The specter of hospital wards lined with small bodies unable to move, ghostly faces staring out from iron lungs and frantic parents hovering nearby was a reality that struck American towns each summer for decades. The wards would clear out by fall, leaving some tiny victims struggling in heavy braces, others dead and still others fully recovered. The inability to understand this plague, why it struck in the summer and how it chose its victims filled mothers and fathers with dread. Polio paralyzed America in more ways than one.

Medical personnel tend to polio victims in an iron lung ward during a 1950s epidemic in Boston.

Photo courtesy of March of Dimes Birth Defects Foundation

“I can remember my mother telling me not to make new friends in the summer and not to play too hard,” recalls Dr. David Oshinsky, author of “Polio: An American Story” and a professor of history at The University of Texas at Austin. “The real horror was that no one knew what caused polio so there was no way for parents to protect their children.”

In the 1940s and 1950s, polio was one of the most feared diseases in America. And yet, during this same time, 10 times as many children would die in accidents and three times as many from cancer. So what was America’s fixation with polio? The highly visible and lifelong remnants of its annual scourge on the most innocent of victims no doubt contributed to the heightened sensitivity, but Oshinsky’s research found a well-crafted, aggressive public relations machine fueled by political luminaries and Hollywood glitterati that kept polio at the forefront of America’s consciousness.

Rise of the Polio Plague

The first polio epidemic was recorded in Vermont in 1894 and included 123 cases. The next major outbreak was reported in Sweden in 1905 with more than 1,200 victims. It was around this time that polio began to enter the edges of American consciousness as a serious health concern and finding a cure for the disease became a focus of the newly created Rockefeller Institute. Simon Flexner, a physician and director of the Rockefeller Institute, would spend the latter part of his career searching for a cure for polio.

“Flexner inadvertently set back the field of polio research by decades due to a random and unfortunate decision to use rhesus monkeys for his experiments,” said Oshinsky. “This particular breed is a rare type of primate that cannot contract polio through oral feeding. Because of this, Flexner surmised that polio entered the body through the nasal passages and traveled via nerve endings to the spinal cord. This ‘conclusion’ meant that a vaccine, which stops a virus in the blood stream, would not work to impede polio.”

It was not until President Franklin D. Roosevelt, one of polio’s most famous victims, founded the National Foundation for Infantile Paralysis in 1938 that polio research would again push the envelope of scientific discovery. And it was not until a decade later that a little-known researcher named John Enders would scientifically disprove Flexner’s theory. Enders showed that poliovirus could be cultivated in skin, muscle and kidney tissue in a test tube—not just in a monkey’s brain or spinal column as previously believed. The implications of this discovery were enormous: scientists could mass produce a vaccine to fight polio. This finding opened the door for an intense competition to develop a safe and successful vaccine.

Revolutionizing the Crusade for a Cure

According to Oshinsky, the National Foundation for Infantile Paralysis revolutionized the way charities raise money. In 1938, Roosevelt friend and popular celebrity Eddie Cantor coined a slogan and started a drive that would fundamentally alter fund raising in America. He suggested the National Foundation undertake a “March of Dimes” and he called on men, women and children across the country to send their dimes to Roosevelt at the White House to help fight polio. The response was staggering, with 2,680,000 dimes, in addition to thousands of dollars in checks and paper money, flooding the White House in the days following the campaign’s introduction.

The March of Dimes first “poster child” drove home a simple message: the contributions of ordinary Americans restored a child to health.

Photo courtesy of March of Dimes Birth Defects Foundation

“Cantor and Roosevelt were not the only high visibility names attached to the polio crusade,” said Oshinsky. “Joe DiMaggio, Richard Nixon, Bing Crosby, Jack Benny and many others took part in events promoted by the National Foundation and helped to elevate public awareness of the polio crusade.”

The National Foundation also was responsible for creating the first “poster kids” to support a cause. Following a serious outbreak of polio in Hickory, N.C., the National Foundation created posters that featured children who had survived the epidemic. Their smiling faces and strong bodies were a tangible symbol for all Americans of what their donations could accomplish.

“The National Foundation, through its effective use of celebrities, poster kids and other advertising, pioneered grassroots fund raising,” explained Oshinsky. “Prior to the depression, fund raising typically consisted of several very wealthy individuals giving large donations, not generating small donations from the masses.”

By 1954, the National Foundation accounted for nearly half of the $140 million raised by the nation’s eight major health charities. With only 100,000 cases of polio reported that year, it raised $66.9 million. By comparison, the American Heart Association raised $11.3 million with 10 million reported cases and the Arthritis Foundation, which reported 11 million cases, was able to generate only $1.8 million.

Children Used for Testing

The mass experimentation on child “volunteers” that took place in the name of finding a cure for polio would never be possible today given federal guidelines. In 1935, William H. Park and Maurice Brodie of New York University Medical School conducted the first round of human testing by administering a killed-virus vaccine to a dozen children “volunteered by their parents.”

Dr. David Oshinsky, George Littlefield Professor of American History and author of “Polio: An American Story.”

When the results of the Park-Brodie experiment were published and showed no children contracting polio, the researchers were invited to test the vaccine on a larger scale in communities experiencing polio outbreaks. Some individuals suspected these secondary trials actually induced cases of polio but, according to Oshinsky’s research, the experiments were so poorly conducted and tracked it was impossible to prove the allegation.

