Making Masks During The 1918 Flu Pandemic

I’m still here! I’ve just been extremely busy.

A few months ago, when I had to sew face masks for my family, I made several bad prototypes before finally finding a helpful JoAnn’s Fabrics video tutorial. I rummaged through my fabric scraps, searching for the recommended 100% cotton fabrics. And because I have an embarrassing amount of unfinished sewing projects tucked away, I already possessed soft ¼ inch elastic, so I didn’t have to sew cloth strings.    

I had previously posted an article about the flu pandemic of the late 1910s. Today, I searched more specifically on “influenza” and “masks” in that timeframe. If you’ve struggled with sewing a mask, I hope you appreciate these small finds.

“Red Cross workers of Boston, Massachusetts, removing bundles of masks for American Soldiers from table where other women are busily engaged in making them.” National Archives Identifier: 45499363

From “Comments On Influenza” in Virginia Medical Monthly, 1918.

The Face Mask: With terrible emphasis the public, as well as the profession, has had its attention drawn during this epidemic to the rise of the mask for the protection of people diseases. The surgeons while operating have used the mask during recent years to prevent disease germs from entering wounds of the patients from the mouth and nose of the surgeons. During this terrible epidemic, the proper use of a properly made mask undoubtedly protected many people from “taking” the “Spanish Flu.”

The use of the mask should become more general. At certain periods of the year, when epidemic diseases entering the body through respiratory route appear, it should be used especially by children in schools, on cars, or in moving picture theatres, etc. Of course, the mask should be properly made should be worn on same side, and should be sterilized before being again used. Measles, whooping-cough, meningitis, infantile paralysis, scarlet fever, influenza, pneumonia and tuberculosis–maybe, at least in part, held in check through this precaution. Remembering that the micro-organisms which make possible these diseases implanted and propagated in bodies of the people and disseminated therefrom to infect the respiratory passage of other bodies, every means that tends to obstruct and prevent this transplantation should be used thoroughly.

In an interesting article (Jour A. M. A.  October 12th, 1918 page 1216), Doust and Lyon reported experiments with face masks and reached the following conclusions:

1 During ordinary or loud speech, infected material from the mouth is rarely projected to a distance of four feet, and usually less. A four-foot danger zone exists about the patient under these conditions.

2 During coughing, infected material from the mouth may be projected at least ten feet. The danger zone about a coughing patient has then, a minimum radius of ten feet.

3 Masks of coarse or medium gauze of from two to ten layers do not prevent the projection of infected material from the mouth during coughing. Such masks are worthless, therefore, in preventing the dissemination of respiratory infections.

4 A three layer buttercloth mask is efficient in preventing the projection of infectious material from the mouth during speaking or coughing. It is a suitable mask, therefore, be worn in connection with respiratory disease.

Then buttercloth, six by eight inches, hemmed on the edges (with four tapes), makes the best cloth mask.

from Influenza, a Study of Measures Adopted for the Control of the Epidemic, by Wilfred H. Kellogg. Issue 31 of Special Bulletin, California State Board of Health. 1919.

From “Home Treatment of Influenza” in Good Health, 1919.

While it is hoped that there will not be a repetition of the influenza epidemic which occurred last year, yet we should be very foolish to be caught as unprepared before. Even though the majority our nurses have returned from the war, there is still a great shortage in the country, and it is highly important that every woman should prepare herself to do the things in case the disease should again invade her home or neighborhood.

That much can be done by the woman who has only a short course in nursing, is illustrated by what a group young women did last winter when influenza came to Battle Creek. There was, of course, a very great shortage nurses and the calls coming to the outpatient department of the Battle Creek Sanitarium were so numerous and urgent that those in charge of the work were all distracted because of their inability to supply the demand for assistance. The young women of the Battle Creek Sanitarium School of Home Economics were therefore invited to co-operate with the Dispensary by going into the various homes of the sick and rendering such assistance.

The first point of instruction was that of prevention. Each girl was supplied with a face mask and instructed to wear it every moment that she was in the house where the influenza prevailed. The mask consisted of three thicknesses of heavy cheesecloth, commonly known as buttercloth, the mask being large enough to cover both the nose and the mouth. This was six by eight inches in size and was fastened by strings coming from the four corners. In order to make the mask a little more comfortable, three or four small tucks were placed at each end thus a little fullness over the nose.

