THE GREAT SNEEZE
Osteopaths’ Intervention in the 1918 Influenza Pandemic
The author would like to certify that this dissertation entitled “The Great Sneeze” is entirely his own work.
Author: Philip Aarons B.Sc(Ost) ACOH
October 2002-
“ I do not believe, and I say that only after forty years of close observation and experiments, that there are such diseases as fever – typhoid, typhus or lung-rheumatism, sciatica, gout, liver disease, croup, or any other of the present so called diseases. They do not exist as diseases.
I hold that, separate or combined, they are only effects of cause, and that in each case, the cause can be found and can be limited by excited action of the nerves which control the fluids or a part of, or of the entire body. My position is the living body swarms with healthy corpuscles which are carried to all parts of the body.”
A.T Still
1870’s
The Great Sneeze
Contents
Introduction Page 1
Tickle in the Throat: Background History Page 4-7
Raw Feeling: Offers of Help
Page 7
Is it a Cold?: Ideas at this Time
Page 8-11
The Great Sweat: Treatment of Influenza
Page 12- 17
Mopping that Brow: Facts and Figures from
Page17 -18 that period
Till death us do part: Discussion
Page 19-21
One hot cup of Tea: Conclusion
Page 22
Introduction to the Main Plate of a Virus
Perhaps when the elderly heroes of the generation that fought so bravely in the Great War look back, they do not realise quite how lucky they had been. Out of every 100 American soldiers that died at war, 15 died from battle and 85 from flu (1). During 1918, Influenza infiltrated the American people to kill 500,000 citizens in the space of six months (2), more souls than the USA had lost in all the wars it entered in the 20th century. Physicians watched its devastating effects powerlessly. Worldwide, an estimated 25 -40 million people died. Nowhere seemed safe to hide against this mighty virus. To this day battles rage over what made the virus so virulent, why it took such a toll and when it may return.
This dissertation aims to provide insights into what American Osteopathic Physicians were trained to do at that time. The chapters will discuss beliefs held and explain how influenza was treated. Papers from the Journal of American Osteopathic Association (JAOA) in the six month period September 1918 to February 1919 indicate patterns of Osteopathic thought at the time and will be used to throw light on this pandemic. This journal, first published in 1901 by the American Osteopathic Association, is considered a good source for contemporary reflections on the profession. I have linked my research to this six-month period, as papers from the entire period are not easily accessible or even still available.
To set the context one must first understand the political and historic position of the Osteopath and the place he held in the American medical establishment in the 19th and early 20th century.
A Brief Tickle in the Throat of Osteopathic History
The 19th century in America was a period of upheaval with increasing disenchantment towards regular medicine. There was no certain knowledge of bacteria being responsible for disease. Aseptic surgery was unheard of and even anaesthesia was not available until the mid 19th century. The death rate from infection during the 1860 civil war is grim. Of 286 surgeons from Kansas who attended the war, 231 died from disease (3). When the Surgeon General, Dr. William Hammond attempted to ban Calomel and Tartar enema it left physicians with few options in their kit bags. Subsequently, perhaps due to his interference, he was court marshalled for ungentlemanly behaviour. As a consequence of this dissatisfaction, alternative ideas began a prolific rise. Phrenology, Mesmerism (introduced by Charles Poyen in America in 1836), Magnetic Healing, Hypnosis, Homeopathy and many more became popular. The one we will be concerned with is Osteopathy.
In 1874, 44 years before the 1918 epidemic, a young doctor from the Kansas medical school- Andrew Taylor Still was “struck, not in the heart but the dome of reason by an arrow charged with the principle of philosophy” and on June 22nd announced his discovery, Osteopathy. He was the son of a strict Methodist preacher whose language was flamboyant and steeped in biblical verse. His training was both in Heroic medicine, from the teachings of Benjamin Rush, and in the more conservative tradition of John Wesley, who believed that prior to Original Sin there was no ill health. Wesley wrote Primitive Physick (1792), a book that was often kept in the saddles of missionaries like his father. It quoted Thomas Sydenham and advocated physical exercise and cleanliness. It opposed the harsh medicine of Rush and apothecaries used many of its remedies. As with Sydenham, patient observation and interpretation was important. Andrew Taylor Still was later inspired by his contacts with John M Neal MD, who introduced the ideas of Alfred Russell Wallace and Herbert Spencer (a philosopher). He later pointed out that although deflated by his experiences in the civil war he was elevated by a belief in perfection and nature, and formulated a system of medicine based loosely upon the following tenets:
1. Structure Governs Function. The body is looked upon not as a series of separate systems but an integrated whole. Still’s analogy to the body quoted from ‘Research and Practice’, is “a well organized city and reason by comparison that a city makes all the workshops necessary to produce such machinery as is required for the health and comfort of its inhabitants. Each organ is a laborer of skill and belongs to the union of perfect work”(4)
2. The rule of the artery is supreme. The arteries and tubular system carry nutritive elements. Disturbance in circulation will produce pathology from hypoxia to an area of acidosis. It will delay healing. Nerves are looked at as vessels. Disturbance of the autonomic nervous system can lead to disturbance of blood flow. This may start from muscular skeletal or visceral origins.
