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From The Saturday Evening Post, June 10, 1961
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How the Doctors Saved Chicago's Burned Children
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The dramatic struggle for the lives of a hundred children who were hospitalized by the worst school fire in Chicago's history
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By Alice Lake
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No one ever learned who the man was. At 2:52 on a Monday afternoon, he brought the first six children into St. Anne's Hospital. He spoke only once. “There will be more,” he said and disappeared.
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There were more, many many more. By four P.M. almost eighty children had arrived — children on stretchers, in policemen's arms, supported by firemen whose helmets glistened with water; children shivering from cold, dazed by shock, whimpering in fear; children who had cuts and bruises and broken limbs; children with the ugly odor of burned flesh, skin blackened, or angry-red with swelling blisters.
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These were the children from Our Lady of the Angels School, sixteen blocks away on Chicago's northwest side. Fire had broken out less than half an hour before the three P.M. dismissal time, crackled from the basement up the stairwell to the second floor, trapping the upper grades. Panicky, some children jumped twenty-five feet to the pavement below; others waited for the ladders, fire hissing at their backs; a few sat at their desks, books open, and died. Before the day was out, the toll was counted at eighty-seven children dead and 100 in seven hospitals. The final count: Ninety-five dead, three of them nuns, ninety-two children. It was the worst school fire in Chicago's history.
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Michele McBride will never forget that day—December 1, 1958. Michele was thirteen, an eighth-grader, one of a group of six girls who played and studied together. She is the only one left. In the classroom Michele shrank back from jumping while hysterical classmates pushed and clawed to get to the window. Fire had swept through the room when Michele reached the ladder. A few rungs down, she fell.
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“I woke up in the hospital,” she recalls, “and I heard someone say, 'Bring her over here. She's a bad one.'”
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Michele was the first “bad” one to arrive. Her head was Cut and almost two thirds of her body burned. Thick bobby socks protected the ankles, but the rest of her legs was burned, the left to the knee, the right, up to the thigh. Skin was burned away from her back and both her hands. On her face, burns seared the forehead and the left cheek down to the ear lobe.
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A severe burn is the most serious insult the body can endure. Every interlocking system of the complex human machine is thrown violently out of kilter. With skin destroyed, 60 per cent of Michele's body was an open wound. Vital fluids seeped from her blood stream into the tissues around the burned areas. Blood remaining in the vessels slowed its flow, started to pool, like water in a sludge clogged pipe.
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Michele's heart was affected, its output diminished. Kidney action faltered, and wastes were retained. Blood pressure dropped, pulse rate rose. The rate of destruction of red blood cells would soon increase. Michele was sick and would get sicker. Within eight hours she would be in desperate danger of death from shock.
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Unfortunately a serious burn is not merely a medical emergency. Skin is the body's protective covering. Where it is missing, there is no barrier to the entrance of lethal bacteria. Death from septicemia—blood poisoning—is a constant hazard until the body's open wounds are covered with substitute skin.
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Yet—where to find the skin? It must be borrowed from another part of the body. Where the need is greatest—as in a massive burn like Michele's—the least skin is available. Months of repeated operations are required to cover the wounds completely.
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Could a child as seriously burned as Michele live? The figures are sobering. In children, burns of more than a quarter of the body are serious, and burns of over half, desperate. A survey at Toronto's Hospital for Sick Children revealed recently that less than one out of every two children with 50 per cent burns survived. With burns of 80 per cent of the body, none lived.
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Yet Michele was not the most seriously injured child brought to St. Anne's. Ten were dead on arrival or survived only a few minutes. Five others were burned over 60 per cent of their body or more. Thirteen had up to 40 per cent burns. Twelve suffered broken bones, including two fractured skulls, a crushed chest, a shattered hip—thirty-six fractures in all. Twenty-four with minor injuries were treated and sent home. Forty-six, including three nuns, were admitted.
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At three P.M. in the emergency area Michele was examined and given a sedative. Immediately doctors started the vital early treatment of burns, the replacement of body fluids lost from the circulation. No one knew how much plasma Michele had lost, in what proportion the important chemicals—salt, bicarbonate, potassium—were missing from the blood stream. Doctors based their emergency treatment on the proportion of her body which was burned. Later twice-daily laboratory tests would be necessary. Giving Michele too much fluid could dangerously overload a faltering circulatory system. Too little could lead to death from shock.
