The Spanish Influenza
Spanish Influenza Outbreak, 1918 by Sarah Cummings
had a little bird. Its name was Enza.
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.
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.
BostonDuring the last days of August 1918, Navy physician J.J. Keegan, stationed at the Chelsea Naval Hospital overlooking the waters of Boston Bay, began to hear rumors of an unusual epidemic taking form just across the bay at Commonwealth Pier. Keegan had expected a slow August, stationed as he was far from the European battlefields of the Great War. He had expected to find himself treating the occasional sunburn or sour stomach as thousands of inductees--strapping young men in the prime of life--passed through Boston en route to taking on the Germans across the sea. But as news spread about an illness sweeping through the large, noisy sailors' barracks known as the Receiving Ship, Keegan considered how to fight a silent enemy just making its presence felt on US shores.
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 FranciscoSan Francisco was spared during the first wave of influenza in the spring of 1918. As the second wave took its toll on eastern cities in September, San Franciscans theoretically had plenty of time to prepare themselves for a possible onslaught. Dr. William Hassler, Chief of San Francisco's Board of Health was an early advocate of taking strong preventative measures against the flu. He, however, seemed to curb his concern and went so far as to predict that influenza would not even reach San Francisco. The reasons for his change of opinion are not clear, but what is known seems to indicate that public officials did their best to downplay any news that would alarm or inconvenience large numbers of people. Little notice was made, therefore, when Edward Wagner, a new arrival from Chicago, fell ill with the deadly flu of 1918 on September 24.
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 3500Officials in Philadelphia knew what was coming their way. All through September 1918 they had seen reports coming out of Boston of a virulent, deadly influenza. In fact, the Philadelphia Bureau of Public Health had issued a bulletin about the so-called Spanish Influenza as early as July 1918. Despite the prescience of some, Philadelphia's health and city officials had still failed to even list influenza as a reportable disease, thereby putting the city's population of nearly two million in grave danger.
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.The onset of illness for those battling the flu of 1918 was quite sudden. In a matter of mere hours, a person could go from strapping good health to being so enfeebled they could not walk. Victims complained of general weakness and severe aches in their muscles, backs, joints, and heads. Often enduring fevers that could reach 105 degrees, the sick fell prey to wild bouts of delirium. Innocent objects--pieces of furniture, wallpaper, lamps--would adopt wicked manifestations in the minds of those consumed by fever. When the fevers finally broke, many victims fortunate enough to have survived now endured crushing post-influenzal depression.
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*.
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