21.09.2002
By EUGENE BINGHAM
Dr Alan Murphy pulled on his white lab coat determined for success in
the battle against a deadly disease that was striking down children,
causing schools to close and towns to be barricaded off.
Staring down the lens of his laboratory microscope, he was hunting
for a breakthrough.
It was Auckland Hospital in the 1950s and the country was in the grip
of polio. Waves of epidemics had killed or paralysed hundreds since the
turn of the century. They were desperate times. Murphy, a pathologist,
was searching for an important link that would help medical science to
combat the disease.
The key was to find tissue or protein polio could grow on. If
researchers could find an effective way to study the disease in a
controlled laboratory environment, they could understand how it attacked
the body and find ways of halting it.
Murphy was baffled. He was frustrated that more was known about the
life history of the common flu than about polio, all because someone had
discovered that the influenza virus could grow in hen eggs.
His experiments began with different types of tissue discarded during
operations in the hospital's surgical wards.
Around the country, others in the medical fraternity watched his work
with interest.
Five-yearly epidemics had struck since 1916, infecting an average of
800 people a time. In between, there were reported cases, too. Polio was
not only causing epidemics, it was endemic.
The first recorded case of polio in New Zealand was a 6-month-old
baby in 1887. In 1895, seven people were admitted to Wellington
Hospital, but the first major outbreak occurred during World War I. By
the 1950s, there had been seven epidemics - and another that struck New
Zealand troops serving in the Middle East in 1941.
In 1947, Auckland Hospital was so short of beds that doctors had to
restrict the number of cases being admitted to hospital. Large numbers
of people carrying signs of the disease had to be turned away from the
hospital doors.
Health officials fought as best they could to cope. Extraordinary
measures were employed. During the 1947-48 epidemic, schools and Sunday
schools were closed, and children's gatherings banned. Children were not
allowed to travel between islands, go to public swimming pools or
picture theatres.
And yet authorities seemed powerless to stop the spread. The New
Zealand Medical Journal noted that one house-bound woman who lived in a
rural area near Timaru had been infected in 1948, even though all but
two of the other cases at the time were in the North Island. They looked
to medical researchers for answers. In America, two men whose work would
eventually earn them the right to have polio vaccines named after them -
Albert Sabin and Jonas Salk - had begun a post-war race to defeat polio.
Besides these two brilliant men, others were feeding into the
international body of work, including New Zealanders Alan Murphy,
Professor John Miles and Professor John (Jock) Caughey.
In the early 1950s, Murphy began his experiments in Auckland. At
first, he tried tonsils and other organs removed from patients in
surgery. But there were problems with bacteria and the search went on
for a better alternative.
In 1953, funded by money bequeathed to the hospital for research,
Murphy knew he was on the brink of a breakthrough. During experiments in
his Auckland laboratory, he began using stillborn human foetuses.
In today's climate, where we debate stem cell research and whether
aborted foetuses should be used by scientists, Murphy's work would be
controversial and ethically fraught, especially if it was conducted
without the consent of the mothers - as was probably the case.
Medical ethicist Professor Donald Evans says the mother's consent
would be crucial for ethical approval of human embryo research now.
According to the Ministry of Health, research on human foetuses would be
illegal under present legislation, although the ban is under review.
In 1954 Murphy's work was exciting research. He told a science
congress of his efforts.
"Very little work along these lines seems to have been attempted
overseas ... It does not seem to have been considered by the virologists
as a practical proposition."
In a New Zealand Medical Journal article he set out how he used the
foetal tissue. Muscle from the foetuses was minced into 1-2mm pieces.
Four to six pieces were placed in a test tube and held in place with
remnants of chick embryos. For nourishment, the foetal tissue was
covered with a cocktail of horse serum, fluid from cow wombs and
extracts of calf embryos.
Murphy wrote how after three to four days connective tissue, or
fibroblasts, was visible under the microscope.
When polio extracts were added to the samples, the virus attacked the
fibroblasts and destroyed them in three to five days. This destruction
was the breakthrough he had sought.
He used the technique to figure out which of the three strains of
polio virus were prevalent in New Zealand. In 1955, he tested blood
samples from 100 children to see if they had antibodies to any of the
viruses.
The next year, he used the technique to diagnose which of the viruses
had attacked polio victims in the 1955-56 epidemic. It was during this
research that Murphy realised how desperate the situation had become.
