“OBEY AND WEAR THE LAWS THE GAUZE”
The Second Wave—Autumn 1918
A streetcar in Seattle carries a warning about spitting. [National Archives and Records Administration]
Obey the laws
And wear the gauze
Protect your jaws
From Septic Paws
—Public health rhyme encouraging mask use
KATHERINE PORTER was eager to get into uniform—just like Walt Disney, Franklin D. Roosevelt, and many other Americans. But for her, it would mean the crisp white dress and nursing cap emblazoned with the Red Cross symbol. A transplant from rural Texas, the twenty-eight-year-old journalist was working as a reporter at Denver’s Rocky Mountain News in the autumn of 1918. Her reviews of local events were popular with readers, and her colleagues admired Porter’s knack for dashing off a newspaper column with ease and style. But as she watched young men enlist and head off to fight, she wanted to trade in her typewriter. Katherine Porter wanted to do her part.
She had already survived a bout of tuberculosis, then a deadly disease. But now Katherine was completely recovered. As anti-German propaganda filled the air in 1918 and war fever spread around the country, she set out to join the Red Cross.
The Red Cross was formed in Switzerland in 1863 as the International Committee for Relief to the Wounded. Its creation led to the first Geneva Convention in 1864, which provided for the care of injured soldiers and protected medical workers as neutral for the first time in the history of warfare. Under the terms of the convention, medical workers who wore a red cross on a white background—the inverse of the Swiss flag—were supposed to be safe from attack as they tended the wounded. The symbol became an icon. In May 1881, Clara Barton, who gained fame as a nurse during the American Civil War, launched the American branch of the Red Cross.
A private organization officially chartered by Congress to serve the nation in emergencies, the Red Cross had practically grown into an arm of the government. With the coming of the war in Europe, the Red Cross had expanded aggressively, organizing fifty base hospitals in France and training nurses for the U.S. Army and Navy. According to Red Cross records, more than twenty-three thousand Red Cross nurses enrolled during the war. Of these, nearly twenty thousand were assigned to active duty with the army, navy, U.S. Public Health Service, and the Red Cross overseas.
Red Cross posters also played on fears of German savagery to both recruit volunteers and raise funds for the organization. [Library of Congress]
Red Cross promotional posters depicted its nurses as angels of mercy who could fix things with a smile while wearing a crisp white blouse. [Library of Congress]
But before she could put on a Red Cross nurse’s uniform, Katherine fell sick in October 1918. For days, she lay in bed with a dangerously high fever, her body wracked with agonizing pain. Katherine’s landlady tried to put the desperately sick reporter out of the house, terrified that she would infect other boarders. The Spanish flu had hit Denver hard, and the hospitals were all full. For a time, there was no room for Katherine.
The U.S. Treasury offered inexpensive stamps as a form of war bond, saying, “Your country needs every penny which every man, woman, and child can save and loan.” [Library of Congress]
Burning with fever, Katherine was finally admitted. But it seemed to be too late. Drifting in and out of consciousness, she lay in bed with a temperature that rose to 105 degrees and remained there for days. Lingering near death, Katherine was screened off from other patients. Fellow reporters prepared her obituary. Family members made arrangements to collect her remains to be returned to Texas for burial.
As she lay dying in a hospital corridor, Katherine’s chances for recovery seemed bleak. Then fate intervened. A group of young interns decided to give Katherine an experimental shot of strychnine—a deadly poison now mostly used for killing rodents. At the time, doctors tried it in very small doses as a “convulsant,” to produce muscle contractions. Some athletes, including Olympic marathoners, also used injections of strychnine—what today would be called a “performance-enhancing drug.”
“Miraculously, it worked,” writes her biographer, Joan Givner, “and she began to fight her way back to life.”
Katherine Anne Porter’s fever broke. She recovered and lived. She had lost all her hair, but she was among the lucky ones.
A little more than twenty years later—in 1939—Porter published a collection of short stories called Pale Horse, Pale Rider. The title story told of Miranda, a young newspaper writer in Denver who nearly dies of influenza. A gallant young beau named Adam cares for Miranda, then visits her in the hospital while home from an army training camp. Adam is not so lucky. He also comes down with the Spanish flu, but unlike Miranda and Katherine Porter, he does not survive.
