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{"id":4654,"date":"2014-08-15T11:00:52","date_gmt":"2014-08-15T15:00:52","guid":{"rendered":"http:\/\/circulatingnow.nlm.nih.gov\/?p=4654"},"modified":"2024-10-15T15:52:28","modified_gmt":"2024-10-15T19:52:28","slug":"a-physicians-perspective-on-the-russian-flu","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2014\/08\/15\/a-physicians-perspective-on-the-russian-flu\/","title":{"rendered":"A Physician\u2019s Perspective on the Russian Flu"},"content":{"rendered":"<p><em>In November 1889, a rash of cases of influenza-like-illness appeared in St. Petersburg, Russia. Soon, the \u201cRussia Influenza\u201d spread across Europe and the world. This outbreak is being researched by teams of Virginia Tech students as a case-study of the relationship between the spread of the disease and the spread of reporting about the disease. In this last of three posts, <\/em>Circulating Now<em> welcomes guest bloggers Alexis Abraham, Veronica O\u2019Rourke, and Crystal Velasco, who look at the diagnosis of the disease from the perspective of a contemporary physician.<\/em><\/p>\n<p>In December 1889, doctors all over Europe were confronted by patients with symptoms thought to be associated with the Russian Flu. The rapid spread of the disease presented doctors with new challenges in diagnosis and treatment. In the first months of the disease outbreak, newspapers reported on discussions among scientists and physicians about the common symptoms, probable impact, and expected course of the disease. (For examples, see <em><a title=\"La Epoca\" href=\"https:\/\/hemerotecadigital.bne.es\/hd\/viewer?oid=0000521619&page=3\" target=\"_blank\" rel=\"noopener\">La \u00c9poca<\/a><\/em>, December 2, 1889; <em><a title=\"Le Temps Archives Historiques\" href=\"https:\/\/www.letempsarchives.ch\/recherche?q=russian+flu\" target=\"_blank\" rel=\"noopener\">Le Temps Archives<\/a><\/em>, December 13, 1889; <em><a title=\"Biblioteca Digital Hisp\u00e1nica\" href=\"https:\/\/hemerotecadigital.bne.es\/hd\/viewer?oid=0000602323&page=2\" target=\"_blank\" rel=\"noopener\">Diario oficial de avisos de Madrid<\/a><\/em>, December 20, 1889). Because the flu symptoms varied among patients, it was difficult for physicians to give an explicit and proper diagnosis. At the same time, the widespread news reports about the widespread and seemingly deadly disease increased pressure to make correct diagnoses.<\/p>\n<p>The process of identifying flu victims during these early stages of a disease outbreak can be illustrated using a report published after the epidemic subsided. Dr. John Moore, a Dublin physician during this period, offered this account to demonstrate how physicians relied on the self-reporting of symptoms by individuals to help with their diagnosis. <a title=\"NLM's LocatorPlus Catalog\" href=\"https:\/\/catalog.nlm.nih.gov\/permalink\/01NLM_INST\/1o1phhn\/alma992041063406676\">This 1890 report<\/a>, in volume 8 of the <em>Transactions of the Royal Academy of Medicine in Ireland<\/em>, which included notes on patients and personal observations, provides evidence of how medical officials across the world sought to identify and control a disease that produced such varied symptoms among patients.<\/p>\n<p><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/article-title.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"4731\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2014\/08\/15\/a-physicians-perspective-on-the-russian-flu\/article-title\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/article-title.jpg?fit=1394%2C616&ssl=1\" data-orig-size=\"1394,616\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Article-Title\" data-image-description=\"<p>The Influenza Epidemic of 1889\u201390, as observed in Dublin. By John William Moore, B.A., M.D., M.Ch., Univ. Dubl.; Fellow and Registrar of the King and Queen\u2019s College of Physicians; Physician to the Meath Hospital, Dublin. [Read in the Section of Medicine, February 28, 1890.]<\/p>\n\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/article-title.jpg?fit=300%2C133&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/article-title.jpg?fit=840%2C371&ssl=1\" class=\"aligncenter wp-image-4731 size-large\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/article-title.jpg?resize=650%2C287&ssl=1\" alt=\"Detail of the title page of Dr. Moore's Journal article: The Influenza Epidemic of 1889-90, as observed in Dublin.