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Höstens Spöke De Svenska Polioepidemiernas Historia Höstens spöke De svenska polioepidemiernas historia av Per Axelsson fil.mag. AKADEMISK AVHANDLING som med tillstånd av Rektorsämbetet vid Umeå universitet för avläggande av filosofie doktorsexamen offentligen försvaras i Samhällsvetarhuset, hörsal B, fredagen den 12 mars 2004, kl. 10.15 Per Axelsson, II ös/e//s spöke. De svenska polioepidemiernas historia. \The Autumn Ghost - the History of Polio Epidemics in Sweden \ Stockholm 2004, pp. 311. Swedish text with a summary iti I English. Department of Historical Studies, S 901 87 Umeå ISBN 91-7203-583-8 ISSN 0349-5132 Abstract Although other epidemics declined due to improved hygiene and sanitation, legislation, and vaccination, polio epidemics appeared in Sweden in 1881 and at the turn of the 20th century the disease became an annual feature in the Swedish epidemiological pattern. Due to vaccina­ tion starting in 1957 epidemics ceased to exist in Sweden around 1965. This thesis deals with the history polio epidemics in Sweden, 1880-1965 and studies the demographical influence of polio, how the medical authorities investigated and tried to combat it, and the care of those who contracted the disease. A study of polio mortality and incidence in Sweden at the national level during 1905-1962 reveals that the disease caused 6,000 deaths out of the 51,000 cases reported. At the beginning of the 20th century polio primarily attacked children up to 10 years of age. At the end of the period victims were represented in all age groups, but mainly in the ages 15-39. Moreover, a regional incidence study shows considerable regional differences. Due to its enigmatic appearance, polio was not considered as an epidemic infectious disease during the 19th century. Sweden's early epidemics enabled Swedish medical science to act and together with American research institutes it acquired a leading role in international medical research on the disease. From clinical-epidemiological studies, scietice turned to laboratory research to explain the characteristics of polio. In the United States polio was seen as caused by a virus that entered through the nose, traveled via the brain to the spinal cord, and left the body the same way it entered. In Sweden researchers suggested that the disease was an alimentary illness where the virus entered through the mouth, grew in the intestines, and left the body through the rectum. Using epidemiological studies it was concluded that the majoritv of cases occurred close to watercourses and that polio must be seen as an alimentary illness. These different ways of understanding polio characteristics created different preventive mea­ sures against polio. Moreover, in the 1950's Sweden developed its own vaccine, different in choice of methods and materials from the widely used Salk-vaccine. When polio was classified as an epidemic in 1905, those infected by polio were usually taken to an isolation hospital. These hospitals were owned and financed by the state. The aftercare of polio victims was financed by philanthropist organizations. Polio was associated with dirt and unhygienic circumstances until the 1950s when the theory of polio epidemics as a backlash of good hygiene and sanitary standards was estab­ lished. The theory is built upon the correlation between neonatal mortality and polio inci­ dence. However, correlation analysis at the regional level reveals no significant relationship between these variables. In Sweden, the hygienic movement had been very influential, and this study suggests that the theory quickly was accepted, because it explained why Sweden could be hit by epidemics and still be considered a welfare state with good hygienic and sanitary standards. Keywords: polio, history of medicine, history of diseases, demography, medical science, pre­ ventive measures, vaccination, health care, disability, therapeutics, Sweden. 20th century HÖSTENS SPÖKE Per Axelsson, Höstens spöke. De svenska polioepidemiernas historia. [The Autumn Ghost - the History of Polio Epidemics in Sweden ] Stockholm 2004, pp. 311. Swedish text with a summary in English. Department of Historical Studies, S 901 87 Umeå ISBN 91-7203-583-8 ISSN 0349-5132 Abstract Although other epidemics declined due to improved hygiene and sanitation, legislation, and vaccination, polio epidemics appeared in Sweden in 1881 and at the turn of the 20th century the disease became an annual feature in the Swedish epidemiological pattern. Due to vaccina­ tion starting in 1957 epidemics ceased to exist in Sweden around 1965. This thesis deals with the history polio epidemics in Sweden, 1880-1965 and studies the demographical influence of polio, how the medical authorities investigated and tried to combat it, and the care of those who contracted the disease. A study