1800-1987: The rise and fall of polio

One of the neat things about the poliomyelitis virus is it basically hangs around for thousands of years, staying alive in random hosts, pretending it
doesn't exist, waiting for an ideal moment to wreak.  That moment arrives at the turn of the 19th century. 

Polio, therefore, is barely a threat to society prior to the 18th century, and is  basically ignored.  Yet once it started showing up as random epidemics in Europe and the United States, people started taking notice.  The search was on to find the causative agent, and a cure. 

Jo Nugent, in his 1987 article in The Rotarian, "The historic battle against polio," explains that the disease spreads rapidly in areas with poor sewage systems, so larger cities where sewage was dumped into the streets provided a haven for the virus.  Kids playing in the streets were in constant contact with the virus.  Once on a kid's finger, it was only a matter of time before the finger was set into a mouth.  The virus went to work. 

Nugent lists the following as the critical events in the evolution of the disease, and the quest to learn about it, and get rid of it (1, page 24):

• 1789:  Michael Underwood makes the first clinical notation of the disease
• 1801:  First recorded epidemic occurred in Scandanavia
• 1807:  Swedish researchers note the disease "struck otherwise healthy youngsters, and not necessarily in the poorest population samples."
• 1840:  German orthopedist Jakob von Heine makes the first clear description of the disease
• 1887:  Oscar Medin of Sweden is the first to recognize it as a pandemic. He was the first to describe the pathogen as a virus.  
• 1896:  C.S. Caverly observs polio also occurs in non paralytic forms
• 1905:  Medin's pupil, Ivan Wickman, experiences the Swedish epidemic, and "concluded that the manner of transmission was person to person."  Christian Legaard confirms Cavalry's theory in a study of over 1,000 cases.  He describes that people with passive forms of the disease are spreading it to others
• 1908-1911:  During the Swedish epidemic it's determined the disease rarely occurs in the same rural areas oftener than every five years, since the population develops immunity to the infection at an early age.  It's learned mortality is lowest in the 0-5 age group, and mortality rises with age. 
• 1909:  Karl Landsteiner of Viena learns the virus can be isolated in a laboratory
• 1911-1918:  Sister Elizabeth Kenny establishes a method of "moist heat stimulation and reeducation of muscles of polio patients.
• 1921:  While Secretary of Navy, Franklin D. Roosevelt comes into contact with polio virus.  He becomes paralyzed, and this later has a major impact on his life, and on the lives of others inflicted with the disease -- for the better.  I will write about FDR's polio impact later.
• 1929:  Philip Drinker and Louis Shaw invent the iron lung which saves many lives, and helps give birth to the respiratory therapy profession.
• 1940:  Kenny's methods are adapted by U.S. physicians.  Her therapy is disputed by the American Medical Association. 
• 1949:  Dr. John Enders and associates grow the polio virus in test tubes. The March of Dimes grants over $1 million for research at four universities
• 1951: It's found there are three types of the polio virus: Bulbar, Spinal, and Bulbar Spinal
• 1955:  Dr. Jonas Salk introduces the inactivated poliovirus vaccine (IPV). 
• 1959:  Dr. Albert Sabin introduce the live attenuated poliovirus vaccine (OPV).  The IPV and OPV vaccines result in a stunning decline in new cases of polio. 

Since the introduction of these two vaccinations, there have been very few cases of polio in places where children have been inoculated.  There were minor epidemics in 1972 and 1979 in the United States, although these occured in areas where there was "low vaccination coverage," according to Nugent. 

However, while polio cases are basically nonexistent where people are given the vaccine, in developing areas of the world, where the vaccine is scarcely provided to children, polio continues to climb (at least as of the time of the article in 1987).  (1, page 48)

References:

1. Nugent, Jo, "The historic battle against polio," The Rotarian, April, 1987, 24-26, 48-49

1771-1832: Sir Walter Scott has polio?