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With plasma dripping into a vein on her right foot, a chemical solution entering through a vein on her left, Michele was wheeled at 3:15 P.M. to the elevator and up to surgery. There two nurses cut away her clothing, while Dr. Paul Fox, chief surgeon, hastily summoned from his office, gently washed the burned areas and stitched up her lacerated forehead. Michele's hands were bandaged in a position of function to avoid later distortion, but the rest of her pitifully charred body remained naked.
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Placed gently on sterile sheets, Michele was wheeled down the corridor to a room in the pediatric ward. Before the night was over, a neurosurgeon examined her for possible brain injury; an ophthalmologist looked at her eyes; a pediatrician and an internist checked her general condition several times. A nurse never left her side. Asked how she felt, Michele answered drowsily, “Pretty well done.”
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“A single burned child like Michele,” Dr. James Hartney, St. Anne's pathologist, remarked later, “is a topic of hospital conversation for weeks. Five such cases can bring normal hospital procedures to a halt. No other injury or illness requires so much grinding time, so much skilled nursing, so many laboratory tests. If diligence slackens for a minute, they may just slip away.”
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Somehow a hospital to which five serious burns might be a disaster cared for nineteen. Somehow a laboratory which normally performed 100 specialized blood-chemistry analyses each month did 300 in three days. Somehow experienced doctors, the world's greatest individualists, took orders from other doctors, made rounds like humble interns.
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St. Anne's admitted twice as many children that day as any other hospital. By chance they were the most seriously burned children. Although a dozen or more went to each of three smaller hospitals—Franklin Boulevard, Garfield Park and Walther Memorial—where they received fine care, the main drama unfolded at St. Anne's. An ordinary neighborhood hospital of 322 beds, without fame in teaching or research, it handled its overwhelming problems as if major disaster were an everyday occurrence. “The children received superb treatment,” one expert in burns said later. St. Anne's final results: No deaths from shock, one from multiple body fractures, only three from burns.
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Although the hospital's disaster plan, eight years in the making, played a significant role, although the gentle warmth of the fifteen nun supervisors encouraged effort almost beyond endurance, the common denominator was the children. Doctors neglected their private practice because of the children; nurses gave generously of their time; and the city of Chicago opened its resources and its wallet to the children. In the background were years of concern for burned children—concern by a plastic surgeon in Scotland, by Army medical officers in Texas, by researchers in government and hospital laboratories. From all these sources St. Anne doctors drew to save children's lives.
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Twenty-four workmen who died in 1947 helped the children. At that time an explosion at a nearby industrial plant brought twenty-five horribly burned men to St. Anne's. “It was our first major disaster,” recalls Dr. James Segraves, orthopedic surgeon. “And like most hospitals, we had no blueprint for handling it.” In the emergency area the scene was out of Dante's Inferno. Men with their clothes half burned away ran screaming down the corridors. The men's lungs had been seared by live steam, and only one survived.”
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St. Anne's disaster plan was born that day. Doctor Segraves fathered the plan, discussed it, revised it, rehearsed it. When the real test came that Monday afternoon in December, 1958, St. Anne's 647 employees, its medical staff of 104, its 120 student nurses moved into action with the quiet precision of a trained football team.
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First came the telephone calls. At 2:52 the emergency room called Sister Mary Almunda, hospital administrator; 2:54, Sister Almunda reached Doctor Segraves at his private office; 2:55, switchboard operators called their list of key doctors; three o'clock, as doctors raced for their cars, their secretaries telephoned other doctors on secondary lists.
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At the hospital, nurses going off duty at three p. M. remained to augment the arriving staff. Hospital stretchers were brought to the emergency area, intravenous racks rolled to the hospital auditorium, designated as a temporary receiving ward. Student nurses cleared away auditorium chairs, brought in extra beds, set up long tables for bandages, needles, plastic tubing, drugs, syringes. Housekeeping sent down blankets and sterile sheets. Pharmacy workers checked their supplies.
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Bottlenecks developed, of course. The three slow hospital elevators, each able to hold only two stretchers, delayed the movement of the sickest children to the sixth-floor operating pavilion. Incoming calls jammed telephone lines, and new wires had to be put in hastily. Traffic clogged the streets for half a mile, forcing doctors to abandon their cars and run.