\" width=\"650\" height=\"287\" \/><\/a><\/p>\n<p>One of the most important contributions of these physicians\u2019 reports were the detailed case histories of individual patients, which were designed to show both the challenging of diagnosis and the relative effectiveness of treatments. One of these case studies is included here:<\/p>\n<div class=\"tiled-gallery type-rectangular tiled-gallery-unresized\" data-original-width=\"840\" data-carousel-extra='{"blog_id":1,"permalink":"https:\\\/\\\/circulatingnow.nlm.nih.gov\\\/2014\\\/08\\\/15\\\/a-physicians-perspective-on-the-russian-flu\\\/","likes_blog_id":"52242398"}' itemscope itemtype=\"http:\/\/schema.org\/ImageGallery\" > <div class=\"gallery-row\" style=\"width: 840px; height: 724px;\" data-original-width=\"840\" data-original-height=\"724\" > <div class=\"gallery-group images-1\" style=\"width: 840px; height: 724px;\" data-original-width=\"840\" data-original-height=\"724\" > <div class=\"tiled-gallery-item tiled-gallery-item-large\" itemprop=\"associatedMedia\" itemscope itemtype=\"http:\/\/schema.org\/ImageObject\"> <a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2014\/08\/15\/a-physicians-perspective-on-the-russian-flu\/casei_page1\/\" border=\"0\" itemprop=\"url\"> <meta itemprop=\"width\" content=\"836\"> <meta itemprop=\"height\" content=\"720\"> <img decoding=\"async\" class=\"\" data-attachment-id=\"4730\" data-orig-file=\"https:\/\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/casei_page1.jpg\" data-orig-size=\"1394,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"CaseI_page1\" data-image-description=\"<p>Case I.\u2014The Nervous, Neuralgic, or Rheumatoid Type.\u2014One of the earliest cases which I saw was that of a lady, who was seized on the evening of Friday, December 20, 1889, and who was seen next morning by my friend, Dr. James Craig, one of the Assistant Physicians to the Meath Hospital. The following is the lady\u2019s own account of her attack:\u2014\u201cFriday, Dec. 20th, 1889, I went to the oratorio at St. Patrick\u2019s Cathedral apparently in my usual health. Shortly after entering the Cathedral I felt Chilled, as if cold water was being poured down by back and legs. When I returned home I warmed myself at a good fire, was given some hot wine and water, and went to bed; then my face and head got very hot and uncomfortable, and pains began in my arms, shoulders, and legs. All night the pains were very bad, sometimes so sharp across the back of my chest that I could have cried out; and, although I felt burning to the touch, the cold-water sensation continued. I got no sleep that night. Next day, about twelve o\u2019clock (mid-day), I was given a powder (Salicylate of sodium) and in two hours afterwards another, which put me into a perspiration. The pains in my limbs got better but my head began to ache badly and all day I felt very ill. I suffered from<\/p> \" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/casei_page1.jpg?fit=300%2C258&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/casei_page1.jpg?fit=840%2C723&ssl=1\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/casei_page1.jpg?w=836&h=720&ssl=1\" width=\"836\" height=\"720\" loading=\"lazy\" data-original-width=\"836\" data-original-height=\"720\" itemprop=\"http:\/\/schema.org\/image\" title=\"CaseI_page1\" alt=\"A passage from a journal article in which a doctor recounts a patient's report of symptoms.\" style=\"width: 836px; height: 720px;\" \/> <\/a> <\/div> <\/div> <!-- close group --> <\/div> <!-- close row --> <\/div>\n<p> <\/p>\n<div class=\"tiled-gallery type-rectangular tiled-gallery-unresized\" data-original-width=\"840\" data-carousel-extra='{"blog_id":1,"permalink":"https:\\\/\\\/circulatingnow.nlm.nih.gov\\\/2014\\\/08\\\/15\\\/a-physicians-perspective-on-the-russian-flu\\\/","likes_blog_id":"52242398"}' itemscope itemtype=\"http:\/\/schema.org\/ImageGallery\" > <div class=\"gallery-row\" style=\"width: 840px; height: 399px;\" data-original-width=\"840\" data-original-height=\"399\" > <div class=\"gallery-group images-1\" style=\"width: 840px; height: 399px;\" data-original-width=\"840\" data-original-height=\"399\" > <div class=\"tiled-gallery-item tiled-gallery-item-large\" itemprop=\"associatedMedia\" itemscope itemtype=\"http:\/\/schema.org\/ImageObject\"> <a href=\"https:\/\/circulatingnow.nlm.nih.gov\/2014\/08\/15\/a-physicians-perspective-on-the-russian-flu\/case-i-page-2\/\" border=\"0\" itemprop=\"url\"> <meta itemprop=\"width\" content=\"836\"> <meta itemprop=\"height\" content=\"395\"> <img decoding=\"async\" class=\"\" data-attachment-id=\"4729\" data-orig-file=\"https:\/\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/case-i-page-2.jpg\" data-orig-size=\"1394,658\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Case-I-page-2\" data-image-description=\"<p>By Dr. J. W. Moore. [page] 67<br \/> great thirst. Saturday night slept better. Sunday morning about 5 a.m. I wished for a cup of tea, but could not taste it. I might have been drinking hot water. Sunday evening pains had quite gone. I had no headache. I got up for a while, but felt very weak. For several days I had no energy for anything, the lease exertion tired me. My sense of taste did not return for four or five days. I also got a cough which was very troublesome. Temperature\u2014Friday night 101\u00b0; Saturday morning 100\u00b0, evening 98.8\u00b0.”