1862: Phoebus writes symptoms of 'summer catarrh'

Since Dr. John Bostock defined hay-fever for the medical community in 1819 and 1828, there was little mention of the ailment until Dr. Philipp Phoebus published a book titled "On the Typical Catarrh of Early Summer, or the so called Hay-fever or Hay-asthma" in 1862.  (1)

Dr. Phoebus was professor of medicine at the University Giessen in Germany. He describes six groups of symptoms, of which may vary from one case to another.

1.  Nostrils.  Severe catarrh (inflammation).  This results in "severe sneezing, which is very and frequent and recurs in paroxysms of ten, twenty, or more sneezing in rapid succession, coming on at short intervals; so that the sufferer may sneeze as often as several hundred times in the course of a day."

2.  Eyes.  Catarrh and increased secretions. The eye feels full, itchy and irritating.  The eye looks red and swollen.  Eyesight is weakened, and there is an intolerance to light. Both eyes are usually affected simultaneously.

3.  Throat. Pharynx is red, and swollen; there is intense itching of the fauces (back of the mouth behind the tongue) and posterior part of the soft palate; and this unpleasant sensation is aggravated by the ineffectual efforts which the patient makes to relieve it by moving the tongue about the mouth.  Sometimes there is difficulty swallowing. 

4.  Head.  Headache.  "Some more slight, but more frequently severe, and situated either at the forehead, which is hot and burning, at he occiput (back part), or over the whole of the head. The pain is often brought on and increased by the paroxysms of sneezing, and, assuming a neuralgic character, may extend along the course of the facial nerve, or into the external auditory passage. The patient complains of a constant feeling of irritation and itching about the forehead, the nose, the chin, and the ears."

5.  Lungs.  Mucus membrane of larynx to bronchi. Bronchial catarrh. Asthma. Dyspnea (shortness of breath). Cough may be insignificant or severe and loud. Expectoration may occur with this cough.  Irritation of larynx and trachea, and "feeling of weight and pressure within the chest; the patient's voice becomes muffled and coarse... The difficulty of breathing is occasionally very distressing, and wheezing, sibilant sounds may then be heard throughout the greater parts of the lungs. The attacks of dyspnea are more strongly marked towards evening, and continue through the whole of the night. It is in this class of cases that the patient's sufferings are the most severe.Generally, after having been asleep for one or two hours, or a longer period, the patient wakes up suddenly, gasping and struggling for breath, as if every moment would be his last; his eyes are protruded, his lips and face become livid, and ho eagerly throws open the doors and windows of his room in his ineffectual efforts to get more air, until at last he sinks down completely exhausted. When he falls asleep, his slumber is short and restless, and he is again aroused, after a brief interval of repose, by the same painful constriction across the chest, and difficulty of breathing. When the asthmatic symptoms are well-marked the dyspnoeal paroxysms come on earlier at night, or in the evening, and continue until the next morning."  These are thus called asthma attacks, or hay asthma, or periodic asthma.

6.  Nervous disturbance.  This is coupled with catarrhal fever. Shivering and cold perspirations with sneezing and coughing. "The patient is uncomfortable, restless, , and unfit to attend to his ordinary avocation, and complains of weariness, defective memory, inability to fix his attention upon what he is doing, and heightened susceptibility to external impressions. There is a sense of general irritability, and the least noise, draughts of cold air, and various trifling inconveniences, which at other times would pass unheeded, disturb and distress the patient very much; and his sufferings are too frequently increased by the want of sympathy and apparent disbelief of the severity of his ailment, shown by persons about him, who, enjoying perfect immunity themselves, cannot form any adequate idea of the extent of the patient's sufferings."

These symptoms generally "make their appearance suddenly, and remain for some weeks, or even, in severe cases, months." 

What brings on the attack?

