Poliomyelitis 
IN 
DAHO 
1947 - 1948 
A REPORT ON THE OUTBREAK OF ACUTE ANTERIOR POLIOMYELITIS AS THE 
DISEASE OCCURRED IN IDAHO 
JULY 1. 1947 TO APRIL 1. 1948 
PREPARED BY 
THE IDAHO STATE DEPARTMENT OF PUBLIC HEALTH 
BOISE, IDAHO FOREWORD 
The task of collecting and assembling the data contained In this report grew 
Into a tremendous undertaking as the epidemic of 1947-48 spread over a large portion 
of the State of Idaho, 
I wish to acknowledge the work of the following groups who made It possible to 
prepare this rer _>rt; 
Local public Health NUTfees 
Division of Vital statistics 
Crippled Children's Service 
information Service of Idaho State Health Department 
Advisory Committees from Local and State Medical Societies 
Library Staff, St. Luke's Hospital 
I also wish to personally thank: Dr, A. G, Gilliam, university of Michigan School 
of public Health, whose guidance and leadership gave us our Inspiration.’ 
Madelene m« Donnelly, m.D. 
Director, Bureau Maternal and Child Health 
and Crippled Children's Service 
State Department of Health 
Boise, Idaho 
Health NUMBER OF CASES BY COUNTY 
NORTHERN AREA 
Boundary 
Bonner 
Nez perce 
Lewi s 
Clearwater 
Idaho 
SOUTHWEST AREA 
Adams 
val 1 ey 
Washington 
payette 
Gem 
Canyon 
Ada 
Elmore 
Owyhee 
EASTERN AREA 
Bear Lake 
Lemhi 
Custer 
jefferson 
Madison 
Teton 
Bannock 
Bingham 
Bonneville 
power 
SOUTH CENTRAL AREA 
Blaine 
Li ncoln 
jerome 
Gooding 
Minidoka 
Twin Falls 
Cassia 
Lemhi and Custer counties are placed in the Eastern Area because the terrain facilitates 
faster transportation to Pocatello, Bannock County, than to Boise, Ada County. POLIOMYELITIS IN IDAHO, 1947-1948 
part x 
EPIDEMIOLOGY 
Idaho suffered its first major epidemic of poliomyelitis in the summer of 1947. 
previously, this disease had been reported yearly since 1916. in the three decades, 1916-1925, 
1926-1935 and 1936-1945, an average annual case rate of 4.6, 7.2 and 4.2 cases per 100,000 pop- 
ulation were reported, in 1946 a rate of 9.6 or 48 cases were reported.* 
The largest number of cases reported In any one year was In 1934 when 156 cases were 
reported. The most Interesting year was as early as 1910, when Dr, George Hyde, Rexburg, 
president of the State Board of Health, reported on 76 cases in Idaho County.** Thirty-five 
of these cases had paralysis and 5 were fatal. Vomiting, constipation, rigidity, .and hyper- 
aesthesla were predominant symptoms. Dr, Hyde noted that 62% of the cases were males, 84% 
under 10 years of age, and that 7 families had multiple cases. The Incidence started In May, 
reached Its peak In July and subsided In August. This report, now 38 years old, embodies many 
of our present day channels of thought. 
From January 1 until July 1, 1947, 12 cases of polio were reported throughout the 
State, as a matter of fact. It ms felt that they were actually cases carried over from 1946, 
in the first part of July there vas a sudden appearance of acute cases. This 
Increased Incidence continued the remainder of the year and Into 1948. in all, 383 cases 
were reported In 1947, This created a case rate of 73.4 cases per lOO.OCO population. 
in comparison with other states suffering from polio In epidemic proportion Utah*** 
In 1945 reported a case rate of 17.3 and 23.2 In 1946, Colorado case rate In 1946, 80.9, North 
Dakota In 1946, 88.7 and Minnesota in 1946, of 115.1. 
This report Includes the cases occurring during the 40 epidemic weeks, July l, 1947 
to April 1, 19480 During this time there was no actual cessation of new cases. The 401 cases 
reported are herein reviewed. 
Fatality, Seventeen of the 401 cases terminated fatally, resulting In a death rate 
of 3.2 per 100,000 population, in comparing this rate with other states, Utah had a death 
rate of 4.1 In 1943, 3.2 In 1945, while California, In these same years had a rate of 2.0 and 
.63 respectively,**** Illinois, In 1943, reported a death rate of 2.0 and 1.3 In 1946. 
The Idaho death rate seems high and It Is actually lower. Three deaths were report- 
ed In young children, which upon Investigation, revealed a sudden onset of high fever, con- 
vulsions and death In a few hours. None of these diagnoses were substantiated by laboratory 
work or autopsy, but as they were reported to the Division of Vital Statistics as polio on the 
death certificates, they must be recognized as such. 
