An Intern at the Center of the Great Flu Pandemic of 1918
One in an occasional series about Einstein Healthcare Network historical medical moments
It was Tuesday, Oct. 8, 1918. In the week before, 700 people had died of influenza or pneumonia caused by flu in Philadelphia, the worst-hit U.S. city in the deadliest flu pandemic in modern world history.
Sidney Rosenblatt, MD, a first-year doctor (intern) on the staff of the Jewish Hospital (now Einstein Medical Center Philadelphia), set pen to paper to write to his parents, Benjamin and Elizabeth Rosenblatt of Atlantic City.
“For the last couple of weeks I have been going through a living hell,” he wrote. “All I was doing was pronouncing and signing death certificates. I went out on the ambulance one night as a relief to the ambulance Dr. and the sights were heart wrenching.”
Just a few months out of medical school, Dr. Rosenblatt had been thrown into the middle of a crisis that would have been devastating for any city at the best of times. But these were not the best of times. The nation was at war. About one-quarter of the city’s doctors and even more of the nurses were away in the military. Many of those who remained were sick.
“For a whole week I was in entire charge of the medical side of the house as all the chiefs were laid up,” Dr. Rosenblatt wrote. “All I have to tend to are as follows: The Help’s Quarters, old folk’s home, Guggenheim Building and entire medical building besides the Children’s ward and a few cases that have developed in the Surgical Ward.”
“At present time we have about 55 cases of pneumonia and influenza,” he wrote. He said that things seemed to be slacking off compared with the week before.
Everyone in this city of 1.7 million hoped fervently that the pandemic was indeed slacking off. Throughout late September and October, health officials kept reassuring the public that things were getting better. And yet the daily death tolls climbed.
711 Deaths in a Day
By Oct. 16, later identified as the peak of the pandemic in Philadelphia, public health officials reported 711 deaths in a single day from flu and pneumonia. During the week when the outbreak peaked, there were 250 deaths above the normal death rate for every 100,000 people in the city.
That was by far the highest peak number of all U.S. cities, according to a 2007 analysis in the Journal of the American Medical Association.
According to the College of Physicians of Philadelphia, more than 11,000 people died in October alone. The final wave of the pandemic arrived 100 years ago this month, in February 1919. Over the full 24 weeks ending Feb. 22, 1919, Philadelphia’s toll of excess deaths was 748 per 100,000 people, second only to Pittsburgh.
How It Began
The 1918 pandemic (worldwide epidemic) was believed to have started in March in Fort Riley, Kan. In a world at war, with hundreds of thousands of soldiers and sailors on the move, flu outbreaks appeared during the next six months at sporadic locations in the United States and Europe. But death rates were no higher than in a normal flu epidemic.
Then, in August 1918, the virus changed. A deadlier strain broke out at almost the same time in Brest, France; Freetown, Sierra Leone; and Boston, Mass.
Flu cases began appearing in late August at a barracks ship in Boston Harbor for sailors in transit. Within a week, the outbreak spread to the Harvard Navy Radio School in Cambridge and Camp Devens, an Army training center just outside of Boston. The number of cases and deaths in these crowded facilities soon exploded.
On schedule, about 300 sailors shipped out from Boston to the Philadelphia Navy Yard. By the time of their arrival Sept. 7, many were already sick. Despite attempts to disinfect barracks, the illness spread.
Newspaper reports of the time told the story of the unfolding outbreak.
By Sept. 18, there were 600 cases of flu and flu-related pneumonia at the Navy Yard. Three days later, there were 1,083 cases. But Wilmer Krusen, MD, director of the city’s Department of Public Health and Charities, insisted that it was “nothing more than old-fashioned ‘grip’ [flu],which was epidemic in Philadelphia a number of years ago.”
The Board of Health issued a statement, saying it was “fully convinced … that no epidemic of influenza prevails in the civil population at the present time.”
The Pandemic Builds
On Sept. 25, four days later, newspapers reported 118 new cases in the last 24 hours. Many of them were civilians.
Influential doctors urged health authorities to close public gathering places. But Dr. Krusen and the Board of Health refused, not wanting to create panic. They also decided to allow a parade supporting the national war bonds drive to go forward on Sept. 28. More than 200,000 people jammed Broad Street to hear bands play and cheer the marines, sailors and soldiers who marched.
By Oct. 1, three days after the parade, every hospital bed in the city was filled. That day, 117 people died of flu or pneumonia. On Oct. 2, the city finally issued an order closing all schools, churches, theaters, movie houses, music halls and many other social and entertainment venues. The next day, it closed the bars, too.
And yet the cases and deaths kept building. On Monday, Oct. 7, Dr. Krusen estimated there were 200,000 cases of flu or flu-related pneumonia in the city. Deaths within the last day had totaled 289.
The Jewish Hospital Responds
The pandemic hit first in southern sections of the city, but by October the Jewish Hospital on North Broad Street was packed.
The hospital “confined itself to medical care of those caught by the epidemic,” Maxwell Whiteman wrote in “Mankind and Medicine: A History of Philadelphia’s Albert Einstein Medical Center.”
“Surgical work was at a minimum,” he wrote. “The war reduced the number of resident physicians from nine to four, and many of the already overworked doctors, nurses and members of the Hospital’s service staff were stricken.
“Employees who were fortunate enough to escape the disease worked long hours to maintain the smooth functioning of the Hospital…. Ambulances were constantly on call, and the clanging of their bells was endless.”
Dr. Rosenblatt, the young intern, reassured his parents that he was holding up well. “I felt ill the other night, but I went to bed and had a good night’s sleep and felt tip top the next morning,” he wrote.
