Iceland in Florida

Dr. David Charles Poskanzer got a phone call in his Albany, N.Y. office: "Dave, what do you know about Iceland disease?" By chance. Dr. Poskanzer, a disease detective for the U.S. Epidemic Intelligence Service (TIME. Jan. 19, 1953), was able to answer: "I've just read the entire world literature on the subject--both papers." Immediately, his boss ordered him to a spot where an outbreak of the rare disease was suspected. The spot: Punta Gorda, Fla.

That was a year ago. Last week Dr. Poskanzer, 28, reported to the American Federation for Clinical Research, meeting in Atlantic City, N.J., what he and his colleagues had found in Punta Gorda.

That Tired Feeling. The whole town (pop. 2,500) was full of cases of a mysterious, ill-defined but often disabling illness. Typical was the case of a beauty-shop operator, who noticed in May of last year that she just could not shake off that tired feeling, had increasingly severe and frequent headaches and pain in the neck.

Then her right leg went numb. She became tense, and her hands lost their wave-setting skill. They shook so that she could not write legibly. She could not recall the names of regular customers, or what to charge them for a permanent. After four weeks she saw a doctor: he had no idea what to do, and for three days more she felt that she was "shaking all over inside"; she had backache, dizziness, diarrhea, nausea and vomiting. During a month in the hospital she developed some new symptoms : spells of rapid, pounding heartbeat, periods of frantic overbreathing. Gradually the symptoms abated. But as soon as she went home and started light housekeeping, she had a sharp relapse and had to spend three more weeks in bed.

Examined again in October, the patient was still depressed, still had difficulty with simple mental arithmetic. There were local areas of tenderness on her body, paradoxically occurring with continued numbness in the right leg, and she could not stand steady with eyes closed.

Ages of Immunity. The beauty operator's case was typical of 21 which the disease detectives studied in detail. Then they did some medical gumshoe work, sent interviewers to every house in town, turned up scores of additional cases. Some victims also had other symptoms, such as terrifying dreams, difficulty in swallowing, and a feverish feeling not justified by a slight rise in temperature. Nearly always there was a letup after a few weeks, then a series of relapses throughout the five-month period of study. Women were victims twice as commonly as men, and their cases were more severe. Inexplicably, there were no cases among children under twelve and few among oldsters past 60. Despite an estimated total of 300 cases in the area, there were no deaths.

What was the disease? Dr. Poskanzer had to rule out some unsettling possibilities. Could it be mass hysteria? No, he decided, because the cases developed in a sequence typical of a true infectious epidemic, and moreover, the townspeople never really panicked about it. Besides, two of the three local doctors, and then Dr. Poskanzer himself, came down with cases. Could it be polio? But there was no characteristic paralysis; while nerve pathways in the spinal cord might be temporarily affected, they were not permanently damaged. From 100 specimens of throat washings, blood, stools and spinal fluid no known virus could be isolated. Definitely ruled out (besides polio) were the Coxsackie viruses and those that cause various kinds of encephalitis. Dr. Poskanzer and his colleagues concluded that the first suggestion must have been correct. Their verdict: Punta Gorda had suffered from an epidemic of "Iceland disease," so named for an earlier outbreak in Akureyri, Iceland in 1948-49.

Now the disease detectives are convinced that there have been at least a dozen outbreaks from Seward, Alaska to Adelaide, Australia. The earliest, unearthed by sleuthing through medical archives, seems to have been in Los Angeles in 1934. For reasons unknown it appears to hit hospital people (especially doctors and nurses) with special frequency. While epidemiologists are still trying to track down the cause of Iceland disease, they are hassling over a more mystifying, professional-sounding name for it. Current favorite: epidemic neuromyasthenia. because it involves weakness of the muscles presumably caused by involvement of the nerves.

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