North Carolina medical journal

              August, 1964
fied with less than adequate service and
other preferring better service if they could
afford it.
Data were collected by personal inter-views
with a random sample of mothers
who were delivered in the county during
the year 1960. In order to tabulate the re-sults,
the mothers were grouped according
to type of obstetric service: delivery by a
midwife, home delivery by a physician, and
hospital delivery by a physician. Results
regarding the amount of prenatal care re-ceived
were shown graphically for com-parison
with ideal standards.
Results indicated that few mothers in
any of the three groups received completely
ideal prenatal care. It appeared that the
proportion of mothers who received inade-quate
or questionably adequate care was
larger in the group of mothers attended by
midwives. However, a significant number
who had hospital deliveries also received
questionable prenatal care.
The reasons given for choosing a hospital
delivery were not unusual or unexpected .
A majority of the mothers having midwife
deliveries indicated that they would have
gone to the hospital if it had been financial-ly
possible. A small number indicated sus-picion
or dislike of the hospital.
Conclusion
It was concluded that the low level of
maternal medical care in the county was
largely due to financial depression and a
Between October 1, 1918, and March 1,
1919, North Carolina lost 13,703 of its citi-zens
by death from influenza. According to
Dr. W. S. Ranking Director of the State
Board of Health, the monthly death toll dur-ing
the epidemic was: October, 6561; No-vember,
2083; December, 1920; January,
2266; and February, 873. The rapid onset
and development of the epidemic, together
with the shortage of civilian physicians be-
MATERNAL HEALTH-LAMB AND MAY
generally low educatic nag level . It was rec-ognized
that the county health department
has striven admirably to minimize this situ-ation
. The work of pu blic health personnel
appears to offer the bE St immediate aid; the
long-term solution to the maternal health
problem in this count 7 involves improving
the economic and ec ucational level of a
large segment of the )opulation.
Refer, mces
1. Eastman, N. J., and Hel man, L. M. : Obstetrics . New
York, Appleton-Century crofts, Inc., 1961 .
2. Reports of the Committe ~ -.on Maternal Welfare to the
Medical Society of the State of North Carolina, 1957
and 1959 .
3. D~onnelly, J. F. : A Revie :v of the First 1000 Consecu-tive
Maternal Deaths in North Carolina, Part II. N
Carolina Med J 14 : 25.3-; 55 (June) 1953 .
4. United States Bureau o' the Census : United States
Census of Population : 1360 : Number of Inhabitants,
North Carolina . Final Eeport PC (1)-35 A, U. S.
Government Printing Of 'ice, Washington, D. C., 1961 .
5. United States Bureau c,' the Census. United; States
Census of Population : 11 60 . General Population Char-acteristics,
North Carol. na. Final Report Pc(1)-35
B.U .S . Government P inting Office, Washington,
D. C., 1961 .
6. Jones, W. B. : Unpublished material .
7. United States Bureau ( f the Census. United States
Census of Population : 1960 . General Social and Eco-nomic
Characteristics, 1 north Carolina, Final Report
PIC(1)-35 C, US. Govei nment Printing Office, Wash-ington,
D. C., 1961 .
8. North Carolina State Pcard of Health . Instructions
for North Carolina Midw Ives (Condensed from Manual
of Instructions) . (N . P., N. P., N. D.)
9. North Carolina State 13c and of Health : Recommended
Standards for Issue of Midwife Permit, Revised May
1953.
10 . Donnelly, J. F. : Oppor .unities in the Field of Ma-terna'
1 Welfare. N Carol .na Med J 15 : 603-608 (Dec.)
1.954.
11 . Jones, W. B., Dean, R. ~., and Cassel, J. C. : The Use
of Private Physicians `tecords for Maternal Health
Studies: A Pilot Study. ) 1 Carolina Med J 24 : (March)
1963 .
A Local Chronicle of the Influenza Egidernic of 1918
As Gleaned from Newspaper Accounts of the Dcy
H. GARRETT ADAMS, M.D.
WINSTON-SALEM
351
cause of the war, cr(!ated difficult admini-strative
problems on) ocal, state, and nation-al
levels . The difficulties were compounded
by the highly contag .ous nature of the dis-ease.
According to Dr. Rankin, many of
the overworked phys cians and nurses were
stricken during the f rst week or two of the
epidemic. He stated that perhaps no com-munity
in North Car(lina received anything
like adequate medico 1 and nursing care.
