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 polio
Second Edition
Anthrax, Second Edition Lyme Disease
Antibiotic-Resistant Mad Cow Disease
Bacteria Malaria, Second Edition
Avian Flu Meningitis
Botulisim Mononucleosis,
Campylobacteriosis Second Edition
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Infections
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Syndrome
Infections
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Second Edition Tularemia
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 polio
Second Edition

Alan Hecht, D.C.

CONSULTING EDITOR
Hilary Babcock, M.D., M.P.H.,
Infectious Diseases Division,
Washington University School of Medicine,
Medical Director of Occupational Health (Infectious Diseases),
Barnes-Jewish Hospital and St. Louis Children’s Hospital

FOREWORD BY
David Heymann
World Health Organization
Deadly Diseases and Epidemics: Polio, Second Edition

Copyright © 2009 by Infobase Publishing

All rights reserved. No part of this book may be reproduced or utilized in any
form or by any means, electronic or mechanical, including photocopying,
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in writing from the publisher. For information contact:

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An imprint of Infobase Publishing
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Library of Congress Cataloging-in-Publication Data

Hecht, Alan.
Polio / Alan Hecht ; foreword by David Heymann. -- 2nd ed.
p. cm. -- (Deadly diseases and epidemics)
Includes bibliographical references and index.
ISBN-13: 978-1-60413-238-0 (alk. paper)
ISBN-10: 1-60413-238-8 (alk. paper)
1. Poliomyelitis--Juvenile literature. 2. Poliomyelitis--History--Juvenile litera-
ture. I. Title. II. Series.

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 Table of Contents
Foreword
David Heymann, World Health Organization 6

1. The History of Polio 8

2. The Transmission of Polio and

How It Affects the Body 20

3. Vaccines and How They Work 31

4. The Life of Jonas Salk 42

5. The Life of Albert Sabin 49

6. Nobody Is Exempt 57

7. Just When We Thought It Was Safe:

Post-polio Syndrome 68

8. What Lies Ahead? The Future of Polio 82

Notes 101

Glossary 103

Bibliography 106

Further Resources 108

Index 111

About the Author 116

About the Consulting Editor 116

Foreword
Communicable diseases kill and cause long-term disability. The
microbial agents that cause them are dynamic, changeable, and resilient:
They are responsible for more than 14 million deaths each year, mainly
in developing countries.
Approximately 46 percent of all deaths in the developing world
are due to communicable diseases, and almost 90 percent of these
deaths are from AIDS, tuberculosis, malaria, and acute diarrheal and
respiratory infections of children. In addition to causing great human
suffering, these high-mortality communicable diseases have become
major obstacles to economic development. They are a challenge to
control either because of the lack of effective vaccines, or because the
drugs that are used to treat them are becoming less effective because of
antimicrobial drug resistance.
Millions of people, especially those who are poor and living in
developing countries, are also at risk from disabling communicable
diseases such as polio, leprosy, lymphatic filariasis, and onchocer-
ciasis. In addition to human suffering and permanent disability,
these communicable diseases create an economic burden—both on
the work force that handicapped persons are unable to join, and on
their families and society, upon which they must often depend for
economic support.
Finally, the entire world is at risk of the unexpected communica-
ble diseases, those that are called emerging or re-emerging infections.
Infection is often unpredictable because risk factors for transmission
are not understood, or because it often results from organisms that
cross the species barrier from animals to humans. The cause is often
viral, such as Ebola and Marburg hemorrhagic fevers and severe
acute respiratory syndrome (SARS). In addition to causing human
suffering and death, these infections place health workers at great
risk and are costly to economies. Infections such as Bovine Spongi-
form Encephalopathy (BSE) and the associated new human variant
of Creutzfeldt-Jakob Disease (vCJD) in Europe, and avian influenza
A (H5N1) in Asia, are reminders of the seriousness of emerging and
re-emerging infections. In addition, many of these infections have
the potential to cause pandemics, which are a constant threat our
economies and public health security.

