Effective, compassionate nursing care was the only thing found to prevent the crippling effects of the disease Poliomyelitis, a disease which required special nursing care for its victims, impacted many in the nursing profession prior to vaccine availability in 1955. Effective, compassionate nursing care was the only thing found to prevent the crippling effects of the disease (Sepples, 1992). Patients required constant care aimed at both respiratory support and orthopedic management. Nurses were also in the forefront of vaccine field trials and immunization, as well as caring for patients with post-polio syndrome. This article explores the impact of nurses in the different phases of care for polio, such as combating epidemics; treating victims; providing education for the public; and helping to eradicate the disease.

Polio Transmission

Owing to the number of young children who contracted the disease, polio was originally named infantile paralysis. Later the disease was renamed poliomyelitis for inflammation of the grey matter; polio meaning grey, myelos meaning matter, and “itis” the suffix for inflammation (Dunphy, 2001). The cause of polio was found to be a virus, which was spread from person to person through contaminated fecal waste (Oshinsky, 2005). The virus multiplied in the intestines, crossed into the bloodstream, and destroyed neurons in the spinal cord (Halstead, 1998).

It was unknown for many years how the disease was transmitted... It was unknown for many years how the disease was transmitted but outbreaks seemed to have been seasonal, usually occurring in the summer. Epidemics occurred nearly every year from 1900-1950 (Dunphy, 2001). The first largely reported epidemic in the United States (US) occurred in New York City in July 1916, causing 9,000 cases of polio and 2,343 deaths (Dunphy, 2001). Numerous people in the Italian neighborhood were infected with the disease, thus it was thought to be carried by immigrants. Another fear was that cats and dogs carried the disease and this led to over 72,000 cats being destroyed (72,000 Cats killed in paralysis fear, 1916). Other feared sources of polio were flies; contaminated drinking water; swimming in infected pools or lakes; and contaminated milk (Wellner, 2005).

Advances in Nursing

His affliction also helped to fuel private sector funding for research Many Americans were aware of the crippling effects of polio because of President Franklin D. Roosevelt’s bilateral lower limb paralysis due to this disease. His affliction also helped to fuel private sector funding for research (Carter, 2001). In 1937, President Roosevelt and his law partner, Basil O’Connor, established the National Foundation for Infantile Paralysis (NFIP). This was a private organization whose role was, according to Roosevelt, “to lead, direct and unify the fight on every phase of this sickness” (American Association for Advancement of Science, 1937, p. 301).

The NFIP recognized the importance of nursing care to help people stricken with the disease and made available grants to prepare nurses skilled in the care of patients with polio (O’Connor, 1942). These grants were awarded to the National Organization for Public Health Nursing (NOPHN) to encourage nurses to become educated in orthopedic public health nursing; to prepare a manual for orthopedic nursing care; and to provide scholarships for nurses to take supervisory and teaching positions in orthopedic nursing. The National League of Nursing Education was awarded a grant from the NFIP to join with the NOPHN to create a joint orthopedic nursing advisory service. Teacher’s College at Columbia University, Western Reserve University, and the University of Minnesota were also recipients of grants to establish centers to provide education for nurses in the care of patients with polio (Carter, 2001; O’Connor, 1942).

The NFIP provided support for hospitals during epidemics; this included an increase in the number of nurses to provide necessary care. There were four types of nursing services supplied for care of the patient with polio: graduate nurses on hospital staff; student nurses under the direction of graduate nurses; special duty graduate nurses; and polio epidemic volunteers, also supervised by graduate nurses (Carter, 2001). To acquire these nurses, the NFIP joined forces with the American Red Cross. These two organizations had committees led by nurses who were tasked to find nurses within the community during times of epidemics.

Nurses who worked in the hospital polio wards had their salaries paid by the hospital. Nurses who worked in the hospital polio wards had their salaries paid by the hospital. They received supplemental money provided by the NFIP, which also insured the nurses if they contracted polio (Dunphy, 2001). When the need for nurses exceeded local resources during the epidemic of 1946, the Army Nurse Corps supplied additional nurses to help (Carter, 2001).

