Articles

Who could have imagined that Ron Chernow's fine biography of Alexander Hamilton would inspire a blockbuster Broadway musical? We are always surprised when historians have a genuine impact beyond academic and general readers of history. Yet, at least three of David Oshinsky's writings have had such an effect on society. First came his fine book Worse than Slavery: Parchman Farm and the Ordeal of Jim Crow Justice, which received the Robert F. Kennedy Book Award for Justice and Human Rights. In awarding the prize, the center’s judges stated that "this impressive work reminds us that the abolition of slavery did not end the institutionalized oppression of African Americans." Worse than Slavery was published in 1997, long before the issue of mass incarceration became part of the public dialogue. Then there was an influential article that David wrote for the New York Times after an eerie encounter with the notorious Mississippi preacher and Ku Klux Klan leader Edgar Ray Killen. David's New York Times story, more than thirty years after the murder of the three civil rights workers in the summer of 1964, helped focus national attention on this monumental miscarriage of justice. The preacher was subsequently indicted, convicted, and imprisoned. Finally, there is David’s Pulitzer Prize-winning book Polio: An American Story. It has had a dramatic effect on the drive to eliminate polio worldwide through the leadership of the Gates Foundation. As Bill Gates has explained, "Reading Oshinsky's book broadened my appreciation of the challenges associated with global health issues and influenced the decision that Melinda and I made to make polio eradication the top priority of the foundation, as well as my personal priority." What greater impact can a historian have than that?

M. L. G.

David Oshinsky’s lecture was funded by the Pulitzer Prize Centennial Campfires Initiative in observance of the one-hundred-year anniversary of the Pulitzer Prize. The lecture was delivered on June 8, 2016, as part of Humanities Texas's "Post-War America, 1945–1960" teacher institute in Austin.

The 1950s is the polio decade. I am old enough to have lived in the era before the two polio vaccines were developed. I can remember, every single summer, polio would come like the plague. Around Memorial Day, the newspapers in New York City, where I lived, would start printing box scores of the number of kids sent to polio hospitals and polio wards. The numbers would go up in July, they would go higher in August, and then, around Labor Day, they would peak. Polio season would be over. During that time we were not allowed to go swimming; the belief was that poliovirus traveled through the water. Swimming pools all over the country were closed. The beaches were closed, and you couldn't go bowling or go to the movies because we were told to stay out of crowds. I remember my mother—and every mother and father in the country—had these polio tests where every night you had to put your chin into your chest and touch your toes, just to make sure there was no stiffening. People were absolutely panicked. There was no cure for polio. There was no prevention. Every child was at risk.

You would see the vestige of it everywhere: kids on crutches, in leg braces, wheelchairs, and some of them in iron lungs lined wall-to-wall in hospitals with children staggering to breathe. You would come back to school in September and see the occasional empty desk: that meant a child had not survived. He had died of polio. You could feel the sense of panic and hopelessness among adults. They knew polio was coming again the next summer—the crippling and killing would surely return.

There are many big questions we don't know the answers to. Why did polio come in the summer? Why was it primarily a summer disease? The answer is: we don't know. There are certain diseases, like influenza, that hit hardest in winter season. These diseases tend to infect the respiratory system; they are droplet infections. Polio is an intestinal disease. It enters through the mouth and replicates in the gut; such infections tend to do better in warm weather—at least, that is one of the theories.

For some reason, polio strikes more boys than girls. Why? We don't know. The theory at the time was that boys played harder than girls, and, therefore, when the poliovirus was around, their immune systems were more easily compromised. Is that true? Probably not. There likely is a genetic component. Many more boys than girls are autistic, for example. It's a complicated and perplexing matter.

The most extraordinary part of the polio puzzle is that, in epidemic numbers, meaning tens of thousands of cases, polio was a disease of the West, particularly the United States, Europe, and Canada. It also, in epidemic terms, is a disease of the twentieth century. There are numerous theories as to why. Some see polio as a disease of cleanliness, meaning the more antiseptic our society became in the twentieth century—with pure food, pure water, the introduction of household disinfectants—the less likely infants were to be exposed to poliovirus at a time when they had protective maternal antibodies and the disease itself is less virulent. What we notice with polio is that not only were the numbers rising in the 1930s and 1940s and particularly the 1950s, but the age of the polio victim was going up as well. It used to be called infantile paralysis; suddenly it was called polio, or poliomyelitis, for the virus involved. It was still crippling two-year-olds and four-year-olds and seven-year-olds, but teenagers and adults were also coming down with it in large numbers as well.

