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The Boston outbreak that turned into the deadliest pandemic in modern history

The city’s new health commissioner had to get the public to take the crisis seriously, without setting off a panic. When it was over, 50 million had died worldwide.

Red Cross workers removing bundles of masks for American soldiers from table where other women are busily engaged in making them, Boston, Massachusetts, 1918. (Photo by PhotoQuest/Getty Images)
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As Red Cross workers in Boston treated sick soldiers in 1918 , all eyes were on the city’s new health commissioner, William Creighton Woodward.

TROUBLE ARRIVED IN BOSTON just a few weeks after he did. Dr. William Creighton Woodward had moved from Washington, D.C., during the summer of 1918 to become Boston’s health commissioner. By early September, he was struggling to get a handle on the several hundred cases of influenza that had been reported around the area, a few of them fatal.

Anti-German wartime fervor was fueling public speculation that enemy Huns had unleashed the deadly illness on Boston’s shores through vials carried by secret U-boat missions — or even flu-laced Bayer aspirin. Yet Woodward, a 50-year-old Georgetown-educated physician and lawyer, hadn’t earned his sterling national reputation in public health by giving in to panic.

He had no way of knowing then the horror that lay ahead, how Boston would become the beachhead for the deadliest pandemic in modern history, one that would ultimately claim the lives of an estimated 675,000 in America and more than 50 million people worldwide.

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All Woodward knew at the time was that this was a serious issue demanding an intelligent response. He was reassured that the vast majority of the region’s influenza cases to date involved military personnel — Navy men housed in the hulking yet overcrowded barracks on Boston Harbor’s Commonwealth Pier, or Army recruits packed cheek by jowl at Camp Devens, 40 miles northwest of the city. Because Boston was a bustling and critical transfer station for US forces and supplies in the Great War, it was no stretch to suspect that ships arriving from Europe had carried this strain of the flu along with servicemen returning from those godforsaken trenches on the Western Front. Woodward figured if the outbreak could be effectively contained to military installations around Boston, it might pass as quickly as it had appeared.

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That’s just what had happened during the first wave of the virus in 1918, when a late-winter bout of flu cases hit an Army base in Kansas, trailed by a few dozen deaths from pneumonia. A crush of influenza cases in Spain that spring had also crested, though not before afflicting the king and so many of his subjects that the malady picked up its new nickname, “the Spanish flu.”

Over the years, even though the flu’s punishing symptoms of chills, fever, labored breathing, and heavyweight hits to the gut sometimes made its victims miserable enough to moan that they wanted to die, relatively few of them actually did. Most people who got influenza — also known then as the grippe — recovered after a week or so. The flu was so common that, in most places, doctors were not even required to report cases to their local health departments. It didn’t come close to packing the fright punch that smallpox or typhoid fever did.

Typhoid was the communicable disease Woodward knew best. It had brought him national attention a decade earlier, after he and a colleague conclusively traced an outbreak to a healthy woman running a dairy farm in Maryland. His detective work had come right on the heels of the infamous Typhoid Mary case, where a cook had unknowingly infected dozens of wealthy Long Islanders through her signature dessert of ice cream with raw peaches. Woodward’s dairy-farm sleuthing helped forge his approach as a rigid disciplinarian who remained calm in a crisis even as he relentlessly pushed the people around him for answers.

For his first major announcement about the first crisis of his new post, Woodward struck a strong yet measured tone. He declared war on public spitting, ordering a wholesale roundup of anyone caught doing so on streetcars or sidewalks, as well as rigorous inspections of lodging houses. Police officers attached to the health department would fine or arrest offenders. Woodward was less than thrilled when Dr. David Brough, who had been appointed deputy health commissioner by Woodward’s predecessor, told The Boston Post a good way to counteract the outbreak “would be the calling off temporarily of all kissing by girls of their soldier or sailor sweethearts.” Brough also remarked that anyone feeling symptoms of the grippe “should go to bed and should use a good gargle.”

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Woodward knew his easygoing deputy with the bushy mustache was well liked around Boston. But he also knew the way to reassure a nervous public was through appropriate actions, not the winking musings of a country doctor. Then again, two days later the US surgeon general adopted a similarly relaxed approach, recommending bed rest and aspirin.

