Sep 13, 2016

When Polio Walked the Earth

It is hard to capture the sense of panic that once gripped cities and towns in North America during “polio season”—summer and early fall. Parents kept children indoors, public places were deserted, quarantines were put in place, and victims were isolated from the healthy. Every year for forty years, from 1910 to 1950, an outbreak of polio took place somewhere in North America, as well as in Europe and in huge swaths of Asia and Africa. The 1953 epidemic was the peak of a new series of infections that had begun in 1949. During those five years, 11,000 Canadians came down with polio, 9,000 in 1953 alone. Newsreels and newspapers depict a country in panic. The medical system was overwhelmed and there was a severe shortage of doctors, nurses, and therapists to deal with the tsunami of cases. City and town councils argued with school officials and public-health officers about whether schools should be opened and pools kept closed, and sometimes vice versa. In big cities, those who had the means fled to cottages and resorts deep in the woods, away from population centres. In a recent Discovery Channel survey of the ten worst epidemics to affect humans, polio still gets top billing, over the 1918 Spanish flu, the Black Death, hiv/aids, and malaria.
Polio is a devastating disease, highly infectious, easily transmitted, and with no known cure. The disease attacks the spinal cord and the nervous system, and depending on the severity of the infection and the location on the spinal cord, it can paralyze muscles and tendons.
There are three basic classifications of paralytic poliomyelitis: spinal, bulbar, and bulbospinal, which are simply markers of the region of the central nervous system affected and the amount of inflammation and damage that result. The most common form, spinal, attacks motor neurons associated with the movement of muscles; while it can occasionally affect muscles on both sides of the body, it is usually asymmetrical. About 21 percent of all cases of paralytic polio are bulbar or bulbospinal, and these cases dramatically affect the ability to breathe. When you hear polio and you think iron lung, it is patients with these forms you are picturing.
My parents and their generation were no better equipped to deal with polio than their parents or grandparents had been. Polio was first identified in 1840 and the virus isolated in early 1908, but there is clear evidence stretching back at least as far as ancient Egypt of periodic outbreaks and documented occurrences of the disease.
When I was born, contracting polio was truly a crapshoot. The disease was almost Biblical in the sense of a plague sent down by God and touching houses seemingly at random. My mother and father, like any affected parents in 1953, would have been bewildered as to why their house was targeted and not the family two doors down. Doctors weren’t of much comfort, lacking any explanation for why some caught the virus and others didn’t.
Much of what we now know about polio was just conjecture in the year I was born. Research has proven that polio is transmitted orally from person to person through exposure to fecal matter, which goes some way to explaining why children not yet fully toilet trained are such a prime target. Places where people gather and the virus can easily spread—swimming pools, for instance—are probable hot zones.
Polio is a disease rife with truly tricky numbers, almost inexplicable. For every thousand children under the age of five infected by the virus, only one will show any symptoms; the other 999 move about as normal, except that each is a carrier. The incubation period between infection and the appearance of symptoms is anywhere between three and thirty-five days, and everyone is most infectious in the ten-day period before symptoms can appear. The numbers are crueller for children older than six, and adults, with one out of every seventy-five showing symptoms. The majority will experience what is called “abortive polio” or “non-paralytic polio,” whose symptoms include “fever, sore throat, headache, vomiting, fatigue, back pain or stiffness, neck pain or stiffness, pain or stiffness in the arms or legs, muscle spasms or tenderness, and meningitis.” The unlucky few, just 1 to 3 percent of those who show any symptoms at all, contract paralytic polio and experience loss of reflexes, severe muscle aches or spasms, and loose and floppy limbs, often worse on one side of the body. The onset of the actual paralysis will be sudden and is most often irreversible.
Because polio most often and most seriously affected the young, the disease was commonly referred to as “infantile paralysis.” In the year I was born, little was certain about the disease other than that name, which was enough to chill the soul of even the most devout Catholic.
