Sep 182020
 

by Ari McManus, Public History Virtual Intern Summer/Fall 2020

You don’t know me, but please trust me when I tell you that I’m an anxious person, and yet, I’m obsessed with horror. One reason being is how the genre offers an idea about how evil cannot be conquered, but instead, it can only be delayed. Look, yes, it’s a very grim perspective. Except it’s a thought I revisit whenever I’m reading about influenza. Think about it like this, annually the virus wreaks havoc. While a virus is not inherently evil, it can be delayed. 

Preventive medicine is the idea that by a person manipulating their surroundings or changing their daily habits, they can avoid catching an infectious disease. Studies show that by following through with various tactics, one can limit the progression of a disease at any stage.1 This ranges from not smoking to prevent lung cancer to wearing that mask to prevent the spread of respiratory droplets as seen with COVID-19.2

There are so many familiar beats throughout history. Moments that almost feel like deja vu to the point, I feel as if I’m living in a sequel or maybe even a reboot of the 1918 Flu Pandemic. As with everything, it’s more than just a pandemic story. With anything, it’s one of many layers, full to the brim of panic and one where preventive medicine became a key character because like in our present, there was no immunization to act as preventive medicine. 

1918 Flu Pandemic

Influenza slithered its way into people’s lives. In the United States, it started out small at Camp Funston in Fort Riley, Kansas. The first flu-like illness was detected in March 1918, and soon after the first case, more than 100 soldiers fell ill.3 The illness spread without gaining a lot of attention though because the flu is a usual suspect. Not to mention, soldiers being sick? They already battled an array of seemingly worse epidemic illnesses such as meningitis.4

As cases increased, physicians became dumbfounded because patients kept arriving with an array of symptoms. The main symptom causing confusion was how influenza patients experienced respiratory symptoms similar to pneumonia, which in 1918, was often fatal.5 Physicians kept misdiagnosing patients by writing off cases as pneumonia. But the unusual kept on happening as influenza cases increased, younger patients were losing their lives, which was anything but usual.6

At the time, preventive medicine started gaining international attention in the medical community with immunization being the ideal approach to preventive medicine, but there wasn’t a flu vaccine. The pandemic was quick to spawn desperation. There was little physicians could do, forcing people to watch in horror as their immune system turned against them with little to no knowledge on how to prevent or delay the illness.7 A flu patient’s immune system tore apart the lungs.8 Patients arrived with pockets of air leaking from ruptured lungs.9

One physician described this occurrence as “emphysema.” Meanwhile, a navy nurse reported in horror about how patients’ breathing sounded like a bowl of Rice Krispies.10 This was not ok, none of this was ok. To make matters worse, a considerable number of influenza patients experienced epistaxis, which is the hemorrhaging of mucous membranes resulting in dramatic nose bleeds.11

In a desperate attempt to flatten the curve of flu cases, some physicians hoped using a different vaccine would help boost an individual’s immune system. Therefore, the typhoid vaccine was used with this hope in mind, but there was little understanding of how the immune system worked at the time. The immune system did not need a boost because it was the problem.12

During the 1918 Flu Pandemic, people died due to a “cytokine storm”, which is a term coined by modern researchers to describe the lethal measures the immune system takes to fight a virus. In other words, one influenza entered a person’s lungs, the immune system waged a battle against the virus. creating what modern researchers label a “cytokine storm.” This term describes the lethal action the immune system takes to attack a pathogen.13 A person’s immune system changes with age, during their young adult years, it’s at its strongest. 

Woman’s Medical College of Pennsylvania

World War I took its toll on the Woman’s Medical College of Pennsylvania (WMCP), it split their staff up across Europe from France to Serbia.14 Due to the success of women practicing medicine overseas, there was an increase in positions for women in the medical field meaning WMCP needed to remain open with new opportunities. More medical schools were admitting women, internships options increased, and there was even a call for more female ambulance drivers.15 

WMCP’s dean, Dr. Martha Tracy,  observed this increased demand for female physicians believing by 1918 that 2,000 women could be placed annually within the medical field to work at increased demand for female physicians at colleges, hospitals, laboratories. She believed the growth of preventive medicine practice would continue to offer additional career paths for women in medicine. Therefore, WMCP established courses and a department focused on preventive medicine highlighting it as a prime opportunity to welcome even more women into the field.16 Dr. Tracy insisted:

Let us women physicians, by all means, use our opportunities and our influence to interest and recruit the young college women of the country for this medical service.17

Prior to 1918, freshmen classes entering WMCP saw a steady increase, its newest class grew by a third compared to previous classes.18 Although to simplify the matter, 1918 was no ordinary year for those students. Woman’s Medical College of Philadelphia welcomed their new freshmen class and returning students in a world that feared a new plague was haunting them.

