RUTHFULLY YOURS

In the news, there were endless historical accounts of the horrors of prior epidemics. I was not old enough to remember the Black Plague or the Spanish Flu. Asian Flu, Swine Flu, SARS and Ebola were terrible, but they hadn’t shut down the world. Suddenly, the “bring out your dead” scene from “Monty Python and the Holy Grail” wasn’t funny anymore.

I was old enough, however, to recall the terrors of polio. I remembered how proud the people of Pittsburgh were that they had been part of the making of the vaccine.

In his 2010 novel—Nemesis—Philip Roth describes the fear of polio that swept through his childhood neighborhood in Newark during the summer of 1944. “Fear unmans us. Fear degrades us,” Roth wrote.

The disease terrified the nation. The lives of millions of Americans were disrupted. Many of the victims were left paralyzed—or dead.

When—or if—an effective vaccine could be developed was an open question. Sound familiar?

It struck in the summer, and it hit young children the hardest. No one knew how it was transmitted. The insecticide DDT was sprayed widely in many cities to kill flies which were thought to be carrying the disease. Alley cats were rounded up and killed. Swimming pools and movie theaters were closed. Quarantines were imposed across the country; travel was restricted; social distancing was practiced. People were scared to shake hands, touch money, or even talk on the telephone. Parents kept their children at home.

The disease seized the United States, and indeed the entire world, in fear.

During the 1940s and 1950s, poliomyelitis—also known as infantile paralysis, or polio—killed or paralyzed more than 500,000 people worldwide each year. According to the CDC, polio was once one of the most feared diseases in the United States—causing more than 15,000 cases of paralysis each year in the early 1950s. A 1952 public opinion survey found the only thing Americans feared more than nuclear annihilation was polio.

Polio is a virus that attacks the nervous system. There is no cure. We now know that poliomyelitis is caused by poliovirus, which is an enterovirus. Entero is from the Greek word enteron, referring to the intestine—the transmission route for the viruses. It is spread through contact between people, entering the body through the mouth, multiplying along the way to the digestive tract, where it further multiplies.

The first major polio epidemic in the United States occurred in the summer of 1894 in Vermont. By the early 20th century, the virus killed or paralyzed thousands every year. Outbreaks of the disease appeared each summer, typically hitting children ages 5 to 9 the hardest.

Another epidemic struck the nation in the summer of 1916. In the first week of July alone, 552 children in New York City were stricken with polio, and more than 1,000 the second week. The outbreak killed more than 2,000 people in New York City that year. New York and other cities shut down then as they shut down now. That year, polio killed some 6,000 people, leaving thousands more paralyzed.

In the summer of 1921, future president Franklin D. Roosevelt contracted the disease while on holiday on Campobello Island in the Bay of Fundy. At 39, his legs were permanently paralyzed. He would never walk on his own again.

Major outbreaks reached their peak in 1952, with over 58,000 new cases reported and more than 3,000 deaths. In 1954, polio struck hardest among children 5 and 6 years old.

In about 98 percent of cases, polio is a mild illness, with flu-like symptoms or no symptoms at all. The less fortunate ended up in child-sized coffins. The lucky victims could only walk with wooden crutches. Many wore heavy metal leg braces for the rest of their lives. Polio victims were often so paralyzed that they could no longer breathe on their own.

In 1928, industrial hygiene professors Philip Drinker and Louis Agassiz Shaw, Jr. at the Harvard School of Public Health invented a device called the “Drinker Respirator,” better known as the iron lung. Resembling a miniature submarine, patients, usually young children, were placed inside the devices for up to two weeks until they could breathe on their own. Powered by electric motors, the iron lung pulled air in and out of the lungs by changing the pressure inside the airtight metal vessel.

The ventilators of their day, iron lungs came to symbolize the terrifying effects of the disease.

So, how was polio conquered? One man played a critical role.

Jonas Salk was born on October 28, 1914 in New York City to Lithuanian Jewish emigres. His father was a garment worker. As a child, Salk prayed that he could do something good for mankind. His brothers teased him, calling him “little Jesus.” He was the first member of his family to attend college, entering the City College of New York at the age of 15. His mother talked him out of being a lawyer, and he ended up earning a medical degree from the New York University School of Medicine in 1939.

He married Donna Lindsay the day after he graduated from medical school. The daughter of a prominent Manhattan dentist, her father only agreed to the marriage after Salk could be legitimately listed as an M.D. on the wedding invitation. Dr. Lindsay also instructed Salk to improve his “rather pedestrian status” by giving himself a middle name. Edward was the name Salk chose. They divorced in 1968, but their three sons all became doctors.

While in medical school, Salk first conducted research on influenza viruses. Salk interned at Mount Sinai Hospital for two years and then earned a fellowship at the University of Michigan. There, while studying influenza viruses with his New York University mentor Dr. Thomas Francis Jr., he helped pioneer a new approach to vaccine development—ultimately developing a flu vaccine that is still in use today.

At the time, the medical community believed that, to be effective, a vaccine needed to utilize a live virus. Salk’s unorthodox approach was to kill several strains of virus and inject the benign—or “inactivated”—viruses into a healthy person’s bloodstream. The person’s immune system would then create antibodies to fend off the disease.

Salk’s work on an inactivated influenza vaccine at the University of Michigan so impressed William McEllroy, dean of the University of Pittsburgh’s School of Medicine, that he recruited him in 1947 to head their new virus research laboratory.

In 1948, the University’s Graduate School of Public Health was founded thanks to a $13.6 million grant from the Mellon family, and Salk was given a grant by the National Foundation for Infantile Paralysis to begin work on a polio vaccine. Within two years, he had an early version of a vaccine for polio.

