General Articles

DON’T PANIC OVER POLIO

CHARLES NEVILLE August 1 1948
General Articles

DON’T PANIC OVER POLIO

CHARLES NEVILLE August 1 1948

DON’T PANIC OVER POLIO

CHARLES NEVILLE

THOUSANDS of parents this month will lose weight, sleep and peace of mind worrying about a disease which kills far fewer Canadian children each year than the common whooping cough. Poliomyelitis, the mysterious childhood crippler which more frequently maims than it kills, reaches its seasonal peak during the hot, humid days of midand late summer. It is then that a doctor, called to the bedside of a feverish sickly child who complains of stiff muscles, is most likely to shake his head and pronounce the words a parent dreads: infantile paralysis.

For this is the disease we can’t forget. The victims of other more serious ailments die, are buried and pass out of mind: most of polio’s victims live on, pathetically deformed and handicapped, to remind us year after year that here the crippler struck.

This year it will strike in Canada again, but how hard it is impossible to say. In the last two years there have been comparatively severe outbreaks (2,500 cases in 1946, 2,000 in 1947) and since each epidemic brings immunity both to those whose disease is diagnosed and to hundreds of others whose attacks are so mild that they are not recognized, medical authorities hope that the 1948 outbreak will be less widespread.

The Great Unknown

BUT no one can predict for certain. Polio is still among the most mysterious of mankind’s afflictions. During the past 10 years it has been studied more than any other disease, with the exception, possibly, of cancer. The National Foundation for Infantile Paralysis alone has spent $15 millions in polio research since 1938 in Canada and the U. S.

To date there is no proven method of prevention or cure. No one is sure how polio spreads, why it strikes one victim and passes by a thousand others, why it makes a vicious attack in one area and then suddenly appears somewhere else hundreds of miles away, or why an epidemic one year kills one out of every four of its victims and only one out of every 25 victims the next.

Yet some of the mystery is lifting. The disease is no longer the unfathomable unknown that it was 20 and even 10 years ago. Somewhere, maybe next week, maybe a decade hence, one of the thousands of polio research projects will throw off the final secret and reveal a cure or a preventive that will close the books on one of the greatest scientific assaults of history.

But, in the meantime, the biggest comfort for parents is this:

Polio is actually an uncommon and mild disease. Doctors say that even when it reaches so-called epidemic proportions the odds of any one particular youngster contracting polio are about 1 in 1,500, so small that a professional gambler would put all his money on such a sure thing.

Polio epidemics rarely follow that familiar pattern of contact and infection true of all other contagious diseases. If Susie s playmate next door goes down

with scarlet fever, the chances are high that Susie, too, will have caught the disease. If Susie’s playmate gets polio instead, of course there is still the chance that Susie will have picked up the infection. But polio is like lightning—there is no knowing where it will strike next. The next case may crop up in a youngster 10 blocks away who has apparently had no contact at all with the disease.

Continued on page 31

Polio, the dreaded crippler, is actually an uncommon disease. Even in an epidemic

YOUR CHILD’S CHANCES ARE:

1.500 to 1 against catching the disease;

7.500 to 1 against being crippled by it; And — 30,000 to 1 against dying of it

In midsummer polio weather—

DON’T let your child become chilled in swimming; don’t let him swim in polluted water; don’t let him get overtired.

DO wash all fresh fruit and swat that fly; try to postpone tonsil operations till fall; call the doctor if there’s polio nearby and your child is drowsy, has nausea, a fever or headache and stiffness in the neck or limbs.

Don't Panic Over Polio

Continued from page 7

In an average outbreak of polio serious enough to be regarded as an ePidemic, only about one youngster in every one to two thousand will acquire the disease in a diagnosable form. Some ^arS Asease is much more virulent than others and the percentages of deaths and paralyses vary widely. But, j even in the severe years, polio’s threat I as a crippler and killer is grossly overj rated in the minds of parents. Remember, only one youngster in one to two thousand is going to have polio in first place. Of these, on the average, more than half will recover with no trace of muscle weakness or paralysis.

A quarter of the victims will be left with minor weaknesses and paralyses which can be corrected by treatment. Only a fifth of the cases will result in permanent crippling. Death, as a result of paralysis of the chest or heart ¡ muscles, will come to only one in 20.

Thus, if polio strikes in your neigh| borhood, there is only one chance in ! 30,000 of your own child dying from j the disease, and one chance in 7,500 j of your child being permanently ! crippled. These are the odds which every August fill parents with an awesome dread unknown to any other disease.

Polio, no denying it, is a childhood menace, but the attitude parents should take toward it is one of soberminded concern, not unreasoning panic, i Let's take a close look at this disease.

