Medical Front Lines

The Forgotten Epidemic

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We recently purchased a new television and, at the urging of our children, moved into the 21st century (25 years late!), dropped cable and picked up Netflix, YouTube, and Amazon Prime.

Admittedly, I’ve become addicted to reruns of “Downton Abbey”. Recently, I watched the episode where Cora contracted the Spanish Flu, which renewed my interest in the 1918 epidemic, mainly because it plays an indirect link to my ancestry.

And because I’m thinking about writing a romance based on my then-widowed grandmother, Olivetta DeJulio, who lost her first husband to the epidemic, then married my grandfather, Luigi D’Ambrosi.

But first, here’s a bit about America before the 1918 epidemic. The United States was involved in a world war, but despite that, people had more leisure time than any previous generation. They flocked to dance halls, pool halls, movies, and roller-skating rinks. Fans were obsessed with Hollywood celebrities and went to the movies regularly.

Though phone companies were working hard to expand their limited lines, the use of telephones up to 1918 was expensive. People traveling by rail tripled from 1896 to 1918. Only a Few Americans could afford cars. But Henry Ford, with his innovations, was about to change everything. So, the only way people could get news was from the newspapers. Every small town had at least one newspaper. Breaking news that needed to get out was done by printing another newspaper. These papers were called ‘extra’…now you know how the phrase, “Extra, extra, read all about it!” came about.

However, I digress…back to the epidemic of 1918.

There were two waves of the flu in the spring and fall. Though called the Spanish flu, it didn’t originate in Spain. They really don’t know for sure where it originated. Three suggestions are East Asia, Europe, or even Kansas. Why Kansas? It was March 9, 1918, at Fort Riley, Kansas, where 26,000 troops were stationed. They had several thousand horses and mules that deposited large amounts of manure. The problem arose of disposing of it. They decided burning it would be a good idea. March 9th brought a harsh dust storm, the combination of sand, dust, and manure ash stung the skin and offended the nose. The storm was so bad that it nearly blocked out the sun. Two days later, on March 11th, 100 men reported to the infirmary, all complaining of the same ailments of a bad cold. Whether or not this was the point of origin of the 1918 influenza that took over 600,000 American lives, we will probably never know. The epidemic spread not only within the U.S. but the abroad as well. By November 1918, the whole world was affected by the growing pandemic.

So, who died in this epidemic? You might think the young and old. If you guessed that, you’d be wrong. The 1918 pandemic disproportionately killed the healthy young adults. The reason wasn’t known why then, but through research, experts have discovered the virus killed through an overreaction of its immune system. The stronger the immune system, the stronger the reaction. Therefore, the young adults were far more susceptible, whereas a child or middle-aged adult had a milder reaction. Tragically, death came quickly. Victims had such a violent immune response that there are stories where people died within hours of showing symptoms of the flu. Their lungs would fill with fluids, and they would suffocate. The medical professionals of the time were helpless to stop the toll that the influenza took on young adults.

World War I added to the complications of the 1918 flu. Many doctors and nurses were overseas helping save our soldiers from sickness and wounds, leaving the United States short on clinicians. Struggling to keep up with the growing need, retired doctors were requested back to work, and medical students were summoned from their studies to help aid the sick.

Hospitals were so overwhelmed and overloaded with the sick that schools, buildings, church parish houses, armories, and even private homes were used as makeshift hospitals.

In attempts to slow the virus, schools, theaters, and churches were ordered closed in many cities. Some communities imposed quarantines as well as demanded that people wear masks.

Morgues were overloaded, caskets were in short supply, and secondary diseases were cropping up due to the lack of disposal of bodies quickly. Cities everywhere were running into the same problems. Casket companies were told they couldn’t make ornate coffins—they all had to be plain. In some places, public funerals were banned. All coffins had to remain closed unless they were identifying a body, and then they had to cover their mouth and noses.