 Foreword 

Science has given us vaccines and anti-infective drugs that have

helped keep infectious diseases under control. Nothing demonstrates
the effectiveness of vaccines better than the successful eradication of
smallpox, the decrease in polio as the eradication program continues,
and the decrease in measles when routine immunization programs are
supplemented by mass vaccination campaigns.
Likewise, the effectiveness of anti-infective drugs is clearly demon-
strated through prolonged life or better health in those infected with
viral diseases such as AIDS, parasitic infections such as malaria, and bac-
terial infections such as tuberculosis and pneumococcal pneumonia.
But current research and development is not filling the pipeline
for new anti-infective drugs as rapidly as resistance is developing, nor is
vaccine development providing vaccines for some of the most common
and lethal communicable diseases. At the same time, providing people
with access to existing anti-infective drugs, vaccines, and goods such
as condoms or bed nets—necessary for the control of communicable
diseases in many developing countries—remains a great challenge.
Education, experimentation, and the discoveries that grow from
them are the tools needed to combat high mortality infectious diseases,
diseases that cause disability, or emerging and re-emerging infectious
diseases. At the same time, partnerships between developing and indus-
trialized countries can overcome many of the challenges of access to
goods and technologies. This book may inspire its readers to set out on
the path of drug and vaccine development, or on the path to discover-
ing better public health technologies by applying our present under-
standing of the human genome and those of various infectious agents.
Readers may likewise be inspired to help ensure wider access to those
protective goods and technologies. Such inspiration, with pragmatic
action, will keep us on the winning side of the struggle against com-
municable diseases.
David L. Heymann
Assistant Director General,
Health Security and Environment
Representative of the Director General for Polio Eradication
World Health Organization
Geneva, Switzerland
1
The History of Polio
It is likely that polio has caused paralysis and death for most of human
history. One of the earliest written accounts of polio is that of the Pharaoh
Siptah, who ruled ancient Egypt from 1200 b.c. to 1193 b.c. It is said that
Siptah was stricken with a paralyzing disease as a young boy. The illness
left his left foot and leg deformed. People of the time believed that Siptah
was being punished for his father’s sins because his father had overthrown
the previous Pharaoh Seti II and seized the throne.
In addition to Siptah’s story, the oldest identifiable reference to polio
also comes from Egypt in the form of an Egyptian stele, a stone engrav-
ing that is more than 3,000 years old (Figure 1.1). The engraving depicts
Ruma, a Syrian who served as a gatekeeper at the temple of Astarte in
Egypt. When Ruma was five years old, he suffered from pain in his head
and a sore leg. When his condition did not improve, his father took him
to the temple to see the priest who, it was believed, would cure him with
potions, charms, and amulets. The treatments did not work, and Ruma
was left with a paralyzed right leg.
The stele explains that Ruma’s leg withered as he got older and that he
was forced to use the long stick shown in the engraving as a crutch. He is
shown with his wife Ama and his young son Ptah-m-heb. Ruma is carry-
ing fruit, wine, and a gazelle as gifts of thanks to the goddess he believes
saved his life.
Sanitation was poor in ancient days, and therefore people were fre-
quently exposed to sewage that contained bacteria and viruses, including
the active poliovirus. In the case of poliovirus, the virus entered the sewage
system because poliovirus passes through the intestines and into the feces
of infected people, and the feces contaminated the water. Interestingly, this


 The History of Polio 

Figure 1.1 Polio has plagued humans for thousands of

years. Some of the earliest descriptive accounts of the dis-
ease come from ancient Egyptian steles, or stone engrav-
ings, like the one pictured above. This particular stele
depicts the deformed foot of a man assumed to be Ruma of
Syria. (Courtesy WHO)

presence in the sewage system also helped to create immunity,

keeping cases at a much lower level than what would be seen
after the development of sewage systems. When a person is
frequently exposed to very low levels of a virus that are not
10 polio

sufficient to cause the disease, constant exposure stimulates

the immune system into making antibodies against the virus,
which will protect the individual.
Gradually people learned to dump waste away from the
drinking water supply, a measure that protected against
diseases like cholera and polio, which are often spread via
contaminated water. However, low-level exposure no lon-
ger occurred, and thus people no longer developed immunity.
The number of polio cases increased.

