Small Steps

by Peg Kehret

  March of Dimes

  One of the rare photographs of President Franklin D. Roosevelt in his wheelchair. Roosevelt was stricken with polio in 1921, before he became president. In this photo taken at Hilltop Cottage, the home in Hyde Park, New York, he built for his retirement, the president holds his dog Fala on his lap and is speaking to Ruthie Bie, the daughter of the cottage’s caretakers.

  Franklin D. Roosevelt Library

  Sister Elizabeth Kenny, an Australian nurse, successfully treated polio patients with hot packs, muscle massage, and stretching exercises. The technique she developed helped me recover. Here she demonstrates her method on a young American polio patient.

  Library of Congress

  Pictures of appealing children on March of Dimes posters encouraged the public to donate money for research to fight polio. The March of Dimes is an organization whose initial goal was to eliminate polio.

  March of Dimes and Peg Kehret

  In antiques shops, I found some old March of Dimes buttons.

  March of Dimes and Peg Kehret

  Dr. Jonas Salk and research assistant Ethel Bailey in his laboratory at the University of Pittsburgh, where he developed his killed-virus polio vaccine. The research was funded by the March of Dimes.

  Carnegie Library of Pittsburgh

  In 1954, 1.8 million young schoolchildren took part in nationwide

  trials testing the Salk vaccine. The trials were led by Dr. Thomas Francis, Jr., of the University of Michigan. The vaccine proved successful, and the children were called “Polio Pioneers.” They each received the tin button shown above.

  March of Dimes and Peg Kehret

  March of Dimes

  On April 12, 1955, the Salk vaccine was pronounced safe and effective. The next morning, newspapers announced the thrilling news; polio would be conquered!

  March of Dimes

  Dr. Albert Sabin, shown here in his laboratory at the University of Cincinnati, developed a live-virus vaccine that was approved for use in the U.S. in 1962. It soon replaced the Salk vaccine. Dr. Sabin’s research was also funded by the March of Dimes.

  March of Dimes

  Renée, me, and Dorothy at our reunion in September 1997.

  Peg Kehret

  This photo of my husband, Carl, my mother, and me was taken in 1996, the year Small Steps was published. When I first recovered from polio, Mother destroyed every photo of me in the wheelchair or using my walking sticks. She said she didn’t want to remember that part of my life. By the time Small Steps was published, she was eager to talk about polio and enjoyed giving copies to her friends.

  Peg Kehret

  Carl and me with our dog Daisy in front of our motor home in 1997. Pete and Molly, our cats, were inside. After I began writing books for children, we traveled this way for many years when I gave talks at schools, libraries, and conferences.

  Peg Kehret

  I’m wearing my “award necklace,” which has a charm for every state where I’ve won the Young Reader Award for my children’s books. Each charm is engraved on the back with an abbreviation of the winning book’s title and the year that it won. The photo is from 2001. There are presently twenty-five charms on the necklace.

  Peg Kehret

  In 1957, the U.S. Postal Service issued a three-cent stamp honoring those who helped fight polio. A thirty-three-cent stamp titled “Polio Vaccine Developed” was issued as part of a 1999 sheet of commemorative stamps. For both stamps, special “first day of issue” envelopes were created for collectors. Dr. Salk and Dr. Sabin were both honored with new sixty-three-cent stamps in 2006.

  Peg Kehret

  More about Polio

  References to polio date back thousands of years. A stone carving made around 1500 b.c.e. shows a man named Ruma, a gatekeeper at an Egyptian temple, leaning on a staff. Ruma’s right leg is smaller and shorter than the left, and his right foot points down in the “dropfoot” characteristic of polio.

  Although the disease had not yet been named, cases of what must have been polio were also reported in ancient Greek and Roman times. The first clinical description was written by a British physician in 1789, but he still did not name the illness. Most cases of polio cause flu-like symptoms but do not cause death or paralysis. Until epidemics of paralytic polio began to occur, a century later, the disease got less attention than diseases such as diphtheria and smallpox.

  In 1840, a German doctor named the disease “infantile paralysis” because victims were so often children. Eventually, the disease’s scientific name would be poliomyelitis, but it is usually called polio.

  In the late 1800s, the first recorded polio epidemics struck, in Scandinavia. In 1894, a small town in Vermont reported forty-four cases of paralytic polio, and in 1916, twenty-seven thousand cases were reported in the United States, with six thousand deaths. By then it was known that polio is caused by a virus, but no one knew how to keep the disease from spreading or how to treat those who contracted it. For the next forty years, major epidemics broke out each year in the U.S.

  Ironically, scientists believe that improved sanitation caused the dramatic increase in polio. Until the beginning of the twentieth century, most infants acquired the polio-virus from unsanitary conditions, such as fecal material in the water supply. The babies were infected, but because they were still protected by antibodies from their mothers, their sickness was mild. (Antibodies are substances produced by the body’s immune system that destroy or neutralize bacteria, viruses, or other harmful toxins.) The virus stimulated the babies’ immune systems enough to produce their own antibodies, which gave them lifelong protection against polio.

