July 1, 2020
Physicians Report
Many physicians did not diagnose patients with influenza or pneumonia, but with other illnesses such as meningitis.[59] The Dedham Transcript printed “Uncle Sam’s Advice on Flu,” published by the United States Public Health Service, reminding readers that, “some of the patients, however, develop pneumonia, or inflammation of the ear, or meningitis, and many of these complicated cases die.”[60] The most frequently mentioned result of influenza-pneumonia was the cyanotic condition in which the patients were found and from which they rarely recovered. Upon autopsy, the lungs were in a condition described by Dr. Herbert French of London as “not like the common broncho-pneumonia of ordinary years,”[61] but were described as “two sacks filled with a thin, bloody, frothy fluid.”[62] London physicians reported similar findings upon autopsy of influenza victims with “not only acute congestion, but diffuse hemorrhaging, miliary abscesses, croupous pneumonia, passive edema, sometimes purulent bronchiolitis and even complete lung collapse.”[63]
Complications experienced by its victims were quite varied and included urine retention leading to acute nephritis, hypothermia suggesting “apparent death” (sometimes leading to accidental burials), cardiovascular disease and swollen lymph glands.[64] Spanish Influenza was not just a simple case of the flu, rather it was an illness that defied categorization. An Italian medic, Second Lieutenant Guiseppe Agostoni, attempted to save men under his care by drawing blood from a vein in the arm of the afflicted only to find that the dark blood, due to lack of oxygen, quickly clotted in the syringe, forcing him to discontinue his efforts.[65] A similarly frustrated doctor at Presbyterian Hospital, Albert Lamb, noted that,
“On admission most of the early cases were blue as huckleberries. Most of them died. Nearly all were coughing up liquid blood and continued conscious until a short time before death. We had to stand by helpless except for what temporary relief we could give.”[66]
For the average person, another frequent and easily identified symptom of Spanish Influenza was the “blood sputum” and “sudden nosebleeds” which so commonly occurred among the ill.[67] This extremely frightening hemorrhagic nosebleed often signaled a turning point towards life and even occurred after the patient had become cyanotic or developed pneumonia. Physicians believed this bleeding served to eliminate the toxic blood in the patient. Many doctors noted this phenomenon. One was Dr. Brulard of France when he observed a patient recover after experiencing severe diarrhea and nosebleeds, “it has saved her, it has all acted like a purge.”
Unfortunately, even if one did survive the frequent complications of influenza or pneumonia, there were a variety of other illnesses lying in wait. An upsurge in pulmonary tuberculosis, kidney and heart problems, deafness and blindness, early Parkinsonism, and a mysterious brain disease (encephalitis lethargica, noted after the epidemic until 1928) were frequent reminders of the pandemic.[68] Doctors had never experienced an influenza that exhibited so many medical complications.[69]
The best medical information available today is from the United States Navy, for its medical records were better maintained than were those of the civilian population. The Navy later estimated that approximately 40% of its personnel were ill with the flu during the fall and winter months of 1918.[70] General Pershing, eager for new recruits, realized the severity of the flu when he stated, “. . .the death rate from influenza rose to 32 per cent of cases for the A.E.F. [American Expeditionary Forces] and was as high as 80 per cent in some groups.”[71] He clearly understood why the draft was halted and why his new recruits were not forthcoming.[72]
The ability to maintain community services was dangerously interrupted. In 1919, the United States Public Health Service surveyed eleven cities and towns around the nation and determined that more than one-quarter (280/1000) of the populace had contracted the flu.[73] In the spring of 1918, those ages “0–35 years [suffered a] 30–40 percent” mortality, the highest of any age group. In the autumn of 1918, fully half the deaths that occurred attacked the 20–40 age range with the smaller third wave attacking the same age.[74] On average, the second wave lasted six weeks in a city and then gradually disappeared.[75] To compare the death rate for the 15–34 year old population with other years, recent evidence suggests that “influenza and pneumonia death rates for 15-to-34-year-olds were more than 20 times higher in 1918 than in previous years.”[76] In December of 1918, the American Public Health Conference came to the general conclusion that those who became ill and died “had been in the best of physical condition and freest from previous disease.”[77] The virulence of the influenza decreased over the course of the pandemic, for hospital reports early in the pandemic, provided to the Board of Health in 1918, discovered an initial mortality rate of approximately 60% from influenza/pneumonia.”[78]
