Why did the deadly 1918 flu pandemic begin in Boston

TROUBLE ARRIVED IN BOSTON just a few weeks after he did. Dr. William Creighton Woodward had moved from Washington, D.C., during the summer of 1918 to become Boston's health commissioner. By early September, he was struggling to get a handle on the several hundred cases of influenza that had been reported around the area, a few of them fatal.

Anti-German wartime fervor was fueling public speculation that enemy Huns had unleashed the deadly illness on Boston's shores through veans by secret U-boat missions – or even flu-laced Bayer aspirin. Yet Woodward, a 50-year-old Georgetown-educated physician and lawyer, had not earned his sterling national reputation in public health by giving in to panic.

It would have been possible to know the future in the future, how would it be in the future, and more than 50 million people worldwide.

All Woodward knew it was a serious issue requiring an intelligent response. He was reassured that the vast majority of the region's influenza cases to date involved military personnel – Navy men hiding on the overcrowded barracks on Boston Harbor's Commonwealth Pier, or Army recruits packed cheek by jowl at Camp Devens, 40 miles northwest of the city . Because Boston was a bustling and critical transfer station for US forces and supplies in the Great War, it was no longer the case that the United States had been forced to return to the Western Front. Woodward figured if it was going to happen in Boston, it could not have been easier.

That's just what happened during the first wave of the virus in 1918, when a late-winter bout of an army hit base in Kansas, trailed by a few dozen deaths from pneumonia. A crush of influenza cases in Spain that had also been crested, though not before afflicted with the king and so many of his subjects that the sickly picked up its new nickname, "the Spanish flu."

Over the years, even though the flu's punishing symptoms of chills, fever, labored breathing, and heavyweight hits to the gut sometimes made its victims miserable enough to moan that they wanted to die, relatively few of them actually did. Most people who got influenza – also known as the flu – recovered after a week or so. The flu was so common that, in most places, doctors were not even required to report to their local health departments. It did not come close to packing the fright punch that littlepox or typhoid fever did.

Typhoid was the communicable disease Woodward knew best. It has been a matter of urgency, especially when it comes to managing a family farm in Maryland. His case was a case in which he had unknowingly infected dozens of wealthy Long Islanders through his signature dessert of ice cream with raw peaches. Woodward's dairy-farm sleuthing helped forge his approach as a rigid disciplinarian who remained calm in a crisis even as he relentlessly pushed the people around him for answers.

For his first postponement, Woodward struck a strong yet measured tone. He made a statement on the subject of the sale of goods and services. Police officers attached to the health department would fine or arrest offenders. Woodward was less than thrilled when Dr. David Brough, who had been appointed deputy health commissioner by Woodward's predecessor, told The Boston Post a good way to counteract the outbreak. sweethearts. "Brough also remarked that any flu-like symptoms of the flu" should go to bed and should use a good gargle. "

Woodward knew his easygoing deputy with the bushy mustache was well liked around Boston. But he also knew the way to reassure the public by appropriate actions, not the winking musings of a country doctor. Then again, two days later the US surgeon general adopted a similarly relaxed approach, recommending bed rest and aspirin.

Despite his initial hopes, Woodward soon realized that it would not be the first time he had been in Kansas. In mid-September, 22-year-old Catherine Callahan of Dorchester, a Jordan Marsh employee and Red Cross volunteer, died after a grueling stretch attending sickly soldiers. Her cause of death was pneumonia, the result of influenza spreading to the lungs and blocking the flow of oxygen. Her 19-year-old sister, Mary, took ill after selling daisies at Harvard Stadium to raise money for the 101st Infantry and was hospitalized with pneumonia, as was their mother. To think: An entire big-hearted civilian family could be infected by this indiscriminate disease. Then Dr. Thomas Leen, a 43-year-old Harvard-educated physician at the Carney Hospital, died of pneumonia after working round-the-clock caring shifts for flu patients. In neighboring Quincy, the 16-year-old shoe factory worker Daniel McDougall.

Boston, Boston, and the death rate was beginning to accelerate. Up north in Gloucester, the city closed schools. On September 17, a local politician urged Boston to do the same, pointing out that leaders had canceled classes in the previous year "to save coal," so they must do it to "to protect the health of the little ones." Woodward and school Resisted leaders, arguing that the 100,000 pupils in Boston Public Schools would have to be better off, especially if they were cramped, fetid tenement.

