Legacy of Poliomyelitis

Over many years large numbers of people have worked to defeat the polio virus and to create the high level of immunity which is seen in the developed world today. There were many people involved in this work, some of whom are household names and others who were less fêted in the annals of fame in the battle to defeat poliomyelitis.

In the field of research and medicine perhaps the most famous is Jonas Salk M.D. (1914-1995) who developed a vaccine (IPV) that was proven to be effective in mass immunization against the polio virus and is credited with stopping epidemics in the late 1950's. Salk was eventually awarded a Nobel Peace Prize in 2002 for his endeavours.

Dr. Albert Bruce Sabin (1906–1993) devised an oral vaccine (OPV) which was eventually licensed in 1961. Because this form of vaccination was easy to administer it became a preferred means of mass immunisation against polio and is still used today in the WHO Global Eradication programme as well as for babies in the developed world..

However, lesser known-names outside the scientific community included:

Hilary Koprowski (1916- ) He created the world's first polio vaccine in 1950, based on oral administration of attenuated polio virus. In researching a potential polio vaccine, he had focused on live viruses that were attenuated (rendered non-virulent) rather than on killed viruses (the latter became the basis for the injected vaccine that was subsequently created by Jonas Salk).

Dr. John Enders, Dr. Frederick Robbins and Dr. Thomas Weller who were awarded a Nobel Prize in Medicine in 1954 after they devised an in-vitro (Latin:"in glass") means of culture growing the polio virus.

With this breakthrough, scientists could create cultures of the polio virus in a variety of cell types. Previously, poliovirus could only be grown in nerve tissue, which is difficult to maintain, or in live animals. Previously, researchers had to infect an animal with polio and try to deduce information about the virus, a laborious and difficult technique.

Dr. Philip Drinker and Dr. Louis Agassiz Shaw devised a respirator commonly known as an "Iron Lung", that saved the lives of many who were struck down with Bulbar Polio and required artificial assistance in order to breathe. The technique used by the iron lung is known as Negative Pressure ventilation.

There were others; John Haven Emerson devised a more-efficient version of the iron lung that was available at a substantially lower cost. Emerson was sued by Drinker for breach of patent, but the courts found in Emerson's favour allowing substantial numbers of his design to be produced.  Emerson also devised a rocking bed as a means of assisted respiration for those who had difficulty breathing.

Although these methods were generally effective there were still problems associated with the more acute cases of Bulbar Polio (affecting the bulbar or upper region of the spinal cortex) which controls the swallowing and breathing.

Bjørn Ibsen (1915- ), a Danish anaesthesiologist, suggested positive-pressure ventilation as a means of preventing the death of those  patients who breathing was affected by polio. During an epidemic outbreak in Copenhagen, Denmark, in 1952, Ibsen was consulted and came to two radical conclusions.

Atelectasis (lack of gas exchange within alveoli due to secretions in the lungs) and elevated blood CO2  was the principle cause of death.  He went on to apply a tracheotomy under local anaesthesia to a twelve-year-old girl, a cuffed endotracheal tube was fitted, and she was eventually ventilated satisfactorily with a manually operated rubber bag. The method devised was successful and the foundation of the positive-pressure ventilation technique that is in use in modern intensive care is thanks to innovation and insight by Bjørn Ibsen.

James Watson & Francis Crick worked together as microbiologists on the structure of DNA in Cambridge, England.  James Watson was provided with a grant by the National Foundation for Infantile Paralysis in the USA.

In collaboration with Francis Crick they discovered the molecular structure of DNA.  The now well known double-helix structure which is a major milestone in the understanding of the structure of cells and replication especially the interaction and replication by viruses within host cells.

Less well-known was Sister Kenny who devised methods of treating and remobilization of those who had been paralysed by the polio virus. However, some of Kenny’s methods have been called into question in recent years..

Elizabeth Kenny was born in Australia in 1880. She was trained as an army nurse and treated the sick for 31 years in the bushlands of Australia. She acquired the title "Sister" -- used in British countries for "nurse."

In 1911, when she encountered her first case of polio, Sister Kenny was unaware of conventional polio treatment -- immobilizing the affected muscles with splints. Instead, she used common sense and her understanding of anatomy to treat the symptoms of the disease. Sister Kenny applied moist hotpacks to help loosen muscles, relieve pain, and enable limbs to be moved, stretched, and strengthened. The theory of her treatment was muscle "re-education" -- the retraining of muscles so that they could function again.

In 1940, Sister Kenny travelled to the United States and eventually to Minneapolis, Minnesota, where, in 1942, the Sister Kenny Institute was established. Sister Kenny's pioneering principles of muscle rehabilitation became the foundation of physical therapy. Today, Sister Kenny Rehabilitation Institute is one of the premier rehabilitation centres in the country, known for its progressive and innovative vision.

Thanks to these developments, polio for those in the developed counties where vaccination programmes have been implemented is virtually unheard of and no longer considered a threat to children or adults because of the protection afforded by immunisation.

Today, there is a global endeavour to eradicate polio in the same way that smallpox has been eradicated, the project being led by the World Health Organisation and Rotary International and others..

Those people  who contracted polio and learned to get on with their lives have discovered that, in many instances, the long-term effects of the neurological damage caused by the disease has led, with aging, to the onset of new debilitating symptoms. Known as Post Polio Syndrome, the condition shows its effects many years after the onset of polio. 

The British Polio Fellowship is actively publicising the existence of post-polio syndrome and gives considerable support and advice to the medical professions and its members.