Wilson on Williams, 'Paralysed with Fear: The Story of Polio'

Gareth Williams. Paralysed with Fear: The Story of Polio. New York: Palgrave Macmillan, 2013. Illustrations. xvii + 354 pp. $29.99 (cloth), ISBN 978-1-137-29975-8; $20.00 (paper), ISBN 978-1-137-50658-0.
Reviewed by Daniel J. Wilson (Muhlenberg College)
Published on H-Disability (July, 2015)
Commissioned by Iain C. Hutchison
Gareth Williams’s recent history of polio, Paralysed with Fear: The Story of Polio, traces the rise and fall of epidemic polio in the twentieth century. Focused on the medical and scientific aspects of the disease, the book pays relatively little attention to the men and women who had the disease and then lived with permanent muscle weakness and paralysis. Williams traces the clinical and laboratory research on polio from the late eighteenth century to the late twentieth century, and he rehearses the familiar story of the competition between Jonas Salk (1914-95), Albert Sabin (1906-93), and others to produce an effective and safe vaccine. While Williams is attentive to polio epidemics and polio research worldwide, much of his book is focused on the United States where the polio epidemics were the most severe, where much of the research leading to the vaccines was conducted, and where the fundraising strategies of the National Foundation for Infantile Paralysis turned polio into the most feared childhood disease of the mid-twentieth century.
Williams begins with an overview of polio and the early history of its discovery. He describes polio as “one of the diseases that defined the twentieth century” (p. 26). In chapter 2, “The Crippler,” Williams briefly explores the impact of the disease on the individuals who were infected. As he notes, paralysis was a relatively rare complication of the disease; most individuals infected had no symptoms and no paralysis. Only about 1 percent of individuals infected with the virus experienced paralysis, and the extent of that paralysis varied significantly. He claims that “the acute attack was just the start of a grim life with paralysis, deformities, and disability” (p. 32). While a significant number of polio survivors did indeed live with paralysis, deformities, and disability, many, including the reviewer, would strongly disagree with Williams’s assessment that their lives were “grim.” This chapter concludes with several brief accounts of lives following polio.
In succeeding chapters, Williams traces the history of medical research into the poliovirus and the disease. For the late nineteenth and early twentieth centuries, he explores all sorts of investigations into the illness, many of them ultimately dead ends or wrongheaded. He frequently passes judgment on the scientific validity and value of these experiments, many of which were dubious at the time and which now appear to have been bad science. What Williams seems to forget is that these scientists and doctors did not have our scientific knowledge and tools. They were working with a disease-causing entity they could not see and with a clinical picture that was anything but clear and straightforward. Perhaps the most notable of these wrong turns was the conviction of Simon Flexner (1863-1946) that polio entered the body through the nose, based on his ability to induce infections in monkeys by injecting their nasal passages with the virus. Flexner’s prestige as director of the Rockefeller Institute in New York meant that his views were not seriously challenged for more than two decades. In addition to Flexner’s misguided approach, Williams explores other reasons advanced as the cause of polio, including “teething, pesticides, ptomaine poisoning, electrical appliances or misaligned vertebrae in the neck” (p. 69). Even when scientists focused on germs as the cause of polio, there were several early candidates, including streptococci, bacteria, and “globoid bodies” (p. 79). After disposing of several of the wrongly identified causes of polio, Williams turns to the scientific and medical explorations that eventually led to our modern understanding of the poliovirus and the disease.
In a chapter titled “Fear Is the Key,” Williams describes how fear of polio came to be pervasive, especially in the United States following the large polio epidemic in 1916 in New York and surrounding states. He looks at several epidemics in the United States and compares them to epidemics occurring elsewhere, including England and Sweden. Williams argues that several factors conspired to keep the threat of polio before the American public and, thus, to keep fear levels high. These were the press coverage of the 1916 epidemic with its twenty-seven thousand cases and six thousand deaths; the well-known case of Franklin D. Roosevelt (1882-1945); and the fundraising campaigns of Basil O’Connor (1892-1972), the National Foundation for Infantile Paralysis, and the March of Dimes. He describes the fundraising of the March of Dimes as a terror campaign based on a “classic stick-and-carrot strategy, but with both elements carved from fear” (p. 133).
Following his account of fundraising through carefully manipulated fears, Williams devotes a chapter to the care of acute and recovering polio patients. In “First Do No Harm,” Williams argues that many of the treatments devised for the rehabilitation of polio patients were barbaric, painful, and often useless. As with his fascination with the wrong turns of polio research, he is equally fascinated with the more unusual and bizarre polio treatments contrived to prevent and correct the typical deformities of paralytic polio. He characterizes many of these treatments as “forms of torture” (p. 141). There is also a brief discussion of the work of Sister Elizabeth Kenny (1880-1952) whose method of hot packs and guided therapy eventually became the standard for polio care by the 1940s, and he credits her with helping to end immobilization as the standard polio treatment. The chapter includes a discussion of the development and use of the iron lung for patients whose paralysis left them unable to breathe on their own. While he acknowledges that the iron lungs saved some lives, and that some individuals lived a long time reliant on the iron lung, his analysis stresses that “life inside the iron lung was difficult and sometimes horrific” (p. 157). He concludes the chapter by examining briefly some of the other therapies proposed and often tried in the effort to cure those left crippled by polio. Although he discusses the impact these therapies had on the patients who endured them, his emphasis is on the men and women who developed the therapies rather than the experience of those who were being treated.
