Show Notes
What if summer once meant danger instead of vacations? What if a simple swim could change a child’s life forever?
In this episode of Tribulations, Dr. Ravi Kumar takes you back to the chilling reality of the polio era in the United States. This was a time when hospitals filled with iron lungs, public spaces shut down, and families lived with the constant fear that a virus could steal a child’s ability to walk or breathe.
You will explore how a silent gastrointestinal virus became one of the most feared diseases in America, and how a global scientific effort led to one of the most successful vaccines in human history. From the panic-filled summers of the 1950s to the breakthroughs of Jonas Salk and Albert Sabin, this episode reveals how science and public courage pushed polio to the edge of eradication.
In this episode, you will discover:
- Why polio became more dangerous after sanitation improved
- How the virus attacks the nervous system and causes paralysis
- What iron lungs did and why they became symbols of the epidemic
- The story of Paul Alexander, who lived 72 years inside an iron lung
- How Franklin D. Roosevelt launched the March of Dimes and fueled vaccine research
- Jonas Salk’s bold pursuit of a killed-virus vaccine that challenged scientific beliefs
- The massive 1954 field trial involving 1.8 million Polio Pioneers
- The Cutter incident and how it reshaped vaccine safety
- Albert Sabin’s oral vaccine and the United States and Soviet partnership that surprised the world
- How global vaccination campaigns drove polio cases down 99 percent
- Why eradication is closer than ever, but not guaranteed
Key Takeaways
- Polio was once the most feared disease in America, paralyzing thousands of children each year
- Iron lungs delivered negative pressure ventilation for children who could not breathe on their own
- Salk’s inactivated vaccine and Sabin’s oral vaccine worked together to stop widespread transmission
- The March of Dimes became a national crowdfunding movement that accelerated vaccine research
- Polio remains endemic in only two countries, which shows that eradication is possible but requires vigilance
- When diseases become invisible, public memory fades and motivation to vaccinate can fall
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Transcript
[00:00 –> 00:32] Welcome to the doctor Kumar Discovery podcast. My name is doctor Ravi Kumar, and this is another episode of tribulations where we look back at turning points in medical history that shaped the world we live in and still guide us today. This episode brings us back to a very different time in America, a time when the warm months of June, July, and August were not simply summer vacation. They were polio season. Parents watched the calendar slide towards summer with a tightness in their chest because they knew that danger would come.
[00:33 –> 00:56] They knew that this could be the summer that the grim hand of polio would touch their child. In 1952 alone, nearly sixty thousand people in The United States were sickened with polio. More than twenty thousand were left paralyzed, and more than three thousand died. These numbers were not abstract. They were neighbors, classmates, and children who had been healthy only days earlier.
[00:56 –> 01:18] City pools were drained. Movie theaters went dark. Church picnics vanished from the calendar. Children were warned not to drink from water fountains, not to visit their friends, and to stay indoors on the brightest, most beautiful days of the year. People’s lives were dictated by fear that lingered in every home, a fear that a simple afternoon at the pool might destroy a life.
[01:18 –> 01:57] There were no PCR tests, no color coded dashboards, no social media debates. There was only the slow realization that a child who ran through a sprinkler in July might be in leg braces in September, and the reminders were everywhere. Newspapers printed photos of gymnasiums filled wall to wall with iron lungs, which were metal cylinders stacked in rows, each holding a child who could no longer breathe on their own. So today, we’re gonna step back into that world and understand the epidemic that terrified a generation and the race that led to one of the most important vaccines in history. So what is polio?
[01:57 –> 02:29] Well, polio is a virus, and it’s a virus that most of us have never seen. And the same polio that haunted mid twentieth century America is the same polio that shadowed mankind for millennia. It’s a human enterovirus that infects the gastrointestinal tract, spreads through the fecal to oral route, and moves quietly from person to person on hands, toilets, food, and in water. People swallow it without ever knowing it was there, and then the virus infects the gut and the cycle continues. We can trace the existence of polio back thousands of years.
