Poliomyelitis is a highly infectious disease caused by a virus that is spread through person-to-person or faecal–oral contact. The effects of the disease range from mild to severe, from a minor transient illness to extensive long-term paralysis and even death. The virus invades the nervous system and can cause total paralysis in a matter of hours. The vast majority of cases produce very mild or no symptoms and these usually go unrecognised. No one knows why only a small percentage of infections lead to paralysis. Between 5% and 10% of those who are paralysed die when their breathing muscles become immobilised. Poliomyelitis can strike at any age, although it mainly affects children under the age of five, which is reflected in the name ‘infantile paralysis’ by which the disease was known until the 1870s. At all ages there are more male than female cases, although the case fatality rates of both genders are similar. There is no cure for poliomyelitis; it can only be prevented. The development of effective vaccines to protect against paralytic poliomyelitis was one of the major medical advances of the twentieth century. Poliomyelitis vaccine, given multiple times to a child, affords lifelong protection against the disease. Vaccination against poliomyelitis was introduced to Ireland in April 1957, coincidental with the waning of the epidemic outlined below.
Poliomyelitis may be as old as the human race but there are very few early examples of the disease. Minor poliomyelitis epidemics were reported from England, the United States and the island of Saint Helena in the 1830s, followed by more serious outbreaks in Scandinavia and the north-east of the United States in the 1890s and early 1900s. In 1916 there was a serious epidemic in New York City, where more than 9,000 cases occurred. After this, the incidence of poliomyelitis in the United States fell to a low level, but the number of cases rose to an annual average of some 40,000 between 1951 and 1955. From the mid-1950s, with the development of effective poliomyelitis vaccines, the incidence of the disease fell dramatically in the United States, Canada, South Africa, Australia and several European countries. Less than twenty years ago poliomyelitis was widely endemic on five continents but is now found only in parts of Africa and southern Asia. The World Health Organisation had targeted 2005 for the global eradication of the disease but this has not been achieved.
Ireland
Poliomyelitis only became a notifiable disease in Ireland in 1941. The first epidemic occurred in 1942 and continued into the following year. In all, 487 cases and 133 deaths were notified to the Department of Health, a fatality rate of 27.3%. The incidence of the disease fluctuated during the following years, with epidemic waves in 1947, 1950 and 1953. The following table shows the number of cases and deaths that were notified to the Department of Health for the 26 counties for the years 1950 to 1955 inclusive.
Year Notified cases Deaths
1950 200 30
1951 63 15
1952 96 13
1953 245 33
1954 82 14
1955 119 3
Source: Report of the Department of Health, 1956–57 (Stationery Office, 1957), p. 43.
Cork city and county escaped the 1942–3 outbreak completely, but the area was not so fortunate in the summer and early autumn of 1956. The first case was notified to the city medical authorities on 13 June. Two further cases were reported on 19 June, one on 2 July and another two on the following day, in the wake of which Dr J.C. Saunders, the city Medical Officer of Health (MOH), concluded that ‘an epidemic was imminent’. There was a steady increase in the number of cases from the second week of July onwards. By 9 August 90 cases had occurred in the city and 34 in County Cork, with one death, that of a five-year-old girl at St Finbarr’s Hospital on 15 July. Of the 90 notified city cases, 71 were under six years of age, eight were between six and ten years old, five were aged between ten and twenty, and the remaining six were older than twenty. The majority of cases occurred in the south side of the city, with Ballinlough, Friars Walk, Ballyphehane and Wilton particularly affected.
Iron lungs
Most victims were treated at St Finbarr’s Hospital, where a regional poliomyelitis centre had been established, one of three in the country. The others were the Dublin Fever Hospital, Cherry Orchard, and Galway Regional Hospital. In these centres, patients whose respiratory muscles had been affected were immobilised inside ventilators known as ‘iron lungs’, huge metal cylinders that operated like a pair of bellows to regulate breathing and keep patients alive. One survivor described the experience as similar to lying in a coffin with one’s head sticking out.
The medical authorities in Cork treated the situation seriously from the outset. Their objectives were to stop the spread of the disease and to limit the consequences in those who had contracted it.
