November 21, 2011 • 26 mins
Polio was a terrifying threat in the early 20th century: It often left victims paralyzed or dead. Yet two vaccines caused an immediate drop in polio cases and today they've nearly eradicated the disease. But what exactly happened? Tune in to find out.
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Speaker 1 (00:00):
Welcome to Stuff You Missed in History Class from how
Stuff Works dot Com. Hello, and welcome to the podcast.
I'm Sarah Dowdy and I'm devilin a talker boarding and Devilino.
This year, during Halloween, I put on a really fun,
(00:20):
campy movie. I know you like campy movies. This was
a Boris Karloff movie, but it wasn't one of his
more famous repertory and it like Frankenstein or The Mummy
or something. It was called The Ape and it was Yeah,
it was pretty old movie. I'm not gonna lie. It
was about a mad scientist in a small town, but
(00:42):
not your typical mad scientists who's, you know, like rolling
his fingers and looking evil. He was a kindly sort
of fellow. He had a heart, and he was trying
to cure something called paralysis in the movie. My Netflix
Q told me though it was polio and got I
love Netflix. I gotta love Netflix. Very informative um. But
(01:04):
the doctor Boris Karloff was trying to cure this paralysis
and he was going to do so by obtaining a serum.
And of course, because it's a campy horror movie, it
goes to the point where he dawns an ape suit
and goes about murdering people trying to obtain their spinal fluid.
But I also noticed though that the movie came out
in nineteen forty and as silly as it was, I mean,
(01:27):
it was enjoyable, I recommend it. But as silly as
it was, it was playing off of a very real
fear at the time. And that was of course the
paralysis in the movie Polio as we know it, because
since polio first started striking in epidemic proportions in the
late nineteenth century, it had only grown worse and worse
(01:47):
and worse. People didn't know how to stop it, they
didn't know how it spread, and worse to all, it
was something that usually struck kids in the severest form,
killing them or paralyzing them for life of an extremely
disturbing disease. In the United States, for instance, polio epidemics
would sweep across the country each summer, striking rural and
(02:08):
urban areas, poor and wealthy neighborhoods. Teens and adults could
get it too, um and it was usually actually worse
for them To stop the spread. Modern cities would revert
to Renaissance like plague practices, no travel, no trade, and
they would sometimes put quarantines on the homes. The Smithsonian
Museum of American History has a New York Times clipping
(02:29):
from nineteen sixteen about a man who was unable to
find a physician for his sick child, and so he
drove around and around until the boy died, and even
then he couldn't find anyone to take the body. Yeah,
and it wasn't just the fear of catching polio. The
after effects of the epidemic were also extremely haunting kids
and wheelchairs and leg braces, patients in the dreaded iron
(02:52):
lung We're going to talk about that a little more later.
And in the early stages of the disease, the patient
would often be separated from his her family for about
two weeks, followed by very limited contact, you know, just
an hour or so every now and then. And these
extended periods of separation made adjusting to life after polio
with all its consequences, a lot harder. But today people
(03:16):
if people have any understanding of polio, usually relates to
FDR President Franklin Delano Roosevelt, who contracted the disease as
an adult in ninety one. Unless you're living in one
of the four countries where wild polio virus is still present.
The fear just isn't there anymore. You couldn't put out
a movie anymore about this um paralysis. It needs to
(03:40):
be some other sort of scary contagious virus because there's
no longer any reason for somebody to contract polio. So
we're going to talk about the two very different vaccines
that have almost eliminated polio, the men who created them,
and the mass inoculations of the nineteen fifties and the
sixties that took place. But first we're going to talk
(04:02):
a little bit about what polio actually is. It's paralytic
poliomyelitis and is sometimes called infantile paralysis, and it's caused
by a virus, the polio virus, which was discovered in
eight by Karl's Landsteiner and Irwin Popper. And today we
know that the virus takes a fecal oral route, meaning
that contaminated fecal matter gets into the mouth through the hands,
(04:24):
or through food, or even through droplets from an infected
person's cough or sneeze, and once the virus is in
the mouth, it starts multiplying in the gastro intestinal track
and lymph nodes. From there it spreads to the bloodstream.
But here's the thing that's where it stops. For most people,
which I didn't know before about. People who contract polio
(04:46):
don't experience severe symptoms. They might feel like they have
the flu, or maybe not notice anything at all. These
people become resistant to whichever strain of polio they've contracted exactly.
But if the poliovirus keeps going, attacks the central nervous system,
destroying the motor cells of the spinal cord and brainstem,
and this usually ends up affecting the limb muscles, so
(05:09):
thus polleys association with paralyzed legs. But it can also
hit the facial muscles, or the back and abdominal muscles,
causing twisted spines. And in the worst cases, it strikes
muscles in the respiratory area, which in the early days
usually meant a death sentence. The development of the iron
lung in the nineteen twenties helped keep these people alive. Interestingly,
(05:33):
if you could get through the the acute phase the
first couple of weeks um in an iron lung, your
muscles could usually develop enough strength or tone to start
being able to breathe on your own again. But it
took a while to get to that point. Even though
the poliovirus wasn't discovered until nineteen o eight, it's believed
(05:53):
to have existed long before that. The mummy of a
nineteenth dynasty pharaoh, for example, who lived between thirteen forty
two and eleven ninety seven b c. Even shows deformities
that are characteristic of polio. But still polio must not
have been widespread for many, many centuries. It didn't begin
appearing in medical texts until the seventeen hundreds, and it
(06:15):
wasn't until eighteen sixty eight that the first epidemic occurred
in Oslo. And I think that's so interesting that there's
this long dormant period essentially, oh, I mean not dormant.