3. The body contains its own medical chest. The defence of the body is first by skin and mucous membranes. Once violated, neutrophils, macrophages and lymphocytes are called upon to protect the body. The physician provides the environment that the body needs for healing, but the actual repair is inherent to the body.
4. Find it, fix it and leave it alone. Once the body is structurally sound, leave it alone.
He began to experiment with the concept that every disease is a manifestation of a cause; the cause was structural displacement or disharmony within the body. A lot of therapies had similar principles, emphasising uninterrupted flow of blood or nerve channels. However it was Still’s practical and mechanical mind that reshaped the therapy of applied anatomy. In 1874, Still began “an extended study of the drive wheels, pinions cupsarms, and shafts of the human life .. .the how and where the motor nerves receive their power and motion, their work done in health, in parts obstructed … the study of human mechanics awakening with new vigor within me”(5)
A charter for the American Osteopathic School was obtained on May 10th 1892. Its purpose was stated “to improve our system of surgery, midwifery and the treatment of general diseases in which the adjustment of bones is the leading feature of this school of pathology.” Later, in 1894 it was changed, to “incorporate obstetric and impart information to the medical profession.”(6) Its intent was to reform medicine.
Like a lot of late 19th century medicine so many ideas had changed in such a small period of time that general dissatisfaction urged it on.
Osteopathy was legalised in Missouri in 1897 giving Osteopaths independent licensing to practice as Physicians and Surgeons. In 1897 the American School of Osteopathy had 63 graduates and by 1899 thirteen other Osteopathic colleges had been set up, some teaching drug therapy. Osteopathy’s popularity grew, evidence of this may be the increasing distribution of the “Journal of Osteopathy” distributed to friends and patients at the school in 1894, at this stage numbering hundreds. By 1896 circulation had risen to18,000. American Senators, judges and the famous embraced the therapy. Mark Twain also being a big supporter of the osteopathic movement (7). The attention of America had focused on the home of the school in Kirksville. In 1904 the American Osteopathic Association voted on a compulsory three year, 27 month course in order to graduate. By 1911 the Schools taught vaccine therapy, bacteriology and other standard medical school ciricula. By 1915 after several merges there were only seven schools. Located in Boston, Chicago, Des Moines, Kansas City, Kirksville, Los Angeles and Philadelphia. The course was increased to four years by 1915. Traditionally osteopaths looked for mechanical explanations for illness, but through the developments of Pasteur, Koch and others; uncovering the mystery of infection, so the teaching changed. However, it was still based on the tenets and philosophy described earlier. When the 1918 Influenza virus hit what were the remedies available and how did Osteopaths cope?
Raw Feeling
Although outside the scope of this dissertation it is felt that it may be of use to touch upon another conflict, beside the First World War (WW1). That between Osteopaths and ‘ Medics.’ This started as early as 1893 when practitioners were sued for practising without license in certain states. This battle raged and did not finish in the United States until 1966, when the Secretary of Defence, Robert McNamara ordered all armed services to accept qualified osteopaths as military physicians and surgeons. The politics of this conflict are too complex to cover adequately in this dissertation but for those interested, Norman Gevitz’s book, The “D.O’s” covers the subject neatly.
In WW1 the War department, despite having 500 DO’s in army service did not assign Osteopathic physicians to work with the sick. It is arguable, looking at the statistics and death rate, that was an expensive mistake.
Is It a Cold?
What is a Virus?
In the 21st century we know what a virus looks like. The Flu virus is round, very small and has a halo of spikes surrounding it. We characterize the flu virus according to proteins called heamagglutin and neuraminidase on the outer skin. There are 15 types of heamagglutins (H1, H2, H3 etc.) and 9 of neuraminidase (N1, N2, N3 etc). Hence they are called H1N1, H2N2 etc or H5N3. Collectively influenza is a myxovirus of which there are two main types. Orthomyxoviruses are large enveloped RNA viruses that have an affinity to mucoid substances, Paramyxoviruses are similar but do not contain neuraminidase. Influenza is a primary respiratory illness. It is characterized by inflammatory changes in the bronchiole and its’ mucosa. Often, secondary bacteria such as S. pneumonia or S. aureus can occur. In rare cases it can lead to infection of the alveoli and viral pneumonia. (8) Pneumonia is inflammation of the lung parenchyma with fluid in the interstitium or alveoli.
