Polio conundrums

Denis Gill
Dublin, Ireland (Fall 2017)

 

Ancient Egyptian stele of Ruma

For most children, infection with the polio virus caused no symptoms or a minor illness.  But about 1% of those infected experienced paralysis of one or both lower limbs. Worse still, bulbar paralysis could lead to the  inability to breathe. The effects of polio were devastating for a previously well child.

Polio has virtually disappeared from the earth, except for remaining cases in Nigeria, Chad, Pakistan, and India. The World Health Organization (WHO) hopes to declare polio eliminated by 2020, which would be approximately 230  years since the first description of the condition in 1789. Some questions about polio in history remain unanswered. Where was polio virus before 1789? Why is there no reference to polio in ancient Arabic, Asian, Roman, Greek, and Indian literature? Why were there no epidemics until 100 years after its description? Was the ancient stele, a much-produced figure of the Egyptian priest Ruma, a representation of polio? Did Franklin Delano Roosevelt really have polio?

 

A brief polio timeline

1789  British physician Michael Underwood provides the first clinical description
of polio, calling it a “disability of the lower limbs.”
1840  German physician Jacob von Heine publishes a  monograph with the clinical features
of the disease and notes that its signs and symptoms suggest the involvement of the spinal cord.
1869  Jean-Martin Charcot first describes the atrophy of the anterior horns
of the spinal cord in infantile paralysis.
1875  Wilhelm Heinrich Erb is the first to use the term “acute anterior poliomyelitis”.
1890  Karl Oskar Medin, a Swedish physician, is the first to describe a polio outbreak.
1894  The first major polio epidemic is described in Vermont USA with 132 cases.
1909  Karl Landsteiner isolates the polio virus in Vienna, Austria.
1916  Large epidemic of polio in USA
1921  Franklin Delano Roosevelt (FDR) is said to contract polio.

 

There are, according to Gareth Williams, no convincing descriptions of polio-like illness in collected ancient writings of physicians in  Arabia, Greece, Rome, India, or China. It is unlikely that paralysis of one or more limbs in a previously well child would not have been noted in ancient civilizations if it had occurred. Descriptions of polio between 1789  and 1890 include only a few sporadic case reports. The first outbreaks of one hundred or more cases were in Sweden in 1890 and in Vermont USA in 1894. The first big epidemic of polio was in New York in 1916, where over 9,000 cases were recorded. Another major outbreak occurred in Los Angeles in 1934,  with almost 2500 cases recorded at the Los Angeles County General Hospital. Poliovirus is spread by human to human transmission and there is no known animal vector.  Were the epidemics related to cities, sewage, and fecal contamination?   Curiously, polio was largely a summer-autumn condition.  It seemed to be more prevalent amongst middle class and well-off social groups.   In 1952 there were 58,000 cases in the US alone.  By 1988 there were still approximately 350,000 cases of polio occurring worldwide. An excellent oral history (though written as fiction) was given by Philip Roth in Nemesis, describing a polio outbreak among a Jewish community in New Jersey in the early 1940s.

Photo of FDR showing wasted lower limbs

Almost every textbook and historical review of polio carries an illustration of an ancient Egyptian stele (or tomb carving) from the Eighteenth Dynasty (1570-1342BC). Ruma, guardian priest of a temple in Memphis, is depicted with a wasted, shortened, and floppy right leg. This is the only representation of a polio-like condition in the ancient world. While Ruma may well have had polio, there is a considerable differential diagnosis:  non- polio enterovirus, West Nile virus leading to polio-like syndrome, transverse myelitis, botulism, Guillain-Barre Syndrome,  or tick bite paralysis. We will never know for sure.

Did Franklin Delano Roosevelt (FDR) really have polio? There is extensive North American literature on this topic. FDR was in his island cottage in Maine during the summer of 1921 when he was thirty-nine years old.  In August he developed a high fever, backache, an ascending polyneuropathy, exquisite paresthesia, and paralysis of his bladder and bowel.  He was cared in the cottage by local doctors who did not perform a lumbar puncture and was catheterized for six weeks.  A Boston orthopedic surgeon made a diagnosis of poliomyelitis some weeks later. FDR spent two years trying to wiggle one toe and described polio as a childish disease that an adult should be able to outgrow.   FDR’s age, the bilateral and ascending nature of the paralysis, the involvement of bowel and bladder,  pain, and course of the disease are all much more suggestive of Guillain-Barre Syndrome.  Many observers have suggested that the myth should be allowed to persist because FDR’s polio diagnosis led to remarkable research, prominence, and fundraising through the March of Dimes, ending in Salk and Sabin competing for the Nobel Prize in medicine for their polio vaccines.

Other famous figures in history that may have had polio include the Roman Emperor Claudius, who was stricken by a disease as a child and had a limp for the rest of his life.  Sir Walter Scott suffered “a teething fever” in 1773 at the age of two, which deprived him of the power of his right leg for the rest of his life.

Although polio was never as prevalent as measles or pertussis, its potential for severe disease was capable of causing great fear amongst parents.  Even if polio is eliminated by 2020, its long history has nonetheless left its mark on mankind.

 

References

  1. Paul, JR 1971.  A History of Poliomyelitis.  Yale Univ Press.
  2. Roth, Philip 2010.  Nemesis.  Houghton.
  3. Cockburn, Patrick.  “A Broken Boy”  2005.  Vintage.
  4. Williams, Gareth.  Paralysed with Fear.   The Story of polio 2013.  Palgrave McMilliam
  5. Wikipedia FDR’s Paralytic Illness.
  6. Rowley, Helen 2010.  Franklin and Eleanor Farrar, Strauss and Giroux

 


 

DENIS GILL, MB, BSc, DCH, FRCPI FRCPCH is a retired Professor of Paediatrics, Children’s University Hospital and RCSI, Dublin, Ireland.

 

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