They were instructed always to disinfect their hands and face with a solution of bichloride of mercury, tablets of which can be obtained at any drugstore, or a weak solution of carbolic acid. In removing the mask they were to fold it with the side worn next to the face on the inside of the fold, and to lay it on a clean surface, made so by washing with a disinfectant–the mask to be replaced before again entering the room of the patient–care being taken to put the same side toward the face as had previously been worn or, a better plan still, to put a clean disinfected mask on each time. It is believed that the careful wearing of the mask was responsible for so few cases of influenza resulting among the students. Only three out of about seventy-five who were assisting in homes where the influenza prevailed, contracted the disease. One of them admitted that she had been careless in the wearing of her mask.

“Taking food to the family all down with the “Flu” at Charlotte, North Carolina. They found the mother had just died.” National Archives Identifier:  533586

Baking Victorian Bread

Years ago, when I was a Mark Bittman devotee, the no-knead bread craze hit. I hadn’t made bread before because I was scared of the process, which seemed like a sacred art of sorts. When Mark Bittman published his version of the no-knead recipe in the New York Times, I had found a bread recipe that even I could do. I had started my gluten-free-ish lifestyle by that time, but I still loved making bread for the sensory aspects: the smell, texture, how the bread transformed over the cooking process, and the joy that warm bread gave others.

However, my growing children demanded my time, and it was easier to buy bread at the grocery store bakery than to bake our own. That is until the pandemic hit and store shelves were stripped bare. Now, stuck at home, I, like many Americans, have been baking. I’ve found an updated version of my beloved no-knead recipe that makes wonderful bread. My children are amazed that I can actually bake. However, my teens are amazed whenever I show any kind of aptitude. This morning, as my latest baking project rose on the counter, I researched Victorian bread making. I’ve decided to excerpt from two books that are from the earlier decades of the Victorian Era because they explain how to make yeast.  

Let’s start with The Good Housekeeper, Or the Way to Live Well, And To Be Well While We Live, published in 1839 and written by Sarah Josepha Buell Hale, supposed author of “Mary Had A Little Lamb” and a long-time editor for Godey’s Lady’s Book.

ADVANTAGES OF BREAD MAKING. If you wish to economize in family expenses, bake your own bread. If this is good, it will be better as well as healthier than baker’s bread.

The rich will find several advantages in having a portion, at least, of their bread baked at home, even though the saving of money should not be an object. They can be certain that their bread is made of good flour. This is not always sure when eating baker’s bread. Much damaged flour, sour, musty, or grown, is often used by the public bakers, particularly in scarce or bad seasons. The skill of the baker and the use of certain ingredients-(alum, ammonia, sulphate of zinc, and even sulphate of copper, it is said, has been used !)—will make this flour into light, white bread. But it is nearly tasteless, and cannot be as healthy or nutritious as bread made from the flour of good, sound wheat, baked at home, without any mixture of drugs and correctives. Even the best of baker’s bread is comparatively tasteless, and must be eaten when new to be relished. But good home-baked bread will keep a week, and is better on that account for the health.

If the sponge be set at seven or half past, in the morning, and everything well managed, the bread will be ready to be drawn from the oven by twelve. Four or five hours of attention, then, is required ; but three fourths of this time might be employed in needlework, or other pursuits. Only half or three quarters of an hour, devoted to kneading the bread, is wanted in active exertion ; and this would be one of the most beneficial exercises our young ladies could practise.

I have dwelt at length on this subject, because I consider it as important as did “Uncle John,” that “ Girls should learn to make bread—the staff of life”–and that to do this well is an accomplishment which the lovely and talented should consider indispensable, one of the “ must haves” of female education.

There are three things which must be exactly right, in order to have good bread—the quality of the yeast; the lightness or fermentation of the dough ; and the heat of the oven. No precise rules can be given to ascertain these points. It requires observation, reflection, and a quick, nice judgment to decide when all are right. Thus, you see, that bread-making is not a mere mechanical treadmill operation, like many household concerns ; but a work of mind ; the woman who always has good home-baked bread on the table shows herself to have good sense and good management.

MAKING BREAD, A large family will, probably, use a bushel of flour weekly; but we will take the proper quantity for a family of four or five persons.

Take twentyone quarts of flour, put it into a kneading trough or earthen pan which is well glazed, and large enough to hold double the quantity of four. Make a deep, round hole in the centre of the flour, and pour into it half a pint of brewer’s yeast, or the thick sediment from homebrewed beer—the last if good, is to be preferred. In either case the yeast must be mixed with a pint of milk-warm water, and well stirred before it is poured in. Then with a spoon stir into this liquid, gradually, so much of the surrounding four as will make it like thin batter; sprinkle this over with dry flour, till it is covered entirely. Then cover the trough or pan with a warm cloth, and set it by the fire in winter, and where the sun is shining in summer. This process is called ” setting the sponge.” The object is to give strength and character to the ferment by communicating the quality of leaven to a small portion of the flour ; which will then be easily extended to the whole. Setting sponge is a measure of wise precaution-for if the yeast does not rise and ferment in the middle of the flour it shows that the yeast is not good ; the batter can then be removed, without wasting much of the flour, and another sponge set with better yeast.

