President's Message
June 2020  

 

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

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

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

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

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

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

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

Stay safe and be well.

Sincerely,
Arlene W. Keeling, PhD, RN, FAAN

 

 

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

 
Sister Kenney, courtesy mnopedia.org

In August 1944 Louisville’s Fourth Street toy store advertised “Christmas in August” offering toys on sale for parents desperate to entertain their children who had been cooped up at home, banned from movie theaters, swimming pools and all public gatherings.[1]  The reason was polio.[2] Kentucky’s largest epidemic had started in late June; it ended with 718 reported cases and 37 counties classified as epidemic areas.  Showing how confusing polio’s transmission was, health officials in Louisville investigated cases by asking when children had gone swimming, been visited by “infected” friends, had a tonsillectomy, played with nearby animals and fowl, or eaten water, milk, butter, ice cream, candy and other foods.[3]

It was clear by July that there was a critical need for trained nurses to care for the patients filling the Kosair Crippled Children’s Hospital and Louisville’s General Hospital.  In 1942 Kosair had introduced a new method of caring for paralyzed children: the Kenny method, developed by Australian nurse Sister Elizabeth Kenny who rejected enforced immobilization through plaster casts and splinting and instead relied on the use of distinctive hot packs (made of steamed pieces of blanket wrapped around painful muscles) and muscle re-education exercises. Kenny’s Institute in St Paul, Minnesota had been training nurses and physical therapists since 1941; graduating “Kenny technicians” wore a special blue uniform with a head veil.[4] Kenny claimed that her method worked best when applied immediately to acute, newly diagnosed patients.  The physical therapist at Kosair was transferred to the General Hospital’s isolation department “in order to give the children admitted there the best possible care.”[5] Just before this epidemic the Journal of the American Medical Association announced that a committee of orthopedic specialists did not approve of Kenny’s work.[6] Physicians and nurses in Kentucky ignored this report.

City officials asked the American Red Cross and the National Foundation for Infantile Paralysis (popularly known as the March of Dimes) to send graduate nurses and physical therapists, preferably those trained in the Kenny method. Seven therapists and 141 nurses came from around the U.S. to work in Kentucky during the epidemic, their salaries paid by the state chapter of the March of Dimes.[7]  With overcrowded wards at both Kosair and the General Hospital, children who were mildly paralyzed were quickly discharged to make space for more seriously ill cases. Kosair set up a new physical therapy outpatient clinic in the basement of its south wing to serve patients from around the state.  There Kenny technicians, supervised by orthopedic surgeons, taught parents how to care for their children.[8] That summer a nurse who had cared for paralyzed children at the General Hospital during the state’s previous serious epidemic in 1935 told the public health director that using the Kenny method made the disease “more bearable” for patients for “it was altogether different… when children cried all night from the pain. Now they get some sleep.”[9]  Preparing and applying hot packs in stuffy and crowded hospital wards was challenging work.  By the end of July members of Kosair’s staff were exhausted and the hospital’s superintendent called for additional nurse volunteers saying “we have enough doctors, but we need more nurses and more people to apply hot packs. They need not be trained – we can teach them if they are willing to learn.”[10]

Widespread fear of polio led many people to shun families who had a child with polio. “On several occasions,” one official reported, “the neighbors were so frightened they would not raise their windows on the side next to the home of the stricken patient. People living in the same block would walk on the other side of the street to avoid passing the patient’s home, even though the patient had been taken to the hospital.” Family members from other parts of the state accompanying a patient to Louisville “often found it difficult to secure rooms even for one night” as rooming houses and many hotels refused to rent rooms to anyone who had been “exposed” to polio.[11] Parents themselves alluded to these fears, as mothers seeking outpatient care admitted worrying if their child had a visible limp in case people would think the child had polio.[12]

The Courier-Journal breathlessly reported “encouraging” results by University of Pittsburgh researchers who had treated two patients with polio with penicillin, the wartime miracle drug.[13] More soberly, Dr Hugh R. Leavell, the public health director who also taught at the University of Louisville’s medical school, told civic leaders that he could not give them “any hope” for there were no proven “methods of preventing poliomyelitis.” “Perhaps,” Leavell added, “before our time for an epidemic comes around again in nine or ten years, more will be known about the disease and [a] means of preventing it will be found.”[14] By the early 1950s Jonas Salk had begun testing his polio vaccine which was found safe and effective in 1955.[15]

Polio epidemics left a toll on physical therapists, nurses and nursing aides who worked in hospital wards amidst infected children, braving exposure and the possibility of paralysis. Frustrated parents sought to deal with children forced to stay at home and the community faced the challenges of coping with a disease that was not clearly understood, caused widespread fear and stigma, and threatened to overwhelm health care resources.  We remember the efforts of these health care workers as we honor current struggles to fight Covid-19.


