The 1918 Influenza Pandemic in Worcester

This exhibition was adapted from a presentation given by Megan McBurnie, MD and John Ryan, MD, at the UMass Memorial Hospital on June 19, 2020.

Introduction: Worcester in 1918

The Worcester of a hundred years ago wasn’t so different from the city today. The size of the population was nearly identical, with 180,000 residents, about a third of whom were foreign born. Immigrants in Worcester came mainly from Ireland, Italy, and Sweden, with smaller numbers of Russians, Poles, and Lithuanians. Worcester had a small African American community, accounting for between 1 and 2% of the population, some of whom were descended from former slaves who came to Worcester in the 19th century via the Underground Railroad. Worcester residents were highly literate, with an illiteracy rate of only 0.6% (although this figure was higher among foreign-born adults). The city was a manufacturing hub — second only to Boston — specializing in a range of products from corsets and envelopes to machinery and tools, with a GDP of $208 million ($9 billion in today’s currency).

In 1918, Worcester was also — like every other city, town, and village in the country — militarized. Although the United States had only entered World War I in April of 1917, it had mobilized rapidly. Most of Worcester’s manufacturing had shifted to aid the war effort, and Worcester citizens contributed by rationing supplies and growing their own food. Ultimately nine thousand Worcesterites would serve in the war abroad, and 355 would perish.

Worcester’s public health department was also quite busy at this time. Public health and modern medicine were still in their infancy in 1918, and much of the department’s time was devoted to inspecting milk (as pasteurization was not yet widely used) and monitoring the dentition of children, as well as tracking communicable diseases. In addition, they fielded complaints from citizens regarding sanitation in the city and fined offending individuals and businesses as necessary. In 1918, the public health department recorded 533 complaints of “dirty yards,” 98 complaints of “filthy tenements,” and 34 complaints of “pigs kept without license.”

The limitations of public health, sanitation, and medicine resulted in significant childhood mortality relative to today’s standards. In 1918, 4% of all deliveries resulted in stillbirths, and 10% of all babies who were born alive would die before their first birthdays. In a page from the Annual Report from City Hospital, it is recorded that of the 612 babies born at Worcester City Hospital in 1918, 91 (15%) would not live to discharge. Once children reached their fifth birthdays, their mortality rates improved, reaching an average of 60 years for men and 63 years for women.

Infectious disease posed a serious threat to both children and adults around the turn of the 20th century. Although scientists had identified the microorganisms responsible for more than 30 infectious diseases, there were very few specific remedies. Treatment consisted mainly of medicines that alleviated the symptoms of the disease — such as opium and morphine (used to relieve pain), willow bark and meadowsweet (used to reduce fevers) — along with instructions for rest and diet, warm baths, and gargles. Most medicines were topical or dissolved in liquid as there was no sterile procedure for injection and pills were difficult and time consuming to make. Narcotics were widely used, even for infants; the popular patent medicine Mrs. Winslow’s Soothing Syrup, advertised as a remedy for teething pain, contained a mixture of morphine and alcohol.

By 1918, however, a new era in the treatment of infectious disease was on the horizon. Physicians had begun to utilize serum therapy — which utilizes the antibodies produced by survivors of infectious disease to treat the disease in newly infected patients — to treat streptococcal and meningococcal infections, as well as diphtheria. At the same time, public health officials raised the standards of hygiene and sanitation and systematized the milk supply in order to reduce the spread of milk-borne infections. As a result, mortality from the most common infectious diseases — including measles, scarlet fever, pertussis, and diphtheria — was already on the decline. The development and growth of Worcester’s hospitals reflect the changes in medicine happening around this time. These facilities and their employees would play a major role in the 1918 influenza epidemic.

The 1918 Influenza Pandemic

Although the disease responsible for the 1918 epidemic would come to be known as “Spanish flu,” this is a misnomer. Spain was one of the few nations that remained neutral in 1918, as most of the world’s leading powers were locked in World War I. Consequently, Spain was also one of the few nations that was not censoring its media. As the news of a global pandemic would have been bad for morale, warring nations suppressed coverage of the outbreaks in their respective populations. This led many to believe that Spain, the first to report on the pandemic, was also the source of the disease. In fact, the “Spanish flu” almost certainly originated in the United States, specifically in Kansas. The novel influenza virus responsible for the pandemic was the result of mutations in the influenza A virus. The initial outbreak of this strain in Kansas in the spring of 1918 was mild, not dissimilar to the endemic influenza that struck communities annually. However, as the virus spread from Kansas to transport ships, to the encampments and battlefields of Europe, and then back to the United States, it increased in virulence and morbidity. Its spread was hastened by the crowded conditions both in manufacturing cities — where adults were so densely crowded into tenements that they were forced to sleep in shifts, using shared bedding — as well as enormous and hastily built military encampments. It was one of these encampments, located just 30 miles northeast of Worcester, that would be the first to fall victim to this increasingly deadly strain.

