University Contributes to Fight Against Polio; Doctors Develop New Electric Breathing Aid
Public Health, Medical Schools Combine to Wipe Out Disease, Help Victims Recover
Over 90 percent of the people in this country either have had some form of polio or are carrying the virus in their systems. The reason why some are crippled by the disease upon exposure and others show no effect is one of the projects under research at the Medical School and the School of Public Health.
Harvard's School of Public Health, where the first iron lung was developed more than 20 years ago, is the birthplace of a new discovery to aid polio victims--the electric lung. By electric impulses, this device causes the diaphragm to contract, thus filling the lungs.
These machines are only two of the many contributions the School of Public Health and the Medical School have made to the fight against infantile paralysis.
Laboratory men are growing polio virus in human tissues, hoping eventually to find a vaccine against the germ. Researchers have discovered ways to immunize mice partially. Other doctors are finding new means to help victims walk again by surgery and exercise, while psychologists are watching the effects on patients of living in an iron lung. The likeliness and control of epidemics are also getting attention. Nearly every phase of polio is being studied at the University.
The electric lung, formally known as the electrophrenic respirator, was perfected by two men in the Physiology Department of the School of Public Health, Dr. James L. Whittenberger and Dr. Stanley J. Sarnoff.
Most often applied externally to the neck, it electrically imposes its own breathing pattern on the nerves controlling the diaphragm. The machine can be plugged into any household socket and is light enough to be carried right to the bedside of a patient.
The EPR is not meant to replace the iron lung because it is mainly effective against only one type of polio--bulbar polio. This variety of the disease attacks the bulb at the base of the skull where the nerve center is located. The EPR takes over for the disturbed nerve center and substitutes its own steady breathing impulses for the weak, irregular ones from the brain.
Sarnoff conceived the idea while assisting at an operation at the Massachusetts General Hospital three years ago. The surgeon performing the operation accidentally touched the phrenic nerve, causing the patient's diaphragm to contract. Sarnoff wondered why this couldn't be done artificially to cause regular breathing and took the idea to Whittenberger who was studying the respiration of polio victims. Together they developed the electric lung.
The idea was not original, but Sarnoff and Whittenberger did not know this until a few months ago. Someone then referred them to a book, printed in 1861 in England, which describes the method with crude apparatus.
The two doctors had to find the exact spot on the neck where the device could be applied with the greatest success. Sarnoff's wife, also his laboratory assistant, served as a human guinea pig, and the doctors spent hours probing her neck with the electrode before they were successful.
The National Foundation for Infantile Paralysis, which gives most of the funds for University research on polio, contributed money to this project at its birth and recently provided $23,000 to the department for further work on respiration.
The first iron lung was also conceived and invented by a man in the School of Public Health, Phillip Drinker, head of the Department of Industrial Hygiene. Over 20 years ago, Drinker was watching a colleague, Louis A. Shaw, perform experiments to measure the amount of air a cat held in its lungs after a normal breath.
Leads to Development of Iron Lung
Shaw had the cat in an air-tight box, with its head sticking out of a rubber collar in the side. There was a guage attached to the box, and when the cat inhaled--expanding its lungs--the air in the box would be compressed and would cause the guage's pointer to rise. As the cat exhaled, there would be a partial vacuum in the box, and the pointer would fall.
Why, thought Drinker, can't we reverse the process? First, push air into the box to press on the lungs, making the cat exhale, and then draw air out of the box, causing air to rush into the lungs and fill the vacuum. The two men got to work at once and soon were making the cat breath mechanically by pumping air into and out of the box.
Drinker and Shaw constructed a crude mansized model, only to store it away in an old warehouse. Then, on Friday, the 13th of September in 1929, a man named Barrett Hoyt was dying of polio in the Peter Bent Brigham Hospital. Since his breathing muscles were paralyzed, the doctor in charge decided to chance Drinker's respirator. The lung had only been tried once before, and then, the patient had died of pneumonia.
Lung Saves First Life
Hoyt was barely breathing when the bulky equipment reached the hospital. They put him in the machine, started the motor, and in a few minutes, Hoyt was breathing regularly. Today he is alive and well.