The NFIP also supported the Nursing Advisory Service for Orthopedics and Poliomyelitis, a group established by the National League for Nursing (Carter, 2001). In 1951 this organization, along with the American Nurses’ Association (ANA), convened a conference to develop the Recommendations on Polio Nursing (ANA and Joint Orthopedic Nursing Advisory Service, 1952). These guidelines included both how to care for patients and how to educate and recruit nurses.

Nursing Care and Polio

...the first goal of the nurse was to establish confidence with patients and their families According to Jacquelyn Cook (1953), the first goal of the nurse was to establish confidence with patients and their families. This skill was perceived as equally important as prevention of deformities. In addition to establishing confidence, explanation of procedures was also important. Cook stated, “The patient cannot be expected to cooperate if he does not understand what is taking place” (1953, p. 100). Further nursing care was directed at use of keen observation skills, including noting any rigidity of the chest, as well as change in the tone of the voice, which may indicate the bulbar form of polio. Cook (1953) stressed the importance of the warmth of nurse’s hands, which may prevent muscle spasms. Kenny packs and iron lungs are examples of treatment modalities that were used to help patients with polio.

Kenny packs and iron lungs became very useful in the care of the patient with polio. Kenny packs and iron lungs became very useful in the care of the patient with polio. Sister Elizabeth Kenny, an Australian nurse who claimed to be a nurse, despite the fact there is no evidence of her graduating from a nursing program.  Kenny believed that the application of moist heat packs helped to alleviate muscle spasms and prevent contractures (Oshinsky, 2005). Nurses made moist heat packs by placing cloth into hot water and applying these to the involved muscle groups. This was a very time intensive procedure as the nurse applied these packs a minimum of every two hours for 12 hours a day, or as frequently as every 15 minutes in the event of acute spasm (Sepples, 1992). Nurses also provided passive range of motion to prevent contractures. Use of splints on limbs was considered controversial. Followers of Kenny believed they led to muscle contractures due to shortening of the muscle fibers, but others believed they helped to prevent contractures.

Caring for patients within the iron lung required special education for the nursing staff. Due to paralysis of the muscles for breathing, many patients were supported by a negative pressure ventilator known as an iron lung. Caring for patients within the iron lung required special education for the nursing staff. They had to learn to quickly time their nursing care to the breathing pattern of the patient and coordinate it with the timing of the machine. Port holes in the machine allowed the nurse to access the patient to provide bathing, turning, toileting, and assessment (Dunphy, 2001). If there was a loss of electricity or mechanical malfunction, the nurse had to operate the bellow of the machine manually. This task was so arduous that it often required several people, each taking over for a short time and then rotating (Dunphy, 2001).

Public Health Nurses and Polio Care

The role of the public health nurse was to prepare for an epidemic. Perhaps the nurses directly involved with educating the public and caring for patients with polio were public health nurses. The role of the public health nurse was to prepare for an epidemic. This included calming public fears via education about the disease by dispelling myths and teaching families to care for children stricken with disease (Stevenson, 1943). Public health nurses helped to control outbreaks. This involved awareness about the extent of an area epidemic; collection of data; administration of gamma globulin injections; and provision of specific patient care to prevent spread of disease and body deformities (Rives, 1954). School nurses also educated parents and teachers about the signs and symptoms of polio and how to care for children post-polio (Jean, 1951).

There were new opportunities for advanced education for nurses due to polio. There were new opportunities for advanced education for nurses due to polio. Federal financial assistance was available to support pediatric nursing education (Carter, 2001). By 1950, the National Nursing Accrediting Service recognized 39 graduate public health nursing programs (Stevenson, 1950). Carter noted that, “[a]ccess to learning opportunities was as scare for black nurses as was access to adequate care for the black patient” (2001, p. 256). In an effort to address this inequity and educate Black nurses about polio, the NFIP established the Infantile Paralysis Center at Tuskegee Institute in Tuskegee, Alabama (Carter, 2001). 

Polio Vaccines

Salk Vaccine Field Trials
There is little information available regarding the role of nurses in these studies...In 1954, Dr. Jonas Salk was ready to trial his polio vaccine on a national scale. The trial was also funded by the NFIP and included 623,972 children (Meldrum, 1998). It was estimated that 40, 000 nurses would be needed (Oshinsky, 2005). There is little information available regarding the role of nurses in these studies beyond drawing up the vaccine into syringes for the physician to administer (Oshinsky, 2005; Wellner, 2005). After vaccines were given, local physicians were responsible for the observation of the children to determine if disease was contracted. On April 12, 1955, the results of Salk’s vaccine trial were announced as successful to prevent polio (Dawson, 2004).