People are still getting polio, so we believe, but not
anywhere like the kind of polio they were getting in
the twentieth century. The first US epidemic didn't happen until
(06:36):
eighteen ninety four in Vermont, and by that point doctors
around the world were starting to piece together the fact
that you could get polio and not have any symptoms
or be resistant and not know that you had ever
had polio. Um you know, better understanding the virus and
the disease. But by the nineteen teens, epidemics were Polio
(06:58):
epidemics were becoming a regular summer occurrence. In New York
City's first epidemic, for instance, happened in nineteen sixteen. It
affected nine thousand people and killed two thousand forty three.
So the race to find a cure for this or
create a vaccine to prevent it was definitely on. But
before we go on to discuss the attempts to create
(07:21):
a vaccine for polio, I think it will help to
know exactly what a vaccine is, I mean, just in
case anybody doesn't, and then better understand how people understood
vaccines in the twenty century, what they were going into
it with. Okay, So first, here's a scenario for you.
If you had Type one polio before and you didn't
(07:42):
get sick, it would mean that your body had successfully
produced antibodies to fight it off. When you encounter the
virus a second time, your body would know what to
do with that. Again. A vaccine, of course, essentially attempts
to mimic this response, tricking the immune system into producing
antibodies to fight off a virus. It's not actually the
full strength real deal. It's something similar but not as dangerous,
(08:05):
or it's weakened, or it's in a very small quantities,
but it's enough to teach your body what to do
so that it's ready when the real thing comes along exactly.
So humans have been likely attempting self vaccination for thousands
of years, but immunization, as we understand it really kicked
off in sevente with Edward Jenner, and he inoculated a
(08:26):
young English boy against smallpox using cow pox, which was
not as scary, not as deadly as smallpox, but still
produced a similar response with antibodies. So the next big
leap happened in five when Louis Pasteur used a syringe
to vaccinate a boy who had been bitten by a
(08:48):
mad dog against rabies. The boy would have definitely gotten sick,
you would have died from rabies um and the syringe
proved to be a way more reliable delivery method than
the earlier technique of using things like lances and pus
from pox and you know, kind of kind of gross
but also kind of unreliable methods. Uh from their large
(09:10):
scale immunization started by World War One with diphtheria, and
it really became something that people were used to, at
least with a few specific diseases. But even though medical
researchers knew that a vaccine was also feasible for polio,
there were some advancements to be made, namely a better
understanding of the virus and how to grow it in
(09:31):
large enough quantities for a vaccine. In one Australian researchers
realized that polio came in different types, and that just
because you had resistance to one, it didn't mean that
you couldn't catch another. So this meant that any vaccine
would need to cover all types. That was why that
example you deeply know you gave earlier specifically was like
if you've got polio type one, because if you had
(09:54):
type two and you encountered type one, then you wouldn't
necessarily have a resistance. Another big advancement happened in nineteen
forty one when dr Albert Saban and Robert Ward showed
that poliovirus wasn't just a disease of the nervous system,
even though that was what people understood it as since
that's what it attacked. They realized that it entered through
(10:15):
the mouth and it first affected the digestive system, so
that suggested that a vaccine could possibly stop the virus
while it was still in the bloodstream, before it even
got to the nervous system and started causing so much damage.
Then in nineteen forty nine, researchers at Johns Hopkins confirmed
that the one suggestion that polio came in different types
(10:38):
was true. There are three main varieties one, two, and three,
and again any vaccine had to work on all of
them to really work. And in nineteen forty nine Dr
John Enders, Thomas Weller, and Frederick Robin showed that the
virus could grow on other types of tissue than nervous tissue,
like embryonic skin or muscle tissue. So before this, cultivating
(11:00):
the virus meant that you had to use live monkeys
to grow it, which is something that was expensive and
not available to a small labea having huge amounts monkeys
growing polio virus. So these three guys ended up winning
the Nobel Prize in nineteen fifty four for their work,
and that finding was really crucial in developing a vaccine
(11:22):
because you've got to make large amounts of a vaccine
if it's going to do anything. So in the worst
decades of polio paranoia and fear, there were obviously these
big jumps in our understanding of the virus, but there
were also some setbacks. In nineteen Dr Maurice Brody and
Dr John Colemer each conducted separate human trials for their
(11:44):
own versions of a polio vaccine. The results were completely disastrous.
A lot of kids contracted polio, a few people died.
But by World War Two there were again some new
advancements in how vaccines were made, the introduction and of
um commercially made vaccines for soldiers, manufacturing guidelines, definitely more
(12:06):
stringent rules about clinical testing. So it was setting the
stage again for this big revolution we're going to talk
about that happened in the nineteen fifties. Fighting polio also
became an almost warlike matter for Fdr. In He said,
quote the dread disease that we battle at home, like
the enemy we oppose abroad, shows no concern, no pity
(12:28):
for the young. It strikes with its most frequent and
devastating force against children, and that is why much of
the future strength of America depends upon the success that
we achieve in combating this disease. But how are they
going to combat it with polio? There were two main
ways to go. They could use an inactive or killed
virus as the basis for the vaccine, or they could
(12:51):
use an attenuated or weakened virus as the basis for
the vaccine. So ironically, both of these ended up working well.
