Gresham College Lectures

Polio: A Cultural History

November 11, 2022 Gresham College
Gresham College Lectures
Polio: A Cultural History
Show Notes Transcript

Polio has a major role in the cultural history of the West. The early symptoms – which were often mild flu-like symptoms – would end in paralysis. Vaccinations against the disease proved controversial, given their trials on incarcerated prisoners and the use of “poster children”.

Epidemics of the disease illustrate the uneven transmission of ideas about health and sickness. They show how the period's germ theories resulted not only in mass deaths, but also in the demonisation of immigrants and poor households. 


A lecture by Professor Joanna Bourke

The transcript and downloadable versions of the lecture are available from the Gresham College website: https://www.gresham.ac.uk/watch-now/polio-history

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- I'm going to start with the Great Cat Massacre. No one knows about this except me? There was a Great Cat Massacre July 1916 in New York. By the end of the month, 72,000 cats had been killed, 72,000, and around 8,000 dogs. Headline, New York Times screamed out the news that cats had been "killed in paralysis fear," "killed in paralysis fear." The Times reported that this fear was due to an epidemic of infantile paralysis, or poliomyelitis, a viral inflammation, itis, of gray, polios, anterior matter of the spinal cord, myelos, which we now know comes in three serotypes or three viral strains. This Great Cat Massacre was not a workers' protest, as in Robert Downton's famous exposition of the massacre of the feline population in Paris in 1730. Those of you who are historians here will know about that very, very famous book, one of the really classics and cultural history, "The Great Cat Massacre," 1730s. Rather, it was a massacre sparked by epidemic levels of polio in New York City, as well as throughout the US. The Crippler, as polio was often crudely referred to, has a long history. We can find it engraved in Egyptian tablets. But it soared to epidemic levels in the 20th century, peaking in the US in 1952 with nearly 14 cases per 100,000 people. I mean, this is serious epidemic. The 1916 polio epidemic, however, was believed to be the largest in the developed world. More than 27,000 Americans were infected, of whom one third lived in New York City. Terror of the disease was intensified by the fact that 80% of those infected were children under the age of five, 80% children under the age of five. One quarter died, okay? Now ironically, the mass killing of cats and dogs was orchestrated by the Society for the Prevention of Cruelty to Animals. Thomas F. Freel, superintendent of the SPCA, complained that his inspectors were being required to work from seven in the morning until one the following morning in order to entrap and exterminate scores of unwanted cats. Their lethal gas chambers were working at maximum capacity. The city's panic was fueled by uncertainty about what actually spread this terrifying disease. Theories proliferated were blueberries, unpasteurized milk, sugar, ice cream, Italian immigrants to blame, or as we now know was the virus spread person to person through droplets or fecal-oral contamination of hands, water, and food. Freel sought to reassure New Yorkers that their cats were innocent. He told the New York Times that despite the statement issued by Health Commissioner Haven Emerson, that cats do not carry the germ of the disease. People were afraid, they were panicking. He wrote, "Since the beginning of the alarm of infantile paralysis, we have been receiving on average 800 requests a day for our men to cull for unwanted domestic pets." Mostly cats. So-called animal guardians, animal guardians is the old term for what we today would call animal rights activists, so animal guardians were surprised to observe that on hearing the alarming statistics on the spread of polio throughout the city, families turned their cats out of doors immediately, and some who had dogs did the same. Their actions not only resisted in the massacre of 72,000 cats, it also, I love this, led to the appearance of pirate cats, the leader of whom was called Wang, a tailless mauve cat from Formosa. Wang. That's a lovely name for a cat. Wang and his cat gang of between 50 and 100 other cats, other pirate cats, terrorized the pious people of the West 80th Street and other residents of the West Upper Side. The cat gang were not only accused of spreading a paralyzing disease, but also of stealing legs of mutton, frightening dogs, and keeping people awake at night by their screeches. The SPCA promised residents, "We're working as hard as we can to ensure that Wang and his band of cats will be rounded up in due course with the other nocturnal nomads of the city." In other words, the Great Cat Massacre of July 1916 fused fears of