The Moth in the Iron Lung

Having read and very much enjoyed his book "Crooked", I was keen to read Forrest Maready's  "The Moth in the Iron Lung". It does not disappoint. Although only a short read at 173 pages, it nonetheless packs a punch. It is a fascinating exposé of the myths surrounding polio. The prevailing myth is that poliomyelitis was once a widespread and crippling disease caused by the polio virus. The introduction of vaccines in the late 1950s and 1960s was responsible for bringing the disease under control. This is the same story as is told for measles, mumps, whooping cough, dipheria etc. The lethal effects of these childhood killers were thwarted only by the development of vaccines.

It's a great story. The triumph of modern medicine over a plethora of deadly pathogens. The reality of course is quite different. Poliomyelitis means inflammation (-itis) of the grey (polio) nervous tissue (myel) of the spinal cord and was often referred to as infantile paralysis. In the late eighteenth and early nineteenth century, children were described as having a poliomyelitis and this inflammation was not necessarily thought of as having been caused by a virus. The very notion of a virus was still not fully understood. Whatever the cause, it affected children almost exclusively and then again mostly boys.

What is now largely forgotten about that period of time, at least in the United States, is that lead arsenate and later DDT were being used to combat pests that were destroying crops. These compounds were sprayed manually at first and later, after World War 1, aerially. DDT was dusted over everything, including people, to keep bugs at bay. The extent of its application is scarcely conceivable nowadays but photographs of the period provided graphic evidence. 

Source

The medical authorities assured the public that such spraying was "safe and effective" and the FDA of course gave its stamp of approval. During this time, many medicines were metal-based, containing lead and arsenic, and were routinely administered to children. The author makes an interesting point about the difference in anatomy between small children and adults. In the former, the intestines are on the same level as the base of the spine whereas in adults there is more vertical separation. This makes any gut leakage, caused by damage from medicines and pesticides, more likely to affect the base of the spine and cause paralysis.

Medical research focused on identifying a virus that was causing the paralysis in young children. While there were a number of viruses capable of causing paralysis, they only become dangerous when the integrity of the gut lining had been compromised and the immune system weakened. Once the dangers of lead arsenate, DDT and metallic medicines were realised, Western countries drastically curbed their use and infantile paralysis quickly waned. The vaccines contributed little to this decline but claimed full credit as they did with other childhood illnesses.

Let's finish with the headline from the source quoted earlier in the DDT photo. It should remind us of how insane the situation was back then and how the cure vastly exacerbated the disease. 

Read my earlier post here about Forrest Maready's book "Crooked". I'm happy to be posting more regularly to this blog having begun to overcome, to some extent at least, my despair at the seeming hopelessness of it all. I have to remember that there are plenty of like-minded people out there who are similarly exasperated and we must keep trying to enlighten those around us. Here is an excellent synopsis of the book by a reader who posted his or her thoughts on goodreads:

After reading Crooked earlier this year, I was intrigued by what the author might have to say about polio, a disease that has helped to shape the direction of children's healthcare for decades. One of the arguments from people who are staunchly in favour of vaccines seems to boil down to an indignant wail of, "Do you want to see children in iron lungs again?" or, "The polio vaccine saved us all! Salk is the biggest hero who ever lived!" or simply, "What about polio?" Yes, what about polio? In this book, Mr. Maready takes on those questions and provides ample evidence—some of it once known but now forgotten—that polio was, for the most part, a man-made scourge. An appropriate subtitle for this book could also be, "A Biography of Modern Man's Hubris" because, for all of our technological might and good intentions, we really do keep repeating the same mistakes ... and then throwing the blame (or the accolades) in the wrong direction.

The poliovirus has probably been with us for the entire course of our evolution. It's an enterovirus, which is a group of pathogens that often make their home and multiply in our gut. Usually, enteroviruses are fairly mild; they might cause a slight illness, the sort of thing you probably wouldn't even bother your doctor about. For most of its history, the poliovirus was like this. It wasn't until the late 1800s that something changed, and what was once an innocuous enterovirus started paralyzing people (mostly children).

Mr. Maready does not dispute that the poliovirus was causing the paralysis in many cases. But here's the thing: the poliovirus (and other enteroviruses) are fairly benign—unless they somehow gain access to the central nervous system. This book describes a few ways that could happen, and each one is a result of man trying to pull one over on Mother Nature:

Pesticides: By the late 1800s, medicine was already full of metal-containing concoctions. If you were ill, the standard treatment was to purge the bowels. This was usually done with medicines made from mercury or arsenic. That was bad enough, but the real problem began in the 1890s when large-scale application of pesticides—containing arsenic and lead—began to be spread to combat such pests as the gypsy moth. This new pesticide stuck to everything, and the dangers were unknown at the time... and so people were eating this lead arsenate-laced produce, not knowing that they were damaging their guts.

