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Poliomyelitis was first recorded in sporadic form in Australia in the year 1887, when there were cases on the Clarence River, New South Wales, and in Port Lincoln, South Australia. There were further sporadic cases in New South Wales between 1890 and 1893.
The first small outbreak in Australia was at Port Lincoln, South Australia, during March and April in 1895, when there were fourteen cases of the spinal type. The second outbreak occured in Sydney in the summer of 1903-4, and from there it spread over the greater part of New South Wales and Queensland. Litchfield recorded thirty-five cases in Sydney between November 1903 and March 1904, and Wade noted thirty-four cases between December 1903 and January 1904, most of them under the age of two years. At the Royal Alexandra Hospital for Children, Sydney, cases of the disease were reported from 1891 on, the numbers rising to fifty in 1913. The following year in Sydney, sixty-four cases were notified.
During the last fifteen years or so [ed: 1948-1963], the greatest number of admissions to Prince Henry Hospital of poliomyelitis per year was in the winter of 1946, and the summers of 1950 to 1954 inclusive. The summer 1950-1 was particularly bad, as there were approximately 250 admissions in 1950 and no less than 450 in 1951; in the worst weeks of November 1950 to March 1951 there were up to forty admissions weekly.
This was a particularly distressing time for the staff of the hospital as they were caring for children and young adults, many of the latter of their own age, who were crippled to greater or less degree when in the vigour of youth, and some of whom were dying of respiratory paralysis. The risk of the staff contracting the condition was of course always present and was another cause of anxiety. However, only three nurses at the hospital contracted the disease and they, fortunately, were affected mildly. This was a time when the spirit of service of the old Coast Hospital was seen in its finest form.
About 1945, Lord Nuffield donated a respirator to the North Bondi Surf Life Saving Club, which in turn presented it to the hospital. Several respirators were made in the hospital workshops, and from the experience gained, modifications and improvements were incorporated in the design. The American Society and several commercial firms in Sydney then donated an additional six new improved respirators to the hospital, to cope with the flood of patients. The machines were designed so that in event of electric power failure, they could be manually operated. Such a sudden power failure was always a critical event to patients in the respirator, as often there were as many as eight victims at one time requiring the maintenance of artificial respiration for life. To reduce the risk, the electricity authorities had a direct power line installed from the Bunnerong Power House to the hospital. When power failure did occur, all available staff was summoned to work the machines. Patients were kept alive in respirators for years and several, after six years, were then transferred to their local district hospitals.
An account of poliomyelitis in Australia would hardly be complete without a mention of Sister Kenny and the contentious issues aroused by her at the time. Sister Elizabeth Kenny was by nature a forceful personality and a born crusader, who used the powerful tools of publicity, the lay press, radio, books and the screen to propagate her ideas on the management of patients with poliomyelitis. These ideas of hers had been forming for some twenty years while she was a bush nurse in the outback, and what she had seen of the results of the then current methods of treatment convinced her that many people with poliomyelitis were suffering unnecessary disability because of excessively prolonged splinting–during the recovery phase joints and muscles became stiff and muscles wasted from disuse.
In 1935 a Royal Commission was set up in Queensland to enquire into the current treatment of poliomyelitis and in particular the Kenny method. The results of the commission were not particularly favourable. In 1941 the medical committee of the National Foundation for Infantile Paralysis in America announced its agreement with her theories. She was appointed guest instructor at the University of Minnesota Medical School in 1942 and at the end of that year the Elizabeth Kenny Institute in Minneapolis was dedicated.
It was inevitable that such a personality would arouse criticism and resentment among many who were caring for these patients, and the situation was aggravated by her dogmatic statements, not supported by objective evidence, concerning the pathological changes which occurred in the disease.
There is no doubt that her contribution to the treatment of poliomyelitis was a very valuable one which led to improved methods used today, and that her crusading led to a public awareness of the disease and its effects, which resulted ultimately in the provision of the more adequate physiotherapy services, finance and equipment needed in the rehabilitation of these sufferers.
During the five epidemics of the disease that occurred between 1925 and 1931, for instance, the aftercare of paralysed people was exceedingly difficult because of lack of finance. In recent years it is realized that generous and prompt expenditure of public money is required if crippling is to be prevented or reduced.
During the epidemics of poliomyelitis that occurred in Sydney in the 1930’s and 1940’s, Sister Kenny was an occasional visitor to Prince Henry in the interesting capacity of adviser. She is remembered as a tall heavily built woman of strong personality and wearing a very large hat adorned with a feather of most impressive dimensions. The effect she had on the medical press is apparent in the medical literature of those times when her methods were being investigated by workers in Australia and America. In the latter country, interest in the disease had been aroused by President F. D. Roosevelt during the early 1930’s, as Roosevelt himself had been crippled by poliomyelitis.
