Dr. Dorothy Horstmann: Pioneer in the Fight Against Polio

March 8, 2023 is International Women’s Day, and it has me thinking about polio.

The mere mention of polio when I was a child sent shivers through me. But in truth, I didn’t worry about it often. I lived in a rural area in the Midwest, and the number of people my community came into contact with was small. It wasn’t a place where large outbreaks of polio were occurring, like in large cities or towns. We didn’t swim in public swimming pools, one place where people were believed to contract it. Moreover, by the time I was born, at least one vaccine was available, and within a few years, another.

But that wasn’t always the case. Polio, or poliomyelitis, is a disabling and potentially deadly disease that can infect the spinal cord, causing paralysis. Scientists believe polio has existed since prehistoric times, but no one described it clinically until a British physician recorded it in 1789. It wasn't until 1840 that a German doctor recognized it as a condition.[1]

By the 20th century, however, research was well underway, and while treatment had progressed, there was still no cure. Widespread outbreaks were occurring, spreading panic like wildfire. Much like during the recent COVID-19 pandemic when pressure to find a vaccine was fierce, people were afraid for their health. In the case of poliomyelitis, children were especially susceptible to the virus, sending parents into a frenzy to protect them.

Child in an iron lung. Photo Source: World Health Organization

The medical profession was in a frenzy as well. Today we remember one woman in particular who had an international impact on the fight against this crippling disease.

The Woman With the Cure

Some people run into the fire. So says author Lynn Cullen when referring to Dr. Dorothy Horstmann, protagonist in her book The Woman With the Cure. Set during the polio epidemic during the 1940s and 1950s, Cullen tells the story of Dorothy Horstmann and a cadre of fascinating people who finally stopped the disease in its tracks.

Reading Horstmann’s story in fiction is refreshing, for it allows non-scientists and non-medical people like me a glimpse into who she was, what inspired her work, and what she had to do to survive in a male-dominated field.

Dr. Dorothy Horstmann, it turns out, was one of only a handful of women involved in the race for a cure for polio. An epidemiologist, virologist, clinician, and educator, she earned her place in history as the first person to discover that the poliovirus reached the central nervous system through the bloodstream, challenging the conventional understanding at the time that the virus was transmitted through the nasal passage.

Dorothy Millicent Horstmann was born in 1911 in Spokane, Washington, to German immigrants but grew up primarily in San Francisco. She graduated from UC Berkeley in 1936 with an undergraduate degree and a degree in medicine in 1940 from UC San Francisco.

That’s it. Usually in my posts I go into a historical figure’s personal life and anecdotes about her. But information about Dorothy beyond her medical accomplishments is stubbornly difficult to find. What I can gather, however, is The Woman With the Cure captures what is known about her in a highly factual way.

The Woman With the Cure opens in Nashville in 1941. Dorothy arrives as a new resident at Vanderbilt University, surprising the chief of medicine. On paper, her credentials read D.M. Horstmann. Dorothy knew by now she was working in a man’s profession. She needed to do everything she could to downplay her missing Y chromosome. Her goal: fly under the radar, get the work done. The chief of medicine isn’t happy about Dorothy being a woman; Dorothy doesn’t care. With her quick wit, she signals she’s there to stay. Blending in wasn’t easy at six feet one inch tall, making her tower over most men, but she was determined to hold her ground.

Also arriving on the scene shortly thereafter is the cocksure Dr. Albert Sabin from Cincinnati to do an autopsy on a young boy that has just died from polio, a patient of Dorothy’s. Dr. Sabin is a brazen egomaniac; Dorothy just happens to be a master at managing egos. After the autopsy, Dr. Sabin exits to go back to Cincinnati; Dorothy continues her residency.

But Dr. Sabin’s already famous for his polio research, and Dorothy’s already dedicated herself to finding a cure. They are bound to meet again. However, months later, Pearl Harbor occurs. Research on polio shifts to the nation’s back burner. But not for Dorothy, who burns the midnight oil tending children in the polio’s hospital ward and quietly looking for a cure in the lab. Researchers like her had studied polio for years. When they weren’t examining patients, they examined feces and flies. Such was the case with Dorothy. We can safely assume this part of her job was not glamorous.

