Polio: An American Story
David M. Oshinsky
Oxford University Press, USA, 2005
342 pp., 35.00
Polio and Its Aftermath: The Paralysis of Culture
Harvard University Press, 2005
336 pp., 41.0
Post-Polio Syndrome: A Guide for Polio Survivors and Their Families
Julie K. Silver
Yale University Press, 2001
304 pp., 55.0
Living with Polio: The Epidemic and Its Survivors
Daniel J. Wilson
Chicago Distribution Center, 2005
312 pp., 35.0
Edward E. Ericson, Jr.
Oh No, Polio
Editor's Note: This article first appeared in the November/December 2005 issue of Books & Culture, taking note of a cluster of books occasioned by the 50th anniversary of the Salk polio vaccine.
"Hey, driver! Hold up!" a voice cried from the bus' back door. "I can't wake up my buddy, and he's gotta get off here." Two boys were coming home from a Cubs game at Wrigley Field, and Richie, age ten, finally got Roosk, age nine, off the bus and down the half block to home. Roosk told his mom he was tired and dropped on his bed, not hearing her ask if he was ok. "Oh no, polio? Please God, not polio." Thus did she pray the prayer of all Chicago parents in the epidemic year of 1949. Roosk woke up 16 hours later with a fever. Doc Olson came over, did doctor things, and announced, "No polio." Later, Doc said to take the boy to the church's family-week camp. "I'll be there and can keep an eye on him."
Polio was no respecter of persons. The most famous victim was Franklin Delano Roosevelt. "Super Crip" crusaded against the plague by helping establish the National Foundation for Infantile Paralysis (NFIP), later known as the March of Dimes, the greatest health-related fund-raiser ever. Other notables stricken were Justice William O. Douglas, Canadian Prime Minister Jean Chrétien, track star Wilma Rudolph, actress Mia Farrow, filmmaker Francis Ford Coppola, writer Wilfred Sheed, scholar Edward Le Comte, and … and Hitler's propagandist Joseph Goebbels.
The first major polio epidemic in the United States hit in 1916, spreading out from New York City, and for the next 39 years, the public simply took what poliovirus dished out. In the 1920s and 1930s, the annual rate of cases was 4 per 100,000; by the early 1940s, the rate doubled; by the late 1940s, it redoubled; by the early 1950s, it had reached 25 per 100,000, with a peak of 37 per in 1952. Between 1937 and 1955, 415,624 cases were reported, 57,879 in 1952 alone. Newspapers ran tallies of local victims—like baseball box scores—by age, sex, type of paralysis. The United States has 1.6 million living polio survivors, 600,000 of whom show ongoing effects; comparable figures for the world are 24 million and 7.5 million. Fears that vaccination is part of the West's conspiracy to commit genocide keep polio from being stamped out worldwide.
Polio is a viral intestinal infection; it is contagious. Polio is difficult to diagnose early, because its typical symptoms are the common ones of fever, headache, sore throat, muscle pains, and nausea. Poliovirus is carried by fecal waste and enters the body through the mouth. It then attacks nerve cells. Surviving nerves can sprout new connections to the "orphaned" muscles, thus doing double duty. This neurological disease is erratic, is relatively seldom fatal, and can leave temporary or permanent paralysis as an aftereffect. The legs are the favorite target of spinal polio, the most common type. Bulbar polio, the other familiar type, attacks the brain stem (bulb), impairs swallowing and breathing, and is deadlier; iron lungs are used for this type.
At the camp Roosk's gait had become stiff-legged and ungainly. Other mothers hurried their children indoors. The family women got him into the cabin. Said one aunt, "I don't care if it is polio; he's our Rooskie Boy." When Doc arrived, one look and he said, "Oh no, it's polio. Sometimes we can't tell until paralysis sets in. Take my wife's car and drive the boy straight to the Municipal Contagious Disease Hospital." For all seventy-five miles back to Chicago, Gram prayed aloud.
