The Spanish Influenza

Spanish Influenza Outbreak, 1918 by Sarah Cummings

I had a little bird.  Its name was Enza.
I opened the window, And in-flu-enza*

Children's Rhyme 

In the midst of perfect health, in a circumscribed community... the first case of influenza would occur, and then within the next few hours or days a large proportion- and occasionally every single individual of that community- would be stricken down with the same type of febrile illness, the rate of spread from one to another being remarkable... Barrack rooms which the day before had been full of bustle and life, would now converted wholesale into one great sick room, the number of sick developing so rapidly that hospitals were within a day or two so overfull that fresh admissions were impossible.

-Dr. Herbert French to the British Ministry of Health (Hoehling,18)

By the time it was over, the Spanish Influenza cost the lives of approximately 20,000,000 humans across the globe

In September of 1918, soldiers at an army base near Boston suddenly began to die. The cause of death was identified as influenza, but it was unlike any strain ever seen. As the killer virus spread across the country, hospitals overfilled, death carts roamed the streets and helpless city officials dug mass graves. It was the worst epidemic in American history, killing over 600,000--until it disappeared as mysteriously as it had begun.
 

Fort Riley, Kansas, was a sprawling establishment housing 26,000 men and encompassing an entire camp, Camp Funston, within its 20,000 acre boundaries. Soldiers often complained about the inhospitable weather to be found at the site: bone-chilling winters and sweltering summers. And sandwiched in between these two extremes were the blinding dust storms. Within the camp were thousands of horses and mules that produced a stifling nine tons of manure each month. The accepted method of disposing of the manure was to burn it, an unpleasant task made more so by a driving wind. On Saturday, March 9, 1918, a threatening black sky forecast the coming of a significant dust storm. The dust, combining with the ash of burning manure, kicked up a stinging, stinking yellow haze. The sun was said to have gone dead black in Kansas that day.

Some, looking for a point of origin of the so-called Spanish influenza that would eventually take the lives of 600,000 Americans, point to that day in Kansas. Shortly before breakfast on Monday, March 11, the first domino would fall signaling the commencement of the first wave of the 1918 influenza. Company cook Albert Gitchell reported to the camp infirmary with complaints of a "bad cold." Right behind him came Corporal Lee W. Drake voicing similar complaints. By noon, camp surgeon Edward R. Schreiner had over 100 sick men on his hands, all apparently suffering from the same malady.

Any evidence of an influenza epidemic in the spring of 1918 was furnished by those institutions that kept a close eye on those under their watch: the military and prisons. In April and May over 500 prisoners at San Quentin in California came down with the same condition that had struck soldiers at camp Riley, as well as camps Hancock, Lewis, Sherman, Fremont, and several others. Influenza spreading amongst men living in close quarters did not particularly alarm the public health officials of the day. Little data existed at the time to indicate a sizable spread among the civilian population. Besides, the nation had bigger matters on its mind. There was a war to win.

In the spring of 1918, it appeared that America's involvement in the fight against Germany was beginning to make a difference. In March 84,000 American "dough-boys" set out for Europe; they were followed by another 118,000 the next month. Little did they know they were carrying with them a virus that would prove to be more deadly then the rifles they carried. While sailing across the Atlantic, the 15th U.S. Cavalry incurred 36 cases of influenza, resulting in six deaths. By May, the killer flu had established itself on two continents, and was still growing.

The influenza of 1918 showed no bias in its approach to the combatants in World War I: men from all sides were sickened and killed. Great Britain reported 31,000 influenza cases in June alone. The flu proved such a leveler of men that war plans were altered. Attacks that had been painstakingly planned had to be postponed due to a shortage of healthy men. By early summer, the flu extended its reach beyond the U.S. and western Europe. Numerous cases of influenza were reported in Russia, North Africa, and India. The Pacific Ocean provided no protection as influenza spread to parts of China, Japan, the Philippines, and down to New Zealand.

By July, the influenza of 1918 had left its mark globally. Tens of thousands had fallen ill and died. This first wave was a mere prelude, however, to the perilous path the flu would cut when it reappeared in full force that fall.

 When influenza began to cut its deadly path across the U.S. in the autumn of 1918, it did so with such speed and fatal efficiency that some believed sinister forces to be at work. By the early 1900's, many Americans had lulled themselves into thinking that the wonders of medical science could vanquish any foe, no matter how microscopic. For over a century, after all, the booming science of medicine had gone from one triumph to the next. Researchers had developed vaccines for diseases ranging from anthrax to smallpox. Great advances in microbiology had eliminated the mystery from once fatal diseases. When it turned out that influenza was confounding even the most brilliant medical minds of the time, fear set in, and along with it, suspicion.

