Philadelphia Parade Worsens Spanish Flu Outbreak

Philadelphia Parade Worsens Spanish Flu Outbreak

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On September 28, 1918, a Liberty Loan parade in Philadelphia prompts a huge outbreak of Spanish flu in the city. By the time the pandemic ended, an estimated 20 million to 50 million people were dead worldwide.

Influenza is a highly contagious virus that attacks the respiratory system and can mutate very quickly to avoid being killed by the human immune system. Generally, only the very old and the very young are susceptible to death from the flu. Though a pandemic of the virus in 1889 had killed thousands all over the world, it was not until 1918 that the world discovered how deadly the flu could be.

The most likely origin of the 1918 flu pandemic was a bird or farm animal in the American Midwest. The virus may have traveled among birds, pigs, sheep, moose, bison and elk, eventually mutating into a version that took hold in the human population. The best evidence suggests that the flu spread slowly through the United States in the first half of the year, then spread to Europe via some of the 200,000 American troops who traveled there to fight in World War I. By June, the flu seemed to have mostly disappeared from North America, after taking a considerable toll.

READ MORE: How US Cities Tried to Halt the Spread of the 1918 Spanish Flu

Over the summer of 1918, the flu spread quickly all over Europe. One of its first stops was Spain, where it eventually became known the world over as the Spanish flu. The Spanish flu was highly unusual because it seemed to affect strong people in the prime of their lives rather than babies and the elderly. By the end of the summer, about 10,000 people were dead. In most cases, hemorrhages in the nose and lungs killed victims within three days.

As fall began, the flu epidemic spiraled out of control. Ports throughout the world—usually the first locations in a country to be infected—reported serious problems. In Sierra Leone, 500 of 600 dock workers were too sick to work. Africa, India and the Far East reported epidemics. The spread of the virus among so many people also seems to have made it even more deadly and contagious as it mutated. When the second wave of flu hit London and Boston in September, the results were far worse than those from the previous flu strain.

READ MORE: Amid 1918 Flu Pandemic, America Struggled to Bury the Dead

Twelve thousand soldiers in Massachusetts came down with the flu in mid-September. Each division of the armed services was reporting hundreds of deaths each week due to flu. Philadelphia was the hardest-hit city in the United States. After the Liberty Loan parade (celebrations to promote government bonds that helped pay for the Allied cause in Europe) on September 28, thousands of people became infected. The city morgue, built to hold 36 bodies, was now faced with the arrival of hundreds within a few days. The entire city was quarantined and nearly 12,000 city residents died. Overall, in the United States, five out of every thousand people fell victim to the flu.

In the rest of the world, the death toll was much worse. In Latin America, 10 out of every thousand people died. In Africa, it was 15 per thousand and in Asia it was as high as 35 per thousand. It is estimated that up to 20 million people perished in India alone. Ten percent of the entire population of Tahiti died within three weeks. In Western Samoa, 20 percent of the population died. More people died from the flu than from all of the battles of World War I combined.

See all our pandemic coverage here

How two US cities responded to the 1918 flu pandemic very differently — and what we can learn from those mistakes

On September 28, the city of Philadelphia hosted its "Liberty Loan" parade in the midst of the flu outbreak of 1918-19 — sometimes referred to as the Spanish flu. Shortly thereafter, hospitals were at capacity and 2,600 people had died.

Around the same time, the city of St. Louis was closing schools, libraries, courthouses, churches, playgrounds as well as limiting the number of people on streetcars and staggering work shifts to minimize contact.

Eventually, Philadelphia followed suit. But according to a study published in the Proceedings of the National Academy of Sciences, it was just two days — from October 5 to October 7 — between when the first cases showed up in St. Louis to closures being enacted. In Philadelphia, it was over two weeks.

These very different actions against the flu pandemic in 1918-19 led to very different outcomes for the two cities. At its height, the death rate in St. Louis was one-eighth what it was in Philadelphia. In fact, from September through February of that winter, the flu death rate was approximately 358 per 100,000 people in St. Louis and 748 per 100,000 in Philadelphia, according to a study in JAMA.

While we live in different times compared to 1918, there are lessons we can learn from this history to advise how we deal with the current coronavirus pandemic.

"Closing schools, theaters, and other locations where a lot of people come together is essential, as respiratory viruses, including both the 1918 pandemic flu and SARS-CoV-2 are easily spread when people are in close proximity to each other and when they touch the same surfaces, even hours apart," said Jennifer Toller Erausquin, a social epidemiologist and assistant professor in the department of health education at UNC Greensboro.

"The goal of social distancing and isolation is to lower the peak mortality rate. A secondary goal is to lower cumulative excess mortality. Taken together, this is what epidemiologists mean when we talk about 'flattening the curve.'" St Louis was able to do both of these things, she said.

The 1918 Parade That Spread Death in Philadelphia

The influenza pandemic of 1918-19 killed between 50 and 100 million people around the world, more than died in the battles of World War I. In the United States, the hardest-hit city was Philadelphia, where the spread of the disease was spurred by what was meant to be a joyous event: a parade.

Writing in Pennsylvania History: A Journal of Mid-Atlantic Studies, the historian Thomas Wirth explains what happened: “On September 28, despite the increased infiltration of the disease among the civilian population, a rally for the Fourth Liberty Loan Drive proceeded with minimal debate about the repercussions for public health.” The head of Philadelphia’s Naval Hospital told the Public Ledger in the days before the parade: “There is no cause for further alarm. We believe we have it well in hand.” So, the parade went forward. “In the streets of downtown Philadelphia 200,000 people gathered to celebrate an impending allied victory in World War I. Within a week of the rally an estimated 45,000 Philadelphians were afflicted with influenza.”

While frequently called Spanish flu, the disease did not originate in Spain. Rather, the country’s wartime neutrality contributed to higher reports of its escalation in its newspapers. Exactly where and when it started in 1918 is still under speculation. But by the fall of that year, it had arrived in Philadelphia.

“At first, Philadelphia’s epidemic did not differ from that in other major American cities,” the historian James Higgins writes in Pennsylvania Legacies. “Yet by the first week of October, roughly five weeks into the outbreak, Philadelphia’s mortality rate accelerated in a climb unmatched by any city in the nation—perhaps by any major city in the world.” And that spike is attributed to the patriotic event, one of several Liberty Loan rallies organized in Philadelphia to raise money for the war. This time it was joined by a baneful guest: “The virus, an invisible presence at the parade, had enjoyed an unprecedented opportunity to spread throughout the city and in the coming days announced its presence in a skyrocketing wave of sickness and death.”

Soon hospitals were at capacity, as were the morgues and cemeteries. In a study published in 2009 in the Proceedings of the National Academy of Sciences on the incidence curves of the 1918 epidemic in Philadelphia, researchers note that, 72 hours following the parade, all the beds in the city’s 31 hospitals were filled and by “the evening of October 3, the closure of schools, churches, and places of public amusement was adopted by the Philadelphia city council.”