<\/p> \" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/case-i-page-2.jpg?fit=300%2C142&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/case-i-page-2.jpg?fit=840%2C396&ssl=1\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/07\/case-i-page-2.jpg?w=836&h=395&ssl=1\" width=\"836\" height=\"395\" loading=\"lazy\" data-original-width=\"836\" data-original-height=\"395\" itemprop=\"http:\/\/schema.org\/image\" title=\"Case-I-page-2\" alt=\"A passage from a journal article in which a doctor recounts a patient's report of symptoms.\" style=\"width: 836px; height: 395px;\" \/> <\/a> <\/div> <\/div> <!-- close group --> <\/div> <!-- close row --> <\/div>\n<p>The patient\u2019s symptoms of hot and cold flashes, head and body aches, fever, and weakness are just a few examples of what patients experienced at the time. The classification of these symptoms as evidence of \u201cThe Nervous, Neuralgic, or Rheumatoid Type\u201d is suggestive of this era when physiological health symptoms, such as fever or cough, were associated with mental conditions, such as nervousness or anxiety.<\/p>\n<p>The rapid spread and apparent aggression of the outbreak caused many doctors, Dr. John Moore being one of them, to keep detailed records on this flu. These records included extensive documentation of temperatures, under the belief that sudden changes in atmospheric conditions caused the flu to be more prevalent. Dr. Moore\u2019s article includes a detailed table marking temperature changes for this flu season and the years prior to it. The level of detail indicates how big a role the weather was thought to play in the spread of disease. Due to this belief, many doctors recommended that people stay inside to avoid the change in weather. They were also recommended to keep warm in order to avoid the slow chill which would depress the immune system and cause one to get sick. But the figures presented by Dr. Moore did not show any close relationship between low temperatures and mortality rates. For the first several weeks of 1890, temperatures were higher than normal\u2014and so were death rates from influenza, leading Dr. Moore to exclaim: \u201cBut how different were the facts!\u201d<\/p>\n<figure id=\"attachment_4732\" aria-describedby=\"caption-attachment-4732\" style=\"width: 650px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/table.jpg?ssl=1\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"4732\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2014\/08\/15\/a-physicians-perspective-on-the-russian-flu\/table\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/table.jpg?fit=1600%2C892&ssl=1\" data-orig-size=\"1600,892\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"Table of temperature and casue and number of deaths in Dublin in 1889 and 1890\" data-image-description=\"<p>Table I.\u2014Showing the Mean Temperature in Dublin City, and the Deaths from all and from Certain Specified Causes in the Dublin Registration District, during the last Four and first Seven Weeks of the Year, in 1889\u201390, and on the Average.<\/p>\n<p>The most significant data in the table shows that in the third week of 1890 the mean temperature was 48.6, higher than any other week and the number of deaths from influenza was 13, significantly higher than any other week. <\/p>\n\" data-image-caption=\"\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/table.jpg?fit=300%2C167&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/table.jpg?fit=840%2C468&ssl=1\" class=\"wp-image-4732 size-large\" title=\"Table of temperature and casue and number of deaths in Dublin in 1889 and 1890\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/table.jpg?resize=650%2C362&ssl=1\" alt=\"The most significant data in the table shows that in the third week of 1890 the mean temperature was 48.6, higher than any other week and the number of deaths from influenza was 13, significantly higher than any other week.\" width=\"650\" height=\"362\" \/><\/a><figcaption id=\"caption-attachment-4732\" class=\"wp-caption-text\">A detailed table correlating temperature to influenza deaths published in Dr. Moore’s report. The significant data here is that in the third week of 1890 the mean temperature in Dublin was 48.6, higher than any other week, while the number of deaths from influenza was 13, also significantly higher than any other week. This was the opposite of what Dr. Moore expected to see.<\/figcaption><\/figure>\n<p>While <a title=\"The National Institutes of Health\" href=\"http:\/\/www.nih.gov\/news\/health\/mar2013\/fic-08.htm\">current medical knowledge<\/a> calls into question any direct causal relationship between temperature and influenza, other preventative measures recommended by Dr. Moore were more consistent with current understanding. Dr. Moore\u2019s most understandable recommendation was for individuals to avoid those who are already sick. Yet his advice to avoid the mail because they flu was spreading via the postal system reflects the more limited understanding at this time of the actual amount of time viruses could spread beyond direct human contact. Dr. Moore also recognized how this epidemic spread quickly throughout society. Unlike other diseases, such as cholera which had a strong class-based pattern of transmission, the influenza was spreading just as quickly \u201cthrough the suburbs as it did through the crowded streets and alleys of the city\u201d.