[02:29 –> 03:01] Some of the earliest depictions were in Egyptian stone carvings, showing people with withered legs, shortened limbs, leaning on canes. These ancient figures likely lived through the same disease that would one day fill American newspapers with iron lungs. Before anyone knew what a virus was, there was simply a mysterious illness that killed some people, crippled many, and lingered in human history. The irony is that polio did not truly become the monster that we would come to know until sanitation improved. This is what’s called the sanitation paradox.
[03:01 –> 03:38] Before modern plumbing, children were exposed to polio very early in life because polio was endemic in all around us. Young infants would still carry protective antibodies in their blood given to them by their mothers. And if a mother survived to her childbearing years, she had already done immunological battle with the virus, and she could then pass those antibodies and that immunity onto her baby. So babies in unsanitary environments often caught polio while still protected by maternal antibodies. The infection was mild or silent, and they walked away with a lifelong immunity.
[03:38 –> 04:04] But as cities cleaned up, water became safer, and sewage systems improved, something unexpected happened. Children stopped getting infected by the virus early in life. They encountered it later when maternal antibodies were long gone. And now, for the first time, millions of children were completely unprotected. What we see in history books, the images of children paralyzed or trapped inside iron lungs, is only the tip of the iceberg.
[04:04 –> 04:31] Most people who get polio never know they had it. The vast majority experience a routine viral illness with fever, headaches, sore throat, or muscle aches. A small fraction develop meningitis, and only about one percent go on to develop paralytic polio. In that unlucky one percent, the virus escapes the intestinal tract and attacks the central nervous system. It targets the motor nuclei in the brain stem and the anterior horn cells in the spinal cord.
[04:32 –> 04:52] These are the neurons that control muscle strength and movement in our body. When polio infects and destroys these motor neurons, the muscles they serve lose their connection to the brain. Weakness develops, limbs buckle, and breathing can fail. One of the most frightening consequences of paralytic polio was the loss of the ability to breathe. Breathing is not a passive act.
[04:52 –> 05:17] It depends entirely on muscle contraction. The diaphragm sits beneath the lungs and contracts downward to pull air in. The intercostal muscles between the ribs expand and contract the chest wall to help push air out. When polio destroys the motor neurons that control these muscles, the entire system collapses. A child who is running and playing one day can suddenly lose the ability to ventilate their own lungs the next day.
[05:17 –> 05:45] Because many children could recover strength over weeks or months, doctors faced a desperate question. How do we keep a child alive long enough for their nervous system to heal? They needed a way to move the chest wall for them, hour after hour, day after day, without destroying their airways or sedating them into unconsciousness. This is where the iron lung changed everything. The first version was developed in 1928 by Philip Drinker and Lewis Shaw, originally for treating coal gas poisoning.
[05:45 –> 06:10] A few years later, in 1931, John Emerson introduced an improved and more affordable model. That design is the one most people see in pictures. The iron lung was essentially a large steel chamber powered by a vacuum pump. The patient lay inside the airtight cylinder with only their head sticking out through a rubber collar that sealed around their neck. The machine then cycled between gentle negative pressure and slightly positive pressure inside the chamber.
[06:10 –> 06:31] As the pressure dropped, the chest wall was pulled outward and air flowed into the lungs. Then as the pressure in the chamber equalized, the chest wall naturally relaxed and air flowed out. It was mechanical breathing, but from the outside. This was called negative pressure ventilation. It meant no tubes down the throat, no sedation, no risk of airway trauma.
[06:31 –> 06:54] Children could be awake. They could talk, eat, listen to the radio, read books, and even do schoolwork while the machine breathed for them. Many children lived in the iron lung for days or weeks until their nervous system recovered the ability to breathe. Others suffered such extensive motor neuron loss that they depended on the machine for life. One of the most extraordinary stories is of a man named Paul Alexander.
[06:55 –> 07:24] In the 1952, he contracted polio and lost the ability to breathe on his own. He entered an iron lung as a young boy and lived inside it for seventy two years. He learned a technique called frog breathing or glossopharyngeal breathing, which allowed him to gulp air into his mouth and use his tongue and throat muscles to force that air down into his lungs. And that gave him short periods of independence outside the chamber. But his diaphragm never recovered enough to be completely free of the machine.