That America was engaged in a World War provided a convenient target upon which to heap suspicion: the reviled Kaiser and his German countrymen. As thousands of Bostonians fell under the flu's deadly spell, rumors began to spread almost as fast as the flu itself. One widely accepted notion -- outside of the medical profession, that is -- had German spies deliberately seeding Boston Harbor with influenza-sprouting germs. Such innuendo was lent credence by statements of individuals who should have known better. On September 17, 1918, Lt. Col. Philip Doane, head of the Health and Sanitation Section of the Emergency Fleet Corporation, forcefully voiced his opinion that the epidemic might have been started by Germans put ashore from U-Boats. Said Doane, "It would be quite easy for one of these German agents to turn loose influenza germs in a theater or some other place where large numbers of persons are assembled. The Germans have started epidemics in Europe, and there is no reason why they should be particularly gentle with America."

Other notions of this strain of influenza's origin contained less-politically charged, but equally specious logic. According to one theory, poison gases used in the war, air charged with carbon dioxide from the trenches, and gases formed from decomposing bodies and exploding munitions had all fused to form a highly toxic vapor that flu victims had inhaled. Among the other causes advanced were: air stagnation, coal dust, fleas, the distemper of cats and dogs, and dirty dishwater.
 

 While possible origins of this influenza were debated and investigated, one fact remained inescapable: it was deadly. Lacking reliable medical defenses against influenza, public health officials and private citizens poured their energies into taking preventative measures. The United States Public Health Service (U.S.P.H.S.) faced the challenge of educating the public about an illness that was largely a mystery. To that end, the Red Cross, Post Office, and Federal Railroad administration all did their part to assure that instructive posters adorned the entire nation. Surgeon General Rupert Blue, the nation's Chief Public Health Officer, ordered the printing and distribution of pamphlets with titles like, "Spanish Influenza," "Three-Day-Fever," and "The Flu." The Colgate company pitched in by placing ads detailing twelve steps to prevent influenza. Among the recommendations: chew food carefully and avoid tight clothes and shoes. Alfred Crosby, in "Epidemic and Peace, 1918," his definitive history of Spanish influenza, observed that if influenza could have been smothered by paper, many lives would have been spared.

The Committee of the American Public Health Association (A.P.H.A.), believing the disease extremely communicable, strongly advocated legislation that would prevent the use of common cups and utensils and would ban public coughing and sneezing. The A.P.H.A. implored the public to develop the habit of washing their hands before every meal and paying special attention to general hygiene. They cautioned that nervous and physical exhaustion should be avoided and encouraged exposure to fresh air. A more controversial method of flu prevention, disputed by the A.P.H.A., involved gargling with a variety of dubious elixirs. Various physicians advised rinsing with everything from chlorinated soda to a mixture of sodium bicarbonate and boric acid.

Efforts to get the word out to the people concerning influenza, as ambitious as they were, still left whole sectors of the population in the dark. Citizens of rural outbacks especially found themselves relying on folk remedies to fend off or cure the flu. Tales abounded of mothers insisting that their children stuff salt up their noses and wear goose grease poultices or bags of garlic-scented gum around their necks. For some, onions were looked upon as a potential savior. A Pennsylvania woman boasted of serving up onion omelets, onion salads, and onion soup with every meal. Not one of her eight children contracted the flu. Meanwhile, a four-year-old girl from Portland, Oregon was said to have recovered fully from the flu after her mother dosed her with onion syrup and buried her from head-to-toe for three days in glistening raw onions. Those with an aversion to onions swore by a shoveful of hot coals sprinkled with sulfur or brown sugar, which enveloped every room in a noxious blue-green smoke. While evidence that any of these measures had any positive effect was anecdotal, they were in keeping
with the belief that doing anything to fend off influenza was better than sitting idly by, waiting to become a statistic.
 