wild cats who had been cast adrift by their owners with itinerants and morally suspect night workers. Well, it's a fun story, but actually, you know what? New Yorkers were not wrong to panic. Polio was a disease to fear. Around one quarter of people diagnosed with polio woke up to find their limbs were permanently paralyzed, and/or they had difficulties breathing or swallowing. Between 2 and 10% overall died. As a 1941 textbook on the disease said, "It is not death that is feared so much as the crippling aftermath of the disease, a physical crippling which may last a lifetime and impair the activities of an otherwise healthy person." In the 1950s when Americans were asked, "What keeps you awake at night?", fear of polio with second only to the atomic bomb, okay? Fear of polio second only to the atomic bomb. Such fears were stoked up, of course, by media representations of the disease. Although at least 150 movies, at least ones I know of, referenced polio, the most famous of these, of course, is Alfred Hitchcock's "Rear Window," released in 1954, just before the massive vaccine campaign against polio was instigated. The film contributed to the stigma and terror associated with polio. Ironically, even organizations dedicated to funding public health education and vaccine research stoked up terror of the disease. 1947, for example, and this is the one that is, I think, one of the worst, the National Foundation for Infantile Paralysis released a film called "In Daily Battle." The film, which was unofficially known as "The Crippler," used techniques drawn from horror films, especially German expressionist cinema. You know, in other words, it used shadows a lot, so there's always a shadow hovering over, shadows as the embodiment of the virus poliomyelitis. This ominous shadow speaks, saying things like, "I specialize in grotesque twisting and deforming human bodies. That's why I'm called The Crippler." The shadow moves from the countryside to the city, striking down people as it goes, laughing in a sinister manner. Virus poliomyelitis says, "As you probably know, I'm very fond of children, especially little children." Now, as was the case during the Great Cat Massacre of July 1916, a fear of polio was fueled, as I've already mentioned, by uncertainty about what actually caused it, and therefore, what steps could people actually take to protect themselves and their families. Was polio transmitted through the air? Through physical contact? By flies? In 1912, the author of an article

entitled "Paralysis:

The New Epidemic," warned readers that, "The fly is a carrier of infection. Kill the fly. Not one fly should ever be allowed in or around a house. This is imperative. Never let a fly touch a baby." Or could the root of transmission be traced back to classrooms, playgrounds? Were school children who shared pencils passing on the disease? Or were these children being infected through swimming in municipal pools? These were unanswered questions until the 1940s. Now, without reliable evidence about the transmission of the disease, authorities instigated these major public health campaigns, and they targeted poor and marginalized communities although there was, and there certainly is now, but there was at the time good evidence that polio was actually more prevalent in middle class households. The poor were stigmatized, and particularly Italian and Jewish immigrants as well as, of course, no surprise here for those of you who heard my talk on TB, residents of urban slums. Vegetables had to be washed before eating, unpasteurized milk avoided. Playgrounds, swimming pools, and theaters were shut down. Library books were fumigated. Areas with high incidence of polio infections were placed in lockdowns. Patrols were set up to ensure that potentially infected people remained in their homes and immediate neighborhoods. Swat the Fly campaigns were instigated because flies were thought to transmit the virus. You know, flies were believed to transmit the virus from the so-called unhygienic homes of poor people to wealthy suburbs. It's really interesting. Flies never seem to fly in the opposite direction. (audience laughing) Anyway, in the midst of this kind of uncertainty, scientists worked day and night to identify the causes of this devastating disease. Part of the reason they struggled so long to identify it, to identify the precise nature of polio, was because the disease was caused by a virus, not bacterium. It was too small to be seen under microscopes used at the time. In the end, solving the mystery of polio was central to the growth of the scientific discipline or scientific specialty of virology itself. The virus was only identified in 1909 by the Viennese physician Karl Landsteiner. The following year, Simon Flexner, laboratory director of the Rockefeller Institute for Medical Research, was able to show that it was infectious. Flexner