Home
The Middle-Class Plague:
Epidemic Polio and the Canadian
State, 1936-1937*
ByCHRISTOPHER J. RUTTY, Ph.D.
HEALTH
HERITAGE RESEARCH SERVICES
96 Durie Street, Toronto, Ontario, Canada, M6S 3E9
http://www.healthheritageresearch.com
hhrs@healthheritageresearch.com
© Christopher J. Rutty, 1999
Originally published in the Canadian
Bulletin of Medical History 13 (1996): 277-314
View the original article as a pdf file
Click here for online access to all issues of the Canadian Bulletin of Medical History
PAGE INDEX:
ABSTRACT | POLIO
IN THE CANADIAN CONTEXT | Second Wave
Epidemics & the Provincial Public Health Response | PREVENTION
& TREATMENT METHODS IN CANADA:﹃Paralysis Nose Spray: Just Squirt &
Smile﹄| "Miraculous Metal Monsters"
| Standardized Treatment, Hospitalization & Aftercare
| CONCLUSIONS | ENDNOTES
Figure 1 | Figure 2
| Figure 3 |
Table 1 | Table 2 | Table
3 |
ABSTRACT:
During the pre-Salk era, paralytic
poliomyelitis was one of the most feared diseases of twentieth-century
North America. This perception, held most strongly by the middle class
-- polios principal target -- shaped a unique Canadian response to it
based on comprehensive, standardized and unconditional programs of﹃state
medicine﹄at the provincial level. Of Canadas four major waves of provincial
polio epidemics, the second struck Ontario to an unprecedented degree in
1937, generating a similarly unprecedented response from the Ontario government
in its control, treatment, hospitalization and after-care measures. As
this article discusses, the severity of this epidemic led the provincial,
and other Canadian public health authorities, to face a central question:
How far should governments be compelled to go to ensure the advantages
of modern treatment for their people? This article helps place the social
impact of, and political and scientific response to, epidemic polio within
the context of Canadas evolving public health and state medicine infrastructure
at the time.
POLIO
IN THE CANADIAN CONTEXT
Until the Salk and Sabin vaccines
were introduced in 1955 and 1962, respectively, paralytic poliomyelitis
was one of the most feared diseases of twentieth-century North America.
Indeed, during the two or three decades before 1955, parents told their
children to﹃to regard [polio] as a fierce monster that lurked in the damp
hollows of their experience,﹄and personified the disease as "a grim terror...
more menacing, more sinister than death itself."(1) This frightening imagery,
generated and magnified each summer -- "polio season" -- by the popular
press, shaped a unique Canadian response to this disease. In fact, polios
dramatic threat and associated paralysis striking otherwise healthy middle
class children was more significant to its public management than its actual
prevalence relative to other, more deadly, diseases of the period. Indeed,
as Richard Carter stressed in his study of American voluntary health organizations,
one could reassure the public that polio was "a comparatively rare disease
hardly worth all the razzmatazz... but you could not convince them, because
they knew from experience that nothing was more frightening or tragic than
a polio epidemic."(2)
This climate of fear was reinforced
by the sharply rising incidence of epidemic polio during the first half
of the century, especially among middle class families living in the﹃better
areas,﹄and by the fact that little to nothing could be done to prevent
"the crippler" until polio vaccines were widely used. There is still no
cure for polios paralytic effects, nor for the post-polio syndrome that
is now forcing many polio survivors to fight the disease, physically and
psychologically, all over again.(3) In a context of celebrated success
in combating many other infectious disease by the early decades of the
twentieth, the Canadian medical profession frequently acknowledged a profound
helplessness with respect to polio. For example, in 1936, an article in
the Manitoba Medical Association Review declared that "There is
no disease over which the public is more apprehensive and in which both
the laity and the medical profession feel so helpless than Epidemic Poliomyelitis."(4)
Thus, despite medical science -- and, ironically, because of improving
public health and personal hygiene standards that delayed what had earlier
been an endemic, invisible, harmless and almost universal gastrointestinal
infection -- during the first half of this century epidemics of paralytic
polio escalated throughout the industrialized world. For geographic, demographic
and epidemiological reasons, Canada was particularly vulnerable.
The many serious polio epidemics
that have occurred between the late 1920s and early 1950s have received
minimal historical attention. Most studies of this disease have focused
on the American scene surrounding the Salk vaccine story;(5) on the major
epidemics of earlier decades, especially the great 1916 Northeastern U.S.
epidemic;(6) or on the personal experience of polio victims, especially
the most famous one, Franklin D. Roosevelt.(7) Until quite recently, no
comprehensive national study of polio had been attempted, nor had many
Canadian studies been written.(8) This article forms part of a national
study that places the social impact of, and public response to, epidemic
polio during the 1930s within the context of Canadas evolving public health
and state medicine infrastructure before the development public hospital
and medical insurance.
The nature of the states response
to polio was mitigated, in general, by recognized local and national traditions
of public health activity, the relationship of governments and public health
authorities with the medical profession, and the level of activity among
voluntary organizations and individuals.(9) In the United States, the emphasis
was on philanthropic, individual, and especially voluntary support for
polio victims, and not on governments. This direction was reinforced by
Roosevelts experience with polio in 1921 and, after his 1932 election
as President, his establishment of the National Foundation for Infantile
Paralysis, or "March of Dimes in 1938."(10) In the same period, however,
and in many ways in reaction to the American approach, an opposite strategy
to the polio problem developed in Canada.
Figure 1 (Click for full image)
The evolution of a government-focused
Canadian response to epidemic polio began in 1927-28 when the first major
epidemics hit western Canada and provincial governments, especially in
Alberta, responded aggressively (for Canadian incidence data see Figure
1 and Table
1, Table 2 and Table
3). In most provinces, and to varying degrees, provincial polio
strategies expanded during serious epidemics with the development of specific
preventive, treatment and hospitalization services that were freely available
to all polio cases, regardless of income. No other disease generated such
a broad and unconditional response from Canadian governments during this
period -- and with the blessing and cooperation of the medical profession.
In the absence of any effective treatments for polio, the assumption of
responsibility by provincial governments helped to relieve some of the
extraordinary frustrations and pressures polio increasingly placed on private
physicians. Bearing the brunt of Canadas worst epidemics, Alberta, Ontario,
Manitoba and Saskatchewan developed the most sophisticated and generous
polio policies in this period.
Underlying and reinforcing this
Canadian response to the polio problem were several distinctive public
health and political factors. Most significant were the close institutional
and personal links between leaders in local, provincial, and federal health
departments, in the medical profession, and in public health education,
research and the centralized, non-commercial production of biological products
-- all through the University of Torontos Connaught Laboratories and the
School of Hygiene. In the first half of the century, these two intimately
linked institutions, under the leadership of Dr. Robert D. Defries (1889-1975),
stood at the centre of Canadas public health network and the evolution
of Canadas scientific, political and public health response to polio.
Most provincial and federal deputy ministers of health were trained at
the School of Hygiene, and thus shared a common professional education
and active public health vision disseminated through Defries and Connaughts
founder, Dr. John G. FitzGerald (1882-1940); as well, Connaughts comprehensive
polio research efforts after 1947 proved essential to the development and
large-scale production of the Salk vaccine.(11) In many ways, between 1914
and mid-1930s, these close relationships played a similar role in the Canadian
management of diphtheria, a dangerous and much-feared childhood disease
that shared several features with polio until an effective immunizing toxoid
was widely tested and freely used by the early 1930s -- largely through
Connaughts and the Ontario governments pioneering leadership.(12)
The establishment and expansion
of provincial polio programs closely followed conjunctions between major
epidemics in Canada and the emergence of new polio therapies on which public
hopes and dramatic publicity focused, and often despite medical controversy
over their effectiveness. Striking conjunctions occurred in 1927-28, 1936-37,
1941-42, 1952-53, 1953-54 and 1959-60. Each involved different polio treatments,
ranging from a human immune, or convalescent serum, in the late 1920s and
early 1930s, to prophylactic nasal sprays in the mid 1930s, to the unorthodox
physical therapy methods of Sister Elizabeth Kenny in the 1940s, to gamma
globulin in 1952-53, and finally to two different polio vaccines in the
mid 1950s and early 1960s. The enthusiasm surrounding these "polio weapons"
largely originated in the United States and created significant political
pressures north of the border for their expedited use. In an effort to
appear to be doing something against the ravages of polio, most provincial
governments, and eventually Ottawa, assumed direct control of the financing
and production of such therapies and distributed them freely and unconditionally.
The severity of Canadas second
epidemic wave, which peaked in 1937, brought the medical, public health,
technological and political pressures of polio in Canada to a dramatic
new level. This second wave involved two major provincial epidemics:
Manitoba in 1936, and Ontario in 1937. The management of the Ontario epidemic
by the provincial government marked the most comprehensive and unconditional
preventive, treatment, hospitalization and after-care program yet deployed
against any infectious disease in Canada. Each of these aspects of the
1937 Ontario epidemic will be discussed below.
Nationally, the seriousness of the
1937 Ontario polio epidemic helped focus the attention of the Ontario Department
of Health and other Canadian public health authorities on an central question:
Just how far should any government be compelled to go to ensure the advantages
of modern treatment for its people? The Ontario governments high level
of financial involvement in polio treatment and after-care support during
and after this epidemic reinforced the growing value of "state medicine,"
and set important precedents in its subsequent expansion, especially in
the face of worsening polio epidemics in the 1940s and 1950s across Canada.
(To Page Index)
Second
Wave Epidemics and the Provincial Public Health Response
After the rise and fall of the first
epidemic wave that, in turn, hit British Columbia and Alberta in 1927,
Manitoba in 1928, Ontario in 1929 and 1930, and Quebec in 1931 and 1932,
during the "polio seasons" of 1933 and 1934 Canadian polio incidence remained
low. Alberta was hardest hit in 1935, while in 1936 the disease was confined
mainly to Manitoba. However, in 1937 alarming epidemics struck Alberta,
Manitoba, New Brunswick, Saskatchewan, and most severely in Ontario. Nationally,
1937 was the second worst polio year in Canadian history with a reported
case notification rate of 35.4 per 100,000, representing some 4,000 cases
and 200 deaths across the country. Only 1953 was worse when a national
case rate of 60 was reached, the highest national polio case rate ever
recorded in North America, and among the highest in the world.(13) The
majority of the 1937 cases occurred in Ontario, although the seriousness
of the Alberta and Saskatchewan situations provoked similar provincial
responses (see Figure 1 and Table
1, Table 2 and Table
3).