In parts dreamlike, Porter’s autobiographical story captured the almost surreal experience of falling victim to the Spanish flu. Many survivors reported a hazy mental state as high fever altered their perceptions of reality. The same story depicted another reality—the nation’s fevered wartime mood, as Americans were urged and later pressured to buy Liberty Bonds to pay for the cost of America’s involvement in World War I. In the story, two unrelenting war bond salesmen come to Miranda’s office and put on a hard sell.
“The two men slid off the desk, leaving some of her papers rumpled, and the oldish man had inquired why she had not bought a Liberty Bond.… ‘Look here,’ he asked her, ‘do you know there’s a war, or don’t you?’”
As her fellow workers look on, the men expect Miranda to turn over a portion of her meager salary to buy a bond.
In fact, such men were part of a force of seventy-five thousand Four Minute Men, who traveled the country giving brief speeches—the length of time it took a projectionist to change reels on a movie projector—pressing audiences at motion picture theaters, religious meetings, union meetings, and town halls to buy bonds and war savings stamps. The refusal to buy bonds meant being labeled someone who wasn’t “doing their part.”
The Four Minute Men were part of a larger government agency called the Committee on Public Information. Established by executive order after war was declared, the committee’s purpose was to create enthusiasm and boost public support for the war effort. Although the committee’s leader, George Creel, rejected the word “propaganda,” that is essentially what the agency did with newsprint, posters, and eventually radio and original movies. “Liberty Sings,” weekly community events where patriotic songs were sung by church choirs and barbershop quartets, were sponsored across the country. What began as a morale-building effort rapidly became a high-pressure loyalty test.
The Committee on Public Information was operating even before the United States passed a new Sedition Act, which made it a crime to “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the form of government of the United States.” A volunteer group called the American Protective League was formed and given powers by the Justice Department to enforce the Sedition Act.
Porter’s fictional Miranda knew that to challenge the Committee or its Four Minute Men was no small matter. Americans were being told that refusing to support the war bond effort was one step away from treason. A poster produced by the committee left no doubt about those who did not do their part. “I am Public Opinion. All men fear me!… If you have the money to buy and do not buy, I will make this No Man’s Land for you!”
Part of the propaganda effort was aimed at German Americans, who were increasingly viewed with suspicion. Some states outlawed teaching German. Famous conductor Leopold Stokowski wrote to President Wilson asking if Bach and Beethoven—both German composers—should be eliminated from his concerts. Otto Kahn, chairman of New York’s Metropolitan Opera, made a similar query, asking the president if German operas and opera singers should continue at the opera house. “Wilson hated to see the loss of German opera,” notes biographer A. Scott Berg, “but left the decision to Kahn and his board—which chose to bar German works.”
Hamburgers were renamed “liberty steaks” and sauerkraut was called “liberty cabbage.” Berlin, Iowa, changed its name to Lincoln, and Brooklyn’s Hamburg Street was renamed Wilson. Even beer was suspect. According to Alfred W. Crosby, “American brewers, condemned because of their Teutonic names and the Germanness of beer and ale,” had to defend their loyalty with a newspaper ad.
The anti-German mood of the country—similar to the anti-Irish Catholic intolerance of an earlier age and the anti-Muslim fervor of post-9/11 America—was pushed by propaganda that depicted all Germans as untrustworthy and dangerous.
Against this atmosphere of supposed German spies and saboteurs—and the spreading flu epidemic—there was no letup in the push to sell war bonds. On September 28, 1918, the nationwide frenzy to support the war bond campaign was on full display when Philadelphia’s leaders pressed on with their Liberty Loan parade, intended to sell millions of dollars’ worth of war bonds. Philadelphia was a major port city and shipbuilding site, situated between two major army bases—Camp Dix in New Jersey and Camp Meade in Maryland. The organizers hoped to stage the greatest parade in the city’s history, with thousands marching and a huge crowd lining the streets to watch.
