years 20,916 deaths were caused by this disease. The estimate for 1953 is 35,000 cases.

Of the victims of poliomyelitis, 50 percent recover completely; 30 percent have no disabling aftereffects, 14 percent are severely paralyzed, and 6 percent may die.

According to a United States Public Health Service report, more children died in 1952 from poliomyelitis than from any other reportable communicable disease.

Recently the national foundation attempted to calculate the risk of contracting clinical poliomyelitis, the diagnosable kind. In 4 representative States from which statistical information was available, it appeared that among children born in 1930, 1931, 1932, 1 out of every 156 acquired poliomyelitis during the first 20 years of life. In those same groups of children, 1 out of every 1,945 died from infantile paralysis before reaching the age of 20. It is obvious, then, that the chance of getting poliomyelitis is not as insignificant as many people believe.

According to the World Health Organization, the relatively low incidence of paralytic poliomyelitis compared to many other infectious diseases is counterbalanced by the permanence of the resulting disability, since treatment, prolonged and expensive as it is, is only a palliative; a nerve cell, once irreparably damaged cannot be replaced. The National Foundation for Infantile Paralysis from 1938 through 1952 spent 145 million for patient care. By the end of 1953 it is estimated that more than 258,000 patients will have received direct financial assistance, in whole or in part, from the National Foundation for Infantile Paralysis. In 1952 alone the patient-care program expenditures were $24,910,000 for aid to 80,000 poliomyelitis patients, more than half of them victims of previous years.

I think that it is important to note there that the problem of the national foundation and the patient-care program has been the cumulative caseload that has come from previous epidemic years. Even in 1952, with 57,000 reported cases, there was not only the problem of that year alone but the cases that had occurred in previous years.

The average cost of inpatient hospital care of polio patients (per patient day in all general and special short-term hospitals) during the first 7 months of 1953 was $14. The daily average cost of care of a patient in an iron lung is approximately $19. Service to respirator patients can cost as high as $10,000 to $12,000 a year for a seriously involved case. There are more than 1,500 patients today in iron lungs for all or part of each day.

A study of 35,882 notices of original acute admissions reported to the national foundation during the period July 20 to December 31, 1952, showed that: 54 percent were under the age of 10; 23.9 percent were age 10-19; 22.1 percent were 20 and over. Ten percent of the patients were in the age group 30-39; above the age of 40 the percentage becomes minimal. Up to the age of 20 more boys than girls fall victim to this disease; above that age the proportion changes, and of all females in the group studied, 28 percent were in the age group 20 and over.

There is no way of estimating manpower loss accurately in terms of interruption of schooling or denial of playtime for children. The high incidence among women of 20 and over strikes into the group of young mothers, whose loss to their families is incalculable. Per

manent crippling of the boys and girls under 20 means perhaps 50 years of economic handicap. Recovery periods after a poliomyelitis attack often stretch for months, and some patients cannot be restored to earning power for years, if at all.

The long-lasting effects of this disease are illustrated by our findings during the first 4 months of 1953, that of 6,064 poliomyelitis patients admitted for treatment, 1,031 had their initial attack in 1948 or before; 388 in 1943 or before. During 1953 the national foundation still was paying for care of some victims stricken in the 1916 epidemic.

National foundation records show that 7,756 patients out of the 50,338 aided from July 20, 1952, to January 3, 1953, had a service connection or were from families of veterans.

It should be mentioned that the national foundation chapters carry individual patient care expenses as long as the attending physician believes treatment will bring benefits to the patient and the family cannot pay full costs of essential followup treatment. Maximum recovery usually can be expected within 18 months, but many cases go far beyond this.

A total of 24,217 bills received by the national foundation during January through May 1953, for care of 11,666 patients, showed that the average cost for treatment per patient was $629, of which the national foundation contributed $550 for each. In 1953 the cost was $621 for care of one patient stricken in 1902; $1,458 for care of one patient who had poliomyelitis in 1912. Cost of equipment used is not included.

An iron lung costs from $1,800 to $2,100; a rocking bed from $700 to $1,500. The price of a portable chest respirator and its accessories is approximately $1,250; hotpack machines used in hospitals range from $225 to $400. Purchase of a wheelchair takes around $175, and braces, for leg or back, from $50 to $300. National foundation chapters supply these items to patients and hospitals as required.

