Fear of Polio in the 1950s
© 1997, Beth Sokol

Paralytic poliomyelitis, "polio", held a reign of terror over this nation for decades. But unless you were born before 1955, polio may seem to be just another ephemeral disease that has been nonexistent for years. Those born before 1955 remember having a great fear of this horrible disease which crippled thousands of once active, healthy children. This disease had no cure and no identified causes, which made it all the more terrifying. People did everything that they had done in the past to prevent the spread of disease, such as quarantining areas, but these tactics never seemed to work. Polio could not be contained. Many people did not have the money to care for a family member with polio. This was one of the reasons the National Foundation for Infantile Paralysis was organized. The March of Dimes, the fund raiser headed by the National Foundation for Infantile Paralysis, raised thousands and thousands of dollars to help people care for their polio stricken family members and to aid in the cost of research for a vaccine that would put an end to this misery that affected the lives of so many people.

Poliomyelitis was the term used by doctors to describe the condition in which the gray (polios) anterior matter of the spinal chord (myelos) was inflamed (-itis). Until a cure was discovered, no one had the slightest idea where "polio" had come from or why it paralyzed so many children. People learned later that, oddly enough, it was the improved sanitary conditions which caused children to be attacked by the virus. Since people were no longer in contact with open sewers and other unsanitary conditions which had exposed them to small amounts of the polio virus as infants, when paralysis is rare, the disease grew from a very mild, uncommon occurrence to a terrifying epidemic. This was now the second generation to deal with the fear of this crippling disease. In an attempt to control the disease, bewildered health officials reinstituted the usual rules of sanitation which they would later learn had worsened the threat of polio. They advised against open drains and unscreened windows. Parents were instructed to keep their children well bathed, well rested, well fed, and away from crowds. Bathing suits were locked away in closets, and nobody went to the public pools. When polio struck, movie theaters were shut, camps and schools were closed, drinking fountains were abandoned, draft inductions suspended, and nonessential meetings were canceled until the epidemic appeared to be over for the time being.[1]

These precautions were harmless, but not particularly helpful. In the past, these precautions proved very effective in stopping the spread of diseases such as influenza and plague. For three decades now, people still did not know why they were getting their disease. And for three decades now, doctors, epidemiologists, and laboratory researchers were trying to figure out how the disease was spread.[2]

Nobody has ever discovered completely how it is that polio is spread. The best evidence suggests that the virus is excreted in the stool and passed through hand to hand or hand to mouth contact by people who do not wash their hands properly or often enough. It was during the first few years of the fifties and many years before then, that health department officials continued to quarantine households, take in-depth histories of everywhere and everyone the patient had come in contact, inspect drains and garbage cans, and in general make it seem as though it was the patient's own fault that he had the virus. Although keeping track of this contagious disease continued to be of great concern throughout this time, the many health inspectors and visiting nurses could not help but admit that they really did not know exactly what they were looking for or where they might find it.[3]

Many doctors resented the amount of fuss made about polio, and complained that all of this exaggerated fear diverted attention from more serious health threats. The majority of people who had polio never even knew it. Of those who were diagnosed, most recovered with little or no disability. In 1952, the worst epidemic year, three thousand people died from polio, while in 1950, thirty-four thousand died of tuberculosis.[4] In 1957, 62,000 people died from influenza during a notorious epidemic.[5] Although by this time a cure for polio had been discovered, the chances of contracting and dying from influenza were much greater than the chances of contracting and dying from polio even in years prior to this epidemic. But this line of thinking misses the mark. Epidemic diseases which strike a community at one time are far more alarming than chronic diseases that kill individuals over a number of years. Diseases whose causes are 5 understood are much less frightening than diseases whose origins are unknown. Diseases which attack the young and active are more horrible than ones which strike the weak and old. To many people, there was only one thing worse than dying of paralytic poliomyelitis. One could get the disease and live.[6]

People who recovered from influenza did so completely in three to ten days. They had no paralysis or respiratory difficulty once they had recovered. Regarding tuberculosis, recovery took much longer than with influenza. In fact, treatment with medication lasted up to a year. But with proper care and effective drug therapy, a person did fully recover. Interestingly enough, it was in 1952 that a drug called Isoniazid was used in treatment of tuberculosis.[7] These people contracted the disease, recovered, and continued on with their lives unchanged. Some survivors of polio contracted this disease, recovered from the actual illness itself, and continued on with their lives. Only, in contrast to the survivors of influenza and tuberculosis, these polio victims lives' were forever changed due to their paralysis -- a remnant of their battle against polio. This puts people's terror of polio into perspective and makes it more understandable. It was not the disease itself that horrified people; it was what the disease left behind for its victims to cope with in their lives that was so terrifying.[8]