[07:24 –> 08:00] He essentially spent his entire life inside the iron lung. He went to school, earned a law degree, practiced law, and lived a full life with this machine at the center of it. His story is both heartbreaking and inspiring. It shows the resilience of the human spirit and the ingenuity of mankind, that someone who lost the neurological ability to breathe could still build a long and meaningful life with the help of a mechanical device and, of course, a courageous mind. One of the most famous influential cases of polio in American history was Franklin d Roosevelt, the thirty second president of The United States Of America.
[08:00 –> 08:24] In 1921, after a summer trip, Roosevelt developed paralytic polio at the age of 39. He was left permanently paralyzed from the waist down. This was concealed from the public as much as possible during his political rise, but privately, it shaped the rest of his life. Roosevelt used his influence to attack polio on a national scale. In 1938, he helped create the National Foundation for Infantile Paralysis.
[08:25 –> 08:46] Americans came to know it by a much catchier name, thanks to a TV personality named Eddie Cantor, who urged families to mail a single dime to the White House. This movement became the March of Dimes. Millions of envelopes were mailed to the White House, filled with silver coins. Those dimes did everything. They bought braces, iron lungs, and access to rehabilitation.
[08:47 –> 09:14] They built treatment centers, and they funded the scientists who would ultimately discover the vaccines that ended the epidemic. Roosevelt never lived to see the cure, but the movement he started bankrolled the research that changed the world. And that brings us to Jonas Salk. Salk was a scientist who had an idea that almost no one in the mid twentieth century believed in. At the time, most experts insisted that a proper vaccine had to be a weakened live virus.
[09:14 –> 09:48] This thinking went all the way back to Edward Jenner in the creation of the smallpox vaccine. The belief was that the immune system needed exposure to something alive, something that could still replicate in order to generate long lasting protection. Salk saw it differently. He believed you could grow massive quantities of poliovirus in cultured monkey cells, kill the virus completely with formaldehyde, and use that as the vaccine. It would essentially be a dead virus, something that could not replicate, could not revert to a dangerous form, and could be produced safely at huge scale.
[09:48 –> 10:12] At first, it sounded too simple, too safe, too conservative. But in early animal studies and in small human trials, the inactivated virus worked exactly as Salk had predicted it. It triggered the production of neutralizing antibodies that prevented paralytic polio. These antibodies acted like grappling hooks binding to the virus and marking it for destruction. Still, laboratory breakthroughs weren’t enough.
[10:13 –> 10:40] The country and the world needed real clinical proof, and they were desperate for it. Every summer, polio swept through communities and emptied playgrounds. It was wearing down the resilience of families everywhere. So in 1954, as pressure reached its breaking point, the moment to put Salk’s vaccine to the ultimate test had come. Doctor Thomas Francis, a respected epidemiologist and Salk’s former mentor, led what became the largest medical field trial in history.
[10:40 –> 11:06] It involved 1,800,000 children. Hundreds of thousands received the real vaccine, while more than a million served as controls and received the placebo. These children were called the polio pioneers and received little pins and certificates for their effort. They were the volunteers, the draftees in America’s war against polio. The trial began in 1954, and on 04/12/1955, America held its breath.
[11:06 –> 11:33] The day was called v day for verdict day. In Ann Arbor, Michigan, Thomas Francis stepped up to the microphone and announced to the country that the vaccine was safe, effective, and potent. He reported that it was roughly eighty to ninety percent effective at preventing paralytic polio. The reaction across the nation felt like the end of a war. Church bells rang, factory whistles blew, people cried in the streets.
[11:34 –> 11:53] Storefronts were painted with the words, thank you, doctor Salk. Salk instantly became a national hero, and after such a monumental discovery, he chose not to patent the vaccine. When asked why, he offered a simple answer. Could you patent the son? He believed the polio vaccine belonged to humanity, not to him.
[11:53 –> 12:11] And because he declined the patent, nothing slowed the rollout. Pharmaceutical labs began producing the vaccine within weeks, shipping doses across the country as fast as they could be made. And America was ready, desperate even. Families had lived too long with the fear of polio. Now they finally had hope.