But there's one that got more of the glory, all right,
So enter Dr Jonas Edwards Salk, who was born October
nineteen fourteen in New York City to Russian Jewish immigrants.
He was the first in his family to go to college,
(13:12):
and he earned his m d. From New York University
College of Medicine. But while he was studying there, Salk
worked under a microbiologist named Thomas Francis Jr. Who was
attempting to create a flu vaccine, which was later used
successfully in World War Two. So Salk got this early
exposure to making vaccines and trying to think about things
(13:36):
like that, and in nineteen forty seven, the University of
Pittsburgh recruited him to work specifically on viruses and ultimately
on the poliovirus, and by nineteen fifty two his research
had paid off. He was ready to start testing a
killed virus vaccine, so a virus that had been killed
(13:56):
with formaldehyde, but um it left enough of the structure
intact to trigger response like it would to live polio.
So first he tested it on kids who had already
had polio and recovered and they showed boosted antibodies. Then
he tested it on institutionalized kids who were disabled or
(14:17):
mentally handicapped, as well as on himself, his wife, and
his own kids. And I mean that's a good point
to note that all of this polio research, um it
can come across this kind of unethical today because of
tests on institutionalized kids and tests on prisoners, tests on
your own family, on on yourself, and also animal testing too.
(14:38):
I think more than one hundred thousand monkeys were killed
during the whole process of making these viruses or making
the vaccinations rather, So um just you know, something to
to throw out there. And another random note, um testing
it on his wife and kids. It wasn't this wife,
but Silk's second wife was Picasa's um widow mistress sort
(15:01):
of France Suis Guillo, who is the mother of Paloma.
A little bit of an unexpected connection there. I just
I thought I had to mention that since I sit
next to a photo of Picasso here in the studio.
Actually yeah, I mean, well, there's another connection. Develina is
sitting next to Tesla. I know all of you on
a podcast say I think people might like mine better.
(15:23):
But so no one got sick from these trials, and
since nineteen fifty two had also been polio's peak year
in the United States with fifty seven thousand, six hundred
twenty eight cases, it was big news in nineteen fifty
three when Sealk published as Findings in the Journal of
the American Medical Association. So by nineteen fifty four, Salk
had large amounts of an injectable vaccine and was ready
(15:45):
for large trials. The pilot program included fifteen thousand kids
in Pittsburgh, but the main field trial was massive one
point eight million kids in the US, Canada, and Finland
in grades one through three at two hundred and fifteen
test sites. The whole things directed by Dr Francis Salk's mentor,
and it featured a double blind process, which meant that
(16:06):
six hundred and fifty thousand people received the vaccine, seven
hundred fifty thousand received a placebo, and four hundred thirty
thousand received neither. And it took three hundred thousand volunteers
just to get out there and administer all of these vaccines,
and the record taking Francis ran a tight ship. The
record keeping was really immaculate, all sorts of follow ups
(16:29):
on these people. But by April nineteen it was official.
Francis declared Salks vaccine to be quote safe, effective, and potent,
and it became available commercially just a few years later,
and cases in the US a polio dropped immediately, I
mean eighty five to nine percent. There was one big
(16:50):
step back though, in nineteen fifty five, a major scare
when two hundred kids were affected by the vaccine. It
ended up being traced back to one specific manufacturer. There
was a not quite dead virus included in the vaccine,
but ultimately, once it was determined it was from one
specific place, people did go back to Salk's inactivated polio
(17:14):
virus vaccine, the i p V, and the last US
case of polio occurred in nineteen seventy nine in an
unvaccinated Amish population and Salk essentially became one of the
most famous medical heroes of the twentieth century. I read
something interesting his fame almost alienated him from the medical community,
(17:37):
just because he was so celebrated, and because other researchers
felt like they didn't get any credit for things that
they had contributed. Um so interestingly, Salk continued his research,
I think on HIV kind of stuff, you know, continuing
that viral research. But we do have a second vaccine
(17:57):
to talk about. We said that there were two. We
said that one sort of got all the glory. But
what about the vaccine made not from the killed virus
but from the weekend virus. Well, if you grew up
in the US and you were vaccinated before two thousand,
you didn't get salks IPv. Instead you got Albert Saban's
oral poliovirus vaccine op V for short. And if you
(18:20):
live outside of the US or outside of Europe, you
almost certainly got the o p V. So why are
there two and what are the benefits and the dangers
of each kind? Well? Saban was a Polish Jew who
had immigrated to America as a child, and he had,
as we mentioned, discovered in that the polio virus was
not just a disease of the nervous system but one
(18:40):
of the intestinal track. So Saban had a problem with
salks idea for a vaccine um even though well, if
prepared correctly, Salks vaccine using the killed virus would definitely
not give you polio because it had a dead virus
in it. It also might not confer a lie lifetime
(19:00):
of immunity, it wouldn't be as strong. So Saban wanted
to create something that was stronger, stronger vaccine using live poliovirus,
although of course that means certain risks. So instead of
just killing the virus and creating a vaccine from there,
he experimented on nine thousand monkeys and one hundred gems.
We did mention there were a lot of primates involved here.