Despite his initial hopes, Woodward soon realized the Massachusetts outbreak would not be making the kind of early exit it had during that first wave back in the spring in Kansas. In mid-September, 22-year-old Catherine Callahan of Dorchester, a Jordan Marsh employee and Red Cross volunteer, died after a grueling stretch attending to sickly soldiers. Her cause of death was pneumonia, the result of influenza spreading to the lungs and blocking the flow of oxygen. Her 19-year-old sister, Mary, took ill after selling daisies at Harvard Stadium to raise money for the 101st Infantry and was hospitalized with pneumonia, as was their mother. To think: An entire big-hearted civilian family could soon be wiped out by this indiscriminate disease. Then Dr. Thomas Leen, a 43-year-old Harvard-educated physician at the Carney Hospital, died of pneumonia after working round-the-clock shifts caring for flu patients. In neighboring Quincy, the flu claimed the life of 16-year-old shoe factory worker Daniel McDougall.

Library of Congress
Health commissioner Dr. William Creighton Woodward.

The outbreak had spread well beyond the military, and well beyond Boston, and the death rate was beginning to accelerate. Up north in Gloucester, the city closed schools. On September 17, a local politician urged Boston to do the same, pointing out that leaders had canceled classes the previous year “to save coal,” so they must do it now “to protect the health of the little pupils.” Woodward and school leaders resisted, arguing that the 100,000 pupils in Boston Public Schools would not necessarily be better off at home, especially if home was a cramped, fetid tenement.

Woodward lamented his bad luck that this second, more pernicious wave of the flu had entered the country through Boston, when he’d scarcely had time to unpack all of his boxes from Washington. Yet he knew his reputation for competence and confidence is exactly why Boston Mayor Andrew Peters had hired him. A former Democratic congressman, Peters had won the mayor’s race nine months earlier on a “good government” platform, ousting mansion-dwelling “man of the people” James Michael Curley and his Irish-dominated political machine.

Harvard man Peters, whose dramatically sloped eyebrows looked as if they’d been put there by a cartoonist, had won with the enthusiastic backing of the Brahmin-dominated Good Government Association. After the election, The Boston Globe had cheered, “The city government will be, for the first time since the new city charter was adopted, controlled by Good Government men.”

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Woodward knew more than a few of those Brahmin power brokers were big business owners who wouldn’t take kindly to public health measures that might leave their mills without workers or their department stores without customers. That wouldn’t stop him from taking dramatic actions, but he simply didn’t feel they were warranted yet. He was grateful to have the backing of a bright man like Peters, even if the new mayor often seemed more invested in his golf game and yachting excursions than in day-to-day city management. On September 20, Woodward told the papers, “I now believe the plateau, if not indeed the peak of the epidemic, has been reached.”

Then his confidence was shaken. The death toll from influenza and pneumonia in Boston on that day alone turned out to be more than 50. The next day it reached 80. As someone who had many years earlier buried his infant daughter and young son, Woodward found the deaths of children to be particularly heartbreaking. As a public health specialist, though, he knew flu and pneumonia deaths tended to hit the very young and very old the hardest. Yet the hardest-hit group in this outbreak appeared to be healthy men in their 20s. Just what kind of plague was he up against?

There were other reasons for alarm. In the last week of September, the Army dispatched to Camp Devens a contingent of some of the nation’s most eminent physicians. They were horrified at what they found: Sturdy young men rapidly reduced to dead-eyed, sunken-cheeked souls gasping for air. Dr. Victor Vaughan, a former president of the American Medical Association, would later write that the “ghastly” scene at Devens was bound to stay with him until he died: “Their faces soon wear a bluish cast; a distressing cough brings up the blood stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood.”

Other parts of Massachusetts, particularly the dense mill cities of Fall River and Brockton, were getting pummeled. Woodward’s counterpart in Brockton, where an estimated 20 percent of the population was infected, compared the battle against the flu to “fighting with a ghost.”