Back in 1918 this was not known. Different ‘flus’ were considered separate illnesses. The term “grippe” was often used in France to describe the flu; it literally means to grip or attack. The Italians first used the term “influenza” in 1743; meaning influence as they thought it was probably due to the stars or some unknown influence. Pneumonia was often seen as a direct consequence of influenza.
In the early 1890’s one of the most brilliant bacteriologists, Richard F.J Pfeiffer, who was head of the research at Berlins Institute of infectious diseases saw a bacillus in the sputum of the victims of flu and named it after himself. However his research began after the 1880 Influenza epidemic had stopped, leading to later criticism that the germ he studied was not the one of the epidemic. Koch’s postulates were followed using the bacillus in the upper respiratory tracts of flu victims. He then grew the pure culture and injected it to monkeys and many other animals. He could not produce exact lesions but stated they reminded him of flu lesions. He could not fulfill Koch’s third postulate or indeed his fourth. In spite of this many saw his words as fact and in 1919 Hans Zisser in his textbook of Bacteriology stated Pfeiffer bacillus was responsible for influenza. Ten years later, in 1929 the Pfeiffer bacillus was argued to be its cause. (9) It can be seen that both Osteopaths and Medic’s training were based on the then known fact, that flu was caused by Pfeiffer bacillus. The Osteopaths however viewed the Pfeiffer bacillus being responsible only when the body was in a state of ill health, which allowed proliferation of the bacillus and ill health to ensue. The medics saw the bacillus as attacking the healthy body causing ill health. This classic difference leads back to ancient Greek times when Asklepious daughters argued the same point. The difference is subtle in words but huge in philosophy.
Charles Creighton in his book, ‘ History of Epidemics in England’,claimed that the flu had been preceded by epidemics of respiratory illness in horses.(10). Two army bacteriologists found that horse flu called gourme and Spanish Influenza were the same. Others too were thinking upon the same line. Ideas that it spread from pigs and countless others were discussed. In the discussion at least one modern paper suggests the swine hypothesis may be near the truth. What we know now about the 1918 virus was that it was exclusive to human beings outside the laboratory (11)
Ideas at that time
It is commonly thought that the young and healthy should be able to resist infection to a greater extent than the old or febrile. However in 1918 two thirds of those that died were between 20 and 40. (12) The reasons may be manifold. Hundreds and thousands of young men were involved in ship transportation and trench warfare to barrack dwelling and other such enclosures. Public health measures such as hygiene and food content were low and even vitamins were not even recognised until 1911. Perhaps flu virus attacked that age group specifically or as Tucker suggests, stressed men were affected due to their adrenal gland being compromised.
Osteopaths defined immunity as “the ability of an organism to successfully resist the action of the agents of infection” (13). One has to understand the philosophy of the Osteopath to understand why he treated in the way he did. Being a new profession one should also understand its political needs.
Traditional Viewpoint of the Osteopath.
Dunglison Medical Dictionary was well used in Osteopathic teaching as well as Dorlands (14). When Osteopaths were training in the 1900’s etc, they defined Influenza as epidemic catarrh, grip or grippe. The disease was put down to the micro-organism called Pfeiffer bacillus or Bacillus influenza. They were taught it lasted a few days to a week. Dunglison divided it in three, cerebral, gastrointestinal and pulmonary.
Still, the father of Osteopathy, asked Osteopaths to “lay aside all the ‘pathies’ with their many theories and take up the matter as a mechanic would take up their machinery in which he is familiar and which it out of repair and ask as he would ask, ‘why will it not work as it is intended it should’” (15)
Infection
In 1918, the Journal America Osteopathic Association, pointed out the evidence towards the lymphatics, spleen, adrenal gland and bone marrow being important in contributing to the immunity of an organism. Osteopaths viewed infection such as
ILL HOST + VIRUS = INFECTION
The symptoms seen were the bodies way of attempting to manifest its inherent ability to defend and repair itself. There are many theories which were put forward to explain infection and I have picked a few out to demonstrate their diversity and yet logical thought. In September 1918 two Osteopaths let known their view on how bacteria enters the body and effects us. During inhalation bacteria on dust particles are drawn into the respiratory tract via the nose. The immediate defence of the body would be the small nose hairs, followed by the turbinate bones. These bones would direct the air in eddies to centrifuge it, leaving the heavier bacteria in the recesses of the turbinates. The bacteria should land on the mucous membranes so they can act to destroy it by secretions etc. In exhalation air passes straight through, little disturbed by the turbinates action. The theory was based upon Padget experiments in 1915 with miner’s tuberculosis, which demonstrated dilation of the anterior nares, as well as dried tubercular bacilli, could create immunity. If the upper nasal area is clogged or there is no odour to encourage nasal breathing, air is taken in through the mouth and then the soft palate acts as a catching basin for these foes. This can cause a sneeze, which creates expulsion of the offending bacteria and also temporary hyperemia (dilatation of venous tubules) thrusting the blood into the area to add phagocytes and drain lymph. Using deduction the author of this early paper felt that if this mechanism could be kept working by intra nasal techniques it could render the patient free from most infection from pollen to influenza.