During the summer and fall of 1936 paralytic poliomyelitis was a "disease of outstanding importance" in Manitoba, and was worse than the epidemic of 1928, when 434 cases and 37 deaths were reported. Then, according to a prominent doctor, the disease incited "a terror" in Winnipeg comparable to the air raids of World War I.(14) In 1936, a total of 525 cases and 37 deaths were reported across the province, with most rural areas involved.(15) One major difference from 1928 was that the Manitoba Department of Health and Public Welfare was under the leadership of a new Deputy Minister, Dr. Fred W. Jackson, who held a Diploma of Public Health (D.P.H., 1929) from the University of Toronto School of Hygiene.(16) He assumed a much broader and more direct role in the management of the epidemic in terms of strict disease control measures, diagnosis, prophylaxis and after care. By contrast, the 1928 epidemic was managed largely through the use of convalescent serum under the direction of a University of Manitoba Research Committee with the financial support of the provincial health department.(17) Convalescent serum, an immune serum prepared from the blood of recovered polio cases, was the great medical, popular and government hope of Canada?s first wave of epidemic polio. Despite increasing and largely American scientific controversy surrounding the serum?s real value in minimizing paralysis, most provincial governments prepared and supplied it free to all diagnosed polio cases starting in 1928.(18)
In 1936, under Jackson direction,
Manitobas provincial health department implemented a broader approach
against polio. An epidemiologist was appointed to work in the hardest hit
area of Boissevain. He was given the﹃power to insist on rigid observance
of quarantine regulations﹄and act as a diagnostic consultant for the affected
area. As the situation deteriorated more special investigators were appointed
to expand these services across the province. Public Health Nurses were
also assigned for an intensive education program to urge parents to call
a doctor quickly in the event of symptoms of the disease appearing. Some
municipal governments passed local by-laws to prevent﹃the ingress of individuals
from the infected areas.﹄Despite such strict measures, Jackson felt they
"do not seem to be of great value, at least such would appear to be the
case."(19)
Despite the debate about its value,
convalescent serum remained central to the Manitoba governments polio
strategy. The medical community, and especially the public, demanded that
the serum be used, "whether or not [it] is of value...."(20) However, early
in the epidemic, physicians remained overly dependent upon spinal tap confirmation
before giving the serum. With no simple diagnostic test available for polio
comparable to the diphtheria schick test, the only diagnostic method was
the lumbar puncture, or spinal tap. An examination of the spinal fluid
for characteristic cell counts indicated polio, although this was often
done after the appearance of paralysis. Waiting for a spinal tap often
led to "disastrous results" and Jackson stressed to doctors that a clinical
diagnosis alone was enough to justify immediate serum administration, even
though until weakness or paralysis was evident, the clinical symptoms of
polio were difficult to differentiate from many other common childhood
ailments. Further bolstering confidence in the serum, however, many physicians
claimed that the general clinical results obtained from it were "quite
comparable to those secured when diphtheria antitoxin is given in a case
of diphtheria."(21)
The most significant problem Jacksons
Department faced in managing the 1936 epidemic was its severity in the
"dried-out area[s]" of the province in the midst of the Depression. Many
parents delayed or refused to call a doctor simply because they could not
afford to pay for their services. As the serums effectiveness was thought
to depend upon its early administration, if parents could not afford to
see a doctor, it became "very apparent that something had to be done to
ensure that everyone in the district who became ill had medical attention
at the earliest possible moment."(22) Through Jacksons personal efforts,
the local governments of each of the affected areas were convinced to provide
free diagnostic and treatment facilities unconditionally to every resident,
with the municipality paying the doctors fee. Physicians were paid a special
scale of fees which was about two-thirds the normal charge. Special resolutions
were passed by local governments to offer and also widely advertise this
service. The municipal by-law read:
On and after this date any resident
of this municipality who believes he or any member of his household may
be developing infantile paralysis, the symptoms of which are upset stomach,
headache, fever, rapid pulse and stiffness in the neck or back, has the
right to call his own doctor at the expense of the municipality to make
a visit to decide what the illness is. If it should be infantile paralysis
the municipality will also be responsible for the cost of any further medical
attention required.(23)
As the epidemic spread this program
was expanded into other municipalities, with "truly remarkable co-operation
on the part of the Municipal officials."(24) This was a unique achievement,
particularly as the province did not cover the costs and local governments
were under intense financial pressures for basic relief in one of the worst
years of the Depression.(25)
The 1937 Ontario "infantile paralysis"
epidemic recorded a total of 2,546 cases, at a case rate of 70 per 100,000,
and claimed 119 lives. Of this total, 758 cases and 31 deaths were registered
in the City of Toronto (population 648,309) at a case rate of 117.(26)
Since the majority of cases occurred among children under 10 years of age,
the age-specific incidence rate in this group in Toronto was 510. Just
over half of the number of provincial cases exhibited paralytic symptoms,
and by the following March, 839 remained paralyzed to varying degrees.The
size, severity and dramatic intensity of this epidemic came as a major
shock to Ontario. Such an epidemic situation has not been repeated in the
province by polio or any other infectious disease.(27)
As had been the case in 1929, an
epidemic in 1937 was not unexpected because it followed Manitobas in 1936.
Using the general Canadian trend of epidemics moving from west to east
since 1927, and an apparent seven year epidemic cycle, the Ontario Society
for Crippled Children (OSCC)(28) predicted a significant outbreak in 1937
and devoted the entire June issue of its newsmagazine, The Horizon,
to articles on polio.(29) This striking geographic and epidemiological
pattern can be explained by the relative regional differences in immunity
levels to the three distinct types of the poliovirus. In Canada this situation
shifted from west to east through the first decades of the twentieth century
with the establishment of new and isolated settlements, particularly in
the west and northern regions, along with rising population levels, improving
health and economic standards and increased personal mobility through the
growing use of automobiles and air travel.
The Horizon issue included
articles by the Minister of Health, Dr. J. A. Faulkner, his Chief Medical
Officer of Health, Dr. J.T. Phair, and the Director of Preventable Diseases,
Dr. A.I. McKay. The tone of these and other articles emphasized the public
health value of "the most rigid quarantine," and the continuing use of
convalescent serum. McKay was
well aware of the serum debate, but argued that "Even ten children escaping
paralysis as the result of the use of the serum certainly warrants any
effort in time and money expended in making it readily available."(30)
When the epidemic began, the press
coverage of the serum was as hopeful as ever, but as it quickly escalated,
clear and public signs of controversy became evident among physicians and
local health officials over its value.(31) Such unusually open debate went
beyond the serum issue itself, with some doctors publicly questioning the
seriousness of the epidemic itself.(32) The serum policy outlined by the
Minister of Health to every Ontario physician stressed that "The serum
has no value as a preventive agent and should not be used except for the
treatment of children showing the early signs of the disease."(33) When
the serum was given, such cases were required to be treated as official
polio cases and thereafter were subject to provincial and local health
regulations.(34) Later they were also eligible for free diagnosis, treatment
and hospitalized after-care for a limited period. Once diagnosed, provincial
health regulations required isolation of the patient for three weeks and
all family contacts quarantined; "rigid adherence to the regulations" was
required.(35)
Early in the epidemic, local medical
officers of health (MOHs) requested special diagnostic consultants from
the province. Thirteen full-time physicians were appointed and given a
three-day course on polios epidemiology, diagnosis and the early treatment
of paralyzed cases. They were each assigned a specific region and by August
a total of sixteen consultants provided much needed clinical assistance
to MOHs province-wide. They also gathered considerable statistical and
other types of information which were later used in the most detailed report
ever published on a Canadian polio epidemic.(36)
With three major daily newspapers
in Toronto, in an era when the public relied on newspapers for the majority
of their news,(37) the emerging polio epidemic was a big story by mid-August.
The provincial health department was determined to provide an extensive
public education program about the disease and was confident that it could
control how the press covered the epidemic. Carrying out both efforts soon
proved difficult, if not impossible. In early August, the Toronto Board
of Control, fearing the economic impact of the epidemic on city business
and trade, instructed the Toronto Board of Health to limit public information
and statistics on the outbreak. Within a day, however, Toronto MOH, Dr.
Gordon Jackson, was forced to lift the ban.(38) Provincial
health authorities were disturbed by the controversy and assured the public
that there would "be no putting the lid on" information about the current
epidemic.(39) In the Departments effort to keep the public informed, "the
newspaper publicity was changed to suit the peculiarities of the editors."
A detailed full-page "Statement by the Ontario Department of Health on
POLIOMYELITIS ("INFANTILE PARALYSIS")" was placed in all daily papers in
the province by 30 August.(40) The
Department also held daily press conferences during the peak weeks of the
epidemic to insure "that accurate information would be available to the
public at all times."(41)
The local management of the epidemic
in Toronto was the focus of further controversies over the delaying of
school openings, the closing of public pools, parks and churches, and whether
or not to cancel﹃Childrens Day﹄at the Canadian National Exhibition (CNE).
The issue of postponing public school openings beyond Labour Day to minimize
contact among children developed into an emotional debate between health
authorities and physicians inside and outside the city.(42) As had been
the case in Alberta during the 1927 epidemic, and elsewhere, this debate
highlighted the uncertainty within the medical community between the conflicting
neurotropic and systemic models of the disease.(43)
By the early 1930s, and since the
1910s, the dominant scientific model of poliomyelitis was that the poliovirus
was completely neurotropic; i.e. present and pathogenic only in nervous
tissues as demonstrated experimentally in laboratory monkeys. This model
focused on the specific paralytic pathology of the disease with limited
attention devoted to its general clinical course or natural epidemiology.(44)
However, this laboratory model of polio had little practical value for
many physicians, many of whom could not reconcile the acute polio symptoms
they saw in their patients with the idea that only the nervous system was
involved. Another, broader understanding of polio had emerged at the turn
of the century, based on pioneering epidemiological and clinical work in
Sweden that had established the concept that polio was a generalized systemic
infection with paralysis "but an accidental and incidental occurrence."(45)
This inconsistency remained a strong undercurrent which increasingly surfaced
to challenge the orthodox neurotropic model as North American epidemics
grew larger during the 1930s. For example, a report on a 1935 epidemic
in Virginia concluded:
We cannot consider poliomyelitis
solely in terms of its neurological manifestations as is the current medical
tendency. We think it proper to consider it a systemic disease with neurological
manifestations in the majority of instances. To think otherwise precludes
the probability of diagnosis of early abortive and non-paralytic cases
and interferes very materially with a proper conception of its probable
incidence.(46)
During the 1937 Ontario epidemic, renewed
interest in the systemic model of polio led some doctors and local MOHs
to argue that unless health authorities were prepared to strictly and consistently
apply control measures by restricting children from all potential places
of contact, and in effect close down the entire city of Toronto, there
seemed little hope of successfully managing the epidemic.(47) It was the
economically and politically charged issue of canceling the popular﹃Childrens
Day﹄at the CNE which brought these models into conflict.(48)
This issue first arose in Toronto
Board of Education with a motion officially asking parents to at least
keep their children at home during the CNE.(49) The motion failed, but
the issue was taken up by Dr. R.H. Saunders of the Toronto Board of Health.
Saunders suggested that Childrens Day alone should be canceled, since
schools, public parks, pools, theatres and churches had already been closed
to children during the epidemic. The Board of Health had been vociferous
in its pleas for parents to keep their children at home, and it seemed
that to be consistent, 200,000 children should not be encouraged to mingle
freely at the CNE on Childrens Day.(50) The 1937 edition of the CNE was
expected to be large, particularly to celebrate the Coronation Year of
King George VI. Also, the local economy had recently improved and an extensive
international advertising campaign had been launched to attract the largest
crowds possible.(51) The epidemic had forced the closure or postponement
of smaller local fairs across the province, but any thoughts of doing the
same with the CNE were vigorously resisted by CNE and city officials. Torontos
mayor attacked the idea and denounced its supporters as﹃unfit representatives
of the public.﹄This left MOH Jackson in a difficult position in advising
parents to keep their children at home and had to admit that he had no
power to compel them to do so.(52)
Childrens Day went on as scheduled,
the CNE actually doing very little to meet concerns about the epidemic
other than canceling its annual Baby Show Contest and offering free tickets
to children good for the duration of the fair.(53) Nevertheless, parental
concerns and the extensive publicity about "paralysis" had the effect of
keeping attendance for the day down 78,000 less than the previous year,
and reduced by 300,000 over the entire 1937 run of the CNE.(54) The local
press, reliant upon considerable advertising revenues derived from the
CNE directly and indirectly, tried to maintain a positive outlook, although
there were differences evident in how each paper covered the issue.(55)
This controversy and intense press
attention reflected the confused medical and scientific understanding of
polio, the frustrating lack of progress in developing effective measures
to prevent and control epidemics, and the profound fear "paralysis" generated
among parents and the community. Mothers felt this fear and frustration
the strongest and their voices were frequently heard in the daily press
in painful letters to the editor and through many poignant human interest
stories.(56) One front page story published in the Toronto Star
at the peak of the epidemic dramatically captured this situation. The headline
read, "Mothers of the World Again Must Bear Brunt in War With Paralysis,"
the article couching maternal fears in war imagery.﹃All we can do is wait
until the enemy cracks us down. Then we play stretcher bearers. Just carrying
off the stricken.﹄Although it attempted to ease parents anxieties about
the disease, the article admitted that﹃the truth unquestionably is that
after 57 years, medical science is totally in the dark﹄on how infantile
paralysis originated, was transmitted, and how valuable convalescent serum
really was. Indeed, in this war, "the front line troops are not the scientists
of the world, but the mothers of the world."(57)
(To Page Index)
PREVENTION AND TREATMENT
METHODS IN CANADA
"Paralysis Nose Spray: Just Squirt
and Smile"(58)
During the polio season of 1936
widespread enthusiasm developed around the prophylactic potential of nasal
sprays based on the prevailing idea that the portal of entry of the poliovirus
was the olfactory nerves of the nose.(59) Interest in the chemical blockade
of the nasal mucosa first emerged in 1934 with attempts to protect white
mice against an intranasal inoculation of equine encephalitis virus with
a tannic acid solution.(60) Similar experiments were conducted with as
many as 150 different solutions on mice using the St. Louis type of encephalitis
as a "feeler" for polio research with monkeys.(61) A picric acid solution
was eventually settled on, and in the summer of 1936, Dr. Charles Armstrong
of the U.S. Public Health Service advocated that such a spray be given
a human field trial based on monkey experiments and the repeated spraying
of himself "and a small group of volunteers without apparent ill effects."
