Influenza Epidemic - The Story of the Red Cross Nurses - 1922

American Red Cross Public Health Nurse On Her Rounds.

American Red Cross Public Health Nurse On Her Rounds. History of American Red Cross Nursing, 1922. GGA Image ID # 15044063af

In the fall of 1918 the nursing needs of the civilian population engulfed the American Red Cross. Late in August, Spanish influenza broke out among the men of the Navy Receiving Ship in Boston Harbor and swept across the United States during September and October.

The first call for Red Cross assistance came on September 14 from the United States Public Health Service, for nursing personnel for the Quarantine Station, Boston Harbor. Almost simultaneously, calls began to come in from all parts of New England and from Washington, D. C.

Within a few weeks the infection had become pandemic in the eastern cantonments and spread from the soldiers to the civilian population and thence westward. One thousand nurses, it will be remembered, had been withdrawn from the cantonment nursing staffs and had arrived in August in France.

True, the American Red Cross had sent the papers of 2700 additional nurses to the Surgeon General's office in August alone, but it took some time to assimilate these nurses into the Military Establishment.

On September 7 the Army School had only 221 students on duty in seven cantonment hospitals, according to the Acting Surgeon General's letter of September 7 addressed to Dr. Martin.

These students were "green probationers" and it was estimated that it would take four months of training before their services would be of material value. The truly desperate condition which existed in the cantonment and Naval hospitals during that memorable September and October of 1918 has already been described.

Colonel Ayres wrote:

More than 40,000 died of pneumonia. Of these, probably 25,000 resulted from the influenza-pneumonia pandemic which swept through every camp and cantonment in this country and caused thousands of deaths in the Expeditionary Forces.

Up to September 14, 1918, only 9840 deaths from disease had occurred in the Army and the death rate for the period of the war up to that time was only 5 per year for each 1000 men.

During the eight weeks from September 14 to the 8th of November, 316,089 cases of influenza and 53,449 of pneumonia were reported among troops in this country.

The explosive character of the epidemic is shown in diagram 56: [83.6% of the total deaths were from pneumonia]. It reached its high point the second week in October, when four out of every 1000 troops under arms in this country died.

The situation among the civilian population was equally critical and responsibility for aid was vested in the United States Public Health Service and the American Red Cross.

At National Headquarters a meeting was called at which were present representatives of the Surgeon Generals of the Army, the Navy and the Public Health Service and of the Red Cross and a preliminary plan for affording nursing relief was formulated.

Miss Delano was then in Atlantic City attending a meeting of the American Hospital Association, so Miss Noyes drew up the plans for the mobilization of nursing resources and throughout the pandemic carried all national details regarding nursing relief.

National Headquarters was of course the center to which the nursing needs of the entire country came. National morale was already under a heavy war strain and the confessed lack of medical knowledge regarding the nature of the disease fanned the flames of public alarm.

Many hundreds of nurses in civilian and military service themselves came down with the disease and the calls for nurses increased proportionately. By long distance telephone, by telegraph and personal interviews with Miss Noyes, State health officials, Army officers, heads of civilian hospitals and particularly men in charge of industries, importuned National Headquarters: "If you cannot send us nurses," they affirmed, "our men will all come down with the flu and production will stop."

On September 24 Miss Noyes wired the Division Directors of Nursing to mobilize all Home Defense nurses for emergency duty to meet the situation.

The assignment to influenza work of nurses who were being mobilized for military service was to be avoided as long as possible. No Division was permitted to recruit nurses from other Divisions without conferring with National Headquarters.

Nurses not enrolled in the Red Cross Nursing Service, attendants, practical nurses and laywomen volunteers who had taken the Red Cross course in Home Hygiene and Care of the Sick, were to be assigned to duty under the direction of enrolled Red Cross nurses.

All Local Committees on Red Cross Nursing Service were to be called upon immediately for recruiting nursing personnel. In every Division Department of Nursing, additional clerical assistance was to be secured and masks made in the Chapters for use in Army cantonment hospitals. Complete records of all assignments were also to be kept.

The need for nurses daily grew more imperative. On September 27 Miss Noyes telegraphed to all Division Directors of Nursing:

We should like you to organize in your Division one or more mobile units of ten to fifteen nursing personnel to be sent to other localities if necessary. Place competent Home Defense nurse in charge and authorize her to secure assistants, under graduates, attendants, or nurses' aides and prepare them for instant service.

Several days later the general manager appointed a National Committee on Influenza, which was composed of the directors of the departments at National Headquarters, with W. Frank Persons, then Director General of Civilian Relief, as chairman.