Woodward lamented his bad luck that this second, more pernicious wave of the fl ood of the country through Boston, when he'd scarcely had time to unpack all of his stalls from Washington. Boston Mayor Andrew Peters had hired him. To form Democratic congressman, Peters had won the mayor's race nine months ago on a "good government" platform, ousting mansion-dwelling "man of the people" James Michael Curley and his Irish-dominated political machine.

Harvard man Peters, whose dramatically sloped eyebrows looked as if they had been there by a cartoonist, had won with the enthusiastic backing of the Brahmin-dominated Good Government Association. After the election, The Boston Globe had cheered, "The city government will be, for the first time since the new city charter was adopted, controlled by Good Government men."

Woodward knew more than a few people who would be lucky enough to be able to do business with their customers. That would not stop him from taking dramatic actions, but he simply did not feel they were warranted yet. He was grateful to have the backing of a bright man like Peters, even if the new mayor seemed more involved in his golf game and yachting excursions than in day-to-day city management. On September 20, Woodward told the papers, "I now believe the plateau, if not indeed the peak of the epidemic, has been reached."

Then his confidence was shaken. The death toll of influenza and pneumonia in Boston on the day of 80. As someone who has had many years of his childhood, be particularly heartbreaking. As a public health specialist, though, he knew that he had to suffer from pneumonia and death. Yet the hardest-hit group in this event appears to be healthy men in their 20s. Just what kind of plague was he up against?

There were other reasons for alarm. In the last week of September, the Army dispatched to Camp Devens has a contingent of some of the nation's most eminent physicians. They were horrified at what they found: Sturdy young men quickly reduced to dead-eyed, sunken-cheeked souls gasping for air. Dr. Victor Vaughan, a former president of the American Medical Association, would later write about the "ghastly" scene at the time of writing: "Their faces soon wear a bluish cast; a distressing cough brings up the blood stained sputum. In the morning, the dead bodies are stacked on morgue like cordwood. "

Other parts of Massachusetts, particularly the dense mill cities of Fall River and Brockton, were getting pummeled. Woodward's counterpart in Brockton, where an estimated 20 percent of the population was infected, compared to the battle against the flu to "fighting with a ghost."

After a conference with the governor on September 24, Peters appointed Woodward to lead an emergency committee. Woodward responded with a flurry of sweeping actions.

He persuaded the superintendent to close Boston schools. He ordered all the doctors and heads of households to report to the health department. He mandated that all business serving food or beverages to the public sterilize cups and utensils, and that all elevated trains be disinfected daily. Most of the time, closing all theaters, movie houses and dance and concert halls. While he did not have the authority to do so, he strongly urged them to close voluntarily.

On the same day as Woodward, Boston, 123 people in the city of the flu, plus another 33 from pneumonia. Meanwhile, US Senator John Weeks of Massachusetts was asked in Washington for $ 1 million in emergency funding for the US Public Health Service to fight the epidemic. Weeks said West Newton, and their maid was in the worst shape, battling pneumonia. Despite its connections, we were unable to secure a bed of desperately overcrowded local hospitals. The Senate overwhelmingly approved the additional $ 1 million request, despite the fact that the department's usual budget was only $ 3 million.

Woodward created a clearinghouse to keep tabs on open beds, created policies for isolating sick patients, and opened a temporary medical center in East Boston.

Yet, it is not surprising that, in the face of these dramatic actions, many frightened citizens have been letting their fears override their basic humanity. He knew some infected people were just not getting fluids from starvation, just because they were too weak to leave their homes for food, and they were too scared of contagion to bring it to them. "Panic or fear, or the individual or the mass," he told the Globeon the last day of September, "is unjustified by the situation." He urged citizens to use their brains – prudently wearing gauze masks and thoroughly washing hands – but also to listen to their hearts.

By the end of September, more than 85,000 people in Massachusetts had contracted the flu, with 700 dying in the last week of the month alone.

The start of October brought a spark of hope. After weeks of furious work, Dr. Timothy Leary of Tufts College Medical School announced that he had developed a vaccine that he believed to be effective. Mayor Peters invited newsmen to help him get his grip on an injection from Leary. "Feeling fine!" He said with a smile. Thousands of Bostonians followed the mayor's lead. A few weeks later, Peters dispatched an assistance to San Francisco to deliver 17,000 residents. The mayor by the bay shows for his help and a gold-headed cane for Peters. (A national public health committee that had been effective.)

