Polio Particles - Issue 9

Mary Westbrook

Earliest known polio case was over 4,000 years ago

Many books about polio include a picture of the man considered to have had the earliest known case of polio. He appeared on an Egyptian carving dating from the period of the eighteenth Egyptian dynasty, around 1552-1306 BC, about three and a half thousand years ago. The young man had an atrophied and shortened left leg such as is found in many people who contracted paralytic polio in childhood. He is supporting himself with a staff held under his arm like a crutch. Some Egyptologists think that he was a priest.

However an earlier case of polio was identified in 1989 during archaeological excavations at Tell Abraq, on the coast of the Arabian Gulf in the northern Arab Emirates. Professor Dan Potts from the University of Sydney headed the Australian team of archaeologists working on the site. On UAEinteract (the website of the United Arab Emirates) Potts is quoted as saying that Tell Abraq site is without doubt, one of the most important yet discovered in the United Arab Emirates, showing evidence of successive settlement from around 2,500BC for a period of at least two thousand years. There is extensive evidence of international trade with Mesopotamia and with the Indus Valley … Tell Abraq may have been the site of a petty kingdom in the Third Millennium BC… At its peak Tell Abraq must have been a dominant feature of the coastal plain. A fortress 40 metres in diameter was excavated, the largest Bronze Age building yet discovered in the Arabian Peninsula. Ten metres west of the fortress a large stone circular tomb about six metres in diameter was found. It contained the remains of several hundred people. The skeletons showed no signs of malnutrition though a number had signs of chronic diseases. The grave was covered by sand some time between 2,000 and 1,000 BC. One of the skeletons excavated was that of a young woman, who was identified as having had polio, the earliest evidence yet discovered anywhere in the world of the disease.

I contacted Professor Potts who put me in touch with Professor Debra Martin, a biological anthropologist from Hampshire College, Amherst, Massachusetts, who was the member of the archaeological team responsible for the diagnosis of Leslie's polio. This name was given to the skeleton before her gender was identified. Professor Martin was kind enough to send me a copy of some of her data on Leslie, which is yet to be published, including a photograph and medical assessment of her skeleton. Leslie was about 20 years of age and it is thought that she developed polio in her teens. Her legs were of similar lengths. Her right leg shows evidence of overuse in the early osteoarthritic changes in the knee and ankle. There is evidence of muscle weakness and wasting in the left leg with some deformity in the left foot. Some of the bones of the lower legs show early osteoporosis. Leslie's pelvis is asymmetric and she had scoliosis of the lower spine. The type of curvature of her lower spine suggests that she was fairly sedentary and sat much of the time. Leslie is now at Amherst. Her discovery moves the date of the earliest known case of polio back around 500 years.

Polio during pregnancy

A question sent to Dr Richard Bruno's column, Post-Polio Forum, in the April 2001 issue of New Mobility asked: My mother had polio when she was pregnant with me. At age 35 I began suffering symptoms that match PPS very well. I am wondering if I caught polio in the womb from my mother? Bruno replied that the chances of this occurring are infinitesimal. He described a study done in Los Angeles and Illinois during the polio epidemics that identified almost 1000 pregnant women who contracted polio. None of their babies were born with polio-like symptoms and it is assumed that their mothers' antibodies protected them. Catching polio while pregnant is particularly dangerous, however. In the Los Angeles-Illinois study, pregnant women who contracted polio were five times more likely to die from polio than were other polio cases. Miscarriage rates were not higher than normal among these women. Autopsies of their miscarried foetuses did not show signs of polio. However the doctors who treated these women considered that their polio had contributed to the loss of their babies. Bruno referred to another research study, which looked for records of cases of polio in babies less than six months of age born between 1897 and 1956. It identified 150 cases. Four of these babies showed signs of paralytic polio at birth. So it seems that in very rare cases the mother's antibodies do not protect the foetus. One such person recently asked on an Internet mailing list, to which I belong, whether anyone knew of another case. Only one of the thousand or so list members responded in the affirmative.

PPS in Recent Novels

Finding passing references to PPS in recent novels suggests that knowledge of the condition is becoming more widespread. In Barbara Kingsolver's widely acclaimed book The Poisonwood Bible an American missionary takes his family of four daughters to the Belgian Congo in 1959. Adah is the only daughter who returns to the US where she becomes a doctor. Middle-aged at the end of the book she describes her pastimes: Sometimes I play chess with one of my colleagues, an anchorite (hermit) like myself, who suffers from post-polio syndrome … Sometimes we go out to a restaurant in the Atlanta Underground, or see a film at a theatre that accommodates his wheelchair.

Ellie and the Shadow Man is the latest book by prize winning New Zealand author Maurice Gee. It tells the life story of painter Ellie Crowther. Early in the novel 14-year-old Ellie meets Hollis Prime the brother of a wealthy school friend. He is a law student who contracted polio aged 11. Ellie recalls the 1954 epidemic: the schools were closed. She remembered doing schoolwork at home, and a girl called Muriel in her class who had caught polio, although not badly. Back at school, no one wanted to share a desk with her. They pretended they could see germs hopping over, and ran to the taps and washed their hands if they had to touch Muriel in folk dancing. Ellie blushed slightly remembering her part in it.

Ellie asks Hollis what happened when he contracted polio. Nothing much. I got carted off. Then I was in a wheelchair. I wore calipers. I'm OK now, he replies.
So you'll always limp?
Sure … You want to know the worst thing? It's my parents.
Why? asks Ellie.
I don't mind being crippled. It's no big deal. But Mum thinks I'm spoiled. Like a bloody bike that's got a buckled wheel. She doesn't want me any more.
She doesn't say that?
She doesn't need to. She used to be all over me when I was a kid, but now she doesn't even like touching me. She's always telling me to wash my hands. She went along to school after it happened … She accused them of letting me play with dirty kids … Polio is working class, not for the Primes.

