Living with Polio: The Epidemic and Its Survivors
http://www.100md.com
《新英格兰医药杂志》
Epidemic poliomyelitis first appeared in the United States a century ago, at a time when America was rapidly evolving from its postcolonial agrarian roots toward industrialization, urbanization, and the ascension of the middle class. Polio, a new "emerging infection," was an unanticipated consequence of the invention of the flush toilet and the adoption of the use of toilet paper. These hygienic advances brought about the control of most diseases transmitted by enteric bacteria, but they paradoxically increased the risk of paralytic disease by delaying poliovirus infection beyond the age at which infants are protected by maternal antibodies acquired by way of the placenta. The epidemics of poliomyelitis that resulted captured the attention of the public as did no other disease at the time, in part because of fears of a disease that could strike randomly, and in part because of a strong and effective public-relations campaign by one of the first single-disease advocacy organizations, the National Foundation for Infantile Paralysis (the March of Dimes). Both of the books under review, which were published on the 50th anniversary of the licensure of the Salk vaccine, are set within the political, social, and cultural milieu of mid-20th-century America, and both are accurate records of poliomyelitis and its effects on our society, yet each from a very different perspective.
Polio: An American Story is a modern historical narrative that spans the appearance and the disappearance of epidemic poliomyelitis. Historian David M. Oshinsky has mined the personal papers of Jonas Salk, Albert Sabin, Thomas Francis, and other sources to write this scholarly and readable book, in which he argues that the opportunity and entrepreneurial spirit unique to a particular period of American history were the critical factors in the conquest of polio.
Oshinsky relates the enigmatic rise of poliomyelitis throughout the first half of the 20th century and the response of the public, public health institutions, the press, the government, and the scientific community. He zeros in on the lives, the character, and the personalities of those who made major contributions to the understanding and control of polio and on how their ambitions and relationships with others shaped their roles. Many of the figures are well known; Oshinsky describes Franklin Delano Roosevelt's defiant struggle with his permanent lower-limb paresis, Sister Elizabeth Kenny and her self-styled method of treating acutely paralyzed limbs with hot woolen compresses, and Basil O'Connor, Roosevelt's one-time law partner, who was the founder and autocratic leader of the National Foundation for Infantile Paralysis. Complete biographies of Salk and Sabin are woven through the narrative, focusing on their early development as scientists; their relationships with the National Foundation, the scientific community, and the public; and the mutual antagonism that these two giants carried to their graves. The passages in the book that recall the public fundraising events promoted by the National Foundation will summon memories in those of us who are of boomer age and older — the nationwide Birthday Balls on Roosevelt's birthday, the endorsements of the March of Dimes campaign on the radio and in movie reels by comedian Eddie Cantor and other celebrities of the time, and the very successful annual Mothers March on Polio during the early 1950s.
(Figure)
President Franklin Roosevelt Holding His Dog, Fala, while Talking to Ruthie Bie, Granddaughter of the Caretakers of the Hill Top Cottage at His Hyde Park, New York, Home, February 1941.
M.L. Suckley, FDR Library / AP/Wide World Photos.
The failures, some of them tragic, are not overlooked, including the premature administration of inadequately inactivated experimental vaccines to children in the 1930s and the well-known Cutter incident that followed the initial licensure in 1955 of inactivated polio vaccine, which paralyzed more than 200 vaccine recipients and their contacts. (The irony is that paralytic disease developed in more persons in the United States after the administration of inactivated polio vaccine than after vaccination with the live virus.)
The mid-century events leading up to and including the introduction of inactivated polio vaccine and, slightly later, the oral polio vaccine, are presented in extensive, well-documented detail. The period since then holds less interest for Oshinsky, who has compressed the progress of the past four decades into a final chapter, "Celebrities and Survivors," that reads more like an epilogue. Little attention is given to developments that have continued to shape the story, including the discovery of vaccine-associated poliomyelitis shortly after licensure of oral polio vaccine, the importance of transmission of viruses contained in the oral polio vaccine in influencing vaccine policy, and the global initiative to eradicate poliomyelitis. The author passes over the last polio outbreak in the general population in south Texas in 1970 — a curiosity, considering that he begins the book with a vivid description of an outbreak in the same locale in 1949 — and he omits the last indigenous cases, which occurred among Amish persons exposed to virus that had been imported from Europe in 1979.
