The Volunteers’ Vow

The inspector recommended additional labor. Saturday, October 19, 1918, at Potter’s Field. The recommendation went into a report that would sit on a desk until Monday morning. The dead did not wait.

Three days later, on Tuesday morning, October 22, a woman sat at her kitchen table in South Philadelphia and wrote a letter to her sister in Pittsburgh.

She described the previous afternoon: a neighbor had knocked, a woman whose husband lay feverish in the bedroom, whose children were too young to help. The letter writer had gone with a basin of water and a cloth. She had opened the windows, though the air was cold. She had washed the man’s face and hands, and when he coughed blood into the basin, she had carried it to the alley and emptied it. She had stayed until the woman could stand to be alone. “There was no one else,” she wrote. She did not name the disease. She did not mention that she had never nursed anyone before.

She signed the letter, sealed it, and walked it to the post office on Broad Street. The postal clerk wore a gauze mask. So did the woman ahead of her in line.

That same Tuesday morning, at 9:15, a Red Cross volunteer arrived at Emergency Dispensary No. 7, a requisitioned dance hall on Catherine Street.

She signed her name in a ledger kept on a card table by the door. The previous day’s entries ran to four pages: twenty-three volunteers, morning and afternoon shifts, names in different hands, some with addresses, some with telephone numbers, most with neither. The volunteer took her assignment from a woman in a nurse’s uniform who did not give her own name. The uniform was borrowed; the woman was a schoolteacher.

The volunteer was to carry soup and bread to six addresses in the neighborhood, houses where families had telephoned or sent children or simply hung a white cloth from a window. The soup came from a restaurant on South Street whose owner had emptied his kitchen for the emergency. The bread came from a bakery whose drivers had stopped delivering to shops and started delivering to dispensaries.

The volunteer loaded her wagon—a child’s wagon, with a wooden bed—and pulled it through streets where the normal sounds had thinned to almost nothing. No streetcars ran. The few automobiles moved slowly, as if lost.

She knocked at doors and left the food on stoops when no one answered. At one house, a girl of perhaps twelve opened the door and took the pot without speaking. Her eyes were red. The volunteer made a mark on her list and moved to the next address.

She returned to the dispensary at 1:30, signed out, and walked home. The ledger recorded her hours. It did not record what she had seen.

These two documents—the letter and the service log—sat in different archives for decades. They describe the same city on the same day. They do not describe the same system.

The epidemic had arrived in Philadelphia through the Philadelphia Navy Yard on September 19, 1918, carried by sailors returning from Europe. The city had been raising $259 million for the Fourth Liberty Loan, the largest of the war bond drives, which offered $6.9 billion in 20-year bonds at 4.25 percent. The parade on September 28 had drawn two hundred thousand spectators. Twenty-four hours later, 118 Philadelphians were described as coming down with a mysterious, deadly influenza. The numbers had climbed through October: 289 on October 5, 428 on October 10, 759 on October 16. The hospitals had filled, then overflowed. The morgues had filled. Potter’s Field had filled. The official apparatus of the city—the Board of Health, the Bureau of Health, the Department of Public Safety—had responded with closures and bans and appeals for calm, but the machinery was built for ordinary emergencies. This emergency was not ordinary.

By October 19, the city had begun to improvise. The improvisation had no center. It grew from individual decisions, from people who could not wait for instructions.

The Red Cross had established emergency dispensaries in borrowed buildings: dance halls, lodge rooms, a synagogue basement on Marshall Street. The dispensaries did not treat patients; they coordinated volunteers. The volunteers delivered food, collected information, drove the sick to hospitals when beds could be found. The system ran on telephone calls and handwritten lists. A woman serving as chairman of the Philadelphia chapter’s influenza committee worked from an office at 1425 Locust Street where the telephone rang constantly and the files multiplied on every surface. The chapter had enrolled 2, 500 volunteers by October 20. Many had never done relief work before. The chapter’s reports noted this without comment. There was no time for training.

Nursing presented a deeper problem. Professional nurses were scarce. Many had been called to military service; others had sickened or refused to enter infected houses. The Red Cross attempted to organize “aides”—women with no medical training who would provide basic care under telephone supervision from registered nurses. The aides received a printed card with instructions: open windows, keep the patient warm but not overheated, give liquids, watch for signs of pneumonia. The telephone supervision was theoretical. The nurses were overwhelmed. The aides worked alone.

The Bureau of Health meanwhile operated on a different track. On October 18, Wilmer Krusen had issued an order requiring influenza cases to be reported by telephone, a measure designed to locate the sick and direct resources. The order assumed resources existed to direct. The telephones at the bureau rang unanswered. The street addresses reported by those who got through were added to lists that no one had time to read. The bureau’s inspectors, who normally checked food handlers and milk deliveries, were reassigned to death certificate verification, a task that kept them in the morgues and away from the living.