Camp Devens (now known as Fort Devens) was built in a little over two weeks in August of 1917. Although designed with a capacity of 36,000 soldiers, more than 45,000 occupied the camp by September. From Camp Devens, soldiers would disseminate the Spanish flu to the Boston Navy Yard, and from there to the rest of the United States, ultimately reaching nearly every major city in the world.

A truly global event, the 1918 influenza pandemic would ultimately kill 50 million people worldwide — more than the Black Death of the Middle Ages had killed in a century. More people died of influenza in 24 weeks of 1918 than died of AIDS over 24 years. Furthermore, the 1918 influenza pandemic was particularly deadly to certain demographic groups. Unlike annual influenza outbreaks, which were usually fatal to infants, toddlers, and the elderly, the 1918 flu appeared to target young people in the prime of life. Fifty percent of those who died were young adults in their 20s and 30s. It is estimated that 1-6% of the world’s population was killed by the 1918 flu, including 8-10% of all young adults.

By the second week of September, 1918, the city of Worcester was alert to the increasingly dire situation in nearby Camp Devens. Yet the leadership at city hall felt confident that Worcester would be unaffected. On September 18, it was reported that although a few cases of influenza were under treatment at City Hospital, physicians did not think that they were likely to prove fatal.

The following day, the first patient treated for the “Spanish flu” in Worcester had died. James Roche was a 25-year-old sailor who had been on leave from the Newport Naval Training School to visit his parents on West Street. His mother would die two days later, and his father a short time after that.

The number of infections in the city quickly escalated, and local hospitals became overwhelmed. Four days after the death of James Roche, fifteen nurses at City Hospital had been stricken with the flu, and the hospital had closed its doors to new patients. Yet the city was slow to respond. Despite the concerns of teachers and parents, Mayor Pehr Gustaf Holmes was adamant that the schools remain open in order to maintain a sense of normalcy. Many principals chose to take matters into their own hands. Taking advantage of a school board rule that allowed teachers to dismiss classes if the room temperature dipped below 60 degrees, they ordered the closure of entire school buildings, citing the damp and chilly weather. Under normal conditions, the furnaces in Worcester’s schools were not lit until December 1. In response to the school closures, however, Mayor Holmes relaxed this rule, ordering janitors to fill the furnaces with cords of wood to ensure that the schools were sufficiently warm. While schools remained in session, Mayor Holmes did take the measure of banning public spitting in order to slow the spread of influenza. Despite the fact that other cities in Massachusetts had taken it upon themselves to enact closures, city officials in Worcester waited for guidance from the state regarding the closures of schools and businesses, insisting that closing public places was unnecessary. Meanwhile, the local Red Cross began to urge local women to volunteer as emergency nurses, even if they had no training or experience.

It was not until September 27 — eight days since the first influenza death in Worcester — that the Commonwealth issued an order to close all public places. The State also provided recommendations for preventing infection, including the use of handkerchiefs while sneezing, cleaning one’s nose, maintaining a simple diet, and keeping hands clean. The following day, churches in Worcester canceled their regular services. Some clergy complained that private businesses, including saloons, remained open. By September 11, funerals and wakes had been limited to private viewings. The Red Cross aided their colleagues at Camp Devens with a delivery of 3,250 hand-sewn masks.

Despite orders and guidance from the state, Worcester’s city officials remained seemingly ill equipped to handle the growing crisis, prompting local hospitals to take the initiative. Samuel Winslow, president of the City Hospital board of trustees, joined with the leaders of other hospitals to present a proposal to Mayor Holmes calling for the construction of an emergency field hospital to relieve the city’s overwhelmed medical facilities. The New England Fairgrounds in Greendale were chosen as the site of the hospital. Owned by the Worcester Agricultural Society, the Fairgrounds were the site of Worcester’s annual harvest festival and were located on West Boylston Street, next door to Norton Manufacturing, the city’s largest employer. The hospital would be located in the exhibition hall and dance hall on the property. Norton Manufacturing volunteered to renovate and outfit the buildings as well as provide medical, lighting, and sanitary equipment. The creation of the hospital was expected to take two days.

