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Friday, March 27, 2009

Influenza and Other Epidemics

Spanish influenza caused the deaths of 100 million people world-wide in a major pandemic in 1917-1920. This 1918 illustration from the St. Louis Globe Democrat depicts the horror.







This photograph of a nursery for well children of parents sick with Spanish influenza is the only known photograph of the impact of the epidemic in Vermont, The nursery was in the First Congregational Church in Burlington (photo: Vermont Historical Society).



This monument is for influenza victim Lee Parker who died at the Naval Hospital in Norfolk, Virginia in 1918. Parker was the son of Harry and Sara Parker, editors of the United Opinion and one of 11 from Bradford who died from the illness.
THIS ESSAY IS JUST ONE OF TWENTY-ONE AVAILABLE IN THE E-BOOK, “IN TIMES PAST, ESSAYS FROM


THE UPPER VALLEY” AVAILABLE ON KINDLE FOR $9.99. PROCEEDS BENEFIT THE BRADFORD PUBLIC

LIBRARY, BRADFORD, VT. NO HARD COPIES ARE AVAILABLE.



Originally published on November 26, 2008
Journal Opinion.

November, 90 years ago, was a month of mixed blessings. That Thanksgiving month, 1918, brought peace to a world racked by the Great War. The war had touched every home in the area with shortages of goods and the absence of family members. But several months earlier another unwelcome visitor had entered many homes. It was influenza, the Spanish Lady. By November, the number of ill was in decline. By the time the epidemic had run its course, it killed over 5000 residents of Vermont and New Hampshire.

Illnesses caused many deaths in every decade of our area’s history. Until the middle of the 19th century, there was relatively little knowledge of their causes. Existing medical practices and folk remedies, while used with some success on minor illnesses and injuries, were ineffective against serious illness. Local cemeteries are filled with the victims of both epidemics (rapid outbreaks of contagious diseases) and endemic diseases (diseases normal to an area). Many common diseases of the past are largely unknown today. Many current diseases were called by different names.

The most devastating epidemics occurred among the Native Americans upon contact with Europeans. Lack of acquired immunity to infectious diseases such as scarlet fever, smallpox, influenza, measles and diphtheria led to death rates of up to 75%. Some indigenous groups experienced death rates from illness and war of more than 90%, leading to their virtual destruction as a cultural entity.

Zadock Thompson, in his 1842 history of Vermont, suggests that many earlier outbreaks of disease were caused, “by the sudden changes of temperature to which our climate is subject.” He lists outbreaks of smallpox, scarlet fever, influenza, dysentery, and typhus as regular deadly visitors to early Vermont homes. “In 1804, an influenza or catarrhal fever and canker rash produced considerable mortality along the western part of the state.” The latter disease scourged Corinth in 1804 causing 30 deaths.

Between 1805 and 1812, there were periodic outbreaks of spotted fever. In some eastern Vermont towns, 20 to 30 deaths per town from a single outbreak were not uncommon, “calculated to produce the utmost alarm.” In 1810, 57 deaths from this disease were reported in Peacham. Wells’ History of Newbury mentions that during an 1815 outbreak of spotted fever in Warren “whole families were swept away, and entire neighborhoods were depopulated.”

The largest number of deaths from a single epidemic in Vermont history occurred in 1812-1813. Lung fever, a form of pneumonia, broke out among soldiers stationed in Burlington and then spread rapidly. Death frequently followed within hours of the onset of the disease. Thompson wrote that the death toll from the disease “was estimated more than 6000 deaths, or one death to every 40 inhabitants.”


No less disastrous was the “Vermont epidemic” of 1842-1843, when a disease similar to St. Anthony’s fire (erysipelas) caused thousands of deaths. This disease was a skin infection marked by swellings and fever and was often fatal for young people and pregnant women. Nineteenth century Vermonter Abby Hemenway wrote, “A large portion of the population was clothed in mourning.” (One reader of the original article told me that her grandmother died of erysipelas.

Because the name of the disease sounds so much like syphilis, the cause of her death was rarely mentioned by the family.

An examination of the death records of 1857-1866 for Newbury and Bradford gives insight into fatal diseases common to the area. Of the 700 deaths recorded, 20 percent were from consumption (tuberculosis). An additional 9 percent was from typhoid, that disease being especially devastating to the Newbury family of John and Esther Douse. Other causes of death included various fevers, congestion of the brain, suicide, war and accidents. Infant mortality was evident at a time when one observer wrote “that a newborn infant in the United States had less chance of surviving a week than did a man of 90.” The area seems to have escaped the diphtheria epidemics that caused hundreds of deaths in Caledonia and Washington counties during this period.

During the Civil War, deaths from disease outnumbered battle deaths. This was the result of large numbers of men gathered together in unhealthy conditions and without acquired immunities. The first Vermont soldier to lose his life in that war was Bradford’s Benjamin Underwood who died at Fortress Monroe, VA, a victim of the measles. At the same time, George Lougee of Fairlee died of “quick consumption”, the first of five Fairlee men to die of disease during service.

Diseases led Hartford historian William Howard Tucker to note the high mortality rate in counties along the Connecticut River during the second half of the nineteenth century. He listed consumption, pneumonia, typhoid and heart disease. The Sanitary Visitor, published in 1889 by the Vermont State Board of Health, condemned the New England farm practice of locating wells too close to barns, cesspools and other sources of contamination. To avoid the resulting diphtheria, typhoid and lung diseases, Vermont began an active campaign to deal with contamination.

In 1894, the nation’s first epidemic of infantile paralysis or polio occurred in the Otter River Valley of Vermont. There were 123 cases and 18 deaths. Thereafter, summer often became the “polio season.” An outbreak in 1914-1918 led to 583 cases with a 17 percent fatality rate, a tragedy that would be frequently repeated until the wide use of Salk vaccine after 1955.

