Read an Excerpt

Living with Polio

University of Chicago Press

Introduction

Polio begins innocently enough with the symptoms of an intestinal virus, fatigue, nausea, and a fever. In more than 90 percent of the infections, the virus remains in the alimentary and intestinal tract, does no permanent damage, and conveys lifelong immunity to that type of polio virus. However, in less than 2 percent of the cases, the virus invades the nervous system, where it damages or destroys the anterior horn cells of the spinal cord. These spinal cord cells are part of the motor neuron system, and their damage or destruction produces the paralysis associated with polio. Because polio is highly contagious, children, adolescents, and adults diagnosed with polio were usually quickly whisked away to the isolation wards of the nearest hospital accepting polio patients. Here, separated from the support of parents and family, these patients endured creeping paralysis as doctors and nurses stood by unable to do more than make them comfortable while the disease ran its course. Only when the acute infection waned could patients and doctors begin to assess how much paralysis had resulted from the damage done by the virus. Polio patients whose muscles were paralyzed faced months, perhaps years, of arduous physical therapy to strengthen weakened muscles and to compensate for those atrophied because their motor neurons had been destroyed. In addition, many polio survivors would undergo repeated surgeries to fuse bones or to transplant ligaments and muscles in an effort to improve function.

In spite of the best efforts of the patients, their therapists and surgeons, many survivors ended rehabilitation still significantly disabled by their paralyzed muscles. At that point, polio survivors confronted the challenge of reconstructing lives so abruptly altered by the disease and of finding ways to live, to succeed in school and work, and to have a family in spite of their disabilities. And then, after having lived with their familiar impairments for decades, polio survivors discovered to their dismay that their bodies were failing them once again. After pushing their bodies for two to three decades, many began to experience new pain, fatigue, and muscle weakness with what came to be called post-polio syndrome. Many survivors came to view post-polio syndrome as a second disability. Paralytic polio was thus a disease whose physical and emotional consequences shadowed the entire lives of those who had contracted it.

Although polio is associated in the public mind with the period from 1930 to 1960, when epidemics occurred every summer somewhere in the United States, poliomyelitis is actually a very old disease. There is some visual evidence of the crippling typical of polio in ancient Egypt and other evidence suggestive of the disease in the classical world. Until the advent of modern sanitation in Europe and North America in the late nineteenth century, polio was apparently endemic, and most individuals were exposed to the virus as young children when they possessed some protection through maternal antibodies. The poliovirus is an intestinal virus that is spread largely through contaminated fecal material. The mouth is the normal entry portal for the virus, which in the vast majority of infections causes only a minor case of stomach flu. Ninety to ninety-five percent of infections are "completely inapparent." Four to eight percent produce "abortive" cases of "minor illness" and only one to two percent produce a major illness and paralysis. Poliomyelitis became epidemic in Northern Europe and in the United States in the late nineteen and early twentieth centuries when modern sanitation practices increasingly kept children from coming into contact with the poliovirus. This meant the development of a population of older children, no longer protected by maternal antibodies, who were vulnerable to the virus. When the virus appeared in a community where it had been absent for some time, the result was an epidemic among those born since the previous epidemic and thus susceptible to the disease.

In addition to becoming epidemic, poliomyelitis was changing in other significant ways in the twentieth century. The age distribution of those who contracted the disease was shifting and becoming older. Whereas the vast majority of cases in the great 1916 epidemic had been under the age of four, by the 1940s and 1950s a significant number of cases were between five and nine or older than ten. This was significant because there was good evidence that the older one contracted the disease, the more likely it was to be paralytic. The rate of polio also increased in the 1940s and 1950s. While the 1916 epidemic remained the most severe in American history, the years from 1944 to 1955 recorded ten of the worst epidemic years in the United States between 1912 and 1970, and the 1952 epidemic was second only to 1916 in severity. From 1937 to 1955 there were 415,624 reported cases and 361,555 (87 percent) of these occurred from 1944 to 1955. Thus, although the rates of poliomyelitis remained well below those of such diseases as tuberculosis, scarlet fever, whooping cough, and measles, the increase in the number and severity of cases was real in the 1940s and 1950s and gave Americans considerable reason to fear the disease.

