As influenza swept the country, health departments and other local offices were frantically looking for ways to stop the disease's spread. Most cities across the nation were confronted with not only containing the epidemic, but also dealing with the problems influenza left in its wake.
The War Department was not the only government agency attempting to combat influenza's spread. Local, county, city and state governments throughout the country enacted laws and ordinances to stop the epidemic. Holding to the belief that influenza was spread more easily in crowds, many cities and states enacted bans on all public gatherings. In Newark, for example, on October 10, the Board of Health ordered "all schools, churches, theaters, moving picture houses, dance halls, saloons and sporting arenas closed." (1) In many cities, funerals also fell under the category of public gatherings and were subsequently banned. Aside from the fact that funerals had the potential to create "dangerous" crowd situations, medical officals believed that the corpse was a source of infection. The following is typical of the laws passed across the country:
There shall be no public church or chapel funerals held in Chicago over any body dead from any disease or cause whatsoever. No wakes or public gatherings of any kind shall be held in connection with these bodies… No dead body shall be taken into any church or chapel for funeral services in connection with such a body during the period of the present epidemic. (2)
In addition, undertakers were instructed to "wrap the bodies in gauze treated with antiseptic and hermetically seal the coffins." (3)
The task of preparing and burying the dead was more easily said than done. In many cities, this essential service was near collapse. The sheer numbers of dead overwhelmed undertakers; they had never before faced such a huge number of dead at one time. During a pandemic, the breakdown of this particular service creates two major problems. First, the accumulation of bodies allows for the possiblity of secondary epidemics caused by organisms that thrive on dead flesh. Second, and perhaps more significantly, the build up of corpses will lower and eventually break the morale of the population. Private undertaking house were working around the clock at full capacity, and many were trying to turn misery into profit by raising their prices, sometimes as high as 600%. Some cemeteries were charging burial fees and then making the relatives of the deceased dig the graves themselves. (4)
Corpses arrived at the cemeteries more rapidly than they could be buried. In New York, "the mayor was sufficiently concerned to order city engineers to start digging graves. There was evidence that the specter of unburied dead was commencing to haunt New York, even as it had other cities." (5) Across the Hudson river, in Newark, the situation was just as bad, if not worse:
…often the dead remained unburied for days and even weeks because of the lack of men to inter them. City employees were used for grave digging… teams of horses were used in several cemeteries to plough trenches in which influenza victims were buried in long rows. When 140 unburied bodies crowded Holy Sepulcher Church at once, the city hired laborers — at high wages — to perform the corporal work of mercy. (6)
Coffins were also in short supply, and consequently very expensive. Many families, unable to afford coffins, had to resort to burying their dead in crude, homemade pine boxes. In Washington, D. C., the Commissioner of Health commandeered two boxcar loads of coffins bound for Pittsburgh in the name of the District of Columbia without any consideration of the legal aspects of such an action. The coffins were taken to a high school playground, covered with tarpaulins, and left under heavy police guard. The commissioner "had no illusions that even coffins were not highly desirable objects of theft." (7) The shortage was so severe in Buffalo, that the city announced it would make its own caskets. The Health Commissioner declared:
They will not be $1000 caskets or even $100 caskets. They will be plain, with plain handles and respectable… the health department will make them and will sell them at cost to families needing them and will give them to the families of the poor. (8)
As a direct result of both the unavailiblity of coffins and the lack of men to bury victims, morgues around the country were literally overflowing with bodies. Almost every major city of the United States recorded scenes such as this one in Philadelphia:
The city's only morgue… was a scene of gristly confusion. Ordinarily, its capacity was 36 bodies: it now had several hundred. They were piled three and four deep in the corridors and in almost every room, covered only with dirty and often blood stained sheets. Most were unembalmed and without ice. Some were mortifying and emitting a nauseating stench. (9)
Not even the United States Army could escape these problems. As one Army Physician recorded:
