Medicine Before the Vaccine: A Review of Polio Wars

In an era before vaccination against polio--which has chased the paralytic form of the disease  from all but 2 countries--care for those afflicted with the dread disease was paramount. That care was severely hampered by a lack of understanding of all the facets of polio including that it is a gastrointestinal virus which causes paralysis only in rare cases. At that time bed rest, splints, and orthopedic surgical procedures were part of the routine care administered to a patient. 

To a person reading this in 2015, bed rest should sound like a foreign concept as anyone suffering with a paralytic condition caused by, for example, a stroke is basically overwrought with visits from physical medicine and rehabilitation physicians (physiatrists), physical therapists, and occupational therapists who work diligently with the patient in the hope of regaining function as well as learning to accommodate any permanent dysfunction.

It is hard to imagine it otherwise, but it was.

In Polio Wars: Sister Kenny and the Golden Age of American Medicine Yale University historian Naomi Rogers provides an exquisitely detailed and scholarly account of how an Australian bush nurse took America, in the decade before the Salk vaccine, by storm and crusaded to change how polio was treated and conceptualized in the face of fierce opposition by the medical establishment. At one time, she was the most admired woman in America and the subject of a Hollywood biopic. 

Reading the book one is immersed in the world of American medicine in the 1940s and 1950s where physicians held a special status that, I believe, has eroded into the Burger King Have-It-Your-Way style of medicine of today. Physicians forcefully debated, physicians voraciously read, and physicians meticulously thought. While life in such rarified air might be refreshing to read about for physicians, especially when they are today deluged by complaints from patients doggedly pursued by administrators who care little for whether a medical decision was correct or not, the downside was a recalcitrance by some to pursue therapeutic leads if their pedigree was lacking. Such was partially the situation with Elizabeth Kenny and her efforts to improve the care of polio patients. 

While Kenny, who may have lacked a full understanding of the pathophysiology of polio, clearly seems to have embellished and exaggerated the results of her work, which was centered on early mobilization, treatment of muscle spasm, and retraining of muscles (some of which had been advocated pre-Kenny) her intransigence was admirable and her battles with the well-connected and powerful instructive as well as instrumental to the professionalization of the field of physical therapy and highlighted the important role of physical medicine and rehabilitation physicians.