Pregnant women in 1918–1919 were the group at highest risk for mortality due to influenza and pneumonia. During those years, there was a significant increase in the rate of spontaneous abortions and stillbirths as revealed that for “1350 pregnant women who had influenza…abortion, stillbirth or premature labor occurred in 26 per cent of those without pneumonia and 52 per cent of those with pneumonia. The prognosis was said to be serious for the women who aborted or went into labor.”[79] Dr. George Kosmak, an obstetrician in New York, reported up to a 70% mortality among his pregnant patients.[80]
Observations from all over the world, including one from a navy medical officer, confirmed that those who fell ill “were robust, young men when attacked.”[81] Dr. Victor Vaughan, acting Surgeon General of the Army, observed that “the husky male either made a speedy and rather abrupt recovery or was likely to die. Nature overdoes the resistance, kills the invading organisms too rapidly and sets free such an amount of poison that death occurs…Infection, like war, kills the young vigorous robust adults.”[82] City boys, more frequently exposed to a variety of infections, had stronger resistance to this disease than did the young country boy.[83]
Hospital Avoidance
Apparently, people who avoided the hospital frequently did so to their benefit. Private Wallace went AWOL for three days while he was ill with the flu and a painful ear infection, a common side of the influenza. He survived on stewed apricots while an Italian-American soldier cared for him in an army cookhouse.[84] Wallace knew that many of his friends who went to the military hospital with influenza never came out alive and his decision was, to him, clearly a logical one. The flu so severely disrupted military life, no one ever realized that Wallace had been AWOL from the 319th Engineers. In Medfield, another fortunate survivor of the pandemic, Herbert H. Morse, “seriously ill with pneumonia,” was retrieved from Fort Slocum, New York, by his father and brought home to recuperate as reported by the Dedham Transcript on October 26, 1918.[85] The military, inundated with ill young men, was probably overjoyed that a parent would bring a doughboy home to recover or die. The same paper later reported that Morse was “passing a furlough at his home here while convalescing from an illness with pneumonia.”[86] The care received at home by his father and stepmother was more salutary than that he would have received in the military hospital.
Many doctors realized that the most important chances for recovery lay in resting during the fever and convalescence.[87] The importance of rest can be found in the success stories of many of the servicemen who recovered from the flu. Seaman Joseph Chevalier tricked the doctor during inspection by scrubbing his tongue vigorously with a toothbrush to force it to appear a healthy pink. He then went home to Cherbourg, France, to recuperate at the hands of his mother. He later learned he was the only survivor from the barque Lange de Fécamp to which he was assigned—his comrades went into the hospital and never came out alive.[88] Another soldier, John Lewis Barkley, also stationed in France, became ill and was cared for by a loving French family. He too recovered his good health.[89] Sing Sing Prison in New York reported 100% success when 106 convicts became ill with influenza. They established a strict quarantine, enforced rest and quiet in unheated rooms (open-air treatment) and fed them whiskey, milk and eggs. Fourteen of the prisoners had severe pneumonia, but no one died.[90]
Mortality in Medfield and Millis
The high infection and death rate in the military was apparently due to overcrowding, because it found its counterpart in mental institutions. The correlation between high mortality rate and overcrowding is revealed when comparing the mortality rate in Medfield and Millis with that of Medfield State Hospital. Comparing the years 1917 and 1919 in Medfield and Millis with 1918, life expectancy plummeted significantly in 1918 as it did in the rest of the country. In 1917 in Millis, the total number of deaths was 17, with an average age at death of 46.[91] In 1919 the total number of deaths was 19 with an average age of 50½.[92] Millis in 1918 experienced 25 deaths with an average age of 38 years. Nine deaths were related to influenza or pneumonia with persons exhibiting a similar age at death as seen throughout the world: 9, 33, 11, 21½, 34, 42½ , 43, 17¾, 58, and two infant deaths. These deaths occurred between October 4 and December 15. While there was no note of his mother’s health, Arthur Pierce was born on October 30, 1918, and died on November 18, 1918, reflecting the infant mortality seen during the epidemic.[93] As of July 1, 1918, the State Department of Health reported that Millis had a population of 1470 and an end-of-year report logged only five deaths and two cases of pulmonary tuberculosis. Influenza was not yet a reportable cause of death. The State Department of Health stated that the general rate of mortality across the state was 5.4 per cent (perhaps based per 1000; unclear from information).[94] Arriving at 5.4% is confusing for after calculating the rate of death (in towns over 100,000 persons) in Worcester (.58%), Fall River (.60%), Boston (.64%), and Lowell (.51%) using Crosby’s numbers, a rate of .54% would be more likely.[95] Beveridge also states that approximately 0.5% of the population in the United States died during the pandemic (approximately 500,000 persons).[96] The rate of mortality in Millis was approximately .61%.[97]
