British workers making iron lungs for polio victims.

What we do -
and don’t know -
| about polio

= ‘By Dr. MURRAY ABOWITZ

Te common name for poliomyelitis—infantile paralysis—is peculiarly appropriate, not only because

the

ahd

AS a sporadic disease, polio is
a old. Sigirest even suggests
ih Possibility of it going back
the 18th Egyptian dynasty.
cg Suddenly and without any
tate reason, polio began to ap-
time as an epideniic—for the first
1897 i Stockholm, Sweden; in
iy pand then in the U.S. in Vert
Snt in 1894, From that time to
bia Present, polio epidemics ra-
Py spread throughout the civi-
tia _World, ‘the epidemics  in-
~ “asing in size and frequency.

Sou the very beginning we run
(ety the first of a long sefies
;, Uhanswered questions regard-

"Ng polio: i
sud Polio; why did it change so

*Pidemic disease?

Another unsolved mystery is
a 8eographical distribution.

© epidemics are limited to the
mi. ot and subtropical cli-
Tees, and, significantly, polio

Completely confined to those
Ba of the world that have
hy € the most progress in sani-
‘on and hygiene.

Epidemic. polio is unknown, for
Chtnen in China, though many
®sé citids, like Peiping,
‘nghai and Tsientsin, have the
ear latitude and comparable
ate as the commonly afflict-
Cltigg eropean and American
* The conclusion is obvious

ae baffling; polio epidemics oc-
i, in cities with modern sati-
8tion,

The

Polig only known host for the
at Vitus in nature is man. Al-
iene in the laboratory animals
Ae 8S monkeys and mice can
oa tected with the disease, it

‘Oe
— *S Rot occur naturally.

Numerous animals, insects,

denly from a sporadic to an

it strikes primarily. at. young people, but also because it is the infant, historically speaking, among
Toster of epidemic diseases.

Epidemics and pandemics of bubonic plague, black plague, smallpox,
“Pius and leprosy, are as old as man himself. But within our lifetime’ we have seen a disease suddenly

Completely change its character.

foods and other possible sources
of infection, either as carriers or

_as intermediate hosts, have been

investigated and ruled out. The
common housefly, long regarded
with suspicion, has been exoner-
ated by large scale experimental
decontamination with DDT.

During an epidemic in 1941,
polio virus was discovered in sew-
age from New York City. The
finding was greeted with hope-
ful enthusiasm, but subsequent
investigations failed to relate
possible means of transmission.
Tubercle bacilli, human _ type,
were found in the same sewage,
and we know that that is not the
way tuberculosis spreads.

What, then, is the means of
spread of transmission of polio?
This is the most significant and
controverial question — particu-
larly because this is the very
heart of the problem as to what
preventive measures are to be
taken by a community -to safe-
guard itself during an epidemic.

At .first it was generally
thought the virus entered the
brain through the olfactory nerve.
This theory was based on a few
observations on monkeys, but
was never confirmed in man.

Then, about a decade ago, it
was discovered that large quan-
tities of the virus were present
in the intestinal tract arid stool
of polio victims, as long as
twelve weeks after onset. This
led to a general acceptance of the
gastro-intestinal tract as the por-
tal of entry for the polio virus
and the olfactory nerve theory

’ was discarded.

.

However, in the last few years,
another theory has been revived.
It was long known that polio
yirus was occasionally found in

the nose and throat, but only in .

a low percentage of cases com-
pared to the frequency in the
stool. It has only recently been
noted that.the virus is present in
the nose and throat only for ap-
roximately five days before and
five days after onset of disease.
So if examinations are confined
to that period, virus is found in
the nose and throat in an im-
pressively higher percentage of
cases, enough to give the nose
and throat mere serious consi-
deration as the portal of entry.

This controversy regarding the
portal of entry is of considerable
practical + importance, because
dependent on it are the theories,
of the transmission of polio, on
which in turn depend the even
more controversial and more
practical problem of public health
measures.

If the portal of entry is the
intestinal tract, then polio is more
likely a filth-borne disease and,
in some as yet undertermined
manner, the presencé of virus
in the stool plays an important
role in its transmission. It also
follows that the spread from per-
son to person is less likely, be-
cause personal contact with in-
fected stool is uncommon, though
no doubt possible.

If on the other hand the portal
of entry be the nose and throat,
then the virus can be spread by
means of drioplets which can be
minute and even microscopic,
and can be discharged into the
surrounding air in large quan-

tities by coughing, sneezing, and
by children especially, by laugh-
ing and shouting.

From this it would follow that
the chief mode of transmission
is from person to person, that the
transmission does not require an
intermediate mechanism, that
the spread of infection can occur
with comparative ease wherever
people gather.

I venture to state that droplet
infection, person to person trans-
mission, is at present, with only
a few exceptions, generally ac-
cepted by the investigators and
epidemiologists. Numerous field
studies indicate that such is the
case.

