Why were so many Polio Patients Hospitalized for so long?

“I’ll walk without crutches. I’ll walk into a room without scaring everybody half to death. I’ll stand easily enough in front of people so that they’ll forget I’m a cripple.” Franklin D. Roosevelt, Class of ‘29

Question:

Why were so many polio patients hospitalized for so long? I think I could have gone home after six months at the most. I didn't have surgery there, it was just rehab. The main challenge at home might have been schooling.

Dr. Bruno’s Response:

Just as surgeries that required a week long inpatient stay in the 70s are now done in an afternoon as “outpatient procedures,” medical treatments change. Some polio survivors stayed in the hospital for surgeries in the 50s far longer than they would for the same procedure today. That said, many polio survivors report having had virtually perpetual and often punishing physical therapy in hospital that continued after discharge for years:

• I had polio at five and went to the rehab hospital. I was ten years old when I left. My legs hadn't moved since I was five and I had worn two full-length leg braces. But the doctor told me when I was discharged, “You’ll walk out of those braces before your senior prom.” I still wonder what he was thinking.

• I was admitted at age six, spent two years in a rehab hospital and then had physical therapy after discharge until I left for college eleven years later with no improvement.

Why indeed was rehab hospitalization and physical therapy continued for so long when patients didn't improve? A 1955 study by British polio pioneer W.J.W. Sharrard found that polio survivors regained nearly 95% of the strength they would ever recover during the first 11 months after the polio attack as a result of remaining, poliovirus-damaged motor neurons sprouting, muscle fiber hypertrophy (fibers getting bigger) and learning to use functioning muscles to substitute for those that were permanently paralyzed. That’s eleven months, not eleven years!

I think one answer for long hospitalization and years of physical therapy is the fact that polio was one of the world’s great plagues. Friends, sometimes even relatives, afraid of contagion or unable to deal with polio striking so close to home, severed ties with "afflicted" families. People crossed the street to avoid walking in front of a home where someone was known to have had polio. Many avoided contact with “polio victims” for fear that the “crippling” was contagious:

• Years after I had polio, when adults saw me coming they would say out loud to their children to stay away from me because they could "catch it." My brothers and sisters did not want my "bad leg" to touch them.

• A stranger accosted me on the street and accused me of "upsetting people," saying, "You cripples shouldn't be allowed in public!"

Polio survivors were made to feel unclean, unwanted and isolated, their braces and crutches repulsive reminders of everyone's vulnerability to the poliovirus. In different parts of the country and during different decades, newly built polio isolation hospitals were actually called "The Pest House." For some of our patients the Pest House was New York City's Willard Parker Hospital. For many others The Pest House was an outbuilding, a former laundry, at The New York State Rehabilitation Hospital. This Pest House actually had bars on the windows:

• I had polio in when I was five. I hadn't remembered a thing about the "The Pest House" until I walked into Dr. Bruno's office. Then it all returned to me in a flash. I was taken 250 miles from home, admitted to the hospital and didn't see my mother for two months. When I did see her again she was on one side of a glass window and I was on the other. She couldn't hold me, she couldn't comfort me. She couldn't even touch me.

Polio survivors and their families painfully discovered that if there were any chance of being “accepted” by society, physical abilities had to be maximized and polio thoroughly hidden:

• My mother constantly demanded that I should be NORMAL. I was an embarrassment to her and her family. I was the "odd note." My disabilities were covered up and I was always supposed to be better than everyone else.

Why were so many polio patients hospitalized for so long? Magical thinking. In a vain hope for “normalcy,” the only readily available tool to treat polio - inpatient and outpatient physical therapy - was applied for far to long even when research showed that maximum recovery would occur in about a year, not a decade.

See The Polio Paradox (The Pest House, Chapter 5) for an extensive discussion of these issues.

The Encyclopedia of Polio and Post-Polio Sequelae contains all of Dr. Richard Bruno’s articles, monographs, commentaries, videos and “Bruno Bytes”