(19:23):
Before he found a strain of the virus that would
reproduce in the intestinal tract but not in the central
nervous system, making that nine discovery pretty important. So this
meant that he could use a live, weaker strain of
the virus and from that create a longer lasting vaccine.
And there's kind of a strange perk about the Saban vaccine,
(19:47):
and that when people who get it go to the bathroom.
Their feces contains a weaken version of the virus which
helps boost the immunity of the population as a whole,
which made it pretty desirable in certain areas. We'll talk
about that a little bit more. Though. Saban had a
problem though. Once he had finally perfected his O p
(20:09):
V version of the polio vaccine, yes, he was ready
to go forward with large scale tests right around the
time that Sulks vaccine was being celebrated as a medical miracle.
So he couldn't find enough people stateside who were willing
to participate, because why I take a risk participating in
a trial if there's already a good cure out there, right,
So it's a prevention exactly. So Saban went to the
(20:32):
Belgian Congo and in the middle of the Cold War,
to the Soviet Union, and the government gave him a
medal for this. I mean, that's how badly they wanted
to handle polio, how bad polio was around the world,
they would let this American guy, a a Polish jew immigrant,
come into the Soviet Union and do this wide scale
(20:57):
medical test. But by the early sixties, Avan's vaccine had
caught on in the United States too, it was cheaper,
it was easier to produce UM. One big perk is
that it didn't require a shot because it was an
oral vaccine, so that makes it easier to administer too.
And it became completely vital for world eradication efforts, which
(21:19):
really took off in the nineteen seventies. And today polio
is endemic only in Nigeria, India, Afghanistan, and Pakistan. Of
the three types of viruses, poliovirus two is probably eradicated.
The last case to the last known case was in
Indian and poliovirus three is probably also close to eradication. Yeah,
(21:41):
And in two thousand, the US switched back to I
p V after it was determined that you were it
wasn't worth the risk anymore having that live virus in
O p V because your risk of contracting polio in
North America wild polio was just pretty much nothing. UM.
(22:01):
You were only likely to to maybe pick it up
if you went to one of those countries where it
was still endemic. So the US switched back to IPv,
but there's still a big hurdle in eliminating polio in
some of those remaining countries. And that's fear and suspicion,
just not knowing exactly what, um, what people are coming
(22:22):
in to do when they're administering these o p vs. Yes.
For example, in two thousand three, the World Health Organization
launched a huge campaign to vaccinate fifteen million kids in Nigeria,
but leaders there spread word the vaccines had been mixed
with anti fertility drugs and the HIV virus. So the
World Health Organization has started from the bottom up, instead
(22:44):
meeting with local leaders and winning their approval first before
going in and doing us in order to to try
to knock it out in Nigeria. One sort of final
note on the story and the men involved, Salk and
Saban both chose not to patent their vaccine, And I
mean they could have probably made huge amounts of money
off of this, but they considered the vaccine their gift
(23:06):
to humanity. Um. I was really I enjoyed researching this
and learning a little bit more about polio. I hadn't
known much about Saban at all, which is surprising now
that I realized what a huge contribution he had to
to eradicating polio in most of the world. Yeah, I
thought it was pretty interesting too, And I think, um,
(23:28):
even in this day and age, it's important for people
to kind of understand what they're dealing with when they're
dealing with different vaccines because there's so much misinformation out
there and debate about vaccines today. UM, I think it
just helps. The more you know, the better, definitely. So
I'm glad that I decided to watch that scary Halloween
movie and um inspired me to go research polio. I mean,
(23:51):
I know lots of people have suggested it, but UM,
I just thought that we're alternate history sort of from
nineteen forty involving eight made me want to learn more
about the real thing. And it brought you back to
medical history again, which we've been delving into a lot,
at least recently. And we love talking about medical history.
And we do have a medical related email to share
(24:13):
with you. So this message is from Christopher and he
wrote in you guys suggested we email you if we
listen to your podcast while doing interesting things. I'm a
graduate student at cal Tech getting my PhD in chemistry
and listen to you guys while working in the lab.
I was listening to your podcasts, in which he mentioned
(24:34):
the scientists who dissolved to Nobel prizes in Aqua Regia
to keep them from the Nazis. I keep a bottle
of the same stuff on my bench in lab. I
use Aqua Regia on a weekly basis, though usually not
to dissolve Nobel prizes. It's really helpful in cleaning really
dirty glassware because it will dissolve medals but not the
glass itself. It's great stuff, though super smelly and pretty dangerous.
(25:00):
You wouldn't want to use it to clean your dirty
dishes at home, which makes me think of a whole
another mad scientist type movie, one who uses one who
use of chemical solutions to do the dishes? Which one
is that? Oh no, just one of making up our
head right now, let's go back to your cubes and
write it too plaina. Okay, so that wasn't medical related,
(25:20):
but it was science related, science related, and um, I
thought it fit well enough with polio. So thank you, Christopher.
That was a fun um fun note to share. And
if any other folks want to write us, suggest medical topics,
suggest any other kind of topics, uh. You can find
us at History Podcast at how stuff works dot com.
(25:42):
We're also on Twitter at mist in History and we
are on Facebook. And if you want to learn a
little bit more about vaccines and some of the facts
and the myths surrounding them, you can look up an
article called how Vaccines Work on our website by visiting
us at www dot how stuff Works dot com. Be
sure to check out our new video podcast, Stuff from
(26:04):
the Future. Join How Staff Works staff as we explore
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Welcome to Stuff You Missed in History Class from how
Stuff Works dot Com. Hello, and welcome to the podcast.