In six weeks, 12,000 were dead. The smell of bodies left to rot in homes while they waited to be removed permeated the streets. The spread of the virus was exacerbated by existing conditions in the city: a booming population drawn by the wartime industries, a density of housing, and a lack of sanitation services and safe drinking water in these working-class neighborhoods.

The Liberty Bonds parade in Philadelphia, 1918 via Wikimedia Commons

Adding to the crisis was a shortage of medical staff, as many were abroad in the war effort. As more and more people got sick, the operation of the city ground to a halt. “Thousands of city workers were out sick, including street car drivers, telephone receptionists, shopkeepers, and garbage collectors,” writes the nursing historian Arlene W. Keeling in Public Health Reports. “In the already overcrowded tenement districts, conditions simply got worse. When the nurses also became sick, the situation became critical.”

The city’s public health director Wilmer Krusen declared: “If you would ask me the three things Philadelphia most needs to conquer the epidemic, I would tell you ‘Nurses, more nurses, and yet more nurses.'” With this dearth of nurses, nuns from the Roman Catholic archdiocese stepped in to offer care. Importantly, they didn’t just visit hospitals, they went into neighborhoods long marginalized by the city where many of the sick—especially those unable to pay for medical services, or African Americans who were not permitted in the segregated hospitals—were dying.

“The importance of the Sisters’ work in the African American communities cannot be overstated during this time of stark racial segregation,” the historian Christina M. Stetler writes in Pennsylvania History. “The Sisters were going into the homes of African Americans to provide much-needed care, for African American patients and families had few other avenues of assistance.”

Students from the Catholic seminaries helped bury the mounting dead. In June 1919, Rev. Thomas C. Brennan recalled the situation at the Holy Cross Cemetery, as recorded in the Records of the American Catholic Historical Society of Philadelphia:

Who can describe the scenes that met the eye during these harrowing days? Animus meminisse horret luctuque refugit. We must be content with little intimations. Everywhere, in every direction, fresh graves swept away from the gaze of the onlooker, causing the well-kept cemetery to resemble a shell-torn field of battle. A constant procession of hearses pressed at the gates—hearses and substitutes for hearses: newspaper wagons, trucks, coal-carts, ash-wagons.

Many of those buried were interred without headstones in long trenches. The deaths must have felt like they would never end. But by November, the virulence of the disease eased. Although there were cases into 1919, the frequency of infection slowed. Grass grew over the hastily dug graves in Holy Cross. And as people got better, and the country was caught up in the euphoria of World War I’s end, the brief turmoil of the epidemic began to fade from the collective memory.

Even in March 1919, only months after the outbreak, Rev. Francis E. Tourscher felt compelled to begin a compilation of oral histories from the Catholic nuns of Philadelphia, with an acknowledgement of the amnesia of epidemics:

Facts unrecorded are quickly lost in the new interests of changing time. […] We have little left now, beyond mere material statistics, and vague impressions drawn from “paper accounts” of the epidemic of cholera which visited Philadelphia in 1832. We know probably as much of the “Black Death” of 1348 in Europe or of the “Sweating Sickness” of 1529 in England as we do of the “Yellow Fever” which raged in our cities of the South, and threatened the North, in 1849 and again in 1854.

The stories from these witnesses are now invaluable in offering a ground-level view of the Philadelphia epidemic. They relate how the nuns worked across class and racial lines. There are scenes of whole families dying one by one. The nuns described cleaning houses, visiting hospitals, carrying clean water to those who were weak, and staying with the dying in their final moments. Tourscher’s account, concluded in the September 1919 issue of the Records of the American Catholic Historical Society of Philadelphia, includes sisters from St. Anne’s who find “a mother and two children [who] had been lying fully clothed for four days with no one to go near them.” In another “‘well-to-do family’ the Sisters [of St. Columba’s] found five children, all lying ill, in different parts of the house, and the mother in bed absolutely unconscious.” The sisters did what they could— changing bed linens, bringing food, and sometimes ultimately sending for a doctor and a priest.

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No public memorial or monument in Philadelphia commemorates the actions of those who cared for the sick or those who died. On September 28, 2019—exactly 101 years since the deadly 1918 parade—the artist group Blast Theory, in collaboration with the Mütter Museum of the College of Physicians of Philadelphia led a procession to commemorate the dead and honor those who cared for them. Participants carried the names of a victim as the litany of the dead was sung out.

A film of this contemporary parade is part of the new Spit Spreads Death: The Influenza Pandemic of 1918-19 in Philadelphia exhibition at the Mütter Museum. Through artifacts, personal stories, death certificates, and recent research, it recalls this often forgotten era of history. It also looks ahead to how the lessons of the past can prepare for the future, asking: are we more prepared for an epidemic today, and who will be there to care?

Philadelphia Parade Worsens Spanish Flu Outbreak - HISTORY

The cartoon on The Inquirer sports front on Oct. 6, 1918 portrayed what was happening in Philadelphia during the grim grip of the Spanish influenza that fall and winter.

A disheveled, cigar-chomping fan was pictured sitting atop a sporting world that had been “closed on account of illness.”

“Gee,” the disgruntled fan said, “this is gittin’ to be a lonesome dump.”

In 2020, as sports officials here and elsewhere struggle to deal with the worldwide coronavirus outbreak, the influenza epidemic of a century ago might offer some clues.

During that fall and winter, the flu killed an estimated 50 million worldwide, 675,000 in the United States. Here in Philadelphia, where at one point city workers went block to block collecting bodies, 12,191 residents died in a four-week period. More than 700 succumbed on Oct. 16 alone.

All throughout the city, little girls were chanting a macabre rhyme as they jumped rope:

Officials responded by banning most public gatherings. Impacted sporting events included high school and college football games, amateur soccer matches, and a fight between Jack Dempsey and Battling Levinsky.

The outbreak also claimed some prominent Philadelphia sports figures.

A former Penn football star, tackle William Robinson, died from the illness while training to be an Army pilot. Chandler Richter, the son of the founder and editor of the Sporting Life, an influential, Philadelphia-based weekly, was another casualty. And the brother of A’s manager Connie Mack, Tom, died from the flu at his Massachusetts home with his famous brother at his side.

“My dad was delirious,” Tom’s daughter Helen told reporters. “But when Uncle Connie came, he straightened up and they talked about family and business and baseball. They spent the last few hours together before my father died. Uncle Connie was very shaken.”

At Penn, where the Quakers were coming off a Rose Bowl appearance in 1917, the flu hit football hard. Coach Bob Folwell had to be hospitalized, and at one point in mid-October, only 22 of his players were healthy enough to practice.

Penn’s game against Georgia Tech was canceled. The Quakers postponed a contest with the Navy Yard’s Marines, and when it took place on Oct. 26, it was played at an empty Franklin Field.

A campus rally for a much-anticipated game against eventual national champion Pitt was called off, as was a war-bond fund-raiser featuring movie star William S. Hart.

Penn wasn’t alone. Most college football teams, including an unbeaten Michigan squad, had to shorten their schedules because of the epidemic.

While Pittsburgh allowed them to take place in empty stadiums, Philadelphia banned all high school football games. When Minneapolis did the same, some schools ignored the restriction and police had to stop the illicit contests.