Of course the most famous polio survivor is Franklin D. Roosevelt. FDR got polio at the age of thirty-nine in 1921. He was a big man, well over six feet, strapping, athletic, from one of the leading families in the America. I remember, when I was writing Polio: An American Story, my editor said to me, "How did FDR get polio?" I looked at her, and I said, "He was unlucky." She looked back at me, and said, "That's not going to cut it. We need more than that, so why don't you try to figure out some sort of timeline?" And I did: FDR was a rising star in the Democratic Party. He had been assistant secretary of the Navy during World War I, and then he had run a strong but unsuccessful race for the vice presidency in 1920. Roosevelt also had been raised at his ancestral home in the Hudson Valley of New York state, north of New York City. He had been homeschooled, meaning that he had very little contact with other children. But once FDR left Hyde Park to go to private school and then to Harvard and to Columbia Law School, his list of illnesses read like a medical encyclopedia. He came down with every imaginable disease. In other words, because he had come into contact with so few children early on, his immune system really had never fully developed. Then everything changed. He came down with double pneumonia in college. He almost died in the great influenza epidemic of 1918-19. Then, following his vice-presidential defeat, FDR contracted polio. What happened?

So, here is my chart. In 1921, FDR was hauled before Congress to answer questions about homosexuality in the Navy during World War I. It was a bogus investigation, with the intent of tarnishing a promising Democrat's political future. Roosevelt testified in the brutal summer heat of Washington. It was a brutal, humiliating experience, and I suspect it compromised his health and temporarily weakened his immune system. Roosevelt then headed for his summer home on Campobello Island off the Maine-Canada coast, but, on the way, he stopped off at Hyde Park and took part in the Boy Scout jamboree. The last photograph we have of FDR walking unassisted is with his arms around young Boy Scouts in their parade. It's very likely that that is where the poliovirus was transmitted to him. He then journeyed to Campobello and engaged in frenetic physical activity, which is potentially dangerous when that virus has entered your body. While sailing in the Bay of Fundy, he fell from his yacht and said he had never felt water that cold. He spent that afternoon in a wet bathing suit doing correspondence. What your parents told you about chilling is true—it can lower your immunity. The next morning, he awakened with a fever, and, by that afternoon, he was fully paralyzed from the waist down and would remain so for the rest of his life.

That is my chart. A man who had let a sheltered youth, his medical problems afterwards, his humiliation in Washington, the Boy Scout jamboree, the trip to Campobello, the frenetic exercise once there, the fall from his yacht, the afternoon in a wet bathing suit. Is that how FDR got polio? It's possible—but, of course, nobody really knows.

Roosevelt would spend the rest of his life trying to find the cure for polio. He bought a ramshackle hotel in Warm Springs, Georgia, which later became his summer White House. He invited other polio survivors to join him there to bathe in the soothing, spring-fed waters for hydrotherapy and exercise. Roosevelt tried everything but never found the cure. But he did initiate the most important philanthropy in the history of the United States: the March of Dimes.

The March of Dimes provided the playbook for every philanthropy that came afterwards. When Roosevelt decided to return to politics and run for office in 1928, he turned the March of Dimes, this new organization, over to his law partner, Basil O'Connor. The headquarters was in New York City, and O'Connor, a visionary of sorts, hooked up with a new profession centered in Manhattan on Madison Avenue—in other words, advertising. Soon, the March of Dimes was presenting polio to the public as a commodity, much like soap or automobiles. In the past, charities had relied on large donations from a few wealthy families. What the March of Dimes decided, particularly in the Great Depression when there wasn't a whole lot of money circulating, was that it didn't want big contributions from the few. It wanted millions of contributions from all Americans. No person in this country was too poor to give a dime to help a kid walk again. That was an exceptional strategy—a winning strategy—for the March of Dimes. It turned philanthropy on its head. Remember, this was an era before government funding of medical research. Big Pharma had not yet fully arrived. Research had to be done through the benevolence of private philanthropies. Today, the National Institutes of Health is the major funder of biological and medical research in the United States, and Big Pharma does a huge amount as well. But in those days, it was private contributions, and the March of Dimes was pulling in millions of dollars. It revolutionized both philanthropy and medical research.

