Poliomyelitis: its epidemiology and prophylaxis.

IN the history of poliomyelitis we have the story of a disease undergoing a series of transitions with a pattern of evolution which has passed through at least three stages: first, the protracted era of old-fashioned "infantile paralysis," then the terrifying stage of epidemic ccpolio," and finally the present stage, in which paralytic poliomyelitis currently seems to be coming under cont~ol through the use of vaccination. To review the history in more detail one finds that, although infantile paralysis is probably as old as written history, as a clinical entity it does not seem to have attracted the attention of physicians until the late eighteenth century. Subsequently, for more than half a century this affliction was regarded as ubiquitous and a curious aftermath of teething or some short fevers. Not only were there no accounts of large epidemics during the greater part of the nineteenth century, but there was little mention of anything suggesting contagion, nor was the condition regarded as a medical problem of any magnitude. How prevalent poliomyelitis was 100 years ago is unknown, but Jacob Heine of Cannstatt, Germany, was able to collect in 1840 a considerable series of late paralytic cases. Coincidentally, North American surgeons of the 1830's made occasional mention of acute paralysis in infancy, without comment as to rarity. Apparently, this mid-nineteenth century situation with regard to infantile paralysis is reminiscent of that found in certain tropical countries and urban populations today where substandard sanitary conditions exist, where the disease is endemic and limited to infants, and where it is not regarded as a problem of major importance. The first small outbreaks of what might be called epidemics were noted in the 1830's and 1840's by British and American observers. However, it was not until 1868, when 14 cases were reported in Norway,