By Dan Olmsted and Mark Blaxill

Our research on the natural history of autism convinced us that while there may have been a few scattered cases throughout history, the disorder first occurred in appreciable numbers – as clusters and ultimately as an epidemic -- only after 1930. Observations at that time about the rarity and novelty of the disorder are far more persuasive than retrospective efforts to claim significant numbers of cases before then.

The same holds true for poliovirus. Nowhere is that clearer than in the 1917 book “Poliomyelitis In All Its Aspects,”[i] by John Ruhrah and Erwin E. Mayer. “It seems to be a disease of comparatively recent origin,” they wrote. “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.”

The same point is driven home by John R. Paul in his standard 1971 text on the disease, A History of Poliomyelitis [ii]. “There was no idea in the eighteenth and early nineteenth centuries that poliomyelitis was contagious,” wrote Paul, a professor of preventive medicine and epidemiology at Yale who conducted important polio research himself. A half a dozen cases within a half-mile of each other might have escaped notice, but “had there been larger outbreaks in the early or mid-19^th century it seems highly unlikely that they would have gone unnoticed.”

But just as arsenic and lead caused instances of paralysis before the invention of lead arsenate, there was also an emerging medical literature of poliomyelitis before recurring outbreaks began in 1893. Beginning just before 1800, there’s a history of doctors who took a reasonable cut at identifying the disease. These include, in 1789, Michael Underwood, who used the term “debility of the lower extremities”[iii]; and in 1840, Jacob Heine, who is sometimes credited as the first to diagnose poliomyelitis.

Several doctors later used the word “paralysis” in describing a similar condition in infants: West in 1843; Rillet in 1851; Duchesne in 1864. By 1860, Heine had pinpointed the spinal cord as the source of the paralysis, and in 1872, the great French neurologist Jean-Martin Charcot called it “tephromyelitis anterior acuta parenchymatose.” This was a pretty modern description, but his precise nomenclature didn’t quite catch hold. In 1874, German doctor Adolph Kussmaul coined the term “poliomyelitis anterior acuta,” later shortened to poliomyelitis.

Going further back, plausible descriptions grow sparse but include the crippled Egyptian priest in a stele dated from 1580-1350 B.C. In 460 B.C., Hippocrates wrote about clubfoot, which may have included some cases of infantile paralysis. And in 200, Galen also discussed clubfoot.

But those were vanishingly rare, and when Underwood described “debility of the lower extremities” in 1789, he clearly thought he was reporting a new phenomenon, just as Ruhrah and Paul asserted with the benefit of much greater epidemiological sophistication. “This disorder either is not noticed by any medical writer within the compass of my reading, or is not so described as to ascertain the disease here intended,” Underwood wrote. “It is not a common disorder anywhere, I believe.”

--

Outbreaks of more than one case, then, were a distinctly 19^th-century phenomenon, and until the 1890s worldwide episodes can be counted on two hands[iv]:

-- In 1835, John Badham’s description of 4 cases in Worksop, England.

-- In 1830-36, Charles Bell’s discussion of multiple cases in St. Helena.