North Dakota and the Polio Killer Virus: An Investigative Report
For the first time since 1939, no North Dakotan has contracted poliomyelitis, shortened to polio, formerly called infantile paralysis because the dreaded disease attacked mostly the very young. Not until the 1930s with the invention of the electron microscope did scientists identify this mysterious virus—mysterious because it struck quickly without warning, causing hysteria among the people of a community that it invaded.
By the 1940s researchers began to understand how the polio virus affected the body. It entered through the mouth, followed the digestive tract, and was excreted in the stool. Most frequently it produced mild symptoms such as headache and nausea. In one in a hundred cases the virus attacked the brain stem and central nervous system through the bloodstream, destroying nerve cells, causing muscles to contract. At its worst, polio caused permanent paralysis, most often of the legs; at its very worst it caused death. The majority of deaths happened when breathing muscles were immobilized, a condition called bulbar polio in which the brain stem was badly damaged.
Polio was spread from person to person much like the common cold. Just how the virus originated in a community remains a mystery today. Some blame flies and other insects; some blame unsanitary conditions. There is, however, no mystery concerning the physical devastation that the disease has caused throughout human history. The scant records from the Middle Ages refer to paralyzed children, but not until the mid-1880s did a polio pattern emerge. Outbreaks occurred in places far apart from each other: a farm community near Stockholm, Sweden; a rural parish in Louisiana; an English town in Nottinghamshire. In all cases the disease emerged during the late summer and attacked the young.
The first systematic observation of polio came in 1894 when a small rural Vermont community suffered 123 cases. A young country doctor charted all the cases; each began with a headache, fever, nausea, fatigue, and a stiff neck. Eighty-four cases were under the age of six; in all, 50 people were permanently paralyzed and 18 died. How the disease in epidemic proportions came to his rural community puzzled the doctor.
Polio became more widespread as the twentieth century progressed. The outbreaks followed no geographic pattern: New York City in 1907; Minnesota, Nebraska, Ohio, and Massachusetts in 1910. In 1916 polio struck with intensity in New York, Connecticut, and Pennsylvania. The epidemic lasted from July through October and killed 27,000 people; 80 percent were children under five. Panic accompanied the insidious disease. Some towns refused to let in strangers; in a New York City neighborhood health officials killed 72,000 cats, suspecting them to be the carriers of polio.
In 1921 polio gained national attention when Franklin Roosevelt, a healthy, athletic 39-year-old man of political prominence, contracted polio. Polio could attack anyone in any place. Roosevelt would never walk again without steel leg braces and then only a few steps. Four years later in 1925 North Dakota suffered its first serious polio outbreak: 187 cases with a death toll of 33, a very high death percentage. Another appearance in 1928 killed 16 of the 128 who contracted it.
By the 1940s polio had become a national disease with national concern. Research and public notice intensified. Organizations such as the March of Dimes spearheaded fundraising for scientific investigation and to assist those crippled by the illness. National publications carried detailed stories about communities where polio attacked. Public campaigns stressed the need for cleanliness and rest, especially during the heat of summer. This attention to polio aroused fear—even panic—in places barely touched by the virus. In 1944, for example, an epidemic struck Catawba County in North Carolina, 454 cases. Although two-thirds recovered, newspapers dwelled upon the deaths and those who were crippled for life. Although in that year North Dakota recorded only 53 cases and three deaths, news from far-away North Carolina caused North Dakota health officials to issue stern warnings about cleanliness and the avoidance of group activities. Swimming pools in the state’s cities closed early, and children were told to be in their homes before dark for what was happening in North Carolina could happen in North Dakota.
And it did two years later. In 1946 North Dakota suffered its worst polio outbreak, 492 cases with 28 deaths. For children and adolescents, polio became the fastest growing infectious disease. Statistically, the chance of contracting a serious case was small and the chance of permanent paralysis very small, and the chance of death even smaller. Many more children and adolescents were killed in accidents than suffered death from polio. Polio, however, instilled an intense fear in the population for no one knew when the virus would strike at home.
In 1949 national cases reached an all-time high: 42,000—one for each 3,775 people. Life magazine labeled polio the nation’s leading death threat, calling it “sudden,” “capricious,” and “uncontrollable.” In North Dakota of the 451 cases, 23 died. Polio here attacked about one in 5,000 people, less than the national average.
The year 1952 has been called the year of the plague with 57,000 American cases of which 21,000 suffered permanent paralysis and 3,000 died. The horror stories of that season filled North Dakota newspapers. On an Iowa farm, 10 of 14 children in one family came down with the virus. None died, but two were left paralyzed. Front pages carried the story of a Wisconsin family near Milwaukee where bulbar polio suddenly struck. The 17-year-old high school football player became ill; he was dead by evening. The next day his four-year-old sister complained of stiff neck and fever in the morning; she died later that day. The eight-year-old sister died two days later; and polio killed the third sister, age 13, the following day. Polio struck out of nowhere and could cause death the day it entered the body. For whatever reason North Dakota cases dropped that year to 299 with two deaths. That, however, did nothing to quiet the anxiety of the state’s people. To many the epidemic of fear seemed as bad as polio itself.
With no cure and no vaccine, folks could only protect themselves by following the rules of cleanliness and the avoidance of crowds. Cities used extraordinary amounts of DDT, a powerful insecticide, to kill flies and other insects that were regarded as the carriers of the virus. The iron lung, an airtight tank that exerted a push-pull motion on the chest was designed to help polio victims breathe until they showed signs of recovery. This gave patients with respiratory paralysis a few hours or days with a chance of recovery. Some recovered; some did not.
The fight against polio became a nationwide crusade. Aided by millions of dollars raised to support research to fund anti-polio vaccine, research scientists worked laboratories overtime in the race to eradicate the “capricious, uncontrollable” disease. Two researchers, Albert Sabin and Jonas Salk, led the way. Sabin experimented with a vaccine that used live polio virus. This caused a natural infection strong enough to generate lasting immunity but too weak to cause a serious case. Salk worked with a killed-virus intended to strengthen the immune system against polio without creating an infection. In 1954 the Salk vaccine was field tested on two million elementary school children, including North Dakotans. Sabin tested his vaccine in the Soviet Union. Both were effective, but the federal government and the American Medical Association believed that the Salk vaccine, which used the killed-virus approach, was less risky. North Dakotans lined up by the thousands to receive the Salk vaccine, bringing to an end the summertime nightmare that was polio. As has been the case nationally, North Dakota polio cases have dropped each year, just 17 in 1959 with no deaths. Each year the number of cases has gone down; now in 1965 not one North Dakotan contracted polio. The war against this insidious killer has been won. North Dakota summers are now entirely free of polio fear.
By Dr. D. Jerome Tweton
Originally published as The North Star Dakotan student newspaper, written by Dr. D. Jerome Tweton and supported by the North Dakota Humanities Council.
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