Let the sponge stand till the batter has swelled and risen so as to form cracks in the covering of flour ; then scatter over it two table spoonfuls of fine salt, and begin to form the mass into dough by pouring in, by degrees, as much warm water as is necessary to mix with the flour. Twentyone quarts of flour will require about four quarts of water. It will be well to prepare rather more ; soft water is much the best ; it should in summer be warm as new milk ; during winter, it ought to be somewhat warmer, as flour is a cold, heavy substance.

Add the water by degrees to the flour, mix them with your hand, till the whole mass is incorporated; it must then be worked most thoroughly, moulded over and over and kneaded with your clenched hands, till it becomes so perfectly smooth and light as well as stiff, that not a particle will adhere to your hands. Remember that you cannot have good bread, light and white, unless you give the dough a thorough kneading.

Then make the dough into a lump in the middle of the trough or pan, and dust it over with flour to prevent its adhering to the vessel. Cover it with a warm cloth, and in the winter the vessel should be placed near the fire. It now undergoes a further fermentation, which is shown by its swelling and rising ; this, if the ferment was well formed, will be at its height in an hour-somewhat less in very warm weather. It ought to be taken at its height, before it begins to fall.

Divide the dough into seven equal portions ; mould on your paste-board, and form them into loaves ; put these on well floured tin or earthen plates, and place immediately in the oven.

The oven, if a good one and you have good dry wood, will heat sufficiently in an hour. It is best to kindle the fire in it with dry pine, hemlock furze or some quick burning material; then fill it up with faggots or hard wood split fine and dried, sufficient to heat it-let the wood burn down and stir the coals evenly over the bottom of the oven, let them lie till they are like embers; the bricks at the arch and sides will be clear from any color of smoke when the oven is sufficiently hot. Clean and sweep the oven, throw in a little flour on the bottom, if it burns black at once, do not put in the bread, but let it stand a few moments and cool.

It is a good rule to put the fire in the oven when the dough is made up—the batter will rise and the former heat in about the same time.

When the loaves are in the oven, it must be closed and kept tight, except you open it for a moment to see how the bread appears. If the oven is properly heated, loaves of the size named, will be done in an hour and a half or two hours. They will weigh four pounds per loaf, or about that—thus giving you twentyeight pounds of bread from twentyone quarts (or pounds) of flour. The weight gained is from the water.

It is the best economy to calculate (or ascertain by experiment) the number of loaves of a certain weight or size, necessary for a week’s consumption in your family, and bake accordingly. In the winter season bread may be kept good for a fortnight; still I think it the best rule to bake once every week. Bread should not be eaten at all till it has been baked, at least, one day. When the loaves are done, take them from the oven, and place them on a clean shelf, in a clean, cool pantry. If the crust happen to be scorched, or the bread is too much baked, the loaves, when they are taken out of the oven, may be wrapped in a clean, coarse towel, which has been slightly damped. It is well to keep a light cloth thrown over all the loaves. When a loaf has been cut, it should be kept in a tight box from the air, if you wish to prevent its drying.

YEAST. It is impossible to have good light bread, unless you have lively sweet yeast. When common family beer is well brewed and kept in a clean cask, the settlings are the best of yeast. If you do not keep beer, then make common yeast by the following method.

Take two quarts of water, one handful of hops, two of wheat bran; boil these together twenty minutes ; strain off the water, and while it is boiling hot stir in either wheat or rye flour, till it becomes a thick batter; let it stand till it is about blood warm ; then add a half pint of good smart yeast and a large spoonful of molasses, if you have it, and stir the whole well. Set it in a cool place in summer and a warm one in winter. When it becomes perfectly light, it is fit for use. If not needed immediately, it should, when it becomes cold, be put in a clean jug or bottle ; do not fill the vessel and the cork must be left loose till the next morning, when the yeast will have done working. Then cork it tightly, and set in a cool place in the cellar. It will keep ten or twelve days.

