Philadelphia, 1918

1
Philadelphia, 1918
Influenza!
by Paul Rega, M.D., F.A.C.E.P.
2
Foreword

• To review influenza pandemic of 1918-1919 is an
  enormous undertaking. J.M. Barrys excellent
  study is over 700 pages long and it mainly deals
  with events in The United States. How, then,
  does one attempt to convey the gravity of a
  pandemic in a manner that can be assimilated more
  easily? The way I have chosen is to present the
  effects of the Flu on simply one city during its
  most grueling month. Philadelphia, in a sense,
  will serve as a microcosm of the events
  surrounding the Great Influenza Pandemic of
  1917-1919 across the globe.
• Paul Rega, M.D.

3
Cast of Characters

• Wilmer Krusen, Department of Public Health and
  Charities
• Political appointee
• Gynecologist
• Lt. Commander RW Plummer, Chief Health officer
  for Philadelphia Naval District

4
Chapter One The Background
5
Philadelphia in 1917

• 1.75 million
• Slums worse than in NYC
• Housing scarce
• 4 families per apartment sleeping in shifts
• the worst-governed city in America. L Steffens
• Victim of a strong political machinery.
• Graft, corruption
• Social services suffered as a result
• City government power split among political boss,
  precinct captains, and mayor.

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Chapter Two The Disease
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The Flu

• Severe headaches, extreme arthralgias, fever,
  chills, malaise, anorexia, intense cough, nausea,
  vomiting.
• Nasal congestion, oropharyngeal, tracheal,
  pulmonary congestion, severe earaches.
• Intense cyanosis (blue-black).
• Gasping for breath.
• Blood from mouth, nose, GI tract, conjunctiva.
• Delirium.

8
Autopsy Reports

• No organ untouched.
• Kidneys, liver, adrenals, testes
• Marked hyperemia of the brain.
• Pericarditis, myocarditis.
• Lungs Findings similar to that found in plague
  lungs or lungs exposed to toxic gas.

9
US Flu Stats

• 47 of all US deaths were from flu at that time.
• 1918-1919 675,000 died.
• Equivalent to 1,750,000 now.
• 15 times as many civilians died as military.
• Most vulnerable Pregnant females.
• Anywhere from 23-71 depending on area

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TYPICAL INFLUENZA
Impact
Young
Old
Age of the Population
11
1918 INFLUENZA
Impact
Young Young Adult
Old
Age of the Population
12
Chapter Three The Philadelphia Story
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September 7

• Sailors arriving in Philadelphia Navy Yard.

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September 11

• Flu settles on the sailors.

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September 15

• 600 sailors are hospitalized at Navy Hospital.
• More are sent to the civilian Pennsylvania
  Hospital in the city.
• 5 doctors and 14 nurses collapse 2 days later.
• Krusen denies threat to the city.
• Meanwhile, 1000 die in Boston from flu.
• He has meeting with local medical experts and
  agrees to monitor events.

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Between September 15 and 20

• Plummer and Krusen
• They believe they have a handle on the situation.
• Municipal Hospital for Contagious Diseases opens
  its doors to increasing numbers of ill sailors.
• Civilians in the city begin dying with growing
  regularity.

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September 21

• Board of Health announces flu to be a
  reportable disease
• It announces to the public
• Stay warm
• Keep feet dry
• Keep the bowels open
• Avoid crowds

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Avoid Crowds??

• Could be a problem
• On September 28, the Great Liberty Loan Parade
  has been scheduled to run.
• Hundreds of thousands are expected to attend.

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Great Liberty Loan Parade and Local Medical
Experts

• Local infectious disease experts and general
  physicians want the Parade cancelled in order to
  limit disease transmission.

20
Request Denied

• The United States posture was focused totally on
  the war.
• It was crucial to keep morale high.
• The Parade was important for morale.
• Meanwhile any controversy or discontent was
  discouraged across the country.
• Free speech discouraged.
• Union halls raided.
• 1200 union workers locked in boxcars.
• Eugene V. Debs jailed 10 yrs for opposing war.
• So, it is not surprising that the concerns of the
  medical community in Philadelphia were not
  published in the Press.

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September 26

• 1400 sailors hospitalized so far.
• Local Red Cross opens the first alternative care
  site in the city.
• 500 bed United Service Center

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September 27

• Out of 200 hospitalized that day, 123 are
  civilians.

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September 28

• The Great Liberty Loan Parade takes place.
• Several hundred thousand attend.
• Note The incubation period for the Flu was less
  than 48 hours.

24
September 30

• As the numbers of ill climb, Krusen announces an
  epidemic is occurring in Philadelphia.
• Two days after the Parade.

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(No Transcript)
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October 1

• All beds in all 31 hospitals are filled.
• Hospitals refuse admission unless patient has a
  doctor or police order.
• Nurses refuse 100 bribes.
• Lines of people are waiting to get into
  Pennsylvania Hospital.
• Doctors and medicines are at a premium.
• 117 die that day.