Major League Baseball got lucky. Because of World War I, its season had ended a month early, on Sept. 2, before the worst of the outbreak. Still, throughout organized baseball, at least seven players, including Negro League star Ted Kimbro, eventually died from the flu.

In Philadelphia, that early conclusion to the season spared the sixth-place Phillies and eighth-place Athletics any real effect. But by the time the Red Sox and Cubs met in the only World Series played entirely in September, the flu was gaining strength.

That Series was contested despite the pleadings of some Boston physicians, who warned that the big crowds at Fenway Park could be disease incubators. Boston’s Babe Ruth, then a robust 23-year-old, was stricken twice but fought it off sufficiently to pitch and win a pair of games for the victorious Red Sox.

Baseball would temporarily ban the spitball as a health precaution, and in at least one minor-league game, players wore masks, prodded by a little ditty that urged them to “obey the laws and wear the gauze. Protect your jaws from septic paws.”

The nontitle fight between Dempsey and Levinsky, a Philadelphia light heavyweight, was postponed in late September. When it finally took place in November at the Olympia Club, Dempsey scored a third-round knockout.

Philadelphia wouldn’t have an NHL team for another 49 years, but the impact of the flu on the hockey league can be detected on its most famous artifact, the Stanley Cup.

Amid the roster of champions engraved on the Cup is this entry:

The Canadiens had gone to overtime to win Game 5 in Seattle on March 30. Afterward, several Montreal players collapsed with fevers as high as 105. Some had to be hospitalized. Others were helped back to their hotels.

With the series tied at 2-2-1, the deciding game was set to be played on April 1. Less than six hours before its scheduled start, Montreal general manager George Kennedy, himself ill, said his flu-depleted team was unable to continue. When the NHL rejected his request to use players from another team, Kennedy announced that the Cup would have to be forfeited to Seattle.

The sporting Metropolitans wouldn't accept his largesse, contending that the illness was not the Canadiens' fault and that they should not be made to suffer because of it.

Four days later, one of the afflicted Canadiens, defenseman Joe Hall, died. Kennedy never fully recovered and succumbed a few years later.

Philadelphia Parade Worsens Spanish Flu Outbreak - HISTORY

It crept into the city like a shadowy burglar in the late summer of 1918, and when it left, in March of 1919, it trailed a line of corpses 20,000 strong.

The great flu pandemic killed 50 million to 100 million worldwide and about 700,000 around the United States in 1918 and 1919. Philadelphia received a devastating blow. At one point, during a six-week period in the fall of 1918, one Philadelphian was dying of the flu every five minutes.

On Oct. 12, 1918, the insidious disease killed 800 in the city, the highest one-day toll.

Deep into the outbreak, the city posted street-side warnings: “Spit Spreads Death.”

And that was pretty much the whole of government acknowledgment that things weren’t going well. There was no real public recognition of the magnitude of the disaster. It just faded away.

Now the Mütter Museum of the College of Physicians of Philadelphia — who else? — is preparing its most ambitious exhibition ever to bring the deadly outbreak out of the shadows and tell the story of disease, government obfuscation, public heroism, and the legacy of death.

The exhibition, titled appropriately, "Spit Spreads Death: The Influenza Pandemic in Philadelphia,” opens Oct. 17 for a multiyear run. A parade commemorating the fallen and acknowledging the heroism of public health workers and the many volunteers will take place Sept. 28. It is being produced by the U.K.-based artist collective Blast Theory.

“There are no monuments to the flu,” said Robert Hicks, director of the museum and the college’s vast historical library. “The war ends. The war is the thing that overshadows everything and the government had a lot to do with the fact that the flu doesn’t get acknowledged. President Wilson never made a public utterance about the flu because he did not want to divert public attention away from World War I and the last great push to win the war.”

In Wilson’s view, nothing was more important than waging and winning the war, except, perhaps, paying for it. So it was that on Sept. 28, 1918, after the city was already in the grips of pestilence, the fourth Liberty Loan parade kicked off down Broad Street with the aim of raising funds for war bonds.

More than 200,000 people lined Broad Street that day to cheer on the war effort, and unwittingly to spread disease.

It’s not that no one knew the dangers of large public gatherings convened in the midst of contagion. Doctors knew. But the city declined to publicly talk about those dangers, perhaps because the federal government did not wish anything to hinder funding efforts.

A group of frantic doctors went to the press. Surely the public would be alerted by the newspapers.

“There were physicians that warned the city that the parade was a bad idea and they were told, ‘We’re going to do the parade,’" said Hicks. "Then the physicians said, “We’re going to put public notices in the newspapers warning people.' No newspaper would run them. This was all part of the hyper-charged patriotism of World War I. We’ve never seen censorship in this country like we did in World War I, exercised from the president on down. We had no federal agency stepping in to do a big thing or make the big announcement.”

The parade went on, as planned, and people died, perhaps for lack of warning. Nancy Hill, project manager for the Mütter, said there was a “dramatic spike” in flu-related deaths following the parade, although it is difficult to say that the parade in and of itself was the cause.

“The parade was a pivotal moment when awareness shifted,” she said. Once the patriotic frenzy focusing on money for war bonds died down, she said, people looked around and realized they had slipped into a “bring out your dead situation.”

The Mütter intends to commemorate the fallen on Sept. 28, the 101st anniversary of the ill-conceived Liberty Loan parade, with a four mile march from the Navy Yard to City Hall, produced by Blast Theory.

The parade will feature large, illuminated floats and a musical score created by Pulitzer Prize-winning composer David Lang (who had family members struck down by the flu) and the Crossing, the Grammy-winning choral group. The music, interlaced with the names of those who died on the most fatal day, Oct. 12, will be streamed over the cellphones to parade participants.

With the illuminated glow from cellphone screens and luminous movable platform walls, the parade should create a somber efflorescence at dusk — at least that’s the hope.

(Members of the public are invited to sign up to participate in the parade at

Blast Theory is also making a film of the event, which will be on view in the museum exhibition, along with numerous digital interactive exhibits that allow exploration and sorting (by neighborhood or block, for example) of 20,000 death certificates artifacts more than 200 photographs documents oral histories and public health information.

“Each death certificate opens a window into the life of a person who is otherwise unknown,” Hicks said. “For example, we learned about Eliza Boney, an African American woman who was born in North Carolina and who ‘kept house for husband’ in North Philadelphia. She was in the early stages of pregnancy when she died just before her 20th birthday. Eliza is one of many who are not in the history books, but this exhibition will honor her memory.”

“Blast Theory has worked very hard to make sure this is not a funerary march,” said Hill, the project manager. “We want to commemorate those who died in 1918, who often didn’t get the burials, the funerals, anything they may have wanted. We also want to honor modern public health workers. We want to make sure we draw a parallel between this woman out and on the ground and wearing a Liberty Loan button in 1918 and the nurses in our emergency rooms today who will be the first to know when this happens again. They’re putting themselves in harm’s way of another new virus like this.”

In that same vein, the Mütter will host a health fair in Mifflin Square park in South Philadelphia on Sept. 7. Free flu shots will be offered there, at the parade, and at other times during the exhibition.