With all hospitals full, the city opened emergency hospitals in any large buildings deemed suitable. On Oct. 7, the city’s five medical schools sent their most senior students out to care for patients.
There was a severe shortage of nurses. Non-cloistered Catholic sisters were assigned to serve in hospitals and homes. Health authorities issued calls for help from women or police officers with any amount of nursing training. Then they called for anyone at all who could help to nurse the sick.
At the Jewish Hospital, “53 women volunteers offered their services to a hospital in desperate need,” according to the Einstein history. “Six Catholic sisters representing various orders, two members of the Wolf family, two Leopolds, a Baum, Blumenthal, Fleisher and Goldsmith joined the emergency volunteer service.”
On Friday, Oct. 11, newspapers reported 514 deaths in the last 24 hours. There were 500 bodies waiting to be buried, and a shortage of caskets. Prisoners, volunteer shipbuilders, and even Catholic seminarians were put to work digging graves.
Finally, the outbreak began to decline. In the last week of October, public gathering places reopened. By the time the outbreak faded in early November, a reported 12,162 people had died in Philadelphia. A shorter and less severe resurgence occurred during February 1919. According to the College of Physicians of Philadelphia, the number of flu-related deaths dropped below 100 per week only once from September 1918 until spring of 1919.
Dr. Rosenblatt completed his residency and moved back to Atlantic City, where he was a general practitioner for more than 50 years. Two of his children and two grandchildren also became doctors. One of those grandchildren, Michael Rosenblatt, MD, MPH, provided a copy of his grandfather’s letter and other resources about the pandemic to Einstein Healthcare Network. He is Chief Medical Officer of Lahey Hospital in Burlington, Mass.
Flu Still Kills Today
The flu pandemic of 1918 was the deadliest outbreak of modern times. It killed an estimated 50 million people worldwide, including 675,000 in the United States. Unlike most flu epidemics, it killed mostly people in their prime – young and middle-aged adults.
But the anniversary of this pandemic serves as a reminder that flu viruses change constantly, kill thousands every year, and could cause a devastating pandemic again. An estimated 80,000 died in the 2017-18 U.S. flu season, a more severe outbreak than average.
“The influenza epidemic of 1918 was caused by a bird flu that entered the human population,” noted Steven L. Sivak, MD, President, Einstein Physicians Philadelphia. “Bird flu viruses exist today, and it is likely that sometime in the future we will have another pandemic with a virulent strain.
“We are better prepared now than in 1918 with vaccines, antiviral medications, modern ICU care and antibiotics …, but we must remain vigilant and responsive to the emergence of this type of infection. “
“Despite all that modern medicine brings, flu remains deadly…,” Dr. Michael Rosenblatt said. “The best thing to do is be sure that you get your annual flu shot and wash your hands. If you get sick, cover your cough and stay home until you get better.”
- Learn more about Einstein’s history.
- Barry, John M., The Great Influenza: The Epic Story of the Deadliest Plague in History, Viking Penguin, 2004.
- “City ‘Over Top’ in Fight on Grip, Dr. Krusen Says,” Evening Public Ledger, 8 Oct. 1918.
- Davis, Kenneth C., “Philadelphia Threw a WWI Parade That Gave Thousands of Onlookers the Flu.” Smithsonian Magazine, 21 Sep. 2018, https://www.smithsonianmag.com/history/philadelphia-threw-wwi-parade-gave-thousands-onlookers-flu-180970372.
- “Day’s Influenza Death Toll 289.” The Philadelphia Inquirer, 7 Oct. 1918, p. 25.
- “Fewer Influenza Cases Reported.” The Philadelphia Inquirer, 11 Oct. 1918, p. 11.
- “Grip Breaks City’s Death Rate Record.” Evening Public Ledger, 5 Oct. 1918, p. 1.
- “History of 1918 Flu Pandemic,” Centers for Disease Control and Prevention, 21 Mar., 2018, https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm.
- “Influenza Increase Due to Late Reports.” The Philadelphia Inquirer, 6 Oct. 1918, p. 13.
- Marke, Howard: Lipman, Harvey B.; Navarro, J. Alexander, et al. “Nonpharmaceutical Interventions Implemented by U.S. Cities During the 1918-1919 Influenza Pandemic,” Journal of the American Medical Association, 7 Aug. 2007, pp. 644-654.
- Morens, David M., and Taubenberger, Jeffery K. “Influenza Cataclysm, 1918,” New England Journal of Medicine, 13 Dec. 2018, pp. 2285-2287.
- “Phila. Closing Ban Rescinded, to Take Effect Wednesday,” The Philadelphia Inquirer, 27 Oct. 1918, p. 1.
- Rosenblatt, Michael, Untitled PowerPoint presentation, email and other documents, Feb. 2019.
- Rosenblatt, Sidney, Letter of 8 Oct. 1918. Rosenblatt family collection.
- “Schools and Churches Shut by Philadelphia Health Board,” The Philadelphia Inquirer, 4 Oct., 1918, p. 13.
- “Scrapbook of newspaper clippings concerning the influenza epidemic in Philadelphia, 1918-1919,” Historical Medical Library of the College of Physicians of Philadelphia.
- Whiteman, Maxwell, Mankind and Medicine: A History of Philadelphia’s Albert Einstein Medical Center, Albert Einstein Medical Center, 1966, p. 95.
- Woodruff, Carolyn, “Influenza,” Historical Medical Library of the College of Physicians of Philadelphia, undated, http://histmed.collegeofphysicians.org/for-students/influenza.