Although work on the hospital began immediately, with crews working day and night, the two day time frame proved to be unrealistic. Furthermore, public health officials were concerned that the shortage of nurses to staff the new hospital beds would effectively defeat the purpose of the facility. They continued to plead with the public to volunteer as emergency nurses.

Public health officials did not mandate that physicians report influenza cases in Worcester until October 2 — nearly two weeks since the pandemic had come to the city. James Coffey, the Executive Officer of the Worcester Board of Health who was renowned for his success in clearing the pigs from Main Street, resisted making influenza a reportable disease, acquiescing only when it was mandated by the state. This measure made it possible for physicians and health officials to track the epidemic, helping to inform their decisions to extend or lift the ban on public gatherings and business.

Dr. May Salona Holmes, who had served as the superintendent of the Isolation Hospital on Belmont Street since its opening in 1895, reported on the crisis taking place under her watch. Like other hospitals in Worcester, the Isolation Hospital faced severe bed and staffing shortages due to the influenza pandemic. Part of the Putnam Tuberculosis Ward, opened in 1915, was requisitioned for influenza patients. On October 3rd, Dr. Holmes was forced to open the diphtheria pavilion — which was under renovation — on a half hour’s notice as ambulances delivered a constant stream of patients suffering from influenza. She reported that most of the nurses who treated these patients ultimately fell victim to the disease themselves, increasing the burden on the over-extended staff.

On October 4, fifteen days into the outbreak in Worcester, the ban on public gatherings was extended a week further, disappointing residents who had been looking forward to the Worcester Music Festival on October 7th and the Columbus Day Parade on October 12th. At the same time, the public was asked to volunteer either as nurses in the city’s hospitals or by carrying out food delivery to ill residents who were confined to their homes. Through newspaper accounts, the citizens of Worcester were kept apprised of the progress of the epidemic and were well aware of the gravity of the situation facing the city.

The emergency field hospital at the New England Fairgrounds was finally completed on October 5th, a week after the plan was devised. The severity of the nursing shortage became readily apparent. At the onset of the pandemic, Worcester nurses had volunteered their services to Camp Devens, where the situation was initially most critical. With the opening of the field hospital, Worcester sent a request to Camp Devens for these civilian nurses to return to the city, and anxiously awaited a response from the military. In the meantime, the call for volunteer nurses was answered by Worcester’s schoolteachers.

In the midst of the outbreak, and despite a mounting number of deaths, Worcester’s saloons, soda fountains, and billiard halls had not closed. Amanda Peterson, head of the Women’s Christian Temperance Union, decried what she viewed as the hypocrisy of churches being closed while saloons remained open, saying, “Is it any healthier to pass your night in a saloon drinking some poisonous concoction mixed by some bartender who might find some more essential and manly trade than mixing drinks for these poor creatures, like maybe going to church and listening to the word of God?” Conceding to pressure from the public, city health officials finally closed saloons on October 8th. The following day, the city’s closing ban was made indefinite.

On October 11th, six days after the city made its desperate plea to Camp Devens for the return of its nurses, military officials issued a response, stating that no nurses could be spared from the camp. Under the present wartime conditions, the military superseded civil authority. Worcester would be forced to make do with its present corps of volunteer nurses.

In contrast to previous outbreaks, the 1918 influenza pandemic resulted in an unprecedented number of orphaned children, as young parents succumbed to infection. The two emergency orphanages that were established in Worcester were woefully understaffed. The residents of Worcester responded enthusiastically to the call for assistance, volunteering money and time to staff the orphanages and in some cases, taking children into their own homes.

Four weeks into the epidemic, just when the situation appeared the most grave, the cases of influenza began to decrease. While business owners were eager to see restrictions lifted, healthcare officials — along with most of the public — remained wary. Dr. Charles Drew, superintendent of City Hospital, urged the Board of Health to proceed cautiously. Although the number of cases was declining, he pointed out that the overall number was still quite high. Rosabelle Jacobus, the head of the District Nurses Association, thought that the prospect of reopening public places at that time was “ridiculous,” stating:

“Everyone is worn out and people are exhausted, and who would care for others who would be stricken? I have been in houses where six and seven are ill in the room, and no one to give them a drink, no one to help them. This sickness has struck almost every home, one, two, and three in a single family being ill, and in many families it has been fatal to more than one member. Deaths are still occurring and we are yet in great danger.”

