<< Back To Home

NEW THIS TUESDAY: BOOK REVIEW, PARALYSED WITH FEAR: THE STORY OF POLIO

Monday, 27th of May 2013

The Lancet, Volume 381, Issue 9880, Pages 1805 - 1806, 25 May 2013

Polio revisited

Original Text

Paul Offit a

Paralysed with Fear: the Story of Polio

Gareth Williams

Palgrave Macmillan, 2013336

£20·00. ISBN-9781137299758

Contrary to the signature opening of the television series Star Trek, Gareth Williams, professor of medicine at Bristol University in the UK, has decided to boldly go where many men and women have gone before. Like Richard Carter in Breakthrough, or Tony Gould in A Summer Plague, or Aaron Klein in Trial by Fury, or John Paul in A History of Poliomyelitis, or Naomi Rogers in Dirt and Disease, or Jane Smith in Patenting the Sun, or John Wilson in Margin of Safety, or Nina Seavey in A Paralyzing Fear, or, most notably, David Oshinsky in his Pulitzer-Prize-winning, Polio: An American Story, Williams has written a book about polio and the polio vaccine. Remarkably, in Paralysed with Fear: the Story of Polio, Williams has made a significant contribution.

Williams doesnt shy away from the science. He begins by detailing the discovery of poliovirus and its method of spread in a manner so dramatic that we cant wait to turn the page, even though we already know the ending. He accomplishes this feat by mixing a conversational tone (“This is a good moment to put the science of polio to one side”) with great writing (“If smallpox was a mass murderer, then polio was a sniper, and all the more menacing because nobody would see where the fatal shots had come from”). In describing two experimental polio vaccines from the 1930s that had inadvertently paralysed and killed several children, Williams writes, “like the head of traitors stuck up around the walls of a medieval city, they were also a warning to others not to go down the same dangerous path”. Williams also affords the virus human qualities; when describing a successful vaccine, he writes, “[Polio] had unwisely chosen to target the American people, and therefore set itself up for revenge through the might of American science.”

Perhaps most surprising, Williams successfully interjects humour, which is not easy when the subject is children maimed or killed by a virus. In discussing disease transmission, he describes how “From the 1910s until the 1940s, flies created a considerable buzz in the polio research community”, and later he writes “What do a cold-shouldered Swedish virologist, a fly-encrusted monkey in a cage, 5000 snuffly American schoolchildren, and 70 000 dead cats in New York City all have in common? Answer: they were all victims of bizarre ideas of how polio was spread.” In his account of natural paralysing agents like tetrodotoxin, he writes, “Tingling of the lips often precedes paralysis and is Natures way of telling you to put your fork down.”

Taking an approach reminiscent of John Barrys The Great Influenza, Williams puts the development of the polio vaccine in the context of the evolution of medical thought, causing us to relive our most primitive notions about what causes diseases and how to treat them. Using remedies that harked back to ancient Greece, polio victims were treated with bloodletting, cupping, counter-irritants, emetics, purgatives, blistering agents, and leeches. In Williams telling, we learn how efforts by scientists in the 19th and 20th centuries determined the most basic principles of biology, physiology, microbiology, and cause and effect.

Like other writers in this field, Williams describes the many blind alleys and false leads of the early days of polio research, when doctors, scientists, and public health officials were convinced that the disease was transmitted by bedbugs, budgies, cats, and flies, or caused by seafood, cows milk, jimson weed, fruit, vegetables, and DDT, or that it was more likely to attack children who were “plump and well nourished, with a broad face, freckles, and gaps between their teeth”. Williams tells us about Benjamin Sandler who claimed that polio was caused by too much sugar, which prompted a dramatic drop in sales of ice cream, cookies, and Coca Cola in Asheville, North Carolina. And we learn of dangerous therapies like picric acid sprayed into the nose, which left thousands of children without a sense of smell; and of George Retans attempts to replace spinal fluid with saline, which only hastened death; and of branding patients backs with hot irons or administering dangerous drugs like dimercaprol. All in a desperate attempt to treat the untreatable. Williams separates himself from other authors in that he doesnt hold those who proffered dangerous therapies less accountable than those who unknowingly developed dangerous vaccines. “Kolmer may have had ten crippled and dead children on his conscience”, writes Williams, in reference to a failed polio vaccine made with ricinoleate, but “Retan should have had hundreds”.

Williams also uses the polio story to sound broader themes, such as the lure of alternative medicine. In the face of a disease without a clear cause or cure—enter the clowns. Royal Raymond Rife developed a machine that he claimed in part could cure polio; one that is still used by alternative healers today to treat the mythical chronic Lyme disease. Homoeopaths, whose discipline is based in part on “like cures like”, offered highly diluted preparations of Lathyrus sativus, the Indian grass pea, which causes paralysis. Chiropractors claimed they could cure polio by manipulating patients spinal columns: their numbingly simplistic treatment for many diseases. And Frederick Klenner, who would later be inducted into the Orthomolecular Medicine Hall of Fame along with megavitamin evangelist Linus Pauling, recommended that patients should take 30 grams of vitamin C.

Another larger theme in Williams polio story is how readily the public embraced conspiracy theory in the face of uncertainty. Anti-vaccinationists blamed vaccines like smallpox for causing polio, much as they later blamed vaccines for causing autism, attention deficit disorder, hyperactivity, multiple sclerosis, diabetes, and allergies. Others believed that pesticides caused polio and that manufacturers had paid off the federal government to pursue viral research knowing full well that a virus didnt cause the disease. (This would be more laughable if books published today didnt also claim that pesticides cause autism and chronic Lyme disease.) And we learn of Edward Hoopers notion that early polio vaccine trials in Africa were the source of the AIDS epidemic, again claiming a massive cover-up by scientists supposedly fully aware that they had caused harm.

Most moving, Williams is a master at telling the personal stories of patients who suffered the disease. By documenting the voices of polio victims, Paralysed with Fear gives insight into exactly what life was like inside an iron lung or how a patient with quadriplegia cried “inconsolably because his paralysis had robbed him of the means to kill himself”. And we learn, to our surprise, that Mia Farrow, Francis Ford Coppola, Joni Mitchell, Johnny Weissmuller, Itzhak Perlman, Arthur C Clarke, Alan Alda, and Sir Walter Scott all suffered from the disease.

Williams also compels the reader with the tragic stories of scientists who suffered the quest to find the cause of polio. For example, Karl Landsteiner, the first to discover poliovirus—and who later won a Nobel Prize for defining blood groups—ultimately fled his native Vienna and saved his life. And Hideo Noguchi, who with Simon Flexner had believed that a spirochete caused yellow fever and a bacterium caused polio, eventually died from yellow fever. “The virus won the final round”, writes Williams. Noguchis last words were, “I dont understand.” And George Dick, the Scottish microbiologist who was the first to find that Albert Sabins live attenuated polio vaccine could revert to neurovirulent type and itself cause polio. While trying to inject a mouse with rabies, Dick inadvertently injected the virus into his thumb, at which point “he calmly picked up a scalpel and sliced off the end of the digit”.

Williams has written a story about good and evil, successfully making poliovirus a villain in a gripping, multiact play. His book is especially timely as we are now on the verge of eliminating poliovirus from the world. Indeed, only three countries continue to suffer endemic disease and type 2 poliovirus has already been eradicated—the second human virus to succumb to vaccination (smallpox was the first). His book should be read by anyone interested in science, medicine, history, and public health. And by anyone interested in an incredible story told by a great storyteller.

Paul Offit is the author of Do You Believe in Magic? The Sense and Nonsense of Alternative Medicine(HarperCollins, 2013).