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October 3 Krusen Acts

• All public meetings are banned.
• All churches, schools, theaters, courts are
  closed.
• No public funerals
• Amazingly, saloons stay open!
• Why? They are a key voting bloc for the political
  machine.
• Nevertheless, they are closed the next day by the
  State Health Commissioner.

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Emergency Hospital 1

• Another alternative care site opens at the City
  Poorhouse.
• 500 beds are filled in a single day.
• Eventually 12 similar sites open across the city.

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In 10 Days

• The Flu takes a stranglehold on the community.
• Escalation of cases
• From a few hundred sick civilians to hundreds of
  thousands ill.
• From 1-2 deaths per day to hundreds of dead in a
  single day.
• Still, the newspapers stay mute!

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Placards Disseminated Across the City

• Avoid Crowds
• Use Handkerchiefs
• Spitting Equals Death
• Arrested if caught spitting.
• 60 arrested in 1 day for spitting in public.

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October 5

• 254 deaths on this day.
• Public health authorities announce The peak of
  the disease has been reached!

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October 6

• 289 die on this day.

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October 7

• More than 300 dead this day.

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October 8

• Greater than 300 die on this day.

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October 9

• 428 deaths today.
• That toll will double in the next few weeks.
• 2/3 of the dead are under 40 years of age.

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The Dead

• Gravediggers refuse to bury them.
• Bodies begin to pile up.
• Coffins accumulate in funeral homes.
• A casket shortage develops.
• Armed guards are posted by unused caskets.
• Dead family members lie next to their ill
  relatives for days because everyone is too weak
  to move them.
• In some homes, families pack their dead in ice
  while waiting for removal.
• Stench is unimaginable.
• Bodies are placed on porches to be picked up by
  dead wagons.

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City Morgue

• Capacity 36
• Jammed with 200 bodies.
• Stench!

38
Mental Stress

• People increasingly isolated.
• They avoid each other for fear of contracting
  disease.
• There are no social activities.
• Public gatherings were banned.
• Phone company allows only emergency calls.
• No social interaction even from a distance.

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Philadelphia General Hospital

• 8 doctors 54 nurses are hospitalized (43).
• 10 nurses die.
• Board of Health appeals for retired nurses and
  doctors.
• One old doctor treats his patients with purging
  and venesection!

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Medical/Pharmaceutical Students

• 5 medical schools and 1 pharmaceutical school are
  located in Philadelphia.
• They dispatch their students to assist.
• 1 medical student is placed in charge of an
  entire floor at one of the Emergency Hospitals.
• ¼ of his patients die each day.

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More Help?

• From National Red Cross Nothing
• From PHS Nothing
• From the City Nothing
• ..death toll for 1 day in Philadelphia alone was
  more than the death toll from France for the
  whole American army for one day.

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Real action begins October 7
43
The Women Take Charge

• From the oldest and wealthiest families.
• They created
• Council of National Defense
• Emergency Aid Society
• They provided
• Organization and leadership
• Money
• They acted independently of Public Health.

44
Emergency Aid Society

• Uses existing system to distribute everything
  from medical care to food.
• Divides city into 7 districts.
• Dispatches doctors according to geography.
• Develops databank of physicians.
• 24 hour phone bank for information and referrals.
• Soup kitchens in public schools for the ill.
• Recruits volunteers by the thousands.
• They use their private cars as ambulances.
• They drive physicians on rounds.

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Krusen Wakes Up

• Gives the rich women control of nurses.
• Seizes 100,000 in the emergency fund and 25,000
  in the war emergency fund
• Supplies hospitals.
• Hires doctors (twice what PHS paid).
• Sends doctors to police stations to provide care.
• Cleans streets.
• Requests Feds not to draft Philadelphia doctors.
• Approved

46
Krusen, The Women, The Catholic Church, The
Dead

• Police priests clear bodies.
• 33 cops die by mid-October.
• 6 alternative morgues are developed.
• Streetcar company builds coffins.
• Embalming students and morticians are recruited
  from 150 miles away.
• Seminary students dig graves.
• Heavy equipment is employed to dig mass graves.

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October 10

• 759 die.
• Before the flu, death from all causes averaged
  485 per week in Philadelphia.
• Orphans abound.

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The Unsung Heroes

• Attrition rate for volunteers is high.
• Medical profession continues its efforts.
• Few flee.
• Police continues its heroic activities.
• A request went out to them for 4 volunteers to
  remove decomposed bodies.
• 118 responded!

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Week of October 16

• 4,597 deaths.
• Worst week of the epidemic.

50
Thenthe numbers begin dropping
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October 26

• The ban on public gatherings is lifted.

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November 11

• The flu is officially declared gone from
  Philadelphia.

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Afterword

• Those who do not know
• history are condemned
• to repeat it.

George Santayana
54
Bibliography

• Barry JM. The Great Influenza- The Epic Story of
  the Deadliest Plague in History. Viking Press,
  New York. 2004.