I focus on the polio epidemics that occurred between 1930 and 1960 because I have found few narratives from the earlier epidemics and because the polio experience changed in the middle decades of the twentieth century. Two things, in particular, altered the experience after about 1930. First, Franklin D. Roosevelt, whose legs had been paralyzed by polio in 1921 when he was thirty-nine, entered the national political stage first as governor of New York in 1929 and after 1933 as president of the United States. Roosevelt, who always portrayed himself as having recovered from polio, gave the disease new prominence and served as a role model for the many thousands who contracted the disease every year. In addition, by establishing a polio rehabilitation facility at a run-down resort in Warm Springs, Georgia, Roosevelt helped initiate a new approach in which restoring the confidence and determination of the survivors was as important as rehabilitating their bodies.

The second development that changed the polio experience was the establishment of the National Foundation for Infantile Paralysis (NFIP) under Roosevelt's sponsorship in 1938. Through the fund-raising efforts of the March of Dimes, the NFIP under the leadership of Basil O'Connor sponsored and funded scientific and medical research to understand the virus and its actions in the body and to develop a vaccine to prevent the disease. In addition, the NFIP spent substantial sums every year to pay for the care of the children, adolescents, and adults who developed paralytic polio. The publicity machine of the NFIP-with its March of Dimes posters, newsreels, and magazine and newspaper articles describing the latest scientific discoveries and offering advice on how to protect children against polio and what to do if the disease struck-soon made infantile paralysis both widely known and widely feared. Although polio treatment and rehabilitation were never fully standardized, the national and local efforts of the NFIP clearly shaped the way polio was experienced from the early 1940s to the end of the epidemics. Mothers learned the warning signs of polio, children learned to avoid water fountains and swimming pools, and adolescents with a summer flu feared the worst. Beginning in the early 1940s, the NFIP tried to ensure that the medical community was informed of the best methods of treating polio. In addition, by paying much of the cost of treatment the NFIP tried to guarantee that polio patients received proper care and appropriate rehabilitation. While the amount and quality of care during both the acute and rehabilitative phases of the disease still varied widely from place to place, the efforts of the NFIP nonetheless established a kind of template for the polio experience, even though every patient's experience had its unique aspects. The implications of the Roosevelt model for what was expected of polio patients and the work of the NFIP to fight polio and care for its victims meant that the polio experience from 1930 to 1960 was different from that in the earlier epidemics.

This book is an exploration of lives altered by their encounter with the poliovirus. It tells the story of polio from the perspective of the polio patient and polio survivor. The book is organized around the experience of having polio, recovering from the disease, and living with a disability in the second half of the twentieth century. The separate chapters deal with the phases of the polio experience from the diagnosis and acute illness through recovery and rehabilitation; reentry into the worlds of home, school, and work; life with a permanent disability; and the physical and emotional consequences of the late effects of polio. I have sought to portray the range of experiences of polio patients and polio survivors as they have moved through the stages of the disease and its consequences. I have not tried to construct a typical polio experience because I don't think there was one. Some cases were quickly diagnosed and sent to isolation hospitals. For others, there was a considerable delay in diagnosing the disease. And some polio patients were treated at home and never hospitalized. Many polio patients experienced recovery and rehabilitation in large wards segregated by age and gender, but others had private or semiprivate rooms or recovered at home using a mixture of orthodox and unorthodox treatments. Some polio survivors were welcomed back to schools or jobs, while others experienced prejudice in school and discrimination seeking work. Many polio survivors, but not all, succeeded in finishing their educations, having careers, marrying, and raising families. And while many survivors have experienced the distressing symptoms of post-polio syndrome, others have thus far escaped. Each polio experience was, to some extent, unique, but elements of the experience were shared, and I have tried to bring out the central characteristics of each phase of living with this disease and its crippling aftermath.

