Flu

The overlooked pandemic

October 20, 2006|By Linell Smith | Linell Smith,Sun Reporter

Through the veil of nearly 90 years, Paul Schenker remembers people lining up outside any rowhouse they saw a doctor enter. Then a teenager in East Baltimore, he watched his neighbors wait anxiously to plead for a remedy, for anything that might cure the influenza.

Now 103 and living in a condominium on Park Heights Avenue, the retired surgeon recalls how helpless he felt when his own mother became ill.

"Everyone was frightened," Schenker recalls. "I was frightened. I knew it was a deadly disease."

It was the fall of 1918. While America fought the final battles of World War I in Europe, the homeland was attacked by a virus that would kill as many as 650,000 Americans - more than were lost to all the battles of the 20th century.

Death came so swiftly, so abundantly, that Baltimore could not furnish enough coffins. Soon it lacked for gravediggers.

Few nowadays are familiar with what transpired during an event that some call the "forgotten pandemic." It was long neglected by historians even though as many as 50 million died worldwide by the next spring. Tributes were paid to war dead or disaster victims and rarely to those lost to the flu.

Instead families have handed down their private memories. To bring them to light, The Sun asked readers to share their accounts. Among the dozens who responded were several, such as Schenker, who had first-hand experiences. Many of their recollections appear online or in this article, a part of Baltimore's history that would otherwise go untold.

Lately scholars and health care planners have been tracing the flu's trail through society. They are learning not only how the pandemic crippled institutions but also how it affected human behavior, revealing the need to anticipate psychological as well as physical trauma. The threat of avian flu makes their findings relevant.

The 1918 flu caused havoc in part because the virus selected the hardiest along with its usual victims among infants and the elderly. Now scientists think they know why: A reconstructed form of the 1918 virus triggered a powerful immune response that can destroy the lung.

There are parallels to the response in present-day avian flu victims, says Laurie Garrett, an author whose expertise includes infectious disease. "The immune system goes haywire," she says. "And the people who seem to have had the harshest response are the ones with the most robust immune systems."

In 1918, the loss of the very workers and parents who made society run smoothly magnified the effects of the flu. Although medicine has made great strides since, the existence of high-tech health care may not be enough to prevent spiraling unrest in a future pandemic.

Drawing from the lessons of the past, flu planners should tackle emotional as well as physical needs, scholars say. The stresses of illness, death and municipal breakdowns in 1918 prompted unpredictable acts of heroism and selfishness, they found. And the reverberations, sometimes unspoken, lasted for decades.

"Behavior was completely erratic," says Nancy K. Bristow, a professor of 20th-century U.S. history at the University of Puget Sound in Tacoma, Wash. She says some people did all they could, while others only protected themselves.

"There'd be a sick widow and children starving on one block because no one would bring them food while there was a major mobilizing effort to help victims occurring on the next block."

A medical anthropologist has tried to anticipate how modern society would react to the sort of mass suffering and social disruptions caused by the flu. Using Baltimore as a model, Monica Schoch-Spana wrote "Lessons from the 1918 Pandemic Influenza" in 2000 for the Johns Hopkins University Center for Civilian Biodefense Strategies.

Her report was intended as an analog for a possible bioterrorism attack. Now it also provides insights for flu preparedness.

Schoch-Spana found that in 1918, Baltimore's emotional needs exceeded "narrowly defined medical ones" and suggests finding ways to help people cope with such traumatic circumstances as witnessing death.

She concluded, for instance, that the city inadvertently heightened public anxiety by closing churches and synagogues.

"It was seen as taking away a central place for comfort and solace," says Schoch-Spana, who is now at the University of Pittsburgh's Center for Biosecurity.

She also found that bigotry limited African-Americans' access to hospital care and that public morale was shaken by lack of clear communication.

"An epidemic is a disaster that unfolds over time. It has an extended crisis period in contrast to something like a hurricane," she says.

The pandemic hit the United States in three waves. The first, in the spring of 1918, was mild. The most lethal came that fall. The last, in the winter of 1919, was less virulent. Yet it brought the death toll in Baltimore to about 5,000, one of the worst records among cities measured by the Census Bureau.

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