Medfield had an estimated population of 3764 on July 1, 1918, which included the Medfield State Hospital population of 1644.[98] In Medfield, there were 22 cases of lobar pneumonia and 33 deaths; pulmonary tuberculosis, eight cases and 35 deaths and tuberculosis, other forms, with one death noted by the Health Department.[99] If the total Medfield population was 3764 and the State Hospital population was 1644, that designates approximately 2122 persons as residents in the town of Medfield. The average age of death in Medfield in 1917 was 61, with 29 deaths in the town and 126 at the State Hospital.[100] In 1919, the average age of death was 62, (almost 68½ excluding infant deaths) with 24 deaths. The State Hospital still reported 67 deaths that year. Medfield had a visitation of the flu again in the winter months of 1919.[101] During 1918, there were 185 deaths at the State Hospital and 36 deaths of Medfield town residents. The first death in Medfield due to influenza was that of Chester Dyer, 29 years old, and occurred on September 17. The year ended with the death of Alma Herron on December 18, at age 17. In between, there were 12 deaths due to flu or directly related to flu. The pattern of deaths in the town due to the flu was slightly different than Millis, with more than one death occurring per day: September 17, 26, October 3, 4, 5, 6, 9, 9, 10, 10, 11, 20, 22, and December 18. Medfield reported no infant deaths during this time period; however, four women were between the ages of 22-23, and thus pregnancy could have been a factor in their deaths. The average age of death that year was 38½, or 40½, excluding the stillborns that occurred earlier in the year. The rate of mortality in Medfield was .66%.[102]
In comparison to both towns, the state hospital experienced 185 cases of influenza and suffered 55 deaths.[103] The Superintendent’s Report from Medfield State Hospital concurs with other findings of high mortality among the robust and youthful populations as published around the world. Some of the more important observations made by us are as follows:
- The disease attacked our robust patients and, on the male side, particularly those who were accustomed to work about the grounds, on the farm and at various other outdoor work. Many of these patients lived on so-called open wards and had the best hygienic conditions possible in this hospital.
- It was found that the greatest mortality occurred in those patients between the ages of 30 and 35, the youngest was 18 and the oldest 75.
- As to the open-air treatment, no conclusions could be deduced. The percentage of deaths among the insane patients was 17.2 per cent, being much greater than the percentage of employees, and yet it was the insane patients who received the greatest amount of open-air treatment.[104]
A death toll of 17.2% reported from the hospital compares to similar death tolls described on the African continent (14.2–17.7%) as well as mortality rates observed in the military.[105] The 1919 Medfield State Hospital Annual Report, remarked that due to the influenza epidemic in the year before, there was an increase in the “number of deaths from tuberculosis of about 65 per cent,”[106] which was also observed in the general public. They noted that most of the newer cases of tuberculosis had earlier suffered from influenza.[107]
Cures and Precautions
In 1918, there were 140,000 doctors in the United States, 40,000 of whom were enlisted in the military. This caused a severe shortage of doctors to care for the civilian population during the flu epidemic.[108] Even had doctors been available, many people could not afford the care of a doctor. Home remedies such as Foley’s Honey and Tar for coughs,[109] whiskey, “mustard spread on their chests” or “sacks of camphor around their necks” were offered as treatment.[110] Ads for various disinfectants such as “carbolic disinfecting powder for sick rooms” or “Steri-Foam” for cleaning toilet bowls were found in the Milford Daily News (which sold 4850 copies daily in Milford and surrounding towns.)[111]
A variety of conflicting cures were suggested by both doctors and friends including remedies such as consuming large quantities of aspirin or shunning all aspirin; becoming a cigar smoker;[112] ingesting castor oil, or refusing all castor oil; partaking in exercise or avoiding exercise; wearing a veil, not wearing a veil; preventing the circulation of library books; avoidance of shaving; no hand shaking; and wearing clean pajamas.[113] Serious attempts were made at creating a viable vaccination for the flu; unfortunately, none was truly effective against this strain of influenza.[114] In a move that was tantamount to admitting defeat, Surgeon General Blue in Washington D.C., stated “the Health Service urges the public to remember that there is as yet no specific cure for influenza and that many of the alleged cures and remedies now being recommended by neighbors, nostrum vendors and others do more harm than good.”[115]