In time, Dorothy’s residency at Vanderbilt ends. Her work on polio research, however, has distinguished her enough to earn her an internship for polio research at Yale University, where she becomes a clinical epidemiologist. Her job shifts to gathering samples onsite wherever there is an outbreak. In all, she travels to five major outbreaks in the U.S. to collect … you guessed it: feces and flies. Below is a photo of her in Life magazine in North Carolina in 1944, where she happened to be present during a scheduled magazine photo shoot. (Dorothy is in the plaid dress.)

As Dorothy’s story unfolds, we see more of what she encounters as a woman in the medical field. We feel for her as she is passed over, how her work is overlooked, and how she is presumed to be granting sexual favors to get ahead. As a modern reader, it’s hard not to wince.

But while her male counterparts look for ways to minimize her, Dorothy makes a discovery. She finds poliovirus in the blood early in the infection period of one child. From there, she forms a hypothesis. Was the virus visible in the blood for only a short period before symptoms occurred? If so, did polio enter the central nervous system through the bloodstream, not the nasal passage, as was the conventional thought? Eager to discover more, she conducts tests on rhesus monkeys. She soon finds she's on to something.

Sadly, no one listened to her. She was, after all, just a woman.

Persistence Pays Off

Dorothy applied for resources to validate her findings, but was denied funding time and time again. This went on for nine years. Nine years! However, she never gave up on her hypothesis. Eventually, others started paying attention to her. When they did, the race for a cure for polio shifted course, changing human history. Her discovery became the foundation for groundbreaking research that eventually resulted in a polio vaccine. Oddly, the one person who believed in Dr. Dorothy the most was surly Dr. Sabin, who, in time, turned to her to help him conduct critical research.

Reading the book, don’t worry about being immersed in the medical world if you aren’t in medicine. Cullen does a superb job using medical terms judiciously so as not to bog down the reader, making Dorothy’s world accessible. She also captures the motivations of those dedicated to a cure and their personalities. The environment is competitive on all levels, most notably between Dr. Sabin and Dr. Jonas Salk, each determined to beat the other to finding a vaccine.

In the book and in real life, Dr. Salk wins the race. Thus, you may remember his name from your high school biology class. Dr. Salk tested the vaccine on himself and his family in 1953. After a trial run on 1.6 million people, the U.S. government approved it for distribution in 1955. Two years after that, the number of annual cases in the U.S. dropped from 58,000 to 5,600. While a marked improvement, Dr. Salk’s vaccine wasn’t 100 percent effective. And there were some problems. Some people developed the disease from the vaccine, the result of mishandling at one of the manufacturing sites.

Dr. Sabin, who plays a much larger role in The Woman With the Cure than Salk, had different notions about a vaccine, one that would use the virus in a weakened form given through oral drops or in a sugar cube. He tested his vaccine in 1956, then later in a wide-scale trial on over ten million subjects in 1958 in the Soviet Union, and on over one hundred thousand Czechoslovakians in 1959, both with stunning 100 percent results. (Sabin needed to test his vaccine on a population that hadn’t had the Salk vaccine.)

Dr. Sabin was eager to introduce his vaccine in America. The World Health Organization (WHO), however, needed someone to go behind the Iron Curtain to validate the results. The Soviet Union would admit only one person. The WHO’s choice: Dr. Dorothy.[2] Based on her sole judgment, in 1961, the U.S. licensed Dr. Sabin’s vaccine for distribution in the States.[3]

While reading about Dorothy, I kept wondering whether she advocated for herself, or if she was too quick to accept the status quo. Based on her character in the book, it appeared clear she could certainly hold her own in a room full of men, but she didn’t seem to ruffle anyone’s feathers. When they told her to brew coffee, she smiled and poured.

I reached out to Lynn Cullen, who responded enthusiastically to my questions. Dorothy did, indeed, advocate for herself, Cullen stated. “It’s documented that she had to argue her way into every job she ever got. But the prejudice against women in science was powerful and unyielding. Isabel Morgan crumbled under it, driving her from her position as the developer of the first polio vaccine. Bernice Eddy’s loud warning that the ‘Salk’ vaccine manufactured at Cutter Laboratories was paralyzing monkeys was brushed aside, and when her warning came true, her reputation was blackened.” Cullen makes reference in the book to both Isabel Morgan, who plays a minor role, and to Bernice Eddy.

Dorothy’s selection by the World Health Organization to go to Moscow was also significant. According to Cullen, Dorothy knew Sabin’s vaccine as well as he did, for she had helped develop the research underlining it, and that “she was known to be diplomatic and could work with anyone, including the archenemy of the U.S. during the Cold War.” This says a lot about Dorothy, the physician—and the person.