Sabin Vaccine
Differing from the Salk vaccine, Albert Sabin conducted his experiments and trials using a vaccine developed from attenuated virus. One advantage of this vaccine was oral administration. In 1961, the U.S. Public Health Service approved the vaccine for use in the United States and it became favored over the Salk vaccine.

Public health nurses and school nurses were instrumental contributors to polio prevention clinics... Public health nurses and school nurses were instrumental contributors to polio prevention clinics held in cities large and small across the country. The newly formulated Sabin vaccine required three doses. School aged children received their dose of oral polio vaccine at school during normal school hours. “Polio Prevention Sundays” were held in school facilities to reach preschoolers and adults. (450,000 in 18 counties get type III polio vaccine, 1964; The Chicago Tribune, 1964; Polio's most paralytic form target of Sunday's Sabin vaccine drive, 1964). These clinics were heavily advertised in newspapers, radio and television spots, and public speaking events featuring local physicians (Hayman, Bock, Turnbull, & Pettis, 1965).

Post-polio Syndrome and Nursing Care

Today’s nurse needs to be aware of PPS...Polio was eradicated in the United States in 1979 (Centers for Disease Control and Prevention [CDC], 2019). According to the World Health Organization (WHO), there are currently 10 to 20 million polio survivors, including 750,000 in the United States (WHO, 2020). People who survived polio may experience post-polio syndrome (PPS) and require additional nursing care. Today’s nurse needs to be aware of PPS, a non-infectious condition, which may occur 10 to 40 years after recovering from the disease (Chasens & Umlauf, 2000). PPS may present as increased weakness, fatigue, dyspnea, dysphagia, and impaired sleep, and should not be confused with changes people may experience due to the aging process (Chasens & Umlauf, 2000). The goal in treating PPS is to manage symptoms and improve quality of life (Salk Institute for Biological Studies, 2020).

Considerations for Polio Vaccination Today

Worldwide efforts to vaccinate children continue.The CDC guidelines recommend polio vaccinations at 2 months, 4 months, 6 to 18 months, and a booster between ages 4 and 6 (CDC, 2019). When the polio vaccines became available in 1955 and 1964 people lined up at doctors’ offices and clinics to get their children vaccinated (Bowling, 2018). It has been suggested that many parents have not experienced childhood illness due to having been vaccinated themselves. Some doubt the need for vaccinations as they fear the vaccine more than the disease (Downs, deBruin, & Fischhoff, 2008; McNeil, 2002). Some parents fear vaccines due to false information, social media posts, or may refuse to have children vaccinated due to political or religious reasons (Smith, Kennedy, Wooten, Gust, & Pickering, 2006). It is important for pediatric and public health nurses to establish trust with parents, provide necessary education, and work to increase the numbers of children who receive necessary vaccines (Smith et al., 2006).

Efforts of nurses to care for patients with polio prior to 1955 cannot be understated. Worldwide efforts to vaccinate children continue. The WHO reports only three countries, Afghanistan, Pakistan, and Nigeria, which have not yet eradicated polio (WHO, 2020).

Conclusion

Efforts of nurses to care for patients with polio prior to 1955 cannot be understated. Nurses worked long and tirelessly to provide direct care; educate the public; assist with vaccine trials; and coordinate vaccine administration. The nursing profession also benefitted as a whole from these efforts as the private sector recognized the need for increased funding and nursing education to combat this disease. Nurses continue to practice on the front line today as they provide care to survivors with PPS, educate the public, and administer vaccines.

Author

Kelley H. Pattison, PhD, RN
Email: kelley.h.pattison@wmich.edu

Kelley H. Pattison is an assistant professor at Western Michigan University Bronson School of Nursing. She has a great interest in how events in history have shaped nursing and how nursing has impacted historical events. She has previously presented at the American Association for the History of Nursing and the Canadian Nurses History Association conferences.