While some physicians counseled caution, money spoke louder. Fear of spreading contagion took a back seat to a distorted sense of civic-mindedness as Philadelphia health officials assured the public that they would be safe—the military would contain the illness. These officials seemed more concerned with getting out big crowds and meeting bond quotas.
False hope and wishful thinking also kicked in. Optimistic reports—later proven wrong—suggested that the flu had already disappeared among the Allied troops in Europe. Hopes flew even higher when the Philadelphia Inquirer reported that a researcher had found the likely cause of the flu—a bacteria called Pfeiffer’s bacillus, named after the nineteenth-century German scientist who had discovered it. But it was a case of mistaken identity. The public had also been told with confidence that a vaccine might soon be ready. That, too, was wrong.
Deciding that the show must go on, the city health commissioner approved the march. Filled with bands, Boy Scouts, marines, and sailors, the line of marchers stretched for two miles. More than two hundred thousand massed on the sidewalks on September 28.
Soon after the parade ended, the floodgates opened. In just two days, some 635 cases of influenza were reported. Short-staffed hospitals quickly filled to capacity and the health commissioner declared an epidemic existed. Schools were ordered closed, along with all places of “public amusement,” including theaters and bowling alleys. Some wary members of the press, thinking that the city was overreacting, condemned the closings as a violation of common sense and personal freedom.
The flu hit shortly after Frank Biberstein started school at St. Joseph’s College and Seminary in Philadelphia. He and other seminary students were put to work, walking the streets with a horse-drawn cart to collect the dead. They went door to door, calling for victims. Once they retrieved a few bodies, they would return to a makeshift field hospital. Decades later Frank Biberstein would tell his family tales of bringing out the dead, much as it had been done in medieval Europe in the days of the Black Death.
“They would do this for several hours a day and he did it for most of the semester,” his grandson Paul Kendall relates. “My grandfather was not a big man, so I remember him telling me how hard it was for him to carry the bodies out. He said there was no one else who would or could collect the dead, so the powers-that-be decided that they would get the young men studying to be religious to do the work.”
Also filling the void was Philadelphia’s well-organized Visiting Nurses. These women worked around the clock, assisting those who were sick but unable to get to a hospital. They often entered houses to find starving orphaned children, alone beside the corpses of their dead parents.
“Visiting nurses often walked into scenes resembling those of the plague years of the fourteenth century,” historian Alfred Crosby notes. “They drew crowds of supplicants—or people shunned them for fear of the white gauze masks that they often wore. They could go out in the morning with a list of fifteen patients to see and end up seeing fifty. One nurse found a husband dead in the same room where his wife lay with newly born twins. It had been twenty-four hours since the death and the births, and the wife had no food but an apple which happened to be within reach.”
A public health nurse teaches a young mother how to sterilize a bottle. [National Library of Medicine]
Just as plague had transformed medieval daily life during the Black Death, the Spanish flu was changing America—and rarely for the best. The crisis was producing acts of courage, but also cowardice. While many communities saw armies of volunteers willing to risk their own health to help the sick, there were also many people who turned their backs, too frightened to go to the aid of infected friends or family.
As a young girl, Mary McCarthy had witnessed this fearful mood during the fatal weeks after the epidemic struck her birthplace of Seattle, Washington. McCarthy would later describe a time “when no hospital beds were to be had and people went about with masks or stayed shut up in their houses, and the awful fear of contagion paralyzed all services and made each man an enemy to his neighbor.”
McCarthy’s parents left Seattle to take shelter with family members in Minneapolis after the flu hit Seattle. “We began to be sure it was all an adventure,” she later remembered of the train trip halfway across the country. Then both of her parents fell ill, and her mother raised suspicions as she lay listless in the sleeping berth while the train rolled east. “We saw our father draw a revolver on the conductor who was trying to put us off the train at a small wooden station in the middle of the North Dakota prairie.”