MILK YEAST. One pint of new milk ; one tea-spoonful of fine salt, and a large spoon of flour-stir these well together; set the mixture by the fire, and keep it just lukewarm; it will be fit for use in an hour. Twice the quantity of common yeast is necessary ; it will not keep long. Bread made of this yeast dries very soon; but in the summer it is some. times convenient to make this kind when yeast is needed suddenly

Never keep yeast in a tin vessel. If you find the old yeast sour, and have not time to prepare new, put in salæratus, a tea-spoonful to a pint of yeast, when ready to use it. If it foams up lively, it will raise the bread, if it does not, never use it.

HARD YEAST. Boil three ounces of hops in six quarts of water, till only two quarts remain. Strain it, and stir in while it is boiling hot, wheat or rye meal till it is thick as batter. When it is about milk warm add half a pint of good yeast, and let it stand till it is very light, which will probably be about three hours. Then work in sifted [corn] meal till it is stiff dough. Roll out on a board; cut it in oblong cakes about three inches by two. They should be about half an inch thick. Lay these cakes on a smooth board, over which a little flour has been dusted; prick them with a fork, and set the board in a dry clean chamber or store-room, where the sun and air may be freely admitted. Turn them every day. They will dry in a fortnight unless the weather is damp. When the cakes are fully dry, put them into a coarse cotton bag ; hang it up in a cool dry place. If rightly prepared these cakes will keep a year, and save the trouble of making new yeast every week.

Two cakes will make yeast sufficient for a peck of flour. Break them into a pint of lukewarm water and stir in a large spoonful of flour, the evening before you bake. Set the mixture where it can be kept moderately warm. In the morning it will be fit for use.

Let’s cross the ocean to England and look at yeast made from potatoes, as well as, a time-table for baking rolls. This excerpt comes from  The Young Cook’s Assistant, and Housekeeper’s Guide, published in 1841.

To make Yeast or Barm.

Boil three pounds of potatoes, in as much water as will cover them, to a mash, and pass them with the water through a sieve (take care in paring the potatoes that all the eyes are picked out); then add more water, till it is about the thickness of common yeast. Put in six ounces of lump sugar, and when nearly cold, add four table spoonfuls of good yeast: stir it in at the time, but not after. Let it stand twelve hours in a rather warm place-any part of a room where there is a fire will do. Then put it in a cold situation, and in twelve hours it will be fit for use. Put it in a jar, and tie a paper over: it will keep a week or ten days.

Another.

When good potatoes are not to be had, use a flour paste made about as thick as gruel. Add to every pint of it, when nearly cold, one ounce of sugar and a spoonful of yeast. Work it as the potato yeast, and keep it in a jar. As this is seldom made except in hot weather, it will not keep more than three or four days. It must stand in a cold place, but not in ice, for that destroys the strength of the yeast.

Rolls for Breakfast. The last thing over-night take three pounds of fine flour, rather more than half-a-pint of potato yeast, or of the paste-yeast, a little salt, and two eggs: then warm a little milk (which in hot weather should boil and get cold again), and make a light dough of it; set it on the kitchen table all night, covered with a cloth. The next morning turn it on the dresser, mould it over, and make it up in whatever shape you want it. Twists are made by taking a bit of butter on the dresser instead of flour, and rolling out a long thin length of the dough: then cut it in lengths and turn it in whatever shape you fancy, or may have seen. Place them on the baking-sheet and set it by the fire half-an-hour, to rise, while the oven is heating. For French rolls, put a piece of dough in each shape, set them to rise, and place them in the oven ten minutes before the others, as they must be rasped. The very small fancy twists, &c., should be brushed over the top with an egg, beaten with a little milk, before you set them to rise. Bake these in a slow oven, as they should be coloured but very little.

Buns. Take a piece of the dough made for the rolls; dissolve a bit of butter in a very little warm milk, beat it together, and mix with the dough. Add a little sifted lump sugar, one egg, a little allspice, carraway seeds, and currants—any or all of them, as approved. It must then have an hour to rise; after which, take a little flour on the dresser, and make the buns in whatever shape you please. Place them on the bakingsheet, and set them by the fire to rise. Brush them over with the eggs and milk as prepared for the small rolls, or sift a little white sugar on the top; for which purpose whisk the white of an egg, brush it over, and then sift the sugar upon it. These must have rather a slow oven, and will take a little longer baking than rolls of the same size.

Household Bread. The potato yeast is best for this purpose; and moist sugar will do if lump is a consideration. For a bushel of flour use the quantity of yeast that two pounds of potatoes make, with a handful of salt, and lukewarm water. First make a hole in the middle of the flour, put in the yeast and salt, and three quarts of water, and stir it up to a stiff batter: this is what is called the sponge. Shut it up two hours, and then make it into dough with warm water, but not very stiff.