What made the March of Dimes different? The first thing it did was to invent the "poster child"—a staple of charity publicity today, from Jerry's Kids to St. Jude's. In the 1940s, it was a small child, usually blonde and white, walking into the sunshine, throwing his or her crutches to the ground and saying, "With your help, I will walk again." Every time you went to the movies in this era, a "polio can" would pass through the aisles, much like a church collection plate, with a crippled child's picture on it. I can't tell you how many hours I spent putting dimes into the little folders and sending them to the White House or the March of Dimes. It was extraordinary.

The March of Dimes was also the first organization to use celebrities. No one had thought of this before. Early on they would use people you might not have heard of—Eddie Cantor, Bob Hope, Bing Crosby. They later used Elvis Presley. There is a picture of young Richard Nixon as vice president on his knees pumping gas for polio. Celebrity power was extraordinary, and by that I mean that every celebrity wanted to be associated with a charity that helped children walk. It made them feel good, and it also was good for their careers. One photo was especially revealing. Every year on the anniversary of FDR's birthday, the March of Dimes would hold giant fundraisers throughout the country. They would book the biggest hotels in the biggest cities. In New York City, they used the Waldorf Astoria. In this particular photo, showing the massive Empire Room, we see Grace Kelly walking down the runway in a Dior gown. The music is being played by Rogers and Hammerstein, and the backdrop has been painted by Salvador Dali. In terms of celebrity power, circa 1955, that said it all.

The other thing the March of Dimes did was to get millions of mothers involved. They had Mothers Marches for polio, very much like what the Susan G. Komen Foundation does today. By 1950, these devices had raised more money for polio than for all other charities combined, except for the American Red Cross. Polio raised so much that organizations like American Cancer Society deeply resented the March of Dimes for taking too much of the charity dollar. The March of Dimes didn't share with community chests or the United Fund. It simply made two promises to the American public: "First, we'll use your contribution find you a vaccine; second we will pay to help rehabilitate every polio patient in the United States." They made good on both of these promises.

With tens of millions of dollars to spend, the March of Dimes put together the best committee of virologists in the country. To make a successful vaccine, three main questions had to be answered: First, how many strains of polio virus are out there? Second, how do we produce enough safe poliovirus to pack into the vaccine? Third, how does poliovirus travel through the body? The belief at this time was that poliovirus traveled through the nose into the brain and then into the central nervous system. If that were true, a vaccine would do no good because vaccines produce antibodies in the blood. But a very famous female researcher, whom I'll talk about in a minute, figured out that poliovirus actually traveled through the mouth into the gut. In 99% of the cases, it was excreted out in the waste, but in a tiny number of cases it bubbled through the bloodstream and into the central nervous system. A successful vaccine could prevent this from occurring by producing powerful antibodies that neutralized the virus in the bloodstream.

What was extraordinary about the March of Dimes was its insistence on recruiting the best researchers possible. You have to bring yourself back to the 1940s. This was a time of enormous anti-Semitism in medical research and all kinds of quotas against Jews in medical schools. The March of Dimes didn't care. The two biggest grants went to Jews: Jonas Salk at the University of Pittsburgh and Albert Sabin at the University of Cincinnati. The March of Dimes also looked beyond the major research centers to find its talent. It didn't care whether these scientists were at Harvard or Johns Hopkins or Stanford—they wanted smart, ambitious people who would follow the program. The reason Jonas Salk was at Pittsburgh and Albert Sabin was at Cincinnati was that those were among the places Jews could get in and go. Pittsburgh today is one of the great medical centers of the world, but it was a backwater in the 1940s. As I'll mention, Salk and Sabin hated each other's guts. It was one of the ugliest medical rivalries of the twentieth century, but [the March of Dimes] made them "play nice" and share information.

