Early Days

In the early ninetieth century cases of a disease which may have been polio were recorded in Europe and the United States of America. Some decades later reports of poliomyelitis or infantile paralysis began to appear in Australian medical journals, personal documents, hospital records and death registers. In Victoria in 1885 Dr JW Springthorpe described polio in a young man, commenting that the disease had been recognised in the previous 30 years but as yet the cause was not understood. After the patient’s acute illness had subsided, he had been left with some muscle weakness and wasting which was improving with massage and electrotherapy. At the same time another practitioner Dr Jameson remarked that he had seen 3 cases of polio in the previous few years.

Isolated cases were also occurring in Western Australia. The register of deaths in the York district in 1879 reveals that a 2 year old boy had died of the disease. In 1895 Alfred Adams was admitted to Perth’s largest hospital with a diagnosis of poliomyelitis. In its first 15 months of operation since the opening of the Children’s Hospital in 1909, the honorary masseuse treated 13 children with residual paralysis after poliomyelitis.

The Management of Infectious Diseases - The Health Act 1911

Poliomyelitis remains one of the many infectious diseases confronting populations around the world. The field of Public Health is concerned with maintaining the sound health of the population and the aim of its measures is to reduce the incidence of disease, premature death and disability. It has been described as the organised response of a society to protect and promote health and to prevent illness, injury and disability.

 As the British established their colonies in Australia and population density increased, the incidence of infectious diseases such as measles, smallpox and influenza began to rise. State governments recognised the need to have public health regulations enshrined in the legislation. 

In line with other Australian states, the first Western Australian Public Health Act was established in 1886, making provision for a 5 member Central Board of Health to administer the legislation. Local Boards were set up in several municipalities. Local doctors were appointed as Health Officers and reported health issues to the Central Board. Local Boards were able to implement measures to control the spread of infectious diseases such as smallpox and cholera.

A second Health Act with greater powers was proclaimed in 1911. The Central Board was replaced by a Department of Public Health, with the department head, the Commissioner of Public Health, answerable to the health Minister. The new Act also provided a legal framework for action to be taken by the Minister, the Commissioner or his delegates, should a serious outbreak of an infectious disease occur in the community. Twenty-five conditions were listed as notifiable and included leprosy and tuberculosis but in 1911 polio was not included. When a listed disease was diagnosed the doctor was required to notify the local authorities and the Commissioner. However notification was a contentious issue and doctors needed an incentive of a fee of 2 shillings per report and risked a fine of £10 for non- compliance. In WA polio was listed as a notifiable disease in 1912, resulting in case numbers being recorded each year since that time.  Key management objectives of the Act were to prevent the spread of all infectious diseases in the community by implementing whatever measures the Commissioner deemed necessary and to ensure all those who contracted the condition had adequate care and treatment.

Before the Epidemics

Between 1913 and 1937, in contrast to escalating numbers of cases in Tasmania and Victoria, fewer than 20 cases of polio a year were recorded in WA. But despite the low prevalence, the Commissioner for Public Health Dr Everitt Atkinson regarded an epidemic in Western Australia as inevitable. As he was empowered to do under the Health Act, in 1916 he put in place a detailed plan to manage any situation which may arise and restrict the spread of the diseaseThe plan reflected the limited knowledge of polio and the method of transmission between individuals almost a century ago. Milk was regarded as a possible agent of transmission and sales from infected premises were forbidden. Mucus, saliva, urine and faeces were also suspected while biting insects had been pretty much ruled out.

In comparison to the way outbreaks would be managed in the future, Atkinson’s proposed restrictions can only be described as harsh. Patients would be quarantined for 6 weeks and the isolation period would be followed by another two weeks of exclusion from school and public gatherings. If the patient was being nursed at home, the entire household would be quarantined with groceries and milk delivered to the front door.   Contacts would be required to restrict their social activities and gargle with a weak solution of permanganate of potash or hydrogen peroxide. The Health Department recommended crockery and cutlery be disinfected and toys, books and games burnt. Carpets, rugs and bedding from infected premises could not be taken outdoors for beating or sunning without special permission from the local authorities. 

Sporadic cases of polio continued to occur in metropolitan areas and country towns. They included Victoria Park, Claremont, Fremantle, Cunderdin and Bruce Rock. It seems no deaths were recorded and it’s unclear to what extent any restrictions were imposed or how patients and their families were affected. 

Early Treatment - Aftercare

Aftercare or rehabilitation can be described as training for the recovery of function. The aim is to restore muscle function and prevent the development of deformities. Such programs for the physically disabled began in the nineteenth century when massage and electrotherapy were used to promote healing.  The practice of electrotherapy gradually declined but massage became the forerunner of modern day physiotherapy.

