‘Wear a Mask and Be Safe’ — Mayo Clinic and the 1918 Influenza Pandemic

This look back to 1918 and how Mayo Clinic responded to the influenza pandemic is written by Matthew Dacy, director of Mayo Clinic Heritage Hall.

Headlines tell the story.

“New Disease Is In Rochester Now.” This brief notice appeared in the Rochester Daily Post and Record on Sept. 21, 1918. Taking up barely two inches of newsprint, the statement described a single patient undergoing treatment for an obscure disorder — but such an event hardly stood out amid the newspaper’s extensive coverage of the First World War, which was raging overseas, and the public’s preoccupation with the harvest at home.

Yet for most people at Mayo Clinic, this modest announcement was perhaps their earliest exposure to what became a cascade of coverage for one of the greatest disease outbreaks in human history: the 1918–1919 influenza pandemic.

Scattered early cases quickly multiplied and spread in successive waves of infection since travel by motorcar, railroad and ocean liner connected people in far-flung locations, and large-scale public events such as Liberty Bond rallies brought crowds together in close proximity. Standards of personal hygiene varied widely among individuals and communities. There was little general knowledge of germ control and risky behaviors.

Its nickname, the “Spanish Flu,” is a misnomer. Even today, the pandemic’s exact point of origin is not known. Some of the first news reports came from Spain, which was neutral during World War I and not subject to the wartime censorship that suppressed initial coverage in other countries. Wherever it began, the disease spread worldwide.

According to the U.S. Centers for Disease Control and Prevention, it struck an estimated 500 million people — about one-third of the earth’s population at the time — and caused 50 million deaths, far surpassing the approximately 8.5 million combatants who died in four years of fighting during World War I. The United States experienced about 675,000 fatalities related to the pandemic. In addition to children and the elderly, the population segments typically at risk, this particular strain of influenza was particularly hazardous for otherwise healthy adults between 20 and 40 years of age.

The disease subsided in 1919, possibly due to mutation into less-lethal forms or for other reasons. More than a century later, key aspects of the influenza pandemic remain a mystery.

Values and mission

Mayo Clinic’s experience with the fast-breaking crisis of influenza pandemic aligned with its foundational values and threefold commitment to patient care, research and education. This story also reflects Mayo’s impact, which ranges from the local community to the international sphere. Its lessons link the generations.

“The disease broke out in a mild form in the town first,” wrote Helen Clapesattle in “The Doctors Mayo,” her acclaimed biography, “then suddenly and virulently in the hospital itself.”

Thanks to providence and sound planning, Saint Marys Hospital had a new resource to meet the challenge: an isolation unit, close to but separate from the main facility. The Sisters of Saint Francis had recently purchased the Lincoln Hotel, originally a large private home, which stood near the hospital. They adapted it for treatment of communicable diseases, and opened it in June 1918. The isolation unit stood ready for an influx of patients, but soon was stretched to the limit.

“Within a week the new unit was packed,” wrote Clapesattle, “even to cots in the hallways.”

Her account continues: “Every doctor, nurse, technician and secretary worked wherever needed most at the moment, often until late at night. Relatives or friends with any time to spare were called into service, Dr. Will’s younger daughter Phoebe among them. The doctors worked on the Clinic floors … and then started out on drives through the countryside, sending the worst cases they found to the isolation unit at Saint Marys.”

According to the “Annals of Saint Marys Hospital”: “The Sisters in charge were in great straits … they had to get the (isolation unit) heated up, prepare beds, do the cooking for their patients, and attend to all the nursing. … Saint Marys was so short of nurses and general help that everyone felt it her duty to assist to the limit of her endurance, wherever the need was greatest. The supervisor of nurses, Miss Ledwidge, with nurses from the floors, was sometimes to be seen working in the laundry, where help was utterly depleted.”

Communication technology proved invaluable. Telephone calls — a rarity for many people at the time — hit new volumes as relatives and friends deluged Mayo Clinic and its affiliated hospitals, seeking news of their loved ones. The telegraph and Rural Free Delivery of mail helped speed information along with local newspapers, national magazines and silent movie newsreels.

“Rochester to Fight Disease” was the headline on Oct. 2, describing a Red Cross initiative to make 2,500 “contagious ward masks” for public use — all within one week. From houses of worship to neighborhood groups, sewing circles were mobilized to produce masks according to widely published plans and patterns.

For many women in Rochester and throughout the nation, most of whom did not work outside the home, this was an early foray into the “public sphere.” The confidence and assertion they felt by making a difference in fighting influenza and other wartime endeavors helped pave the way to women winning the right to vote barely two years later.

“We must put forth our best efforts to do this greatly needed work,” a Red Cross executive said at a meeting in Rochester. Soon, however, large social events would be disbanded.

‘Rochester closed down because of flu’

“Wear a Mask and Be Safe,” the Rochester Daily Post and Record urged readers on Oct. 16, while also announcing “Rochester Closed Down because of ‘Flu’: Theaters, Pool Rooms, Churches, Sunday Schools, Meeting Places; All Shut Because of Contagious Disease…”

The article quoted local officials: “In view of the fact that we are a city of hospitals, we think it best to take this action in such time that we hope to prevent the disease (from) spreading.” On the same page, an advertisement titled “Banking by Mail” described helpful new ways to conduct business while limiting personal contact and risk of contagion.