Cover it up again another hour, or an hour and a half, and in the meantime heat the oven; then take out the dough on the moulding-board before the oven, and mould it in pieces the size of half a loaf: give it a good moulding, and leave it on the board before the fire, at least half-an-hour; it will then only require making into loaves, when the oven is ready. If you make eight loaves of a bushel of flour, they will take three hours and a half baking. Take care the oven is hot, and while it is heating frequently scrape one side and turn the fire over to it, and then scrape the other side. You need not shut the door at first, if too warm.

French Cottage Bread. French bricks are made of the same dough as rolls, or they may be made of a piece of the bread dough. Mould it well, and put it into a tin shape-it should be only half full-set it by the fire, and it will rise to the top. Do not shake it in putting it into the oven. Bake according to the size of the tin used: all kinds of bread ought to be well baked.

Victorian Perfumes

I’m glad I found this little article “Perfumes and Perfumery” in an 1888 issue of Good Housekeeping. I’ll feel more confident describing my Victorian characters as smelling of lavender, clove, jasmine, or patchouli.

ATCHOULY is an East Indian perfume and was of rare popularity when first brought into prominence as a handkerchief extract by the élite. Of a peculiar heavy smell in its full strength, when diluted as an extract it resembles very much a mixture of camphor and snakeroot (wild ginger). Patchouly is one of the most powerful odors amongst oils, and can be made with other perfumes into exquisite and most harmonious extracts, being possessed of rare qualifications in this respect; or being injudiciously handled may create a very discordant smell.

An extract for the handkerchief is made thus:

Extract Patchouly.

Oil patchouly, one-half dram; cologne spirit, eight ounces. Mix. If desired sweeter, add otto rose, ten drops, oil sandalwood, five drops.

La Toilette
Louise Catherine Breslau

Vetivert is another East Indian perfume, peculiar in its character and not much liked. It assimilates with sandal wood and patchouly, more particularly the latter. Has given a character to many fashionable perfumes.

Civet, an animal perfume of some prominence, is a secretion from the civet cat, a native of the East, whence it was first brought by the Dutch. Civet has a most unpleasant smell in its crude state, and would be thought a very unlikely substance for use in perfumery by most persons. Properly diluted it enters into some of the most flowery bouquets known, is largely employed by the French in their finest extracts, and we think quite a favorite with Americans also, judging from the sense of smell when entering their factories. Its place in perfumes is to “hold” other and more volatile odors, and sometimes to act as a “backer” to some flower perfumes with which it chords.

Ambergris is likewise a well-known animal perfume. Pieces of it have been found upon the seashore from the earliest times.

Tonquin, or Tonka, is a very agreeable and somewhat in tense odor derived from the Tonka bean of commerce–the snuff bean of our grandmother’s days, when one was usually kept in the snuff-box to impart a pleasant odor to its contents.

When fresh they are very fragrant and give out a smell resembling the new made hay of localities where the “sweet smelling vernal grass” is common, as both possess the same odoriferous principle, “coumarin,” which may be seen in the form of crystals upon the beans, and which, according to a German chemist, is found in not less than thirty-one species in two families of plants. Tonquin enters into the composition of a variety of bouquets, being somewhat of a favorite with many perfumers. It is the leader in the perfume we now give, called New-Mown Hay.

Extract Tonquin bean (double), two and one-half ounces; extract rose geranium, one ounce; extract orange flower pomade, one ounce; extract rose pomade, one ounce; extract jasmine pomade, one ounce; extract cassie pomade, one-half ounce; extract rose triple, one ounce. Mix.

Fanny Eaton

Clove is the only one of the spice oils which enters into liquid perfumes worthy of our present notice. It gives to many bouquets a zest not otherwise obtainable, plainly shows its presence in the pink family, and performs a part in Rondeletia of which “more anon.”

Lavender is an old favorite English perfume in which country it finds its best conditions of growth.

There are some four to eight grades of lavender oil in the market, the Mitcham and Hitchin, English, commanding the highest price.

Vanity
Gustave Léonard de Jonghe

Lavender enters into the composition of colognes, some bouquets, also into Lavender Water.

Oil of lavender (English or French), two drams; cologne spirit, seven ounces; water, free from obvious impurity, one ounce. Mix.

The following recipe is based upon the principle well known to the art of two odors blending together in such harmony as to produce, as it were, a new perfume. It is copied from an old work on perfumery, there having been no essential variation since the writer first had the pleasure of making his debut by attempting this extract over thirty years ago:

Rondeletia.