A striking illustration of the financial burdens this disease imposes is that of a doctor in Santa Cruz, Calif. He received March of Dimes care at the rate of about $14,000 a year from late 1949 through 1951. In 1952 this was reduced to approximately $5,500 because this physician, though still forced to spend some time each day in an iron lung, had resumed the practice of medicine.

Hospital bills for another poliomyelitis victim for the period April 7 through July 21 of this year amounted to $5,100.

During the years 1938-52 the national foundation allocated a total of $16,400,000 for professional and public education. In 1952 almost $2,400,000 was allocated for this purpose. Of 6,000 physical therapists working in the United States in 1952, almost 2,000 were trained under national foundation scholarships, for which $2,250,000 had been provided.

Funds amounting to $18,100,000 were authorized for scientific research in the years 1938-52; $3,300,000 of this amount in the year 1952. On June 30, 1953, the national foundation announced awards totaling $2,283,384 to 21 universities, medical schools, hospitals, and organizations for research and professional training. Included in this sum was $334,108 for pilot studies to integrate the concept and skills of complete medical rehabilitation at George Washington University School of Medicine, the University of Pennsylvania School

of Medicine, New York University College of Medicine, and Cornell Universiay Medical College.

So far no rapid diagnostic device has been perfected by national foundation grantees but there are signs that research on this subject may produce results soon.

A dramatic and practical contribution of recent years has been support of seven regional respirator centers, located at Houston, Tex.; Wellesley Hills, Mass.; Ann Arbor, Mich.; Buffalo, N. Y.; Hondo, Calif.; Chicago, Ill.; New York City. Several hundred of the most seriously afflicted poliomyelitis patients-those with breathing difficulties have been grouped for care and study and rehabilitation. In 1952 5 centers discharged 303 of these patients-70 percent of whom were completely weaned from respiratory devices. The sum of $800,000 had been authorized for their operation through December 31, 1952. It is our hope that through work done in these centers many iron-lung patients of the future will be able to live at home and lead useful lives.

During the years 1938-52 administrative costs of the national foundation were $9,200,000, which represents 4.4 percent of funds used.

Financial assistance to poliomyelitis patients who could not pay all or part of the costs of medical care amounted to $145 million from 1938 through 1952. Net proceeds of the annual March of Dimes have been divided between local chapters and national headquarters, the chapters' share being used for patient care, that of national headquarters for research, professional and public eduction, epidemic aid. This practice has been followed throughout the existence of the national foundation. During this period, however, six States, Arkansas, Colorado, Idaho, Minnesota, Mississippi, and North Carolina have had the use of $3,759,010 more than their total net receipts from the March of Dimes. These States spent more than the total funds they had raised; all but three (Connecticut, Delaware, and Rhode Island) of the other 42 States had available for patient care more than their 50 percent share of March of Dimes funds, and only the District of Columbia ended the 15-year period without an advance of funds from national headquarters.

May I explain the use of the word "advance"? When local chapters have utilized all of their funds available, we advance from what we call an epidemic aid fund sufficient funds to carry them through the balance of the year to care for patients.

In 1952, Arkansas, Michigan, Minnesota, Mississippi, Texas, and Wisconsin spent more than their total net March of Dimes proceeds. Statistics for this year show that chapters actually had the use of 71 cents out of every dollar of the net March of Dimes proceeds on a national average, and headquarters only had 29 cents out of every dollar for its programs.

As a recorded disease, polio has a history dating back to 1789. However, there are references in the literature which indicate that the disease had its roots in antiquity. The severe seasonal epidemics, which we now regard as characteristic of the disease, swept the northern European countries in the 1890's, but it was not until 1916 that America experienced its first massive epidemic.

From the early 1900's well into the 1930's there was much scientific interest in the nature of the disease. However, the interest was that

of unsupported individuals who investigated, within their own limited means, those phases of the problem which particularly interested them. As a result, scientific knowledge of the disease was sparse, uncoordinated, and in many important phases, contradictory. Contributing also to the confusion, was the fact that since polio as a virus disease was a relatively new concept in medicine scientists lacked the basic techniques and tools for studying the problem.

In 1938, with the support and guidance of the National Foundation for Infantile Paralysis, there began a scientific plan of attack against polio. It was a plan designed to accumulate the basic knowledge that would ultimately yield a reply to that question asked over and over again by parents and scientists alike, "How can polio be prevented?" Natural protection against any infectious disease depends on whether a person has in his blood tiny molecules called antibodies. These powerful substances are manufactured by the body following an infection by a germ or other disease-producing organism. Exactly how and where the body manufactures them is still a mystery to scientists, but they do know that each germ induces, by its presence, the production of a special antibody to fight it.

