Polio was a significant public health challenge of the 20th century, and Northfield Wards played a central role in South Australia’s response. The hospital became known for caring for acute adult and children patients suffering from polio, as well as those left with long-term disabilities.
In the summer of 1922, South Australia was struck by a serious polio epidemic. In response, the government built the Metropolitan Infectious Diseases Hospital at Northfield, opening in 1932. As well as caring for polio patients, the hospital treated all patients with infectious diseases.
First Polio Epidemic
Through the early 1930s, polio was relatively uncommon, with only a handful of cases reported each year between 1931 and 1936. That changed dramatically in 1937, when a major outbreak in Melbourne spread into South Australia. By the end of the year, the government had introduced strict emergency measures. Acute polio patients were no longer admitted to Adelaide Hospital or Adelaide Children’s Hospital during the three week infectious period. Instead they were sent directly to the Metropolitan Infectious Diseases Hospital, while the main city hospitals took on patients only once they were no longer contagious.
The pressure on the Metropolitan Infectious Diseases Hospital was immediate. In December 1937, the hospital’s Medical Superintendent, Dr Alan Finger, urgently called for 12 trained nurses to be appointed within four days to handle the rising admissions. Four wards were already filled with polio patients, and all six of the hospital’s mechanical respirators, known as iron lungs, were in constant use. Three had been running without pause since January.
Building a Better Iron Lung
At the time, Australia relied on imported Drinker Iron Lungs from the United States. They were expensive, heavy and hard to get. In response to the outbreak, the South Australian government asked Edward and Donald Both to develop a cost-effective iron lung. Within weeks, the Both brothers had produced a simpler, lightweight respirator made mostly from wood. The device worked on the same principle as the Drinker Iron Lung, negative pressure ventilation. The mechanism that created the negative air pressure inside the cabinet was external. It used an electric motor connected to a large cylindrical bellows mounted on a wheeled stand. A wide flexible tube connected the bellows to the cabinet, and the rhythmic movement of the bellows generated the necessary pressure changes to support the patients breathing. Despite being made of plywood, these respirators were still called ‘iron lungs’.
As the epidemic grew, hospital routines became more rigorous, New admissions were given full examinations, vital signs were recorded every four hours and urine tests were frequent. Tracheotomy tubes were regularly cleaned, and respirators were checked daily for airflow, pressure and seal integrity. Skin checks for infections or bedsores were mandatory.
Sharing the Load Between Hospitals
By 1939, polio showed no signs of easing. Space at Royal Adelaide Hospital and Adelaide Children’s Hospital was tight, so convalescent patients were transferred to Northfield, children under 12 from the Children’s Hospital and patients over 12 from Royal Adelaide Hospital. During this time, physiotherapy and massage treatments began to be incorporated into treatment plans, with both hospitals using the Metropolitan Infectious Diseases Hospital facilities for follow up care. That same year, to ensure respirators could continue running during power outages or failures, an emergency power plant was ordered from England and installed in the paralysis ward. This avoided the need to manually operate the respirator during blackouts, something that not only put patients’ lives at risk but caused considerable distress, especially during electrical storms or unexpected power cuts.
In the early 1940s, the hospital’s equipment improved further. Keepalite battery systems were added to ensure uninterrupted power, and manual rotary beds were introduced to prevent bedsores and help patients with breathing. Life inside an iron lung was made more bearable with books, radios and newspapers, often read through a mirror positioned above the patients face.
The next major outbreak came in May 1949. By then, the Metropolitan Infectious Diseases Hospital management had transferred to the Royal Adelaide Hospital and was renamed the Northfield Wards of Royal Adelaide Hospital. By September, polio patients were peaking at over 80 cases. Dr Howard Linn, Northfield’s Medical Superintendent, enforced strict isolation. Between May 1949 and early 1950, the hospital treated 661 confirmed cases. In his office, Dr Linn kept a large map of Adelaide studded with red pins showing the spread of the disease. The heaviest clusters lay in the eastern suburbs, although no area was untouched.
A Patients Story
A patient who arrived at Northfield Wards in February 1950 described the experience. On arrival, blood and spinal fluid samples were taken, and if polio was confirmed, a three week isolation period began. The wards were spread across the site and linked by covered cement walkways. In the early days of admission, many patients couldn’t sit up, speak, or swallow, and suffered severe headaches, muscle weakness or paralysis. “You are simply put to bed, fed and you keep your fingers crossed,’ she wrote.
Small comforts made a difference. The arrival of mail was the day’s highlight, and parcels often brought amusement. One husband sent his wife a sugar bag stuffed with gifts, including three dozen boxes of matches. Patients spent mornings on the verandah for fresh air, separated from the rest of the hospital by high wire fences. After two weeks, those well enough were finally allowed a bath, a welcome change from 4am sponge washes.
(Part of the hospital’s 50th Anniversary Celebrations)
Discharge was determined by the physiotherapist. Those not yet fit to return home were moved from the infectious section to a convalescent ward outside the fenced compound, where rehabilitation began. The polio ward offered little in the way of personal comfort. Patients wore striped hospital pyjamas, often mismatched. Personal belongings were confiscated for fumigation and returned only upon discharge. Letters sent by patients were also fumigated. There was no privacy or luxury. ‘Hairdos were a thing of the past’. There was also real anxiety about the long term effects of the disease. Muscle weakness could appear months after the acute infection, and mothers worried about how they would manage once discharged.
Northfield’s staff came from many backgrounds, including new arrivals to Australia. One of the ward’s most popular nurses was a young Estonian woman, trained in Europe. The patient concluded her account by noting, ‘What I saw at Northfield showed me how terrible poliomyelitis can be, especially if not recognised early’.
Some cases stayed in the public mind. Joyce Brooks, a 26 year old mother of two, spent almost three years confined to an iron lung at Northfield Wards. Completely paralysed below the neck, she was known for her optimism and warmth. Her death in November 1954 deeply affected the community.
Vaccine
By 1956, doctors had learned that weaning long term patients off respirators brought both physical and psychological challenges, with some developing dependency after prolonged use. That same year, Australia began its polio vaccination program with the Salk vaccine, and case numbers began to fall quickly.
- 1956: 38 cases
- 1957: 18 cases
- 1958: 3 cases
- 1959: 2 cases
- 1960: 8 cases
- 1961: 44 cases
- 1962: 17 cases
- 1963: 6 cases
The first post vaccine outbreak in Victoria in late 1957 was quickly contained, but South Australia had a brief outbreak in 1961. Public education and vaccination quickly brought numbers back down.
Since opening, through every South Australian polio outbreak, Northfield Wards was front and centre, providing both acute treatment and long term rehabilitation for thousands of patients across the state.
Written by Margot Way, CALHN Health Museum
