The “Spanish Flu” Pandemic: Influenza in Montgomery County

[ Music ]>>This is the usual disclaimer that DOD requires
everybody to put out. I will have to add
one additional one. It seems like my body
decided the way to prepare for this is get a
little bit sick. So, if I sound a little
bit rough, I apologize. First, let’s talk a little bit
about the museum that I work at. We were founded in 1862
as the Army Medical Museum and we were part of the Armed
Forces Institute of Pathology. We were aligned in 2005,
but the Base Realignment and Closure Commission
is now located in Silver Spring, Maryland. So, we are actually a
Montgomery County Institute and we are now part of
the Defense Health Agency. Again, this is the
size of our collection, not only of historical
artifacts, but pathological specimens,
histological preparations and archival materials. If there’s any questions
or anything like that, feel free to talk to me. This is kind of the outline of
the talk that I’m going to give. I took from a CDC description of how epidemiologists
look at disease outbreaks. It’s got a variation
of the five W’s. First part is what
is the disease, the healthcare issue of concern? Second is who are
the people affected? Third, where it is on? In this case, the terrain of
Montgomery County in 1918. When? How the disease moved
through the county over time? And then why and how. How the disease was spread? Health concerns? And lastly, I’ll
look at some changes. Montgomery County has
resolved the disease and Montgomery County’s
continued role and understanding this disease
in the 21st century and a word about the methodology. This paper is primarily based
on the Montgomery Sentinel from 1918 and 1919 and the
Montgomery County Historical Society and the county
death register, which is in the Maryland
State Archives. Also, I just want to point out
every lecture on the history of influenza is going
to have two elements. No different versus the little
rhyme that you see up there, which is a [inaudible]
from that time period. Influenza is a virus,
caused by a virus. It’s spread by people,
can be spread by people about six feet apart. Most experts think that
the viruses may spread through the droplets when
people sneeze, when people cough or talk to each other. And again, the distance
it travels would be about six feet away, so
you’re pretty close apart, close together. You also might be able to get
it by touching the surface or an object where a person had
sneezed or left fluid on there, and then touching their
own mouth or nose. Healthy adults may be able to
infect the person one day prior to getting the symptoms. So, if you’re ever worried
about the person coughing, worry about the person next
to you that is not coughing and then after five to seven
days after becoming sick. Children may pass the virus
longer than seven days and symptoms can
start one to four days after the virus enters the body. The 1918 influenza
was a variation of the H1N1 A avian flu, and I’ll talk a little
bit more about that later. What’s important is what
was known in 1918 about it. Spanish influenza was
broke out about 30 years after Robert Koch proved that
bacteria could cause diseases. As a result, many
scientists and doctors knew about the germ theory of disease
and how it could be spread, but they attributed
it to a bacteria. In this case, it was
Pfeiffer’s bacillus was believed to be the cause of influenza, sometimes called
influenza bacillus. However, they’re
beginning to question that and there were some people
suggesting the concept of what they call
a filterable virus. They could not detect
it through a microscope, but they could deduce its
existence as something was ran through a very small
permeable filter. One of the things
that scientists at that time did not understand
and found kind of puzzling was that patients who have been sick from previous epidemics
were not getting immunity from this one, from
other epidemics. That was something that was
kind of a puzzle on there, and the main thing that they
understood was it was brought here from Valencia, Spain. The influenza was described as “Resembled a very contagious
type of cold accompanied by fever, pains in the head,
eyes, ears, back and other parts of the body, or feeling
of severe sickness.” In most cases, the symptoms
disappear after three to four days if the
patient rapidly recovers. Some patients however develop
pneumonia, inflammation of the ear, meningitis, and many of these complicated
cases “dying.” The onset of symptoms on
influenza was more severe than a cold and it spread
rather rapidly throughout the community. In order to protect
from the disease, public health officials
recommended the person maintain proper proportion of
work, play and rest, consuming what we would
today call a wholesome diet, balanced diet. Overcrowded conditions were
conducive for the spread of the diseases and streetcar
riders were cautioned to keep their faces turned away
from other people so as not to inhale the air
breathed out by others. People should cover their nose
and their mouth when they sneeze and every effort should be
made to breathe pure air. This was the advice that
was given out to people. This was published in
Montgomery Sentinel shortly after the disease broke out. Of course, this was
easier said than done. Now, most of those who died
from the disease suffered from a combination of diseases
other than just influenza and the army [inaudible]
found that disease noted “A special attention
must be paid to all cases of respiratory infection in
relation to the development and signs of pneumonia. It’s also impossible on
the onset to distinguish between influenza
without consolidation and actual pneumonia
and all cases referable to the respiratory tract and
must be viewed with suspicion and hospitalized and
carefully watched.” And the Montgomery County