The formation of these protective antibodies, however, does not come about only as the consequence of an actual disease process. Since the days of Edward Jenner, the 18th century country physician who dared to prove that smallpox could be controlled, medical science has demonstrated time and time again that the body can be tricked into the production of antibodies through vaccination.

This can be accomplished either by a live vaccine, as in the case of smallpox, or by an inactivated vaccine, as in typhoid. The smallpox vaccine is composed of the living "cousin" of smallpox, the cowpox virus, which causes a mild, allied form of the disease. The typhoid vaccine is composed of inert typhoid germs that cause no disease but nevertheless stimulate the body to produce special protective antibodies. The advantage of the live vaccine is that it causes quicker and more abundant production of longer-lasting antibodies. The inactivated vaccine, however, is usually the safer preparation.

It has taken 16 tedious years of laboratory investigations, $20 million in March of Dimes contributions, and the cooperative efforts of hundreds of scientists in scores of universities to reach the present hopeful stage in the search for a polio vaccine.

One milestone in that search was reached in 1949 when a scientific journal published an article by a research grantee of the national foundation describing a method for growing polio virus in test tubes that contained bits of nonnervous tissue. Except to the educated ears of polio researchers, there was little in the precise words of the author-John F. Enders, M. D., virologist at Harvard University and the Boston Children's Medical Center-to indicate the tremendous scope and importance of his discovery.

Previously scientists had been able to grow polio virus only in the bodies of certain experimental animals, mainly monkeys. Thus, the virus needed for producing possible vaccines could be obtained only from the infected brains and spinal cords of these animals. But scientists well knew that a vaccine prepared from virus grown in nervous tissue was too dangerous for human use, since nervous tissue injected into man held within it the threat of an illness even worse than polio.

Until polio virus could be produced free of nervous tissue, hope for a vaccine was dim indeed. That is why scientists hailed Dr. Enders' achievement as the end of the monkey era in polio research and the beginning of a new, definite hope for a vaccine.

There was yet another stumbling block in the path of polio researchers. For years they were aware that polio was caused by more than one virus, but no one knew how many types there were and how they differed. Before these facts were known, it was impossible to concoct a vaccine that would be effective against all the kinds of polio virus that caused the disease.

Because of the urgency of this problem the National Foundation for Infantile Paralysis in 1948 embarked on a unique project. Backing its request with a grant of $1,370,000, the foundation enlisted the aid of teams of scientists at four leading universities-Southern California, Utah, Kansas, and Pittsburgh-in a cooperative investigation to determine how many viruses cause polio. Hundreds of specimens of polio virus obtained from patients all over the world were parceled out to the scientific teams for "fingerprinting."

Three years later, in 1951, the task of identification was at last completed. The results showed that there were three major types of polio virus capable of causing the human disease. For the time being they were referred to as the Brunhilde type, named for the chimpanzee used in experiments in Baltimore; the Lansing type, the original of which was obtained from a young man who died of polio in Lansing, Mich., and the Leon type, so-called for a young boy in Los Angeles who also died of the disease.

Though all three viruses produce identical symptoms, infection by one will not induce antibodies effective against either of the other two. This explains why a few unfortunate victims have had polio twice. (Triple attacks of the disease have not been recorded.) Scientists quickly realized, therefore, that the preventive they sought-whether drug, serum, or vaccine-would have to be prepared in such a way as to make it effective against all three types of virus.

I think that it would be well to note there, as I have stated, this original typing program cost in excess of $1 million. It was reported just last week at the meeting of the advisory committee of the national foundation that additional typing programs had been continued using tissue culture, and while some 100 specimens were tested in this original typing program, since then some 200 have been carried through the typing process at a cost of something less than $100,000 for doing twice the number we did in the dim ages before the tissue culture techniques.

Once these and other critical facts were at their command, scientists were able to move at a faster pace. Dr. Enders and others speedily demonstrated that each of the three types of polio virus could be grown in test tubes on various kinds of nonnervous tissue. Rapid improvements in this method have apparently solved the problem of producing enough polio virus for the vast quantities of vaccine that would be required for general use. Recently, scientists have expressed the opinion that there is now no practical limit to the amount of virus that can be produced.

But what troubled many scientists was whether a vaccine for poliosupposing that one could be developed-would actually work. Polio investigators had long believed that the virus usually entered the