Boston

 Little did Keegan know that the influenza he was seeing was actually making its second appearance in the US. It had likely originated at Fort Riley, Kansas, the previous spring and accompanied unknowing troops across the Atlantic. Now, the sailors filling the wards of Chelsea Naval Hospital quickly overwhelmed the resources of medical professionals. The men Keegan saw were suffering from no common flu--a nuisance ailment resulting in sniffles, aches, a low fever, and a few days of bed rest. Rather, the sailors coming into Keegan's wards, many displaying a bluish complexion with purple blisters, had been leveled by hoarse, hacking breathes, barely supplying enough oxygen to keep them alive. As confounded as doctors were about this ailment, they were certain of one fact--this was no ordinary flu, and the number of its victims was growing. Within just two weeks of its first appearance, two thousand officers and men of the First Naval District had contracted influenza. As bracing as these numbers were, more shocking to medical professionals was what was found within the bodies of the dead: lungs soaked with a bloody, foamy fluid that seeped out from beneath the physician's scalpel. What the fluid contained, what caused it to drown the lungs, remained a perplexing mystery.

City officials in Boston were caught off guard when three civilians dropped dead of influenza in early September. The epidemic had now moved beyond the confines of the military and into the general population. A "Win The War for Freedom" parade that marched through the streets of Boston featured 4000 men, including 1000 sailors from Commonwealth Pier and 200 civilian Navy and shipyard workers. This rousing display of patriotism did little to end the war, and much to spread the deadly flu. Doctor John Hancock of the Massachusetts Department of Health, sensing that perhaps the genie was already out of the bottle, issued a statement warning that "unless precautions are taken the disease in all probability will spread to the civilian population of the city."

 For young Dr. Keegan, these were deeply troubling days. Not only was he forced to stand helpless as legions died before his eyes, he had to live with the knowledge that he was exposing himself to their fate just by remaining within their airspace. Additionally, Keegan and his colleagues began to question some of the assumptions they had made about the science of infectious disease. Theirs was the age of modern medicine; an age when scientists at last had a grasp of how disease was caused and transmitted, and more importantly, how it might be prevented and cured. Keegan and his colleagues now found themselves chagrined, yet exhilarated, by the challenge before them. As they dove into research and experimentation, the flu continued to cut a deadly path along the Atlantic seaboard. Reports poured in of cases appearing at naval bases from Rhode Island to Florida. As September 1918 drew to a close, Boston had lost more than 1000 citizens to the silent, relentless killer. The deadly influenza now posed a threat to the entire nation, and the world at large.

San Francisco

 Despite rumblings of a killer flu, most San Franciscans in late September and early October found themselves in the grip of a fever of the patriotic variety. And while no one can say with any certainty that numerous rallies, speeches, parades, and marches greatly exacerbated the spread of the flu, such undertakings are exactly the types of activities a community seeking to protect itself from an epidemic would work to avoid. By mid-October, there was no denying the presence or seriousness of influenza in San Francisco; over 4000 cases had been reported. Echoing the pleas of municipal leaders in the East, schools, theaters, and other places of public gathering were declared closed and off-limits. Although they proved to be too little, too late, appeals came from all sectors of city life. The Church Federation of San Francisco preached prompt reporting of all new flu cases, counseled strict avoidance of persons with respiratory illness, and urged the "cultivation of a wholesome and optimistic spirit, and sense of God's nearness."

As the city was divided into districts, each with its own medical personnel, telephones, transportation and supplies, an already-depleted corps of medical professionals was forced to admit they were not up to the challenge before them. A Dr. W. Fowler of San Jose reported seeing 525 patients in a single day. So overburdened was the Red Cross that they could respond to only half the calls they received. Appeals went out to citizens of every stripe to assist in providing care to the sick; students, teachers, retirees, and homemakers rolled up their sleeves and did what they could do to aid the ill and comfort the grieving.

Typically, immigrant communities were the hardest hit by the epidemic. Whether due to language barriers, entrenched poverty, or overt racism, immigrants routinely failed to seek out and receive proper medical care. Many lived, even in the best of times, in conditions bordering on squalor. When influenza struck, such environments only fostered its rapid spread. One matter of grave concern was the collection of garbage. The number of city workers able to collect and dispose of refuse fell as illness thinned their ranks. As a stop-gap measure huge mountains of trash were simply covered over with dirt.

As the medical community frantically attempted to cure the flu, or hold back its advance, numerous totally useless, and possibly, dangerous vaccines were foisted upon a desperate public. One of the more highly touted efforts involved the wearing of gauze masks to thwart the spread of flu germs. A law was passed making it mandatory to wear the masks in all public places. The city's mayor, with the backing of the Board of Health and the Red Cross, boldly declared, "Wear a Mask and Save Your Life! A Mask is 99% Proof Against Influenza." Citizens of San Francisco were reminded to don their masks through a popular rhyme of the day: "Obey the laws, And wear the gauze. Protect your jaws from septic paws." Generally, the public obeyed and those who did not went to jail.

