Legacies Spring 2019: Epidemics and Public Health in Pennsylvania History by Historical Society of Pennsylvania

The Historical Society of PENNSYLVANIA

SPRING 2019

VOLU M E 19, N U M B E R 1

Recognizing Our Supporters

lacing items from our collections—like original letters, diaries, and maps—in the hands of young students is one of the most rewarding experiences we can offer. Students connect with history at a level above and beyond a standard textbook lesson. HSP’s K-12 workshops are integral to HSP achieving its mission of making history relevant and exhilarating to all, and we have a number of supporters to thank for their role in sustaining and growing our education program. Two such donors we recognize and thank are the Haverford Trust Company and Elliott-Lewis. Both companies used the Education Improvement Tax Credit (EITC) program to designate generous funds to be used by HSP’s K-12 programs. EITC is a valuable program offered by the Commonwealth of Pennsylvania that can lower the tax liability of businesses contributing to eligible educational organizations. Thanks in part to these two donors, we engaged directly with 4,000 K-12 students last academic year through our onsite workshops and

classroom outreach. We also debuted a summer program called History Makers Camp where a group of students combined archival research and technology to create a walking tour app focused on the history of civil rights in Philadelphia. We are grateful to the Haverford Trust Company and Elliott-Lewis for their commitment to education and for giving back to their communities! To learn more about HSP’s K-12 education program or EITC, please contact J.C. Hatalski at jchatalski@hsp.org.

O F F I C E R S O F TH E B O A R D O F C O U N C I LO R S

Bruce K. Fenton Chair

Timothy R. Schantz Executive Vice Chair

Majid Alsayegh

Treasurer and Vice Chair, Planning and Finance

Georgiana W. Noll Secretary

Alice L. George

Vice Chair, Collections and Programs

Lori E. Cohen

Vice Chair, Institutional Advancement

Steven R. Klammer Vice Chair, Audit

David A. Othmer At-Large Member

Sarah D. Price

At-Large Member

S E N I O R STA F F

Charles T. Cullen President and CEO

Lee Arnold

Chief Operating Officer and Senior Director of the Library and Collections

John Houser

Chief Information Officer

Beth Twiss Houting

Senior Director of Programs and Services

Dennis Williams

Chief Financial Officer

Lynette Zimmerman

Chief Development Officer

HSP is one of the nation’s largest archives of historical documents, with over 21 million manuscripts, books, and graphic images encompassing centuries of US history. Through educator workshops, research opportunities, and public programs, we strive to make history relevant and exhilarating to all. To learn more about the Historical Society of Pennsylvania and how you can support its extraordinary collections, its programs, and its publications, please visit our website at www.hsp.org or contact Jon-Chris Hatalski, Director of Institutional Giving, at jchatalski@hsp.org or 215-732-6200 ext. 220.

Historical Society of Pennsylvania tel

215-732-6200

fax

1300 Locust Street, Philadelphia, PA 19107-5699

215-732-2680

website

www.hsp.org

P E N N SY LV A N I A L E G A C I E S

Rachel Moloshok

Managing Editor of Publications and Associate Manager of Scholarly Programs

Masters Group Design Design

The Historical Society of PENNSYLVANIA

LEGACIES

SPRING 2019

In the “Midst of Death”: When African Americans Saved Our Nation’s Capital by

Billy G. Smith

VO LU M E 19, N U M B E R 1

Note from the Editor

3 Window on the Collections by

Lazaretto Ghost Stories by

David Barnes

Anna Leigh Todd

Teachers’ Turn by

Karalyn McGrorty Derstine

34 Generations by

Jane Neff Rollins, MSPH

36 Legacies for Kids by

Christopher A. Brown

38 Book and Website Reviews by

Maureen Iplenski

Homefront Casualties: Philadelphia’s Influenza Disaster by

Laura Fassbender, Carolyn Byrnes, MPH, and Rachel L. Levine, MD

James Higgins

Polio in Pennsylvania by

Food for Thought by

ON TH E COVE R

Daniel J. Wilson Cover image adapted from “Protect the public from disease / use your handkerchief when you sneeze,” a World War I–era poster issued by the Philadelphia Committee of the Pennsylvania Society for the Prevention of Tuberculosis. Historical Society of Pennsylvania Poster and Broadside Collection. See the original at https://digitallibrary.hsp.org/index.php/Detail/ objects/11273. Unless otherwise noted, all images in Pennsylvania Legacies are from the collections of the Historical Society of Pennsylvania. © Historical Society of Pennsylvania, 2019. All rights reserved. ISSN 1544-6360 (print); ISSN 2169-687X (online)

NOTE FROM THE EDITOR

Pennsylvania in Sickness and in Health

he year 2018 marked the end of World War I—a catastrophic global event that shaped the course of world history and claimed tens of millions of lives. But it also marked the beginning of a related global catastrophe that killed millions more even than the war itself. Spread by troop movements and other global exchanges, the influenza pandemic of 1918–19 caused the deaths of an estimated 50 million people throughout the world—including over 67,000 Pennsylvanians. As historian James Higgins points out, Pennsylvania suffered the highest mortality rate in the United States during the epidemic, and the flu’s toll on Philadelphia was so singularly devastating that even 100 years later, experts from around the world point to it to demonstrate the devastation an infectious agent can wreak in an urban environment. Certainly, epidemics have played a special role in Philadelphia’s history, connecting the city to larger biological forces that have shaped the modern world and affected the development of the early United States. Between August 1 and November 9, 1793, yellow fever claimed the lives of 5,000 Philadelphians—approximately 10 percent of the city’s population. At the height of the crisis, President George Washington and his cabinet, along with many of the nation’s political and intellectual leaders, fled from what was then the capital city of the United States. Virulent arguments about the causes of and proper responses to deadly diseases pitted Federalists against Anti-Federalists, prompted debates over the merits of restricting immigration and international commerce, inspired a historic libel suit, guided the work of city planners and charitable organizations, and led to the construction of the Philadelphia Lazaretto, the nation’s oldest surviving quarantine station. Pennsylvania has been the site not only of destruction caused by deadly epidemics but of innovations in public health that arose in response to them. Who can forget the

Pennsylvania Legacies Spring 2019

significance of the polio vaccine, developed by Jonas Salk’s laboratory at the University of Pittsburgh and first tested on children in western Pennsylvania? The articles in this issue of Legacies explore epidemics and public health in the commonwealth’s history from a variety of angles. Billy G. Smith focuses on the heroism of black Philadelphians during the 1793 yellow fever outbreak; David Barnes contemplates the legacies of the Philadelphia Lazaretto; James Higgins details how the influenza epidemic unfolded in Philadelphia and the factors that contributed to its deadliness; and Daniel Wilson looks at Pennsylvania’s prominent place in the global fight against polio. In this issue’s Generations column, genealogist Jane Neff Rollins provides a guide to researching ancestors affected by the 1918–19 influenza pandemic; our Window on the Collections feature looks at the efforts of the Public Baths Association of Philadelphia to prevent outbreaks by encouraging hygiene; our slate of book and website reviews points the way to further resources for readers of all ages; and our Teachers’ Turn installment offers suggestions on using this issue in the classroom. Finally, our concluding Food for Thought essay looks to the lessons of past epidemics to inform the response to public health crises affecting Pennsylvanians today, including HIV/AIDS and opioid use disorder. Taken together, the articles in this issue of Legacies serve as a reminder that epidemics and public health are more than medical matters: factors such as environment, infrastructure, immigration, economics, and inequality play a role not only in when and how epidemics strike but in whom they affect—and how badly. Given the significance of epidemics and public health in the Keystone State’s past and present, it is no surprise that Philadelphia’s medical heritage should be an area of focus of the Global Philadelphia Association as it celebrates the major cultural accomplishments and rich history of this World Heritage City, a status that

Philadelphia-area seminarians digging a mass grave during the influenza epidemic, 1918. Catholic Historical Research Center of the Archdiocese of Philadelphia.

Philadelphia reached in 2015 and shares with hundreds of other important cities around the world. The Historical Society of Pennsylvania (HSP) is collaborating with Global Philadelphia (GPA) and other cultural institutions around the city to focus some of their 2019 programs and exhibitions on the theme of Philadelphia’s Global Medical Heritage as part of GPA’s biennial GlobalPhilly Expo, which will be held September 1–October 15, 2019. This summer, HSP staff will host a multidisciplinary teacher workshop focused on a curricular unit based on the articles in this issue. In the fall, HSP will have a small exhibit with its holdings focused on Philadelphia’s Global Medical Heritage. May you, dear reader, enjoy these programs—and this magazine issue—in good health. Rachel Moloshok Managing Editor of Publications & Associate Manager of Scholarly Programs

WINDOW ON THE COLLECTIONS

Public Health and Personal Hygiene in Progressive-Era Philadelphia BY ANNA LEIGH TODD

t its most basic, public health as a field and practice is about connections between people. It operates on the principle that the health of individuals is good for the health of the nation, and vice versa. Modern public health initiatives can trace their roots back to antiquity, but they also count among their more recent predecessors an ambitious and socially minded cohort known as the Progressive reformers. Concerned by the increasing social ills that accompanied the technological and industrial innovations of the early 20th century, the Progressives chartered countless social organizations to address the dangers of modern society, including poverty, neglect, violence, and disease. Arguably, the most important of their efforts were to instill the doctrine of public health in an increasingly interconnected society by educating people about prevention and cleanliness. The Historical Society of Pennsylvania houses a number of collections dedicated to such reform efforts, but one in particular, the Public Baths Association of Philadelphia Collection, sheds light on a lesser-known form of Progressive-Era public health reform: the public bath movement. The public bath movement kicked off in the mid-1800s in response to a lack of indoor plumbing in city slums. Through their efforts to erect personal hygiene facilities in immigrant and working-class neighborhoods, bath reformers epitomized the broader idea that the cleanliness and health of every individual body was crucial to ensure the public health of all. The Public Baths Association of Philadelphia (PBA) came into being in 1895 largely due to the efforts of local philanthropist Sarah Dickson Lowrie. For much of the 19th century, Philadelphia’s municipal government sponsored several public swimming pools during the summer months, and various for-profit baths dotted the city. Indoor bathing

“Baths for Every Body” advertisement card, circa 1902. Public Baths Association of Philadelphia Records.

facilities for the poor that were open yearround, however, did not garner the same support. According to the PBA’s history, the pitiable state of bathing facilities in the city’s working-class neighborhoods was brought to Lowrie’s attention through her work with immigrant children in the city’s poorest neighborhoods. Lowrie shared her concerns about this absence with her charitably minded peers at a dinner party

hosted by Philadelphia magnate John Wanamaker, out of which the initial plans for the PBA emerged. At its most basic, the PBA’s mission centered on the construction and maintenance of affordable public bathing facilities intended to cultivate habits of health and cleanliness among the city’s immigrant working poor. True to the optimistic tradition of Progressive reform, Spring 2019 Pennsylvania Legacies

Women and girls doing laundry at a Philadelphia public bathhouse, undated photograph. Public Baths Association of Philadelphia Records.

PBA organizers argued that the urban poor were seldom dirty by choice but, rather, constrained by the deplorable conditions of their jobs and neighborhoods. If given the chance, the reformers assumed, the laboring poor would gladly embrace the personal habits of cleanliness and begin working toward their own social uplift. Key to this narrative of uplift were other goals, which included instilling qualities of modesty, domesticity, industry, and selfrespect. Indeed, charging a small price of admission—thus conveying a sense of selfimprovement rather than outright charity— was central to their service mission. The PBA planned their bathhouses to convey a sense of modern efficiency and economy. Facilities often stood a couple of stories tall, with dozens of showers and several bathtubs split between sexsegregated floors. Patrons typically paid 5 cents for a shower or 10 cents for the use of a bathtub, which included the costs of a clean towel and an individual portion of soap. In order to encourage bathing as a family affair and to educate the next generation, children under the age of

Pennsylvania Legacies Spring 2019

10 were allowed to bathe free of charge when admitted with a parent. Attendants stationed at the baths limited patrons to 20 minutes of washingand instructed them in what reformers deemed the proper manner and temperature of bathing in order to maximize benefits and efficiency. The first of these facilities opened at Gaskill and Leithgow Streets in Southwark on April 20, 1898. It immediately proved popular, providing 21,656 baths in its first year. At this time, the neighborhood primarily consisted of Eastern European Jewish immigrants, but it was also located on the border of the Seventh Ward’s largely African American community. The Gaskill area’s vibrant mix of races and ethnicities only furthered its appeal to the PBA, which often boasted of their facility’s diverse patronage. This first bathhouse also included a public laundry in the basement, an addition that was considered an innovation within the field of public bath reform at the time. PBA organizers intended these laundry facilities to be reserved for the exclusive use of female patrons tasked with the family washing. Working-class men quickly challenged this assumption, however, as they

flocked to the sinks to wash their only sets of clothing. Indeed, the popularity of the bathhouse among male patrons prompted the organization to open a second bath across the street in 1903, reserved exclusively for the use of women. Patronage of the baths grew steadily for the first several decades of the organization’s operation, prompting the construction of two more baths at 718 Wood Street and 1203–5 Germantown Avenue, built in 1900 and 1912, respectively. By the time of the 1918 flu epidemic, the total number of baths provided had risen to 386,313, a nearly 180 percent increase in two decades. While the organization did not explicitly comment on the epidemic, the remarkable surge in baths in the year 1919, totaling 50,449, speaks to a broader public concern with cleanliness in the face of rampant illness. In the wake of the outbreak, the organization’s fifth bath was constructed in 1921 at the intersection of Passyunk and Wharton in the midst of a vibrant Italian immigrant enclave in the city’s southern wards. The PBA’s popularity reached its peak in 1928 with the opening of its sixth and final

bath at 1808–14 Hazard Street, serving the industrial neighborhoods of Kensington. Unfortunately, patronage dropped sharply the next year with the unexpected onset of the Great Depression and continued a steep decline over the next two decades. Even as the national economy slowly recovered, the accessibility of indoor plumbing rose steadily into the mid-20th century, further reducing usage of the baths. As a result, the PBA periodically shuttered several of their baths throughout the 1940s before liquidating their assets and ultimately disbanding on January 11, 1950. Researchers at the Historical Society of Pennsylvania can track the rise and fall of the PBA through the minutes of the organization’s trustees, one of the two main record types that comprise the collection. The minutes, which begin in 1902, provide a sense of the main concerns of the organization’s governing body, including personnel issues, the allocation of funds, property upkeep, and the association’s decline. Accompanying these minutes are a number of loose documents regarding the PBA’s various real estate dealings—central

to their primary function of constructing and maintaining bathing facilities. In addition to these more internal, logistical records, the collection also houses three scrapbooks that shed light on the public-facing side of Progressive-Era public health reform. The carefully bound and curated volumes contain scores of newspaper clippings documenting the reception and use of the bathhouses, advertisements commissioned by the association, and various other brochures, tickets, and photographs that truly give readers a sense of the everyday experience of the baths. Read carefully, this eclectic assemblage of materials provides insight into both the intentions of PBA reformers and the realities of working-class life, two factors which often came into conflict amid the same swirling waters that were intended to bring them together. Anna Leigh Todd is a doctoral student and Benjamin Franklin Fellow at the University of Pennsylvania.