Saunders and his medical colleagues ordered the closure of the Victoria Cross open-air swimming pool, warned of the dangers of swimming in any part of the River Lee, as the whole drainage of the city flowed into it, and published in the local newspapers a list of recommendations issued by the Department of Health for the control of poliomyelitis, including advice on hand-washing, especially before meals and after using the toilet, and on general hygiene. In addition, the medical authorities warned against undue fatigue and unnecessary travel into or out of communities where the disease was prevalent. They urged children to avoid crowded places, gatherings of other children and excessive exercise, and encouraged parents to have their offspring in bed before nightfall.
Authorities keen to allay fear and panic
Civic and church leaders, including the lord mayor of Cork, Alderman Seán Casey, TD, the minister for health, T. F. O’Higgins, and the Catholic bishop of Cork, Dr Cornelius Lucey, lent their full support to the public awareness campaign. All three were keen to allay fear and panic among the public. They claimed that the outbreak was a mild one and they stressed the necessity of adhering to the guidelines issued by the Department of Health. On 20 July, Alderman Casey appealed to the public to cooperate with the city MOH in combating the disease. He referred specifically to Dr Saunders’s exhortation ‘to avoid any excessive exercise or undue fatigue by the children’, adding that it was ‘most important that they should retire to bed at an early hour’. He had toured the city on the previous evening and was ‘dismayed and disappointed to find children still playing on the streets at a very late hour’. One week later, O’Higgins and his advisors attended a meeting in the city, after which the minister stated that there was no need for panic or public alarm. He emphasised that there should be no mass exodus from the city, nor should people be deterred from visiting Cork. Subsequently, O’Higgins inspected St Finbarr’s Hospital and St Mary’s Orthopaedic Hospital, and expressed satisfaction with the arrangements for dealing with the emergency.
Dr Lucey designated 28 July a day of special prayer for poliomyelitis victims and their families. Like the minister for health, the bishop of Cork was anxious to reassure the public. He observed that while it was a time of anguish and anxiety it was not a time for panic, although it was incumbent on everyone to take all reasonable precautions.
Despite the best endeavours of these individuals to assuage the public’s natural fears and concerns for their children’s health, the epidemic caused widespread fear and panic, a popular reaction that mirrored the public response to typhus fever, Asiatic cholera and other murderous and mysterious epidemics in the nineteenth century. Rumour abounded. It is now recognised that poliomyelitis is a faecal-borne disease spread by close human contact, but in the 1950s doctors disagreed over the causation and transmission of the disease. It was variously suggested that poliomyelitis was spread by flies, that it had been imported in second-hand clothes from the United States, where there was a high incidence of the disease, or, among other possibilities, that the outbreak was connected with pasteurised milk or with defective sewage systems.
Social and commercial life badly affected
Cork’s social and commercial life was badly affected, and school reopening was deferred. Tourism and business suffered, especially in the wake of advice by some government departments against unnecessary travel into or out of Cork. Many Cork people who worked in places like Dagenham, especially those with young children, cancelled their annual visit home. Attendance at cinemas, dance halls and sporting events dropped dramatically; children under twelve years of age were not admitted to cinemas; a scheduled visit of Buff Bill’s circus to the city was cancelled; and swimming and tennis tournaments and GAA activities were either postponed or abandoned.
On 1 August, following a request from Dr J. B. O’Regan, Dublin City MOH, the chairman of Cork County GAA Board appealed to supporters of the Cork football team not to bring children under fourteen years of age to the Cork–Kildare All-Ireland senior football semi-final at Croke Park on the following Sunday. The publication of this appeal in the following morning’s newspapers prompted a number of concerned Dubliners to contact the Department of Health and other agencies. One, writing under the pseudonym ‘People of Dublin’, asked the minister for health what steps his department had taken ‘to prevent the entry of Cork people, en masse’, into Dublin for the match. ‘Let “Cork’s own town” keep their polio and not infect our clean city’, he added, before urging the minister to ‘wake up and do something before polio of the Corkonians is laid upon us’. The failure to cancel the match infuriated at least one Dublin mother. She castigated the minister for having ‘the nerve to allow thousands of people come up from Cork last Sunday’, stating that it was disgraceful ‘to expose the children and people of Dublin to such danger. Of course’, she noted cynically, ‘the game of football is so much more important than the health and lives of children and adults. If there is an outbreak in the next few weeks, you will be responsible and have it on your conscience—but, it will be us mothers who will have the anxiety and sorrow if our children are struck down and I hope you will remember this.’
