Hello, I’m Anna Dhody, Curator of the Mütter Museum and Director of the Mütter Research Institute.
Welcome to Spit Spreads Death: the 1918-19 Influenza Pandemic in Philadelphia.
In front of you, there is a freestanding archway welcoming you into the exhibition.
We hope you’ll keep the images and questions you are about to see in mind
as you explore the exhibition.
Before you enter through the archway into the exhibition, on the right,
you see a photo of a lamp post with a paper sign reading “Spit Spreads Death”
slapped up over a sturdier wood sign for the Fourth Liberty Loan Parade.
Exhibit staff found this image particularly profound.
It shows how the city went from the high of the largest parade in the city’s history,
held to raise funds for the first World War,
immediately to the low of attempting to control pandemic flu.
On the left, you’ll see a series of questions.
What happens when a deadly disease strikes a crowded city?
How do people cope?
What do they feel and fear?
What would you do?
We created this exhibition before the Covid-19 pandemic,
and these questions have obviously become more revealing for us
since our own stay at home orders began.
However, we hope you’ll keep these questions in mind as you navigate both the 1918 pandemic,
and your own modern day experience.
As we enter the exhibition, you see a large screen playing a film, and hear somber choir music.
This is a film created by Blast Theory UK, with footage
from a parade they held along South Broad Street in Philadelphia
in honor of the 1918 pandemic victims,
and music composed by David Lang and recorded by The Crossing Choir specifically for the parade.
If you listen to the music, you’ll hear 1918 health advice,
as well as the names of all of the Philadelphians who died on October 12th, 1918,
which was the most fatal day of the flu pandemic in Philadelphia.
Blast Theory held this parade on the 101st anniversary of the Fourth Liberty Loan Parade in Philadelphia,
which was on September 28th, 1918.
Now, the flu had already entered the city via the Navy yard and started to kill people.
Public health officials had urged the city to cancel the parade, but the city officials,
feeling that the flu was and could be contained,
and that the parade was too important to cancel, went ahead with it.
Roughly 200,000 people gathered along Broad Street to watch the procession,
and while we can’t definitively say that the parade was the catalyst for the outbreak,
we do know that within 72 hours of the parade, all 32 hospitals in Philadelphia at the time were full,
and within two weeks, people started dying in unprecedented numbers.
To understand why this decision was made, let’s step back into 1918 Philadelphia, and the US as a whole.
The next section of the exhibition addresses the wartime home front.
Philadelphia at this time was an industrial powerhouse, and once World War I started,
many of these industrial factories started producing war materials:
helmets, ammunition, aircraft, ships, etc.
With many men away, women stepped into these production roles, as well as people from outside the city.
In 1918 the population of Philadelphia was about 1.7 million,
with an extra quarter million people coming to the city from other locations to work in war industry factories.
This is roughly the same population as we have today, but with a very different density.
Row homes that now house 2 to 3 people were housing 2 to 3 families,
and many areas were without running water and shared an outhouse with their whole block.
The war effort was central in the public’s daily consciousness, and how could it not be?
There were patriotic / propaganda posters everywhere,
and there had already been three other Liberty bond parades in Philadelphia since the war began.
The two worst things you could be at this time were a "hoarder,"
someone who hoarded valuable or rationed materials,
and a "slacker," someone who didn’t do their part to support war effort,
which included spending as much as you could on war bonds.
Everyone was expected to participate: young women, children, people of color, immigrants,
and there is a particularly telling poster of an adult man being shamed on a trolley
for not wearing his “honor button,” a button you got with bond purchase to show you’d done your part.
So perhaps it makes sense that the war and the Kaiser were considered a bigger threat than the flu at first.
This war had been going on for years, and the public wanted a victory.
But the war also had another intersection with the flu.
Much of the local medical force was away in Europe with the military.
In the next section, “The City in Crisis," we discuss the efforts of the remaining medical force
and general public to address the growing pandemic.
In 1918, there was no flu vaccine or antibiotics effective
against the secondary bacterial infections that followed the flu, most often pneumonia.
Doctors did what they could, but nurses were often more successful treating patients.
Best practice was to keep patients fed, hydrated, clean, and cool, and nurses did that well.
There were a number of treatments used: asphidity bags, containing pungent herbs, to ward of the flu,
camphor amulets, red pepper sandwiches, and whiskey,
which was used widely, both by citizens and medical professionals.
These were questionably effective at best, but better than nothing.
What exactly happened when you caught the flu?
This flu acted very quickly, with some reports of people waking up with a sniffle in the morning and dying that night.
The virus would attack cells causing a high fever, weakness, distorted color perception,
and would eventually target the lungs.
In the lungs, the virus would destroy the alveoli , the little sacks in the lining on your lungs
that help distribute oxygen to the rest of the body.
As these were destroyed, patients would either turn cyanotic, or blue, from lack of oxygen and suffocate,
or develop a secondary infection in their now open lung tissues, such as pneumonia.
Despite the best efforts of doctors and nurses, there were massive losses in Philadelphia.
If you’d like to explore deaths by date with the option to view by different demographics,
such as age, sex, and ethnicity, the digital interactive in this section is available online.
These massive losses of life created a new problem: a burial crisis.
On an average day in Philadelphia before the pandemic, there were 70 to 90 deaths from all causes.
At the peak of the pandemic, there were almost 900 deaths in a single day.