Polio is, counterintuitively, "a disease of cleanliness." Until modern hygiene and sanitation kicked in, newborns picked up the virus from their mothers, but in mild doses that produced the antibodies needed for lifelong inoculation. Thus, the cleaner, the riskier; the better, the worse.
A hospital doctor stuck a huge needle right into Roosk's spine. It hurt, hurt, hurt. Then came three long days in a men's ward where, as Roosk remembers it, no one spoke. His parents wrote chalkboard signs that he read through two walls of glass. Did he want ice cream? No. A newspaper? He shook no again. That's when they got really scared.
The fiftieth anniversary of the Salk vaccine in 2005 has brought forth a raft of books about polio, four of which are sampled here. David Oshinsky writes the definitive history of the war against polio in America. Daniel Wilson traces the experience of polio from beginning to end. Marc Shell subjects polio to a cultural-studies examination of the disease and of all the books, movies, and assorted cultural artifacts directly or obliquely related to it. Julie Silver offers practical advice on how to manage the post-polio syndrome.
Oshinsky, a University of Texas historian, traces the dramatic race to find a polio vaccine. Amid a large cast of characters, FDR and his associate at law, Basil O'Connor, play major roles. In the late 1940s, their March of Dimes tried house-to-house solicitations: "Turn On Your Porch Light! Help Fight Polio Tonight!" The Mothers' March on Polio, 2,300 strong by 1950, became "one of the indelible images of postwar America." Between 1951 and 1955, the NFIP raised $250 million. The money funded research and defrayed the medical costs of needy patients, with eighty percent qualifying.
Roosk's family was asked to pay a grand total of 24 dollars. Roosk's father vowed to repay the March of Dimes for the full bill.
Rival researchers Jonas Salk and Albert Sabin raced to create a workable vaccine. Salk, then at the University of Pittsburgh, got there first. The Salk vaccine trials of 1954 involved more than 1.3 million children, one of the largest clinical tests ever undertaken. The favorable outside evaluation announced in 1955 set off huge celebrations. Car horns honked; church bells rang out; banner headlines screamed, "Polio Is Conquered." The moment had come to re-punctuate "Oh no, polio" as "Oh, no polio." Salk appeared on Time magazine's cover and at President Eisenhower's White House. He accepted all too gladly the public's desire for a singular hero. At his coming-out news conference, Salk said not a word about the dedication of the many assistants ranging behind him onstage. Julius Youngner, for one, never forgot and never forgave. Fifty years later, he observed that Salk did nothing else of scientific note: "Being small-minded myself, I take some pleasure in that. Schadenfreude, it's called."
Roosk used to sell his blood for its antibodies, which went into a stopgap pre-vaccine serum. Salk put Roosk out of business.
If Salk was a glory-hog, Sabin was worse: "arrogant, egotistical, and cruel." He sneered at Salk's lionization: "You could go into the kitchen and do what he did." Salk's was a killed-virus vaccine. Sabin, who had been working at the University of Cincinnati on a live-virus vaccine, did not finish first because it is harder to attenuate live virus than to kill it. Sabin was the professionals' favorite. But Salk was the people's choice—until one batch of his vaccine went out with some live virus and caused five children to die. Salk is named among history's most famous scientists, but Sabin's vaccine triumphed, its victory cinched by its oral delivery system. By 1961, only a thousand new cases in the United States were reported.
Readers who want to know what it was like to be a polio victim should try Wilson. True, the Muhlenberg College historian opens with forbidding dissertationese and informs us dullards that polio narratives "slight the experience of polio patients who died during the acute phase of the illness" and that "the earliest narratives shape those that follow." Don't be discouraged. Citations from many narratives by "polios" spice the subsequent chapters. Wilson takes readers through the whole polio experience: the onset, the acute stage, early recovery in rehabilitation hospitals, life on the polio wards, the long process of recovery, the efforts to reestablish normal living, the demands of sustaining the new normalcy—and then, after all the travail, the return of the "old foe" in the guise of post-polio syndrome, when "Use it or lose it" becomes "Use it and lose it."