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Then there were the parents. Many rushed from hospital to hospital. Spilling into busy corridors, they peered at each passing stretcher, hoping a burned face might be familiar, yet fearing that it was. Nuns led them to the nurses' lounge, where sandwiches, hot coffee and bulletins on the children awaited.
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Meanwhile, children were moving in a steady stream, first to the emergency room where Doctor Segraves diagnosed the injuries, then to the operating room, down the corridor to X ray, or to the auditorium where doctors administered sedatives, tetanus antitoxin, antibiotics and started the slow drip of fluids into the veins. “
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Curiously, it was deathly quiet,” recalls Doctor Segraves. “The children whimpered, but they didn't cry. They were abnormally polite, pitifully grateful. I remember one badly burned girl of nine. She kept worrying about her little brother who was a first-grader at the school. She wouldn't let anyone give her a sedative until she learned that he was safe at home. Then, 'Please give me something to make it stop hurting,' she said.”
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By seven P.M. the auditorium and the operating rooms were empty, and every child bedded down. At 8:30 twenty-five weary doctors gathered in the lounge to make plans. Their basic problem: Who was to treat the children and how. Their solution: Temporarily suspend the private practice of medicine; appoint an internist, Dr. Thomas Moore, and a pediatrician, Dr. Joseph Forbrich, as team captains and enlist the rest of the medical staff to carry out their orders; assign doctors in groups of three to three-hour hitches of duty round the clock, making rounds, checking each child, giving medication.
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The team approach was not new with St. Anne's. It is the treatment recommended by Brooke Army Medical Center at Fort Sam Houston, Texas, probably the leading burns center of the country. For St. Anne's no other plan was feasible. With the same orders for every child, drug demands were simplified, laboratory procedures could be streamlined and youngsters grouped for nursing care.
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Another critical decision made during the first night was to treat all burns by the exposure method. Introduced in 1949 by Dr. A. B. Wallace of Edinburgh, Scotland, pioneered in the United States at Brooke, the method simplifies treatment and is believed to reduce infection. Instead of being swathed in warm moist dressings, which encourage the growth of bacteria and which must be changed every few days, the patient lies naked on a sterile sheet. Nature soon covers his open wounds with a crust—thick and reddish-brown like bacon rind, a natural barrier to the entrance of bacteria.
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The open treatment, practical as it is for mass casualties, adds problems of its own. At each bedside meticulous observance of sterile technique is required. Nurses donned sterile gown and mask as they entered each room, wore sterile gloves when they touched a burn. It would have been easier, and possibly safer, to bar all visitors. But St. Anne's knew that children needed their parents, and so the chance was taken that sterile precautions would be inadvertently broken. Parents, also masked and gowned, visited day and night.
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Some found their burned children in beds which looked like canvas slings. Continued pressure on uncovered burns may worsen their severity. When burns circled the body, children had to be turned constantly, as often as every two hours. Their special beds were called Stryker frames—“the most uncomfortable bed in the world,” according to Michele. Two nurses were needed to flip over a child like a pancake, from stomach to back and back to stomach again. Some lay on circle beds, electrically operated versions of the Stryker frame.
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With the open treatment, children were cold. Deprived of the natural insulation of the skin, her body untouched by blankets, Michele complained of being “hot on the inside but cold on the outside.” Rooms were kept tropic-warm, and nurses created ingenious tents by draping sheets and electric blankets over bars above each Stryker frame.
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Burned children needed spunk to keep going those first few weeks. “What pulled me through?” says Michele. “It was my sense of humor and my appetite.” Michele started begging for food her first night in the hospital. Three weeks later she ate a whole pizza which her mother had brought in. One afternoon she wolfed a dozen rolls.
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Although she remained very sick for weeks, still running a fever of 104 degrees late in December, Michele's humor was infectious, her imagination unbounded. She cheered herself and other youngsters too. A particular concern was a friend of her own age, burned over two thirds of her body. “She was always a goofy kid like me,” Michele recalls, “but after the fire, I couldn't get her to laugh. She just didn't seem to care.” Michele's friend died in March, 1959.
