Toronto pandemics past: polio the paralyzer

In his fourth in a series on Toronto pandemics past, Richard Longley recounts Canada’s crucial role in the fight against polio, the paralyzer of older children and young adults, including some that would go on to become Canada’s biggest stars.

It’s a paradox of childhood illnesses, polio included, that children who survive them often grow up to be remarkable individuals. Polio has existed for millennia, but in Canada, the best-known survivors are children of the epidemics of the 1950s: Donald Sutherland, Neil Young, Joni Mitchell, soprano Lois Marshall, artist Bill Reid, Canada’s first female aeronautical engineer Elsie McGill, former CEO of Cineplex Garth Drabinsky and former Lieutenant Governor David Onley.

Crucial for the role Canada would play in the fight against polio, future federal minister of health, Paul Martin Sr., who contracted polio in 1907 when he was four years old. His son, the future prime minister Paul Martin Jr., would be temporarily paralyzed in the throat by polio in 1946 when he was eight years old.

In the U.S., polio’s most famous – and one of its oldest – survivors was future president Franklin D. Roosevelt. He was infected in 1921 when he was 39. FDR’s polio was not entirely a curse. Crucially, it gained his sponsorship, when he was president, for the creation in 1938 of the National Foundation for Infantile Paralysis and its March of Dimes campaigns for polio treatment and research.  

Polio is highly contagious, caused by a virus and, like cholera and typhoid its entry is “fecal-oral” or “oral-oral”, meaning infection is via water that’s been contaminated with human sewage. When that kind of pollution was practically universal polio was little noticed because it was caught mostly by very young children who usually suffered only intestinal symptoms that could be so mild, they passed almost unnoticed. It was only rarely that polio turned paralytic.

In 1860 it was discovered that the cause of what used to be called infantile paralysis was inflammation of nerves in grey matter of the spinal cord and immobilization of the muscles they serve. In 1874 that understanding was built into a new name, poliomyelitis. As well as becoming less infantile polio was becoming more common in its paralytic form and more often a paralyzer of older children and young adults. What caused this was a cruel paradox.

Starting in the mid-19th century the developed world began to adopt the “sanitary idea” which proposed that, as well as a city’s health its prosperity, self-image and all-round wellbeing depend on the elimination of cholera, typhoid and other waterborne diseases. 

By the early 20th century, most cities in Europe and North America were equipped with water filtration plants, sewers and sewage treatment plants. The product of this colossal investment was a near-total elimination of cholera, a dramatically reduced incidence of typhoid and the transformation of polio into a paralytic disease of epidemic proportions.

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Building iron lungs in the basement of Sick Children’s Hospital, August 1936. Photo credit: Hospital  Archives, The Hospital for Sick Children,  Toronto.

Coffin-like machines

In August 1910 a young girl was taken to a Hamilton hospital with what was thought to be rabies but after her death, the cause was found to be polio.

In 1912 Helen MacMurchy wrote in Maclean’s: “1910 was in a terrible sense a ‘wonder year’ for epidemic poliomyelitis.” It was a wonder year everywhere. In 1910, polio was all over Europe. MacMurchy noted that it reached even “Nauru, a small island in the Pacific, 160 miles from the nearest land, where there were 700 cases and 30 deaths though the total population was only 2,330.”

Of a total of 658 cases caused by this country’s first major outbreak, 354 were in Ontario. Polio would return again. From 1932 to 1937 it moved through British Columbia, Alberta, Manitoba, Ontario and Quebec. In 1936 and 1937, Manitoba and Ontario. In 1941 Manitoba and New Brunswick. In 1946 to 1953 all provinces and into the Arctic.

There were patients who recovered or appeared to recover, completely, others who recovered partly who would depend on crutches or leg braces to the ends of their lives and patients who remained dependent on iron lungs, the coffin-like machines that rhythmically inflated and deflated to allow patients to breathe. If they were lucky they would recover on their own when the nerves supplying the muscles of the diaphragms recovered sufficiently. There were mothers who gave birth inside an iron lung and, later in life, victims of post-polio syndrome who lived long enough for the unparalyzed nerves that supported them for decades to whither and allow the symptoms of polio to return

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A lineup of iron lungs on the grounds of the Hospital for Sick Children, August-September 1937.

Mad scramble for remedies

When polio became epidemic in 1910 there was a scramble to explain its mode of action. Toronto’s Medical Officer of Health Charles Sheard wondered if “the modern invention” of electricity might promote polio. (In 2020, G5 antenna towers are being vandalized in places where they are suspected of being the cause of COVID-19.)

There was also a scramble for remedies.

In 1928 infected children were given “convalescent serum” made from the blood of people who had recovered from polio. The thinking was that antibodies in the serum would fight the virus. It didn’t work for polio but convalescent serum is being evaluated today, as a potential treatment for COVID-19.