The numbers of poliomyelitis admissions fell steadily after 1954, so that, during 1958 for instance, there were only two patients with the disease admitted. However, in the early summer at the end of 1961, several critically ill patients with poliomyelitis were sent from the Wollongong area, and it soon became apparent that this was not to be an isolated outbreak.
The trickle of cases became a flood. An urgent programme of acquiring additional modern respirators and training a full team of medical and nursing staff to cope with the heavy demands of a respiratory unit, was put into operation. Events justified making the programme one of top priority as, in March 1962, there were no fewer than thirty-one patients in the respiratory unit requiring constant artificial respiration to maintain life.
The present [ed: 1963] respiratory unit in ward 20 was planned, designed and built in a space of eight weeks, and is a fully air-conditioned unit with oxygen and suction piped to each bed, a liquid oxygen generator, and a bed capacity of fifteen. This epidemic occurred at a time when Salk vaccine had been available to the community long enough to enable everyone to have acquired adequate protection against the disease. That so many were afflicted is a sad commentary on the apathy of those who neglected to obtain this immunity. Everyone, from the first year of life to middle age, should be immunized against poliomyelitis.
1938 Epidemic
Poliomyelitis known as infantile paralysis is caused by an ultra microscopic or filter passing virus usually conveyed by droplet infection from infected mucus membranes or contaminated faeces.
The disease was not confined to children. Joan Bushnell (1937-41) remembers:
The poliomyelitis epidemic of 1938 was frightening. It was a crippling disease. Most of us had known or seen a child at school limping around with one shortened leg, wearing an ugly built-up boot with iron splints around the leg.
Joan was unaware then that she would be closely involved in subsequent poliomyelitis epidemics at Prince Henry as a Sister.
In severe cases Polio attacks groups of motor nerve cells in the spine and depending upon the extent of inflammation, various muscles in one or more limbs can be paralysed. If the paralysis involves the diaphragm or respiratory muscles artificial respiration is required to keep the patient breathing
Initially the patient was kept at rest. The paralysed limbs were supported and splinted, care had to be taken that the limbs remained straight and did not become cold and blue from lack of circulation. When the patient’s condition improved, usually after several weeks, massage, movement and re-education of the affected limbs would commence. A cheerful optimistic atmosphere was an essential requisite for the convalescent stage, as regaining all or some mobility was a long painful process for the patient. Hydrotherapy was used in some cases.
Irene Hamilton (Mrs Dillon) 1936-40 worked in the Bush Wards, formerly known as the Military Wards:
There was a saltwater pool in one of the wards. The old attendant in charge of the pool had a scientific way of testing the salinity. He would get a pannikin, scoop up some water, taste it and say “more salt needed”… The “Bush” had one large kitchen with a fuel stove, put my cooking skills to good use there.
The poliomyelitis epidemic changed Sister Laura Hansen’s career path forever. She had graduated in 1929 and had, except for leave to complete a midwifery certificate at “Montrose” remained on the staff gaining experience in supervising general and infectious wards.
She enjoyed working and living at Little Bay, that was, until she heard and saw the charismatic Sister Elizabeth Kenny demonstrating her radical and controversial method of treatment for poliomyelitis patients during a one day demonstration at Prince Henry. Laura Hansen was impressed. She had read about Sister Kenny’s revolutionary treatment, which was not a cure but a way of treating patients in the acute stage with movement, massage, etc., in order to prevent or lessen the accepted crippling effects of severe poliomyelitis. She resigned in 1938 and joined the Sister Kenny Clinic in Queensland and continued to teach the Kenny method long after Miss Kenny had answered an invitation from medical sources in the United States of America to teach there.
In 1943 Sister Hansen’s admiring niece Pauline Merle Hansen commenced training at P.H.H. and in 1987 Pauline’s son (Laura’s grand nephew) Andrew Chalmers, a science graduate from the National University, Canberra enrolled in the special two year nursing course for University Graduates at P.H.H.
1945-54 Epidemic
The poliomyelitis epidemics that occurred between 1945 and 1954 were the worst outbreaks of that disease recorded in Australia. Joan Bushnell (1937-41) was a ward sister during the peak years:
We were all alarmed when polio began to reach epidemic proportions in the summer of 1945. It seemed to be shaping up to be worse than the epidemic in 1938 when I was a trainee. There was no immunisation against it unless it was a natural immunity. Everyone in contact with polio sufferers was at risk, the virus could be transmitted by droplet infection, by contaminated faeces or from articles used by the infected person. Isolation methods and personal hygiene had to be strictly observed. All those working in polio wards would imagine at some time that they were contracting the disease; as far as I know only three nurses were hospitalised with mild attacks.
