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Ancient Illness

A piece of art depicting a stele from Egypt, part of the Neurology, Illustrated exhibition at Tufts Medical Center in Boston.unknown artist
Stele of Roma the Doorkeeper
1403-1365 BCE
limestone, paint
Ny Carlsberg Glyptotek Museum
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This stele from ancient Egypt, featuring a priest with a withered leg, is one of the earliest known depictions of polio—a viral infection of the spinal cord that targets motor nerves. Ancient Egyptian art tends to be very formulaic, with little variety or individuality amongst the figures. It is rather unusual, therefore, that the artist of this stele (an upright, decorated stone, frequently used as a funerary monument) has portrayed this man with a clear deformity characteristic of polio. His right leg is atrophic (withered) and too short. The artist has also depicted the cane the priest utilized to help him walk.

Egyptian art is extremely formulaic, with few changes over a period of thousands of years. The human body was portrayed in a manner not physically possible, but one that showed off each body part to the clearest advantage: the head in profile, but the eye frontally viewed, shoulders frontal, hips and feet in profile, and so on. Grid patterns were used to ensure that proportions remained consistent, even when scale was exaggerated (prominent individuals were depicted on a much larger scale). Little variety is shown in body type, other than distinctions between male and female. Of the thousands of depictions of the human body that survive from ancient Egypt, mostly in tombs, few figures stand out as unique.

A painting on the tomb of Userhat, a piece in the Neurology, Illustrated exhibit at Tufts Medical CenterTherefore, when variation is found it is of special note. An Egyptian stele now in Copenhagen, dating from the 18th dynasty, shows a priest whose right leg clearly differs from the norm. The right leg is atrophied, or withered—it is too short and skinny when compared with the healthy left leg. The figure is using a stick to aid his walking. Interestingly, this is not the only example from Egyptian art where a figure shows these characteristics: in a painting from the tomb of Userhat we see a man with a similarly atrophied leg. The appearance in both is typical of someone with a history of polio. These works suggest that polio was present in ancient Egypt; in fact, this stele is possibly the oldest known work of art to represent the disease. An inscription identifies the figures pictured here, “the doorkeeper Roma” and “the lady Imaya,” and informs us that the man and the woman are making offerings to the goddess Astarte.

Before the twentieth century, most people who came into contact with the polio virus did so as breast-feeding infants. When they were infected, they were partially protected by maternal antibodies and had a very mild illness or no illness at all. As a result of the infection, they also created their own antibodies and acquired life-long immunity. Polio is transmitted by the disturbingly-named “fecal-oral” route. With improved hygiene in the twentieth century many babies did not get exposed until well after the maternal antibodies were no longer available to help them. With no immunity of their own, and no help from the mother, the impact of infection was worse. Still, most patients with polio have a typical and uncomplicated viral illness with minor symptoms such as fever and malaise. However, the virus can invade the central nervous system, usually the spinal cord, which occurs in only about one in 1,000 infected patients. It is there that the virus selectively infects and destroys the motor nerves that start in the spinal cord and supply the muscles with the messages to move. Without those nerves, paralysis follows. Which muscles become paralyzed depends entirely on what part of the spinal cord is infected.

Over the course of just a few days, muscles become weak and then stop working. Legs are more commonly affected than arms. The greatest danger is when breathing muscles are affected. The “iron lung” kept many people alive, through the heroic efforts of their doctors and nurses. A remarkable instructional video of how to manage patients in such machines can be seen here. Only one in three patients with weakness regain full strength—the rest are left with varying degrees of paralysis. Muscles that have lost their neurological innervation become thin and wasted. A leg that is affected in childhood will fail to grow normally and will end up shorter than the unaffected side, as in this Egyptian stele.

One of the most famous men afflicted with polio was a public figure who was able to keep the extent of his paralysis hidden from millions who voted for him again, and again, and again. Franklin Roosevelt is thought to have had polio (although some speculate that in fact he had Guillain-Barré syndrome). He went through great effort to keep his inability to walk unassisted from the American public as he did not want to be seen as a “cripple.” There are only rare films of him on his feet and walking. One was only discovered and released to the public in 2014: it shows him walking up a ramp at baseball’s Major League All Star Game in 1937. Just a few months later, in January 1938, he founded the “National Foundation for Infantile Paralysis.” Despite celebrity support, the foundation was unable to keep up with the growing needs of the polio epidemic in the USA. One of those celebrities, the singer Eddie Cantor, suggested that if enough people sent a single dime, then more money could be raised. The foundation was renamed “The March of Dimes,” as a verbal play on the “March of Time” newsreels. The appeal was a success. It is estimated that almost three million dimes arrived at the White House in 1938. In 1949, Jonas Salk was tapped to direct the March of Dimes’ effort to create a polio vaccine. The vaccine was shown to be successful in 1955.

references:

Jørgensen, Mogens.  Catalogue Egypt II (1550-1080 B.C.), Ny Carlsberg Glyptotek.  Copenhagen:  Ny Carlsberg Glyptotek, 1998.

Garcia-Ruiz, Pedro J., et al.  “Art and Dystonia.”  Journal of the Neurological Sciences 356 (2015):  49-54.


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