Wednesday, June 17, 2020

Firsthand Accounts From Doctors And Nurses On The Frontlines Of The Spanish Flu


Susanna Olson April 15, 2020
Arriving at the tail end of WWI, the so-called "Spanish" Flu (or the H1N1 virus) traveled with returning soldiers to every inhabited continent. Doctors and nurses worked tirelessly to care for their patients, sometimes forgetting to sleep or eat. Thousands of medical workers expired on the front lines of the fight against the disease.
The fatal strain of influenza may have originated in the United States, France, or the United Kingdom. The countries were in the midst of fighting WWI, so their governments downplayed the outbreak in the name of keeping up morale. Because Spain was neutral in the war, Spanish newspapers were free to report about the pandemic. Thus, the disease became known as the “Spanish” Flu. Before it was over, at least 50 million people had lost their lives. It was the worst pandemic of the 20th century. 
Despite the shortage of official reporting, photographs from that time period and chilling quotes from health workers can help us understand what life was like during the 1918 pandemic.
"It Seemed As If It Would Not Be Possible To Get Coffins For The Dead"
In June of 1918, influenza began wreaking havoc on the city of Manchester. The city’s Medical Officer of Health, Dr. James Niven, said that: 
The distress was prolonged, so that it was realized that a real calamity had befallen the city. Mothers and fathers were often stricken together. The children, themselves ill, could not receive attention, and for a time it seemed as if it would not be possible to get coffins for the dead, or gravediggers to dig the graves.
Manchester wasn’t the only place with a coffin crisis. In some places, whole towns ran out of wood to make coffins. In one case, a city's health official decided to steal a load of coffins from a passing train. Dr. Niven described the effect of the shortage on his city: 
Great difficulty occurred in getting the dead buried at the height of the epidemic, partly because of the lack of grave diggers, partly because of the difficulty in getting coffins. Bodies were left as long as a fortnight unburied, partly at home, partly at the public mortuaries, and partly at the premises of undertakers.
"We Don't Care A Rap What The Owners Of The Building Think About [The Quarantine]"
During the height of the outbreak in the United States, public health measures varied drastically from city to city. Spokane’s public health officer, Dr. John Anderson, imposed some of the strictest regulations in the country, including closing public places, requiring everyone to wear masks, and arresting people who initiated social gatherings. 
Dr. Anderson plowed forward with plans to turn a local hotel into a hospital, even when the hotel owners refused to cooperate: 
We don’t care a rap what the owners of the building think about it or about us… We don’t propose to haggle with them over it. This is a very serious emergency and if the owners of the Lion Hotel think they can put a dollar in one side of the scale and a human life in the other and get away with it they are very, very badly mistaken. 
Anderson believed in protecting his city at all costs. As the body count rose, he continued to take drastic measures, regardless of public opinion. He told a local newspaper
It is just as necessary to concentrate responsibility and authority in one man here as on the battlefield. Perhaps more so, for the soldier fights a visible foe while the health authorities and the physician are combating an invisible enemy… It is prompt action which saves the day, and we know it as never before after this epidemic.
"We Would Put Winding Sheets On Them Even If They Weren't Dead"
After graduating nursing school, Josie Mabel Brown moved to Great Lakes Naval Hospital. As she settled into her first nursing job, influenza cases began to overwhelm the staff and resources of her hospital. The pain of her first placement stayed with her the rest of her life. Since there were twice as many sick men as beds, she had to wrap soldiers for burial before they passed: 
As the boys were brought in we would put winding sheets on them even if they weren't dead. You would always leave the left big toe exposed and tag it with the boy's name ran[k], and next of kin.
"The Dead Bodies Are Stacked... Like Cord Wood"
The first wave of flu hit armies in Europe right at the end of WWI. More soldiers succumbed to the disease than in combat. Medical personnel, like Victor C. Vaughan, despaired at the scale of the crisis: 
I see hundreds of young, stalwart men in the uniform of their country coming into the wards of the hospital in groups of ten or more... They are placed on the cots until every bed is full and yet others crowd in. The faces soon wear a bluish cast; a distressing cough brings up the blood-stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.
"I Wonder Whether We Can ... Control The Hysterical Desire ... To Get Into Nursing"
When the first outbreak of influenza hit the United States in 1918, thousands of professional nurses were abroad serving with the army. This led to a massive shortage of healthcare workers in the US. To respond to the crisis, cities began recruiting nurse volunteers through short-term training programs. Clara Noyes, the head of the American Red Cross Nursing Service, noted: 
There are moments when I wonder whether we can stem the tide and control the hysterical desire on the part of thousands, literally thousands, to get into nursing.
Registered nurses, like Noyes, had spent decades demanding respect and fair pay for nursing professionals. Noyes despaired that the rise of volunteer nurses might damage their hard work: “[T]he most vital thing in the life of our profession is the protection of the use of the word nurse.”
"The Nurse Developed A Lung Infection, Dying Soon After The Woman She Had Been Nursing"
During the peak of the pandemic, hospitals did not have enough space to adequately distance beds or enough equipment to keep medical personnel safe. As a result, thousands of nurses perished while in service. 
Basil Hood, the medical superintendent of St. Marylebone Infirmary, mourned his diminishing staff: 