Polio is thousands of years old; Egyptian skeletons dating hack to j 3700 B.C. show crippling that was I obviously the result of polio. Not until 1916 did the first really large epidemic i occur; that year polio killed 6.000, mostly children, and left 27,000 crip! pled in Northeastern U. S. Families fled in terror before this new and mysterious killer, vigilante committees guarded j towns with shotguns to keep out the j children of neighboring regions. The i world’s first polio panic had come. As epidemic followed epidemic in later j years some of this initial terror abated, j but in general this panic in a somewhat J moderated form lingers yet.

For many years doctors believed that the polio epidemics came in cycles four to six years apart; few think so today. Canada had 2,000 cases in 1941, then the score slipped back to 700 in 1942, 300 in 1943, back up to 700 in 1944, down again to 400 in 1945, then zoomed j upward to 2,500 in 1946 and around 2,000 in 1947.

Polio killed one out of every four of its Canadian victims in 1940, but only one out of every 30 in 1941. Then ! from a one-out-of-ten death rate in 1942 it has gradually grown less ! virulent until the 1947 toll was one I in 20.

Polio, like chicken pox, mumps, influenza, the common cold and sister’s hated warts and cold sores, is caused by one of those midgets of the microbe world which scientists know as viruses. The polio virus is one of the smallest known. No one has actually seen one, i not even with the powerful electron microscope.

And they’re as tough as they are small. All ordinary disease germs curl j up and die when they come in contact j with glycerin, but the polio virus has j kept its kick after eight years in the stuff. They seem just as resistant to j cold. One experimenter found that polio virus frozen for 40 days still I packed a disease-inducing wallop.

Polio in its severe form is rare, yet strangely the virus which causes it has been found to he very widespread. Tests have revealed the presence of polio antibodies in the blood of 90% of healthy adults selected at random, indicating that all these persons have carried the virus or had polio in a minor unrecognizable form some time during their lives and have built up subsequent j immunity.

Hard to Diagnose

Polio experts believe that before one can become an actual polio case the virus must jump from the blood stream, the nose, throat or intestines, where it ] seems to do no harm, to the nervous j system. Once the virus starts setting j up housekeeping in the body’s nerve fibresusually the brain or spinal cord j at first— trouble begins.

Unfortunately, polio in its early ; stages is about the most difficult human disease to diagnose. The victim may have one, a few or all of the following symptoms: headache, fever, nausea, diarrhea or constipation, loss of appetite, drowsiness. If there are polio cases in the neighborhood and your child develops any of these sympj toms, call the doctor. If he suspects polio, he will probably advise i hospitalization.

Blood tests and the microscope are i of no help in polio diagnosis. The only sure way is to take samples of intestinal discharges and throat and nasal secretions, inject them into monkeys, then wait a week or two to see whether the monkeys catch the disease. Researchers follow this procedure, but it’s too costly and too slow for practical use. Examination of the spinal fluid is an aid in early polio diagnosis, but it’s not always reliable.

In half the polio cases, the disease goes no further than these minor early symptoms. The child is sick for a few days and then recovers, none the worse for the attack. He should now have immunity to future attacks. (But polio, the unpredictable, adheres to no hard and fast rules. In Stratford, Ont., a 16-year-old girl who had been partly paralyzed and recovered from polio in 1946 had a second attack within a year.)

In half the cases, though, the virus starts to destroy the nerve cells which carry the brain’s messages to the muscles. The patient has a stiff neck, or a stiff back, tremors or weakness in the arms and legs and, in the unfortunate few, muscular paralysis. Usually the nerve damage is so slight that the body can repair it and the victim may recover with only minor or no crippling. In a quarter of those who get polio, though, the nerves are so badly injured that the body cannot mend them and there is permanent crippling. The muscles normally guided by the broken nerves go slack and may allow live muscles unaffected by the disease to pull soft young bones out of shape.

If the virus attacks the nerves which control the heart muscles, death can result. And if the muscles which control breathing go limp, the victim may die of suffocation unless he is rushed into an iron lung until the damaged nerves are repaired—if ever. Until 10 years ago it was assumed that there was only one door by which the virus could gain entry into the nervous system—the exposed ends of the olfactory nerve (by which we smell) at the rear of the nose. The battle erV of polio research became: “Protect the nose and prevent polio.”

In 1936 an investigator at Stanford University in California, experimenting with monkeys (apes, monkeys and man are the only animals which contract polio easily) found that a nasal spray of a solution of zinc sulphate covered the nerves of smell with a protective coating. When polio virus was sprayed into the noses of monkeys so treated, not one succumbed to polio.

Everyone gave three cheers and assumed that polio was at last defeated.

The Swimming Menace

In the summer of 1937 the continent’s severest polio outbreak was in Toronto. Five thousand Toronto children received the nasal spray. Then the scientists and the general doctors who had aided in the project sat back to await developments.

And what happened? Polio attacked the treated children almost as often as it struck those who had received no treatment at all. In cold figures, the zinc-sulphate spray had a protective value of less than one per cent. Today we know that the virus can worm its way into nerve tissue via the throat and intestines, as well as through the nose.