His was the first of many thousands of lives to be saved by Drinker's machine. Hoyt lay in the lung for four weeks, during which Drinker had many anxious moments as to whether the respirator would hold up.
Important as this work on respiration is, it is only part of what the Medical and Public Health faculties are doing on the care of polio victims and the disease's cure.
Most revolutionary in the latter field is the work of a team of Harvard researchers at the Children's Medical Center. These men have found a new, less dangerous, less expensive way of growing polio virus in many type of human tissue. The discovery may aid in the development of a vaccine against the disease.
Vaccine in the Future
Such a vaccine is now only a plan for the future, the researchers claim. Meanwhile, they have been able to cultivate the three strains of the polio germ representing the types of virus. They can now test a patient inexpensively to determine which type of virus is the cause of his disease.
Immunization experiments on mice are being done by John E. Gordon, head of the Department of Epidemiology in the School of Public Health. He found that litters of immunized mothers were protected against mild forms of the disease for two months after their birth. Virus administered after that time had no crippling effects; thus the mice were immunized against the disease and could transmit some of this protection to their off-springs.
In the care and treatment of certain categories of the disease, the Harvard doctors are doing more work than is being done anywhere else in the country.
The Children's Medical Center, run by the University, is the nucleus of these activities. Several wards in the hospital are devoted to polio victims. During polio epidemics, one-third of the state's immobilized cases are cared for there, and more than two-thirds come in regularly for treatment and exercise.
To aid crippled victims to walk again, the Orthopedic Department of the Medical School takes over when the patient has passed the crisis stages of the disease. By X-rays and study of the growth of a child's normal leg, orthopedists can tell how long the stunted leg will be when it stops its retarded growth. They operate on the good leg when it reaches this length, removing a portion of the bone so that it will stop growing. When the afflicted leg has grown as much as it can, both legs will be the same length, enabling the child to walk almost as easily as a normal person.
In addition, surgeons graft muscles onto bones whose natural muscles have been deformed by the disease and plant nerves and tendons in paralyzed portions of the body.
Harvard's earliest contribution to the after-care of polio victims was the Infantile Paralysis Commission, established in 1916, and now known as the Massachusetts Infantile Paralysis Clinic.
Located in the Children's Medical Center, the clinic treats those who are recovering from the disease, gives them exercises, and teaches them to use their constricted muscles again. During 1949, a peak year, the clinic handled 1,895 new patients. It is not officially a part of the Medical School but is completely staffed by it.
Facilities at the clinic include a pool where newly crippled children learn to walk, and a rocking bed which sways back and forth to aid in breathing. There is also an exercise room--furnished with stairs, the model of a public bus, and ping-pong tables.
Besides the physical aspects of the disease, University doctors study the possibilities of epidemic outbreaks and the psychological effects of the disease on families of patients.
Dr. Theodore H. Ingalls, an epidemiologist in the School of Public Health, recently conducted a survey on the likeliness of a polio outbreak in an average camp or boarding school. He found that the ordinary establishment need not expect such an outbreak more than once a century.
The reason for the occurrence of many cases at about the same time, says Ingalls, is simultaneous exposure to the virus rather than the spread from person to person. Ingalls and his colleagues believe the disease may behave like measles or scarlet fever. In this case, the contamination of milk or food may account for epidemics, as it does with those diseases.
Finally, Miss Elizabeth P. Rice, assistant professor of Medical Social Works, does exhaustive studies on the families of children who are stricken.
She discovered that people whose children have polio are frequently shunned by others in the community who fear they may catch the virus. This feeling is due, she said, to the publicity the disease gets during an epidemic, with accounts of the death and injuries inflicted, and no mention of the large number of recoveries made.
The virus itself is as old as civilization, and epidemics have been known to occur only in civilized countries. Scientists have ascertained its presence in mummies taken from ancient Egyptian tombs. They attribute the cause to the highly perfected sanitary arrangements in civilized societies. Among savage groups, where sanitation is not developed, children get exposed to the disease early and in small amounts, thus building up an immunity.
Whether this method could be introduced in modern machine is something doctors have been wondering for a long time. A vaccine to immunize everyone at birth, similar to the smallpox vaccine, is still a dream, but in the laboratories of the Medical and Public Health Schools are test tubes which may contain the answer