The Hearing in the State House

Seen from above, the winter landscape of Pennsylvania held a clear line between the frozen uplands and the thawed valleys, with the Susquehanna threading brown through the fields. Across the settled pattern of farms and towns, a single plume of coal smoke marked a thin disturbance—the westward passage of the Pennsylvania Railroad’s morning train from Philadelphia. It moved past orchards and quiet communities, while inside its Pullman cars, passengers read newspapers filled with talk of peace and lingering disease, holding private knowledge of a gathering inquiry that the headlines did not name.

Dr. William H. Welsh, Secretary of the State Board of Health, had convened the hearing for December 14.

The location was the State Capitol building on Third Street, a structure whose dome—still unfinished in bronze, still wrapped in the scaffolding of a decade’s construction—loomed over Harrisburg’s modest grid like a promise of authority not yet fully paid out. Welsh had served as health officer of Allegheny County before his state appointment. He had watched Pittsburgh’s epidemic curve rise and fall while Philadelphia’s soared past it, and he had noted the difference.

Pittsburgh’s health director had closed the schools on October 5, banned public gatherings on October 7, and kept the closures in place for three weeks. Philadelphia’s Wilmer Krusen had waited until October 3, after the Liberty Loan parade had released its crowds into the packed downtown streets, and even then the closure order had arrived with the hedged language of a man who still hoped to minimize disruption.

Welsh had the mortality tables before him. He had the dates. He intended to ask what had happened in the interval between knowledge and action. The city of Philadelphia had been in charge of raising $259 million for wartime efforts and had seen the parade as a way to raise those funds, a pressure that shaped the interval Welsh sought to examine.

The hearing room occupied the second floor, a chamber with high windows and a long oak table where the state board members sat with their backs to the light. The Philadelphia delegation entered at nine-fifteen: Krusen, his assistant director Dr. C.Y. White, and two members of the city council who had insisted on attending. They took the chairs reserved for respondents. The room held perhaps forty observers, mostly county health officers from across Pennsylvania who had come to learn what not to do, and a single reporter from the Harrisburg Telegraph whose dispatch would be the only newspaper account. Welsh called the session to order. He stated that the board sought information, not accusation. The distinction did not hold.

Krusen spoke first. He had prepared a statement, drawn from the forty-seven-page report he had submitted to Mayor Thomas B. Smith on November 18. The report attributed Philadelphia’s catastrophe to the virulence of the disease, the density of the population, and the impossibility of obtaining timely federal guidance. He read it in the flat voice of a man who had rehearsed its cadences until they carried no inflection. The influenza had arrived, he said, with the returning servicemen. The Navy Yard had been the portal. The city had done everything possible within the constraints of wartime necessity. The Liberty Loan parade had been sanctioned by the federal government as essential to the war effort. The closure orders, once issued, had been comprehensive. The death toll, while tragic, reflected the severity of the particular strain that had struck Philadelphia rather than any failure of administration.

Welsh let him finish. Then he produced a document: Public Health Bulletin No. 116, dated August 19, 1918, signed by Surgeon General Rupert Blue. The bulletin had warned of severe respiratory disease in military camps. It had recommended immediate reporting and isolation. Welsh asked when Krusen had received it.

Krusen consulted his notes. August 26, he said. The regular post from Washington.

Welsh asked what action had followed.

Krusen replied that the bulletin had described a camp disease, not a civilian threat. The Navy Yard was federal jurisdiction. The city had awaited further guidance.

Welsh produced a second document: a telegram from Blue to Krusen, dated September 18, warning of influenza at the Boston Navy Yard and requesting immediate cooperation in reporting cases. Welsh noted that September 18 was the day before the first cases appeared at the Philadelphia Navy Yard. He asked whether this communication had prompted any preventive measures before the parade.

Krusen said that the telegram had arrived late in the day. The parade was six days away. The decision to proceed had been made at higher levels.

Welsh asked which levels.

