Dogged Persistence: Harrington, Post-polio Scoliosis, and the Origin of Spine Instrumentation by Marc A. Asher (review)

Marc Asher’s Dogged Persistence is both a biography of Dr. Paul Harrington and a history of the development of his system of spine instrumentation designed to correct scoliosis. Harrington was one of the first surgeons in the post–World War II era to invent, manufacture, and use a system of metal rods to correct moderate to severe spinal curvatures. The existing system of using body casting to straighten the spine and maintain stability following a fusion of the vertebrae involved long periods of immobility and had a high failure rate. Harrington was convinced that he could design metal rods and connectors that could straighten and hold the spine in place with or without an accompanying fusion and without lengthy immobilization. Developing this procedure and instrumentation involved many years of trial and error and overcoming the resistance of his fellow orthopedic surgeons before spine correction using implanted instrumentation became commonplace in the 1960s.

Harrington was born in Kansas City, Kansas, in 1911. Educated in the public schools of Kansas City, he was also a standout athlete in basketball and track. He later graduated from the University of Kansas and its medical school. Following graduation, he entered an orthopedic residency in Kansas City with the ambition of becoming “the top in orthopedic surgery” (p. 38). During World War II he served as a surgeon in an evacuation hospital in North Africa and in Europe following D-Day. After the war, Harrington and his wife moved the family to Houston where Harrington joined the newly created Texas Medical Center. He remained in Houston for the rest of his career and died there on November 29, 1980.

The polio epidemics of postwar America resulted in a significant increase in the number of young patients who developed scoliosis as the result of paralyzed or weakened muscles of the torso. Very involved in the care of polio patients in the Houston hospitals, Harrington by the early 1950s had developed a theory to support his evolving ideas on scoliosis treatment. Placing a great deal of emphasis on what he called the “dynamic stability and dynamic balance” (p. 98) of the spine, he designed his instruments to restore that balance. Asher devotes considerable attention to the details of Harrison’s efforts over two decades to design effective rods and connectors and then to modify them based on his experience in the operating room. Asher’s descriptions are helpfully supplemented by many of Harrington’s drawings of the instrumentation. Harrington’s extensive correspondence with Zimmer Manufacturing describes these changes in some detail and portrays the close collaboration as the company worked with the orthopedist to manufacture instrumentation to his specifications.

Asher also recounts ways in which Harrington’s rods went from being an experimental instrumentation to an accepted technique in orthopedic spine surgery. Harrington’s rods and procedures initially met significant resistance from other surgeons, and Asher details Harrington’s efforts through publications and presentations to win acceptance for his methods. In addition, Asher describes in detail the creation of the Scoliosis Research Society in which Harrington was a charter member.

Asher provides a detailed account of Harrington’s career and surgical innovations, but the reader is sometimes overwhelmed by minute changes in instrument specifications and by summaries of numerous orthopedic conference presentations. Some of this material could have been summarized. The book would also have been stronger had Asher given attention to the patients’ perspectives. It would have been helpful to know, for example, how patients regarded Harrington and how they responded to his surgical interventions. There are apparently patient letters in the Harrington papers, but Asher makes almost no use of them.

Dogged Persistence is a traditional medical biography in which Asher emphasizes Paul Harrington’s career and the development of his innovative spinal instrumentation and surgery. Asher concludes that Harrington’s achievement was a significant advance in treating...