I'm Sarah Dowdy and I'm devilin a talker boarding and Devilino.
This year, during Halloween, I put on a really fun,
(00:20):
campy movie. I know you like campy movies. This was
a Boris Karloff movie, but it wasn't one of his
more famous repertory and it like Frankenstein or The Mummy
or something. It was called The Ape and it was Yeah,
it was pretty old movie. I'm not gonna lie. It
was about a mad scientist in a small town, but
(00:42):
not your typical mad scientists who's, you know, like rolling
his fingers and looking evil. He was a kindly sort
of fellow. He had a heart, and he was trying
to cure something called paralysis in the movie. My Netflix
Q told me though it was polio and got I
love Netflix. I gotta love Netflix. Very informative um. But
(01:04):
the doctor Boris Karloff was trying to cure this paralysis
and he was going to do so by obtaining a serum.
And of course, because it's a campy horror movie, it
goes to the point where he dawns an ape suit
and goes about murdering people trying to obtain their spinal fluid.
But I also noticed though that the movie came out
in nineteen forty and as silly as it was, I mean,
(01:27):
it was enjoyable, I recommend it. But as silly as
it was, it was playing off of a very real
fear at the time. And that was of course the
paralysis in the movie Polio as we know it, because
since polio first started striking in epidemic proportions in the
late nineteenth century, it had only grown worse and worse
(01:47):
and worse. People didn't know how to stop it, they
didn't know how it spread, and worse to all, it
was something that usually struck kids in the severest form,
killing them or paralyzing them for life of an extremely
disturbing disease. In the United States, for instance, polio epidemics
would sweep across the country each summer, striking rural and
(02:08):
urban areas, poor and wealthy neighborhoods. Teens and adults could
get it too, um and it was usually actually worse
for them To stop the spread. Modern cities would revert
to Renaissance like plague practices, no travel, no trade, and
they would sometimes put quarantines on the homes. The Smithsonian
Museum of American History has a New York Times clipping
(02:29):
from nineteen sixteen about a man who was unable to
find a physician for his sick child, and so he
drove around and around until the boy died, and even
then he couldn't find anyone to take the body. Yeah,
and it wasn't just the fear of catching polio. The
after effects of the epidemic were also extremely haunting kids
and wheelchairs and leg braces, patients in the dreaded iron
(02:52):
lung We're going to talk about that a little more later.
And in the early stages of the disease, the patient
would often be separated from his her family for about
two weeks, followed by very limited contact, you know, just
an hour or so every now and then. And these
extended periods of separation made adjusting to life after polio
with all its consequences, a lot harder. But today people
(03:16):
if people have any understanding of polio, usually relates to
FDR President Franklin Delano Roosevelt, who contracted the disease as
an adult in ninety one. Unless you're living in one
of the four countries where wild polio virus is still present.
The fear just isn't there anymore. You couldn't put out
a movie anymore about this um paralysis. It needs to
(03:40):
be some other sort of scary contagious virus because there's
no longer any reason for somebody to contract polio. So
we're going to talk about the two very different vaccines
that have almost eliminated polio, the men who created them,
and the mass inoculations of the nineteen fifties and the
sixties that took place. But first we're going to talk
(04:02):
a little bit about what polio actually is. It's paralytic
poliomyelitis and is sometimes called infantile paralysis, and it's caused
by a virus, the polio virus, which was discovered in
eight by Karl's Landsteiner and Irwin Popper. And today we
know that the virus takes a fecal oral route, meaning
that contaminated fecal matter gets into the mouth through the hands,
(04:24):
or through food, or even through droplets from an infected
person's cough or sneeze, and once the virus is in
the mouth, it starts multiplying in the gastro intestinal track
and lymph nodes. From there it spreads to the bloodstream.
But here's the thing that's where it stops. For most people,
which I didn't know before about. People who contract polio
(04:46):
don't experience severe symptoms. They might feel like they have
the flu, or maybe not notice anything at all. These
people become resistant to whichever strain of polio they've contracted exactly.
But if the poliovirus keeps going, attacks the central nervous system,
destroying the motor cells of the spinal cord and brainstem,
and this usually ends up affecting the limb muscles, so
(05:09):
thus polleys association with paralyzed legs. But it can also
hit the facial muscles, or the back and abdominal muscles,
causing twisted spines. And in the worst cases, it strikes
muscles in the respiratory area, which in the early days
usually meant a death sentence. The development of the iron
lung in the nineteen twenties helped keep these people alive. Interestingly,
(05:33):
if you could get through the the acute phase the
first couple of weeks um in an iron lung, your
muscles could usually develop enough strength or tone to start
being able to breathe on your own again. But it
took a while to get to that point. Even though
the poliovirus wasn't discovered until nineteen o eight, it's believed
(05:53):
to have existed long before that. The mummy of a
nineteenth dynasty pharaoh, for example, who lived between thirteen forty
two and eleven ninety seven b c. Even shows deformities
that are characteristic of polio. But still polio must not
have been widespread for many, many centuries. It didn't begin
appearing in medical texts until the seventeen hundreds, and it
(06:15):
wasn't until eighteen sixty eight that the first epidemic occurred
in Oslo. And I think that's so interesting that there's
this long dormant period essentially, oh, I mean not dormant.
