The Epidemic That Preyed on Children

“Do you want to spend the rest of your life in an iron lung?” Children heard these words during polio outbreaks when they begged to play outside.

Children in San Angelo watch as DDT sprays over their community.
Children in San Angelo, Texas, watch as officials spray DDT over their community in order to fight the polio outbreak. (Bettmann / Getty)

In the late spring of 1949, the local newspaper in San Angelo, Texas, reported that a child had been rushed to the hospital with a fever, aching joints, and mild paralysis of the legs—the telltale signs of polio. A city of 50,000, dotted with oil rigs and cattle ranches, San Angelo was no stranger to the disease. Each year following World War II, polio would arrive like clockwork as summer approached, striking down a child or two before burning itself out.

Within days that spring, however, the hospital’s ICU was overflowing with children, most in critical condition, and mild concern turned to panic. “Polio Takes Seventh Life,” screamed the banner headline. “San Angelo Pastors Appeal for Divine Help in Plague.”

Prayer proved insufficient. For the first time in anyone’s memory, social distancing took hold. The city council voted to close theaters, bars, bowling alleys, and the municipal swimming pool. Tanker trucks sprayed DDT, singling out the open pit toilets on the “Negro” and “Mexican” side of town. Tourist traffic disappeared. The locals stopped handling money, and some refused to speak on the telephone, believing that germs traveled through the transmission lines. Known for its neighborliness, San Angelo quickly ditched the niceties that it once took for granted. “We got to the point that nobody could comprehend,” a pediatrician recalled, “when people would not even shake hands.”

Although polio is only a memory in the United States, the current pandemic is stirring up feelings analogous to when this insidious crippler terrified a nation. Like the Great Influenza of 1918, polio offers historical perspective. Both the poliovirus and the coronavirus rely on “silent carriers”—those showing no immediate symptoms—to spread the disease, inciting a fearful sense of uncertainty. Both target specific, if dramatically different, age groups: COVID-19 seems especially lethal for the elderly, polio for the young.

In San Angelo, some businesses remained open, simply hoping to survive. The local cleaning establishment vowed to disinfect its equipment before each pressing and wash. The Sherwin-Williams Paint and Hardware Company promised its loyal customers toxic bug spray free of charge. (“Bring your own container,” it advised.) Agents hawked special “polio insurance,” while the town chiropractor boasted that he could prevent the disease by “keeping your child’s body correctly adjusted.”

The epidemic lasted until early fall, when the cool winds of October helped extinguish its destructive reach. In 1949, the United States reported about 40,000 polio cases, one for every 3,775 people. San Angelo, meanwhile, reported 420 cases, one for every 124 people. Eighty-four of the city’s children would be permanently paralyzed, and 28 would die. The San Angelo polio outbreak would stack up, percentage-wise, as one of the most destructive ever recorded anywhere in the world.

Numbers aside, its patterns were all too familiar. The epidemic preyed on children, doing its worst damage in the summer months. It appeared to hit the tidy, stable neighborhoods of San Angelo far harder than those marked by poverty and squalor, a reversal of the belief that filth triggers disease. Much remains unknown about polio because the development of two effective vaccines in the 1950s and early ’60s made further research moot. Why did it strike almost exclusively in warm weather? Why did most of its victims appear to come from middle-class surroundings? And why was epidemic polio primarily a disease of the 20th century that struck the world’s more developed nations, especially the United States?

There are no certain answers. Some believe that polio, a virus transmitted primarily through oral-fecal contact, not airborne droplets as with the coronavirus, is uniquely suited to warm-weather transmission. Others see polio’s dramatic spread in the 1940s and ’50s in terms of cleanliness. As Americans grew more germ-conscious and sanitary-minded, there was less chance that they would encounter poliovirus very early in life, when the disease is milder and maternal antibodies provide temporary protection.

“Do you want to spend the rest of your life in an iron lung?” Children heard these words when they begged to go swimming or play outside, when they jumped through a puddle or licked a friend’s ice-cream cone, when they refused to take a nap or balked at the daily home polio test (“Chin to chest, touch your toes”). Hitting with full force at the very height of the Baby Boom era, a time of unprecedented prosperity and population growth, polio became the crack in the middle-class picture window, a summer plague dotted with visual reminders: wheelchairs, crutches, leg braces, breathing devices, withered limbs.

The coronavirus, too, reminds us of our limits. The richest nation on Earth seems unable, at present, to offer health providers the basic supplies and protection they need to fight this pandemic. We face COVID-19 as we have faced so much else in recent years: divided by partisanship and ignorance, bombarded with mixed messages, uncertain of what constitutes proper behavior during a crisis. It should chasten us to know that Americans came together during the polio era to fight the disease with fewer tools than we have now but with greater purpose and determination.

The great polio epidemic struck at a time when the federal government wasn’t much involved in the medical problems of the citizenry. The National Institutes of Health had a small budget, the Centers for Disease Control and Prevention was barely up and running, and the Cabinet-level Department of Health, Education, and Welfare wouldn’t be created until 1953. (President Dwight Eisenhower could barely remember its name, calling it “Health, Welfare, and Whatnot.”) Virtually all of the research, publicity, and patient support surrounding polio was accomplished by a single private charity, the March of Dimes, which raised hundreds of millions of dollars with its promise to end the scourge in a single generation.

Celebrities from Bing Crosby to Elvis Presley to Marilyn Monroe implored Americans to donate their spare change. And millions of volunteers went door to door to collect dimes and quarters in tin cans and mason jars. The money raised exceeded the contributions of every other charity put together, with the exception of the Red Cross. In 1954, America’s parents lined up their children, almost 2 million strong, for the largest public-health experiment in our history, the Salk polio-vaccine trials, run by the March of Dimes with virtually no government oversight. It was partly a matter of risk versus reward—the terror of polio far outweighed the potential dangers of the vaccine. But there was more: Polio’s conquest represented a milestone for voluntarism and public-spiritedness. When Eisenhower invited Jonas Salk to the White House, the president choked back tears as he thanked the young researcher who had developed the polio vaccine for saving the world’s children. There was no grandstanding, no attempt to share credit. The victory belonged to science, and to the people.

Although that moment seems unrecognizable today, the victory will come nonetheless.