Sunshine and fresh air were found to be successful in many places; however, people in Boston believed that the open-air treatment was “barbarous and cruel.” Roosevelt Hospital in New York bedded the children down on the roof and supplied them with “hot-water bottles, [and] screens shielding them from northwest wind.”[116] Perhaps it was the State Commissioner of Health, Eugene Kelley, who recommended that Medfield State Hospital attempt the open-air treatment since Kelley observed that after some fresh air and sunshine, patient temperatures frequently dropped from 104ºF to 97ºF.[117] “Insane patients who contracted the disease were treated in the hospital wards, getting the benefit of the outdoor treatment.”[118]
Doctors and nurses protected themselves with woven gravy-strainers with which they covered medicated gauze pads.[119] One nationwide attempt to prevent the spread of influenza was the wearing of masks while in public. Spitting carried a stiff fine in many parts of the country. The Department of Health published recommendations for avoidance of the flu along with the care of influenza victims in all the local papers such as the Dedham Transcript, Milford Daily News, Franklin Sentinel, the Townsman of Wellesley and the Framingham Evening News. The Dedham Transcript, published weekly, contained a column on Medfield and small pieces about Millis. The Milford Daily News also mentioned Millis occasionally, so it is likely that, at the very least, two papers penetrated Medfield and Millis with health information. These recommendations included “general closing orders; the use of masks; the care of hands; the care of food and utensils; the use of prophylactic vaccines; and the isolation and quarantine of patients,” and requested thorough reporting to the state by all communities on the numbers of ill and expired.[120] The Wellesley Townsman on September 20 published “Defence Against Influenza Timely Advice” by Sara Newcomb Merrick, M.D. Dr. Merrick listed several rules on how to remain well with extensive discussion following each rule.
Rule I Avoid fear, worry, anger, grief …Rule II Dress comfortably…Rule III Never eat a hearty meal…Rule IV Concerns Work. Do not work to exhaustion…Rule V Keep the interior of the body CLEAN…Rule VI Avoid constipation…Rule VII Be especially careful to attend to the toilet of Nose and Mounth![sic][121]
The Medfield Board of Health and the Selectmen of the Town requested parents keep their children at home to prevent the spread of infection, to avoid public gatherings, at the same time seeking nurses to volunteer for duty. The need for nurses was desperate and the selectmen reported that the District Nurse Association would compensate nurses.[122]
The public believed influenza was spread by coughing, sneezing and the expulsion of other fluids from the respiratory tract, but flies were also believed to cause the spread of influenza.[123] Medfield State Hospital realized dysentery occurred more during August and September, believing it to coincide with the fly population. The existence of flies and the positive results of the screens used against them was noted in the Annual Report of the Medfield State Hospital when the number of deaths due to dysentery observed in 1917 was 31 and 1918 dropped to only four. The hospital believed that the decrease in deaths reflected “the more complete screening of the kitchens, ward buildings and dining rooms [which] undoubtedly had something to do with this favorable condition.” The hospital changed its policy of allowing garbage to pile up around the buildings and believed “it is probably more than a coincidence that, compared with last year, there were many less flies.”[124]
In Medfield, the majority of people who died from influenza or pneumonia remained at home regardless of their economic situation. Apparently lack of family members to care for the ill was the determining factor for hospitalization. “Everett H. Simpson, aged 10, youngest son of Mr. and Mrs. Thomas P. Simpson, …died last Thursday with influenza. Several other members of the family are ill with the disease.”[125] Miss Laura Herron, 17, died at home from pneumonia.[126] Flora Kingsbury, the only person noted to have died in a hospital, was 40 years old and a single housewife. If she had not been single, perhaps someone would have cared for her in her home and she would not have died at Boston City Hospital. Apparently no one came forward to pay for her funeral as the Town of Medfield paid $50 to have her buried properly. Fifty dollars was a very inexpensive burial for 1918 and did not include embalming.[127] Mr. Granville Mitchell, son of Colonel Edwin V. Mitchell, age 31½, died at his home in Medfield.[128] Mr. Granville Mitchell was the vice-president of the Edwin V. Mitchell, Co., as well as an involved member of the community of Medfield.[129] In comparison to Miss Kingsbury’s funeral, Mr. Granville’s was far more elaborate, costing $273 and included the singing of the Lotus Quartette and extra care of the gravesite.[130] Charles Snow, engineer at the Medfield State Hospital also died in his home, leaving a wife and one son.[131]
To be continued…
[59] Crosby, 5.