[1] Michael W.R. Davis “Kentucky’s 1944 Polio Epidemic” Filson Club History Quarterly 74 (Winter 2000) 363, citing Courier-Journal August 5.

[2] Polio is a common, contagious and usually endemic disease, which can cause paralysis in a small number of infected cases; see David M. Oshinsky Polio: An American Story (New York: Oxford University Press, 2005) and Naomi Rogers Polio Wars: Sister Kenny and the Golden Age of American Medicine (New York: Oxford University Press, 2014). Today it is understood to be spread by fecal material, usually through individual contact.

[3] Marian Williamson “Review of the Current Poliomyelitis Epidemic” [1944], Director Kentucky Crippled Children Commission, RG 102 Children’s Bureau Central File 1944-1948, Box 103, 4-5-16-1, Infantile Paralysis, National Archives, 2; Davis “Kentucky’s 1944 Polio Epidemic,” 358, citing Courier-Journal July 11 1944.

[4] Davis “Kentucky’s 1944 Polio Epidemic,” 355. Kosair had adopted Kenny methods in 1942; see also Rogers Polio Wars.

[5] Williamson “Review of the Current Poliomyelitis Epidemic,” 2.

[6] Rogers, Polio Wars 197-201. The orthopedists rejected both Kenny’s “rigid technique” and her theories of the disease.

[7] Williamson “Review of the Current Poliomyelitis Epidemic,” 2.   

[8] Williamson “Review of the Current Poliomyelitis Epidemic,” 2-3; Davis “Kentucky’s 1944 Polio Epidemic,” 360. Williamson identified this (or another?) clinic at the General Hospital rather than at Kosair and noted that it was under the supervision of the Crippled Children Commission and the University of Louisville School of Medicine; Williamson “Review of the Current Poliomyelitis Epidemic,” 2-3.

[9] Davis “Kentucky’s 1944 Polio Epidemic,” 368 citing Courier-Journal July 12 1944.

[10] Davis “Kentucky’s 1944 Polio Epidemic,” 363.

[11] Williamson “Review of the Current Poliomyelitis Epidemic,” 3.

[12] Williamson “Review of the Current Poliomyelitis Epidemic,” 3.

[13] Davis “Kentucky’s 1944 Polio Epidemic,” 356-357.

[14] Davis “Kentucky’s 1944 Polio Epidemic,” 364 citing Courier-Journal 16 August 1944. Hugh Redman Leavell (1920-1976) graduated from Harvard medical school in 1926m and received a MPH from Yale in 1940. A specialist in children’s diseases and allergies he turned to public health and in 1946 joined the Harvard medical school faculty as a professor of preventive medicine; “Dr. H.R. Leavell Dead in Virginia,” New York Times August 12, 1976.

[15] See Oshinsky, Polio; Charlotte DeCroes Jacobs Jonas Salk: A Life (New York: Oxford University Press, 2015).

 

Home-Made Masks: Useful but Not Enough in 1918;
Useful but Not Enough Now

 Marian Moser Jones
University of Maryland School of Public Health
[email protected]

       
Courtesy Beth Hundt, PhD, RN

How many masks can you make? Friends with sewing machines – many drowning in child care, elder care, and work – have been inundated with these demands through social media.

Posting homemade mask patterns and tutorials online, an improvised army of volunteers is producing thousands of non-regulation face coverings for COVID-19 first responders, and is asking you to do so too.

Yes, it is noble that citizens have taken matters into their own hands, as the supply chain for N95 masks and other Personal Protective Equipment (PPE) remains entangled in politics, red tape, and profiteering, forcing health care workers on the pandemic’s frontlines to wear bandanas and sports goggles to protect themselves.