At a time when there was enormous discrimination against women in the medical profession, two of the most significant grants from the March of Dimes and two of the most significant breakthroughs came from the laboratories of women. One was a researcher named Dorothy Horstmann at Yale. Dorothy Horstmann was the one that figured out how the virus traveled through the body. With March of Dimes money, she became the first full professor of medicine at Yale, the first woman to hold a chair at Yale, and one of the first women to be inducted into the National Academy of Sciences. Quite amazing. [The other woman was] Isabel Morgan, the daughter of Thomas Hunt Morgan, who won the Nobel Prize for his work in genetics. Isabel Morgan was brilliant, and she was working at the Rockefeller Institute in New York—the Mecca of biomedical research. But because she was a woman, Morgan couldn't get good lab space, she couldn't get good grants, she wasn't being promoted, and she finally figured, "The heck with this!" She joined the Johns Hopkins polio unit, where there was a respectable place for her. Isabel Morgan began working on a polio vaccine, and, by my count, she was a full year ahead of Jonas Salk in that race for the first vaccine. Then in 1949, at the height of her research prowess, she made the decision that women had to make in those days and to some degree still have to make today: she decided to get married and to raise a family, and she left polio research forever.

The big question is, had she stayed, would we be talking today about the Morgan vaccine and not the Salk vaccine? The answer is, I don't know. It's counterfactual history—you can say whatever you want. But, it is a possibility, and what you can say for certain is that Isabel Morgan blazed the trail that Jonas Salk took to completion. Looking at Isabel Morgan's papers, which are in Philadelphia and are amazing, her father, the Nobel Prize winner—he called her Ibby—he was always writing these letters saying, "Ibby, you're going to save tens of thousands of lives of children. Keep at it! God bless you. Love, Dad." But there would sometimes be a P.S. at the bottom that would say, "When are we going to see grandchildren?" You realize the conflict she faced, and it was powerful.

By 1954, Jonas Salk was ready to test his killed virus vaccine on humans. A killed virus vaccine is a one where the poliovirus is actually killed by formaldehyde, so if properly done you cannot get polio from the shot. They add things called adjuvants that juice up the vaccine to to produce a stronger antibody reaction. The other vaccine is an oral polio vaccine that probably most of you received as children. You take it as a sugar cube or a dropper on your tongue, and that is live poliovirus that has been weakened to the point where it will produce a very mild case of polio that you won't even know that you have. It also will produce also lifetime of immunity against the disease. It's a harder vaccine to produce, and that's why Salk's vaccine came out first.

This was an era before what we would call "informed consent." By that I mean that Jonas Salk, when he wanted tested on humans, went to the Pennsylvania home for the feeble-minded, got the director of the home simply to give his permission, and tested his vaccine on "feeble-minded" kids. There were few rules. You were like a buccaneer; you did whatever you wanted, and you went as far as your conscience and imagination would take you. Jonas Salk had first tested on monkeys and chimpanzees. You wonder whether a researcher today could do that. Polio researchers sacrificed close to 100,000 monkeys in that era. It's hard to imagine doing that in the current climate of animal rights.

In 1954, Jonas Salk believed he was finally ready for mass human testing, and the March of Dimes agreed. They ran a double-blind study in which one group gets the real vaccine, a second group gets the look-alike placebo, and neither the person getting the vaccine nor the person giving the vaccine knows which is which. It's all coded. Jonas Salk initially opposed the double-blind model. He believed that his vaccine worked and that it was unconscionable in the middle of polio season to give 500,000 kids a placebo, not the real vaccine. But the March of Dimes demanded a study that would pass scientific muster, and Salk acquiesced.

The Salk vaccine trials of 1954 still stand as the nation's largest public health experiment. Almost two million kids participated. Can you imagine in today's world lining up two million schoolchildren for a vaccine no one knew was perfectly safe? Or how well it worked? Think about that. Quite impossible. Why then did it work in 1954? Because people like my mother had seen forty thousand to fifty thousand kids getting polio each year. She pushed me to the front of the line because she understood—as did millions of other parents—that the potential danger of the polio vaccine paled in comparison to the real dangers of remaining unvaccinated. My mother was a very tribal woman, and, in the back of her mind, she was no doubt thinking, "Salk's Jewish. We're Jewish. How bad could this be?" It took a full year [to complete the study]. This was pre-computer. They had to do it all by hand. Three shots for each kid, half getting placebo. Millions of bits of evidence to quantify. It took a full year to get the results.

In 1955, in one of the most famous press conferences of the 1950s, word came down: the polio vaccine is safe, it's effective, and it's potent. That day became a national holiday. Church bells tolled, factory whistles blew, people were hugging each other in the streets—it was like a war had ended. President Eisenhower invited Jonas Salk to the White House, and, for the first time in anyone's memory, Ike broke down in tears as he thanked Jonas Salk for saving the children of America. What an incredible moment—the president of the United States thanking a forty-year-old laboratory researcher.