Sentinel, we also talked about pneumonia as
part of the things to look out with influenza. They correctly identified
the cause of pneumonia as microorganism such as
pneumococcus, streptococcus and “other germs
with long names.” The purpose of this study,
I have used the diagnosis of only pneumonia included in
the sample and the reason I did that is not because I know
that the person suffered from influenza, but
because I cannot rule it out that they did not
have influenza with it. It’s hard to tell exactly
what the doctor is doing and how the doctors
diagnosed then. It was in 1918, pneumonia
was categorized by anatomical location
of the infection. Lobar pneumonia was an infection
of the single lobe of the lung and bronchiole pneumonia which
affected the area of lung around the bronchi, air tubes. Now, the army did autopsies on
patients who died of influenza, of course, Montgomery County
physicians generally did not. This is the lungs
of patients who died from influenza were
different than pneumonia and were comparable to those
who died of pneumonic plague or inhaled chemical
agents in warfare. These are examples
of lungs removed from influenza patients
upon autopsy. The lung on the left shows
the air sacs have been filled with inflammation resulting
from just the red blood cells and things like that
down there and the lung with a characteristic
red appearance on that. On the other side, on the
right is a medical illustration showing what the lung
looked like on autopsy. You can see the bright
red appearance of it. More typically, bronchopneumonia
was inflammation of the pulmonary lobes and again
this was accumulation of fluid in the lungs in the
pleural cavity. Again, this is a long
specimen on the photograph from that time period,
from an army soldier. Now, contrary to what
was stated at the time, ground zero for the
epidemic was not Spain, but was actually Camp
Funston in Kansas. The first case was reported
was a private reported duty on March 4th, 1918 and
then within three weeks, 1100 soldiers had
influenza reports in hospital and those 30 died. Now, the reason they
got attributed to Spain and not Kansas and why we’re
talking about Spanish flu and not Kansas flu is the
fact that Spain was one of the few countries at that
time that was not at war and did not have censorship. The first newspaper
reports came out in Spain. Now, one of the patients in the first wave was a
Private Roscoe Vaughn, who on September 18, 1918
reported the [inaudible] at Camp Jackson, South Carolina
complaining of chills, fever, coughing and headache. His doctor noticed
his face was flushed and his throat was congested. His heartbeat was regular,
but he had trouble breathing and the physician concluded
that Vaughn had influenza. Four days later, Vaughn developed a
secondary infection pneumonia. By that evening,
his pulse was feeble and he appeared somewhat dazed. He lingered on for
three more days and died on the morning of
September 26th. Now, most of the patients
report complained of fever and that was one of the primary
symptoms of it, usually a fever of 103 or 104 degrees
Fahrenheit. They complained of a headache
in the frontal region, pain in the limbs and chest and sometimes they
knew it was coming because they developed a chill when they first felt
they were being infected. Other way to diagnose pneumonia
was the stethoscope here. Patients had coughing fits
and difficulty breathing. Pneumonia went through
several different phases. The first phase, the congestive
phase was kind of a rattle or kind of like crackling
salt thrown on a fire or a Rice Krispies and milk
and in fact, one nurse, that was the way she
described it and later on just could not stand
the sound of Rice Krispies and milk just because of dealing
with the influenza epidemic, which brought back
too many memories. As the lungs filled with
fluid, the rattle disappeared and breathing could
only be heard through the bronchiole tubes and
then later on as the lungs began to deteriorate and as pus formed
and the abscess is then passed into the bronchiole tubes, you could hear a mucus gargling
sound through the stethoscope. Now, we talk about
the types of people that were affected
by the disease. By race, influenza claimed a
larger number of Caucasians and African Americans
which is not surprising. Caucasians were the large
majority of the county. However, when you look
at proportionately, African Americans had
almost double the rate of white people on there. So, they were hit much harder. They tended to be in poorer
health, and they tended to live in a much more crowded
conditions. Now, I mentioned you two
things that you’ll see in any history of
influenza paper. This is the second one is the
chart on your upper right side. The characteristic of most
influenza cases occur, you kind of have
a U-shaped graph. It affects usually the very
young and the very old. What was unusual about the
1918 influenza was the W-graph, which is the solid line on
here and that’s because people in their 20s and 30s were
hit particularly hard. So, not just kind of the
U-shaped of very young and very old dying, but also
the very young and there’s kind of a blip of people
that were young adults. And this is one of the
reasons why the epidemic was so devastating because it
hit kind of a perfect storm. We have World War I going on. Soldiers were moving
all over the place. People were confined. So, the people of very
vulnerable age were being grouped together and
being moved around and they were being
spread and spreading around the world very quickly
because you had transportation. You had people being
shipped not only to camps in the United States,
but also across the ocean to Europe to fight in the war. From Europe, ships were going
out to other parts of the world and spreading the disease