During the 18th and 19th century, there were frequent outbreaks of influenza or la grippe. In the 1890s, there were widespread epidemics of influenza that, according to the reports of the Vermont State Board of Health, directly or indirectly caused “great mortality.” In January, 1891, the United Opinion reported, “Colds and the grippe have become epidemic in this vicinity.” The Orfordville reporter wrote, “Johnnie Cochran is sick with fever, making eleven of Mr. Cochran’s family who have been sick with the same disease.” In 1895, 7 of the 30 deaths recorded in Newbury were from influenza.

But it was in 1918-1919 that area residents really felt the impact of influenza. That outbreak was truly a pandemic with estimates of world-wide fatalities as high as 100 million. Over one-quarter of Americans had the illness and 675,000 died directly or indirectly from the disease. It may have first appeared among troops along the Eastern European Front, but for propaganda reasons was underreported. It was known as “Spanish flu” because Spanish newspapers were the first to openly report the epidemic. The most deadly wave of the flu came in the fall of 1918. There was a major early outbreak at Camp Devens in Massachusetts, where a number of local men were in training.

Vermont historian Michael Sherman of Montpelier has written and spoken widely on the impact of the disease on Vermont. He writes that “A public notice from Bradford, VT, in early October 1918 repeats widely circulated claims that ‘it probably originated in the ranks of the German Army and in prison camps.’” A report from Orford called it “a Kaiser’s contribution to this country.’ ”

The United Opinion of September 27, 1918 reported that local health officials were warned by the State Board of Health that “the apparent seriousness of the disease makes it necessary that some precautions be taken to limit its spread…patients should be isolated in the home.” Affected families were told to keep their children from school and family members from public gatherings.

As the “unwelcome visitor” spread, schools were closed in all the area towns. The October 4 edition of the United Opinion reported that several area businesses, including the bank, closed for lack of adequate staff. It listed 21 Bradford residents who were seriously ill. In Topsham, the post office was moved to the home of J. R. McLam, as the postmaster had the grippe. Sherman writes “On October 4, 1918, finally recognizing its inability to deal effectively with the raging epidemic, the State Board of Health issued an order closing all public meeting places and prohibiting public assemblies throughout the state.”

The next week’s edition of the Bradford newspaper included the following front-page announcement, “The Opinion force is decimated by sickness and otherwise, and the local happenings being confined almost entirely to sickness and death notices, unprecedented in our long years of experience in publishing this paper, is our excuse for lack of local items this week.” The “otherwise” to which Editor Harry Parker referred included the death of his 27-year old son Lee, who had died of influenza at the Navy base in Norfolk, Virginia. Owing to the epidemic conditions only close family members and friends attended his funeral service, held at his parent’s home on Wrights Avenue.

As with young Parker, the disease had an especially high toll among younger residents. Of the nine influenza deaths listed in the Newbury records, the ages of the deceased range from infants to age 41. The average age of death among the eleven Bradford victims was 33. Doctors, nurses, and pharmacists were overwhelmed by the case load, often falling ill themselves. The Opinion paid tribute to William Welch, a popular Bradford druggist, who died after spending long hours filling prescriptions even after he fell ill. Caskets were in such short supply that the Bradford undertaker reused one ornate casket for funerals until the handles of the casket finally fell off.


Marcia Casais, a descendant of Bradford's Low family responded to this column with the following story: Her uncle, Kenneth Low, was stationed at Camp Drum and became ill with the flu. He was placed in a ward in which a coffin was placed under each patient's bed in anticipation of death.

Because doctors were unable to cure the flu, many families tried other remedies including Vick’s VapoRub, new to the national market. One source reported that “some tried gargling with bicarbonate of soda, boric acid and chlorinated soda. A few took sugar laced with turpentine or kerosene.” Others tried aromatic remedies including garlic, onions or camphor balls. More effectively, gauze face masks were issued to those dealing with the public and frequent hand-washing was recommended.

In 2006, Mike Leavitt, U. S. Secretary of Health and Human Services, summed up the impact of the epidemic on the two states: “The pandemic’s arrival was sudden, its spread was rapid, and its toll was shocking. Those who were fortunate enough to escape the flu were struck with the tragic experience of watching friends suffer and loved ones die.” Sherman concludes that the number of ill in Vermont was greater than the 43,735 reported cases, “many not being reported on account of the overworked situation of the physicians.” New Hampshire, which suffered the least of the New England states, still recorded 3,000 deaths.

The epidemic gradually faded. In early November, the state-wide closing order was lifted.
By spring, 1919, the flu had simply run out of potential new victims. Influenza would come again in the ensuring years, but never with such an impact. But recently, health officials have raised the specter of another epidemic. The interdependent global network makes it both possible and likely to be widespread.

In October 2008, the Vermont Department of Health urged residents to prepare for a possible worldwide flu epidemic. Health Commissioner Wendy Davis added “And we think it’s not unlikely that it could occur fairly soon.” Public health officials say that during a flu pandemic, families won’t be able to go to work, school or the store. Families are urged to stock enough food for two weeks.

Laura Stephenson Carters prefaces her 2006 Dartmouth Medicine article on the subject with the comment, “If an influenza pandemic strikes again, it could be cold comfort to know that lessons learned from the 1918 flu epidemic may offer more help than modern medicine.”

“I had a little bird, Its name was Enza. I opened the window, and in-flew-enza.” This is a children’s rhyme from the pandemic of 1918. As Carter writes, “Enza was anything but a cute little bird. She was vicious. She was violent. She was a killer.” To which it can be added, she is incurable and she is still very much around.



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