DR. SALK

Seems like a good time to bring up a vaccination story. People today don't remember the panic that engulfed America in the 1930s because of the dread disease poliomyelitis, commonly known as polio. In fact, the panic may have been worse than the disease itself, as it paralyzed the American consciousness at least as effectively as the virus paralyzed its victims' bodies.




Other viruses have wreaked havoc on American culture over the decades--HIV-AIDS, Herpes, Ebola, Zika and others come to mind. But polio may have had the most profound impact. During the 1920s and 1930s, the terrors of the disease came to the forefront. Traditionally it did its greatest damage during the summer months. Polio was initially called infantile paralysis

because it so often struck the very young just as their bodies were developing. The disease begins with inflammation to the spinal cord, the virus having been ingested usually through inhalation. Most people who are exposed have no symptoms or a few mild symptoms that might accompany any viral exposure. But a small percentage of people had the virus penetrate their bloodstream and attack their nervous system. The virus left them partially or wholly paralyzed for life and in severe cases led to death.

Polio struck randomly without warning. One town would be beset by numerous cases and a neighboring town would have none. One street in a neighborhood might have three victims but the next block would be immune. If a neighbor's child contracted the disease, that family was now viewed as a pariah. Quarantine signs would be posted on the door of the house and everyone stayed away. Since it was presumed that the virus could be easily transmitted through water, people avoided local community swimming pools, even on the hottest days of July. Movie theatres were often off limits--because you just didn't know who you might be sitting next to.

The most prominent case of polio was the one attributed to the president, Franklin D. Roosevelt (I say attributed because some thing his affliction might have been caused by a slightly different virus than the polio virus--nevertheless, the effects were similar). Roosevelt was older when he first suffered polio's ravages, but his muscles weakened and he spent most of his life on crutches or in a wheelchair. America never really knew how severely impaired their president was because of the tacit agreement by members of the press not to photograph the president looking weak and frail.




Pictures of the president (like the one above) were rare. When he spoke from the podium, he would struggle to pull himself up from his wheelchair, and he would grip the top of the podium to provide himself balance and support while he spoke. But the cameras didn't start rolling until he was standing behind the podium and ready to deliver his powerful addresses with his sonorous, patrician voice. Roosevelt often vacationed in Warm Springs, Georgia, where he bathed in the hot waters as a form of hydrotherapy. Of course, in today's political climate, Roosevelt's "weakness" would be readily attacked by the political opposition.

The children who suffered the most from this insidious illness were those who were relegated to enclosure in coffin-like machines that reduced the pressure around their bodies so they would better be able to breathe. These machines, negative pressure ventilators, were known as "iron lungs" and seen by many as a fate worse than death. In effect, they were like giant bellows designed to replicate the in-out of normal breathing. Imagine lying supine within a machine, completely enclosed except for your head, which rested on a pillow outside the machine. You can't really swivel your head left or right. You see the ceiling or you see the world through the reflection in a mirror attached to the top of the iron lung.

Even those children who didn't need an iron lung often found themselves bound by a wheelchair in a world that had no accommodations for them. No extra-wide bathroom stalls, few elevators, no sidewalk ramps, no bus step-lifts. Really no public transportation at all. Often, students with polio had to attend schools far from home designed to meet the needs of crippled youth.

In the late 1930s, FDR helped found the March of Dimes, a charity created to fight the scourge of polio. Stores would put up cards with slots next to cash registers so that if you got a dime in your change, you could easily donate it to the March of Dimes. As a grade-school student I would go around collecting dimes for the cause. They gave us a little box with a slot. Every little bit helped. A lot. Charities were transformed. Prior to the March of Dimes, charities solicited large donations from a few wealthy philanthropists. But the March of Dimes showed that tens of millions of dollars could be raised for research if tens of millions donated as little as a dime each.

In 1952, there were more than 50,000 cases of polio in the United States, and a search for a cure continued. But a few scientists thought that a vaccine might be a faster solution than a cure. Vaccines were a scary thing to many Americans. There was no vaccine culture at the time. Thanks to funding from the March of Dimes, both Jonas Salk and Albert Sabin pursued a vaccine. Salk's vaccine was tested on nearly two million volunteers. Salk's team met with thousands of doctors and members of the public health community. Finally, in 1955, news of the medical breakthrough was blazoned across the headlines of every newspaper. Salk was a national hero. The country embraced vaccine culture. People realized that the risks of vaccines were minimal, especially by comparison to the threat posed by a killer disease that struck indiscriminately. I got my shot, just as all my friends did.

Not everything about this chapter in medical history was a happy one. There were reports that some doctors tested the early live virus vaccine formulas on those with mental disabilities, children unable to give informed consent. Tragically, as with most early testing, some people were given the vaccine to prevent polio and wound up with the disease. Salk garnered some bad publicity when a batch of the vaccine gave a community polio, but it turned out that a local doctor had administered the wrong vaccine. There are always sad stories with this kind of scientific pursuit.

Salk tried as much as possible to avoid the limelight that accompanied his success. He pushed for universal vaccination, and the rest of the world embraced the idea. He won just about every honor and award known to man. Though not often spoken of today, he is still considered a titanic presence in the history of modern medicine. In the late 80s, an effort was made to eradicate polio worldwide. There were 300,000 cases reported in 1988. By 2018, that number had fallen to 33. Only in Afghanistan, Pakistan, and Nigeria are any cases reported, and that's because groups like the Taliban won't allow doctors into tribal regions. It has been a remarkable success story.

Naturally, a story like this contains a few ironies. You may recall that I mentioned Dr. Albert Sabin, who very much viewed the pursuit of a polio vaccine as a race. Well, Salk's vaccine was first and he got all the glory. But by 1957, Sabin and his team created a safer oral vaccine that they tested extensively. By 1960, Sabin's oral vaccine became the standard for polio vaccination globally. Sabin never took a patent on his discovery because he wanted it available throughout the world for minimal cost. But Sabin finished second in the race and never received anywhere near the recognition that blessed Salk. Both men dedicated the rest of their lives to immunological study.

Probably more important than Salk's vaccine itself was Salk's contribution toward getting the world to accept the idea of vaccines. As a child, I experienced Measles, Mumps, and Chicken Pox. Many of my friends suffered through Rubella or "German Measles". Now all children receive vaccinations for MMR and Chicken Pox. Students today receive vaccinations for the Human Papilloma Virus (HPV), both girls and boys. I recently got a Tdap vaccine booster shot and I get a flu shot every fall. I never think twice about doing so, and I tip my hat to Jonas Salk and his compatriots for their achievements. I am saddened by the current Measles outbreak due to the willful ignorance of a few unthinking individuals.

Below is an episode of the PBS series American Experience which provides Part 1 of a fascinating study of the history of polio in the US. If it doesn't connect to the link, you can watch it on the PBS site at: https://www.pbs.org/wgbh/americanexperience/films/polio/