With entertainment big business and all those people getting together, it became a huge concern for public health experts. At the height of the epidemic, government officials rushed in and closed many entertainment venues, fearing the spread of the virus. Since rail systems were so popular, it became an easy channel for the spread of the influenza virus. During the epidemic, cities became concerned about how easily the virus spread, causing some cities to limit and even close their transportation systems. Many cities that remained open had people wearing masks to reduce the risk of infection.

Onto a personal note…as I mentioned earlier, my maternal grandmother lost her husband to the Spanish flu. In 1919, she found herself a widow with four children. She nearly lost her oldest son, my Uncle Phil, too. Thinking he had succumbed, she called the coroner. Once he arrived, he noticed a twitching in his limbs. I’m happy to say he went on to live a long life as a tugboat operator on the Hudson River.

As the epidemic claimed more lives, family dynamics changed, leaving orphans, widows, and widowers.

 

One day, two women approached my grandmother asking to adopt my Aunt Jean and Aunt Mary. They surmised (wrongly so, in my grandmother’s opinion) that she would be better off with fewer children to raise. She sent them on their way, married her sister’s brother-in-law, and ultimately had five more children.

The 1918-1919 pandemic led to improvements in health education, isolation, and sanitation. It improved our understanding of influenza transmission, which is still implemented today to stop the spread of a disease that carries a heavy burden.

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On a much, much brighter note, I have a new book releasing September 20th!!

Pre-Order Link

Caroline Stoddard clung to Sister Benedict’s words like a lifeline as the train took her across the country from Boston to Pine Ridge, Colorado. After learning the orphanage was closing and she’d be without a roof over her head and a teaching position, she couldn’t have been more surprised when the Prioress referred her to Millie Crenshaw, owner of the Westward Home and Hearts Matrimonial Agency.

But life had another surprise in store for Caroline when she stepped off the train in Pine Ridge, Colorado. Instead of the new start she expected with James Murdock, her intended groom, he is nowhere to be found. With only a few coins to her name and no reason to return to Boston, she’s determined to make the best of it in this rugged land.

As the deputy sheriff in Pine Ridge, Knox Manning is haunted by a robbery gone wrong, making him question his ability to protect the town, and a stranded woman at the train depot with nowhere to go is the last thing he needs. But walking away isn’t in his nature. The badge he wears is both an anchor and a burden, one that caused him to sacrifice the one thing he always wanted—a chance for a home and a family.

Just as they begin to see each other in ways neither expected, and Knox dares to dream about a future with Caroline, the town of Pine Ridge is threatened by the same outlaws he’d been tracking for two years.

When Caroline is abducted, Knox realizes the gang had given him something worth fighting for—worth dying for, if necessary.

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Train Doctors (Reprised)

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Hello everyone, Winnie Griggs here. I apologize for reprising a previous post but I’m knee deep in tax filing prep right now. And since I have nineteenth century railroads on the brain (I’m part of the Love Train series author group some others have mentioned here) I thought this post from back in 2009 would be fun to look at again. So here we go.

There are articles and headlines aplenty to be found around the topic of health care, but would it surprise you to learn that one of the early adopters of employer-based health care was the railroads?

While the vast majority of nineteenth century workers had to find and pay for their own medical care, the railroads were developing a unique and valuable benefit for their employees.

Because the nature of railway work and travel conditions led to a higher-than-normal likelihood of injuries not only to railway workers but also passengers and bystanders, some form of available medical services became a necessity.  The problem was only exacerbated when the transcontinental railroad opened, greatly expanding long distance overland travel opportunities.  As an ever increasing number of people traveled the rails across unsettled territory, territory that never seen trained physicians or even the most rudimentary of medical facilities, the railroad companies had no choice but to hire their own physicians and create medical facilities along their routes.

Thus was born the era of train doctors.  Most of the physicians who answered this call were actually general practitioners who could also perform surgery. And because of the unique dangers railroad workers faced, the so-called train doctors found themselves dealing with types of injuries which few had dealt with before.  They were pioneers in the development of trauma care under primitive conditions, developing techniques and treatments that eventually found their way into routine medical practice.