<\/p>\n<p>With no effective cure for the influenza, the best that doctors could do at the time was to treat the symptoms rather than the disease itself. Because influenza was closely related (and easily mistaken for) other common diseases such as Phthisis, Heart Disease, Acute Bronchitis, Chronic Bronchitis, Pleurisy, and Pneumonia, medical officials had to prescribe medications based solely on each individual\u2019s symptoms. Doctors recommended a limited range of treatments during this era. According to Dr. Moore, some examples of the medications prescribed include Antipyrine and Quinine, which were administered when a sedative action was desired. Salicylate of soda was given with marked benefit. Lastly, stimulants were administered only in complicated cases or where the patients were known to have unusual debility.<\/p>\n<p>Dr. Moore\u2019s attention to the range of symptoms (Influenza Like Illnesses, or ILI, in current <a title=\"Centers for Disease Control and Prevention\" href=\"https:\/\/www.cdc.gov\/flu\/\" target=\"_blank\" rel=\"noopener\">CDC terminology<\/a>) shows the difficulty for doctors and public health authorities to accurately identify outbreaks of influenza. While Dr. Moore\u2019s belief that temperatures had a direct causal effect on influenza rates was reflective of the mistaken \u201cmiasmic\u201d theories of the late nineteenth century, his recommendations regarding other preventive measures are more consistent with current understandings. Most importantly, his detailed case studies contributed to a growing understanding among medical experts of the challenges of accurately and quickly identifying influenza outbreaks on a global scale.<\/p>\n<p><em>Using materials from the National Library of Medicine as well as <a title=\"Virginia Tech\" href=\"https:\/\/blogs.lt.vt.edu\/russianflu\/2014\/05\/22\/46\/\" target=\"_blank\" rel=\"noopener\">newspaper sources<\/a> located, and in many cases translated, by the research teams at Virginia Tech, these postings address core issues for epidemiologists related to the speed, scope, and severity of a disease outbreak. By studying these patterns in the past, historians of medicine can contribute to contemporary and future responses to the threat of widespread infectious diseases. Learn more about the Tracking the Russian Flu project at: <a title=\"Virginia Tech\" href=\"http:\/\/blogs.lt.vt.edu\/russianflu\/\" target=\"_blank\" rel=\"noopener\">http:\/\/blogs.lt.vt.edu\/russianflu\/<\/a><\/em><\/p>\n<p><em>Alexis Abraham is a Biological Systems Engineering major at Virginia Tech.<\/em><\/p>\n<p><em>Veronica O\u2019Rourke is a Biology and Spanish major at Virginia Tech.<\/em><\/p>\n<p><em>Crystal Velasco graduated as an Economics, International Studies, and Spanish major from Virginia Tech.<\/em><\/p>\n<p><em>\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>In November 1889, a rash of cases of influenza-like-illness appeared in St. Petersburg, Russia. Soon, the \u201cRussia Influenza\u201d spread across<\/p>\n","protected":false},"author":19605840,"featured_media":4734,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"Circulating Now: Part three of our 'Russian Flu' series: A Physician\u2019s Perspective on the Russian Flu 1889\u20131890 http:\/\/wp.me\/p3xcDk-1d4","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[12763,51014],"tags":[273905,25639,29189,768,668],"class_list":["post-4654","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-collections","category-guests","tag-1800s","tag-epidemiology","tag-influenza","tag-ireland","tag-research"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/08\/article-title_feature.jpg?fit=932%2C361&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3xcDk-1d4","jetpack-related-posts":[],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/4654","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/users\/19605840"}],"replies":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/comments?post=4654"}],"version-history":[{"count":23,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/4654\/revisions"}],"predecessor-version":[{"id":39866,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/4654\/revisions\/39866"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media\/4734"}],"wp:attachment":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media?parent=4654"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/categories?post=4654"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/tags?post=4654"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} |