First Contact with the Virus

The first influenza case was admitted to the college hospital at the Woman’s Medical College of Pennsylvania on September 18, 1918. Another case was quick to follow on September 21, 1918.19 Influenza cases were relentless, within the next six weeks the hospital saw about 50 cases of the flu, which then led to overflow by October. Hospital staff soon started to fall ill with the flu, as well.20 With staff catching the flu, the college hospital faced a severe problem. They didn’t have enough people to care for their community because WWI already caused a shortage of physicians, and now the physicians left behind are losing their lives on a new homefront in the United States.

The instant rise in influenza cases forced WMCP’s classes to come to a halt. For about three weeks, classes were canceled while faculty figured out how to commit to the following academic year while also supporting the flu crisis at hand.21

Due to a shortage of hospital staff, students rose up to work in their place as nurses or interns to better support the front line staff of hospitals.22 Since the freshman class experienced little training, they focused on making sure the college continued to run while also providing relief for those working on the front lines.23

As overflow continued to serve as a problem, the college’s gymnasium was soon fitted as an emergency ward. Except even then, it wasn’t enough as cases continued increasing and the hospital in turn continued to expand into different spaces on the college campus.24 Influenza became one of two focuses. Even surgical procedures were postponed until further notice.25

Keep in mind, this hospital was one of dozens in Philadelphia. In fact, the college hospital physically shared space on the same block as the Woman’s Hospital of Philadelphia in 1918. All facilities faced overflow, which meant no matter how much space the WMCP converted, it was never going to be enough.26 The odds were in nobody’s favor. 

A Different Solution

The world was still in shock as younger flu patients continued to die. In previous epidemics, the flu only seemed dangerous to infants, the elderly, those in the military, and was often connected to miscarriages and the death of pregnant people.27  Such a fear dated back to the 1500s, and the fear was grounded in reality. Pregnant individuals were highly susceptible to influenza, and those who survived often lost their children. Throughout the 1918 Pandemic, the going death rate for pregnant individuals ranged from 23-71%.28

And while the hospital at WMCP converted its space to intake more flu patients, they needed to ask: What about all the pregnant patients? How could the hospital best serve them? If one pregnant flu patient was admitted to the ward, it would be devastating. WMCP’s hospital is one example. Nearby, the overflow of patients forced staff at the West Philadelphia Hospital for Women to use bathtubs as cribs for infants. The majority of their space was converted to support only flu patients.29

Therefore, WMCP staff concluded: If a pregnant patient experienced flu-like symptoms was admitted, they were not admitted to the Maternity Ward but instead to the Medical Ward with the rest of the flu patients. The hospital refused to turn away a patient in need, which meant a balance needed to be created to best support everybody.30

WMCP’s efforts worked in their favor even with the Maternity Department seeing an increase in cases at the start of the flu epidemic. Throughout the 1918-1919 period, 224 babies were delivered, which included 8 pairs of twins. To support additional preventive medicine efforts, the Maternity Department educated new mothers on feeding their infants and general hygiene.31 The Maternity Department did not lose one case to the flu or pneumonia.32

Meanwhile, the admitted pregnant patients with flu symptoms faced more complications especially during the puerperium period, which is the period after delivery. About seventeen women struggled through this period due to influenza after effects, and out of those cases, seven women lost their lives.33

Relearning Epidemics

The lessons learned in the former epidemic, which only a few of us remember, have to be relearned in this.34

Elizabeth L. Peck spoke at the WMCP’s 1919 Annual Alumnae Association Meeting in the aftermath of the flu pandemic. Her haunting words above focus on the idea of tackling influenza treatment because 1918 was not the first time the United States saw the flu cause an epidemic.

Prior to 1918, about 20 years earlier the US battled a flu epidemic from 1889-1890. And yet, even with physicians who lived and worked during the prior epidemic, their information was not passed down forcing people to relearn the process of facing an epidemic. Therefore, Dr. Peck’s sought to highlight the importance of preventive medicine. If physicians could not conquer influenza, then a practice needed to be put into place to delay influenza from taking such an apocalyptic grip on society. The practice of preventive medicine needed to explore different avenues beyond only relying on immunization to save lives.

