Infectious and Epidemic Disease in History

Department of History
University of California, Irvine
 Instructor:    Dr. Barbara J. Becker

Week 9.  Cleanliness?

A Retrospect of the Influenza Epidemic
by Permelia Murnan Doty, Executive Secretary Nurses Emergency Council

New York City

At the present time when we are hearing frequent warnings about the advisability of being prepared to meet a possible return of the influenza epidemic it may be interesting to review, briefly, some phases of the work carried on in New York City by the Nurses Emergency Council during the epidemic of 1918.

A meeting of representative nurses was held on October 10, 1918, in response to a call sent out by the Atlantic Division of the Red Cross.

At this time the epidemic was gaining headway with alarming rapidity.  The director of the Nursing Service of the Henry Street Settlement reported that over 500 new cases of pneumonia and influenza had been cared for by the staff nurses in the last four days.  A survey of one city block showed 220 out of 1400 people ill.  The resources of the city would doubtless have been taxed to the utmost under ordinary conditions in an attempt to cope with the serious situation brought about by the epidemic, but at that time, because of the great shortage of doctors and nurses due to war needs, the task was one of the unprecedented difficulty.

It was the consensus of opinion at the first meeting that there should be an immediate organization of the nurses of the city in order that all nursing forces, trained and untrained, might be mobilized at once.  It was of course essential, if relief was to be given in the most efficient way, that all necessary resources should be carefully conserved and any duplication avoided....

[I]n twenty-four hours the Nurses Emergency Council was a working organization...

It was increasingly evident that the nurses of the city would be quite unable to cope with the situation unless their service was conserved in every possible way.  Women who had had training either as attendants or aides were needed to accompany the nurses, and help them in their work in the homes, for visiting nurses were reporting, not one patient ill in the family, but four, five and six.  One pair of hands, however skilled, could do but little in the short time it was possible to spend in one home, when in so many other families the need was acute.

Few of our hospitals have an adequate nursing staff under normal conditions:  how could they hope to handle anything so terrible as the epidemic of influenza which the medical profession believes to be the worst scourge this country has known since 1850?  Twenty-bed wards were stretched to take in forty and fifty patients; when there were no more beds, cots and wheel chairs were used.  The nursing staff remained the same for forty and fifty that it had been for twenty, and still ambulances were busy night and day carrying the sick from homes, where they could get absolutely no care, to hospitals from which they could never be turned away.  Hospitals reported that their nursing staffs were greatly depleted because of illness.  One school had thirty nurses out of a staff of one hundred and forty off duty ill with influenza at one time.  If the sick were to have even the simplest nursing care help must be sent to the hospitals at once.  Women who had had training or experience in the care of the sick were especially desired, but there was work for every one who was willing to help.

The first big task was, therefore, to get the need before the public.  The Red Cross inserted a quarter page advertisement in all the Sunday papers calling for service from the women of the City.

The Council had 15,000 hand bills with the same appeal struck off.  The printers to whom we had explained the urgency of the situation sat up all night in order that these handbills might be ready for distribution early the following morning.  These were practically all distributed before two o'clock in the afternoon.  Volunteers gave them to the passersby on various Fifth Avenue corners, others distributed them in the principal shops and in the Grand Central Station, and still others visited the women's clubs of the city, requesting that this statement of the urgent need for women to help in a critical situation be posted in a conspicuous place in the club....

The women of New York responded to this call for service as they have to every other call during the past four years.  They came, the rich and poor alike, not knowing just what the work was to be, but realizing the need and anxious to help.  All were told that the task was a difficult one and that they would need courage and determination to see it through.

To save time and confusion, all applicants were first interviewed at the Red Cross Bureau of Nursing Information, and only those suitable for the emergency work, and ready for immediate service, were sent to the Council office.  Nurses who would go out of town were referred to the Atlantic Division of the Red Cross, since urgent appeals for help were constantly received from other communities.  Cards were made out for all applicants in the outer office, giving the name, address, telephone number, training or experience, and whether they were volunteer or paid workers.  To this was added the assignment, or any other information necessary, and the card was filed according to the assignment made.  A separate file was kept for applicants on call, and colored flags were used to indicate the different types of workers.  The records were as simple as possible, the aim was to get the workers to the hospital or home, where they were so greatly needed, without delay.

During the first few days the great majority of workers were sent to the different hospitals in the city, since the need seemed most urgent there.

The reports from the various hospitals regarding the work of the volunteers were exceedingly interesting....  Several superintendents of Nursing Schools said they did not know how they could possibly have managed at all without this volunteer assistance.  The criticism of [it] was usually the same.  A great many of the untrained workers could and did do splendid work, but they did not "stick"--they dropped out in a day or two--and one could not be sure from day to day how many could be depended on to return the next day....

This is, of course, the usual criticism of the volunteer.  There is not the same feeling of obligation and responsibility that trained workers have.  There is the usual difficulty in making adjustments to new work.  In this case, doubtless, some of the workers became ill or had illness in their homes.  Unpaid workers cannot be expected to stand the long hours of duty and the hard work that nurses have had to become accustomed to through a long period of training.  This work means, not only physical strain, but nervous and mental as well, and it is not surprising that many found the work too difficult....

By the end of the first week there was a decided decrease in the requests for help sent in by the hospitals....  [T]he Council felt justified, therefore, in concentrating on home care....

All cases reported to the forty-three community centres and the forty-two nursing centres were first investigated in order to find out what the real need was....

This important work of investigation was carried on by teachers released by the Board of Education and the Public Community centres....

But, as might have been expected, the element of hysteria was not lacking during this epidemic, and urgent appeals, even demands, were made for nurses when their services were not really needed.  In some instances nurses were even locked in the house by the patient's friends, or kidnapped on their rounds, so panic stricken had the people become....

The nurses left the centres at nine a.m., usually in an automobile, each carrying a supply of soup and linen.  They were frequently accompanied by an aide, who gave whatever assistance she could in the homes, either household or nursing work as the need was indicated.  The second rounds were started at two p.m....

Later, because of the great increase in the number of cases, a night service was started in five districts....

Nurses were finding many households where whole families were ill, or perhaps a mother and several children, without anyone to give them even the simplest nursing care.  Some of the patients were critically ill.  Because of the prejudice against hospitals, which was doubtless accentuated during the epidemic by reports of so many deaths in institutions, it was necessary that some one be found to stay with the sick in the homes--since many people refused to allow their friends and relatives to be taken to a hospital....

Go to:
  • News articles from The New York Times:
    • June 1918
    • July 1918
    • August 1918
    • September 1918
    • October 1918
  • "The Influenza Epidemic and How We Tried to Control It" by Elizabeth J. Davies, R.N., from Public Health Nurse (1919) 11(1):  45-47
  • "Influenza Vignettes" by Mary E. Westphal, Assistant Superintendent, Visiting Nurse Association of Chicago, from Public Health Nurse (1919) 11(2):  129-32
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