That summer a serious polio epidemic in Alabama presented an opportunity
for such a field trial.(62) Federal and state health officials had hoped
it "would be a test by and under the [medical] profession," but it soon
became, "largely through the activity of the people themselves..., a test
by the masses, largely uninstructed, with all the many variations of method
which such a procedure implies."(63) The U.S.P.H.S. issued a statement
on the nasal spray which stressed that "homemade concoctions are not favored."
Also, "early applications at least should be administered by a physician."
This statement was published in the Manitoba Medical Association Review
in September 1936 during the peak of the provinces polio epidemic.(64)
The U.S. statement had essentially
given permission to Manitoba physicians to try using the spray. Its use
was also encouraged by Public Health Nurses who had been sent to the affected
areas by the provincial department of health to "[give] instruction where
requested, on the use of the nasal spray."(65) However, the Manitoba government
did not seem to pay serious attention to the spray and made no attempt
to control its use or evaluate its effectiveness. The members of the Dominion
Council of Health, Ottawas national health advisory committee made up
of the federal and provincial deputy ministers of health, plus others,
including the Director of Connaught Laboratories and the School of Hygiene,
echoed concerns that only physicians administer the spray; otherwise the
topic generated little discussion.(66) This relative complacency in Canada
lasted until the inconclusive results of the Alabama trial were published
in early 1937.
Controlled field trials of prophylactics
were rare prior to the late 1930s, with random selection of control groups
rarely done systematically.(67) Generally, however, it was not until after
1940 that "[t]he concept of randomization gradually gained acceptance in
clinical medicine..."(68) One of the first such field trials took place
ten years earlier in Ontario with diphtheria toxoid. Diphtheria toxoid,
prepared from diphtheria toxin inactivated with formaldehyde, had been
discovered in 1923 by Gaston Ramon of the Pasteur Institute in Paris and
was quickly applied in Canada through a close relationship between Ramon
and Dr. J.G. FitzGerald, Director of Connaught Laboratories and the School
of Hygiene. Of particular significance in expediting its use in Canada,
and later in the United States, was the development at Connaught of a diphtheria
"reaction test" by Dr. P.J. Moloney, which became known as the﹃Moloney
Test.﹄By October 1925 the new toxoid was ready to be given to children
in Canada, with initial studies focused in Hamilton, Brantford and Windsor.
This was followed by an unprecedented scientific, statistical and public
health attack on diphtheria in Toronto involving 36,000 children between
1926 and 1930. The study conclusively proved that the toxoid reduced diphtheria
incidence by at least 90% among those given three doses. This work represented
the first statistical demonstration of the value of a non-living vaccine
in preventing a specific disease. Subsequently, diphtheria incidence declined
sharply in Canada, dropping effectively to zero cases and zero deaths in
many centres by the early 1930s.(69)
The most significant problem noted
in the 1836 Alabama nasal spray trial seemed to be technical, with the
spray not reaching high enough into the nose to be effective. A long special
tip was thus needed on the atomizer which could only be inserted by a professional
nose-and-throat specialist. Furthermore, experiments using a zinc sulphate
spray on monkeys reported in June 1937 suggested that this was more effective
than the picric acid spray and was worthy of a human trial.(70)
In Ontario, parents grew desperate
for any kind of preventive measure as the 1937 epidemic spread and news
of the potential value of the nasal spray generated increasing demands
that it be given by private physicians. Such demands were stimulated by
widely-quoted press statements from American spray enthusiasts, such as
noted virologist Dr. Thomas Rivers. In August 1937 he recommended:﹃If
I had a child in an area where poliomyelitis appeared, I would take my
child to a good otolaryngologist and ask him to apply the spray in the
manner set forth by Dr. [Max] Peet,﹄who had developed the newer treatment.(71)
Despite the caution of some MOHs, doctors began offering the spray and
considered it "both safe and cheap." A London, Ontario doctor provided
the press with the sprays formula and application procedure. Newspapers
quickly picked up the spray story and even reported that some desperate
parents were spraying their childrens noses with salt water. Other physicians
were not so sure about the spray, one warning that﹃until we have definite
proof that children contract the disease through the nose,﹄there was﹃no
point in using the spray, which [was] difficult to administer, uncomfortable
and possibly dangerous.﹄Despite such controversy, physicians were soon
overwhelmed with calls from parents wanting the children treated with the
spray.(72)
The Ontario government thus came
under intense pressure to provide the spray, but did not know if it would
work or if it was safe. In order to prevent an "epidemic of spraying,"(73)and
more importantly, to be able to offer a definitive opinion about the sprays
preventive value, the province gave approval for a plan to carry out a
nasal spray field trial. This was limited to 5,000 Toronto children, in
addition to an observed control group of equivalent size. The control group
was obtained by Public Health Nurses who canvassed each of Torontos eight
health districts, which seemed to provide "a reasonably representative
group."(74) This plan was designed to avoid the pitfalls of the Alabama
trial, since it was clear that "unless great care is exercised, no really
helpful information will be likely to come out of such further work."(75)
The Ontario plan was immediately
presented to a group of Toronto otolaryngologists from the citys hospitals,
who would administer the spray in special clinics.(76) The trial was financed
entirely by the province and carried out with the assistance of the Toronto
Department of Health. Responsibility for the study was assumed by the Hospital
for Sick Children and the School of Hygiene, with the entire trial under
the supervision of Dr. R.D. Defries, Acting Director of the School and
Connaught. As was noted after the trial, "In few cities has there been
such whole-hearted co-operation on the part of the administrative authorities,
the public, and the press in an undertaking which was definitely presented
as an experiment. To this extent the study was unique."(77)
The trial was first publicly announced
in the Toronto press on 30 August, its details outlined with﹃a very conservative
statement﹄that emphasized the limited size of the "experiment" and included
a consent form for interested parents to return. A chance to participate
in such a hopeful experiment generated intense public and media interest
and within three days more than 6,000 forms flooded in from parents who
clamored for any kind of protection for their children.(78) Those who could
not be included in the "experiment" demanded the spray from their doctors.(79)
The first clinics opened on 31 August with 5,233 children sprayed by 5
September, and 4,585 children sprayed a second time two weeks later.
The trial organizers were concerned
about how well the public would respond, particularly since parents had
been strongly advised to keep their children away from crowds. The large
response was surprising and attributed﹃in no small measure, to the excellent
publicity given to the study by the press who, through suitable articles
and news items, kept the public informed of the purpose and progress of
the effort.﹄The experimental nature of the trial was stressed in the press,
"although some measure of hope was offered,"(80) thus effectively raising
public expectations and demand for the spray, either within the formal
structure of the trial, or on the free market. As was stressed in newspaper
coverage of the trial, here then was a clear chance for children and their
parents to take part in an important scientific experiment.(81) But such
publicity made it difficult to limit the sprays use and prevent other
communities, and even some private businesses, from making the spray available
to its citizens or employees.(82)
As was reported in November 1937,
the trial clearly demonstrated that the spray was ineffective as a polio
preventive, and also potentially dangerous to those treated. Eleven cases
of polio were reported among those sprayed, while nineteen cases occurred
in the control group, suggesting that the differences between the attack
rates in each group were not statistically significant.(83) As was the
case with the 1936 Alabama trial, the Toronto report blamed faulty administration
methods for the failure of the spray. The objective of the nasal spray
was to block the poliovirus from entering the olfactory nerve, and thus
a temporary loss of the sense of smell (anosmia) was expected. When this
was tested during and after the trial, no more than 25 per cent of the
children sprayed reported losing it.(84) Most devastating, however, it
was found that among those children losing their sense of smell and/ or
taste soon after the trial, many had not regained it months later. There
was also a notable case of anosmia among one of the trial organizers, Dr.
Donald T. Fraser, who would not try anything on anybody that he would not
try on himself. He took this self-experimentation in stride, though, noting
later "that his only objection to this loss was that he couldnt enjoy
his sherry anymore."(85) As well, the practical problems of organizing,
deploying and administering the spray quickly and safely during the emergency
of an epidemic largely undermined enthusiasm for its further scientific
study or use.(86)
Despite its lack of success, the
Toronto field trial marked an important step in polio research with its
relatively high standards of professionalism, methodology and administrative
and public cooperation. This was reinforced by the close physical proximity
between the provincial health department, the Hospital for Sick Children
and the University of Torontos School of Hygiene and Connaught Laboratories,
along with the experience of, and close professional, academic and personal
links between Defries and the others involved. These were features lacking
with the earlier use of the spray in Manitoba, and especially in Alabama,
and with other prophylactics used against polio, such as convalescent serum
and the two rival polio vaccines developed by Brodie and Kolmer in 1934-35.
These were primitive "killed" and "attenuated" precursors to the Salk and
Sabin vaccines, and under the pressures of major polio epidemics, as well
as scientific and commercial rivalry, were widely and prematurely used
in the U.S. with considerable controversy and some tragic results.(87)
In the wake of the Toronto nasal spray trial it also became clear that
"the problem of preventing human poliomyelitis was not to be easily solved
on the basis of evidence deduced from the experimental disease in the rhesus
monkey." Combined with other evidence, polio historian Dr. John R. Paul
argues that "the experience in Toronto aroused uneasiness about the whole
hypothesis of a nasal portal of entry in man."(88) Indeed, soon after the
Toronto trial, success was quietly reported in the long standing problem
of isolating the poliovirus from human intestinal washings, results which
were highly significant for later epidemiological and immunological research.(89)
(To Page Index)
"Miraculous
Metal Monsters"(90)
One of the most serious and unexpected
developments of the 1937 epidemic was the large number of "bulbar" cases
of respiratory and/or throat paralysis, which impaired breathing and swallowing
and usually caused death.(91) Polio mortality statistics averaged about
four percent of reported cases, but the management of bulbar cases represented
a major medical and technological challenge. The image of the "iron lung"
was first ingrained into the Canadian public consciousness during the 1937
Ontario polio epidemic.
The first "iron lung" or electric
tank respirator designed for severe polio cases was built in 1928 at Harvard
University by Philip Drinker.(92) It was essentially a metal tank into
which all but the head of an individual was sealed. A motor, or hand crank,
operated a set of bellows, and since the head remained outside of the lung,
the negative pressure inside acted like the human diaphragm and forced
the lungs to expand and contract to allow regular breathing. The first
iron lung in Canada was an original Drinker model that arrived at Torontos
Hospital for Sick Children (HSC) in 1930, and it apparently remained the
only one in the country until August 1937.(93) Bulbar cases were rarely
mentioned during earlier epidemics since most died tragically when there
was little that could be done to help them. Death rates from polio varied
widely, between about 4 and 30%, and "tend[ed] to vary inversely with the
number of cases, being relatively low in epidemic years and relatively
high in non-epidemic years"(94) (Table 3).