The only mark the flu left in the city, Hicks noted, is in the cemeteries, where gravestone after gravestone bears a death date of a bleak day in the fall of 1918.

The dead speak eloquently in their silence, but here they speak alone. No policies for public health management were altered as a result of the disaster. Hospital protocols remained the same. After all, the epidemic was over by March of 1919, why plan for the past?

Only medical researchers, who engaged in a relentless pursuit for the origins and treatment of the flu, stuck to it. They determined that it was a virus in the 1930s and developed a vaccine by the 1940s. Along the way they made some other discoveries pursuing flu virus research — we owe them penicillin.

“The most visible lasting effect is just gravestones,” said Hicks. “One of the things people should ask is, ‘Is there a city plan, an emergency response plan?’ They should ask what that means.”

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Cholera vs. flu: Philadelphia’s historical epidemic successes and failures

By now, most Americans have heard the cautionary tale of Philadelphia’s decision to hold a huge patriotic parade with nearly 100,000 spectators in the fall of 1918, a super-spreader event blamed for the city’s overwhelming outbreak of flu in the following days. Within 72 hours of the parade, all hospital beds in the city were full. Within six weeks, more than 12,000 people died, amounting to a death every five minutes.

During the current pandemic, Philadelphia’s 1918 response has become the poster child of how not to handle an outbreak. But the “Spanish flu” certainly wasn’t the first infectious disease the city had ever faced, and historian Timothy Kent Holliday makes the case that Philadelphia was well equipped for outbreaks decades and even centuries earlier.

Holliday earned his Ph.D this spring with his dissertation entitled “Morbid Sensations: Intimacy, Coercion, and Epidemic Disease in Philadelphia, 1793-1854.” His research looks at epidemics in Philadelphia and the role of what he calls intimate care in managing those diseases in institutions, hospitals, prisons, and quarantine stations like the Lazaretto.

Penn Today spoke with Holliday about why he thinks Philadelphia was better prepared for cholera in 1832 than it was nearly a century later when the flu landed at the Navy Yard, and what lessons citizens and governments can take from comparing the two outbreaks.

Why is the 1918 flu epidemic referenced so much during the current COVID-19 outbreak?

The best parallel to what’s happening now is always going to be the 1918 pandemic just because it’s a centennial sort of thing, it’s viral, and it’s airborne.

But the 1832 cholera outbreak is also something that you can draw parallels with to COVID because it’s a disease wending its way across the world and people are really frightened by it. The world is tracing its movement, and it is interpreted as a new disease, as was cholera in the mid-1800s.

The place where the cholera outbreak becomes a good foil for the 1918 pandemic is that Philadelphia was really well prepared for cholera. They had hospital care in place to address the excess mortality and excess illness that cholera would bring. There wasn’t the same kind of strain on public health as there was in 1918.

Why was Philadelphia more prepared for cholera than the flu?

For one, cholera spread over the course of years, so cities could brace themselves a little further in advance.

Secondly, and this is kind of a happy accident, Philadelphia had a really good municipal water supply. And they didn’t know it at the time, but cholera was transmitted through water.

What did the city do to gear up for a possible cholera outbreak?

As cholera was spreading throughout Europe, the city government and the board of health established a number of cholera hospitals, sort of temporary locations where cholera of patients could be treated. These are like schoolhouses, carpenter shops, not newly erected buildings. They were places chosen for their airiness that were easily ventilated. Basically, they were whatever buildings fit that criteria they could get their hands on because a lot of places didn’t want to volunteer to house cholera patients out of fear. People didn’t want to be living next to places that were going to be designated as cholera hospitals.

They established about 20 of these temporary hospitals. A lot of them housed just a few patients over the course of the epidemic. Some of them stayed empty the whole time.

So, Philadelphia was really well prepared in terms of having an infrastructure in place to house cholera patients and to take care of them. They also appointed cholera physicians who would be tasked with managing the hospitals and the Sisters of Charity were really important as care providers during this time, too. So, you had religious nurses, you had lay nurses, you had attending physicians, and you had the presiding physicians in these hospitals. They were really very well staffed.

They could be chaotic places, some of the more crowded ones. But I think the point of all this is that Philadelphia prepared itself for the arrival of cholera well in advance.

To compare, in the early 20th century, and maybe the late 19th century, the onus was often placed on individuals to combat disease. There’s a big moral component and an individual component to what’s called ‘the new public health model’ in the era of the 1918 pandemic. As a result of that, at a governmental level, the underlying sort of systemic factors that contributed to the spread of infectious disease were ignored in favor of putting the onus on individual action.

Why was this idea of individual action popular at the time?

I think that it’s connected really strongly to germ theory because one of the side effects of germ theory is that the seat of disease becomes the individual. Disease is transferred from person to person.

So, the focus is on educating the individual, modifying the individual’s habits, and as a result, a lot of public health officials and physicians ignored or just didn’t pay attention to underlying systemic factors that would influence behavior or a range of behaviors available to people. Like we see today, not everybody is in a position where social distancing is an option. It was the same in 1918. You have people who are living in crowded tenement houses and are not able to avoid congregating. You have people whose livelihoods depend on close intimate contact with others. And there’s the focus on, ‘Oh, you need to do this and that and the other as an individual, as a person to make yourself a better person.’ Rather than saying, ‘Here’s what we as a community need to do to fix what is wrong or what needs to be addressed on a systemic level.’

How did the idea of individual action affect the response?

Philadelphia in 1918 is a really good example of an object lesson of how not to do public health.

The city’s public health director, Wilmer Krusen, gets a lot of blame from historians and amateur historians for letting the parade that we’ve all heard about go on in 1918 that led to the spike in cases in Philadelphia. Some historians have started to push back against that and say that it wasn’t necessarily within Krusen’s power to cancel it. Especially because the mayor at the time, Thomas Smith, was such a ‘boss mayor,’ very typical of what you might associate with that era.

Krusen toed a middle line between putting the ball in the court of individuals versus the government. So, when the state government ordered the closure of cinemas, theaters, ice cream parlors, and other places of social gathering, Krusen also added to that the closure of schools and places of worship. So, he recognized in a way that a lot of historians have ignored that there was a role for umbrella government initiatives to enforce what we would call social distancing.

There were things done wrong, and a lot had to do with corrupt politicians. If you look at the mortality rate of the 1918 flu pandemic, the top three cities are Pittsburgh, Scranton, and Philadelphia. Not only are they all in Pennsylvania, which had a lot of government corruption at the time, but they’re all cities with big boss mayors or boss governments.

The most obvious thing that's associated with ‘boss politics’ is corruption, corruption, corruption. Like a mayor who makes nails and sells them to the city and has the city buy them at exorbitant prices. It’s basically just running the government like a machine, like a business. Appointing people to positions based on personal financial interests and operating in ways that might seem pretty familiar on the federal level today.

So, what kind of lessons can citizens and governments take from the cholera epidemic?

Public health organizations, and the government more broadly, need to be invested in preparation for an infectious disease outbreak, even when there is no clear and present danger for such an outbreak.

