Polio Wars Read Free Page B

work dealt with a high profile disease and filled the therapeutic vacuum that surrounded it. Polio epidemics in the 1930s grew more serious and more frequent. Although the disease remained a relatively minor cause of morbidity and mortality, parents saw it as a major threat to their children’s health. Polio left family doctors at a terrifying loss: epidemics could not be predicted or controlled; paralyzed patients sometimes recovered mobility, but often remained disabled in a world unfriendly to the disabled; and until the mid-1950s there was no vaccine to prevent it.
    Kenny provocatively promised ambitious results. Her goal was fully recovered movement. She transformed standard polio therapies—especially splinting and surgery—into symbols of a failed and even harmful clinical program. Her therapies, especially her hot packs and muscle exercises, were based on distinctive ideas about polio as not solely a neurological disease but also one that affected muscles and skin. At first she talked about clinical signs (physical manifestations visible to the outside eye) that had been ignored and left untreated by polio experts, but gradually she came to see them as crucial symptoms (experiences of the patient) that provided evidence for a rethinking of polio’s pathology and physiology. 24 Her challenge to existing concepts of polio attracted patients and families as it embodied a different style of clinical practice: optimistic, energetic, patient-centered care.
    In describing the experience of polio as she saw it Kenny relied on 3 crucial terms:
spasm
(a muscle in pain and contracting),
alienation
(a “physiologic block” that prevented “the proper transmission of a nerve impulse from the central nervous system to a contractible or nonparalyzed muscle”), and
incoordination
(the “loss of ability to use muscles in proper relationship to one another”). 25 The language she used was strange to physicians’ ears. The only term familiar to many orthopedic surgeons and physical therapists was spasm: a spastic muscle was well known in a variety of neuromuscular conditions, especially cerebral palsy. 26 But Kenny’s definition made polio’s spasm unfamiliar, especially when she linked it to her system of treatment. Using a distinctive understanding of polio’s clinical picture and her own techniques, her methods, she claimed, would help to restore normal function to a patient’s muscles “to the fullest extent possible.” 27
    Immobilization, Kenny argued, had many dangers; most crucially, it prevented the treatment of the symptoms she had identified. It also interfered with the nutrition of skin, tissue, and muscles and diminished the volume of nerve impulses through the nervous system “along the afferent and efferent paths,” as well as interfering with “the normal function of the subconscious mind” and giving patients “an adverse psychological outlook.” Yet immobilization was “the paramount principle upon which the orthodox system is founded” and, according to the Kendalls, the main treatment for polio was “rest in a well-protected position.” The orthodox system was therefore based on principles that were the exact opposite of her system, especially in its view of how muscles were affected by the polio virus and how to ameliorate paralysis. In orthodox polio care affected muscles were not seen as spastic but flaccid, and were depicted as hanging loosely “like a hammock between their two points of attachment.” Paralysis was believed to be caused by healthy muscles stretching these weaker ones. But in Kenny’s view, muscles in spasm were in fact the central cause of paralysis. 28
    According to Kenny, her methods treated properly identified symptoms correctly and therefore had far better clinical results. Spasm was the main reason that patients with polio experienced pain and paralysis. The
affected
muscles