352 NORTH CAROLINA
The United States Public Health Service
and the American Red Cross joined forces in
an attempt to meet the challenge; but "in
less than a week both of these great agen-cies,
swamped with appeals from all parts
of the country for doctors and nurses, threw
up their hands in despair and admitted
their inability to supply the urgent appeals
for help . In combatting the epidemic, all the
doctors of the state were overworked, their
vitality dangerously drawn upon, and prob-ably
more than half of the profession con-tracted
the disease."
Dr. Wingate Johnson of Winston-Salem
estimated that he worked 30 or 40 hours
on a stretch at the height of the epidemic.
Most of the patients were visited in their
homes because they were quarantined. Dr.
Johnson might sleep about four hours, call
his nurse to have a new supply of tongue
depressors and medicine ready when he
came by the office, then be off again.
Following is a chronicle of events up to
and during . the epidemic, in and around
Winston-Salem, during the months of Oc-tober
and November, 1918. The information
was gleaned from reports appearing in the
Twin City Sentinel2 . Particular attention is
drawn to the development of the epidemic,
the difficulty presented by the desire of
people to congregate for various reasons, and
the futile, almost ludicrous attempts at
treatment that were resorted to by the popu-lation.
Tuesday, October 1
A United States Public Health Official
passing through Wilmington, North Caro-lina,
announces that he will remain in the
city to try to curb the epidemic. Announce-ments
proclaim : Annual Piedmont Fair
Opens Today . . . . See Becker Brothers
Pianos on Exhibit just as the disease is be-ginning
to spread.
Wednesday, October 2
A front-page headline reports : Immense
Crowd Attends Second Day of Fair. In one
corner of the same page, however, is an
ominous item from Washington, D. C., bear-ing
the caption, Spanish, Influenza Still
Spreading. "Conferences were held with
managers-of motion picture theaters and
/IEDICAL JOURNAL August, 1964
other public places, looking toward improve-ment
of conditions to check the spread of
infection."
Locally it is noted that services are being
held at the Salvation Army hall simultan-eously
with the fair.
Dr. Bulla, Director of the Forsyth County
Board of Health, asks physicians to report
all cases of influenza or grippe for inclusion
in his weekly report to the United States
Public Health Service. Concern is expressed
about a possible epidemic among soldiers .
Thursday, October 3
A front-page story is headed: Record-breaking
Attendance at Fair Wednesday.
It goes on to say: "Early in the afternoon
the grounds were packed, and that condition
continued throughout the evening. From
eight o'clock on, the grounds were a spirited
mass of humanity, everyone enjoying him-self
to the limit."
Friday, October 4
In Roanoke, Virginia, less than 200 miles
from Winston-Salem, it is announced that
public schools are closed in Floyd County
owing to the spread of Spanish influenza-more
than 500 cases in Roanoke alone.
Church services, the October Circuit Court,
and other scheduled events are cancelled.
Ministers are asked to .discuss the epidemic
in their sermons to and warn the people
against careless spitting and coughing.
Officials of Davidson College report 60
cases of influenza during the opening days
of the session. "Fortunately it has been only
a very mild type and there have been no
serious illnesses other than high fever."
(This is characteristic of influenza.)
In spite of the epidemic, Salemites are still
holding social functions : Rally Social Held
at Trinity Moravian Church-Splendid At-tendance.
"Everyone locally is looking for-ward
to the heralded performances here at
the auditorium tomorrow, matinee and
night, of the black-face organization Para-mount,
Gus Hill's Big Ministrels ."
Although `Winston-Salem is apparently
oblivious of the danger, nearby Burlington
is preparing for it . On the same page with
the foregoing social plans it is reported
that Burlington Puts Ban on Public- Gather-
August, 1964
ings for 14 Days. (Although there were few
cases there at the time, it was hoped that the
measure would prevent entrenchment of the
disease.)
From Raleigh comes the report: "The
State Board of Health, with the advice of the
government and State Superintendent of
Schools, today called on the authorities of
every town or community where influenza
appears, promptly to close the school and
all public meetings . . . It [influenza] is now
spreading from Wilmington up the Atlantic
Coast and inland via the Atlantic Coast Line
and Seaboard railways ."
Nationally, the Surgeon General recom-mends
closing churches, schools theaters,
and public institutions in every community
where the epidemic develops . . . . Phila-delphia
Reports Epidemic . . . . The Surgeon
General issues a pamphlet containing all
available information about the disease.