Pneumonia
Pneumonia was considered from the view of general infection with local manifestations in the lungs. (16) This led to the alveoli being impervious to air. In 1919 medics showed pneumonia as a self limiting and infectious disease, which was unable to be cut short by any known system. Although much was known about it, little could be done to change its course. Professor of Clinical medicine at Pennsylvania University, John Musser, points out “it has (pneumonia) scant respect for the methods employed against it.”
At the American Public Health Association meeting in Chicago, December 12th 1918, Dr. C Hangsea, argued
“ we are natures skilled aids. A tremendous amount of damage is done by interfering with nature. After twenty-five years in practice I feel like a disciple of Shakespeare “ throwing physics to the dogs”. We have little power over pneumonia. I am convinced, as many patients have been killed as cured by physicians. I did my share of killing while in hospital giving whiskey strychnine and so forth. If they were left alone they would have recovered.” (17)
The Osteopathic philosophy, Find it, Fix it, leave it rings out.
The Osteopath is told pneumonia is often preceded by headache, back pain, malaise, angina, insomnia, gastritis or infections. Rusty sputum appears, as well as rigor and pain in the side. Shaking occurs, a chill followed by overheating. The skin becomes dry and dyspnoa is aggravated by pain when coughing.
The Great Sweat
Influenza and its treatment
Influenza is a germ disease that must be stopped from two angles, one to prevent the germ entering the system and two to nullify the effects of those that have. The treatment protocol for Influenza was applied to pneumonia of any sort.
If we look to Still’s book of 1890 on practice he gives a treatment protocol.
“ when treating my influenza patients I generally stand in front of them, be they young or old, and have them place there arms on my shoulders, then I begin to explore from the tenth rib upwards. I carefully examine the ribs of both sides as I go up to ascertain whether the rib is pulled down below the transverse process of the spine or is pushed above it. When I find it displaced I halt right there and adjust that rib. I then continue adjusting everything found out of line as I go up until I get to the first rib. I make sure whether or not the clavicle is drawn heavily against the anterior surface of the neck; whether the clavicle, first or second rib is pulled down and back producing compression of the inferior cervical ganglion. ……. pressure irritating the nervous system that governs the arterial supply and venous drainage.”
Although written in the 1880’s we can see the trend to examine as a system that has cause and effect. Remove the anatomical object, such as muscle or rib, causing inhibition on a nerve and good health will be restored. The Influence of Still lived on well into the early 20th century and indeed the 21st.
The War Dept. had on October 18th 1918, declared 9,705 deaths from sea or killed in action and 13,059 deaths from influenza. The Journal American Osteopathic Association (JAOA) was well aware of the epidemic sweeping the country and quickly published advice from the editor of the journal.
In October 1918 the editor tried to calm the nerves of practitioners by reporting many cases were probably mild influenza or colds. However, he advised to be over zealous and over cautious and look for “ grippe that is sudden, with prostration occurring and severe aching.”
Not all Osteopaths reflected on the same treatment plan but as much as possible I have tried to collect the basic ideas from authors of papers. Letters written in January 1919 show Osteopaths using slightly different methods but all under the Osteopathic philosophy. Some may have thought that the epidemic was not normal Influenza but blamed deadly effluvia, decomposing from turned over sod, from graveyards and battlegrounds across Europe. “A Black Plague which scoured the world and eliminated the unprepared and unfit” (18). This heritage of the Greeks led to the belief that climate and place were responsible for much disease. A miasma of air interfered with the humours of the individual and he or she’s ability to contract disease. The eighteenth century revived these ideas and as air was experimented with, so it took on a responsibility and could be blamed. The fact that it could not be tracked down meant one had to relay on its smell. Thus graveyards and refuse dumps were thought to spawn these miasmas. (19). Even in the 20th century, with evidence to the contrary these ideas were still being used.
The range of advice begun with a prompt response. Osteopathic treatment was advised within twenty-four hours. This was to be combined with an eight-minute hot bath, hot lemonade and wrap in hot blanket until the patient perspired freely. One was not to share utensils or linen. As far as vaccines were concerned the advice was they were not known to be of proven use. Osteopathic treatment was to be applied 1-3 times in the first day and food was to be avoided if possible, in severe cases a little juice or broth could be taken if necessary. The patient was to stay in bed until his temperature had dropped for two consecutive days.
