Infantile Paralysis
^ilthough epidemic infantile paralysis (poliomyelitis) had occurred in European countries and in England during the 17th, 18th, and 19th centuries, the first known epi demic of any size in the United States oc curred in Vermont during the summer of 1894. Subsequent epidemics in Vermont, no tably in 1914 and 1916, left many crippled children requiring care. Through the concern of the Vermont state health officer and help from an anonymous donor, a special fund was created for a study of the cause and treatment of the disease and its after effects. Vermont thus became the first state to pro vide a state-wide program for the aftercare of patients with infantile paralysis. The program was known as "The Vermont Plan" and it became the prototype for other state pro grams for crippled children. 1
Robert W. Lovett Among the persons instrumental in devel oping "The Vermont Plan" was Dr. Robert W. Lovett, an orthopedic surgeon of Boston. At the time (1914), Dr. Lovett was professor of orthopedic surgery at Harvard University and orthopedic surgeon at the Children's Hospital of Boston (later the Children's Medical Cen ter). Under Dr. Lovett's direction, clinics were established in various centers throughout Ver mont. Dr. Lovett believed strongly in involv ing local physicians, nurses, and particularly members of the patients' families in providing follow-up care. He recognized the impossibil ity of adequately treating the large number of patients through direct services of visiting
42
Wilhelmine Wright Wilhelmine Wright had special training in exercise and massage in Germany. In 1907, she was placed in charge of a gymnasium which Dr. Lovett maintained for his patients in Boston. As infantile paralysis epidemics spread into New York State, Miss Wright as sisted in establishing clinics in that state un der the auspices of the New York State Health Department. From her careful observation during clinical work, she prepared material for her book, Muscle Function. 3
PHYSICAL THERAPY
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Pioneers in Treatment
health workers. Teaching, therefore, became a large responsibility of the visiting teams. These teams consisted of orthopedic sur geons, public health nurses, physiotherapists (generally referred to as "physicians assist ants"), bracemakers, and stenographers. Working with Dr. Lovett in his practice in Boston were a number of young women whose preparation was primarily in physical education and who had special training un der Dr. Lovett's supervision in muscle train ing, corrective exercise, and massage. Among them were Wilhelmine Wright, Janet Merrill, and Alice Lou Plastridge (now Mrs. Harold Converse). These people, among oth ers, attended the itinerant clinics with Dr. Lovett and other orthopedic surgeons teach ing and demonstrating aftercare of the infan tile paralysis patients. In connection with the treatment of these patients, Dr. Lovett believed that although electricity and massage were used exten sively, these procedures were not always used intelligently because too little was known about the real therapeutic value of these measures. He stated, however, that muscle training was of "undoubted value." 2 He also recognized the importance of accu rate evaluations and recordings of muscle strength, weakness, and paralysis and used charts which he obtained from Dr. E. A. Sharpe of Buffalo. On these charts the condi tions of the major muscles and muscle groups were recorded as paralyzed, partially paralyzed, or normal. Dr. Lovett also devel oped a system of spring-balance tests to de termine the strength of muscle groups.
(Right) Janet Merrill with infantile paralysis patient. (Below, I to r) Wilhelmine Wright, Windsor, Vermont, 1928. Alice Lou Plastridge. Robert W. Lovett, MD. (Bottom) Departure for clinics for infantile paralysis pa tients after Vermont epidemics, early 1920s.
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(Above, I to r) Patients with infantile paralysis. These pa tients are representative of the thousands of patients who were victims of infantile paralysis in the first half of the 20th century. Courtesy of the Children's Hospital Medical Cen ter, Boston, Massachusetts.
