The Army of the Sick

The measure of their success or failure would become visible only in the mortality figures for the following weeks, when the city would experience the deadliest period of its history. But first came the phones.

At the Bureau of Health on South Broad Street, the switchboard began lighting up before dawn on Friday, October 4, 1918. The night operator had already logged forty-seven calls by six in the morning, and the day shift found the lines still jammed when they took their posts.

Dr. William H. Frost, a Public Health Service officer detailed to Philadelphia, would later recall that physicians were reporting case volumes far exceeding any precedent in his experience—a rate of accumulation that appeared in his field notes and was repeated in the bureau’s internal summary.

The operators, working from a printed card of standard responses, had no entry for this volume of distress. They wrote down the numbers as fast as they could, filling the margins of their log sheets with addresses and symptoms: fever, cyanosis, hemorrhage from the nose. The system had been designed to track infectious disease through deliberate, orderly channels—weekly reports from hospitals, monthly returns from undertakers, the occasional telegram from a port medical officer. It had not been designed for this.

By eight o’clock, the bureau’s director, Wilmer Krusen, had the log sheets on his desk. He had signed the closure orders only the evening before, at seven p.m., following an emergency session of the Board of Health that had run past midnight. The orders were sweeping: all theaters, moving-picture houses, dance halls, and schools closed until further notice; public gatherings prohibited; churches permitted to hold services only if they opened windows and limited attendance. The Evening Bulletin had printed the text in full, with a headline announcing “City Acts to Check Epidemic.” Now, twelve hours later, the phones suggested that the epidemic had not noticed.

Krusen faced a choice that would repeat itself through the day: whether to expand the orders or to enforce the ones he had. The legal machinery of closure was already in motion. A police captain had drawn up deployment orders for two hundred officers, with instructions to visit every licensed amusement venue in the city and post the closure notices by noon. The officers would find, in many cases, that their authority had been anticipated by fear.

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At the Garrick Theater on Chestnut Street, the manager had locked the doors himself at ten o’clock the previous evening, before the official order reached him. He had watched the afternoon matinee empty out at intermission—too many coughs, too many patrons rising suddenly and walking out—and had made his decision without consulting the health bureau. When two officers arrived at eleven on Friday morning with the printed notice, they found the lobby dark and a handwritten sign taped to the glass: “Closed by Order of Management.” The senior officer noted the violation in his report—the sign implied a city order that did not yet exist—and pasted the official notice beside it.

The officers walked south to the Walnut Street Theater and found the same scene: darkened marquee, deserted box office, a watchman who told them the company had dispersed to wait out the sickness. At the Forrest Theater on Walnut, they found the doors open and the janitor mopping the lobby. The manager appeared, red-eyed, and accepted the notice without argument. The company was finished, he indicated; the audience had already made its decision.

This pattern, authority following where panic had already led, repeated across the city’s twenty-three licensed theaters and sixty-seven moving-picture houses. The police reports, compiled for the Board of Health meeting on October 7, showed that four-fifths of venues had closed before the officers arrived. The remaining fifth accepted the notices without protest. The summary noted no arrests, no fines, no resistance. The enforcement operation, which had been planned as a show of municipal resolve, became instead a documentation of collapse. The theaters were closed because the public had stopped coming; the schools were empty because parents had kept their children home; the dance halls were dark because the dancers had fled. The orders had been issued, in Krusen’s phrase, “to prevent panic.” They arrived to find panic already in command.

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While the police walked their routes, the hospitals filled. Philadelphia General Hospital, the city’s public institution at Thirty-Fourth and Pine, had 542 beds on October 1. By the morning of October 4, the admission ledger showed 847 patients, with the overflow laid on cots in corridors and on mattresses in the solarium. The hospital’s superintendent had begun refusing elective admissions on October 2; by October 4, he was refusing everything except influenza and its complications.

The ledger entries for Friday, October 4, run across eleven pages in the hospital’s surviving records, with timestamps beginning at 12:03 a.m. and continuing without break through 11:47 p.m.

The handwriting changes four times, different clerks relieving each other, but the entries maintain the same compressed format: name, age, address, occupation, temperature at admission, diagnosis. “Influenza, bronchopneumonia.” “Influenza, lobar pneumonia.” “Influenza, hemorrhagic.” The temperatures cluster between 102 and 105 degrees Fahrenheit.

The ages range from seventeen to sixty-three, with a visible concentration in the twenties and thirties, the mortality pattern that would later distinguish this pandemic from seasonal influenza, though no one at Philadelphia General had time to notice the shape.