believed that it was spread through inhalation and did not circulate in the digestive tract or blood, and he was wrong in this. He and his collaborator, Hideyo Noguchi, insisted that polio was a disease of the nervous system, and they had this wonderful poetic descriptions about the innumerable bright dancing points that they began to see through their microscopes. A major step forward to an understanding of the transmission of the virus was made in the 1930s by these two men here, John Paul and James Trask of the Yale University School of Medicine. They were the ones who established that the virus entered the body through the mouth, where it replicated in the lymphatic tissues of the intestines or oropharynx before entering the bloodstream and then the central nervous system. These scientists also solved the mystery of why in the world was this disease more likely to affect middle class children, okay, why? As early as 1912, Canadian physician Helen MacMurchy informed readers that, "victims of this disease are not among the poor or delicate. Often the vigorous and healthy are attacked, and those who have comfortable homes and good care." In the past, most children would have been infected with polio as infants, but they would've only experienced mild flu-like symptoms. Being infected in infancy, however, would have given them immunity for life. The increased obsession with cleanliness in wealthier homes changed this. By cutting exposure in infancy, children were more at risk of developing polio later in their life. In other words, polio outbreaks were a direct outcome of sanitization of homes and workplaces, making polio a classic example of a disease made worse by progress. A relatively mild epidemic, endemic, sorry, endemic disease became a deadly epidemic one. Now, as with TB, as we saw in the last lecture I gave on the series, most patients were treated in their communities by local medical professionals. These local doctors watched in horror as young patients who they might have treated since infancy appeared with symptoms typical of a summer cold, for example, headaches, upset stomachs, fever, but then advanced with terrifying rapidity to paralysis or difficulties breathing or swallowing. Many of these physicians would've found the task of distinguishing polio from other diseases, such as cerebral spinal meningitis, impossible. Now, it could be done by examining spinal fluid, but lumbar puncture would've been beyond the capacities of most local doctors, most regional doctors. It was also a very painful procedure, making, you know, local doctors actually quite reluctant to inflict yet more pain on people, and children particularly, who were already suffering. Not surprisingly, many polio sufferers therefore turned to alternative means of managing the disease. After all, treatments, formal treatments, were expensive. At a time when the median annual wage was less than $900, treatment, that's a year, treatments ranged from 2,000 to 3,000 the first year, and between $75 and $150 every year thereafter. So in rural areas, desperate families might, for example, seek the expertise of bone setters, who would vigorously massage the affected limbs. Others were driven into the arms of unorthodox practitioners, who resorted to a vast range of unproven practices. And one of my favorites is they would rub the body with kerosene. Okay, now, orthodox medicine prescribed absolute rest and immobilization. Splints, braces, were used to immobilize limbs, sometimes for nine months, sometimes, in fact, for a year. But, you know, for long periods. Many patients underwent painful orthopedic surgeries aimed at straightening their limbs. From 1928, severely paralyzed people, patients, were encased in iron lungs, most commonly the Drinker tank respirator, named after Philip Drinker of Harvard University, which was a negative pressure ventilator. So what happened is patients would be sealed in these heavy, bulky cylinders from the neck down while alternating positive and negative air pressure enabled them to breathe. (Joanna deeply breathing) They remained in the device until their recovered muscles strengthened. Many died. Imprisonment inside an iron lung meant that patients were thrown overnight into a situation where they were entirely dependent on nurses, family members, other caregivers, just for everyday survival. Marshall Barr, he developed polio in 1949 when he was seven years old, he had to be placed in an iron lung after he had a relapse in his twenties. He found that even the most basic activities, eating for example, required incredible amount of thought and care. He recalled, "You can eat in the iron lung because your head is outside, but the rest of your body is inside. However, since you're flat on your back, you really need to be careful when you swallow. You have to swallow in rhythm with the machine because it's pulling your