• Flowering of the grass
• In the fields where a late crop of hay is grown
• Emanations given out by decomposing leaves and other vegetable matter
• Operation in low-lying localities, near stagnant water

Just think for a moment of suffering from the above mentioned symptoms in 1862 when there was absolutely nothing you could do for it.  I mean, there were remedies, but nothing even remotely as effective as what we have at our disposal today.  In the worse cases, modern medicines only take the edge off.

I can honestly say there have been many times I have suffered from the above.  I have experienced the burning, itchy eyes that I can't help but to rub, and this rubbing merely exacerbates the problem.  I remember the itchy throat, and scratching it by rubbing my upper palate to the lower, and sometimes by making a grunting noise that my family and friends teased me about. And this just made the itching worse. 

When I was a kid in the 1970s there was a warning on the package of antihistamines that said don't use if you have asthma.  My parents and doctors took this seriously, and so I often had to suffer much as a hay-fever sufferer would have in 1862.  There were many agonizing days and nights. 

As a sufferer myself, I can't help but to have empathy for these sufferers.  I can't help but to see them, and feel their agony.

 "Unless the length of the attack is abridged by medical means, the patient often remains for many weeks, at least, in deplorable condition, and is incapacitated from following his ordinary occupation."

References:

1. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24.  The quotations are from Smith's descriptions of Phoebus's ideas. 

1873: Blackley studies hay fever

Dr. John Bostock defined hay-fever for the medical industry in 1819, and by 1840 physicians in England and the United States were diagnosing patients with the disease.  The quest was on to better understand the condition, and the person up to the task was Dr. Charles Harrison Blackley, a surgeon from Manchester, England. 

He was born in 1820, and worked as a printer and engraver until he was 35.  He studied at Royal Manchester School of Medicine, and he qualified as a doctor in 1838.  Yet he did not receive his M.D. until 1854 in Brussels.

References:

1. "Charles Harrison Blackley, 1820-1900," The University of Manchester: The John Ryland University Library: Manchester Medical Collection, http://archives.li.man.ac.uk/ead/search?operation=full&rsid=dc.title%20any%2Frelevant%2Fproxinfo%20%22William%20Charles%20Henry%22&firstrec=1621&numreq=20&highlight=1&hitposition=1638, accessed 9/13/14
2. Blackley, Charles Harrison, "

and by the time he was 28, in 1848, he was diagnosed with the newly defined disease called hay-fever.  He wanted to learn as much as he could about his disease, and he "carefully read over most of the scanty bits of literature of the disease then existing," Blackley explained in his 1873 book "Hay-fever: its causes, treatment, and effective prevention." (2, page 8)

His quest frustrated him, as he wasn't able to generate any knowledge about the "nature of the cause," he writes.  "I was inclined to regard heat as the principle exciting cause, but my experiences did not quite coincide with the opinions of those who had written on the disorder, and this experience had, unfortunately, compelled me to come to the conclusion that until something more was known than I had learned from the writings of others, or from my own previous observations, there was no chance of escape from the annual torment. I had thus a personal interest in getting a more thorough knowledge than I then possessed of all the phenomena of hay-fever." (2, page 8)

So he decided to do experiments.  At first he tried to find subjects to experiment on, yet only a few volunteered.  So this basically forced him to resort to experimenting on himself, which he started doing in the year 1859.  Surely there were some who criticised him for this, although his experiments were so well founded that they were readily accepted by the medical community.  (2, page x)

John Fry, in his 1963 article "The Natural History of Hay Fever," which appeared in the Journal of the College of General practice, wrote that hay fever was usually diagnosed "in patients who presented with characteristic bouts of sneezing with dry nose and running eyes during the 'hay fever season' between the end of May and the end of July." (1, page 260)

Fry explains that by the mid 19th century many studies were performed on the reproduction of plants, and it was determined that plants reproduce sexually, and pollen was discovered.  It was learned that some plants were pollinated by bees and others by wind. (1)

Also at this time there were many new ideas to explain diseases.  One of the greatest scientists of the 19th century was Louis Pasteur (1822-1895).  He performed many studies and became among the first physicians to believe -- and prove -- that diseases were caused by tiny microbes. (1)

