Spanish Influenza Outbreak, 1918 by Sarah Cummings
"In the midst of perfect health, in a circumscribed community... the first case of influenza would occur, and then within the next few hours or days a large proportion- and occasionally every single individual of that community- would be stricken down with the same type of febrile illness, the rate of spread from one to another being remarkable... Barrack rooms which the day before had been full of bustle and life, would now converted wholesale into one great sick room, the number of sick developing so rapidly that hospitals were within a day or two so overfull that fresh admissions were impossible."
- Dr. Herbert French to the British Ministry of Health (Hoehling,18)
Between the months of August and November of 1918, Spanish influenza spread quickly across the United States and around the world in epidemic proportions. The disease was thought to have been brought from country to country by sea-faring vessels passing through major port cities around the world, with illness striking men of French troops, the British Royal Navy, civilians in America, and more. The Public Health Service sanitation officer and member of the First Navy District, Dr. William M. Bryan, was aware of the conditions in Boston and was worried by them, where hot, dusty, and dry conditions exacerbated the problem, forcing sailors and soldiers into crowded conditions in Boston, where the close conditions and poor housing aided in the quick spread of influenza from person to person (23).
Although influenza itself did not cause the deaths, but caused the pneumonia which did cause deaths, the number of deaths were still striking and rising. The deaths of three men in one afternoon in Quincy, Massachusetts caused the public to take notice. Bostonís church closed on September 22 to keep the public separated from each other (33). The disease proceeded to cause death in large numbers throughout the country. At one point, Philadelphia was stricken with 289 deaths within 24 hours(71).
If the problems involving the quick spread of the disease could have been foreseen, it would have been wise to take precautions concerning the close quarters in the major port town of Boston. There may have been a way to separate people to a greater degree and not allow them to be on such close terms that they could have passed the virus so quickly from one to another. A larger number of available places to board, though impractical, would have been helpful because the disease would have had more difficulty spreading than in the close confines that existed. These precautions, however, would not have had a great effect on stopping the progress of the disease at large, for the epidemic was so widespread. It was very easy for people to carry the virus from a boat into a city, and spread it to other people, who would then travel across the country. The short incubation period kept infected people from travelling too far, but the ease with which the influenza spread from person to person caused the outbreaks to occur at large frequency.
There were many opinions concerning the ways in which to prevent the spread of the disease to individuals. The use of the face mask by medical professionals was a controversial issue. Some believed that the mask would protect from the spread of infection, while others believed that the mask would not help at all. Influenza is spread through coughs, from one mouth to another, so masks would have been helpful in preventing infection of health care workers. Masks would have also been helpful for preventing the spread of pneumonia, which actually killed more people than the actual influenza virus itself. Those who did not wear masks put themselves at risk in an ineffective action. In some places, "open-faced sneezers" (81), were fined or sometimes jailed. The law began to take public health into its own realm. Different approaches for infection prevention were taken at military training camp on Goat Island, in San Francisco, where vaccines were given and objects such as drinking fountains and telephones were sterilized (35). These methods did not involve infringement upon the rights of the individual while attempting to protect the larger population, and were socially just methods of prevention. The vaccinations, however, would only be helpful if the patient had not yet developed influenza, but would aid in keeping the numbers down on the spread of infection. Sterilizations were non-invasive methods of increasing the sanitary conditions, which would also keep down the likelihood of infection.
The same group in Goat Island, San Francisco, was quarantined to isolate the infection. Because the island was a military training camp, the men there were separated from the rest of their families, and the imposed quarantine isolated them. They were unable to be with their familiesin San Francisco. Had the influenza outbreak been selective and small in size, only occurring at the Goat Island training camp, the quarantine may have been necessary and effective. The incubation period and length of the course of disease for influenza are relatively short, and the isolated incident could have been controlled and stopped. The outbreak of influenza was not contained to the training camp, though. Quarantine was actually imposed to keep influenza out of the community, and while it was extremely effective at doing so, those soldiers released from the camp quickly picked up the infection from San Francisco. The quarantine was less effective than intended, and bordered on being a socially unjust response. Because the quarantine on the island was unlikely to have stopped the spread of the infection in the rest of the world, it seemed an unnecessary measure biologically, and an unjust measure socially. As soon as the men were released from quarantine, they were exposed to the disease. In order to have been effective, the quarantine would have had to been imposed for a greater length of time, and until influenza had been eradicated from surrounding areas.