diaphragm in and then pulling it out again, pushing it out again. You just wait until it's breathing out and then you swallow." Although Barr was actually remarkably stoical about his life in the iron lung, really remarkably stoical, I'll get to that in a minute, others lamented, of course, their loss of autonomy and privacy with its accompanying infantilization. Their only access to the wider world was provided by a mirror. There we go. A mirror that suspended above their face so they could see what was happening behind them. The death of fellow patients was signaled by a sudden sinister silence that fell on the ward when one of the noisy breathing machines was switched off, and nurses would then all of a sudden rush in to turn everyone's mirror to face the rear of the machine so that survivors wouldn't see the corpses being wheeled out behind them. Now, from the early 1940s, polio patients who did not need the assistance of the iron lung, but had been left with twisted limbs, were presented with an alternative to the standard treatment involving immobilization. Okay, now until this point, till this time, the medical establishment had concluded that polio was a neurological affliction, they believed. When connections between the muscles and the nerves were severed, the weakened muscles atrophied, distorting limbs or paralyzing patients. This was their rationale for forcibly straightening limbs and immobilizing them. Sister Elizabeth Kenny. Sister, she's not a nun, that's not a religious title, it's a medical title. Sister Elizabeth Kenny, snowy-haired Australian bush nurse who had immigrated to Britain, she had different ideas. She argued that immobilization was exacerbating the problem faced by polio sufferers. Believing polio to be a systemic disease, she wanted to focus, she believed they should focus, on muscles, in particular muscular spasms. Rather than immobilization, she argued that patients needed intense physical therapy carried out by nurses, or indeed by the patients themselves, using hot compressors to reduce spasms. Now, this was extremely innovative to put it mildly. Kenny promoted a shift away, and this is important, a shift away from viewing polio as a deformity which required the straightening of limbs, to polio as creating a disability. The emphasis on deformity had encouraged, you know, techniques that tried to make people normal, while Kenny's focus on disability stressed functionality and the need to enable polio sufferers to live full lives. Her therapeutics were also presented a different way to think about the role of pain in treating polio patients. For many orthodox physicians, pain was actually regarded as necessary for any return to normality, while for Kenny, it was a symptom of underlying pathology that needed to be eradicated, okay? So it's a big shift, these things. Now, the male medical establishment (growls) were appalled. They held Kenny in contempt, claiming that she was an ignorant fraudster or even mentally unhinged. They were not impressed by her trust in hands-on experience with patients as opposed to laboratory experiments and clinical trials. They were, and not without good cause, they were riled by her brash, opinionated mannerisms. Now, polio patients and their families tended to disagree. Such was her celebrity status that in 1946, Kenny was immortalized in film. It's a brilliant film, by the way. The glamorous star Rosalind Russell, who played Sister Kenny in the film of that name, won a Golden Globe Award for Best Actress in a Leading Role and was nominated for an Academic Award for Best Actress. Five years later, a Gallup poll ranked Kenny in first place as America's most admired woman, beating the celebrated Eleanor Roosevelt. (tongue clicks) Not surprisingly, this further irked orthodox practitioners. Their clashes with Kenny were legendary, exposing the gendered tensions between a largely male establishment and a woman without scientific credentials who challenged their authority. Kenny's popularity with patients and their families was part of a wider move towards understanding the harms carelessly and thoughtlessly inflicted on people who were regarded by some as abnormal due to physical difference. The stigma associated with being disabled meant that families sometimes sought to hide them away. Employers preferred to give jobs to able bodied. In the street, strangers gawked voyeuristically. A large proportion of polio sufferers ended up confined to institutions for cripples, where visiting hours were restricted, facilities were bare, and there was little investment in up to date technologies. Isolation and loneliness were endemic. In his memoir, "Bottom High to the Crowd," 1973, polio sufferer Don Krikendall described visiting the crippled children's home in Fargo, North Dakota in the 1930s. He was shocked to see the unkempt children in drab hospital garb, children with