Transcript Philadelphia Flu 1917

Philadelphia, 1918
by Paul Rega, M.D., F.A.C.E.P.
Foreword
To review influenza pandemic of 1918-1919 is an
enormous undertaking. J.M. Barry’s 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.
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
Chapter One: The Background
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.
Chapter Two: The Disease
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.
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.
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
TYPICAL INFLUENZA
Young
Old
Age of the Population
1918 INFLUENZA
Young
Young Adult
Age of the Population
Old
Chapter Three: The Philadelphia
Story
September 7
Sailors arriving in Philadelphia Navy Yard.
September 11
Flu settles on the sailors.
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.
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.
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
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.
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.
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.
September 26
1400 sailors hospitalized so far.
Local Red Cross opens the first alternative
care site in the city.
500 bed United Service Center
September 27
Out of 200 hospitalized that day, 123 are
civilians.
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.
September 30
As the numbers of ill climb, Krusen
announces an epidemic is occurring in
Philadelphia.
Two days after the Parade.
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.
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.
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.
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!
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.
October 5
254 deaths on this day.
Public health authorities announce: The
peak of the disease has been reached!
October 6
289 die on this day.
October 7
More than 300 dead this day.
October 8
Greater than 300 die on this
day.
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.
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”.
City Morgue
Capacity: 36
Jammed with 200 bodies.
Stench!
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.
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!
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.
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.”
Real action begins October 7
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.
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.
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
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.
October 10
759 die.
Before the flu, death from all causes
averaged 485 per week in Philadelphia.
Orphans abound.
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!
Week of October 16
4,597 deaths.
Worst week of the
epidemic.
Then…the numbers begin
dropping
October 26
The ban on public gatherings is lifted.
November 11
The flu is officially declared gone from
Philadelphia.
Afterword
George Santayana
Bibliography
Barry JM. The Great Influenza- The
Epic Story of the Deadliest Plague in
History. Viking Press, New York.
2004.