Each day the difficulties became more pronounced as the patients increased and the nurses decreased, going down like ninepins themselves... Sad to relate some of these gallant girls lost their lives in this never-to-be-forgotten scourge and as I write I can see some of them now literally fighting to save their friends then going down and dying themselves.
Dr. Hood described how one nurse was so dedicated to her patient that she refused to rest. He said, “She was consumed with a burning desire to save her … inevitably, the nurse developed a lung infection, dying soon after the woman she had been nursing.”
“Porters Went To Fetch [A Patient] With A Wheelbarrow Because There Was No Other Transport Available."
During the pandemic, hospitals lacked sufficient supplies to care for their patients. Medical workers had to make due with whatever was available. For example, one nurse in Christchurch, New Zealand, described her harrowing experience moving a patient in a wheelbarrow
The wife was taken back to her hotel, but nobody knew where it was. The husband was admitted to my ward. He was very delirious, singing hymns one minute, cursing the next. He got out when no one was looking and, in his nightshirt… The porters went to fetch him with a wheelbarrow because there was no other transport available. He died later that same day.
The nurse goes on to explain that this couple was on their honeymoon. The H1N1 virus was particularly fatal for young people between the ages of 20-40. Medical workers watched patients expire right as their lives were supposed to begin.
“We Thought She Had Black Stockings On, Until We Discovered It Was Dirt!”
In the midst of all the tragedy, healthcare workers had to maintain both grit and fortitude to treat all their patients with dignity. A volunteer nurse named Dorothy Hoben remembered that: 
One night the ambulance men brought in a fat old woman who must have weighed at least sixteen stone and was incredibly dirty. We thought she had black stockings on, until we discovered it was dirt! … She was so very, very ill. At least the poor old soul died clean.
“He Just Couldn’t Accept That He Hadn’t Died, And Became So Deranged... He Was Removed To A Mental Hospital.”
In some cases, the mental stress of the pandemic led to mental breakdowns. Jean Forrester, a member of an ambulance brigade, reported of one patient: 
[He] was delirious and kept asking if it was four o’clock, as he was going to die then. Four o’clock came and went, but he did not die. He just couldn’t accept that he hadn’t died, and became so deranged in his ravings that he was removed to a mental hospital.
This case was not an isolated anomaly. New York City’s Health Department Chief reported that in some influenza patients “intense and protracted prostration led to hysteria, melancholia, and insanity with suicidal intent."
A Live Woman Was Found In Bed With Her Dead Husband “Driven Out Of Her Mind.”
While in some patients the virus brought on delirium and self-destructive behavior, others faced mental breakdowns due to the stress of the pandemic itself. The pandemic spurred despair and anxiety, even in healthy people who never caught the virus. For example, while on a house call, Maurice O’Callaghan of the St. John Ambulance Brigade, found a woman in bed with her deceased husband: 
We found a man who had been dead three days. His body was in the bed, and his wife was lying in the same bed, not dead but driven out of her mind with a dead husband and could not get up.
A WWI Veteran Said Working As A Flu Nurse Was Worse Than Losing His Arm In Battle
One night, as Ivy Landreth was volunteering as a nurse in New Zealand, a sick man ended his life by cutting his throat. Her brother had to take care of the body. She recalled her brother, a WWI veteran, saying that working in the hospital was worse than going to battle: 
He had never experienced anything so bad all the time he was at the war, in spite of the fact that he had lost his left arm at Passchendaele.
Some call the generation that came of age during WWI and the Spanish Flu "the Lost Generation," because so many young people lost their lives. Many soldiers and nurses who survived the war, passed soon after from influenza. 
The St. Louis Health Commissioner Refused To Ease Social Distancing Measures, Telling The Mayor “You CAN’T Do It” And “I WON’T.”
During the 1918 influenza pandemic, the health commissioner of St. Louis, Dr. Max C. Starkloff, closed all non-essential businesses (including schools, churches, parks, saloons, and dance halls) and banned gatherings. He knew that St. Louis citizens were not happy about the drastic measures: “I looked into my waiting room (the next day) and it was black with people protesting the order...” 
Even the Mayor objected, telling the commissioner that he had “overdone it.” When the Mayor asked Starkloff to lift the rules, Starkloff stood firm. “Mr. Mayor, you CAN’T do it,” Starkloff said, “and I WON’T.”
Dr. Starkloff’s leadership paid off. A 2006 study concluded that St. Louis lowered the impact of the virus more successfully than any other large city in the US.
Patients Were “As Blue As Huckleberries”
At first, it was difficult for doctors to differentiate between H1N1 and the conventional flu. Patients developed flu-like symptoms, including fever, nausea, and aches. However, in more severe cases patients developed dark spots on their skin and severe pneumonia. 
Dr. Albert Lamb from a New York City hospital described watching his patients suffocate as their lungs filled with fluid: 
On admission, nearly all of the cases were as blue as huckleberries… Most of them died… We had to stand by helpless except for what temporary relief we could give.
“We Worked Day And Night, Hardly Taking Time To Eat”
Throughout the pandemic, nurses, doctors, and public health officials worked tirelessly to save lives. One nurse from Michigan, Annie Conlon, described her experience working on the front lines: 
We had a terrible time in this country (Luce County, Michigan), losing 100 persons, or one person out of 50… I worked with Dr. Perry, our health officer, going to the logging camps in the hospital, in the homes, wherever the need was greatest at the time. We worked day and night, hardly taking time to eat.
Annie’s story reminds us of the heroism of healthcare workers, past and present

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