listless limbs and vacant stares. He observed that the children in wheelchairs all had sad, unsmiling eyes. For such patients, the range of activities, sorry, the range of anxieties could be overwhelming. Would they ever become normal? Would they always have to endure the shame and humiliation of dependency? Had they been abandoned by their family, friends? Would they be able to catch up with peers in terms of education or careers? Were they to be forever condemned to fall short, letting everyone down? Physical rehabilitation firmly founded on Protestant self-help doctrines and the need to pursue normalization dominated their waking lives. This helps explain why many polio sufferers, especially in the US, turned for inspiration to Franklin D, Roosevelt, FDR, who had contracted polio in 1921 and went on to become US Senator, Governor of New York, and then President of the United States. Of course, FDR was able to mask the full extent of his disability through the resources made available to him as president and through the tacit agreement by journalists not to often, he was an exception, not to photograph him in his wheelchair or wearing braces. However, the thousands, many thousands of letters written to him by polio sufferers, testify to the strength of their identification with him. And just reading these letters is heartbreaking. Now, this is not to deny that there was extreme bitterness and anger expressed by polio sufferers about being constantly reduced to their disease. They were polios, as if their illness kind of constituted their sole identity. Being labeled cripples similarly stamped them as deformed, hideous even. as Jim Marugg explained, "I am not polio. I am bigger than this thing that has happened to me." Polio sufferers complained about the huge pressures placed upon them to behave in certain ways. And by the way, these things continue today. Perhaps most galling was the mantra that cure, if not survival itself, depended on them fighting the virus with every inch of strength that they possessed. And they were expected to accept, embrace, the tough love of nurses and other caregivers with a smile. In the 1930s, J. Brooks Emory insisted that what was needed was proper medical treatment and the right attitude. Exaltations to be cheerful, gutsy, and relentlessly positive were endorsed by the association for the Aid of Crippled Children. They contended, so this is a formal association for them, they contended that, "The crippled child had to express his, hmm, express his pain, his desires, his hopes, and his anguish only in the most superficial manner. If he expresses his bitterness deeply or with any sense of personal tragedy, he risks alienating the non-handicapped. As long as the handicapped individual is cheerful and lighthearted, he is, like the jolly fat boy, usually accepted by his peers." Posters published by the National Foundation for Infantile Paralysis also sported cheery, brave children who through sheer willpower and passive submission to doctors and nurses would eventually be able to walk across a fundraising catwalk or sports field. Polio sufferers sought to live up to such demands, nervous about not seeming sufficiently grateful. This was the point being made by Brenda Serotte in her 2006 memoir entitled "The Fortune Teller's Kiss." Serotte had been brought up in a Jewish household of Turkish descent, living in the Bronx. 1954, when she was eight years old, she contracted polio and was sent away to be cured. Like many young children, she believed that she was to blame for becoming paralyzed. In her words, "I got the impression that I'd done something really bad this time to warrant such punishment." She later recalled that she, "heard the words guts so often that by the time I was 10, it had become my mantra and middle name. All of us, every kid at all three hospitals, was brave, courageous, gutsy." Serotte admitted that she was indoctrinated with the idea that, "I could do anything, miraculous things, but that I'd never, ever achieve the physical mobility I wanted unless I pushed harder than anyone else in the world. And if I did not reach my goal, it meant that I didn't work hard enough, didn't try my best." Guts were necessary not only for her own wellbeing, but also in order not to let everyone down. A puritan worth ethic pervaded the treatment, convincing polio patients to work hard, harder, cheerfully if they were to reap the rewards of normality. Even in more recent years, the idea that suffering makes a person better, stronger, appears time and again. As late as 1996, this was the view of George Will in an article about Roosevelt entitled, "Don't Hide His Source of Strength." According to Will's Washington Post article, Roosevelt probably would not have become president and certainly would not have become the tough president that he was without passing through the furnace of polio. In the US, major campaigns were started to help alleviate the sufferings of polio patients and promote research. The most prominent is one I've already mentioned; that is, the National Foundation for Infantile Paralysis. This was instigated by Roosevelt who passed it on then to Basil O'Connor. They urged people to send in small donations, dimes, directly to President Roosevelt. This was the March of Dimes, a term coined by the comedian Eddie Cantor, a witty play on "The March of Time," which was a very popular newsreel series shown in movie theaters. 