About 300 pages on, now middle aged, Ellie and Hollis meet again. He has given up law and is buying a vineyard. A relationship develops. A few years later Ellie wonders, Why is Hollis so tired just as he is set to succeed? Hollis tells her that he has post-polio syndrome. She had never heard of it. He explains: after the illness some of the nerve cells partly recover. New fibres and filaments transmit the messages. So the victim carries on with his life (in Hollis's case limping with his slightly shortened leg). Then as you start ageing the new pathways wear out, become overgrown - 'choose your metaphor', Hollis says -- and your trouble starts all over again: a sort of flaccid weakness, then sudden deadly fatigues. Mysterious pains, and pain referred in the butt and thigh. Loss of mobility and loss of balance. 'Bitching and bad temper'. Hollis says, 'I'm sorry, love'. Ellie almost cries. But it's not fair. 'What can we do?' she asks instead. 'Live with it. Keep going. Pull my horizons in' ... 'If I can't do much work here, at least I can manage it.' He tries to grin. 'I'll still be boss'. 'Yes,' she says, 'of course you will. But treatment, I mean.' He tells her pain-killers, and massage and mudpools up at the hospital in Rotorua. By midwinter Hollis is forced to change his stick for crutches. Later Ellie watches Hollis walk up the path to the vines. He had mowed it … instead of going straight up, he'd cut an easy dog-leg so he could manage on his crutches … He pushed himself too hard and seemed to have a dark enjoyment of his pain. He reminded her more and more of the boy she had first seen forty years before, sitting in the rain by the tennis court. He had been a singularity - but no, she protested, he's not any more, not sucking everything into himself. Soon: There were daily changes in him - more pain, stronger pills and, since Christmas, a trip to Rotorua and another one planned. She had learned to massage his legs. And now there were the modified controls …
The book is published by Penguin and sells in Australia for $26.

PPS in developing countries

In a recent article in Disability World (May-June 2001) Dr Christopher Howson, director of global programs for the March of Dimes, is quoted as saying: In developing countries, where polio outbreaks still occur or have ended more recently (than in the west) medical systems will be facing PPS for decades into the future. He says that in developing countries PPS is less recognised than in advanced countries and speculates as to the reasons for this. Perhaps PPS is underreported because health care providers are not recognizing it. Or perhaps people who are more at risk of PPS in developing countries tend to die before they reach the age of recognized disease onset. Also, PPS seems to be more common and severe in people who successfully rehabilitated themselves from the initial polio attack. Perhaps a lower percentage of people in developing countries have had the opportunity for rehabilitation and thus, haven't put themselves at additional risk of PPS.

Deborah Goebert, medical researcher at the University of Hawaii speculated (in articles in World Health and The Rehab Journal in 1990) on the influence of cultural practices on the development of PPS symptoms. She found in a small study that far fewer polio survivors in the Marshall Islands (8%) reported fatigue, reduced energy and exhaustion than did those in Hawaii (65%). The lifestyles of the groups differ. The Marshallese, both ablebodied and polio survivors, rest for an hour or more several times during the day. Goebert suggested that this habit of rest breaks might delay, or perhaps even prevent, the development of some PPS symptoms.

President Roosevelt and the onset of PPS

Roosevelt is arguably the world's most famous polio survivor. Without his fundraising efforts far fewer American polio cases would have received rehabilitation and the development of the polio vaccine would have been delayed for years. Roosevelt dealt with polio and PPS by total denial as Hugh Gallagher has discussed in his books FDR's Splendid Deception and Black Bird Fly Away (see review in Newsletter 41). FDR never discussed his polio or PPS symptoms with ANYONE. Lorenzo Milam, a polio survivor, has speculated about FDR's reaction to PPS in his (Milam's) memoirs, The Cripple Liberation Marching Band Blues: There was one crucial day in Roosevelt's life-as-president which has never been documented. … It was the day Roosevelt decided not to try any more. It was the day that, for the first time since the fever crusted his nerves, he decided not to get up and walk. It was the day he decided that strapping on the braces, hoisting his weight on the crutches, feeling the squeeze of leather against thigh and calf, the burning weight of wooden handle against palms was just too damn much trouble. I am sure it didn't come about just that way. I am sure that Roosevelt said to himself: 'I don't have time to get up today. Tomorrow, I'll do it tomorrow'. And then tomorrow came, and then tomorrow, and then there was no petty pace at all. None of the grinding strain to get up and move about. More comfortable in the wheelchair -- the wheels have become my hand. I'll do it next week. Meanwhile, I will let the helping hands move me on these round rubber legs, with their spokes, and these comfortable leather arms. … Roosevelt succumbed to the unmitigating, undeniable truth of his body. Accompanied by terminal despair, he found he was growing, again, to be as helpless as he was in the awful days at Campobello. He learnt that the disease is the master, the ultimate master; and our efforts to surmount it are … tinsel, cut from the glaze of ultimate defeat. When my friend Gallagher, the historian, asks people who knew Roosevelt, asks how he reacted to the second crippling that must catch all 'old ' polios … they always say 'O, No problem. Nothing at all. Didn't bother him at all. He was magnificent' … Didn't bother him at all? Didn't bother the Master of Control at all? Fat. F---ing. Chance.