With the great prepdnderance
of scientific evidence in its fa-
for, this theory, until proven
otherwise, must be the rational
basis for public health measures
to prevent and control polio. Fu-
ture developments can and may
disprove this theory, in which
case we will only be guilty of hav-
ing played safe.

The final and most important
question is the problem of pre-
ventive measures to be taken
during an epidemic. There are
several schools of opinion on this
Subject.

One schoo] maintains person-
to-person contact is not thé car-
dinal means of tiiansmission and
therefore crowds, public gather-
ings, school rooms, swimming
pools, do not play an important
role in spreading the polio virus.
The other school, chiefly the ad-
herents to the droplet inféction,
person - to - person transmission
theory, believe the spread of in-
fection can be diminished by
avoiding crowds, keeping schools
and swimming pools closed.

I would like to quote a few

-authorities on this subject.

The entire issue of the Ameri-
can Journal of Medicine of May,
1949, was devoted to a symposium
on polio, In an article entitled
‘Public Health Considerations of
Polio,” Dr. Joseph Molnar of the
Detroit department of health
wrote:

“Since person-to-person con-
tact is probably the most im-
portant of the many proposed
theories of the mode of trans-
mission of the disease, and be-
cause circumstantial evidence
strongly suports this proposal
it. should be recommended that
persons, particularly children,
do not travel to or from the
epidemic area. The closing of
community borders, schools and
churches is not recommended;
by the time such measures are
initiated the seeding of infec-
tious agents in the community
or in the area would be so éx-
tensive that at best they would
be only gestures or futile at-
tempts.

..“However, in the event that
polio occurs in epidemic pro
portions at a time thag schools
are to be opened, it may be con-
sidered a measure of expedi-
ency to delay their opening. It
is considered expedient to pro-
tect children so far as prac-
tical against unnecessary con-
tact with persons outside their
homes, and it is recommended
therefore as good practice dur-
ing an epidemic of polio to
keep children away from swim-
ming pools, wading pools, thea-
ters ‘and churches.”

The Nations! Foundation for
Infantile Paralysis, an organiza-
tion that must certainly know
something about. polic, ran an ad-
vertisement in the New Yorker
magazine on April 80, 1949, in
which was a list of precautions
for parents to take against polio.
Heading this list is the following:

“Avoid crowds and places
where close contact with other
persons is likely."

The respectable and conser-
vative New England Journal of
Medicine in 1947 editorialized on
the subject ef polio prevention as
follows:

“Closing of dlaygrounds,
pools, etc., where children come
in direct «ontact with each
other, seems justified. The clos-
ing of schcols depends on
whether it is possibly better to
avoid contuct between chil-
dren in or out of school.”

Lawson, in the New England
Journal of Medicine, 3948, states:

“At present, the most con-
vincing evidence indicates that
close contact between human
carriers of the virus plays the
most importat role. Ordinary
contact in schools, movies and
churches may play some role,
but intimate contact between
children ‘during an epidemic
appears to be the most danger-
ous factor in the spread of the
virus and should be reduced
to a minimum.

A few weeks ago in New York
city, I talked with Doctor I. Jay
Brightman, assistant director of
the division of medical services,
New York state department of
health. He said that he and his
department did not believe that
restrictions during a polio epi-
demic were of any value. At his
own suggestion he sent me a copy
of the state department of héalth
bulletin, dated May 9, 1949, which
had a statement on polio.

This official bulletin advised
as follows. “So far as possible,
it is well to avoid crowds and
new contacts in trains, buses,
boats or other crowded places
where you may be close to an-
other’s breath or cough.”

I cite this as a typical example
of the general confusion that un-
fortunately exists régafding polio.
3S

What, then, shall we do dur-
ing a polio epidemic to secure
the maximum degree of safety
for children? I would like to sub-
mit. the following list of sugges-
tions.

@ That the opening of schools
be postponed if they are sche-
duled to open during an epi-
demic.

@ That public swimming pools
be closed.

@ That all children under a
certain age limit (the exact age
to Pe determined) be prohi-
bited from all places of public
gathering, such as _ theaters,
circuses, sports events, public
transportation, department
stores, etc.

‘@ That public playgrounds in
crowded areas remain open but
these be adequately supervised
and controlled.

@ That the public be kept in-
formed of the exact status of
an epidemic and a moré ade-—
quate campaign of warning and
education be carried out, in or-
der to ensure enforcement of
the above program and under-
standing of its necessity.

I am fully aware such a pro-
gram might cause some incon-
venience and perhaps even hard-
ship. But so does polio. In conclu-
sion, it is to be hoped that what-
ever measures are taken by our
city officials during the next
polio epidemic, that commercial
and financial interests be given
less consideration.

@ Condensed from an addresé
given before the Hollywood
Arts, Sciences and Professions
Council.

PACIFIC TRIBUNE—AUGUST 5, 1949—PAGE 5

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