There was no place to put the bodies at the base hospital. The Quartermaster Department… could not obtain coffins or embalmers. At the base hospital there was a small plain morgue… [with] space for not more than a dozen bodies… every hour more bodies were borne to the morgue. In that dreadful little morgue as many as 140 bodies were crowded and for a while, no opportunity to dispose of any. (10)
The impact of the pandemic was probably most heavily felt by the medical profession. The almost impossible task of seeing and caring for the large number of people stricken simultaneously was not helped by the military's drafting of many doctors and skilled nurses. In some cities the shortage of medical personal was critical. In Philadelpia, the University of Pennyslvania School of Medicine gave its third and forth year students one lecture on influenza, suspended classes and "volunteered" the students to work at an emergency hospital. (11) Doctors and nurses around the country routinely worked 14 or more hours a day. One Newark physician, who reportedly treated three thousand patients in 29 days wrote:
You walked out of your office in the morning and people grabbed you as you walked down the street. You just kept going from one patient to another until late in the evening. (12)
Although the medical profession did not know the exact means of the transmission of influenza, the role of sneezing and coughing was recognized. In New York City, "open-faced sneezers" were considered public enemies and were subject to fines and jail sentences. (13) Newark police were instructed to eject sneezers and coughers from public places. (14)
One of the most controversial preventive measures directed against the spread of influenza was a mask worn over the nose and mouth. Some, like Dr. Mustard, a health administrator in Washington, D. C., thought the masks were useless against influenza: "[They] maybe as effective as fish nets against flies. They are an absurdity, a menace when worn by the civilian population." (15) Dr. John Kyle of California agreed: "Masks are for doctors and nurses in an operating room. They look good to the poor innocent patient." (16)
Some people, such as the San Francisco City Board of Supervisors, saw the masks as beneficial. On October 18, the Board passed what was known as the Mask Ordinance, which said in part: "Every person appearing on the public streets, in any public place… shall wear a mask… over the nose and mouth, consisting of… butter cloth or fine mesh gauze." (17) For the next month, most of San Francisco's population was hiding behind white gauze. Those who did not wear the masks paid fines and went to jail. (18)
Today, medical science knows that because of the influenza virus's extremely small size, the masks were about as effective as Dr. Mustard predicted. However, the mask was effective at catching some of the dust particles and water droplets that the virus rode on, but in order to be even slightly helpful, it had to be worn all the time, be of a certain thickness, and be tightly tied around the face. Needless to say, the mask wearers seldom met these conditions. (19)
The real reasons for the masks were probably more psychological ones than anything else. The masks gave the people a feeling of security; they had something tangible to protect them from influenza. Economically, the mask was also beneficial. Since masks were supposedly accomplishing the same task as the bans against public gathering, and the limits on business hours, stores were able to stay open throughout the pandemic's sweep of the city.
In San Francisco, by the time the Board of Supervisors declared the use of the masks a success, the pandemic was declining in strength all over the country. By Thanksgiving, this country truly had something to be thankful for — the pandemic seemed to be coming to the end of its course.
A third wave of the epidemic passed through the United States in February and March 1919, but this wave was considerably less virulent and deadly than the second wave. By mid-spring, with the exception of some rather remote places, the third wave had run its course. The Spanish influenza steadily declined through the 1920's, and by 1930, it had all but vanished from the human population of the earth.
Chapter IV Footnotes
- Stuart Galishoff, "Newark and the Great Influenza Pandemic of 1918," Bulletin of the History of Medicine, May/June 1964, p. 250.
- A. A. Hoeling, The Great Epidemic, 1961, p. 147.
- Galishoff, p. 250.
- Alfred Crosby, Epidemic and Peace, 1918, 1976, pp. 76-77.
- Hoeling, p. 126.
- Galishoff, p. 250.
- Hoeling, p. 77.
- Ibid., p. 88.
- Crosby, p. 77.
- Carey McCord, "The Purple Death," Journal of Occupational Medicine, November, 1966, Vol. 8, p. 596.
- Isaac Starr, "Influenza in 1918: Recollections of the Epidemic in Philadelphia," Annals of Internal Medicine, October, 1976, p. 516.
- Galishoff, p. 262.
- Hoeling, p. 81.
- Galishoff, p. 249.
- Hoeling, pp. 76, 84.
- Ibid., p. 84.
- Crosby, p. 102.
- June Osborn, History, Science and Politics: Influenza in America, 1977, p. 11.
- Crosby, p. 101.