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Although laughter helped, still the children were frightened. One little girl became hysterical as a nurse tried to light the candles on her birthday cake. Even Michele had nightmares for weeks, reliving the fire. “Don't let them push me,” she kept crying in her sleep.
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Fears receded slowly. Months later a boy, ashamed of his bald burned head, hid in the closet whenever visitors came. Even a first-grader, who hadn't been harmed at all, couldn't forget. Taken to a new school, a two-story structure like Our Lady of the Angels School, he shrank away in terror. “I want to go to a flat school,” he whimpered.
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Worst was the pain. Every time a nurse had to touch a wound, to pry it gently loose from the sheet, to turn a child, the pain was exquisite. One pain receded to be replaced by another. Michele dreaded most the ache of the donor site from which a skin graft had just been removed. “It's like an open sore that's really open,” she said. Because only parchment-thin skin layers were cut away by an ingenious instrument, the electric dermatome, nerve endings were intact, and each quivered with pain. Within a month skin on the donor sites, mostly on Michele's thighs, regenerated and was used again.
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Eleven children and one nun, Sister Helaine, required repeated skin grafts. On December nineteenth Michele was wheeled to the operating room, where she remained under anesthesia for two hours. Skin was first transferred to her left shoulder, the back of her right knee and her right hand, areas around joints in danger of permanent stiffness if inelastic scar tissue were allowed to form.
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Michele had six further skin-grafting operations, the last two and a half months after the fire. Because only a meager amount of unburned skin was available, her surgeon, Dr. Paul Fox, used postage-stamp grafts on her lower legs. Instead of moving the skin in a single sheet, he cut it up into one-inch squares and scattered them a half inch apart over her calves. Because skin grows outward from its edges, the gaps eventually filled in.
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Doctor Fox's problems with Michele were routine compared to those faced by Dr. William Dvonch, the surgeon who cared for Johnny, also thirteen, the most severely burned child in the hospital, (At the request of his grieving parents, Johnny's real name has not been used.) Johnny had lost 80 per cent of his skin. Burns charred his back, his chest and abdomen, part of his legs and arms, the right side of his face and his right ear. Johnny was a fine-looking boy with sandy hair and warm brown eyes. He was the most polite child in the hospital, and everyone loved him.
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Doctor Dvonch told Johnny's parents not to hope, but did not take his own advice. For eight months he fought to keep the boy alive. “From Johnny I learned that no burn is too bad to treat,” says Doctor Dvonch.
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Grafting was started on Christmas Eve, but it soon became clear that the boy just didn't have enough skin to cover his wounds. Homografts would have to be used. These are grafts from another person which provide temporary covering of the open wound. A homograft will live three weeks or more before it begins to slough away. The Navy Tissue Bank at Bethesda, Maryland, has developed an ingenious method of freeze-drying skin for future homografting.
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Called on for aid, the Navy flew in 6000 square inches of preserved skin, and on New Year's Eve Johnny's first homograft was applied. By March more drastic measures were needed. Johnny's mother was hospitalized, and 240 square inches of skin transferred from her thighs to her son's upper back. In April a neighbor volunteered. Her skin was used to cover the boy's lower back and buttocks. Each woman was hospitalized for more than a week, incapacitated for close to a month
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By June Johnny had been wheeled twenty-five times to the operating room. Most of his wounds were now covered with skin. The take was remarkable. Even the homografts held well. He was the only one of the burned children still in the hospital, but he kept cheerful and busy. Johnny built model airplanes, a useful exercise for his severely burned left elbow. Lying on his stomach on the Stryker frame, a book resting on the floor, he read while a nurse flipped the pages for him. But Johnny's body tired of fighting. His liver began to fail. Soon he was yellow with jaundice. On August ninth, 251 days after the fire, Johnny died
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Louise, a nine-year-old, lived. The tip of her nose and part of her lip were the only unburned areas on her face. She was unable to close her burned eyelids or mouth. The backs of both hands and her forearms were burned too. St. Anne's had no plastic surgeon on its staff, but it called in a consultant, Dr. Clarence Monroe. On New Year's Day he started a series of incredibly delicate skin-grafting operations to give Louise a passable face. Eight operations were performed at St. Anne's, and ten at Presbyterian-St. Luke's Hospital, to which she was transferred in March. Louise will never look normal, but she can close her eyes and her mouth and play the organ with her grafted hands. Skin on her face, taken from her unburned trunk, is mobile, not mask-like. For her, further treatment lies ahead. Two and a half years after the fire, she is the only child who has not yet returned to school
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Even with skin grafting complete, the road back to normalcy has not been easy for the children. Michele accomplished it by fierce determination. Discharged from the hospital after four months, Michele was graduated with her class, its ranks sadly thinned, in June. She devoted the summer of 1959 to a struggle against stiff limbs. “
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I must have climbed the stairs of our house hundreds of times,” she says. “I played badminton whenever I could. I love riding my bike. It took three months of steady work before I could ride comfortably again.” today at sixteen, Michele is a tall slim teenager in harlequin glasses, her light brown hair worn in bangs to hide her scarred forehead, her skin-grafted legs in bobby socks. “I have two boy friends, believe it or not,” she says. Yet physical and emotional problems have not vanished. Michele's legs are blotchy and still occasionally painful, especially after she exercises too vigorously. She refuses to wear shorts in the summertime. “People still stare at me, especially the neighbors. And they whisper, how they whisper. This child is crippled, that one is affected mentally, things like that. I guess after something like the fire, you have to prove yourself all over again to the world.”