Iwas infected at the height of the polio season, in August 1953, just around the time Jonas Salk was performing his trials. His modern medical miracle, however, arrived too late for me. As was the norm at the time, after I fell ill, my family was quarantined. I was isolated in hospital for a year while my parents worried and prayed at home. Isolating polio victims to stem the spread of the virus was known to be futile by 1940, but the practice continued simply to calm the public by creating a sense that something was being done.
The first signs my parents noticed—a high fever, my obvious intense discomfort and stiffness—had them panicked. All babies display a range of behaviours, but this was late summer and polio seemed to be everywhere. I turned out to be one of the lucky ones, because the damage could have been much worse. It is true that my left lower leg didn’t function as such, and this would have serious ramifications over time, but at two months old at least I was alive, and I wasn’t so damaged that I needed to be confined to hospital for years, as was the case with other children. My parents were forced to stay in Deep River, Ontario, my father for work, my mother to care for my siblings. I was entrusted to the staff at the Deep River Hospital and then at Toronto’s Hospital for Sick Children for a year, with my parents visiting when they could.
At the hospital, the staff first examined my stool, then took a throat swab and subjected me to a spinal-tap procedure. These were the only tests available for a relatively quick diagnosis. The gold-standard test involved a long needle and a tricky procedure. In the spinal tap (a lumbar puncture, to use the correct medical terminology) a needle is inserted into the lower part of the spinal cord and cerebrospinal fluid is drawn out and examined for increased white blood cells, higher-than-normal protein levels and the presence of the polio virus. If all three are present, odds are you have paralytic polio. In my case, all three were present.
The procedure is painful for adults and arguably horrific for children. The patient is positioned on his side with his knees drawn up to his chest and his back and neck straightened. The patient must be kept perfectly still, rigid even. For a number of reasons, I would undergo spinal taps at numerous points in my life, and each and every time one was ordered I experienced the closest thing I can imagine to primal dread. Even writing the words spinal tap causes my skin to crawl and my nerves to cringe. In some of the accounts I have read of the panic of the triage rooms in hospitals during the polio epidemics of the 1940s and ’50s, the eeriest reports are those of babies and toddlers moaning as the procedure is performed. I may not remember my first lumbar puncture, but at my core is a clear, affective account of the experience.
In addition to taking the necessary diagnostic steps, the nurses fed me, tried to manage my fever and aches and pains, and, with the doctors and therapists, attempted all the latest treatment fads. This meant immobilizing my left leg, massaging the affected limb, and trying to exercise the other limbs. The muscles in my left leg were paralyzed and immobilizing the limb was believed to be a way to prevent further damage and possibly give the muscles time to heal. The argument over the question of immobility versus exercise went to the very heart of medical authority. I don’t know how my parents reacted to the choice of treatment options at the time, but the way they responded to later medical quandaries and dilemmas, issues I was more aware of and involved with, provided me with some clues. My mom the nurse and my dad the authoritarian were each in their own ways respectful of authority. When faced with conflicting ideas, they would have been worried, panicked, and at a loss as to what was the right thing to do, before finally deciding that leaving the decision to the doctor was both the best and the wisest course of action.
As a baby, not only did I lack the means to tell nurses or doctors what or how I was feeling, but also it wouldn’t always have been clear how I was responding to the various types of treatments and exercises I was being given. Fixing my limbs and moving my limbs would have involved a lot of guesswork and day-to-day adjustments. As a growing baby, my development was soon completely out of whack. At a point when you might expect spontaneous turning and rolling and crawling, I was doing none of that, and no one was quite sure when, how, or if I might start.
Post Polio Litaff, Association A.C _APPLAC Mexico