The Foundation was created in 1938 by Franklin Roosevelt during his second term as president. The Foundation came to be known as the “March of Dimes” thanks to comedian Eddie Cantor, making a play on the name of the newsreel series “March of Time.”

Over 80 million people donated to the foundation in a single year. Children across the country collected coins to fund polio vaccine research. Roosevelt also later transformed his estate in Warm Springs, Georgia, into a recovery retreat for polio victims. In 1946, on what would have been his 64th birthday, Franklin Roosevelt’s image was added to the 10-cent coin to posthumously honor his role in the effort to eradicate polio.

Working out of a cramped, 40 by 40-foot laboratory located between a morgue and a darkroom in the basement of the Pittsburgh Municipal Hospital—constructed in 1941 by Roosevelt’s Public Works Administration—Salk’s five-person research team included Julius Youngner, who had earlier worked on the Manhattan Project. Outside the hospital were a line of ambulances, bringing in up to seventeen new polio admissions daily, pushing doctors and nurses to the limit. On the third floor of the same building was a ward filled with children suffering from polio. All of them were in iron lungs.

By using inactivated poliovirus, Salk believed that they could immunize without risk of infecting the patient. Salk’s team developed the first inactivated polio vaccine using virus grown on monkey kidney cells and “killed” with formaldehyde.

Skeptical of Salk’s approach was Dr. Albert B. Sabin who focused on developing a live poliovirus vaccine. In the end, Sabin’s vaccine was proved not as reliable as the Salk vaccine because recipients excreted live virus in their stool, causing the disease to spread further. Five years after Salk’s death, the United States discontinued the use of Sabin’s live virus vaccine.

After successfully testing their vaccine on thousands of monkeys, Salk began to test the vaccine on humans. In 1952, Salk took his vaccine home. After boiling the needles and syringes on his kitchen stove, he injected himself, his wife, and his three sons in his kitchen. All developed anti-polio antibodies and experienced no negative reactions to the vaccine. Salk announced the initial success of the human trials on a national radio program on March 26, 1953.

In 1954, the team launched the largest controlled national field trial in history. Nearly two million children, ages 6 to 9, who became known as the Polio Pioneers, were injected with the vaccine.

The final results were announced on April 12, 1955, at the University of Michigan’s Rackham Auditorium. Speaking to a crowd of scientists and reporters, Salk’s mentor, Dr. Thomas Francis, Jr. who directed the vaccine’s evaluation project, described the vaccine as “safe, effective, and potent” in preventing paralytic polio. As a result, the federal government approved the vaccine for the public.

The nation celebrated as if a war had been won. Church bells rang out. Newspapers ran banner headlines “Polio is Conquered.” The announcement was described by Newsweek as a “summit moment in history.”

Soon after the vaccine was introduced, a faulty batch of the vaccine manufactured by Cutter Laboratories caused some 40,000 cases of polio, leaving 200 children with varying degrees of paralysis and killing 10. The Cutter lab failed to effectively kill the virus—so their batches contained active viruses rather than inactivated viruses. Despite this tragic setback, new polio cases dropped to under 6,000 in 1957, the first year after the vaccine was widely available.

Within three years, cases of polio in the United States dropped by 85 percent.

Salk never patented the vaccine or earned any money from his discovery, preferring it to be distributed as widely as possible. In an interview with Edward R. Murrow on April 12, 1955, Murrow asked Salk who owned the patent to the polio vaccine. Salk answered, “Well, the people, I would say. There is no patent. Could you patent the sun?”

Despite his monumental scientific contribution to humanity, Salk never received a Nobel Prize for his work. Although he was nominated in 1955, 1956, and again in the 1960s, his work was not considered prize-worthy.

On April 25, 1955, 40-year-old Jonas Salk was honored at a ceremony at the White House by President Dwight D. Eisenhower. In the Rose Garden, the former Supreme Allied Commander was so moved he broke down. Tearing up, the president removed his reading glasses and slid them into the breast pocket of his suit jacket.

Before handing Dr. Salk a citation for his extraordinary achievement, Eisenhower said to him, “When I think of the countless thousands of American parents and grandparents who are hereafter to be spared from the agonizing fears of the annual epidemic of poliomyelitis . . . all the agony that these people will be spared . . . I must say to you that I have no words in which adequately to express the thanks of myself and . . . all 164 million Americans, to say nothing of all the people in the world that will profit from your discovery.”

He described Salk as a “benefactor of mankind” and his work as the “highest tradition of selfless and dedicated research.”

In his remarks, Salk described the moment in his laboratory when he realized the success of his research, “when a light glimmered through the darkness with hopeful brilliance.” He added, “I had never even dreamed of meeting the president of the United States, much less on an occasion such as this.”

The president also cited the role of the March of Dimes for its “unswerving devotion to the eradication of poliomyelitis” and its founder—the late President Franklin D. Roosevelt—“whose personal courage in overcoming the handicap of poliomyelitis stands as a symbol of the fight against this disease.”

The man who prayed as a child to do something good for mankind had conquered polio. The building that housed the Pittsburgh Municipal Hospital and Salk’s laboratory is now known as Salk Hall. Salk is still considered a hometown hero in the Steel City—along with such legends as Terry Bradshaw, Roberto Clemente, Franco Harris, Mario Lemieux, Bill Mazeroski, Fred Rogers, Willie Stargell, Jonas Wagner, and Andy Warhol.

Today, we follow the news, reporting daily on the increasing number of COVID-19 cases throughout the world. We follow the economic and social carnage, and we pray for a solution. We hope for a miracle to eradicate this plague. We pray that in a cramped laboratory somewhere, there might be another Salk. We pray that once again the darkness might be pierced by a light of hopeful brilliance.