[12:11 –> 12:35] But in the middle of this incredible moment, a tragedy occurred. One manufacturer, Cutter Laboratories, failed to fully inactivate the virus in a batch of vaccines. About 120,000 doses containing live virus were shipped out. Children who received those doses became infected, Hundreds developed paralytic polio, and several died. The contaminated lots were immediately recalled.
[12:35 –> 13:10] Investigators traced the problem to cutters manufacturing practices, and the government rapidly tightened safety regulations for vaccine production. It was a dark chapter, but even this did not stop vaccination. Parents continued bringing their children in for the shot because they remembered what uncontrolled polio looked like. They knew the risk of the disease was far greater than any risk from the vaccine, and that public and social commitment kept the national vaccine campaign moving forward. At the same time, another researcher named Albert Sabin was pursuing a very different idea.
[13:11 –> 13:34] Sabin belonged to the mainstream camp that believed that live attenuated vaccines produced deeper, longer lasting immunity. And in one important way, he was right. Salk’s vaccine was injected into the arm. It produced strong neutralizing antibodies in the bloodstream. Those antibodies protected children from paralytic polio, but they did not stop the virus from entering the gastrointestinal tract.
[13:34 –> 14:11] Vaccinated children could still get intestinal polio infections, still shed polio virus in their stool, and still pass it on to others. Sabin believed that to truly stop polio, you had to stop it in the gut. You had to trigger immunity at the mucosal surface of the intestines where the virus first replicated. His idea was to create a live, weakened virus, one that would cause only a mild intestinal infection, but would replicate just enough to generate strong immunity. That immunity would block viral replication in the gut and dramatically reduce shedding, breaking the chain of person to person spread.
[14:11 –> 14:35] And because it was taken by mouth, it was far easier to distribute. No syringes, no sterile equipment, no trained staff. A few drops on a sugar cube were all it took. In The United States, Salk’s vaccine was perfect for the moment. Sanitation was good, distribution networks were strong, and the paralyzing form of polio could be quickly eliminated through mass injection campaigns.
[14:35 –> 14:59] But in countries with poor sanitation or limited access to refrigeration and medical equipment, Sabin’s oral vaccine was far more practical. It was cheap, simple, and ideal for large populations. Salk and Saban’s theories collided. They respected each other’s intelligence, but disagreed fiercely about almost everything else. Both wanted to defeat polio, but they envisioned very different paths.
[14:59 –> 15:20] As Salk became a national hero in the mid nineteen fifties, Sabin quietly kept refining his oral vaccine. But there was a problem. The United States had already committed fully to Salk’s vaccine. There was little room for Sabin’s competing approach, so Sabin looked elsewhere. This was the era when The United States and The Soviet Union were locked in a tense nuclear cold war.
[15:20 –> 15:54] But at the same time, both countries were also battling crippling polio outbreaks. Soviet children were dying in large numbers, so Sabin began working with a Soviet virologist named Mikhail Chumakov. Together, they organized some of the largest vaccine trials ever conducted. Tens of millions of children and adults across The USSR swallowed sugar cubes infused with two drops of Sabin’s attenuated virus, and it worked. It stopped outbreaks, lowered transmission, and proved that Sabin’s vaccine could protect entire cities and regions with remarkable efficiency.
[15:54 –> 16:25] So while our governments traded threats, spies, and propaganda, American and Soviet scientists quietly collaborated to save children. It was one of the rare moments when science rose above geopolitics and proved that human lives mattered more than political ideologies. Sabin’s vaccine went on to become the workhorse of global eradication campaigns. In places without reliable electricity, without cold storage, without syringes, or trained medical staff, the oral vaccine made mass vaccination possible. It was simple.
[16:25 –> 16:50] It was effective, and it helped bring the world to the brink of finally defeating polio. In The US, polio numbers fell like a stone. In the early nineteen fifties, The United States saw more than ten thousand cases of paralytic polio each year. Within a few short years after vaccination, that number dropped to the hundreds and then to the double digits. And by 1979, polio was eliminated from The United States.
[16:50 –> 17:18] Globally, Sabin’s oral vaccine became the engine of mass immunization campaigns through the nineteen sixties and seventies. Volunteers went door to door, placing two drops of vaccine on a sugar cube and giving it to each child. Once the child swallowed it, a little purple ink on the fingertip marked him as protected. It was simple, cheap, and transformative. In 1988, the World Health Organization and UNICEF launched a global eradication initiative, and national governments joined in.