worldwide and this is one of the reasons why this was
such a devastating epidemic because it hit right at the
tail end of the First World War. The larger graph is
showing the age groups and this is just death by age,
raw numbers unlike the other one which I’ve seen to be
proportional by age cohort. This is just the raw numbers on
and again you can see the number of children, teenagers,
young adults, and middle age individuals, and
again rather than the elderly and these were the people that
were out in the community. They were working. They were going to school. I also want you to note, pay
attention, there’s a spike on the one to four
cohort and we’ll talk about that in a minute. Now, this is when you break
it down by race and you notice that the spike on the one
to four cohort were blacks, were African Americans
and the next spike on African Americans
were school age. They are teenagers
as well as whites. You start seeing it
kind of an increase. It’s not so much the children, but you also start seeing a
spike in the younger age groups and again this is the
working age people. Most African Americans
worked on farms. A lot of the white people were
commuting working and bringing in contact with other people. Let’s talk a little bit about Montgomery County
at the time period. Let’s look at the place
that this was occurring. And again as I mentioned
earlier, whites were the overwhelming
large proportion of the people in the county. Most of the people in the
county lived in rural areas. Again, only statistics I have on
breaking down by ages or farmers and not other professions
and, again, African American
farmers were a bit older than the white farmers on here. It was transitioning from
a rural farming community into the bedroom suburb,
Washington, D.C. and compared with other areas, housing
was above average of it. Most houses were described
as freshly painted two and three story houses. Most commodity is uncomfortable
[inaudible] every modern convenience at the
upper in the county. The houses were a
little bit smaller. And while African American
farmers were below average, white farmers, they were
significantly better than the blacks in other parts
of the United States and this is from the survey done by the
Presbyterian Church in 1910. African Americans were about
the quarter of the population. Now, when you look at the one
of the things that was happening in Montgomery County
at the first part of the 20th century was
transportation was changing. We talked a little bit about
the metro system a little bit earlier and, of course, the metropolitan branch being
a railroad was established in 1873, which of course is
the modern rail line for that. You started seeing the
trolley cars in about 1890, so you’re starting to see that mechanisms were
connecting people to the City of Washington, D.C.
for commerce. The other thing that was also
happening too was roads were starting to get paved. There’s only a small number
of roads about 90 miles of the 828 miles of
roads in the total roads in the county in
1910 were paved. The rest were dirt roads. So, you’re starting
to see small areas with very good communications
with rail with the Washington, D.C. The other parts you’ll
look at is the healthcare. Now, Montgomery County had a
comparatively healthy population and even when you look at the African American
population whose death rate was twice of whites. It was still better than
the average death rate of the United States
for that time period, which was 14.7 per 1000. So, you still had a
fairly healthy population. Prior to the influenza
epidemic in 1910, pneumonia was the leading
cause of death in that county, so you have a fairly
large incidence of that. Most people received
their healthcare from individual physicians. Residents and sick people
were treated in their homes. However, during the epidemic
and during the pandemic, an overwhelming number of
the patients both black and white were seen by a
physician prior to their death. According to the death records,
the physician is supposed to record if he had
treated a patient or not. Only 2% died without being
cared for by a doctor. However, the caveat
I will put on that is that Montgomery County
Death Register rely on reporting from physicians. So, there is a possibility
that people who died without receiving medical
care might have gotten missed. Most of those requiring
hospitalization had traveled to Washington, D.C. By
1918, you are beginning to see some specialized
healthcare facilities. Cedarcroft Sanitorium, psychiatric hospital
near Wheaton. Chestnut Lodge Sanitarium, psychiatric hospital
in Rockville. Starmont Sanatorium, a
tuberculosis sanatorium in 1905 in Washington Grove. The Washington Sanatorium
in Takoma Park, which is the Washington
Adventist Hospital is established in 1907 by
the Seventh Day Adventist and they were inspired
by the Kellogg Sanatorium in Battle Creek, Michigan. By 1918, they began to
transition into a hospital. The wife of the founder,
Lauretta Kress, was the first woman to practice
medicine at Montgomery County. And it was beginning to
become an acute care hospital at the time of the epidemic. The other one was a small
facility located near Olney established by a Dr. Jacob Berg
called [inaudible] Hospital. That’s the photograph you
see on larger photograph. It was established in
a converted farmhouse, described as a small
establishment in an inconvenient location, simply an older dwelling
with few alterations. That was a hospital
building south there and that’s what the hospital
care in Montgomery County. Now, when you describe
influenza, the medical association
published a pamphlet in 1918 where the doctor,
Benjamin Fuentes wrote “One of the startling features of the
pandemic is a sudden flaring up and equally sudden
decline reminding one of a flame consuming highly
