An American Story
by David M. Oshinsky
Oxford, 342 pp., $30
SINCE IT HAS ONLY BEEN a little over 50 years since Americans experienced the scourge of polio, it is a little alarming that the Smithsonian's National Museum of American History decided to call a recent exhibit, "Whatever Happened to Polio?" If contemporary Americans think about polio at all, evidently, they have only vague ideas about this bygone affliction. They might remember polio's most remarkable celebrity sufferer, Franklin Delano Roosevelt, or its unlikely conqueror, the scientist Jonas Salk. But they recall little else, despite the fact that there are, by some estimates, 400,000 polio survivors still living in the United States.
But as David M. Oshinsky's excellent new book reminds us, in the 1950s, the enemy within that concerned Americans wasn't only communism; it was polio. Here was a disease that targeted children and that frustrated the physicians and public health officials who sought to prevent it. They knew that it struck in the balmy months of summer, affected more boys than girls, and respected no geographical or socioeconomic boundaries. It left its victims weakened or permanently paralyzed, and often killed the most vulnerable. But the etiology of the virus was little understood. Oshinsky, a historian at the University of Texas and the author of previous books about McCarthyism and justice in the Jim Crow South, skillfully weaves archival resources and medical description to argue that polio was, in important ways, a uniquely American experience.
"Americans were primed to see polio as an indigenous plague with an indigenous solution," he writes, "a problem to be solved, like so many others, through a combination of ingenuity, voluntarism, determination, and money." As with previous (and future) health crusades, victory was assumed. "One of the most common mantras of the post-World War II era, repeated by fund raisers, politicians, advertisers, and journalists," Oshinsky notes, "was the bold and (ultimately) truthful, promise, 'we will conquer polio.'"
Two stories emerge from Oshinsky's well-drawn narrative, which focuses largely on efforts in the 1940s and '50s to understand the disease and develop a vaccine. The first is the tale of the National Foundation for Infantile Paralysis (later called the March of Dimes) and how it permanently transformed crusades for American public health and charitable giving. The second story focuses on the scientific rivalry between the two polio researchers intent on creating an effective polio vaccine: Albert Sabin and Jonas Salk.
Central to the first story were the efforts of polio's most famous victim, FDR, who, in 1921, at the age of 39 and at the cusp of a promising political career, fell ill with polio. Seven years later he won the governorship of New York and had become the public face of polio survivors--although he skillfully downplayed the extent of his physical disabilities. But FDR's "splendid deception," as one historian called it, did not preclude a lifelong desire to improve the lives of other polio sufferers. Roosevelt created the Warm Springs Foundation (run by his law partner Basil O'Connor), which was the forerunner of the National Foundation for Infantile Paralysis.
As president, Roosevelt encouraged fundraising for polio research and treatment at nationwide "birthday balls" (complete with songs written specifically for the occasion by Irving Berlin) and worked with O'Connor to turn the foundation into "the largest voluntary health organization of all time," Oshinsky notes. When the vaudeville actor and Ziegfeld Follies alum Eddie Cantor suggested a campaign, called "The March of Dimes," where Americans could send dimes to the president in support of a polio cure, the White House was inundated with dime-laden mail.
As Oshinsky convincingly notes, however, even during the worst decades of its spread, polio was "never the raging epidemic portrayed in the media." Nevertheless, polio generated fear across the country. After all, the notion that misfortune could be prevented with the helpful enlightenment of science and good public policy was an American truism. But preventive measures had failed, and, as a result, "the dilemma facing America's parents," Oshinsky argues, was "a feeling of personal helplessness in the midst of an apparently runaway epidemic, grimly chronicled in local newspapers and national magazines."
One can understand the fear generated by the hiss of the iron lung (or tank respirator), which was perhaps the most chilling reminder of polio's power. Victims were placed on a large tray that slid into the iron tank, leaving only their head visible, as the machine forced air pressure onto their chests and diaphragms to assist with breathing. Oshinsky tells the story of Fred Snite Jr., who contracted polio in 1936 while traveling with his family in China. He was lucky that a hospital in Beijing (then called Peiping) had one of the world's 222 iron lungs. Snite, called "Crazy Foreign Devil" by the Chinese, traveled in the iron lung all the way back to Chicago, where he lived on. He attended Notre Dame football games, got married, had three children, and cheerfully raised money for polio research--all from his iron lung--until he succumbed, at the age of 43, to heart and lung failure. He had spent 18 years in an iron lung.
