Guest column: Today's news is reminder of polio pandemic - Victoria Advocate

Posted: 09 Apr 2020 12:00 AM PDT

Today, there is constant news about the COVID-19 pandemic. A few months ago, no one knew anything about this new disease, its effect on humans, how it spreads, cure or its treatment.

Today, we don't hear much about the polio pandemic of 1952 because a vaccine now prevents it.

I'll write my polio story since I have firsthand knowledge about the polio virus and how it impacts one's body. A 1952 headline appearing in newspapers throughout the United States: "Polio Strikes Terror in Texas and Across the Nation." From the Houston Chronicle, July 1952: "Six new cases of polio reported at Hedgecroft Hospital in Houston on Saturday. Among them were two brothers Frank Fishar, 7, and Jerome Fishar, 4, of East Bernard."

In 1950 at the age of 5, I started first grade at Holy Cross Catholic School. After finishing second grade, I was on summer break, and that meant that my siblings and I would work on the farm – mostly chopping cotton and later picking cotton by hand.

In the early summer of 1952, I began complaining about being tired and weak. I was having difficulty getting up from the bed and chairs. It was as if my muscles were not working. Like most families, we did not have a TV. Our news came from the radio and the local newspaper.

My parents were paying attention to the news. On July 3, my parents took me to the Shumann Clinic in our town, and I was diagnosed with poliomyelitis (polio). I had never heard of polio and knew nothing about this disease or what would happen to my body. My parents were terrified. A deadly virus was striking their son, and there was no vaccine and no cure.

July 4 was supposed to be a happy day. Our family always celebrated that day with a big barbecue and fresh vegetables from the garden, and I was in the clinic. In the evening, my parents brought me a barbecue plate. I remember my parents talking with Dr. Shumann, but I wasn't getting any information other than the doctor said he would treat me for polio. I wasn't too concerned yet.

On July 5, my parents decided to seek treatment for me in Houston. They carried me to the car and placed in the back seat of a two-door sedan with my brother-in-law helping my parents get me to Houston. We arrived at Hedgecroft Hospital and Clinic in the Montrose area on South Main. Being a big boy, I told my brother-in-law I would get out of the car by myself. As I moved to get to the front seat, I collapsed on the floor board. I realized, then, I was paralyzed. The hospital was on the second floor, and there was only one big room that had beds for 70 patients. There was only enough room between the beds for the nurses and doctors to move about. Seeing all the other patients with various conditions frightened me.

I was paralyzed on the right side of my body and lost the use of my legs. I remember it like it was yesterday. Hedgecroft was a hospital, clinic and training school for the treatment of poliomyelitis, and it was in place to face the 1952 pandemic.

The most devastating year for the infection was in 1952 with 57,879 cases reported nationwide, including 3,145 in Texas. The wave began around Memorial Day, peaked in July and abated by October. The death rate was 5.4% of those affected. (Source: The Polio Years in Texas, Battling a Terrifying Unknown, Heather Green Wooten, 2009.)

I immediately started physical therapy, including hot whirlpool baths, hot blanket wraps on my legs, electric shock treatment on my right leg. Also being a research hospital, they did experimental things to find a cure. I was given experimental drugs and other things. No one from my family was allowed to stay with me in the hospital. My parents visited me whenever they could, usually twice a week. It was a long trip to Houston.

After about four weeks of treatment, I began to walk. On Aug. 5, I was released to go home. I'll have to return for weekly therapy, though. I am now walking and running, and I think I got this whipped. I was wrong.

Paralytic polio can lead to temporary or permanent muscle paralysis, disability, bone deformities and death. I experienced all except death.

After my recovery from the initial poliovirus infection, I had physiological and psychological problems dealing with the disease. Two years later, I began to experience curvature of the spine. I was sent to a back brace company to measures for braces.

While being measured, I began to rebel internally about having to wear a brace. I said to myself, "Not me, I have seen those kids with braces from head to toe. I wasn't going to be one of them."

I didn't get approved by the Texas Fund for Crippled Children, so no back brace. I made every effort to sit up straight. I was also having problems with my right leg. The muscles and bones in my leg were not growing as fast as my left leg. Over a period of four to five years, my right leg was 5/8 inch shorter than the left leg, and my muscles appeared about half size. I was limping. My leg was tested for muscle strength and if it was at 30 percent or less, I would get muscle transplants from another part of my body. It was 40% and I was pleased with that.

