Great Polio Epidemic

Epidemic

Date: 1916

Place: 26 states, particularly New York

Result: At least 7,000 deaths, 27,000 reported cases

Nearly all Americans coming of age during the first half of the twentieth century have childhood memories that include the apprehension each summer brought, when polio epidemics could begin without warning, leaving many paralyzed or dead in their wake. Although poliomyelitis, or infantile paralysis, as it was also called, had existed for hundreds of years, the first large-scale epidemic of the disease hit the United States in 1916. An earlier outbreak had occurred in Stockholm in 1887, with 44 cases reported. There were also outbreaks in New York City in 1907, New York City and Cincinnati in 1911, and Buffalo, New York, in 1912, but none approached the horror and severity of the 1916 epidemic. Indeed, the 1916 polio epidemic set the pattern for polio epidemics through the middle of the twentieth century, both in the virulence of the disease and in the public’s response.

Rate of Infection. Typically, in the early years of the twentieth century, the rate of polio infection in the United States was less than 7.9 cases per 100,000 people. In 1916, that figure rose dramatically, topping out at 28.5 cases per 100,000. People in 26 states were affected by the disease. All told, between roughly July of 1916 and October of 1916 some 27,000 cases were reported. Of these, about 7,000 people died. In New York City, the hardest hit area of the country, there were about 9,000 cases, and nearly all of these cases occurred in children younger than sixteen years of age. During the week of August 5, 1916, at the height of the epidemic, there were 1,151 cases reported in the city and 301 deaths. Many cases went unreported because the families of victims feared that they would be quarantined and unable to leave their homes.

Many victims of the disease suffered mild or no symptoms, often only complaining of a low-grade fever. However, others complained of stiff necks and backs and increasingly painful limbs. Sometimes, this muscular distress grew more severe, with the limbs becoming paralyzed. In the worst cases, the virus destroyed the nerves controlling the muscles responsible for breathing, leading inevitably to death. The swift onset of the disease, the often dire consequences, the mysterious nature of transmission, and its predilection for attacking adolescents and young adults in the prime of life made polio a terrifying word. During epidemics, horrified populations submitted to intrusive public health regulations that they never would have endured otherwise, all in the hope of quelling the infection’s spread.

Polio Becomes Epidemic. Ironically, some researchers believe that the improved sanitation in American cities in the twentieth century changed the way the population experienced the virus. The improved sanitation, while a boon in preventing many forms of illnesses, may have contributed to polio becoming a typically epidemic disease. In the years before the twentieth century, human feces containing large amounts of polio virus were the most common form of transmission. Water contaminated with feces led to many cases. Thus, before the twentieth century, polio infected almost all babies. These babies only suffered a mild reaction, generally no more than a low-grade fever or cold symptoms.

Sometimes babies who were infected did not exhibit symptoms at all. They were, nonetheless, immune to future infection by the virus. Further, polio had always been a far more serious disease in adults than in infants. Improved sanitation meant that fewer babies were exposed to the virus. As a result, more adults were susceptible to the disease. When the virus struck the largely unprotected population, it reached epidemic proportions as adolescents and adults passed the disease to other adolescents and adults, often with disastrous consequences. The illness this population suffered was of a far more serious nature, often leading to paralysis or death.

Although the cause of polio had been identified as a virus as early as 1909, no vaccine existed in 1916. Further, the medical community was uncertain how the disease was passed from person to person, and they did not know why the disease always peaked in the summer, only to ease in the winter. At the time of the 1916 outbreak, popular wisdom attributed polio to wildly different sources. Many believed that the disease was caused by poisonous caterpillars or moldy flour. Others thought that gooseberries or contaminated milk could cause polio. Still others thought that contact with human spit or sewage odors might be the culprit.

In spite of popular opinion, in 1916 medical researchers generally subscribed to the germ theory. That is, they believed that disease was passed from person to person via invisible germs. Much of the general public and some epidemiologists, however, still believed that most disease was caused by dirt. If there were such a thing as germs, they reasoned, then they must be spread by dirty people. Such reasoning led to the extreme measures to enforce quarantine and isolation that characterized the 1916 epidemic, particularly in New York City.

Public Health Response. Public health officials undertook many measures to try to slow the spread of the disease in the summer of 1916. They placed quarantine signs on the doors of victims, instructed that all bed clothing be disinfected, and required nurses to change their clothing immediately after visiting with patients. In the mistaken notion that dogs and cats could spread the disease, pets were not permitted to go into rooms with people suffering from polio. As the epidemic wore on, public health officials gathered up and destroyed many dogs and cats. On July 14, 1916, New York officials announced a new regulation forbidding travel in or out of parts of the city stricken with the epidemic. Further, New York City children had to carry identification cards certifying that neither they nor anyone in their families had polio before they were allowed to leave the city.