Simple methods relative to its prevention,
manner of spread, and care of patients are
given.
Saturday, October 5
Public meetings are still being planned
in the Twin City. The front page of the
paper announces : Mass Meeting for the Lib-erty
Loan Tomorrow, . . . . Maude Adams To
Be Here Tuesday at Auditorium; Capacity
House for This Play Expected . . . . Special
Reduced Rates of Rail to Virginia State Fair
. . . . Colored Fair Scheduled Oct. 15-17 . . . .
"One hundred members of the Board of
Churches of Salem congregation attended
a party held Friday night."
The Board of Aldermen holds special ses-sion
to discuss closing of schools and other
public meeting places as a result of a State
Board ordinance received by Dr. R. L. Carl-ton,
City Health Officer. Dr. Carlton said
there have been 119 mild cases of inflenza
in the city. Dr. Bulla reported 2 cases at
Hanes Station and 7 at Walkertown. (The
ordinance was put in force at the special
session of the Board of Aldermen last night.)
Sunday, October 6
Bishop Edward Rondthaler, in his Mem-orabilia
of Fifty Years', makes a sad com-mentary
on the times : "On October 6, for the .
FLU EPIDEMIC-LAMB AND MAY
first time perhaps, in the 151 years of its
history, the church w: Ls closed for worship,
with all the other chi rches of the commu-nity,
because of a serious outbreak of Span-ish
influenza."
Monday, October 7
353
The State Health 0:i-der is extended for a
week; 7'5 new cases are : reported since Satur-day-
night, and some social functions are
cancelled . Admiral M:Gowan sends a tele-gram
to the people of .er cancellation of the
city-wide Liberty Loan meeting. Maude
Adam's appearance , Lt the auditorium is
cancelled.
Despite the early ?recautions taken by
Roanoke, Virginia, the city is reported to be
hard hit by the epid(mic.
Tuesday, October 8
Fifty thousand cas as of influenza in 20
Southern cities are reported unofficially,
but in Tidewater, Vi: ~ginia, where the ma-lady
first took hold, nor new cases are-report-ed.
Mild weather in the South supposedly
has contributed to th, ~ less virulent form of
the disease encounter ~d here. The Hampton
Roads Section of Virginia, comprisin Nor-fold,
Newport News, and Portsmoutt, has
reported more than 1),000 cases, Richmond
10,000, and Jacksonv:i lle 3,000 .
Dr . Carlton describ(~s the situation here as
satisfactory, but makes the following recom-mendations
: Use ind. vidual paper cups for
drinks and paper sau. ,ers for ice cream; boil
spoons or use recoiamended disinfectant .
He also encourages children to use play-grounds.
Ateacher at Salem College conducts class-es
by telephone thro ugh a special hook-up
arranged by the telep :zone company.
Monday, October 14
Spanish Influenza -Term Is Isolated, reads
a front-page announ cement. (It is hard to
determine what orga: zism was meant at this
time, but it was probably Hemophilus in-fuenzae,
which had actually been isolated
by Pfeiffer in 1892. [t was such a common
secondary invader it . 1918 that it was mis-taken
for the causatve organism.)
The mayor of Higl Point dies of influenza.
354 NORTH CAROLINA
Tuesday, October 15
The epidemic in Winston-Salem continues
unabated. Since Saturday more than 500
new cases have been reported .
Wednesday, October 16
Washington, Oct. 16-During the week
ending October 12 there were 6112 influenza
deaths in 30 cities across the nation in con-trast
to 19 in the week ending September 14,
when the disease got its first foothold in
Boston. The same week (October 5-12) there
were 4409 deaths. from pneumonia.
Soda fountains in Winston-Salem are
closed.
Dr. Carlton reported at 10 :00 A.M. that
during the past 48 hours the condition has
gotten worse. There have been more than
3000 cases in the city since it started. He
advises against too frequent gargling :
"Don't take aspirin unless prescribed by a
doctor and don't gargle more than three or
four times a day. Above all, don't get hys-terical."
Thursday, October 17
Tobacco houses are closed in Winston-
Salem. Stores are ordered closed at 5:00 P.m.
on week days and at 7:00 on Saturdays. No
special sales will be held and no goods sent
to homes on approval.
Associated charities took soup and other
"proper foods" to 75 sick families yesterday.
