Category: Archives and Records Management

How One Hospital Handled the 1918 Influenza Epidemic

By , April 2, 2020
Three doctors at the Peter Bent Brigham Hospital in Boston, MA outfitted for handling the influenza epidemic of 1918.

Doctors at the Peter Bent Brigham Hospital in Boston, MA outfitted for handling the influenza epidemic of 1918.

In 1918, no hospital, including the Peter Bent Brigham Hospital, a parent institution of the Brigham and Women’s Hospital, was spared the responsibility of caring for those afflicted by the worldwide influenza epidemic. The records of their battle with the mysterious illness endure in the BWH Archives held in the Center for the History of Medicine, Countway Library.

I say mysterious, because there was very little known about viruses or routes of contagion in the early years of the twentieth century. It would be more than a decade before the viral nature of influenza was uncovered and another quarter-century before the development of a vaccine or the widespread use of antibiotics for secondary bacterial infections. At the time, hospitals such as the Brigham could offer influenza patients supportive care (fluids, oxygen delivery, attention to heart, bowels, etc.). Also considered therapeutic—a good dose of fresh air.

Ventilation

The current Brigham and Women’s Hospital complex evolved on the site of the original Peter Bent Brigham Hospital. The Peter was designed in 1912 in the pavilion style, a hospital building system for which Florence Nightingale had been a strong advocate in the late Victorian era. The idea was that disease was probably spread in the “miasmic” air around the sick. This meant that patient wards were built as physically separated buildings designed for maximum cross-ventilation, with extra space between patients, and access to the outside. The wards were connected to each other and the main hospital building by an outdoor walkway.

The patient wards of the Peter Bent Brigham Hospital in 1918.

The patient wards of the Peter Bent Brigham Hospital in 1918. Note the outdoor beds for flu victims. (The ward pavilions were torn down in 1980.)

Flu patients in the Peter Bent Brigham Hospital recovering outdoors on the ward porch in 1918.

Flu patients in the Peter Bent Brigham Hospital recovering outdoors on the ward porch in 1918. Many archival photographs show patients recovering from illness outside in the early years of the hospital.

A New Warfront

When the influenza epidemic hit Boston, Dr. Henry A. Christian, the first Physician-in-Chief of the Peter Bent Brigham Hospital, was already dealing with a shortage of the experienced doctors and nurses who had taken leave to serve at military hospitals during the first World War—the armistice coming too late in the year to cause an appreciable change in staffing. Though filled to capacity and understaffed, the Brigham’s doctors, nurses, students, and volunteers worked selflessly to help the afflicted.

The best account of how the hospital managed the unexpected avalanche of influenza patients and the toll on his staff is from Dr. Christian’s own 1918 report:

 

The Influenza Epidemic

Henry A. ChristianIn the year 1918 no hospital event exceeded in importance and seriousness the epidemic of influenza, which burst upon Boston in September, and at the close of the year, was still prevalent, though to a lessened-degree. For a number of weeks practically the entire hospital was given over to the care of influenza cases. Every medical bed and half of the surgical beds were occupied by influenza cases. In the remaining beds were concentrated such surgical and medical cases as must needs remain in the hospital or be admitted as emergency cases. The Surgical Staff loaned to the Medical four of their house officers to care for influenza cases, and very generously the surgeons curtailed their work to a minimum. Without this help from the Surgical Staff we would have been unable to meet the needs of the situation.

The hospital cooperated with the Board of Health and took, in the main, cases selected by them, patients who could not be cared for at home, or those in almost dying condition that it was necessary to get out of their homes to ease the problem of home management of less seriously sick ones. Many died in a few hours after being brought to the hospital. The wards were filled with patients extremely ill with the pneumonia that accompanied influenza. More than half of our nursing and medical staffs themselves had influenza, but we managed to carry on without any outside help and without using probationers [newly admitted student nurses] or nurses’ aids in the immediate care of patients, feeling that for the less well trained the dangers of acquiring the disease from contact was greater.