People are still getting polio, so we believe, but not
anywhere like the kind of polio they were getting in
the twentieth century. The first US epidemic didn't happen until
(06:36):
eighteen ninety four in Vermont, and by that point doctors
around the world were starting to piece together the fact
that you could get polio and not have any symptoms
or be resistant and not know that you had ever
had polio. Um you know, better understanding the virus and
the disease. But by the nineteen teens, epidemics were Polio
(06:58):
epidemics were becoming a regular summer occurrence. In New York
City's first epidemic, for instance, happened in nineteen sixteen. It
affected nine thousand people and killed two thousand forty three.
So the race to find a cure for this or
create a vaccine to prevent it was definitely on. But
before we go on to discuss the attempts to create
(07:21):
a vaccine for polio, I think it will help to
know exactly what a vaccine is, I mean, just in
case anybody doesn't, and then better understand how people understood
vaccines in the twenty century, what they were going into
it with. Okay, So first, here's a scenario for you.
If you had Type one polio before and you didn't
(07:42):
get sick, it would mean that your body had successfully
produced antibodies to fight it off. When you encounter the
virus a second time, your body would know what to
do with that. Again. A vaccine, of course, essentially attempts
to mimic this response, tricking the immune system into producing
antibodies to fight off a virus. It's not actually the
full strength real deal. It's something similar but not as dangerous,
(08:05):
or it's weakened, or it's in a very small quantities,
but it's enough to teach your body what to do
so that it's ready when the real thing comes along exactly.
So humans have been likely attempting self vaccination for thousands
of years, but immunization, as we understand it really kicked
off in sevente with Edward Jenner, and he inoculated a
(08:26):
young English boy against smallpox using cow pox, which was
not as scary, not as deadly as smallpox, but still
produced a similar response with antibodies. So the next big
leap happened in five when Louis Pasteur used a syringe
to vaccinate a boy who had been bitten by a
(08:48):
mad dog against rabies. The boy would have definitely gotten sick,
you would have died from rabies um and the syringe
proved to be a way more reliable delivery method than
the earlier technique of using things like lances and pus
from pox and you know, kind of kind of gross
but also kind of unreliable methods. Uh from their large
(09:10):
scale immunization started by World War One with diphtheria, and
it really became something that people were used to, at
least with a few specific diseases. But even though medical
researchers knew that a vaccine was also feasible for polio,
there were some advancements to be made, namely a better
understanding of the virus and how to grow it in
(09:31):
large enough quantities for a vaccine. In one Australian researchers
realized that polio came in different types, and that just
because you had resistance to one, it didn't mean that
you couldn't catch another. So this meant that any vaccine
would need to cover all types. That was why that
example you deeply know you gave earlier specifically was like
if you've got polio type one, because if you had
(09:54):
type two and you encountered type one, then you wouldn't
necessarily have a resistance. Another big advancement happened in nineteen
forty one when dr Albert Saban and Robert Ward showed
that poliovirus wasn't just a disease of the nervous system,
even though that was what people understood it as since
that's what it attacked. They realized that it entered through
(10:15):
the mouth and it first affected the digestive system, so
that suggested that a vaccine could possibly stop the virus
while it was still in the bloodstream, before it even
got to the nervous system and started causing so much damage.
Then in nineteen forty nine, researchers at Johns Hopkins confirmed
that the one suggestion that polio came in different types
(10:38):
was true. There are three main varieties one, two, and three,
and again any vaccine had to work on all of
them to really work. And in nineteen forty nine Dr
John Enders, Thomas Weller, and Frederick Robin showed that the
virus could grow on other types of tissue than nervous tissue,
like embryonic skin or muscle tissue. So before this, cultivating
(11:00):
the virus meant that you had to use live monkeys
to grow it, which is something that was expensive and
not available to a small labea having huge amounts monkeys
growing polio virus. So these three guys ended up winning
the Nobel Prize in nineteen fifty four for their work,
and that finding was really crucial in developing a vaccine
(11:22):
because you've got to make large amounts of a vaccine
if it's going to do anything. So in the worst
decades of polio paranoia and fear, there were obviously these
big jumps in our understanding of the virus, but there
were also some setbacks. In nineteen Dr Maurice Brody and
Dr John Colemer each conducted separate human trials for their
(11:44):
own versions of a polio vaccine. The results were completely disastrous.
A lot of kids contracted polio, a few people died.
But by World War Two there were again some new
advancements in how vaccines were made, the introduction and of
um commercially made vaccines for soldiers, manufacturing guidelines, definitely more
(12:06):
stringent rules about clinical testing. So it was setting the
stage again for this big revolution we're going to talk
about that happened in the nineteen fifties. Fighting polio also
became an almost warlike matter for Fdr. In He said,
quote the dread disease that we battle at home, like
the enemy we oppose abroad, shows no concern, no pity
(12:28):
for the young. It strikes with its most frequent and
devastating force against children, and that is why much of
the future strength of America depends upon the success that
we achieve in combating this disease. But how are they
going to combat it with polio? There were two main
ways to go. They could use an inactive or killed
virus as the basis for the vaccine, or they could
(12:51):
use an attenuated or weakened virus as the basis for
the vaccine. So ironically, both of these ended up working well.
