Most cases went unreported and the true numbers will never be known

From Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It by Gina Kolata.  Page 18.  In the modern city of Philadelphia, the account reads very similar to corresponding accounts from the Middle Ages and the Black Death or from ancient accounts from the Roman Empire and earlier.  

Perhaps Philadelphia was ravaged early in the epidemic’s course because the flu spread so easily from the city’s Naval Yard. The flu first struck those Navy seamen on September 11, 1918, not long after it had arrived in Fort Devens. Or perhaps it was because the city was near two large Army camps, Fort Dix in New Jersey and Fort Meade in Maryland, and both of them were hit by the flu a few days later. Or perhaps “the flu got its start in Philadelphia because the city had a huge Liberty Loan Drive parade, which drew a crowd of 200,000 on September 20. Or maybe it was all of these combined that gave the virus its foothold. But whatever the reason, Philadelphia was among the hardest hit of all American cities. And it was almost completely unprepared.

Few public officials anticipated the disaster and almost no members of the public did. The outbreak, in fact, was preceded by soothing words from medical authorities with a sort of band-played-on bravado. The Journal of the American Medical Association opined that medical authorities should not be alarmed by the flu’s nickname, “the Spanish flu.” That name, the journal wrote, “should not cause any greater importance to be attached to it, nor arouse any greater fear than would influenza without the new name.” Moreover, the journal said, the flu “has already practically disappeared from the Allied troops.”

Yet as the flu spread, the city did take a few precautions. On September 18, its health officials began a public campaign against coughing, spitting, and sneezing. Three days later, the city made influenza a reportable disease, which meant that records had to be kept of numbers of cases. On that same day, September 21, however, scientists reported good news—it seemed that the battle against influenza was won. The Philadelphia Inquirer wrote that researchers had found the cause of the flu—a bacterium called Pfeiffer’s bacillus. As a consequence, the paper wrote, the finding has “armed the medical profession with absolute knowledge on which to base its campaign against this disease.”

But by October 1, the city was under siege. In one day, 635 cases of the flu were reported to public health officials. That, however, was an underestimate. Doctors had become so overwhelmed caring for the sick that most cases went unreported and the true numbers will never be known. On October 3, the city closed all schools, churches, theaters, pool halls, and other places of amusement in a frantic attempt to slow the spread of the disease.

In the week that ended on October 5, as many as 2,600 were reported to have died in Philadelphia of the flu or its complications. The next week, the flu death reports reached more than 4,500. Hundreds of thousands were ill. Sick people arrived at teeming hospitals in limousines, horse carts, and pushcarts.

Within a month after the flu arrived in Philadelphia, nearly 11,000 people died from the disease. On one fateful day, October 10, 1918, 759 Philadelphia flu victims died.

“Visiting nurses often walked into scenes resembling those of the plague years of the fourteenth century,” wrote historian Alfred W. Crosby. “They drew crowds of supplicants—or people shunned them for fear of the white gauze masks that they often wore. They could go out in the morning with a list of fifteen patients to see and end up seeing fifty. One nurse found a husband dead in the same room where his wife lay with newly born twins. It had been twenty-four hours since the death and the birth and the wife had had no food but an apple which happened to be within reach.”

Undertakers were overwhelmed, observed Crosby. “On one occasion, the Society for Organizing Charity called 25 undertakers before finding one able and willing to bury a member of a poor family. In some cases, the dead were left in their homes for days. Private undertaking houses were overwhelmed and some were taking advantage of the situation by hiking prices as much as 600 percent. Complaints were made that cemetery officials were charging fifteen dollar burial fees and then making the bereaved dig graves for the dead themselves.”

At the city morgue, bodies were piled three and four deep “in the corridors and in almost every room,” Crosby said. They were “covered only with dirty and often bloodstained sheets. Most were unembalmed and without ice. Some were mortifying and emitting a nauseating stench. The doors of the building were left open, probably for circulation of air, and the Grand Guignol chaos was on view to anyone who cared to look in, including young children.”

 

Philadelphia’s nightmare was a prelude to an epidemic that roared throughout the world, bringing with it accumulating tales of horror. No place was safe, few families were spared. By the first week of October, the flu had spread to every part of the globe except for a few remote islands and Australia.