Physicians have observed that polio frequently attacked children within a day or two after they had been swimming. So common did this observation become that the water of swimming pools and bathing beaches was blamed for spreading polio infection. But a few years ago a child specialist in a Chicago hospital began to doubt that water-borne infection was the whole explanation. By experiments on monkeys, he showed that the fatigue and chill caused by prolonged swimming doubled their susceptibility.

Two of the important safeguards that parents can exercise during polio outbreaks are: 1. Don’t allow children to remain too long in cold water; 2. Don’t permit them to overplay, overwork or go without sleep to the point of exhaustion.

Polio studies have revealed other ways in which parents can inadvertently give the polio virus a helping hand. When teeth contain cavities the nerve is frequently exposed. Such unprotected nerves provide a wideopen door for the polio virus. Sound teeth, of course, are not a complete safeguard against polio, but, if teeth are well cared for, the child’s antipolio armor is that much stronger.

In 1941 at Akron, ().. five in a family of six children became ill with polio and three of them died. The sixth child also carried the polio virus in his intestinal discharges. Why had he remained healthy while the others became severe polio cases? There was one outstanding clue. The five polio victims had all had their adenoids and tonsils removed a few days before they developed polio, the sixth and youngest child was not operated on because of his age.

Considerable evidence has now been accumulated to suggest that removal of adenoids and tonsils, which leaves raw nerve ends exposed for a few days until the the operation heals, increases susceptibility to the polio virus. Most doctors advise that these operations be postponed until after the summer months, unless the tonsil or adenoid infection is severe enough to demand their immediate removal. Some polio investigators claim that teeth extractions in children should also be avoided whenever possible during the polio season, for this too leaves nerve ends exposed for a short time.

What other precautions should a parent take?

The first, so obvious that it hardly merits mentioning, is to avoid homes where polio is known to have struck.

Precaution No. 2 is to avoid swimming in sewage-poilu ted water when polio is present in the area.

Wash All Fruit

In recent years authorities have come to suspect that the commonest method in which children pick up the polio virus is by eating contaminated food. The culprit which makes this possible is the house fly. ’I’he moral is to protect food in the home from flies; food such as fresh fruit which has probably been in contact with flies before being purchased should he washed and brushed before it is served. Make sure Junior washes his hands before he starts eating.

In every polio epidemic more boys than girls take the disease. At first this baffled researchers, but now it is believed due to the fact that boys get dirtier, play harder and are thus more often fatigued, and swim oftener so that they are more subject to chills.

When, daspite all precautions, polio strikes and advances to its most serious stage, there is as yet no known drug or treatment that can ward off’ paralysis. But modern methods,started early, can reduce its effect and minimize deformity. As soon as paralysis is evident, the affected limb is exercised regularly and treated with hot moist packs. This can prevent muscle wasting and its resultant deformity and frequently, even though a muscle has lost all its funclions, adjacent muscles can be reeducated to take over its job.

Paralyzed limbs used to be put in splints on the theory that rest was needed to restore the wasted nerves and prevent deformity. Thanks in large part to the caustic criticisms of Sister Kenny, the Australian polio crusader, this practice has been abandoned; the splint treatment as often as not caused the muscle to wither from disuse, increasing the crippling instead of overcoming it.

One interesting treatment for paralysis, developed by the U. S. Navy during the war, is deliberately to cut or pinch off the damaged nerve by pounding the body over the nerve with an instrument like a riveting hammer. This causes the nerve to send out new shoots like a pruned shrub. Many polio cases so treated have made a complete recovery from paralysis and the over-all experience is a 50% improvement in muscle strength. It’s too early yet to make definite claims for this method, but it holds tremendous promise.

The final answer to the challenge of polio will probably come in the form of a drug, serum or vaccine which will rout the polio virus and prevent it from ganging up for its paralyzing assault on the nervous system. A serum made from the blood of persons who have recovered from polio has been used for years, but its value is questioned.

There is more hope that a vaccine which can be scratched into the skin or injected into a muscle will do the desired job. For several years now there has been a new vaccine containing virus killed by ultra-violet radiation. It has been tested and retested, scientists have injected it into themselves, but they are still not ready to release it to the public at large.

Most scientists believe that somewhere there is a drug which will turn out to be polio’s most effective remedy. Thousands have been tested. The recently developed wonder drugs are powerless against the polio virus. Researchers, knowing that penicillin and streptomycin came from earth molds and bacteria, are even combing the soil itself for an agent capable of battling the virus.

One of the hopeful clues bared by polio research is that the disease very rarely attacks pregnant women, especially in pregnancy’s early stage. (Though regarded as a childhood disease, it does attack adults quite commonly.) Researchers are studying sex hormones, trying to determine whether here may be the antipolio drug that has long been sought. One of them, gonadotropin, is found nowhere but in the urine of women who are in early stages of pregnancy. Research in this most promising field has barely begun. Gonadotropin is still a mystery substance. Will it turn out to be polio’s death knell? A-