combustible material would soon die down as the material
consumed was exhausted.” That’s how a lot of
people looked at this. The first wave of the pandemic
occurred in spring of 1918 and did not affect
Montgomery County at all. The second and third waves
did affect the county and probably the best
account you’re going to find of the pandemic in
Montgomery County is the Annals of Sandy Spring, which
described these waves. However, the other thing
I think is important to note is most people
understood this pandemic according to death. If you look at this graph
here, you’ll look at the cases, deaths do not tell
the whole story. And in fact, when you look
at the number of deaths, you see a couple of waves
that occur in the epidemic, one in October of
1918 and the other in December and January of 1819. If you look at the
overall number of cases, you have a standard
bell-shaped curve. Some of the cases, some of the
diseases became more virulent. It waxed and waned as
the disease progressed. Going back to Annals of Sandy
Spring, “The dread disease known as Spanish influenza was
first seen in Washington, D.C. about September
1st increasing rapidly that by October 1st
the fatalities from it and frequently complemented
pneumonia, very numerous and alarming. September and October
were beautiful months with little rain and exquisite
sunshine while the hideous influenza stalked
abroad to find any power or skill to combat it.” And a little bit later, “November was quite
unlike November of 1917 as it was possible to be
with bright beautiful days. This time was the lessening of
the Spanish influenza is hoped and believed that
it was leaving us.” A bit later, “In early December, the dread influenza
greatly increased in extent and severity assuming the
more dangerous form here than in October. And later still, January
was filled with sickness in about almost all directions
and little else but regarded, but the hundreds of cases
of influenza and pneumonia, which fall rapidly against
all efforts to extinguish it.” It talks a little bit
about how the thing kind of waned maximally and
progressively on there. Again, here’s another look at the chart looking
at the deaths of it. Now, one of the things
on this, this is taken from the death register and I
think I’ll talk a little bit about how the information
passed through the community. We received the information
almost instantly and it’s easily to forget. That was not the case in 1918. The Montgomery County Department
of Health collected information about the deaths on it. Every month, an individual
physician would come into the county courthouse, read
their casebooks to the clerk who will record the
information into a logbook and then the county government
did not find out the full toll of the epidemic until
the end of the month. That is not clear that county
compiled the data before passing it over to the State Board
of Health of Maryland. These results combined with other county governments
were published after the fact. In fact, the first report of
Montgomery County of influenza in 1918 was not published
until 1922, four years after the epidemic. The official good
numbers you did not get. People did not know
about until well after the epidemic had passed. Now the other part that you
look at is what’s reported in the newspaper the
Montgomery sentinel, and what I’ve [inaudible]
here is a chart showing the obituaries that were
published in the paper. Now he published a
section in page three. It was kind of the society page of the paper included the
obituaries, included some things on there, and then however there
were some weeks in the epidemic when you started seeing
a column called deaths toll which he started compiling
all of the obituaries into one column on here, and this is what shows the
column here on the epidemic, kind of the bars on there. And again you can see that while
it’s not perfectly an accurate representation of
people who died, it kind of at least gives you
a good idea of what [inaudible] from reading the people
so people could find out weekly roughly what was
going on in the near county. Now, you probably notice on
the week of eight November, that there are more obituaries than there were deaths
in Montgomery county. And that is because
two of those who died, died outside of Montgomery. One in Washington DC and the
other in Frederick county. So, again, mixed in the
numbers are also people that are in other areas that are of
interest to the readers, who we thought were the
readers of this newspaper. But I think you’ll find that most people encountered
it through the deaths. Again, they learned it
through the deaths of friends, neighbors, fellow
church members. And this is a graves registry
of a Saint Mary’s church in Rockwell, Maryland. And you can see in January a
cluster of deaths attributed to influenza in 19 [inaudible]. So, you can kind of see it. So, again, most of the
people who saw it kind of saw it very anecdotally
and very fragmented way. It took a long time
for the actual picture to really come clear on it. Now, let’s kind of walk
through how the influenza passed through Montgomery county. The first fatality in Washington
DC was a railroad break man who had contracted the disease in New York City
four days earlier. The first fatality in Montgomery
county was in Forest Glen on the 28th of September, and
it was a Glen Coleman aged 9 who died of [inaudible]
pneumonia and influenza and pneumonia. But, again, you can see
a small number of cases. But October it exploded. And Gaithersburg was
particularly hit hard with 46 reported cases, 7.4 percent of the population
was sick and of those, half of them, half
the fatalities were African Americans. In Tacoma Park, there
were 109 reported cases, about 8.4 percent
of the population and 9 percent mortality. Now, the first mention