His laboratory could not cope with the number of polio samples being
forwarded to it and ran out of human foetal tissue. He turned to
Auckland Zoo for help. With the permission of zoo authorities, he
obtained monkey kidneys to continue his testing.
Murphy and other researchers knew that if polio was going to be
defeated, the world needed a successful vaccine. John Miles, a professor
in microbiology at Otago University, was also publicly calling for a
widespread vaccination campaign to stamp out the disease.
Miles, who had studied polio among Aboriginals in the Australian
Outback, made a plea in a June 1956 New Zealand Medical Journal paper
for the immunisation of children and adolescents as soon as a safe
vaccine could be found.
Around this time, Salk had won approval for his vaccine, which
immunised patients with a killed strain of the virus. Sabin, whose
vaccine could immunise patients with the sip of a syrup containing a
live strain of polio, was also competing for worldwide approval.
Authorities in New Zealand opted for the quick answer, Salk's
vaccine, and began an immunisation programme. There was some public
unease after problems in the United States, but small shipments of the
serum arrived and primary school children lined up to be injected.
A trawl through Government documents held in the National Archives
shows the lengths authorities went to in the early vaccination
programmes - they were determined that as many people as possible,
especially children, were vaccinated.
Child welfare agencies changed their policies so state wards could be
immunised without their parents' consent. Officials even had the power
to override parental objections.
"Immunisation against these diseases is a widely accepted practice
and it is considered reasonable to proceed with it in the case of our
wards ... " said a Government paper dealing with the change.
It was a similar attitude which led health authorities battling
typhoid from the 1920s to allow for the immunisation of Maori children
without their parents' consent, although Pakeha parents had to be asked
first. In the 1950s, concerns that public health authorities jabbing
Maori children without their parents' consent may be accused of assault
led the Cabinet to secretly indemnify the nurses.
The ends, officials believed, justified the means. Mother state knew
best.
Today's doctors and health officials could never dream of being able
to get away with these vaccination programmes.
Take the meningitis vaccination studies under way in Auckland this
year. Researchers believe they have found a way of immunising children
against a particular strain of this deadly disease, but they are having
to follow careful ethical and legal guidelines before they even
contemplate a vaccination programme.
Public health director Colin Tukuitonga, who is responsible for
immunisation, is a little envious of his predecessors' ability to
vaccinate as many people as they could.
"In the old days, the doc knew best, he jabbed everyone he thought
needed the good stuff and away we went."
He accepts and encourages the fact that people are more aware of
their rights as patients, although he believes that people who rail
against immunisation have it easy in some ways.
"Vaccination is a victim of its own success," he says. "It's meant
diseases that were once common, devastating and deadly, people don't see
any more. They become blase about the risks of measles and polio, and
that has shaped a lot of the current attitudes to immunisation."
By the end of 1958 about 80 per cent of schoolchildren had been
dosed, but polio continued to stalk the country. After another epidemic
in 1961, including seven deaths, Miles argued for a rethink in the
strategy. His efforts helped to convince authorities to switch to
Sabin's live vaccine. While schoolchildren were initially targeted from
August 1961, gradually it was made more widely available.
In September 1962 - 40 years ago this month - Sabin's syrupy sip of
immunity was made available to the general population. The Department of
Health estimated 80 per cent of the country was inoculated.
The results were dramatic and immediate. The following year, 1963,
was the first year since records began that there were no reported cases
of polio in New Zealand.
Murphy's dream of having polio defeated had come true. Whether his
work or that of Miles, Caughey or other New Zealand researchers
contributed directly to Sabin or Salk's success will never be known -
the fiercely competitive nature of American medical research in the
1950s means the US was never likely to acknowledge any help along the
way.
In the years since the battle was won, only a handful of cases of
polio have been recorded - including one where a parent appeared to have
caught the disease while changing the nappy of his three-month-old baby
inoculated with the live virus. Cases such as this led the Ministry of
Health to switch back this year to the inactivated or killed variety of
vaccine.
Miles, who retired in 1979 and now lives near Wanaka, aged 89,
remembers the defeat of polio as one of the highlights of his career.
"I would put it fairly well up the list," he says with a dose of
understatement. "It was extremely satisfying - it gave us a great deal
of pleasure."
As to whether Murphy ever celebrated the success in the polio war, it
is impossible to say.
He moved to Australia many years ago where he still lives, but was
unavailable for interviews.
All that is left of his role in one of New Zealand's most stunning
public health victories is the research he published in medical
journals.