Once the polio infection had run its course, usually in about 3 weeks, the residual damage was assessed and a rehabilitation program planned and managed, usually by an orthopaedic surgeon. Where neurons had only been partially damaged and muscle cells were still receiving stimulation, some degree of function could be restored. In time some patients could make a full recovery. But if the neurons were completely destroyed the patient was left with permanent paralysis. Surgery was occasionally offered but not until all more conservative treatments had been exhausted. Rehabilitation was provided in the major public hospitals in Perth and Fremantle, the Children’s Hospital and Lady Lawley Cottage-by-the-Sea, polio patients sharing the wards with others with a diverse range of conditions.  With little demand for aftercare, there was no need for the authorities to consider providing special facilities for polio patients.

The early aftercare treatment of polio patients was heavily influenced by the work of Victorian specialists Mr Colin MacKenzie (1871-1938) and Dr Jean Macnamara (1899- 1968). Both practitioners advocated the immobilisation of the affected area by splinting, long periods of rest and muscle re-education – a program of graduated exercises carried out by a masseuse with the aim of restoring strength in the affected muscles and reducing the risk of deformity. 

The Children’s Hospital opened in 1909 and in its first 15 months of operating the Honorary Masseuse Catherine MacCaulay treated 13 polio patients with massage and passive movements of the limbs. In 1923 Perth’s only orthopaedic surgeon Mr Alexander Juett, was appointed director of the newly formed specialist orthopaedic department. Juett subscribed to the ideas of MacKenzie and Macnamara and introduced the treatment of polio patients with bedrest, splinting and muscle re-education, in some cases supplemented with massage.

Elizabeth Kenny - More Emphasis on Movement

In the 1930s most Australian doctors were treating polio patients using the standard treatment of bedrest, splinting, massage and
muscle re- education but in Queensland Sister Elizabeth Kenny was treating polio patients in a way some saw as unorthodox. 
Kenny regarded a muscle re-education program as beneficial but considered prolonged bed rest, immobilisation and splinting as
detrimental to the recovery of function and having no place in a treatment program. She advocated gentle movement which
should be initiated as soon as possible after the onset of the disease, preventing the stiffness and muscle wasting associated with
disuse and reducing the risk of spasms. Furthermore, she believed frequent movement reduced the risk of deformity.

Elizabeth Kenny had had no formal training but during the Great War she had served in the Australian Army and her practical
experience resulted in her promotion to the rank of Sister. Anyone who met her could not fail to be impressed by her stature, the
size of hats and her strong belief that her treatment methods were superior. The first Kenny Clinic opened in Townsville in 1934 and
subsequently in Brisbane, Sydney, Toowoomba, Cairns and Hobart. Kenny hoped that her treatment methods would be endorsed
across Australia and beyond.

Kenny’s clinics reflected the optimism and conviction that drove her and seem to have been rather refined establishments. The care and comfort of the patient was of top priority. She wrote:

Nothing that jars the senses should be allowed to intrude.  The eye must be soothed
by a good colour scheme . . .  the colour blue predominates and glare is avoided. The
ears must not have to contend with harsh or discordant sounds. Food that is distasteful 
must not be served.

All treatments were carried out by a doctor or Kenny’s trained assistants. Her staff were expected to conduct themselves according to strict behavioural guidelines.

  . . . all suggestions of helplessness must be vigorously combatted . . . No display of impatience or bad temper can be tolerated

Local orthopaedic surgeon Mr Reg McKellar Hall was impressed with Kenny’s approach and campaigned for a clinic in Perth but many members of the medical profession were sceptical. Some were appalled at the thought of abandoning the splints. The Commissioner of Public Health Dr Everitt Atkinson was amongst the detractors and saw no value in establishing a Kenny Clinic in Western Australia. 

Mon Hughes had been treated at the Children’s Hospital in 1929. In 1937 she was invited to meet Kenny who was in Fremantle en route to London to attend a conference. Mon recalled her opinion:

 . . . immediately the sickness passes . . .start up and into it so your limbs haven’t got used to not doing anything . . . the trouble with me [was that] I was kept in bed in plaster for months

In 1940, worn down by the ongoing scrutiny and criticism in Australia, Kenny moved to the United States of America. However, her legacy continued with a number of orthopaedic surgeons adopting her techniques. Mr Bill Gilmour who had arrived in Perth in 1952 held Kenny’s work in high regard. He and Reg McKellar Hall treated their patients along the lines of Kenny’s recommendations, Gilmour noting:

What we did was to keep people’s joints mobile . . .get them walking, get them functioning
And we were sure we were not increasing their paralysis. . . we were certainly improving their 
overall functioning by doing exactly what Sister Kenny was saying to do.