But while this grassroots response may seem like a heart-rending return to the homespun American voluntarism of yesteryear, history tells us a more complicated story.

As a public health historian who’s studied the American Red Cross, I am reminded of the eight million female Red Cross volunteers who organized industrial-style assembly lines to roll bandages and sew garments for wounded troops during World War I. When pandemic influenza arrived in 1918, they switched gears to churn out 1.4 million gauze masks.

In Boston, the first U.S. city struck by pandemic flu, 537 volunteers from the local chapter worked for 17 days straight to produce 83,606 masks, according to chapter records. The Red Cross Motor Corps, affluent women who drove their own cars on Red Cross errands, delivered the masks to hospitals, local organizations, and private homes.

Other cities followed suit, with 30,000 chapter sewing rooms participating. Red Cross publications touted the efficiency of this system. “One day an S.O.S. call came into central headquarters,” Red Cross leader Henry Davison later wrote. “Contagion was rampant at an Iowa camp and the hospital must have ward masks. [The] Chicago [office] had none on hand, but she knew where they were to be had, and in three days twenty thousand of the precious filters were on their way from a northern neighbor.”

However, news reports depict a less organized picture. In Richmond, Virginia, the local chapter announced it would sell home-made masks for two cents apiece. When customers lined up at chapter headquarters, (likely spreading flu), the chapter soon ran out.  Moreover, given that most white hospitals refused to treat African Americans even during the pandemic, and that many Black women reported being rebuffed when trying to volunteer at local chapters, it is also highly likely that chapters preferentially distributed home-made masks to white hospitals and white people.

Additionally, mask makers likely exposed themselves to flu: photographs of these activities depict 30 or more uniformed volunteers working shoulder-to-shoulder in crowded rooms. Such gatherings ran counter to local public health officials’ bans on public gatherings to stem the spread of flu. Considering that many U.S. women engaged in such unpaid work due to social pressure to demonstrate their patriotism, and that “slackers” who failed to do so were publicly shamed, the additional disease exposure that mask-making women incurred becomes more ethically problematic.


National Library of Medicine

Overall, these collective mask-making projects exemplify the  patchwork nature of the social restrictions that local officials in the U.S. tried to impose to stem the flu in 1918 and 1919. The delayed, volunteer-driven response in many U.S. cities, along with the staggering mortality from influenza, serves as an object lesson about the weaknesses of federalism in addressing a pandemic.

In World War II, millions of American women again gathered in Red Cross sewing rooms to roll bandages and make surgical supplies. But by then, the War Department deemed that homemade medical supplies failed to meet modern hospital standards. Instead it promised to use these items to meet shortages in military hospitals within the U.S., while contracting with commercial firms to obtain bandages “especially processed, sterilized and sealed for shipment to the front lines.”

We can learn from this development. Just as hand-rolled bandages had become backup supplies by the Second World War, home-made masks in 2020 should be reserved for people in the second line of vulnerability – workers who cannot avoid contact with the public but are not pandemic health care workers or first responders.

Meanwhile, we should continue to collectively insist that government and manufacturing sectors be mobilized immediately to produce and distribute sufficient, adequate, top-quality PPE for the workers on the front lines of this pandemic, the way the War Department insisted on providing professional-grade hospital supplies for troops fighting in World War II. While homespun solutions may help, they are insufficient to address this 21st-century crisis.

 

37th AAHN Annual Conference Update

Dear AAHN Colleagues, Members and Friends,
It is with sincere regret that we announce the likely postponement of the 37th AAHN Annual Conference, due to take place this September in Chester, England. We know this will come as an enormous disappointment, not only to those who submitted abstracts for presentation but also to our hosts in Chester, our colleagues from numerous countries, and others who agreed to participate in our event.  Nonetheless, given the widespread impact of COVID-19 (coronavirus) and the fluidity of the situation, we believe it is in our best interest to begin to develop an appropriate contingency plan.

As healthcare professionals, our primary concern is always the responsibility we have towards our members and colleagues, and all others who support nursing and the nursing history community. Whilst only a short time ago we felt optimistic that September was far enough away to confidently proceed with our plans, as it stands today [20 March] we cannot guarantee the delivery of an event that would ensure the safety of  all attendees.