I am firmly convinced that the fresh air and sea breezes at P.H.H. kept us healthy. After the heavy atmosphere of infectious wards it was a pick-me-up to walk out into the sunshine and be ruffled all over by the wind. I felt thoroughly cleansed by the time I reached the Quarters.
The term “infantile paralysis” was a misnomer, adolescents and young adults were the principal victims. This caused emotional stress in young trainees resulting in some resignations. Sisters and senior nurses were distressed by the unhindered and wanton destruction of lovely young bodies. There were some sad cases that haunt my memory still.
Muriel was a pretty 15 year old schoolgirl when she was admitted directly into a respirator where she stayed for months, specialled day and night. Her long and tedious fight to breathe without the respirator, increasing her rate by seconds a day was a lesson n courage. Finally she was able to breathe herself, stay out of the respirator by day, returning to it at night. Years came and went and Muriel’s cheerful, deeply religious attitude towards life was an inspiration to nurses and patients. She was intensely interested in our lives, she always wanted to know what we were doing off duty. One evening she gave me a small white flower to wear as she knew that I was being taken to a show in town that night. The next morning when I arrived at the ward I was told that Muriel had just died. Nurses do weep when they lose their patients; the whole hospital mourned for Muriel, a courageous patient and a loving friend to all. We were her extended family, she celebrated her 21st Birthday with us and was 23 years old when she died.
Thelma Doris Armstrong (1939-43) had returned to the hospital in 1946 and was in charge of polio wards from 1949 to 1951. She admired and appreciated Dr Symington’s untiring concern for the polio patients. As head of the Infectious Division, his advice was sought by hospitals and doctors in N.S.W. and elsewhere. He would send sisters from P.H.H. to other hospitals to instruct doctors and nurses on the management of polio patients in respirators. Thelma Armstrong was sent to Goulburn.
The reputation for expertise in polio nursing care acquired by P.H.H. nurses had its drawbacks, as some nurses would find when working in other hospitals. Instead of gaining experience in new medical areas they would be put in charge of polio admissions as only they had this special knowledge.
Betty McKell (1940-44) returned to P.H.H. as a Sister in 1953. She wrote:
Cases were admitted with a few muscle pains or slight to severe paralysis. Experienced staff, after examination, knew the cases who would eventually need a respirator. These cases were specialled. As the paralysis spread to the chest breathing became laboured and to prevent collapse they were placed in respirators. The sister was the only person permitted to open a respirator, she stood at the head of the patient, on either side of the respirator were two nurses, each nurse knew her job, teamwork was essential as all nursing care had to be performed in a short space of time. The first time out of the respirator was about 30 seconds Sister timed the seconds. Breathing normally out of the respirator was at times so difficult the patient panicked but, if the patient was ever to breathe without a respirator the time had to be gradually extended. It was the sisters responsibility to gauge the time accurately; should a patient lose consciousness, it could cause brain damage or death. Nurses spent a lot of time psychologically preparing the patient for those precious seconds. Progress depended a lot on the attitude of the patient. They were young people, some when they discovered they would be paralysed decided it would be better to die than be a burden on their family. Some fought and lived, others fought but died.
Respirators were like a big box with a lid, the only part of the body exposed was the head, round the neck opening was a fitted rubber collar which, when turned, made the respirator airtight. Two portholes on either side were fitted with the same rubber and turned sufficiently to allow the hands into the respirator to attend to the patient’s needs. Electricity powered the machine which operated the respirator. If the power failed, which often happened in the immediate postwar years, the machine would be pumped by hand–an exhausting task during a long blackout.
Each machine had its own sound and any variation was checked by the maintenance men. The men in P.H.H. workshops saved lives and made patients comfortable by supplying and fitting tubes for oxygen etc., mending machines, making splints and pads for pressure points. They were inventive, dedicated, nothing was a trouble or beyond their ability.
The pathology department or more specifically the Institute of Epidemiology and Preventative Medicine, headed by Dr A. Platt and later Dr Neville Stanley engaged in valuable research during the polio epidemics. This led to an early and accurate identification of the type of polio virus, which aided the medical and nursing teams. These brilliant scientists also developed a live vaccine which was stopped at the human experimentation stage because the Commonwealth Health Department favoured an inactivated type of vaccine.