Despite these concerns, city officials went forward with the reopening of Worcester. On October 21st, 32 days after the first death in the city, they declared that the “battle against the epidemic is won.” Two days later, the Board of Health lifted the restrictions on schools, churches, and other public businesses. The worst was over for Worcester. Although a rebound surge of influenza in the winter would claim additional lives, it would not reach the same level of severity as the autumn outbreak. On November 11, the first world war ended. Due to concerns about infection, Worcester’s armistice day parade was delayed for six months.

Summarizing the crisis, Samuel Winslow — who had helped to spearhead the creation of the emergency hospital — wrote in his annual report:

“The trustees of the City Hospital feel deeply grateful to all those who so generously volunteered to share the burdens during the influenza epidemic. They also feel it a duty to emphasize the importance of being prepared for such an epidemic as is liable to visit our city at any time. If this epidemic had visited Worcester in all its violence during mid-winter instead of during the pleasant days of autumn, the suffering would have been even greater.”

The city of Worcester would ultimately record 6,884 influenza cases and nearly 1,300 deaths in the course of the 1918 influenza pandemic. In comparison, only 325 people in Worcester died of the yearly influenza outbreak in 1917. Roughly 19% of the reported cases of influenza reported in Worcester in 1918 resulted in death. However, this percentage is almost certainly higher than reality, as a large number of infections went unreported, particularly in the weeks before physicians were required to report cases of influenza to the state. Cities with more comprehensive data reported a case mortality rate of 2.5%. Applying this percentage, we can estimate that approximately 52,000 people contracted influenza in Worcester, amounting to nearly one third of the city’s population.

The city’s excess death rate — or the number of people who died in excess of what would normally be expected — for the entire pandemic (September 1918-February 1919) was 655 per 100,000 people. This was high compared to nearby cities, such as Lowell (523) and Cambridge (541). Of all the cities in Massachusetts, only Boston had an excess death rate that was higher than Worcester’s, at 710.

Revisiting the 1918 influenza epidemic in Worcester, it is possible to appreciate the selfless dedication of medical providers and the mobilization of an entire community in confronting a deadly crisis. To quote Dr. May Salona Holmes, writing in the annual report of the Board of Health at the end of the year: “I cannot possibly express to you in words, the spirit and fidelity which my hospital family have displayed during this ordeal.”

Bibliography

Fourteenth Census of the United States: State Compendium Massachusetts. Department of Commerce. Bureau of the Census. Washington, D.C. 1921.

Forty-eighth Annual Report of the Trustees of the City Hospital Worcester, Massachusetts for the Year ending November 30, 1918 (Worcester, MA: Commonwealth Press, 1919).

Annual Report of the Board of Health of the city of Worcester Massachusetts for the Year ending December 30, 1918. Worcester, MA: Commonwealth Press, 1919.

May Salona Holmes. www.worcesterthen.com

The Great Influenza. John Barry. Penguin Books, New York NY, 2004. 

The Worcester of Eighteen Hundred and Ninety-Eight: Fifty Years a City. F.S. Blanchard & Company, Publishers. Worcester MA, 1899.

Influenza Encyclopedia City Essay: Worcester Massachusetts. University of Michigan Center for the History of Medicine and Michigan Publishing. University of Michigan Library. Ann Arbor, MI.

Coppock, Mike “The race to save Nome.” American History. August 2006. 41(3): 56–63.

Currie, M. “Fever Hospitals and Fever Nurses: A British Social History of Fever Nurses: A National Service.” London: Routledge, 2005. 

Diphtheria: A Popular Health Article. The Public Health Journal 18 (Dec.1927): 574.

Nespor. C. (2013, March 27) “Medical treatments in the late 19th century.”

Taubenberger JK, Morens DM. 1918 Influenza: The mother of all pandemics. Rev Biomed. 2006; 17 (1): 69-79. 

“How We Poison Our Children.” New York Times. May 13, 1858. 

Emil von Behring: The Founder of Serum Therapy.

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