The Outbreak of 1937/38  

Management

In 1937 an epidemic of poliomyelitis which had begun in Victoria and spread to other eastern states became the worst Australia had experienced thus far. Aware that the cause of the disease remained a mystery and of the possibility of it spreading to WA, the health authorities made two decisions that proved both timely and wise.

Following the lead of Victoria, NSW and SA, the WA Minister for Health the Honourable Selby Munsie appointed a Consultative Committee which included the Commissioner of Public Health Dr Everitt Atkinson and eight fellow medical practitioners. The Committee was the first of similar advisory committees which continued to operate for the next twenty years, in fact up until the epidemics were over. The group advised on all aspects of poliomyelitis and shared the responsibility of enforcing any directives from the Department of Public Health. In years to come it became known as the Advisory Committee.

Poliomyelitis was a notifiable disease but its status was now upgraded to that of a Dangerous Infectious Disease. Under the terms of the Health Act 1911 the Commissioner had wide ranging powers and could prevent anyone entering or leaving the state if they were at risk if infecting other individuals. Atkinson also imposed what some regarded as an extreme measure- a General Order. Under its terms any child arriving in WA from Victoria was to be identified, located, monitored and isolated for 3 weeks from the date of departure from that state.

The Order generated a mountain of correspondence between individuals and the Commissioner. Some simply sought advice while others felt that the restrictions were inadequate and would not prevent the spread of the disease. One enquiry came from the proprietor of the Hotel Rockingham who was seeking advice as to whether he should accommodate a Victorian family who wanted to spend their summer school holidays at the seaside resort. The Commissioner responded that the 2 children would need to be isolated from any other children and excluded from the dining room and therefore it seemed unwise for the proprietor to accept the booking. Residents of the town of Noggerup expressed their concern that a Victorian family was about to move into a house near the school. If the children were potential carriers, perhaps they should be removed from their parents and quarantined in a state facility. The Commissioner responded that the quarantine of potential carriers had not been imposed anywhere in the world and while he understood the concern such extreme measures were impractical.

Atkinson remained concerned at the possibility of the eastern state’s epidemic spreading to WA and just before Christmas 1937 issued a second General Order, extending the isolation regulations to include children from all Australian states and New Zealand. This Order proved equally as controversial as the first.

Non Compliance

 In order to reinforce the idea that no one was exempt from the regulations, cases of non compliance were listed in the magistrate’s court and the details published in the local newspapers. Oliver Richards had arrived from South Australia with his young son Harry and taken the boy with him to the railway yards where he worked. Mr Richards was fined £5 and almost as much in costs. Irvine Murray and his family was newly arrived from Sydney and had allowed his wife to take their young child for a stroll around Fremantle. The magistrate held Mr Murray responsible and fined him £15 plus costs.

Possible Causes

As unaware as the health authorities on the likely causes of the disease, concerned members of the community also wrote to Dr Atkinson with their views on the origins of the outbreak. They ranged from the risks of children running around bare footed to a lack of Vitamin B in the diet. A resident of South Africa suggested that children who drank boiled milk were immune from the disease. To Atkinson’s exasperation the writer also suggested confirmation of his theory should attract an in kind fee of an assisted passage to Australia for him and his family of six. A response from the Commissioner was not forthcoming.

The First Iron Lung Patient - Elsa Okely

The second timely decision taken by the Consultative Committee was a request for the urgent delivery of
respirators, lifesaving equipment for patients with respiratory paralysis. An alarming number of such cases
had been recorded in the Victoria and WA was unprepared.

The machine known as an iron lung had revolutionised the treatment of respiratory paralysis, the main
cause of death in polio patients. The Victorian firm H Beecham and Company had begun to manufacture
electrically powered respirators based on an American design. The equipment consisted of an airtight
rectangular wooden tank with a removable plate at one end.  In December 1937 two machines were
delivered to the Infectious Diseases Hospital.

Patients remained in the iron lung continuously until their respiratory muscles had recovered sufficiently and
they could breathe independently. The person lay on a rubber mattress with the body completely enclosed
in the tank and their head protruding through the removable plate at one end. A sponge rubber collar ensured a seal around the neck. Breathing was simulated by creating negative pressure inside the tank which resulted in air being drawn into the lungs. As the pressure in the tank was restored, the patient’s chest and lungs returned to the resting position and the flow of air was reversed. The changes in pressure resulted in the patient’s chest being alternately squeezed and released so that air moved in and out, imitating normal breathing.

When her ability to breathe deteriorated rapidly on Christmas Eve, fourteen year old Elsa Okely was rushed to the Infectious Diseases Hospital (IDB) and became the first West Australian patient to benefit from treatment in an iron lung.

IDB consisted of a collection of poorly maintained buildings connected by timber walkways and with views of the sewerage works, an abandoned tennis court and the charred remains of a building which had been destroyed by fire. Faced with the urgent need to accommodate polio patients, the somewhat derelict Ward 8 had been made habitable. But never had the Hospital Board envisaged it would be required to house vital equipment requiring a continuous power supply. Elsa’s iron lung depended on power from the main city grid and shared an electrical circuit with a refrigerator.