Polio vaccines were introduced in Australia in 1956 (Salk) and 1966 (Sabin) and were followed by mass immunisation programs. With the continuing immunisation of children, the disease has effectively been eradicated in Australia. The Polio vaccine is now included in the Australian Government’s childhood immunisation program.
It is estimated that a minimum of 20,000 – 40,000 people had paralytic polio in Australia between 1930s and 1960s. Actual figures for the number of people infected with the virus are up to a hundred times greater, 2 – 4 million Australians. Polio is no longer present in Australia.
Polio Vaccines
An effective polio vaccine was developed in 1952 by Jonas Salk and a team at the University of Pittsburgh. Salk reported a successful test on a small group of adults and children on 26 March 1953. Beginning 23 February 1954, the vaccine was tested at Arsenal Elementary School and the Watson Home for Children in Pittsburgh, Pennsylvania and was then used in a test called the Francis Field Trial, led by Thomas Francis, the largest medical experiment in history at that time.
The Francis Field trial began with about 4,000 children at an Elementary School in Virginia, and eventually involved 1.8 million children, in 44 American states. By the conclusion of the study, roughly 440,000 received one or more injections of the vaccine, about 210,000 children received a placebo, consisting of harmless culture media, and 1.2 million children received no vaccination and served as a control group. The children were then observed to see if any contracted polio.
The results of the field trial were announced 12 April 1955 (the tenth anniversary of the death of President Franklin D. Roosevelt, whose paralytic illness was generally believed to have been caused by polio).
The Salk vaccine proved 60–70% effective against PV1 (poliovirus type 1), over 90% effective against PV2 and PV3, and 94% effective against the development of bulbar polio. Salk’s vaccine was licensed in 1955.
Australian scientist Dr Percival Bazeley, of the Commonwealth Serum Laboratories (CSL), had been working with Salk since 1952 and returned to Melbourne in 1955 to begin manufacturing the vaccine locally. The first Salk vaccines were distributed across Australia in June 1956. 25 million doses were produced by CSL under Dr Bazeley’s directorship.
Around the same time that Salk began his work on a killed-virus vaccine, Albert Sabin began work on an attenuated live-virus vaccine.
Sabin felt that an oral vaccine would be superior to an injection, as it would be easier to administer. He began to grow and test many virus strains in cultures and eventually found three mutant strains of the virus that appeared to stimulate antibody production without causing paralysis. Sabin tested these strains on humans: his subjects included himself and his family, research associates, and prisoners from a nearby Penitentiary.
Because Salk’s vaccine was being used successfully in the US, Sabin was not able to get support for a large-scale, controlled field trial. In 1957 Sabin, convinced the Soviet Union’s Health Ministry to conduct field studies with his vaccine. After the Soviet trial succeeded, the U.S. Public Health Service approved the vaccine for manufacture in the United States, and the World Health Organization (WHO) began to use live-virus vaccine produced in the USSR.
In the late 1950s Sabin entered into an agreement with the pharmaceutical company Pfizer to produce his vaccine. He presented Pfizer with the master strains of the virus, and the company began to perfect its production technique in its British facilities.
Sabin’s live-virus, oral polio vaccine (administered in drops or on a sugar cube) soon replaced Salk’s killed-virus, injectable vaccine in many parts of the world.
The Sabin oral vaccine was first used in Australia in 1966. In October 2000 the World Health Organization declared the Western Pacific region, which includes Australia, to be polio-free.
Overall, thanks to the Salk and Sabine vaccines, global incidence of polio cases has decreased by 99%.
Eradicating Polio
In the mid-1980s wild polio was still endemic in about 125 countries. Queensland accountant Sir Clem Renouf, who was then World President of Rotary International, decided to launch an eradication program, similar to that which had eliminated smallpox. In 1985 he persuaded Rotary clubs around the world to raise money to make this happen.
Having raised $247 million, Rotary began work in South America. The World Health Organization, realising that Rotary was meeting with success, joined forces with Rotary and other non-government organisations and launched the Global Polio Eradication Initiative in 1988.
Today The Global Polio Eradication Initiative (GPEI), a public-private partnership led by national governments with five partners – the World Health Organization (WHO), Rotary International, the U.S. Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF) and the Bill & Melinda Gates Foundation has as its goal the complete eradication of polio worldwide.
Since it launched more than 2.5 billion children have been immunized against polio thanks to the cooperation of more than 200 countries and 20 million volunteers. In 2020 wild poliovirus continues to circulate only in Afghanistan, Nigeria, and Pakistan, although efforts to immunise children in these countries continue despite the challenges.