How Rivers handled the Spanish Flu Pandemic in 1918

David Burzillo
The closure of the Rivers campus for the entire spring trimester is an unprecedented shutdown in terms of its length, but the closure is not unprecedented in and of itself. During the 1918-1919 school year, the school’s second at its Dean Road campus in Brookline, the school was closed for one month between September and October, and then for another week at the end of the Christmas holiday. Then as now, concerns about halting the spread of infectious disease led local communities to order the closure of the schools as well as other businesses and to prohibit public gatherings. There are a number of important similarities in how each of these pandemics impacted Rivers, with “closure” being perhaps the most significant. A comparison of the pandemics also makes clear some significant differences in how the school--and the local community—experienced each pandemic.

For Mr. Rivers, the 1918-1919 influenza pandemic provided an early test of his faith in the ability of his open-air philosophy to promote student health and well being. His conviction that open-air education offered students the best protection against infectious disease was dogma for him. Some years after the pandemic he provided a clear articulation of that dogma: “We have never pretended that fresh air would be a panacea for all ills; there are too many ways to pick up germs in our modern life; only we have said that we would suffer less often—and that when we did suffer we would suffer less.” Mr. Rivers’s analysis of the impact of the 1918-1919 pandemic on his school confirmed for him the salutary nature of open-air education.

The influenza pandemic of 1918-1919 was not only a test for Mr. Rivers’s optimism about open-air education, it was a test for all of human society. History has shown that this pandemic was particularly devastating in its impact and disrupted every aspect of society. Statistics provide a sense of the pandemic’s reach. In the United States there were an estimated 675,000 deaths, with residents of Massachusetts suffering about 45,000 of those deaths. The total number of deaths worldwide has been estimated to be in the range of 50-100 million. Determining the total number of deaths in America—or worldwide—has proved challenging, as many deaths early in the pandemic were initially attributed to pneumonia and other causes. Re-evaluation of medical records from the time has led scholars to revise their estimates of total influenza deaths significantly. It is now clear that more people died in the 1918-1919 pandemic than in any other disease outbreak in history.

Influenza is a viral disease, and it is something that humans have had to deal with for millennia. Because of influenza’s ability to mutate, the particular strain varies from year to year as does its impact. Scientists have established that the type of flu circulating in 1918-1919 was H1N1. For a variety of reasons this particular flu season was quite long and deadly, and its course can be divided into three distinct waves. The first wave, a ‘mild’ one, struck in the spring and summer of 1918. This was followed by a second wave in the fall of 1918 that proved much more deadly. Finally, a third, less severe wave came in the winter and spring of 1919.

In Brookline the experience of influenza was typical of most local communities in some ways but not in others. One important difference in Brookline’s experience was the influx of influenza patients from outside the town. During the pandemic’s second wave, the town became home to a tent hospital on Corey Hill for over 300 sailors with influenza, sailors who had been recruited for service in the merchant marine by the United States Shipping Board and were training in Boston Harbor. Dr. William A. Brooks, a Brookline resident, was the Surgeon General of the Massachusetts State Guard, medical director of the Recruiting Service of the United States Shipping Board, and director Brooks Hospital in Brookline. Boston hospitals were already hard pressed to deal with mounting influenza cases, so Brooks enlisted the Massachusetts Guard to help construct a tent camp on Corey Hill to treat these men. Like Robert Rivers, Brooks believed in the palliative nature of fresh air and sunshine. Ultimately 351 seamen were treated at the camp, and all but 35 survived, a much better survival rate, Brooks believed, than in area hospitals. Though the survival rate of the sailors at the tent hospital was undoubtedly viewed as a success story by the town, officials at the Board of Health likely cringed to read a story in the Brookline Chronicle encouraging citizens “to climb the summit of Corey Hill and there behold the tented city….”

As is the case in so many places affected by the pandemic, the actual number of those affected by influenza in Brookline is hard to ascertain. The town’s health officer reported 2,369 cases of influenza in 1918 but suspected “that figure should probably be doubled to represent the number of cases that occurred.” The second wave of the pandemic severely strained the ability of the department’s nurses and doctors to meet the needs of citizens and this led town officials to order the cessation of certain activities in an attempt to stop the spread of the flu. Schools, bowling alleys, pool rooms, billiard halls, and soda fountains were closed, and gatherings at churches and halls were prohibited. Gatherings were also prohibited in houses where there was a deceased person. Unlike today, businesses were not shut down. Many local businesses adapted their newspaper advertising to reassure customers that they were open for business, adapting to the circumstances of the pandemic, and prepared to serve their customers.