  Then health officials began keeping the water supply clean, and rules of hygiene such as washing one’s hands before eating became widely known. While standards of cleanliness rose, so did the number of polio cases because now children were not exposed to the virus until long after the immunity that they got from their mothers had ended.

  As polio increased, so did fear of the disease. During epidemics, public swimming pools closed, and children were barred from movie theaters so infection wouldn’t spread. In the 1916 epidemic, officials in New York City, which had the most cases, thought that animals might spread the disease. They captured and killed seventy-two thousand stray cats. Towns near New York City placed signs on their main roads warning children from the city not to enter. Since the epidemics occurred during the summer months, some parents decided sunshine made children more vulnerable, so they allowed their children to go outdoors only after dark. Other children were required to wear gloves all summer, to keep germs off their hands.

  None of these preventive efforts stopped the polio epidemics. Many victims died. Those who survived were often crippled for life. Their withered limbs, heavy metal braces, and wheelchairs were constant reminders of the devastation polio caused. People encased in iron lungs symbolized the terrible helplessness that parents felt as they feared for their children. For half a century, dread stalked American families. Children and adults, rich and poor, city dwellers and farmers—all feared the same unseen foe: polio.

  The poliovirus attacks the nerve cells in the brain and spinal cord that control the muscles of the body. If damage to the nerve cells is slight, the muscle weakness will be temporary. If the virus kills many nerve cells, paralysis will be extensive and possibly permanent.

  There is no cure for polio. There are no miracle medicines to stop the damage to nerve cells or repair those already damaged. Today’s polio patients are still treated with moist heat and muscle-stretching exercises, just as I was over fifty years ago.

  In 1921, Franklin Delano Roosevelt, aged thirty-nine, was diagnosed with polio. Roosevelt had run for vice president of the United States a year earlier, and although he lost that election, he was a popular public figure who anticipated a national political career. The best doctors confirmed his diagnosis but could not cure him or even suggest treatment. Roosevelt’s legs were paralyzed.

  He did not give up easily
. Determined to regain the use of his legs, he spent seven years in rehabilitation, but despite his efforts, he never again walked without help.

  Much of Roosevelt’s rehab was done at Warm Springs, a spa in Georgia whose warm waters were said to cure paralysis. Although he wasn’t cured, the buoyant water helped Roosevelt move better, swimming built up the strength in his upper body, and the exercise gave him a feeling of well-being.

  In 1926, Roosevelt bought Warm Springs. The next year, he and his law partner, Basil O’Connor, made it a nonprofit foundation for polio survivors. In 1928, Roosevelt left Warm Springs to run for governor of New York.

  Roosevelt went on to win four terms as president of the United States. Instead of leading the secluded life of an invalid, as expected at that time, he led the U.S. toward victory in World War II and out of the Great Depression. In those days, disabled people were perceived as weak and unable to contribute to society, so Roosevelt discouraged photographs of himself in his wheelchair. When he gave a speech, he wore hip-high leg braces and used a cane so that he could stand while he spoke.

  To raise money to support its programs, the Warm Springs Foundation held “Birthday Balls” in eight cities on Roosevelt’s birthday, January 30, 1934. The balls were so successful that they became an annual event, spreading to more locations each year.

  In 1938, Roosevelt, then in his second term as president, established the National Foundation for Infantile Paralysis. With much fanfare, he announced that the new organization would finance investigation into the cause of polio and the methods by which it might be prevented. The National Foundation would also pay for patient care.

  Eddie Cantor, a famous entertainer, suggested a new kind of fund-raiser, aimed not at the wealthy few who attended balls but at the masses of ordinary citizens who, fearing for the safety of their children, wanted to defeat polio. Cantor coined the phrase “The March of Dimes” and urged people to send their dimes directly to the White House. Mailbags full of silver coins soon arrived in Washington, D.C.—a total of two million, six hundred eighty thousand dimes in the first few months! That method of fund-raising continued, and was so successful that eventually the foundation’s official name was changed to the March of Dimes.

  Celebrities such as Willie Mays, Lucille Ball, and Frank Sinatra championed the cause. Movies were stopped partway through while volunteers from local March of Dimes chapters passed collection plates, asking people to donate their change.

  Each year a few children who had polio were chosen to be photographed, and the photos were made into posters that were widely displayed.

  In 1946, a biographical movie, Sister Kenny starring Rosalind Russell, took the country by storm. It increased the fear of polio and also the determination to find a way to prevent it. (Years later, my husband and I rented this film, but I couldn’t bear to watch it. An early scene of a young girl in pain and unable to move her legs left me tearful and shaking.)

  As more and more men went overseas to fight in World War II, women took over the important volunteer positions with the March of Dimes. In 1950, a group of women in Phoenix, Arizona, organized a Mothers’ March on Polio. On the night of the Mothers’ March, anyone who wanted to contribute money to fight polio was asked to turn on their porch light at seven o’clock. The marching mothers would knock only at dwellings whose outdoor lights were on.