Quarantines were also imposed in other areas. Washington D.C. enacted a law that made it illegal to appear out of doors and out of one's home. The quarantine infringed upon the personal rights of the townspeople to attempt to benefit the greater population. Again, if the outbreak had been small and easily contained, the quarantine may have been necessary and effective, but attempts to stop the greater outbreak and spread of influenza by quarantine were not necessarily useful.
Some towns closed places of public entertainment to stop the spread of the virus from person to person contact. The Pennsylvania Health Commissioner, Dr. B.F. Royer, issued a statewide ban closing theaters, saloons, schools, churches, and public meetinghouses. The move was a smart attempt to control the disease within the small town population. Because the influenza outbreak was highly contagious and easily spread by coughs, it was a good idea to keep the population of the town from congregating in large groups to prevent the spread of the outbreak around the town. Although the rights of the individuals were somewhat infringed upon in order to protect the community, the measure seems to be an appropriate response in order to sustain the disease from spreading too much within one subset of the population. The difference between this ban and the quarantine of an entire group of people is that the bans prevented large groups of people from congregating and spreading the disease within themselves, while the quarantine did not provide for that kind of protection, but attempted to keep one population from spreading the disease to the other groups of people. The ban situation is an infringement of rights, but a smaller infringement to a better end than the quarantine. The ban is therefore more socially just than the quarantine.
As the summer and fall progressed, the frequencies of the influenza outbreaks increased. Problems arose concerning available funds to counteract the spread of infection. Money sources were dwindling on local levels, supplies of medicine were growing scarce, and many health care providers were becoming sick from exposure to the virus. The shortage of money and people seemed to be inversely proportional to the frequency of infection. The Surgeon General declared that the "United States Public Health Servic ha[d] no funds for epidemic control" (53). Congress respomded quickly, granting one million dollars for aid. People in Boston were so desperate for healthcare workers that they petitioned to President Woodrow Wilson for aid. People on numerous levels began to initiate new projects to provide relief and aid. The Red Cross began collecting and supplying emergency funds to stricken areas. In Philadelphia, to combat the shortages, a telephone switchboard service was set up at the department store Strawbridge and Clothier to take in calls from the ill and reference them to the necessary resources. Churches also sprung into action, and crossed religious and social bounds to take in the ill and infirm of any creed to take care of them. The action of the community was a strong and powerful force, and it appears that issues of social injustice were overpassed in order to take care of the greater issue, which was to overcome the epidemic.
Those who remained healthy did not always strive to solely take care of the ill and nurse the community back to health, but sometimes drove wedges into interpersonal relations for personal gain. Prices for medication rose, and some found that $15 burial fees did not include the gravedigging (Hoehling, 118). In these cases, the response of some community members was not at all useful or effective in combating the disease, but instead caused greater problems to those who were in need of medication or burial.
The problems did not necessarily end when the outbreak itself ended. After the official end of the epidemic, it may be imagined that life tried to continue as usual. The places of entertainment that had been previously closed were reopened, but there were a record number of arrests for drunkenness coinciding with the reopening of pubs. In November 1918, the epidemic "ceased to exist officially" (Hoehling, 185), according to the Philadelphia department of Health and Charities. The number of casualties had been large, and had totaled 13,000 in Philadelphia. By 1919, with outbreaks gradually ending, the epidemic ceased to exist in America and around the world.
Works Cited
Hoehling, A.A. The Great Epidemic. (Boston: Little, Brown, and Company, 1961).