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Directly after the fire, no child had to prove his need to the city of Chicago. Gifts and get-well cards poured into the hospitals by the thousands. Many children needed round-the-clock private nursing for months, and Chicago's nurses rushed to fill the need. One gave up her vacation. Another hired a baby sitter for her daughter and went back to work. Other hospitals filled buses with their own staff members, went shorthanded themselves. In the first days nurses worked without pay. The 3800 hours of time they donated would otherwise have added more than $9000 to the children's bills.
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No one can estimate the dollars-and cents value of the doctors' time. For the first week no attention was paid to who treated what child. Doctor Moore, one of the St. Anne team captains, worked steadily from 3:30 Monday afternoon to five A.M. Wednesday, going home once briefly to change his clothes. He saw no office patients for a week. Doctors accepted medical-insurance payments, but turned the checks over to their hospitals or to funds established for the burned children. “We felt,” a doctor explained, “that we wanted no profit from the children.”
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No treatment is more expensive than that for a serious burn. Hospital and medical fees have already cost more than $100,000 and nursing care, $65,000. One child's expenses have reached $25,000. Sixteen children were still being treated in 1960, and at least ten are expected to have medical bills in 1961.
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No parent has paid out of pocket for these expenses. Within a day after the fire, money started pouring in—almost $150,000 to Catholic Charities, and more than $500,000 to a special fund set up by Chicago's Mayor Richard J. Daley. These two funds have paid out about $500,000 for burial expenses and medical bills, for physical therapy and private tutors, for fountain pens and eyeglasses to replace those lost in the fire, for wigs for two youngsters with burned scalps. Catholic Charities' fund went into the red long ago, but the mayor's fund has more than $250,000 left. However, a note of discord was struck in June, 1959, when the first lawsuits were filed. Fifty-five suits are now pending in the courts against the Archdiocese of Chicago, forty brought by parents of children who died in the fire, and fifteen by parents of injured children. The suits allege “carelessness and negligence” in the operation of the school and seek damages totaling $4,660,000.
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One small gift to the burned children may someday prove to have the greatest value of all—a gift of blood from fifty five persons who themselves had recovered from serious burns. The seven sickest children at St. Anne's—Michele was one—received this convalescent blood. Whether it saved lives is a question still being fiercely debated among the experts.
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The debate goes back more than twenty years. Doctors have long observed that a patient with massive burns shows typical signs of toxicity or poisoning. Often he is restless, confused, unresponsive, with an elevated pulse and a soaring fever. Many doctors have wondered if his own burned tissue may be poisoning him by releasing toxic products into the blood stream.
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In 1937 Dr. Sol Roy Rosenthal of the University of Illinois College of Medicine reported that he had isolated a specific toxin in the blood of recently burned animals and humans. Moreover, he added, the body reacts to this toxin by producing an antitoxin to destroy it. Although Doctor Rosenthal continued his research, aided in part by a grant from the Office of Naval Research, other investigators were unable to reproduce his experiments.
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If Dr. Rosenthal was right, blood transfusions from persons convalescing from burns would carry antibodies to help a child fight his own burns. But was he right? St. Anne doctors, believing that the new treatment was without danger, were willing to find out.