Janet Merrill
Alice Lou Plastridge Alice Lou Plastridge first became associ ated with Dr. Lovett in 1916 as a junior gymna sium assistant in his Boston office. As was his custom, Dr. Lovett arranged for his assistants to treat patients in their homes as the pa tients' conditions warranted. The assistants sometimes stayed in the homes for periods of time to treat the patient and teach family mem bers. Among Miss Plastridge's patients was Franklin D. Roosevelt with whom she worked in his Hyde Park (NY) home. Dr. Lovett was instrumental in Miss Plastridge's move to Chi cago in 1917 to provide follow-up care for his patients living in that area. While in Chicago, she lectured on and demonstrated patient care to institutional and public health nurses and, in 1927, she became affliated with Gertude Beard and Dr. John S. Coulter on the teaching staff of the program for physical therapists at Northwestern University. From 1930 to 1941, Miss Plastridge was the director of physical therapy at the Georgia Warm Springs Foundation and was named director 44
The National Foundation for Infantile Paralysis The incidence of infantile paralysis in creased and epidemics occurred periodically. Among the worst of the early epidemics was the one in 1916, with reported cases number ing over 27,000. In 1927, over 10,000 cases were reported; in 1931, over 15,000. The inci dence per population continued to increase during the 1940s and the 1950s. The largest incidence occurred in 1952 when 57,879 cases were reported. 4 The National Foundation for Infantile Paral ysis (NFIP) was founded in 1938, its work in the fight against infantile paralysis supported in large measure by the voluntary contribu tions of the American public. In 1938, $1,823,000 was contributed for research, education, and patient services; in January 1955, more than $50,000,000 was raised. 5 The NFIP recognized the vital role of physi cal therapy in the treatment of infantile paraly sis and the assistance members of the Associ ation could be in the recruitment and prepara tion of physical therapists for this work. Cath erine Worthingham, a former president of the Association, was named Director of Techni cal Education on the Foundation staff in 1944. Over the 20 years from the early 1940s to the time the poliomyelitis vaccines proved effective, the support the NFIP gave the Asso ciation provided substantial impetus to the growth of physical therapy. Through a grant of $5,000 made to the Asso ciation by the Foundation, the Association's first national office was established in New PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/56/1/42/4567969 by University of Texas at Dallas user on 16 February 2019
Janet Merrill, a 1912 graduate of Sargent College of Physical Education, studied and worked with Dr. Lovett and Wilhelmine Wright for two years. From 1915 to 1917, she was the physical therapy director of the infan tile paralysis program in Vermont, thus be coming probably the first public health physi cal therapist in this country. In 1917, she was placed in charge of the physical therapy ser vices administered by the Harvard Infantile Paralysis Commission which was founded afteran epidemic in Massachusetts. Miss Mer rill served as a Reconstruction Aide during World War I and taught in an emergency train ing program for aides in Boston. After the war, she was the director of the physical ther apy department at the Boston Children's Hos pital and physical therapy director of the courses offered at the Harvard Medical School. She continued as director of these programs after their transfer to Simmons Col lege in 1947 until her death in 1951. Miss Merrill was the first treasurer of the American Women's Physical Therapeutic As sociation and served as secretary of the first executive committee.
of the graduate programs for physical thera pists at the foundation in 1941. In 1947, Miss Plastridge was awarded the "Golden Palms of the Order of the Crown" by the Prince of Belgium, for work she did after a serious epi demic of poliomyelitis in that country.
^ilthough epidemic infantile paralysis (poliomyelitis) had occurred in European countries and in England during the 17th, 18th, and 19th centuries, the first known epi demic of any size in the United States oc curred in Vermont during the summer of 1894. Subsequent epidemics in Vermont, no tably in 1914 and 1916, left many crippled children requiring care. Through the concern of the Vermont state health officer and help from an anonymous donor, a special fund was created for a study of the cause and treatment of the disease and its after effects. Vermont thus became the first state to pro vide a state-wide program for the aftercare of patients with infantile paralysis. The program was known as "The Vermont Plan" and it became the prototype for other state pro grams for crippled children. 1
Robert W. Lovett Among the persons instrumental in devel oping "The Vermont Plan" was Dr. Robert W. Lovett, an orthopedic surgeon of Boston. At the time (1914), Dr. Lovett was professor of orthopedic surgery at Harvard University and orthopedic surgeon at the Children's Hospital of Boston (later the Children's Medical Cen ter). Under Dr. Lovett's direction, clinics were established in various centers throughout Ver mont. Dr. Lovett believed strongly in involv ing local physicians, nurses, and particularly members of the patients' families in providing follow-up care. He recognized the impossibil ity of adequately treating the large number of patients through direct services of visiting
42
Wilhelmine Wright Wilhelmine Wright had special training in exercise and massage in Germany. In 1907, she was placed in charge of a gymnasium which Dr. Lovett maintained for his patients in Boston. As infantile paralysis epidemics spread into New York State, Miss Wright as sisted in establishing clinics in that state un der the auspices of the New York State Health Department. From her careful observation during clinical work, she prepared material for her book, Muscle Function. 3
PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/56/1/42/4567969 by University of Texas at Dallas user on 16 February 2019
Pioneers in Treatment
health workers. Teaching, therefore, became a large responsibility of the visiting teams. These teams consisted of orthopedic sur geons, public health nurses, physiotherapists (generally referred to as "physicians assist ants"), bracemakers, and stenographers. Working with Dr. Lovett in his practice in Boston were a number of young women whose preparation was primarily in physical education and who had special training un der Dr. Lovett's supervision in muscle train ing, corrective exercise, and massage. Among them were Wilhelmine Wright, Janet Merrill, and Alice Lou Plastridge (now Mrs. Harold Converse). These people, among oth ers, attended the itinerant clinics with Dr. Lovett and other orthopedic surgeons teach ing and demonstrating aftercare of the infan tile paralysis patients. In connection with the treatment of these patients, Dr. Lovett believed that although electricity and massage were used exten sively, these procedures were not always used intelligently because too little was known about the real therapeutic value of these measures. He stated, however, that muscle training was of "undoubted value." 2 He also recognized the importance of accu rate evaluations and recordings of muscle strength, weakness, and paralysis and used charts which he obtained from Dr. E. A. Sharpe of Buffalo. On these charts the condi tions of the major muscles and muscle groups were recorded as paralyzed, partially paralyzed, or normal. Dr. Lovett also devel oped a system of spring-balance tests to de termine the strength of muscle groups.