The Bible Speaks of Polio

Many references to polio appear in the Bible. In the book of
Luke 5:18 the reference to polio is translated using the word
palsy: “And, behold, men brought in a bed a man which was
taken with a palsy: and they sought means to bring him in, and
to lay him before him.”
In English language translations of the Bible, the word palsy
is used instead of the word paralysis because it is derived
from the Old French word paralesie, which actually means
paralysis. Middle English shortened this into palesie, which
appeared as palsy in the King James Version of the Bible in
the seventeenth century. Of course, today we use the word
paralysis when referring to the result of an infection with the
poliovirus.
Another reference to polio appears in the book of
Matthew 8:5–6 “And when Jesus was entered into Capernaum,
there came unto him a centurion, beseeching him, and saying,
Lord, my servant lieth at home sick of the palsy, grievously
tormented.”
Polio appears again in the Acts of the Apostles 9:33. Here
the permanent paralysis associated with polio is described:
“And there he found a certain man named Aeneas, which had
kept his bed eight years, and was sick of the palsy.”
Matthew 12:9–10 evokes the shriveling that often results
when a person is stricken with polio: “Going on from that place,
 The History of Polio 11

he went into their synagogue, and a man with a shriveled hand

was there.”
An additional reference to polio describing withering and
the inability to walk due to that condition appears in John
5:2–3, 5: “Now there is at Jerusalem by the sheep market a
pool, which is called in the Hebrew tongue Bethesda, having
five porches. In these lay a great multitude of impotent folk,
of blind, halt, withered, waiting for the moving of the water.
And a certain man was there, which had an infirmity thirty and
eight years.”

A Disease of Children
Polio generally afflicts the young. Although these biblical
references do not specifically mention children, later historical
accounts do. Sir Walter Scott (1771–1832), a Scottish novelist and
poet, wrote about his own case of polio. His account, written
in 1827, was the earliest recorded in the United Kingdom:

I showed every sign of health and strength until I was

about 18 months old. One night, I have been often told,
I showed great reluctance to be caught and put to bed,
and after being chased about the room, was apprehended
and consigned to my dormitory with some difficulty. It
was the last time I was to show much personal agility.
In the morning I was discovered to be affected with the
fever which often accompanies the cutting of large teeth.
It held me for three days. On the fourth, when they went
to bathe me as usual, they discovered that I had lost
the power of my right leg . . . when the efforts of regular
physicians had been exhausted, without the slightest
success . . . the impatience of a child soon inclined me
to struggle with my infirmity, and I began by degrees to
stand, walk, and to run. Although the limb affected was
much shrunk and contracted, my general health, which
was of more importance, was much strengthened by
12 polio

being frequently in the open air, and, in a word, I who

in a city had probably been condemned to helpless and
hopeless decrepitude, was now a healthy, high-spirited,
and, my lameness apart, a sturdy child. 1

In 1789, Michael Underwood, a British physician,

published the first known clinical description of polio as a
“Debility of the Lower Extremities.” Once again, the passage
refers to children:

The disorder intended here is not noticed by any medical

writer within the compass of my reading, or is not a
common disorder, I believe, and it seems to occur
seldomer in London than in some parts . . . It seems
to arise from debility, and usually attacks children
previously reduced by fever; seldom those under one, or
more than four or five years old. The Palsy . . . sometimes
seizes the upper, and sometimes the lower extremities; in
some instances, it takes away the entire use of the limb,
and in others, only weakens them.” 2

In analyzing the content of Underwood’s description

from a twenty-first-century point of view, anyone who is very
familiar with polio can see that the description was technically
accurate for a doctor of the eighteenth century. This is surpris-
ing since there was not much known about polio during this
time. A twenty-first-century physician could have written
the account. Because polio has historically occurred more
often in children than in adults, the term infantile paralysis
was originally used to identify the disease.