One physiological theory was that germs enter the nose, throat or oesophagus passing through the alimentary tract “to multiply in the cesspool of the rectum.”(20) Because of this thought it made sense to cleanse the nose and throat three or four times daily with mild Listerine or salt water. The bowels were to be cleaned out with an enema at least every other day. Reid describes one way to administer salt water to the throat. He places salt water in a fountain syringe and hung it above the patient to drip down. A glass medical dropper was used to give a fine stream of water to the open mouth. A quart of water was used and drained into a basin. Osteopathic manipulative treatment is advised to be short, daily and not to exhaust the patient’s resources. A side lying flexion technique was advised to relax the deep intrinsic muscles of the spine. The ribs were to be released from spasm. The fingers should pull parallel to the rib angles until the muscles relax. Elevation of the abdomen to lift the liver is encouraged, in an attempt to stimulate it and the kidneys. Advice was given to treat the clavicle and first rib, to allow lymph drainage from the throat and encourage blood flow. Osteopaths were told temperatures might reach 104 or 105 degrees at times. (21) It is of interest to note the public and immediate health matters raised by the journal. The editor tells us Pandemics bring out the dangers of overcrowding, poor ventilation, insufficient food and fatigue, which lead to susceptibility.
Osteopaths were told the treatment was to keep the body clean and reduce food intake. This should decrease germ life and increase nerve force, which would aid the body to recovery. By November statistics were accruing. The Bureau of Census had published weekly reports of the mortality of Influenza and pneumonia. Of forty-six large cities with a combined population of 23,000 000 the reports show a period from September 8th to November 8th. 82,306 deaths had occurred. Normally only 4000 would be expected, leaving 78,000 attributed to the epidemic. (22) The epidemic reached its peak in the two weeks ending October 26th, in which 40, 782 deaths were reported. The spread of disease appeared to be east to west.
Others writings post 1918.
Tuttle and Rodgers divide Influenza into two types, gastro-intestinal and respiratory, or a mixture of the two. Rogers, reflects on the epidemic, pointing out that as treatment may be given as often as every three hours, nurses were employed to administer the treatment. Patient presented dosed up on whiskey and antipyretic medication, as well as heavy cough syrups. This “promiscuous drugging, made matters worse,” (23) the heavy cough syrups delayed bronchial secretions and caused pneumonia.
Throat infection was immediately treated with silver nitrate applications. Nasal and postnasal irrigation was undertaken with Deasons solution, bicarbonate; boric acid and salt. The throat was sprayed with tincture of iodine or salt solution. Napkins and tissues were collected and burnt. These would be followed by daily short vigorous treatment to the cervical and upper dorsal spine region. The purpose of this manipulation was to induce expectoration, and if it did not, oil of eucalyptus, or tincture of benzoin or apinol was used.
As debate occurred in the pages of the JAOA Tuttle and Rodgers argued that heat makes little, if any benefit to the patient and imply it is for comfort only. The liquid diet is also debated and they gave egg albumen mixed with orange juice to the febrile. When the patient wanted a change, Ovaltine was given every three hours. Osteopathic treatment was to relax the spinal muscles and stretch the ribs to maintain and give normal function. Laboratory tests were used to confirm Influenza in the diagnosis as much as possible. Room temperature was kept at 72 degrees, but coal was still hard to come by so it was not always possible. Oil and gas stoves were banned as they devitalised the air. 100 to 150 square foot was provided to each patient. Windows were kept open and drafts avoided. Mention is also made of Osteopathic Physicians attending factories to keep workers fit to carry on their duties. Bed rest was advised for one to two weeks even after the fever subsided. During the epidemic daily urine and sputum checks were made on patients as well as differential leukocyte counts. (24)
MacFadden (25) agreed use of a well-ventilated room. He cleansed the Gastro-intestinal tract and applied manipulation to the thermal centres of the spine. Water and Lemon juice was taken to cleanse the GI tract and later fruit juices and baked apples. No alcohol was permitted, as it was thought paralyses of the end plates of the nervous system would occur. Water and a teaspoon of vinegar was applied as a sponge bath. Mentholated balm could be used on the chest and warm jugs to heat the patient to sweat.
Hickson D.O. also fasted the patient and gave hot lemonade until the patient sweated freely.
Drs Wolf and Star (26) in Montana kept weekly records, which they had to present to the county health officer. Although in a State where some farms were forty miles from a town they showed farmers what to do and how to administer treatment. Out of a county with a 6000 population they treated 467 cases to January 7th 1919. They diagnosed pneumonia and complications of influenza such as endo-carditis, acute nephritis and phlebitis. They recorded a five percent loss of patients compared to a 25% loss by their local hospital. This is almost exactly the national average for pneumonia treated by Osteopathy.
By February 1919 Tucker tried to explain the physiology behind the devastating influenza. The adrenal gland was one of the chief organs of defence against infections.(27) Its nerve supply comes mainly from the 11th dorsal nerve about rib eleven area. Visceral somatic reflexes mean that back ache is often a common onset. He notes the adrenal gland is larger in men than women where the pituitary gland is more affected. This he reasons is why flu affects the sexes differently. The adrenal gland stands for the fight and flight response. It dilates the bronchi tubes, the capillaries of the lungs; it decreases blood flow to the abdomen, forces more blood into the liver, where blood vessels expand. The adrenal should stimulate the thyroid, which is why on flu cases it was observed that goitre or neck swelling could occur. Lastly it stimulates the heart, and hastens clotting in the blood stream.
