Sept 1, 2020
Public Health Advances
Dr. Martha Wollstein of the Rockefeller Institute of New York was one of many scientists who worked diligently to determine both a cause for the influenza and to produce vaccines to eradicate it.[180] Unfortunately, microscopes of the day did not attain the necessary magnification and scientists were not able to see their tiny viral enemy. It was necessary to envision other avenues of attack.[181]
The greatest advance resulting from the epidemic was the “extensive research on influenza and massive growth in the size and power of public health departments, and to confidently predict generous government appropriations for these purposes.”[182] The influenza pandemic left behind an expanded Public Health Service with a noticeably improved method of reporting death and disease.[183] Americans supported changes in the public health system with concerns that focused on: “increasing number of hospitals, the growing professionalization of physicians, and the great influenza epidemic of 1918–1919.”[184] The public learned that it was imperative to fight the war against poverty and chronic/contagious diseases and changes in sanitation practices occurred around the country. Arizona devised a revolutionary sanitary code that gained acceptance and spread throughout the United States. This plan included mandatory methods for the cleansing of dishes in public facilities, clean laundry for guests and sterile toilets with inspections by the health department at any time. New York implemented an “after-care system” at their newly available health clinics with a primary focus of treating neglect and malnutrition.[185] These trends, reflecting fears of a reoccurrence of the influenza epidemic, ushered in a “cleanliness craze” in the American homes of the 1920s.[186] Around the world, governments realized the importance of coordinating the leading scientists of the day in the fields of epidemiology, bacteriology, chemistry and sanitation to keep track of contagious disease movements.[187] This sentiment was expressed by Raymond Pearl, PhD in a report on “Influenza Studies” in the “Public Health Report of 1919” in which he stated, “if every epidemiologist does not take advantage of the present opportunity to investigate with all possible thoroughness epidemic influenza, to the end of making a better defense next time, he will have been derelict in his plain duty.”[188]
Medfield, Millis, and the Medfield State Hospital reflected the changing attitude toward public health. Prior to 1918 no funds were granted to pay for a Visiting Nurse to assist in health matters in either Medfield or Millis as permitted by a State Act approved in 1911.
An Act Authorizing Towns to Appropriate Money for the Employment of Nurses.
Approved March 1, 1911. House No 1460.72 Section 1
Towns are hereby authorized to appropriate annually a sum not exceeding two thousand dollars for the employment of district or other nurses. The said sums may be expended directly by the town through its selectmen or under the direction of the board of health when authorized so to do by the selectmen.[189]
This powerful piece of legislation was not of interest to Medfield and Millis until the 1918 influenza pandemic. In the Millis Town Report of 1919, the budget appropriated $300 to Mrs. Josephine Cayneau, District Nurse, for the ensuing year.”[190] In the Medfield Town Report of 1918, the Health and Sanitation report exceeded its budget by $804.12, a sizeable overage. Medfield collected $116 in medical reimbursements from its influenza cases during 1918, perhaps collected from the State as part of its increased budget during the epidemic.[191] However, in 1919, Medfield was still owed $175 from “various bills still due Town in influenza cases.”[192] In 1919, Medfield wisely increased their appropriation to $500 to the Board of Health.[193] The general community became concerned about health issues and the Hannah Adams Club brought in guest lecturer Dr. Russell Sprague, member of the Massachusetts State Board of Health in November of 1918. Dr. Sprague delivered a program on “Communicable Diseases” including information on “diseases declared to be dangerous to the public health, disease prevention and control; epidemics and their control; proper care of the teeth.” Dr. Sprague’s use of moving pictures served to improve the understanding of the discussion. “The public is invited and urgently requested to attend.”[194] The general public comprehended the commitment necessary to achieve overall good health in a community.
In an indication of the critical nature of public health, the Medfield Town Report of 1919 began placing the Board of Health Report in the Table of Contents on the front page. While there had been a Board of Health report in previous Medfield town reports, it had not been listed on the front page in the table of contents. Health had now become as serious a concern in the small town as it had in the rest of the country. The 1919 report reiterated the events of the previous year, without naming the disease. “In view of the fact that this Department has so much exceeded the appropriation the past year, it seems advisable to render the following report” and reminded the town that $116 was collected from influenza cases in 1918 with an appropriation of $300.[195] The Medfield State Hospital trustees were happy with their new screens in the hospital and the lowered levels of dysentery that accompanied their “successful campaign waged against the housefly.” The trustees also reported that “subsequent to the epidemic of influenza the general health of the hospital has been good.”[196]
The state health department was relieved that the third wave of influenza was not as aggressive as the second wave and that many in Massachusetts did not become severely ill. The department also felt that they were somewhat successful in their attempts at vaccinating people against influenza, but also acknowledged that the warm weather was equally a contributor to the disappearance of the disease. “We know no more about the etiology or means of prevention of this dreadful visitor than we did before its recent world-wide spread.” The Health Department readily acknowledged the changes that lay ahead for its department under the section entitled “Changes in Organization.”