The organization will move to the domestic
science department of the high school to-morrow
to prepare food for families in which
everyone is sick and for patients who live
alone.
Emergency hospitals will be established
for white and colored patients . Ladies of the
city will serve as nurses.
The United States Public Health Service
is receiving a nightly wire from the city
and county reporting the number of new
cases and deaths. Owing to the illness of
workers and the load of emergency calls,
people are asked to use the telephone only
when necessary . Since October 7, 2365 cases
and 25 deaths have been reported, but it is
estimated that this represents less than half
the actual number of cases.
(To be
IIEDICAL JOURNAL August, 1964
The Red Cross, Associated Charities, and
the Forsyth Medical Society decide to estab-lish
an emergency hospital for white pa-tients
at North Winston School and ore for
colored patients at Depot Street School.
Friday, October 18
The Rotary Club will provide 50 beds,
mattresses, and pillows for each of the emer-gency
hospitals. The Red Cross is providing
one registered nurse and five -untrained
nurses for each hospital, in addition to medi-cine,
bed linen, and other supplies.
Mrs. JohnW. Hanes, who has four sons in
the Service, has offered her splendid house
on West Fourth Street as an emergency hos-pital.
Men are being solicited to serve as
orderlies. Many women have volunteered to
serve food, and men are expected to respond
to the call for help "equally as well."
Monday, October 21
The colored hospital opens this morningat
Depot Street School. More trained nurses are
needed.
Franklin D. Roosevelt, Secretary of the
Navy, has been seriously ill with influenza,
but is back at his desk now.
Tuesday, October 22
Associated Charities carries milk, soup,
and Brunswick stew to about 200 people
today.
Wednesday, October, 23
Dr. Carlton received a telegram yesterday
from Daniel C. Roper, Commissioner of In-ternal
Revenue, stating that Collector Watts
would supply the necessary whiskey for
relieving the influenza epidemic in Win-ston-
Salem . He was directed to deliver seiz-ed
whiskey, tax paid, where the emergen-cies
exist; however, Collector Watts said it
had all been used already.
Thursday, October 24
The County Health Department has es-tablished
an emergency hospital at Hanes
Station. Dr. Carlton expects abatement of
the epidemic at an early date. Mr. H. E.
Fries, director of the local Red Cross, has
enlisted ministers for a house-to-house can-vass
to determine the extent of the problem.
Con:luded )
Septeinber, 1964
A Local Chronicle of the Influenza Epid.em is of 1918
Gleaned from Newspaper Accounts of the Day
Friday, October 25
Epidemic in North Carolina Reported To
Be In Steady Decline.
The following methods are recommended
for using "flu" masks: Mark the outside of
the masks so that if they are removed and
put back on, the contaminated side will not
be accidentally put against the mouth and
nose. Masks should be worn for only two
hours at a time, and should be sterilized-with
dry heat if possible-or boiled for 20
minutes.
The situation at Greensboro is better and
Hickory greatly improved. Charlotte schools
are still closed.
Dr. W. S. Rankin, of the State Board of
Health, has refused to approve an order for
two cases of rum to be used in connection
with the treatment of patients at the emer-gency
hospitals here. He states that there is
no scientific basis for the use of whiskey
as a drug, and its use should be discouraged.
Dr. Carlton states that he, too, does not
advocate alcohol as a drug for general use,
but after days of contact with the suffering
influenza patients he is convinced that it
does give relief and should not be discour-aged
when prescribed by a physician for
influenza. Insisting that personal opinions
in this matter must, in the emergency, be
put aside, he promises that in the perform-ance
of his duty as city health officer, he
will make an effort to put at the disposal of
the physicians every means possible to com-bat
the disease.
Hanes Emergency Hospital calls for un-trained
volunteers . . . . South Carolina pa-tients
improve.
Saturday, October 26
As
CONCLUSION
Dr . Bulla requests a report from all school
committeemen on conditions in their dis-tricts
relative to the reopening of school.
City Health Committee orders stores to
close -at 4:00 P.m ., grocery stores, meat mar-
H. GARRETT ADAMS, M.D.
WINSTON-SALEM
Monday, October 28
Tuesday, October 29
Wednesday, October 30
Thursday, October 31
397
kets, and news stands excepted; these will
close at 7:00 P.M.
Dr. Carlton estimate, at 2000 the present
number of cases of infh enza in the city . . . .