But there's one that got more of the glory, all right,
So enter Dr Jonas Edwards Salk, who was born October
nineteen fourteen in New York City to Russian Jewish immigrants.
He was the first in his family to go to college,
(13:12):
and he earned his m d. From New York University
College of Medicine. But while he was studying there, Salk
worked under a microbiologist named Thomas Francis Jr. Who was
attempting to create a flu vaccine, which was later used
successfully in World War Two. So Salk got this early
exposure to making vaccines and trying to think about things
(13:36):
like that, and in nineteen forty seven, the University of
Pittsburgh recruited him to work specifically on viruses and ultimately
on the poliovirus, and by nineteen fifty two his research
had paid off. He was ready to start testing a
killed virus vaccine, so a virus that had been killed
(13:56):
with formaldehyde, but um it left enough of the structure
intact to trigger response like it would to live polio.
So first he tested it on kids who had already
had polio and recovered and they showed boosted antibodies. Then
he tested it on institutionalized kids who were disabled or
(14:17):
mentally handicapped, as well as on himself, his wife, and
his own kids. And I mean that's a good point
to note that all of this polio research, um it
can come across this kind of unethical today because of
tests on institutionalized kids and tests on prisoners, tests on
your own family, on on yourself, and also animal testing too.
(14:38):
I think more than one hundred thousand monkeys were killed
during the whole process of making these viruses or making
the vaccinations rather, So um just you know, something to
to throw out there. And another random note, um testing
it on his wife and kids. It wasn't this wife,
but Silk's second wife was Picasa's um widow mistress sort
(15:01):
of France Suis Guillo, who is the mother of Paloma.
A little bit of an unexpected connection there. I just
I thought I had to mention that since I sit
next to a photo of Picasso here in the studio.
Actually yeah, I mean, well, there's another connection. Develina is
sitting next to Tesla. I know all of you on
a podcast say I think people might like mine better.
(15:23):
But so no one got sick from these trials, and
since nineteen fifty two had also been polio's peak year
in the United States with fifty seven thousand, six hundred
twenty eight cases, it was big news in nineteen fifty
three when Sealk published as Findings in the Journal of
the American Medical Association. So by nineteen fifty four, Salk
had large amounts of an injectable vaccine and was ready
(15:45):
for large trials. The pilot program included fifteen thousand kids
in Pittsburgh, but the main field trial was massive one
point eight million kids in the US, Canada, and Finland
in grades one through three at two hundred and fifteen
test sites. The whole things directed by Dr Francis Salk's mentor,
and it featured a double blind process, which meant that
(16:06):
six hundred and fifty thousand people received the vaccine, seven
hundred fifty thousand received a placebo, and four hundred thirty
thousand received neither. And it took three hundred thousand volunteers
just to get out there and administer all of these vaccines,
and the record taking Francis ran a tight ship. The
record keeping was really immaculate, all sorts of follow ups
(16:29):
on these people. But by April nineteen it was official.
Francis declared Salks vaccine to be quote safe, effective, and potent,
and it became available commercially just a few years later,
and cases in the US a polio dropped immediately, I
mean eighty five to nine percent. There was one big
(16:50):
step back though, in nineteen fifty five, a major scare
when two hundred kids were affected by the vaccine. It
ended up being traced back to one specific manufacturer. There
was a not quite dead virus included in the vaccine,
but ultimately, once it was determined it was from one
specific place, people did go back to Salk's inactivated polio
(17:14):
virus vaccine, the i p V, and the last US
case of polio occurred in nineteen seventy nine in an
unvaccinated Amish population and Salk essentially became one of the
most famous medical heroes of the twentieth century. I read
something interesting his fame almost alienated him from the medical community,
(17:37):
just because he was so celebrated, and because other researchers
felt like they didn't get any credit for things that
they had contributed. Um so interestingly, Salk continued his research,
I think on HIV kind of stuff, you know, continuing
that viral research. But we do have a second vaccine
(17:57):
to talk about. We said that there were two. We
said that one sort of got all the glory. But
what about the vaccine made not from the killed virus
but from the weekend virus. Well, if you grew up
in the US and you were vaccinated before two thousand,
you didn't get salks IPv. Instead you got Albert Saban's
oral poliovirus vaccine op V for short. And if you
(18:20):
live outside of the US or outside of Europe, you
almost certainly got the o p V. So why are
there two and what are the benefits and the dangers
of each kind? Well? Saban was a Polish Jew who
had immigrated to America as a child, and he had,
as we mentioned, discovered in that the polio virus was
not just a disease of the nervous system but one
(18:40):
of the intestinal track. So Saban had a problem with
salks idea for a vaccine um even though well, if
prepared correctly, Salks vaccine using the killed virus would definitely
not give you polio because it had a dead virus
in it. It also might not confer a lie lifetime
(19:00):
of immunity, it wouldn't be as strong. So Saban wanted
to create something that was stronger, stronger vaccine using live poliovirus,
although of course that means certain risks. So instead of
just killing the virus and creating a vaccine from there,
he experimented on nine thousand monkeys and one hundred gems.
We did mention there were a lot of primates involved here.
(19:23):
Before he found a strain of the virus that would
reproduce in the intestinal tract but not in the central
nervous system, making that nine discovery pretty important. So this
meant that he could use a live, weaker strain of
the virus and from that create a longer lasting vaccine.