[17:18 –> 17:48] Later, the Rotary Club, the CDC, and the Gates Foundation added enormous support. Since that campaign began, worldwide cases of polio have fallen by more than ninety nine percent. Millions of people who would have lived their lives in braces, wheelchairs, or died instead grew up walking, running, playing, and living full lives. It’s a true testament to how much good science and philanthropy can do in the world. Today, wild polio remains endemic in only two countries, Afghanistan and Pakistan.
[17:48 –> 18:08] Occasionally, we’ll find polio in wastewater and other places as well, and this just serves as a reminder that eradication is difficult and requires constant vigilance. But the goal is still within reach. We have already erased smallpox from the planet. Polio is poised to be next. Today, we’ve come a long way from the perils of the nineteen fifties.
[18:08 –> 18:31] Every summer back then, parents braced for the possibility that their child might never walk again. The possibility of children returning from summer break in leg braces or not returning at all was real. Polio was the background fear of American life. It took strong and healthy children without warning. Now fast forward to today, most people 70 years old have never seen natural polio.
[18:31 –> 18:55] Diseases like diphtheria, measles, and polio feel like old textbook curiosities, not real threats. And this sets up a paradox in the modern world. The better vaccines work, the more invisible the diseases become. And when the diseases become invisible, all we see are the shots. All we can see are the warnings, the rumors, the social media conspiracies, because humans respond emotionally to vivid stories.
[18:55 –> 19:20] That’s just how we work. In the nineteen fifties, the vivid stories were of wheelchairs, twisted lambs, and rows of children and iron lungs. Today, the vivid stories are videos on social media that plant seeds of doubt in vaccination. Our grandparents saw horrible diseases and thanked God for vaccines. And today, we see vaccines as a potentially risky intervention for diseases that we’ve never seen.
[19:20 –> 19:45] And it’s important to note that questions about the side effects of vaccines are not irrational. Vaccines are medical interventions, and they do carry risks. But vaccines have also saved more lives than any other medical breakthrough in human history. They lifted us out of an age defined by fear of infectious disease and into an age of naivete. These diseases that once haunted humanity have not disappeared.
[19:46 –> 20:13] They’ve only been pushed back and held at bay. But the control we have is reversible. Diseases return when immunity falls and when memory fades. And I’m telling you right now, our memories are rapidly fading. So I’m not here to tell you what to think about vaccination, but I am asking you to try, even for a moment, to imagine the world before we had the luxury of doubting vaccines, a world where every summer felt like a gamble with your child’s life.
[20:13 –> 20:53] Today, we’re close enough to eradication that each new polio case in the world is a headline with a name, not a statistic lost in thousands. Polio is on track to become only the second human disease ever eliminated from the earth after smallpox. So somewhere out there, a child will be the last person on earth to ever get polio. How soon that happens depends on us, on what we fund, what we teach, and how we choose to protect one another. And that is the legacy of this story, a story of fear, ingenuity, triumph, and the collective will of millions of people who refused to accept a world where children lived in iron lungs.
[20:53 –> 21:08] They gave us the world we live in now. Now we have to decide what kind of world we give the next generation. Okay. So I hope you enjoyed that. In our next episode, we’re gonna talk about a disease that touches millions of lives, depression.
[21:08 –> 21:42] It’s one of the most misunderstood conditions in all of medicine, and far too many people are suffering quietly because they don’t know where to begin. I wanna break this topic wide open. We’re gonna talk about what depression actually is, what it does to the brain and body, and more importantly, what truly helps people climb out of it. I’m gonna give a clear evidence based road map for recovery that most people will never get in a ten minute office visit with their doctor. If you or someone you love has ever felt stuck, heavy, hopeless, I want you to join me for this one.
[21:42 –> 21:55] This is a disease that has touched me and my family, and it’s very personal. I promise this will be one of the most practical and empowering episodes I’ve ever done. So until then, stay curious, stay skeptical, and stay healthy. Cheers.