Weeks after her admission a power failure caused Elsa’s respirator to fail. Responding rapidly to the emergency, the nursing staff administered manual artificial respiration while the hospital engineer searched frantically for the cause. An hour later the fault was traced to a blown fuse in the fridge. With the power restored Elsa was returned to the respirator. The Medical Superintendent Dr Muecke announced that the patient had survived the ordeal splendidly but the incident had highlighted to need for emergency backup. The Commissioner ordered a hand pump from Victoria and the power supply was reorganised to ensure the iron lung had a circuit of its own.

Once Elsa would breathe independently she was transferred to the Perth Hospital where she spent 7 months in rehabilitation receiving massage and muscle re- education. On her discharge her legs remained paralysed and she had little movement in her arms. She acquired a 3 wheeled carriage which enabled her mother to take her to her outpatient appointments.

The carriage also enabled Elsa to attend social occasions. She joined a Girl Guide troop and on the day of her induction, her fellow guides pushed Elsa in her carriage up the steeply sloping Malcolm St to the ceremony in King’s Park. Friends of the Okely family organised a number of benefit concerts to raise money to support the family, in which there were 3 other children. Ironically attending one of these concerts may have contributed to Elsa’s premature death. After attending a concert in November 1939 she developed pneumonia and died, aged 16.

Between 18th December 1937 and mid May 1938 48 cases of polio and one death were recorded in Western Australia. In comparison in 1938 nearly 1000 cases of diphtheria occurred, resulting in 41 deaths. As the cases of polio were scattered around the south of the state and the authorities were unable to demonstrate any connection between them, the outbreak was not classed as an epidemic.

A Philanthropic Solution

The inevitability of an increase in the number of respiratory cases weighed heavily on the minds of health authorities across the country. Furthermore, in a land as vast as Australia, respiratory paralysis patients may need to be treated outside metropolitan areas. During the 1937 epidemic in South Australia the prolific inventor Edward Both was asked to produce a simple and inexpensive alternative to the currently available machines. He produced the Both cabinet respirator and his new invention was distributed around the world. In 1938 the British philanthropist Lord Nuffield was so impressed with the Both machine he’d seen at the Radcliffe Infirmary that he offered to provide one for any hospital in the British Empire.

The Australian government was quick to accept Nuffield’s offer and in 1939 announced that Western Australia would receive 12 of the 198 iron lungs which would be installed in metropolitan and rural hospitals across the country. Kalgoorlie already had a machine so the new ones would go to the Children’s Hospital and 11 district hospitals between Broome and Albany.

By mid-1941 the majority of hospitals had reported that their respirators had been installed and were in good working order. Broome and Northam were the exceptions. In Broome the rubber bellows had perished in the tropical heat. The matron had requested a replacement be delivered urgently but the part was too large to fit through the loading door of the plane. The patient who was in profound distress from food poisoning died. The Northam Hospital authorities claimed to have no available space for their machine and it remained in its box on the back veranda.

In the next 15 years the network of respirators around WA would prove life saving for several polio patients. The 1956 epidemic brought an unprecedented number of respiratory cases and several patients owed their lives to the Australian government’s foresight and Lord Nuffield’s generosity.

The 1948 Epidemic

By the end of May in 1948, 40 cases of polio had been reported across WA. Furthermore, the health authorities realised that the pattern of spread was quite unlike anything they’d seen previously and a newly infected person had frequently been in touch with an established case. The State was now facing its first epidemic.

An Advisory Committee was reconstituted and the health authorities called for advice on how best to manage the situation. Dr Thomas Stubbs, a Queensland orthopaedic surgeon and advocate of Sister Elizabeth Kenny’s treatment regime was invited to speak to other doctors about diagnosis, treatment and aftercare. Doctors requested advice from an eminent Victorian authority Dr Jean Macnamara DBE and she in turn co-opted her colleague Dr Elizabeth McComas.

Dr Macnamara’s report covered the epidemiology of the disease, preventative measures and the care of the patient during the acute illness. The most comprehensive section was devoted to her recommendations for the urgent provision of aftercare services and facilities. She claimed that no patient was more deserving of aftercare than those paralysed by poliomyelitis. In a stinging indictment of patient treatment in Perth, she claimed she’d observed potential cripples being turned in to finished cripples because of a lack of appropriate aftercare.