Philadelphia in 1831 was preparing itself for cholera, but it was also already kind of prepared in the sense that there was already a strong history of public health, stretching back to the 1790s with yellow fever. Public health initiatives in Philadelphia really strengthened in response to that. The really clean municipal water supply is just one example of that.

For today, the big lesson from the cholera response is to be prepared, even in times when there isn’t an imminent risk for an outbreak.

1918 Spanish Influenza Outbreak: The Enemy Within

Horse-drawn carts plied the streets with a call to bring out the dead in the city where bodies lay unburied for days. The afflicted died by the thousands, and survivors lived in fear. But this wasn’t medieval Europe being stalked by the Black Death. This was Philadelphia, October 1918, and the city was under siege from a new variant of one of mankind’s oldest specters: influenza.

The flu lurking in the midst of this patriotic fervor, however, would prove far more lethal than trench warfare and poison gas. Most alarming was the fact that the disease ravaged previously healthy young adults in their 20s and 30s: the men and women who worked the factories, cleaned the streets, tended the sick — and fought the wars.

Many assumed, wrongly, that the flu had originated in Spain, where 8 million fell ill during a wave of relatively mild flu that had swept the globe in the spring of 1918. Because Spain was neutral and its press uncensored during the war, it was one of the few places in Europe where news about the epidemic was being reported. Whatever its origins, the flu was taking a toll on frontline troops. Commander Erich von Ludendorff blamed the disease for the failure of Germany’s major spring offensive.It was a grievous business, he said, having to listen every morning to the chiefs of staff’s recital of the number of influenza cases, and their complaints about the weakness of their troops.

Influenza wasn’t Ludendorff’s only obstacle. General JohnBlack Jack Pershing, commander in chief of the American Expeditionary Forces in Europe, pushed relentlessly to build up troop strength. The U.S. Army had fewer than 100,000 soldiers when it entered the war — the general’s plans called for approximately 4 million. The Americans would not simply plug holes in the British and French lines. The AEF would stand alone, and march to victory under the American flag. To do that, Pershing needed more men, more materiel. Always, endlessly, more.

Back home, the ramp-up hit a snag. On March 4, 1918, the Army installation at Camp Funston, Kan., reported a single case of flu. Before the end of the month, 1,100 men had been hospitalized, and 20 percent of those men developed pneumonia. Flu spread rapidly among Army camps as troops were rushed through on their way to the front. But the outbreak had subsided by summer, and it looked like the worst was over.

Only a Matter of Hours
Camp Devens, 35 miles northwest of Boston, was seriously overcrowded. Built to house 36,000 troops, it contained more than 45,000 in early September 1918. The flu struck there with a suddenness and virulence that had never been seen before.These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen, wrote Roy Grist, a doctor at the Camp Devens hospital.Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured man from the white….It is only a matter of hours then until death comes….We have been averaging about 100 deaths per day….We have lost an outrageous number of Nurses and Drs.

Flu victims were wracked by fevers often spiking higher than 104 degrees and body aches so severe that the slightest touch was torture. Cyanosis was perhaps the most terrifying hallmark of the pneumonia that often accompanied this flu. A lack of oxygen in the blood turned one’s skin a bluish-black — leading to speculation that the Black Death had again come calling.

While Devens tried unsuccessfully to contain the outbreak, a similar situation was developing at Commonwealth Pier, a naval facility in Boston. Flu was reported there in late August, but the war would not wait. Sailors were shipped out to New Orleans, Puget Sound and the Great Lakes Naval Training Station near Chicago. Josie Mabel Brown was a young Navy nurse living in St. Louis, Mo., when she was called to duty at Great Lakes.There was a man lying on the bed dying and one was lying on the floor, she said of her first visit to a sick ward.Another man was on a stretcher waiting for the fellow on the bed to die….We wrapped him in a winding sheet and left nothing but the big toe on the left foot out with a shipping tag on it to tell the man’s rank, his nearest of kin, and hometown….Our Navy bought the whole city of Chicago out of sheets. There wasn’t a sheet left in Chicago. All a boy got when he died was a winding sheet and a wooden box we just couldn’t get enough caskets.

Three hundred sailors from Boston landed at the Philadelphia Navy Yard on September 7 on the 19th the Philadelphia Inquirer reported that 600 sailors and marines had been hospitalized with the flu. It should have been apparent to city officials that a potential crisis loomed. In Massachusetts the flu had spread rapidly from military encampments to the public at large. Medical practitioners in Philadelphia called for a quarantine, but Wilmer Krusen, director of the city’s Department of Public Health and Charities, declined. There was recent precedent for such action: Quarantines were regularly enacted during a terrifying polio epidemic in 1916. But that was in peacetime. No civilian deaths from flu had been reported locally, and a Liberty Loan parade — perhaps the largest parade Philadelphia had ever seen — was scheduled for the end of the month. A quarantine would only cause panic, and the city would most certainly not meet its quota of war-bond sales.

Every American seemingly had a personal stake in winning the war. Even children were eager to do their bit. Anna Milani, who was a child in Philadelphia during the epidemic, remembered the rhyme she and her friends would sing in the street:

Tramp, tramp, tramp the boys are marching
I spied Kaiser at the door
We’ll get a lemon pie
And we’ll squash it in his eye
And there won’t be any Kaiser anymore

The parade stepped off as planned on September 28 with marching bands, military units, women’s auxiliaries and Boy Scout troops. Some 200,000 spectators thronged the two-mile-long parade route in a show of civic pride. Three days later, 635 new civilian cases of flu, and 117 civilian deaths from the disease and its complications, were reported in Philadelphia.

Worry is Useless
October 1918 was brutal in the City of Brotherly Love. Schools, churches, theaters and saloons were closed. So many Bell Telephone operators were home sick that the company placed notices in city newspapers pleading with the public tocut out every call that is not absolutely necessary that the essential needs of the government, doctors and nurses may be met. Krusen authorized Bell to discontinue service to those making unnecessary calls, and 1,000 customers were eventually cut off.

Even if emergency calls did get through, there weren’t enough people to answer them. A quarter of Philadelphia’s doctors and nurses were away serving in the military. Volunteers were called, but many were too sick themselves — or too frightened of contracting the disease — to be of much help. Entire families were stricken, and the prognosis was often grim.My mother called the doctor because the whole family was sick with this flu, said Harriet Hasty Ferrell.And I, being an infant baby, was very sick, to the point that the doctor thought that I would not make it. He told my mother it wasn’t necessary to feed me anymore.

Still, there were those who tried to quell panic. An October 6 editorial in the Inquirer advised:Live a clean life. Do not even discuss influenza….Worry is useless. Talk of cheerful things instead of the disease.