Pasteur proved that by injecting small amounts of proteins from harmful microbes into a person you could protect people from certain diseases, and even cure some diseases (such as rabies).  This type of therapy was referred to as prophylaxis, which means protection from. (1)

So other doctors soon picked up on Pasteur's ideas. Fry explains that Dr. Blackley believed his own hay-fever was the result of exposure to grass pollen not hay.  So he decided to perform tests on himself to prove his theory.  In 1873 he published his work in a book called "Experimental Researches on the Cause and Nature on Catarrhus Aesivus (Hay-Fever, or Hay-Asthma)." (1)(2)

Blackley made two significant observations about hay fever:

1. It was caused by grass pollen, not hay
2. It was a disease of the educated, upper class and wealthy, including physicians and clergy

Terry Allen Hicks, in his book "Allergies," (2006, China, page 40) describes how Blackely saved some grass pollen in a jar until winter.  When all the grass was dead he opened the jar, inhaled, and almost immediately started sneezing.  He thus proved that allergy symptoms were not caused by hay but pollen.  Yet despite this evidence, the term 'hay fever' stuck. (3)

Blackley performed another test on himself where he "inserted pollen into a small cut on his skin and a rash developed within 20 minutes.  He later determined that this test proved he was allergic to pollen, and his experiment became the first ever allergy skin test.  Today's allergy testing is similar to what Blackely used," wrote Paul Ehrlich and Shimer Bowers in their 2008 book "Living with Allergies."  (5)

Bostock believed hay fever was a condition of the upper and middle classes.  Philipp Phoebus came to the same conclusion.  William Abbotts Smith considered this theory, although he writes that he witnessed "many well-marked cases of Hay-fever amongst the poorest classes."  (7, page 36)

Blackley tended to agree more with Bostock and Phoebus.  He said he experienced only two cases of working class people with hay fever, and therefore concluded the disease to be an "aristrocratic disease." (2, page 6)

Gregg Mitman, in his 2007 book "Breathing Space," explains Blackley's thinking on this subject.  He writes that...

 "before the industrial revolution... a large portion of the population in England was exposed to the atmospheric conditions of country life, either through the cultivation of the soil or the production of woolen, linen, and cotton goods, largely in rural villages and towns.  As England's population increased, large numbers of people moved from the 'country to the workshops and mills of towns.'  In doing so, they removed themselves from pollen and other exacerbating factors to which agricultural laborers were continually exposed.  At the same time, the influx of population into cities, where greater educational opportunities, wealth, and luxury prevailed, created circumstances 'favorable to the development of the pre-disposition to hay fever.'  The frenzied pace of urban life, the mental demands of modern business, and the removal from nature, which could fortify the body and calm the hurried mind, had strained the nervous system of the city's educated and well-to-do classes.  'As population increases and as civilization and education advance,' Blackey warned, hay fever 'will become more common'" (2, page 14)

So Charles Blackley was a significant contributor to the knowledge of hay fever.  Of interest is that his theory about hay fever being a disorder of the upper class is an idea that still emulates in the medical community.  A new theory is that it's a disease that develops because the immune system isn't exposed to enough germs, and therefore the immune system doesn't develop properly, and hay fever (allergies) and asthma develop. A theory now is that it's a disease associated with modern civilization. He passed away in the year 1900.
References:

1. Fry, John, "The Natural History of Hay Fever," Journal of the College of General Practice, 1963, 6, page 260
2. Blackely, Charles Harrison, "Hay-fever: its causes, treatment, and effective prevention," 1873, 1880 2nd edition, London, Bailliere
3. Hicks, Terry Allen, "Allergies," 2006, China, page 40
4. Mittman, Gregg, "Breathing Space," 2007, New Haven and London, Yale University Press
5. Ehrlich, Paul M., Elizabeth Shimer Bowers, "Living with Allergies," 2008
6. Beard, ibid, pages 12 and 13, referenced by Beard from Dr. Mr. W. Gordon's paper "Observations on the Nature, Cause, and Treatment of Hay-Asthma," London Medical Gazette, 1829, vol. iv, page p. 266, reference from "Experimental Researches on the Cause and Nature on Catarrhus Aesivus (Hay-Fever, or Hay-Asthma), by Dr. Charles Blackly, London, 1873
7. Smith, William Abbotts, "On Hay-Fever, Hay-Asthma, or Summer Catarrh," 1867, London, Henry Renshaw, pages 17-24.  The quotations are from Smith's descriptions of Phoebus's ideas. 

1898: A description of hay fever x

The affliction was described in a letter to the editor by Dr. J. J. S.Doherty of New Haven Connecticut in the 1898 edition of "The Medical World" as follows (1, page 391):

Editor Medical World:—The season for hay fever is at hand, and as but few who are susceptible to the complaint know how to avoid, much less to cure it, a few words relative to the nature and treatment of the ailment would perhaps not be amiss. 

Hay fever is a nervous affection analagous to asthma in its manifestations, usually most prevalent during the spring and early summer. The poorer classes, and more especially those living in populous towns, rarely, if ever, suffer with it. It occurs principally among the educated classes, whose nervous systems are highly developed. Tho not in any sense a dangerous ailment, it is at all times very troublesome and irritating.

The inhalation of atoms of hay or blooming grass, the pollen of flowers, the particles producing the odor of fruit, dust or exposure to draught will excite an attack in persons subject to the complaint, but rain or damp weather invariably brings relief. 

At one time it was generally supposed that the odor of hay when being mowed or carted could induce an attack, but recent observation shows that it may occur entirely independent of the existence of hay fields and is really a nervous derangement. A visit to the seaside, a trip to the mountains, or residence in a populous town, will, however, remove the asthmatic tendency. To effect a cure the treatment should begin from six to eight weeks before the attack is expected.

A good prescription to use is: 

• Fowler's solution .... dr. iij
• Tr. belladonna; dr. ix
• M. Sig.—Twelve to sixteen drops for a dose.

This should be continued daily until the period of the attack has passed, and repeated again the following year at the same season. Each successive year the attack will become lighter and susceptibility may cease in two years, altho four years is the average time required for a cure. This line of treatment was taught us back in the '70s, by Prof. William H. Thomson, of the New York University

J. S. Doherty, M.D.

New Haven, Conn.

References:

1. Taylor, C.F., editor, "The Medical World," volume 16, 1898, Philadelphia, 

1873: The Trendelenburg position is born x

Probably just about every person in the medical profession is familiar with the trendelenburg position.  It's where you set the patients bed so that his hips are higher than his head.  Basically, you set him so that he's upside down. 

This is done for therapeutic reasons.  Respiratory therapists do it to aid in the drainage of secretions during chest physiotherapy.  Chest physiotherapy is where the therapist cups his hands and bangs on the patients chest to a rapid rhythm.  Vibrations supposedly help knock sections from the lungs. 

By placing the patient in trendelenburg, this allows the now loose secretions to flow to the upper airway, where they can be coughed up or suctioned out.  Patients who require such therapy are any patients with thick, tenacious secretions, such as bronchiectasis or cystic fibrosis.  Sometimes it's done for COPD patients too. 

Another use for trendelenburg is to help drain blood to the brain to increase blood pressure.  It seems that one of the first reactions when it's determined a person's blood pressure is critically low is to place the person in trendelenburg.  Yet one might wonder: does this really work to lower blood pressure?