Geographic Distribution. The first cases appeared In Ada County, the first 5 coming 
from an ar*a of one block In south Boise, immediately the question of the relationship to 
sewage disposal was raised. Soon cases appeared In adjoining Canyon County, and In a few weeks, 
Source: u. S. public Health Service. "Notifiable Disease, prevalence by States" 
Bureau of the Census, "Census of the united states." 
•"Second Biennial Report of the state Board of Health of Idaho. 
***Bureau of vital Statistics. 
S.public Health Service, etc. on down the Snake Elver and Into Washington County. Great controversy was aroused concerning 
the role of the Snake Elver In the spread of the disease, in the 6th week, cases appeared up 
the river In the Jerome and Minidoka areas, and later is far up the river as Teton County. 
Thirty-three of Idaho's 44 counties reported cases. True, these counties border the 
Snake Elver, but so does Idaho's population with 75% of the total population living In these 
33 counties. 
Geographically, Idaho Is divided Into several distinct areas. Arbitrarily, the 
counties Involved In polio have been divided Into four areas, North, Southwest, South Central, 
and Eastern, in plotting the Incidence of cases, It Is Interesting to examine these areas 
separately. 
The total epidemic reached a sudden peak the 8th week, with a secondary rise the nth 
week. Then It rose again the i?th week to Its highest level with a secondary peak the 20th 
week. Following this, the drop was rather sudden, but a third lesser peak occurred the 27th 
week, approximately January i, and continued until April. 
When the State Is separated Into the four areas mentioned, It shows that the South- 
west and South Central areas had almost Identical Incidence curves, the South Central being 
approximately six veeks later than the Southwest. The Incidence In the Eastern area was quite 
low but starting In the 5th week extended conslstantly throughout the rest of the epidemic 
period. The Northern area suffered least, with only 16 cases. However, the cases from that 
area were quite severe, it Is not believed that this vas a matter of diagnosis, as The Idaho 
State Crippled Children's Service has since held several clinics throughout that area and we 
have not picked up undiagnosed cases, in other areas a large number of cases who had not seen 
doctors and had not been diagnosed were found. Such cases have been reported and placed under 
treatment. 
‘ 
Eesldence. The question of residence In rural or non-rural areas Is usually of 
Interest, Forty-six per cent of our cases came from non-rural areas while 54% came from rural 
areas, Idaho's total population Is 66.2% rural* 
Length of residence previous to the onset of the disease was stated In 317 cases. 
Fourteen per cent of the total cases had resided In their present residence for less than one 
year, while 64% of the total cases had lived In their homes for more than one year. Length 
of residence was not stated In 22% of the cases. 
Sex. The ratio of males and females was about the same as usually found In other 
epidemics. Fifty-six percent or 225 were male and 44% or 176 were female. This ratio was 
maintained In all four areas of the State, Idaho's total population is 51% male, in com- 
paring It with other epidemics, Minnesota In 1946 reported 55% male and Utah In 1945» 53% 
males, * 
Eace, Eace played no part In this epidemic. Four hundred cases were white and l 
case was a Japanese baby, Idaho's total population Is 98.9% white. 
incidence In Families. The 401 cases Involved 346 families, of this total, 308 
families had i case, 28 had 2 cases, 4 had 3 cases, 5 had 4 cases and 1 family had 5 cases. 
A total of 93 cases were from families In which there was more than one case, in 17 of the 
38 multiple Infected families, one of the affected members had bulbar Involvement, in 2 
families, 2 members had bulbar symptoms. 
•"infantile paralysis in the State of Utah, 1945" by John A. Anderson, h*0. There were a total of 1834 members In the families of the 390 polio cases; 265 of 
of these household contacts gave a history of minor Illnesses prior or subsequent to the onset 
of polio. 
Age incidence. The age of the patients was not unusual with 72.8% of all cases being 
under 15 years of age, and 2% over 40 years of age. Although a very small percentage were 
under 1 or over 40 years of age, the actual ages ranges from 6 weeks to 65 years. A detailed 
analysis of age grouping Is listed and compared to that reported by Minnesota In 1946.** 
Age 
Minnesota (1946) 
percent of H87 cases 
Idaho (1947) 
percent of 401 cases 
Under 5 
27.4 
27.9 
5-9 
28.7 
29.2 
=t 
1 
O 
tH 
16. 7 
15.7 
15-19 
10.0 
7. 5 
20-24 
5.9 
4. 0 
25-29 
4.8 
6.5 
30-34 
3.2 
4. 2 
35-39 
1.7 
2. 7 
Over 40 
1. 5 
2.0 
Age apparently had no effect on the type of polio as seen from the following analysis. 
The percentage of spinal bulbar Is highest In the second, third and fourth age group, but like- 
wise non-paralytic and spInals are higher in these same groups. 