And that brings us to the first way that polio could enter the central nervous system: through a damaged gut. Mr. Maready points out that it's probably not coincidental that the paralysis seen in many polio cases would correspond to damage of the spinal cord right behind the intestines (especially in children, since their anatomy is slightly different; their spinal cord extends lower, relatively speaking, than it does in adults). Also of note: most cases of poliomyelitis paralysis did not affect sensory function. Why is this important? Because the nerves for sensory input are located on the back of the spinal cord. Only the nerves on the front—nestled against the intestines—affected motor control.

It's probably also not coincidental that the largest polio epidemics—which affected children and adults, coincided with the heavy use of DDT. Once that pesticide fell out of favour, the epidemics also fell away... but there was another temporal association that would take all of the credit: the polio vaccine. (Mr. Maready points out that India still uses DDT, and is in fact the largest producer in the world today. India is also still struggling to eradicate "polio", despite ongoing vaccination. Coincidence?)

Tonsillectomies: For many years, this was pretty much a rite of passage. This was an eye-opening section of the book. Apparently, mouth-breathing was associated with lower IQ, so tonsillectomies were routinely performed to make children smarter! In any case, once these started happening en masse, a new form of polio emerged: bulbar polio. This meant the paralysis was much higher up, often affecting the head, neck, and trunk. Could the open wounds of the tonsillectomies have provided an entry point for the poliovirus to the nervous system and the "bulb" (the medulla oblongata), which was only an inch or so away from the tonsils?

The syringe: The advent of the hypodermic needle meant that drugs could suddenly be delivered rapidly into a person's system, bypassing the gut entirely. Unfortunately, puncturing the skin could also drive the pathogens on it deep into the tissue... giving the poliovirus another route to the nervous system. In some cases of polio, paralysis was confined to or began in one limb ... which may have just been the unfortunate recipient of some sort of injection. Mr. Maready points out that this may be what we're seeing in these sporadic "polio-like" cases of paralysis that have been cropping up in children in the last few years. Since the poliovirus is not the only enterovirus that can cause paralysis if it reaches the nervous system, the theory is that "provocation polio" may be behind some of these cases ... especially given the late-summer timing (which is often when some kids are getting their back-to-school shots).

Scientists of the day were well aware of the dangers of tonsillectomies and injections with regard to polio, as evidenced by this article from The New York Times from 1952:

Seek a doctor’s advice about nose and throat operations, inoculations and teeth extractions during the polio season.

There are plenty of reasons to shake your head while reading this book. Mr. Maready shows us how our arrogance in the face of things we don't understand continues to be our downfall, and we continue to repeat our mistakes (he references the Zika outbreak of 2015, framing it as yet another example of our own hubris; this is covered in more detail in Crooked).

Was the poliovirus responsible for the 20th century's polio outbreaks? Yes and no. In some cases, our own actions may have given an otherwise-innocuous virus a chance to wreak havoc in our bodies. In other cases, a different virus may have been to blame. In yet other cases, the symptoms may have been simply the result of toxicity from pesticides or metals. The change in diagnostic criteria for polio after the advent of the vaccine (requiring that the paralysis be there for 60 days rather than just 24 hours, as had been the case before) meant that the numbers of official polio victims suddenly dropped... making it look as though the vaccine was a miracle. On paper, it may have seemed that way. But there still would have been people suffering from paralysis, even if they were no longer counted as polio victims, and that paralysis had to come from somewhere.

I was surprised that there was little mention of the Cutter incident (except in passing, and not by name). Perhaps Mr. Maready felt that this was outside the scope of the book, which focused mainly on the ways the virus could get into the nervous system, rather than the vaccine history. Still, for a book subtitled "A Biography of Polio", it wouldn't be unreasonable to see a more thorough explanation of this medical debacle.

This is an easy-to-read book that offers a new—and very plausible—alternative to the accepted story about the rise and fall of polio. Will we continue to make the same mistakes, forging down the wrong path for political or financial reasons, doomed to repeat the lessons of polio forever? Or will we one day be brave enough to look at the evidence without bias and see where it actually takes us? Only time will tell ... but if our repeated screw-ups throughout modern medicine's history are anything to go by, it won't be for some time yet.