The Toronto press focused considerable
attention on the need for more life-saving iron lungs as the 1937 epidemic
worsened through August. The emergency was leaving﹃little tots struggling
for breath﹄in hospitals.(95) HSCs single Drinker machine was used for
a small number of mild chest paralysis cases, but on 21 August, a young
girl in critical condition was placed in the lung, which happened to be
open, but it was clear that she would have to remain in it for a long time.
She would then have to be "weaned" off the iron lung when evidence of recovery
was clear and periods outside the iron lung could then be progressively
lengthened. This situation greatly concerned HSCs Superintendent, Joseph
H.W. Bower. The City of Toronto had ordered one commercial machine for
Riverdale Isolation Hospital. London and Hamilton had also ordered lungs.
Yet it would be several days at least before Riverdales lung arrived,
and it would be ten days to two weeks before another one would be available.(96)With
this news, Bower knew he would have to build respirators at the hospital
for any bulbar cases that might develop.
Meanwhile a four-year-old boy had
been admitted with chest paralysis on the morning of 26 August. As the
Drinker machine was in use, an experimental respirator for premature infants
was modified and coupled with a quickly-built wooden box in which the little
boy was placed and stabilized. This﹃emergency-made lumber lung﹄"saved"
the childs life. The boys mother then turned to the newspapers to plead
for the "wealthy to buy iron lungs," each of which was worth some $2,000.
The prominent place of this appeal in the Toronto press reflected the unusual
vulnerability to polio among the well-to-do, whose wealth could not protect
them from this disease. Two more commercial "lungs" were eventually bought,
largely through an "Anonymous Donor."(97) Meanwhile, at HSC, efforts were
concentrated on building more lungs. By noon of 27 August, plans were complete
and enough parts were ordered and delivered by the next evening to start
assembling the first iron lung. Two days later this first lung was complete
and placed on HSCs Infectious Floor; within fifteen minutes a patient
was placed in it. By 31 August, four "homemade" iron lungs had been assembled
in the hospitals basement.(98)
Figure 2 (Click for full image)
The Deputy Minister of Health was
impressed with the speed of HSCs iron lung production. Just as the first
four "welded steel" lungs were completed the Department ordered three more
for use by the province, and shortly increased this order to twelve. With
production running 24-hours-a-day, they were delivered within the next
seven days. Financed by the province at a cost of between $650 to $700
each, HSC assembled 27 iron lungs under the close direction of Superintendent
Bower, who lived in the hospital for the duration of the epidemic (see
Figure
2). Most of these lungs were used at HSC or at neighboring Toronto
General Hospital, while the rest were shipped to other hospitals in the
province, as well as to Winnipeg, Regina and Edmonton. The original﹃wooden
lung﹄by this time was no longer in use; in response to an emergency call,
the Toronto Star arranged to fly it to Denver, thus saving the life
of a young girl.(99)
The dramatic story of the﹃Herculean
efforts﹄at HSC to manufacture iron lungs drew intense press attention.
Soon there were riveting stories in the Toronto press describing how﹃Seven
Tiny Heads in a Row Tell of Fight With Disease: Big Steel Monsters Hold
Children Battling Bravely to Overcome Paralysis of Lungs.﹄A month later
another story detailed the way "Massive Iron Lungs Grotesque, Glorious,
Coax Life to Tots: Hushed Rhythmic Action Keeps 7 Tots Alive in Hospital
Room: In Gleaming Row."(100) Over the years the press covered the birthdays
and even the weddings of "famous" polio sufferers who had been confined
to iron lungs indefinitely.(101)
Despite the many stories of lives
being saved by wooden or iron lungs, their efficacy in preventing bulbar
polio deaths remained controversial. During the 1937 epidemic, 63 polio
cases were treated in iron lungs, and by the following March, 40 had died,
12 had recovered and 11 still remained in respirators, six of whom "will
probably continue to require the respirator indefinitely."(102) Despite
this generally grim record, iron lungs had a significant effect on public
perceptions, ranging from fascination with the hopeful power of science
and technology in an otherwise fruitless war with polio, to terror, as
rows of iron lungs encased polios helpless young victims for weeks, months
or years. The iron lung symbolized the disease and its worst possible effects
while at the same time it provided the medical community with a specific
and hopeful technological tool against them. Still, the limited supply
and success of iron lungs, especially during the crisis of an epidemic,
frequently raised the difficult ethical dilemma of having to decide who
to treat and for how long. Nevertheless, the iron lung also gave the provincial
government another opportunity to demonstrate that it was doing everything
possible against the worst effects of this disease.
(To Page Index)
Standardized
Treatment, Hospitalization, and After-Care
Other than the efforts of Alberta
in 1927-28, where a special polio hospital was opened in Edmonton,(103)
the issue of treatment, hospitalization and after care of paralytic polio
cases was rarely addressed by provincial governments for the next decade.
In the wake of the 1936 Manitoba epidemic the province took a modest step
forward in how it viewed the problem of after-care and hired an orthopaedic
specialist, Dr. A.A. Murray, who at no charge, assessed every paralytic
case outside of the Greater Winnipeg area, and outlined the required treatment
methods to minimize deformities. This service was recognized as "a new
departure in the Public Health work of Canada."(104) The issue of hospitalization,
however, was rarely mentioned, and was viewed as a last resort for orthopaedic
surgery. But as Murray stressed, patients﹃should be discharged to their
homes as soon as they feel well following operation, and so save an enormous
amount of public money.﹄He once felt that the state should freely provide
splints, appliances and hospital and medical care to the indigent, but
his polio work seemed to change his mind. Few such patients took care of
free appliances and he thought they were "apt to lose their independence
and capitalize on their disability in order to live without work."(105)
These conservative views, likely hardened by the Depression, were not shared
by such provincial health authorities as Deputy Health Minister Jackson,
whose public health background and recent experience during the epidemic
reinforced a more liberal approach. He argued that since
the State ultimately may have
to support most of those permanently and totally disabled by poliomyelitis,
it is in the interest of the State that it should make provision for: 1)
Early and adequate diagnostic and treatment facilities; 2) An adequate
supply of immune serum readily available to every practicing physician;
3) Consultant diagnostic service for cases of residual paralysis; 4) Corrective
treatment and appliances for indigent persons.(106)
The more serious polio situation in
Ontario in 1937 forced a significant expansion of such state provisions,
particularly in the area of hospitalization, and beyond just for the indigent.
By early September the epidemic emergency prompted the calling of a special
"Symposium on Poliomyelitis" by the Toronto Academy of Medicine.(107) Of
particular interest to many at the symposium, as the number of cases approached
2,000, was the problem of "preventing unnecessary crippling" and deformities.
Much of the pressure placed on the government to do something about treating
those stricken by "paralysis" originated with the Ontario Society for Crippled
Children and its Executive Director, Reg Hopper.(108) The OSCC had been
founded under the auspices of the Rotary Clubs in 1922 after a number of
similar societies emerged in the United States. In Ontario, by 1930, the
OSCC recognized that polio was "the most important cause of crippling,
accounting for as much as 40% of the total number of handicapped children."(109)
This percentage grew alarmingly in 1937.
In mid-September, at the request
of the province, the OSCC called a meeting of orthopaedic surgeons in Toronto.
Based on conclusions reached at the earlier symposium, Dr. D.E. Robertson,
Chief Surgeon and orthopaedic specialist at the Hospital for Sick Children,
recommended that:
1) Every case of muscle weakness
or paralysis following poliomyelitis should be placed on a Bradford frame.
2) Six months is the minimum period of recumbency. Some cases may require
eighteen months or longer. 3) Suitable splints are to be worn if required
on extremities. 4) Massage is to be commenced when it is not uncomfortable
for the patient. 5) Muscle training is to be begun only after the patient
has shown definite and considerable recovery in power.(110)
Until there was evidence of muscle
recovery, or until the pain had subsided, the principle of immobilization
of the paralyzed limbs and absolute bed rest was the medical orthodoxy
in Canada until the early 1940s.(111) The "Bradford Frame" was essential
to maintaining immobility and consisted of a rectangular pipe with canvas
laced to it. No pillows or cushions were allowed and patients were nursed
and carried around while strapped to the frame. To insure immobility, splints
on the affected limbs were attached to the frame and "maintained until
recovery occurs to a degree sufficient to permit useful function."(112)
In most cases, however, this state of immobility lasted for months in the
hope that when the damaged motor neuron cells in the spinal cord finally
recovered, the affected muscles and limbs would be free of deformities
and fit to be used again(113) (see Figure
3).
Figure 3 (Click for full image)
At the meeting of orthopaedic surgeons,
the province agreed to an aggressive plan to provide standardized frames
and splints "without delay for all cases showing evidence of paralysis
or muscle weakness."(114) These appliances were manufactured at the governments
expense at HSC, and at Hamilton General Hospital and Londons Victoria
Hospital, and were distributed by the Department, free of charge, to all
paralysis cases.(115) This was the first time that standardized splints
and frames had been prepared for polio treatment in North America. Previously
they had been made to order, which took days or weeks, but under this system,
when an order arrived giving the size, height, length of leg, or arm, "the
frames and splints are on their way in a few minutes."(116) By late November,
with some 2,531 cases reported in the province, a total of nearly 2,000
splints and frames had been provided free by the Ontario government.(117)
These splints soon became known as "Toronto splints" and until the early
1940s were the North American standard. In 1939 the National Foundation
for Infantile Paralysis began stockpiling as many as 15,000 of them in
New York City, "ready to be flown wherever doctors demanded them."(118)
The provincial department went further
in their polio policy and recognized that﹃deformity arises from too early
attempts to get around, from unsupervised treatment or from no treatment
at all.﹄The Ontario government therefore decided on 16 September,
to provide free of charge for
all such cases, a limited period of care... from one to three weeks in
hospital following isolation... in order that patients may learn to adapt
themselves to the proper use of the Bradford frame and necessary splints.
It is of the utmost importance that not only the patient but also the patients
family be fully impressed with the necessity for prolonged and adequate
orthopaedic care if unnecessary crippling is to be prevented.(119)
This hospitalization plan was initially
available only at HSC, Torontos General, Western and St. Michaels hospitals,
as well as at the general hospitals in most centres across the province.
However, it soon became﹃apparent that our childrens hospitals could not
handle this large number of cases﹄and, consequently, the province took
over the old Grace Hospital in Toronto and placed medical staff and nurses
in attendance.(120) The 150-bed "Ontario Orthopaedic Hospital," as it was
newly-christened, officially opened on 29 September. It was exclusively
a childrens hospital, staffed by HSC, and under the direction of Robertson
and Dr. Alan Brown, HSCs physician-in-chief.(121) By Christmas 1937, it
had "graduated" a total of 283 polio patients, while in the province as
a whole, "650 patients had three weeks" treatment at the Governments expense."(122)
The principal purpose of the﹃Ontario
Orthopaedic Hospital﹄and the orthopaedic wards in the other designated
hospitals, was also to teach patients and their parents how to manage the
effects of "paralysis" at home. During two days in October they were﹃personally
advised and lectured as to the paramount importance of keeping the little
patients on the frames and in the splints.﹄Otherwise, parents were barred
from seeing their children, except through glass, while nurses and doctors
gave the patients "weeks of routine, to accustom them and to discipline
them, to the steep road that lies before them."(123)Parents were instructed
to carefully massage the weakened limbs, turn the child regularly and watch
for redness of the skin. They were to occupy their childs mind, but warned
not to "call attention to his condition, dont pamper him, dont tire him,
keep the house quiet, give him plenty of rest and sleep, etc."(124) For
many parents, such a regimen was very difficult, if not impossible, and
in many cases had to continue indefinitely.