Cork reached the All-Ireland hurling and football finals in 1956. Both games were postponed by the central council of the GAA following a request from public health officials in Dublin, who were worried by the prospect of large numbers of Cork people descending on Croke Park. The medical authorities might have had cause for concern, given that there was a record attendance of 83,096 at the hurling final on 23 September, and a crowd of 70,772 at the football decider on 7 October. Both Cork teams were defeated, the hurlers by a superior Wexford team, in what proved to be Christy Ring’s last All-Ireland final appearance. In a fine sporting gesture, Ring was chaired off the pitch on the shoulders of Wexford backs Nicky O’Donnell and Bobby Rackard at the end of the game. Galway won the football encounter, deservedly, by a three-point margin. The sports headlines in the Cork Examiner on the following morning acknowledged that ‘Cork had no answer to Stockwell–Purcel combination’. Frank Stockwell scored two goals and five points and was, according to the Examiner, ‘the vital difference between two great-hearted teams’.
‘A trifling epidemic’
The epidemic peaked in September but the number of reported cases of paralytic poliomyelitis nationwide remained comparatively high for the next seven months, and it was not until May 1957 that the incidence of the disease returned to ‘normal’ levels. Dr Saunders claimed that there was no justification for the panic that gripped Cork city and the country generally during the summer and autumn of 1956, which he blamed on sensationalist reporting in certain newspapers. He and other commentators acknowledged the scale of the epidemic but stressed that the outbreak was relatively mild in character, an assessment that was borne out by the official statistics. In 1956, 499 cases of paralytic poliomyelitis, resulting in twenty deaths, were notified to the Department of Health for the entire country. Of this total, 213 cases were admitted to the Dublin Fever Hospital in Cherry Orchard; eight died, giving a fatality rate of 3.83%, compared with 3.49% in 1955 and 8% in 1954. There were 220 cases and five deaths in Cork city and county, a comparatively low fatality rate of 2.3%, particularly if the 1942–3 epidemic is taken as the benchmark. Dr Gerald P. McCarthy, MOH for County Cork, concluded, with some justification in the light of these figures, that the poliomyelitis outbreak in the city and county was no more than ‘a trifling epidemic’.
On 11 November 1957, Dr Patrick N. Meenan, a pathologist at St Vincent’s Hospital, Dublin, warned, in a report to the Medical Research Council on Irish antibody levels to poliomyelitis virus, that the country was ‘at considerable risk of large scale poliomyelitis epidemics’. Meenan’s survey disclosed that antibody levels to the virus throughout the country were relatively low and, he concluded, ‘if living conditions continue to improve we must expect to share the experience of all other countries where natural immunisation against poliomyelitis has fallen coincidentally with rising standards. One of the most striking features of the epidemiology of poliomyelitis in recent years has been the occurrence of severe epidemics in countries which previously had remained exempt, and there is no reason to suppose that this country should be spared.’ That the country was spared another poliomyelitis outbreak was due to the introduction of an effective vaccination programme, even if the public’s response to the initiative was less than enthusiastic at the outset.
The number of deaths that resulted from the 1956 poliomyelitis epidemic in Cork was relatively small, but many survivors were left with a physical disability. Rehabilitation services were inadequate, and the Cork Poliomyelitis Aftercare Association was established on 29 May 1957 to address this situation. This body evolved into the COPE Foundation, whose activities today encompass the care of children presenting with various types of intellectual disability in the city and county of Cork.
Laurence M. Geary lectures in history at University College Cork.
Further reading:
B132/308 General: Polio outbreak in Cork 1956. Department of Health and Children Papers, Hawkins House, Dublin 2.
P. Cockburn, The broken boy (London, 2005).
H.V. Wyatt, ‘Poliomyelitis’, in Kenneth F. Kiple (ed.), The Cambridge World History of Human Disease (Cambridge, 1993).