From September 9 to December 31 we treated 557 cases of influenza. Of these about 60 per cent had clinically demonstrable pneumonia, a large percent being admitted to the hospital with pneumonia already developed. Of the influenza cases 153 died. A striking contrast to the general hospital cases were our nurses and doctors, who, put at once to bed and kept there, recovered with one exception. It seems certain that failure to go to bed and remain there was an important cause of the high mortality of the disease throughout the country. It had seemed wise to us to insist on a prolonged stay in bed after the temperature was normal. The very few relapses that we saw seemed amply to justify this course. No patients were hurried out of the hospital; all were urged to stay until we felt sure that their strength made the exertion of home life and getting there safe. In following up our patients since discharge we have found that results appear to show the wisdom of this course, for bad after-effects of the disease have been surprisingly few in our patients.

In handling influenza patients all who came in contact with them were gowned, capped, and masked, and care in washing hands was insisted on. Our present knowledge of influenza is too inadequate to make certain how far these precautions are necessary. At present they seem wise. Consideration of the infection among our nurses and doctors indicates that they acquired the disease not from patients in the wards but from contact with one another, or with maids, or with outside friends just developing the disease; in other words, the disease is most contagious during the incubation period. Only one non-influenza patient in the hospital acquired the disease in the hospital wards, and one patient acquired influenza in the operating room, probably from one of the doctors who assisted in operating on him as the doctor shortly thereafter developed influenza. Thus it would seem reasonably easy to maintain quarantine, even within an infected institution, when all visitors are excluded and other means of isolation are carried out. Such rigid quarantine probably is not possible in the community at large…

…Our nurses did most excellent work during the epidemic. The numerous cases of the disease among them made it necessary for the well ones to work with redoubled energy. Pupil nurses had to replace graduate head nurses as the latter fell ill, and so had thrust upon them much responsibility. Nurses could not but feel the grave danger they ran in handling a disease which evidently in some part of its course was extremely contagious and which was causing a high toll of deaths right under their eyes. There was no faltering; each did her duty and carried out her work efficiently. Particularly did the night nurses have a strenuous time, for in the silent hours of the night delirium was most active, and then it was that death claimed its largest numbers. The way our nurses met these demands upon them has caused the staff to feel great pride in them, and has been, I am sure, an occasion for much gratification to Miss Ivers and her associates who are immediately responsible for the training of the nurses. Personally it is a pleasure to me to voice here the feeling which all of the Medical Staff shares.

Leone N. Ivers, R.N., Acting Superintendent of Nurses, reported the situation for her nurses that same year:

On September 16, 1918, twelve nurses came down with influenza, and this epidemic was very serious during the balance of the year; the blackest day starting with forty-five nurses off duty. It was necessary for about one month to increase to a ten-hour day, with one afternoon off each week and four hours on Sunday. Enough cannot be said of the faithfulness and devotion of the nurses able to continue on duty during this period. It is with sincere regret that I am obliged to record the death of two of our pupil nurses. Marion Louise Winslow died from influenza at the New York Nursery and Child’s Hospital, New York City, October 12, 1918. She would have graduated January 26, 1919. Mabel Downton died from influenza at this hospital December 28, 1918. She was just starting on her senior year.

The full reports of all the administrators of the Peter Bent Brigham Hospital in 1918 can be read in the online version of the Peter Bent Brigham Hospital Annual Report for that year:
https://iiif.lib.harvard.edu/manifests/view/drs:427307276$1i

Center Receives Harvard Six Cities Study Research Data

By , June 4, 2018

Between 1974 and 1977, Harvard Six Cities Study researchers recruited residents who then completed questionnaires about their medical and occupational history, and underwent lung function (spirometry) tests. In this 1961 photo, a spirometer is demonstrated at the Harvard School of Public Health.

Respiratory Health Effects of Respirable Particles and Sulfur Oxides, commonly called the Harvard Six Cities Study, followed the respiratory health and air pollution exposure of children and adults living in six US communities between 1975 and 1988 (Harriman, Tennessee; Portage, Wisconsin; St. Louis, Missouri; Steubenville, Ohio; Topeka, Kansas; and Watertown, Massachusetts). Techniques were advanced to understand indoor, outdoor, and personal exposure to particles, acid aerosol, acid gases, nitrogen dioxide, and ozone, among other contaminants. Sponsors of the study included the National Institute of Environmental Health Sciences, the Electric Power Research Institute, and the Environmental Protection Agency.

The results were stunning. Residents of Steubenville—the city with the dirtiest air among the six studied—were 26% more likely to die almost two years earlier than citizens of Portage, which boasted the cleanest air.  These results paved the way for the nation’s first-ever Clean Air Act regulations on particulate matter smaller than 2.5 microns in diameter—rules that are now responsible for adding years to thousands of lives.

