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The Final Chapter?

John F. Modlin, MD

JAMA. 2004;292:1749-1751.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Epidemic poliomyelitis is a disease that both appeared and disappeared in the United States during the last century. The first recorded outbreak of paralytic disease in the United States occurred near Rutland, Vt, in 1894.¹ Within a decade, thousands of infants and young children were permanently crippled during summertime epidemics that swept through cities on the East Coast and, later, throughout the country.² The likely explanation for the dramatic emergence of epidemic polio during this era lies in the paradox of improved standards of hygiene, particularly the invention of the flush toilet, which reduced exposure to polioviruses in feces and delayed infection until the protective effect of passively acquired maternal antibodies had waned.³

These annual epidemics increasingly affected older children, adolescents, and young adults, and the total number of paralytic cases continuously increased throughout the first half of the 20th century until the introduction of inactivated . . . [Full Text of this Article]

Author Affiliations: Dartmouth Medical School and Children’s Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

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