Polio Wars Read Free

patient was told to continue to wear the braces and use the crutches and to return for a follow-up examination, which usually involved testing individual muscles for strength and range of motion. When underused muscles withered and limbs grew unevenly, and after physicians determined that no further recovery of muscle strength could be expected, they prescribed orthopedic surgery such as muscle transplantation. 7 “Probably no other one disease requires so many different types of operations for its satisfactory treatment,” reflected one orthopedist in the 1920s. 8 On rare occasions critics warned that immobilization, while important, could lead to “vasomotor and trophic disturbances in the affected extremities” as well as “circulatory interference.” 9 Only much later did polio experts admit that many orthopedic surgeons got “terrible results.” In 1955, an orthopedist recalled with horror 24 patients in the 1930s who were placed in casts and splints, some for as long as 2 years, while he and other specialists waited “for their muscles to recover.” 10
    Muscle testing, codified by Lovett and Legg, was the major technology used by physical therapists to show patients and other professionals improvement in muscle strength and power, and to assess the necessity for orthopedic surgery. It was based on 2 techniques: muscle positioning and muscle movement. In muscle positioning the body parts not being tested had to be held as firm and stable as possible as the therapist applied pressure (or “resistance”) to the muscle or muscle group in order to estimate its strength based on the amount of pressure applied and the amount of strength required to hold the test position. The therapist had to understand the intricate workings of muscles and muscle groups to be able to detect any substitution movements used by the patient (consciously or unconsciously) to compensate for muscle weakness. To assess a muscle’s range of motion and flexibility, a part was moved through a specified arc of motion and in a specified direction. These tests were used to seek a pattern of muscle weakness, for the degree of functional strength was believed to bear a definite relationship to the extent and degree of pathology, including the site of the nerve lesion. Such tests required a detailed understanding of anatomy and muscle function to be able to achieve an accurate grading of muscle strength and motion. 11 Their accuracy depended on the skill and judgment of each individual physical therapist. Indeed, testing could also be used to assess the efficacy of therapies; thus, Lovett used the muscle test to indicate the danger of excessive “massage and therapeutic exercise.” 12 Further, while muscle testing demanded that the therapist understand intricate muscle anatomy and physiology, it did not assume any such knowledge for the patient. Indeed these tests tended to point out muscle weakness and inability, rather than strength and functionality.
    In the early 1920s a few orthopedic surgeons developed other treatments. Los Angeles orthopedist Charles Lowman turned a former fish pond on the grounds of the Orthopedic Hospital-School into a modern therapeutic pool, shortened the long watchful waiting period typical for early polio cases, and began to allow patients into the pool using muscle reeducation under water as early as a week after the quarantine period. These techniques Lowman believed helped to keep “the channels of communication open between the central nervous system and the muscle.” 13 The experience of Franklin Roosevelt in the 1920s inspired a surge of optimism around hydrotherapy. Roosevelt, a wealthy lawyer who had been nominated for the vice presidency by the Democratic Party, was paralyzed by polio in 1921 at the age of 39 years. In his search for therapies that would enable him to walkagain he traveled to Warm Springs, then a run-down resort in rural Georgia, to try