By September over 200 cases had been notified and the most urgent task was to establish aftercare facilities to ensure the best possible outcome for survivors. Local orthopaedic surgeon Mr Alec Dawkins was appointed Director of Aftercare. IDB’s transition from an infectious disease hospital to a rehabilitation facility began with the renovation of Ward 7 for women and Ward 8 for men. Because of their location in the Shenton Park bushland the 2 small weatherboard buildings at the end of a covered timber ramp were known as Scrub. Children continued to be treated at the Children’s Hospital or Lady Lawley Cottage in Cottesloe while adult outpatients attended (now Royal) Perth Hospital. Additional physiotherapists, an occupational therapist and a splint maker were appointed.

The aim of the main aftercare treatment known as muscle re-education was to return affected muscles to their previous strength, maintain flexibility and reduce the risk of deformity. The individualised program for each patient was devised by a doctor in conjunction with a physiotherapist and implemented by the latter on a daily basis.  Therapists now required their patients to actively participate and work their muscles during treatment sessions, rather than lying passively on a table receiving massage. The affected muscles and joints were identified and recorded on a muscle chart. The strength of each muscle or group of muscles was assessed and its capacity to function rated on a scale from 0 to 6. A score of 0 meant the muscle was incapable of any contraction, 1 was a flicker and 6 indicated normal strength. Once a baseline had been established a set of exercises was designed with the aims of the program in mind.

The 1948 epidemic was regarded as moderately severe with 90% of cases resulting in some degree of paralysis. 66% recovered or were left with a minor disability with children under the age of 9 accounting for about half the cases.

Aftercare of Children - The Golden Age

As the epidemic escalated it became clear that the Children’s Hospital no longer had the capacity to accommodate and treat an increasing number of children needing inpatient aftercare. 

The two storey Golden Age Hotel in Leederville had been delicensed in 1929 and since then had accommodated a kindergarten and an infant health centre. A purchase price was negotiated between the owner, the Swan Brewery, the hospital and the state government. The Public Works Department undertook a refurbishment and the Golden Age, officially Ward 9 of the Children’s Hospital, opened in November 1949 with 15 inpatients and 7 more attending as outpatients during the week.

The nursing staff were accommodated in the upper storey and the three wards, the kitchen, treatment rooms, bathrooms and an office were located on the ground level. In 1951 Sister Ivy Bryan was appointed Sister in Charge. A full time teacher Mrs Barbara Rumney was responsible for teaching all the children which could range in age from Infants to Standard 6. The physiotherapists and occupational therapists divided their time between the main hospital and the Golden Age. A full time cook Mrs Lawrence provided the meals for staff and patients.

A significant number of children spent many months as inpatients at the Golden Age. While physiotherapy and
occupational therapy were the first priorities with education a close second, the staff did their best to create a
home away from home for their young charges. Adopting the ideas of Elizabeth Kenny and others in the caring
professions, the focus was on maintaining a positive atmosphere. The walls in the wards were decorated with
murals and a large fish tank installed. Teacher Barbara Rumney wore bright floral prints to help develop a cheerful
environment. Donations enabled a merry go round and a swing to be purchased for the garden.

 The nursing staff looked to the Sister in Charge as their role model and Ivy Bryan’s warmth and kindly nature proved ideal.  Many of the nurses willingly hugged a distressed child and aware of the concerns of older patients, considerately set aside larger sized pyjamas for them.  On Saturday nights some children were invited to join the nurses and toast bread on the fire in the office. Nurse Dyer handwrote letters for Wesley Jones whose writing arm was paralysed. Wesley had been transferred from IDB to the Golden Age and Health Department regulations stipulated that reading material could not be taken from the facility. Wesley wanted his mother to send him comics and pocket money.

Outings, special visitors and birthday celebrations were also organised for the children.  During the warmer months the older children were taken to Mettam’s Pool. The Leederville Salvationists conducted Sunday School and the Anglican deaconess Sister Dorothy Genders visited regularly, bringing a generous supply of sweets. In 1956, in the hope of inspiring children with profound physical disabilities, Group Captain Douglas Bader DSO DFC CBE, a former pilot who had recovered after losing both legs in an aerobatics accident, was invited to visit the hospital.  The cook Mrs Lawrence baked a special birthday cake for a disappointed patient whose parents were unable to visit. All the patients were invited to celebrate Ricky Scheeren’s birthday and his parents brought in balloons, party hats, soft     drinks and sweet treats. Country and western singer Tex Croft entertained the children at the Christmas party.

In 1953, in recognition of the psychological needs of children, the newly appointed Medical Superintendent. Dr Robert Godfrey introduced measures that were aimed at minimizing the trauma children suffered when separated from their parents. Godfrey dispensed with the highly restricted visiting hours and introduced daily visiting for 2 ½ hours, the most liberal of any hospital in Australia. The sceptics stood ready to criticise, maintaining that visitors interfered with the routine in the ward, but the new policy was deemed to be so successful in terms of patient happiness and wellbeing that in 1956 formal visiting hours were abandoned altogether and parents could be with their children any time of the day or night.

