Note: Here is the "The Age of Polio: Explosion" series to date, revised and combined. Each new installment published on AOA will be added to it.
By Dan Olmsted
"Everything should be made as simple as possible, but not simpler." -- Albert Einstein
On May 1, 1916, thirteen-month-old Lettie Caruso* moved with her family to a tenement at 1295 Gates Avenue, Brooklyn. A fifty-six-year-old woman named Mrs. G.H. Franklin lived and worked on the first floor, where she ran a small ice cream parlor that “the children naturally frequented,” according to a subsequent report by the New York Health Department. Lettie and her family lived in the apartment adjacent to the ice cream shop. On May 9, Lettie became ill. “A private physician was called the first day and came several days,” the Department reported. “She was examined with the stethoscope and at the first visit the doctor thought it was only a cold. As she grew worse a physician from New York was called in consultation. Mrs. Caruso thought the diagnosis was pulmonary bronchitis. So far as she knew the child was not paralyzed, but she cannot remember any special examination for that. There has been no Infantile Paralysis in this house, nor in the adjoining properties.”
That was about to change.
Looking back with perfect hindsight, Brooklyn in May 1916 was ground zero for an explosion that no one saw or heard for a month and more -- and, to this day, no one has satisfactorily explained. Before it ended late that summer, 25,000 people in the Northeast developed paralytic poliomyelitis, most of them young children, and an extraordinary 5,000 died -- nearly half of them in the City of New York, a toll approaching the September 11 tragedy. It was by far the largest and most lethal polio epidemic to date, and it remains one of the biggest ever (see chart).
As spring turned to summer, polio gripped every family with fear, not just in the Northeast but nationwide. It was a fear that never entirely lifted until the outbreaks ended in the United States and most other countries after the Salk vaccine was introduced a half-century later, an occasion so momentous that church bells rang out across the country. But 100 years ago, and especially Brooklyn, there was barely suppressed panic that the authorities and the media did their best to tamp down.
"While there is no need of undue alarm," the Brooklyn Daily Eagle reported in a careful front-page (but one column) article on June 17 announcing the epidemic, "the officials of the board of health are somewhat worried and are taking measures to stamp out the disease."
Since 1894, clusters had occurred with increasing frequency and virulence in the U.S.. The first, in Vermont, affected 132 and killed 18. The worst, in 1907, killed 125 in New York City. It almost seemed like a rehearsal, or a warning. But 1916 marked the moment the Age of Polio arrived in America.
No one could explain why the epidemics began appearing around the turn of the century. As Albert Sabin, inventor of the live virus polio vaccines, mused in 1947: “No circumstance in the history of polio is so baffling as its change during the past fifty or sixty years from a sporadic to an epidemic disease.” It certainly wasn’t a matter of better diagnosis or greater awareness – this of all diseases, with its sudden onset and often permanent disability or death, was as impossible to miss as a child in an iron lung.
“There was no idea in the eighteenth and early nineteenth centuries that poliomyelitis was contagious,” wrote John R. Paul, a professor of preventive medicine and epidemiology at Yale who conducted important polio research himself. “Had there been larger outbreaks in the early or mid-19th century it seems highly unlikely that they would have gone unnoticed.”
In 1917, the year after the Great Northeast Epidemic, John Ruhrah and Erwin E. Mayer wrote, “It seems to be a disease of comparatively recent origin. In the history of most diseases there is a gradual shading off into the older writers until the disease is lost in confusion of inaccurate descriptions. Not so with polio.” They continued: “The disease is so striking in its symptomatology, so devastating in its results, and produces such a deep impression on the popular mind that it does not seem possible that any very considerable epidemics could have happened in the countries in which there were physicians making records of what occurred.”
Perhaps because the outbreak rose and fell so suddenly, bracketed by much that came to define the turbulent 20th century -- war in Europe in 1914, the sinking of the Lusitania, which departed from New York Harbor, the next year; shark attacks along the crowded Jersey shore that sweltering summer of 1916 that caused sensational press coverage and became fodder for Jaws 60 years later; U.S. entry into WW I in 1917; and the Influenza Pandemic that killed 2,157 New York City residents in the week of November 1, 1918, alone -- the epidemic has faded from collective memory.
But the question remains, and it remains important in an age of new diseases like EV-68 and Zika, and disorders like autism, that seem to come out of nowhere and spread like wildfire: What caused the Explosion of 1916? If I'm right, an environmental bomb dropped on Brooklyn set it off, spreading with a smooth but terrible precision like a pebble dropped in a still volcanic lake. That kind of bomb could go off again at any time, anywhere. We need to understand it.
I've foreshadowed some of this saga in ways not yet apparent. It takes twists and turns I never imagined when I began. I only ask that you withhold judgment till the keystone has locked the blocks into place.
(*Sources and notes: Information about the sugar industry in 1916 comes from multiple sources including articles on newspapers.com and in specialized sugar journals. Case histories of Lettie Caruso, Mrs. Franklin and others are from the New York City Health Department archives of the 1916 epidemic at the American Philosophical Association library in Philadelphia. All names have been changed, which the library required as a condition for access. The chart showing the spike in the polio rate is by my colleague Mark Blaxill. Our series in 2011 proposing a new explanation for the roots and rise of polio epidemics paved the way for this series.)