of Spanish influenza, in the Montgomery Sentinel,
was published on 4th October. And by 11 October there is an
estimated 12,000 cases estimated in the county. And October 28th Washington
DC started requiring people to wear gauze masks in public. Now, a couple things
that were notable in this was Dr. Lithgum
noted that he treated, on 13th October, he treated a
total of 95 patients in one day. That was the most that
he had treated on there. And, again, these are a couple
of the columns of death toll that was also published in the Montgomery Sentinel
on 11 and 18 October. So, again, you can kind of
see the anecdotal evidence of the epidemic growing
and exploding. But the other part was some of
the notable people who did die. Two physicians died of
the influenza pandemic, and they both died in October. Dr. C. S. Etcherson, aged 32. Also owned the drug store in
Gaithersburg, which still stands and I believe is
still a drug store. He was stricken two weeks prior and was recovering rather
well until, suddenly, he discovered he suddenly took
a turn for the worst and died. And then the other one was
Dr. Dave Bliss, aged 33, who practiced in
Laytonville, Maryland. So, the two doctors that died
very early on in the pandemic. Now, in November mortality
of the disease waned. The cases in Gaithersburg
was a smaller number, and there were no
fatalities at all, there were 29 reported cases
and there were no fatalities. In Rockville you saw 77 reported
cases but, again, no fatalities. And the one column of death toll in the Montgomery
Sentinel was mostly in cases that died in October. And, of course, 11
November was the armistice of the first World War there
and people were relieved. They thought, well, maybe
this thing had passed us, maybe it was gone. But it wasn’t. In December of 1918, the second
crest of fatalities came. 53 people died. There’s 618 reported cases,
this was kind of the peak time of the epidemic in
reported cases. And you start seeing
reports in the paper of organizations closing due to
the possibility of influenza, you know, the Montgomery
Chapter, the daughters of the American Republic
had postponed their meeting indefinitely and Rockville
high school closed for the rest of the year due to the epidemic. People were worried. And, again, some of the
cases on here, this is some of the obituaries on here. One is John Thomas,
a prominent citizen. But notice how he was described. “Perfect specimen of a
strong and robust manhood, struck down after
a short illness.” This was a shock. Healthy people were dying. [inaudible], again, aged 50. Described as very
athletic, a sportsman, and also a politician. But some of the cases this time
were kind of heartbreaking, too. And on the death register
there’s a couple cases of mother, a baby or a
stillborn due to influenza. The mother dying a
couple days later. This was the Jackson
family and three members of that family died
due to the pandemic, one of the hardest hit families. And, again, response varied. Like I mentioned, the [inaudible] is
the RA did not meet, they postponed their meeting because they did not
want to risk influenza. However, the ladies of the Methodist Episcopal
Church south decided they were stronger stuff, and they held
their annual bazaar in the town of Poolesville on December 14th,
and the public was invited. So, January, pandemic
still continued. Overall, it declined
from the high in December but still a number of
people, fatalities were 63. In Sandy Spring over 200
cases reported in the area. And, again, more
meetings were cancelled or postponed due
to the influenza. However, on January 13th
the county schools reopened following Christmas day
vacation and the epidemic. And on January 17th county
agent Fred Van Hansen delayed a warning of the boy’s club
project due to being sick from the influenza
for three weeks. So, again, people were starting
to get back with their lives. It kind of looked like maybe a
corner had been turned on it. And [inaudible] on January 24th
the Montgomery county medical society holds a meeting
to discuss the epidemic. Again, some of the notable
obituaries that were on here occurred, a
Charles Boyd died, aged 38. Another prominent
citizen and, of course, death toll getting kind of
a bunch of people who died, a compilation of the
people who died in January. And, of course, Charles Boyd
kind of had his own obituary, such a prominent citizen. In February 1919, 40
cases have gone down. There was 159 reported
cases and only 4 deaths. In Rockville there
was 58 reported cases and there was no mortality. By probably the end of the
pandemic was marked by this item that appeared in the
Montgomery Sentinel in March. And Miss Claudia Hall
returned home to her parents. She had been sick with influenza
under medical treatment since October of 1918, and
she was taken suck while under the employee
of the government. And she had pneumonia and
typhoid fever, and she suffered from critical illnesses
but she recovered. And, as you note, the last
line all her acquaintances, the friends and acquaintances
she made by her pleasant manner as a teacher in the
public schools in the county will learn what
the light of [inaudible]. But, again, this is really
kind of the end point of it. You don’t see any more coverage in the Montgomery
Sentinel after this. And it’s kind of a relief
of an editor can kind of report some good news
regarding the epidemic. Now, we kind of look at some
the risk factors on this. You can see right
as Washington DC and Louis Montgomery county
tracks rather closely except for the very, you
know, the second wave of the pandemic hit
Washington DC much harder. But you can kind of see that
it follows rather closely, tracks very closely
with what was in DC. But the other risk factor
is also this transportation. We talked about roads, this was
a disease that appears to be of the mobile, the people. And a lot of the cities