The Golden Age became redundant after the epidemics ended and closed in 1958. The building was demolished and the land was resumed to make way for the Mitchell Freeway.

The 1954 Epidemic

In the early 1950s the quest for the ultimate control of the polio virus was underway. Investigators had made progress with identifying how the disease was spread and now recognised that faecal contamination of food and hands contributed significantly – in fact it was now regarded as a faecal disease.  As poliovirus is a parasite which is unable to survive outside the human host for a long period of time, it could be eradicated by vaccinating all susceptible individuals. In 1949 researchers at the Harvard School of Public Health in America were successful in culturing poliovirus in artificial conditions in the laboratory. This significant breakthrough enabled Dr Jonas Salk of the University of Pittsburgh to develop the first vaccine but its efficacy was yet to be established. But before an effective vaccine could be distributed, Western Australia would experience 2 more epidemics.

In 1954 20 cases of polio were notified in the first 10 days of February and the Advisory Committee advised the Health Minister that a second epidemic had commenced. Realising that some in the community did not understand the meaning of faecal contamination, the Commissioner issued an explanatory press statement in plain English, adding that thorough hand washing after going to the toilet was essential. An intensive fly eradication campaign was initiated, swimming lessons were cancelled and social gatherings discouraged. Furthermore, a visit by the newly crowned Queen Elizabeth ll and her husband the Duke of Edinburgh was scheduled for the end of March.

The Royal Visit

The Royal tour went ahead without any dire consequences.  The Queen and the Duke were given gamma globulin injections to boost their immunity and their planned stay at Government House was cancelled. The couple slept on board the royal yacht Gothic which was berthed at Fremantle and had most of their meals on the ship. Food for a dinner at Government House was prepared in the ship’s kitchen. 

 Children were regarded as more likely to be responsible for spreading the disease, prompting a gathering of 30,000 children at the Showgrounds to be cancelled. However smaller gatherings were permitted in six country towns including Kalgoorlie, Boulder and Albany with the proviso that children remained in their school groups.    In Perth children were permitted to stand along a designated route with their class mates to see the royal couple pass by in an open car. Rosa McGillivray remembers assembling with fellow patients outside the Children’s Hospital. Hand shaking was not permitted and gifts and bouquets presented to the Queen were deposited on a nearby table. However the highlight of the Royal Visit, a formal ball on the lawn outside Winthrop Hall at the University of Western Australia, and a garden party for 2300 people at Government House went ahead.

Consolidation of Aftercare

More aftercare services and facilities had been established since the 1948 epidemic. At IDB the change in focus to a rehabilitation centre was boosted with appointment of Melbourne trained orthopaedic surgeon Mr George Bedbrook who worked closely with his colleagues which included Mr Reg McKellar Hall,  Mr Bill Pannell, Mr Alec Dawkins and Mr Bill Gilmour. In a bid for patients to regain as much physical ability as possible the senior orthopods advocated early mobilisation. Bill Pannell commented that rehabilitation should begin in the ambulance. The first intake of students into the West Australian physiotherapy program graduated just before the epidemic commenced and a full time occupational therapist was appointed shortly thereafter. A galvanised iron squatter’s tank used for hydrotherapy at IDB was replaced with a tiled heated pool measuring 8.3 x 3.3 metres with a ramp and a hoist to facilitate patient access.  The splint shop now had a staff of 6 and was regarded as the most advanced in Australia.

Home care

Perhaps mindful of the latest research into the effects of separating young children from their mothers, home care was introduced as official policy as an alternative to hospitalisation in patients with mild paralysis and no breathing or swallowing difficulties. The decision was left to families and their general practitioner. A health inspector visited the home and stressed the need for sound hygienic practices. The patient’s eating utensils were to be washed separately, drinking straws were to be burnt and handkerchiefs boiled and soaked in disinfectant before washing. 

As polio was regarded as a faecal disease all receptacles and excreta needed to be treated with great care to prevent the spread of infection. Faeces were to be flushed down a lavatory connected to the sewerage system or a septic tank. Homes with a back yard privy required special attention. The so called nightman collected the pans twice weekly and the containers were washed, burnt out and tarred before being returned to service with a disinfectant. While home care   could be intense and exhausting for the primary carer the patient could be nursed in a familiar environment and the intense pressure on hospitals was relieved to some extent. At the end of the epidemic the policy was described as an outstanding success.

In the 1954 epidemic 436 cases were notified to the Public Health Department. It was regarded as less severe than the 1948 epidemic. Only 45% were paralytic and the vast majority were expected to recover completely or be left with a minor disability.

