The 1918 Flu 2 The Philadelphia Story



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The 1918 Flu 2 - The Philadelphia Story
 


  • Imagine a group of young girls in 1918, playing jump rope on the sidewalk – if we listened closely, this is what we might have heard:


  • I had a little bird, Its name was Enza
    I opened up the window and in-flu-enza

  • In our last lecture, we learned about how the flu originated in Kansas, and was carried to Europe in our troop ships

  • Today we will learn what happened when the genetically altered virus that our soldiers carried overseas returned to our shores

  • We’ll look at the city of Philadelphia, as a case study of how American cities responded to the pandemic

  • And we’ll learn why the flu hit so many isolated native populations especially hard

  • Most authorities think that the American flu mutated into a killer in its new European population

  • By late summer, this mutant or hybrid strain was poised and ready to re-enter the US

  • Re-entry may have occurred Aug. 12, 1918, from passengers on the Norwegian ship Bergensfjord

  • The liner entered New York harbor with 200 sick - four had been buried at sea.

  • The sick and exposed people were so frightened, they ran down the gang plank as soon as it docked, and scattered into the New York City population

  • Ms. Olsen, a passenger on the Bergensfjord, was one of the first to die in America in the second wave of the flu

  • Over half a million Americans followed her into the grave…

  • This scene was no doubt repeated over and over again, as the flu America had sent overseas returned with a vengeance

  • June 1918, the City of Exeter arrived from Liverpool, docking in Philadelphia with 28 ill…

  • The victims from the City of Exeter were rushed into strict quarantine and the city was spared for a while...

  • The Somali, arriving from India, with 89 sick crewmen, put ashore at Grosse Isle, Canada…

  • Port cities and cities with large military installations were the most vulnerable

  • Boston was an early target…

  • One story is that a group of 106 sailors in Boston called in sick at Commonwealth Pier - 26 died, and the flu spread rapidly from there

  • Camp Devens, Boston, was especially hard hit

  • Col. Victor Vaughan, former AMA president, was among those sent by the army to Camp Devens to investigate the outbreak

  • Vaughan saw:

  • “Hundreds of stalwart young men in the uniform of their country coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full, yet others crowd in. Their faces soon wear a bluish cast; a distressing cough brings up the blood-stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.”

  • One of the first cases at Devens was a young soldier from the 42d Infantry

  • He ached so badly that he screamed whenever anyone touched him!

  • He was misdiagnosed with meningitis, along with several others

  • In a single day at Camp Devens 1,543 soldiers reported sick

  • The medical staff was soon overwhelmed

  • Then the doctors and nurses started to sicken and die

  • A doctor at Devens describes it:

  • One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies…It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce…It beats any sight they ever had in France after a battle.”

  • From sailors and soldiers in coastal cities, the flu spread inland, following the rivers and railroads

  • It ravaged the Great Lakes Naval Training Station near Chicago

  • One of the nurses recalls wrapping still-living men in winding sheets and putting tags on their toes, because it saved time and they were utterly exhausted

  • In her nightmares she wondered “what it would be like to be that boy who was at the bottom of the cord wood in the morgue.”

  • Camp Grant, near Rockford, Illinois, was jammed with over 40,000 troops

  • Col. Charles Hagadorn, commander of Camp Grant decided to ignore army regulations against overcrowding

  • The camp medical staff objected, but were over ruled

  • The first soldier reported sick on Sept. 21st, from an infantry training group that included officers from Camp Devens

  • Within a week he was joined by 4,102 other soldiers

  • 1,810 soldiers reported sick in a single day!