1938 alone, the March of Dimes received $1.8 million worth of donations. By 1945, annual contributions had reached 19 million. As one White House employer complained, "The government of the United States darned near stopped functioning because we couldn't clear away enough dimes." These campaigns were based on a new model of bottom up philanthropic fundraising. They saw mothers knocking on neighbors doors, collecting money. The National Foundation for Infantile Paralysis actively argued against federal funding for research. Why? It's communistic, anti-American. Of course, polio suffers fought back. Some survivors even claimed that polio enhanced their talents. And I'm not going to go through all of this, but there's a vast range of artists and musicians who survived polio. This is just a tiny, tiny group of some of my favorites. (laughs) You get my musical tastes, I hope. (laughs) And theater tastes. Anyway. Including, you know, Joni Mitchell, the reggae group Israel Vibration, and so on and so on. And of course Ian Dury, if you really want what I think. I mean, I dislike... Not my kind of music, (laughs) but if you really want some really interesting musical reflections on polio, this is where you go. You know, just go into YouTube, the "Dance of the Screamers." The title says it all. And "Hey, Hey, Take Me Away," which is about the institution where he spent some time, really graphic descriptions of sexual abuse and casual violence. So just type that in and have a look, but turn down the volume. The campaign to reduce and eventually eradicate polio was led by scientists searching for an effective vaccine. 1930s saw some failed experiments. Most tragically, the vaccines created independently, incidentally, by John Kolmer and Maurice Brodie infected recipients and killed others and did really damage in terms of reputation of vaccines. Kolmer had tried to weaken the poliovirus so that when it was injected into people, they would develop protective immunity. But when he tested his vaccine on 10,000 American and Canadian children, 10 became paralyzed and five died. Jonas Salk and Albert Sabin were more fortunate. Salk created a killed vaccine while Sabin experimented with a live but weakened one. Now, the advantages of Sabin's vaccine included the fact that it could be administered orally, just on a sugar cube, and it stimulated the immune system really, really quickly, while Salk's vaccine required three injections in addition to a booster while Sabins only needed a single dose. Now, the story of the bitter rivalry between these two men, both extremely competitive and disagreeable men, has been told innumerable times so I'm not going to tell this very familiar story here. Their differences were really as much about personal style as about scientific content. It was a medical drama that drew its oxygen from the structure of the US healthcare system, the early growth of virology as a discipline, the politics of the Depression and the Cold War. Unfortunately, their legendary rivalry has led historians of science to overlook the scientific genius of a John's Hopkins University virologist called Isabel Morgan. She was actually the first scientist to identify the three serotypes of poliovirus, all of which needed to be taken into account if you're going to have a successful vaccine. Her killed virus vaccine culminated in the approval of Salk's vaccine in 1955. Morgan did not reap the benefits of her research because in 1949, when she was at the height of her career, she married, leaving her laboratory behind. It was Salk's research that initially triumphed. He was ruthless, keen for scientific breakthroughs. He tested the virus on his wife and children before setting out to persuade millions of parents and teachers to allow their children to become guinea pigs, effectively. His field trial was the largest test of a medical product in the US. It eventually involved 1.8 million people, some of whom were given the vaccine, others were given a placebo, a saline injection, others were given nothing. So it was also a double blind trial, so this was a really big trial. It was also a double blind trial. In other words, neither the doctors giving the injections, nor the participants knew whether or not they had actually been vaccinated. The trial was a sensation, with the first shot being given on the 26th of April, 1954, to this little boy here, Randy Kerr of Fairfax County, Virginia. And the results concluded that the vaccine was between 60 and 80% effective. Showing a cavalier attitude to accuracy, newspapers throughout the country declared polio was conquered. 