The 1956 Epidemic

In 1955 the general consensus amongst health authorities was that developed nations had triumphed over polio.  In America Dr Jonas Salk had developed an effective vaccine, the Commonwealth Serum Laboratories in Melbourne had untaken to manufacture supplies and its distribution across the country was being planned. But in January 1956 the number of notifications warranted the announcement of a third epidemic. 151 cases occurred that month and there was huge concern that there had been 5 cases of respiratory paralysis. Twelve more presented in February and another nine in March, the situation challenging the resources of the hospital.

A Crisis in Respiratory Patient Care

Respiratory paralysis and its complications were a major cause of death during the acute phase of the illness. The health authorities recognised that the chances of a successful patient outcome was most likely where specialised equipment, laboratory facilities and an experienced medical and nursing team were on hand. The Infectious Diseases Hospital best fulfilled the criteria and although some country hospitals had iron lungs thanks to the generosity of Lord Nuffield in 1939, IDB was chosen as the treatment centre for respiratory patients from around the state. 

Wards 1 and 2 became the respiratory wards and by early March 17 respirators of different ages and types had been assembled, together with a recently developed walk in respirator known as the submarine because of the size of its massive white cabinet. The hospital was fortunate to have on the staff Dr John Colebatch who had had polio himself in 1953 and had personally experienced the iron lung. Not only did he have considerable technical knowledge but also an awareness of the patient’s physical and psychological needs. Nursing staff were trained on site. To assist them to understand what their patients were experiencing,  each trainee was installed in an iron lung. One commented on the strange feelings of the deep negative pressure, the rhythm of the machine and of air being forced in and out of her lungs. She said it was impossible to breathe against the action of the iron lung.

In a state as vast as WA the inevitable question arose as to how to safely transport patients from rural and remote areas to the main treatment centre at IDB. While the logistics of air transport were still being worked out, the Health Department equipped a mobile Xray trailer with an iron lung, oxygen and other equipment. A driver accompanied Dr Gordon Sarfaty and 2 nurses. During the epidemic the team was responsible for successfully transporting 9 patients to IDB for specialist care.

Paul Berry, Alec Hearn and Phil Talbot

Paul Berry, Alec Hearn and Phil Talbot were all treated in iron lungs and shared a ward at IDB. Like other iron lung patients they were completely helpless and depended on the medical and nursing staff for their every need. 

The day began at 6am with the men having their faces washed, hair combed and teeth cleaned before a nurse fed each patient their breakfast. After the meal five nurses assembled to prepare each man for a full body wash and a change of bed linen. As the patient could only be out of the lung for a very short time, one nurse stood ready with a resuscitator to administer oxygen if necessary.  The machine was opened and the other 4 nurses worked as quickly as possible to wash and dry the patient, change the sheets and resettle him in the machine.

Patients often experienced paralysis of the bladder and most were catheterised. Constipation was relieved with a daily dose of paraffin which acted as a lubricant. The nurses quickly discovered that the dose needed careful monitoring to avoid having to wash the patient and replace the bed linen all over again.

Patients struggled with the emotional issues which arose when they realised their illness was life threatening. The staff encouraged their relatives to visit and assist with the demanding care regime. Some simply sat by the patient while others chatted, read to them and helped with feeding. Paul Berry’s father made a reading frame which perched on top of Paul’s respirator and   could support a newspaper.  Paul became accustomed to re-reading some articles several times as he waited for someone to turn the page.

The respiratory patients could not progress to Aftercare until they were able to breathe independently. The weaning process involved removing the patients from the machine, initially for a very short time, and encouraging them to attempt breathing on their own. Paul Berry recalled:

      After I’d been in  . . . 6 or 7 weeks [ I was told] . . . Right, we’re going to open the lid and I want you to self breathe. And I thought, “ Oh good, that’ll be good.” So they opened the lid and I soon realised [ I couldn’t] breathe which wasn’t much fun .I didn’t have any diaphragm or intercostals so I [could only] last just a couple of minutes. The next day you went through the same routine again. This went on for 5, 6 or 7 months and then I found I had an abdominal muscle on one side and I used that . . . Phil and Alec were much the same. It takes a long time to do all this and of course you can’t do any physio or try any other exercises because all your time is spent just trying to breathe.

After about 9 months the three men were able to spend a few hours each day out the iron lung. Full independence from the iron lung was expected in about 80% of patients who survived the acute illness. The remaining 20% would rely on some form of mechanical support for the rest of their lives. 

Innovative Measures - The Cairass, the Rocking Bed, the Cough Machine and Frog Breathing

During the transition from full dependence on the iron lung to independent breathing, the patient’s breathing ability could be enhanced with other non-invasive respiratory aids such as the cuirass, the rocking bed and the cough machine as well as by learning alternative breathing techniques such as the so called frog breathing.

