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Tuesday
Dec112012

The Nemesis of Polio

Polio--or more formally, poliomyelitis--was first diagnosed as a distinct disease in 1840 by a small-town German orthopedist named Jakob Heine. He noticed many adults in his town and others in isolated pockets in the Black Forest had a similar set of symptoms, including paralyzed and/or atrophied limbs; he began to make an anecdotal study, finally bringing together the first record of observable symptoms.

The viral spread was mostly contained to mountain towns where populations would come into daily contact with each other and not much with the outside world. The disease, however, began to reach pandemic proportions in Europe, the United States, Canada, Australia, and New Zealand in the early 1900s with increasing urbanization.

We now know that it is spread primarily through the oral ingestion of human fecal matter--or more specifically, the small amount of mucus in it. Thus, the virus can also be airborne, particularly propelled from sneezes--although more rarely so. The virus takes up residence in mucus, first in the mouth, then onto the tonsils, before moving into the digestive tract, feeding there before jumping--and this, rarely--to other systems in the body, including the nervous system, resulting then in the alarming cases of paralysis. It is an RNA virus, hijacking cells from the inside and using them for transportation and protection. Most polio infections end up with influenza-type symptoms--and that's it. Paralytic polio is actually a rarer disease.

A multi-person iron lungThe worst polio outbreak in the U. S. occurred in 1952 with almost 58,000 cases reported nationwide. In 1955, Jonas Salk produce the first vaccine--and polio was put into permanent decline in the West, although it still occurs with rather shocking frequency in isolated pockets around the globe.

That polio erupted in waves in the summer was merely circumstantial. That it was associated with flies was also circumstantial, given the nature of how it is transmitted. (The virus is only infectious among humans, no other animals.) But in the summer, more children were outdoors, more children were playing together, and more children had more contact with each other. Swimming pools, of course, became localized sites of infection because of the way the virus is transmitted. However, it is extraordinarily resilient, able to go dormant without the presence of water and become active later on.

Why polio became a childhood disease in the U. S. is still not fully understood. In fact, paralytic polio is much more likely to affect adults, not children. In adults, the paralytic strain of the virus results in debilitating symptoms in one in 75 adults--but only one in 1000 children. (FDR contracted the disease at 39.) There is some thought that the childhood pandemics in the West were again circumstantial: adults wash their hands more carefully than children, cover their mouths more frequently when they sneeze, and generally do not come into such close contact as children who are, say, playing baseball or tag-you're-it.

Of course, the horror of the disease localized into the visions of the negative pressure ventilator, or "iron lung"--and rooms full of them at that. At the present moment, there are at least seven people in the United States still living in iron lungs as a result of paralytic polio. They have chosen not to be ventilated--and so live in this artificial breathing machine, forcing their chests up and down and thus air into their lungs through the changes of pressure inside the tube. They spend their days searching eBay and other sites, looking to bid on old iron lungs or their spare parts.

I have been in contact with several of them over the years--I became interested in this lifelong, living hell several years ago--and the three I have written to seem quite content with their lives. They are all now in their 70s and survive about the way you would imagine a person would survive: by distractions. One is even married. As you may know, people in iron lungs do not necessarily need to be inside the tube all day every day. (Such a case is detailed in the current movie "The Sessions," one of the best movies I've seen all year--go see it!) These people can come out, for varying amounts of time, sometimes a few hours, sometimes the full day. As their chest muscles tire from breathing, they go back in and get "recharged," as it were, letting the machine do the work.

However, these survivors all had a mild case of paralytic polio which allowed them to live on with some assistance. The majority of children who entered iron lungs in the 1940s and 1950s died in them. And thus they met their nemesis.

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