The public reaction in New York to the 1916 epidemic is particularly interesting because it reveals the deep resentment the upper and middle classes bore toward the poor and immigrant populations. When most public health and elected officials attributed the epidemic to dirty people, they did not have far to look in New York City, with its large, poverty-stricken immigrant population. As a group, the poor were generally ill educated and did not wield political clout. Consequently, public officials took restrictive measures that were directly aimed at this population. For example, a New York City law required that any sick child living in a home without a private toilet and whose family could not provide a private nurse must be hospitalized. Thus, virtually any sick child who also had the misfortune to be poor was hospitalized. Since hospitals were often the sites of secondary infections, such hospitalization was not always in the best interest of the child. Even more extreme, poor children without symptoms were also quarantined, due to the public’s belief that such children spread the illness to their middle-class and upper-class neighbors.

Residents attributed the large outbreak of polio in New Rochelle, New York, to its immigrant population. Indeed, the immigrant population was looked upon with growing suspicion as the epidemic dragged on through the summer. Immigrant children were banned from city functions and camps. In contrast, middle-class and wealthy children were sent out of the city for the summer, to places their parents deemed were “safe,” often meaning to places that had low immigrant populations. More than 50,000 children were sent out of New York City over the course of the summer.

Several wealthy New York suburbs isolated themselves from the rest of New York, forbidding nonresidents from entering their towns. Hastings-on-Hudson, for example, refused to admit 150 families who wanted to summer there, and police intervention was needed to send them away. Some communities closed their beaches to nonresidents.

The polio epidemic of 1916, then, shows clearly how a public health issue can quickly become an issue of politics, race, economics, and class. In some places, such as Oyster Bay, a summer resort town, the interests of the less wealthy permanent residents were at odds with the wealthier summer guests. J. N. Hayes, in The Burdens of Disease: Epidemics and Human Response in Western History (1998), cites a study by Guenter Risse of the public reaction in Oyster Bay during the time of the epidemic. The permanent residents, many of whom made their living by supplying the summer residents with services, did not want a quarantine imposed that would destroy their livelihoods. At the same time, they did not want to pay through their taxes for health services for the rich guests. That many of the permanent residents were of Irish or Polish descent further convinced the summer guests that they were at risk in the resort.

As the epidemic continued, it became clear that the transmission model that most middle-class and upper-class members held was not accurate. Contact with poor and immigrant populations did not lead to the transmission of the disease; victims seemed randomly chosen. Some public health officials began to advocate for the eradication of the fly, on the grounds that flies spread filth and disease. Once again, the public backed these measures because it gave them a sense that there was something they could do. Nonetheless, killing flies did not stop the spread of polio.

Conclusions. While such reactions seem extreme, it is difficult to overestimate the panic the population felt with a serious epidemic underway, an epidemic that seemed impervious to modern medicine, and to all contemporary public health measures. During the 1916 epidemic, parents began keeping their children indoors and away from crowds, a pattern that repeated itself each summer until a vaccine was discovered.

During the polio epidemic of 1916, federal health officials kept many records and statistics in their efforts to better understand the cause and transmission of the disease. It took over two years to assemble and analyze the data and to release their report. The results of the report did nothing to allay public fear over future epidemics. The report said that the quarantine efforts had been a failure, and the federal health officials were unable to establish the way polio moved through communities. There was no indication that the disease was linked to family socioeconomic status or ethnic background. The report did raise hope that a cure or vaccine could be found if research efforts were focused on those people who had contracted the disease but had not become ill.

The polio epidemic of 1916 was only the first of a series of major polio epidemics that raced through the nation in the subsequent summers. This epidemic, along with the influenza epidemic of 1918, undermined public trust in modern medicine, which had held out such hope for the eradication of disease just a few years earlier. It would not be until nearly 1960 before children would once again populate beaches and pools in the heat of summer.

Bibliography

Daniel, Thomas M., and Frederick C. Robbins, eds. Polio. Rochester, N.Y.: University of Rochester Press, 1997.

Gehlbach, Stephen H. American Plagues: Lessons from OurBattles with Disease. New York: McGraw-Hill Medical, 2005.

Gould, Tony. A Summer Plague: Polio and Its Survivors. New Haven, Conn.: Yale University Press, 1995.

Hayes, J. N. The Burdens of Disease: Epidemics and Human Response in Western History. New Brunswick, N.J.: Rutgers University Press, 1998.

Kluger, Jeffrey. Splendid Solution: Jonas Salk and theConquest of Polio. New York: G. P. Putnam’s Sons, 2004.

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