The gap between these systems—official and volunteer, centralized and scattered—widened by the hour. The volunteers did not wait for the bureau. The bureau could not catch up to the volunteers.

On Sunday, October 20, a group of women from the Society of Friends met at the Race Street Meeting House. They had been running a small relief operation for the families of men interned as enemy aliens. The epidemic had made that work impossible; the interned men were the least of anyone’s concerns. The women voted to redirect their efforts to “general relief.” They had no medical training, no vehicles, no supplies except what they could purchase or borrow. They divided the city into districts and assigned members to each. They would visit houses, assess needs, and report to a central committee that would attempt to match resources to requirements. The central committee met daily at 4 p.m. The first meeting lasted seventeen minutes. They had nothing to report.

The Friends’ operation ran parallel to the Red Cross, parallel to the bureau’s faltering inspection system, parallel to dozens of neighborhood initiatives that left no records. A Catholic parish in Kensington organized its own visitation committee. A Jewish mutual aid society on South Fourth Street converted its loan office into a temporary dispensary. The Norwegian-Danish Hospital on Norris Street, a small institution serving its ethnic community, opened its doors to all comers and ran out of cots on October 21. The hospital’s administrator sent a telegram to the state health department in Harrisburg requesting supplies. The reply, when it came three days later, directed him to the federal Public Health Service office in Washington. He did not have three days. He sent a nurse to the wholesale drug district on Market Street and bought morphine with his own money.

The federal presence in Philadelphia had expanded since mid-September. Surgeon General Rupert Blue had dispatched investigators to the Navy Yard, then to the city itself. The United States Public Health Service team operated from offices at 19th and Callowhill Streets, maintaining a technical distance from the municipal authorities they were observing. Their reports to Washington described the epidemic’s progress in the language of epidemiology: attack rates, case fatality ratios, secondary pneumonia indices. They did not describe the volunteers. The volunteers were not part of their data.

Paul Lewis, the researcher Blue had assigned to study the pathogen, worked from a laboratory at the University of Pennsylvania. He was attempting to isolate the causative agent, following methods developed at the Rockefeller Institute. His work was invisible to the women pulling wagons through South Philadelphia, to the Friends visiting houses in Germantown, to the nurses sleeping in hospital storerooms because they could not go home. Lewis’s laboratory notebooks, preserved in the university archives, contain no mention of the social crisis unfolding beyond his microscope. The crisis was not his subject. The organism was his subject.

The separation between the laboratory and the street, between the federal investigator and the local volunteer, was not unusual. It was structural. The public health system of 1918 assumed that knowledge would flow upward and instructions would flow downward. The epidemic broke both flows. Information from the streets did not reach the laboratories in usable form. Instructions from the authorities did not reach the sick in time to matter. The volunteers operated in the gap.

On Monday, October 21, the Red Cross influenza committee recorded 4, 847 calls for assistance. The figure counted telephone contacts, not people helped; many calls requested the same services repeatedly as volunteers failed to arrive or arrived too late. The committee stopped distinguishing between “medical” and “non-medical” requests. The categories had collapsed. A call for a doctor became a call for anyone who could come. A call for food became a call for someone to enter a house where the parents were dead and the children were alone.

The volunteers entered these houses without protective equipment. Gauze masks were available at some dispensaries, but supplies were irregular and the masks’ effectiveness was disputed. The Red Cross distributed instructions for making masks at home, recommending four layers of gauze or two layers of butter cloth. The instructions noted that masks should be changed frequently and boiled when soiled. The women entering sickrooms did not have time to boil masks. Many stopped wearing them.

The risk was not abstract. The Philadelphia General Hospital reported twelve volunteer nurses admitted with influenza on October 21 alone. The hospital’s superintendent requested permission to convert the women’s ward to influenza cases. The permission, when it came, was verbal; the written authorization arrived October 23, by which time the ward had already been reorganized twice.

The Bureau of Health’s mortality returns for the week ending October 19 showed 4, 597 deaths from influenza and pneumonia. The highest weekly total yet recorded. The returns were compiled from death certificates, which were filed by physicians who had not seen the patients alive, by undertakers who had not examined the bodies, by family members who could not read or write. The bureau’s statisticians knew the numbers were incomplete. They published them anyway. The incomplete numbers were the only numbers they had.

The curve that these numbers traced was beginning to bend. The peak of the epidemic in Philadelphia would prove to be the week of October 12-19, the week of four thousand dead, though this would not be clear until later. The volunteers of October 21-22 were working at the absolute crest of the wave, in conditions that the official system could neither measure nor control. Their labor did not appear in the mortality returns. It did not appear in the Public Health Service reports. It appeared only in the documents they left behind: the ledgers, the letters, the memory of neighbors who survived.