The historical narrative of the Six Cities Study has been relatively well-captured through numerous publications and Harvard T. H. Chan School of Public Health documentation; however, the long-term custody and preservation of the research data itself had yet to be addressed.

In September 2016, archivists from the Center for the History of Medicine, Francis A. Countway Library, met with faculty and researchers involved in the study to establish a plan, and in December 2016, custody of the data was transferred to the Center. Over the following six months, this large collection was rehoused, box listed, and cataloged. In addition to paper, Center staff discovered data in a variety of formats, including legacy media. Archivists also discovered photographs of researchers taking measurements in the field, background correspondence, and records relating to early precursor studies from one of the Harvard Six Cities Study’s early Principal Investigators, Benjamin Ferris.

Legacy media from the Harvard Six Cities Study being reviewed by archivists in June 2017.

In October 2017, after the physical transfer of the records had been completed, Center staff met again with faculty and researchers to better understand the types of data present in the collection and to determine how to facilitate future access. The group also discussed the various types of filters and media present in the collection to appraise their current research value.

Future collaborations are anticipated to help celebrate this significant study and its continued impact and relevance in today’s political climate.

The HOLLIS record relating to the Harvard Six Cities Study’s sponsored project administration records can be viewed here.The study’s original published findings (1993, NEJM) can be read online.

Staff Finds: Netter’s Clinical Symposia Illustrations and Other Publications and Pamphlets

By , May 10, 2017
Clinical Symposia 21, no. 1 (January-March 1969). Topics: “The Surgical Treatment of Myocardial Ischemia” and “Surgical Treatment of Cardiac Valvular Disease.” H MS c477

Clinical Symposia 21, no. 1 (January-March 1969). Topics: “The Surgical Treatment of Myocardial Ischemia” and “Surgical Treatment of Cardiac Valvular Disease.” H MS c477. From the Harvard Medical Library in the Francis A. Countway Library of Medicine.

While processing the papers of Marie C. McCormick (born 1946), Center staff found a collection of interesting pamphlets and publications on a range of topics. McCormick collected these materials as reference in her professional and research activities. Among those best represented in the collection are issues of the journal Clinical Symposia. The journal was published from 1948 to 1999 by Ciba Pharmaceutical Products, Inc. More than 250 issues of Clinical Symposia were illustrated by Frank Netter, M.D.; many of those illustrations were compiled into the 13 volume The CIBA Collection of Medical Illustrations (1953). Even after he retired in the early 1970s, Netter continued to produce illustrations at the astonishing rate of a new image every several days. In 1989, two years before he passed away at the age of 85, Netter published the Atlas of Human Anatomy, which was widely adopted at American medical schools and across the world. In all, Netter painted more than 4,000 medical illustrations during his lifetime (Hansen, 482-483).

Other publications collected by McCormick demonstrate the types of health and parenting advice that were distributed to parents in the late 20th century. They include a 1984 booklet entitled “Childhood Vaccination: Current Controversies,” a 1979 pamphlet entitled “What Parents Should Know about Shoes, Twisted or Bent Legs, and Flatfeet in Children,” which has easy-to-understand diagrams, and an undated booklet entitled “What Are the Facts about Genetic Disease?” which includes charts explaining how dominant, X-linked, and recessive inheritance works.

Also of interest is the graphic design on the covers of pamphlets. “Regional Emergency Medical Communications Systems” (1978) draws the eye with an interesting stylization of a warning light, “The Sudden Infant Death Syndrome” (1976) implies a harrowing situation, and “Cleaning Products and Their Accidental Exposure” (1989) subtly connects women with housework through dress-like bottle designs.

These examples and more can be found in the Marie C. McCormick papers, 1956-2016 (inclusive), 1968-2009 (bulk), which are expected to be open to research in spring of 2017. For information regarding access to this collection, please contact Public Services staff. Processing of the collection is part of the Bridging the Research Data Divide project, funded by a Hidden Collections grant administered by the Council on Library and Information Resources (CLIR). For more information on the project, please contact the project’s Principal Investigator, Emily R. Novak Gustainis, Deputy Director of the Center for the History of Medicine.

 

Reference
John T. Hansen. “Frank H. Netter, M.D. (1906-1991): The Artist and His Legacy.” Clinical Anatomy 19 (2006): 481-486.

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