Christmas in August: Polio and Nursing in Kentucky,1944
Naomi Rogers
In August 1944 Louisville’s Fourth Street toy store advertised “Christmas in August” offering toys on sale for parents desperate to entertain their children who had been cooped up at home, banned from movie theaters, swimming pools and all public gatherings.[1] The reason was polio.[2] Kentucky’s largest epidemic had started in late June; it ended with 718 reported cases and 37 counties classified as epidemic areas. Showing how confusing polio’s transmission was, health officials in Louisville investigated cases by asking when children had gone swimming, been visited by “infected” friends, had a tonsillectomy, played with nearby animals and fowl, or eaten water, milk, butter, ice cream, candy and other foods.[3]
It was clear by July that there was a critical need for trained nurses to care for the patients filling the Kosair Crippled Children’s Hospital and Louisville’s General Hospital. In 1942 Kosair had introduced a new method of caring for paralyzed children: the Kenny method, developed by Australian nurse Sister Elizabeth Kenny who rejected enforced immobilization through plaster casts and splinting and instead relied on the use of distinctive hot packs (made of steamed pieces of blanket wrapped around painful muscles) and muscle re-education exercises. Kenny’s Institute in St Paul, Minnesota had been training nurses and physical therapists since 1941; graduating “Kenny technicians” wore a special blue uniform with a head veil.[4] Kenny claimed that her method worked best when applied immediately to acute, newly diagnosed patients. The physical therapist at Kosair was transferred to the General Hospital’s isolation department “in order to give the children admitted there the best possible care.”[5] Just before this epidemic the Journal of the American Medical Association announced that a committee of orthopedic specialists did not approve of Kenny’s work.[6] Physicians and nurses in Kentucky ignored this report.
City officials asked the American Red Cross and the National Foundation for Infantile Paralysis (popularly known as the March of Dimes) to send graduate nurses and physical therapists, preferably those trained in the Kenny method. Seven therapists and 141 nurses came from around the U.S. to work in Kentucky during the epidemic, their salaries paid by the state chapter of the March of Dimes.[7] With overcrowded wards at both Kosair and the General Hospital, children who were mildly paralyzed were quickly discharged to make space for more seriously ill cases. Kosair set up a new physical therapy outpatient clinic in the basement of its south wing to serve patients from around the state. There Kenny technicians, supervised by orthopedic surgeons, taught parents how to care for their children.[8] That summer a nurse who had cared for paralyzed children at the General Hospital during the state’s previous serious epidemic in 1935 told the public health director that using the Kenny method made the disease “more bearable” for patients for “it was altogether different… when children cried all night from the pain. Now they get some sleep.”[9] Preparing and applying hot packs in stuffy and crowded hospital wards was challenging work. By the end of July members of Kosair’s staff were exhausted and the hospital’s superintendent called for additional nurse volunteers saying “we have enough doctors, but we need more nurses and more people to apply hot packs. They need not be trained – we can teach them if they are willing to learn.”[10]
Widespread fear of polio led many people to shun families who had a child with polio. “On several occasions,” one official reported, “the neighbors were so frightened they would not raise their windows on the side next to the home of the stricken patient. People living in the same block would walk on the other side of the street to avoid passing the patient’s home, even though the patient had been taken to the hospital.” Family members from other parts of the state accompanying a patient to Louisville “often found it difficult to secure rooms even for one night” as rooming houses and many hotels refused to rent rooms to anyone who had been “exposed” to polio.[11] Parents themselves alluded to these fears, as mothers seeking outpatient care admitted worrying if their child had a visible limp in case people would think the child had polio.[12]
The Courier-Journal breathlessly reported “encouraging” results by University of Pittsburgh researchers who had treated two patients with polio with penicillin, the wartime miracle drug.[13] More soberly, Dr Hugh R. Leavell, the public health director who also taught at the University of Louisville’s medical school, told civic leaders that he could not give them “any hope” for there were no proven “methods of preventing poliomyelitis.” “Perhaps,” Leavell added, “before our time for an epidemic comes around again in nine or ten years, more will be known about the disease and [a] means of preventing it will be found.”[14] By the early 1950s Jonas Salk had begun testing his polio vaccine which was found safe and effective in 1955.[15]
Polio epidemics left a toll on physical therapists, nurses and nursing aides who worked in hospital wards amidst infected children, braving exposure and the possibility of paralysis. Frustrated parents sought to deal with children forced to stay at home and the community faced the challenges of coping with a disease that was not clearly understood, caused widespread fear and stigma, and threatened to overwhelm health care resources. We remember the efforts of these health care workers as we honor current struggles to fight Covid-19.
[1] Michael W.R. Davis “Kentucky’s 1944 Polio Epidemic” Filson Club History Quarterly 74 (Winter 2000) 363, citing Courier-Journal August 5.
[2] Polio is a common, contagious and usually endemic disease, which can cause paralysis in a small number of infected cases; see David M. Oshinsky Polio: An American Story (New York: Oxford University Press, 2005) and Naomi Rogers Polio Wars: Sister Kenny and the Golden Age of American Medicine (New York: Oxford University Press, 2014). Today it is understood to be spread by fecal material, usually through individual contact.
[3] Marian Williamson “Review of the Current Poliomyelitis Epidemic” [1944], Director Kentucky Crippled Children Commission, RG 102 Children’s Bureau Central File 1944-1948, Box 103, 4-5-16-1, Infantile Paralysis, National Archives, 2; Davis “Kentucky’s 1944 Polio Epidemic,” 358, citing Courier-Journal July 11 1944.
[4] Davis “Kentucky’s 1944 Polio Epidemic,” 355. Kosair had adopted Kenny methods in 1942; see also Rogers Polio Wars.
[5] Williamson “Review of the Current Poliomyelitis Epidemic,” 2.
[6] Rogers, Polio Wars 197-201. The orthopedists rejected both Kenny’s “rigid technique” and her theories of the disease.
[7] Williamson “Review of the Current Poliomyelitis Epidemic,” 2.
[8] Williamson “Review of the Current Poliomyelitis Epidemic,” 2-3; Davis “Kentucky’s 1944 Polio Epidemic,” 360. Williamson identified this (or another?) clinic at the General Hospital rather than at Kosair and noted that it was under the supervision of the Crippled Children Commission and the University of Louisville School of Medicine; Williamson “Review of the Current Poliomyelitis Epidemic,” 2-3.
[9] Davis “Kentucky’s 1944 Polio Epidemic,” 368 citing Courier-Journal July 12 1944.
[10] Davis “Kentucky’s 1944 Polio Epidemic,” 363.
[11] Williamson “Review of the Current Poliomyelitis Epidemic,” 3.
[12] Williamson “Review of the Current Poliomyelitis Epidemic,” 3.
[13] Davis “Kentucky’s 1944 Polio Epidemic,” 356-357.
[14] Davis “Kentucky’s 1944 Polio Epidemic,” 364 citing Courier-Journal 16 August 1944. Hugh Redman Leavell (1920-1976) graduated from Harvard medical school in 1926m and received a MPH from Yale in 1940. A specialist in children’s diseases and allergies he turned to public health and in 1946 joined the Harvard medical school faculty as a professor of preventive medicine; “Dr. H.R. Leavell Dead in Virginia,” New York Times August 12, 1976.
[15] See Oshinsky, Polio; Charlotte DeCroes Jacobs Jonas Salk: A Life (New York: Oxford University Press, 2015).