The last available cot was occupied at 9:14 a.m., according to the ledger’s marginal notation. After that, admissions continued to be recorded, but the bed assignment column was left blank or marked “floor, Ward C” or “corridor, east wing.” At 2:37 p.m., a clerk wrote “linen closet” in the bed column for a thirty-one-year-old machinist from Kensington, then crossed it out and wrote “floor, Ward D.” The linen closet had been judged unacceptable even in extremis. By 6 p.m., the superintendent had telegraphed the Bureau of Health to report that the hospital had reached capacity and could not accept further cases without additional staff and supplies. The telegram, preserved in the bureau’s files, reached Krusen’s desk at 7:15 p.m. He did not respond until morning. There was, by that point, nowhere to send the overflow.

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Three miles northeast, at the Episcopal Hospital in Kensington, the same compression was occurring on a smaller scale. The Episcopal was a private institution with 186 beds, supported by the Protestant Episcopal diocese and staffed by the Sisters of the Holy Cross. Its admission records for October 4 survive in a bound volume now held by the College of Physicians of Philadelphia, with the day’s entries distinguished by a heavier pen and more hurried hand than the entries for the first three days of the month. The recording sister had developed a shorthand for the repeated diagnoses: “Flu” with a trailing “p” for pneumonia, “Flu-h” for hemorrhagic presentation.

At 11:20 a.m., she recorded the admission of a twenty-four-year-old woman, address given as “near the yards,” with a temperature of 104 degrees and a notation indicating recent stillbirth and postpartum admission. The woman’s occupation was listed as domestic, her husband’s as absent on Navy service. The entries for the afternoon show the same compression of catastrophe: a nineteen-year-old clerk, cyanotic with pneumonia; a forty-year-old foreman, dead in the receiving room; a thirty-three-year-old laborer of unknown address, found unconscious on Frankford Avenue and brought by police ambulance.

The Episcopal’s last available bed was filled at 4:45 p.m., according to a note in the margin of the ledger. After that, admissions were marked “floor” or “chair, Ward 2” or simply “waiting.” The hospital’s chapel was converted to patient space at 7 p.m., with mattresses laid between the pews and the altar screen. The sisters continued to record admissions through the night, though the timestamps grow less precise after midnight, “early a.m.,” “before dawn,” as the rhythm of crisis overwhelmed the discipline of documentation. By the morning of October 5, the Episcopal Hospital had 312 patients in space designed for 186, with six sisters and four nurses attempting to provide care that the medical staff had already tacitly admitted was futile. The hospital’s medical director would write in his report to the diocese that their function had shifted from treatment to preparation for death.

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The burial system broke in public. On Saturday, October 5, the Public Ledger carried a brief notice on page seven, under the heading “Undertakers Overwhelmed.” The notice quoted Samuel E. Gibson, proprietor of the city’s largest funeral establishment, announcing that his firm could accept no more bodies until further notice. His firm had thirty-seven bodies in its charge, he indicated, and could not procure caskets or the services of grave-diggers in sufficient number to reduce this accumulation. The notice ran without editorial comment, positioned between a war bond advertisement and a report on the Liberty Loan quota. Its placement suggested that the editors had not yet recognized its significance, or that they had recognized it and chosen to minimize its visibility.

Gibson’s announcement was the first public acknowledgment that the city’s systems of death management had failed. Philadelphia’s burial infrastructure had been designed for a steady state: approximately thirty deaths per day in normal times, handled by a network of licensed undertakers, municipal cemeteries, and church burial grounds. The system assumed availability of caskets, manufactured by local firms and shipped from New England, availability of grave-diggers, typically casual laborers hired by the day, and availability of burial space, the city having opened a new municipal cemetery in 1917 with capacity projected for twenty years. The system did not assume a sustained mortality rate of two hundred, three hundred, five hundred deaths per day.

By October 5, the casket manufacturers had closed, some from illness among their workers, some from the general closure order that had not exempted coffin-making as an essential service. The city’s lumber yards, which might have supplied rough boards for improvised coffins, were also closed. The grave-diggers, who worked outdoors and in close contact with the dead, were falling ill at rates that suggested the occupation itself was fatal. Gibson’s thirty-seven unburied bodies were only the visible portion of a backlog that extended across the city’s forty licensed funeral establishments. The Inquirer would report on October 7 that many private homes were retaining bodies for lack of undertaker services, though the paper did not specify how many or in which neighborhoods.

The municipal response to this collapse was delayed by a jurisdictional dispute. The city’s Department of Public Works, which managed the municipal cemeteries, maintained that burial was a private responsibility; the Bureau of Health maintained that unburied bodies constituted a public health emergency; the Mayor’s office, occupied by Thomas B. Smith, maintained that the crisis was being exaggerated by the press. The dispute was resolved, temporarily, by an order from the State Health Commissioner on October 6, directing the city to provide for the decent interment of the dead by any means necessary. The order authorized the use of trench burial in the municipal cemeteries, with multiple bodies interred in common graves. It also authorized the impressment of labor for grave-digging, including prisoners and such other persons as might be available.

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The prisoners came from the Eastern State Penitentiary, the seminarians from the Philadelphia Divinity School.

