View Day in pandemic and plague
St Bartholomew’s Hospital medical director Edward Rowland explores the history of the hospital through past epidemics such as the Spanish ‘flu.
How often have we heard that these are unique times in our lifetime?
They are, but pandemic and plague is not new, and if we are looking for precedents and parallels the Great Plague of 1665 and the 'flu pandemic of 1918/19 stand comparison to our experience, both in terms of mortal impact and on the disruption to normal life.
How do the experiences of these and other pandemics compare in their effects on the life of St Bartholomew's Hospital?
What is fascinating is that, despite the completely different social and scientific times, the nature, resilience and humanity of care seem to remain constant.
The devastation of the 1665 Plague seems to have begun insidiously in spring as warm weather replaced a bitterly cold winter.
Plague was a recurring pattern of life, but in 1665, it was clear that this was more severe than usual.
The 17th century version of social isolation was introduced, closing certain areas of London, requiring the people to keep indoors and, if you were rich, leaving the city.
Unsurprisingly, the impact of the plague on the poor was devastating. Reaching its peak in September, over 7,000 deaths per week were recorded in the City of London.
St Bartholomew’s Hospital played its part, admitting patients in the words of the time “visited with the plague”, and not without tragic effect on the staff. Three successive hospital Beadles died between June and November 1665.
The surgeon to the hospital also succumbed.
Reminiscent of our times, there was also zoning, surgeons were appointed to look after “those with pestilence”, while other surgeons were deputed to “be excused from special charge sheets of plague patients”.
It’s intriguing to see that the latter group, unlike the former, were not offered a special reward by the governors at the end of the year.
It’s clear from the hospital records that the plague had abated greatly by the start of 1666, well before the Great Fire of London.
The mortality of the 1665 plague pales into insignificance against the presumptive deaths of the 'flu pandemic of 1918/19, estimated to have resulted in between 50 and 100 million deaths worldwide.
Paradoxically, St Bartholomew's Hospital seems to have been minimally affected, or if it was it was hardly mentioned. The hospital journals of 1918 to 1920 contain a single article about it.
The article, entitled use of intravenous sodium salicylate to treat Spanish influenza, resonates with the present day absence of detailed knowledge of how to treat coronavirus. The report was of a single case detailing the presumed beneficial effect.
Searching medical literature of that era, however, has numerous articles suggesting that many more patients died as a result of salicylate poisoning than derived benefit.
Perhaps it was the predominant background of the First World War that moderated reporting the influence of the pandemic.
There certainly was an impact on the hospital and it fell predominantly on the nurses (for much of the detail of the 1918/19 pandemic read the articles by the eminent virologist of QMUL and St Bartholomew's Hospital, Professor John Oxford).
Several publications of the time refer to the heroic sacrifices of the nursing staff.
The toll on the staff was profoundly felt, as witnessed by the deaths of two doctors, Dr AE Stansfield and Mr Harry Blakeway, who were, judging by their obituaries, destined to achieve great distinction for the hospital.
Reflecting the very different times of social welfare in both cases, memorial funds were established to raise money to support their widows and children.
One aspect of the 1918 virus was that it affected all ages, but seemed especially virulent amongst young children. Perhaps it was this that inspired the Poet Laureate of the day Robert Bridges, a doctor who had trained and worked at St Bartholomew's Hospital before accepting the Laureate post, to pen one of his most moving poems, On a Dead Child.
Throughout the latter part of the 19th century, influenza epidemics were not unusual. Often referred to as “Russian flu” they were characterised by high levels of anxiety in city dwellers.
An observer in 1891 noted, arriving at St Bartholomew’s hospital in the morning, to find “more than 1,000 patients clamouring for treatment”.
Whether there was truly a gender predisposition it was noted that, unusually, “male patients were so alarmed that they took themselves to hospital immediately”.
We are not the first, nor will we be the last at St Bartholomew's Hospital to experience a pandemic.
Perhaps it is in some ways reassuring that the fear of an unseen enemy, observing a pathogen that can have predispositions to cause selective morbidity and mortality, and to witness the vulnerability of certain sections of society, are not new.
What is also not new is the care and dedication of our colleagues in healthcare and the sacrifices they make for those afflicted.
It is a wonderful tribute to the hospital that those exemplary standards of care and compassion are still as true in the 21st century as they were in the 17th century, and a constant in which we take enormous pride.