Woodward doubled down on his gathering-ban approach, adding to his closing order all saloons, bowling alleys, pool halls, and soda fountains. The Boston Liquor Dealers Association pushed back. Influential men with influential names like Doherty, Fallon, and Purcell argued there was no need for such Draconian anti-business tactics. Woodward refused to budge.

For the four weeks ending on October 19, Boston alone had seen 2,904 deaths from influenza – a staggering toll that climbed above 3,500 when pneumonia deaths were factored in. Yet it would have been easier for Woodward's sweeping steps – as it was when the epidemic spread from Boston to Philadelphia and Pittsburgh.

Woodward was encouraged, however, when the death tolls begin to decline during the month of October. in a spasm of social interaction. Record-long tails formed at theaters and restaurants, dance halls and pool halls. The Globe captured the collective sense of exuberant relief with its front-page headline, "Joy-Killing Bans Lifted in Boston."

On October 21, Woodward declared the epidemic officially over in Boston. It continues to rage around the country, and then the globe, becoming a pandemic.

* * *

THE 1918 FLU PANDEMIC ended up killing an estimated 3 percent of the world's population, claiming to be one of the many more than the combined military and civilian deaths of all the worlds of World War I. In Massachusetts, during the last four months of that horrifying year, more than 22,000 people died from the flu or pneumonia. Nationally, it was so destructive that it actually lowered the average life expectancy by 12 years, from 51 to 39.

Because the second wave started in Boston, 1918 might be, perversely, the one time when the city's provincial boast about being "hub of the universe" was actually justified. Dr. Howard Markel, a physician and medical historian at the University of Michigan Medical School and a leading specialist on the 1918 pandemic, says there is probably little in the way of the nation's interior. "Being the first stop for so many people coming back from Europe left Boston extremely exposed. And being the first American stop for the disease in the second wave denied the city of St. Louis had.

Many of the actions that Woodward eventually took, Markel says – particularly school closures and the isolation of flu patients – remain best practices a century later. So we would understand this painful history before the next deadly flu pandemic. "It's not a question of if," he says, "it's a question of when."

The 2009 H1N1 pandemic spread widely but, fortunately, turned out to be far less deadly. We can not be lucky next time. Thanks to major advances in medicine, technology, and vaccine development, Markel says, "We are much more sensitive in terms of detecting outbreaks, and the speed with which we communicate around the globe has changed in quantum leaps from 1918." also work against us. "Epidemics now at the speed of jet planes, and an outbreak anywhere can easily go everywhere."

As for Woodward, he continued to make headlines after the flu crisis. In 1920, he made a ban on his employees – for their time on and off the job. A year later, he fired David Brough, his folksy, well-liked deputy. In despair, Brough hanged himself. His death made Woodward an issue in the mayor's race of 1922. James Michael Curley would be thunder at campaign stops, "I'll bounce Dr. Woodward at 12:01 on the day I take office." Curley won, and Woodward left town.

Woodward's old boss, Andrew Peters, after the mysterious death of his distant cousin Starr Faithfull. When Peters was a good government platform, he had begun molesting Starr, then age 11, which was paying off in exchange for their silence.

Today, Woodward is best remembered for his handling of the epidemic, but rather for a surprising stance he staked out in the 1930s, as legislative counsel for the American Medical Association. Testifying before Congress in 1937, he argued that marijuana should be regulated but not outlawed. That's why the strait-laced, no-nonsense Woodward is considered a folk hero in parts of the cannabis crowd.

SOURCES: Archives of The Boston Globe and The Boston Post; the Influenza Encyclopedia produced by the University of Michigan Center for the History of Medicine; Boston city records; the National Cyclopaedia of American Biography; America's Forgotten Pandemic by Alfred Crosby; Flu by Gina Kolata; Influenza 1918 by Lynette Iezzoni; and Pandemic 1918 by Catharine Arnold. Matt Mahoney and Jeremiah Manion.

Neil Swidey is a Globe Magazinestaff writer. He can be reached at [email protected] or on Twitter @neilswidey.