Influenza pandemics: learning the lessons of the past « Back to Blogs
When we think about learning from previous influenza pandemics, we often think of the great pandemic of 1918. This pandemic mainly affected young people. One hypothesis as to why this occurred is that older people had more immunity – and this was thanks to exposure to the influenza pandemic of 1889-1890. Much less is known about this pandemic.
However, there are papers on the 1890 pandemic, and some of them were published by The BMJ and so are available on its digital archives. One such paper is a case series of 290 patients with influenza by Dr. Edward Charles Barnes. (1)
Barnes was divisional surgeon to the London metropolitan police and medical officer to the Hammersmith District Post Office. It is fascinating to read his paper and to consider how much and how little has changed in over 100 years of outbreaks.
Barnes looked after three groups of patients: policemen, post officers and residents of a convent. It is not clear who the residents were but they are described as inmates – this suggests that it may have been a workhouse or a nursing home. In any case it is striking how quickly the pandemic spread among his patients. All 290 patients presented over a period of just eight weeks. The residents of the convent may have been living in close proximity and this is probably why it spread so quickly. The same rapid spread occurred among the families of his patients. The policemen and postmen had one thing in common – they were both out in the community and so would have been in the frontline of exposure to the virus. How best to protect residents of institutions and essential workers remain hot topics in influenza today.
Almost inevitably Barnes caught influenza himself but was forced to continue working, as the outbreak was then at its peak. Doctors and other healthcare professionals are the ultimate “essential workers” and controversy still exists today on how best to ensure that they can continue to work during an influenza outbreak. In most countries, healthcare professionals are offered vaccination; some countries are considering making such vaccination compulsory.
In 1890, Barnes was diagnosing without access to any investigations. It is noticeable that he describes patients’ symptoms and signs with a great deal of detail. Has easy access to modern methods of investigation caused our clinical skills to deteriorate? Certainly, we do not describe clinical symptoms and signs in as much detail as in the past.
The author also describes how he treated patients – largely with bedrest, fluids and nourishing food. He also describes prescribing drugs for some patients – from alcohol to quinine to salicylates. Over one hundred years later, bedrest, food and fluids remain the mainstay of treatment.
Lastly Barnes makes a great deal of the data that is available to him. The data is limited but he makes the most of it by tabulating, interpreting and explaining his findings.
The purpose of documentary research is to help us to learn from previously published papers. (2) So, what can we learn from this paper? A short summary is that much has changed but much has also stayed the same. It is still vitally important that we consider how best to prevent influenza among essential workers (including healthcare professionals) and how best to limit outbreaks at institutions. We could also think more about how to better use the skills of history taking and clinical examination to make diagnoses – without having to continually access high cost investigations. But perhaps most importantly, today we have access to a great deal more data on epidemics than was available one hundred years ago. Do we make as much of it as we could?
- Barnes EC. Notes on 290 Cases of Influenza. Br Med J. 1890 Mar 15;1(1524):599-600.
- Walsh K. Documentary research and evaluation in medical education. Journal of educational evaluation for health professions. 2014;11.
Kieran Walsh works for BMJ which produces a range of clinical decision support and educational resources in infectious diseases.
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