Oil lavender, two drams; oil bergamot, oil clove, each, one dram; otto rose, twenty-five drops; extract musk, extract vanilla, extract ambergris, each, one-half ounce; cologne spirit, twenty ounces. Mix. Let stand to age.

Pot pourri
Herbert James Draper 

The Contents Of A Victorian Lady’s Traveling Bags

Lately, I’ve been studying Victorian train travel. I assure you that deciphering Victorian train schedules is no easy task. If I were a Victorian traveler, I would never arrive anywhere on time for having taken numerous wrong trains.

I’ve excerpted from the 1876 American etiquette book The Ladies’ Book of Etiquette, and Manual of Politeness by Florence Hartley, regarding the practical items a woman should pack in her traveling bags.  

here is no situation in which a lady is more exposed than when she travels, and there is no position where a dignified, lady-like deportment is more indispensable and more certain to command respect.

Have a strong pocket made in your upper petticoat, and in that carry your money, only reserving in your dress pocket a small sum for incidental expenses. In your traveling satchel carry an oil skin bag, containing your sponge, tooth and nail brushes, and some soap; have also a calico bag, with hairbrush and comb, some pins, hairpins, a small mirror, and some towels. In this satchel carry also some crackers, or sandwiches, if you will be long enough upon the road to need a luncheon.

First Class: The Meeting…and at First Meeting Loved
Abraham Solomon

In your carpet bag, carry a large shawl, and if you will travel by night, or stop where it will be inconvenient to open your trunks, carry your night clothes, and what clean linen you may require, in the carpet bag. It is best to have your name and address engraved upon the plate of your carpet bag, and to sew a white card, with your name and the address to which you are traveling, in clear, plain letters upon it. If you carry a novel or any other reading, it is best to carry the book in your satchel, and not open the carpet bag until you are ready for the night. If you are to pass the night in the cars, carry a warm woolen or silk hood, that you may take off your bonnet at night. No one can sleep comfortably in a bonnet. Carry also, in this case, a large shawl to wrap round your feet.

There is scarcely any situation in which a lady can be placed, more admirably adapted to test her good breeding, than in the sleeping cabin of a steam-boat. If you are so unfortunate as to suffer from sea-sickness, your chances for usefulness are limited, and patient suffering your only resource. In this case, never leave home without a straw-covered bottle of brandy, and another of camphor, in your carpet-bag. 

American carpetbag – circa 1865
wool, leather, metal
Metropolitan Museum of Art   
The Irritating Gentleman
Berthold Woltze
Don’t you feel so sorry for this girl?

Pandemic in a Time of War

Today I’ve excerpted from the 1919 article “War’s Deadlier Rival, the Flu,” by Samuel Hopkins Adams. The article oddly begins on page 16 of Collier’s Weekly and is the fourth headline down on the cover. Please, please, please do not take the numbers or the science in this article as facts. The epidemic lasted until 1920, and there has been much subsequent scientific research into its origins and overall global devastation. I merely want to offer you a contemporary account of the epidemic, as well as some images.

Current with the world war, and culminating in a mortality far above it, runs another agency of death. The pandemic of influenza has been less sensational than the flaming scourge of war; but it has been vastly more destructive. Now that its second seasonal onset has passed in this country and presumably the great majority of those liable to it have been infected, it is possible to reckon up roughly the account for the United States.

National Archives

Conservatively speaking, for every American killed by the Germans, ten were killed by the flu. The total of those dying in battle or afterward from wounds is under fifty thousand. Nearly five hundred thousand had died of the epidemic up to the 1st of January. (The Metropolitan Life Insurance Company, which has compiled the only detailed figures on a large scale, reckons, on the basis of its records, that the total influenza deaths for the nation up to January 1, 1919, were upward of 470,000.) Fifty thousand more is a very moderate estimate for this spring’s recurrence; twice that number is probably nearer the truth. Even reckoning the total human cost of the war, those dead from sickness and accident as well as from wounds, influenza’s mortality record is as six to one, compared to war’s.

Compared with other epidemics in America, the present visitation stands forth in still more startling relief. Though figures for the great grippe epidemic of 1889-90 (practically the same disease as the flu) are unreliable and fragmentary, it may be safely stated to have been less than half as deadly as the present onset. But parallel this flu with a pestilence of a more sensational character, the famous “yellow jack” of 1878 which centered in New Orleans and swept through the South spreading terror and paralyzing commerce. More people succumbed in a single week of flu in Philadelphia than died in the whole course of the 1878 pest in New Orleans; and the flu deaths of one week in New York and Philadelphia together exceeded the total yellow fever mortality of the entire nation in the “plague year.”