[60] “US Public Health Service Issues Official Health Bulletin on Influenza,” Dedham Transcript, October 26, 1918, 4.
[61] Hoehling, 21.
[63] Crosby, 8.
[63] Hoehling, 21
[64] Collier, 221, 251; Hoehling, 15; Patterson and Pyle, 13.
[65] Collier, 10.
[66] Hoehling, 49.
[67] Crosby, 7.
[68] Collier, 11, 290; Hoehling, 136; Patterson and Pyle, 20.
[69] Collier, 36.
[70] Crosby, 205.
[71] Hoehling, 64.
[72] Crosby, 49.
[73] Crosby, 205.
[74] Beveridge 31.
[75] Beveridge, 43.
[76] Taubenberger, 1793.
[77] Crosby, 216.
[78] Department of Health 1918, 99.
[79] Beveridge, 14.
[80] Collier, 263.
[81] Crosby, 215-6.
[82] Hoehling, 40.
[83] Collier, 9.
[84] Crosby, 135-7.
[85] Dedham Transcript, October 26, 1918, 2.
[86] Dedham Transcript, November 11, 1918, 2.
[87] Beveridge, 14.
[88] Collier, 115.
[89] Collier, 178.
[90] Collier, 113.
[91] Thirty-Third Annual Report of the Town of Millis for the Fiscal Year Ending December 31, 1917. Millis: G. W. Woolvett, 1917, 31.32
[92] Millis Town Report 1919, 35-6.
[93] Millis Town Report 1918, 31-32.
[94] Department of Health 1918, 199; 214-215.
[95] Crosby, 60-61.
[96] Beveridge, 31.
[97] Millis Town Report 1918, 31-32.
[98] Department of Health 1918, 210-211; Twenty-Third Annual Report of the Medfield State Hospital at Medfield, Massachusetts For the Year Ending November 30, 1918. Public Document No. 59. Boston: Wright and Potter Printing Co., 1919, 9.
[99] Department of Health 1918, 210-11.
[100] Medfield Town Report 1917, 30
[101] Medfield Town Report 1919, 57.
[102] Medfield Town Report 1918, 30-31.
[103] Medfield State Hospital 1918, 10.
[104] Medfield State Hospital 1918, 11.
[105] Patterson and Pyle, 4.
[106] Medfield State Hospital 1919, 12.
[107] Medfield State Hospital 1919, 12.
[108] Collier, 44.
[109] Milford News, October 3, 1918, 3.
[110] Brox, 76.
[111] Milford News, October 5, 1918, np.
[112] Collier, 106.
[113] Hoehling, 120-121.
[114] Beveridge, 98.
[115] Hoehling, 169.
[116] Collier, 77.
[117] Collier, 78.
[118] Medfield State Hospital 1918, 10.
[119] Collier, 78.
[120] Department of Health 1918, 199-200.
[121] Townsman (Wellesley), September 20, 1918, 9.
[122] Dedham Transcript, October 12, 1918, 2.
[123] Berkshire County, 57.
[124] Medfield State Hospital, 10.
[125] Dedham Transcript, October 5, 1918, 2.
[126] Dedham Transcript, December 28, 1918, 2.
[127] J.A.R., np.
[128] Medfield Town Report 1918, 30.
[129] Dedham Transcript, October 12, 1918, 2.
[130] J.A.R., np.
[131] Dedham Transcript, October 12, 1918, 2.