The cuirass consisted of a shell which was made to fit snugly over the patient’s chest and upper abdomen. In fact it was a cut down version of the iron lung. A hose connected the shell to a small motor which produced the changes in pressure, maintaining respiration. The advantages over the tank respirator were that the patient’s limbs were free, it was less cumbersome and there was a portable version which patients could use outside the hospital.

The rocking bed was an electrically powered bed which tilted from the horizontal position to 45 degrees about 16 times per minute. The movement of the patient’s abdominal contents forced air in and out of the patient’s lungs. Motion sickness was rare in patients but not uncommon in observers.

The old adage that necessity is the mother of invention certainly applied in the epidemic of 1956 and Paul Berry was one of the fortunate patients who benefitted from the search for a solution.  An infection in the lungs combined with an inability to cough was potentially fatal for iron lung patients. Patients needed a mechanism which would simulate a cough to clear the congestion from their lungs. After trialling other possibilities the hospital’s assistant engineer Mr A Saunders and his workshop staff adapted a high speed suction/blower which had been designed originally for spray painting. Using the blow option and with a mask over the patient’s face, the lungs were filled with air in about 2 ½ seconds. A manually operated change-over valve enabled a sudden change to suction, producing a flow of air at least equal to a normal cough. The cough machine quickly became part of routine treatment and was hailed as the best in Australia at the time. Paul Berry commented that he would never have survived without using the cough machine regularly.

Patients who were able to learn the technique of frog breathing, also known as glossopharyngeal breathing, could abandon the lung for several hours a day. The technique involved the patient filling the oesophagus with air and then pumping it into the lungs using the cheeks and tongue.  The  process was continued until the lungs were filled. The air was released through partly closed lips and the process of filling the lungs started over again. Patients could take several months to learn the technique which was taught in many hospitals around the world but once mastered the patient could manage about 6 breaths per minute.  Paul Berry recalled that he and Alec Hearn never accomplished the technique but Phil Talbot was successful and he was able to participate more freely in social and therapeutic activities. However, the breathing action was not automatic and a patient with no respiratory power needed to return to the iron lung for sleeping and eating.

Aftercare and Other Activities at IDB

Once respiratory patients had regained the ability to breathe independently, children were transferred to the Golden Age and adults joined paraplegic and fracture patients in the IDB aftercare unit. Patients who had suffered extensive and severe paralysis faced months if not years of physiotherapy and occupational therapy and many took advantage of the well equipped gymnasium and the long awaited hydrotherapy pool which had opened in September 1955.

The patients were in hospital primarily for treatment but as they recovered, the vast majority developed friendships with staff and fellow patients. As adults they were able to venture out unaccompanied and contact with the outside world contributed to their recovery, helping them to develop some perspective on their lives, ward off depression and maintain those all-important   feelings of belonging to family and friends. Visitors, weekend leave, outings and socialising created diversion and interest and some of the nursing staff went out of their way to provide activities for long term patients.

Films from a wide variety of genres were shown fortnightly and the sessions were run by two staff members who happened to be qualified projectionists. Paul Berry’s parents visited regularly with a home cooked meal and he appreciated a nurse and her boyfriend taking him out for a drive, propped up with pillows in the back seat of the car. Paul also recalled:

There was a lady called Sabrina who [visited] IDB. . .  I don’t know what she was famous for, a singer or something like that, but she was a rather well endowed young lady and all the doctors were falling over themselves to assist her in any way. Also the Harlem Globetrotters came down and had a game of basketball in wheelchairs [against] the paraplegics.

The Shenton Park Hotel was the closest pub and those who could walk the distance or had any form of transport such as a wheelchair or a scooter could get to the hotel for a drink and pick up orders for their more restricted mates. During the football season, many enjoyed going out to a game.

As the crisis of the epidemic subsided and with newfound awareness of the needs of long term respiratory patients, plans for a new facility at IDB were drawn up. The ward was divided into 9 bays separated by screens and the walls were painted in soft pastel colours. Eight respirators and a rocking bed were installed, along with an oxygen supply and suction outlets. Paul Berry, Phil Talbot and Alec Hearn were 3 of the patients who moved into the new ward in June 1957. All of them had been in hospital for well over a year.

As the state government met the cost of hospitalisation and aftercare of post polio patients, it was in its interests to
assist patients to go home, not only for humanitarian reasons but to reduce its expenditure. In 1957 the Minister for
Health approved the supply of 4 cough machines, a rocking bed and 3 cuirasses to enable 4 patients to leave
hospital. Phil Talbot was able to be discharged and in March 1958 was reported to be managing very well at home.

What became of Alec Hearn has not been established. Paul Berry was never discharged. He regained the ability to
breathe independently during the day but needed to return to his iron lung at night. He became one of IDB’s most
longstanding, loved and respected residents and died in his respirator in 2005.

The West Australian Epidemics