Monday, February 9, 2009

Influenza in 1918: Recollections of the Epidemic in Philadelphia

In 1918 when the influenza epidemic hit Philadelphia, Isaac Starr was a third-year medical student. With so many medical practitioners away in the army, the third and fourth year students were called upon to act as nurses and interns. Starr wrote about his experiences in an essay that was published in 1976 then republished in 2006 (free PDF) in the Annals of Internal Medicine. (Picture: Emergency hospital during 1918 influenza epidemic, Camp Funston, Kansas)

As a third-year, Starr was assigned duties of head nurse. The epidemic started mildly with most of his patients admitted with just a febrile illness because their families were all ill and there was no one at home to care for them. This soon changed. He vividly describes the progression of the illness.

"As their lungs filled with rales the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth."

The physicians he had supervising him were mostly retired specialists. "I recall a laryngologist who seeing herpes labialis on a gasping cyanotic patient was much interested in it and prescribed application of guaiac." He was taught "cupping" by another physician. He was reprimanded for not leaving the windows open as this was the practice of the time for treating pneumonia (perhaps treating the dyspnea associated with it?).

Starr had few therapeutic options available. "When the pulmonary froth endangered life I gave atropine; when the patient was moribund and the pulse weak I injected camphor in oil." At the peak of the epidemic, the death toll was over 25% per night.

Starr wrote his account of the 1918 epidemic to share his experiences so that we might be better prepared if this should happen in the future. In reading his essay, I can't help feeling the helplessness they must have been experiencing. To see such death and suffering and know that there wasn't much that you could do to make it better, or even slow it down. I can't imagine what it was like to be still in medical school and charged with caring for a ward of dying patients. Even with all our medical advances, I find Starr's descriptions to be terrifying. It seems that an influenza epidemic is just as much a threat today as it was in 1918.

Reference: Starr, Isaac, Annals of Internal Medicine 2006; 145:138-140

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