  • The same day that the first soldier died of flu at Camp Grant, Hagadorn ordered a crowded troop train to leave Camp Grant for Camp Hancock, near Augusta, Georgia

  • He ignored demands for a quarantine of the camp

  • Hundreds of men were packed into each car, and the flu spread rapidly on board the overcrowded train

  • 2,000 of the 3,108 soldiers on that train got the flu, with a death rate estimated at over 10%

  • When the death toll at Camp Hancock passed 450 men, Col. Hagadorn instructed his staff to clear the building, shut himself in his office, and shot himself

  • One of the reasons the flu was so terrifying at the time is that no one had any real idea of what caused it

  • Researchers followed several bacterial dead ends

  • In the wake of the 1889-1890 flu pandemic, Dr. Richard Pfeiffer had isolated a new species of bacterium which he called Bacterium influenzae, also known as Pfeiffer’s bacillus

  • Now known as Hemophilus influenzae, the bacterium was thought by many, including the Public Health Service, to be the causative agent

  • The bacterium could kill its hosts in the lab, but the symptoms it caused were not quite identical to those of influenza

  • Nevertheless, Pfeiffer insisted he had found the culprit, and his sterling reputation and high standing in the scientific community managed to convince many of his colleagues that he was correct

  • Despite improved culture techniques, however, the bacterium was not always present in flu victims, and was usually found together with several other pathogens

  • By 1919 the bacterial hypothesis had been rejected, and researchers concluded that whatever the cause, it must be viral

  • That was a controversial conclusion, because it was based entirely on negative evidence, the gradual elimination of all the alternative hypotheses

  • Remember that viruses were still a big mystery in 1918

  • The first influenza virus wasn’t isolated, and observed, until 1934

  • The first flu vaccinations weren’t until 1944

  • So, was the whole thing a fiendish German plot?!

  • Maybe German spies had mined Boston Harbor with “influenza-sprouting germs”

  • Maybe it was started by Germans put ashore from U-Boats, setting germs loose in theaters and other public places

  • There was no cure - even secondary bacterial infections like bacterial pneumonia were untreatable – sulfa drugs and antibiotics had not yet invented yet

  • Medical treatment consisted mostly in comforting, and, whenever possible, isolating the patient – basic nursing

  • Treatments included:

  • Bleeding (!), saline or glucose injections, enemas, alcohol, camphor oil, heroin, morphine, mustard plasters, castor oil, sulfur smoke, lard mixed with camphor and chloroform, or lard mixed with turpentine

  • Public health responses included:

  • Fumigation of trains, buses, passengers and luggage, urging people to wear gauze masks, campaigns against spitting and sneezing, warnings about public gatherings, and a general prescription of rest, fresh air, and reporting of cases to the authorities

  • Folk cures included:

  • stuffing salt up children’s noses, magic charms, wearing goose grease poultices, hanging bags of garlic or onions around your neck, and gargling with disinfectants

  • “Snake oil” salesmen were everywhere…

  • By mid-October the full, tragic potential of the epidemic had been realized

  • Many American cities and towns were hard hit, with unprecedented mortality rates

  • Families were devastated, and all public life ground to a halt

  • William Sardo, of Washington DC, says:

  • “People were afraid to kiss one another, to eat with one another, they were afraid to have anything that made contact because that’s how you got the flu…You were constantly afraid, you were afraid because you saw so much death around you…It wiped out entire families from the time that the day began in the morning to bedtime at night…There was an aura of constant fear…”

  • An Ottawa newspaper writes:

  • “Street cars rattled down Banks Street with windows open and plenty of room inside. Schools, vaudeville theaters, movie palaces are dark; pool halls and bowling alleys deserted.”

  • Philadelphia was typical of most big cities ravaged by the flu

  • The Philadelphia Navy Yard was booming – the Hog Island shipyard, the world’s largest, with over 35,000 workers, had just opened that year

  • Munitions factories, Midvale Steel, Baldwin locomotive – the city, like many American cities at the time, was bursting at the seams

  • The war industries added 300,000 people to the city’s population of 1.7 million

  • Housing was nearly nonexistent, with Boy Scouts patrolling the city to locate shelter for new arrivals


  • Boarding houses and apartments were jammed to capacity, with workers on separate shifts often sharing a single bed

  • Overcrowding, inadequate social services, and squalid living conditions among its poor, all of these made Philadelphia a powder keg for epidemic disease

  • City government was so bad, and so corrupt, that Lincoln Steffens called it “the worst-governed city in America”