[Meanwhile,] there was another researcher out there named Albert Sabin, who was working on a live virus vaccine that he and the rest of the virology community thought was much better than Salk's vaccine. [The live virus vaccine] creates a natural infection and gives a stronger dose of immunity, but Sabin couldn't test in the United States because so many kids had already gotten the Salk vaccine. So, in one of the great stories of the Cold War, the State Department allowed him to go to the Soviet Union to test this vaccine. And this was no double-blind study. Seventy million kids got the live virus vaccine. There are amusing letters Sabin wrote back to his friends in the United States. He says, (I'm paraphrasing, of course): "I love it here! You tell 'em to come Wednesday at ten o'clock and form a straight line, and it's perfect!" He came back with phenomenal results: the vaccine was safe and strong; there were no polio outbreaks; antibody levels were high.

Within a very short period of time, Albert Sabin's vaccine knocked Jonas Salk's vaccine right off the market. Albert Sabin was kind of a zero-sum game player. It wasn't enough for him to win. Jonas Salk also had to lose. So Sabin said things like, "I can go to my kitchen and do what Salk did." He and his supporters blackballed Salk from the National Academy of Sciences. It's a scandal. The father of the polio vaccine is the only major polio researcher never to have been inducted into the National Academy of Sciences. Can you imagine?

Still, Jonas Salk remains the people's scientist. He came first and he is the one we remember. Albert Sabin was a scientist's scientist. If you asked a virologist today, he would likely say Sabin was far superior to Salk. But, in 1999, TIME magazine did one of its retrospectives, "100 Most Important Minds of the Twentieth Century." On the cover, Albert Einstein is lying on a couch being psychoanalyzed by Sigmund Freud, and in the background is a picture of Jonas Salk. It's quite a tribute. Salk was once asked, "Do you feel bad that you never won the Nobel Prize?" Salk replied, "You know, I don't feel bad because most people think I did win the Nobel Prize." Sweet revenge.

When Jonas Salk's vaccine was released, the number of polio cases in the United States went down from forty thousand cases a year to about 1,500. It's harder to give a vaccine by injection than by mouth. Sabin's vaccine took that number down from 1,500 down to fewer than fifteen a year. So we went from forty thousand cases to about 1,500 with Salk to fifteen with Albert Sabin's vaccine. That's extraordinary. There was a problem, however: every single one of those fifteen cases was vaccine-induced. In other words, the child got polio from the oral vaccine itself. It is live virus, and, in an infinitesimally small percentage of cases, it will revert to virulence in the gut. Thus, the problem with Sabin's vaccine is that although you could get [the number of cases] way down, you could never get it to zero. Sabin refused to believe this. Indeed, he and Salk both died in the early 1990s believing that Sabin was the winner. But, later in that decade, researchers developed a more powerful version of the Salk killed-virus vaccine that stopped polio in its tracks. Because it's a killed-virus vaccine, there are no worries about vaccine-induced polio. That vaccine took over, and there hasn't been a case of polio in the United States since then.

There still are isolated pockets of polio in other parts of the world—Afghanistan and Pakistan, among them. In some of these areas, there is cultural resistance to medical advances coming from the West. Dozens of polio vaccinators in Pakistan have been killed by the Taliban. It's a horrifying story. But there is optimism that [despite] these problems—and there are many—we will find and end the last case of polio by 2018. There are some public health experts who say, "Why are we spending billions of dollars on a disease that is now in the hundreds of cases when we could be spending this money on malaria, which is in the millions?" But the clear response is that, by wiping polio out entirely and never having to worry about it again, you will not only save the lives of children in the future, but it will also be more cost-effective. For example, only one infectious disease in human history has been completely wiped off the face of the earth, and that is smallpox. Because we have to don't vaccinate against smallpox anymore, we have saved untold billions of dollars in the process. And I strongly believe that because we have two effective vaccines against polio, it is morally unconscionable not to give it to every child in the world. That race is still being run, and 2018 will hopefully be the year we cross that finish line.

And what a tribute to FDR, and the March of Dimes, and thousands of volunteers like my mother, as well as Jonas Salk and Albert Sabin, and all the building-block scientists such as Dorothy Horstmann and Isabel Morgan, that the most insidious childhood disease of the twentieth century will not survive the twenty-first.