“Died of Respiratory Muscle Paralysis”: Etiopathogenesis, Diagnosis, and Treatment of Poliomyelitis in Interwar Lithuania

Abstract

The first cases of poliomyelitis date back to ancient times: a possible case of polio was depicted in one of the earliest sources in human history – an Egyptian funerary stele from around 1400 BC. It took more than one millennium before the term ‘poliomyelitis’ was coined. In the 18th century medical literature, the disease was still called “debility of the lower extremities”, while inflammation of the gray matter in the spinal cord was observed during autopsy studies, without knowing its causative agent. Meanwhile, in the 19th century, polio was known as Heine-Medin disease, whose epidemics, especially in densely populated cities of the Old and New Worlds became more and more frequent. The huge number of individuals with polio, as well as severity of residual symptoms prompted scientists to further studies on the etiology of the disease, to search for effective preventive and treatment methods. Finally, virologists Macfarlane Burnet and Jean MacNamara identified three types of poliovirus in 1931. The invention of the ‘iron lung’ in the early 20th century was an important milestone in symptomatic treatment of acute paralysis of respiratory muscles caused by polio. In 1952, the first successful injectable polio vaccine, developed by Jonas Salk, was finally introduced; a decade later, the oral polio vaccine, developed by Albert Sabin, helped to accelerate the scale of vaccination worldwide. As a result, poliomyelitis no longer exists in developed countries today; the last case of polio in Europe was recorded in 1998.
The aim of this study is to find out how the etiology, pathogenesis and clinical manifestations of poliomyelitis were perceived, what diagnostic and treatment methods were used in Lithuania in the period of 1920–1939. By examining the publications on poliomyelitis cases in the scientific journal Medicina, published in Lithuania during the interwar period, we reveal how the etiology and pathogenesis of poliomyelitis were perceived by physicians in our country, and how this disease was diagnosed and treated. By conducting a microanalysis of only one disease – poliomyelitis – and comparing the treatment of polio patients in Lithuania with the data available from other regions of the time, we also aim to indirectly assess the level of development of medical care in interwar Lithuania.