  • Its machine-appointed health director, Dr. Wilmer Krusen, was honest, but inexperienced, over cautious, and, in the end, ineffective

  • Despite frequent warnings, and mounting military cases, he made no plans for an epidemic, he made no stockpiles of medicine or equipment, and he didn’t even draw up a list of doctors and nurses to contact in an emergency

  • The news of the epidemic raging in Boston arrived in Philadelphia too late to put the city on alert

  • And besides, the AMA Journal had announced in September that the flu was nothing special, and has “already practically disappeared from the allied troops”

  • On Sept. 28th, 1918, life in Philly was great

  • The biggest local news stories were the ongoing coal miners’ strike, and the upcoming parade

  • The Liberty Loan Parade, designed to sell war bonds, was to be the biggest parade in the city’s history

  • Flu had already arrived in the city, hitting the Navy Yard in mid September

  • The day before the parade, over 200 flu cases were reported, 123 of them civilian

  • Naval personnel tried to stop the parade, but with no success – morale trumped public health

  • Dr. Krusen continued to insist that there was no danger of an epidemic, that it was only, as he called it, “old-fashioned influenza or grippe”

  • The enormous crowd of several hundred thousand were packed together for hours, as the two-mile long parade flowed by

  • Airplanes flew over head, while antiaircraft guns fired live shells rigged to explode at low altitude

  • As hospitals begin to fill up, lines of desperate people formed, waiting to get in, offering nurses bribes of $100 or more

  • Crosby tells us that:

  • “Visiting nurses often walked into scenes resembling those of the plague years of the fourteenth century. One nurse found a husband dead in the same room where his wife lay with newly born twins. It had been twenty four hours since the death and the births, and the wife had eaten no food but an apple which happened to lie within reach.”

  • 12 emergency hospitals would eventually open to receive the growing number of the sick and dying

  • Like most big cities, Philadelphia had a severe shortage of doctors and nurses, with 850 of them away on war duty

  • In Philadelphia’s General Hospital, 54 nurses ended up as patients, 43% of the nursing staff – 10 of them died

  • The call went out for retirees and even medical students

  • All five Philadelphia medical schools closed, sending their 3d and 4th year students to help out

  • On October 3d, Krusen finally ordered all schools, churches, and theaters to close, and banned all public gatherings

  • Most grocers were closed, and few stores of any kind were open

  • The closing of schools and churches further isolated citizens from one another, and contributed to the growing climate of fear

  • An editorial in the Philadelphia Inquirer asks:

  • “Since crowds gather I congested eating places and press into elevators and hang to the straps of illy-ventilated street cars, it is a little difficult to understand what is to be gained by shutting up well ventilated churches and theatres. The authorities seem to be going daft. What are they trying to do, scare everybody to death?”


  • Shutting down bars and taverns created some unusual problems

  • Because whiskey was only available at the drugstore, and could only be purchased with prescriptions, drugstores became crowded with people buying whiskey


  • A few unscrupulous pharmacies pushed the price of whiskey as high as $52 a gallon

  • So many people took the ferry to nearby Camden, because the bars there were still open, that the City of Camden shut down its taverns to stem the tide of new customers bearing the flu

  • The local press and public health officials continued to lie to the public about the epidemic, insisting that the worse was over

  • They created a prevailing attitude of public mistrust of government at every level

  • In early October Krusen insisted that “These deaths mark the high water mark in the fatalities, and it is fair to assume that from this time until the epidemic is crushed the death rate will constantly be lowered”

  • The next day, 428 people died, and the body count kept going higher and higher

  • Citizens took to hanging crepe paper on their doors to show that someone had died

  • White paper meant a child or young adult had died, black meant that the victim was middle-aged, and grey was used to mark the death of the elderly

  • In the suburb of West Manayunk, a mob of weeping housewives blocked the car of a local doctor making a house call, and wouldn’t let him leave until he had treated every child in the neighborhood, all 57 of them!