Another reoccurring wonderment I had while reading the book was, where did romance fit in for a woman who spent all her time chasing a virus, someone who looked in the eyes of infected children and couldn’t rest until there was a cure? I became particularly keen on this topic when Cullen introduced Arne Holm into the story. Being one of those people who looks up characters as I read historical fiction, I could find no evidence of him. Was he real?

No, Cullen told me, Arne Holm was not a real figure. He was inspired, however, by a comment Dorothy made later in life to a colleague in which she said, in order to achieve all she wanted to achieve, she had to sacrifice much personally, that she could not have it all. Dorothy, Cullen said, knew she had to work harder than any man.

It's worth noting that Arne was not a haphazard creation Cullen whipped up in a vacuum. “He is a composite of several actual Danish heroes and the timing of his meeting and relationship with Dorothy are based on reality. He had to be worthy of Dorothy and a test for her resolve. What would she sacrifice in order to save children around the world? The sad thing is, a man would not have to make this choice.”

How very true. As a way to demonstrate that men didn’t have to sacrifice marriage or family, Cullen said she included Dr. Sabin’s wife as a minor character to show how men had women behind them holding things together at home.

Dorothy’s sacrifices, however personal, eventually paid off. She earned the respect of her male peers and was the first woman appointed as a professor at the Yale School of Medicine in 1961. In 1969, she became the first woman to receive an endowed chair. In 1975, the National Academy of Scientists elected her to their roll.

Dr. Horstmann and Dr. Sabin in 1984

I suspect one day we’ll read historical fiction about how the COVID-19 vaccine was developed. Or not. Desperate for a solution, in the 1950s and the 1960s, people lined up to get the polio vaccine. The response to the COVID-19 vaccine was vastly different. Call it what you will—due diligence, mistrust, a sign of the times, the result of disinformation, or all of the above. But I, for one, will always stand by the medical profession, for I believe people like Dorothy Horstmann populate its ranks. I’m grateful for whatever sacrifices they are making, which we can assume to be many. Mistakes are made, to be sure, but Dorothy’s story reminds me that medical practitioners at all levels are among life’s many heroes.

So how does polio actually spread? It remained an unanswered question for me after finishing the book, so I looked it up. Person-to-person contact with feces in invisible amounts is the culprit. It can also spread through a sneeze or cough droplets from an infected person, but rarely so.

Fortunately, by 1994, polio was considered eradicated in North and South America. While it still exists in some countries, it does not infect people at the devastating rate it once did. And it is preventable through a simple vaccine.

Nowadays, children in the U.S. get the vaccine in four doses between ages two months and six years old, based on the same regimen developed by Dr. Sabin. And Dr. Dorothy, let’s not forget.

For more about Dr. Dorothy Horstmann, you might enjoy this informative article by Dr. David M. Oshinsky of NYU’s School of Medicine. To read more regarding her medical contributions, this article provides you with further, more technical details.

Many thanks to Lynn Cullen for putting Dr. Dorothy Horstmann in the spotlight and for helping me understand this amazing woman. You can follow Cullen on Facebook and Instagram.

Looking for a spring read?

I encourage you to consider reading more from Lynn Cullen. The Woman With the Cure is the fourth of her books I’ve read. I have to say, she's become a go-to author for me. The Sisters of Summit Avenue, Twain's End, and my personal favorite, Mrs. Poe, are all terrific biographical novels.

An aspect of Cullen's storytelling I particularly like is her inclusion of vivid historical detail, which beyond plot, authenticates her stories. Her novels take readers back in time. Case in point: when writing The Woman With the Cure, Cullen described on Friends and Fiction how she used old magazines from the era as one of many resources for her world building. This hands-on attention to detail is foremost what I value in historical fiction. She does this in the other books pictured as well. If you visit her website, you’ll see three more books she’s written.

I'd love for us to stay connected. Sign up below if you'd like to recieve my monthly posts directly to your email inbox.

Thanks for reading. I'm glad you're here.

Nancy Mastro

Footnotes:

[1] World Health Organization. A crippling and life-threatening disease. Retrieved from https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-polio-vaccination [2] Ibid [3] Mayo Clinic, Rochester, Minnesota. History of polio: outbreaks and vaccine timeline. Retrieved from https://www.mayoclinic.org/coronavirus-covid-19/history-disease-outbreaks-vaccine-timeline/polio