He tries to show that larger more fighting males, especially those between 23 to 35 are more prone to this gland malfunction. As the gland already overworks, any infection to it will be worse and attack the body quickly. Perhaps this explains why male soldiers were so hard hit. In females, the onset is often face and tooth pain, as the pituitary is chiefly affected. The osteopath has to stimulate the adrenal gland or pituitary to help the patient recover. Combined with bed rest. He advises against sheep adrenal extract, which could be obtained, as any hormone but your own can be harmful.
By 1919 Wolf and Rosenow, bacteriologists, had studied pneumonia in vitro. They found opsonin (the part of the blood which destroys bacteria) increases in the early stages of pneumonia and the pneumonic leukocytes were more phagocytic than normal ones and are more resistant to heat The higher the opsonin count, the greater the patients chance of survival. Andrew Tayor Still had similar thoughts some years earlier. “if you raise the opsonic power of the blood up to its normal efficiency it renders bacteria capable of being ingested or engulfed by the phagocytes, and hence, destroys them and robs them of there virulence”(28)
La Rue implies that if, in the early stage of disease, you can avoid the use of any suppressing drug which may decrease the opsonin index and stimulate the body to increase the index, success is the more likely outcome. Treatment should consist of cleansing the bowel; applying hot packs to the spine, treatment to the visceral motor centres of the spine, deepen respiration, aid expectorate, stimulate the heart to expel toxins and induce sleep. Poultices of mustard or onion were used. Stimulation of the lungs was encouraged. The patient lay on his back, arms folded across the umbilicus. The practitioner started at the head end and grasped the elbows raising them above the patient’s head as he inhales. The arms were returned on exhalation. The superior axilla area was pumped while using the arms as a counter lever. The idea was to stretch the pectorals, separate the ribs, increase circulation to the body, and induce activity in the lymph glands, which should help expel the toxins. The neck muscles should be relaxed to stimulate the nerves.
Throughout 1919 the Journal is packed with ‘experiences of the epidemic’, which I have tried to highlight above. The thought process was logical applied anatomy and in the days before the antibiotic seemed sensible. The results may show that they were right.
Mopping that Brow
The Treatment outcomes
The Osteopaths treated the American population in 1917 – 1918 for influenza and its sequel pneumonia. Various manipulations, rest, hydration and advice were offered. After the death sweep abated a survey was undertaken to find out what effect the treatments had been. It is very difficult to be accurate as in many states Influenza and Pneumonia were not reportable diseases. In 1919 requests were made to every State Health Commissioner and every city Health Commissioner in city’s with population over 40,000. One hundred and forty eight replies were received. Conservative estimates range State to State, for instance in Boston, Influenza reported killing 27% of the normal population and 34 ½ % in army camps. In Chicago of those with Influenza there was a 14% mortality rate, 26% for pneumonia. (29)
In November 1918 Osteopaths in America and Canada were sent a questionnaire and asked to report only well developed cases of influenza and pneumonia. It was shown that of those 2445 osteopaths that treated 110,122 cases of Influenza there were 257 deaths. Of the 6258 pneumonia cases treated there were only 635 deaths. (30) The results showed those patients treated through the principles of the profession who suffered from Influenza had a death rate of 0.5% whereas medically and chemically treated patients had a 6% death rate. Those with pneumonia also fared well, with a death rate of 10% compared with 33% of those treated by MD’s. In basic terms according to this literature we are to believe that if you had Influenza out of 1000 people treated Osteopathically only 2 ½ died and with 1000 pneumonia patients 100 died. So if treated Osteopathically your chances of recovery are 400 to 1 in your favour. If treated by regular MD only 19 to 1 (6 to 1 in Chicago).
Chart to show death rates comparing Osteopaths to Medics in 1918
Till Death Do us Part
Discussion.
The question begs, how true the above is? What made the difference and in what historical context can we understand it?
The 19th and early 20th century saw radical changes in the context of the history of medicine. From the late 19th century discoveries ranging from James Simpson Young use of Chloroform, the Public Health acts, Pasteur’s bacteria association with disease and Koch’s postulates were set down. Aspirin began use as a antipyretic and analgesic, replacing opium, Lister’s surgical reforms were being utilised and vitamins were found in foods. The medics at this time were fast moving, from what we would consider naivety towards a solid base of information. Even so, in 1918 some health boards in America did not statistically count deaths from all diseases. This leads to anomalies in the death certificates as cause of death.
