Question

By the spring of 1934, a great deal was known about poliomyelitis. The mode of transmission was known to be person-to-person. The two-phase process of the disease was well understood, and mild non-paralytic infections or anterior poliomyelitis as well as paralytic infections were all understood to be major means of contagion. Animals and most insects were eliminated as vectors. It was known that some victims will die in a few days. Some would have crippling paralysis, and others would recover without a sign. The polio virus had been isolated and identified from most parts of the body---most importantly, the CNS; blood; saliva; gastrointestinal tract, especially the small intestine; mesenteric lymph nodes; and nasopharynx. The damage caused by the polio virus was known to be done in the spinal cord's anterior horn of the grey matter and in the brain tissue.*

When the poliomyelitis epidemic hit Los Angeles, many horror stories from past epidemics had been deeply planted in the minds of medical and nursing professionals. It appears that the medical professionals at the time were well informed about the facts of poliomyelitis, yet most ignored them and, moreover, failed to inform the public. The Contagious Unit of the Los Angeles General Hospital was responsible for most of the activities of the epidemic, and fear of the disease seemed to dominate its efforts, in spite of evidence that much of the sickness that occurred in June of 1934 was not poliomyelitis.*

Physicians and nurses were strained, worried, and terrified of contracting the disease themselves. By June 15, 50 cases a day were being admitted to most hospitals, yet by June 29, only 1 fatal case of poliomyelitis had occurred, producing a sample of the polio virus. A second case produced another sample on July 4.*

When the Poliomyelitis Commission arrived in Los Angeles from Yale University School of Medicine, headed by Dr. Leslie T. Webster of the Rockefeller Institute of Medical Science of new York City, a public meeting was held to review the situation of the epidemic. The meeting digressed to physicians and nurses discussing their risk of getting poliomyelitis and whether they might receive disability pensions if paralyzed by the disease and were disabled in the line of duty.*

New interns in training at the Los Angeles County Hospital were deprived of teaching and proper guidance because the attending physicians were afraid of getting the disease and stayed away, consulting by phone instead of going to the hospital. Doctors who worked at the County Hospital in the communicable disease wards were not welcome on house calls because their patients viewed the hospital as a pet house.*

No one knew how much of the disease that year was really polio. Nearly all adults, especially the nurses and doctors, were afraid of getting paralytic polio. In those who got the serious form of the disease, health care providers observed much pain and weakness, but very few deaths occurred. The number of cases of paralysis was much lower than one would expect. The question was this: Could it be another virus or different strain of the virus? Dr. Webster believed that 90% of the cases were actually not poliomyelitis.*

Researchers had little success in searching for the polio virus in the nasal passages of suspected victims through nasal washings. The disease could not be produced in monkeys or lab animals. Webster believed that the problem was complex and that the infantile part of the infantile paralysis was missing because most cases were in adults. The paralysis face of the disease was also missing, as no paralysis occurred in most cases.*

Oral washings with ropy (an adhesive, stringy-type thread that was soaked in a special solution and swirled around in the throat in order to capture samples of mucous tissue) were done routinely. Ropy washes were able to gather even a few flakes of mucous and the debris in it. The ropy washes used a special solution that helped save samplings of potential polio virus evidence and preserved the evidence for months (101) days for later study. Even after such a long time, the specimen could be spun in a centrifuge and yield the virus; thus, in future outbreaks, disease investigators would not need to take an army of public health workers along to gather specimens.*

Hysteria raged on in the main populace. Not only was the general public afraid of getting the disease, but a major part of the medical and nursing profession was also participating in the fear. Yet officials were not daring enough to tell the public that the disease was not polio. It was disclosed that half of the 1,301 suspected cases were not poliomyelitis. The actual attack rate was estimated to be from 4.4% to 10.7%.*

There was no doubt that Los Angeles was visited by the epidemic of poliomyelitis in the summer of 1934, but it was a mild one. Most of the people who were sick that summer were sick either from another disease (encephalitis, meningitis, or influenza) or from a mild form of a different strain of the poliomyelitis. Patients had atypical symptoms for polio, and the observed symptoms were rheumatoidal or influenzal with striking emotional tones of fear that they might get polio. It was observed by US Public Health Service officer Dr. A. G. Gilliam, of the Los Angeles County Hospital"s personnel, "Irrespective of actual mechanisms of spread and identity of the disease, this outbreak has no parallel in the history of poliomyelitis or any other CNS infections"*

As an unfortunate outcome of this epidemic and its resulting hysteria, patients who exhibited even a slight degree of weakness were immobilized in plaster casts. This was a common practice in the 1930s, and many were subjected unnecessarily to this treatment.

Answer the following three question below

Case Questions to Respond to

3. What were the final conclusions about the polio epidemic of 1934 in Los Angeles, and what were the implications for the future?

Answer 1