(If you’ve recovered from COVID-19 and you would like to participate in that study, contact the National Clinical Trial that’s being conducted by Canadian Blood Services. If you’d rather participate in the trial of some other potential treatment, there are many approved by Health Canada that are seeking volunteers.)

In 1937, 5,000 children inhaled a nasal spray containing zinc sulphate in a Toronto study to find out if it would prevent infection through the olfactory nerves. The spray proved to be ineffective and in some children, it disturbed their sense of smell but the trial did show that the poliovirus does not enter the body through the nose.

More cruel was “treatment” by stretching and prolonged immobilization of contracted muscles in the medieval-looking Bradford Frame.

In Australia outback nurse Elizabeth Kenny insisted what was needed was vigorous massage and manipulation of limbs paralyzed by  “spasm”. Kenny was scorned by orthodox experts but that did not prevent her from treating almost 8,000 patients and becoming famous worldwide, the movie Sister Kenny being made about her triumphs.

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Boy on a Bradford Frame with attached arm and leg splints designed and built by the Hospital for Sick Children, Toronto, and provided free to all paralytic polio patients by the Ontario Department of Health. (Photo from Hospital for Sick Children 62nd Annual Report, October 1, 1936 –September 1, 1937).

Return of an epidemic

The epidemic that raged in Canada between 1946 and 1953 culminated in the worst year for polio ever in this country, with 8,878 cases and 494 deaths.

Life during the baby boom years that followed the Second World War was supposed to be safer and healthier, science-based and modern, where the only things to fear were communists, nuclear war and abduction by aliens from outer space. But children were being paralyzed by polio in droves.

In Toronto, the founder of Connaught Laboratories, John Gerald FitzGerald who fought so hard to defeat diphtheria had died in 1940 but led by his successor, Robert Defries and backed by funding from the “March of Dimes”, Canadian Life Insurance Companies and the newly launched Federal Public Health Research Grants, Connaught would participate mightily in the campaign to eradicate polio.

In 1949 a team led by Raymond Parker had developed, after 198 failed attempts, “Medium 199”, a synthetic tissue culture for studying cancer cell nutrition.  In 1951 Medium 199 was tested for growing poliovirus by a team led by Andrew Rhodes. Medical historian Christopher Rutty describes that when Rhodes heard that the poliovirus multiplied at a rate much faster in Medium 199 than it did in traditional animal-based serum –and in a way that could be safe to use in a human vaccine – ‘the otherwise unflappable scientist, jumped up on a chair and cheered.”

Meanwhile, in his lab at the University of Pittsburgh, Jonas Salk had developed a method to reliably inactivate poliovirus using a precise concentration of formaldehyde at a precise temperature over a precise period of time, making it non-infectious, yet able to stimulate an immune response in monkeys. But he used a traditional animal-based medium to cultivate the virus that would be unsafe to test in humans. So, not long after Rhodes had jumped up on that table at Connaught and cheered, Salk asked him to send him some Medium 199 that would allow him to prepare a human-safe vaccine.

The first Salk vaccine trial took place in a residence for disabled children in Pittsburgh. Most of his “volunteers” had already contracted polio and the test was primarily for possible side effects. There were none. The next challenge was to make a huge amount that would be needed for a large trial to see if the vaccine prevented polio in healthy children.

In 1952, at Connaught’s Spadina Division (in the former Knox College that is now the Daniels Faculty of Architecture) Leone Norwood Farrell focused on the next critical step: scaling up production of polio vaccine. She would do that by developing the “Toronto Method” of cultivating the virus in monkey kidney cells and Medium 199 in 5-litre glass bottles kept at human body temperature and agitated on a rocking frame.

In July 1952, Jonas Salk inactivated poliovirus prepared by the Toronto Method to make vaccines he tested on himself, his wife, his three sons and 200 Pittsburgh schoolchildren. On March 26, 1953 (the year the poliovirus was first seen through the electron microscope) Salk announced the success of this preliminary trial on the radio. Encouraged by the promise of Salk’s vaccine while epidemic polio was raging in the U.S. and Canada, the National Foundation for Infantile Paralysis committed to funding an unprecedented field trial.

In July 1953, Connaught Labs began what Salk called the “herculean task” of preparing the 3,000 litres of poliovirus fluids that would be needed for the vaccine trial. It was taken from Toronto twice a week by station wagon, to the two U.S. drug firms that inactivated it, tested it and turned it into a vaccine. (The station wagon also carried a can of gasoline in case it crashed so it could be incinerated along with its viral cargo.) 

Enabled by funds raised by the March of Dimes – and bolstered by parents terrified by the spectre of polio – 1.8 million “polio pioneers”, children in grades 1 to 3 in 44 U.S. states plus 26,000 in Canada and 19,000 in Finland, participated in a year-long medical trial starting in 1954 that would be largest and most expensive in history. Supervised by 325,000 doctors, nurses, teachers and volunteers, one-third of the children received polio vaccine, another third received “Medium 199” as a placebo, and the other third were observed to see if any became infected.