They were deployed to the municipal cemetery at Mount Moriah in Southwest Philadelphia on the morning of October 6, working in shifts that continued through the night. The cemetery superintendent kept a log of the burials that survives in fragmentary form: “Oct. 6, Trench 7, 34 bodies, prisoners 6, seminarians 4, hours 14.” The arithmetic of this entry, forty man-hours for thirty-four bodies, suggests the labor intensity of trench burial, even with the ground prepared by steam excavator.

The bodies arrived in sheet-wrapped bundles, having been transferred from undertaker establishments or directly from homes by police wagon. The superintendent recorded the transfers by number rather than name: from Gibson, twelve; from Harrison, eight; from police, fourteen. The names, when they had been recorded at all, were on tags tied to wrists or ankles, and many of these tags had been lost or rendered illegible by the fluids of decomposition.

The seminarians, who had volunteered through their dean, worked in teams of four, with two digging and two reading prayers. The prisoners worked in chains, six to a trench, under the supervision of a single guard who remained at a distance. The superintendent’s log notes that the prisoners worked without complaint, a phrase that appears in his official report and was repeated in the Bulletin’s account of October 8.

The seminarians, by contrast, were described as visibly affected by the work, with two requiring replacement on the afternoon of October 6. The difference in these descriptions, stoic prisoners, overwhelmed seminarians, may reflect the superintendent’s assumptions about the appropriate responses of each group, or it may reflect a genuine difference in their exposure to the dead. The prisoners were lifers, serving sentences for murder or armed robbery; they had, in the superintendent’s phrase, seen death before. The seminarians were young men in their early twenties, preparing for ordination, and they had not.

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While the trenches were being opened at Mount Moriah, the hospitals continued to fill. The Bureau of Health’s phone log for Sunday, October 6, shows a pattern of escalation: calls from physicians reporting not individual cases but households entirely prostrate, a boarding house of twelve all sick, a factory shift of forty men unable to work.

The operators, working from revised instructions, were now directing callers to improvised treatment centers rather than to the overwhelmed hospitals. These centers, schools, armories, church basements, had been opened in haste on October 5, with volunteer nurses from the Red Cross and the Visiting Nurse Society attempting to provide care without medical supervision. The Bureau of Health’s summary for October 6 notes that many cases were being treated in their homes by neighbors and friends, with such remedies as were available, a bureaucratic phrasing that concealed the reality of thousands of sick persons without professional care of any kind.

The cycle of official optimism and suppressed alarm had shattered publicly. Krusen’s closure orders, issued to prevent panic, had arrived in a city already panicking. His subsequent orders, expanding the closures and authorizing emergency measures, arrived in a city already beyond the reach of municipal authority. The gap between what the system could do and what the epidemic required was visible in every phone log, every hospital ledger, every trench at Mount Moriah. The city had been designed for order, and order had failed.

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On the evening of October 6, Krusen convened an emergency meeting of the Board of Health in his office at City Hall. The minutes, recorded by the board’s secretary, show a session dominated by logistical impossibilities. The city had 1, 200 trained nurses, of whom 400 were already sick; the hospitals had requested 500 additional nurses, and the Bureau of Health could supply 80, drawn from retirement and from training programs accelerated to emergency completion. The hospitals had requested 10, 000 additional beds; the bureau had located 2, 400, in schools and armories not yet converted for medical use.

The undertakers had requested authority to use plain wood coffins rather than the decorated caskets required by city ordinance; Krusen had granted this authority orally on October 5, but the manufacturers were closed and the lumber unavailable. The trench burials at Mount Moriah were proceeding at a rate of 150 bodies per day; the mortality returns for October 5 showed 423 deaths, and the returns for October 6 would show 528.

The minutes record a single intervention by Krusen, near the session’s end: the Director stated that the present emergency exceeded the capacity of any municipal health department, and requested that the Board authorize him to seek assistance from the State and Federal governments. The authorization was granted unanimously. The request was transmitted by telegram at 9:47 p.m., addressed to the State Health Commissioner in Harrisburg and copied to Surgeon General Rupert Blue in Washington. The telegram, preserved in the National Archives, reads in full: Philadelphia requires immediate assistance. Hospitals overwhelmed. Burial facilities inadequate. Request dispatch of medical personnel and supplies by fastest available transport.

The response would not arrive in time for the week that followed. Between October 7 and October 14, Philadelphia would record 4, 597 deaths from influenza and pneumonia, the deadliest seven days in the city’s history. The hospitals would continue to fill, the trenches to deepen, the phones to ring. The measures that might have contained the epidemic, closure, isolation, quarantine, had been applied too late, and the systems that might have managed its consequences had been designed for a different scale of catastrophe. A hospital corridor with no space left, a shuttered undertaker’s shop with bodies stacked in its back room, a trench at Mount Moriah receiving its thirty-fourth wrapped bundle as dawn broke over the city: this was the pressure that the official orders had sought to contain, and this was the pressure that would determine what survival now required.