Some parents had difficulty believing
in or accepting the prescription of long term immobility which prevailed
in Canada until 1941-42.(125) This view was evident from a series of historical
questionnaires distributed to polio survivors across Canada.(126) Recovery
was "too slow" for many because they believed immobilization "caused a
great deal of muscle atrophy."(127) Among polio survivors, this type of
treatment seemed insensitive and often led to dissatisfaction, if not rebellion
against medical authority. Objectification was common. One survivor has
vivid memories of feeling like "a prisoner" in the hospital and being﹃tied
to my bed﹄on a Bradford Frame with a straight-jacket. "No one treated
me like a person."(128) Frustrated by such treatment, osteopaths were sometimes
resorted to, as were chiropractors, much to the chagrin of physicians during
much of the epidemic era.(129) In one 1937 case,﹃we had an osteopath coming
in one door while the medical man was going out the other.﹄A watch was
kept in case the doctor returned, in which case "wed quickly put the irons
back on."(130) This flouting of medical authority left some paralyzed children
confined at home without any medical attention. This happened to a 14 year-old
boy whose parents constantly turned him over and over again in bed. Fifty
years later he vividly remembered how "he would scream and scream" in pain.(131)
Parents were nevertheless repeatedly warned "against the bad advice of
well-meaning but ignorant relatives and friends and irregular practitioners."(132)
One particular irregular practitioner
who worried Ontario doctors was Sister Elizabeth Kenny, an unorthodox Australian
nurse. In the late 1930s she had become a kind of cult heroine based on
press reports of her "miraculous" work for polio patients in Australia
and her resultant clashes with orthopaedic surgeons and physicians. The
Canadian popularity of Sister Kenny and her methods of active massage and
heat, preceded her personal arrival and medical acceptance in North America
in the early 1940s.(133) Sharp conflicts frequently occurred between parents
and physicians when her methods were applied in the home.(134) In one case
in 1939 the mother of a two-year-old boy "asked the surgeon whether the
Sister Kenny approach might be beneficial. He ridiculed her and made her
cry -- his approach was the only one!"(135) Others stricken with polio
during the late 1930s felt that "the Kenny Method should have been used
on me right from the first, then I wouldnt be so disabled today."(136)
One of the more vexatious clashes
over the Kenny methods took place in Toronto during the 1937 epidemic.
A ten-year-old child suffering from almost total paralysis lay at the centre
of a battle between her mother, described as a "practical nurse," her family
physician, the Hospital for Sick Children, and the provincial health department.
The conflict was driven by the mothers "stubborn" insistence on nursing
her daughter at home using the "non-restrictive" methods she had read about
that were being advocated by Sister Kenny. Sparking what became a year-long
struggle was the mother being "forced" to take her daughter to HSC to confirm
the polio diagnosis by spinal tap. According to her daughter,﹃My mother
refused to let them admit me and we waited there for hours before they
let me go.﹄While at home﹃My parents let me do whatever I felt I could
do, even if I fell or hurt myself.﹄However, this clash cost her family
financial assistance from the province.(137) Benefits were contingent on
cooperating with the standardized system set up by the government. By contrast,
the father of a nineteen-year-old woman also stricken with polio in 1937,
who borrowed from his life insurance to pay the hospital bill, was surprised
the following spring to receive a government cheque that "reimbursed him
for the hospital bill, which included special nurses."(138)
The Ontario Society for Crippled
Children cooperated closely with the provincial governments hospitalization
and treatment plan with transportation and follow-up services. It also
loaned one of its staff to the new polio hospital, who served as a link
between the Department of Health, the OSCC and other local service clubs
throughout the province.(139) The OSCC executive was concerned, however,
that many families might be unaware, unable, or even unwilling to take
advantage of the appliances and hospitalization offered by the government.
Families needed to be﹃worked up to demand these free services, as it is
apparent that many physicians will not act promptly, if at all.﹄The Department
recognized the need to protect its not insignificant investment and agreed
"that a follow-up nursing service will be of the utmost importance in conserving
surgical treatment which has been instituted in hospital." The province
was "prepared to spend a considerable amount of money in hospitalizing
children and providing them with the necessary equipment."(140)
The follow-up nursing program began
in early November 1937, the OSCC taking on two extra public health nurses
for a year to meet the demands across the province at a total cost of $7,000.
To meet these extra costs the OSCC was forced to launch a major fund-raising
campaign in December.(141) This program was reliant upon the Department
keeping track of each paralytic case by using serum records and outlining
to the parents and attending physician of the necessary after-care. If
necessary, this information was forwarded to the local MOH.(142) By May
1938, OSCCs nurses had visited some 800 paralytic cases across the province,
with visits continuing for some 500 of these(143)
The visiting nurses were first required
to check with the local MOH and each patients private physician in order
to get permission to visit and assist with each case.(144)While this procedure
generally met with cooperation from the medical profession, the zeal of
some nurses, and especially the press statements from OSCCs Reg Hopper,
generated conflict with some physicians. Hopper made his concerns public
in press statements in December﹃with respect to the individual patients
he had found without proper after-care.﹄To McGhie, the Deputy Minister
of Health, such statements were "a little dangerous," and he worried that
"physicians who have been responsible may not react kindly."(145)
One such upset physician was none
other than Dr. D.E. Robertson, Chief Surgeon of HSC, who was quite "disturbed"
about Hoppers suggestion that the OSCC was responsible for the treatment
of convalescent patients. Robertson, who until this point served on OSCCs
Board of Directors, was offended when an OSCC nurse approached him for
permission to visit one of his private patients. He refused, and as he
explained to McGhie, a "voluntary organization can never do a thing as
well as a Government Department such as yours did with the polio epidemic
last autumn."(146) However, Hopper was clearly told by the government just
what the OSCCs role was in its follow-up work: 1) continue to uncover
unreported cases; 2) gather as much data regarding known cases; and 3)
avoid entering the field of treatment. To avoid further embarrassment,
all material used for publicity and appeal purposes had to be reviewed
by the Department.(147) All this
was carefully done without upsetting the Departments close relationship
with the OSCC and their important and useful follow-up program.
While some individual physicians
may have been upset with the aggressiveness of the OSCC, this follow-up
program and the Ontario governments overall handling of the epidemic,
generally received strong and enthusiastic praise from all who were closely
associated with it.(148) Federal health officials in Ottawa were﹃greatly
impressed﹄with McGhies detailed report on the epidemic to the Dominion
Council of Health. The Federal Director of Public Health Services, Dr.
John J. Heagerty, suggested that﹃a copy should be sent to the League of
Nations for their information,﹄since he felt that the provinces efforts
during the epidemic were the "most comprehensive that has ever been undertaken
anywhere."(149)
Ontarios experience with polio
in 1937 reinforced a significant shift in the Department of Healths larger
approach to "state medicine." At a December 1938 meeting of the Dominion
Council of Health, Ontarios new Minister of Health, Harold J. Kirby, posed
the difficult question,﹃How far does the responsibility of the Provincial
Department of Health go in the treatment of disease?﹄He reported that
recently almost all of his Departments total budget was﹃spent on activities
that are in the main treatment.﹄It seemed increasingly clear to the Minister
there was strong public and professional support for the idea that the
government might properly assume responsibility for the expense of the
more costly methods of recognized treatment.﹃Frankly, the therapeutic
aspect of the public health program is swamping the prophylactic.﹄His
report outlined his governments expenditures on biologicals and other
direct treatment agents, its venereal disease treatment program, cancer
treatments, and the costs of hospitalization for polio patients.
In a number of provinces during
the mid-1930s, government interest in cancer treatment, in particular,
as with polio, was a new extension of provincial health services against
prominent and growing public health threats. By 1938 the Ontario government
had spent over $750,000 to set up seven provincial cancer clinics, and
bought seven grams of radium (worth $400,000 alone). The clinics provided
diagnostic and treatment services with radium and x-rays, but were designed
"for the indigent and near-indigent groups in our population." The fees
were kept as low as possible, "having in mind the fundamental objective
of establishing the clinics, namely the provision of modern facilities
for cancer treatment accessible to all."(150)
Prior to 1937 the Ontario government
spent an average of $4,000 per year on polio, mainly to pay blood donors
and to make convalescent serum. However, as Kirby outlined, in 1937﹃the
interest of the Department in the matter of [polio] treatment was expanded
far beyond that ever previously conceived.﹄In total, the government spent
$197,000 during the epidemic, "$152,363 of which was for treatment."(151)
Yet the widely-acknowledged success of the governments management of the
epidemic left Kirby with a more significant question to consider: "Frankly,
how far should any government be compelled to go in ensuring for its people
the advantages of modern treatment?"(152) The 1937 epidemic established
an important precedent and reinforced a growing trend towards "state medicine."
It was clear that polio, despite its relatively minor incidence and mortality
compared with cancer, was a disease that, even more than cancer, required
that the public be given as much access to the advantages of modern treatment
as the state could possibly afford, "regardless of station." In subsequent
years, the Ontario government worried about further polio epidemics that
might prove even worse. The polio policy developed during 1937 was maintained
and modified over the next decade, and expanded into the most comprehensive
in the country.
(To Page Index)
CONCLUSIONS
By the end of the second wave of
major polio epidemics in Canada a high degree of provincial government
interest had developed in the treatment, hospitalization and unconditional
financial support of those stricken by this tragic disease. The unprecedented
polio crisis of 1937 in Ontario, its middle class impact, and the very
limited prospects for prevention, had generated an expanded program in
state medicine. The previous experience of other provinces with epidemic
polio, particularly Alberta in 1927-28 and Manitoba in 1936, had established
important precedents in the unconditional deployment of free diagnostic
and treatment programs by provincial governments. In most provinces, as
polio epidemics worsened into the 1940s, and especially into the 1950s,
such government treatment programs evolved into specific and often sophisticated
provincial polio policies. Their expansion was also driven by the prominent
example of the unconditional patient treatment program of the National
Foundation for Infantile Paralysis in the United States. The interest of
Ottawa in the polio problem also grew, especially after World War II, catalyzed
by the general post-war expansion of the federal government, and by the
particular personal experience and political agenda Paul Martin, who was
stricken by polio in 1907 as a child, and whose son, Paul Martin Jr., became
a polio victim in 1946, just prior to the elder Martins appointment as
Minister of National Health and Welfare.(153)
This article has also stressed the
importance of the close professional and personal cooperation that existed
between provincial health authorities in Canada, especially in Ontario,
and the public health and scientific leadership of the School of Hygiene
and Connaught Laboratories in the University of Toronto. This relationship
was distinctive in North America and proved highly significant to the 1937
Toronto nasal spray trial, which had important implications for the subsequent
scientific understanding of polio and its human etiology. Also crucial
to this relationship, particularly with respect to the treatment of polio,
was the Toronto Hospital for Sick Children, and its pioneering use of standardized
splints and frames, and for its "Herculean efforts" to manufacture "homemade"
iron lungs in its basement. These Canadian public health, scientific and
political relationships grew in importance during the next two decades
and became of fundamental importance to the development, production and
distribution of the Salk vaccine and the ultimate control of epidemic polio
in Canada.(154) These unique factors surrounding the growing problem of
polio and its control during the first half of the twentieth century thus
played an influential role in justifiying and shaping the subsequent development
of Canadas public healthcare insurance system.
(To Page Index)
ENDNOTES
●
This article is based on aspects of my
"A Grim Terror More Menacing, More Sinister Than
Death Itself: Physicians, Poliomyelitis and the Popular Press in Early
20th-Century Ontario," MA Thesis, University of Western Ontario, 1990,
but more directly on my dissertation, "Do Something!...
Do Anything! Poliomyelitis in Canada, 1927-1962," Ph.D. Thesis, University
of Toronto, 1995. I would like to thank the Hannah Institute for the History
of Medicine for their substantial financial support for each thesis, my
close advisors, J.T.H. Connor, Paul Rutherford, and especially Michael
Bliss, for their wise and constructive counsel. Special thanks to also
Dr. Connor for his long support of my polio research since the beginning,
and for his patience in awaiting the final version of this paper.