"What was it like to have polio?" one may ask. Well, many cases have told a story of feeling a little badly for a day or two, but not so badly that they could not participate in their normal everyday activities. But then, a few days later, they would lose all control of their limbs and under a doctor's care were placed in casts or draped in hot packs of wet wool in order to keep their muscles from going into spasm.[9]

Hospital treatment was still hard to come by in some areas, because not all hospitals would accept polio patients. So, many of the infected had to make do with whatever care and equipment that they could find at home. Although many people who won their battle against polio had no after-effects, there were plenty of people who were left paralyzed with little to help them deal with their new lot in life. The sparse range of braces and crutches that existed were expensive, heavy, and quite often painful to use. Even the wheelchairs at this time were difficult in which to get around. Elevators were rare and ramps did not exist nor did the idea of rights for the handicapped.[10]

Charity drives were started to raise money to care for the numbers of polio survivors which continued to grow.[11] These fund-raisers liked to show a patient smiling inside an iron lung, a machine which cleared the patient's lungs of mucus, helped him to breathe, and fed him through a tube. If a patient remained in the iron lung for several days, often he began to have hallucinations that, ironically, they were moving in a car, a train, or an airplane. Even after they recovered and realized that these were only hallucinations, they often remembered their "travels" quite vividly. It was these dreams that they grasped onto tightly in a time that they feared they might never be able to leave the iron lung.[12]

Once they were able to breathe outside of the iron lung, the patients were moved to a device called a rocking bed. This tilted a patient up and down so that gravity would help force air in and out of the weakened lungs. If they were able to breathe for themselves, the nurses had to 'wean' them away from their iron lung. After all, this machine presented these people with a sense of security, an assurance that they would continue to breathe and remain alive. The lucky majority survived with little or no residual damage. Those who were not as fortunate remained in the hospital, struggling to breathe in the iron lung, trying to wiggle a finger or toe, learning therapy routines, and being fitted for orthopedic devices. Regardless of whether they survived and became "lame or limber", they were always going to be "polios."[13]

By 1954, when the people of the U.S. were pushing for the field trial of a new vaccine developed by a man named Jonas Salk, the National Foundation for Infantile Paralysis arose. The NFIP could be found everywhere from the mothers who went from house to house collecting money to the White House introduction of the new poster child for the year. Many people gave this organization their complete approval and saw the NFIP as a public institution. This organization raised enough money each year to pay for hospital and rehabilitation costs of any polio patient in need of help, while at the same time sponsoring training programs for nurses and physical therapists and supporting the laboratory research that led to both the Salk and Sabin vaccines. But, as with every issue involving money, there were a few who condemned the National Foundation as an instrument used by powerful men and women to establish ongoing, elaborate, and expensive publicity campaigns to incite fear into the hearts of the American people. Hence, the people would be terrified into contributing money. One thing was certain, and that was the fact that the National Foundation and its efforts were a very visible part of American life in the 1950s.[14]

With regard to the specialized community of people who collected the money and gave it way, the NFIP was famous for other reasons. For example, the NFIP was the first nationwide charitable organization to successfully operate only asking for a small amount of money -- dimes, not dollars. This seemed so little to give that people could not help but donate to this cause. In the early 1950s, the privately supported NFIP spent ten times as much money on polio research as the National Institutes of Health, which were tax supported. Another aspect that NFIP was famous for was that it collected the money from people who had never been a part of groups such as the Junior League or the American Red Cross. It was in groups like these that one's social standing rather than their devotion or interest more often determined one's role within the organization. The NFIP was the first national charity in that it went directly to the "middle" of the middle class to recruit its volunteer workers. The NFIP appealed to small business men and young parents, to local citizens who had yet to become leaders, and to the great number of people the NFIP wanted to fight for its cause and not so much the politicians and other prominent political figures who were already too much involved in other affairs. The structure of the NFIP was straightforward and unlike many other organizations of the era. Where most organizations were commandeered by financially and socially powerful volunteers directing the activities of subordinate professional staff, the NFIP had all of its power located in its National Headquarters, a suite of offices in one building. There were three thousand local chapters, which were staffed by about ninety thousand year-round volunteers. These people were supervised by only five paid regional directors who reported directly to National Headquarters, where a man named Basil O'Connor basically acted as president of the NFIP.[15]

Whether it was breeding laboratory animals or the purchasing of orthopedic devices, the executive committee of the National Foundation asked the advice of scientific and medical experts and paid them well for their opinions. But at all times, the major decisions made regarding each field that the NFIP granted money to were made by National Headquarters. Apparently, everybody knew that this meant that Basil O'Connor was making the decisions. O'Connor once explained his philosophy, making no effort to tone down his feeling that "Committees are to help you do what you want to do, and if the committee doesn't do it, fire them and get a new one!" O'Connor's view outraged a great many people, but no one could deny the overall good that the NFIP was doing in providing needed funds for the research to find a cure for polio and for the communities stricken with the polio epidemic. Despite people's accusations that the NFIP used scare tactics or misused funds, the fact remained that this system ran by O'Connor was extremely successful.[16]