Figure 1 -- Sir Walter Scott

Sir Walter Scott was one of the greatest novelists in the world during the later 18th and early 19th centuries.  Most people know him through his works of fiction, although in the medical field we know him best as providing one of the earliest descriptions of the disease we now know as polio. 

As a youth he became a "voratious reader of poetry, history, drama, fairy tales and romance."  He had an excellent memory, and often impressed others by his ability to recite poems.  It probably surpised no on when he grew to be one of the greatest writers of his era, if not all time, according to Britannica.com.

In his 1902 article "The Medical History of Sir Walter Scott, Roberts Bartholow writes that Scott was not "reticent" about his debilitated leg, and even wrote about it.  Scott wrote:

"I showed   every sign of health and strength until I was about eighteen months old... In the morning I was discovered to be affected with the fever that often accompanies the cutting of large teeth.  It held me three days.  On the fourth, when they discovered that I had lost the power of my right leg... There appeared to be no dislocation or sprain; blisters or other topical remedies were applied in vain.  When the effects of regular physicians had been exhausted without the slightest success, my anxious parents, during the course of many years, eagerly grasped at every prospect of cure which was held out by the empirics, or ancient ladies or gentlemen, who conceived themselves entitled to recommend various remedies, many of which were sufficiently singular." (2, page 314)
Bartholow writes that there were various attempts to help him with his "lameness."  When four-years old he was "sent to bath, where he lived a year and 'went through al lth usual discipline of the pump room and baths, but he believed without the least advantage to his lameness."  Here Bartholow quotes Scotts son in law and biographer John Gibson Lockhart.  (2, page 314)

Bartholow explains that he was "also treated by the celebrated electrical quack, Dr. Graham, who made a great parade of electical appliances, but he was not benefitted in the least by the magnetic tough of the splendid quack, or by the electric current. (2, page 314)

Figure 2 -- Lord Byron

By the end of the 19th century massage, movements and local electrization were shown to be effective as treatments of such paralysis, which historians believe to be poliomyelitis, or what was also referred to as infantile paralysis.  It was called this because it affected infants, and caused paralysis, mainly of the legs, for life.  (2, page 314)

Other treatments were also used.  Baartholow writes:

Scott's grandfather was Dr. Rutherford, professor of medicine in the University of Edinburgh, and by his advice, besides going into the country to rough it, efforts were made to call into action the affected muscles by the will. This method consisted in placing bright objects, or things that the boy especially desired, in such a position that he could get them only by the most powerful efforts in which the affected members participated. By the persistent use of this plan of "natural exertion" there ensued a great gain In the power of the will over the muscles, and they increased in size and in the range of their actions until the limb ultimately became quite useful, although always lame. This method of dominating the paralyzed and wasted muscles by the forcible action of the will is only possible in those cases in which a little voluntary control was still preserved. Some response to the will may be present, when the faradaic or interrupted galvanic currents have no longer any power to excite muscular contractions. That this was the case with Scott is shown by the results of the method of "natural exertion." As he writes in his autobiography:- "My frame gradually became hardened with my constitution, and, being both tall and muscular, I was rather disfigured than disabled by my lameness. This personal disadvantage did not prevent me from taking much exercise on horseback and making long Journeys on foot, in the course of which I often walked from twenty to thirty miles a day."

The poet, Lord (George Gordon) Byron  (1788-1824), who as a friend of Sir Walter Scott's, also had an obvious limp that some historians speculate was probably also caused by polio.  However, unlike Scott, Byron was taciturn about his condition, wrote none of it, and hated even to have people recognize he had a limp leg. 

References:

1. "Sir Walter Scott: First Baronet," Encyclopedia.com, http://www.britannica.com/EBchecked/topic/529629/Sir-Walter-Scott-1st-Baronet, accessed 11/27/12
2. Bartholow, Roberts, "The Medical History of Sir Walter Scott," The Southern California Practitioner, volume XVII, Walter Lindley, editor,1902, pages 313-320

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