  • As the true horror of the flu took hold, Philadelphia became a city of the dead

  • Isaac Starr, a University of Pennsylvania student, wrote that “the life of the city had almost stopped”

  • Absentee rates ran from 20-40% for those businesses and factories that remained open


  • So many phone workers were out sick, calls were limited to emergencies only

  • Bell Telephone took out ads in the local papers to announce that no calls would be accepted “other than absolutely necessary calls compelled by the epidemic or by war necessity.”


  • One such ad reads:

  • “Telephone Service Faces A Crisis ---
    The situation is one which the public must meet squarely -- 800 operators -- 27% of our force -- are now absent due to the influenza. It is every person's duty to the community to cut out every call that is not absolutely necessary that the essential needs of the government, doctors and nurses may be cared for.”

  • Crosby tells us that Dr. Krusen empowered the phone company to cut service to any customers making unnecessary calls, and that about 1,000 people were disconnected

  • As the casualties continued to mount, orphans and starving children became a problem – there was no one left alive to feed them

  • As the epidemic peaked, during the week of October 16th, 4,597 people died, 759 of them in a single day (October 10th)

  • With a severe shortage of undertakers and gravediggers, bodies piled up rapidly

  • Prisoners, seminary students, and clergymen were pressed into service

  • To bury its poorest citizens, the city finally resorted to trench graves dug by steam shovels in Potter’s Field

  • Some undertakers took to profiteering, raising rates up to 600%

  • Some cemetery workers and gravediggers demanded an extra fee of $15 or more (a lot of money in 1918), and even insisted after being bribed that the customers dig the graves themselves!

  • Citizens were left with wooden boxes, and instructed to leave their dead on the front porch

  • In some cases, bodies were simply tossed in a heap on wagons, reminiscent of the plague years in Medieval Europe

  • Many people were forced to live with the dead, often for several days - closing them off in a separate room if they could, or just wrapping them in a sheet and leaving them in a corner

  • Soup kitchens and tenement houses opened their doors to long lines of hungry people, in scenes that would be echoed in the Great Depression

  • Citizens became increasingly isolated, huddled behind closed doors

  • Ambulances were supplemented with private cars, police cars, anything with wheels

  • Taxi drivers were pressed into service, and to their credit not one of them refused to carry the sick and dying to the hospital

  • Every social agency in the city, public and private chipped in to help as best they could, thout regard to race, creed, or color

  • Idled teachers volunteered in droves, along with nuns, priests, Boy Scouts, firemen, policemen, and hundreds of private citizens


  • Archbishop Dennis Dougherty sent 1,000 Sisters of Saint Joseph into the community to help care for the sick


  • By October 18th the worst was over, and emergency hospitals began to close

  • On Sunday the 27th, churches were reopened, and schools started up the next day

  • On the 30th, bars and theaters reopened, followed by a noticeable spike in arrests for drunk and disorderly conduct…

  • As many as 500,000 citizens had been infected, and at least 12,897 had died

  • These numbers are very conservative, as thousands of cases went unreported in the chaos that had descended on the city

  • All across America, in the aftermath of the flu, the fate of the survivors became a major problem

  • Many families were impoverished, with one or more bread winners sick or dead

  • The flu left behind a world filled with widows and orphans – 21,000 orphans in New York City alone!

  • Deaths of 15-34 year olds rose to 20 times the normal rate, it wasn’t just the very young and very old who died this time

  • Why did so many more young people die?

  • We’ll try to answer that question in our next lecture

  • More elderly people survived than usual, maybe because they were exposed to a similar virus earlier in their lives

  • The initial attack may have been so mild it wasn’t noticed, but left them with some immunity to the new, related virus

  • Influenza is unusual in that new strains are fiercely competitive

  • This is an interesting example of competitive exclusion

  • One competitor is so successful that it drives the other into local extinction

  • The flu triggers the body’s immune response against any and all strains of flu that person has come in contact with

  • Existing strains that try to re-infect someone will find the door already closed, and rapidly die out as a result

  • So only one subtype of flu can exist in the human population at one time

  • As time goes on, fewer and fewer people are creating antibodies for other forms of flu, so a fresh strain has an open playing field

  • Competing strains usually coexist for a brief period, a few months perhaps

  • The only way to trace the path of the flu is by serological archaeology, taking blood samples from various age groups, and examining the antibodies, to see what strains each age group was exposed to

  • The third and final wave followed in late 1918 and into 1919

  • The flu seems to have gradually mutated into weaker strains – the third wave was short and sharp, but mild compared to the killer second wave

  • The final toll was grim

  • Estimates of American dead run to 675,000, out of a population of 105 million!