Polio Makes the News

Outbreaks of polio in Europe were not recorded until the early
nineteenth century. In 1840, a German orthopedic surgeon
named Jacob von Heine wrote the first detailed description
 The History of Polio 13

Figure 1.2 Sir Walter Scott is shown in this portrait with the
cane he needed to walk. (© Bettmann/CORBIS)

of polio based on his studies of infected patients. His writings

identified the spinal cord as the site of involvement, which we
now know is correct.
14 polio

Von Heine’s description came only five years after small

outbreaks of polio were reported in the United States and
United Kingdom. Considering how little was known about
polio during this period in history, von Heine’s work was
quite insightful and forward thinking. After his discovery, an
interesting pattern developed. Polio epidemics in developed
nations in the Northern Hemisphere began to be reported each
summer and fall, but not in the spring or winter.
The epidemics became more and more severe, and the
average age of those affected increased. The number of deaths
from polio began to increase as well. A disease that had existed
for thousands of years in only a few areas, and that had affected
a limited number of people, was now coming to the forefront
in many locations.
It was not until 1908 that the Viennese immunologist Karl
Landsteiner and his associate Ervin Popper discovered that
bacteria could not be found in the spinal cord tissue of infected
humans. Perhaps, they thought, bacteria were not the cause of
the disease. This led them to suggest that a virus was the caus-
ative agent of polio. Of course, without an electron microscope,
they could not actually see the virus, but today we know that
their supposition was correct.

Did you know that . . .

Jacob von Heine published a 78-page monograph in 1840
that described the clinical features of polio and also noted
that its symptoms suggested the involvement of the spinal
cord. The limited medical knowledge of the time and the
submicroscopic nature of the poliovirus kept von Heine and
others from understanding the contagious nature of the disease.
Even with the relatively large outbreaks of polio that occurred
in Europe during the second half of the nineteenth century,
physicians attributed the disease to causes such as teething,
stomach upset, and trauma.
 The History of Polio 15

Figure 1.3 Karl Landsteiner was one of the first scien-

tists to hypothesize that polio was a viral infection. Prior to
his studies, researchers believed that bacteria caused the
disease. Landsteiner and Ervin Popper proved their viral
hypothesis by injecting spinal cord tissue from children
who had died of polio into monkeys, which later developed
the disease. (U.S. National Institutes of Health/National
Library of Medicine)

A Dynamic Experiment
Landsteiner and Popper set out to test their hypothesis. To
prove that a virus, not bacteria, was the cause of polio, they
ground up the spinal cords of children who had died of polio
16 polio

and injected the material into monkeys. Soon the monkeys

developed the disease.
The following year, researchers Simon Flexner and Paul
Lewis, working at Johns Hopkins University in Baltimore,
Maryland, confirmed Landsteiner and Popper’s findings.
This was of great importance since scientists could now
attempt to find a vaccine to stop the spread of this deadly
disease. Flexner and Lewis were able to successfully trans-
fer polio from one monkey to another. They started out
the same way that Landsteiner and Popper did, by injecting
diseased human spinal cord tissue into the brains of monkeys.
Once a monkey began to show symptoms, a suspension of
its diseased spinal cord tissue was injected into other mon-
keys. Because each successive monkey developed the disease,
their work was considered a huge success.
After the success of the experiment, Flexner was quoted
as saying, “We failed utterly to discover bacteria, either in film
preparations or in cultures, that could account for the disease.”
Therefore, they concluded, “ . . . the infecting agent of epidemic
poliomyelitis belongs to the class of the minute and filterable
viruses that have not thus far been demonstrated with certainty
under the microscope.” 3