(LEFT) Customers

line up outside for a wash at Gaskill and Leithgow Streets, undated photograph; (TOP RIGHT) “Man it’s sure great to be clean!” Public Baths Association poster, undated; (BOTTOM RIGHT) Public Baths Association of Philadelphia calendar card, 1902. Public Baths Association of Philadelphia Records. Spring 2019 Pennsylvania Legacies

In the

“Midst of

Death

”

WHEN AFRICAN AMERICANS S AV E D O U R N AT I O N ’ S C A P I TA L by Billy G. Smith

Dead House on the Schuylkill during the Yellow Fever in Philadelphia in 1793, watercolor by David J. Kennedy. David J. Kennedy Watercolors Collection.

Pennsylvania Legacies Spring 2019

“T

hey are dying on our right hand and on our Left; we have it opposite us, in fact, all around us, great are the number that are called to the grave. . . . To see the hearse go by is now so common that we hardly take notice of it; . . . we live in the midst of death.” While Isaac Heston penned these words to his brother on September 19, 1793, yellow fever claimed the lives of about 70 Philadelphians each day. “When I see the Metropolis of the United States depopulated,” the 22-year-old moaned, “it is too distressing and affecting a scene for a person young in Life to bear.” A mosquito carrying the virus bit Heston about the time he wrote the letter; he died 10 days later. It all started in late July 1793 in a brothel near a pier in the northern part of the city. Two mariners, mostly likely from the ship Hankey or one of the other vessels that had arrived a few days earlier from the West Indies, had rented a room at the “disorderly house.” A violent fever quickly killed one of the sailors. An English boarder in the house shivered with an elevated temperature, vomited a black substance, and died a few days later. Mrs. Parkinson, an Irish lodger (or prostitute), suffered with sunken eyes, jaundiced skin, and blood trickling from her nose and mouth for a week before she expired. Both brothel owners died, as did the second mariner and several next-door neighbors. All these fatalities in such a brief time attracted the attention of Dr. Benjamin Rush, the most distinguished physician in the new nation. After visiting a few of the sick people in the neighborhood, he announced in late August that yellow fever now stalked the city’s streets. During the next three months, the disease killed more than 5,000 people—one out of every 10 Philadelphia residents. Not until the late 19th century did physicians understand that infected Aedes aegypti mosquitoes were the source of all this human misery. Philadelphians fled in panic. “So great was the general terror,” the newspaper printer Mathew Carey noted, “that for some weeks, carts, wagons, coaches, and [riding] chairs, were almost constantly transporting families and furniture to the country in every direction.” At least a third of the city’s inhabitants abandoned their homes. George Washington, Thomas Jefferson, and virtually every other prominent federal leader numbered among the refugees from Philadelphia, the nation’s capital during the 1790s. State and city officials likewise joined the flight. Government at all levels ceased to function. By mid-September, Mayor Matthew Clarkson was the sole elected city administrator who stayed in the city.

Spring 2019 Pennsylvania Legacies

In desperation, Clarkson appealed directly to the ordinary citizens of Philadelphia to help. The most pressing needs were nurses to care for the sick, cartmen to carry away bodies piling up in the streets, and gravediggers to bury them. But everybody thought these duties were too dangerous, since they brought one into direct contact with the supposed sources of infection. Even though they were the most despised people in the city, black Philadelphians shouldered the moral responsibility of aiding their neighbors. When they learned about the mayor’s plea for help, members of the Free African Society—an organization founded in 1787 that emphasized self-determination by choosing the name “African”—volunteered their services. Two clergymen, Absalom Jones and Richard Allen, cofounders of the African Church of Philadelphia (later renamed the African Episcopal Church of St. Thomas), (LEFT) Portrait of Dr. Benjamin Rush; (RIGHT) Portrait of Mathew Carey. took the lead. When they visited City Hall, the mayor Historical Society of Pennsylvania Portrait Collection. responded enthusiastically to their proposal. He even agreed to free black prisoners in the Walnut Street Jail— most of them confined for fleeing racial bondage—if they would help save the city. During their duties, volunteers encountered horrifying scenes. Jones and Allen, along with William Grey, another leader of the They discovered hundreds of corpses alone in homes, reported Jones Free African Society, placed ads in newspapers announcing that and Allen, “many of whose friends and relations had left them, black Philadelphians stood ready to care for the sick and collect died unseen, and unassisted.” Some lay “on the floor, without any and bury the dead. “Sensible that it was our duty to do all the appearance of their having had even a drink of water for their relief; good we could to our suffering fellow mortals,” Jones and Allen others were lying on a bed with their clothes on, as if they had come noted, we “set out to see where we could be useful.” In groups of in fatigued, and lain down to rest; some appeared, as if they had fallen two, they walked the streets every day, stopping to see who needed dead on the floor, from the positions we found them in.” help. For the next several months, African Americans, both free The encounters with orphans were particularly heartrending. and enslaved, cared for the stricken, carted the ill to the hospital “We found a parent dead and none but little innocent babes to be and the dead to the cemetery, organized workers to dig graves, and seen, whose ignorance led them to think their parent was asleep. buried the dead. They also acted as constables: patrolling the streets, On account of their situation, and their little prattle, we have been guarding abandoned properties, apprehending looters, and keeping so wounded and our feelings so hurt, that we almost concluded to order amid chaos. For the first time in history, the black community withdraw from our undertaking.” Fear of catching the disease kept wielded enormous public authority in America. white neighbors and kin from offering any help, sometimes to the Jones, Allen, and Grey worked tenaciously themselves and extent that it gave the “appearance of barbarity.” When possible, the supervised a large group of others willing to help. They followed up humanitarian patrols “picked up little children that were wandering after Dr. Rush, visiting 100 sick people a day. Nursing is particularly they knew not where, and took them to the orphan house.” beneficial to yellow fever patients, since hydration is one of the keys As they exposed themselves to the disease by going into homes to recovery. Without regular water, most infected people die. around the city, especially those near the Delaware River, where the Black volunteers likewise helped transform colonial lawyer Andrew infection was most intense, many African Americans began to sicken Hamilton’s Bush Hill estate from a private mansion to a hospital. and die. Dr. Rush had told them that yellow fever “passes by persons of When authorities first assumed control of the building, it served your color.” However, except for those who had immunity from growing primarily as a warehouse for sick people on their way to the grave. up in West Africa and contracting the disease during childhood, black Lacking beds, medical supplies, food, blankets, doctors, and nurses, Philadelphians possessed no biological resistance to yellow fever. To it quickly became known as a den of death. Many of the ill refused to draw attention to the sacrifice of the African American community, go to the hospital during the early weeks of the epidemic, preferring Allen and Jones cited the increase in burials: “In 1792, there were 67 instead to take their chances at home. of our color buried, and in 1793 it amounted to 305; thus the burials As black laborers and draymen steadily carted supplies and among us have increased more than fourfold.” They concluded that just water to Bush Hill, Anne Saville, a member of the Free African “as many colored people died in proportion as others.” Society, took over the nursing responsibilities, not only caring for My own study, based on mapping all residents of the city during the individual patients but also organizing the staff, both blacks and 1790s, confirms Allen and Jones’s contention about the high mortality whites. Under her direction, the hospital changed within weeks endured by black Philadelphians. The map “Yellow Fever Deaths from “a great human slaughterhouse” to an institution in which 1793” shows higher and lower concentrations of deaths caused by most patients survived the disease. the disease. In darker red areas, along the northern wharves and in

Pennsylvania Legacies Spring 2019

YELLOW FEVER DEATH S 1793

W S

0.1–4.99%

Deaths from Yellow Fever by Street

5–9.99% 10–14.99% 15–19.99% 20–67%

F REE AF RI CAN AMERICAN H OUS EH OLDS in philadelphia 17 89–1791

Free African American Heads of Household

(TOP) The

map “Yellow Fever Deaths 1793,” shows higher and lower concentrations of deaths caused by the disease. In darker red areas, along the city’s waterways, between 20 and 67 percent of residents died. In the middle and western portions of the city, however, deaths were much fewer. (BOTTOM) “Free African American Householders in Philadelphia 1789–1791.” Most free black householders in Philadelphia congregated in the middle or western edge of the city, the neighborhoods that suffered the least mortality during the epidemic. As black people volunteered to nurse and bury victims, however, they exposed themselves disproportionately to the mosquito-borne plague. Both maps created by Billy G. Smith and Paul Sivitz, et. al.

Spring 2019 Pennsylvania Legacies

“At the Peril of Our Lives” Absalom Jones and Richard Allen Respond to Mathew Carey

Early in September, a solicitation appeared in the public papers, to the people of colour to come forward and assist the distressed, perishing, and neglected sick; with a kind of assurance, that the people of our colour were not liable to take the infection. Upon which we and a few others met and consulted how to act on so truly alarming and melancholy an occasion. . . . . . . We called on the mayor next day. . . . The first object he recommended was a strict attention to the sick, and the procuring of nurses. . . . Soon after, the mortality increasing, the difficulty of getting a corpse taken away, was such, that few were willing to do it, when offered great rewards. The black people were looked to. We then offered our services in the public papers, by advertising that we would remove the dead and procure nurses. . . . When the sickness became general, and several of the physicians died, and most of the survivors were exhausted by sickness or fatigue; that good man, Doctor Rush, called us more immediately to attend upon the sick. . . . This has been no small satisfaction for us; for, we think, that when a physician was not attainable, we have been the instruments, in the hand of God, for saving the lives of some hundreds of our suffering fellow mortals. We feel ourselves sensibly aggrieved by the censorious epithets of many, who did not render the least assistance in the time of necessity, yet are liberal of their censure of us, for the prices paid for our services. . . . We feel ourselves hurt most by a partial, censorious paragraph, in Mr. Carey’s second edition, of his account of the sickness, &c. in Philadelphia . . . where he asperses the blacks alone, for having taken the advantage of the distressed situation of the people. . . . It was natural for people in low circumstances to accept a voluntary, bounteous reward; especially under the loathsomeness of many of the sick, when nature shuddered at the thoughts of the infection, and the task assigned was aggravated by lunacy, and being left much alone with them. Had Mr. Carey been solicited to such an undertaking, . . . what would he have demanded? but Mr. Carey, although chosen a member of that band of worthies, who have so eminently distinguished themselves by their labours, for the relief of the sick and helpless—yet, quickly after his election, left them to struggle with their arduous and hazardous task, by leaving the city. . . . (TOP) Portrait

. . . The case of the nurses, in many instances, were deserving of commiseration, the patient raging and frightful to behold; it has frequently required two persons, to hold them from running away, others have made attempts to jump out of a window, . . . others lay vomiting blood, and screaming enough to chill them with horror. Thus were many of the nurses circumstanced, alone, until the patient died, then called away to another scene of distress, and thus have been for a week or ten days left to do the best they could without any sufficient rest, many of them having some of their dearest connections sick at the time, and suffering for want, while their husband, wife, father, mother, &c. have been engaged in the service of the white people. . . . Few have been the whites that paid attention to us while the black were engaged in the other’s service. We can assure the public we have taken four and five black people in a day to be buried. In several instances when they have been seized with the sickness while nursing, they have been turned out of the house, and wandering and destitute until taking shelter wherever they could (as many of them would not be admitted to their former homes) they have languished alone and we know of one who even died in a stable. . . . It is even to this day a generally received opinion in this city, that our colour was not so liable to the sickness as the whites. We hope our friends will pardon us for setting this matter in its true state. The public were informed that in the WestIndies and other places where this terrible malady had been, it was observed that the blacks were not affected with it. Happy would it have been for you, and much more so for us, if this observation had been verified by our experience. When the people of colour had the sickness and died, we were imposed upon and told it was not with the prevailing sickness, until it became too notorious to be denied, then we were told some few died but not many. Thus were our services extorted at the peril of our lives, yet you accuse us of extorting a little money from you. Absalom Jones and Richard Allen, A Narrative of the Proceedings of the Black People, during the Late Awful Calamity in Philadelphia, in the Year 1793: And a Refutation of Some Censures Thrown upon Them in Some Late Publications (Philadelphia, 1794) (excerpt)

of Bishop Richard Allen. Historical Society of Pennsylvania Portrait Collection. (BOTTOM) Portrait of Rev. Absalom Jones. Leon and Beatrice M. Gardiner Collection.

Pennsylvania Legacies Spring 2019

a crooked line along Dock Creek, between 20 and 67 percent of the residents died. In the middle and western portions of the city, however, deaths were much fewer. The reason for this disparity was the range of the mosquitoes that spread the virus. The Aedes aegypti fly fewer than 100 yards in their lifetime, meaning that after they were introduced along the wharves by docking ships, they fed on people living within a few blocks of the Delaware River. Most free African American householders congregated in the middle or western edge of the city, the neighborhoods that suffered the least mortality during the epidemic. As black people volunteered to nurse and bury infected victims of the disease, however, they walked the streets near the wharves, exposing themselves disproportionately to the diminutive denizens of death. Their higher mortality resulted from their selfless commitment. After the epidemic, many white people praised black Philadelphians’ invaluable service to the city. Mayor Clarkson and Dr. Rush both commended African Americans for their work. Other white citizens agreed. As Isaac Heston noted gratefully, “I don’t know what the people would do if it was not for the Negroes, as they are the Principal nurses.” Black volunteers had saved countless lives of white and some African American inhabitants. Racism would devise its own interpretation, though. In his popular instant history of the epidemic, Mathew Carey accused black nurses and gravediggers of extorting money for their services. In virtually all epidemics during the previous century, caretakers had been criticized for ineptitude, thievery, and neglect of their patients. This attack was different, however, because it was also racially based. Black leaders were appalled to see their community excoriated in one of their finest hours. If this was the reaction to their heroic sacrifice, then what hope did they have for gaining acceptance and some measure of equality from the larger white community? Outraged, Allen and Jones responded to Carey’s censure, writing a remarkable pamphlet, A Narrative of the Proceedings of the Black People, during the Late Awful Calamity in Philadelphia in the Year 1793. The document provided an extraordinary eyewitness report of the conduct of one of the earliest free black communities. Even more important, it also publicly articulated the anger of many black people toward Carey specifically and to the wider institution of slavery in general. These feelings had rarely, if ever, found their way into print in early America. Since Carey’s account praised Jones and Allen by name, the two ministers easily might have decided not to reply to his criticism of other African Americans. Their heated response indicates that they identified deeply with their community, believed they needed to defend its reputation, and desired to establish an African American voice independent of the control of whites. Carey’s critique also required a response because it undermined arguments that the behavior of blacks during the epidemic demonstrated their rights to equality and full citizenship. The epidemic thus provided the first platform for black Americans to critique slavery in a public forum. Jones and Allen pointed out that slaves were not content with their lot, contrary to what many whites believed. Were “we to attempt to plead with our masters, it would be deemed insolence,” the authors explained. “We do not wish to make you angry, but excite your attention to consider, how hateful slavery is in the sight of that God, who hath destroyed kings and princes, for their oppression of the poor slaves.” Jones and Allen also warned whites of the danger inherent

A Sunday Morning View of the African Episcopal Church of St. Thomas in Philadelphia.—Taken in June 1829, by W. L. Breton. Historical Society of Pennsylvania Medium Graphics Collection.

in keeping people in bondage. North American slaves, like their contemporary counterparts in St. Domingue, might rebel. Jones and Allen addressed other African Americans in their pamphlet as well. As Christian ministers, the authors exhorted slaves to take solace in religion and to love their masters regardless of their misdeeds. Individuals in bondage, they urged, should try to convince their owners to grant them an opportunity to gain freedom. The two ministers, along with thousands of other enslaved persons, had achieved their liberty through selfpurchase or individual manumission during the earlier decade. They advocated the same avenue for others. Regardless of Carey’s criticism, the laudable behavior of African Americans during the 1793 epidemic helped soften the racial attitudes of white Philadelphians during the 1790s. “We have been beholden to the poor; to the despised blacks, for nurses to attend the sick,” read the report of the Committee to Alleviate Suffering, “as if Providence were determined to convince us that they are equally the objects of His care, with ourselves.” Still, the larger society ultimately refused to embrace blacks as either citizens or equals. Carey’s original criticism, coupled with the mortal evidence that blacks did not enjoy a special immunity to yellow fever, discouraged many African Americans from attending the sick in subsequent epidemics in the city during the next decade. As discouraged black people withdrew from the fight against the disease, the city’s mortality rose even higher during subsequent outbreaks. Billy G. Smith has been teaching, researching, and writing history for approximately 107 years. He is a distinguished professor of letters and science at Montana State University.

