A review of Iron Curtain, Iron Lungs: Governing Polio in Cold War Hungary, 1952-1963, by Dora Vargha.
In Iron Curtain, Iron Lungs, Dora Vargha investigates the relationships between international politics, communist state legitimacy, and the struggle against poliomyelitis in Hungary. During a series of increasingly severe epidemics in the years after World War Two, polio and the devastating effects of infantile paralysis became a central focus of public health activities and vaccine research around the globe. Through the lens of polio eradication efforts in 1950s Hungary, Vargha argues that Cold War political divisions were far less rigid than is typically recognized, and further, that this epidemic disease acted as a direct threat to the most basic paternalist claims of the communist regime (pp. 13-19). Regardless, once the menace of poliomyelitis was under control, the state largely eschewed responsibility for the bodies and lives of those most severely affected.
The first chapter of Iron Curtain, Iron Lungs explores the internationalization of the fight against polio, particularly after the major epidemic in 1952. Polio has an outsized impact on the youngest and most innocent members of society, and the adverse effects of the disease can lead to permanent disability and death. These peculiarities presented an especially acute threat to the nascent communist regime in Hungary and its imaginations of a modern, healthful, and technologically advanced society (p. 30). Claims of progressive state-craft and a fruitful communist future were directly contradicted by the figure of the paralytic Hungarian child (pp. 53, 72-73). The urgency of this situation, according to Vargha, created space for direct international cooperation which ignored the supposedly rigid boundaries of the Cold War — especially for those nations with fewer resources to combat the disease.
Chapter 2 shifts focus to the next major polio outbreak in 1957. This epidemic, coming directly on the heels of the 1956 Hungarian revolution, posed a new set of dangers to the regime. In its efforts to regain legitimacy within the body politic, sub-standard treatment capacities and an obvious lack of resources to handle epidemic response were stark indictments of the state’s self-appointed provider role (pp. 80-87). As a result, the regime tried to counter-balance its position as caretaker with appeals to personal responsibility and the disruptions of revolution. This involved not only an effort to propagandize the morality of cleanliness, but also a loosening of import laws and willingness to accept aid from a variety of Western, international, or religious organizations in order to increase domestic supplies of the difficult to produce and expensive Salk polio vaccine (pp. 98-109, 120). The Iron Curtain, so to speak, was drawn open (p. 14).
Chapter 3 examines how this far reaching and costly vaccination campaign — and in turn, the state’s legitimacy — was called into question after another major polio epidemic in 1959. As the severity of the outbreak became clear, the communist party, medical community, and further, the population more generally, each sought to place blame for the epidemic on the activities of the other. Yet, Vargha argues, the failure of the Salk vaccination program in Hungary was largely overdetermined. Issues such as non-standard medical supplies or vaccine regimens, inadequate dosing, less effective intracutaneous vaccine administration, poor inter- and extra-departmental communication or cooperation, bad management of limited resources, insufficient record keeping, low educational awareness, and the inability to control population movement all contributed to the surprising scale of the 1959 polio epidemic (pp. 152-157).
The fourth chapter discusses the introduction of the Sabin live virus vaccine into Hungarian polio eradication efforts in 1959. Vargha maintains that the rapid transition from the Salk to the Sabin vaccine — as well as the accompanying mass vaccination campaign — was largely a product of the communist party’s desire to re-assert its authority and prove the legitimacy of its administration. Controversies involving the Sabin vaccine, particularly the skepticism it produced in the United States, were disconcerting to both Soviet and Hungarian health authorities. Nevertheless, these concerns were disregarded in favor of an ambitious effort to quickly and completely eradicate polio, and in turn, prove the enlightened and valuable role of the Hungarian communist party in daily life (pp. 186-187). In the process, Vargha argues, the choice of Sabin’s vaccine over Salk’s was increasingly cast in Cold War terms, closing the gaps in the Iron Curtain that had formed only a few years before.
Chapter 5 moves focus to patient experiences and medical treatment, particularly at the Heine-Medin Rehabilitation Hospital in Budapest. Established in the midst of the 1956 revolution, the Heine-Medin facility was the only specialty clinic for long-term polio care in Hungary. Despite material assistance from various international organizations, the former kindergarten buildings of Heine-Medin were poorly supplied, inadequately staffed, inconveniently located, and completely unsuitable for anyone suffering mobility issues (pp. 208-214). Such lack of consideration boded poorly for those with severe physical impairments, and with the threat of polio receding from view in the 1960s, the specialty clinic was closed. Most patients other than those with permanent respiratory paralysis, in turn, were left to the care of their families and the limited resources of district health administrators (pp. 247-248). The communist regime’s neglect and disregard for these disabled citizens, as Vargha describes in her conclusion, led to the unlikely formation in 1981 of a state approved public advocacy group, the National Federation of Disabled Persons’ Associations (pp. 252-254).
The history of medicine in communist east central Europe is a nascent field, and Iron Curtain, Iron Lungs brings welcome exposure to the manner socialism in the Eastern Bloc responded to and was transformed by issues of health and disease. Building on the work of east central European historians such as Mark Pittaway and Malgorzata Fidelis, Vargha’s work shows how perceptions of popular legitimacy deeply shaped the actions and decisions of the communist party, and further, how the communist system was far more vulnerable to the peculiarities of sociopolitical context than is often understood. In addition, Iron Curtain, Iron Lungs seeks to expand on the work of medical historians as diverse as Daniel J. Wilson and Marcos Cueto in its effort to both bring patient experiences to bear on our understandings of polio while simultaneously placing the struggle against infectious disease in the mid-twentieth century in its global, Cold War setting. The resulting monograph will be a unique and important contribution to both the history of east central Europe as well as the history of medicine.
Bradley Matthys Moore
Joint PhD Program in History and the History of Science, Medicine, and Technology
University of Wisconsin – Madison
Oral History Interviews
Hungarian National Archives
Archives of the World Health Organization
Rutgers University. 2013. 276 pp. Primary Advisor: Paul Hanebrink.
Image: Child receiving Sabin vaccine in Budapest. Népszava, December 15, 1959 p1. Photograph by György Gonda. From Dora Vargha’s profile.