Though avoiding sweeping judgments, Oshinsky does not shy from inserting his own opinions of people and events. Some are on target. Others are not, including his statement that the sequential-vaccination program introduced in 1997 was a compromise that "did not work as well as expected" because of ongoing vaccine-associated disease (which did not occur in any child vaccinated with the sequential schedule). Medical scientists familiar with polio and polio vaccines will also discover other inaccuracies to quibble about. However, these lapses are few and generally minor, and most readers will appreciate Oshinsky's intellect, insight, and clarity of style.
In Living with Polio, Daniel J. Wilson, a historian at Muhlenberg College, writes about poliomyelitis in the same era from a strikingly different perspective — that of the victims of poliomyelitis. The author draws on personal accounts from many sources — oral narratives, magazine and newspaper articles, the Internet, and his own experience with paralytic disease — and weaves these stories through chapters that progress sequentially from the onset of paralysis, through hospitalization and treatment for acute disease, rehabilitation, and ultimately the return home and adaptation to life with a physical handicap. Wilson explores all facets of the human experience with paralytic poliomyelitis, including the physical pain that accompanies both the acute disease and the preferred treatment methods; the psychological stress of prolonged hospitalization; the inevitably altered relationships to parents, siblings, and spouses; the physical and psychosocial challenges confronting the patient on his or her return to the world of the able-bodied; and the profound effects on the lives of parents and spouses who care for severely impaired or respirator-dependent patients in the home.
Many of the stories recall common experiences and emotions, including the fear and anxiety that follow isolation from parents and other family members, the loss of autonomy and personal dignity from dependence on caregivers, the terror of breathlessness during periods out of the iron lung, and the development of personal relationships with nursing staff — some positive, some negative, and some intimate. Wilson goes to considerable lengths to show that patients with polio who experienced similar adversity coped and adapted in many different ways. The lives of some were devastated even by minimal disability, whereas others drew strength and resolve from their misfortune and worked relentlessly to overcome it. In the end, the reader is impressed that the responses of polio victims to the challenges they face are as varied as human nature itself.
The book is also a worthy sociological record of the lives that "polios" led during recovery from acute paralysis, and the months to years that they spent together in hospitals and rehabilitation facilities. Children were forced to abandon behavior and values learned at home and conform to the subculture of the polio ward, with its own sanctions and reward systems. Still, there were strong efforts to maintain as much of a normal existence as possible. The chapter on life on the polio wards recounts how resourceful children and adolescents managed to play games, pursue other leisure activities, develop a social life, continue their education, and even get into trouble. These communal experiences not only mirrored those in the outside world but formed a most important bridge to resumption of life after release from the hospital.
Living with Polio is carefully researched and written in a clear, dispassionate style. The photographs dispersed throughout the book nicely support and complement the text. My only criticism of this otherwise interesting and well-written book is the considerable redundancy of content among chapters, including repeated anecdotes and other personal accounts.
John F. Modlin, M.D.
Dartmouth Medical School
Lebanon, NH 03756
john.modlin@dartmouth.edu(By Daniel J. Wilson. 300 )
Polio: An American Story is a modern historical narrative that spans the appearance and the disappearance of epidemic poliomyelitis. Historian David M. Oshinsky has mined the personal papers of Jonas Salk, Albert Sabin, Thomas Francis, and other sources to write this scholarly and readable book, in which he argues that the opportunity and entrepreneurial spirit unique to a particular period of American history were the critical factors in the conquest of polio.
Oshinsky relates the enigmatic rise of poliomyelitis throughout the first half of the 20th century and the response of the public, public health institutions, the press, the government, and the scientific community. He zeros in on the lives, the character, and the personalities of those who made major contributions to the understanding and control of polio and on how their ambitions and relationships with others shaped their roles. Many of the figures are well known; Oshinsky describes Franklin Delano Roosevelt's defiant struggle with his permanent lower-limb paresis, Sister Elizabeth Kenny and her self-styled method of treating acutely paralyzed limbs with hot woolen compresses, and Basil O'Connor, Roosevelt's one-time law partner, who was the founder and autocratic leader of the National Foundation for Infantile Paralysis. Complete biographies of Salk and Sabin are woven through the narrative, focusing on their early development as scientists; their relationships with the National Foundation, the scientific community, and the public; and the mutual antagonism that these two giants carried to their graves. The passages in the book that recall the public fundraising events promoted by the National Foundation will summon memories in those of us who are of boomer age and older — the nationwide Birthday Balls on Roosevelt's birthday, the endorsements of the March of Dimes campaign on the radio and in movie reels by comedian Eddie Cantor and other celebrities of the time, and the very successful annual Mothers March on Polio during the early 1950s.
