The Role of the Flush Toilet
in the Spread of Polio
At a recent wedding reception I attended in Raleigh, North Carolina, I sat next to a lovely lady who was a long time friend of the bride; they both had worked in Public Health before their retirements. Pam (not her real name) volunteered that her husband was suffering from post polio syndrome which is a recurrance of many of the problems of polio even though the person may have been free of problems for many years. As she finished up her story about her husband, she asked the ladies at our table if anyone knew what was the cause of the polio epidemics of the 40s and 50s? No one at the table had a clue so she supplied the answer. She said, "It was the widespread use of the flush toilet."
I lost a teenage friend to polio in the mid 40s; her death left an indelible mark on my young life. The scourge of polio kept us from congregating in large groups, going to the movies or swimming in public pools. While I was intimately aware of polio, I did not know the flush toilet was the culprit behind the epidemics.
When I returned home after the wedding, I researched the connection between polio and the flush toilet. While ironic, it is true, improved sanitation was the root of the dreaded epidemics.
Poliomyelitis is said to have first occurred nearly 6,000 years ago in the time of the Ancient Egyptians. The evidence for this, is in the withered and deformed limbs of certain Egyptian mummies. SEE: POLIOMYELITIS — A GUIDE FOR DEVELOPING COUNTRIES; INCLUDING APPLIANCES AND REHABILITATION by Ronald L. Huckstep; Published by Churchill Livingstone.
From Wikipedia I learned that before the 20th century, there were cases of polio, but they were few and no major outbreaks occurred. The question then is how did polio emerge from centuries of obscurity to becoming a killer in just a few decades? The answer lies in a major change in sanitation practices. Before the advent of modern indoor plumbing and sewage systems, many cities had open sewers that were no more than gutters with outhouses in the backyard. Almost everyone had, at one time or another, been exposed to polio, and with open sewers and outhouses the norm--there was ample opportunity to contract polio. Polioviruses infected generations of babies, who were protected in part by antibodies passed on to them by their mothers. When a child became infected with the poliovirus the results were flu-like or cold-like symptoms. The diagnosis of polio was rare because the symptoms were often indistinguishable from other childhood diseases.
Cases of paralytic polio began to rise once changes in public sanitation and other health measures came about, such changes as purification of the water supply and milk pasteurization. Better hygiene meant that babies and young were not receiving some immunization from their mothers. When the disease struck older children or adults, it was more likely to take the paralytic form. In northern Europe and the United States, epidemics of paralytic polio began to appear in the late 19th and early 20th centuries, though small.
Polio's full impact wasn't felt in the United States until the summer of 1916, when an outbreak resulted in 27,000 people paralyzed, and 6,000 deaths. The 1916 epidemic caused widespread panic and thousands fled the city to nearby mountain resorts. Movie theaters were closed, meetings were cancelled, and public gatherings were almost nonexistent. Children were warned not to drink from water fountains; and children were told to avoid amusement parks, pools, and beaches. From 1916 onward, a polio epidemic appeared each summer in at least one part of the country, with the most serious occurring in the 1940s and 1950s. In the United States, it would be the 1952 polio epidemic that marked the worst outbreak in the nation's history. Of the nearly 58,000 cases reported that year; 3,145 died and 21,269 were left with mild to disabling paralysis. Statistically, more children died of polio in 1952 than of any other infectious disease. For more details visit Bulbar Polio. and Polio
Also see: Polio and Clean Water by John H. Lienhard.
The Crippling History of the Poliomyelitis Virus by Dr. Patrick Treacy. (About midway down the page.)
An extensive collection of articles on Polio from the Health Heritage Research Services of Canada.