The pandemic met its end in 1919, but it wasn’t until the 1930s when researchers isolated influenza allowing them to define it as a virus that turned an individual’s immune system into a fatal enemy. The first flu vaccine followed in 1942. About 20+ years after the 1918 flu pandemic, physicians found their “magic bullet.”35

Dr. Peck and the Woman’s Medical College of Pennsylvania understood the importance of upholding preventive medicine practice and research.36 With no sight of a vaccine in the near future, they chose to focus on looking at how to improve the practice since it sought to help people understand how to manipulate their surroundings or change their daily habits to avoid catching an infectious disease. While a handful of good ideas took root during the pandemic, further research needed to happen to better define proper hygiene tactics or how to best wear a mask to prevent the spread of respiratory droplets in order to save lives.37

Works Cited

“Guardian of the Health of Negro Women”: The Work and Legacy of Dr. Virginia Alexander

 From the collections, Interns  Comments Off on “Guardian of the Health of Negro Women”: The Work and Legacy of Dr. Virginia Alexander
Jun 112020
 

by Mikaela Finlay, Virtual Intern Spring 2020

In the midst of a global pandemic, doctors have become heroes, putting themselves at risk every day to help those affected. Today, doctors are more important than ever before, but they have been selflessly helping others long before the spread of coronavirus. Doctors have a responsibility to help those in need, and no one exemplifies that better than Dr. Virginia Alexander. In Philadelphia in the 1930s, Alexander ran a clinic from her home where she provided medical services to those who were denied them elsewhere, even if patients could not afford to pay. She used her facility to train future physicians, and her legacy is carried on today by women who share her vision and values.

“Above all, give knowledge to negro women.”

For most of the nineteenth century, women had difficulty gaining acceptance to medical schools and were often ridiculed by their male counterparts.1 The Woman’s Medical College of Pennsylvania, established in 1850,2 provided opportunities for women who could not find an education elsewhere.3 However, as opportunities for white women in the medical field broadened in the late nineteenth century, opportunities for black men and women became increasingly limited.4 Though African Americans could receive medical degrees, both African American doctors and their patients were excluded from white hospitals.5 This exclusion led to the establishment of over two hundred black hospitals in the United States by the 1930s.6 The establishment of more hospitals led to a conflict between black organizations pushing for equality and integration and African American doctors who felt their only opportunities were at black institutions.7 As a black woman physician, Virginia Alexander worked in both black and white hospitals in Philadelphia but conducted her most important work at her private clinic.8, 9 

Dr. Tallant, professor of obstetrics at WMCP outside the college’s maternity clinic c. 1923 (From the Clara Dickinson scrapbook Acc1993.01)

Virginia Alexander was born on February 4, 1900.10 She and her three siblings were raised by her widowed father.11 Though Alexander offered to drop out of school to help support her family, her father refused and instead encouraged all of his children to complete their education.12 After high school, Alexander attended the University of Pennsylvania and the Woman’s Medical College of Pennsylvania (WMCP).13 Following her graduation, she converted part of her small home in Brewerytown into a six-bed clinic called the Aspiranto Health Home (AHH).14 In 1928, she was one of about ninety African American women physicians in the country,12 and according to Philadelphia’s 1930 census, there were over three thousand white doctors in the city and only seven black women physicians.15 

Despite her extensive training and education, Virginia Alexander had difficulty finding equal treatment from hospitals. White hospitals would not accept her African American patients, and as a result, she was forced to bring patients she could not treat in her clinic to Mercy-Douglass Hospital, Philadelphia’s black hospital at the time. At the AHH, she provided medical care for pregnant women and young mothers, and gave babies the medical care they needed at the beginning of their lives.11 Though she saw white patients, her focus was on providing quality medical care to African Americans.14 She explained, “…we will have to… above all, give knowledge to Negro women who are going to become mothers”.11 Her practice was a state-licensed facility and a forerunner of modern-day birthing centers.12 

“She can never be repaid for the service she has given her race.”