Dr. E. K. Graham, pre; ident of the Univer-sity
of North Carolina dies of pneumonia
following influenza . . . . Dr. Carlton reports
notable improvement in the city last week.
A vaccine purportec I. to prevent pneu-monia
after influenza will be made available
to Army personnel, Sur geon General Brais-ted
announces.
Dr. Bulla says there is no change in the
epidemic here : 100 new cases were reported
yesterday. He orders al stores with the ex-ception
of grocery and meat stores to close
at 5:00 P.M.; the latter N, Till be allowed to re-main
open until 7:00.
All stores within 3 miles of the city limits
ordered closed completely.
A recommended diet i or influenza victims
is reported as follows : beef broth, chicken
broth, and broth albun.in. (What is broth
albumin?)
A dispatch from Loi don announces the
arrival of a transport currying 6000 Ameri-can
soldiers at a Briti; h port. During the
voyage there were only !i0 cases of influenza
and one death recorded Every man wore a
cloth mask during the ` oyage. (Opinion re-garding
the use of the masks was divided.
In situations such as this they appeared to
be useful. Some of the larger cities of the
nation imposed fines for failure to wear the
masks, as well as for sp'.tting in the streets.
Later the masks were at andoned, however.)
Conditions in Winstu i-Salem continue to
improve. One 11 :00 A. W. worship service
will be allowed on Si: nday. Schools will
398 NORTH CAROLINA
probably reopen on Monday, November 11,
if the public continues its splendid coopera-tion.
The emergency hospitals, however, will
remain open. The State Board of Health
says that it will be safe to go to the polls
next Tuesday if congregating around the
voting place is limited.
The Tire Service Company of Winston-
Salem is sponsoring a scheme for raising
funds for the Hanes Emergency Hospital . It
will collect and sell old tires, giving the
profits to the hospital .
The Gilmer Specialty Sample Store coop-erates
with the Winston-Salem Health De-partment
by paying for a full-page advertise-ment
about the treatment and prevention of
influenza.
Social and business life is beginning to
pick up. Department stores may remain
open until 7:00 P.M., grocery and meat
stores until 8 :00. Barbershops will be allow-ed
to resume business as usual. Eleven
o'clock worship services will be permitted
November 1 . The appearance of Maude
Adams has been rescheduled for November
19; however, the North Carolina Teachers
Assembly for this year has been cancelled.
The sum of $688 .92, collected from en-forcement
of government-fixed fuel regula-tions,
was given to the Red Cross today.
Monday, November 4
The Public Library will reopen Thursday.
Charlotte's quarantine will also be lifted on
that day.
Tuesday, November 5
The local theater will reopen on Monday.
Soda fountains will be open tomorrow.
Schools will reopen next Monday as was
hoped.
Friday, November 8
The Depot Street School Emergency Hos-pital
is being disbanded and fumigated in
preparation for school Monday. The Tire
Service Company's old tire sale netted
$109.13; the money was turned over to the
Red Cross.
"Victory Monday", November 11
Armistice Day. is observed by a public
celebration at 5:00 p.m.
IEDICAL JOURNAL September, 1964
Tuesday, November 12
The well known revivalist, Gypsy Smith,
is holding a meeting at the auditorium.
Monday, November 18
An interesting new item concerns crowd-ed
conditions at the high school : In order to
accommodate 500 pupils in a building in-tended
to house 250, an all-day schedule is
instituted requiring children to report only
when on recitation . Thus the same room is
used by several groups of students.
Thursday, November 21
Dr. Bulla announces that the epidemic is
past except for a few scattered cases.
Friday, November 22
The epidemic has revived in Oak Ridge.
There have been seven deaths in that town-ship.
Dr. Bulla announces: "It is established
that since September 1 we have had 350,000
cases of influenza in North Carolina, and
that 250,000 of these cases were contracted
from well people ." He advocates staying
away from public meetings when disease is
epidemic in the community, and reiterates
the classic preventive measures: Always
use separate drinking cups, dishes, and
towels, or have them boiled before using
after another. People are urged once more
to hold a handkerchief over the mouth when
sneezing or coughing.
Thursday, November 28
New outbreaks of the epidemic have oc-curred
in many sections of the state, in some
instances to such an extent that all former
restrictions had to be reimposed. The gen-eral
celebration held in virtually every com-munity
on Victory Monday brought crowds
together and rendered futile even those pre-cautionary
measures that were still in force.
