public health law.
If it had been made reportable only and no suggestion as to its possible
etiology had been implied in the law, unlimited research would have
undoubtedly been carried out during the last half century and the mystery
surrounding the disease would probably have been solved.
COMMENT
Although poliomyelitis is legally a contagious disease, which implies
that it is caused by a germ or virus, every attempt has failed conclusively
to prove this mandatory requirement of the public health law. The manifest
truth that we must take into consideration is that progress in
poliomyelitis investigations has been impeded by this prematurely
formulated public health law. Hoyne21 (1951) recently summed up our
cumulative knowledge of poliomyelitis since it was made a reportable
contagious disease as follows: "Notwithstanding the intensive studies of
investigators, very little information of practical value has been added to
our knowledge of poliomyelitis during the past forty years."
Hoyne points out, as others have also indicated, the rarity for a
patient to give a history of exposure to a known case of poliomyelitis; the
prevalence of epidemics of this disease in the summer, whereas nearly all
common acute infectious diseases occur in seasons when life is principally
within doors and schools are in session; the warm weather prevalence which
is unusual for a communicable disease; and the inability to prevent
poliomyelitis according to the standards employed in preventing known
infectious diseases. He then makes the startling revelation that the
etiologic agent of the disease is still unknown.
Unlimited poliomyelitis research ceased abruptly when this disease was
legally made a communicable disease. However, definite progress toward a
solution to the problem was being made before the public health law made
poliomyelitis a germ or virus disease. For example, it was reported by
toxicologists and bacteriologists that poliomyelitis could be produced both
by organic and inorganic poisons as well as by bacterial toxins. The
relationship of this disease to beriberi was also being given
consideration. However, these investigations lost support when a germ or
virus came to be considered by some to be the full and final answer to the
problem. Funds for poliomyelitis research were from then on designated for
the investigation of the infectious theory only.
Nevertheless, there are today many investigators who have strong
evidence contradicting the infectious theory. Vitamin and mineral
deficiency, poison, allergy and other theories are being presented to
explain the mystery, but these men, because of the public health law and
the limited ability to obtain funds or cooperation from any source cannot
work freely on the problem of cause of poliomyelitis.
What Louis Bromfield22 states about research in agriculture in his
book, "Out of the Earth," could obviously apply to poliomyelitis
investigations if unlimited research were encouraged. He says: "In the long
history of mankind, the tiniest observation or speculation of the most
humble men (and all really great men are humble in the face of Nature) has
sometimes led to vast and dynamic discoveries of the utmost importance to
man. Many of the greatest contributions to agriculture in our time have not
come from the billion dollar Department of Agriculture nor from the
countless Colleges of Agriculture but from a county agent or a farmer who
had the power to observe, the imagination to speculate and the logic to
deduce a process from which vast benefits have developed. ... [sic] Each
day brings forth some new discovery which completely pulls the carpet from
under theories which in the past were accepted as facts. It is not
impossible that many accredited theories of today may join the exploded
superstitions of yesterday." Bromfield points out that circumstances and an
apparently impregnable chain of circumstance threw the investigator off the
real track. Although he indicates that the pendulum has not infrequently
swung in agriculture from one theory to another than provided the full and
final answer to the problem, however, in poliomyelitis investigations it
has been impossible for the pendulum to move perceptibly because of the
public health law.
The mother, general practitioner, country doctor and clinician have all
made important observations during epidemics of poliomyelitis and have
formulated their own theories regarding the cause of the disease. However,
they have been unable to have these observations seriously considered,
especially when they have disagreed with the orthodox concept of the cause
of the disease. This situation is admittedly unfortunate since our
fundamental knowledge of the disease, as incorporated in the public health
law, has originated form laboratory workers experimenting on animals that
are not naturally susceptible to poliomyelitis. Jelliffe23, 32 years ago,
cautioned: "The purity of laboratory experimentation is rarely repeated in
nature."
Shaw and Thelander24 (1949) emphasize these facts when they state: "The
clinician has not been presented with any sound doctrine regarding its
epidemiology and transmission, its precise pathogenesis, or the details of
diagnosis and treatment. The clinician who observes the only animal
naturally subject to this disease, must develop his own credo regarding
most of the aspects of the human form of the disease including not only
details of management of the affected patient but also the many hypothetic
considerations which influence one's judgment during epidemics."
Shaw and Thelander indicate in the above statement that poliomyelitis
is entirely out of the hands of the clinician, a fact that Sachs25, 41
years before, had also intimated.