Dr. Alexander in an undated photo (from the Black Women Physicians Project collection Acc178)

At the AHH, Alexander provided impoverished African Americans in Philadelphia with the health care they could not afford to receive elsewhere. To help these women, she did not charge those who could not afford their treatment and often gave her profits back to poor members of her community.16 Alexander also provided contraceptives to women free of charge for two years,17 and at one point, she had over seven thousand dollars in uncollected bills.18 In a letter, she explained, “I have accumulated nothing in the way of the world’s goods; but I think I have established a fairly sound practice”.19 She was described as the “guardian of the health of negro women”,11 and one patient said, “she is one of the most useful women in the community because she can never be repaid for the service she has given her race”.14 Over the course of five years, Alexander saw two thousand patients and delivered forty-three babies, including the granddaughter of W. E. B. Du Bois.16 

Alexander’s Aspiranto Health Home not only allowed her to help impoverished members of her community receive much needed medical treatment, but it also paved the way for other young physicians and for her colleague Helen Dickens. Alexander used her clinic to help aspiring doctors start their own practices in Philadelphia. The AHH was a “teaching home,” as she hosted young physicians in her home so they could gain experience at her practice. She hoped her training would enable them to establish their own community-oriented private clinics similar to her own by helping them make connections and learn the needs of their Philadelphia patients.16, 17 Helen Dickens was one such physician who worked closely with Alexander and eventually took over the AHH.  After her time at the AHH, Dickens went on to study at the University of Pennsylvania Graduate School of Medicine, becoming the first African American to receive a Master’s of Medical Science degree from the University.10 In 1948 Dickens became the director of the Department of Obstetrics and Gynecology at Mercy Douglass Hospital and was the first African American woman to become a member of the prestigious American College of Surgeons since its inception in 1913.20, 21

“Our relationship is ingrained in our care”

Virginia Alexander spent her life providing medical care to underprivileged members of her community. As a physician, she used her station to aid those less fortunate than she. Through her commitment to equitable public health, Alexander established a clinic to provide her community with the healthcare they were denied elsewhere. She opened the doors of her clinic not only to patients but also to other young physicians, providing them with the experience necessary to eventually open their own clinics. She worked tirelessly and selflessly to help others, not striving to make money or gain recognition. 

Asasiya Muhammad at her clinic, Inner Circle Midwifery (photo by Rachel Wisniewski for WHYY)

Today, the WMCP of Virginia Alexander’s day is no longer standing. The University of Pennsylvania hardly resembles the one she attended, and her six-bedroom clinic has long since been renovated. Though little remains today to remind us of her work, Alexander’s legacy is carried on by those who share her commitment to selfless public service. A 2019 story by WHYY reporter Taylor Allen details the work of one such woman. Asasiya Muhammad runs a maternity clinic in Germantown. She is the only black woman in Philadelphia who is a certified professional midwife, and she established Inner Circle Midwifery in 2016. She has always been passionate about reproductive justice, and her goal is to create a safe space for minority women where they can receive care from midwives who relate to their experiences. As an African American woman and a mother of five, she has experienced microaggressions from dismissive doctors at hospitals, and she wanted to provide a different experience for other mothers. She explained, “It feels better being with someone who feels like a mom, an aunt, someone you can relate to. Our relationship is ingrained in our care”.22 Maternity centers such as Muhammad’s are important because minority women are at a much higher risk for birthing complications. In Philadelphia in 2012, African American women made up 74% of maternal deaths, and nationally, black women experience fatal pregnancy complications four times more frequently than white women.23 Like Virginia Alexander, she is using her clinic to help others start their careers as well. Her interns gain experience before going on to pursue careers in women’s health and social justice.22 The women in Muhammad’s clinic are preparing to be the next generation of advocates and doctors like Alexander. Though Alexander’s work is not widely recognized, her legacy is carried on by women such as Muhammad who share her commitment to equitable care for everyone and her dedication to the health of African American mothers.

 

To see Mikaela Finlay’s full paper on Virginia Alexander, click here

 

Bibliography

1Abram, Ruth J. “Will There Be a Monument?: Six Pioneer Women Doctors.” “Send Us a Lady Physician”: Women Doctors in America 1835-1920, edited by Ruth J. Abram, W. W. Norton & Company, 1985, pp. 72–75.

2Peitzman, Steven J. A New and Untried Course: Woman’s Medical College and Medical College of Pennsylvania, 1850-1998. Rutgers University Press, 2003, pp. 1, 13, 147-161.

3Hine, Darlene Clark. “Co-Laborers in the Work of the Lord: Nineteenth Century Black Women Physicians.” “Send Us a Lady Physician”: Women Doctors in America 1835-1920, edited by Ruth J. Abram, W. W. Norton & Company, 1985, p. 110.

