In 1953, the year Jonas Salk announced he had first successfully tested his polio vaccine, more than 58,000 Americans—mainly children—contracted the disease, 3,000 of whom died. The death toll would have been far worse, and the road to a successful vaccine far longer, if not for the work of doctors and scientists right here in Boston.
For those of us born after the mid-1950s, it’s hard to fathom just how devastating a disease polio was, explained Dr. Mark Rockoff, vice chairman of the anesthesiology department at Boston Children’s Hospital.
"Polio was an enormous problem in the 20th century," he said. "It was probably the most terrifying infectious disease that existed."
A virus that attacks the nervous system, polio began breaking out in annual summer epidemics in the United States in 1916. Some years it infected hundreds, others years it infected thousands—mainly children. The disease could cause severe muscle weakness and temporary—or permanent—paralysis. That paralysis frequently occurred in the legs, but also in the chest—with dire consequences.
"People would be unable to breathe and go on to die," Rockoff said. "Unless their respiration could be supported until their respiratory muscles returned function."
The problem was that in the early 20th century there was simply no reliable or effective way to support that respiration; at least not until an innovator at the new Harvard School of Public Health took up the cause.
"It was developed by an engineer, not a physician: Phil Drinker," Rockoff explained. "He was an industrial engineer, a chemical engineer, who was hired at the school of public health, mainly to look at industrial problems."
In the 1920s, those industrial problems included coal-gas poisoning and respiratory failure due to electrocution. And so Drinker set about developing a pressurized chamber, with a diaphragm powered by a vacuum-cleaner motor, that could literally make a body breathe. At least a very small one.
"It’s a very simple concept," Rockoff said. "He originally was working with cats in a little tank that he hand-built, and [he] did all this by hand."
At the time, Harvard’s School of Public Health was located next door to Boston Children’s Hospital, where Drinker regularly saw, first-hand, the devastating effects of polio.
"He watched these kids come in, get paralyzed, and die, and he was very deeply affected," Rockoff said. "And he said, 'I think I could make a big one and make it work for people.'”
And so Drinker set about scaling up his machine—known first as the Drinker Respirator and, eventually, the iron lung. He tested it on himself, his colleagues and volunteers. By Oct. 12, 1928, when an 8-year-old girl with acute polio was admitted to Children’s hospital, he hoped it was ready.
"She started getting so blue because she couldn’t get oxygen and she lost consciousness," Rockoff said. "She was about to die. They put her in their device and within minutes she woke up. She was pink. She started talking and soon she was asking for ice cream. It was absolutely revolutionary at the time. Most people who witnessed this were crying when they saw it."
By the next year, iron lungs were being installed in hospitals across the country. Over the next four decades, Drinker’s iron lung would be enhanced, and save thousands upon thousands of lives.
Meanwhile, at Children’s Hospital, a new front in the war on polio was being blown wide open by microbiologist Dr. John Enders.
"He was the one who figured out, with a couple of his colleagues, how to culture it in cell culture," Rockoff said. "Before that, nobody knew how to do that."
Rockoff points out that while we rightfully remember Jonas Salk and Albert Sabin today for their revolutionary polio vaccines, it was Ender’s breakthrough that made their work possible.
"It was not Dr. Salk or Saban who got the Nobel Prize for this discovery. It was Dr. John Enders from Children’s Hospital with two of his Harvard Medical School colleagues who were residents here and then worked with him in the lab."
Mass vaccinations began rolling out in the mid-1950s. In 1957 there were fewer than 6,000 polio cases in the US. In 1961, there were fewer than 200. According to the CDC, the last known polio case to originate in the United States occurred in 1979.
"It’s one of the great stories of collaboration of engineers and physicians looking at a great problem of human health, coming up first with the iron lung to treat it, and then coming up with ways of preventing it," Rockoff said. "It’s a great story of innovation in medicine and it all happened in Boston."