(一)
Jane S. Smith, Patenting the Sun:
Polio and the Salk Vaccine (New York: William Morrow & Co., 1990);
B. Davies, "Death Walks in Summer," Canadian Magazine, 82 (July
1934): 7.
(二)
Richard Carter, The Gentle Legions
(Garden City, NY: Doubleday, 1961), p. 94.
(三)
Lauro S. Halstead and Gunnar Grimby (eds.),
Post-Polio
Syndrome (Philadelphia: Hanley & Belfus, 1995).
(四)
C.R. Donovan, "News Items," Manitoba
Medical Association Review (MMAR), 16 (Sept. 1936): 187.
(五)
The most significant general works include:
John R. Paul, A History of Poliomyelitis (New Haven: Yale University
Press, 1971); Smith, Patenting the Sun; Tony Gould, A Summer
Plague: Polio and its Survivors (London: Yale University Press, 1995).
On the Salk vaccine story see: Dorothy M. Horstmann,﹃The Poliomyelitis
Story: A Scientific Hegira,﹄Yale Journal of Biology and Medicine,
58 (1985): 79-90; Allan M. Brandt,﹃Polio, Politics, Publicity, and Duplicity:
Ethical Aspects in the Development of the Salk Vaccine,﹄International
Journal of Health Services, 8 (1978): 265; Richard Carter, Breakthrough:
The Saga of Jonas Salk (New York City: Trident Press, 1966). On the
political and legal aspects of the Salk vs. Sabin vaccine debate, see Christopher
J. Rutty,﹃Salk vs. Sabin: The Great Polio Vaccine Debate: Legal Liability,
Informed Consent and American Public Health Policy, 1955-1995,﹄paper presented
at American Association for the History of Medicine Meeting, Buffalo, May
1996.
(六)
Naomi Rogers, Dirt and Disease: Polio
Before FDR (New Brunswick, N.J.: Rutgers University Press, 1990); Guenter
B. Risse,﹃Revolt Against Quarantine: Community Responses to the 1916 Polio
Epidemic, Oyster Bay, New York,﹄Transactions and Studies of the College
of Physicians of Philadelphia, 14 (1992): 23-50; Saul Benison,﹃The
Enigma of Polio, 1910,﹄in L.W. Levy and H. Hyman (eds.), Freedom and
Reform: Essays in Honor of Henry Steele Commager, (New York City: Harper
& Row, 1967), p. 235-41; Saul Benison,﹃Speculation and Experimentation
in Early Poliomyelitis Research,﹄Clio Medica, 10 (1975): 1-22.
(七)
Richard T. Goldberg, The Making of
Franklin D. Roosevelt: Triumph Over Disability (Cambridge: 1981); Hugh
G. Gallagher, FDRs Splendid Deception (New York City: Dodd, Mead
& Co., 1985); Daniel J. Wilson,﹃Covenants of Work and Grace: Themes
of Recovery and Redemption in Polio Narratives,﹄Literature and Medicine,
13 (1994): 22-41; Daniel J. Wilson,﹃More Good Than a Gallon of Medicine:
Polio, Stigma, and the Inspiration of FDR,﹄paper presented at American
Association for the History of Medicine Meeting, University of Pittsburgh,
May 1995; Fred Davis, Passage Through Crisis: Polio Victims and Their
Families (New Brunswick, N.J.: Transaction Publishers, 1963, 1991).
(八)
The foundations of a Canadian polio historiography
are: Christopher J. Rutty,﹃A Grim Terror More Menacing, More Sinister
Than Death Itself: Physicians, Poliomyelitis and the Popular Press in
Early 20th-Century Ontario,﹄MA Thesis, University of Western Ontario,
1990; Gillian Liebenberg,﹃Disease and Disability: Poliomyelitis Rehabilitation
and Social Reform for Disabled Persons in New Brunswick, 1941-1955,﹄MA
Thesis, University of New Brunswick, 1994; Christopher J. Rutty,﹃Do Something!...
Do Anything! Poliomyelitis in Canada, 1927-1962,﹄Ph.D. Thesis, University
of Toronto, 1995.
(九)
See for example: Douglas O. Baldwin,
"Volunteers in Action: The Establishment of Government Health Care on Prince
Edward Island, 1900-1931," Acadiensis, 19 (1990): 121-47; Jay Cassel,
"Making Canada Safe for Sex: Government and the Problem of Sexually Transmitted
Diseases in the Twentieth Century," in C.D. Naylor (ed.), Canadian Health
Care and the State: A Century of Evolution (Montreal and Kingston:
McGill-Queens University Press, 1992), p. 141-92; Heather MacDougall,
Activists
and Advocates: Torontos Health Department, 1883-1983 (Toronto: Dundurn
Press, 1990); John Duffy, The Sanitarians: A History of American Public
Health (Chicago: University of Chicago Press, 1990); Carter, The
Gentle Legions.
(十)
See: Carter, The Gentle Legions;
David L. Sills, The Volunteers: Means and Ends in a National Organization
(Glencoe, Ill.: The Free Press, 1957).
(11)
Rutty, "Do Something!... Do Anything!"
p. 262-359; Robert D. Defries, The First Forty Years, 1914-1955: Connaught
Medical Research Laboratories, University of Toronto (Toronto: University
of Toronto Press, 1968); Paul A. Bator with Andrew J. Rhodes, Within
Reach of Everyone: A History of the University of Toronto School of Hygiene
and the Connaught Laboratories, Volume I, 1927-1955 (Ottawa: Canadian
Public Health Association, 1990); Paul A. Bator, Within Reach of Everyone,
Volume II: A History of the University of Toronto School of Hygiene and
Connaught Laboratories Limited, 1955-1975, With an Update to the 1990s,
(Ottawa: Canadian Public Health Association, 1995); Christopher J. Rutty,
"Dr. Robert D. Defries: Canadas Mr. Public Health," in L.N. Magner (ed.),
Doctors,
Nurses, and Practitioners (Westport: Greenwood Press, 1997).
(12)
Jane Lewis,﹃The Prevention of Diphtheria
in Canada and Britain, 1914-1945,﹄Journal of Social History, 20
(1986): 163-76; Claude E. Dolman,﹃Landmarks and Pioneers in the Control
of Diphtheria,﹄Canadian Journal of Public Health (CJPH),
64 (July-Aug. 1973): 317-36; Arthur Gryfe,﹃The Taming of Diphtheria: Ontarios
Role,﹄Annals of the Royal College of Physicians and Surgeons of Canada
20 (March 1987): 115-19; J.G. FitzGerald, R.D. Defries, D.T. Fraser, P.J.
Moloney and N.E. McKinnon, "Experiences with Diphtheria Toxoid in Canada,"
American
Journal of Public Health (AJPH), 22 (Jan. 1932): 25-28.
(13)
M.-J. Freyche and J. Nielsen,﹃Incidence
of Poliomyelitis Since 1920,﹄in World Health Organization, Poliomyelitis
(Geneva: WHO, 1955), p. 59-106.
(14)
O.J. Day,﹃Poliomyelitis in Manitoba
in 1928,﹄Canadian Medical Association Journal (CMAJ), 21
(Nov. 1929): 555.
(15)
Manitoba Department Health and Public
Welfare, Annual Report, 1936 (Winnipeg, 1937), p. 60; F.W. Jackson,
"Infantile Paralysis in Manitoba - 1936," Dominion Council of Health (DCH),
2-3 November 1936, Appendix I, p. 1, Archives of Ontario (AO), RG1-05-06;
C.R. Donovan, "Poliomyelitis in Manitoba 1936," MMAR, 17 (Aug. 1937):
143.
(16)
M.R. Elliott and R.D. Defries,﹃The Manitoba
Department of Health and Public Welfare,﹄in R.D. Defries (ed.), Federal
and Provincial Health Services in Canada (Toronto: Canadian Public
Health Association, 1959), p. 95; Bator with Rhodes, Within Reach of
Everyone, p. 137-8.
(17)
Manitoba Department of Health and Public
Welfare, Report on the Poliomyelitis Epidemic in Manitoba, 1928
(Winnipeg: February 1929).
(18)
Paul, History of Poliomyelitis,
p. 190-99.
(19)
Jackson, "Infantile Paralysis...," DCH,
p. 2; F.W. Jackson, "The 1936 Epidemic of Poliomyelitis in Manitoba," Canadian
Public Health Journal (CPHJ), 28 (Aug. 1937): 364-6.
(20)
Jackson, "Infantile Paralysis...," DCH,
p. 4.
(21)
Jackson, "The 1936 Epidemic...," p. 364-6;
A.J. McIntyre, "Infantile Paralysis in Manitoba - 1936," Bulletin of
the Academy of Medicine, Toronto, 11 (Dec. 1937): 61.
(22)
Donovan, "Polio in Manitoba...," p. 144.
(23)
Jackson, "The 1936 Epidemic...," p. 363-4;
McIntyre, "Infantile Paralysis in Manitoba," p. 62.
(24)
Jackson, "Infantile Paralysis...," DCH,
p. 2-3.
(25)
James H. Gray, The Winter Years: The
Depression on the Prairies (Toronto: Macmillan, 1966), p. 111-3.
(26)
Ontario Department of Health (ODH), Report
on Poliomyelitis in Ontario, 1937 (Toronto, March 1938); Toronto Department
of Public Health, "Annual Statement, 1937," Volume of Statements, 1935-1940
(Toronto, 1941), p. 1, 16-27.
(27)
A.B. LeMesurier,﹃The Methods Used in
Handling the Epidemic of Poliomyelitis in Ontario in 1937,﹄Journal
of Bone and Joint Surgery, 21 (Oct. 1939): 867-78.
(28)
Reg Hopper,﹃History, Ontario Society
for Crippled Children,﹄unpublished manuscript, undated (c. 1967),
Ontario Society for Crippled Children (OSCC) Archives.
(29)
F.A. Logan, "Address of the President:
Report on Poliomyelitis", OSCC Meeting, 18 March 1938, p. 1, OSCC Archives.
(30)
A.I. McKay,﹃The Use of Convalescent
Serum in Ontario and Elsewhere,﹄The Horizon, (June 1937), National
Archives of Canada (NAC), RG29, Vol. 194, file 311-P11-3, pt. 1.
(31)
"75 Give Blood for Serum," London
Free Press, 27 August 1937; "Doctors Doubtful of Serum"s Effect," Toronto
Star, 27 August 1937.
(32)
"Near Panic... Parents Imagination is
Blamed for Influx of Tots to Hospital," Globe & Mail (Toronto),
18 August 1937; "Disease Data is Overdrawn Doctors Feel," Toronto Telegram,
2 September 1937; "Will Not Hide Epidemic Data Board Assures," Toronto
Telegram, 2 September 1937.
(33)
J.A. Faulkner to all Ontario physicians,
4 August 1937, NAC, RG29, Vol. 192, file 311-P11-1, pt. 1.
(34)
B.T. McGhie, "The 1937 Outbreak of Poliomyelitis,"
DCH, 15-16 October 1937, p. 13, NAC, Microfilm, Reel C9815.
(35)
Faulkner to all Ontario physicians, 4
August 1937.
(36)
"Poliomyelitis Epidemic," Meeting of
Board of Directors, OSCC, 28, September 1937, p. 2, OSCC Archives; ODH,
Report
on Poliomyelitis, 1937, p. 59-60.
(37)
Carleton McNaught, Canada Gets the
News (Toronto: Ryerson Press, 1940), p. 1-35; Paul Rutherford, The
Making of the Canadian Media (Toronto: McGraw-Hill Ryerson Ltd., 1979).
(38)
"Clamps Censorship on News of Paralysis
Cases," London Free Press, 11 August 1937;﹃Censorship on Illness
Lifted,﹄London Free Press, 12 August 1937.