Chapters 8 through 10 focus on the scientific effort to develop a successful vaccine. There were several contenders for this prize and Williams stresses the competition among these scientists. He characterizes the campaign as a “lively saga, in which scientific endeavor and the thrill of discovery were often eclipsed by the baser aspects of human nature [which] was not a dignified unfolding of the scientific process, but an unseemly race which often descended into backstabbing and bitchiness” (p. 168). Williams begins with the early history of vaccination devised by Edward Jenner (1749-1823) for smallpox and with the failed polio vaccines developed in the 1930s by Maurice Brodie (1903-39) and William H. Park (1863-1939) and the competing vaccine created by John Kolmer (1886-1962). The failure of these vaccines to protect against polio and, in a small number of cases, vaccines’ actually being a cause of the disease, discouraged vaccine research for years. He then turns to the story of Salk and his killed virus vaccine. Rather than the triumphalism that marks many accounts of Salk’s achievement, Williams emphasizes the problems associated with the vaccine. Then, in a chapter unfortunately titled “Poles Apart,” Williams describes the intense competition between two Polish immigrant scientists, Hilary Koprowski (1916-2013) and Sabin, to develop an attenuated live-virus vaccine. While Williams discusses the science behind Koprowski’s and Sabin’s achievements, he seems more interested in the intense competition between the two men and their jockeying for financial and scientific support. Both eventually developed viable and safe vaccines, but for a variety of reasons that Williams explores, Sabin’s vaccine became the widely adopted and standard vaccine in most countries for several decades.
In the last three chapters, Williams details the history of polio subsequent to the widespread adoption of the Salk, and then the Sabin, vaccines. Most dramatically, of course, was the significant reduction of polio cases in those nations that conducted organized mass vaccination campaigns, which after the early 1960s usually employed the Sabin vaccine. He examines movements in several countries to resist and oppose vaccination, often for religious reasons. And he explores more unusual consequences, such as the alleged connection between polio vaccines and the development of AIDS in central Africa, an idea he dismisses. He also describes some of the challenges facing the World Health Organization’s polio eradication campaign that has restricted polio to a handful of countries in Asia and Africa, but has failed to bring the campaign to a successful close because of political and military strife in such countries as Afghanistan, Pakistan, and Nigeria. Williams includes brief biographies of key individuals in the effort to understand and conquer polio, focusing on their lives following their significant polio contributions.
Williams’s style is breezy and cheeky, and his book is an easy read. The scientific aspects of the conquest of polio are clear and easy to understand. Though focused on the American experience, his account includes significant developments in other nations. There are, however, errors that mar the text. For example, Haven Emerson (1874-1957), health commissioner of New York City during the 1916 epidemic, did not invent the Emerson iron lung. His son, John Haven Emerson (1906-97), developed an iron lung that improved on the original design of Philip Drinker (1894-1972). Williams also states that O’Connor “sacked” the writer Paul de Kruif (1880-1971) in 1936. In fact, de Kruif resigned from the National Foundation for Infantile Paralysis on August 10, 1941, in a dispute with O’Connor over the failure of the foundation to award a research grant to a friend. Errors of this kind undermine confidence in Williams’s overall account.
Williams’s Paralysed with Fear places the focus clearly on the medical and scientific quest to understand polio and to produce a successful vaccine. Although he recounts the many successes on the way to effective vaccines in the 1950s, he is more interested in exposing the flaws of modern science and its practitioners. He pays careful attention to powerful egos, sloppy research techniques, competition among scientists, and outlandish and bizarre theories and treatments. He is also skeptical of earlier triumphalist accounts of the National Foundation for Infantile Paralysis, O’Connor, Salk, and Sabin, finding all too human flaws in the running of the organization and in the lives of the three men. He also relies significantly on the work of previous historians, including John R. Paul, Jane Smith, David Oshinsky, and Paul Offit. Still, readers seeking an engaging account of the polio epidemics from an English perspective will find much to appreciate in Williams’s volume.
Readers of H-Disability may, however, be more disappointed. Williams clearly adopts a medical model of disability in which the emphasis is on the doctors and scientists engaged in trying to understand the disease and to treat patients afflicted with it. There are brief biographies of several individuals who had polio and a chapter devoted to the treatment of polio’s characteristic deformities. However, that chapter deals almost exclusively with the medical professionals who designed the treatments rather than with the patients who endured them. When he addresses the lives of polio survivors, he concludes that “the acute attack was just the start of a grim life with paralysis, deformities and disability” (p. 32). That conclusion is contradicted by the mini-biographies included in his book, as well as by the many polio memoirs published in the last fifty years and a growing body of scholarship that includes my Living with Polio: The Epidemic and Its Survivors (2005). There is no denying that many polio patients and survivors had experiences that can only be described as grim, but most polio survivors proved to be amazingly resilient in building good lives in spite of their paralysis and deformities and the social and physical barriers that society placed in their path. Readers seeking to understand what it was like to experience acute polio and the many disabilities resulting from permanent paralysis will have to look elsewhere.
Printable Version: http://www.h-net.org/reviews/showpdf.php?id=43474
Citation: Daniel J. Wilson. Review of Williams, Gareth, Paralysed with Fear: The Story of Polio. H-Disability, H-Net Reviews. July, 2015.
URL: http://www.h-net.org/reviews/showrev.php?id=43474

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