Spring 2019 Pennsylvania Legacies

LAZARET GHOST STORIES by David Bar nes

Pennsylvania Legacies Spring 2019

veryone says the Lazaretto is haunted. Why wouldnâ&#x20AC;&#x2122;t it be? It was a quarantine station and hospital for nearly a century. Ships, cargo, sailors, and immigrants were detained there, sick people were treated there, and many died there. Hulking and empty, built in 1799 and awaiting restoration, the Main Building certainly feels spooky. Volunteer firefighters on the night shift across the way say that a female figure used to appear periodically at a second-story window. Others say theyâ&#x20AC;&#x2122;ve heard disembodied voices telling them to leave, or children crying out for their parents. Tales of apparitions go back decades. The Lazaretto Quarantine / Tinnectum on the Delaware, by Thomas L. Cernea, watercolor, circa 1860s, 43.7.10. Courtesy of the Philadelphia History Museum at the Atwater Kent.

Spring 2019 Pennsylvania Legacies

I have never believed in ghosts. To my mind, the Lazaretto is just full of stories. There’s the story of Dr. Thomas Jefferson Perkins Stokes, the quarantine physician who was prosecuted for dereliction of duty in 1853 after he allowed a ship to proceed to the city, where it allegedly ignited a yellow fever epidemic. There’s also Tobias Smith, a mischievous 11-year-old orphan who was accused of starting a yellow fever outbreak in 1805 by illegally visiting ships under quarantine and returning to the city. And Mary Riddle, the widow who saved the Lazaretto from chaos and despair in its darkest hour, when an 1870 outbreak of the same disease engulfed the station, killed its principal officers, and spread upriver into the city of Philadelphia yet again. Then there’s Mary Ann Ganges, the nine-year-old girl who was captured and enslaved in West Africa, then freed as soon as she arrived in the United States and indentured as a domestic servant to the quarantine master. The place is positively saturated with stories. They are stories of pain and sickness, of fear and despair and death. They are stories of separation, of longing, of hope and healing and survival. If you listen carefully, you can even hear 21st-century echoes of distant 19th-century voices: immigrants calling out for medicine, food, shelter, opportunity; nativists fearing what the immigrants might bring with them; warnings of yet another epidemic imported from overseas; calls for vigilance— always more vigilance—against shadowy foreign threats; and patients and caregivers seeking healing in the midst of suffering and death. Maybe that’s just another way of saying it’s haunted. Yellow fever struck Philadelphia four times in the 1790s with devastating fury, killing upwards of 11,000 residents in the nation’s capital and largest city. Desperate to stem the deadly tide, the city’s newly established Board of Health replaced the old quarantine station at the mouth of the Schuylkill with a new, larger outpost farther downstream on the Delaware River at Tinicum Island. Doctors were bitterly divided over whether yellow fever spread contagiously from arriving ships or originated locally in accumulated filth. The Board of Health resolved both to clean up the city and to intercept incoming vessels at the Lazaretto. From 1801 to 1895, ships, cargo, and passengers were inspected and occasionally detained at Tinicum Island before being permitted to proceed to the Port of Philadelphia. Hundreds died at the Lazaretto; thousands more survived shocking shipboard conditions to begin new lives in a new land. When I first laid eyes on the Lazaretto 13 years ago, I was completely unprepared for what I saw. What does a “quarantine station” look like, anyway? I imagined a homely utilitarian warehouse, half-ruined and crumbling into the river. After pulling my car over next to the fence on Second Street in Essington, just a couple of miles from the airport, in a

Pennsylvania Legacies Spring 2019

riverside neighborhood of small industrial sites and modest workingclass homes, I peered across a five-acre lot of patchy grass. There were a few decrepit boats scattered around the field on rusting trailers. Looming beyond, as if still standing silent sentry over the riverfront, was what looked like a huge red-brick Georgian manor house. My eyes widened. This place was BIG, I thought. Not just big, but grand. Stately. I found an opening in the fence and walked toward the Main Building. Up close, the signs of age became more apparent. Patchy pointing in the elegant Flemish bond brickwork and leaning pillars on the long colonnaded portico testified to years of disuse. An intricately detailed wrought-iron gate, three smaller empty outbuildings, and the repurposed Lazaretto physician’s house (now the Riverside Yacht Club) hinted at a once larger campus of differentiated functions. Even with the jets taking off overhead, the vista across the slow ribbon of river to the forest of Little Tinicum Island struck me as weirdly bucolic. My head swam with questions: Why so big? Why so stately? Why here, of all places? And most of all: What went on here? I have been hunting for answers ever since. At the Philadelphia City Archives, the first piece of paper I saw took my breath away. August 1, 1801, the first surviving entry in the minutes of the Board of Health after the Lazaretto’s opening earlier that year: “A communication was received from the Resident Physician stating the arrival of the Brig Adventure . . . from Liverpool, with 102 passengers, 53 of whom died on the voyage, and the remainder with the crew, except the Mate, are all sick. Therefore Resolved that the sick be immediately removed to the Hospital, and the well, if any, be provided with tents back of the Lazaretto, where they are to be supplied with every necessary suitable to their health & comfort, and the vessel to be detained, untill she has been thoroughly cleansed & purified.” I was hooked.

(LEFT TO RIGHT) “The

Main Building at the Lazaretto,” photograph by Henry Leffmann, in Henry Leffmann, Under the Yellow Flag (Philadelphia, 1896); Third-floor passage, center block, Lazaretto Quarantine Station. Photograph by James W. Rosenthal, 2005. Historic American Buildings Survey (HABS PA-6659-34), Library of Congress Prints and Photographs Division, Washington, DC; Hospital building and “After Dinner” at the Lazaretto, Sept. 30, 1886, photographs by Henry Leffmann, in Henry Leffmann, Under the Yellow Flag (Philadelphia, 1896).

Years of research later, when I visit the Lazaretto, I hear stories wherever I turn. I walk up to the gate, admiring the ironwork, and I hear the voices of the Woodburys, a lonely wife and her seafaring husband, separated only by that iron gate as they briefly reunited by permission of the Board of Health when Mr. Woodbury’s ship was detained at the Lazaretto in May 1803. I hear the stern indignation of the members of the board as they rebuked the Lazaretto physician and quarantine master for not policing comings and goings at the gate more strictly just a year after the Tinicum station’s opening. And I am reminded that security at the gate had a dual function: it guarded against the possible spread of disease beyond the Lazaretto’s fences, but it also played a role in the performance of public vigilance. The station’s officers and the Board of Health needed both to be vigilant and to seem vigilant. The efficacy of quarantine had a biological dimension and a social dimension. A traumatized and anxious public needed to know that its maritime quarantine was leakproof, just as today we need to know that public health and homeland security officials aren’t letting down their guard in protecting us from pandemics and terrorists.

As I approach the river’s edge by the flagpole and the wobbly seaplane pier, I turn to face downriver. On a clear day, I can see as far as Wilmington, Delaware, 15 miles to the southwest. Behind the roar of jet engines overhead, I can hear the sailors’ boisterous shouting and the creaky rigging of the three-masted ships sailing toward Philadelphia, laden with coffee from Cuba, rags from Leghorn (Livorno) in Tuscany, and starving immigrants from Ireland. I hear today’s debates over the benefits and dangers of “globalization,” discussed as if it were a new phenomenon, and think of the Lazaretto’s early years, which were also the nation’s early years. Commodities, people, and news from the farthest corners of the world flowed past this place every day, into and out of the busy port city of Philadelphia. Walking back toward the Main Building across the lawn, I hear the angry voices of the German passengers from the ship Rebecca, who arrived at the Lazaretto in August 1804. Waves of cases of typhus or “ship fever” from shiploads of mostly German-speaking arrivals overwhelmed the station. These were the “redemptioners,” poor immigrants forced to indenture themselves upon arrival to pay for their passage. There was no room indoors for all of the sick, much less for the healthy passengers undergoing quarantine, so they were housed in tents on the lawn. Resentment over their callous treatment during the unusually long voyage and frustration that their progress had been stalled so close to their destination boiled over into a riot among the Rebecca’s passengers, causing several hundred dollars’ worth of damage to the Lazaretto. Their harrowing journey first opened my eyes to the prevalence of human trafficking in the early settlement of the northern United States. Less remembered (and less extensive) than the horrors of the slave trade, the traffic in “voluntary” migrants nevertheless impoverished and killed thousands over decades. Networks of recruiters and middlemen, working in tandem with shipowners and sea “The Kind of ‘Assisted Emigrant’ We Can Not Afford to Admit,” cartoon by Friedrich Graetz, published in Puck, July 18, 1883. Balch Broadsides: Satirical Cartoons.

Spring 2019 Pennsylvania Legacies

PESTILENCE The Yellow Fever in this City HOW IT WAS BROUGHT AMONG US First Victims of the Disease TERRIBLE DANGER MENACING PHILADELPHIA

An Infected Cargo at Windmill Island

Another more violent disease than the relapsing fever is at our doors—aye, in our very midst. It is the yellow-fever, by many known as the fatal black-vomit. This frightful epidemic years ago scourged this city, and only as recently as 1855 swept with devastation through Norfolk and Portsmouth, Va., carrying away hundreds every day. . . . THE BLACK-VOMIT AT OUR DOORS. Assertions go for naught, but facts are indisputable things, and we will now lay before our readers that which will make them ponder and reflect as to the criminal responsibility of some one for not preventing the spread of the direful black vomit almost at our very doors. On the evening of the 29th of June, the barque “Home,” from Blackriver, Kingston, Jamaica, arrived in the Delaware off Quarantine. She had a cargo of logwood consigned to this city, and it being reported that the Commander, Captain Phillips, had died of a malignant fever off Cape Hatteras, she was detained, anchored off the Lazaretto. While here, several lighters were engaged to take the logwood which was discharged from her. Some filthy old rags, which were stored in the hold, were taken therefrom and burned on the Quarantine wharf. This is a little more than a fortnight since, and a few days afterward the yellow fever made its appearance, both among the officers and crew of the vessel and the people living on the bank of the Delaware close to the “Lazaretto.” Some attributed the disease to the burning of the rags, and others to the logwood which was being discharged. The barque was very filthy, and during the passage some of the logwood became very wet and foul, and in this it is surmised that the seeds of the disease were developed. Be this as it may; it is very certain that the disease was brought by the vessel, and by this time has spread itself, not only beyond the locality in which it originated, but to this city, and to points many miles distant, as facts which have been developed plainly show. ITS SPREAD. Though it was impossible to ascertain all whom the disease had attacked, yet it is pretty certain to have commenced outside of the Quarantine grounds in the family of Mr. Jacob Pepper, who keeps a public house adjacent to the Lazaretto Station. . . . The physicians in attendance did not at first announce the true nature of the disease, but upon its attacking some of the older members of the family, the fever presented such unmistakable symptoms of its true character that all had to coincide that it was yellow fever. . . . About the first victim was a very aged lady, Mrs. Enos, the mother-in-law of Mr. Pepper, who died during the early part of last week.