How is it Transmitted?
In the meantime, it became extremely important to find out
how the disease was transmitted from one person to another.
Initially, Flexner and Lewis felt that polio was spread directly
from the nose to the brain. They introduced washings from the
nose and throat of infected people into monkey nasal passages.
Because the monkeys developed polio, the scientists concluded
that this was the mode of transmission. For more than 20 years,
people believed that this was, indeed, the way polio spread.
Unfortunately, when scientists thought that this was the correct
mode of transmission, they stopped searching for any other
 The History of Polio 17

Figure 1.4 Albert Sabin was the first researcher to show that
the polio virus was present in the digestive system as well as the
brain and spinal cord. Sabin developed the first oral vaccine for
polio. Jonas Salk had earlier developed a polio vaccine that was
given as an injection. (© AP Images)
18 polio

mode of spreading the disease. Later it was found that this was
not the route of transmission.
A hint as to the true means of spreading the disease was
found in 1912, when Swedish researchers discovered poliovirus
in the contents and walls of the human small intestine. At the
time nobody knew that this was the real pathway of the virus.
Unfortunately, because of Flexner and Lewis’ work, it was
believed that these intestinal viruses only existed because of
swallowed nasal contents.
It was not until 1941 that a researcher named Albert Sabin
(Figure 1.4) showed that poliovirus was not present in the
nasal membranes of patients who had died. He was able to
demonstrate the presence of the virus in the digestive tract as
well as the brain and spinal cord. Other researchers were able
to support Sabin’s findings, and this led scientists to agree that
polio actually began as a digestive illness.
Today we know that the majority of polio cases actually do
not cause symptoms in those who are infected. In fact, symp-
toms only occur in approximately 5 percent of infections. One
of three sets of symptoms occurs depending on which form of
the disease a person actually has. The three forms of polio are
mild polio, nonparalytic polio, and paralytic polio.
In a case of mild polio, a person will experience headache,
nausea, vomiting, general discomfort, and a slight fever for about
three days. These symptoms resemble a typical intestinal virus.
Following this, the person will recover fully because the virus is
defeated by the immune system before it can develop into any-
thing more serious.
In a case of nonparalytic polio, the patient will have the same
symptoms as with mild polio, with the addition of moderate
fever, stiff back and neck, fatigue, and muscle pain. No paralysis
occurs in this type of polio. It is sometimes referred to as
aseptic meningitis.
Patients who actually develop paralytic polio will experience
muscle weakness, stiffness, tremors, fever, constipation, muscle
 The History of Polio 19

pain and spasms, and difficulty swallowing. These patients will

most likely develop paralysis in one or both legs and/or arms.
This paralysis can last days or weeks before strength returns.
Some people will be permanently disabled. Depending on the
degree of paralysis, their disabilities will vary.
2
The Transmission
of Polio and How It
Affects the Body
On the beautiful summer day of August 10, 1921, a 39-year-old lawyer
named Franklin Delano Roosevelt (known familiarly to the public as
FDR) was enjoying a well-earned vacation on Campobello Island in New
Brunswick, Canada. Unfortunately, he had just lost the election of 1920
as the vice presidential candidate for the Democratic Party. However, the
lost election did not put a damper on his spirits as he and his three eldest
children, Anna, James, and Elliot, sailed around the island on his 24-foot
sloop, Vireo.
After their trip, they returned home for a two-mile jog to their favorite
pond for a swim. When the future president returned to the cottage, he felt
a chill come over him and was too tired to eat with the family. He read for
a while and went to bed with a sore back.
The next morning, he awoke with a fever of 102°F and aching, weak
legs. As the day wore on, the pain in his legs spread to his back and neck,
and eventually he was unable to move his legs at all. Until this point in
his life he had been an active, healthy man who was used to exercising.
He would spend the rest of his life in a wheelchair, never walking again
(Figure 2.1).
What FDR did not know at first was that at some point in the
weeks before he arrived at Campobello, he had contracted polio. The

20
 The Transmission of Polio and How It Affects the Body 21

Figure 2.1 Franklin Delano Roosevelt, who was president of the

United States from 1933 until 1945, is one of the most famous
survivors of polio. He had to use a wheelchair or strong leg braces
due to the damage the disease had caused to his legs. (© AP
Images)
22 polio

usual incubation period for polio is 3 to 21 days, depending on

how much virus the person is exposed to.
After several doctors examined Roosevelt and could not
determine why he was not improving, they consulted Dr.
Robert Lovett, a Harvard specialist and an expert on infantile
paralysis. Sadly, he confirmed the family’s worst fear: FDR
had indeed contracted polio.