No amount of happy talk could make the nightmare go away. Between October 12 and October 19, 4,597 Philadelphians died of the flu and related respiratory diseases, and survivors struggled to carry out familiar mourning rituals.We couldn’t go inside the church, one city native remembered.The priest would say Mass on the step, and we would all be congregated outside….They figured maybe outside you wouldn’t catch the germ. Another recalled that her 13-year-old cousin, who was sick with the flu, had to be carried to the cemetery wrapped in a blanket in order to say the traditional Jewish prayers at his mother’s funeral service. Hundreds of unburied corpses posed another serious health risk. Caskets were in such short supply that the J.G. Brill Co., which manufactured trolley cars, donated packing crates to fill the need. The Bureau of Highways used a steam shovel to dig mass graves in a potter’s field. By the end of the month, the Spanish flu had claimed 11,000 victims in Philadelphia and 195,000 nationwide.

The tragedy played out with varying degrees of severity across the country. The city of San Francisco, where the flu hit hardest in late October, mandated that gauze masks be worn in public at all times. The mandate was widely followed, though in reality, masks did little to prevent the spread of flu. They were also uncomfortable and inconvenient, and the public would not tolerate them for long. Even officials showed a less than vigilant attitude when the mayor, a city supervisor, a Superior Court judge, a congressman and a rear admiral were photographed at a prizefight sans their protective masks. And there were those who claimed the act was an unconstitutional attack on personal freedom: If the Board of Health can force people to wear masks, said the San Francisco Chronicle, then it can force them to submit to inoculations, or any experiment or indignity.

Doctors searched desperately for a cure, or at least a stop-gap measure. But they were on the wrong track. Conventional wisdom held that the flu was caused by bacteria vaccines to fight bacterial infections, however, had no effect on the disease. (Flu was not identified as a virus until 1933.) The epidemic was a crushing blow to medical science, which had only recently come to be seen as a professional discipline.

Government agencies fared no better. Surgeon General Rupert Blue, head of the U.S. Public Health Service, was aware that an outbreak of flu was possible. But in July 1918, he denied a request for $10,000 to be dedicated to pneumonia research, and he made no other preparations. Blue’s first public warning came in mid-September and included such tips as avoid tight clothes, tight shoes, tight gloves — seek to make nature your ally not your prisoner and help by choosing and chewing your food well. Congress appropriated $1 million in emergency funding for USPHS Blue eventually returned $115,000 to the government.

Worse still, the government contributed to the national paranoia surrounding all things German. The USPHS officer for northeastern Mississippi planted stories in the local papers that the Hun resorts to unwanted murder of innocent noncombatants….He has [at]tempted to spread sickness and death thru germs, and has done so in authenticated cases. Lieutenant Colonel Philip Doane, head of the Health and Sanitation Section of the Emergency Fleet Corporation, which oversaw U.S. shipyards, theorized that U-boats had delivered German spies to America to turn loose Spanish influenza germs in a theatre or some other place where large numbers of persons are assembled. So persistent was the belief that Germany had somehow launched a biological attack that USPHS laboratories devoted precious time to investigating claims that Bayer aspirin, which was manufactured in the States under a German-held patent, had been laced with deadly flu germs.

“Let the curse be called the German plague, declared The New York Times in October.Let every child learn to associate what is accursed with the word German not in the spirit of hate but in the spirit of contempt born of the hateful truth which Germany has proved herself to be.

Over There
The death toll mounted at home through September and October even as President Woodrow Wilson was faced with General Pershing’s demands for more soldiers. Through the summer, Americans were being sent to Europe at the rate of 250,000 a month. But flu was running rampant on troopships, and those who survived the interminable voyage simply spread the disease to frontline staging areas. Wilson was urged by several advisers not to dispatch additional troops until the epidemic had been contained. The president consulted with his chief of staff General Peyton March, who conceded that conditions on the overseas transports were hardly ideal. He would not, however, concede anything that might stand in the way of winning the war.Every such soldier who has died [on a troopship], said March, just as surely played his part as his comrade who died in France. Wilson relented. The transports continued.

Wilson had won a second term in 1916 because he had kept the United States out of the war. Once war was declared in 1917, however, he could not afford to waver in his commitment to seeing the conflict through to Allied victory. To shore up public support, Wilson created the Committee on Public Information a week after declaring war on Germany. (One of its lasting contributions was the Uncle Sam “I Want You” recruiting poster.) The CPI’s news division issued thousands of press releases and syndicated features about the war that made their way, often unedited, into newspapers across the country. The CPI also had a pictorial publicity division, an advertising division and a film division. In short, it used every possible media source to influence public opinion.

Wilson’s zeal for advancing democratic ideals abroad was secured by his willingness to suppress them at home. Dissent was not tolerated. Under the 1917 Espionage Act, roundly criticized as being unconstitutional, Socialist leaders Eugene Debs and Victor Berger were sentenced to a combined 30 years in prison for their antiwar protests. The act also gave the postmaster general the right to determine what constituted unpatriotic or subversive reading material and ban it from the U.S. mail. The Justice Department authorized the 200,000 members of a volunteer group called the American Protective League to report on suspected spies, slackers who didn’t buy war bonds and anyone who voiced opposition to the government.

In this hyper-patriotic atmosphere, fighting the flu came second to winning the war. Public officials, and the public itself, downplayed the seriousness of the silent enemy within and focused on the more tangible enemies of a nation at war. The Germans could be defeated on the battlefield overseas and by surveillance at home. Nothing could stop a disease that immobilized great cities for weeks and carried off hundreds of thousands in the prime of life.

And then, it was over. By the end of 1918, deaths from flu and pneumonia nationwide had subsided greatly, and a third wave in the spring of 1919 left far fewer casualties in its wake.In light of our knowledge of influenza and the way it works, explained Dr. Shirley Fannin, an epidemiologist and current director of disease control for Los Angeles County, Calif.,we do understand that it probably ran out of fuel. It ran out of people who were susceptible.

Those who survived their exposure to the flu developed immunity to the disease, but not to its lasting consequences. William Maxwell, writer and longtime editor at The New Yorker, was a 10-year-old in Lincoln, Ill., when the flu struck his family, killing his mother.I realized for the first time, and forever, that we were not safe. We were not beyond harm, he remembered eight decades later.From that time on there was a sadness, which had not existed before, a deep down sadness that never quite went away….Terrible things could happen — to anybody.

For all the advances in medical science, it is still not clear where the 1918 virus originated, or why it took such a toll on healthy young adults. Flu viruses are extremely adaptable. According to the National Institutes of Health, one new strain of flu appeared in humans between the Hong Kong flu outbreak in 1969 (the last flu pandemic) and 1977. Between 1997 and 2004, five new strains appeared.

Modern researchers agree that it is probably impossible to prevent an outbreak of flu, but it is possible to prepare for one — if the public, health officials and government agencies can agree on a plan of action. Today, as in 1918, a global conflict demands an ever-increasing amount of resources. The government has enacted extraordinary measures in the name of national security. And a public health crisis of the magnitude of the 1918 epidemic is almost incomprehensible. After all, it’s only the flu.

This article was written by Christine M. Kreiser and originally published in the December 2006 issue of American History Magazine. For more great articles, subscribe to American History magazine today!

Not a typical Philly jawn

The parade is a precursor to a Mütter Museum exhibition all about the flu outbreak opening mid-October.