Krusen named the Fourth Federal Reserve District, the Liberty Loan Committee, the Navy’s regional command. He did not name himself.

The hearing continued through the morning. Welsh called a health officer from Pittsburgh to describe his city’s response. The officer testified that he had received the same bulletins, the same telegrams, and had acted on them without waiting for federal confirmation of civilian risk. He had closed the schools when the first cases appeared in his county, not when the hospitals filled. The mortality difference between the two cities—Pittsburgh’s death rate approximately half of Philadelphia’s—spoke for itself, though the witness did not press the point. Welsh permitted himself a single observation: that the State Board of Health had recommended uniform closure policies on September 27, and that Philadelphia had been the only major city in the commonwealth to proceed with a mass gathering on September 28.

The afternoon session brought medical testimony. Dr. Paul Lewis appeared by invitation, not subpoena. He had come from his laboratory at the University of Pennsylvania, where he was attempting to isolate the causative agent of the epidemic. His appearance marked the hearing’s turn from administrative failure to scientific uncertainty.

Lewis testified that the pathogen was almost certainly a bacterium, probably Pfeiffer’s bacillus, though his cultures had produced inconsistent results. He described the difficulty of working without pure samples, without adequate equipment, without the time that proper research required. The epidemic had moved faster than the science.

Welsh asked whether earlier closure might have altered this trajectory. Lewis replied that no intervention could have stopped the virus—he used the word provisionally, as hypothesis—but that the timing of mass gatherings might have affected the velocity of spread. He would not say more.

His testimony occupied forty minutes, and when he finished, the room understood that the medical frontier offered no refuge for administrative decisions. The science was too new, the evidence too partial, the dead too numerous for laboratory uncertainty to excuse civic paralysis.

The hearing’s third day, December 16, introduced testimony that Welsh had gathered from outside Philadelphia. Dr. John M. Dodson, health officer of Chester County, described visiting Philadelphia in early October at the request of the State Board.

He had found the Bureau of Health’s office overwhelmed, the clerks unable to process death certificates in less than ten days, the director unavailable for consultation. Dr. Ezra O. Rothrock, from Northampton County, testified that Philadelphia’s hospitals had refused transfers from surrounding counties even when beds sat empty, the refusal justified by bureaucratic protocols that no emergency had suspended.

An undertaker from Reading, not a medical man but called to describe the supply chain, reported that Philadelphia’s coffin shortage had forced his firm to ship finished caskets to the city at the expense of his own community’s needs. Each witness added a dimension that Krusen’s report had omitted: the failure of coordination, the rigidity of procedure, the absence of anyone with authority to adapt rules to circumstances.

Krusen responded to each item with the same structure. The bureau had followed established protocols. The scale of the emergency had exceeded any preparation. The federal government had not provided clear guidance until too late. He did not explain why Pittsburgh, with the same federal government, the same protocols, the same disease, had suffered half the mortality. Welsh did not ask him to. The question hung in the room, answered by the silence with which the board members turned their pages.

The hearing’s final morning, December 17, brought a witness whose appearance Welsh had arranged with particular care. Dr. Victor C. Vaughan, former president of the American Medical Association and dean of the University of Michigan medical school, had served as a consultant to the Army’s Surgeon General during the epidemic. He had visited Camp Devens in Massachusetts at the height of the outbreak there.

He had seen the autopsy rooms where pathologists worked in twelve-hour shifts, the stacks of bodies awaiting identification, the medical officers who collapsed at their desks and were carried to the wards they had just left. Vaughan testified that no military or civilian administration in the United States had been prepared for what arrived in September 1918. He had seen generals weep. He had seen surgeons refuse to operate because they could not distinguish living tissue from necrotic. The disease was, in his professional judgment, unprecedented in its velocity and lethality.

Welsh asked whether these conditions excused the failure to cancel a public parade when influenza was known to be present in the city.