While we do not currently have an alternate date scheduled, at this time we are asking all members and interested participants to pause their plans as they relate to registration, flights, hotel bookings or other arrangements for the September event.  We will continue to monitor the situation closely and will keep our members and key stakeholders abreast of our plans.  (Our post-conference trip is on pause as well. Witte Travel is swamped right now, so I ask you to hold off contacting them if you can, until we know more).

Abstracts
For those who have submitted abstracts, please know that we are continuing to review them and that we will provide an opportunity for every presenter once our final course of action has been determined. Once you are notified that your abstract has been accepted, you may list it on your curriculum vita as “Peer-reviewed and accepted for International AAHN Conference, (date TBD given COVID19 pandemic)”
Our thoughts and concerns are with those affected by this pandemic around the world. Please stay safe, take care of yourselves and each other. Feel free to contact me at [email protected] with questions.
Sincerely,
Arlene Keeling PhD, RN, FAAN
President
 

Nursing’s most important lesson from SARS in Toronto 2003
Sioban Nelson, PhD, RN FAAN, FCAHS
Professor, Faculty of Nursing, University of Toronto

 With the number of infections and deaths around the world rising in an exponential curve with COVID-19, it may seem that the 2003 story of SARS (SARS-CoV1), barely rates a mention. The total deaths in Toronto, the epicenter of the corona virus outbreak outside of Asia, was only 43.  However, SARS provided a dress rehearsal for a twenty-first century pandemic and offers hard-learned lessons on preparedness and worker safety.[1] It’s message is critical for today.

The first lesson of SARS was the now familiar message of slowing community transmission to enable the system to respond, both in terms of developing a cure or a vaccine (depending on the cause of the pandemic) and upholding the precautionary principle which urges a decisive and rapid response at the earliest possible stage. The second lesson speaks to what awaits us in North America – the issue of health worker safety when the system is overwhelmed. This is the lesson from SARS in Toronto that most directly affects nurses[2].

Despite the media heralding the heroism of nurses and their front line colleagues during the winter/spring of 2003, by summer the overwhelming response of the nursing profession had hardened to anger. It was clear from the way SARS had been effectively contained in Vancouver and other cities outside of China and Hong Kong that it could and should have been contained. Nurses in Toronto were painfully aware that the failure of the precautionary principle in Toronto that year was the result of an eight-year austerity program in the province characterized by deep budget cuts, hospital closures, nurse layoffs and widespread casualization. By the time SARS hit the city, the system had been depleted of most middle nursing management and casual contracts[AK1]  for nurses were the order of the day. ERs and ICUs were already overflowing. As the submission from the Registered Nurses Association of Ontario (RNAO) stated to the Campbell Commission set up to investigate the province’s response to SARS, the problem was not the virus. SARS could not be contained because Ontario had “a system that was poorly connected; a public health sector that was under-resourced and disintegrated; a home care sector that was destabilized; a hospital sector that was unprepared for major emergencies; and a nursing workforce that battled dangerously low staffing levels, high workloads, and an over-reliance on part-time, casual and agency staff.”[3] This was the recipe for turning a moderately infectious new corona virus into a nosocomial emergency.

When I taught the story of SARS just a few months ago to a class of NPs, many students only vaguely remembered it from their high school days. After reading Adrienne Byng and my chapter on SARS,[4] I encouraged students to talk to nurses who had worked in Toronto at that time. This exercise sparked interesting intergenerational discussions. Students reported back to their classmates the traumatic memories of their older colleagues and family members who recalled the confusion and the terrible sense of abandonment by their employers as they felt unsafe at work. They also recalled feeling abandoned, by the public as nurses became the victims of widespread fear and stigma. For example, nurses found themselves unable to travel on public transit without abuse if they wore any hospital identifiers, of being told to keep their children out of school (sometimes through anonymous letters), of their difficulties when quarantined in their own homes (however small), of the terror of infecting their families, and the distress of their children. In Toronto, medical staff were at times quarantined in hotels at the expense of the government or hospital while nothing was provided for nurses who arguably had fewer domestic resources. As the post SARS research all showed, the emotional toll on nurses was enormous.