And there's kind of a strange perk about the Saban vaccine,
(19:47):
and that when people who get it go to the bathroom.
Their feces contains a weaken version of the virus which
helps boost the immunity of the population as a whole,
which made it pretty desirable in certain areas. We'll talk
about that a little bit more. Though. Saban had a
problem though. Once he had finally perfected his O p
(20:09):
V version of the polio vaccine, yes, he was ready
to go forward with large scale tests right around the
time that Sulks vaccine was being celebrated as a medical miracle.
So he couldn't find enough people stateside who were willing
to participate, because why I take a risk participating in
a trial if there's already a good cure out there, right,
So it's a prevention exactly. So Saban went to the
(20:32):
Belgian Congo and in the middle of the Cold War,
to the Soviet Union, and the government gave him a
medal for this. I mean, that's how badly they wanted
to handle polio, how bad polio was around the world,
they would let this American guy, a a Polish jew immigrant,
come into the Soviet Union and do this wide scale
(20:57):
medical test. But by the early sixties, Avan's vaccine had
caught on in the United States too, it was cheaper,
it was easier to produce UM. One big perk is
that it didn't require a shot because it was an
oral vaccine, so that makes it easier to administer too.
And it became completely vital for world eradication efforts, which
(21:19):
really took off in the nineteen seventies. And today polio
is endemic only in Nigeria, India, Afghanistan, and Pakistan. Of
the three types of viruses, poliovirus two is probably eradicated.
The last case to the last known case was in
Indian and poliovirus three is probably also close to eradication. Yeah,
(21:41):
And in two thousand, the US switched back to I
p V after it was determined that you were it
wasn't worth the risk anymore having that live virus in
O p V because your risk of contracting polio in
North America wild polio was just pretty much nothing. UM.
(22:01):
You were only likely to to maybe pick it up
if you went to one of those countries where it
was still endemic. So the US switched back to IPv,
but there's still a big hurdle in eliminating polio in
some of those remaining countries. And that's fear and suspicion,
just not knowing exactly what, um, what people are coming
(22:22):
in to do when they're administering these o p vs. Yes.
For example, in two thousand three, the World Health Organization
launched a huge campaign to vaccinate fifteen million kids in Nigeria,
but leaders there spread word the vaccines had been mixed
with anti fertility drugs and the HIV virus. So the
World Health Organization has started from the bottom up, instead
(22:44):
meeting with local leaders and winning their approval first before
going in and doing us in order to to try
to knock it out in Nigeria. One sort of final
note on the story and the men involved, Salk and
Saban both chose not to patent their vaccine, And I
mean they could have probably made huge amounts of money
off of this, but they considered the vaccine their gift
(23:06):
to humanity. Um. I was really I enjoyed researching this
and learning a little bit more about polio. I hadn't
known much about Saban at all, which is surprising now
that I realized what a huge contribution he had to
to eradicating polio in most of the world. Yeah, I
thought it was pretty interesting too, And I think, um,
(23:28):
even in this day and age, it's important for people
to kind of understand what they're dealing with when they're
dealing with different vaccines because there's so much misinformation out
there and debate about vaccines today. UM, I think it
just helps. The more you know, the better, definitely. So
I'm glad that I decided to watch that scary Halloween
movie and um inspired me to go research polio. I mean,
(23:51):
I know lots of people have suggested it, but UM,
I just thought that we're alternate history sort of from
nineteen forty involving eight made me want to learn more
about the real thing. And it brought you back to
medical history again, which we've been delving into a lot,
at least recently. And we love talking about medical history.
And we do have a medical related email to share
(24:13):
with you. So this message is from Christopher and he
wrote in you guys suggested we email you if we
listen to your podcast while doing interesting things. I'm a
graduate student at cal Tech getting my PhD in chemistry
and listen to you guys while working in the lab.
I was listening to your podcasts, in which he mentioned
(24:34):
the scientists who dissolved to Nobel prizes in Aqua Regia
to keep them from the Nazis. I keep a bottle
of the same stuff on my bench in lab. I
use Aqua Regia on a weekly basis, though usually not
to dissolve Nobel prizes. It's really helpful in cleaning really
dirty glassware because it will dissolve medals but not the
glass itself. It's great stuff, though super smelly and pretty dangerous.
(25:00):
You wouldn't want to use it to clean your dirty
dishes at home, which makes me think of a whole
another mad scientist type movie, one who uses one who
use of chemical solutions to do the dishes? Which one
is that? Oh no, just one of making up our
head right now, let's go back to your cubes and
write it too plaina. Okay, so that wasn't medical related,
(25:20):
but it was science related, science related, and um, I
thought it fit well enough with polio. So thank you, Christopher.
That was a fun um fun note to share. And
if any other folks want to write us, suggest medical topics,
suggest any other kind of topics, uh. You can find
us at History Podcast at how stuff works dot com.
(25:42):
We're also on Twitter at mist in History and we
are on Facebook. And if you want to learn a
little bit more about vaccines and some of the facts
and the myths surrounding them, you can look up an
article called how Vaccines Work on our website by visiting
us at www dot how stuff Works dot com. Be
sure to check out our new video podcast, Stuff from
(26:04):
the Future. Join How Staff Works staff as we explore
the most promising and perplexing possibilities of tomorrow. The House
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