that were hit were clustered around rail transportation. And you can see kind of the
blue part of the pie graph shows that they were attached to
either a trolley station or, down with a trolley station or
a railroad station on there. And then when you factor in with
the red part of the pie graph, you know, towns within five
miles of a rail station, you can see part of it. And then when you look at
roads along the page roads on there you can see the
overwhelming majority of the people who died of
the disease died with access to good transportation. The other things, there’s
certain localities were hit much harder. The two hardest hit towns were
Takoma Park and Gaithersburg. Gaithersburg hit the hardest. And, although Takoma
Park had more fatalities, it was a smaller
proportion of the population. But, again, it’s
significantly higher. Most of the, you know,
towns in the yellow are kind of marked significantly higher than Washington DC
or Montgomery county. So, you can kind of see
how it affected and, again, a lot of these towns were
very hit hard you can see. You can overlay a railroad
map or a road map on there and you’ll see, you’ll see the
towns kind of pop up on there. One exception on this seems to
be is Damascus, which at least as of 1910 did not
have a paved road. It was not listed as
being under a paved road. I’m just curious, that’s one of
the things I’m not sure about. Did they get a paved road
intervening [inaudible] or not? But why that was seemed to be
so severely hit I’m not clear. And, again, families
is another part. Some families were
hit very hard with it and which is showing
here is compared with the overall
death and mortality. The blue chart, part of the
chip, is showing families who two or less people in
the family household died, and the other chip, other
parts are showing families where three or more died. And you can see, there’s
about two or three families in each racial group that
were hit very severely with the disease. And a small number, you
know, three or more members, 18 percent of the black
population and 10 percent of the white population
had families that had three or more members who
died of the disease. But as the disease
kind of faded, I mean, it’s still in the
backs of people’s mind. This is an ad that appeared in
the Montgomery Sentinel in June. It’s the only time it’s on
here, it’s the only mention of the disease in the summer. It was a sad year. Again, kind of shows that
it was in the background. But maybe not so much because
this is the only time the ad appeared. I guess it wasn’t
that good of a seller or very effective ad I guess
but in the mind of the druggist. But as the approaching winter
came, people started thinking about it, “Well, this hit us
the last time in the fall,” so they started considering
options to get ready for possibly the next
wave of the pandemic. The Potomac division of the American Red Cross hired
a Red Cross public health nurse and began offering
classes in home nursing to disseminate the knowledge
learned from the epidemic. However, the fear of
the epidemic turned out to be considerably milder
than the previous year. 78 deaths in the last
4 months of 1919, compared with 508 deaths in
the last 4 months of 1918. At the same time, Ringwood
hospital was being replaced. Dr. Berg was creating a new
facility and raised money for a new hospital building,
and construction began in the winter of 1919. But in February 1920 they
opened the hospital prematurely because there were suddenly
started seeing an increased number of cases and they
were getting concerned. So, they basically had
the building being built, they had furniture
in that building, but they didn’t have
medical equipment. They literally sent
staff out frantically to buy medical supplies so
they could get the hospital up and running. During the first
year of operation, the hospital treated 19 cases
of influenza, 2 of whom died. And 43 cases of pneumonia,
of whom 8 died. But kind of an interesting
thing on this, was kind of how this
disease was remembered. Dr. Berg was, of course, a very prominent physician
in Montgomery county. The hospital they established
became Montgomery General Hospital, and a very
important facility. And it was the first rural
hospital in the United States. It’s a very significant
facility in a lot of ways. And they profiled him at the end
of his career and he described in 1920 epidemic as the
worst of his career. He called it, “The worst
time in my career.” He noted the time that he and
his staff augmented with nurses from Philadelphia
fought the disease far. According to the article,
among the dead was his wife, and two other doctors. However, this was the memory
where it was transmitted by Dr. Berg’s memory or the
journalist misunderstood. Because his wife died
in November of 1917. The other two physicians I
talked about died in 1918. And, of course, the this
hospital opened in 1920. Somehow, in the memory of
Dr. Berg or the journalist or somehow, the three influenza
epidemics had gotten mingled together and [inaudible]. And you look at contemporary
histories of only 1919, 1920 is the year the influenza
epidemic was mentioned. And they all timed it with the
opening of the new hospital. But the other thing that’s kind
of notable too when you look at the history of Montgomery
county that’s been written since then, the influence
is not mentioned at all. I think the most, if you
look at Peerless Rockville, I think the websites
probably the one place that actually does
mention the epidemic. But previous to the histories, previous to this don’t
mention it at all. They do mention a cholera
epidemic that occurred probably about a decade prior when
[inaudible] being dropped in there, in Montgomery county,
but nothing about this epidemic. It almost kind of