Sep 12, 2016

Disease can break a lot of people. As a new film by Ken Burns and an exclusive video clip show, it helped make Franklin Roosevelt

This much is painfully certain too: somehow, the virus that inhabited the boy found its way to the man, settling first in his mucus membranes, and later in his gut and lymph system, where it multiplied explosively, finally migrating to the anterior horn cells of his spinal cord. On the evening of August 10, a feverish Roosevelt climbed into bed in his summer cottage on Campobello Island in Canada’s Bay of Fundy. It was the last time he would ever stand unassisted again.
Roosevelt’s polio, which struck him down just as his political star was rising, was supposed to be the end of him. The fact that it wasn’t is a self-evident matter of history. Just why it wasn’t has been the subject of unending study by historians and other academics for generations. This year, Roosevelt and his polio are getting a fresh look—for a few reasons.
October 28 will be the 100th birthday of Jonas Salk, whose work developing the first polio vaccine was backed by the March of Dimes, which was then known as the National Foundation for Infantile Paralysis and which itself grew out of the annual President’s Birthday Balls, nationwide events to raise funds for polio research, the first of which was held on FDR’s 52nd birthday, on January 30, 1934, early in his presidency. That initial birthday ball raised a then-unimaginable $1 million in a single evening, a sum so staggering Roosevelt took to the radio that night to thank the nation.
“As the representative of hundreds of thousands of crippled children,” he said, “I accept this tribute. I thank you and bid you goodnight on what to me is the happiest birthday I have ever known.”
This year too marks one more step in what is the hoped-for end game for the poliovirus, as field-workers from the World Health Organization, Rotary International, UNICEF and others work to vaccinate the disease into extinction, focusing their efforts particularly on Pakistan, one of only three countries in the world where polio remains endemic.
Then too there is the much-anticipated, 14-hr. Ken Burns film, The Roosevelts: An Intimate History, which begins airing on Sept. 14. It is by no means the first Roosevelt documentary, but it is the first to gather together all three legendary Roosevelts—Franklin, Theodore and Eleanor—and explore them as historical co-equals. It’s the segments about FDR and his polio that are perhaps the most moving, however—and certainly the most surprising, saying what they do about the genteel way a presidential disability was treated by the media and by other politicians in an era so very different from our own.
“We think we’re better today because we know so much more,” Burns told TIME in a recent conversation. “But FDR couldn’t have gotten out of the Iowa caucuses because of his infirmity. CNN and Fox would have been vying for shots of him sweating and looking uncomfortable in those braces.”
That’s not a hard tableau to imagine—the competing cameras and multiple angles, shown live and streamed wide. And what Americans would have seen would not have been pretty, because never mind how jolly Roosevelt tried to appear, his life involved far, far more pain and struggle than the public ever knew, as a special feature from the film, titled “Able-Bodied,” makes clear. That segment, which is not part of the broadcast and is included only on the film’s DVD and Blu-Ray versions, which are being released almost contemporaneously with the film, was made available exclusively to TIME (top).
Concealing—or at least minimizing—the president’s paralysis was nothing short of subterfuge, the kind of popular manipulation that wouldn’t be countenanced today. But it’s worth considering what would have been lost by exposing the masquerade that allowed FDR to achieve and hold onto power. Roosevelt, as the Burns film makes clear, was a man whose ambition and native brilliance far exceeded his focus and patience. It was a restlessness that afflicted cousin Teddy too, causing him to make sometimes impulsive decisions, like pledging in 1904 that he wouldn’t run again in 1908—an act he regretted for the rest of his life and tried to undo with his failed third-party presidential bid in 1912.
“Who knows what would have happened if Teddy had had the great crises Franklin had—the Depression and World War II?” Burns says. “I do know he was unstable and always had to be in motion. It fell to FDR, who could not move, to figure out a way to outrun his demons.”
George Will, in an artful turn in the “Able-Bodied” clip, observes that when the steel went onto Roosevelt’s legs it also went into his soul. That may have been true in FDR’s case, but it’s true too that suffering is not ennobling for everyone. Some people are broken by it; some are embittered by it. As polio nears the end of its long and terrible run, the things FDR achieved despite—even partly because of—his affliction remain nothing short of remarkable.

Post Polio Litaff, Association A.C _APPLAC Mexico

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