60 to 80% efficiency. I mean, goodness. Anyway, polio was conquered. Salk became the celebrity scientist, much to the annoyance of his team, members of his laboratory, whom he somehow forgot to credit. Many scientists, including Morgan, contributed to Salk's success, but their names were buried under a colossal clinical ego. The adulation came to an end. In the US, unlike Canada, private drug companies manufactured and distributed the virus, the vaccine, sorry, in the spring of 1955. So it's private drug companies, unlike in Canada, where it's state. Spring 1955, one of these companies, Cutter Laboratories in Berkeley, California, released six lots of the Salk anti-polio vaccine that contained live poliovirus. They had not tested their vaccine lots sufficiently. What used to take four weeks to test in 1954 was taking only one day in 1955. Think profits. In other words, their manufacturing processes had not fully inactivated the virus. Salk had assumed that there was a linear relationship between the amount of virus that would be killed by these chemicals and the length of time taken to treat the virus. This was mistaken. 200 people became ill with polio. 11 died. It was a disaster that is often compared with other tragedies associated with vaccines, such as the 1930 Lubeck tragedy in which the BCG vaccine, which I spoke about last time, infected 173 neonates with TB and killed 72, the vaccines against yellow fever administered to US Army troops 1942, which led them to contract hepatitis B, and so on and so on. In the case of polio, a lawsuit subsequently cleared Cutter Laboratories of negligence, but made them liable for damages. This is an important legal ruling, because it meant that even if a company was not at fault, they could still be forced to pay damages. Some commentators claim that this legal doctrine of liability without fault is at least partially responsible for the hesitancy of pharmaceutical companies to produce vaccines subsequently. The Cutter incident had major effects. The American Medical Association accused the National Foundation for Infantile Paralysis of chasing profits and acclaim at the expense of scientific precision. It was pointed out that too much pressure was being placed on manufacturers to distribute a magic bullet to solve the problems of complex diseases. The furore also shifted attention to Sabin's research into the live virus vaccine. Due to the fact tensions between the US and Russia had improved with the death of Stalin in 1953, Sabin was able to collaborate with Russian scientists. Together they vaccinated 10 million Russian children, demonstrating that Sabin's vaccine was safe. Now, the introduction of vaccine was followed by a steep decline in the incidence of polio, but it didn't benefit everyone. Polio survivors found themselves sidelined. There were other more exciting scientific challenges to conquer. The vaccine dramatically reduced the incidence of polio, however, had a less positive effect for patients who had already been infected. These patients had been praised for their guts, their courage, their resilience. After the success of vaccinations, they were cast aside and basically forgotten. As distinguished writer and polio survivor Ton Gould put it

in "A Summer Plague:

Polio and its Survivors," he came from "a generation of polio patients who had been born too soon. They were suddenly ignored as embarrassing emblems of their own poor timing, clumsy enough to get polio before the vaccine that could have protected them was found." Even worse, 40 years after the acute polio phase, polio sufferers who thought that actually they were better, so 40 years after they thought they were better, suddenly there was a revival of their symptoms, especially severe muscle fatigue, joint and muscle pain, cold intolerance, gastrointestinal upsets, and sleep difficulties. Okay, now so far in this talk, my talk has been really terribly homogenizing. You know, we have to remember the effect of racism and the effect of ableism to the story. Pathographies are illness narratives, so people who are ill writing their story, illness narratives. These are ones that prioritize the voices of the sick, of patients. These are highly biased towards white, educated, middle class patients, many of of whom actually were professional writers before they got the disease. Polio survivors of color are less visible to the historians because they're typically cared for in general hospitals, which lack specialist treatment facilities and lack the detailed archival traces that specialist and private hospitals often possess. The much lauded Polio Hospital at