“It’s not like your regular parade, it’s no marching bands, no puppets,” Adams said. “It’s not really for spectators. It’s for participants.”

Participants can go online and pick a person who died of the flu to honor. The list comes from Oct. 12, 1918, the deadliest day of the pandemic when some 750 people died in the city.

The Crossing, Philly’s local Grammy-winning choir, will be heard solemnly singing the names of the victims through parade-goers’ smartphones — Anna Golden (28), Thelma Schumann (1), Marion Bernice Barth Lingle (22), and hundreds of more names.

The piece, written by Pulitzer Prize and Grammy-winning composer David Lang, also offers some practical advice.

“Beware of those who are coughing and sneezing… avoid crowded streetcars… walk to the office if possible…avoid crowds,” sings the choir in slow, spread out sections of music.

Four white 20-foot wide sculptures will also act as speakers. The panels will be illuminated by white light and pushed forward by teams of people.

The event will end with a health fair that celebrates advances made in modern medicine, including the discovery of an effective flu vaccine, which people can get at the fair. It also celebrates the unglamorous profession of public health workers.

“There aren’t many Hollywood films about people working in public health and yet those people save millions of lives year in and year out,” Adams said. “We want to take a moment to publicly honor them.”

“Spit Spreads Death” takes its name from a public health poster that was discouraged spitting at the time of the pandemic.

The exhibit will bring visitors to 1918-1919 Philly, recreating the look and feel of the city at the time while sharing the stories of those who fell ill.

But it’s also meant to get people thinking about how diseases can strike at any moment despite medical advancements. The conversation aims to start conversations about the government and the public’s role in fostering public health.

“We expect anyone coming through this exhibition in its lifetime will have somewhere cooking in their mind some news article they’ve heard of about a disease outbreak,” Hicks said. “It could be Ebola, it could be measles since that’s making a resurgence in places where people have not gotten vaccinated, or it could be the flu.”

Death on parade: How the 1918-20 influenza pandemic ravaged Philadelphia and terrorized the Lehigh Valley

By this time 100 years ago, the pandemic influenza that infected a third of the planet — from teeming cities to tiny towns to paradisaical islands in the remotest stretches of ocean — had done its worst.

In recorded history, no greater mortality from disease had ever occurred in so short a time. The bubonic plague pandemic of the 14th century, the Black Death, may have killed more, but that was over a period of years. The flu, in about a year, reaped a far greater toll than the four years of World War I, in which 16 million died.

In the United States, more than 25 million fell ill and more than 600,000 died. The American city hardest hit by the pandemic was Philadelphia. On Oct. 17, the city’s Mutter Museum is opening an exhibit called “Spit Spreads Death,” recounting a public health calamity in which 20,000 Philadelphians perished — more than 12,000 in just six weeks.

The flu exploded like dynamite there. What lit the fuse was the city’s decision to proceed with the Liberty Loan Parade, a patriotic event to promote the purchase of war bonds, despite the fact that the epidemic was well under way. On Sept. 28, some 200,000 people lined Broad Street, the virus raced among them and, within a day or two, more than 600 fell sick.

Within a week, 2,600 were dead.

Philadelphia would emerge with the highest death rate of any American city. The Lehigh Valley’s municipalities didn’t suffer on that scale, but the flu rampaged here, too, to the extent that one newspaper account called it “the dreaded plague.”

Among the events leading up to the Mutter exhibit is a “parade of light” through city streets on Sept. 28 to commemorate that disastrous decision — a somber musical procession of glowing lights along Broad Street from Marconi Plaza in South Philadelphia to City Hall.

The public is welcome to march in the parade. Participants can march in memory of a particular victim. The website has a searchable database of names for people who may have lost ancestors it can also assign one at random.

From a century’s distance, scientists and infectious disease specialists look back on the pandemic with distinct unease.

“The general consensus is that it isn’t a question of whether we’re going to have another pandemic, it’s a question of when,” said Dr. Jeffrey Jahre, an infectious disease specialist and senior vice president of Medical and Academic Affairs with St. Luke’s University Health Network.

“That doesn’t necessarily mean it will have the same kind of effect, because we do have a number of things we’ve learned since then,” Jahre said. “But that doesn’t mean it wouldn’t be serious.”

Whether it would have comparable impact in an age of antibiotics, antivirals, vaccines and other medical advances is impossible to say.

But, Jahre said, if a pandemic today killed as much of the world’s population as the 1918 flu — 3 to 6 percent — the death toll would range from 200 million to 450 million.

A World Health Organization report released last week said the world isn’t ready for a similar pandemic.

“If it is true to say ‘what’s past is prologue,’ then there is a very real threat of a rapidly moving, highly lethal pandemic of a respiratory pathogen killing 50 (million) to 80 million people and wiping out nearly 5% of the world’s economy," the report said. “A global pandemic on that scale would be catastrophic, creating widespread havoc, instability and insecurity. The world is not prepared.”

Growing fear

The first flu cases were reported in January 1918 among soldiers at Midwestern military posts. Some experts believe those cases may have been the worldwide point of origin for the illness, with soldiers carrying the infection to European battlefields.

Even so, it became known as the Spanish flu. Spain had remained neutral during the war, so stories about the illness weren’t subjected to the censorship imposed on news in other countries. And the Spanish king, Alfonso XVIII — he survived — was among the early victims.

The January illnesses flared into a springtime wave not markedly different from a typical flu outbreak. Victims who sickened and recovered were lucky. They developed immunity that protected them when the flu returned in August — an unusually early start to flu season, which typically arrives in the fall.

It would soon become clear that nature had unleashed something terrible.

The virus attacked with brute force and speed. Some victims rose healthy in the morning and were dead by dinnertime. Others went to bed feeling peaked and were found dead in the morning, blue-skinned from oxygen deprivation. Some, ravaged by the bacterial pneumonia that was the virus’ chief complication, almost literally coughed their lungs out.

Flu is normally most dangerous to the young and old, whose immune systems are immature or compromised. Those age groups certainly fell victim, but this flu also attacked people in their prime at an extraordinary rate. About half the victims in the U.S. were between 20 and 40.

One theory holds that healthy people fell victim to their own immune systems, which overreacted to the virus and caused a deadly inflammatory condition known as cytokine release syndrome.

Other research suggests that a common flu treatment — high doses of aspirin — contributed to deaths. The evidence is that some victims bled from their noses, ears and other orifices aspirin has blood-thinning properties science wasn’t aware of at the time. Jahre, for one, is skeptical of that theory, because the same symptoms occurred in places where aspirin wasn’t prescribed.

Jahre said most people, in that age before antibiotics, were especially vulnerable to pneumonia and other “supra-infections.”

“It’s an infection on top of an infection,” he said. “That happened then and it happens now.”

The federal government, worried that fear of a pandemic would affect wartime morale, minimized the threat. That’s one reason Philadelphia went ahead with its parade.

A lengthy article by the U.S. Public Health Service, “Uncle Sam’s Advice on Flu,” opened and and closed with catchy slogans that seemed designed to normalize a clearly abnormal illness: “Coughs and Sneezes Spread Diseases” and “Cover up each cough and sneeze, if you don’t you’ll spread disease.”