Wilson's book is a hall of mirrors for "polios." Anyone, for example, who underwent a spinal tap "never forgot it."
It hurt, hurt, hurt. Roosk never forgot her name: Dr. Brown.
"Forty and fifty years later, polio survivors still have vivid memories of the fun they had" on the polio wards.
Roosk's 24 days at St. Luke's were some of his happiest ever. Daytime was the best time for pranks; nights were for reading books under the covers by pen flashlight. Roosk didn't learn until later that his parents met a couple there who had a son and a daughter one weekend and neither the next.
Patients felt keenly the indignities of assisted use of urinals and bedpans.
Daily, some young nurse's aide placed her hand where Roosk didn't want her to.
Polio had a "special affinity for the legs."
Roosk's paralysis, from the neck down, gradually—how to describe it?—drained down his left leg and into the foot.
Rehabilitation almost always required physical therapy.
Roosk avoided physical therapy by agreeing to skip afternoon class to rest up for after-school playtime. His playmates envied his polio.
Sometimes tendons were transplanted to restore a modicum of mobility, though not in the first year and not under the age of ten.
Roosk had a tendon transplant at age 13 to allow some minimal control of his toes. Also, a triangular chunk of bone was cut out to keep his foot from growing hooflike. The ugly result was a deformed left foot nearly two inches shorter than the right. As a high school senior, "the kid who limps" played on the football team to prove to the coach that his foot could hold up for basketball.
Outpatient treatment was common for the first 16 months or so, until such recovery of muscle function as was possible ended.
Roosk was treated (at no cost) by star orthopedist Dr. Chandler, and 6 N. Michigan Ave. remains almost a shrine.
Most "polios" had a strong will to succeed, and many excelled at schoolwork and pursued careers requiring intellectual work.
Roosk became a college professor.
Marc Shell's book puzzles blurb writers Wilson and Silver; both say "there is nothing quite like" it. Shell is a Harvard professor of English, a MacArthur Fellow, and miserably unhappy. Amid the current surge of books about polio, Shell complains about "the general repression of the memory of polio." He has ransacked used bookstores on all continents except Antarctica in search of any and all polio narratives, which he suggests libraries have seen fit to make unavailable. Then he expends great effort examining the arts for treatments of polio and finds what he is looking for: "the Polio School" in literature, for instance, and "the dozens of movies about paralysis" (note: not polio) that "would, if taken together constitute a reinterpretation of the history of cinema." The index lists 28 movies about polio and 29 more that are "polio-inspired," including—get ready—The Ten Commandments, The Greatest Story Ever Told, Star Wars, and The Wizard of Oz. With cultural artifacts appearing and disappearing—as if Prufrock's aimless women come and go, talking of polio—readers unable to connect Shell's particulars and his generalizations may feel the tug of the hermeneutics of suspicion. Only advanced education could direct a survivor to lay a cultural-studies template over his polio.
Ah, but Shell refuses to call himself a survivor, because victims only "convive" (live with) their polio. And that is his main point: Polio is not a thing of the past for those who ever went through the acute phase. Release from the disease's clutches comes only with death. This point is pretty obvious, and it applies to sufferers of many other traumas as well. But it is not false.
At age 37, Roosk had a great fall and landed with all his weight on his weakest extremity. Humpty-Dumpty could not quite be put back together again. He no longer could run. Having discovered early that other kids could now out-throw him and that power-hitting should give way to place-hitting, he learned only when he took up golf how diminished was his fine motor control. He also noticed that one leg was submerged by bathwater before the other. Little self-discoveries kept surprising the apparently incurious man.