After both her parents died, Mary McCarthy and her brothers were turned over to an aunt and uncle who were harsh and abusive. In a 1957 memoir, Memories of a Catholic Girlhood, she described the loss that she and her brothers had suffered. “We were beaten all the time, as a matter of course, with the hairbrush across the legs for ordinary occasions, and with the razor strop across the bare bottom for special occasions.… It was as though these ignorant people, at sea with four frightened children, had taken a Dickens novel—Oliver Twist, perhaps or Nicholas Nickleby—for a navigation chart.”
Mary McCarthy and her brothers were part of a flood of broken homes and orphaned children left across the country in the flu’s wake. The health commissioner of New York estimated that twenty-one thousand children had been orphaned in the city. A small town in New Hampshire counted twenty-four orphans, and in a Pennsylvania coal town with a population of six thousand, some two hundred children were orphaned. Many of these children became premature adults, forced to fend for themselves by heading to work in factories. Some wound up in Dickensian “orphan asylums.” Many others, like Mary McCarthy and her brothers, were taken in by extended family—not always with happy results.
Even the loss of one parent could have life-changing consequences. “For Lillian Kancianich, who was born just a few months before the epidemic in 1918, her mother’s death meant the break-up of her home,” records historian Nancy K. Bristow, “because local custom discouraged older men from living without a woman in a household with children.” According to Bristow, children were displaced even while a father survived, and some, like Lillian, were shuffled from place to place. “No one adopted me,” Lillian later told Bristow. “I just went from home to home.… I had six different homes.” The flu epidemic and her mother’s death, Bristow says, changed Lillian’s life completely.
All innocence was lost for children who had to play a new role, some taking jobs to support their orphaned siblings. Children as young as ten years old were called on to work as “runners”—doing errands and carrying home pails of food for sick adults. In many places, children became accustomed to seeing the unthinkable. The sight of entire families dead in their yards became as common as going out to play. It is worth remembering, however, that working children were not unusual in early-twentieth-century America, before federal child labor laws were passed. While some states had begun to limit child labor, many children worked in mines, textile factories, and cotton fields, selling newspapers, and shining shoes.
All of this was taking place in a very different America. In the early twentieth century, the federal government provided few of the resources that are commonplace today. There was no Social Security, federal welfare assistance, unemployment, or disability insurance. Modern medical assistance programs—such as Medicare for senior citizens and Medicaid for those in poverty—did not exist. Neither did agencies like FEMA, the Federal Emergency Management Agency, which coordinates disaster response today.
When the Spanish flu pandemic hit Massachusetts, Lieutenant Governor Calvin Coolidge—a future U.S. president—wired Washington for help. The hard-hit state was home to Camp Devens and Boston, and it desperately needed doctors. With Americans now fully engaged in combat in France creating a pressing need for military doctors and nurses, there were precious few to spare. Other than producing posters and informational pamphlets of dubious value, the federal government was channeling most of its energy and efforts into the war. “If influenza could have been smothered by paper,” says historian Alfred Crosby, “many lives could have been saved in 1918.”
In 1916, Lewis Hine documented five-year-old Mart Payne picking cotton. This photograph was part of a series that Hine took while working as an investigative photographer for the National Child Labor Committee. [Library of Congress]
The best Congress could do was authorize an emergency fund of one million dollars—a substantial amount of money, but far from enough for the crisis the country faced. This meant that many local communities across America had to fend for themselves, especially African Americans. They often had to cope with even less assistance from federal, state, and local governments, and the broader white world. In 1918, America was still living through its Jim Crow era of sharp racial segregation—and not just in the southern states of the former Confederacy. Philadelphia had one of the largest black communities in America at the time, but the city’s hospitals were segregated. In Philadelphia and elsewhere, hospitals that accepted black patients usually assigned them to separate wards, often shamefully located in attics or unheated basements.
“Racism and legalized segregation restricted access by black patients and health professionals to health-care facilities,” physician and medical historian Vanessa Northington Gamble writes. “In addition, African Americans lacked political and economic power and lived in the least desirable and most disease-ridden neighborhoods. But despite their plight, African Americans created separate hospitals, facilities, and organizations to take care of themselves. During the 1918 influenza epidemic, these institutions proved essential because of rigid racial barriers in medicine and public health.”