(39)
"No Lid on Paralysis Says Health Deputy,"
Toronto
Star, 26 August 1937.
(40)
McGhie, "The 1937 Outbreak...," DCH,
p. 13.
(41)
ODH, Report on Poliomyelitis, 1937,
p. 59.
(42)
"Hoping Cooler Weather and Drastic Measures
Clears up Paralysis," Toronto Telegram, 25 August 1937;﹃Toronto
Schools Not To Open Until September 13,﹄Globe & Mail, 27 August
1937.
(43)
R.B. Jenkins,﹃Some Findings in the Epidemic
of Poliomyelitis in Alberta, 1927,﹄CPHJ, 20 (May 1929): 219-24;
"Epidemic in Toronto Held Not Paralysis," Globe & Mail, 25 August
1937; "Doctor Raps Stand Taken on Paralysis," Toronto Telegram,
30 August 1937.
(44)
Margaret L. Grimshaw,﹃Scientific Specialization
and the Poliovirus Controversy in the Years Before World War II,﹄Bulletin
of the History of Medicine, 69 (1995): 44-65.
(45)
J. Craigie,﹃The Second Blackader Lecture
on Some Aspects of Virus Infection,﹄CMAJ, 31 (Oct. 1934): 354;
Paul, History of Poliomyelitis, p. 71-78.
(46)
W.W. Waddell and C.W. Purcell,﹃Poliomyelitis
in Charlottesville, Virginia,﹄AJPH, 26 (Feb. 1936): 112.
(47)
"Hamilton M.O.H. Raps Closing Schools
Here," Toronto Star, 30 August 1937.
(48)
Lorraine ODonnell,﹃A Dread Disease:
The 1937 Polio Epidemic in Toronto,﹄unpublished MA paper, York University,
Toronto, 1989, p. 33-40.
(49)
"Infantile Paralysis Continues to Increase,"
Globe
& Mail, 25 August 1937.
(50)
Toronto Board of Health, 27 August 1937,
City of Toronto Archives, RG20, Series A, Box 2.
(51)
Canadian National Exhibition (CNE) Association,
Annual
Report, 1937 (Toronto, 1938), p. 12-8, CNE Archives.
(52)
"Do You Want to Kill Ex? I Dont Want
to Kill Tots!, Toronto Star, 28 August 1937.
(53)
"Ex to Honour Tickets for Children Daily,"
Toronto
Star, 28 August 1937; CNE, Annual Report, 1937, p. 12-3.
(54)
CNE, Annual Report, 1937, p. 12,
54-5; "C.N.E. Officers Undaunted In Spite of Financial Loss," Toronto
Telegram, 13 September 1937.
(55)
"Keeping Young From Centre of Paralysis,"
Toronto
Telegram, (30 Aug. 1937);﹃Children Flock to C.N.E. For Their Own Big
Day,﹄Toronto Star, (30 Aug. 1937);﹃Paralysis Scare Dams Usual
Great Crowd for Childrens Day,﹄Globe & Mail, (31 Aug. 1937).
(56)
"A Mothers Plea" and "Protect The Children,"
Toronto
Star, 30 August 1937; Editorials: "Parental Anxieties,"
Toronto
Star, 30 August 1937;﹃The War on Infantile,﹄Toronto Star,
10 September 1937.
(57)
G. Clark, "Mothers of the World..." Toronto
Star, 27 August 1937.
(58)
Toronto Star, 2 September 1937.
(59)
J. Craigie, "Some Problems of Poliomyelitis,"
CPHJ,
27 (Jan. 1936): p. 12.
(60)
P.K. Olitsky and H.R. Cox,﹃Temporary
Prevention by Chemical means of Intranasal Infection of Mice with Equine
Encephalomyelitis virus,﹄Science, 80 (14 Dec. 1934): 566-7.
(61)
C. Armstrong,﹃Prevention of Intranasally
Inoculated Poliomyelitis of Monkeys by Intranasal Instillation of Picric
Acid,﹄Public Health Reports, 51 (6 March 1936): 241-3; Editorial,
"Prevention of Experimental Poliomyelitis," AJPH, 26 (Apr. 1936):
421.
(62)
C. Armstrong,﹃Experience With the Picric
Acid-Alum Spray in the Prevention of Poliomyelitis in Alabama, 1936,﹄AJPH,,
27 (Feb. 1937): 103-4; F.F. Tisdall,﹃Nasal Spraying as a Preventive of
Poliomyelitis,﹄CPHJ, 28 (Sept. 1937): 432.
(63)
Armstrong,﹃Experience With the Picric
Acid-Alum Spray...,﹄p. 105.
(64)
C.R. Donovan, "Epidemic Poliomyelitis,"
MMAR,
16 (Sept. 1936): 190.
(65)
Jackson, "Infantile Paralysis...," DCH,
p. 3; Public Health Nursing Division, Manitoba Department of Health and
Public Welfare, Annual Report, 1936, Manitoba Provincial Archives,
G1237, 1936, p. 8.
(66)
DCH, 2-3 November 1936, p. 9, AO, RG10-05-06,
Box 2.
(67)
J. Knowelden, "Prophylactic Trials,"
in L.J. Witts (ed.), Medical Surveys and Clinical Trials (London:
Oxford University Press, 1964), p. 130-47; Harry F. Dowling,﹃The Emergence
of the Cooperative Clinical Trial,﹄Transactions and Studies of the
College of Physicians of Philadelphia,, 43 (1975-76): 20-9; Abraham
M. Lilienfeld, "Ceteris Paribus: The Evolution of the Clinical Trial,"
Bulletin
of the History of Medicine, 56 (1982): 1-18.
(68)
Lilienfeld, "Ceteris Paribus," p. 15-6.
(69)
N.E. McKinnon, H.A. Ross and R.D. Defries,
"Reduction in Diphtheria in 36,000 Toronto school children as a result
of an immunization campaign," CPHJ, 22 (May 1931): 217-23; J.G.
FitzGerald, "Diphtheria Prevention, Methods and Results," CPHJ,
(Feb. 1936): 53-60; J.G. FitzGerald, D.T. Fraser, N.E. McKinnon and M.
Ross, "Diphtheria - A Preventable Disease," The Lancet, (12 Feb.
1938): 391; Ronald Hare, The Birth of Penicillin and the Disarming of
Microbes (London: George Allen and Unwin Ltd., 1970), p. 199-205; Dolman,
"Landmarks and Pioneers in the Control of Diphtheria,;" Gryfe,﹃The Taming
of Diphtheria: Ontarios Role;﹄Lewis, "The Prevention of Diphtheria in
Canada and Britain, 1914-1945."
(70)
M.M. Peet, D.H. Echols and H.J. Richter,
"Chemical Prophylaxis for poliomyelitis: technique of applying zinc sulphate
intranasally," JAMA, 108 (26 June 1937): 2184; R.S. Pentecost,﹃Zinc
Sulphate as a Chemo-Prophylactic Agent in Epidemic Poliomyelitis: A New
Technique for the Application to the Olfactory Area,﹄CPHJ, 28 (Oct.
1937): 493-7.
(71)
"Balk Paralysis With Atomizers," London
Free Press, 20 August 1937; Time, 6 September 1937; Peet, Echols
and Richter, "Chemical Prophylaxis for poliomyelitis," p. 2184.
(72)
"Specialist in London Uses New Nose Spray
to Prevent Paralysis," London Free Press, 23 August 1937;﹃Fewer
Paralysis Cases Admitted,﹄London Free Press, 30 August 1937.
(73)
Editorial,﹃Zinc-Sulphate Nasal Spray
in the Prophylaxis of Poliomyelitis,﹄CPHJ, 28 (Nov. 1937): 564.
(74)
F.F. Tisdall, A. Brown, R.D. Defries,
M.A. Ross and A.H. Sellers,﹃Zinc Sulphate Nasal Spray in the Prophylaxis
of Poliomyelitis,﹄CPHJ, 28 (Nov. 1937): 531, 537.
(75)
E.W. Schultz and L.P. Gebhardt,﹃Zinc
Sulphate in Poliomyelitis,﹄JAMA, 108 (26 June 1937): 2184.
(76)
Tisdall, Brown, Defries, Ross and Sellers,
"Zinc Sulphate...," p. 528.
(77)
Editorial, "Zinc-Sulphate Nasal Spray..."
p. 565.
(78)
"5,000 Children In City To Get New Nasal
Spray," Toronto Star, 30 August 1937; P. de Kruif,﹃Holds Nasal
Nerve Tips Access For Paralysis Germ,﹄Toronto Star, 2 September
1937.
(79)
"Parents Flock To Seek Paralysis Safety,"
Toronto
Star, 31 August 1937; F. Griffen,﹃Mothers Shouldnt Worry If Children
Not Among 5,000,﹄Toronto Star, 3 September 1937.
(80)
Tisdall, Brown, Defries, Ross and Sellers,
"Zinc-Sulphate...," p. 528-31.
(81)
Tisdall, Brown, Defries, Ross and Sellers,
"Zinc-Sulphate...," p. 542;﹃Preston Doctors Say Spray Best Paralysis Check
Yet,﹄Toronto Star, 31 August 1937;﹃Fear Paralysis Epidemic Is
Spreading Northward, Nasal Sprayings Pushed,﹄Toronto Telegram,
2 September 1937; "Paralysis Nose Spray: Just Squirt and Smile," Toronto
Star, 2 September 1937.
(82)
"Spray Noses at Orangeville," Toronto
Telegram, 3 September 1937; "Workers Get Spray Against Paralysis,"
Toronto
Star, 2 September 1937;﹃No Clinic Will Be Opened at Brampton for Time
Being,﹄Toronto Telegram, 3 September 1937;﹃Seeks Nasal Spray Clinics
But York Council Demurs,﹄Toronto Star, 4 September 1937.
(83)
Tisdall, Brown, Defries, Ross and Sellers,
"Zinc-Sulphate...," p. 539-41.
(84)
F.F. Tisdall, Alan Brown and R.D. Defries,
"Persistent Anosmia Following Zinc Sulphate Nasal Spraying," Journal
of Pediatrics, 13 (July 1938): 60-2.
(85)
Bator with Rhodes, Within Reach of
Everyone, p. 51; Saul Benison, Tom Rivers: Reflections on a Life
in Medicine and Science (Cambridge, Mass.: MIT Press, 1967), p. 192.
(86)
"Nasal Spray Ineffective as Paralysis
Preventive Toronto Test Discloses," Globe & Mail, 1 December
1937.
(87)
On the 1935 vaccine trials, see Paul,
History
of Poliomyelitis, p. 252-62; Lawrence B. Berk,﹃Polio Vaccine Trials
of 1935,﹄Transactions and Studies of the College of Physicians of Philadelphia,
11 (1989): 321-37; M. Brodie and W.H. Park,﹃Active Immunization Against
Poliomyelitis,﹄AJPH, 26 (Feb. 1936): 119-25; J.A. Kolmer,﹃An Improved
Method of Preparing the Kolmer Poliomyelitis Vaccine,﹄AJPH, 26
(Feb. 1936): 149-57.
(88)
Paul, History of Poliomyelitis,
p. 248.
(89)
Paul, History of Poliomyelitis,
p. 279-90; P.H. Harmon,﹃The Use of Chemicals as Nasal Sprays in the Prophylaxis
of Poliomyelitis in Man,﹄JAMA, 109 (25 September 1937): 1061.
(90)
"Seven Tiny Heads in a Row Tell of Fight
With Disease," Toronto Telegram, 18 September 1937.
(91)
A. Armstrong,﹃War on Polio Speeds up
Iron Lung Production,﹄Saturday Night, (9 October 1937): 2; F. Edwards,
"Iron Lungs," Macleans, (15 January 1938): 12, 29-31; Max Braithwaite,
Sick
Kids: The Story of the Hospital for Sick Children in Toronto, (Toronto:
McClelland and Stewart, 1974): p. 94-103.
