Milton Helpern was the most famous Chief Medical Examiner for the City of New York —"a Sherlock Holmes with a microscope."
Rose, Harry M. (Moderator). Epidemic Influenza
Sunday, November 24, 1957
This is a special session convened on November 19, 1957, by the New York Academy of Medicine, moderated by Columbia University's Harry M. Rose and including the following:
Morris Greenberg, Director of Bureau Preventable diseases NYC DOH
Milton Helpern, New York City's Chief Medical Examiner
George K Hirst, Director of the Public Health Research Institute
Shirley C[arter] Fisk, Columbia Presbyterian Medical Center
David E Rogers, Weill Cornell Medical Center
Edwin D Kilbourne, Weill Cornell Medical Center
With introductory and closing remarks delivered by New York Academy of Medicine President Dr. Robert L. Levy.
The proceedings were presumably broadcast over the Municipal Radio Station, WNYC.
For more information, see the following CDC reports:
Rundown: Intro remarks by Dr Levy, who calls the special meeting on a â€œvery timely topicâ€ (0:29)
Dr Rose introduces panel
Dr Hirst - â€œmost publicized epidemic weâ€™ve ever hadâ€ (4:23)
Historical overview â€œnow entering another phaseâ€ (7:25), very distantly related to current so very few people have antibodies, strains very different from any previously known. [Sounds scary]
Dr Rose â€œone of the astonishing things indeed is that the epidemic proportions were not even largerâ€ in October (10:41)
Dr Greenberg â€“ current NY situation. First from exchange students from Europe and Asia. Then in late September â€œthe thing came down with a bangâ€ (12:40). So many calls for ambulances â€œpolice was unable to keep upâ€ (12:52) Starts slides. Absenteeism up to 1/3 of student population; since come back to normal, same with reported cases. Children more affected than adults. 51% of all excess deaths among those older than 50; also high for pregnant women and those with heart disease; but (unexpectedly) normal rate for infants. Low vaccine until end of October. â€œWe did not know a great deal; nobody knew very much because this was a new virusâ€ (23:40) Incidence and mortality lower in NYC than elsewhere.
Dr Rose: Do antibiotics work for secondary infection which often causes the actual death? â€œThere are situations in which influenza occurs without super infection in which we are currently quite helplessâ€ (27:10)
Dr Helpern â€“ on death. Unusually high numbers of fairly rapid onset with at first not alarming symptoms. Some exchange students aboard ship Arosa Sky (later Bianca C, the â€œTitanic of the Caribbeanâ€) from Rotterdam. A boy jumped from a window after going â€œberserkâ€ in the care of a relative. 20-25 deaths due to influenzal bronchial pneumonia. Slides showing symptoms of some specific cases, not too different from cases in the past
Dr Rogers and Dr Kilbourne â€“ Gives up on slides. 2 types of patients: One with pneumonia similar to the cases of Dr Helpernâ€™s, another with no additional bacterial infection but dying from the virus itself; most of these have died in the hospital. â€œThis is somewhat terrifying because it indicates that this is clearly a situation where antimicrobial therapy cannot be expected to avail us, and indeed it has notâ€ (53:41)
Dr Rose â€“ Confirms Kilbourne findings. â€œWe are confronted with a situation where in a certain proportion of cases we have a disease which we are in no ways able to controlâ€ after a certain point (55:55). â€œIt is a little bit frightening to think what might happen if we had a recurrence of the disease as we have seen it so far this year and had a larger or a greater incidence of cases of this sort.â€ (56:12) â€œLet us hope and pray that nothing of that sort actually happens and that in the meanwhile we can come up with some ways and means to deal with the problem, should it ariseâ€ (56:24)
Dr Fisk â€“ clinical aspects, advice to physicians. Most are mild infections treatable at home. Small percentages are fulminating, as well as other infections. If Aspirin does not help, assume pulmonary infection. In hospitals antibiotics generally work, first penicillin and streptomycin, then more general antibiotics.
Dr Rose â€“ immunization. Manufacturing issues: vaccine had to be monovalent, and less than ideal quantity, slowly available. How good is the vaccine? Mentions Fort Dix study in August, then an â€œextraordinarily highâ€ peak in October. One with 200 CCA (chick-cell agglutinating) units, one with 750 units, and a control group. Vaccine has â€œsomewhatâ€ of a protective effect at 200 units, but â€œit leaves a good deal to be desiredâ€ (1:11:05) â€“ needs greater potency. Due to Public Health Service recommendations a higher (400 cca) vaccine became â€œofficialâ€ Nov 1.
Dr Kilbourne â€“ multiple doses better although study is small.
Dr Hirst â€“ how immunization works in general; we do not know how it works with new viruses
Q&A â€“ Dr Fisk - cannot clinically distinguish common colds, adenovirus (a-p-c) infection and Asian flu; Dr Rogers thinks they can (rapid onset, headache); Dr Fisk disagrees. Dr Rose talks about possible tests to identify presence of virus, Dr Hirst points difficulties
Dr Greenberg â€“ 2nd wave in Japan same? Will there be a 2nd outbreak in US? Probably not because it has already been all over the world. Infant/children vaccination? Not advisable; bad reaction and low infant mortality. Advise: elder, heart disease, pregnant women
Dr Hirst â€“ Contracting and vaccinating same rate of protection
Dr Kilbourne â€“ Unlike (reportedly) 1918, no neurologic complications. Need more study, better techniques.
Dr Helpern â€“ No brain lesions. One point about earlier slides: bacterial presence does not mean pathology was their result.
Dr Fisk â€“ good idea to give antibiotics to flu patients with chronic pulmonary disease.
Dr Hirst â€“ no antigenic variation
Dr Rose â€“ Vaccine is efficacious
Drs Kilbourne and Hirst â€“ Spacing of double dosage is important, and not settled
Dr Levy â€“ one case with striking periocarditis.
WNYC archives id: 67585