Andrew Taylor Still died one year before the epidemic of 1918 but his influence should not be forgotten. As a powerful voice for the Osteopathic community right to the end, his opposition to drugs of any kind may well have found favour against the flu. Although his school taught bacteriology and vaccine therapy, he remained opposed to interference in the body by drugs of any sort. Like a lot of doctors in the mid 19th century he had seen patients addicted to opium, including his own brother, and this had shaken him to refute its uses. As can be gleaned from above some Osteopaths believed that cough suppressors and aspirin might indeed have contributed to the move from Influenza to Pneumonia and caused an increased death rate. Aspirin is certainly a immunosuppressor. (31) Recent yet unconfirmed papers also show aspirin to predispose children with Reyes syndrome (a uncommon complication of influenza) to be a risk factor. (32).
The idea of adrenal suppression causing a likelihood of Influenza is not as far fetched as it may sound. The adrenal gland, which is supplied by the nerves from the spinal cord, secretes hormones, mineral corticoids, that help water and electrolyte balance and control sodium re-absorption. Glucocorticoids are also secreted and are associated with stress and metabolism. Lastly they produce the adrenal medullary hormone epinephrine and norepinephrine, which are sympathomimetic. (33) Perhaps if these hormones were inhibited in some way the result would not be Cushing’s or Addison disease as we see in the extreme but susceptibility to dehydration or sympathetic arousal. During the war exhaustion was common place and soldiers were placed in extreme situations of stress for long periods. This could quite easily be a pre-disposing factor to adrenal shut down, inappropriate response and a pre-qual to any bacteria infection, in this case Influenza.
Through the role of the autonomic nervous system we can begin to understand the latter day significance of the treatment program. Samir Malik in his dissertation “Osteopathy and the Common Cold” sums it up nicely. (34) Both visceral somatic and somatic visceral pathologies effect the body and set up reflex cycles that can lead to changes in blood flow and nerve function. This compromises the body’s ability to repair and hence may turn a harmless infection into a much more serious one. Psychological effects also relate to infection. (35)
Osteopathy can lower these reflexes.
The statistics quoted in the results were based on case notes and research undertaken by American Osteopaths by sending questionnaires to all Osteopathic physicians in the US and Canada. Two thousand four hundred and forty five Osteopathic physicians reported having treated 110,122 cases of Influenza, and 6248 cases of Pneumonia during the epidemic. (36). They all dutifully sent their replies and statistics were correlated. One can accuse the Osteopaths of bias, but even if a minor bias was involved I think that the results speak very much for themselves.
In April 2000, Michael T Osterholm PhD, MPH, wrote
“ Even with intelligent and extensive efforts by both public and private sectors, the rapidly changing world we live tends to favor infectious agents”(37)
The next flu epidemic is on the way. Scientists do not know when but are sure that it will hit again. All around the world hundreds of people are looking out for signs that it may all start over and do their best to stem and prevent it before it does. The thinking in 1919 that the flu was predisposed by horse respiratory illness or sodden ground etc. may need re-examining. Taubenberger, a leading flu researcher seems to show that the 1918 epidemic was transmitted directly to humans from pigs, although another expert- Webster feels the virus was transmitted into pigs between 1910 and 1912 from an avian source. Webster goes on to say that European pigs will start the next influenza virus. He shows that since 1979 pigs have been infected with a strange avian-influenza strain. (38) Perhaps this alarm and confusion nearly showed itself when in 1997, 500,000 chickens were slaughtered in Hong Kong to prevent spread of the next wave of avian flu. (39) The worry is that these infectious birds may have transmitted it to pigs still roaming remote parts of China.
“Osteopathic manipulative treatment and understanding that led to its use often sound “low tech” compared with the high tech medicines and machines that dominate medicine today. However, the best defense against disease and infection remains health. Optimum health is a result of optimization of function of the individual. Osteopathic care that includes intelligently applied manipulative technique is an excellent preventative treatment. But it must be used to be effective. We must teach our students how to diagnose the body with structural examination, how to interpret what they feel and how to apply manipulative treatment to corrective functional deviations. But perhaps most importantly, we must convince them that this seemingly low-tech approach is still one of the most high tech skills and treatment modalities available for the individual. It involves the most complex machine and computer known to mankind – one human being acting on another human being.
Michael Patterson PhD. May 2000 (40)
A Hot Cup of Tea
Conclusion
It is the authors hope that should a time come when influenza once more rears its head we will not forget how to remain healthy as a preventative measure and that osteopaths may have a part to play in that lesson.