How Did This Happen?

Naturally, everyone wanted to know: “How did he get sick
in the first place?” It was known that the poliovirus could be
transmitted through water, especially in the summer when
people spent much time swimming, often in “water holes”
that were contaminated by sewage. In an area where raw sew-
age is able to enter the water without first being treated, the
poliovirus spreads easily. All a person has to do is swallow some
of this contaminated water either from a drinking water
supply or from a river, lake, or stream where he or she might
be swimming. Once this happens, the virus infects the throat
and intestinal tract.
Once in the cells of the intestinal tract, the virus repli-
cates, or reproduces, making thousands of new viruses.
These viruses are then carried through the intestinal tract and

Did you know that . . .

Few Americans were ever aware of Franklin D. Roosevelt’s
disability. This was due in large part to the cooperation of
members of the press who almost always photographed him
from the waist up. FDR insisted on this policy when he re-
entered politics after his bout with polio, and it was continued
during his presidency. He felt that the nation should see him
as a strong man with no physical problems. This would give
the American people confidence in the government.
 The Transmission of Polio and How It Affects the Body 23

Figure 2.2 Polio is caused by the poliovirus. An electron micro-

graph of this virus is shown here. Poliovirus can cause symptoms
ranging from mild discomfort and muscle weakness to total
paralysis. Polio is usually spread through contaminated food and
water. (CDC/Dr. Fred Murphy, Sylvia Whitfield)

released via the feces back into the sewage system to start the
cycle all over again. In addition to spreading through untreated
water, the virus can spread through human contact, especially
among children who often do not wash their hands.

Catching the Beast

Viruses are not as complex as animal and plant cells, or even
bacteria. They consist of only genetic material and a protein
24 polio

coat. They do not have any systems such as a digestive or repro-

ductive system. In order to replicate, they require a living cell
that they can invade so they may introduce their genetic infor-
mation into the host. Poliovirus infects a person in the same
way that other viruses cause infections. Humans are the only
natural host for the virus (Figure 2.2).
When a virus enters the body, it seeks out cells that have
specific proteins on their surface. These proteins are called
receptor sites and act like parking spaces for the virus. As long
as there is a place to park, the virus attaches to the cell and
introduces its genetic information into the nucleus of the cell
where all of the genes are located.
The viral genes become part of the host cell’s genetic
makeup and then direct the cell to act like a photocopier to
produce millions of copies of the virus. The cell eventually
bursts and releases the new viruses into the system so they can
infect even more cells. Of course, when these cells burst, there
is damage to the tissue.

How Does it Work?

The initial poliovirus infection occurs in the intestinal tract.
Once these cells are infected, one of several situations may
occur. A person may be asymptomatic, meaning that he or she
does not develop the disease or show any symptoms. Or he
or she may have mild symptoms including a headache, fever,
and vomiting that last for 72 hours or less.
If a person does develop symptoms, he or she may have
a nonparalytic and less serious form of the disease. In such a case,
the patient will suffer with diarrhea, a moderate fever, excessive
fatigue, vomiting, pain, muscle tenderness, and spasms in any area
of the body. These symptoms may last for up to two weeks and
then disappear, leaving the patient with no further problems.
Approximately one percent of all polio patients develop the
paralytic form of polio. These patients develop a stiff neck and
back, fever, pain, and headaches. Muscle weakness can come on
 The Transmission of Polio and How It Affects the Body 25

Figure 2.3 Polio can affect the medulla oblongata, the part of
the brain that controls breathing. If this happens, the patient may
have trouble breathing or not be able to breathe at all without
help. The iron lung, invented in 1928 by Philip Drinker, helps
people who cannot breathe on their own. The machine encloses
the patient from the neck down, forms an airtight seal, and regu-
lates the pressure surrounding the patient’s chest, thus aiding the
breathing process. (CDC/GHO/Mary Hilpertshauser)
26 polio

Figure 2.4 This cross section of the brain shows some of the
major components of the organ. Polio affects the medulla oblon-
gata and the spinal cord.

quickly anywhere in the body and may develop into paralysis.