Pennsylvania Legacies Spring 2019

Then, the same day, the servant girl of the family was taken down. On Sunday Mr. Pepper himself expired. . . . A sister-in-law of the deceased, a Mrs. Mary Johnson, is now lying very low with the fever. To-day, too, Mrs. Mary Kugler, the wife of the Steward of the Quarantine station, will be buried, she having also died of the blackvomit, attendant upon the yellow fever. Inside the Quarantine grounds several have died; and, at the present time, Dr. Thompson, the physician in charge, is not expected to recover. He worked assiduously, not only at his official post, but beyond it, and at last fell a victim to the malady which he was earnestly combatting. His wife and daughter were very low with it, but, happily, they are now convalescent. . . . DISEASE DUMPED IN FRONT OF THE CITY. The “Home,” being filthy and diseased, was not allowed to proceed to the city, but her cargo, composed principally of logwood, was transferred to three lighters, one of which sailed up to Windmill Island, opposite the city, where the load of logwood was dumped. The lighter then moved down the Delaware and proceeded up the Schuylkill. The logwood now lies beneath the hot rays of the sun, and if there be yellow fever in it, as many persons suppose, it certainly must be developed sooner or later. . . . . DOWN WITH THE FEVER. . . . Under favorable circumstances, the malady developes [sic] with great rapidity, though, at times, it is known to slumber for a while and then break forth to amaze and terrify people who imagined themselves free from its unwelcome and deadly presence. Cleanliness and plenty of ventilation go a great way toward warding off diseases of all kinds. Private parties should keep this constantly in view and public officials should not lose sight of it, for by strict sanitary precautions an epidemic may be staved off, which, if allowed to get headway, would carry hundreds and thousands to untimely graves. As “an ounce of prevention is worth more than a pound of cure,” it is better now to commence in originating the proper measures than to wait for the disease to get a strong foothold. . . . Philadelphia Inquirer, Aug. 9, 1870 A case of infectious fever (from “81 South Street, 4 doors from Callowhill Street,” Philadelphia) before the New York Board of Health, 1820. Historical Society of Pennsylvania Medium Graphics Collection.

captains, traveled parts of the European countryside scarred by war and economic dislocation, preying upon the hopes of the vulnerable. They promised the world and then systematically separated the migrants from their money and possessions, profiting every step of the way, until they took their final cut from the indenture in the United States. The shouts of the Rebecca redemptioners mingle in my head with the voices of the victims of human trafficking today, telling journalists about the lies they were told and the subhuman conditions in which they were forced to live. I step up onto the portico and peer in through the ground-floor windows at the fancy millwork of the two front rooms in the Main Building’s central pavilion. The elegant adornments of the doors, windows, moldings, and mantelpieces signal that these were the most important and most public rooms at the Lazaretto: the office and the boardroom. Here the Lazaretto physician carried on the public business of quarantine, including writing his twice-daily reports; here members of the board held their meetings when they visited the station. I can hear the board and the doctor debating the delicate question of quarantine in the face of equivocal evidence. Enforce quarantine too strictly, and they risked detaining harmless vessels and damaging the prosperity of a bustling port. Open the doors too widely, and they risked allowing the ember that could ignite another epidemic to pass through. The central dilemma of quarantine amounted to a no-win proposition. Continuing along the portico to the west wing of the Main Building—originally one of the two hospital wings—I look in the windows to the rooms where patients were once treated. I hear the bustle and chaos of those early typhus years and of the occasional arrival of a ship with yellow fever aboard. One or two nurses rushing about, tending to dozens of patients at a time, feeding and bathing and changing bedding and cleaning up excretions and administering remedies, the doctor stopping by in between inspections of newly arrived vessels. Patients calling out in pain, or simply in fear. Then there’s the quiet of sleep, or coma, or worse. But death visited these rooms surprisingly rarely. In the years for which records survive (1847–93), nine out of ten Lazaretto patients survived—even those with serious cases of fatal diseases like typhus and yellow fever, for which no specific and widely effective treatment existed at the time. How was this possible? I think the answer lies in the mundane chores that had the nurses rushing about so busily. Even today, in outbreaks of infectious diseases like Ebola hemorrhagic fever, most patients die from want of basic care, not expensive drugs. Food, water, clean linens, and rest were the “cures” provided at the Lazaretto. And as I look in the windows, I think 19th-century nurses’ and patients’ voices might contribute something valuable to our present-day conversations about “incurable” diseases. When the

next epidemic comes, will we listen to the lessons of the Lazaretto? When I stand on the portico of the Main Building, I look downriver, toward the Atlantic and the wider world beyond, and see the ships laden with goods and immigrants sailing to Philadelphia. I turn and look upriver, toward the city, and see the Board of Health and the anxious populace, anticipating and enduring and remembering deadly disease outbreaks. And I look inside the Lazaretto’s buildings to bear witness to the labor, the suffering, the deaths, and the survival of doctors, nurses, and patients over the years. Their experiences, buried in the archives, testify to the high-stakes drama of quarantine at the water’s edge, where potential tragedy always loomed in the background of everyday boredom and drudgery. After opposition from Delaware County real estate interests shut the Lazaretto down in 1895, the old station became a country club called “The Orchard,” summer home of the Athletic Club of Philadelphia. In 1916, as the United States prepared to enter World War I, a few members of the club bought “flying boats” and opened what eventually became the Philadelphia Seaplane Base, which operated on the site until 2000. Today, Tinicum Township (which now owns the property) is restoring the Main Building in preparation for moving its municipal offices there. A preservation campaign is working to turn the Lazaretto into a site for recreation, education, historical exhibits, and events related to immigration and public health. As I pass by the gate again on the way to my car, I hear one last voice in the distance. It’s a teenage girl, coming home from school. The Board of Health, which alone could permit people to enter and leave the Lazaretto grounds, resolved on July 14, 1806, “that the bound girl of the quarantine master be permitted to attend school in the vicinity of the Lazaretto.” That girl was Mary Ann Ganges, six years after her enslavement, liberation, and indenture. She was about 15 years old. Like a healthy passenger enduring a long quarantine, she was not quite free. I strain to listen, but I can’t quite make out what she’s saying. These are the Lazaretto voices—and silences—that haunt me. David Barnes is associate professor of history and sociology of science at the University of Pennsylvania. He is the author of The Making of a Social Disease: Tuberculosis in Nineteenth-Century France (University of California Press, 1995) and The Great Stink of Paris and the Nineteenth-Century Struggle against Filth and Germs (Johns Hopkins University Press, 2006). (ABOVE) Doorknob

detail, Lazaretto Quarantine Station. Photograph by James W. Rosenthal, 2005. Historic American Buildings Survey (HABS PA-6659-49), Library of Congress Prints and Photographs Division, Washington, DC. (BELOW) Glass lantern slide of the Lazaretto quarantine station. Frances Anne Wister Lantern Slide Collection.

Spring 2019 Pennsylvania Legacies

Pennsylvania Legacies Spring 2019

HOMEFRONT CASUALTIES Philadelphia’s Influenza Disaster

BY JAMES HIGGINS

he centennial of the end of the Great War continues to overshadow the hundredth anniversary of an even deadlier catastrophe, the great influenza pandemic of 1918–19. Estimates of its global death toll top 50 million. In the United States, deaths exceeded 750,000 and may even have reached a million by 1922, when it is generally thought that the last localized outbreaks of the virus responsible for the pandemic occurred. By comparison, the First World War killed about 20 million soldiers and civilians, including 116,000 Americans (most of whom actually died of influenza). Pennsylvania undoubtedly experienced the worst epidemic of influenza in America, especially during its most acute phase, September 1, 1918–March 31, 1919, in which at least 67,000 of the commonwealth’s citizens perished. No other state suffered as many deaths or as high a mortality rate. At the municipal level, Pittsburgh, Scranton, and Philadelphia produced the highest mortality rates for major American cities. For scholars of the pandemic, Philadelphia continues to prove an important touchstone for the havoc the virus proved capable of wreaking. (LEFT) A

newspaper headline from October 16, 1918, announces record numbers of deaths in Philadelphia. World War I Publicity Scrapbook, Emergency Aid of Pennsylvania Records. (TOP) Seminarians unloading caskets from a truck, 1918; (BOTTOM) Seminarians carrying the casket of an influenza victim, 1918. Catholic Historical Research Center of the Archdiocese of Philadelphia.

Spring 2019 Pennsylvania Legacies

Sailors lined up for inspection at the Philadelphia Navy Yard, circa 1918. Philadelphia War Photograph Committee Collection.

The population of Philadelphia soared between 1914 and 1918 as tens of thousands of people flooded the city looking for work in the metropolis’s war industries. The density of the city’s housing increased while sanitary conditions deteriorated and rates of infectious disease climbed. By the spring of 1918, the influenza virus that ultimately caused the pandemic had already begun to sicken people, though it almost certainly did not arise at Camp Funston, Kansas, as is often postulated by scholars who took an early report of influenza at the camp as evidence for the epidemic’s beginning among its soldiers. Instead, a particularly virulent form of the virus appears to have emerged in the port cities of England, perhaps among Chinese laborers employed by the British on the western front. It was from one of these ports, Liverpool, that a ship transported virulent influenza to Philadelphia in what was likely the first recorded instance of a highly lethal iteration of the virus alighting in North America. The virus’s journey began on June 9, when HMS City of Exeter departed Liverpool for Philadelphia. The ship, a small passenger liner that the British pressed into service during the war as a military transport and cargo vessel, had a few dozen sailors aboard, many of them from India. A few days out of Liverpool, men began to fall rapidly ill with symptoms that included wracking body aches, fever, and coughing. Many of the stricken sailors developed serious cases of bacterial pneumonia as a sequel to their viral infection. By June 21, when the ship entered the Delaware River, grievously ill men lay throughout the City of Exeter, and an unknown number may have been buried at sea. Philadelphia health authorities quarantined the vessel before it could reach the city’s docks. The British consul in Philadelphia arranged for the ship’s crew to be moved from the vessel to Pennsylvania Hospital under the care of specialists from the University of Pennsylvania. Of the two dozen sailors taken

Pennsylvania Legacies Spring 2019

off the ship, roughly a quarter succumbed in the hospital to the infection. Throughout the summer of 1918, more ships with sick crews arrived in New York City and Halifax. In a century of research, however, no scholar has produced evidence that another ship with virulent cases of influenza aboard docked in a port in the western hemisphere before the City of Exeter dropped anchor in the Delaware River. Perhaps the virus on board the City of Exeter failed to ignite an epidemic in Philadelphia because of the stringent isolation measure. Or perhaps the virus had run completely through the crew before the vessel docked, leaving behind only cases of bacterial pneumonia. It is also possible that the virus had not yet evolved to optimize itself for transmission between people. In any event, Philadelphia avoided a general outbreak of influenza—as did the rest of the world—until August of that year. During that month, virulent influenza, its mutations having brought it to a level of infectiousness and lethality never matched before or since by an influenza virus, began to sweep across Africa, Europe, and North America. The epidemic in the United States began at the end of August 1918 in a naval facility in Boston. Within a few days, a few men turned up ill with influenza at the Philadelphia Navy Yard. September saw the number of cases build slowly in the city, and by mid-September several hundred cases might be found clustered in the working-class neighborhoods near the Navy Yard and other major industrial firms. At first, Philadelphia’s epidemic did not differ from that in other major American cities. Yet by the first week of October, roughly five weeks into the outbreak, Philadelphia’s mortality rate accelerated in a climb unmatched by any city in the nation—perhaps by any major city in the world. The reason for that acceleration lay in another event unique to Philadelphia’s outbreak. In addition to taxes, America paid for the war effort through Liberty Loans. These were designed with a dual purpose: they not only generated revenue but also raised morale by heightening the public’s patriotism. In all, there were four loan drives. The fourth, which began September 28, 1918, was the most successful. On that date, communities throughout America began the drive with parades. Even very small towns gathered the resources for flags, bunting, and marching bands to proceed down their main streets in great patriotic displays. Philadelphia hosted the largest and most spectacular of these parades. It ran 23 blocks, from Broad and Diamond Streets to Broad and Mifflin Streets, and consisted of several echelons of marchers, including military personnel,

The sheer number of corpses would have overwhelmed the city during even normal times, but with so many sick or away in uniform, the city simply could not cope. industrial workers, and Red Cross nurses. In addition to the usual stock of red, white, and blue onlookers might see at a July Fourth celebration, the Fourth Liberty Loan parade included such splendid sights as an airplane mounted on a float and under construction even as it made its way down Philadelphia’s main thoroughfare. At times, members of the crowd, especially boys, rushed a new piece of modern military technology—a new model British tank—and were allowed to clamber over the behemoth to inspect its tracks and gun ports. Above the city, a formation of new bombers (and in 1918, airplanes were still a rare and exciting sight) circled the city for an hour as anti-aircraft guns in hidden locations engaged them with “defensive fire” (shells fused to explode safely beneath the planes). Military units in the parade stopped to demonstrate bayonet and marching drills while speakers harangued the crowd with brief, pointed speeches about the sacrifices America’s men and women in uniform were making on the battlefields of France. The rally’s final flourish was its review by the governor, mayor, and members of the city’s most powerful industrial families. After the estimated 12,000 marchers disbanded, the parade’s at least 200,000 onlookers continued the festivities in singalongs and saloons before they returned to their homes and jobs. The virus, an invisible presence at the parade, had enjoyed an unprecedented opportunity to spread throughout the city and in the coming days announced its presence in a skyrocketing wave of sickness and death. In the week following the parade, authorities counted over 1,100 deaths attributed to influenza, with dozens more unrecorded, especially among the ranks of war workers and the poor. In the midst of that first terrible week of October, the state department of health mandated a

crowd ban prohibiting most gatherings related to entertainment venues and banned the sale of alcohol for all but medicinal purposes. The city extended the ban by closing schools and all houses of worship. While these measures likely reduced the rate of transmission in many other communities in Pennsylvania, it was too late in Philadelphia—the parade had already done the work of spreading the virus. Even before the crowd ban began, every hospital in the city was packed with the sick and dying. The city’s department of health opened 10 emergency hospitals, but with so many nurses and doctors serving in the military or sick themselves, few healthcare workers remained to staff them. As bad as the first week of October was, the next week was much worse, with roughly 3,000 deaths. The week after that saw well over 4,000 fatalities. The sheer number of corpses would have overwhelmed the city during even normal times, but with so many sick or away in uniform, the city simply could not cope. It was at this juncture that Philadelphia’s outbreak transitioned from an awful, but managed, epidemic to a disaster unlike any other in the developed, urban world. In many cases, the bodies of the dead could not be removed from homes—and those that were, were stacked by the hundreds in a morgue with space for only 36 bodies. Cemeteries could not keep up with the flow of bodies and had no option but to allow the dead to be piled in sheds and on the open ground, often without coffins. People recalled the streets of the poorer sections of the city literally reeking with the smell of putrefying corpses, and the stench in homes must have been unbearable for the loved ones of the deceased. According to elected officials, panic creeped into the minds of the poor, for whom there appeared no end to the sickness and death that stalked their neighborhoods. To the rescue rode the Roman Catholic archdiocese, the largest charitable organization in Philadelphia. The diocese acted on behalf of the city’s health department to pursue a two-pronged rescue effort. Hundreds upon hundreds of nuns moved into the emergency hospitals and throughout the neighborhoods of city. Their presence, and the swiftness with which they reacted to the diocese’s orders, effected an immediate change in the manner in which the sick and dying were treated. Until then, emergency hospitals had acted more as

The Philadelphia Council of Defense took out newspaper ads encouraging flu-stricken readers to call the hotline “Filbert 100—Influenza.” This one appeared in the Philadelphia North American, Oct. 10, 1918. Philadelphia Council of Defense Scrapbook. Spring 2019 Pennsylvania Legacies