Warm Springs, Georgia, which was frequented by Roosevelt, who invested huge amount of money in it, famously swimming his way to health, excluded African Americans from treatment. Segregation led to the establishment in 1941 of the Tuskegee Infantile Paralysis Center for African American sufferers, which also, by the way, trained black medical personnel to work in their communities. There was even the belief that black people were immune to polio, a useful justification for underfunding. The result was a higher mortality rate for black sufferers of polio as John Chenault, the head of orthopedic surgery at Tuskegee's University, John Andrew Memorial Hospital, and later director of the hospital's infantile paralysis unit, was able to demonstrate. The fact that Sabin tested his vaccines on incarcerated prisoners in Ohio, you know, just think about, you know, consent issues here, the fact that he tested his vaccines on incarcerated prisoners in Ohio also meant that there was a disproportionate experimenting on people of color. Ableism was also prominent, and I mean this two ways. First, humans at the bottom of the ableist pecking order were fair game. The first person to test a live virus on humans was Hilary Koprowski at the privately funded Lederle Laboratories. His subjects, who did he test them on, were young, feeble minded, and epileptics at the Letchworth Village in New York. When Salk was given approval by the National Foundation for Infantile Paralysis in 1951 to test his vaccine on humans, up until this time he was testing on monkeys, he turned to the residents of the D.T. Watson Home for Crippled Children and the Polk School for the Retarded and Feeble Minded. He bypassed parental consent for the experiments, most of the parents of the children had IQs under 50 anyway, by persuading the Pennsylvanian state authorities that the experiments were a humanitarian enterprise. Second, ableism was contested by polio sufferers. Speaking out against the unrealistic expectations and individualization of illness was not a new phenomenon. As we have seen, popular prejudices dictated that patients and their families had to adopt, were expected to adopt the hard way, making true men breadwinners and good women wives and mothers of sufferers. This is what sociologist Irving Kenneth Zola was fuming against when he noted that, "If a Franklin D. Roosevelt could overcome handicaps, so could and should all the disabled. And if we fail," he was a sufferer, "And if we fail, it's our problem, our personality defect, our weakness." This is what early disability experts, activists, I should say, fought. So just to conclude, the talk started with the Great Cat Massacre of July 1916, during which 72,000 New York cats were killed as a result of a polio scare. The Great Cat Massacre fused fears of wild cats, including the leader of tack cats, the tailless mauve Wang from Formosa, with itinerants and morally suspect night workers. The virus that caused polio devastated millions of lives, and we owe huge debt to the scientists and other medical personnel who sought and eventually succeeded in creating a vaccine that would protect people in the future. They did so at a cost through exploiting the vulnerabilities of children from poor homes, children and adults with learning difficulties, prisoners, and people of color. The fight back was slow coming, but determined. People who had been stigmatized as polios or cripples refused the label. Through consciousness raising and activism, they insisted not only on their rights to accessible physical and social spaces, but also on their complex humanity. In this way, polio survivors were important in the disability and patients' rights movements, drawing inspiration from and inspiring LGBT activism, women's liberation, students' activism, anti-nuclear campaigns. They started mobilizing against a world where their needs were willfully ignored, or worse, denied. Early targets were curbs, steps, inaccessible bathrooms. Men like Ed Roberts, for example, was the first wheelchair user to attend the University of California Berkeley, where he lobbied for wheelchair access, counseling, and services that would enable disabled people to live in the community. He was the founder of the advocacy group, The Center for Independent Living. Disability activists resisted the assumption by people in "normal land," otherwise known as TABs, temporarily able bodied, for assuming that polio survivors possessed an identity entirely fixed or fixed entirely according to their impediment. They were increasingly suspicious of the tyranny of the medical examiner. And crucially, they contested the idea that a virus alone creates a disability. Rather, scientific ideologies, public understandings, social policy, all interact with a virus to create a disease labeled a disability. And that's all I've got to say. Thank you. (audience applauding)