Sarah Sundin: Historical Polio– Part 2/3

Polio Part 2—Treatment
Helen pedaled down Sixth Street, harder with the left leg than the right, punishing the left leg for its weakness, as she’d learned on the polio ward.
In my novel, Blue Skies Tomorrow, which takes place during World War II, Helen Carlisle deals with many repercussions of a childhood bout with polio. Thanks to vaccination, polio is quickly being forgotten, but it was a dread threat in the first half of the twentieth century. If you write fiction set in this time period, it helps to be familiar with this much-feared disease.
On August 22nd, I discussed the disease, today I’ll discuss treatment, and on August 26th, the vaccines.
There is no cure for poliomyelitis. All treatment revolved around keeping the patient alive and preventing further disability.
Isolation
Since polio is contagious, patients were quarantined, sometimes at home, but more often in hospital polio wards. Early diagnosis was vital, since muscle rest in the acute phase of the illness reduced paralysis.
During the acute febrile phase of the illness, patients were placed in isolation wards, separated from all family and friends. For a young child, this was a frightening experience. They were kept on the isolation ward 2-4 weeks, then transferred to a polio convalescence ward. Visitors were allowed once or twice a week. Since live virus was shed in the feces for 17 weeks after infection, and recovery could take 6-8 months, patients were kept in the hospital for many months.
According to psychological theory of the day, coddling produced hypochondria, so children were often treated in a brusque and unsympathetic manner. A societal stigma against disability caused many families to be ashamed of their polio-afflicted children or to pretend nothing was wrong. Children were encouraged to work hard to overcome their disability, and these patients often became overachievers.
Immobilization
Up until the 1940s, the accepted treatment for polio was to immobilize the affected body parts. Rigid splints, braces, and casts were used, and children’s feet were strapped to boards in the flexed position to prevent foot drop. Immobilization reduced skeletal deformities, but recovery of muscle strength and function remained low.
Iron Lung
The majority of deaths due to polio occurred from paralysis of the diaphragm. About half of patients with respiratory involvement died from the illness. In 1928 the first iron lung was introduced. The iron lung is a negative-pressure ventilator consisting of a cylindrical tank in which the patient lay. Pumps alternately increase and decrease the pressure inside the tank, causing the lungs to inflate and deflate. Improvement in the iron lung occurred throughout the 1930s, and in 1939 the National Foundation for Infantile Paralysis made one available for mass production. The use of iron lungs reduced the death rate from respiratory involvement to about 15 percent.
Tracheotomies also saved many lives during polio epidemics.
Sister Kenny’s Massage Therapy
Australian nurse Sister Elizabeth Kenny (“Sister” being the title for British and Australian chief nurses) arrived in the United States in 1940 and immediately caused controversy. In Australia in the 1930s she had developed a system of polio treatment which rejected immobilization and relied on hot packs, stretching, and massage. Originally derided by the medical community, Sister Kenny’s treatment slowly gained favor. Her patients were more comfortable and had higher and faster rates of recovery.
In the late 1940s and the 1950s, polio patients received a form of Sister Kenny’s treatment. Strips of hot wet wool were wrapped around affected limbs hourly, an often uncomfortable procedure, especially in summer. Stretching and massage was usually painful but was seen as vital to “re-educate” paralyzed muscles.
Rehabilitation
When muscle weakness persisted, braces of metal and leather helped patients to stand and walk. Corsets straightened weakened torsos. Crutches, canes, and wheelchairs aided mobility. Water therapy—performing exercises in warm water—was used on the convalescence wards and at home to relax and strengthen muscles.
Due to the absence of a cure, vaccination was the only hope to avoid polio’s high rate of death and disability.

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Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

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