There simply were not enough undertakers to keep up, and the city quickly ran out of coffins.
Some undertakers, as well as doctors and pharmacists, were price gouging,
and many people could not afford a proper burial even if one was available.
And so, people took to burying their own dead. Families dug their own graves,
with coffins made from shipping crate wood, dynamite crates,
or, according to one family account, barrels.
Seminary students, whose classes had been cancelled, were paired up
and either sent out with a horse and cart to pick up the dead from communities,
a task also taken up by citizen volunteers,
or they were sent to dig mass graves in the Catholic cemeteries.
There were three mass graves in Philadelphia, which were for the most part temporary.
Once the city returned to order, individuals were reburied in proper plots.
Holy Cross, Holy Sepulchre, and the City Potter’s Field at Second and Luzerne, all held mass graves.
Based on the family stories we received, the burial crisis was extremely traumatizing for the general public.
Many people never forgot seeing bodies laid out on porches or front yards.
Coffins stacked on the street corners and the carts picking them up
conjured thoughts of plague-stricken medieval Europe.
If you’d like to explore neighborhoods and local memories in more depth,
please visit our online digital interactive from this section.
This brings us to our next section, "Memory and Loss."
In this section, we hope to show not just the broad historical medical implications of this pandemic,
but the human and social cost it had on families and the general public.
One such family was the Conway's.
In 1918, multiple members of the family caught the flu.
Elizabeth, only three years old, did her best to help them and was called “the little nurse.”
This was different from her usual favorite activity, tea parties with her dolls.
Sadly Elizabeth caught the flu and died.
Therefore, she is sadly missing from this early photo of her siblings.
Her father, unable to find an undertaker to help, had to bury her himself.
Though he rarely spoke of it, throughout his life, her father would excuse himself to the basement,
and spend time amongst his deceased daughter’s toys and possessions.
He would even set up her tea set.
Peg Quann, Elizabeth’s niece, shared this story with us.
Another family affected was the Whitehead Ford Ellis Family, who sadly lost Naomi,
who was 30 years old and pregnant during the pandemic.
Pregnant women were particularly vulnerable to the flu.
Before her death, Naomi did some early Christmas shopping at Strawbridge’s,
purchasing a number of fashion items for her female friends and relatives.
Naomi also purchased festive boxes and tags, and packaged and labeled each item.
However, she died before she could give these gifts, and her family put them away in the attic,
where they were forgotten for a number of decades.
When they were eventually found, they were donated, boxes and all, to the Drexel Costume Collection,
who were kind enough to lend them to us.
Currently, on display is a purse, addressed to Cousin Helen, with a note on the back of the festive tag.
The note reads:
The purse, in an aged white canvas fabric with a brass metal clasp at the top,
a knotted white cord strap, and embroidered with a simple blue floral design.
Additionally, the box from Strawbridge’s is displayed,
featuring a high fashion lady of the time in a blue dress with a parasol.
Another object of interest is a scrapbook, assembled by a now-anonymous Philadelphian,
of small newspaper columns about the pandemic.
Individual obituaries, reports on new cases, and stories about funeral price gouging
are all pasted together, forming a collective story of the flu,
and reveal a bit about the social climate at the time.
Additionally, we have obituaries from a local African American newspaper,
the Philadelphia Tribune, which is still published to this day.
There was a false assumption that African Americans were immune to the flu, obviously not true,
but founded in a history of racist medical assumptions about the bodies of African Americans.
The flu pandemic came on the coattails of post-Civil War African American mass migration out of the South,
and an unfortunate trend can be seen in the death data: a disproportionate number of African American dead,
often with no family nearby to claim their remains, have their burial place listed as “anatomical specimen,”
having likely become anatomical cadavers for overwhelmingly-white medical students.
Medicine always aims to do no harm, but is unfortunately a product
of the culture and time in which it exists.
Today, medical cadavers are obtained through donation and anatomical boards oversee the process.
Our next and last section is "Legacies and Lessons,"
examining some of the more broad long-term effects of this pandemic.
The first section comes from Girard College, which in 1918 was a boarding school
specifically for white male orphans.
After the pandemic, there were a significant number of children left as orphans,
or at the very least without a breadwinner in the family.
Girard saw a large number of students who were flu orphans in the following years.
340 flu orphans were accepted to the school during the 1920s.
The graduating class of 1933 alone had 32 flu orphans.
Additionally, research into the flu, while not successful during the 1918 pandemic,
started in earnest during this time.
A successful vaccine was eventually discovered, and made available to the public in 1945.
The specific strain of the flu that caused the pandemic was reconstructed and identified in 2005.
With permission from tribal authorities, scientists used genetic information
retrieved from the well-preserved remains of indigenous Alaskans,
decimated by the flu and buried in the permafrost.
We’ve had three other outbreaks of pandemic influenza since 1918,
with the most recent 2009 swine flu pandemic being another H1N1 strain.
We undoubtedly will continue to experience pandemic influenza strains,
viruses are constantly evolving after all,
which is why you need a new seasonal flu vaccine every year.
But as medical technology improves and knowledge and awareness of public health increases,
pandemic influenza will hopefully become less and less of a threat to our health and safety.
In honor of our 1918 counterparts, we should all do our part
to keep our larger communities safe and protected.
Thank you for joining us for another virtual tour.
We hope you and your loved ones stay safe, healthy, and disturbingly informed.