On May 27, 1958, I entered an experimental human growth hormone procedure on my short leg. In the operation the doctors drilled a hole in my three leg bones and injected the hormone. While in recovery and having no feeling in my leg, my mom said they had to cut my leg off. I ripped that cover off my feet as fast as I could. I had my legs; Mom was just kidding. I was very upset. I forgave her. I am sure my parents were stressed. The growth hormone did not work.

So what were some of the psychological problems I endured? Obviously, I had a limp. I had to wear a size 8 shoe on my left foot and a size 6 on the right foot starting in about the sixth grade. Also, I started with an added 5/8-inch heel on the right shoe. Later, it covered the entire sole. I didn't like wearing a club on my foot. The kids didn't make fun of me, but I was self-conscious about it.

In seventh grade, I went to the Houston Shoe Hospital, and I got a normal looking shoe made with the uplift built directly inside the shoe and best of all the shoes were of the same size. Today, I still wear shoes with the internal fixture.

I continued my polio therapy through about the 10th grade. I heard about the post-polio syndrome, and I didn't believe it until I experienced it in 2002. I bought 50 square hay bales, and when I went to load them, I couldn't put them on the trailer. Luckily, Glenn Leopold was there, and he loaded the bales for me.

Post-polio syndrome is a condition that can affect polio survivor's decades after they recover from their initial poliovirus infection. I limp more today as that leg muscle continues to get weaker. The polio experience prepared me for another battle of stage four colon cancer since 2009. I feel fine and am doing great. I feel like the luckiest person in the world having faith, family and friends that keep me going.

The most effective way to prevent polio is vaccination. Children in the United States receive four doses of inactivated poliovirus vaccine.

The disease has been virtually wiped out in the Western hemisphere since the introduction of the polio vaccine (the "Salk vaccine") in 1955 and the oral, live vaccine (the "Sabin vaccine") in 1961. My brother, Jerome, recovered without any problems.

And finally, those with COVID-19 will have some of the same issues and questions as the early polio victims had. Not knowing a cure, treatment, how it spreads or its long-term effects will be the challenge.

How a polio outbreak led to the invention of modern intensive care - New Statesman

Posted: 13 Apr 2020 12:00 AM PDT

A worldwide viral epidemic accelerating out of control, a health service on the brink, a critical lack of breathing apparatus: we've been here before. In 1952, an epidemic of polio led to the birth of intensive care, and the invention of the modern ventilator.

Poliomyelitis, or polio, is a paralysing infectious disease caused by the poliovirus. It most commonly affects children under the age of five. In temperate climates it occurs in the warmest months, which explains one of the names – the "summer plague" – that have been given to the disease in its long history of infecting humans. While it can be prevented – billions of people have now been vaccinated against polio – there remains no cure. In the first decades of the twentieth century, there was little that could be done to treat the most severely affected, who lost the ability to swallow, or even to breathe.

In 1928, the American medical pioneer, Philip Drinker, demonstrated that patients could be kept alive by a type of artificial ventilator, nicknamed the "iron lung". The patient was sealed from the neck down in a metal tube, from which air was sucked, causing the chest wall to expand. This drew air into the lungs through the mouth and nose in a process called "negative pressure ventilation". Mortality from polio remained high, but at least there was hope for those whose breathing muscles had been paralysed by the disease.

However, the need for the machines far outstretched their availability. From 1945 to 1949, Western countries saw an annual average of 20,000 new cases of polio. Just as today's government has rushed to set up the new Nightingale hospitals, the countries that could afford it bankrolled huge suites of iron lungs. But in the austerity of postwar Europe, most countries had to go without.

In Copenhagen, the summer of 1952 had begun like any other. The city expected a polio outbreak – in a bad year, a few hundred would contract the disease – and officials were not surprised when, in late July, the first case presented at the Blegdamshospitalet, the city's main treatment centre for communicable diseases. Within a month, however, the number of patients had reached an unprecedented 260. During the first three weeks, 27 of 31 severely paralysed children died, most within days of admission. During 19 weeks over 2,700 patients were affected, with 316 losing the ability to breathe. The hospital, and Denmark as a whole, had one iron lung.