Age Group 
Non-paral yt i c 
Spi nal 
Spinal Bulbar 
(119 Cases) 
(194 Cases) 
(86 Cases) 
under i 
3.6 
3.6 
2.3 
1-4 
18.4 
30.4 
21.0 
5-9 
26.6 
27. 8 
37. 2 
10-14 
21.0 
10.3 
21.0 
15-19 
10.9 
7. 2 
2.3 
20-24 
4. 2 
3. 1 
5.8 
25-29 
9. 2 
6.7 
2.3 
30-34 
2.5 
6. 2 
2.3 
35-39 
1.7 
2.6 
4.6 
over 40 
2.5 
2.0 
1. 1 
Cases of undetermined type - 2. 
The effect of age on recovery was most marked. This Is demonstrated In graph form, 
in case of spinal type, percentage of recovery was more marked In the first 4 age groups, and 
In the group over 40. On the other hand, the spinal bulbar case fatality was definitely higher 
In those under one year of age and over 25. Recovery was greater In the age group of one to 
14 years of age. 
pregnancy, unlike some of the recent epidemics, pregnancy was not a factor In the 
Idaho episode, only eight females were pregnant on admission, one of these aborted spon- 
taneously. The remainder who have reached term have delivered normal babies. Deliveries were 
normal except In one Instance where the attending obstetrician facilitated delivery with low 
forcep extraction. 
Facts and Figures about infantile paralysis from the National Foundation for infantile paralysis. Second Attack, one patient In this series suffered a second attack. She was a young 
girl of 15 who had had an attack seven years ago with a mild residual. She was In the hospital 
recovering from an appendectomy at the time of onset of this Infection. 
Home Environment, it is very hard to evaluate the sanitation of a home "good" or 
"poor", especially with many families In many areas differing In economics and stanch.rds, 
A survey of 346 families was made with the following environmental facts noted; 
Milk; 53.5% used pasteurized milk, 43.5$ raw milk, 3% unstated. 
Water; 55* used city supply, (75* of the-se suppl i es are approved 
by the State Department of public Health), 35* used wells, 
2* ditch water, 7$ unstated. 
Sewage Disposal; 32* on city sewer, 31* used septic tank, 31* had 
outdoor privies, 52 unstated. 
Flies; present in unusual numbers in 46% homes. 
Gnats; present in unusual numbers in 16% homes. 
Mosquitos; present in unusual numbers in 48* homes. 
Sick animals in 6* of the homes. 
Tonsillectomies, in answer to many queries as to relationship of tonsillectomies to 
polio an attempt was made to tabulate this Item. 
The table below shows the number with tonsils out and the number with recent tonsill- 
ectomies as compared to those who had not had tonsils out and the type of polio in each case. 
Number of 
Total 
Tonsils |n 
Tonsils out 
Tonsi 1 s out Less 
than 1 year 
Cases 
401 
232 
160 
41 
Non-paral yt ic 
29.1% 
31.42 
24.3% 
48. 72. 
Spinal Type 
48.32 
50.82 
47.52 
34.12 
8ul bar Type 
21.42 
17. 22 
28.22 
17.02 
no information regarding tonsils; 9 cases. 
.Apparently tonsillectomy had no great effect on type of disease. Although there was 
some slight variation It was not of statistical significance. 
in comparing recovery in groups tonslllectomlzed or not, we find recovery to be 
44,9% In the total group, 46.5% In the un tonslllectoml zed group, 41»e%. In-the group with 
tonsils out, while In the small group having.tonsils out recently, recovery was 68.5%. These 
variations are not significant, 
in conparlng recovery In the various types of polio the same Is true. 
Type 
Total 
Cases 
Tonsils |n 
Tonsils out 
Tonsi1s out Less 
than i year 
Sp f nal 
Recovered 
18. 5% 
16.9% 
21.055 
21.435 
Bulhar 
Recovered 
31.4* 
37. 535 
31. 155 
42. 835 
Fatal 
19.735 
20.035 
20.02 
14.32 
Here again, variations, according to tonsillectomies, are not large enough to be 
of value. Data regarding presence or absence of tonsils In household contacts were assembled. 
Of the 1234 household contacts, 436 or 35% had had their tonsils removed. Minor Illnesses 
were reported In 13% of this group, in the other group of untonslllectomlzed household 
contacts, 25% reported minor Illness, 
Part 11 
THE DISEASE 
No attempt has been made to go Into a scientific discussion of diagnosis or treatment 
In this paper, but rather, an attempt has been made to summarize the type of polio and the 
outcome, 
"Non-paralytlc« refers to those cases never showing any muscle weakness, "Spinal 
type" refers to those cases showing muscle weakness at some time during the disease. "Spinal 
bulbar" or- "Bulbar" refers to those cases showing symptoms of bulbar Involvement, The cases 
with only bulbar Involvement were so few they have not been dealt with separately, 
as to outcome, we have designated those cases with apparently no residual as 
"Recovered. " All cases showing any muscle weakness as of April i are designated as "Weakness." 
NO attempt as yet, has been made to evaluate permanency of paralysis, as this report is pre- 
pared, orthopedists and physical therapists state there are no cases not showing recovery of 
muscle power, 
in plotting the type of polio by week of onset, we do not see any great variation of 
types except that the numbers of spinal types were greater than other types all the way through 
the epidemic. 