 Siren wails on November 21, 1918 signaled to San Franciscans that it was safe, and legal, to remove their masks. All signs indicated that the flu had abated. Schools re-opened, and theaters sought to make back the $400,000 they had lost during each of the six weeks they were closed. The city had survived its attack of influenza in better shape than many of its eastern counterparts: 23,639 cases reported, 2122 deaths. But, any thoughts of victory over the flu were premature. Barely two weeks after the celebratory removal of masks, new flu cases were reported. Five thousand new flu cases would surface in December 1918 alone. Fortunately round three of influenza was far less severe than either rounds one or two. Still, scores were brought low by flu and many eventually succumbed to it, bringing the final tally of influenza fatalities to over 3500

 The timing of the epidemic's arrival in Philadelphia could not have been worse. Over one-quarter of the city's doctors, and a larger portion of its nurses, were lending their medical talents to the nation's war efforts. At Philadelphia Hospital, fully 75% of medical and support staff were overseas. Such personnel shortages were an issue even before influenza had hit; once it did, lack of adequate medical help became a matter of life or death.

Misinformation, and perhaps wishful thinking, added fuel to the influenza's fire. While the Bureau of Health was issuing directives concerning public coughing, sneezing, and spitting, Dr. A.A. Cairns and Wilmer Krusen of the Department of Health and Charities were assuring the public that the illness would not spread beyond military personnel. In late September, Dr. Paul Lewis, director of the Philips Institute of Philadelphia, aroused great hope by declaring that he had identified the cause of this influenza: Pfeiffer's bacillus. The confidence of the medical community quickly spilled over into the general population with dire consequences.

 On September 28, two hundred thousand gathered for a 4th Liberty Loan Drive. Funding the war effort and showing one's patriotic colors took precedence over concern for public health. Just days after the parade, 635 new cases of influenza were reported. Two days later, the city was forced to admit that epidemic conditions did indeed exist. Churches, schools, and theaters were ordered closed, along with all places of "public amusement." Members of the press condemned the closings as a violation of common sense and personal freedom. Meanwhile, the ranks of the sick and dying continued to grow. By mid-October their numbers ran into the hundreds of thousands. Hospitals quickly reached capacity. Church parish houses and state armories doubled as shelters for the sick.

Just as medical facilities were pushed to the brink, so too were medical personnel. Able-bodied doctors were summoned from retirement, while novice medical students were plucked from their studies to tend to the sick. Often, there was little they could do; by the third week in October the death toll in Philadelphia attributed to influenza had soared to over 4500. Along with public horror over the intensifying epidemic came public outcries concerning attempts by some to line their pockets through the misery of others. Certain undertakers raised their prices by more than 500% as grieving families sought proper burials for their loved ones. Tales spread throughout the city of individuals being forced to pay fifteen dollars to dig graves for their deceased family members.

What to do with the growing piles of corpses became a question not just of common decency, but a matter of public health. Rotting cadavers often spurred on secondary infections. The city of Philadelphia was forced to appeal to the federal government to meet their need for embalmers. In an effort to combat this and other epidemic-related problems, the Philadelphia Council of National Defense mobilized a Bureau of Information. Special phone lines were designated for influenza-only questions. At one point, the Bell Telephone Company restricted calls of a non-medical nature, owing in part to the depletion of their employee ranks due to flu.

On October 19, 1918, Dr. C. Y. White announced that he had developed a vaccine that would prevent Spanish Influenza. In short order, over ten thousand complete series of inoculations were delivered to the Philadelphia Board of Health. Whether or not the so-called vaccine played much of a role in loosening this strain of influenza's grip on Philadelphia was a matter of much debate. Mortality and morbidity rates did fall after the vaccine was introduced, but some health officials maintained that the flu had already reached its peak and was waning anyway.

As November rolled around, Philadelphia, like the rest of the nation, turned its rapt attention to the armistice ending the Great War. Slowly life returned to normal. But few would, or could, forget the horrible toll exacted by the influenza of 1918, as the City of Brotherly Love lost nearly 13,000 of her citizens in a matter of weeks.

Victims

This flu was a great leveler of men; it recognized neither social order nor economic status. It struck with impunity among the rich and famous, as well as the lowly and the meek. Among its more well-known victims: Silent screen star Harold Lockwood, swimmer Harry Elionsky, "Admiral Dot," one of PT Barnum's first midgets, Irmy Cody Garlow, the daughter of Buffalo Bill Cody, General John Pershing*, Franklin Roosevelt*, actress Mary Pickford*, and President Woodrow Wilson*.