Work of Defense Council in Fight against Influenza All Problems Met Except That of Motor Trucks, for Which There Is Great Need, to Carry Bodies to Buildings, Where They Will Be Prepared for the Grave. In the comprehensive plans of the Philadelphia Council of National Defense, backed by the Mayor’s pledge of city money to any limit necessary, to bury the city’s dead and free the public mind from fear, it was reported yesterday by Executive Secretary Robert D. Dripps that organization adequate to the problem had been effected along all lines, but the important one of motor trucks. “The main points upon which we are prepared to report to the Mayor,” said Mr. Dripps, are the following:— “‘The pledge of the Mayor, Controller Walton, City Solicitor Connelly and Chairman Gaffney, of city money for funerals up to $75, where it is absolutely necessary, saved the situation, and made it possible to cope with the problem, and end panic. . . . “‘With the support of the city officials’ pledge, the Council of National Defense has got a bureau of information working under Miss M. A. Cannon, of the Hospital Social Service Department, with twelve telephone operators able to handle all the calls for help, for undertakers, doctors, nurses, transportation. “‘With the support of the Council and the city’s pledge, Eugene Hogle, of the Philadelphia Automobile Club, is directing a force of thirty chauffeurs day and night, responding to the calls as received from Miss Cannon for transportation of the sick and the dead. These chauffeurs have performed heroic service with perfect fearlessness as to their own safety . . . . DISTRIBUTION OF CASKETS “Backed by the city’s pledge, . . . the council is able to guarantee an adequate supply of coffins to the 350 undertakers of the city. . . . “As Miss Cannon’s bureau reports the appeals of undertakers or families for help to bury the dead, they are forwarded to Mr. Eckles, who immediately assigns undertakers from his list. “We have not been able to get sufficient trucks for collection of the dead from the houses into the four big buildings, which will hold 4000 embalmed awaiting funeral, if necessary. We are working hard on the transportation problem. . . . “We are dreadfully short of embalmers. Normally there are 500 embalmers in the city, but a large number had gone to camp service; a large number are sick; we have summoned 100 to the city from outside, but we are in desperate need of 100 more at once. . . . “The question has been brought to this council whether the 300 dead which were cleared out of the Morgue today by the Coroner should later be buried in a more regular fashion under the plan of the city’s guarantee to aid the undertakers. . . . CASES OF RELIEF WORK. “Typical cases of the relief work reported today are as follows:— “One of the Council of Defense chauffeurs found a man and wife so sick in bed that they were unable to rise or dress themselves. He wrapped up the wife and carried her to an automobile and then

Pennsylvania Legacies Spring 2019

Caskets in a mass grave, 1918. Catholic Historical Research Center of the Archdiocese of Philadelphia.

wrapped up the husband and carried him to the automobile and delivered them to the hospital. “In a house to which another chauffeur was called, there was an entire family sick. He was met at the door by a demented man, whom he followed to the bathroom. There he found his dead wife in the bathtub. The demented husband had sprinkled the body with what ice he could get. “. . . About 9.30 P. M. came a message from a man who said he was a sailor. He was passing an apparently empty house when he was attracted by a girlish voice. He entered the house and found nine persons sick. Our volunteer visitor, going to answer the sailor’s summons, found an eighteen-year-old girl in charge of eight other sick members of the family. . . . Our worker thereupon got an ambulance and doctor and moved the very sick to hospitals, leaving at home only two girls able to look after each other. “Another case was reported by a neighbor at 1.30 A. M. as in urgent need of medical help. . . . This was a family of fine self-respecting Americans, temporarily in misfortune and far from friends. Obviously such cases cannot stop here, but must be placed in touch with sources of permanent help. This indicates the reconstruction problem ahead in this city. “A part of Miss Cannon’s report follows:— “A thousand inquiries were received during the first twelve hours. Since the first day the stream of appeals has varied somewhat in volume, but has never ceased, and there has been an increased number of extraordinary urgent cases reported. The following are typical of some of the situations in which our help is asked:— 1. Entire family ill. No one to care for them. (Often six to ten in family sick). 2. Mother and father both ill. Care asked for children. 3. Entire family ill with exception of one member. Relief in nursing asked, day or night. 4. Lone man or woman ill in boarding house; no care. 5. Family desperate for doctor or nurse. No regular physicians. Foreign; can’t understand English. . . . Philadelphia Press, Oct. 18, 1918, clipping, in Philadelphia Council of National Defense Scrapbook

A Naval Aircraft Factory float was a highlight of the Fourth Liberty Loan parade in Philadelphia on September 28, 1918. US Naval History and Heritage Command Photograph (NH 41730).

warehouses for the nearly dead than as treatment centers for the sick. With the nuns’ arrival, order was restored to an otherwise chaotic situation, and the quality of care for the ill rose. Those beyond hope, meanwhile, were offered a greater measure of dignity during their final hours. An account of the nuns’ deeds was recorded as a series of oral histories only a year after the epidemic passed, their steadfastness in the face of human suffering on a massive scale— to say nothing of the threat the virus posed to their own lives—a testament to their bravery and faith. At St. Charles Borromeo Seminary in suburban Philadelphia, scores of students in their late teens and early 20s volunteered for duty in the emergency hospitals, where they worked alongside the nuns. Most of these young men, however, undertook an even more grim duty at the behest of the archbishop: taking charge of the many Catholic cemeteries in and around the city. The largest of the burial grounds was Holy Cross in Yeadon, just across the county line from Philadelphia. By mid-October, Holy Cross’s neat rows of monument stones and impeccably manicured lawns stood marred by an obscene collection of corpses, hundreds of which had lain for days, unembalmed and bloated, laid out in rows or thrown in piles on the grass and in various sheds. Poor Italians especially had almost no recourse to caskets and brought their dead to Holy Cross in pasta boxes, crates, and burlap sacks. During the first day of their service, the seminarians overhauled the operations of the cemetery office and began to excavate mass graves with hand tools. Still they could not keep pace, let alone make headway, with the dead. The monsignors in charge of the burials called upon steam shovels from nearby industrial installations to dig long trenches into which bodies, 60 at a time, were stacked two high in parallel rows. In the early 21st century, the rows of dead remain in Holy Cross in the X, Y, and Z sections. All told, more than 4,000 citizens were buried in mass graves by the seminarians. A final task remained to the city and its seminarians: clearing bodies from homes and the city morgue. The morgue at 13th and Wood Streets was given priority. It required teams to clear it of bodies—and the fluids that had leaked from the 500 hundred corpses that had lain for days within. The situation was awful enough to constitute an obscenity; the few photographs taken of the interior show bodies with blackened faces thrown about the floors, while witnesses reported

fluid seeping out to the sidewalk. Once again, the diocese sent laymen and seminarians to untangle the dead and cart them to cemeteries, where many received anonymous burial in mass graves. From the homes and hovels of the poor, and even from the sidewalks in front of homes when loved ones could no longer countenance the sight or smell of their dead, priests carried corpses to horse-drawn carts and from there to burial grounds throughout the city. With the exception of the yellow fever epidemics of 1793 and 1798, Philadelphia never suffered an epidemic as severe as the outbreak of influenza in the autumn of 1918. Even cholera failed to produce the death toll or, importantly, the death rate that influenza exacted. Indeed, as measured by one-week mortality rates, the second, third, and fourth weeks of October 1918 exceeded the weekly mortality rates of even the worst weeks of the 1793 yellow fever epidemic. Philadelphia’s influenza outbreak was singular in the history of the nation and the modern, western, urban world, and no better example exists of the violence the virus can produce under the right conditions. A century after the outbreak, many of the locations that played a prominent role in the epidemic remain. The morgue is now an annex building of the parochial school system, though it is doubtful the students or teachers know of their church’s role in clearing the dead from what became their classrooms, nor can most visitors to Holy Cross envision the trench graves that once snaked across the lawns. The Navy Yard, less busy than it was during the Great War, still tends to the nation’s warships, and the tree-shaded campus of St. Charles Borromeo continues to train young men for the priesthood, though the only reminders of their forebears’ service to the city during the epidemic lie in the school’s archives. Yet, even a century removed from the greatest of disasters in the city’s long history, historians and public health experts draw upon its story to remind leaders and the public that what once happened in Philadelphia might happen again were a new, virulent influenza virus to suddenly appear. James Higgins is a historian of medicine and concentrates especially on the history of the influenza pandemic in Pennsylvania and Texas. He now lectures at Jefferson University in Philadelphia and Rider University in Lawrenceville, New Jersey.

Spring 2019 Pennsylvania Legacies

Polio in Pennsylvania by

Daniel J. Wilson

A Philadelphia school bus driver carries a boy who is unable to walk to the entryway of the J. Willis and Elizabeth Martin Orthopedic School, the first school in Philadelphia for children with physical disabilities, circa 1937. Philadelphia Record Photograph Morgue.

Pennsylvania Legacies Spring 2019

n the hot summer of 1916, a frightening new disease appeared across Pennsylvania. Young children developed a high fever accompanied by vomiting and diarrhea. Many soon recovered, but a growing number developed muscle weakness, fell while trying to walk, or had increasing difficulty breathing. When muscle paralysis set in, doctors were able to diagnose another instance of infantile paralysis, a disease newly epidemic in the United States. Infantile paralysis, or poliomyelitis, was an intestinal virus that in a small percentage of cases invaded the spinal cord, causing permanent muscle paralysis and even death. Map of polio cases in Philadelphia during a 1910 epidemic, in Joseph S. Ness, Anterior Poliomyelitis (Philadelphia, 1911).

Spring 2019 Pennsylvania Legacies

Jonas Salk and a nurse administer the polio vaccine to a girl, circa 1955. Jonas Salk Polio Vaccine Collection, 1917-2005, UA.90.F89, University Archives, Archives & Special Collections, University of Pittsburgh Library System.

Pennsylvania Legacies Spring 2019

Polio, as infantile paralysis came to be known in the 20th century, has a significant place in the history of Pennsylvania. The commonwealth was hit hard in the large 1916 polio epidemic that affected the northeastern United States. When Dr. Jonas Salk established a virology laboratory at the University of Pittsburgh in 1947, Pennsylvania soon became a major center of research on the poliovirus that led to the first successful vaccine against the disease in 1955. Pennsylvania was also where Salk first tested his vaccine, first on institutionalized children and then on schoolchildren in the Pittsburgh area. Polio has continued to impact Pennsylvania as many polio survivors experience the new disabilities of post-polio syndrome and as Sanofi Pasteur, a drug company in Swiftwater, manufactures much of the vaccine currently used in the worldwide campaign to eradicate the disease. Thus, Pennsylvania has both experienced the ravages of this widely feared childhood illness and participated in the science that set it on the road to extinction. Polio, or poliomyelitis as it is more formally known, is an old disease that became epidemic in the early 20th century, paradoxically as a result of improved sanitation. The poliovirus is an intestinal virus that is shed in fecal material. In conditions of poor sanitation, the poliovirus circulates continually, and children are infected early in life, when they are still protected by maternal antibodies. They then safely build their own antibodies, which protect them against later infection. With early-20th-century sanitation advancements, the circulation of the virus was interrupted, and children were not infected until later in life. The later one is infected, the more likely the disease is to cause the characteristic paralysis. The 1916 polio epidemic was one of the largest in the United States and the largest in the world to that date. Centered in the northeast, particularly New York, the epidemic produced 27,000 cases and 6,000 deaths in 26 states. The actual number of infections must have been much higher, since we now know that only about 3 percent of infections result in paralysis. Pennsylvania’s 2,181 cases ranked third behind New York’s 13,223 and New Jersey’s 4,055. The disease spread across Pennsylvania, but Philadelphia experienced the largest number of cases: 1,006, with 307 resulting in death. Polio typically struck during the warmer months of summer, and the epidemic in Pennsylvania followed that pattern. There were only three cases in May 1916, but the number had risen to 120 by July. In August the number jumped to 747, and September saw the most cases with 804. By October, the number had fallen to 379, and in December, there were only 26. Polio was a new and frightening disease in 1916. Doctors could diagnose it once paralysis appeared, but they could do nothing to prevent the disease or to stop the progression of paralysis. Poliovirus causes paralysis when it invades the spinal cord and destroys or damages anterior horn cells that are part of the system of motor neurons. Paralysis could affect any of the body’s muscles, but most typically affected those in the legs. If the muscles that controlled breathing were paralyzed, however, patients died because there were no effective means of artificial ventilation in 1916. Public health officials responded to the epidemic by quarantining and isolating afflicted patients and their families. Children from poor families were often sent to isolation hospitals over the strenuous opposition of parents who feared they would die. In late August, the state health commissioner closed the schools until September 18. Some communities tried to prevent children from epidemic areas

from entering their borders. However, since doctors in 1916 did not understand how the disease was transmitted, these measures were largely ineffective in preventing polio’s spread. The epidemic ended only with the onset of cooler weather in the fall. In the years that followed, the incidence of polio receded to a much lower level. The history of polio in Pennsylvania took an important turn in 1947, when Jonas Salk, a young doctor and scientist at the University of Michigan, arrived at the University of Pittsburgh to establish a new laboratory for the study of viruses. Salk had spent several years studying the influenza virus under the direction of Dr. Thomas Francis. He had learned techniques for developing a “killed virus” vaccine, including how to use formaldehyde to kill the virus, how to add chemicals to increase the effectiveness of the vaccine, and how to run large-scale tests of new vaccines. Salk’s new laboratory was partially funded by a grant from the National Foundation for Infantile Paralysis (NFIP), better known as the March of Dimes, to establish a virus research program. Salk proposed to study influenza, Bracemaker Lewis Darby fits a brace on Betty, a polio patient at the Shriner’s Hospital for Crippled Children in Philadelphia, Feb. 5, 1939. Philadelphia Record Photograph Morgue.

Spring 2019 Pennsylvania Legacies

but he also decided to investigate the poliovirus at least in part to continue to receive funding from the March of Dimes. One of the great unknowns in 1947 was how many strains of the poliovirus existed. Scientists needed to know this number in order to create a vaccine that protected against all strains. This was painstaking, detailed work, but Salk eagerly enlisted his laboratory. The typing program ran from 1949 to 1951 and revealed that there were only three strains of the virus, which would make creating a vaccine much easier. A second crucial step was taken when John Enders and his laboratory at Harvard discovered how to grow the poliovirus on non-nervous tissue—in this case, monkey kidney tissue. Large amounts of the virus would be needed to create a vaccine to protect millions. Even while working on the typing program, Salk’s laboratory had begun to experiment with developing a polio vaccine using the techniques Salk had learned at Michigan. By 1951, aided by a major grant from the March of Dimes, Salk turned full-time to growing large quantities of virus with which to experiment. The challenge was to kill the virus so it could not cause polio but would still prompt the vaccine recipient’s immune system to develop antibodies against wild poliovirus. Salk and his team had to choose the strains to inactivate and then find the ideal process to kill the virus without destroying its capacity to immunize. By late 1951, Salk received permission from Basil O’Connor, the head of the March of Dimes, to test the experimental vaccine produced in his laboratory on humans. At this point, Salk needed experimental subjects. He approached the directors of two Pennsylvania institutions—the D. T. Watson Home for Crippled Children in Sewickley and the Polk State School in Venango County, an institution for children with intellectual disabilities. At the Watson Home, Salk obtained consent to experiment from many of the parents of the patients. All of the “volunteers” at Watson had had polio, and Salk injected them with

a vaccine that matched their strain of polio. He saw a significant increase in antibody levels following vaccination, indicating that the vaccine was working. At the Polk School, by contrast, most of the children were wards of the state. Because there had been a recent polio epidemic at the school, state officials gave Salk permission to proceed. Many of the Polk subjects had not had polio, so the experiment was riskier. Here too, the vaccine proved to be safe, it increased antibody levels significantly, and the protection lasted. These early tests seemed to indicate that Salk and his laboratory had created an effective killedvirus polio vaccine. Following these early successful tests, Salk and the March of Dimes arranged for commercial vaccine manufacturers to make the vaccine following Salk’s directions. He soon vaccinated 7,500 school-age children in the Pittsburgh area using the commercially produced vaccine. Again, the vaccine proved safe and effective in raising protective antibodies against the three strains of polio. The year Salk began testing his vaccine in humans, 1952, was the worst polio epidemic in US history. Some 57,000 individuals were diagnosed with the disease, 27,000 suffered permanent paralysis, and 3,000 died. The need for a vaccine seemed even more urgent. Salk was ready to proceed but needed permission from the March of Dimes. Most polio scientists thought a live-virus vaccine would be more effective, and they were skeptical about the long-term effectiveness of Salk’s killed-virus vaccine. They also thought it was too soon to begin large-scale human testing. Salk and O’Connor disagreed. During much of 1953, officials in the NFIP and the polio scientists they supported debated the merits of Salk’s proposal to conduct a mass trial of his vaccine. O’Connor established a new Vaccine Advisory Committee to make recommendations, and in April 1953, it voted to move ahead with a trial of the Salk vaccine. O’Connor persuaded Dr. Thomas Francis, Salk’s old mentor at the University of Michigan, to conduct the trial so that there could be no question about its objectivity.

