Saturday, April 05, 2003

"A Summer Plague: Polio and its Survivors" by Tony Gould

"A Summer Plague" contains both a history of the polio epidemic and a series of biographical experiences of polio survivors. Biographical information includes the author (who contracted the disease in 1959, at age 20), FDR, rock musician Ian Drury, as well as others affected to greater or lesser degree. The overall focus is more on the social consequences of the disease than on the scientific aspects--though that focus includes controversies and conflicts among the scientific community, as well as between scientists and research-funding organizations. I found it fascinating to see the same kind of clashes of personalities and ambition among physician-scientists in the 1930ies and 1950ies as can be seen in laboratories today--and which has been seen at the cutting edge of medical research since the days of Pasteur, Koch, and Lister.

As an endemic disease, polio is believed to date back over three thousand years. An Egyptian stele, dating from the 18th dynasty (1580-1350 BC) depicts a man with a withered leg--characteristic of polio's lingering effects. It is believed that for most of human history the disease lurked in unhygienic conditions, probably infecting most infants at such an early age that they either died or recovered completely.

Not until modern times, when most people in the developed world escaped early infection, did the disease begin to roll through populations on a massive scale, leaving a trail of paralyzed children and adults. In the absence of any clear understanding of how to control the spread of polio, the New York epidemic of 1916 was dealt with by strict quarantine, close scrutiny of immigrants (Italians, in particular), and rigidly-enforced sanitation laws. There were stories of children being taken from their homes to hospital at gunpoint, because of suspected infection. Cats and dogs, erroneously suspected of carrying the disease, were rounded up and put down.

Polio was known to be a viral disease as early as 1908, but a century later a cure has yet to be developed, and a safe and reliable vaccine wasn't readily available until the late 1950ies. Early virologists were hamstrung by a number of incorrect beliefs about the virus--perhaps the most serious being a stubborn insistence that it was a respiratory, rather than enteric disease, which traveled directly from the nasal passages to the nervous tissue. Because of this belief, vaccination to produce blood-borne immunity was considered by some prominent scientists to be pointless. Picric acid and alum nasal sprays were tried as a preventative in the mid 1930ies, but succeeded only in permanently destroying the sense of smell for some patients. Results of contemporaneous attempts to develop a vaccine, despite doubts about the approach, ranged from ineffective to dangerous.

In 1940, the larger-than-life and ever controversial Sister Kenny arrived in the U.S. from Australia, bringing along her unorthodox (at the time) system of treating polio patients by getting their paralyzed muscles moving as soon as possible. Patients loved her; doctors hated the assurance with which she ridiculed the standard treatment of immobilizing paralyzed patients in splints or casts.

I'm afraid the book's overdue, and can't be renewed anymore, so it has to go back to the library today. Or else I'd write more about the famous Salk/Sabin rivalry and the controversy over live versus killed vaccine. I'll just date myself by mentioning some of my earliest memories of walking over to the local elementary school with my parents to receive my sugar cubes of vaccine. Polio is not quite dead in the wild yet; may it soon be so.

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