After a conference with the governor on September 24, Peters appointed Woodward to lead an emergency committee. Woodward responded with a flurry of sweeping actions.

He persuaded the superintendent to close Boston schools. He ordered all doctors and heads of households to report any cases of the flu to the health department. He mandated that all businesses serving food or beverages to the public sterilize cups and utensils, and that all elevated trains be disinfected daily. Most sweeping was the “gathering ban” he imposed, closing all theaters, movie houses, and dance and concert halls. While he didn’t have the authority to do the same for houses of worship, he strongly urged them to close voluntarily.

On the same day that Woodward pushed through the gathering ban in Boston, 123 people in the city died from the flu, plus another 33 from pneumonia. Meanwhile, US Senator John Weeks of Massachusetts was in Washington asking his colleagues to approve $1 million in emergency funding for the US Public Health Service to fight the epidemic. Weeks said five members of his family were sick with the flu back home in West Newton, and their maid was in the worst shape, battling pneumonia. Despite his connections, Weeks had been unable to secure a bed for her in any of the desperately overcrowded local hospitals. The Senate overwhelmingly approved the additional $1 million request, despite the fact that the department’s usual budget was only $3 million.

Woodward created a clearinghouse to keep daily tabs on available beds, created policies for isolating sick patients, and opened a temporary medical center in East Boston.

Yet he began to worry that, in the face of these dramatic actions, many frightened citizens were letting their fears override their basic humanity. He knew some infected people were dying not from the flu itself but rather from starvation, simply because they were too weak to leave their homes for food, and neighbors or friends were too scared of contagion to bring it to them. “Panic or fear, either in the individual or in the mass,” he told the Globeon the last day of September, “is unjustified by the situation.” He urged citizens to use their brains — prudently wearing gauze masks and thoroughly washing hands — but also to listen to their hearts.

By the end of September, more than 85,000 people in Massachusetts had contracted the flu, with 700 dying in the last week of the month alone.

The start of October brought a spark of hope. After weeks of furious work, Dr. Timothy Leary of Tufts College Medical School announced that he had developed a flu vaccine he believed to be effective. Mayor Peters invited newsmen to accompany him as he rolled up his sleeve to get an injection from Leary. “Feeling fine!” he said with a smile. Thousands of Bostonians followed the mayor’s lead. A few weeks later, Peters dispatched an aide on a transcontinental train to deliver to the mayor of San Francisco enough doses to inoculate 17,000 residents. The mayor by the bay showed his thanks with a gold watch for Peters’s aide and a gold-headed cane for Peters. (A national public health committee that Woodward served on would later conclude there was no real evidence the vaccine had been effective.)

A doctor innoculates Major Peters of Boston against the Spanish Influenza virus during the epidemic, c. 1918. (Photo by Hulton Archive/Getty Images)
Hulton Archive / Getty Images
Boston Mayor Andrew Peters gets a shot of the flu vaccine from the Tufts physician who developed it, Dr. Timothy Leary.

Woodward doubled down on his gathering-ban approach, adding to his closing order all saloons, bowling alleys, pool halls, and soda fountains. The Boston Liquor Dealers’ Association pushed back. Influential men with influential names like Doherty, Fallon, and Purcell argued there was no need for such Draconian anti-business tactics. Woodward refused to budge.

For the four weeks ending on October 19, Boston alone had seen 2,904 deaths from influenza — a staggering toll that climbed above 3,500 when pneumonia deaths were factored in. Yet that historic level of carnage would surely have been worse but for Woodward’s sweeping steps — as it was when the epidemic spread from Boston to Philadelphia and Pittsburgh.

Woodward was encouraged, however, when the death tolls began to decline during that third week of October, enough that he lifted the gathering ban effective at midnight on Sunday, October 20. The city released its pent-up frustration from the weeks-long lock-down in a spasm of social interaction. Record-long queues formed at theaters and restaurants, dance halls and pool halls. The Globe captured the collective sense of exuberant relief with its front-page headline, “Joy-Killing Bans Lifted in Boston.”

On October 21, Woodward declared the epidemic officially over in Boston. It continued to rage around the country, and then the globe, becoming a pandemic.