In Philadelphia, there were two black hospitals. One of them, the Frederick Douglass Memorial Hospital, quickly filled its seventy-five beds. An emergency annex was established in a nearby black parochial school. The facility operated without support from the city’s political or health officials.
In part because of deep-seated racism and institutional segregation, statistics about the Spanish flu’s impact on African Americans as a whole are incomplete. Anecdotal evidence and insurance company records suggest that African American communities were not hit as hard as some white areas, even in the same cities. It may have been that some black neighborhoods had absorbed the first wave of the milder Spanish flu and, as a consequence, developed greater immunity when the second wave hit. There is also the possibility that segregation—being physically separated from the white world—may have provided some protection, a kind of unintended quarantine.
Jim Crow attitudes divided the medical world as well. When the United States entered the war, the army did not accept black nurses. The war and the flu created a new reality, according to Gamble. “The influenza epidemic did what the war could not—it forced the Army to drop its ban on black nurses. On December 1, 1918, three weeks after the war ended, 18 black nurses arrived in Ohio at Camps Sherman and Grant, where large numbers of black soldiers were stationed. Although the nurses lived in segregated quarters, they took care of black and white soldiers.”
Those nurses, doing their duty in the face of racism, were one example of the often selfless dedication of those who took care of the sick and dying. The Spanish flu made heroes of countless everyday people, many of whom volunteered long hours, whether it was tending victims or rolling Red Cross bandages.
But as in almost every catastrophe, others saw opportunity in tragedy—a chance to make a quick dollar and profit from a crisis. Price gouging became commonplace for everything from groceries to funerals. In Philadelphia, some undertakers raised their prices by more than 500 percent as grieving families sought proper burials. Tales spread throughout the city of individuals being forced to pay as much as fifteen dollars—a significant amount of money in 1918, especially for the poor—to dig graves for dead family members.
The delay in burying the unembalmed dead went beyond a question of common decency. It was a matter of public health. Rotting cadavers often led to the spread of other diseases. Philadelphia appealed to the federal government to meet its need for embalmers, and the army sent men to assist.
But the demand was overwhelming. “Wagonloads of bodies, some dead over a week, were buried” in potter’s field, a public mass cemetery for the poor, Philadelphia nurse James F. Armstrong recounts in discussing the history of Philadelphia’s nurses during the crisis. “Highway workers dug large trenches and filled them to capacity. The promise that bodies could later be retrieved and reinterred after the epidemic subsided persuaded relatives to give up loved ones. Relatives never recovered most of the bodies.”
The most visible symbol of the pandemic in many places had become the gauze masks. Thought to be effective in slowing the spread of flu when first tried in one of the army camps, the masks were soon worn everywhere. Police officers, streetcar conductors, postal carriers, and even professional baseball players were required to wear them.
As demand for these masks grew, the Red Cross had its volunteers turn out masks instead of rolling bandages for soldiers. In time, many cities began to require their use.
In Minneapolis, for instance, directions for wearing the masks were issued to the public.
St. Louis Red Cross Motor Corps on duty. [Library of Congress]
The outside of a face mask is marked with a black thread woven into it. Always wear this side away from the face. Wear the mask to cover the nose and the mouth, tying two tapes around the head above the ears. Tie the other tapes rather tightly around the neck. Never wear the mask of another person. When the mask is removed … it should be carefully folded with the inside folded in, immediately boiled and disinfected. When the mask is removed by one seeking to protect himself from the influenza it should be folded with the inside folded out and boiled ten minutes. Persons considerably exposed to the disease should boil their masks at least once a day.
* * *
ONE DOCTOR on the Minnesota State Board of Health advocated wearing the masks but did not wear one himself, saying, “I personally prefer to take my chances.”
When worn by a flu victim, the mask was meant to prevent the infectious droplets from being expelled. In San Francisco the gauze masks were required of the entire public in a trial ordinance, later expanded to include San Diego. In Philadelphia and other cities, this rhyme was promoted as a popular way to remind people of the ordinance:
Obey the laws
And wear the gauze
Protect your jaws
From Septic Paws.