Living with Polio is based on over 150 polio narratives. The narratives are almost evenly divided between men and women. These narratives take many forms. Some are full-scale autobiographies that treat the life before and after polio. Most book-length narratives, however, begin with polio and take the story forward to cover the disease, recovery, and rehabilitation. Many of the longer narratives written during and immediately after the period of the epidemics, which ended in the early 1960s, concluded with rehabilitation and the return to home, school, and work. However, narratives written in the 1980s and after usually continue the account through the writer's development of post-polio syndrome. These book-length polio narratives vary widely in literary quality, tone, and openness to discussing difficult and often painful issues involving treatment and mistreatment and feelings of shame, anger, fear, and resentment. The earlier narratives tend to be narratives of triumph with an uplifting account of how the author overcame polio through hard work, a strong will, and determination. The latter narratives are more likely to be forthcoming about the powerful emotions engendered by polio, the pain and difficulty of polio rehabilitation, anger at treatment and mistreatment by medical personnel, and the shame of living with a disabled body caused by a highly feared disease. I have also relied on shorter narratives and articles published in popular magazines such as the Saturday Evening Post, Life, and Reader's Digest, and in newspapers such as the Los Angeles Times and the Philadelphia Inquirer. Other sources include short essays reflecting on the author's experience and the recollections of polio survivors published in the newsletters of post-polio support groups. Oral histories of polio survivors constitute an additional source as do two documentary films. And, finally, I have used the Internet, where polio survivors on discussion lists carry on threads reminiscing about the hospitals, pranks on the rehabilitation wards, the smell of hot, wet wool, and nurses to hate or love. While some of these narratives are carefully crafted autobiographies or reflective essays by professional writers, the oral histories, support group newsletters, and Internet sources give voice to the experiences of men and women who would have been unlikely to write a formal autobiography. I have also drawn on my own experience of having polio in 1955 when I was five, undergoing a spinal fusion in 1960, and developing post-polio symptoms in the mid-1980s.

By relying on these varied narrative sources I have sought to give voice to the polio patients and the polio survivors. Scholars of illness narratives have argued that such narratives allow us to get inside the experience of illness and the rigorous rehabilitation that followed. As Anne Hunsaker Hawkins has observed about what she calls "pathographies," illness narratives "show us the drastic interruption of a life of meaning and purpose by an illness that often seems arbitrary, cruel, and senseless; and by treatment procedures that too often can appear as likewise arbitrary, cruel, and senseless-especially to the person undergoing them." Hawkins argues, however, that the task of the pathographer is not simply to describe but also "to restore to reality its lost coherence and to discover, or create, a meaning that can bind it together again." Illness narrative restores "the person ignored or canceled out in the medical enterprise and it places that person at the very center." In a very real way, pathography "gives that ill person a voice." Likewise, Arthur Frank, in The Wounded Storyteller, suggests that "the ill person who turns illness into story transforms fate into experience." Stories, he writes, "have to repair the damage that illness has done to the ill person's sense of where she is in life, and where she may be going. Stories are a way of redrawing maps and finding new destinations." And, finally, G. Thomas Couser has noted that "one of the most fundamental functions of the illness narrative ... is to validate the experience of illness-to put it on record, to exemplify living with bodily dysfunction, to offer lasting testimony." Relying on polio narratives, then, provides a way to understand what it was like to contract a greatly feared disease in mid-twentieth-century America, to undergo polio recovery and rehabilitation largely isolated from friends, family, and all that was familiar, and to live with a significant disability in the decades before and after the Americans with Disabilities Act of 1990.

Although these narratives allow us to see and understand the lived experience of polio in the mid-twentieth century, as sources they also have some limitations. The vast majority of narratives that I have found and used are by polio survivors who are white. There are a handful of brief accounts from African Americans, but none from Hispanics. Most of the writers were at least middle class in terms of their economic and social positions at the time of writing. Their middle-class standing is consistent with what other scholars who have used illness narratives have discovered. Both Anne Hawkins and Thomas Couser have noted the predominance of middle-class writers among the authors of illness narratives because they are more likely to have the education and opportunity to write and publish. This is less true of some of the narratives, the oral histories, and the Internet sources. Many of these reveal a background that was distinctly limited in its pre-polio economic status and social aspiration. In fact, the disabilities of polio, by forcing young men and women to focus their energies on their educations, enabled some polio survivors to improve their social and economic status.

(Continues...)

---

Excerpted from Living with Polio by Daniel J. Wilson Copyright © 2005 by The University of Chicago. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---