Vaughan paused before answering. He was seventy-one years old, and his career had spanned the transition from nineteenth-century sanitary reform to twentieth-century laboratory medicine. He had seen cholera defeated by clean water, typhoid by vaccination, and he had watched this new epidemic overwhelm both approaches. He said that exculpation was not his province. He said that the question was not whether anyone could have prevented the epidemic, but whether particular decisions had altered its course. He said that mass gatherings during explosive outbreaks were, by every principle of epidemiology, to be avoided. He said that the decision to proceed with the Liberty Loan parade, knowing what was known on September 28, represented a misjudgment of risk that no subsequent action could correct. He said this without looking at Krusen, and the hearing stenographer recorded his words as the only explicit condemnation the proceedings would produce.

The state board deliberated in private for two hours. Their report, issued on December 20, recommended no sanctions against Philadelphia’s Bureau of Health. The structure of American public health administration made such sanctions difficult; city health officers served at the pleasure of mayors, not state boards, and the power to remove Krusen rested with Thomas B. Smith, who had already accepted his director’s report as sufficient accounting. But the board’s recommendations carried a different weight. They called for uniform state authority to impose closure orders during epidemics, overriding local discretion. They called for mandatory reporting of influenza cases to state headquarters within twenty-four hours. They called for the creation of state stockpiles of medical supplies, bypassing the procurement delays that had left Philadelphia without nurses, without coffins, without hospital beds. Each recommendation addressed a specific failure the hearing had exposed. None named Philadelphia, but every one described it.

Krusen returned to Philadelphia on the evening train. The Inquirer reported his arrival in three sentences on page seven. He resumed his duties the following Monday, preparing the bureau’s response to a second wave of influenza that state health officers had already identified in Massachusetts and New York. The winter of 1918-1919 would bring scattered outbreaks across Pennsylvania, none approaching the autumn’s catastrophe. Krusen issued the closure orders earlier this time, on the advice of the State Board of Health, and the mortality remained local, containable, forgettable. The difference was not in the disease. The difference was in the apparatus of response, the machinery that Welsh had begun to construct from the hearing’s record.

In the Northern Hemisphere, fears of a “recurrence” of the flu grew as fall approached. Experts cited past flu epidemics, such as that of 1889–1890, to predict that such a recurrence a year later was not unlikely, though not all agreed.

The hearing’s transcript, bound in gray cloth and deposited in the state archives, contained no prediction of what would come. It contained only the testimony, the dates, the mortality figures that Welsh had entered into evidence. A reader who consulted it in later years—there would be few—would find the document’s most revealing feature in what it did not contain. No representative of the federal government had appeared. Surgeon General Rupert Blue, whose bulletins and telegrams had been cited throughout, had not been summoned or asked to account for the gap between warning and guidance, between the identification of risk and the authorization of response. The Public Health Service’s role remained, in the hearing’s formal record, a matter of documents rather than testimony, of paper authority rather than accountable decision.

This absence shaped what the hearing could achieve. Welsh had established that Philadelphia’s response had failed by comparison with other Pennsylvania cities, by the standard of federal recommendations that Krusen had received and not acted upon. He had not established, because he could not examine, whether those recommendations had been adequate, whether Blue’s bulletins had described the threat with sufficient urgency, whether the federal structure of public health—fragmented between military and civilian, national and local, voluntary and official—had itself contributed to the paralysis. The hearing had externalized the conflict, moved it from the bureau’s internal report to a state record, but it had not resolved the larger question of where authority should reside when epidemic disease crossed jurisdictional boundaries.

Dr. Paul Lewis, returning to his laboratory, understood this limitation more clearly than the politicians.

His testimony had placed him in an uncomfortable position: the scientist who could not provide scientific certainty, whose provisional findings offered no foundation for policy. In the weeks after the hearing, he intensified his efforts to isolate the pathogen, working with cultures from autopsy specimens, from nasal washings, from the blood of convalescent patients. His methods were meticulous, his notebooks filled with the controlled variables of temperature, medium, incubation time. The bacillus he sought eluded him. Other researchers, in Boston and New York and at the Rockefeller Institute, reported similar failures.