In the case of paralytic polio, the virus spreads through the
bloodstream to infect cells located in the anterior portion of the
spinal cord. This area is used to send signals to muscles so they
can move. When these cells are destroyed, the muscles that used
to receive signals from them in order to move can no longer
function, and paralysis occurs. In addition, the person may have
difficulty urinating and swallowing, muscle spasms, and trouble
breathing. Up to 10 percent of these cases end in death.
If the virus affects the cells of the medulla oblongata, the
structure that controls breathing, a person develops bulbar
 The Transmission of Polio and How It Affects the Body 27

polio. In these cases, breathing becomes almost impossible

without the aid of a device called an iron lung. This was
developed by Philip Drinker and Louis Agassiz Shaw in 1928
and was used for several decades to help people with bulbar
polio to breathe. The iron lung was a large metal machine
that helped regulate the air pressure surrounding the patient’s
chest, thus allowing air to be pulled into the lungs of a person
who could not breathe on his or her own. The patient was
enclosed in the machine, from neck to toes, and an airtight
seal was formed around the neck. Today, iron lungs are only
occasionally used to help people breathe.

The Treatment Plan

Unfortunately, as with most viruses, there is no actual treat-
ment that will cure a case of polio. That does not mean,
however, that some of the patients suffering cannot find some
relief. In addition to using a ventilator, if necessary, to aid
breathing, a patient can be given medicines that reduce the
headaches, muscle spasms, and pain. If a urinary tract infection
develops, antibiotics are prescribed. Physical therapy and
even surgery may prove useful to help restore some of the
individual’s lost muscle function.
Sister Elizabeth Kenny in Australia developed an interest-
ing and useful form of therapy in 1933. She believed that the
main problem in early polio cases was muscle spasms. She felt
strongly that applying hot packs and using physical therapy
was the best method to treat patients when they first developed
the disease. This belief stemmed from her observation that
Aboriginal children in Australia who had polio were treated
with hot cloths.
During this time period, many doctors believed that immo-
bilization using splints and casts was the best way to treat a
polio victim. It is easy to see how a disagreement between Sister
Kenny and the medical profession developed. In fact, one of her
28 polio

Figure 2.5 Sister Elizabeth Kenny, shown here with a

young polio patient, believed that hot packs and massages
would help polio patients regain use of their muscles, a
method she developed in 1933. Although her methods
were popular in her native Australia, doctors in the United
States believed in immobilization of the afflicted limbs.
Kenny’s technique was finally accepted as an alterna-
tive therapy for polio when she was invited to become a
guest faculty member at the University of Minnesota in
1940. (© Bettmann/CORBIS)
 The Transmission of Polio and How It Affects the Body 29

Figure 2.6 Since the creation of the polio vaccines (both Salk’s
and Sabin’s) and nationwide immunization programs, the number
of polio cases in the United States has decreased dramatically.
As this graph shows, the last indigenous, or naturally occurring,
case of polio was in the 1970s. Polio continues to occur in other
places worldwide, however.

most outspoken critics was Dr. Robert Lovett, the polio special-
ist who had treated Franklin D. Roosevelt in 1921.
Never losing her determination, Sister Kenny did not get
angry. She opened the first polio treatment clinic in Townsville,
Queensland, Australia, in 1933. Kenny persisted in her work and
developed an attitude of understanding toward her critics:

The American doctor, in my opinion, possesses a com-

bination of conservatism and that other quality which
has put the United States in the forefront in almost every
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