On October 1, Rupert Blue, Surgeon General of the U. S. Public Health Service, vested in the Red Cross the following responsibility:

In order that all available resources may be utilized to the best advantage in combating the present epidemic of influenza, I have the honor to make the following recommendation in regard to the participation of your organization in this campaign:

1. That the Red Cross assume charge of supplying all the needed nursing personnel and pay the salary and other expenses connected with the detail of such personnel for work during the present epidemic.

2. That the Red Cross furnish emergency supplies, when it is found that local authorities are unable to furnish such supplies with the promptness required by existing circumstances.

On the same day, the War Council appropriated $575,000 for influenza relief and the entire Red Cross organization, in Washington and in the field, set to work to combat this most virulent of any pandemic which had hitherto attacked the country.

The cooperation between the Federal Public Health Service and the American Red Cross was outlined in the following Plan, issued October 3:

1. That the Red Cross should assume charge of supplying needed personnel and will pay salaries and other expenses connected with detail of such personnel for work during the present epidemic.

2. That the Bed Cross will furnish emergency hospital supplies when local authorities are unable to furnish such supplies with the promptness required by existing circumstances.

3. The United States Public Health Service will gather facts about the spread of this disease and the adequacy of existing resources and will determine when and where to send additional nursing personnel and emergency hospital supplies and to what person the nursing personnel shall report and such supplies be delivered.

4. The Public Health Service will decide when any such nursing personnel and supplies have served the emergent purpose and may be transferred to some other place for further duty.

5. The Nursing Department of the Bed Cross will have full charge of enrolling and assigning all nursing personnel as requested by the Surgeon General and will also determine their salaries and other compensation. In this connection it is important to add that the widespread call for nurses and the obligations of the Nursing Service to supply nurses also for the Army and Navy render it imperatively necessary that the Nursing Department shall, through its own officers and committees under the direction of the head of the Department, be and remain in full charge of this part of the program.

6. The United States Public Health Service will conduct all necessary dealings with the state and the local boards of health concerning all the above matters and the Divisional offices of the Bed Cross will act in providing nursing personnel and in furnishing supplies only upon the request of the Federal Public Health Service.

7. The United States Public Health Service will mobilize all needed doctors.

8. The United States Public Health Service will from time to time ask the Bed Cross through the usual channels to distribute official statements issued by the former concerning means of prevention and methods of care of this disease.

9. All general publicity concerning the part of the Red Cross in this program and all general directions concerning the use of the Red Cross resources except the enrollment and assignment of nursing personnel will be issued by the chairman of the Red Cross National Committee on Influenza.

Development of this general plan for further mobilization of the Red Cross for emergency relief was authorized during the next few days. Each Red Cross Chapter was instructed to organize immediately a Chapter Committee on Influenza, consisting preferably of the chairman of the Chapter, a leading physician, a representative of the Local Committee on Red Cross Nursing Service where one existed, the chairman of the Chapter Committee on Nursing Activities, the chairman of the Home Service Section, and such additional members as were deemed necessary.

This committee was instructed to work in close cooperation with the local public health officer, making a survey of available nursing personnel and hospital supplies within its jurisdiction.

Only at request of the local health officer and in consultation with the Division office, however, were these nurses and supplies to be mobilized to meet local needs.

A Division Committee on Influenza was also appointed, made up of the Division Manager, the Division Directors of Civilian and Military Relief, Nursing, Supplies, Accounts and Chapter Production.

After issuing this general plan for mobilization of all Red Cross resources, the National Committee on Influenza left its further developments, excepting where questions of policy arose, to the judgment of the Division and Local committees. The educational campaign was developed largely by the United States Public Health Service.

The medical and nursing relief afforded by the Red Cross to the civilian population in large cities, industrial centers, small towns, and rural and isolated communities was probably as extensive as has ever been offered by any Red Cross society in any country and is therefore of interest.

The efforts of the Red Cross in the larger cities in the United States is well illustrated in the work done in Washington, D. C. In cooperation with the United States Public Health Service, the Local Chapter equipped and maintained an influenza hospital on F Street.

When it became evident that this hospital would be inadequate to care for the increasing number of patients, a second hospital was opened by the U. S. Public Health Service at Eighteenth and Virginia Avenues.

Lucy Minnigerode rendered conspicuous service in organizing the F Street hospital and Rachel Independence Albaugh, whose name will appear numerous times in post-armistice sections of this history, handled details of equipment.

The U. S. Public Health Service divided the city into headquarters and four main divisions, each of which was then subdivided into districts. Each district had a headquarters to which all calls for influenza relief work should come.

A central recruiting station for nurses was opened by the Red Cross Chapter at Fourteenth and F Streets, for the purpose of securing additional nursing personnel. In this the cooperation of the schoolteachers proved of great value.