At one time or another the classical dietary deficiency diseases,
beriberi and pellagra, and even sunstroke, have been considered to be
communicable infectious diseases. If by law any one, or all of these
diseases, had been made a reportable communicable disease, it is obvious
that today it would legally be a germ disease and a search for the
causative germ might still be in progress. If beriberi and pellagra had
been made reportable communicable diseases, it is conceivable that the
epochal studies on vitamins by Funk and subsequent workers could have been
ignored in the search for the infectious agent as the etiological factor in
these diseases. The progress of medicine would have been seriously retarded.
Yet, in poliomyelitis investigations the continued attempts --
unsuccessful to date -- to show a so-called virus enters the human body
under natural circumstances to cause the disease go on over the objections
of those who maintain that the so-called virus is not the cause of the
disease but rather an endogenous product arising secondary to poisoning,
vitamin or mineral deficiency, etc. and despite the protests of the public
who demand that all possible causes of poliomyelitis be investigated.
A virus theory has been considered as an etiological factor in relation
to other diseases, notably cancer26, and convincing evidence has been
presented to support this hypothesis. Nevertheless, research goes on in
this study of cancer cause along many lines of investigation which include
the virus theory rather than on virus studies only, excluding other
theories, as in the investigation of poliomyelitis. If, however, cancer
were incorporated in the public health law as a reportable communicable
disease as a result of these studies, it is obvious that unlimited research
would cease and that those who maintained noninfectious theories to explain
the cause of the disease would neither be able to obtain funds for
extensive research nor cooperation for investigating their ideas.
The time is long past due for careful reappraisal of the poliomyelitis
problem and for many capable workers with various opinions regarding the
cause of the disease to be given the opportunity to work and the funds with
which to work. The implications of the public health law that poliomyelitis
is an infectious communicable disease must be reconsidered if progress is
to be made.
[Summary omitted]
REFERENCES
1. Swayze, G.B.H.: M. Times, 38:321-325, Nov. 1910.
2. Flexner, Simon: Trans. Am. Pediat. Soc., 23:210-216, 1911.
3. Scobey, R.R.: Arch. Pediat., 67:29-46, Jan. 1950.
4. Scobey, R.R.: Arch. Pediat., 67:400-430, Sept. 1950: 462-482, Oct.
1950.
5. Report of Special Committee on Anterior Poliomyelitis: Trans. Am.
Pediat. Soc., 23:223-228, 1911.
6. Lovett, R.W.: Trans. Am. Pediat. Soc., 23:175-185, 1911.
7.. Sachs, B.: Am. J. Obst. & Gynec., 63: 703-710, April 1911
8. Flexner, Simon: Trans. M. Rec., 78:924-926, Nov. 19, 1910.
9. Caverly, C.S.: Yale Med. J., 1: 1, 1894.
10. Sachs, B.: Am. J. Obst. & Gynec., 63: 703-710, April 1911
11. Harris, W.M.: J.A.M.A., 60: 1948-1950, June 21, 1913.
12. Tucker, B.: in S. Harris, Clinical Pellagra, p. 83, 1941.
13. Manning, J.V.: Am. J. Obst. & Gynec., 63: 723-725, April 1911.
14. Report of Collective Investigative committee: J. Nerve. & Ment.
Dis., 36:619-625, Oct. 1909.
15. Lovett, R.W.: J. Nerv. & Ment. Dis., 36: 681-684, Nov., 1909.
16. Editorial: Boston M. & S. J., 157:375, Sept., 12, 1907.
17. Strauss, L.: Am. J. Obstr. & Gynec., 63:711-723, April, 1911.
18. Scobey, R.R.: Arch. Pediat., 67:29-46, Jan. 1950.
19. Collins, J.: J.A.M.A., 54: 1925-1928, June 11, 1910.
20. Editorial: Boston M. & S. J., 165:707, Nov., 2, 1911.
21. Hoyne, A.L.: M. Clin. North American Chicago Number, pg. 175-188,
Jan. 1951.
22. Bromfield, Louis: Out of the Earth, pp. 5, 43-45, 1950.
23. Jelliffe, S.E.: J. Nerve. & Ment. Dis., 49:522, May 1919.
24. Shaw, E.B. and Thelander: H.E.: Pediatrics, 4:277-286, Sept. 1949.
25. Sachs, E.: M. Rec., 78:925, Nov. 19, 1910.
26. Fox, J. DeWitt: M. Ann. Dist. Columbia, Feb. 1951.