“Help me win my victory,” asks a girl recovering from polio in this 1942 poster for the Celebration of the President’s Birthday for the National Foundation of Infantile Paralysis (March of Dimes). President Franklin Delano Roosevelt contracted polio in 1921. Historical Society of Pennsylvania War Posters Collection.

Pennsylvania Legacies Spring 2019

“The year after I got polio the Salk vaccine came out” Monte Montgomery contracted polio in October 1951 at age 14. He shared these memories in a document addressed to his grandsons. The full document, which provides further details on his experience of polio in 1950s Pennsylvania, is in the collections of the Historical Society of Pennsylvania. When I was growing up there were four seasons in the year. They were not fall, winter, spring and summer. They were football, basketball, track and baseball. One thing I had never had in my life was a headache. . . .Then one Tuesday in October, while I was in the ninth grade, during the football season, I got a headache during school. . . . I felt terrible and did not eat anything that night. The next morning I jumped out of bed to go to the bathroom. . . . My legs did not hold me. I fell to the floor. . . . My mother called the family doctor. . . . He immediately called an ambulance and had me sent to the hospital in Bradford, 25 miles away. . . . I got a lot sicker in the Bradford hospital. I was under very strict quarantine there. No one came in the room unless they were covered from head to toe. To verify that I had polio, I had a spinal tap. . . . By this time I was really getting stiff. I could not reach down and touch my knees. To combat this stiffness, every three or four hours the nurses would come to me and put steaming hot wool compresses on my muscles to try and loosen up my body. Why wool? I don’t know other than it sure did itch. I stayed in the Bradford hospital for approximately two weeks and got sicker and weaker and stiffer each day. I was then told I was going to be moved to the Shriner’s Hospital in Erie, Pennsylvania. . . . In the Zem Zem Shriner’s Hospital . . . I would guess each ward held 30 to 40 patients. All the patients were crippled children. I was the oldest patient in the hospital. . . . Everyone went to the workout area once a day, five days a week except me. I went twice a day; once in the morning and once in the afternoon. For the first few months I was transported on a stretcher and then in a wheel chair after the first couple months. . . . The exercises I did in Zem Zem started out as mostly stretching. In the room with the pool (100 degree water) was a large platform at stretcher height. I would get on the platform and one nurse, probably a physical therapist, would lie across my knees. Another would get behind me and push against my back (ABOVE) Boys

trying to loosen up my leg and back muscles. This was quite painful but nothing I could not bear. I just can not explain how tight I was. You may think it is tough to touch your toes, but I could not touch my knees. Finally I got where I could move around a little bit and I was put into the pool, hanging onto rails. Once, on purpose, I kept breathing out and sunk to the bottom of the pool, about four feet deep. The nurses went bonkers until I pushed myself back up and started laughing. I caught Hell! I only did that once. . . . Once my stretching had moved along, I began to go into simple exercises. . . . The physical therapist would raise my leg and I would try and help. . . . I was finally getting along better and better. A brace man (maker of braces) came in to size me up. He took all the measurements and came back in a week or two with a brace. . . . I practiced walking with the brace; the hardest part was going down stairs. In the exercise room was a short set of stairs to practice on. Besides the brace, I used a crutch on the left arm. . . . I had a pair of these crutches and used them both when I did not have the brace on. . . . . . . When they told me they were taking me home. . . I went to the administrative part of the hospital. I was asked if I had any questions. I said, “Just one. Would I be able to play football in the fall?” The head physical therapist answered by saying, “If you every play football again, I will travel anywhere in the world to see you play.”. . . That was the first time I ever realized polio was a permanent disability and I would be a cripple for the rest of my life. It was a terrific shock to say the least. . . . The year after I got polio the Salk vaccine came out for a trial. Mom asked the doctor to have the trial shots for Mary, Tim and Sally because she did not think she would be able to go through the agony of having another child have polio. . . . Account of Monte Montgomery’s Diagnosis, Hospital Stay, and Treatment for Polio as a Teenager in Kane, Pennsylvania, in the Early 1950s (excerpt)

play in the heated pool of the J. Willis and Elizabeth Martin Orthopedic School, Jan. 5, 1941. Philadelphia Record Photograph Morgue.

Spring 2019 Pennsylvania Legacies

Pennsylvania Legacies Spring 2019

(LEFT) City

of Philadelphia memorandum on the Salk Vaccine program, Sept. 14, 1955. Constance Dallas Papers. (RIGHT) Children recovering from polio at Children’s Hospital of Philadelphia practice walking with crutches, Jan. 4, 1946. Photo by Edward Ellis. Philadelphia Record Photograph Morgue.

Because polio was a relatively rare disease, it would take a huge trial to obtain statistically significant results. Ultimately, over 1.3 million children took part, with some 600,000 receiving the vaccine and the rest serving as controls. The trial was conducted in 44 of the 48 states, including Pennsylvania. Parents eagerly enrolled their children in hopes of being the first to protect them against polio. The trial began in April 1954 and continued through late spring in order to be effective for the 1954 polio season that began in June. Francis and his associates followed all of the children through the 1954 polio season, noting their illnesses and deaths. Several hundred children died, most from accidents, but about 5 percent from polio. By April 1955, Francis and his colleagues had concluded their analysis and were prepared to announce their results to Salk, O’Connor, and the world. Until April 12, 1955, not even Salk and O’Connor knew if the trial had been successful. Francis delivered a long scientific report on the trial, but well before he finished, journalists announced that the vaccine worked. It was 80 to 90 percent effective against paralytic polio, 60 to 70 percent effective against Type I polio, and more than 90 percent effective against Types II and III. It was not a perfect vaccine, but it was still the first effective preventive against this dreaded disease. Salk became an instant hero for having devised a way to protect America’s children from permanent paralysis, disability, and death. The March of Dimes had arranged the manufacture of millions of doses of the vaccine so that vaccinations could start as soon as it was approved. The US government approved the new vaccine on the afternoon of April 12, and vaccinations began across the nation soon after. The early euphoria was quickly dashed two weeks later, when doctors began to report that children who had been vaccinated were developing paralytic polio. The surgeon general of the United States stopped the nationwide vaccination program until the problem could be addressed. As additional reports of post-vaccine paralysis emerged, it became clear that all the children affected had been administered vaccine manufactured by Cutter Laboratory in Berkeley, California. The laboratory had not followed Salk’s procedures carefully and had failed to kill the virus in the vaccine. Ultimately, more than 200 youngsters and family members developed polio from six contaminated lots of vaccine. Most were significantly paralyzed, and 11 died. After reviewing the procedures of the other vaccine manufacturers, where few problems had been reported, the surgeon general allowed the vaccination program to resume. Testing procedures for new lots of the vaccine were also altered, and no further incidents occurred. Still, parents, once joyous at the success of the vaccine, were now slow to vaccinate their children, and some 28,000 children developed polio in 1955. In spite of the caution caused by the Cutter incident, an increasing number of parents had their children vaccinated in the ensuing years

as it became evident that properly manufactured Salk vaccine was indeed safe and effective. By 1960, the number of polio cases in the United States had fallen to 3,200. And by 1970, following the introduction in the early 1960s of Albert Sabin’s live-virus oral polio vaccine, only 33 individuals contracted polio. By the late 1970s, polio, once the most feared childhood disease, had been largely eliminated in the United States. Polio, however, has not entirely disappeared from Pennsylvania. Several thousand polio survivors in the state have developed postpolio syndrome 20 to 30 years after they acquired the disease. This condition manifests as new muscle weakness and fatigue, particularly in the muscles weakened by polio. Individuals who once walked now must rely on wheelchairs for mobility, and those who breathed on their own require mechanical ventilation. Not everyone who had polio develops post-polio syndrome, but many do, and for them it represents a new disability. In 1988, the World Health Organization announced a campaign to eradicate polio worldwide. At the time, there were over 300,000 cases per year, mainly in poorer, developing countries. Sanofi Pasteur, a drug manufacturer in Swiftwater, Pennsylvania, has produced over 6 billion doses of the oral vaccine used in the eradication campaign. The campaign has come close to success, though it has proven more difficult than anticipated. Through September 2018, there have been 18 cases of wild polio in only two countries, Afghanistan and Pakistan. The end is in sight, but proving elusive. The development of vaccines against viral disease, of which the Salk vaccine was one of the first, was one of the greatest achievements of 20th-century medicine and public health. Medical scientists ultimately created vaccines against most of the viral diseases that for so long had afflicted and often killed children. That progress is now imperiled by a growing anti-vaccination movement in Pennsylvania and elsewhere. No medical procedure is without risk, but modern vaccines are the safest way to prevent serious viral diseases. In the 1950s, parents rushed to vaccinate their children against the possibility of being crippled or killed by polio. Although the incidence of childhood viral diseases has decreased significantly due to the many children who have been vaccinated, the threat of these diseases remains. One can only hope that more parents will take advantage of a medical advance that took a significant step forward in Pennsylvania with Jonas Salk’s polio vaccine. Daniel J. Wilson recently retired as professor of history at Muhlenberg College after a 40-year career teaching American history and history of medicine. He has published several books and articles on the history of the polio epidemics. He had polio in 1955.

Spring 2019 Pennsylvania Legacies

Teachers’ Turn Pestilence and Pandemics through Pennsylvania History BY KARALYN MCGRORTY DERSTINE

ur students live in an era of germ theory, sanitation, and vaccination. It is often difficult for them to understand an era in which the supposed greatest thinkers did not understand the vectors that caused illness or a time before vaccinations could prevent the spread of communicable diseases. This issue of Pennsylvania Legacies provides accounts of epidemics that have ravaged Pennsylvania communities and the public health responses to these outbreaks. The articles provide teachers with opportunities to bring Pennsylvania’s public health history into their classrooms in a nuanced manner. The intersection of epidemiology and social history of illness makes public health an engaging lens through which to view Pennsylvania’s past.

In the “Midst of Death”: When African Americans Saved Our Nation’s Capital As some of the most famous figures of America’s founding era fled, a group of unsung heroes took action when Yellow Fever wreaked havoc in 1793 Philadelphia. Billy G. Smith’s article provides great insights into how the free black community of Philadelphia rallied to save the nation’s capital from a public health disaster. Despite their valiant efforts, they were met with racism in the aftermath of the deadly epidemic. •H ave students read the article. Then ask them to imagine they are Absalom Jones or Richard Allen. Ask them to write a letter sharing the efforts, work, and service of the black citizens of Philadelphia during the Yellow Fever epidemic.

Pennsylvania Legacies Spring 2019

• Ask students to explore a map of Philadelphia from the 1790s (for example, digitallibrary.hsp.org/ index.php/Detail/objects/5168). Then ask them to mark the map to for the hardest-hit sections of the city, where the free black population lives and note their proximity to the Delaware River. Ask your students to review Smith’s map showing where Philadelphia’s free black population lived. What are the correlations between location and mortality? • Additional resources for teachers on the 1793 yellow fever epidemic can be found on the Historical Society of Pennsylvania’s website. See especially hsp.org/yellow-fever-resource-page and https://hsp.org/education/unit-plans/ diagnosing-and-treating-yellow-feverin-philadelphia-1793.

Lazaretto Ghost Stories David Barnes’s article on the Lazaretto quarantine station gives teachers an opportunity to engage students in a discussion of the ways in which “commodities, people, and news from the farthest corners” flow in and out of Philadelphia—bearing germs as well as goods—and how the city chose to guard against contagion by quarantining those suspected of carrying illness. • Ask each student to imagine that they are an individual quarantined at the Lazaretto and have them write a journal entry from that person’s point of view. What were their symptoms? What was their experience? How long was their stay? Who helped them, and how?

• Barnes points to an incredible fact about the Lazaretto: 90 percent of its patients survived, including many suffering from serious diseases. He believes that “the mundane daily chores that had the nurses rushing about so busily” may be the reason so many Lazaretto patients lived. Have students research the routine tasks of a nurse in the 1800s would have performed and write about and/or discuss how they may have helped patients recover and prevent the spread of disease.

Homefront Casualties: Philadelphia’s Influenza Disaster The year 1918 marked the end of World War I, “the war to end all wars.” As countries across the globe welcomed their soldiers back from the battlefield, they were greeted with an equally deadly adversary: influenza. James Higgins’s article provides a compelling look at how a parade to promote the purchase of Liberty Loans and rally support for the war effort spread the deadly epidemic through the city of Philadelphia and gives a gripping account of the macabre circumstances the city faced. • Ask students to create a graph charting the number of reported cases of influenza, as outlined in the article. What trends do they notice from the chart? Are there months in which the disease has higher incidents? What can students infer from the data they collected? • Engage students in a discussion focused on the global nature and trench warfare of the First World War. What role did

• Public Service Announcements (PSAs) play an integral role in public health. Getting the right message out to communities is essential in combating health issues. For this activity, have students develop advertisement campaigns targeting parents to get them to participate in Dr. Salk’s inoculation programs.

“Fellow polio victims at the Shriner’s Hospital for Crippled Children pay silent tribute” to recently deceased President Franklin D. Roosevelt at 4 p.m. on April 14, 1945. President Roosevelt contracted polio in 1921. Photo by M. Pearlman. Philadelphia Record Photograph Morgue.

these conditions play in causing the influenza pandemic? • Students can experience a first-hand account of the flu’s impact on local citizens by reading the Gibbon family correspondence at the Historical Society of Pennslyvania. Some letters that provide insight into daily life during the epidemic are highlighted in a blog post: hsp.org/blogs/fondly-pennsylvania/dearold-sweetheart-the-gibbon-family-andworld-war-i-part-2. Ask students to read the Report on the Emergency Work of the National League for Woman’s Services in the Recent Epidemic of Influenza, available online at digitallibrary.hsp.org/ index.php/Detail/objects/9238. Ask students to outline roles women played

in addressing the pandemic. What type of work did the organization engage in?