(92)
James H. Maxwell,﹃The Iron Lung: Halfway
Technology or Necessary Step?﹄Millbank Quarterly, 64 (1986): 7.
(93)
J.W. Bower, "Iron Lung and Its Uses,"
Address, Rotary Club of Toronto, 29 April 1938, Hospital for Sick Children
(HSC) Archives, file "Polio."
(94)
ODH, Report on Poliomyelitis, 1937,
p. 17.
(95)
"Buy Iron Lung To Help Victims Paralysis
Rises," Toronto Star, 25 August 1937.
(96)
Bower,﹃Iron Lung and Its Uses,﹄p.
2.
(97)
A. Gibb,﹃Mother Begs Wealthy To Buy
Iron Lungs After Own Son Saved,﹄Toronto Star, 28 August 1937;﹃Anonymous
Donor Buys 2 Lungs,﹄Toronto Star, 1 September 1937.
(98)
Bower,﹃Iron Lung and Its Uses,﹄p.
2-3; "Six New Paralysis Lungs Being Made in Province In Fight Against Disease,"
Toronto
Telegram, 2 September 1937.
(99)
Bower,﹃Iron Lung and Its Uses,﹄p.
3-4; Edwards, "Iron Lungs," p. 31; Armstrong, "War on Polio...," p. 37.
(100)
"Seven Tiny Heads in a Row...," Toronto
Telegram, 18 September 1937; G. Clark, "Massive Iron Lungs...," Toronto
Star, 4 October 1937.
(101)
"Viscount Nuffields Offer," Canadian
Hospital, (Jan. 1939); H. Agnew to R.E. Wodehouse, 7 February 1939,
NAC, RG29, Vol. 182, file 302-3-1;﹃Birthdays in Iron Lungs at Victoria
Hospital,﹄London Free Press, 10 August 1939;﹃Famous Polio Victim
Marries...,﹄London Free Press, 10 August 1939.
(102)
ODH, Report on Poliomyelitis, 1937,
p. 46-7.
(103)
Jenkins,﹃Findings in the Epidemic of
Poliomyelitis in Alberta, 1927;﹄Rutty, "Do Something!... Do Anything!"
p. 82-84.
(104)
Jackson, "The 1936 Epidemic..." p. 367;
McIntyre, "Infantile Paralysis...," p. 63.
(105)
A.A. Murray,﹃The Prevention and Treatment
of Deformities Arising in the Course of Infantile Paralysis,﹄MMAR,
17 (Sept. 1937): 159.
(106)
Jackson, "The 1936 Epidemic..." p. 367-8.
(107)
McGhie, "The 1937 Outbreak...," DCH,
p. 13; "Symposium on Poliomyelitis," CPHJ, 28 (Sept. 1937): 417-41.
(108)
R. Hopper to all Chairmen of Crippled
Children Committees, 18 September 1937; AO, RG10-106, file 279.16.
(109)
Hopper, "History, OSCC," p. 1-4, 11.
(110)
"The Surgical Treatment of Poliomyelitis
During its Early Stages," CPHJ, 28 (Sept. 1937): 441; Logan,﹃Report
on Poliomyelitis,﹄OSCC, 18 March 1938.
(111)
F.H.H. Mewburn,﹃Institutional Care in
the Treatment of Poliomyelitis,﹄CMAJ, 36 (Mar. 1937): 263-7; G.A.
Ramsay and R.A. Johnson,﹃Muscle Conservation and Re-education in Post-Poliomyelitis
Paralysis,﹄CPHJ, 29 (Apr. 1938): 158-65; A.B. LeMesurier,﹃The
Treatment of Muscle Paralysis in Poliomyelitis,﹄University of Toronto
Medical Journal, 18 (Feb. 1941): 163-8.
(112)
"The Surgical Treatment of Poliomyelitis...,"
p. 436-7.
(113)
Ontario Department of Health, Poliomyelitis:
Epidemiology, Diagnosis, Treatment, (Toronto, July 1938), p. 6-14.
(114)
Ontario Minister of Health to all Ontario
Physicians, 20 September 1937, NAC, RG29, Vol. 192, file 311-P11-1, pt.
1; ODH, Report on Poliomyelitis, 1937, p. 60.
(115)
McGhie, "The 1937 Outbreak...," DCH,
p. 14.
(116)
"Splints and Frames," The Horizon,
(Oct. 1937): 10, HSC Archives, file "Polio;" Ramsay and Johnson,﹃Muscle
Conservation...,﹄p. 160.
(117)
"Poliomyelitis Bulletin," The Horizon,
(Christmas 1937): 7, AO, RG10-106, file 279.16.
(118)
Victor Cohn, Sister Kenny: The Woman
Who Challenged the Doctors (Minneapolis: University of Minnesota Press,
1975), p. 150; F.R. Ober,﹃Treatment and Rehabilitation of the Poliomyelitis
Patient,﹄in National Foundation for Infantile Paralysis, Infantile
Paralysis: A Symposium Delivered At Vanderbilt University, April, 1941
(New York City, NFIP, 1941), p. 161-89; LeMesurier, "The Methods..."
(119)
Minister to all Physicians, 20 September
1937.
(120)
McGhie, "The 1937 Outbreak...," DCH,
p. 14.
(121)
"Poliomyelitis After-care in Ontario,"
CPHJ,
28 (Nov. 1937): 570-1; J. Henry, "A New Orthopaedic Hospital,"
The Horizon,
(Oct. 1937): 6, 17.
(122)
"Mothers Train to Nurse Their Children,"
Toronto
Telegram, 20 October 1937; Henry, "A New Orthopaedic Hospital," p.
17; Logan, "Report on Poliomyelitis," OSCC, 18 March 1938.
(123)
G. Clark,﹃Georgie Porgie, Pudding and
Pie,﹄The Horizon, (Christmas 1937): 6; Ramsay and Johnson,﹃Muscle
Conservation...,﹄p. 161-5.
(124)
M. Gould, "Its a Battle for Mothers,"
The
Horizon, (Christmas 1937): 13.
(125)
D. Scholfield (1937, age 18, Smith Falls,
Ont.), L. Scrivener,﹃The Plague of 37,﹄Toronto Star, 6 September
1987; Cora W. (1940, age 10, New Liskeard, Ont.).
(126)
In response to this questionnaire, distributed
through a national network of provincial post-polio support groups across
Canada, in addition other published sources, 96 individual cases were assembled.
This unscientific sample consisted of 61 women and 35 men who contracted
polio between 1905 and 1961 at ages ranging from 6 months to 50 years,
specifically: ages 0-4 (20 cases), 5-10 (32), 11-15 (5), 16-20 (8), 21-25
(12), 26-30 (8), 31-35 (7), 36-40 (2), 40-50 (2). The following periods
are represented: 1905-1926 (8 cases), 1927-1930 (9 cases), 1937-1938 (9
cases), 1939-1946 (13 cases), 1947-1953 (47 cases), 1954-1961 (10 cases).
The provincial breakdown of cases is: British Columbia (8), Alberta (5),
Saskatchewan (5), Manitoba (15), Ontario (49), Quebec (3), New Brunswick
(10) and Nova Scotia (1). For reasons of confidentiality, in referring
to these questionnaires last names have been reduced to an initial. Included
in the reference are the year, age and place of onset, followed by the
date the completed questionnaire was received, or other reference. Thanks
to Shirley Teolis, former Post-Polio Coordinator, Ontario March of Dimes,
Toronto, for her valuable help in designing and distributing this questionnaire.
(127)
Mary B. (1937, age 19, Grimsby, Ont.).
(128)
Cora W. (1940, age 10, New Liskeard,
Ont.).
(129)
Marlene C. (1953, age 5, Toronto, Ont.).
(130)
Scrivener, "The Plague of 37."
(131)
H. Noble (1937, age 14, Toronto, Ont.),
"The Plague of 37."
(132)
E.C. Janes, "Prevention of Needless Deformity;"
The
Horizon, (June 1937);﹃Peacock Opposed to Splints for Poliomyelitis
Patients,﹄Toronto Star, 21 September 1937.
(133)
Cohn, Sister Kenny; Rutty,﹃Do Something!...
Do Anything!﹄p. 143-61.
(134)
Joy M. (1937, age 10, Toronto, Ont.);
Scrivener,﹃Plague of 37;﹄Warren M. (1939, age 5, Toronto, Ont.).
(135)
Robert A.J. M. (1939, age 2, Windsor,
Ont.).
(136)
Patricia M.C. T. (1938, age 8, Restigouche
County, NB).
(137)
Joy M. (1937, age 10, Toronto, Ont.).
(138)
Mary C. (1937, age 19, Grimsby, Ont.).
(139)
F. Chamberlain,﹃A Voluntary Agency Steps
in,﹄The Horizon, (Oct. 1937): 7.
(140)
"Report of the Extension Committee...,"
OSCC, 28 September 1937, p. 2-4; "Epidemic Leaves 900 Still Suffering,"
Toronto
Telegram, 17 December 1937; "Ontario Prepares to Meet Crisis,"
Montreal
Star, 7 May 1938.
(141)
"Womens Institutes and Service Clubs
Answer Plea," The Horizon, (Christmas 1937): 12, 18; Hopper and
F.A. Logan to all OSCC members, 21 December 1937, AO, RG10-106, file 279.16;
ODH, Report on Poliomyelitis, 1937, p. 61.
(142)
McGhie, "The 1937 Outbreak...," DCH,
p. 14-5.
(143)
"Planning for 1937 Polio Epidemic - Ontario,"
May 1938, p. 3, NAC, RG29, Vol. 195, file 311-P11-3, pt. 2.
(144)
"Report of Nursing Supervisor," Meeting
OSCC, 18 March 1938, p. 3, OSCC Archives.
(145)
B.T. McGhie to J.T. Phair, 18 December
1937, AO, RG10-106, file 279.16.
(146)
D.E. Robertson to McGhie, 10 January
1938; McGhie to Robertson, 25 January 1938, AO, RG10-106, file 279.16.
(147)
Phair to Hopper, 28 January 1938, AO,
RG10-106, file 279.16.
(148)
"For Distinguished Service," The Horizon,
(Christmas 1937): 7; J.W. Bower to M.F. Hepburn, 19 November 1937, AO,
RG3, Box 207, file "Health Department, Hepburn General Correspondence,
Public, 1937."
(149)
J.J. Heagerty to Phair, 18 October 1937,
AO, RG10-106, file 119.7.
(150)
A.H. Sellers,﹃The Contribution of the
Ontario Cancer Clinics to the Control of Cancer,﹄CPHJ, 31 (Feb.
1940): 72-3.
(151)
H.J. Kirby, "How far does the responsibility
of the Provincial Department of Health go in the Treatment of Disease?"
DCH, 6-7 December 1938, AO, RG10-106, file 119.8.
(152)
Kirby, "How far...?"
(153)
Paul Martin, A Very Public Life: Volume
I, Far From Home (Toronto: Deneau Publishers, 1983), p. 459-60.
(154)
On the Canadian Salk and Sabin polio
vaccine experience see Rutty, "Do Something!... Do Anything!...," p, 309-380.
For a short summary of the Canadian Salk vaccine story see Christopher
J. Rutty,﹃40 Years of Polio Prevention!: Canada and the Great Salk Vaccine
Trial of 1954-55,﹄Abilities, #19 (Summer 1994), 26, 28.
PAGE INDEX:
Top | ABSTRACT
| POLIO IN THE CANADIAN CONTEXT | Second
Wave Epidemics & the Provincial Public Health Response | PREVENTION
& TREATMENT METHODS IN CANADA:﹃Paralysis Nose Spray: Just Squirt &
Smile﹄| "Miraculous Metal Monsters"
| Standardized Treatment, Hospitalization & Aftercare
| CONCLUSIONS | ENDNOTES
Figure 1 | Figure 2
| Figure 3 |
Table 1 | Table 2 | Table
3 |
April 18, 2000