The NFIP brought the people crippled by this disease out of their "sickrooms" and into the spotlight, but the publicity techniques that they chose to use made numerous people uneasy. They were accused of overstating the perils of polio and the progress the sufferers could possibly make, for the sole purpose of increasing their funds. Many of the accusations were veritable. Whether the fund-raiser was a citizen who had been transformed into a promoter by his position as chapter chairman or a famous entertainer auctioning off his shirt off to the highest bidder, it was common knowledge that dignity had very little to do with the matter at hand. After all, dignity couldn't pay the bill for training a physical therapist or buy crutches.[17]

The National Foundation for Infantile Paralysis provided not only help, but hope to a nation of terrified people. The project that it spawned, "The March of Dimes", held many banquets and had many women collecting money to contribute to its cause. The March of Dimes was not just about solemn research. It was about money and sick little children. Some accused the NFIP of being manipulative, "money-grubbing", and exploitative of the poor diseased children. In response to this, the members of this organization would simply state that it was the scientists' job to be "all pure and intellectual", but that somebody needed to raise the money to pay for their work. Professional training and research were not the kinds of things that got people to donate. It was the cute little children on crutches and children from your home town that convinced people to give money to this cause.[18]

In the decade from 1945 to 1955, the years in which most of the research took place that made the Salk vaccine possible, two unconnected movements came together to increase the importance of the NFIP. First, there was a steady, visible rise in the number of polio cases. The second was the "baby boom", during which the population increased more than it had in three decades from 1917 to 1947. The goals of the NFIP seemed more worthwhile and urgent than ever to a group of people who were having more babies. And after all, there is nothing like the entering into parenthood to make one focus their attention on childhood disease.[19]

The use of the media by the NFIP was an integral part of the war on polio. Whether it was a child with a new pair of crutches or a hospital with another iron lung, a photograph was sure to be in the local newspaper along with a story reminding people that these purchases were possible because of their donations to the March of Dimes. Whenever a polio scientist found something promising, the NFIP publicists made sure that it was printed not only in the scientific journals but also in the popular press. Even more notable was the first sentence of every article which stated that the research had been paid for by the NFIP.[20]

A new era of scientific publicity began during this time with regard to television. Today when famous doctors appear on the evening news, it seems ordinary to hold a special press conference to report results of a nationwide medical experiment that had already been greatly focused on by the media. The 1954 polio vaccine trial set the precedent for this. In order to develop a vaccine that protected against polio, Jonas Salk had combined existing theories and techniques like those developed by a man named Thomas Francis. Francis had developed a new standard for the size, speed, and rigor of field trials combining basic principles of epidemiology with unique public interest. Jonas Salk was interviewed by Edward Murrow on "See It Now". This interview in which Salk described his discovery of the polio vaccine was broadcast by CBS. The NFIP planned to print ten thousand copies of the report and a pharmaceutical company, Eli Lilly and Company, had offered to produce a closed-circuit telecast shown in hotels and movie theaters in sixty-one cities on the night of the announcement, to an invited audience of fifty-four thousand doctors, in hopes that the broadcast would be centered on introducing the new product that they would all be buying and using soon. Further contributing to publicizing the new vaccine, the NFIP began printing their informational pamphlets to parents, this time with the reminder that the free vaccination program plans for the schoolchildren who had not already been vaccinated in the field trial would only take place if the vaccine was licensed.[21]

The most important aspect in the study of this disease was that the investigation was taken off of the list of duties of clinicians and placed back into the realm of the experimental laboratory. It became a time of standardization of criteria and methods. The experimental disease was studied intensively in one particular manner. One strain of poliomyelitis was studied in one species of monkey, the rhesus. One (or at the most, two) route of inoculation, the intercerebral route, was the standard procedure to be followed.[22]

Two men's findings contributed the most to the development of a vaccine against polio. Dr. John Enders and Dr. Thomas Weller, with their assistants, began carrying out an experiment in 1949 that won them the Nobel Prize in 1954. In this experiment, Enders succeeded in growing poliovirus outside the body in laboratory cultures of non-nervous-system human tissue.[23] These men knew from the results of earlier studies that they had conducted on diseases such as mumps that poliomyelitis viruses would multiply in cells other than those of the nervous system. Before their discovery, this was thought to be impossible. This discovery was enhanced by the observation that the viral multiplication was followed by not only injury, but death of the cells. This explains why it took only a fraction of the time and used only a small percentage of monkeys that were required in an earlier method in order to attain adequate amounts of virus for the vaccine.[24]