However, If we divide the epidemic Into Its apparent peaks, we have three groups of 
cases, those In the first peak, or weeks 1-13, those In the second peak, weeks 14-27, and 
those In the last peak, weeks £8-40« 
peak period 
no. of cases 
Non-paralytic 
Sp i nal 
Spinal Bulbar 
weeks 1-13 
178 
69 or 38.7* 
75 or 42.1* 
34 or 19.I* 
weeks iu-27 
189 
43 or 22.7* 
98 or 51.8* 
48 or 25.3* 
Weeks 28-40 
32 
7 or 21.8* 
21 or 65.6* 
4 or 12.5* 
During each peak there was a decrease in non-paralytic type with an Increase In 
spinal type. Spinal hulbar was more predominant In the second peak, which was always con- 
sidered to be the most severe phase of the epidemic. 
Recovery by various age groups and type Is demonstrated by graph form. Recovery Is 
also listed by area of the state. Apparently recovery was less and fatality higher In the 
Northern and Eastern area. This may be related to the greater distance the patients have to 
be transported, not only to Boise but even from their home to the regional hospital. 
The type of treatment In Boise was not remarkably different from that used In other 
epidemics. The staff met frequently and treatments and procedures were quite uniform. There was no set procedure on spinal taps. They were not done routinely on admission 
as many patients had already had examination of spinal fluid, if there was doubt In diagnosis 
spinal taps were repeated, 
Beds were equipped with boards under mattresses and at the foot. At first convention- 
al piece packs were used. Later they were replaced by prone packs. The attending physicians 
felt that the patients were not as apt to be exhausted by the prone pack as the longer pro- 
cedure of piece prcks. 
Water balance was restored, blood transfusions given and antibiotics used as Indicated, 
Nearly all patients received physostlgmlne and curare was used In a few cases. Tracheotomies 
and bronchoscopies were done on Indication, oxygen was used frequently. 
Careful consideration was given to diet. Tray diets were high In protein and protenum 
used In liquid nourishments, large quantities of vitamins were given. This dietary regime 
was continued throughout convalescence. 
The cases sent In by outside physicians were remarkably well diagnosed. There were 
many difficult diagnostic problems, A few cases which were particularly confusing are cited. 
Early In the epidemic three brain abscesses were admitted. Diagnosis was confirmed at autopsy. 
There was a congenital syphilis with paralysis, a tuberculosis meningitis, an Influenza 
meningitis, a hemophilia, a case of scurvy with paralysis, 2 cases of encephalitis, and a 
menlngococclc meningitis. Three cases had severe encephalitic symptoms and diagnosis was 
questionable for some time. Three patients had definite hysterical symptoms, one came In 
with a "paralysis" of an arm following a long ride on a crowded Saturday night bus. He had 
been sitting with his arm over the back of a seat. Another man developed complete paralysis 
while In the mountains and was carried down on a litter between horses. The resident on duty 
diagnosed his case by means of an Ice cold test tube applied to the soles of his feet. The 
third case was really a psychiatric problem and gave a great deal of trouble. 
Reports on respirator cases Is of great Interest, it Is hard to arrange significant 
graphs on these cases as they are usually so few In number. There were 25 cases in respirators. 
Tracheotomies were done on 4 of these. Fifteen cases, Including 2 of the tracheotomies, 
survived. Three cases, Including the other 2 tracheotomies, are still In respirators. 
Tracheotomies were done on 5 other cases, one was done almost "In extremis" while 
the doctor was arranging for transportation. This 10 year-old female died. The other 4, all 
females, aged 15, 12, 4 and 3, lived and have made good recoveries. The following table shows the most pertinent Information on respirator cases, it Is 
apparent sex and tonsils were unimportant, six of the 10 deaths were 34 years of age or over, 
1 was under i year of age. Six recovered enough to be dismissed from the hospital and 6 others, 
although still hospitalized, are no longer In the respirator. Their ages all range from 2 to 14 
It was our experience that the younger respirator cases made better recoveries. 
RESPIRATOR CASES 
Case 
NO. 
Fam i1y 
NO. 
onset 
Week 
Residence 
(County) 
Sex 
Age 
Tonsils 
Out 
Days in 
Hospi tal 
Outcome 
6 
6 
2 
Ada 
M 
3U 
yes 
4 
Fatal 
19 
16 
2 
Ada 
M 
6 wk. 
NO 
127 
Fatal 
25 
21 
4 
Canyon 
M 
8 
Yes 
1 
Fatal 
35 
30 
5 
Canyon 
F 
65 ‘ 
NO 
5 
Fatal 
74 
12 
7 
Canyon 
M 
13 
yes 
43 
Recovered 
Normal Activity 
85 
12 
8 
Canyon 
F 
14 
yes 
19 
Recovered 
Sister of above 
10 4 
90 
9 
Lewi s 
F 
11 
No 
216 
Home 
Has weakness 
110 
95 
9 
Elmo re 
F 
4 
NO 
31 
Weakness ? 