The 1889-1890 epidemic had produced, eventually, a consensus that influenza was caused by a bacterium, Pfeiffer’s bacillus, and the 1918 pandemic had begun with this assumption. By the winter of 1919, the assumption was crumbling. Lewis would not live to see the viral explanation confirmed; he died in 1929, still working on the problem, still uncertain. The hearing had captured him at a moment when scientific authority was itself in question, when the gap between knowledge and action could not be closed by expertise because the expertise did not yet exist.

The state board’s report reached Governor William C. Sproul’s desk on December 23. He read it between appointments for the Christmas holiday, and his response—formal, appreciative, noncommittal—indicated that the recommendations would require legislative action that the incoming session might or might not provide. The 1919 legislature would face other priorities: the return of servicemen, the adjustment of industry to peacetime, the constitutional amendment for women’s suffrage that Pennsylvania would ratify in June. Public health reform, in this queue, advanced slowly. The uniform closure authority Welsh had requested would not be granted until 1923, and then in weakened form. The stockpiles would never be created; the concept of state medical reserves would expire in the administrative transition of the 1920s, when epidemic disease seemed a memory rather than a preparation.

What persisted was the record. The hearing transcript, the mortality tables, the correspondence entered into evidence—these remained in the state archives when the participants had died, when the 1918 pandemic had been absorbed into the larger history of the war, when even the memory of particular deaths had faded from family knowledge. A researcher who consulted the file in 1935, or 1957, or 2020, would find the same documents, the same contradictions, the same unanswered questions about how a city had failed to protect its people. The hearing had not produced accountability in the legal sense. It had produced something more durable: a formal challenge to the narrative of unavoidable disaster, a demonstration that decisions had been made, that alternatives had existed, that the catastrophe was not weather but policy.

Krusen continued as Philadelphia’s Director of Health until 1922. His annual reports after 1918 made no mention of the hearing, no reference to the state board’s findings. He described the bureau’s operations in the language of continuous improvement, noting the expansion of laboratory services, the installation of new equipment, the professional training of staff. The 1918 epidemic appeared only as a statistical peak in mortality charts, a deviation from trend lines that the subsequent years had corrected. This was the bureaucratic method: to absorb failure into routine, to treat catastrophe as anomaly, to resume the posture of competent administration as soon as the emergency permitted. The hearing had interrupted this method for three days in December 1918. It had placed the bureau’s decisions in a comparative frame, measured against Pittsburgh’s earlier closures, against Blue’s warnings, against the federal guidance that Krusen had cited as justification and the hearing had exposed as insufficient.

The comparison would outlast the hearing’s immediate effects. When the next pandemic planning efforts began, in the 1970s and again after 2003, the 1918 record would be consulted for precedent. The Philadelphia-Pittsburgh contrast would become a standard case study in epidemiology courses, an object lesson in the timing of non-pharmaceutical interventions. Krusen’s name would attach to the error, though the error was systemic as much as personal: the confidence loop of wartime normalcy, the pressure of federal expectation, the absence of any structure that could override local discretion when local discretion failed. The hearing had captured this system in operation, had frozen it in testimony that could be checked against other records, other cities, other possible choices.

Welsh submitted his own resignation from the State Board of Health in 1921, returning to private practice in Pittsburgh. He did not publish an account of the hearing, did not exploit his position for professional advancement. The transcript remained his principal contribution to public health administration, the record of questions asked and evasions noted and conclusions left suspended between evidence and judgment. He had established what could be established: that Philadelphia’s epidemic response was now formally challenged in a state record, its failures compared to other cities and federal advice. The challenge would wait for readers who had not yet been born, who would find in its pages the pattern of a failure that repetition, in 1957 and 1968 and 2020, would confirm as structural rather than unique.