7356 Words?References
1 Getz D, Purple Death The mysterious flu of 1918, New York, Henry Holt, 2000 P.56
2 Davis. P, Catching Cold The hunt for the killer virus.Middx, England, Penguin, 1999 P.4
3. Trowbridge C, Andrew Taylor Still 1828-1917, Kirksville, The Thomas Jefferson University Press, 1991 P91
4. Still A.T Research and Practice, Maidstone College of Osteopathy, Revised edition, no date, Page 27
5. Still A.T, Autobiography of A.T. Still, Kirksville 1908 revised edition, American Academy of Osteopathy, Indianapolis USA 1996 Page 93
6. Trowbridge C, Andrew Taylor Still 1828-1917, Kirksville, The Thomas Jefferson University Press, 1991 P141
7. Gevitz N, T^he D.O’s Osteopathic Medicine in America Baltimore USA, John Hopkins University Press, 1991, Page 24
8. Cawson R, McCraken A et al Pathology 2nd Edition Page 127
9. Crosby A , Americas forgotten Pandemic, Cambridge, Cambridge University Press 1989, Page 297
10. Crosby A , Americas forgotten Pandemic, Cambridge, Cambridge University Press 1989, Page 295
11. Hj, hjk
12. Johnson H, Killer Flu, Rolling Stone Magazine 1998, January unknown volume, Page 48
13. Webster GW, Carthage NY, Influenza Epidemic, Journal Of American Osteopathic Association, Sept 1918 P.12
14. Still A.T Research and Practice, Maidstone College of Osteopathy, Revised edition, no date, Preface.
15. Still A.T Research and Practice, Maidstone College of Osteopathy, Revised edition, no date, Page 436
16. LaRue B, Zanesville O, Pneumonia, Journal American Osteopathic Assocation, September 1918, unknown vol. Page 206
17. Reid DO MD, Prevention and Treatment of Influenza, Journal American Osteopathic Association , January 1919, unknown vol. Page 211
18. Kendrick Smith DO , Osteopathy’s greatest Opportunity, Journal American Osteopathic Association Jan 1919, unknown Vol. Page 208
19. Caplan A, Theory’s of Life, Health and Disease, Companion encyclopedia to the history of medicine , London, Routlage 1994 Page 307
20. Reid C.C DO MD, Prevention and Treatment of Influenza , Journal American Osteopathic Association January 1919, unknown Vol. P. 209
21. Chiles H.L DO, Editor, The Treatment of Influenza, , Journal American Osteopathic Association, October 1918, unknown Vol. Page 83
22. Chiles H.L DO, Editor, The Treatment of Influenza, , Journal American Osteopathic Association, November 1918, unknown Vol. Page 147
23. Tuttle L MD DO, Rogers R DO Influenza And Pneumonia Treatment, Journal American Osteopathic Association, Jan. 1919, unknown Vol. Page 211
24. Tuttle L MD DO, Rogers R DO Influenza And Pneumonia Treatment, Journal American Osteopathic Association, Jan. 1919, unknown Vol. Page 211
25. Macfadden D, Letters in Journal American Osteopathic Association, Jan. 1919, unknown Vol. Page 247
26. Wolf R, Star C, L, Letters in Journal American Osteopathic Association, Jan. 1919, unknown Vol. Page 248
27. Tucker E, Spanish Influenza and its Treatment, Journal American Osteopathic Association, Febuary 1919, unknown Vol. Page 273
28. LaRue B DO Treatment of Pneumonia, Journal American Osteopathic Association, Febuary 1919, unknown Vol. Page 274
29. Riley G. Ph.B. D.O Osteopathic Success in the Treatment of Influenza and Pneumonia, Journal American Osteopathic Association August 1919 reprint from Journal American Osteopathic Association Vol.100 No 5. May 2000 Page 315
30. As above same page
31. Malik S, Osteopathy and the common Cold taken from Reference list. BSO Final Year project 1993 No 79
32. Cawson R, McCraken A et al Pathology 2nd Edition Page 126
33. Tortora and Anagnostakos Principles of Anatomy and Physiology 5th edition, Printed USA, Harper and Row1987 Page 420
34. Malik S, Osteopathy and the common Cold. BSO Final Year project 1993 No 79
35. Korr Im (1978) Sustained Sympathicotonia as a factor in Disease, Neurological mechanisms in manipulative therapy. Plenum publ.Corp N.Y. 229-268
36. Ward E, Influenza and its Management. Reprint from Journal American Osteopathic Association Vol.100 No 5. May 2000.
37. Osterholm M, New England Journal of Medicine, April 2000 Page 1280
38. Johnson H, Killer Flu, Rolling Stone Magazine 1998, January unknown volume, Page 64
39. Davis. P, Catching Cold The hunt for the killer virus. Middx, England, Penguin, 1999 , back cover.
40. Patterson M, PhD, Osteopathic Methods and the Flu pandemic. Journal American Osteopathic Association JOAO Associate editor Vol 100. No. 5 Page 310-34.
Other Books Used
2. Schnuker R.V Early Osteopathy in the words of A. T. Still published by Tjup.
3. Osteopathy Quarterly 1959- 1964
4. Various journals kept at the British School of Osteopathy London
|