Moved 
168 
151 
12 
Mi ni doka 
M 
24 
NO 
2 25+ 
Still in Respirator 
Tracheotomy 
203 
179 
15 
Bonnevi11e 
F 
25 
yes 
8 
Fatal 
T racheotomy 
240 
211 
17 
payette 
M 
4 
NO 
220+ 
Out of Respi rator 
1n hosp. weakness 
265 
227 
18 
Cassia 
M 
7 
NO 
23+ 
Out of Respi rator 
1n hosp. weakness 
267 
229 
18 
Canyon 
M 
35 
NO 
36 
Fatal 
Tracheotomy 
277 
237 
18 
Twin Fal1s 
F 
4 
NO 
3 
Fatal 
292 
250 
19 
Twi n Fal1s 
M 
6 
NO 
20 8+ 
Out of Resp. |n 
Hospital, Weakness 
293 
251 
19 
Twin Fal1s 
M 
2 
NO 
198+ 
Out of Resp. |n 
Hosp. weakness 
30 9 
255 
20 
jerome 
F 
9 
yes 
20 2+ 
out of Resp. in 
Hosp. Weakness 
3H 
265 
20 
Lewis 
M 
38 
NO 
5 
Fatal 
3 26 
277 
21 
Bannock 
F 
20 
yes 
3 
Fatal 
330 
280 
21 
Li ncoln 
M 
8 
yes 
192+ 
Out of Resp. |n 
Hosp. weakness 
350 
299 
22 
Lemh 5 
M 
9 
yes 
78 
Weakness 
Moved 
370 
314 
25 
Bannock 
F 
35 
yes 
12 
Fatal 
371 
316 
25 
Canyon 
M 
4 
NO 
47 
Home 
Weakness 
376 
321 
25 
Goodi ng 
M 
17 
yes 
150+ 
(n Resp. |n 
Hosp i tal 
>J 10 
355 
35 
jerome 
F 
36 
yes 
9 6+ 
Tracheotomy, |n 
Resp. |n HOSp. A complete listing of the fatal cases Is presented for more detailed study. 
FATAL CASES 
Case 
NO. 
Residence 
(County) 
Onset 
(Week) 
Sex 
Age 
Respi rator 
Tracheotomy 
Hospi tal 
(Days) 
6 
Ada 
2 
* M 
34 
yes 
NO 
4 
19 
Ada 
2 
M 
6 
wks yes 
NO 
127 
25 
Canyon 
4 
M 
8 
yes 
NO 
1 
35 
Canyon 
5 
F 
65 
yes 
NO 
5 
131 
Lemh i 
11 
F 
1 
NO 
NO 
0 
203 
Bonnevi11e 
15 
F 
25 
yes 
yes 
8 
267 
Canyon 
18 
M 
35 
yes 
yes 
36 
277 
Twin Falls 
18 
F 
4 
yes 
NO 
3 
284 
jerome 
19 
F 
6 
NO 
NO 
0 
311 
Lewis 
20 
M 
38 
yes 
NO 
5 
319 
Lewi s 
20 
M 
34 
NO 
NO 
7 
325 
Bannock 
19 
F 
10 
NO 
yes 
1 
326 
Bannock 
21 
F 
20 
yes 
NO 
3 
333 
Lemhi 
21 
M 
6 
NO 
NO 
1 
364 
payette 
24 
F 
3 
NO 
NO . 
0 
370 
Bannock 
25 
F 
35 
yes 
NO 
12 
402 
Bannock 
31 
F 
2 
mos. no 
NO 
1 
To summarize the 17 deaths: 10 wer e female, 8 had had tonsillectomies, 5 were under 
5 years of age and 6 were over 30. Eight of the cases had their onset between the 18 and 21 
weeks of the epidemic. 
Although It Is no epidemiological Importance, a summary of parts of the body Involved 
In the patients with weakness are listed below. 
no. of cases 
Spasm present 339 
Right cower involvement 158 
Left Lower involvement 154 
Right upper 73 
Left upper 66 
no. of cases 
Abdominal involvement 42 
Trunk involvement na 
Throat involvement 49 
Facial involvement 18 
On June 1, 1948* at the time of writing this report, 75 patients remained In convales- 
cent hospitals In Boise, Three of these were still In St, Lukes In respirators. From July 1, 
1947 until June 1, 1948 the non-paralytic cases were hospitalized an average of 19.6 days, the 
spirals 110.9 days and the bulbars 78.1 days. 
Two hundred thirty-one or 66 percent of the hospitalized patients were admitted within 
seven days following onset of symptoms and 80 or 33 percent were hospitalized during the second 
week of Illness. The remaining 11 percent were admitted after acute period. 