Together, the articles in this issue of Legacies provide students with an interesting look into the public health history of Pennsylvania and the United States, allowing them to explore the impact of disease on society and how illness has been managed by state and local officials. These articles allow teachers to explore the social history of epidemiology and how it intersects with studies of race, gender, and class throughout history. Teachers may also engage students in discussions of the important role of communications in distributing factually accurate information, quelling a population’s fears, and providing clear instructions for ways to stop the spread of disease and engage in healthier practices. By giving students a window into pandemics of the past, we potentially spark the curiosity of the next Salk or spur a generation to ensure the end of a disease of our time. Dr. Karalyn McGrorty Derstine teaches US history at Gwynedd Mercy Academy in Lower Gwynedd, Pennsylvania.

Polio in Pennsylvania Daniel Wilson’s article details how funding from the March of Dimes and the vaccination technique developed by Dr. Jonas Salk at the University of Pittsburgh saved generations of children from the debilitating and sometimes deadly effects of polio. Students may use this article to learn about innovations in vaccination and the ways in which they are protected from illnesses unlike generations before. • Ask students to read the article. Have them consider the unintended consequences of improved sanitation in causing the polio epidemic.

For more ideas on teaching this topic, check out HSP’s new unit plan, created with Global Philadelphia, at https://hsp.org/education/ unit-plans/public-healthphiladelphia-and-world and watch for a summer teacher workshop on the subject. Additional resources can be found at www.LearnPhillyHeritage.org.

Global Philadelphia: Educating Global Kids with Roots

Spring 2019 Pennsylvania Legacies

Generations Find Out How the Spanish Flu Epidemic of 1918–19 Affected Your Pennsylvania Ancestors BY JANE NEFF ROLLINS, MSPH

oes the thought of getting the flu scare you? Maybe not—but it should. Yes, today we have vaccines, antiviral medications, and chicken soup. Even so, CDC statistics show that influenza still kills up to 5,600 people in the United States every year. Imagine, then, what it was like 100 years ago when none of those medical interventions existed. In 1918 and the early part of 1919, influenza hit the entire world and may have killed as many as 100 million people. This pandemic was known popularly as the “Spanish flu.” In Pennsylvania, as in other places worldwide, you couldn’t request a doctor’s house call because the dial telephone didn’t exist yet, and all calls had to be connected by an operator—many of whom were so sick from the flu that telephone exchanges were closed. Even if you could reach the doctor’s office, many physicians were either away fighting in World War I or were sick themselves. So many people died there weren’t enough coffins or gravediggers, and corpses piled up in the streets in Philadelphia and other cities until mass graves could be dug with bulldozers.

database for all people who died between spring 1918 and spring 1919. If you don’t have a computerized database, consult paper records. Compare a given family in the 1910 US census with the 1920 listing. If someone is no longer there in 1920, perhaps he or she died in the flu epidemic. Obtain the death certificate and check the cause of death. Pennsylvania established statewide registration of deaths in 1906, so you should be able to find a death certificate for anyone who died in 1918– 19. Pennsylvania death certificates for this period are available at FamilySearch.org for free and at Ancestry.com. When searching, set the year to 1918 ±1 year to catch those who died in the first quarter of 1919. Keep in mind, though, that coroners during this period were overwhelmed. For public health reasons, bodies needed to be buried quickly, so a certificate may not have been issued. Death certificates for influenza victims also may not list influenza as the cause of death. Pneumonia is more likely to be recorded because influenza was not a reportable disease anywhere in Pennsylvania until Philadelphia resolved to make it reportable on September 21, 1918.

How Were Your Ancestors Affected by Spanish Flu?

Obituary Sources

The most direct effect of the epidemic on your family can be measured if one or more of your ancestors died during the Spanish flu epidemic. To determine this, you’ll rely heavily on death certificates and death notices or obituaries. Even if no one died of the flu, someone in the family may have been ill with it. You’ll likely rely on local newspapers in both cases. Check your preferred genealogy

There were 1,800 newspapers published in Pennsylvania during the flu pandemic, many of which are digitized and available at the Chronicling America website (chroniclingamerica.loc.gov/). The newspapers are all word searchable, making identifying a relevant obituary or death notice much easier. Before starting your search by name, click on the “All Digitized Newspapers” tab to identify whether your ancestor’s

Pennsylvania Legacies Spring 2019

hometown has a newspaper represented on the site. If not, identify adjacent towns and check whether newspapers from there are represented. The advanced search tab allows you to narrow your search by state (Pennsylvania), years (1918 to 1919) and phrase (enter your ancestor’s given name and surname as search terms). Other good sources of obituaries during the epidemic include the Butler County, Pennsylvania, Obituary Index, 1810–2010, on Ancestry.com; the US and world newspapers collection on FindMyPast.com (leave the first/last name boxes blank, enter “influenza” in the “What Else?” box, and narrow results to Pennsylvania); and the State Library of Pennsylvania’s obituary links page (obitlinkspage.com/obit/pa.htm#obit_tools). Finally, funeral homes can be good sources for this type of information. Try telephoning and asking whether they are willing to examine their historical records for you.

Research the Effect of the Spanish Flu on Families Other clues may indicate that your family was affected by the flu. Do you have ancestors who were children during the 1910 census who had seemingly disappeared by 1920? It’s possible that they died and no death certificate was issued. But maybe they were farmed out to other relatives or to an orphanage because one or both parents died. You can look for court records that name a guardian for them or possibly find orphanage records. Did a family business appear in city directories leading up to 1918 but not afterward? Maybe the proprietor died from the flu, or had postinfluenza syndrome including fatigue or Parkinsonism and could no longer manage the

Pennsylvania-Specific Resources

A sign warning against the spread of influenza at Philadelphia’s Naval Aircraft Factory, Oct. 19, 1918. US Naval History and Heritage Command Photograph (NH 41731-A).

company. Look for ads to sell the business or bankruptcy filings in the newspaper.

Research the Effect of the Spanish Flu on Your Ancestor’s Community Even if no one in your family fell ill with the flu, your ancestor’s community was definitely affected. Background information that may not specifically mention your ancestor can provide a picture of how their community was affected by the pandemic. For example, you may be able to find statistics for their town, county, or state. How many cases of flu occurred, and how many people died? How did local hospitals and physicians react to the epidemic in your area of interest? How many doctors and nurses were available, and how many were away serving in the military? Were tent hospitals set up? When was influenza made a reportable disease? Were public places (schools, churches, taverns) closed, and when? Were people required to wear gauze masks in public? Did police patrols remove bodies from homes because there weren’t enough undertakers, as happened in Philadelphia? Look for reports from your county or city’s health department on www.HathiTrust.org. Use

search terms like “annual” or “public health report,” “monthly bulletin,” “municipal year book,” etc. You won’t be able to download entire reports unless you are associated with an affiliate institution, but you can download single pages or do a screen grab. Newspapers can also help you research how the flu epidemic affected your ancestors’ community. Try the following search terms, either singly or in combination: influenza, Spanish flu/Lady, grip/grippe, pneumonia, coffins, mass grave, bulldoze, epidemic, lingering illness, quarantine, isolation, outbreak, fatal, mortal, succumbed, died, death, death toll, victims list, died of disease, Roll of Honor, closed/closure, cancel/ cancelled/postponed.

General Genealogy Web Sites The FamilySearch catalog has a few books of abstracts for Pennsylvania funeral home records for Blair, Fayette, and Lycoming Counties that cover 1918–19. Ancestry.com contains the Cemetery and Funeral Home Collection with more than 4,200 Pennsylvania records, and the Sons of Italy Mortuary Fund Claims database and Enrollment for Benefits List.

Pennsylvania Newspaper Archive (panewsarchive.psu.edu/) has a large collection of newspapers and offers an advanced search option that lets you limit by newspaper or by year range. On Periodical Source Index (PERSI), available through FindMyPast, you can enter “influenza” and the name of the town or county of interest as keywords. A recent search identified articles about the effect of the flu in Berks, Cumberland, Franklin, Indiana, Lancaster, Mifflin, Schuylkill, and Wyoming Counties. The Pennsylvania History and Museum Commission has a webpage devoted to influenza epidemic records at the State Archives (phmc.pa.gov/Archives/ Research-Online/Pages/1918-InfluenzaEpidemic.aspx), and digitized records can be viewed online at psa.powerlibrary.org. Be sure to check out several sets of university yearbooks that cover the 1918–19 period (e.g., East Stroudsburg, Edinboro, Kutztown, Lincoln, Mansfield), the Diaries and Journals Collection within the manuscript collection, and Cadaver Receiving Books (influenza epidemic victims are identified in entries for October 1918 through December 1918). If you are visiting Philadelphia in 2019, be sure to attend the Mütter Museum’s exhibit about the Spanish flu, Spit Spreads Death (muttermuseum. org/exhibitions/going-viral-behindthe-scenes-at-a-medical-museum/), and document displays and public programs at the Historical Society of Pennsylvania related to epidemics and public health in Pennsylvania history. Jane Neff Rollins, MSPH, is a former infectious disease epidemiologist and current professional genealogist, writer, and speaker. She is an alumna of ProGen 29, Salt Lake Institute of Genealogy, and the Forensic Genealogy Institute. More information can be found on her website, sherlockcombsgenealogy.com. Spring 2019 Pennsylvania Legacies

Legacies for Kids Book Reviews BY CHRISTOPHER A. BROWN

Do Not Lick This Book By Idan Ben-Barak Illustrated by Julian Frost New York: Roaring Book Press, 32 pp. Ages 4–6. Explaining the concept of a germ or microbe to the pre-K crowd can be tough, but BenBarak and Frost take on the challenge with aplomb in this funny (and factual) look at a quartet of germs. The ringleader is Min, an E. coli germ that normally lives in your intestine, but can be found elsewhere. Along for the ride are Rae, a streptococcus; Dennis, a fungus; and Jake, a corynebacterium. The members of the foursome are color-coded for easy identification but thankfully are not gendered by color (Min is referred to as “she” but is a brilliant blue). This picture book is delightfully disgusting and may gently remind younger children about the importance of washing their hands. The end of the book includes information for more advanced readers to share and which may help them answer any questions that might arise.

Pennsylvania Legacies Spring 2019

It’s Catching: The Infectious World of Germs and Microbes By Jennifer Gardy Illustrated by Josh Holinaty Toronto: Owlkids, 2014, 64 pp. Ages 8–12. “Disease detective” (and narrator) Jennifer takes readers on a meet-and-greet tour of some of the germs that have affected human history. Influenza, rabies, and malaria, to name just a few, are among those readers encounter in this fascinating nonfiction title that will delight—and potentially terrify— young minds. The book covers a range of topics, including sanitation, public health, and antibiotics (and the consequences of their overuse). Holinaty’s full-color graphics complement Gardy’s crisp text, and their combined efforts will leave readers wanting to learn more about germs, parasites, and epidemics. The tone and vocabulary are perfect for readers 8-12 who love to know the science behind the gross.

Plagues: The Microscopic Battlefield Written and illustrated by Falynn Koch New York: Science Comics, 2017, 128 pp. Ages 9–13. Science fiction fans may gravitate toward this issue of the Science Comics series, in which an anthropomorphic cast of cells, bacteria, and viruses wage war inside a human body. The graphic novel introduces Elena, a scientist, who attempts to persuade Bubonic Plague and Yellow Fever to turn “vaccine” and help humans instead of harming them. The story is bright and engaging, and the science of infectious diseases is nicely woven throughout the story. While many infectious diseases are mentioned, HIV and other STDs are not. As infection rates of these diseases fluctuate annually, it is unusual that they are not included. At the back of the book, the glossary, timeline, and bibliography provide a nice closing touch, and readers 9–12 will benefit from their inclusion.

An American Plague: The True and Terrifying Story of the Yellow Fever Epidemic of 1793 By Jim Murphy New York: Clarion Books, 2003, 176 pp. Ages 10–12. Nonfiction fans will be drawn to Murphy’s title on the yellow fever epidemic of 1793, which received a Newbery Honor in 2004. The book proceeds in a linear fashion from the detection of the illness by the medical community through a description of the disease’s symptoms, treatment, and high mortality rate. (One in 10 Philadelphians died that summer as a result of the illness.) Murphy’s text is far from dry, though, as he examines the social and cultural effects of the epidemic and the treatment options available to members of different levels of society in 1790s America. Political fans will delight in learning about Philadelphia’s committee of 12 that ran the city when most government officials fled. Murphy’s well-researched account of Dr. Benjamin Rush and the Free African Society shines a light on racial inequality in the north, which is frequently underemphasized in popular history. The backmatter of the book includes a bibliography for further reading, illustration credits, and an index. Readers 10–15 who enjoy challenging what they know about history will find this a worthy title.

Invincible Microbe: Tuberculosis and the Never-Ending Search for a Cure By Jim Murphy and Alison Blank New York: Clarion Books, 2003, 160 pp. Ages 10–12.

Fever 1793 By Laurie Halse Anderson New York: Simon & Schuster Books for Young Readers, 2000, 2002 (paperback), 272 pp. Ages 10–14.

The most effective serial killer in human history is not a man or a woman, but a tiny germ that has claimed over one trillion lives. Murphy and Blank spin their nonfiction tale as a “biography” of this serial killer, documenting the effect of tuberculosis across history, literature, and art. The text is spellbinding and will captivate its readers even as it appalls them. Murphy has never shied away from exploring racial and socioeconomic inequality in his historical accounts, and this work is no exception. For a slim volume, the backmatter is weighty: a hefty bibliography provides further reading suggestions for eager minds, and the source notes are well organized. While this title was designed for tween readers, adults may enjoy it as well.

Laurie Halse Anderson provides readers with a powerful tale that is as gripping as it is thoroughly researched. The story follows Matilda (“Mattie”), a Philadelphia teenager, as she experiences a society gripped by yellow fever. As the title implies, the story takes place in the summer of 1793 in the then-capital of the United States, where rumors of a deadly disease are confirmed when the first victims begin to fall. The story twists and weaves as Mattie struggles to survive the illness and keep her family business alive after her mother’s disappearance. Anderson knows how to pull in readers, and her plotting is enthralling. Subplots touching on issues of social status, personality, and race add to the drama. A savvy choice for readers 10–15.