It advised typical precautions and noted that the “proportion” of deaths overall was not excessive, though the number of deaths in some parts of the country was extraordinary.

That piece ran in The Morning Call on Oct. 9 — the same day Allentown, criticized for foot-dragging, finally heeded the advice of the city health inspector and closed schools.

Three days later, Oct. 12, another story advised that the ailment was just one in a long history of outbreaks of what used to be called “the grippe."

No reason for panic, it said. “Go to bed and stay quiet. Take a laxative. Eat plenty of nourishing food. Keep up your strength. Nature is the only cure.”

The papers were full of advertisements for flu remedies. One advised sufferers to “Rub in and inhale Dr. Jones’ liniment, generally known as beaver oil, and get relief.” Another recommended “Hill’s Cascara Quinine Bromide” be taken “at the first sign of a sneeze or shiver.”

Still another promoted “Smok-O” tobacco-less cigarettes. The “medicated smoke” ostensibly disinfected the air passages (“Influenza Germs Smoked Out”) and eliminated the risk of stomach upset from oral drugs.

Readers must have found all of this less than reassuring. The paper had just reported 654 flu cases and 15 deaths in Allentown since the start of the outbreak. Easton and Phillipsburg reported 17 deaths Oct. 7-8. Statewide, deaths between Oct. 2-8 totaled 1,482.

The day the grippe story appeared, 751 Philadelphians succumbed, the city’s worst single-day toll.

“The dreaded plague”

In its Oct. 16 edition, the Allentown Democrat reported eight flu deaths in the previous five days. Two victims, Carl Frey and Roscoe Hargis, were Army privates stationed at Camp Crane, the military post at the Allentown Fairgrounds where soldiers were ordered to wear masks in a vain attempt to halt the flu’s spread.

Mary Brunetaki of Allentown caught the illness from her infant, who died. Brunetaki was too sick to go to the funeral and succumbed even as the child was buried.

Daniel Malone of Bethlehem went to Shenandoah to attend the funeral of his brother, an epidemic victim. Malone fell ill during the service and died within a day.

A Quakertown man, Clinton Schelly, died in a Hamburg sanatorium. An Allentown butcher, Norman Rauch, died at the hospital. Richard A. Parks, president of an Allentown wallpaper company, died at home.

The papers carried dozens of notices of flu-related public event cancellations. The Allentown Democrat ran an editorial demanding that authorities build a “contagious hospital” to quarantine and treat victims of epidemics.

Allentown, the Valley’s largest city, had started strong in the pandemic battle. It was the first Pennsylvania municipality to enact quarantines requiring isolation of patients. That was in September.

But when federal authorities recommended that municipalities consider closing schools and cancelling public gatherings, Allentown Mayor Alfred Reichenbach thought it would be a step too far. His city, unlike Bethlehem, had relatively few cases.

“Bethlehem,” Reichenbach told The Morning Call, "is filthy and dirty. A wagonload of refuse could be secured from three blocks of the highways, the streets are covered with thick layers of dust, the worst breeder of disease.”

Reichenbach would go on to serve as a pallbearer at the end of October for a notable victim, Lehigh County District Attorney Warren K. Miller.

The Chronicle newspaper editorialized that Allentown councilmen “obstinately persist in regarding the epidemic which is sweeping the country, and exacting an enormous death toll, as general cases of common colds.” Council even adopted a resolution saying the “colds” could be blamed on houses that were excessively damp because residents were trying to conserve coal.

“If people would take the opposite step — heat their houses where colds existed and promptly consult a doctor, more serious trouble would be avoided,” the resolution said. “We call upon people to heat their homes properly and call upon doctors promptly at the first sign of any unusual cold.”

The city came around, closing schools and cancelling public gatherings. In the city and across the Valley, churches were asked to suspend Sunday services.

A dozen deaths were reported in the area on Oct. 28 and the next day’s Morning Call headlines were dire.

“INFLUENZA TAKES TOLL OF FIVE IN HOKENDAUQUA: Mother and daughter, a man and two children victims of the dreaded plague.”

“DEATH’S HAND LAID ON YOUNG AND OLD: Dozens of well known in Allentown and Lehigh County pass away.”

Allentown had passed the 3,000 mark in the number of cases, the paper noted, with just shy of 400 cases reported the previous Sunday alone. In October 1917, the city had recorded 81 deaths from all causes. Now, in the same month a year later, more than 200 had been recorded, the vast majority from the flu.

The end

The flu began to abate through November. The Valley toll was grim. According to U.S. Bureau of Census’s Mortality Statistics for 1918, Allentown, a city of 73,500, lost more than 500 people. Easton, with a population of 33,813, lost 382.

Bethlehem’s figures show out of a population of 50,538, a total of 105 died, but historians believe that number is markedly low because the city had spotty record-keeping.

The global effect of the flu could hardly be reckoned. In India, some 5 percent of the population — 17 million — may have died. In Iran, the death toll may have reached 2 million, more than 20 percent of the population.

By the fall and winter of 1919-20, the virus had burned through its available hosts — they had either died or acquired immunity — and it may have mutated into a less lethal strain. So that season’s outbreak was far weaker and not nearly as widespread.

Pandemics have happened since 1918, but none approaching nearly the same scale. The worst, in 1957, killed about 2 million people worldwide. An outbreak a decade later killed about a million.

The most recent, the 2009-10 flu, may have killed 203,000 people, according to a 2013 analysis by an international group of researchers. That outbreak, of so-called swine flu, raised alarms because it was only the second caused by the H1N1 virus. The first was the 1918 pandemic.

Medical care is far more advanced today, of course, and flu vaccines are available each season. But the nature of flu is that it mutates, so it can breach the body’s defenses. And vaccines don’t always protect against all the strains that circulate in a season. The virus also adapts to thwart antiviral treatments such as Tamiflu, which can reduce the severity and duration of the illness.

Jahre is also worried by the effect of the anti-vaccination movement. One way vaccines prevent epidemics is by creating “herd immunity,” meaning the virus can’t find enough hosts to get a foothold in an area. The fewer vaccinations, the more vulnerable the herd. The anti-vaccination trend has already given rise to outbreaks of measles, a disease once thought to have been eliminated.

Jahre said the worldwide medical community maintains a virus surveillance program that flags worrisome outbreaks early on. The World Health Organization issues advisories when new threats emerge or when pandemics are thought to be imminent. These prompt countries to institute precautionary measures.

Even so, he has concerns about how widely and effectively health care could be administered in the event of a fast-moving, devastating pandemic. For example, only a few companies produce flu vaccines, and production disruptions have led to shortages even in ordinary seasons.

And federal government response to other disasters — Hurricane Katrina, for example — has been less than reassuring, he said, with troublesome failures in communication and widespread confusion about who, ultimately, is in charge.

John Kalynych, director of Lehigh County Emergency Management, said local authorities won’t be caught flatfooted in the event of a pandemic. The agency and its counterparts across the state would coordinate the response of hospitals and municipal health departments.

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Watch the video: Philadelphia Mummers Parade 2013