At Saint Marys Hospital, from mid-October 1918 “through May the next year, 360 flu patients were cared for including some of the Sisters and many of the lay nurses. … although some of the Franciscan Sisters were ‘dangerously ill’ according to a request for prayers sent to the entire membership, none of them died. Isolating the patients and applying rigorous standards of cleanliness prevented cross infection and saved many lives.”

Total statistics for influenza patient care at Mayo Clinic during the pandemic are not known.

Saint Marys Hospital has remained in continuous service since opening in 1889, and its meticulous records from 1918–19 are available. At the same time, patients with influenza also were treated at several hotel-hospitals managed by the Kahler Corporation in downtown Rochester. Kahler opened a nursing school in 1918 to meet wartime and influenza demands, and provided about the same number of hospital beds as Saint Marys. In 1954, however, the Kahler Corporation ceased its medical activities, which transitioned to Rochester Methodist Hospital. The Kahler hospital records did not survive. In addition, along with Saint Marys and Kahler hospital care, many people with influenza were treated in the outpatient offices of the Mayo Clinic building, which had opened in 1914 (site of the Siebens Building today) or at home by Mayo physicians and visiting nurses who made house calls.

‘The Clinic is making a sacrifice’

The Rochester Post and Daily Record published “Uncle Sam’s Advice on Flu” on Oct. 21, connecting efforts of the federal government with state and local initiatives. But it was clear that individuals played a key role in fighting the disease. An illustrated announcement in that edition of the paper brought home the message: “Coughs and Sneezes Spread Diseases,” equating influenza contagion with the poison gas being used in World War I combat.

Mayo Clinic responded to the crisis on multiple fronts. Laboratory personnel investigated the strain of influenza with efforts that underscored the importance of clinical trials and other protocols that are now the foundation of medical research. Educational outreach engaged patients, staff and the public about how to limit the spread of influenza.

Mayo Clinic was a destination medical center, attracting patients from throughout the region, the nation and abroad. As a matter of public safety, however, Mayo Clinic leaders made the difficult decision to curtail what today would be called elective procedures: “Why, at the Clinic, daily, numerous letters are answered (from) patients who desire to come to Rochester, asking them to remain at home until the epidemic conditions now existing all over the country are quite eliminated. Hence it is to be seen that the Clinic is making a sacrifice of no small proportions to assist our city in ridding herself of this infectious disease.”

These words come from Dr. Gertrude Booker Granger, the first woman physician who joined the Mayo medical practice. Starting several years before the pandemic, she also served as deputy director of public health for the city of Rochester, working closely with the director, Dr. Charles H. Mayo. Her interview was published on Nov. 15, four days after the Armistice ended hostilities overseas, underscoring Mayo’s commitment to public service.

Dr. Booker Granger drove home the importance of personal responsibility: “The Board of Health has warned people as a whole not to have crowds at their homes (and to) absent themselves from all gatherings or crowds of any sort.”

‘The ills of today must not cloud the horizons of the future’

Through its commitment to America’s armed forces, Mayo Clinic helped fight influenza internationally as well as at home. Soon after the United States entered World War I, Mayo Clinic and the University of Minnesota collaborated in establishing Base Hospital 26, which was deployed to the Western Front near Allerey, France. The hospital and its mobile surgical units provided essential care during periods of intense fighting — and then came the flu.

According to a history of Base Hospital 26, influenza struck “during the period of greatest activity at the hospital.” Recognizing the importance of halting contagion, hospital officials established special wards for infectious disease. “The bed capacity of the hospital was repeatedly taxed to the utmost, so that even the Red Cross recreation hut had to be requisitioned for use as a ward, all wards and tents having been filled to capacity.”

Nell Bryant was born in Louisiana and graduated from the Saint Marys School of Nursing. She served at Base Hospital 26 and with its mobile surgical units that went close to the fighting. She wrote detailed letters to her “Dear Sis” and nephew Charles at home, describing the devastation of war, including aerial attacks on her medical unit. The experience of influenza established a common bond with her family back in the States. “I am sorry that Charlie has the ‘Spanish flu,'” she wrote from France about the same time that Dr. Booker Granger gave her newspaper interview in Rochester. “Hope he is all right by this time, we are having an awful time with it here.”

In addition to injured and ill Allied soldiers, “practically all of the German prisoners” in the region, “wounded or sick, were admitted to Base Hospital 26,” the unit’s historian reported. “Needless to say, all these men received the same attention and care as was given to our own men.”

During the First World War and influenza pandemic, the Mayo brothers were among the most respected physicians in the United States and abroad. As both a practicing surgeon and a statesman of medicine, Dr. William J. Mayo maintained a long-term perspective as Mayo Clinic responded to the immediate crisis.

Even while the influenza pandemic was under way, Dr. Will commissioned a study of best practices in hospital design for “the organization and methods of contagious disease services,” which involved research and benchmarking at leading medical centers throughout the country. The published results were presented to the staff of Mayo Clinic and community-based medical societies elsewhere in the United States, showing the wide applicability of its findings.

Looking to the future, the study concluded: “If professional knowledge is quick to take advantage of an aroused public interest, a new cooperation between physician and layman will bring about advances comparable to those which war has stimulated in other fields of medical practice.”

As a result, Mayo Clinic’s leadership helped inform medical progress long after the crisis of war and pandemic had passed. This positive outcome was consistent with Dr. Will’s forward-looking vision. As he wrote, “The ills of today must not cloud the horizons of tomorrow.”

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