Open season on the child crippler

According to the dust cover, A Summer Plague is the most comprehensive and compulsive account of the rise and fall of epidemic poliomyelitis yet written. It takes the story from the first major outbreak of "infantile paralysis" in New York in 1916 - which induced panic on a scale reminiscent of the great plagues of history - through to its lingering aftermath in the shape of the so called, and still mysterious, "post-polio syndrome".

For events before 1970, there is a serious rival to A Summer Plague. This is A History of Poliomyelitis by John Paul, who was a founder member of the Yale Poliomyelitis Study Unit and also served on the Immunisation Committee of the National Foundation for Infantile Paralysis. Even so, it was possible for Tony Gould to retell the story from a new angle (and add a new chapter) since he is one of many polio survivors who recently learnt that new disabilities may occur without warning 30 to 40 years after the initial crippling.

It was this setback which led Gould to take an interest in the history of poliomyelitis. He originally intended to write about his own reactions to the bad news, but eventually decided to learn more about the disease and the experiences of fellow survivors.

Hence we have a book which, in addition to showing what happened when "Americans en masse, orchestrated by the popular and powerful National Foundation, set out to conquer poliomyelitis", also shows how Gould and fellow survivors are coping with various disabilities.

The sudden excursion of poliomyelitis into the realm of epidemic diseases took the medical profession by surprise and converted a disease of infants into a disease which was also crippling older persons. It began, in 1887, with 44 cases in Stockholm, and was soon causing much larger outbreaks across Europe and North America. In the United States, the "nightmare of increasingly severe epidemics" provided the necessary stimulus for a fundraising project, launched by a famous patient, Franklin Delano Roosevelt, to achieve the status of a National Foundation.

Even so, the vaccine era was slow in coming and the disease in its original (endemic) form is still common in Asia and Africa. During what proved to be a long war against a remarkably elusive organism, there was much infighting between clinicians (who were more successful in saving lives than in dealing with effects of poliomyelitis) and virologists (who were more successful in producing vaccines than in maintaining full scientific control of field trials), and it was not until 1960 that the foundation could be said to have won a 30-years war.

The main stumbling block came from virologists being unable to grow the poliovirus in tissue culture. This problem was finally solved by Enders et al in 1948, and there rapidly followed both evidence that poliomyelitis is an enteric (not a nasal) infection, and successful field trials of the inactivated and attenuated poliovirus vaccines of Salk and Sabin respectively.

By 1930, "iron lung" treatment of respiratory distress was saving lives but other routine procedures, which required rigid fixation of paralysed limbs, were proving far from successful. This orthodox therapy was so painful (and the results so unsatisfactory) that it was possible for a nurse from the Australian outback to defy the medical profession and have immediate and resounding success with a totally different regime.

Meanwhile, and largely as a result of enormous pressure to do "something" to prevent further US epidemics, there was, in 1935, premature human experimentation with lethal and ineffective vaccines. But eventually, on the tenth anniversary of the death of President Roosevelt, the foundation announced to the world that Salk's inactivated poliovirus vaccine was "safe, effective and potent.'" Gould's immensely readable account of these events is followed by an attempt to give added "resonance" to the history of the poliomyelitis by describing the life histories of 14 polio survivors, and updating his own AP (After Polio) experiences. We are also reminded of two outstanding problems: there has not yet been global elimination of poliomyelitis - though this is now a major concern of the World Health Organisation - and the post-polio syndrome remains a mystery.

With this syndrome as part of the poliomyelitis story it is possible that the interview data obtained by Gould from 40 polio survivors have medical as well as historical significance and might be put to good use by epidemiologists.

Alice Stewart is senior research fellow, department of epidemiology, University of Birmingham.