LOC – U.S. General Hospital #16, New Haven, Connecticut

After the pandemic of thirty years ago, influenza, while it still existed here as it did the world over, sank to a low level and stayed there until 1914. In that year the deaths from influenza rise to two typical, seasonal “peaks,” one in the early winter, another in the spring. In 1915 these “peaks” are somewhat more marked. The following year shows a still higher rise, and in 1917 there appears so decided an increase that the absence of expert medical commentary upon it is surprising. The spring of 1918 brought with it a definite epidemic in our camps. It was of a mild type and, at the time, unrecognized. So far as is now known there was no epidemic elsewhere in the world.

What happened then?

A curious but perfectly logical process. The germ which had been gathering power quite slowly in a robust and well-fed population—witness the very gradual rise of the mortality figures—was transferred to a soil far more suitable to its development, the war-harried, undernourished, abnormal peoples of Europe. It gathered momentum and virulence together.

France, where it was first introduced, did not suffer very severely in the early stages; nor did Spain, whither it was immediately transmitted, manifesting itself in May, 1918, very widely, though in mild form, and withholding its real power until the following September when it ravaged the whole kingdom. Probably through the taking of prisoners the infection crossed the French border into Germany, and here found, in the ill-fed civilian population, the ideal condition for its increase. By July its ravages were so destructive that the German medical authorities, despite the demands exercised by the war upon the medical fraternity, were holding “influenza congresses” to devise means of defense, military plans having been seriously deranged by the epidemic. By August the flu had reached its serious stage in France and all Europe became swiftly and formidably involved. There followed the return to America.

The influenza germ … , a comparatively unimportant agent of disease and death, impotent, up to that time, to raise our mortality rates to a point where any notice was attracted, came back surcharged with deadly power. It had acquired a malignity unequaled in the former history of the disease.

Loc “Precautions taken in Seattle, Wash., during the Spanish Influenza Epidemic would not permit anyone to ride on the street cars without wearing a mask. 260,000 of these were made by the Seattle Chapter of the Red Cross which consisted of 120 workers, in three days”

Before the unparalleled swiftness of its spread, methods of prevention collapsed. It could not be stopped. It could not even be checked. In one short week, the scourge swept like a driven flame across eastern Massachusetts and down into Rhode Island and Connecticut. Before the second week was over most of New England was ablaze with it, the infection was raging through eastern New York, eastern Pennsylvania, and New Jersey, and there were far-spread, unaccountable, small plague spots in Alabama, Wisconsin, Illinois, Utah, Texas, and on the Pacific Coast. Within six weeks of the time when the epidemic nature of the disease was recognized, there was no State, there was hardly a county in the whole United States, unstricken. What could our public health system do against such an onset?

Washington newspapers carried display advertisements, calling for volunteer gravediggers, and a local sash and door factory was commandeered by the District authorities and set to turning out coffins at top speed. Three hundred dollars a week was offered in Albany for trained nurses, with no takers. In Alabama relief parties going out through the country found whole families dead in remote houses, so suddenly smitten that they had been unable to get help. This occurred also in the rural districts of western Pennsylvania, the worst stricken section of the country, where in the six weeks of the epidemic’s height 1 per cent of the population died of it, a figure unequaled in American mortality records. Starvation threatened in many cities owing to the crippling of local traffic and the helplessness of the sick; but here the local Red Cross organizations, happily keyed up to a war basis of efficiency, were able to save the situation by a system of central food supply and volunteer deliveries. In the opinion of the highest health authorities, the war emergency alone enabled the country to come through the flu emergency without far greater disaster; since we were organized physically to meet special conditions, and braced, mentally and psychologically, to endure the strain and resist the panic which might otherwise have beset us.

