Cover Story

Cocoanut Grove victims are attended to at Boston City Hospital.

Medical Advances

NFPA Journal®, November/December 2007

By Casey C. Grant, P.E.

IN NOVEMBER of 1942, the city of Boston was able to include upon its voice of recognition the superior medical and scientific research facilities within its domain. After almost a year at war, the urgency of improving certain medical techniques had been given new focus, and Boston found itself directly involved in these efforts.

PHOTOS  PHOTO GALLERY:   View photos from the Cocoanut Grove AUDIO CLIPS   NFPA program director for the Fire Protection Research Foundation Casey Grant on the Cocoanut Grove Fire:  A description of the Cocoanut Grove nightclub  Why was the fire so deadly?  Why did the fire spread so rapidly?  What was the response by the Boston fire department?   Cocoanut Grove survivor Dr. Saul Davis recounts the night of the fire:  His initial reaction to the fire  Fighting the mob  Looking for an escape  More audio clips FROM THIS ISSUE Last dance at the Cocoanut Grove The deadliest nightclub fire in U.S. history is still confounding and frightening 65 years later. Emergency disaster preparedness Boston hospitals faced a variety of challenges following the Cocoanut Grove fire. Medical advances Threatment of victims of the Cocoanut Grove fire helped advance medical knowledge on a variety of fronts. Fire Safety Regulations The tragedy brought about very positive changes in regulations concerning life safety. First Word - The Cocoanut Grove That fire created the opportunity for NFPA to lead the way to major reforms. RELATED NFPA FEATURES  The legacy of nightclub fires (May/June 2007)  Nightclub safety for students (May/June 2007)  NIST report on The Station nightclub fire (May/June 2005)  NFPA Makes sweeping changes following The Station nighclub fire (Jan/Feb 2004)  Safe exit: Nightclub safety equals life safety (July/Aug 2003)  Searching for answers to the Cocoanut Grove Fire of 1942 (May/June 2000) (PDF 2.5MB) NFPA FIRE STATISTICS  Nightclub/assembly occupancy fire fact sheets  10 Deadliest public assembly & nightclub fires in U.S. history  Download NFPA's fire investigation report  (PDF 6.3MB)

Medical research initiatives sponsored on a national scale included the search for improved methods to deal with burn victims. It was expected that the casualties of war would place new demands on burn treatment, and better methods were needed. Thus, early in 1942, research projects had been initiated under contract to federal entities like the Office of Scientific Research and Development and the Office of Naval Research.

Regarding burn treatment, the on-going research in 1942 focused on the following four topics:

1. surface management;
2. surgical management;
3. fluids management; and,
4. respiratory management.

While the greatest steps forward for Cocoanut Grove related medical advances are most appropriately addressed into these 4 groups, other milestones were made on related topics. One of these was the fortification against infection. A new weapon against infection was penicillin, but in 1942 it was new, expensive, and scarce. On Wednesday, December 2, 1942, Cocoanut Grove survivors at Massachusetts General Hospital became the first recorded general patients to receive dosages. Much later when more was known about the new drug, however, it was determined that it was administered in dosages that were much too small.

Surface and Surgical Management
At the time of the Cocoanut Grove fire, research on surface management (burn treatment) and on surgical management (skin grafts) was partly underway. Rather than the fire allowing for new discoveries on these subjects, it instead served as the ultimate test for new methods that were already becoming recognized.

The accepted method of surface management in 1942 was the "tanning process" that involved the application of a solution of tannic acid. This created a leathery scab over the wound that acted as a shield against both the invasion of bacteria and for the loss of vital bodily fluids. Yet this was a time-consuming, cumbersome, skill-dependent process that subjected the patient to agonizing pain because of the scrubbing procedure required before the application of the chemical dyes.

A new method of surface management referred to as the "soft" technique had been devised by Dr. Oliver Cope and his colleagues at Massachusetts General Hospital. This simplified method required the burned surfaces to be swathed in gauze impregnated with boric petroleum, promoting a natural healing of the burns that harnessed the bodies formidable regenerative powers. This innovative method had just been implemented prior to the fire at Mass General, and the patients who suffered only from severe burns (without respiratory or other complications) were recovering nicely. In a crisis situation, the method had proven itself as virtually an unqualified success.

Boston City Hospital, however, used the traditional tanning process to treat their patients. This was because of the overwhelming influx of Grove victims for which they were not fully prepared to handle with a new method that was just becoming policy. But to the credit of this institution, the treatment of one young Coast Guardsman named Clifford Johnson made medical history. Under the care of Dr. Newton Browder, Johnson was given no chance to live after having been brought in with horrible third-degree burns over more than 50 percent of his body, and another 25 percent of this flesh blistered by second degree burns. At that time, it was a medical rarity for anyone to survive third-degree burns over as much as 20 percent of the body. But after almost 12 months and a tremendous ordeal involving diligent care, Clifford Johnson was discharged from Boston City Hospital as a medical phenomenon.

Fluids Management
Another research topic concerned with burn treatment was fluids management (shock). This research was well underway and the Boston hospital’s were well prepared with stockpiles of blood and plasma. But despite these supplies, immense quantities were used on the victims of the fire. In the first 24 hours alone, more blood plasma was given to Cocoanut Grove victims than had been used in Hawaii following the attack on Pearl Harbor. On the day after the fire, 1,200 citizens offered blood, and within days the local Red Cross had collected a much needed 3,800 units.

Respiratory Management
Foremost among all the advancements made in modern burn treatment because of the Cocoanut Grove fire is that involving respiratory management (injury to the lungs). Victims who had succumbed to respiratory tract injuries were significant.

Much to the dismay of medical staff, the effects of these injuries were often delayed and involved individuals who showed very little outward signs of being in danger. A number of these victims had walked into the emergency rooms under their own power and were put aside for patients who were more obviously hurt, only to succumb shortly thereafter.

Postmortem examinations revealed a strange pattern of massive pulmonary edema that developed late and suddenly. This suggested the effects of poison gases, much like the effects of the deadly poison gases used in the first World War. Similar in occurrence was the strange loss of life encountered in the 1929 Cleveland Clinic fire that killed 125. This involved x-ray fi lms that released phosgene gas into the ventilation system. With the Cocoanut Grove, suspicions were aroused that somehow, perhaps from the pyrolysis of the interior finish, a deadly poisonous gas had been released.

It was apparent that many of the hospitalized patients had inhaled a toxic substance. These victims developed post traumatic pulmonary injury and required constant monitoring. The lessons learned from the Cocoanut Grove fire brought an entirely new focus onto the respiratory management of burn victims that revolutionized pulmonary treatment.

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Casey C. Grant, P.E.  is Research Director for the Fire Protection Research Foundation. He can be reached at cgrant@nfpa.org.

In this Section:
			Last Dance at the Cocoanut Grove Once a popular Boston nightspot, the Cocoanut Grove is forever etched in history as the city's worst nightmare.
			Fire Safety Regulations The Cocoanut Grove fire brought about very positive changes in regulations concerning life safety.
			Emergency Disaster Preparedness Boston hospitals faced a variety of challenges following the Cocoanut Grove fire.
			Medical Advances