The transformation from individual mercy to organized brigade was not planned. The arithmetic of need drove it. The woman who had nursed her neighbor on October 21 received a telephone call on October 22 from a woman she did not know, who identified herself as a “district captain” for the Red Cross. The captain asked whether she would take a regular assignment: three houses, daily visits, reporting by telephone each evening. She agreed. She was given a printed form to record temperatures and symptoms, a supply of gauze masks, and the telephone number of a nurse who would answer questions between 7 and 9 p.m. The system had absorbed her. She was no longer acting alone.

This absorption had costs. The district captain who telephoned had received her own instructions that morning from the chairman’s office, where the files had grown to encompass seventeen separate “districts” of the city. The boundaries of these districts followed no existing administrative map; they were drawn by the availability of telephones, the location of volunteers, the accidents of who had offered help and when. A family living on the border between districts might receive two visitors or none. The captain had forty-seven volunteers under her supervision and no way to verify their work. She recorded their names in a ledger. The ledger did not record outcomes.

The Friends’ relief committee, meeting on October 22, confronted a different problem. Their visitors were reporting needs they could not meet: money for rent, coal for heat, a coffin for a child. The committee had no funds. They had applied to the city’s Emergency Aid program, established after the parade to coordinate relief, and had received a promise of “consideration.” The promise was three days old. They voted to advance small sums from the meeting’s own treasury, to be repaid if the city came through. The advance totaled $340. The city would not come through until November.

The parallel systems—the Red Cross with its borrowed infrastructure, the religious societies with their limited resources, the municipal apparatus with its collapsing authority—did not merge. They competed for the same volunteers, the same donations, the same space in newspaper columns that increasingly described the epidemic in the past tense even as it continued. The Evening Bulletin of October 22 ran a front-page story headlined “Influenza Shows Decided Decline,” based on hospital admissions that had fallen from catastrophic to merely desperate. The story did not mention the volunteers. The volunteers were not news. They were the background against which news happened.

The researchers in Paul Lewis’s laboratory were also background, though they would not have described themselves so. Lewis had succeeded in producing a filterable agent from the lungs of deceased patients, a technical achievement that advanced the understanding of the pathogen without affecting its course through the population. His methods required fresh tissue, which meant contact with the autopsy rooms of the city’s hospitals. The pathologists who provided this tissue were themselves falling ill; the Philadelphia General Hospital lost three resident pathologists to influenza between October 15 and October 22. Lewis worked with what he could get. His notebooks record gaps: “No suitable material,” “Autopsy delayed,” “Specimen contaminated.” The science proceeded in fragments, as the care proceeded in fragments, as the city proceeded in fragments.

By October 22, the volunteer network had achieved a kind of stability. Not efficiency—there was never efficiency—but predictability. The women who had started as individual actors had become, however imperfectly, a system. They knew their routes. They knew which houses would have someone to receive them and which would not. They knew the telephone numbers of the few doctors still making house calls, and they knew that calling those numbers rarely produced results. They had developed their own protocols: how long to wait at an unanswered door, what to do with a body when the undertakers were delayed, how to explain to a child that help was coming when it was not.

This knowledge did not transfer. A volunteer who sickened was replaced by someone who had to learn the routes again. The district captains kept their records, but the records were not summaries; they were simply lists, accumulating without analysis. The Red Cross planned to write a report after the emergency ended, to document what had been accomplished. The planning was itself a form of hope.

The epidemic’s curve, invisible to those on its surface, had begun to descend. The week of October 19-26 would show fewer deaths than the week before, though the number—4, 314—would still exceed any natural catastrophe in the city’s history. The descent was not victory. It was the passing of a wave that had already done its damage. The volunteers of October 22 were nursing the survivors of infections contracted two weeks earlier, delivering food to families whose wage-earners had died in the first days of October, maintaining a presence that the official system could not maintain and that the epidemic no longer required in the same desperate measure.

The temporary social order they had forged would not outlast the emergency. The Red Cross would demobilize its influenza committees by November 15. The Friends would return to their original mission, the care of interned aliens. The dance halls would reopen for dancing. The ledgers would be filed, the letters would be read and forgotten, the knowledge of how to run a city on volunteer labor would dissipate into individual memory.

But the fact of the mobilization would remain. It had happened. When the official structure failed, something else had grown in its place—not by design, not by authorization, but by the accumulated decisions of people who could not wait to be told what to do. The city had survived not because its systems worked but because its citizens had worked around them.

On the evening of October 22, the volunteer from Catherine Street made her last delivery and returned the empty wagon to the dispensary. She signed the ledger, noted her hours—seven, though she had not stopped for lunch—and walked home through streets that were darkening early, the autumn light failing at the corners. She would volunteer again on Thursday. The need would continue. The need would continue for weeks, would shift and diminish and finally end, but she did not know this.

She knew only that she had done what she could, that the list for tomorrow was already being prepared, that someone would telephone in the morning with an address and a name. The system she served was temporary, improvised, incomplete. It was also, for this moment, the only system that functioned. She walked home, and the city around her breathed with the labor of thousands like her, unseen, unrecorded, keeping the dead from overwhelming the living by the simple act of showing up.