disappeared from the memory. But there’s more to the story,
as Paul Harvey used to say, the rest of the story. Remember I mentioned
Roscoe Vaugh? Well, after he died an
autopsy was performed on him, a section of his lung
— the wax specimen on your right was preserved. And, of course, the
slide was great of it, it was send to the
Army Medical Museum. And was part of a study of
the influenza during the war. After the war, the slide was
stored in various places. The Army Medical Museum
building on the mall, a warehouse that was a
repurposed ice skating rink in [inaudible] Washington DC. In 1990 the collection,
the specimens, were moved to the
Forest Glen Annex near where the first person had died
in Montgomery county as part of the Armed Forces
Institute of Pathology, the tissue repository. And they began, at the
same time, the AFIP, Armed Forced Institute
of Pathology, began computerizing
their records, making records searchable
so that you could figure out what records they have and what specimens
were preserved on here. And Jeffrey Taubenberger
searched for the things to try to find a kind of way to kind of
understand how we could utilize, you know, these tissue samples. Is there a way or
something we could do with it, and looked at this? He was interested in
combining DNA sequencing with the old tissue
sample to see if we could determine something,
learn something about some of the diseases in the past. And he looked at it and
the one case that he found that matched his requirements for studying the Spanish
flu was Rosco Vaughn. This is Dr. Taubenberger
and Reed. In 1997 they successfully
sequenced part of the virus. What they had done was
they had taken a piece of, a sample from the wax specimen, and you can see a little
Eppendorf tubes kind of in the center of
the picture on there, a sample of the tissue
is on there. And from that they were able
to sequence the DNA that was in there and they
were able to figure out this was lung,
this was pneumonia. And they figured out a
section that was not known, and that was a section
that was called, they thought it was influenza. And they had, on the
right, is kind of the gel that was actually used
by Jeffrey Taubenberger to sequence the disease. And, again, you can see
little cut outs on there, and that’s where they
saw that the flu was, they believed the flu DNA was. They were able to cut that out
and they were able to dissolve that and run it through a
series of DNA sequencers, were able to start replicating
the Spanish influenza. The first step in categorizing
it and this was published in the science magazine
about 1998. But, again, AFIP
was disestablished, and Jeffrey Taubenberger is
now at the National Institute of Allergy and Infectious
Diseases, the National Institute of Health in Bethesda, Maryland. So, Montgomery county’s role in
the Spanish flu still continues, and the primary center of
learning and the expert of understanding this disease and researching it is
still in Montgomery county. And hopefully information
learned on this will be used to kind of prevent
future pandemics, and possibly develop
a universal vaccine so we don’t have to
get any flu shot. And so, that concludes my talk. Just kind of another little
plug for the museum and show you where we’re located
in Forest Glen and Silver Spring, Maryland. Thank you, any questions? [ Applause ] All right, is there a way
I’m supposed to do this? I guess you’re in front,
so you’ll go first. [ Inaudible comment ] Okay, the question was
professional nursing care during the Spanish influenza epidemic. There wasn’t much. I mean, there were two hospitals
in Montgomery county at the time who were treating
influenza patients. One was Ringwood and the other
was the Takoma Park Sanatorium. And so, they did
have nursing staff. As far as information on how it
was done or anything about it, directly related to
Montgomery county I don’t. There are books published
and if you look at the Medical Heritage library of internet archive you can
see some books on nursing care and how to care for people
with influenza in there. But, as far as direct
information on that, there’s not very
much in the records. Most of the medical records that survive are basically the
death records that I’ve referred to on this, so there’s
not much on there. I’m not aware of
any doctor’s records that have survived anywhere
during this time period, so. There. Okay, the question was what
was the government response, was there a county
public health? During the first
World War they did — I can’t remember which
of the alphabet soup that Wilson created at the
time, did have an organization for doctors who were not drafted
basically I guess is the way to put it. They did have kind of an
auxiliary on it, I think. And I’m trying to remember
exactly how it worked, but there was something
in the war department. I’m kind of going
a little bit hazy. I’m sorry I’m not answering
this very accurately, but the war department had
some doctors that were kind of auxiliary type role
and they were loaned to the public health service
during the influenza pandemic. And I’m not clear on who
was actually under that in Montgomery county or not,
I just honestly did not search that or look, find out anywhere. Probably another great line
in the government document on that was talking about
the public health service was at its wits end. So, there was kind, it was
kind of a desperate situation. Most people didn’t
see it coming, and there wasn’t much on there. As far as county
government, there was nothing. It was basically the
volunteer efforts of doctors, of private physicians, okay.>>How did the original
virus develop? Where did it come from? How was it created
or born or whatever?>>As far as we can
tell, influenza, H1N1 that’s caused the
epidemic was an avian flu which means it came from birds. Now, the belief, the