The Trendelenburg position was first used in the mid 19th century by German physician and surgeon Fredrish Trendelenburg, according to AMargo A. Halm in her 2012 article in American Journal of Critical Care, "Trendelenburg Position: 'Put to Bed' or Angled Toward Use in Your Unit."  (1, page 449)

Halm explains that Trendelenburg used the "technique known in the Middle Ages as the "head-down position."  In his surgical text of 1873, Trendelenburg recognized that raising the patient's hips caused the bulk of abdominal viscera to slide toward the diaphragm, providing a less cluttered operative field for lower abdominal and pelvic procedures." (1, page 449)

It wasn't until the early 20th century that the position was used by physiologist Walter Cannot to "displace blood from the lower extremities to enhance venous return in the treatment of hemorrhagic shock.  This action was thought to cause an 'autotranfusion' to the central circulation, increasing right and left ventricular preloads, stroke volume, and cardiac output (CO)."  It would, thus, increase a patients blood pressure.  (1, page 449)

Use of Trendelenburg for raising blood pressure was questioned during the 1950s, but it became widespread anyway as a "mainstay of resuscitation."  Recently there have been studies that show the position does increase blood pressure, although the effect is only short term.  (1, page 449)

Halm notes that most studies conclude that "Trendelenburg position does not lead to beneficial changes in blood pressure or CO/CI..  As a result, this position is probably not useful in rescue efforts.  The associated hemodynamic effects are small and unsustained and thus are unlikely to have a clinically significant impact on hypotensive patients."

The study results, Halm writes, conclude that it's better to use other methods of reducing blood pressure, such as:

• Fluid boluses
• Pharmacological therapies
• Other devices targeted to the cause of hypotension

Yet like any other procedure used by the medical profession, physicians aren't going to stop using something they've been doing for a long time.  Regardless of the evidence, physicians are going to continue doing something that simply sounds like a good idea. 

Yet Halm notes that this might not be such a good idea, because trendelenburg position can be "associated with harmful cardiopulmonary, neurological, and vascular effects, especially in the presence of disease." (1, page 451)

Side effects of trendelenburg include:

• Anxiety
• Restlessness
• Onset of pounding headache
• Progressive dyspnea
• Loss of cooperation
• Hostile patient
• Struggling efforts to sit upright

Although, it would seem that many of these side effects would result in a ticked off patient, something that would almost assuredly increase blood pressure.  I once had a doctor order BiPAP for a patient just because he knew it would tick the patient off, and therefore raise blood pressure. 

She notes that "the position should be used with caution even when immediate/transient benefits are desired."  And I would have to add that the ethics of doing something that has no proven long term effect may work to the disadvantage of therapy.

I think the position would also be harmful when you have a patient in respiratory distress with a low blood pressure.  The temporary rise of blood pressure may come at the expense of making breathing exceedingly more difficult and uncomfortable for the patient. 

All this said, I have never had a patient complain about being in this position, and usually there sick enough, or medicated enough, not to care. 

References:

1.  Halm, Margo A., RN, "Trendelenbug Position: 'Put to Bed' or Angled Toward Use in Your Unit," American Journal of Critical Care, November, 2012, Volume 21, No. 6, page 449-452, www.ajconline.org

1800-1987: The rise and fall of polio

One of the neat things about the poliomyelitis virus is it basically hangs around for thousands of years, staying alive in random hosts, pretending it
doesn't exist, waiting for an ideal moment to wreak.  That moment arrives at the turn of the 19th century. 

Polio, therefore, is barely a threat to society prior to the 18th century, and is  basically ignored.  Yet once it started showing up as random epidemics in Europe and the United States, people started taking notice.  The search was on to find the causative agent, and a cure. 

Jo Nugent, in his 1987 article in The Rotarian, "The historic battle against polio," explains that the disease spreads rapidly in areas with poor sewage systems, so larger cities where sewage was dumped into the streets provided a haven for the virus.  Kids playing in the streets were in constant contact with the virus.  Once on a kid's finger, it was only a matter of time before the finger was set into a mouth.  The virus went to work. 