 * * *

THE 1918 FLU PANDEMIC ended up killing an estimated 3 percent of the world’s population, claiming in roughly one year many more lives than the combined military and civilian death toll from all four years of World War I. In Massachusetts, during just the last four months of that horrifying year, more than 22,000 people died from the flu or pneumonia. Nationally, it was so destructive that it actually lowered the average life expectancy by 12 years, from 51 to 39.

Because the flu’s far deadlier second wave started in Boston, 1918 might be, perversely, the one time when the city’s provincial boast about being the “hub of the universe” was actually justified. Dr. Howard Markel, a physician and medical historian at the University of Michigan Medical School and a leading specialist on the 1918 pandemic, says there’s probably little Boston could have done to avoid its fate, “short of moving itself off the Atlantic coast and into the nation’s interior.” Being the first stop for so many servicemen returning from Europe left Boston extremely exposed. And being the first American stop for the disease’s second wave denied Boston the warning that inland cities like St. Louis had.

Many of the actions that Woodward eventually took, Markel says — particularly school closures and the isolation of flu patients — remain best practices a century later. So we would do well to understand this painful history before the next deadly flu pandemic. “It’s not a question of if,” he says, “it’s a question of when.”

The 2009 H1N1 flu pandemic spread widely but, fortunately, turned out to be far less deadly. We may not be as lucky the next time. Thanks to major advances in medicine, technology, and vaccine development, Markel says, “We are much more nimble in terms of detecting outbreaks, and the speed with which we communicate around the globe has changed in quantum leaps from 1918.” But advances could also work against us. “Epidemics now travel at the speed of jet planes, and an outbreak anywhere can easily go everywhere.”

As for Woodward, he continued to make headlines after the flu crisis. In 1920, he imposed a smoking ban on all his employees — for their time on and off the job. A year later, he fired David Brough, his folksy, well-liked deputy. In despair, Brough hanged himself. His death made Woodward an issue in the mayor’s race of 1922. Running to get his old job back, James Michael Curley would thunder at campaign stops, “I’ll bounce Dr. Woodward at 12:01 on the day I take office.” Curley won, and Woodward left town.

In this November 1918 photo made available by the Library of Congress a girl stands next to her sister lying in bed. The girl became so worried she telephoned the Red Cross Home Service who came to help the woman fight the influenza virus. No one knows the ultimate origin of that terrifying 1918 flu. But researchers hope they're finally closing in on stronger flu shots, ways to boost much-needed protection against ordinary winter influenza and guard against future pandemics at the same time. (Library of Congress via AP)
From AP
The flu outbreak spread from Boston, becoming a pandemic that killed an estimated 50 million people around the world, sometimes wiping out entire families. Here, a distraught girl stands beside her ailing sister.

Nearly a decade later, disturbing details emerged about Woodward’s old boss, Andrew Peters, after the mysterious death of his distant cousin Starr Faithfull. When Peters  was 45 and first running for mayor on a “good government” platform, he had begun molesting Starr, then age 11, eventually paying off her parents in exchange for their silence.

Today, Woodward is best remembered not for his handling of the flu epidemic, but rather for a surprising stance he staked out in the 1930s, as legislative counsel for the American Medical Association. Testifying before Congress in 1937, he argued that marijuana should be regulated but not outlawed. That’s why the strait-laced, no-nonsense Woodward is considered a folk hero in parts of the cannabis crowd.

SOURCES: Archives of The Boston Globe and The Boston Post; the Influenza Encyclopedia produced by the University of Michigan Center for the History of Medicine; Boston city records; the National Cyclopaedia of American Biography; America’s Forgotten Pandemic by Alfred Crosby; Flu by Gina Kolata; Influenza 1918 by Lynette Iezzoni; and Pandemic 1918 by Catharine Arnold. Research assistance by Matt Mahoney and Jeremiah Manion. 

Neil Swidey is a Globe Magazinestaff writer. He can be reached at swidey@globe.com or on Twitter @neilswidey. Get the best of the magazine’s award-winning stories and features right in your e-mail inbox every Sunday. Sign up here.