  The Phoenix moms raised $45,000 that night, and a year later the first national Mothers’ March on Polio was held. By then rumors of a possible vaccine were creating excitement and enthusiasm for the cause. Throughout the country, hundreds of volunteers stood ready to go, and at seven o’clock church bells rang, fire stations blew their sirens, and motorists honked their horns—all to remind everyone that it was time to turn on the light and contribute to the fight against polio. Children accompanied their parents to help collect funds.

  On the evening of that Mothers’ March, I had been home from the hospital for nearly a year. My mother was one of the marchers, and I walked beside her. There were no dark porches in my neighborhood that night; every home blazed with light.

  The fund-raising escalated, but so did the polio epidemics. Year after year, thousands of people were afflicted. The worst year, 1952, brought 57,879 cases. During one horrible five-day period, doctors diagnosed 4,191 cases of polio.

  Hospital staffs were overwhelmed; patients shared rooms intended for one person, and the panic over polio increased.

  The cost of care was astronomical. My parents had used up their savings and remortgaged their house, yet they still couldn’t pay all my hospital bills. Some families had more than one child with polio; sometimes a parent was stricken. The March of Dimes funded all of this patient care, including mine after my parents ran out of funds. Not only did the March of Dimes pay hospital bills, but it purchased iron lungs and other medical equipment and established rehabilitation centers. It also funded scientists as they hunted for a way to prevent polio.

  While the epidemics raged and the public contributed money, researchers worked to develop a polio vaccine. By the late 1940s, scientists knew that the poliovirus enters the body through the mouth, goes into the digestive system, then to the bloodstream, and finally to the nervous system, where it attacks the cells that tell the muscles what to do.

  The principle of immunization was also known: inject a body with a small amount of disease in order to stimulate that body’s immune system to produce antibodies to fight the disease. The trick was to create enough anti-

  bodies without creating a severe form of the disease.

  Getting enough poliovirus to work with was difficult, too, as it was grown in the nerve tissue of live monkeys. It was time-consuming to extract the virus from the monkey tissue, and only tiny amounts of virus could be produced. Since the monkeys were killed before the tissue was taken, more monkeys were always necessary. Scientists needed a way to grow the virus in large quantities outside of living animals.

  Early experiments failed. Then three scientists in Boston discovered how to grow poliovirus in cells in test tubes instead of in live monkeys, which enabled researchers to produce enough virus to make large quantities of vaccine. These scientists, John F. Enders, Frederick C. Robbins, and Thomas H. Weller, won the 1954 Nobel Prize in Medicine for their important discovery.

  A difference of opinion developed among the leading researchers about whether the vaccine should be made from inactive, or killed, virus or from a weakened live virus. Dr. Jonas Salk, who had produced flu vaccines from a killed virus, used that method in his efforts to produce a polio vaccine.

  Dr. Albert Sabin preferred a live but weakened virus, a method that had succeeded against rabies and smallpox. The efforts of both men were funded by the March of Dimes.

  Dr. Salk’s vaccine was ready for human trial first. His faith in it was so great that he injected himself, his wife, and his three sons before he gave it to the public. Lab workers who worked on the vaccine also voluntarily took the injections. No one suffered bad effects, and their bodies’ immune systems produced polio antibodies, as Dr. Salk had hoped.

  In 1954, Dr. Salk was ready for a massive field trial with healthy children from all across the country. By participating in this trial, one million, eight hundred thousand children became “Polio Pioneers.” They each received a certificate and a tin Polio Pioneer button to wear. They were divided into three groups: some received the vaccine, some got injections containing no vaccine, and some simply had their health monitored for comparison.

  It was a huge undertaking. Along with all the doctors

  and nurses, some fifty thousand teachers and over two hundred thousand volunteers were on hand to help. Computers were not much in use yet, so it took a long time for all the data to be recorded, collected, and analyzed. Later, records of polio cases from that summer were compared with the records of the children who actually received the vaccine.

  The field trial took place in the spring and summer of 1954, but the results were not known un
til the spring of 1955. At ten a.m. on April 12, 1955, the tenth anniversary of Franklin Delano Roosevelt’s death, the announcement electrified the world: the Salk vaccine was safe and

  effective!

  I was a student at the University of Minnesota that spring. When I heard the news on the radio, my emotions churned. Elation that polio could be prevented wrestled with regret that I had missed the vaccine by only six years.

  By five-thirty that afternoon, the federal government had licensed the manufacture of polio vaccine. Jonas Salk instantly became a national hero. When asked who owned the patent on his vaccine, he replied, “Well, the people I would say. There is no patent. Could you patent the sun?”

  Within two years, the number of polio cases in the United States dropped by 80 percent.

  In 1959, five years after Dr. Salk’s successful trial, Dr. Sabin was ready to test his live-virus vaccine, which was taken by mouth. A field trial required a large population that had not yet been vaccinated. By this time the Salk vaccine had been widely used in the U.S., so Sabin’s trial was held in Russia, with ten million children vaccinated. It, too, was successful. In 1962, the oral vaccine was approved for use in the U.S. and soon replaced the injected Salk vaccine as the preferred method because it was cheaper and easier to administer.