And thus ends our chronicle of "The
Great Epidemic," as A. A. Hoehling4 has
called it in his recent book. The city ex-perienced
another rather severe wave of the
disease in December, 1918, and another in
February, 1919 . There were 500 cases in the
city from January 25 to February 28, and
two emergency hospitals-one for white and
September, 1964
one for Negro patients-were again pressed
into service.
In reviewing the epidemic for the Annual
Report of the Department of Heath, Dr.
Carlton called attention to the age distribu-tion
of the 159 deaths recorded in the city.
Few young children or very old persons
died. The age groups stricken most severely
were 15 to 25 years (49 deaths) and 25 to 40
(45 deaths) .
Northeast, Winston and Southwest Salem
suffered more deaths than all other sections
of the city combined. It was in these sec-tions
that workers from the Health Depart-ment
most often found all members of a
family ill, and nearly always in ill-venti-lated,
poorly lighted, unsanitary homes.
Treatment
The State Board of Health urged. "sun-shine
and open air" for the treatment of
both influenza and pneumonia. The treat-ment
received support from experience at
the Baptist Orphanage in Thomasville,
where it wasp used successfully . Four hun-dred
ten out of 460 children in that institu-tion
had influenza, and some had pneu-monia;
yet there were no deaths. The treat-ment
involved simply moving patients out of
doors, where they were directly exposed
to sunlight and open air. The windows on
public conveyances were ordered to be kept
open during the epidemic, in line with this
principle.
Calomel was commonly prescribed during
the epidemic. Amanufacturer advertised :
Why do all doctors prescribe Calomel? Of
all the medicine in the world doctors prescribe
Calomel most often and depend upon it almost
universally . . . If you will study the doctor's
books you will find that the medical authori-ties
prescribe Calomel for almost every dis-ease.
The reason is that Calomel is the greatest
and only thorough system purifier . It makes
the liver active, drives out the poisons from
the stomach, bowels, and kidneys, and there-by
purifies the blood. Calomel puts the entire
system in the most favorable condition for
Nature to exercise her recuperative power.
Your doctor will tell you that drugs merely
assist Nature. That is why he prescribes Calo-mel
so often.
Many "sure cure" treatments for influ-
INFLUENZA EPIDEMIC-ADAMS
Discu: sion
399
enza were advised by various people. One
doctor in New Orlea is recommended the
following: "Put a sma 1 amount of sulfur in
each shoe each morr ing, and goodby in-fluenza."
He said he v ent through the New
Orleans yellow fever epidemic of 1897 un-scathed
because of tl ds measure, and in-sisted
that it "kills the germ." He said that
if you carried a half- dollar "in your poc-ket",
it would change color as evidence of
the spread of sulfur tl roughout the system.
Another typical adi ertisement on "How
to Avoid Spanish Inflr enza" reads :
Nothing you can do will so effectively pro-tect
you against the i ~fluenza or grippe epi-demic
as keeping your organs of digestion and
elimination active and your system free from
poisonous accumulatio as . Thoroughly loosen
the bowels with some such mild and non-irri-tating
physic as Dr. P Lerce's Pleasant Pellets.
Drink plenty of hot le nonade and then cover
up with plenty of clot les in bed so as to get
a good sweat. When s veating is free and the
fever reduced, take a ('.ose of 2 Anuric tablets
every 4 hours, followe< by drinking a glass or
two of hot water. Anu -ic tablets help quickly
to relieve the sorene., s of the muscles and
bones from which m.os patients complain and
help the kidney flush Dut the poisons. To re-lieve
nasal obstructio zs and excessive dis-charge
from the nose, probably nothing is
better than such a m: id, soothing, antiseptic
wash as Dr. Sage's Catarrh Remedy. For
strengthening the patie nt-an iron tonic tablet
called Irontic or the wall known herbal tonic,
Dr. Pierce's Golden Me iical Discovery.
Several remarks abo -it the general nature
of the 1918 influenza epidemic are in order.
Dr. Carlton's observation on the prime of
life age range of the victims in Winston-
Salem is corroborated k y several authorities.
Dr. Vaughn, the Actin; ; Surgeon General of
the Army after Dr. Gor ;as sailed for France,
said that the "husky male either made a
speedy and rather abr upt recovery or was
likely to die . . . tho stronger the man,
seemingly the more ra aid his total physical
collapse ." 6 He support ~d this by citing the
high mortality in Army camps and the
equally high mortaliti , among civilians in
the same age range as t he soldiers .