Page 8 The average day to be admitted to the hospital was the sixth day from onset of first symptoms* 
This same service cared for 13 patients from Oregon and l from Washington. They 
lived close to the Idaho border and Boise was the nearest hospital available to them. However, 
statistics on these cases are not Included In this paper. 
part in 
ADMINISTRATIVE PROCEDURES 
Early In July, 1947, when the first few cases appeared almost simultaneously, the 
administrators of the local hospitals, physicians and representatives of the public Health 
Department and a representative of the National Foundation for infantile paralysis conferred 
to discuss the situation and outline plans. At first It embodied local plans but as cases 
came In from other areas administration became statewide. 
The two local hospitals ve re surveyed and It was felt that St* Lukes could be better 
utilized for Isolation purposes, immediately all pediatric cases were transferred to St. 
Alphonsus and the pediatric wing of St. Luke's turned over to polio. Later this became In- 
adequate for acute- cases and another section of the first floor was used for Isolation, in 
the beginning, St, Luke's felt that they could provide ae beds for polio, but later hospital- 
ized as many as 49 patients. 
in the first few weeks, events moved rapidly. Almost-at once It was necessary to 
recruit nurses and physical therapists as none were available locally. At this point, under 
the guidance of the National Foundation for infantile paralysis, a state Advisory Council was 
appointed by Governor Robins. This enabled the pooling of funds from all the local chapters 
for the council to use In care of polio patients. From July 1 until April i the council 
dlspursed $550,000 furnished by the National Foundation for infantile paralysis. The council 
consists of representatives from the State Health Department, State Government, Red Cross, 
Hospitals,Medical Society and the National Foundation for infantile paralysis. The Director 
of Idaho State Crippled Children's Service Is chairman. 
The need for such a large sum of money was due to the fact that Idaho was totally 
unprepared for such a case load and had no teaching medical center, in nearly all large 
epidemics some teaching center has been available to furnish medical care. All of Idaho's 
cases were on a private patient basis. The local pediatricians and orthopedists, who cared 
for the cases organized and rotated services. During the heaviest weeks, the need of resident 
service was acute and residents were hired from medical centers. Their work was Invaluable, 
yet their periods of service were of necessity short and the rapid turn over meant confusion 
In many Instances. 
With only 26 beds at the start. It was soon necessary to find convalescent space. 
The Idaho State Elks Association had been planning a small convalescent home for the Crippled 
Children's Service for many years. Construction on the home had been delayed by the war, in 
August, when the need was acute, the building was hurriedly completed, and patients moved In. 
Later an addition was added and now Is an 85 bed convalescent home, until this unit was 
ready, convalescent patients were housed temporarily at veteran's Hospital, St. Alphonsus 
Hospital and the State Health Department's Rapid Treatment Center, 
in this expansion, It was necessary to buy full hospital equipment and supplies. 
All polio wards had to be rewired to carry the load required by packing machines and 
respirators. interest In the situation In Idaho resulted In the loan of two epidemiologists to the 
State, one from the university of Michigan School of public Health and the other from Children's 
Hospital Research Foundation, Cincinnati. Although neither of these men could stay long. Their 
epidemiological work was of great assistance. 
As polio appeared In other areas of the State, most of the patients were sent to Boise. 
Idaho Falls, Pocatello and Lewiston were able to hospitalize a few acute cases before they were 
sent to Boise for convalescent care. Eight patients from Idaho Falls were sent to Salt Lake 
City for convalescence, in all, from July i, 1947 to April i, 1948» 305 acute cases were 
hospitalized at St. Luke's Hospital and 339 cases received convalescent care In Boise, only 
62 of the 401 cases were not hospitalized at all. 
With patients coming from many areas, It became very difficult to keep the family 
doctor Informed of the patient's progress. There were no medical stenographers available. 
Crippled Children's Service loaned one to the hospital for 8 weeks but the press of follow-up 
clinics necessitated her return to the Crippled Children's Agency. 
The task of finding equipment was ably handled by the local chapter of the National 
Foundation for infantile paralysis. Hot pack machines, respirators and other equipment were 
sent from almost every part of the country through their efforts. 
When patients were ready for discharge It was necessary to organize follow-up clinics. 
This was done by the Idaho State Health Department Crippled Children's Service. At first they 
were held only In Boise but expanded to Twin Falls and Pocatello. When the regular Crippled 
Children's Clinics were held In the fall and spring, extra time was added to accommodate polio 
patients. 
The follow-up service demonstrated the need for continued physical therapy. As the 
number of patients sent home Increased, therapists were assigned to local areas. The service 
of these physical therapists were provided by the National Foundation for infantile paralysis 
under the direction of the Crippled Children's Service. At present, eight areas, Boise, 
Caldwell, pocatello, Idaho Falls, Twin Falls, Rupert, Jerome and Wendell, are being covered by 
seven therapists. Their load Is constantly Increasing and It will soon be necessary to add 
another therapist. 