current understanding is, and please correct
me if I am wrong, is that it got transmitted
into the pork, into the pigs, that got transmitted
into humans somehow. And one of the things with
Camp Funston is it sounds like there was a lot of hog
farming going on in that area, so that’s why it was believed
to have come through that. And we’re not sure exactly
how it came into it, whether it was people
cleaning up after the pigs, or somehow uncooked pork or
how exactly it came from there. I don’t know. Okay, so that’s about the
best we can say on it. I’ll ask you, because
I know you. Marcy.>>Hi Allen. I got your answer for Damascus. Damascus didn’t have a
railroad but in 1914 route 27, which was Ridge Road, was paved
and so that was the beginning of the first World
War of Europe. And it was considered a main
road between Frederick and D.C. for the next 12 years before,
then you started ramping up again with the
highway system in the 20s. So, that’s where
Damascus came into play.>>Okay, thank you.>>Right before.>>I guess right over
here, and then in the back. So, this gentleman here. Thank you. Actually, can we get
a microphone to him because I think this might be
a more interesting question than I can repeat.>>I grew up listening
to the stories of my grandmother,
I call her meemaw. She passed away in
1996, at the age of 88. But in March of 1919 it ended
around here about February, but in the sentinel
valley of Virginia in northern Rockbridge county
between Stanton Lexington, a little place called Newport,
she would lose her father at the age of 34, her
grandfather who was about 67, and her baby sister
Pauline who was only 5. And meemaw told me, she said
she got sick but she didn’t die. They had three family members
right there in Newport. But with Pauline, they suddenly
realized amid this tragedy and the fact that my great
grandmother whom I knew, who lived to be 97, mentioned that they didn’t have
any pictures of Pauline. So, they managed to get somebody
from Lexington to come up and take a picture of
Pauline in the casket. And I’ve always heard
that story, and I inherited the
picture of Pauline. It’s a little teeny
little picture like that, and I need to make
copies of that. But I was well into my 50s
before I suddenly realized, wait a minute, if meemaw
had died instead of Pauline, I wouldn’t be here today. And that’s what makes
it personal, that’s why I came here. Thank you.>>Thank you. Okay, in the back. The green, I guess. [inaudible] Okay. [ Inaudible comment ]>>And outbreaks of Spanish
flu, were we higher than average in terms of the impact? Second to that, is did
environmental factors aside from population density
contribute to susceptibility
to Spanish flu? And how did it compare to the
other biggie of that time, tuberculosis, in terms
of the number of people who were affected and the
treatment of the disease?>>Okay. All right, see
if I can remember this. Okay, first question. How did it compare
with other parts? I showed you kind
of Washington D.C., which was a bit,
considerably higher. Or, not considerably,
but a bit higher. I think Montgomery county
was a bit lower than average. Now, I know statistics out
there, I didn’t sit down and try to track down other major areas. But I think urban
areas were hit harder and rural areas hit less hard, is probably the way I’d
probably characterize it. Did not sit down and try to
look at that too much detail, to be honest with you. I mostly looked at it compared to Washington D.C.
Second one was were there environmental factors? As far as I can tell, no. I think the reason I kind of
latched on to transportation is because that is the
one area we’re going to have people in
a confined space. Based on a rail car
or trolley car. So, that’s going to be the
kind of thing on there. It does seem to be independent
of that environmental factors. There are weather records of
the time kind of looking at, sort of looked at it
briefly, it looked kind of like it was mostly
kind of fairly mild. But, again, I didn’t look
at it in a lot of detail. And the last one
was tuberculosis. Again, you notice when
I listed the diseases that are there the
people who died, you notice that I
didn’t list tuberculosis and actually more people
died of tuberculosis in Montgomery county in 1910 than of pneumonia
and the other things. However, there’s an
important caveat there. Most of the people who died, died in a tuberculosis
Sanatorium, i.e. they came in from somewhere else. Since I can’t figure out
which was Montgomery county tuberculosis versus
somewhere else tuberculosis, I took it out because it
doesn’t really on there. Was it a problem? Absolutely. Treatments, again, it was not
quite as infectious and, again, I’m not an expert on the
history of tuberculosis. There was actually quite a
bit of literature on that, and I would probably refer
you to that rather than kind of rattle off something. Any other questions,
gentleman back there.>>I think we have time for
maybe one more question.>>Okay.>>This is sort of parallel. Did the Sentinel report on
county sons dying from flu in military camps while they
were reporting local deaths, did they also have to report
losses in these families from flu that wasn’t a
county specific occasion?>>Yes. Some of the Death
Toll did include war dead. And there were reports of people
who died in military camps, too, in the obituaries that
were on there too. So, yes, both were reported. What’s kind of interesting
is the obituaries and the death toll columns don’t
necessarily track completely like I said, there’s on example
where two people were reported from out of the area which meant
there were more people reported dead than actually died
in Montgomery county.>>Thank you.>>All right, well thank you
very much for your attention. [ Applause ]

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