The Historian’s Kaleidoscope – Making Sense of Medical History in Times of a Pandemic

In this blog post, Dr Claas Kirchhelle, Lecturer of the History of Medicine at University College Dublin (Wellcome Trust University Award) and Fellow of the Oxford Martin School, urges medical historians to critically reflect on the implications of the COVID-19 pandemic for their field.

Trying to make sense of COVID-19 is to look through a kaleidoscope. Within its brief existence, the virus has revealed the incredible complexity of interspecies relationships, economic interdependencies, health system designs, international relations, the many fallouts of the climate emergency, and differing cultural perceptions of disease and biomedicine. It has also unleashed a storm of attempts by historians, social scientists, and public commentators to make sense of the present against the backdrop of previous epidemics and pandemics.

From late January 2020 onwards, academic journals, websites, blogs, and media outlets saw a burst of contributions analysing the current pandemic in light of earlier ones, commenting on exacerbated social and racial inequalities, cultural biases in attributing causes and solutions, the biopolitics of lockdown, and hopes for a unified drive for a cure. Initial responses were soon complemented by a second layer of debates about how far one pandemic could be compared to another, ground-zero empiricism, and whether anything meaningful could be said before COVID-19 itself had become history.

As a medical historian, I followed debates with a mix of fascination and exhaustion. Holed up in my apartment, I was taking it in turns with my partner – also an academic – to care for our confused toddler while trying to meet funding and publication deadlines. In between writing, zoom calls, and potty training, I was, however, struck by the way that many exchanges were missing their mark. The version of history that was being debated was often too grand or too diminutive to adequately reflect the discipline’s value for public debates and decision-making.

Critics were of course right to highlight that it was too early to provide grand analyses and wrong to make facile comparisons to earlier pandemics. Nobody can accurately predict how interactions between this novel pathogen and its human hosts will evolve and it will likely take decades to retrospectively unpick the complex biosocial interactions that brought us here. However, history is also not as speechless as some seem to imply. While I would distrust anyone proposing a definite analysis of COVID-19, I would be similarly wary of those waiting for the elusive point when current events have ‘safely’ become history.

The COVID-19 pandemic is a biological and social event that is the result of contingent emergence. However, it is playing out within the structural constraints of a human and environmental playing field that was shaped over decades – if not centuries. Historians are uniquely placed to appreciate both the contingency of SARS-CoV-2 and to analyse its pandemic playing field. The relevance of such analyses for decision-making and public discourse is great. I have plenty of colleagues whose excellent work on vaccines, public and global health, infectious disease, mental health, and civil emergencies makes them ideally placed to provide critical context for varying policy responses. Scholars of the medical humanities can also highlight implicit biases and shaky data underpinning some of the epidemiological, behavioural, and economic models guiding current policy. By looking back at previous pandemic or epidemic events, some may even be able to make educated guesses about likely social flashpoints, governance problems, finance bottlenecks, and ethical dilemmata. None of the colleagues I know would make the claim that historical analysis holds universal answers. However, I think that many of them would be comfortable saying that decontextualized policymaking and public debates can be just as flawed – and that expertise from the medical humanities should be represented in official expert bodies.

Reflecting on my own work on antibiotics, laboratory surveillance, and infectious disease control, I have become keenly aware of the kaleidoscopic qualities of the current crisis. All of my research fields have been affected. COVID-19 has accelerated many of the structural constraints that have long prevented equitable and unbiased health provision, international coordination, and global solidarity. However, it has also provided interesting points of departure.

Writing about change, challenges, and prospects in the areas I know best has aided my own historical sense-making and prompted useful exchanges with other disciplines. Together with colleagues from the biomedical and environmental sciences, I have drawn on historical precedents to warn about the likely rise of antibiotic use to deal with bacterial superinfections and resulting selection for antimicrobial resistance (AMR). However, we were also keenly aware that the unprecedented global sharing of scientific information about COVID-19, formation of patent pools, and mobilisation of public funds may also point to new solutions for the long-standing ‘empty pipeline’ problem for antibiotic development. With collaborators from the social sciences, I have reflected on the chequered past of human infection studies in accelerating vaccine development but also exploiting marginalised and colonial populations. We warned that the race for effective SARS-CoV-2 vaccines and the growing tendency to ‘offshore’ trials necessitated a new international framework for infection studies. I was also honoured to reflect on how contagious disease can bring out the best and worst in societies with my former PhD supervisor. Interviews with talented and genuinely interested journalists have also allowed me to stress how the history of drug and vaccine development makes it clear that ensuring equitable access must be at the forefront of current decision-making.

None of these points are particularly revolutionary and I do not pretend to be able to offer a comprehensive interpretation of an unfolding global crisis from the desk in my bedroom. It is, however, clear to me that COVID-19 is rapidly changing the fields I study and the way I see their history. Although I may only be able to see individual pieces of this vast kaleidoscope of change, the time to critically reflect on these changes started in January 2020. To publish these reflections is to stimulate debate, add a critical longitudinal and structural take to public sense-making, and – in my case – to optimistically push for some good things to come out of this global event.

Claas Kirchhelle

Dr Claas Kirchhelle is a Lecturer in the History of Medicine at University College Dublin’s School of History. His research explores the global history of antibiotics, infection control, and the microbial environment. Supported by a Wellcome Trust University Award, he is currently writing an interdisciplinary history of global infectious disease surveillance after 1920. Claas studied history at the Universities of Munich (MA, 2012), Chicago (MA, 2011), and Oxford (DPhil, 2016). He has published across the humanities and biomedical sciences and was awarded the University of Oxford’s 2016 Dev Family Prize for the best dissertation in the history of medicine and the 2020 ICOHTEC Turriano Prize for Pyrrhic Progress. Antibiotics in Anglo-American Food Production (Rutgers University Press). A new monograph on the history of British animal welfare science, activism, and politics is forthcoming with Palgrave Macmilan (2021). Claas has extensive experience in public engagement and broadcasting and co-curated the award-winning Back from the Dead (2016/2017) and Typhoidland (2020/2021) exhibitions on penicillin and the past, present, and future of typhoid control.

‘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

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.