Tuesday, October 08, 2013

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

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