Christopher A. Brown is special collections curator of the Children’s Literature Research Collection at the Free Library of Philadelphia. Spring 2019 Pennsylvania Legacies

Book Reviews BY MAUREEN IPLENSKI

The Contagious City: The Politics of Public Health in Early Pennsylvania By Simon Finger Ithaca, NY: Cornell University Press, 2012 Simon Finger explores a period in which disease loomed large in Philadelphians’ minds. Swarms of mosquitoes spread yellow fever throughout its swampy enclaves. Cholera-contaminated water spewed from the faucets of its homes. Plumes of thick black smoke flowed from nearby factories, and trash overcrowded the streets. Ironically, William Penn, aspiring to create a city free from the disease and disasters of 1660s London, had imagined Philadelphia as a country-like environment with open and airy streets. Finger explores how this vision died and how the city adapted to its booming population and recurrent outbreaks of sickness. Some Philadelphians blamed immigrants, who often entered aboard crowded and filthy ships, for spreading disease. This inspired Philadelphia officials to establish a Lazaretto, the first quarantine hospital in the United States. Inspired by miasma theory, the city government pushed butchers (and their businesses’ foul odors) to the outskirts of town. Finger tracks the vigorous public debates between “contagionists” and “anticontagionists” and the establishment of the College of Physicians of Philadelphia, which aimed “to advance the science of Medicine, and thereby lessen human misery.” In this work, Finger effectively communicates the connection between medical knowledge, disease, and urban politics. Polio: An American Story By David Oshinsky New York: Oxford University Press, 2005 Although a work of historical nonfiction, Polio: An American Story reads like a novel in which David Oshinsky guides readers through the nearly 50year quest to eradicate poliomyelitis. Early in this pursuit, John D. Rockefeller founded the Rockefeller Institute for medical research, headed by Simon Flexner, whose misguided theories delayed the discovery of a polio vaccine. President Franklin D. Roosevelt’s polio diagnosis spurred support for a nationwide eradication campaign, the “March of Dimes.” In 1934, his friend Basil

Pennsylvania Legacies Spring 2019

O’Connor organized “President’s Birthday Balls” in cities across the country at which each attendee made a small donation. In 1938, radio host Eddie Cantor urged the American public to send their spare dimes directly to the White House. By the 1950s, a lively debate emerged between Jonas Salk, who supported a killed-virus vaccine, and Albert Sabin, who supported a live-virus vaccine. Although controversial, Salk’s killed virus was eventually dispersed to the public, to the relief of thousands of children and their families. Oshinsky’s Polio is not just a story about the toll that polio has taken; it is a story about the generosity of the public and the determination to find a cure. The Great Influenza: The Epic Story of the Deadliest Pandemic in History By John Barry New York: Penguin Books, 2005 In The Great Influenza: The Epic Story of the Deadliest Pandemic in History, John Barry presents readers with a library of information. Over the course of two years, the Great Influenza (1918– 19) killed more individuals across the world than the bubonic plague had in a century. Those who were completely healthy one day were at risk of falling deathly ill the next. In such cities as Philadelphia, priests went house to house, urging residents to open their doors and hand off the bodies of their deceased loved ones. Influenza tore through cities, causing its victims to endure violent coughing spasms, bleeding from the ears, and pounding headaches that felt as if “someone were hammering a wedge into their skulls.” However, to learn such vivid details about the Great Influenza, readers must slog through over 100 pages of American medical history, intertwined with an examination of America’s wartime politics. These details that so perfectly express the magnitude of the influenza epidemic are hidden within chapters that primarily focus on such topics as philosophy of Galenic medicine, the rising competition between European and American medical schools, the establishment of Johns Hopkins University, the United States’ involvement in World War I, and the implementation of the Sedition Act. Although these events hold great significance in American history, they seem to overshadow the importance of the 1918 influenza epidemic.

The Immortal Life of Henrietta Lacks By Rebecca Skloot New York: Random House, 2010 Henrietta Lacks was a poor African American woman from rural Virginia. She fell ill shortly after her 30th birthday and was diagnosed with squamous cell cancer, which proved fatal. While at the Johns Hopkins Hospital, Lacks withstood multiple tests and treatments. Prior to her death, her cervical tissue was sent to the lab of Dr. George Gey, a cell biologist, and covered in several drops of culture medium. To the surprise of everyone in the lab, these cells grew with “mythological intensity.” Discovering a method to isolate a specific cell and repeatedly divide it, Gey created the world’s first immortal cell line, now known as HeLa. Soon enough, scientists from across the globe yearned to experiment with HeLa cells. HeLa cells were used to prove

the Salk polio vaccine effective. Russian and American scientists grew them in space to study the effects of space travel. It’s even thought that they could lead scientists to a cure for cancer. Despite her significant role in the scientific community, Lacks’s family did not learn about their relative’s immortal cell line—or the fact that HeLa cells were being sold commercially throughout the medical community—until 24 years after her death. Author Rebecca Skloot delves into HeLa’s importance within the medical community, but she also shares the story of the person and family behind the cell line, effectively capturing the emotional turmoil the Lackses withstood. Maureen Iplenski is an intern in the Programs and Services Department at HSP and an undergraduate at Temple University pursuing a degree in history along with a minor in communication studies.

LEG@CIES

INTERESTING PLACES TO EXPLORE ON THE WEB Whatever Happened to Polio?

The History of Vaccines

amhistory.si.edu/polio/

historyofvaccines.org

In this online exhibit, the Smithsonian Museum of American History not only chronicles over 200 years of polio history but also explores polio’s medical, scientific, and cultural legacies as it spurred advances in disability rights, rehabilitation medicine, assistive technology, and immunization. Through historical images and documents, timelines, interactive activities, and audio clips, the site outlines polio’s reign of terror in 20th-century America and continuing efforts to eradicate the disease worldwide.

Developed by the College of Physicians of Philadelphia, one of the oldest medical societies in the United States, this interactive resource aims to increase public knowledge of the development of vaccinations, their role in the improvement of human health, and the controversies surrounding vaccination by presenting an archive of sketches, photographs, and videos, an interactive timeline stretching over 1,000 years, educational activities, and academic articles. Users may study the development of the HIV vaccine, the practice of inoculation, and the evolution of viruses while exploring a library of additional information.

Politics of Yellow Fever in Alexander Hamilton’s America nlm.nih.gov/exhibition/ politicsofyellowfever Philadelphia’s yellow fever epidemic of 1793 had political as well as medical implications. In newspapers and pamphlets, leading doctors and politicians fiercely debated the cause and treatment of the disease as well as ways to prevent further outbreaks. Through documents, images, and artifacts, this exhibit by the US National Library of Medicine encourages users to explore how different groups of people responded to the epidemic and used it to advance their agendas. Resources include a digital gallery on efforts to combat mosquitoborne illnesses in the 1800s and 1900s and lesson plans for middle-school and undergraduate students.

The Antibody Initiative americanhistory.si.edu/ collections/object-groups/ antibody-initiative Labeled an “object group,” the Antibody Initiative is actually a robust interactive online portal that uses over 1,000 objects in the National Museum of American History’s collections to explore the history of vaccines, serums, antitoxins, diagnostics, and other antibody-based therapies. Topics range from the first smallpox vaccinations to the development of tests for typhoid and syphilis to rabies treatments. Through this exhibit and its related glossaries, animations, and explainers, the Smithsonian aims to share how antibodies have transformed medical history.

MI Spring 2019 Pennsylvania Legacies

FOOD FOR THOUGHT

Looking Back at Past Epidemics BY LAURA FASSBENDER, CAROLYN BYRNES, MPH, AND RACHEL L. LEVINE, MD

ennsylvania is in the midst of fighting a public health crisis, the fatal opioid epidemic. In 2017 alone, 5,456 Pennsylvanians died of an overdose. In 2018, there were a total of 9,662 suspected opioid overdoses in Pennsylvania emergency rooms. The opioid epidemic is a complex problem that requires a multifaceted response. Pennsylvania has faced several other epidemics throughout history: smallpox, measles, influenza, Spanish flu, yellow fever, cholera, typhoid, HIV—the list goes on. Historically, epidemics and diseases have focused on illnesses that are a result of infectious agents. As we work to develop a successful response to this disaster, we must understand that opioid use disorder (OUD) is a disease and the colossal number of lives lost is an epidemic. Reviewing past sudden, widespread disease outbreaks is vital to understanding why some responses were effective and others were not, ways to prevent future epidemics, and recurring themes. Such a review reinforces the need for emergency preparedness, stigma reduction interventions, government investment, education and awareness, and a well-rounded public health approach to combat the opioid epidemic. Drug epidemics are not a new phenomenon; in fact, they can be traced back well into the 1800s. During the Civil War, soldiers became addicted to morphine; cocaine was used to treat morphine addiction and became popular in Hollywood; and, currently, thousands of individuals in the United States and Pennsylvania are dealing with an opioid addiction. In 1971, President Nixon declared the “War on Drugs” in an effort to stop illicit drug use. This “war” resulted in stricter penalties and mandated sentencing for individuals who misused substances. The initiative was unproductive in reducing rates of drug use and addiction and led to an influx of poverty, crime, disparities, and, ultimately, mass incarceration. The War on Drugs widely contributed to the stigma

Pennsylvania Legacies Spring 2019

associated with substance use disorders (SUDs), which is now a disruptive barrier as we face this epidemic. The silver lining of the War on Drugs is what can be learned from it: 1) treating addiction as a crime is counterintuitive; and 2) addiction is a complex disease that should be tackled with robust treatment. Therefore, it is vital to look at how previous disease outbreaks were treated. The first case of the Spanish Influenza (flu) in Philadelphia was in 1918. That same year, 75 percent of Philadelphia’s hospital staff was abroad serving in World War I, and citizens were distracted from the influenza outbreak by excitement over returning soldiers. By October 25, 1919, there were an estimated 350,000 reported cases of the flu in Pennsylvania, 150,000 of them in Philadelphia. Researchers are still attempting to pinpoint the cause of the disease but can confidently say that the pandemic in 1918 will not be the last. In retrospect, thousands of lives could have been saved if there had been a proactive response to influenza. Health officials were ill-prepared for the outbreak, and they had to develop plans quickly. The safety of health care workers was not ensured, clear authority from public health government officials was lacking, and there was no consensus on the proper response among stakeholders. This epidemic demonstrated the need for public health preparedness to minimize the burden of disease outbreaks. Like the influenza pandemic, the HIV/AIDS pandemic has claimed an unprecedented number of lives from the 1980s to today. In 2016, 39,782 Americans were diagnosed with HIV/AIDS, and 35,481 Pennsylvanians were living with HIV. Understanding the response to HIV/ AIDS is particularly valuable because both HIV/AIDS and opioid use disorder are stigmatized. Stigma was addressed in HIV/AIDS interventions from an intrapersonal, interpersonal, community, institutional,

Cover of Piensalo Bien: Una Historica sobre SIDA/Think Twice: A Story about AIDS (Philadelphia, 1998). New Immigrants Initiative Collection.

and governmental/structural level. This multilevel approach should be replicated to address the opioid epidemic. One specific way that HIV/AIDS stigma was reduced was by making HIV and STD testing routine. Incorporating routine testing for SUDs into primary care, OBGYN, and pediatric practice is a promising way to reduce stigma and increase the number of individuals seeking treatment. During the HIV/AIDS epidemic, Surgeon General C. Everett Koop released an informational report to educate the public. In the report, Dr. Koop stated, “We are fighting a disease, not people. Those who are already afflicted are sick people and need our care as do all sick patients. The country must face this epidemic as a unified society. We must prevent the spread of AIDS while at the same time preserving our humanity and intimacy.” Dr. Koop’s attitude helped shift the lens from Americans seeing HIV/AIDS as a social issue to recognizing it as a health issue. Once that shift happened, the nation and states bolstered their resources. In 2017, 7,000 people in the United States died from HIV/AIDS, while 42,000 people died from

opioid use disorder. Still, federal government investment in 2017 was $7.7 billion for HIV/AIDS and $1 billion for OUD. Even in 1988, when the HIV/AIDS epidemic was in full swing, federal funding for HIV/AIDS was $1.6 billion. The HIV/AIDS epidemic demonstrates the need for comprehensive stigma reduction interventions, as well as federal and state investment. The need for investment in education and awareness can be validated by a brief look at past epidemics. Once the public became aware of the cause of typhoid fever in 1880, Philadelphia government officials, activists, and physicians rapidly pulled together resources to improve water quality and slow the spread of typhoid. Similarly, the death rate of cholera plummeted once the miasma theory was challenged by John Snow in 1854 and officials learned the true cause of the disease. Examining past epidemics makes educating officials on the opioid epidemic an indisputable necessity. In the case of the opioid epidemic, a key group that should be educated is those who prescribe opioids, such as physicians, physician assistants, nurse practitioners, and dentists. With that in mind, the Pennsylvania Department of Health offers opioid prescribing guidelines, as well as a free

continuing education course for prescribers that outlines best practices for using the Prescription Drug Monitoring Program (PDMP) and information on how to address substance use disorder with patients. Further, patients, primary care physicians, care managers, public health professionals, and the public must be educated on the dangers of prescription and illicit opioid use. Although the opioid epidemic is one that affects all demographics, many past epidemics and current diseases have disproportionately affected minority populations. In Pennsylvania, rates of cardiovascular disease, heart disease, cancers, injury and accidents, homicide, diabetes, HIV, asthma, infant mortality, and maternal mortality are significantly higher among blacks/African Americans compared to whites. Additionally, LGBT individuals in Pennsylvania are more likely to use tobacco, be overweight or obese, and experience a mental health condition. The Wolf administration, in its commitment to health equity, works to minimize disparities and provide opportunities for all commonwealth residents to live a healthy life. The principal takeaway from reviewing past epidemics is the importance of investing in public health. All past epidemics support the need for ongoing disease prevention,

control, and surveillance. The approach to epidemics must be proactive so that we can prevent people from getting sick in the first place, rather than waiting to try to heal them once they are ill. Naloxone can reverse overdoses and save lives in an emergency, but it will not reduce the rate of addiction. The opioid epidemic presents many parallels to past epidemics; however, it is uniquely complex due to its widespread effects on health, job and housing security, child custody, and financial situations. The Pennsylvania Department of Health will continue to relentlessly leverage public health strategies to reduce the number of lives lost to the opioid epidemic. Future research should robustly examine past disease outbreaks to help equip public health officials to prevent and face imminent epidemics. Laura Fassbender is an intern in the secretary’s office at the Pennsylvania Department of Health. Carolyn Byrnes, MPH, is a special advisor to the secretary of health at the Pennsylvania Department of Health. Rachel L. Levine, MD, is the secretary of health for the Commonwealth of Pennsylvania and a professor of pediatrics and psychiatry at the Penn State College of Medicine.

“Mrs. Anne Gelzman with her daughter Barbara 2½ yrs old who is being inoculated by nurse Elizabeth Coles” at Babies Hospital, 7th and Delancey Streets, Philadelphia. Photo by A. Jarvis, Jan. 27, 1942. Philadelphia Record Photograph Morgue.

Spring 2019 Pennsylvania Legacies

as one of the nation’s largest archives of historical documents, hsp strives to make history relevant and exhilarating to all. address service requested

“Toddler cousins Patricia Bova and Michael Bruzzese, recently inoculated against diphtheria and whooping cough at Philadelphia’s Babies’ Hospital, appear ready to examine and inoculate the doctor.” Photo by Larmour, June 3, 1946. Philadelphia Record Photograph Morgue.