One of the most unusual features of the treatment of these 401 patients has been their 
complete and prolonged care, only 27 patients have not been under the guidance of this central 
convalescent center. Eight have been lost by the family's moving away from the State and five 
have been transferred to hospitals In other states for the same reason. The remainder are 
being followed through the out-patient clinic service, 
in the early months the patients were too sick and too busy with treatment to allow 
much occupational therapy, but this has been added as recovery progressed. The patients are 
now having their time well filled with therapeutic occupational and recreational activities. 
For the past six years the Idaho State Crippled Children's Society has provided two 
part time teachers to serve the children hospitalized In Boise under the Crippled Children's 
program. They were ready to start teaching in September but It was January before many of the 
patients were ready for study. The service was Inadequate for the large number of children, 
even with the addition of a third teacher. The convalescent home was so crowled there was 
not adequate area for group teaching and It was necessary to do bedside work, plans are under 
way to enlarge this service by next fall. The Crippled Children's Service was without a medical social worker. Here again It 
was almost Impossible to find anyone locally with this training. A social worker was employed 
who was of great help In preparing parents and homes for the return of the patient, it was not 
until January that the National Foundation for infantile paralysis was able to find a well 
trained medical social worker. She has found many problems and It Is almost Impossible for her 
to help all in need of aid. 
public health nurses of the state acted as case finders, thus Insuring early and ade- 
quate medical care for many cases. They helped families make the necessary emotional adjust- 
ment to one of their members having poliomyelitis. They helped to Improve home environment 
and made follow-up visits and still continue this service to Insure best use of medical and 
physical therapy treatment provided. Where ever there was a lack of trained personal to provide 
necessary services, public health nurses functioned until such personnel was obtained 
The American Red Cross recruited a total of 260 nurses. This was a terrific task for 
the organization. Housing for the nurses was difficult. The Red Cross and other organizations 
did everything they could to find adequate rooms or apartments, in some Instances, local 
people were afraid to rent to anyone caring for polio patients. 
During December, January and February we had as many as 125 patients hospitalized In 
Boise. They were at St. Luke's Hospital, St, Alphonsus Hospital,The Elks Home and'The Rapid 
Treatment Center, it was very hard to keep each unit adequately covered for nursing service. 
The polio advisory council assigned one nurse to the Red Cross as placement supervisor. 
She visited all areas dally and became familiar with their needs. She then Interviewed all 
new recruits and placed them where needed and where Individual training was best utilized. 
During the epidemic publicity Involving new cases, releases from hospitals and conva- 
lescent units and reports of deaths were handled through one source. This proved extremely 
satisfactory from the viewpoints of the newspapers and radio stations, as well as hospital, 
medical and public health officials. Every effort was made to keep the public Informed as 
to the polio situation without creating panic of hysteria so frequently observed In outbreaks 
of the disease, 
A few local papers used pictures of hospitalized patients receiving treatment for 
purpose of fund-raising. This created unnecessary apprehension to many parents. 
Working relationships between all agencies has been very good and It was only through 
such cooperation that we were able to combat the epidemic. 
PART IV 
REVIEWS AND FUTURE PLANS 
After the first of the year the state polio Advisory Council tried to review their 
activities, criticize policies and formulate plans for the future. All people participating 
In the work and referring physicians were contacted and we have attempted to correlate all of 
these various Ideas and suggestions. 
The referring physicians had only two main complaints, the distance the acute patient 
had to travel and the lack of Information about patients. The council, from an administrative point of view, criticized the lack of uniformity 
In reports and bills from the variety of people from whom services or materials were purchased. 
The local hospitals main complaint was the need of orientation and organization of 
recruited personnel. They also voiced the need of more auxiliary service In the acute stage, 
for example, a dietician who could work directly In the Isolated units. 
Having summarized all sources of comment, the following recommendations are made: 
1. Acute Center, Acute centers should be developed In the Eastern and Northern 
areas. This would embrace equipment of hospitals, training of local doctors, long range 
recruitment of local people for training In polio nursing and physical therapy, working 
relationship should be developed among the staffs of hospitals where acute centers are 
located to Improve treatment and reporting. An acute center should be developed In Boise 
which would not completely disrupt other pediatric service, it Is felt that many doctors 
will continue to refer patients to this area, 
2. Convalescent Care, Convalescent care should continue to be centralized In Boise 
until such a time that orthopedists are available In other areas, 
3. out pitlent, out patient physical therapy and follow-up clinic service should 
continue. 
4. Nursing Service, Emphasis should be maintained on recruiting and training local 
personnel wherever possible. 
When necessary to recruit emergency nurses, each hospital so concerned should prepare 
and organize a staff to control: 
a. Administration of nursing service, 
b, orientation of recruits to physical set up of hospital and existing policies and 
practices, 
c. Expansion of hospital facilities to accomodate larger staff. 
d, organization of In-service training classes. 
The Red Cross should be given assistance In placement of nurses, use of a nurse 
supervisor of placement Is highly recommended. 