As the schools throughout the country were closed during the most virulent periods of the epidemic, many of the teachers volunteered as assistants to the nurses and rendered efficient service. The work of lay volunteers, especially that rendered by women who had had Red Cross class instruction, was of great value.

An enrolled nurse who had once taught classes in Home Hygiene but who had had to give up active service on account of ill health, rallied to duty again during the pandemic. She wrote:

Owing to my semi-invalidism, I was not officially under the local organization, but my former students had enrolled with me and I called on them. We did what we could where we ourselves knew the need to be great and we were able to carry several hundred homes through to safety with only one death.

Many refused relief, but we systematized our work so that the inexperience of the volunteer aides would not work hardship either on patient or aide. I sat at my phone day and night, backing their orders with advice and instruction.

It was the sweetest thing in the world to hear their responses come back when I called on them, "Why, yes, of course I will do what I can to help."

To return to the District of Columbia, the District Chapter Canteen Service organized a kitchen in each of the four divisions, where food was prepared for those who could not secure it in other ways, because of the illness of members of their families or because of the crowded conditions existing on account of the housing problems.

From this kitchen in each division a hot lunch was daily served to doctors and nurses to save their time. The District Chapter Motor Corps put its ambulances and other cars with their drivers to valuable use in carrying patients to the hospital and in transporting the nurses about the city.

The organization which was developed in industrial towns is well illustrated by the work at Wilkes Barre, Pennsylvania.

Mrs. Gertrude Williamson, the Red Cross nurse in charge of the emergency hospital, wrote:

For two days, volunteers mostly from Red Cross classes in Home Hygiene and Care of the Sick, worked like beavers, cutting draw-sheets, making up the Army cots, scrubbing hat racks to serve as linen shelves and cleaning camp chairs to be used as bedside tables.

The Armory was scrubbed from roof to basement and four wards were partitioned off with beaverboard and lavatories and sinks were installed in the only available rooms.

The Red Cross Canteen Service took entire charge of the basement kitchen and, with a few paid employees, but mostly volunteers, served all the food to the nurses, the physicians, the orderlies and the members of the National Guard who were always on duty, besides sending out food, broths mostly, to over 150 families daily, who because of the "flu" had no one well enough to prepare their meals.

In small towns, where there were rarely any hospital facilities of any kind, the emergency was met in an equally efficient way. In Watkins, New York, the Red Men offered the use of their hall to the Local Red Cross Chapter as an emergency hospital.

This offer was immediately accepted. The problem of equipment presented a grave difficulty, but each housewife sent whatever she could spare—a cot, a pair of sheets, a blanket.

In the same way, the kitchen was supplied and the principal of the High School, released for the period of the contagion, took complete charge of the preparation of the diets.

A Rural Red Cross Class in Home Hygiene and Care of the Sick

A Rural Red Cross Class in Home Hygiene and Care of the Sick Gathers at a Cross-Roads Meeting Place. History of American Red Cross Nursing, 1922. GGA Image ID # 150422cc2a

In rural communities, where no hospital facilities existed, the Local Chapters established temporary ones in schoolhouses or churches. Miss Barber, Director of Nursing of the Northern Division, wrote:

The houses are often half a mile or more apart from each other, so we used the rural and village schoolhouses for emergency hospitals, wiring them with electricity in many cases just for this purpose.

We also secured mobile kitchens, which had previously been used in the harvest fields, and attached them to the schoolhouses for canteen service. The result was highly satisfactory.

To the most isolated country districts, we assigned nurses' aides who remained in the houses of their patients as long as the need for nursing care existed.

A nurse assigned to influenza relief work in Denio, Oregon. Wrote:

Our patients are mostly families of sheep herders; they live in miserable cabins scattered in most inaccessible places, a house to a hill and each hill from twelve to fifteen miles apart.

There is no food, no bedding and absolutely no conception of the first principles of hygiene and sanitation or of nursing care.

I have taken over the hotel as a hospital and the Big Boss, who employs the sheep herders, is having all who are not too ill to be moved, brought in here. The men are willing, some are intelligent, but most are sick, and if it were not for the grit and brains of the nurses who have been working here before and for the women of the community, God help us!

I am writing by fits and starts, as 1 can snatch a minute off to jot down our needs, hoping that the situation may be clear to you and that you will be able to get us some supplies before we get snowed in for the winter.

Our greatest need (next to fruit and malted milk) is feeding cups and drinking tubes, which we can't get at Winnimucca, our nearest town. We also need lots of gauze or cheesecloth and cotton for pneumonia jackets; also rubber sheeting and quantities of old rags, to be used and burned, also gallons of formaldehyde, if we are to stamp out the disease ; everything is thrown on the ground and will thaw out next spring and release all these germs again, if we do not take precautions against it.