Pearl estimates that not less than 550,000
persons died of influ enza in the United
400
States alone. This is approximately five
times the number (111,179) of American
soldiers officially said to have lost their lives
from all causes in the War. Eighty-two per
cent of all Army deaths were attributed to
respiratory diseases .
Entry into the United States
The question of how the disease got into
the United State4 and why it was called
Spanish influenza should be answered. The
only reason I can find for its being called
Spanish influenza is that the disease was
prevalent in Spain when it received the first
public notice in America.
It did not come to America from Spain.'
There was an increase in deaths from res-piratory
diseases in New York and Cleveland
in December 1915, and January, 1916 . In
January, 1916, influenza was reported in 22
cities of the Union. These epidemics were
mild and attracted little attention. During
the winter of 1917 many so-called cases of
influenza occurred in Europe among French
and British troops. The same winter similar
cases, supposedly influenza, occurred in
many American camps. The disease appear-ed
without question at Camp Oglethorpe,
Georgia, in March, 1918, a month before it
was recognized to any significant extent in
Europe, almost at the same time that it
seems to have appeared in Spain, according
to Zinsser .7 He believed that it started in
a great many different places at almost the
same time. The disease was prevalent in
China in March 1918, and it was reported on
a Japanese ship in a Chinese port in April.
Dr. R. I . Lee8, professor of hygiene at
Harvard University and a visiting physician
at Massachusetts General Hospital made a
comment about the origin of influenza epi-demics
that would likely find widespread
approval in the United States today. He
said : ". . . it usually starts in Russia and
works westward through the continent and
thence to the United States."
Causation organism
The causative organism of the disease was
by no means believed by all authorities to
be Pfeiffer's bacillus (Hemophilus influen-
NORTH CAROLINA TIEDICAL JOURNAL
zae) . Many reliable authorities ascribed it
to a filterable virus, although it had not been.
isolated . Dr. Henry J. Nichols9, instructor in
bacteriology and preventive medicine, Army
Medical School, Washington, D. C., said that
the diagnosis was purely bacteriologic. He
said further:
The possibility of a primary filterable virus
must be disposed of before any advance is
made. As Metchnikoff says, this possibility is a
"sort of ghost preventing all definite conclu-sions
in problems connected with the absence
or presence of microbes . . ." There is no better
illustration in medicine for the necessity of
scientific knowledge as a basis for practical
work. Our good intentions and organizations
are helpless without it .
Conclusion
Today, although the virus has been iso-lated
and vaccines have even been made
available, it is questionable that we have
conquered influenza. Many authorities be-lieve
that we might remain helpless, as Dr.
Nichols was, in the face of .an organism of
the virulence of that of 1918 .
In closing, I quote Bishop Edward Rond-thaler
of the Moravian Church in Winston-
Salem : "With the latter part of the year
heavier shadows than we can understand
settled upon our community with the out-break
of the influenza. May our Heavenly
Father grant us speedy and complete relief
from this sickness."
References
September, 1964
1. Rankin, W. S.: Annual Report of the North Carolina
State Board of Health, in Transactions of the Med-ical
Society of North Carolina, 1919!, Raleigh,
Edwards and Broughton Printing Company, p. 350.
2. Twin City Sentinel, Winston-Salem, North Carolina,
October-November, 1918.
3. Rondthaler, E. : The Memorabilia of Fifty Years,
Raleigh, Edwards and Broughton Company, 1928 .
4. Hoehling, A. A. : The Great Epidemic, Boston, Little
Brown and Company, 1961, p. 40 .
5. Carlton, R. L. : Annual Reports of the Department
of Health, Winston-Salem, North Carolina, 1918-1922.
(See 1919, pp. 22-23, 1921, pp. 25-26.)
6. Vaughn, V. C. : Epidemiology and Public Health, Vol.
1, Respiratory Infections, Saint Louis, C. V. Mosby
and Company, 1922, p. 313.
7. Zinsser, H. A. W. S. : A Textbook of Bacteriology,
Philadelphia, G. Appleton and Company, 1922, pp.
482-50'3 .
8. Lee, R. I.: Health and Disease, Their Determining
Factors, Boston, Little, Brown and Company, 1920.
9. Nichols, Henry J. : Carriers in Infectious Diseases,
Baltimore, Williams and Wilkins Company, 1922.