Mystery enshrouds various manifestations of the disease. Its greatest fatality was among those in the strongest years of life; between the ages of twenty and forty, when the human organism is supposed to exhibit the highest form of resistance. Why this should be so, science cannot tell. It was markedly more deadly to men than to women. For what reason? No reason which the experts can agree upon 

LOC “Members, St. Louis Red Cross Motor Corps on duty on 5 ambulances. Influenza Epidemic”

What underlies this phenomenon? Something beyond present determination. The experience of the military camps shows, very broadly speaking, that, attacked by flu, the husky athlete died, the undervitalized indoor man recovered; the country boy succumbed, the city boy got well: just the reverse of what might be expected. The fact that very few people beyond the age of forty-five died suggested that this portion of the population had had the grippe in the great epidemic of 1889-90, and so were immunized. But if immunity is the explanation, why have deaths of children under fifteen, in the present epidemic, been so few, comparatively? Certainly they are not immunized by any former attack. Another phase of the mystery! The typical, and most formidable, phenomenon of the pestilence has been its “explosive” quality. In a great majority of the cities and smaller communities the infection, after entering, developed slowly for a brief period and then “exploded” into an appalling mortality for two or three weeks, when it swiftly subsided, an added feature being that the explosions were, generally speaking, nearly simultaneous over a great part of the country, taking place in mid-October and up through early November.

Susanna’s Note: World War I ended in November 1918.

Boston, at the height of the epidemic, showed a death rate about six times its normal; Philadelphia, ten times its normal; Baltimore, about eight and a half times its regular mortality, and Washington about the same. New Orleans, with a high regular death rate, multiplied that by more than six. Pittsburgh went to six times the standard rate. Albany rose to six times the normal, San Francisco to five times, New York to about the same, and Chicago to four times. But while this was typical, other cities exhibited no explosive phenomena whatever. Instead they showed a general level, markedly higher than the normal, but never shooting up to a decided “peak.” Herein was another peculiar feature. Why should New Orleans have blown its figures sky-high while Atlanta maintained a steady rate which hardly rose to one-quarter of the New Orleans high figure? What caused Chicago to explode, whereas the maximum at Grand Rapids never rose above double the normal rate, and Milwaukee kept her epidemic in hand almost as well? Why should Pittsburgh rise to six times its standard, and Columbus to only three times its normal? How explain the fact that Philadelphia’s high figure was two and a half times that of New York?

To one clue to the puzzle, thus far developed from any authoritative source, has been brought out by Dr. Raymond Pearl of the Johns Hopkins School of Hygiene and Public Health, working in collaboration with the United States Public Health Service. It is found that, almost invariably, the cities which showed the explosive flu rates have regularly an abnormal number of deaths from the common organic causes: that is, tuberculosis, heart disease, and kidney ailments.

Where the population is of weak organic constitution, the epidemic spreads and kills swiftly, as in Boston, Baltimore, Washington, Albany, New Orleans, and notably Philadelphia. Where the mortality from these standard causes is low the flu failed to make severe inroads, as in Birmingham, Grand Rapids, Columbus, Atlanta, and Milwaukee. It remains to be seen whether this showing, which appears quite definite and convincing in this country, is borne out by the reports (if they are ever forthcoming) from other parts of the world. General figures for the world epidemic are not yet available. Perhaps they never will be. The civilized world was too preoccupied with war to keep mortality records. In general, it is known that the destruction wrought by the pandemic varied in different countries only according as the people were strong or weak, for reasons of food supply, proper housing, and general condition, to resist it. One of the foremost of American hygienists, who has traveled in Europe studying conditions since the armistice, told me that in his opinion one year of flu and its sequelae killed more than four years of war in the combatant countries of Europe. Geographically there seems to have been no limit to the spread. Wherever  ships touched, there the influenza was disseminated.

Emergency hospital, Camp Funston, Kansas.

In British India five million victims died a heavier toll in few short weeks than the bubonic plague had taken in twenty years, all told. China reported a devastating onset shortly after. The South African’s went down before it as if it were cholera. It swept the European armies, both in camp and at the front. Even Switzerland’s well-fed, carefully housed troops developed it so generally that from 75 to 90 percent of the total fell ill. The contagion was shipped to Australia and New Zealand and thence was diffused throughout the South Sea Islands. In German Samoa between 80 and 90 percent of the populace was down at the same time and more than half the Government officials died. An infected steamship touched at Rio de Janeiro in October. Within a week there had developed from that one source between two and three hundred thousand cases. Within six weeks there were upward of 700,000 cases. The city was paralyzed. The whole medical, hospital, and burial machinery collapsed. Traffic stopped. There was no street-car service. Deliveries even of food were abandoned. A correspondent writes me that it was a common thing to see driverless cabs being drawn about the streets by starving horses in search of fodder! All South America was subsequently infected.

Barcelona, Spain, reported 1,200 deaths daily when the scourge was at its height. The medical expert of the London “Times” estimated that the twelve highest weeks of the pandemic represented a loss of 6,000,000 lives in all; but at the time of his reckoning many countries were still untouched or unreported. Not since the “black death” of the Middle Ages has there been anything to compare with the flu’s ravages.