Nugent lists the following as the critical events in the evolution of the disease, and the quest to learn about it, and get rid of it (1, page 24):

• 1789:  Michael Underwood makes the first clinical notation of the disease
• 1801:  First recorded epidemic occurred in Scandanavia
• 1807:  Swedish researchers note the disease "struck otherwise healthy youngsters, and not necessarily in the poorest population samples."
• 1840:  German orthopedist Jakob von Heine makes the first clear description of the disease
• 1887:  Oscar Medin of Sweden is the first to recognize it as a pandemic. He was the first to describe the pathogen as a virus.  
• 1896:  C.S. Caverly observs polio also occurs in non paralytic forms
• 1905:  Medin's pupil, Ivan Wickman, experiences the Swedish epidemic, and "concluded that the manner of transmission was person to person."  Christian Legaard confirms Cavalry's theory in a study of over 1,000 cases.  He describes that people with passive forms of the disease are spreading it to others
• 1908-1911:  During the Swedish epidemic it's determined the disease rarely occurs in the same rural areas oftener than every five years, since the population develops immunity to the infection at an early age.  It's learned mortality is lowest in the 0-5 age group, and mortality rises with age. 
• 1909:  Karl Landsteiner of Viena learns the virus can be isolated in a laboratory
• 1911-1918:  Sister Elizabeth Kenny establishes a method of "moist heat stimulation and reeducation of muscles of polio patients.
• 1921:  While Secretary of Navy, Franklin D. Roosevelt comes into contact with polio virus.  He becomes paralyzed, and this later has a major impact on his life, and on the lives of others inflicted with the disease -- for the better.  I will write about FDR's polio impact later.
• 1929:  Philip Drinker and Louis Shaw invent the iron lung which saves many lives, and helps give birth to the respiratory therapy profession.
• 1940:  Kenny's methods are adapted by U.S. physicians.  Her therapy is disputed by the American Medical Association. 
• 1949:  Dr. John Enders and associates grow the polio virus in test tubes. The March of Dimes grants over $1 million for research at four universities
• 1951: It's found there are three types of the polio virus: Bulbar, Spinal, and Bulbar Spinal
• 1955:  Dr. Jonas Salk introduces the inactivated poliovirus vaccine (IPV). 
• 1959:  Dr. Albert Sabin introduce the live attenuated poliovirus vaccine (OPV).  The IPV and OPV vaccines result in a stunning decline in new cases of polio. 

Since the introduction of these two vaccinations, there have been very few cases of polio in places where children have been inoculated.  There were minor epidemics in 1972 and 1979 in the United States, although these occured in areas where there was "low vaccination coverage," according to Nugent. 

However, while polio cases are basically nonexistent where people are given the vaccine, in developing areas of the world, where the vaccine is scarcely provided to children, polio continues to climb (at least as of the time of the article in 1987).  (1, page 48)

References:

1. Nugent, Jo, "The historic battle against polio," The Rotarian, April, 1987, 24-26, 48-49

1771-1832: Sir Walter Scott has polio?

Figure 1 -- Sir Walter Scott

Sir Walter Scott was one of the greatest novelists in the world during the later 18th and early 19th centuries.  Most people know him through his works of fiction, although in the medical field we know him best as providing one of the earliest descriptions of the disease we now know as polio. 

As a youth he became a "voratious reader of poetry, history, drama, fairy tales and romance."  He had an excellent memory, and often impressed others by his ability to recite poems.  It probably surpised no on when he grew to be one of the greatest writers of his era, if not all time, according to Britannica.com.

In his 1902 article "The Medical History of Sir Walter Scott, Roberts Bartholow writes that Scott was not "reticent" about his debilitated leg, and even wrote about it.  Scott wrote:

