Friday, 19 July 2013

‘Not unlike an evil dream’: a medical student’s account of Spanish flu in the Meath hospital, Dublin by Anne MacLellan

This month's blog post is by Dr Anne MacLellan, Director of Research at the Rotunda Hospital, who discusses the writings of Dorothy Stopford, a Dublin medical student, relating to the Spanish flu in Ireland.

In January 1916, at the age of 26, Dorothy Stopford (1890-1954) entered Trinity College Dublin to study medicine. The 1916 Easter Rising, the Great War, and the Spanish influenza pandemic of 1918-1919, formed the turbulent backdrop to her introduction to medicine. A remarkable series of letters written by Dorothy to Sir Matthew Nathan (Undersecretary for Ireland 1914-1916) during her time as a clinical clerk on the wards in the Meath hospital, Dublin, provide a compelling account of working through the Spanish flu which, hard on the heels of the Great War, claimed the lives of many young Irish people.

The dreaded flu, with its penchant for young lives, brushed against Dorothy in July 1918, following a whirl of exams, when she, herself, had a ‘touch of Spanish flu, cured at night and ignored during the day’. In October 1918, Dorothy, now a third-year medical student, ‘exercised her powers cautiously’ on the wards as she knew she was ‘horribly ignorant and junior’. She could do little other than what the ward sister suggested. ‘I am in her hands and learning a lot. We are packed with influenza cases, mostly DMP [Dublin Metropolitan Police]’. Mortality was high as it was a very violent form of the flu generally ending in pneumonia. However, Dorothy told Sir Matthew that the ‘bug’ had been found and inoculation was being used for curative purposes although it was too late to say with what success.

A monster representing an influenza virus hitting a man over the head as he sits in his armchair. Pen and ink drawing by E. Noble, c. 1918. Courtesy of Wellcome Images. ICV No 16001.

At the end of the month, she suffered from ‘a private tragedy’ when her great friend Cesca Trench died from the flu on 30 October. After a long courtship, Cesca had married Irish volunteer, librarian and biographer Diarmid Coffey on 17 April 1918. Both Diarmid and Cesca were described by Dorothy as ‘very intimate friends’ and she was ‘the most splendid and beautiful creature I had ever known’, wrote Dorothy. Cesca was only ill for three days and ‘went out like a flash, the last person, full of life and vitality, that you could think of dying’.  Cesca’s death was typical in that this flu was more likely to lead to death among young adults than among the usual flu victims – the elderly and the very young.

In November, Dorothy informed Sir Matthew that the ‘general scrimmage of the influenza epidemic which is pretty hot here’ continued. Dorothy worked with two nurses on a landing  in the hospital where there were about 30 ill patients and the sister had been laid low. The ward was full up with policemen and there were a lot of deaths. ‘It was very horrible’, she declared, but things seemed to getting better and most people recovered. Sadly, the sister, who had been ‘particularly nice’ died.

Dorothy was also impressed by her ‘chief’, Professor William Boxwell, who was not only ‘very clever but also very grand and fine, he is up and about night and day and has pulled a lot of people through’. As for her own contribution, she said it was difficult knowing so little and death seemed very terrible. But, she got used to it quickly in the general busyness of ward work and found her feet. The amount of ‘odds and ends’ of doctoring and nursing that she absorbed in two weeks under pressure was ‘rather astonishing and one gains confidence’.

Dorothy Stopford at the Meath Hospital, undated. Photograph courtesy of Dr Ida Milne.

Professor Boxwell was ‘mad on post-mortems’ and Dorothy assisted him with the dead as well as the living. Boxwell tried to get a portion of lung from each flu victim and, at 10 pm, at night Dorothy would bicycle down to the mortuary where, ‘with or without the aid of a night porter’ she carried in about three corpses into the post-mortem room, and ‘stripped them ready and made them tidy again’. She remembered nights when the rain pelted down on the glass roof and she was alone inside trying to get the corpse into its habit and back on the bench. She recalled these details later and did not mention them in her contemporaneous letters – probably in a bid to spare Sir Matthew the horrific details.

