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Different types of paralysis may occur depending on the nerves involved. Spinal polio is the most common form, characterized by asymmetric paralysis that most often involves the legs. Bulbar polio leads to weakness of muscles innervated by cranial nerves. Bulbospinal polio is a combination of bulbar and spinal paralysis.
Poliomyelitis was first recognized as a distinct condition by Jakob Heine in 1840. Its cause, poliovirus, was identified in 1908 by Karl Landsteiner. Although major polio epidemics were unknown before the late 19th century, polio was one of the most dreaded childhood diseases of the 20th century. Polio epidemics crippled thousands of people, mostly young children; the disease has caused paralysis and death for much of human history. Polio existed for thousands of years quietly as an endemic pathogen until the 1880s, when major epidemics began to occur in Europe; soon after, widespread epidemics appeared in the United States.
Beginning in 1914, epidemics of infantile paralysis became common in Iowa. In 1917 there were sixty-one cases in Davenport and in 1916 reports were made of 260 cases in Iowa. In July, 1918 the city of Dubuque was quarantined due to an especially strong epidemic of the disease. The local board of health issued the following set of instructions:
1. Do not permit children to ride upon street cars. 2. Do do not children to visit department stores or other stores where children are apt to be. 3. Do not permit children to gather together in enclosed placed. 4. Wherever quarantine has been established comply with all the rules and regulations thereof and do not violate any of them. 5. Cooperate with the local board of health and the physician in seeing that all homes and premises are clean and in a sanitary condition. 6. Every person must have a garbage can with a tight lid upon it to prevent the accumulation of flies and other vermin. 7. Notify the local board of health of any violation of the health laws and of any place where unsanitary conditions exist. 8. All police officers have been instructed to see that people keep their premises in a clean and sanitary condition. If any person is instructed by a police officer to clean his property or more the source of filth, comply with these instructions immediately. 9. All moving picture theaters will be closed until further notice. 10. All Sunday schools will be discontinued. 11. Cooperate with the health department to the limit. 12. Remove all manure from all lots and keep stables clean and free of filth.
The public playgrounds, bathing beach, and other out-of-doors places of amusement were temporarily left open with the belief that sunlight would kill the germ quicker than anything else. These places, however, within days were also closed. The names of people who were found to be infected were listed in the Telegraph Herald along with their addresses.
To enforce the quarantine, policemen were stationed at every railroad depot and would not allow any child under the age of sixteen to board outgoing trains. State health officials stated that if city and state officials were unable to enforce the order, the national health commissioners in Washington, D.C. would be called to assist.
One of the questions raised was how to handle children who were visiting relatives in the city when the quarantine was placed into effect. The answer came from Dr. G.H. Summer, secretary of the state board of health:
M.H. Czizek, City Attorney Dubuque, Iowa "Hold all children for ten days. Children must then have certificates from the health officer of Dubuque showing no symptoms of sickness of any kind before leaving. Children over sixteen may be permitted to leave now if in perfect state of health. (Signed) G.H. Summer
Quarantine called for strict precautions toward those affected. The state board required the doctors to report new cases immediately to the local board of health which in turn reported to the state department of health. All persons diagnosed were quarantined for at least six weeks after the beginning of the disease. A thorough disinfection of all infected premises had to be made after the end of the quarantine. Since infectious material was found in the secretions of the nose and mouth of infected people, precautions included sprays and gargles of perhydrol (Merck's) containing 1% hydrogen peroxide. All discharges were to be disinfected with the use of chloride of mercury, carbolic acid, and fresh chloride of lime.
The dramatic increase in polio cases and frequent epidemics became regular events, primarily in cities during the summer months. These epidemics— which left thousands of children and adults paralyzed--resulted in the "Great Race" towards the development of a vaccine. The polio vaccines developed by Jonas Salk in 1952 and Albert Sabin in 1962 are credited with reducing the global number of polio cases per year from many hundreds of thousands to around a thousand. Enhanced vaccination efforts led by the World Health Organization, UNICEF and Rotary International could result in global eradication of the disease.