(Right) Janet Merrill with infantile paralysis patient. (Below, I to r) Wilhelmine Wright, Windsor, Vermont, 1928. Alice Lou Plastridge. Robert W. Lovett, MD. (Bottom) Departure for clinics for infantile paralysis pa tients after Vermont epidemics, early 1920s.
Downloaded from https://academic.oup.com/ptj/article-abstract/56/1/42/4567969 by University of Texas at Dallas user on 16 February 2019
(Above, I to r) Patients with infantile paralysis. These pa tients are representative of the thousands of patients who were victims of infantile paralysis in the first half of the 20th century. Courtesy of the Children's Hospital Medical Cen ter, Boston, Massachusetts.
Janet Merrill
Alice Lou Plastridge Alice Lou Plastridge first became associ ated with Dr. Lovett in 1916 as a junior gymna sium assistant in his Boston office. As was his custom, Dr. Lovett arranged for his assistants to treat patients in their homes as the pa tients' conditions warranted. The assistants sometimes stayed in the homes for periods of time to treat the patient and teach family mem bers. Among Miss Plastridge's patients was Franklin D. Roosevelt with whom she worked in his Hyde Park (NY) home. Dr. Lovett was instrumental in Miss Plastridge's move to Chi cago in 1917 to provide follow-up care for his patients living in that area. While in Chicago, she lectured on and demonstrated patient care to institutional and public health nurses and, in 1927, she became affliated with Gertude Beard and Dr. John S. Coulter on the teaching staff of the program for physical therapists at Northwestern University. From 1930 to 1941, Miss Plastridge was the director of physical therapy at the Georgia Warm Springs Foundation and was named director 44
The National Foundation for Infantile Paralysis The incidence of infantile paralysis in creased and epidemics occurred periodically. Among the worst of the early epidemics was the one in 1916, with reported cases number ing over 27,000. In 1927, over 10,000 cases were reported; in 1931, over 15,000. The inci dence per population continued to increase during the 1940s and the 1950s. The largest incidence occurred in 1952 when 57,879 cases were reported. 4 The National Foundation for Infantile Paral ysis (NFIP) was founded in 1938, its work in the fight against infantile paralysis supported in large measure by the voluntary contribu tions of the American public. In 1938, $1,823,000 was contributed for research, education, and patient services; in January 1955, more than $50,000,000 was raised. 5 The NFIP recognized the vital role of physi cal therapy in the treatment of infantile paraly sis and the assistance members of the Associ ation could be in the recruitment and prepara tion of physical therapists for this work. Cath erine Worthingham, a former president of the Association, was named Director of Techni cal Education on the Foundation staff in 1944. Over the 20 years from the early 1940s to the time the poliomyelitis vaccines proved effective, the support the NFIP gave the Asso ciation provided substantial impetus to the growth of physical therapy. Through a grant of $5,000 made to the Asso ciation by the Foundation, the Association's first national office was established in New PHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/56/1/42/4567969 by University of Texas at Dallas user on 16 February 2019
Janet Merrill, a 1912 graduate of Sargent College of Physical Education, studied and worked with Dr. Lovett and Wilhelmine Wright for two years. From 1915 to 1917, she was the physical therapy director of the infan tile paralysis program in Vermont, thus be coming probably the first public health physi cal therapist in this country. In 1917, she was placed in charge of the physical therapy ser vices administered by the Harvard Infantile Paralysis Commission which was founded afteran epidemic in Massachusetts. Miss Mer rill served as a Reconstruction Aide during World War I and taught in an emergency train ing program for aides in Boston. After the war, she was the director of the physical ther apy department at the Boston Children's Hos pital and physical therapy director of the courses offered at the Harvard Medical School. She continued as director of these programs after their transfer to Simmons Col lege in 1947 until her death in 1951. Miss Merrill was the first treasurer of the American Women's Physical Therapeutic As sociation and served as secretary of the first executive committee.
of the graduate programs for physical thera pists at the foundation in 1941. In 1947, Miss Plastridge was awarded the "Golden Palms of the Order of the Crown" by the Prince of Belgium, for work she did after a serious epi demic of poliomyelitis in that country.