From the outset, most of these practitioners expressed concern over the conditions and equipment they had to work with, as well as the ability to see their patients in a timely manner when minutes could literally mean the difference between life and death.

One tool that resulted from the drive to get stop-gap care to workers who sustained injuries in remote areas, were special packs devised by railway surgeons to be carried on all trains.  These packs were stocked with basic emergency supplies such as medicines, sterile dressings and basic implements. These were, in fact, the precursors of the modern day first aid kit.  Train doctors also promoted training key railroad workers in the use of these materials so that the injured party could be given appropriate first line aide until a proper physician could be reached.

As for facilities, early on railroad doctors tried using hotel rooms, spare rooms in private homes or even back porches for emergency medical care, but such rooms not only lacked the necessary equipment, their use also resulted in a large expense for the railroads who not only paid for the use of the room but also faced cleaning and replacement costs for bloodstained linens and furniture.  As an alternative, the train doctors pushed for the development and use of hospital cars which could serve both as properly equipped surgical stations and as the actual transportation for seriously ill or injured patients.

As could be predicted, the adoption of such cars greatly improved the survival rate of the seriously injured railroad worker and eventually evolved into highly sophisticated facilities.  They had room enough to handle the care of three to four patients at one time as well as house a fully equipped operating room.  They were scrupulously maintained in order to provide a clean environment in which the surgeon could effectively perform his duties, stabilizing his patients before sending him or her on to a regular hospital.

Speaking of hospitals, the railroads were also very influential in establishing such facilities along their routes.  In mid-century it was remarked that a person traveling from St. Louis to El Paso would traverse 1300 miles without passing a single hospital.  And this was only one of numerous such stretches in the country.  The first railroad to respond to this glaring need was the Central Pacific Railroad which opened its own hospital in Sacramento in 1869.  Other railroads quickly followed suit, establishing their own hospitals along well traveled routes.

Dr. C.W.P. Brock, President of the National Association of Railway Surgeons, was quoted as saying: Mr. Greeley’s advice to the young man to “go west” may be followed with great benefit by railway surgeons from the older sections of our country; and when they have seen the superb hospitals and the practical workings of the system they will say, as the Queen of Sheba said after seeing the splendors of King Solomon, “that the half had not been told.”

On a more practical front, another surgeon was heard to estimate that “the daily cost per patient at a railway hospital runs from 40 to 60 cents, compared to $1.00 to $1.50 at a city or contract hospital.”

Train doctors for the most part were  very progressive in the medical field.  They endorsed the emphasis on sterilization and overall cleanliness in patient care well before such thinking was met with universal acceptance.  They were also progressive in their attitude toward embracing women into their profession.

In addition to surgery dealing with railroad-related injuries and general trauma care, railway surgeons also took on the role of an overall health care provider.  They treated a wide range of illnesses, performed routine checkups, delivered babies and advised on safety, health and sanitation issues.

Alas, the train doctors are no more.  There were a number of factors that contributed to the eventual demise of the once highly effective and indispensable system.  Key among them was the change in government regulations and the explosion of medical advances in the 1950s.  The last of the railroad hospitals were sold or closed in the 1970s and the remaining train doctors retired, joined other practices or set up private practices of their own.

But these dedicated men and women left an enduring legacy. Their trade journal, The Railway Surgeon, though it reinvented itself a number of times, remains in print today under the name Occupational Health and Safety

The modern day specialty of occupational medicine can trace its roots to these surgeons.  They also helped to shape modern medical practice, especially in the area of trauma study and care.  They were pioneers in front line field care, in the stabilization and transport of the seriously injured, in overall trauma care and in the development and use of the modern day first aid kit.

All but forgotten by the vagaries of our national memory, train doctors nevertheless played a major, but largely unsung, role in making the settlement of the western frontier a safer proposition for all who travelled through or eventually settled in the surrounding areas.

Thanks for your patience in allowing me to reprise an older post. As a reward I’d like to offer a chaoice of any book from my backlist to on (or more!) of the people who leave a comment here.