President's Message
June 2020

It is hard to keep up with the news these days. Every day brings a new crisis.  Originally, the content of this message was going to highlight the polio epidemics of the past, the shortage of iron lungs in the 1940s, and the relief that came with Dr. Jonas Salk’s discovery of a polio vaccine. To further support that message, I asked Naomi Rogers to write a short piece about nurses and the polio epidemic, based on her book Polio Wars: Sister Kenny and the Golden Age of American Medicine. Her commentary is below.

While that message was in draft form however, more pressing problems occurred in our nation. The recent horrific episodes of police violence against African Americans cannot be swept aside. We cannot as an organization remain silent. To that end, Andre Rosario and some members of the Diversity and Inclusion Committee wrote the following statement for us to consider:

George Floyd died under the knee of a Minneapolis police officer, reminding Black and African American people across the country of the racism that continues to impact these communities.

As an organization committed to the study of history, we ask our members to consider how the history of racism and injustice has enacted trauma on Black and African American people across the country. This legacy of pain is one that many cannot separate themselves from.

We recognize the privilege many of us might enjoy—the privilege of being able to look away from circumstances that others cannot escape. Instead, we challenge ourselves to center our attention on the voices of the communities impacted. We take action in order to advocate for these communities and for leaders and policies that promote justice. We care for our colleagues, our students, and our patients for whom these events have caused pain. We urge leaders in academia and in nursing to do the same.

Thank you to Andre and his committee for these inspiring words. And thank you to many of you who are already researching and documenting an inclusive and diverse history of our profession. (See the Author’s Corner on our webpage)

As to more mundane matters, the Board will be meeting in mid-June to determine next steps about the fall conference. At this point, we are planning something relatively short and virtual.  We should have more specifics in a few weeks. 

Stay safe and be well.

Sincerely,

Arlene W. Keeling, PhD, RN, FAAN

Christmas in August: Polio and Nursing in Kentucky, 1944
Naomi Rogers, Yale University
[email protected]

 
Sister Kenney, courtesy mnopedia.org

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.