However, other students reported the opposite. They spoke with nurses who recalled feeling safe, well informed and supported by management and the wider community. This is the big lesson for us today: we need our front-line workers to be and feel safe. If we want to limit unnecessary deaths from COVID-19 we have to prevent the healthcare system from being overwhelmed. We have to ensure that nurses, doctors and other front-line health workers are fully supported to turn up each day and do their jobs. They need to be supported at work with the necessary equipment and information, assisted in getting to and from work, have access to food (this was a big problem in some hospitals!) and childcare. We need to ensure that nurses are provided with the resources and supports to self-isolate and self-quarantine while protecting their families. We are asking so much of our nurses, we should not be asking them to choose between their duty to care as nurses and the safety of their loved ones. [5] Nurses need to be listened to when they raise concerns – it was the nurses who overcame resistance to raise the alarm and have the second SARS outbreak declared. COVID-19 will be different in each hospital, city, and country. But we need to ensure that beyond the applause and the praise for heroes, the resources are in place to keep nurses and their families safe during this pandemic.


*Sioban’s full text on this is in Chapter 9


[1] Mario, A. Possami, SARS and Health Worker safety: Lessons for Influenza Pandemic Planning and Response, Healthcare Papers, 2007, 8(1) October 2007 : 18-28. doi:10.12927/hcpap.2007.19354

[2] The Honourable Justice Archie Campbell, “Spring of Fear”. Final Report  of the Independent Commission to Investigate the Introduction and Spread of SARS in Ontario. (Toronto: Government of Ontario, 2006).

[3] SARS Unmasked. Registered Nurses Association of Ontario. 29 September, 2003.  https://rnao.ca/policy/reports/sars-unmasked

[4] Sioban Nelson and Adrienne Byng, “Chapter 9: The SARS Pandemic in Toronto, Canada, 2003,” in Arlene Keeling and Barbra M. Wall, Nurses and Disasters: Global Historical Case Studies, (NYC: Springer Publishing, 2015): 229-255

[5] Ross Upshur, and Sioban Nelson,  Duty of Care: Acknowledging Complexity and Uncertainty, Nursing Inquiry, 2008 14(4), 261-62. https://doi.org/10.1111/j.1440-1800.2008.00431.x

 

Why don’t you write something for the website?

Dear members,

As you may be aware the Bulletin was disbanded at the end of 2019 after many years offering news, research updates and local events.

In 2020, we all expect news to be up-to-date and since the Bulletin was produced only twice a year, news was often no longer ‘new’ when you read about it.

Instead, we are would like you to use the website to tell colleagues and fellow-members of your activities, ideas and news.

Do you have a short research item, some news of publications, research funding or activity?  May be you have visited a fascinating archive, held a local nursing history event or are engaging in a new collaboration? Perhaps you have started a new job and are now bringing nursing history to your new employment? Perhaps you have been lucky to travel to new lands and have discovered untold histories of our profession?

If so, we would love to hear about it.

Please send your items to me, the AAHN Chair of Publications and I will pass them onto our web team. I am happy to check any ideas for the website if you are unsure.

I look forward to hearing from you very soon.

Dr Jane Brooks
[email protected]




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AAHN 37TH ANNUAL CONFERENCE

Due to COVID-19, the 37th Annual Conference has been canceled. 

 

            BREAKING NEWS             


The American Association for the History of Nursing is proud to support The U.S. Cadet Nurse Corps Recognition Act in honor of the thousands of Cadet Nurses who studied and served under the U.S. Cadet Corps program in World War II.



About Friends of the United States Cadet Nurse Corps World War II

This group was formed to pass the 2018 bipartisan legislation, "U.S. Cadet Nurse Corps Service Recognition Act." It was introduced in the U.S. House of Representatives as HR7258 and in the U.S. Senate as Senate Bill 3729.  There is no financial or VA benefits. These women of the Greatest Generation only request to be honored as Veterans of WWII with an American flag and a gravesite plaque forever marking their proud service to our country during wartime in the United States Cadet Nurse Corps.  

Action Needed:  Be a  "Friend" of the U.S. Cadet Nurse Corps WWII.  
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How:  Simply let your U.S. Senators and House Representatives know that passing this new bill is important to you by going to their website and clicking on the button.