On April 12, 1955, a crowd of doctors, technicians and nurses jammed into the Crystal Ballroom at the King Edward Hotel in Toronto to learn the results of Salk’s trial via closed-circuit television from the University of Michigan at Ann Arbour, where the trial’s evaluation was based. The news brought cheers. Salk’s vaccine derived from virus produced by the Toronto method was safe and 80 to 90 per cent effective. Mass immunization could begin immediately. Polio might be banished at last. Then, disaster.

In five Western and mid-Western states, 200,000 children received polio vaccine produced by Cutter Laboratories in California.  Within days there were reports of paralysis and within a month the first mass vaccination programme against polio had to be suspended.

But in Canada, where Connaught vaccine was used exclusively, there were no infections linked to the vaccine. The decision to halt vaccination or continue in this country was made by health minister Paul Martin Sr. After a restless night that was described 40 years later, by his widow in a CBC documentary, he made the decision that vaccination against polio in Canada would continue. By mid-1956 2.3 million doses had been delivered, enough for 1.8 million children. Sixty-four years on, the vaccination of children against polio is routine and polio is almost entirely eradicated world wide.

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Hubbard Tank at Thistletown, 1948. One alternative to enforced immobilization was polio treatment by hydrotherapy. 

Post-polio years

The post-polio years were productive for Connaught but turbulent. Expanded production and export of Salk polio vaccine (Salk’s injected version and the oral vaccine developed by Albert Sabin with Connaught collaboration) enabled a building boom. The 1960s also produced a safer, more effective rabies vaccine, an improved test for tuberculosis and sulphated insulin for diabetics who were resistant to natural insulin. Starting in 1967, Connaught served as an international vaccine reference lab during the World Heath Organization’s smallpox eradication program by consulting with Latin American vaccine producers, helping them improve quality, and supplying millions of doses of vaccine. In 1979 the mission to eradicate smallpox worldwide was accomplished.

In spite of these enormous successes, an increasingly regulated, competitive and business-oriented climate in the pharmaceutical industry was challenging the relationship between Connaught and the University of Toronto. The partnership contributed to Connaught’s strong research and development program, but the University lacked the resources needed to expand and upgrade its vaccine production. In 1972, Connaught was sold to the Canada Development Corporation for $29 million that was used to create the Connaught Fund that is dedicated to “the promotion of research and development in medicine and other health sciences”.

Following its reorientation by CDC into a profit-oriented company, Connaught expanded into the US in 1978 by acquiring the research and production facility of Merrell-National Laboratories in Swiftwater, Pennsylvania. In 1989, Connaught’s Toronto and Swiftwater sites were bought by Institut Mérieux of France for $943.5 million. For Canadians who were still reeling from the free trade debate and worried about the decline in the Canadian nuclear and aviation industries, this loss of a prime sovereign asset was a bitter blow.

Less noticed was the strong public health legacy shared by Connaught, Mérieux and the vaccine division of the Pasteur Institute, that Mérieux acquired in 1985. It dated back to 1894 when Marcel Mérieux joined the Pasteur Institute as an assistant, and to 1910 when John Gerald FitzGerald spent part of his “working honeymoon” at the Institute’s lab in Brussels, acquiring the skills that would allow him to pioneer the mass production of rabies vaccine and diphtheria antitoxin in Toronto – successes that led to the founding in 1914 of the Antitoxin Laboratory that would be re-named Connaught Labs in 1917.

But Connaught’s future was still not settled. Its sale to Mérieux was the first in a 15-year succession of acquisitions and mergers that ended in 2004 when the Pasteur Mérieux Connaught consortium was incorporated into Sanofi Pasteur, a company that began life as a subsidiary of the French oil company Elf Aquitaine. 

According to its press releases, what used to be Connaught is thriving: “Sanofi Pasteur’s Toronto Site employs more than 1,500 Ontarians and produces more than 60 million doses of vaccines that protect the world’s youngest pediatric patients in 62 countries – roughly 250,000 newborns in Ontario – from vaccine-preventable diseases like diphtheria, tetanus, polio, pertussis, and Hemophilus influenza B.” 

In partnership with GlaxoSmithKline (GSK) a British Company with a branch in Mississauga that describes itself as “among the top 40 contributors to R&D in Canada” Sanofi Pasteur is also involved in the global race to produce a COVID-19 vaccine. If the Sanofi-GSK collaboration succeeds, for the ghosts of the giants of Connaught’s past who haunt Sanofi’s Toronto site, it will be a great leap forward for a laboratory that began life in a backyard stable in Toronto in 1913.


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