Annie L. Colon, a Red Cross public health nurse on duty in Luce County, northern Michigan, wrote:

Some of our patients lived miles back in the woods in the logging camps where not even a road could reach them. We would go after our patients in hand cars, mounted on the logging trains, and so saved many lives.

We had gasoline engines on the most modern type of hand cars and we hitched a flat car to each one, usually with wire, put a board floor on it, laid mattresses over that and with a canvas cover to break the wind we carried our patients fifteen or more miles to a decent bed and a chance to live.

With this equipment, we rode usually at night through the deep woods and over the rough roadbeds to the camps. Many times we would find thirty or forty cases, sometimes ten people all with fever over 104 degrees, huddled together on two or three beds in a tiny cabin, too sick to remove their clothes.

Assignments of Red Cross nursing personnel (including enrolled nurses, Home Defense nurses, pupil nurses, practical nurses and laywomen who had taken the Red Cross course in Home Hygiene and Care of the Sick), which covered only the first wave of influenza that swept across the country from September 14, 1918, to November 7, 1918, totaled 15,000 women.

On November 2, 1918, the United States Public Health Service reported that 115,000 persons had died from influenza and pneumonia. The battle deaths of the American Expeditionary Forces were 48,900, less than half the influenza deaths, and the pandemic was not yet under control.

The contagion continued to spread and Red Cross relief was carried on until late in the spring of 1919. In round figures, the number of civilian deaths from influenza and pneumonia totaled 150,000 persons.

During the influenza epidemic, National Headquarters had opportunity to test the efficiency, as an emergency relief agency, of Red Cross national, division and local organization to an extent unequaled even by the opportunities for service coincident to the European War. Moreover, National Headquarters learned beyond doubt that this organization could—and did—function efficiently.

The influenza epidemic impressed upon the general public realization of two vital needs. The first of these was the need for organized public health nursing activities in every community.

"The only good which could possibly come out of an epidemic which has carried off a great number of our best as well as our poorest citizens," wrote Katherine La Prade, chairman of the Nursing Committee of the Victoria (Texas) Red Cross Chapter, "is the proof to the public of the need and value of organized public health nursing service and also the absolute necessity for a county hospital in every rural community."

A second need was that of health education. In many places a fear of the influenza prevailed which was akin to the terror of the Middle Ages regarding the Black Plague. Amy Potts, Red Cross public health nurse in Monmouth County, New Jersey, wrote:

One poor woman had nursed her husband and her three boys through serious cases of the flu and then came down with it herself. All she begged was to be left alone, —she was so "tired." Her husband got up and tried to do his best. Not one of the neighbors would come in to help. I stayed there all night and, in the morning, telephoned to the woman's sister.

The sister came and tapped on the window but refused to talk to me until she had gotten a safe distance away. Finally I managed to pull her into the house and convinced her that she had to stay. When she heard that her sister's recovery was doubtful, she was ashamed, but we could do nothing for the woman after midnight, except send for the priest.

The influenza epidemic and the resulting call for nurses came at a time when the entire Red Cross Nursing Service staff was already overburdened with the needs of the Military Establishment.

At National Headquarters, Miss Delano and Miss Noyes had long since begun to show the effects of the responsibility and work they had been carrying. These were trying days, also, for Miss Kerr and Miss Deans, for the patience of these two—perhaps Miss Delano's closest friends at National Headquarters—was often tried by their harassed and exhausted lady-in-chief.

As August and September had passed with crowded, oppressively hot days and breathless nights, the contrast of temperament between Miss Delano and Miss Noyes had daily grown more apparent.

Dark circles deepened under Miss Delano's eyes, her usual kindliness of manner gave way now and then, deep lines appeared about her resolute mouth. But at no time in her entire Red Cross service was she less confident, less splendid in her sure and brilliant strength.

If Miss Delano carried the major responsibility for the policies and ways and means of procedure, Miss Noyes carried the actual responsibility for and details of recruiting and as signing nurses to military and influenza service. As her burdens increased, Miss Noyes grew more silent, more poised, in appearance more cool.

Her unshakable control, the result of temperament and circumstances, seemed to render her impervious to vexatious detail. Looking neither to the right or left, seemingly indifferent at times even to Miss Delano's extreme urgings for haste, she forged ahead on the given task that was hers.

"The War with Germany," pp. 125-126.

Lavinia L. Dock, RN, et al, Extract from "The Influenza Epidemic" in the History of American Red Cross Nursing, New York: The Macmillan Company, 1922, pp. 970-982..


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