"I showed   every sign of health and strength until I was about eighteen months old... In the morning I was discovered to be affected with the fever that often accompanies the cutting of large teeth.  It held me three days.  On the fourth, when they discovered that I had lost the power of my right leg... There appeared to be no dislocation or sprain; blisters or other topical remedies were applied in vain.  When the effects of regular physicians had been exhausted without the slightest success, my anxious parents, during the course of many years, eagerly grasped at every prospect of cure which was held out by the empirics, or ancient ladies or gentlemen, who conceived themselves entitled to recommend various remedies, many of which were sufficiently singular." (2, page 314)
Bartholow writes that there were various attempts to help him with his "lameness."  When four-years old he was "sent to bath, where he lived a year and 'went through al lth usual discipline of the pump room and baths, but he believed without the least advantage to his lameness."  Here Bartholow quotes Scotts son in law and biographer John Gibson Lockhart.  (2, page 314)

Bartholow explains that he was "also treated by the celebrated electrical quack, Dr. Graham, who made a great parade of electical appliances, but he was not benefitted in the least by the magnetic tough of the splendid quack, or by the electric current. (2, page 314)

Figure 2 -- Lord Byron

By the end of the 19th century massage, movements and local electrization were shown to be effective as treatments of such paralysis, which historians believe to be poliomyelitis, or what was also referred to as infantile paralysis.  It was called this because it affected infants, and caused paralysis, mainly of the legs, for life.  (2, page 314)

Other treatments were also used.  Baartholow writes:

Scott's grandfather was Dr. Rutherford, professor of medicine in the University of Edinburgh, and by his advice, besides going into the country to rough it, efforts were made to call into action the affected muscles by the will. This method consisted in placing bright objects, or things that the boy especially desired, in such a position that he could get them only by the most powerful efforts in which the affected members participated. By the persistent use of this plan of "natural exertion" there ensued a great gain In the power of the will over the muscles, and they increased in size and in the range of their actions until the limb ultimately became quite useful, although always lame. This method of dominating the paralyzed and wasted muscles by the forcible action of the will is only possible in those cases in which a little voluntary control was still preserved. Some response to the will may be present, when the faradaic or interrupted galvanic currents have no longer any power to excite muscular contractions. That this was the case with Scott is shown by the results of the method of "natural exertion." As he writes in his autobiography:- "My frame gradually became hardened with my constitution, and, being both tall and muscular, I was rather disfigured than disabled by my lameness. This personal disadvantage did not prevent me from taking much exercise on horseback and making long Journeys on foot, in the course of which I often walked from twenty to thirty miles a day."

The poet, Lord (George Gordon) Byron  (1788-1824), who as a friend of Sir Walter Scott's, also had an obvious limp that some historians speculate was probably also caused by polio.  However, unlike Scott, Byron was taciturn about his condition, wrote none of it, and hated even to have people recognize he had a limp leg. 

References:

1. "Sir Walter Scott: First Baronet," Encyclopedia.com, http://www.britannica.com/EBchecked/topic/529629/Sir-Walter-Scott-1st-Baronet, accessed 11/27/12
2. Bartholow, Roberts, "The Medical History of Sir Walter Scott," The Southern California Practitioner, volume XVII, Walter Lindley, editor,1902, pages 313-320

3700 B.C. The first reports of a crippler virus

The disease is poliomyelitis.  Newspapers after WWII shortened it to "polio" to save space, and the nickname stuck.  The disease is remembered by most for its debilitating effect on kids.  It's remembered by respitory therapists aiding in the birth of a profession. 

David M. Oshinsky, in his book "Polio: An American Story," describes the disease as striking hard after WWII, and there were initially many names for it (1):

• Debility of the lower extremities
• Infantile Paralysis
• Poliomyelitis

Oshinsky explains the latter would stick, later shortened to simply "Polio."  It's an intestinal infection spread from person to person by:

• Contact with fecal waste
• Unwashed hands
• Shared objects
• Contaminated water
• Contaminated food

In other words, it pretty much affected every thing infants and young children come into contact with daily.  The causative agent was a virus, although it wasn't seen until the 1930s when the electron microscope was invented, Oshinsky explains.