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Between mid-December and early January, eighteen units of whole blood and twelve of plasma, all from burned persons, were given to the seven children. The treatment had never before been used on humans in the United States. Was it successful? Doctor Rosenthal says that one or two children were actually snatched from the jaws of death. Reporting last October in the Journal of the American Medical Association, he wrote:
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The improvement was characterized by a decrease of pain, irritability and edema [swelling], and an increase in awareness, mobility, appetite and ability to swallow and sleep. One patient received his second bottle of blood and was “leading the band” on the radio with his arm. He had not been able to move that arm before. . . . [Another] child whose condition had been considered hopeless was now alert and eating and sleeping well.
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Many doctors remained skeptical. They criticized the report for being subjective and for having no controls against which to weigh the results. “The children were given so many different kinds of treatment,” one said, “that it is impossible to credit improvement to a single factor.”
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In recent months a few other doctors have followed the St. Anne pioneers. They report remarkable immediate reactions to the transfusions of convalescent blood, but cautiously avoid more sweeping claims. In Milwaukee Dr. Burt Waisbren gave a single dose of convalescent serum to each of two men, burned in an antifreeze explosion. “It seemed to help,” Doctor Waisbren said.
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Eight-year-old Ana Rosa Zamudio was burned over almost half her body last November in an incinerator fire in San Francisco. At St. Francis Memorial Hospital she was irritable, sleepless, her little body swollen, flushed with a fever of 104°. Dr. E. Horace Klabunde, the plastic surgeon who was treating the child, called on an ex-patient, a woman who had been burned smoking in bed, to donate blood. With the first transfusion, Ana Rosa brightened. Her temperature, pulse and respiration fell almost to normal. Over a four-week period she received seven half-pints of serum and three pints of blood from burned donors.
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Did the transfusions save her life? Doctor Klabunde is not sure. He points out that with half the body burned, doctors are hopeful of saving a life, but not surprised if they fail. “We feel,” he says, “that her over-all course has probably been smoother, and this we would necessarily attribute to the convalescent serum and blood.”
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Doctor Klabunde and a colleague, Dr. Mark Gorney, have used convalescent serum on two other patients. One lived, and the other, a forty-nine-year-old man, died despite the treatment. With further use planned, the San Francisco Blood Bank is now calling on persons who have recovered from burns to register as potential donors.
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Experts from a dozen countries discussed the St. Anne children and convalescent serum last fall when the First International Conference on Research in Burns was held in Washington, D.C. In a carefully documented report, Dr. Ole J. Malm of the Walter Reed Army Institute of Research in Washington said that the serum provided a “constant though not dramatic protective effect” to burned animals.
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Dr. N. A. Feodorov of Moscow made bolder claims. He reported that the serum had “an obviously curative effect” on animals and added that it had already been used in Russia on more than 200 burned humans.
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Further controlled studies, on both animals and humans, will be necessary before science learns whether the St. Anne children pioneered in a dramatic new treatment of burns. Evidence seems to be growing, most of it still indirect, to support the burn-toxin theory.
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“The real question,” says Dr. Nicholas Kefalides of the University of Illinois College of Medicine, “is, why do they die? Why is infection so lethal to burned children? Is there a factor—you can call it a toxin—which lowers their resistance? Some die without apparent reason. What kills them?”
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Seeking an answer to these questions, research is now proceeding at a quickened pace. National institutes of Health funds support a continuing project in Lima, Peru, which has recently developed a treatment for burn shock, of great potential value in mass disaster. A burns research program was started several months ago at New York University Medical College, supported by a $332,000 grant from the John A. Hartford Foundation. Another project is under way at the First Surgical Division of Columbia University's College of Physicians and Surgeons.
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The stakes are high. Although a fire as lethal as the blaze at Our Lady of the Angels School is rare, almost 9000 Americans are killed and 100,000 hospitalized annually from burns. Almost half of the victims are children. The cost of burns is “just too serious to tolerate,” Dr. Lendon Snedeker of Children's Hospital in Boston said recently. “A human being is scarred for life, and the economic penalties for hospital, family and community are enormous.”
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Ask Michele. She knows.
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Story © 1961 The Curtis Publishing Company
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