The Park-Brodie tests were followed later that year by the tests of John Kolmer, a Philadelphia pathologist whose polio research was funded by a group of Philadelphia hospitals and medical schools. Kolmer was testing a live-virus vaccine he had created and, after a sample test on 23 children he claimed had been given parental consent, he moved on to a mass trial of more than 10,000 youngsters. The results were disastrous. At least a dozen children developed cases of paralytic polio attributable to the vaccine and nine of those were fatal.

“The Kolmer fiasco halted human testing of the polio vaccine for more than a decade,” said Oshinsky.

A debate on the benefits and efficacy of a live- versus killed-virus vaccine would continue for decades, with the latter option being viewed as safer by many researchers. Live-virus advocates believed that weakening the poliovirus to stimulate a low-grade infection in the body would produce the highest levels of antibodies to fight the disease. Opponents argued that a killed-virus vaccine, in which researchers “cook” the virus with formaldehyde to inactivate it, would trick the body into producing antibodies without the risk of stimulating even a low-grade case of polio.

In 1950, Hilary Koprowski conducted the next round of live-virus testing using 20 children in a state institution for the “feeble minded and epileptic.” Although he claimed the children were “volunteers” there is no evidence he had approval from the state or their parents.

“Koprowski’s trial, while not harming its ‘volunteers,’ caused a storm of controversy among leading polio researchers based on ethical concerns,” said Oshinsky. “Koprowski staunchly defended the trial, asserting that cures for smallpox, rabies and yellow fever would never have been possible without taking similar risks.”

In addition to the questionable use of human “volunteers,” animal rights activists likely would have waged battle over the use and treatment of monkeys in the search for a vaccine. Throughout the decades, more than 100,000 monkeys were sacrificed to polio research, many of them dying due to poor nutrition and ventilation in transit from India and Africa. From 1949 to 1951 alone, the program to determine how many types of polio existed—a critical link in the effort to develop an effective vaccine—used 17,000 of them.

Rivalry Among Scientists

The National Foundation’s fund-raising prowess allowed it to fund numerous long-term projects for researchers across the country. Its awarding of five-year grants, versus the standard one-year grant, and its coverage of indirect costs revolutionized the funding structure of scientific research and spurred efforts disproportionate to the incidence of disease.

The National Foundation supported research by both Jonas Salk, the first to develop a killed-virus vaccine for mass distribution, and Albert Sabin, the first to introduce a live-virus vaccine for mass distribution. In addition, two female scientists funded by the foundation, Dorothy Horstmann at Yale University and Isabel Morgan at Johns Hopkins University, made significant contributions to the search for a cure. Horstmann was the first to show the viability of a polio vaccine by documenting that poliovirus circulated briefly in the blood prior to entering the nervous system, and Morgan successfully vaccinated monkeys with a killed-virus solution years before Salk’s experiments.

“The National Foundation promoted a collegial approach to curing polio among all researchers, but some scientists tried to undermine the efforts of others in the field,” said Oshinsky. “One dramatic example of this is Sabin’s effort to discredit Salk’s killed-virus vaccine.”

Sabin’s personal papers show an organized effort to communicate with influential people in the medical community and elsewhere to discredit Salk’s vaccine. Sabin expressed concern that a killed-virus vaccine would not be effective and could potentially be dangerous if the virulent strain of virus Salk had chosen was not fully killed during preparations—a worry that would soon become a chilling reality.

In 1954, more than two million children, including six-year-old Randy Kerr shown here, took part in the largest human field experiment ever undertaken.

Photo courtesy of March of Dimes Birth Defects Foundation

“The National Foundation backed Salk and pushed to bring his vaccine to market,” said Oshinsky. “In 1954, Salk conducted the largest human field experiment ever undertaken, immunizing nearly two million children. The testing proved successful and Salk became America’s first celebrity scientist.”

Salk’s success was diminished, however, by a polio outbreak caused by improper preparation of the vaccine for mass distribution by Cutter Laboratories in spring 1955. Allegations later surfaced that government officials, as well as Salk himself, were aware of concerns with the conditions and processes at Cutter but did nothing to block its preparation of the vaccine. Records from the time show that this debacle seriously eroded public confidence in Salk’s vaccine and set back immunizations for the entire summer.

Residual Effects of Polio

Both Salk and Sabin grew poliovirus for their vaccines in the kidney tissue of monkeys. While they didn’t know what simian viruses might be growing in this tissue, they believed that formaldehyde would kill potentially dangerous germs. Since the vaccine was released, more than 40 different simian viruses have been isolated from it, including one that caused tumors in hamsters and led some researchers to warn of a cancerous threat to humans. In 2003, the National Institutes of Health stated that studies conducted in Asia, Europe and the U.S. showed no conclusive evidence of danger to humans from the vaccine.

“Recent outbreaks of polio in parts of Africa and Asia have raised fears that polio is spreading once again,” said Oshinsky. “And in the United States, several hundred thousand polio survivors are struggling with after-effects of the disease.”

A condition dubbed Post-Polio Syndrome (PPS) is believed to affect 25 to 50 percent of polio victims. It tends to appear anywhere from 10 to 40 years after polio and causes a further weakening of the muscles that were affected by the original bout. Doctors have been unable to find a cure for PPS to date.