EMERGENCY HOSPITAL PROVISION FOR CASES OF INFANTILE PARALYSIS

C. JOSEPHINE DURKEE

Director, Division of Public Health Nursing

With considerable consternation on the first day of July, the people of the State of New York realized that they were facing a serious epidemic of an acute infectious disease which would take a high death toll among children, and in many cases leave the victims with more or less paralysis. Persons who had no children were not without personal dread since adults are not always immune to the disease.

On the 30th day of June the city of Hudson had 8 cases of poliomyelitis, Beacon 3, Babylon, Yonkers and Kingston one each. In the next four days new cases developed in Hudson and Greenport in Columbia county, Beacon and Fishkill in Dutchess county, Warwick in Orange county, Jasper in Steuben county, Manhasset, Garden City Park and Farmingdale in Nassau county, a total of 25 reported cases outside of New York City.

Local boards of health and voluntary civic organizations sought information and advice from the State Department of Health with reference to the nature and measures for the prevention of the disease, extent of authority of local boards of health in regulating the freedom of individuals, and measures to be adopted in public health education. Steps were promptly taken to prevent the entrance of the infective agent into the locality, effectively quarantine all frank and suspicious cases, educate the general public in the necessity and nature of preventive measures, and provide treatment for the persons afflicted.

New Rochelle

On the 3d of July the board of health of New Rochelle met and decided that immediate action must be taken not only to prevent the spread of the disease but to provide hospital treatment as soon as it should appear in the city. The Mayor and Board of Estimate promised their hearty support to the measures which were submitted to them for approval by the three commissioners of health. One of the three being. in accordance with the requirements of the law, a physician, to Dr. A. W. Hoyt was assigned the work of supervising the establishment and maintenance of a quarantine hospital. Subsequent events in other communities have shown the wisdom of the policy pursued in New Rochelle; it is therefore believed a rather full account of their methods will be of interest.

A circular of information and warning was immediately printed in English, Italian and Yiddish, a copy of which was delivered by the police officers to every home in the city. A few days later a second circular of

information and warning was similarly prepared and distributed. The board of health decided that since it was impossible to foresee the extent to which they would need to provide isolation quarters, it would be the part of wisdom not to talk about "what we are going to do."

The hospital site was selected on land owned by the city, a septic tank with pipe lines was laid, city water, electricity and gas were brought to the site. Two portable hospital units were purchased and stored where they could be erected within a few hours notice. Bath and laundry tubs, sinks and revolving clothes wringers were also purchased. A head nurse was engaged for the hospital and with her assistance all the necessary equipment including food supplies was purchased with the promise that they would be delivered within two hours of the call to a place the address of which would be furnished later. A cook, laundress, ward maid, orderly and nurses were engaged. No publicity whatever was given to these preliminary movements. The first case of poliomyelitis was reported in New Rochelle July 19. Four others followed in a few hours. Immediately all parts of the portable building were assembled and plumbing connections made. Four hours after the order was given to deliver equipment and supplies, the hospital was in operation with four patients under treatment. With the knowledge that the disease was present in the city, to the citizens of New Rochelle came also the knowledge that all cases were to be removed to the hospital and that contact cases were to be placed under quarantine for two weeks, that two public health nurses were to be assigned to the infected district to observe all contact cases, discover sickness and secure early diagnosis and treatment, and that guards were employed to maintain quarantine of the infected area. If sickness was discovered by the nurses and the family could not provide a private physician, the department of health sent one of its expert diagnosticians, Dr. Titus or Dr. Hall. A branch laboratory had been established in New Rochelle and specimens of spinal fluid were promptly examined and early diagnosis secured.

As soon as the hospital was in operation an incinerator was found necessary and was provided. Because the virus of the disease is thrown off in the body excrement, all cloths and dressings used in removing body waste were promptly burned as was all the hospital refuse. A generous public sent fresh vegetables, milk, growing plants and a sewing machine. At the hospital, all windows and doors are screened, the crib of each patient is securely protected by a fly net, and fly traps of a pattern recommended by the Federal Department of Agriculture have been placed inside the halls to catch such flies as get inside. Revolving fans keep the air in motion. The number of cases has so rapidly increased that one month from the discovery of the first case eight portable units and four army tents are in use, and a large unit, 40 x 40 with an L 30 x 12 is under