The most memorable aspect of Shell's book is his rage—his understandable rage. For his parents told him there was "nothing wrong" with him; he just had a cold in his leg. But he remembered being paralyzed. His father, "for all the love he bore me," took a leather strap to the lad's polio-weakened body parts, as if "to whip the demon out of me." And his mother "actually put my father up to it." So Shell laid his long-range plan: "The child that I was then counted on becoming this adult that I am now, who would try to write that child's polio memoir." Adult bitterness spills over everything. Let others celebrate the "conquest of polio." But even now there is no cure, no effective treatment, merely a vaccine. The NFIP was corrupt, doctors were greedy, parents lied. Polio wards were "made" to "look like concentration camps"— and Shell's next thought is of Cherokees on their Trail of Tears and Japanese Americans in their internment camps. Shell is upset with "polios" who try to achieve some normalcy in their lives, furious with those who inject divine providence into the polio equation, and livid over Christ's "taunt" of doctors, "Physician, heal thyself!" After all, "even he can only do resurrection."
Unsurprisingly, wrath leads to faulty generalizations. "A child polio was the cause of family shame." People are in denial that "all forms of polio damaged neurons, permanently." There is "a consistent tendency to overlook" post-polio syndrome and "often to declare that it doesn't even exist" (this, at the very time when books and internet sites devoted to PPS are flourishing). Charitable polio organizations used a popular song's inspiring lines, "Walk on, walk on, with hope in your heart, / And you'll never walk alone"—about which Shell comments, "To us polio-children, the words of this love song meant both that we would never be able to walk without braces and that we would always be dependent on someone to lean on." Who is this "us," Kemo Sabe?
Wrath, even when inspired by self-pity, is a deadly sin. It is Shell's book's fatal flaw.
Julie Silver, who studied polio because her mother had it, has written a helpful "how-to" book on post-polio syndrome. PPS is about as difficult to diagnose as polio itself. Its symptoms are new weakness, unaccustomed fatigue, muscular pain, new swallowing problems, new respiratory problems, cold intolerance, new muscle atrophy. But who doesn't have such symptoms as aging proceeds? The best one can do in diagnosing PPS is to eliminate all other causes of these symptoms—an impossibility. It is difficult, even, to estimate the percentage of polio survivors who become afflicted by PPS. Silver estimates somewhere between 25 and 60 percent. Yet, since the symptoms range from mild to severe, everything remains in question.
Silver's book functions best as a reference guide. Her advice is level-headed, though limited, and her addiction to lists makes for dreary reading. Are you fighting fatigue, dear oldster? Read the list of twenty possible causes, and if you can eliminate the other 19, PPS is your culprit. If you tire quickly, read the ten steps to energy conservation and pacing. To relax without sleeping, try one or more of eleven ways. To avoid falling, keep in mind 16 intrinsic risk factors and 18 extrinsic ones. If you never had polio, follow her advice anyway.
Polio contributes to back trouble. Yes, but … Can it contribute to meralgia paresthetica? to atrial fibrillation? to … ? But society cannot afford research just to satisfy the curiosity of a dying breed.
On the biggest question, Silver can offer no help. What is polio's impact on longevity? Surely, compensatory overload will take a toll on nerves and muscles. PPS does indeed seem, now that it has been identified, to be a "cruel trick" for those afflicted. Yet, hearteningly, Silver closes with the reminder (pace Shell), "Given the magnitude of their afflictions, most polio survivors cope remarkably well."
Even those who take a certain perverse pleasure in being identified with the 20th century's hallmark disease realize that they now belong to a museum tableau. If they know what frail vessels carried society to the land of scientific promise, most appreciate the ride. They should know, as well, that their scourge bestows no unique advantages for moral reflection. The guises of suffering differ from one to another; the age-old mystery of it remains universal. Some human beings grow through suffering; others shrivel. An incipient utopianism characterizes those who complain perpetually about their polio. They seem to want a world free of sickness and war, of tsunamis and tornadoes, of sin and death. There may be such a world; some say there is. But it is not this one.
Edward E. Ericson, Jr., professor of English, emeritus, at Calvin College, is currently collaborating on two books about Solzhenitsyn, forthcoming from ISI.
Copyright © 2005 by the author or Christianity Today/Books & Culture magazine.
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