Emerging and reemerging infectious diseases: global trends and new strategies for their prevention and control
Influenza 1918: Teacher's Guide
In the spring of 1918, as the nation mobilized for war, Private Albert Gitchell reported to an army hospital in Kansas. He was diagnosed with the flu, a disease doctors knew little about. Before the year was out, America would be ravaged by a flu epidemic that killed 675,000 — more than in all the wars of this century combined — before disappearing as mysteriously as it began.
Influenza: Teacher's Guide (172.7 KB)
Time Period: 1918
Themes: influenza epidemic of 1918, World War I, public health policy, history of medicine
Before WatchingDivide students into two groups, and tell them they are going to see a film about a public health crisis. Make a list of what factors they think might have contributed to the spread of disease in 1918. Ask one group to jot down all the specific activities that contributed to the rapid spread of the disease. Ask the other group to note efforts by local or national officials to slow the spread of the illness and when these occurred.
After Watching1. Put two columns on the board: "Factors contributing to flu spread" and "Actions of public health officials." Using their notes, have the students complete the lists.
Looking back at the flu epidemic, what do students think should have been done to try to control the disease's spread? Why do they think these actions were not taken?
Then have groups of students study an infectious disease that has reemerged as a serious public health threat, particularly one we thought we had eradicated or controlled (e.G., tuberculosis, cholera, malaria, yellow fever, antibiotic-resistant bacterial infections, etc.), and develop recommendations for public health policy to halt its spread.
After each group presents and explains its recommendations to the class, encourage questions. For example: How will strategies be implemented? What are potential drawbacks? How can recommendations balance individual rights and the public welfare?
2. Why do students think Americans largely have not retained this incident in their collective memory? What do you think the impact of it was on those who lived through it? How much do you think the euphoria surrounding the Armistice overshadowed the experience of the epidemic? What can we learn from studying it? Is it an important incident to study? Why or why not?
3. According to the film, many people used home remedies to combat the flu. Have students choose different types of nontraditional medicine to research, including folk remedies, acupuncture, homeopathic remedies, biofeedback, or herbal remedies. They should look at the history of the practice, its strengths and weaknesses, and evidence of effectiveness. They might want to visit or interview staff at alternative medical establishments, homeopathic drugstores, acupuncture clinics, etc. Students may also want to look for parallels to traditional medicine (for example, willow bark and aspirin).
Students can create posters presenting their research, bring in pictures or examples of the medical practice they investigated, or share it through oral reports. What do students think should be the role of alternative medicine in treating illness? Do any of them use alternative medicine? If not, would they consider it? Under what circumstances?
The Flu In Philadelphia
Officials in Philadelphia knew what was coming their way. All through September 1918 they had seen reports coming out of Boston of a virulent, deadly influenza. In fact, the Philadelphia Bureau of Public Health had issued a bulletin about the so-called Spanish influenza as early as July 1918. Despite the prescience of some, Philadelphia's health and city officials had failed to even list influenza as a reportable disease, placing the city's population of nearly two million in grave danger.
The timing of the epidemic's arrival in Philadelphia could not have been worse. Over one-quarter of the city's doctors, and a larger portion of its nurses, were lending their medical talents to the nation's war efforts. At Philadelphia Hospital, 75% of medical and support staff were overseas. Such personnel shortages were an issue even before influenza had hit; once it did, lack of adequate medical help contributed to influenza's deadly impact.
Misinformation, and perhaps wishful thinking, added fuel to the influenza's fire. While the Bureau of Health was issuing directives concerning public coughing, sneezing, and spitting, Dr. A.A. Cairns and Wilmer Krusen of the Department of Health and Charities were assuring the public that the illness would not spread beyond military personnel. In late September, Dr. Paul Lewis, director of the Philips Institute of Philadelphia, aroused great hope by declaring that he had identified the cause of this influenza: Pfeiffer's bacillus. The confidence of the medical community quickly spilled over into the general population — with dire consequences.
On September 28, 200,000 people gathered for a fourth Liberty Loan Drive. Funding the war effort and showing one's patriotic colors took precedence over concern for public health. Just days after the parade, 635 new cases of influenza were reported. Two days later, the city was forced to admit that epidemic conditions did indeed exist. Churches, schools, and theaters were ordered closed, along with all places of "public amusement." Members of the press condemned the closings as a violation of common sense and personal freedom. Meanwhile, the ranks of the sick and dying continued to grow. By mid-October, their numbers ran into the hundreds of thousands. Hospitals quickly reached capacity. Church parish houses and state armories doubled as shelters for the sick.
Just as medical facilities were pushed to the brink, so too were medical personnel. Able-bodied doctors were summoned from retirement, while novice medical students were plucked from their studies to tend to the sick. Often, there was little they could do; by the third week in October the death toll in Philadelphia attributed to influenza had soared to over 4,500. Along with public horror over the intensifying epidemic came public outcries concerning some people's attempts to line their pockets through the misery of others. Certain undertakers raised their prices by more than 500% as grieving families sought proper burials for their loved ones. Tales spread throughout the city of individuals being forced to pay $15 to dig graves for their deceased family members.
What to do with the growing piles of corpses became a question not just of common decency, but a matter of public health. Rotting cadavers often led to secondary infections. The city of Philadelphia was forced to appeal to the federal government to meet their need for embalmers. In an effort to combat this and other epidemic-related problems, the Philadelphia Council of National Defense mobilized a Bureau of Information. Special phone lines were designated for influenza-only questions. At one point, the Bell Telephone Company restricted calls of a non-medical nature, owing in part to the depletion of their employee ranks due to flu.
On October 19, 1918, Dr. C. Y. White announced that he had developed a vaccine that would prevent Spanish influenza. In short order, over 10,000 complete series of inoculations were delivered to the Philadelphia Board of Health. Whether or not the so-called vaccine played much of a role in loosening this strain of influenza's grip on Philadelphia was a matter of much debate. Mortality and morbidity rates did fall after the vaccine was introduced, but some health officials maintained that the flu had already reached its peak and was waning anyway.
As November rolled around, Philadelphia, like the rest of the nation, turned its rapt attention to the armistice ending the Great War. Slowly life returned to normal. But few would, or could, forget the horrible toll exacted by the influenza of 1918, as the City of Brotherly Love lost nearly 13,000 of her citizens in a matter of weeks.
Comments
Post a Comment