One thing that concerned the scientists was the possibility that their research would turn up innumerable individual strains of poliomyelitis. This would have squelched any hope of developing a vaccine. Luckily enough, only three specific types of polio emerged. This was a tremendous step in the direction of developing a vaccine. The second obstruction to the development of a vaccine was the nervous tissue from infected monkeys was the only source of the three types of virus. This was an unacceptable inoculum in humans. When Enders, Weller, and their assistants reported that they had succeeded in growing the virus in tissue cultures of human embryonic muscle and skin cells and could identify its presence by characteristic structured changes in 1949, the potential to develop a vaccine against paralytic poliomyelitis became a reality.[25]

Jonas Salk, who had also been working on a cure for polio, began to equip a lab for the newest production techniques. In 1950, Salk was certain that he had developed a cure and asked to begin testing his vaccine on children. His request was met with some opposition until after another two years of research which convinced the foundation officers that his vaccines were safe. The vaccinations were given to children in 1954. An oral polio vaccine was developed in 1956 by a man named Albert Sabin. The safety and effectiveness of the vaccines were monitored by clinical observation. The results were encouraging, and it was discovered that the vaccine strains readily spread to susceptible contacts. This had never been previously observed and turned out to be a great advantage in immunization programs.[26]

In conclusion, few realize how greatly polio affected people in society in the early 1950s. Everyone was affected when there was epidemic outbreak. Public places were closed, and people were cut off from contact with one another. People lived in constant fear that they would be next to catch the disease, or worse, one of their children would contract polio. The lives of polio victims and those who cared for them were changed forever by the impairments that victims of polio suffered. The thought of being paralyzed was what made polio so terrifying. Although other diseases of the era had much higher mortality rates, none had the permanent ramifications that polio did. No one could understand where this disease came from or why it could not be controlled. Polio was the first high profile disease to be fully covered by the media, and the National Foundation for Infantile Paralysis had a hand in providing polio related information to the media. The National Foundation for Infantile Paralysis was instrumental in helping to pay for the expensive treatment and equipment needed to rehabilitate polio victims. It also funded the research for the development of a cure for polio. These funds paved the way for the improved research techniques and methods of the era carried out by scientists such as Enders, Wellers, Salk, and Sabin to isolate and develop a vaccine against polio. It was not until the development and distribution of the vaccine against polio that people could have a secure sense of hope that they would not fall victim to this paralyzing disease. Once this vaccine proved to be an effective cure, polio was basically wiped out in our nation. Those of us lucky enough to live in a time when vaccination is readily available will never know the terror that permeated the lives of so many just a few decades ago.

Notes

1. Jane Smith, Patenting the Sun: Polio and the Salk Vaccine (New York: William Morrow and Co., Inc, 1990), p. 34.

2. Smith, p. 35.

3. Smith, p. 36.

4. William Atkinson, Epidemiology and the Prevention of Vaccine-Preventable Diseases (Washington Centers for Disease Control, 1996), pp. 168-69.

5. Abram Beneson, Control of Communicable Diseases in Man (New York: American Public Health Association, 1970), p. 119.

6. Smith, p. 37.

7. Beneson, pp. 265-68.

8. Smith, p. 37.

9. Smith, p. 38.

10. Smith, pp. 39-41.

11. Smith, p. 41.

12. Smith, pp. 39-41.

13. Smith, p. 43.

14. Smith, pp. 63-64.

15. Smith, p. 64.

16. Smith, p. 65-66.

17. Smith, p. 66.

18. Smith, pp. 82-83.

19. Smith, p. 83.

20. Smith, p. 302.

21. Smith, p. 305.

22. John Enders, "Some Recent Advances in the Study of Poliomyelitis, 1954" Medicine (September 1992): 316-320, at p. 317.

23. Smith, pp. 126-27.

24. Enders, pp. 317-18.

25. Dorothy Horstmann, "Three Landmark Articles about Poliomyelitis," Medicine (September 1992): 320-25, at p. 322.

Bibliography

Atkinson, William. Epidemiology and Prevention of Vaccine-Preventable Diseases. Washington: Centers for Disease Control and Prevention, 1996.

Beneson, Abram. Control of Communicable Diseases in Man. New York: The American Public Health Association, 1970.

Enders, John. "Some Recent Advances in the Study of Poliomyelitis, 1954". Medicine. Sept. 1992: 316-20. (reprinted)

Horstmann, Dorothy. "Three Landmark Articles about Poliomyelitis". Medicine. Sept. 1992: 320-25.

Smith, Jane S. Patenting the Sun: Polio and the Salk Vaccine. New York: William Morrow and Company, Inc., 1990.