During the year the growing importance of public health nursing as a distinct branch of sanitary science and public health has been recognized by the creation of a special subdivision in this subject. This is expected to merely foreshadow the creation in the near future of a distinct Division of Public Health Nursing.[197]
Medfield State Hospital also believed they had achieved some success with vaccinations.
“In regard to the vaccine treatment, influenza vaccine was obtained early for all the employees who could be induced to take it, and later was given to 902 patients. On the whole, the reaction from the vaccine was not very severe, but most cases presented no symptoms such as headache and slight rise in temperature. Apparently no definite conclusions could be reached as to the benefit of the vaccine treatment. It was the impression, however, of the physicians that those who took the treatment according to the prescribed method presented less severe symptoms and had a slightly smaller death rate.”[198]
While the flu crested in larger cities, it is impossible to say that Medfield and Millis had a definite crest because people continued to die through December. Although Crosby believes that the “pandemic penetrated and then departed from the rural areas later than the cities,” it visited Medfield and Millis at the same time it did the cities and yet altered death patterns for months.[199] Certainly there was a concentration of deaths occurring in Medfield between October 3 and October 11, yet enough deaths occurred due to influenza among the young to continue an abnormal death pattern from September through December.[200] The deaths that occurred in Millis were evenly spread throughout the pandemic in 1918, with an infant death attributed to the flu on January 1, 1919.[201] New cases of influenza reported in the November 16, Dedham Transcript included Rev. George H. Coffin, Jr., pastor of the Second Congregational Church of Medfield. The congregation must have been deeply alarmed at the thought of their pastor succumbing to this horrible illness, but by November 23, he was well enough to deliver his sermon, “The Verdict of Justice.”[202] His speedy recovery reveals the variety of paths this illness pursued. Schools reopened on Monday, October 28.[203] They remained open through the end of the year, despite the illness of the third and fourth grade teacher, Miss Marion Clark, and many absences due to influenza in December. The school committee felt that the “cases were very light” and “decided not to close the schools until the end of the Fall term.”[204] On December 7, the paper reported that the schools held “peace and Thanksgiving exercises” at the “suggestion of the Massachusetts State Board of Education.”[205]
Conclusion
The influenza pandemic of 1918 alerted the world to the reality that scrupulous sanitation and health care are the responsibility of communities and governments. In order to achieve good health and contain the spread of disease, town and city budgets expanded to fund a health department at both the local and federal government levels. As reflected in the mortality rates of Medfield and Millis, living in a small town did not permit escape from diseases such as influenza. The impact of overcrowding on mortality due to influenza and pneumonia was found in a small population as in the Medfield State Hospital as well as that noted in the military. While the actual numbers of people who lost their lives to the influenza was not as significant as other larger towns, Medfield and Millis suffered the loss of youthful community members as did other towns and cities. As the influenza spread, communities saw increased absenteeism and a reduced readiness of soldiers to fight in the war. Medical communities around the world and in local communities struggled to find either an effective treatment for the flu or a way to stop its spread. The most effective strategies to reduce the spread of the influenza whether in a city or a small town included quarantine and a suspension of community activities. Rumors of conspiracies as well as miracle cures appeared within communities and local newspapers. People faced tremendous anxiety knowing that the influenza could spread to their families and wreak havoc on their lives. Despite their best efforts, humanity could not stop the spread of the Spanish flu and eventually enough people became ill and when the disease returned in 1919, most people had enough immunity to repel the invader. The influenza pandemic of 1918 seriously disrupted each person’s sense of control and competence over one’s life, as it swept around the world and demonstrated its power over mere humans.
[180] Hoehling, 47; Crosby, 313.
[181] Crosby, 266.
[182] Crosby, 312.
[183] Fincher, 139.
[184] Green, 178.
[185] Collier, 288.
[186] Green, 182.
[187] Coller, 289.
[188] Raymond Pearl, Ph.D, “Influenza Studies” Public Health Rep (QJA), July-August 1976, Vol 91, no. 4, 383. Vol 34, August 8, 1919, no. 32.
[189] The Commonwealth of Massachusetts; Acts 1911. Chapter 72, Approved March 1, 1911. House no 1460.72, section 1, amendments included.
[190] Millis Town Report 1918, 36.
[191] Medfield Town Report 1918, 44.
[192] Medfield Town Report 1919, 18.
[193] Millis Town Report 1919, 37.
[194] Dedham Transcript, November 30, 1918, 2; December 14, 1918, 2.
[195] Medfield Town Report 1919, 74.
[196] Medfield State Hospital 1919, 12.
[197] Department of Health 1919, 4-5.
[198] Medfield State Hospital 1918, 11.
[199] Crosby, 56.
[200] Medfield Town Report 1918, 30.
[201] Millis Town Report 1919, 35.
[202] Dedham Transcript, November 16, 1918, 2; November 23, 1918, 2.
[203] Dedham Transcript, October 26, 1918, 2.
[204] Dedham Transcript, December 21, 1918, 2.
[205] Dedham Transcript, December 7, 1918, 2.