  • Britain lost 228,000 to the flu

  • The best global estimate is 50-100 million dead, out of 1.8 billion (from Nobel laureate and flu expert Dr. Macfarlane Burnet)

  • Naïve native populations were especially hard hit

  • Many isolated populations avoid regular contact with common viruses

  • This leaves them highly vulnerable in pandemics, because they have no immunity

  • American Samoa, on the other hand, survived without a single victim, because of its early and effective quarantine

  • Australia had the lowest global death rate, also thanks to an early quarantine - a troopship with 90 sick soldiers finally snuck in, but by then the virus had weakened…

  • In Chiapas, Mexico, 10% of the population died

  • In the Fiji Islands, 14% of the population died in 16 days!!

  • In Nome, Alaska, 176 of 300 Inuits died

  • Many Inuit villages were completely wiped out, with other villages sustaining 85% casualties or more

  • Over 20 million people are now thought to have died in India alone!!

  • One Delhi hospital treated 13,190 flu patients, only to watch 7,044 of them die!

  • An estimated one-third of the entire population of Labrador died

  • Okak, Labrador, 266 citizens, only 59 survived

  • Hebron, 150 Inuits dead out of 220

  • In many rural and isolated areas, packs of wild dogs became a serious problem

  • Starving dogs often broke into dwellings to feast on the dead, or on those too ill to fight back

  • The Reverend Andrew Asboe shot over 100 dogs before he was rescued

  • The virus killed an estimated 7% of the entire population of Russia and Iran

  • Such an epidemic is sometimes called a “virgin soil” epidemic

  • Everyone on Earth at one time was probably exposed to virus

  • Those who survived the infection formed an immune reaction

  • In the end, the virus had no place left to go – it could not maintain itself in the human population

  • Fortunately for the flu virus, it doesn’t need humanity to sustain itself

  • Birds are usually its primary host, and as long as bird populations are healthy, the flu will always find a home

  • At the height of the second wave, Victor Vaughan nearly lost hope, writing that

  • “If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth within a matter of a few more weeks”


  • But by late November 1918, the crest of influenza deaths had past

  • It was the worst epidemic in the history of mankind…

  • Many great cities like Philadelphia ground to a halt for several weeks during the pandemic, and as the City of Brotherly Love reminds us, such disasters bring out the best and the worst in humanity


  • What can we do if this killer virus returns?

  • In our next lecture we’ll wrap ourselves in the cloak of Sherlock Holmes, and follow the trail of one of the most curious detective stories of modern times – the search to recover an intact flu virus, a discovery that could help prevent the next pandemic


  • We’ll also learn how the 1918 flu may have helped set the stage for WWII, by infecting President Wilson at a critical stage of the peace talks


Directory: ~bfleury -> darwinmed -> darwinmedlectures
darwinmedlectures -> Although our evolutionary heritage has saddled us with some significant health problems, in the long run it has served us well…
darwinmedlectures -> The 1918 Flu 1 – a conspiracy of Silence
darwinmedlectures -> Germ Theory
darwinmedlectures -> Although our evolutionary heritage has saddled us with some significant health problems, in the long run it has served us well…
darwinmedlectures -> In our last lecture, we looked at the ways that trade, travel, technology and agriculture can provide new habitats and new dispersal routes for microbes
darwinmedlectures -> The Evolutionary Arms Race Remember the Red Queen in Alice in Wonderland?
darwinmedlectures -> The 1918 Flu 1 – a conspiracy of Silence
darwinmedlectures -> So say the Laws of Manu, an ancient Brahmin text on moral conduct Man is a moral animal…
darwinmedlectures -> Pandora's Box Remember the legend of Pandora's Box?


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