The senior physician at Blegdams was Henrik Lassen. Feared and respected by his staff, Lassen had risen rapidly through the medical ranks to be appointed chief of medicine at the early age of 38. On ward rounds, he half-jokingly referred to himself as "the emperor". Yet even he had no answers, and a sense of despair infected the staff. Mogens Bjørneboe, Lassen's deputy, urged him to call in help. He suggested a friend, an anaesthetist called Bjørn Ibsen. That April, Ibsen had helped Bjørneboe to manage an infant boy with intractable seizures caused by tetanus, using the paralysing agent curare. The treatment came at a price: the child was rendered unable to breathe without artificial respiration. The "iron lung" was unsuitable for such a small infant, so Ibsen had proposed a treatment hitherto only used for short periods in patients undergoing heart or lung surgery. It was called "positive pressure ventilation". A tube was inserted into the infant's windpipe, and a team of doctors, working in shifts, manually squeezed air in and out of his lungs using a rubber balloon for more than two weeks.

In the 1950s, anaesthetics was a low-status medical speciality. Anaesthetists were regarded as little more than technicians; the surgeon decided the anaesthetic, the anaesthetist administered it. Lassen, mindful of his international reputation, was offended by the suggestion that he take the advice of an anaesthetist.

As cases continued to rise exponentially, Lassen organised a gathering of the senior staff to review new initiatives. He agreed, reluctantly, to invite Ibsen, but only in order to humiliate the young anaesthetist regarding his lack of experience in polio. Ibsen's forthright view, however, was that the iron lung was not up to the job, and the confident presentation of his positive pressure system won over the assembled physicians. Lassen, fuming, grudgingly agreed to a trial – on the most hopeless case in the hospital, a 12-year old girl called Vivi Ebert, who was considered to be in the terminal phase of the disease.

Ibsen began hand ventilations through a cuffed tube surgically inserted into Ebert's windpipe. She did not improve at first, and one by one the watching physicians drifted away in embarrassment. In a last desperate bid to save the girl, Ibsen administered a general anaesthetic. With the loss of consciousness, Vivi stopped fighting the manual ventilations. By the time the physicians returned from lunch, she had started to improve more dramatically than any of them had expected.

The news spread rapidly through the hospital. At a stroke, Ibsen had discredited the expensive, cumbersome iron lung, replacing it with a simple, cheap, and readily available form of artificial ventilation. Nonetheless, the logistics of hand-ventilating every critical case were daunting. Each patient required a team of four people to cover 24 hours, seven days a week, for up to three months, until recovery. There were only 20 anaesthetists in Copenhagen; hundreds would be needed.

Lassen's leadership skills now came into play. He called up hundreds of medical and dental students, who often received less than ten minutes training before being given the responsibility for keeping a child breathing and alive throughout an eight-hour shift, day and night. By the end of the epidemic, 1,500 medical and dental students had put in over 165,000 hours filling the lungs of those who could not breathe for themselves.

The plan worked. The mortality rate of respiratory polio in Denmark fell from 90 per cent to 20 per cent, and the iron lung became a museum piece. The following year, the Swedish company Engström invented a machine that pumped the ventilations mechanically. The doctors nicknamed these machines "mechanical students".

In 1954, the first polio vaccines were introduced into Denmark. The last polio case with breathing problems was treated in 1958.

We all owe a debt of gratitude to professor Bjørn Ibsen, the father of modern intensive care, who died in 2007. As the coronavirus pandemic stretches healthcare systems around the world, the inventiveness and dedication that he and 1,500 students used to saved a generation of children is needed once more.

Search This Blog

Poliomyelitis

Guest column: Today's news is reminder of polio pandemic - Victoria Advocate

Guest column: Today's news is reminder of polio pandemic - Victoria Advocate

Comments

Post a Comment

Popular posts from this blog

Roseola vs. measles rash: What is the difference? - Medical News Today

poliomyelitis treatment

Managing Atrial Fibrillation in Patients With Heart Failure and Reduced Ejection Fraction: A Scientific Statement From the American Heart Association