Detail of the title page of Dr. Moore's Journal article.

A Physician’s Perspective on the Russian Flu

In November 1889, a rash of cases of influenza-like-illness appeared in St. Petersburg, Russia. Soon, the “Russia Influenza” 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, Circulating Now welcomes guest bloggers Alexis Abraham, Veronica O’Rourke, and Crystal Velasco, who look at the diagnosis of the disease from the perspective of a contemporary physician.

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 La Epoca, December 2, 1889; Le Temps Archives, December 13, 1889; Diario oficial de avisos de Madrid, 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.

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. This 1890 report, in volume 8 of the Transactions of the Royal Academy of Medicine in Ireland, 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.

Detail of the title page of Dr. Moore's Journal article: The Influenza Epidemic of 1889-90, as observed in Dublin.

One of the most important contributions of these physicians’ 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:

 

The patient’s 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 “The Nervous, Neuralgic, or Rheumatoid Type” is suggestive of this era when physiological health symptoms, such as fever or cough, were associated with mental conditions, such as nervousness or anxiety.

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’s 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—and so were death rates from influenza, leading Dr. Moore to exclaim: “But how different were the facts!”

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.
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.

While current medical knowledge 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’s 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 “through the suburbs as it did through the crowded streets and alleys of the city”.

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’s 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.

Dr. Moore’s attention to the range of symptoms (Influenza Like Illnesses, or ILI, in current CDC terminology) shows the difficulty for doctors and public health authorities to accurately identify outbreaks of influenza. While Dr. Moore’s belief that temperatures had a direct causal effect on influenza rates was reflective of the mistaken “miasmic” 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.

Using materials from the National Library of Medicine as well as newspaper sources 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: http://blogs.lt.vt.edu/russianflu/

Alexis Abraham is a Biological Systems Engineering major at Virginia Tech.

Veronica O’Rourke is a Biology and Spanish major at Virginia Tech.

Crystal Velasco graduated as an Economics, International Studies, and Spanish major from Virginia Tech.


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