There Is need for a nurse to coordinate all nursing service In hospitals, convalescent 
centers and homes. This coordinating nurse should be a member of the advisory council with a 
background of training and experience In hospital work and In public health. 
5. Referral of patients. All doctors should be notified of technique to be used In 
referring a patient, it Is recommended that each local physician contact the acute hospital 
directly In requesting a bed, 
6. Finance and Fees, A fee schedule, approved by the State Medical Association, 
should be Instituted to equalize charges, if payment Is to be handled through a central 
committee. It Is recommended that a uniform charge slip be Issued to everyone giving service. 
This would save many bookkeeping hours. 
7. Medical Secretary, Every acute and convalescent center should have adequately 
trained secretarial personnel to permit frequent communications to family and family doctor. 8. Mealcal Social worko This service Is considered to be very vital and should be 
Increased as personnel is available* 
9. Mental Hygiene* The readjustment necessary to accept the physical handicap which 
poliomyelitis may cause, often gives rise to major emotional disturbance In both patient and 
family. Mental hygiene service should be available to these Individuals, 
10. Auxiliary Service. This applies particularly to convalescent centers. Teaching 
and occupational and recreational therapy should be developed. 
11, Rehabilitation. All services should center on rehabilitation of the patient. 
Vocational rehabilitation should enter Into care and planning for these patients eligible for 
for their service. 
12* publicity. The public should be truthfully Informed of Incidence but "scare" 
articles and headlines must be avoided. Honest, helpful articles as to cause and protection 
against polio are appreciated by the public. Actual names and addresses of patients should 
not be published. This Is a source of annoyance to the family at a time when it Is emotionally 
upset. Many curiosity seekers and even well meaning Individuals are prone to approach them 
asking questions, seeking or giving advice, adding to their problem. STATEWIDE-TOTAL CASES - 401 
MALES " 225 - 56c 1% 
FEMALES - 176 - 43.9% 
INCIDENCE 
WEEK OF ONSET 
Number of 
Cases INCIDENCE 
SOUTH WESTERN AREA 
TOTAL CASES 224 
Males 126 -56.3% 
Females 98 -43.7% 
WEEK OF ONSET 
Number 
of Cases SOUTH CENTRAL AREA 
TOTAL CASES 105 
Males 59-56.2% 
Females 46-43.8% 
INCIDENCE 
WEEK OF ONSET 
Number 
of Cases EASTERN AREA 
TOTAL CASES 56 
Males 31-55.4% 
Females 25-44.6% 
INCIDENCE 
WEEK OF ONSET 
Number of 
Cases NORTHERN AREA 
TOTAL CASES 16 
Males -9-56.3% 
Females -7-43.7% 
INCIDENCE 
WEEK OF ONSET 
Number of 
Cases NON PARALYTIC 
118 - By Week onset 
1 - No onset Date 
SPINAL 
194 - By Week onset 
BULBAR & SPINAL BULBAR 
66 -r By Week onset 
TYPE OF POLIO 
BY ONSET WEEK 
Week, of onset 
Number of 
Cases  
TYPES OF POLIO 
OUTCOME AS OF JUNE 1, 
1948 
Non paralytic 
Spinal 
Bulbar And 
Spinal Bulbar 
Not Known 
Total 
Recovered 
Weakness 
Fatal 
Not Known 
State 
119 
194 
86 
2 
401 
180 
200 
17 
4 
29.7% 
48.4% 
21.4% 
.5% 
44.9% 
49.9% 
4.2% 
1.0 
South West 
Area 
77 
105 
41 
1 
224 
112 
104 
6 
2 
34.4% 
46.9% 
18.3% 
. 4' 
50% 
46.4% 
2.7% 
c 9% 
South Central 
Area 
27 
52 
26 
0 
105 
44 
59 
2 
0 
25.7% 
49.5% 
24.6% 
41.9% 
56.2% 
1.9% 
Northern 
Area 
1 
9 
5 
1 
16 
4 
8 
2 
2 
6.3% 
56.2% 
31.2% 
6.3% 
25% 
50% 
12.5% 
12.5% 
1 
Eastern 
Area 
14 
28 
14 
0 
56 
20 
29 
7 
i 
1 
0 
25.0% 
50% 
25% 
35.7% 
51.8% 
12.5% NUMBER AND PERCENTAGE 
OF CASES BY AGE 
72.8% ALL CASES 
UNDER 15 YEARS OF AGE Unknown 
Non paralytic 
Sp i nal 
Bulbar 
PERCENTAGE TYPE OF POLIO BY AGE BULBAR 
1.3% 
Recovered 
Weakness 
Fatal 
unknown 
OUTCOME ACCORDING TO TYPE 
SPINAL 
Recovered 
Weakness 
NON PARALYTIC 
Recovered 
Not 
jRe co vered Completely Recovered 
Weakness 
OUTCOME SPINAL TYPES BY AGE Fata} 
Recovery 
Weakness 
OUTCOME BULBAR TYPES BY AGE 
'outcome unknown