Fellow fellow historic-medico aficionados, Kevin here welcoming you from quarantine to the latest installment of , our semi-regular look back at interesting and unusual accounts from the history of medicine. I hope those of you who don't have to be out are staying home and staying safe. To those of you who are essential workers, thank you for your hard work.
COVID-19 is the subject on everyone's mind and it will remain so as the pandemic continues to rage (check out some information on coronavirus from one of the ). Today's edition of CPP Curiosities is no exception.
Medical quackery and fake news are no strangers to our humble series. See, for example, our two recent accounts of fake cancer cures involving and . It comes as no surprise that medical misinformation is running rampant during the COVID pandemic with phony cures ranging from or , and taking an . The topic of today's edition is a meme that has been recently making the rounds on my Facebook feed, one I feel we at The Center for Education of The College of Physicians of Philadelphia are in a privileged position to address. The meme in question shows a picture from Philadelphia's Liberty Loan Parade, held on September 28, 1918. Above the image is the caption:
In 1918, Philadelphia prematurely ended its quarantine from the Spanish Flu to throw a parade in order to boost morale for the war effort. Some 200,000 people lined the streets on that late-September day. Within 72 hours, every bed in Philadelphia's 31 hospitals were filled and the city ended up with 4,500 people dying from the flu or its complications within a matter of days. What is that proverb? "Those who cannot learn from the past are condemned to repeat it..."
Well, fellow historic-medico aficionados, as someone who helped developed for the Mütter Museum's recently-opened (and suddenly very relevant) , this statement is not entirely accurate. The city did not "prematurely end its quarantine to throw a parade." The real story is, unfortunately, even more tragic, and gives us an opportunity to examine similarities between Philadelphia health officials' efforts during 1918 and their modern COVID counterparts.
The first cases of pandemic flu in Philadelphia appeared in early September 1918, likely brought over by infected soldiers from Camp Devers in Boston. Cases spread through the month, from military training grounds like Camp Dix (now ) in New Jersey and Camp Meade to the factories and the Navy Yard to the general population. While flu at the time was only reportable in the city if it led to death, there arose growing concerns among Philadelphia's healthcare workers that the so-called “Spanish Flu” had reached the city.
This happened at the same time as the city was gearing up for a massive military fundraising campaign known as the . The fourth iteration of the loan campaign was to start on September 28, 1918, with massive patriotic parades held across the country to encourage people to help finance the country's involvement in World War I. The Philadelphia area had a quota of $500 million (roughly $8 billion today) and an army of volunteer fundraisers, including Boy Scouts, war widows, wounded soldiers returned from Europe, and a host of others were determined Philadelphia would do their part, deadly pandemic flu or no.
As cases increased through the month, some health experts in the city pushed for the city to postpone the parade. Their cries fell on deaf ears. Philadelphia Mayor Thomas B. Smith held the final say, and canceling the parade, even if he was considering it, was potentially political suicide. Patriotism was highly policed during the war. Under the and the , it was illegal to openly criticize or give the appearance of interfering with the war effort. This extended to the Liberty Loan, and any measures to interfere with the Loan would have appeared as unpatriotic at best and treasonous at worst.
In any case, against the recommendations of health experts in the city who said the large gathering of people would exacerbate the epidemic, the City held the parade anyway, and 200,000 people lined up and down Broad Street in what was at the time the largest public gathering in the city’s history.
The results are what you might expect from . Within a week after the parade most of the city’s hospitals were overrun with sick patients. Throughout the month of October, the city was forced to open ten emergency hospitals and some private citizens opened some of their own to keep up with the ceaseless demands for beds. And then the morgues started to fill up. The city went so far as to commission a steam shovel to dig mass graves. Newspaper reporters described bodies being hauled to the morgue in horse-drawn carts, likening the city’s misfortunes to the London plague in the 1660s. Eventually, the city's Department of Public Health and Charities banned all public gatherings on October 3, 1918, more than a full week after the parade. These included bans on large crowds, and the closures of schools, churches, saloons, and other places people gathered.
Even after the flu ravaged the city, there were still Liberty Loan boosters trying to get the city to prematurely reopen so the city could sell more bonds and make its quota. One Liberty Loan ad from the October 9, 1918, edition of the Philadelphia Inquirer read, “Most of the channels for inducing subscriptions have been closed because of a senseless panic over the so-called influenza.” By that time, there were between 500-800 reported flu deaths per day with the single worst day on October 12, 1918 (approx. 837 dead). Small Liberty Loan events still took place during the ban.
Newspaper reports did their best to downplay the impact of the epidemic. This was partly because press coverage was highly censored during World War I, with restrictions on any press that could potentially hurt morale. An editorial from the October 5, 1918, edition of the Philadelphia Inquirer denounced ban on public gatherings and cautioned Philadelphia readers that the best medicine was to not to think too much about the flu:
“Eradicate from the mind all fear. Do not dwell on the influenza. Do not even discuss it. Instead of building up a mountain of dread, fill the mind with clean thoughts, proper thoughts that are far removed from panic. The man who does this will be enabled to go about his daily tasks with a far better chance for escape than the man who yields to alarm. Anyone can bring upon himself almost any ill by making a god or a devil out of it. Act, sensibly, therefore, in the present emergency. Worry is worse than useless. What is more, it is physically debilitating. Steer clear of it, therefore, and talk of cheerful things—of health, for instance, instead of disease.” “Spanish Influenza and the Fear of It,” Philadelphia Inquirer, October 5, 1918, pg. 12.
The city's health officials struggled to keep up with the cases. Local residents acted as volunteer ambulance drivers, set up an emergency hotline to handle flu cases, and helped dig graves. Medical students from the local med schools were pressed into service as doctors, as many practicing physicians were overseas. The epidemic eventually subsided and the ban on public gatherings was lifted on October 31, 1918. Roughly 14,000 Philadelphians died over a six-week period (much higher than the 4500 mentioned in the meme) and over 17,500 died during the entire pandemic, the largest totals relative to population of any major American city.
The Mütter Museum is currently closed in response to the COVID-19 pandemic. However, when we do reopen and you happen to be in the Philadelphia area, be sure to check out to learn more about the 1918 influenza pandemic and lessons we have (and have not) leaned from what some call "the forgotten pandemic."
Until next time, stay safe, stay well informed, and always treat memes with skepticism.
Also, as always, catch you on the strange side!
Special thanks to Jane E. Boyd, PhD.