On 15 February, 1919, Dorothy Stopford was finding life very exciting, having attained some self-confidence in her powers of healing. ‘I don’t believe at all in women doctors not liking to take responsibility, at least I don’t see why they shouldn’t  but it’s always charged against them.’ It was largely a matter of knowing your work and being careful, she declared, ‘the rest is experience, more than brains, with plenty of self assurance.’ Dorothy Stopford (later Dorothy Price) became a confident, assured doctor with no reluctance to take responsibility. She became a leading international expert on childhood tuberculosis, a public campaigner for the formation of a national anti-tuberculosis league, and the chair of the National BCG Committee.

In March, Dorothy told Sir Matthew that they were having another epidemic, just as bad as the autumn one. ‘Five with pneumonia, the latter proving frequently fatal, and the hospital is once more not unlike an evil dream; still lots recover too.’ She had another public exam looming in a week’s time but was undecided about sitting it as ‘this flu business puts one off book work’.

Author's note: The letters of Dorothy Stopford to Sir Matthew Nathan (MS. Nathan 204, fols.164-291) are held in the Bodliean library in Oxford, England (many are undated so the chronology of the letters is not always clear). The papers of Diarmid Coffey and Cesca Trench are held in the National Library of Ireland, Dublin. The account of post-mortems carried out during the Spanish flu are to be found in the volume Dr Dorothy Price, written by Dorothy’s husband Liam Price, and printed at the University Press, Oxford,  for private circulation, in 1957.


Video of a lecture, 'Victim or Vector? Tubercular Irish Nurses in Britain 1930 to 1960', by Dr. Anne MacLellan, at the workshop, 'Health, Illness and Ethnicity: Migration, Discrimination and Social Dislocation', held at the Centre for the History of Medicine in Ireland, June 2011

Victim or Vector? Tubercular Irish Nurses in Britain 1930 to 1960 from CHOMIreland on Vimeo.

Anne MacLellan is the Director of Research at the Rotunda Hospital, Dublin. She is the winner of the Royal College of Physicians 2012 History of Medicine Research Award and the joint winner of the Ulster University/Centre for the History of Medicine’s History of Medicine in Ireland essay prize, 2011. Anne’s PhD, from the UCD School of History and Archives (2011), was funded by Wellcome Trust. She may be contacted by email at amaclellan1 "at" gmail "dot" com.

Wednesday, 3 July 2013

How the poor lived: Tenements, public health and medicine in 1913

In April this year, RCPI and the Dublin City Library and Archives held a joint seminar looking at medicine and public health in 1913, as part of the Dublin One City, One Book festival. Webcasts of the two papers give at the seminar are now available on the RCPI Player.

Dr Lydia Carroll holds a PhD from the School of History and Humanities at Trinity College Dublin. She recently published In the Fever King's Preserves. Sir Charles Cameron and the Dublin Slums, the first major biography of Sir Charles Cameron. She has also contributed to Leaders of the City. Dublin's First Citizens 1500-1950, edited by Ruth McManus and Lisa-Marie Griffith. She is a seventh-generation Dubliner, whose family have lived and worked in the heart of Dublin for more than two centuries. Her paper looks at the work of Sir Charles Cameron, Medical Officer of Health for Dublin, and his work in improving the sanitary and living conditions in the city at the end of the 19th and beginning of the 20th centuries.

David Durnin is an Irish Research Council for the Humanities and Social Sciences Doctoral Scholar at the Centre for the History of Medicine in Ireland, University College Dublin. He holds an MA in the Social and Cultural History of Medicine from the Centre. His current research project, entitled 'The War away from Home': Irish Medical Migration during the Great War Era, 1912-1922 explores the role and experiences of Irish medical personnel during the First World War. His paper looks at the conditions facing the medical profession in 1913, and especially the impact of the newly introduced National Insurance Act.