  |
||||||||||||||||
        |
Section I: Poliomyelitis, Treatment, and Prevention Prior to 1955 D. The Epidemic Phase (1920-1955) During the epidemic phase, widespread outbreaks of disease grew in frequency, intensity, and global reach.1 From 1918 to 1955 polio epidemics were a mainstay of summer.
In 1921, future president Franklin Delano Roosevelt contracted polio at age 39. Seven years later he founded the National Institute for Infantile Paralysis, transforming the landscape of polio research. The foundation, which later changed its name to the March of Dimes (initially the name of its signature fundraising drive), was the first private, large-scale effort against a single disease. Funded largely by everyday Americans encouraged to mail dimes to Roosevelt at the White House, the organization benefited from the support of the president, a robust public awareness strategy, and direction by FDR's law partner Basil O'Connor. The March of Dimes was the first major campaign to use celebrities, poster children, and a grassroots fundraising network. Even Mickey Mouse sang, "hi ho ho we'll lick polio."2 Within one week of obtaining the name "March of Dimes," the foundation raised 1.8 million dollars. The organization soon had a chapter in almost every country in the U.S., and half of the money raised remained local to support affected children and their families.3 Some individuals, including many medical researchers benefiting from foundation grants, opposed the fundraising tactics used by the March of Dimes, arguing that they exploited polio patients to garner public sympathy. According to Dr. John Paul, the first recipient of a grant from the foundation and author of A History of Poliomyelitis, by 1940 the foundation had almost transformed the fight against polio from a strictly medical battle to a psychological one, and polio research had become a "holy quest."4 Living with polio during the epidemic phase (1920-1955)
Changing pressures inside the machine allowed the patient to breathe even if his or her breathing muscles (diaphragm) did not function. Though Drinker initially designed the machine to treat coal gas poisoning, its first patient test and greatest clinical implications were for polio victims. Drinker's sister Catherine recalled: "When the machine was perfected, the first patient happened to be a little girl... suffering from severe polio and expected to be in respiratory difficulty very shortly. Phil had the machine moved into the ward near the child's bed so she could see it and get used to the loud whine of the motor. Every next Sunday morning the hospital called Phil. By the time he reached the child she was in the machine, unconscious, but the staff had been afraid to turn on the power. Phil started the pump, and in less than a minute saw the child regain consciousness. She asked for ice cream. Phil said he stood there and cried."5 Iron lungs soon became a fixture in hospital polio wards, and with them came a host of moral questions. Doctors were first bothered by the thought that once they succeeded in saving a polio life through use of the machine, must the patient remain in it forever? Although this did occur in some cases, patients often only needed the lung for a brief period and recovered sufficiently to breathe on their own. Still, as John Paul recalls, agonizing decisions had to be made: "For instance, although three or four patients with respiratory difficulties might be on hand and waiting, there was often only one respirator available - what to do? Whom to choose? The patient with the severest disability, who would possibly die anyway; or the patient with lesser disability and a better prognosis?"6 Another significant change in polio treatment occurred in 1940 when Sister Elizabeth Kenny arrived in the United States. For her polio patients, Kenny prescribed a treatment at odds with standard medical practices of the day: instead of immobilizing weakened muscles, Kenny treated weak muscles with moist hot packs, then pushed and pulled on the affected limbs or area to move the muscles for the patient. Based on the strength in their muscles, patients helped the movement as best they could. Kenny called this "reeducating" the muscles. Her treatment allowed people whose motor neurons were only damaged by the virus to recover to a greater extent, and it is reported to have made life more comfortable for patients. Kenny pioneered her treatment in the Australian bush after encountering a patient and telegraphing a surgeon with her observations to ask for advice. He replied, "Infantile paralysis. No known treatment. Do the best you can with the symptoms presenting themselves." Although Kenny had no formal nursing training, experience gave her a keen sense of the human anatomy and she quickly applied hot packs to relieve muscle pain and then set to work restoring muscle function through passive movement. While in the bush, she claimed to have 'cured' six polio patients this way. Australian medical authorities rejected her treatment ideas, so Kenny traveled to the United States. When Kenny first arrived in the U.S. doctors patronized her and her treatment ideas. Her "admiral"-like clothing and forceful personality conflicted with prevailing ideas of femininity at the time.7
Outspoken and unafraid to challenge important medical professionals, Life magazine called her "the most publicly controversial figure in the medical world today," and Reader's Digest said she was "a strong minded woman who has no time for politics... but does possess an unfortunate faculty for stepping on sensitive toes."8 Doctors soon learned to respect Kenny because her treatment worked, and due to her success in treating the disease, Kenny was the second most popular woman in the United States (after Eleanor Roosevelt) for many years.9 After the integration of the iron lung and Sister Kenny's treatments to polio care, treatment of the disease took the form most remembered and documented by historians. In the "typical" American case of paralytic polio, the family doctor came to the house, examined the child, suspected polio, and immediately sent the girl or boy to quarantine in the local hospital or another building accepting polio patients. The child remained in the hospital or some kind of recovery center for a very long time, possibly years, and visiting hours were limited. Life away from home was difficult for the affected child, too. Many children were not warned of the painful spinal tap that often took place upon hospital arrival. Although polio patients report initial fear of hospitals and recovery centers, they quickly adopted and made friends. For example, in many wards, the clicking of the tongue because the universal symbol of distress because even patients unable to speak could make it. Patients with vocal cords unaffected by the virus would then sound the alarm to the nurses. Living in fear Understanding the fear generated by largely eradicated disease is difficult, but before the vaccine arrived, polio epidemics were second only to atom bombs in surveys of what Americans feared most.11 In 1941, an article in Good Housekeeping stated no disease frightened parents more than infantile paralysis.12 Fear pervaded American society; polio attacked everywhere and anywhere, seemingly without discrimination. Adding to the mystery, usually only one family member contracted the disease. The March of Dimes' fundraising publicity campaigns were thought to have the secondary result of adding to the environment of stigma and fear surrounding polio. For example a short film titled "In Daily Battle" was shown in movie theaters prior to the feature. It described polio as "The Crippler," showing an ominous, crutch-carrying shadow passing over healthy, active children innocently swimming. As one polio survivor described the disease: It was the robber of hope for a generation, several generations of children. There were diseases, and scientists will chart them, that were more devastating, affecting more children, more deadly than polio. But polio left kids crippled, and that was an image that this big strong postwar country simply couldn't abide. We had children lining up in wheelchairs, in iron lungs, whose very vitality and everyone's hope for their future was allayed right at the most critical time in their childhoods... There were many other diseases that were bad for America, but polio broke its heart. Continue to The Path to a Vaccine
1 Smallman-Raynor and Cliff. 23. |
|||||||||||||||
Site Notice |
Contact Us |
University of Pennsylvania |
Penn Center for Bioethics
© 2005—2011, University of Pennsylvania Center for Bioethics. 3401 Market Street, Suite 320, Philadelphia, PA 19104 215-898-7136  VaccineEthics.org is supported by a grant from The Greenwall Foundation. |
||||||||||||||||