4Gamble, Vanessa Northington. Making a Place for Ourselves: The Black Hospital Movement, 1920-1945. Oxford University Press, 1995, pp. xvi.

5Byrd, W. Michael, and Linda A. Clayton. “Race, Medicine, and Health Care in the United States: A Historical Survey.” Journal of the National Medical Association, vol. 93, no. 3 [Suppl], Mar. 2001, pp. 11S–34S., www.ncbi.nlm.nih.gov/pmc/articles/PMC2593958/?page=1.

6“Lone Black Hospital in Houston Ailing.” Philadelphia Tribune (1912-2001), 17 Jul. 1990, p. 1. ProQuest, search.proquest.com/docview/533018659?accountid=70954.

7Bousfield, M. O. “AN ACCOUNT OF PHYSICIANS OF COLOR IN THE UNITED STATES.” Bulletin of the History of Medicine, vol. 17, no. 1, 1945, pp. 61–84. JSTOR, www.jstor.org/stable/44440995.

8Rhodes, Bertha. “Personable REALTOR most OUTSTANDING Philadelphia WOMAN: MOST OUTSTANDING WOMAN.” Philadelphia Tribune (1912-2001), 21 Nov. 1935, pp. 5. ProQuest, search.proquest.com/docview/531391582?accountid=70954.

9“Virginia M. Alexander, M.D.” Drexel Medical Archives, Black Women Physicians Project, Virginia Alexander file.

10Alexander, Raymond Pace. “The Doctor Virginia M. Alexander Scholarship Foundation (A Short Summary of the Life of Dr. Alexander)”. The Doctor Virginia M. Alexander Scholarship Foundation, Incorporated, 01 Mar. 1961. Drexel Medical Archives, Black Women Physicians Project, Virginia Alexander file.

11“Virginia M. Alexander”. Drexel Medical Archives, Black Women Physicians Project, Virginia Alexander file.

12Alexander-Minter, Rae. 14 Mar. 1986. Drexel Medical Archives, Black Women Physicians Project, Virginia Alexander file.

13Medical Woman’s Journal, Jul. 1949, pp. 34-35. Drexel Medical Archives, Black Women Physicians Project, Virginia Alexander file.

14Southern Workman, vol. 62, no. 8, 1933, pp. 340–341. Drexel Medical Archives, Black Women Physicians Project, Virginia Alexander file.

15Alexander, Virginia M. The Social, Economic and Health Problems of North Philadelphia Negroes and Their Relation to a Proposed Interracial Public Health Demonstration Center. 1935. University of Pennsylvania Archives and Records Center, Virginia Alexander Papers. 

16“Can a Colored Woman be a Physician?” The Crisis, Vol 40, No 2, Feb. 1933, pp. 33-34.

17Alexander, Virginia M. Received by Helen Dickens, 2104 Jefferson Street, 1935, Philadelphia, Pennsylvania. University of Pennsylvania Archives and Records Center, Virginia Alexander Papers. 

18Baker, Joseph V. “Dr. Alexander’s Work in Public Health Hailed.” p. 24. University of Pennsylvania Archives and Records Center, Virginia Alexander Papers.

19Alexander, Virginia M. Received by Helen Dickens, 2104 Jefferson Street, 30 Apr. 1935, Philadelphia, Pennsylvania. University of Pennsylvania Archives and Records Center, Virginia Alexander Papers. 

20“Changing the Face of Medicine | Helen Octavia Dickens” U.S. National Library of Medicine, National Institutes of Health, 3 June 2015, cfmedicine.nlm.nih.gov/physicians/biography_82.html.

21“History of the American College of Surgeons.” American College of Surgeons, 2020, www.facs.org/about-acs/archives/acshistory.

22Allen, Taylor. “One of the Few Black Midwives in Philadelphia Wants to Give Women of Color More Healthcare Options.” WHYY, WHYY, 13 Feb. 2019, whyy.org/articles/inner-circle-midwifery-wants-more-natural-births-for-women-of-color/.

23Scott, Emily. “Midwives Hope Philly’s First Free-Standing Birth Center Will Make Inclusive Care More Accessible.” WHYY, WHYY, 17 June 2019, whyy.org/articles/midwives-hope-phillys-first-free-standing-birth-center-will-make-inclusive-care-more-accessible/.