of polio mortality and incidence in Sweden at the national level during 1905-1962 reveals that the disease caused 6,000 deaths out of the 51,000 cases reported. At the beginning of the 20th century polio primarily attacked children up to 10 years of age. At the end of the period victims were represented in all age groups, but mainly in the ages 15-39. Moreover, a regional incidence study shows considerable regional differences. Due to its enigmatic appearance, polio was not considered as an epidemic infectious disease during the 19th century. Sweden's early epidemics enabled Swedish medical science to act and together with American research institutes it acquired a leading role in international medical research on the disease. From clinical-epidemiological studies, science turned to laboratory research to explain the characteristics of polio. In the United States polio was seen as caused by a virus that entered through the nose, traveled via the brain to the spinal cord, and left the body the same way it entered. In Sweden researchers suggested that the disease was an alimentary illness where the virus entered through the mouth, grew in the intestines, and left the body through the rectum. Using epidemiological studies it was concluded that the majority of cases occurred close to watercourses and that polio must be seen as an alimentary illness. These different ways of understanding polio characteristics created different preventive mea­ sures against polio. Moreover, in the 1950's Sweden developed its own vaccine, different in choice of methods and materials from the widely used Salk-vaccine. When polio was classified as an epidemic in 1905, those infected by polio were usually taken to an isolation hospital. These hospitals were owned and financed by the state. The aftercare of polio victims was financed by philanthropist organizations. Polio was associated with dirt and unhygienic circumstances until the 1950's when the theory of polio epidemics as a backlash of good hygiene and sanitary standards was estab­ lished. The theory is built upon the correlation between neonatal mortality and polio inci­ dence. However, correlation analysis at the regional level reveals no significant relationship between these variables. In Sweden, the hygienic movement had been very influential, and this study suggests that the theory quickly was accepted, because it explained why Sweden could be hit by epidemics and still be considered a welfare state with good hygienic and sanitary standards. Keywords: polio, history of medicine, history of diseases, demography, medical science, pre­ ventive measures, vaccination, health care, disability, therapeutics, Sweden, 20th century Per Axelsson ZJT östens JUL spöke De svenska polioepidemiemas historia CARLSSONS Distribution: Carlsson Bokförlag Stora Nygatan 31, 111 27 Stockholm tel. 08-54 52 54 80, fax 08 796 84 57 e-post [email protected] www.carlssonbokforlag.se Omslagsbild: Susanne Axelsson Omslagstypografi: Bo Herlin Sättning: Berit Eriksson, DDB Tryckt hos: ScandBook, Falun, 2004 © Per Axelsson och Carlsson bokförlag Report no. 23 from the Demographic Data Base, Umeå University 2004 ISBN 91-7203-583-8 ISSN 0349-5132 INNEHÅLL FÖRORD 9 KAPITEL I INLEDNING 11 POLIOEPIDEMIERNA OCH FORSKNINGSUPPGIFTEN 13 OM HISTORISK EPIDEMIOLOGI 15 OM LÄKARVETENSKAPEN - SJUKDOMARS ORSAKER OCH PREVENTIVA ÅTGÄRDER 16 OM VÅRDEN OCH DE POLIOSKADADE 19 MEDICINHISTORISKA OCH TEORETISKA UTGÅNGSPUNKTER 20 FORSKNINGSLÄGE 24 KÄLLOR OCH URVAL 28 SKRIFTLIGT KÄLLMATERIAL 28 STATISTISKT MATERIAL 30 POLIONS EGENSKAPER - EN SJUKDOMSDEFINITION 31 KAPITEL II HISTORISK EPIDEMIOLOGI 32 FÖRE EPIDEMIERNA - NEDSLAG I POLIONS HISTORIA 32 HISTORISK EPIDEMIOLOGI - EN DEMOGRAFISK KARTLÄGGNING AV POLIONS INCIDENS OCH MORTALITET 1905-1962 35 NATIONELLA OCH INTERNATIONELLA PERSPEKTIV 39 TIDIGARE FORSKNING OM POLIONS INCIDENS OCH MORTALITET 42 POLIONS EPIDEMIOLOGI 45 NATIONELL UNDERSÖKNING AV MORTALITET OCH INCIDENS 46 KÖN OCH ÅLDER 51 DEN REGIONALA STUDIEN 55 KOMMENTARER TILL DEN REGIONALA STUDIEN 60 SAMMANFATTNING 62 KAPITEL III POLIONS ORSAKER OCH VÄGAR 1880-1945 64 DE GÅTFULLA EPIDEMIERNA 64 5 DEN FÖRSTA EPIDEMIN I SÄVAR OCH HÖRNEFORS BRUK 1881 68 MEDINS INSATS OCH 1887 ÅRS EPIDEMI 70 ETT EPIDEMISKT ÅTERBESÖK 74 SVERIGE VAKNAR MED POLIO 76 PROVINSIALLÄKARNA OM POLIONS ORSAKER 1905 78 IVAR WICKMAN OCH POLIO SOM EN SMITTOSAM INFEKTIONSSJUKDOM 78 FÖRÄNDRINGAR AV NAMN OCH FORSKNINGSINRIKTNING 81 OM POLIONS ORSAKER UNDER DEN STORA EPIDEMIN 1911-1913 ....86 APOR, FLUGOR OCH EXPERIMENTELL FORSKNING 89 PROVINSIALLÄKARNA OM SJUKDOMENS ORSAKER 1911—1913 93 DEN EHINGERSKA HYPOTESEN OCH IMMUNITET 96 NÄSA ELLER MUN? 98 FLEXNER OCH TEORIN OM LUKTORGANET 99 DEN SVENSKA DISKUSSIONEN 103 L'HYPOTÈSE HYDRIQUE 104 ÖVRIGA TEORIER 107 PROVINSIALLÄKARNA OM SJUKDOMENS ORSAKER
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