The March of Dimes was savvy in raising public awareness and, to some extent, public fear about polio. They "employed the latest techniques in advertising, fund raising, and motivational research to turn a horrific but relatively uncommon disease into the most feared affliction of its time," Oshinsky notes. As a result, "the foundation created a new model for giving in modern America, the concept of philanthropy as consumerism, with donors promised the ultimate personal reward: protection against the disease," a technique still used to great effect in public health fundraising.
From this mixture of promotion, dread, and the desire to conquer disease emerged another peculiarly American invention: the poster child. The first poster child was a polio victim named Donald Anderson, and the popular March of Dimes poster on which he was featured showed little Donald, his head flopping out of his neck brace, staring forlornly from a crib in a polio ward. A second, larger photograph showed a slightly older Donald striding purposefully, like a toddler Horatio, toward the viewer with a determined expression on his face and his polio, evidently, cured.
"Your dimes did this for me!" the poster trumpeted.
By 1952, polio cases in the United States reached a high of 58,000, and the public was impatient for a cure. The second story that emerges in Oshinsky's book, the scientific quest for a polio vaccine, is inextricably linked to the first since, at the time, private foundations such as the March of Dimes gave far more money to polio research than did the federal government. Oshinsky introduces us to the key players in polio research, men and women like Thomas Enders, David Bodian, Howard Howe, Isabel Morgan, and Hilary Koprowski, and their work--which included, among other things, an extensive traffic in the rhesus monkeys used for polio research and disturbing revelations about experimentation on so-called feeble-minded children and prisoners.
Oshinsky's portrait of Jonas Salk is of an outsider in the "tight, clubby world of virus research," a technician who was nevertheless considered "a lightweight as a thinker" and grudging in giving his coworkers due credit for their research. His rival, Albert Sabin, an obstreperous workaholic who had little patience for Salk, was no more appealing. As Salk pushed to develop his dead-virus vaccine, and Sabin promoted his own live-virus vaccine, the men reached a state of open warfare--"a bitter, widening free-for-all in which ego, careerism, and principle would become hopelessly blurred," Oshinsky writes.
Salk was the first across the finish line: His polio vaccine trials in 1954 marked the beginning of mass vaccination. From there, Basil O'Connor and the March of Dimes "would launch him into the dizzying world of celebrity science," Oshinsky writes. "Anointed by the foundation, acclaimed by the press, Salk was handed a role virtually guaranteed to offend his colleagues and ensure his ostracism from their ranks. The nation needed a special hero, it was felt, someone to thrill the public that had supported polio research for so long."
But after a dangerous debacle--one of the vaccine manufacturers shipped vaccine that included trace amounts of live polio virus that sickened and killed many children--Sabin's alternative vaccine, which was taken orally rather than by injections, emerged as a challenger to Salk's vaccine. Unsuccessful in his attempts to use American prisoners as test subjects, Sabin went to the Soviet Union in 1959 to test his vaccine. The experiments were successful, and Sabin's vaccine eventually overtook Salk's as the preferred polio immunization. The bitter rivalry between the two men, all too common in the world of research science, is well told by Oshinsky.
Underlying both the story of the March of Dimes and the race for a polio vaccine is another theme: Americans' enduring, pragmatic faith in science and its ability to end suffering. "The battle was fought in a time before federal involvement in medical research and patient care became the norm," Oshinsky reminds us in his conclusion. "Bold leadership would bring together a band of contentious researchers, provide them with a plan of attack, subsidize their efforts, force them to pool their findings and--yes--favor the one among them who showed the greatest urgency in working toward a vaccine." All of this, Oshinsky argues, was done in the "spirit of voluntarism," and "all of it reflected the steady faith of post-World War II American society in the progress of medicine and technology."
Today, slick public relations campaigns featuring celebrity pitchmen have replaced the humble poster child. Glamorous fundraisers to fight the disease du jour occur weekly in cities across the country. Yet the fear of illness and disease, especially among an aging population, has not abated. Oshinsky's book is a provocative reminder that faith in science's ability to conquer disease itself has a history--one that, in the era of the human genome, could not be more relevant.
Christine Rosen is a fellow at the Ethics & Public Policy Center and the author of the forthcoming My Fundamentalist Education.