(Figure)
President Franklin Roosevelt Holding His Dog, Fala, while Talking to Ruthie Bie, Granddaughter of the Caretakers of the Hill Top Cottage at His Hyde Park, New York, Home, February 1941.
M.L. Suckley, FDR Library / AP/Wide World Photos.
The failures, some of them tragic, are not overlooked, including the premature administration of inadequately inactivated experimental vaccines to children in the 1930s and the well-known Cutter incident that followed the initial licensure in 1955 of inactivated polio vaccine, which paralyzed more than 200 vaccine recipients and their contacts. (The irony is that paralytic disease developed in more persons in the United States after the administration of inactivated polio vaccine than after vaccination with the live virus.)
The mid-century events leading up to and including the introduction of inactivated polio vaccine and, slightly later, the oral polio vaccine, are presented in extensive, well-documented detail. The period since then holds less interest for Oshinsky, who has compressed the progress of the past four decades into a final chapter, "Celebrities and Survivors," that reads more like an epilogue. Little attention is given to developments that have continued to shape the story, including the discovery of vaccine-associated poliomyelitis shortly after licensure of oral polio vaccine, the importance of transmission of viruses contained in the oral polio vaccine in influencing vaccine policy, and the global initiative to eradicate poliomyelitis. The author passes over the last polio outbreak in the general population in south Texas in 1970 — a curiosity, considering that he begins the book with a vivid description of an outbreak in the same locale in 1949 — and he omits the last indigenous cases, which occurred among Amish persons exposed to virus that had been imported from Europe in 1979.
Though avoiding sweeping judgments, Oshinsky does not shy from inserting his own opinions of people and events. Some are on target. Others are not, including his statement that the sequential-vaccination program introduced in 1997 was a compromise that "did not work as well as expected" because of ongoing vaccine-associated disease (which did not occur in any child vaccinated with the sequential schedule). Medical scientists familiar with polio and polio vaccines will also discover other inaccuracies to quibble about. However, these lapses are few and generally minor, and most readers will appreciate Oshinsky's intellect, insight, and clarity of style.
In Living with Polio, Daniel J. Wilson, a historian at Muhlenberg College, writes about poliomyelitis in the same era from a strikingly different perspective — that of the victims of poliomyelitis. The author draws on personal accounts from many sources — oral narratives, magazine and newspaper articles, the Internet, and his own experience with paralytic disease — and weaves these stories through chapters that progress sequentially from the onset of paralysis, through hospitalization and treatment for acute disease, rehabilitation, and ultimately the return home and adaptation to life with a physical handicap. Wilson explores all facets of the human experience with paralytic poliomyelitis, including the physical pain that accompanies both the acute disease and the preferred treatment methods; the psychological stress of prolonged hospitalization; the inevitably altered relationships to parents, siblings, and spouses; the physical and psychosocial challenges confronting the patient on his or her return to the world of the able-bodied; and the profound effects on the lives of parents and spouses who care for severely impaired or respirator-dependent patients in the home.
Many of the stories recall common experiences and emotions, including the fear and anxiety that follow isolation from parents and other family members, the loss of autonomy and personal dignity from dependence on caregivers, the terror of breathlessness during periods out of the iron lung, and the development of personal relationships with nursing staff — some positive, some negative, and some intimate. Wilson goes to considerable lengths to show that patients with polio who experienced similar adversity coped and adapted in many different ways. The lives of some were devastated even by minimal disability, whereas others drew strength and resolve from their misfortune and worked relentlessly to overcome it. In the end, the reader is impressed that the responses of polio victims to the challenges they face are as varied as human nature itself.
The book is also a worthy sociological record of the lives that "polios" led during recovery from acute paralysis, and the months to years that they spent together in hospitals and rehabilitation facilities. Children were forced to abandon behavior and values learned at home and conform to the subculture of the polio ward, with its own sanctions and reward systems. Still, there were strong efforts to maintain as much of a normal existence as possible. The chapter on life on the polio wards recounts how resourceful children and adolescents managed to play games, pursue other leisure activities, develop a social life, continue their education, and even get into trouble. These communal experiences not only mirrored those in the outside world but formed a most important bridge to resumption of life after release from the hospital.
Living with Polio is carefully researched and written in a clear, dispassionate style. The photographs dispersed throughout the book nicely support and complement the text. My only criticism of this otherwise interesting and well-written book is the considerable redundancy of content among chapters, including repeated anecdotes and other personal accounts.
John F. Modlin, M.D.
Dartmouth Medical School
Lebanon, NH 03756
john.modlin@dartmouth.edu(By Daniel J. Wilson. 300 )