Oshinsky explains that, like any virus, the polio virus doesn't survive on its own, so it invades living organism, like kids.  It makes it's way to the pharynx and small intestines, an ideal breeding ground for the polio virus.  It multiplies.  Initially minor symptoms occur:

• Headache
• Nausea
• Cold symptoms
• Gastrointestinal symptoms
• No symptoms

In one out of every 100 the virus crosses the blood brain barier, making it's way to the brainstem, and the central nervous system.  It propitiates there and it "destroys the nerve cells, or motor neurons, that stimulate the muscle fibres to contract,"writes Oshinsky. (1)

He explains that :

"The extent and permanence of the resulting paralysis are difficult to predict.  Some infected nerve cells will fight off the polio virus, while others will die.  Furthermore, the surviving nerve cells are capable of taking on more work by enlarging themselves and sprouting new connections to the orphaned muscle fibers.  At worst polio causes irriversible paralysis, most often in the legs.  The majority of deaths occur when the breathing muslces are immobilized, a disease known as bulbar polio, in which the brain stem (or bulb) is badly damaged." (1)

Infestation of the nervous system usually only occurs in older children and adults.  (2) So while most will recover quickly, others will end up disabled, and some will die.  It's a disease where the effects are obvious, the treatment better known, but the cure a mystery until the Salk vaccine was introduced on April 15, 1955. (1)

It's a disease that struck hard in the middle of the 20th, and changed the lives of thousands of boys and girls.  Yet it wasn't a new disease by any means, affecting the lives of millions since the dawn of human existance.

Figure --1 An Egyptian Stele t
hought to represent a polio
victim from the 18th Dynasty
(Circa 1403-1365)

As with most diseases, it's history can only be traced as far back as the earliest written descriptions of it.  The earliest signs of polio were found in an Egyptian mummy dating as far back as 3700 B.C. An Egyptian stone carving from 1300 B.C. indicates signs of the disease, writes Jo Nugent in a 1987 article in The Rotarian:  "The historic battle against polio.  (2, page 24)

Oshinsky explains that even while the disease was present since the beginning of time, described from time to time, it was of minor concern because it generally only appeared endemically, or in one area or region.  (1, page 9-10)

The virus was kept alive in areas with "dreadful sanitary conditions" and poorly contained sewage systems. Through most of history it was "transmitted harmlessly from one host to the next.  The outcome, for almost everyone, was mild infection followed by a lifetime of immunity." (1, page 10)

Oshinsky explains that most early accounts are of individual cases, such as the account displayed on the Egyptian Stele dating to 1500 B.C. Oshinsky describes the tablet (see figure 1) with "the figure of a youg man, probably a priest, with a withered right leg.  He is using a cane to balance himself. Those who have studied the engraving call it 'a probable case of infantile paralysis.' In truth, this is little more than a guess.

The Hippocratic writers of ancient Greece described it in the 5th century B.C.  Greco Roman physician Galen described it in the 1st century A.D. They both wrote about clubfoot in a small number of their patients, which we now know is a symptom of the paralytic form of polio. 

Mayoclinic.comdescribes club foot as "way the foot is positioned at a sharp angle to the ankle, like the head of a golf club. Clubfoot is a relatively common birth defect and is usually an isolated problem for an otherwise healthy newborns.  It will, however, affect the child when it comes time to learning how to walk. 

While the ancient Greeks and Romans didn't name polio, the term comes from Greek "Polios" meaning grey and "Myelos" meaning marrow.  "Itis" is Latin for inflammation.  Later on Poliomyelitis earned a reputation and a name, before being shortened to the more recognizable "Polio."

So early descriptions do little to diagnose nor explain the disease, merely note the symptoms that were obvious to all.  Minor cases, which were about all cases, were completely ignored.  A society was completely oblivious to all the carrier. 

References:

1. Oshinsky, David M., "Polio: An America Story," 2005, New York, Oxford University Press, pages 1-12.  Sshinsky won the 2006 Pulitzer Prize for this book.  It's a great read.
2. Nugent, Jo, "The historic battle against polio," The Rotarian, April, 1987, 24-26, 48-49