No vaccine is currently available for Covid-19, and no vaccine existed in 1918 for the flu—the first flu vaccine would not become available to civilians until 1945. Many bacterial diseases were well understood by 1918, but viral diseases were proving more enigmatic. Scientists had hypothesized that a microbe smaller than a bacterium caused the flu—viruses are so small that about 8000 virions can fit into a bacterium--but the Influenza A and B viruses were not isolated by scientists until the 1930s. Without knowledge of the nature of the microbe that caused the flu, creation of a vaccine was not possible. In the absence of a vaccine, the best that state and local officials could do in 1918 was to employ a number of “non-pharmaceutical” interventions to halt the spread of flu. These interventions included many of the things people are familiar with from life during the Covid-19 pandemic: isolation of the sick, quarantine of those in contact with the sick, school closings, and prohibitions on large indoor or outdoor gatherings. Recent research on the 1918-1919 pandemic has shown that in the country’s largest cities there was much variation in the start date of these interventions, their duration, and the particular combination of interventions introduced in a particular city. The choices officials made in each case led to significant differences in the course of the disease in a given city. In Brookline most of the closures and prohibitions introduced to halt the second wave of flu were lifted after about a month. Schools remained closed for a few additional days, and another restriction was kept in place but modified: the ban on gatherings at homes where a person had died was not lifted, but the focus of this prohibition was narrowed to homes where the death had resulted from influenza or pneumonia.

The citizens of Brookline were blessed with a strong public health department that worked hard to confront the outbreak, providing educational material, support, and treatment to the town’s citizens all while working with the resources allocated for a normal flu year. Health officials distributed printed information to town residents about the nature of the disease and how to care for the sick, but the level of need challenged department staff. The town’s health officer appealed to residents for volunteers to help provide relief to the sick. Many answered the call to help. The Brookline Friendly Society in particular played a significant role in helping out, delivering “nourishing and wholesome food” to the sick in their homes as well as well as sheets, towels, and bedding. Citizens also cooperated with the department in “cheerfully” putting placards in the windows of their homes if there was a resident sick with influenza or one who had died from the disease. The Contagious Hospital in town treated 184 cases of the most seriously ill residents.

The pandemic impacted the schools of Brookline, including Rivers, in a number of significant ways. First and foremost, Brookline schools were closed for extended periods of time on at least two occasions that year, requiring Rivers to close as well. School closures were instituted in many American cities in 1918 to stem the spread of the flu, though some large cities, including New York, New Haven and Chicago, chose not to close their schools. In September 1918 the spike in local influenza cases sparked intense debate about school closure in Brookline. Ultimately the Brookline Board of Health ordered the closure of schools starting September 24. The justification for this action was clear to the town’s health officer: “Early in the epidemic it was noted that the first case in many of the families was a school child and especially children from certain rooms in certain schools. It was evident that the disease was being spread through the schools despite the fact that every precaution was being taken to exclude children showing any suspicious symptoms.” Schools remained closed into late October. After the closure order was extended until October 22, schools were allowed to reopen shortly thereafter.

The second wave of the pandemic eventually passed, but a resurgence of cases in December, attributed by local health officials to the Armistice celebrations in mid -November, again raised concerns about containment of the virus. This led the town officials to order another school closure, this time extending the date for the resumption of classes after the Christmas vacation. Mr. Rivers sent a notice to parents sometime during the week of December 22 that noted the rise of influenza cases in December, and reported that after conversations with Dr. Smith, the head of the school’s health advisory panel, that the school would reopen on December 30. He urged parents to keep their boys home if they had been involved in activities during the vacation involving crowds, if they had family members with influenza, or if parents had any doubt about a boy’s health. He emphasized that there had been only one case of influenza at the school before vacation, and that he wanted to keep it that way. In a follow-up letter, dated December 30, Mr. Rivers noted that the Board of Health would allow the school to re-open on January 2.

In the end, Rivers emerged from the pandemic relatively unscathed. Mr. Rivers reported to parents at year’s end on student health, comparing illness in the student body over the previous two years. According to the data he provided, 1918-1919 was actually a better year for student health at the school than 1917-1918 in all but one statistical category:
 
Reason for Absence1918-191917-18
Days Lost Due to Colds5.2%6.3%
Days Lost Due to Contagion1.2%3.5%
Days Lost Through Minor Illnesses2.9%2.2%
Days Lost Through Illness9.3%11.9%

The attendance records for these years have not survived, so it is not possible to investigate this report in more detail, but Mr. Rivers clearly believed that his students enjoyed good health during the pandemic and weathered the influenza pandemic better than the general public.

Mr. Rivers would continue to hold to his conviction that his students would be healthier in normal and abnormal years because of the school’s open-air philosophy. He touted the school’s success in this way in 1924-1925: “In the last five years the loss at The Rivers School from absence due to respiratory ills – various types of colds, throats, ears, tonsils, etc. of all kinds has been less than five percent of the total possible attendance. That record speaks for itself…. All the little problems and minor inconveniences become negligible when compared to the gifts to health and through health to achievement of living and working in the open air.” In the end, did the open-air philosophy help keep students healthy during the flu pandemic of 1918-1919? Mr. Rivers certainly thought so.









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