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In 1918, it wasn't the coronavirus. It was the flu.
In a photo provided by U.S. National Library of Medicine, misinformation in newspapers and government censors helped the flu spread in 1918. The “Spanish flu” pandemic, the subject of a new, ongoing exhibit at the Mütter Museum, killed tens of millions of people worldwide. U.S. National Library of Medicine via The New York.

by Shannon Eblen

PHILADELPHIA (NYT NEWS SERVICE).- A virus makes its way around the globe causing sickness, death, and spreading panic. Avoid crowds, the public is advised. Wash your hands.

Avoid spitting in public.

“Are you following this coronavirus thing?” asked Robert Hicks, former director of the Mütter Museum, as he took a seat in an office tucked behind the rooms of antique display cases of anatomical specimens. “Some striking similarities to 1918.”

The “Spanish flu” pandemic of 1918-19 — the subject of a new, ongoing exhibit at the Mütter, a medical history museum — is often overshadowed by World War I, but it killed tens of millions of people worldwide. With nothing to offer the sick but palliative care, influenza was as frightening as the COVID-19 coronavirus is today.

The flu arrived in Philadelphia in the summer of 1918. On Sept. 28, despite warnings that the sickness was circulating, the city held the Fourth Liberty Loan Parade, a patriotic affair to encourage buying war bonds. Thousands of people packed Broad Street.

Within days, flu cases — and deaths — erupted.

“The flu followed the parade so closely that nobody had taken down the fundraising banners,” Hicks said, “and instead they started slapping up ‘Spit Spreads Death’ public health posters.”

“Spit Spreads Death,” the name of the exhibition at the Mütter, is a reference to the since disproved belief that illness could be spread through the inhalation of dried saliva particles. Anti-spitting measures included fining offenders and plastering the signs on lampposts and streetcars.

With so many doctors and nurses in Europe on the front lines of World War I, hospitals were understaffed. The city ran out of coffins and pine boxes, resorting to mass burials. Like a scene from the Black Plague, carts were pushed through neighborhoods collecting the dead.

“Someone’s grandmother remembered coming out and wondering why all her neighbors were sleeping on their lawns,” said Nancy Hill, museum manager at the Mütter. “It wasn’t until she was older that she realized that they were all dead.”

The curatorial team referenced existing oral histories and other research to put a human face on the story of the pandemic — the people who died, the families they left behind, the nurses who tended the sick. Since the exhibition opened, dozens more have reached out with their own family stories.

“We knew this would have to be an exhibition that was about those voices,” said Jane E. Boyd, the historical curator for “Spit Spreads Death,” “that it couldn’t just be technical medical information.”

Propaganda posters show the aggressive patriotism that contributed to suppressing news of the illness and to putting war efforts ahead of public health. Even as the virus was devastating the population, Hicks said, “it’s worth noting that Philadelphia not only met, but exceeded their fundraising quota.”

It’s an artifact-light exhibit, but there is one item that is a favorite of the curatorial staff: a small embroidered purse with a handwritten gift tag. It’s one of several Christmas presents bought by Naomi Whitehead Ellis Ford, an expectant mother, in the fall of 1918. She died a few weeks later, and the gifts remained packed away for decades.

“In a sense,” Boyd said, “what we’re trying to do is a little bit of a memorial so these people are not forgotten.”

Interactive maps, a high-tech departure from the museum’s usual displays, help visitors see the effect of the flu by overlaying data culled from death certificates onto maps. One tracks the flu over time, dotting city blocks with deaths until all of Philadelphia is a heat map of infection.

Neighborhoods can be explored on a micro level so visitors can see who might have died on a block, a feature that was made possible because of the work of Nicholas Bonneau, who led the research for the exhibition, and his team of volunteers and students, who sifted through and transcribed tens of thousands of death certificates.

After two years, they had 17,500 documented flu deaths — most likely fewer than there actually were because of mistakes on death certificates and a community overwhelmed by trauma.

While some deaths were harder to map because of development, in a city as historic as Philadelphia, it’s entirely likely Philadelphians could discover that someone died of the flu in their home. (George Keichline, a 47-year-old upholsterer, died at my address.)

“My wife gets a kick out of me,” Bonneau said. “We’ll walk down the street to get a pizza and I’ll be like, ‘hey somebody died of the flu there.’”

Toward the end of the exhibit are the requisite museum response cards. Comments range from musings about the provided pencils carrying germs to passionate pleas for people to get vaccinated.

A flu vaccine wasn’t developed until the 1940s. “In 1918, they didn’t have the option to get a vaccine,” Hill said. Still, she said, she and her colleagues felt it would be negligent not to address contemporary public health issues within the exhibition.

At the entrance of “Spit Spreads Death” is a video of the Sept. 28, 2019, parade in Philadelphia that kicked off the exhibit. A vigil to the fateful 1918 event, the parade was conceived by the London-based artists’ group Blast Theory. In it, participants carried placards with names of flu victims and walked up Broad Street to a Gregorian-style chant of the names of the deceased.

Flu shots were offered at the conclusion of the parade at City Hall. The museum also planned community events and lectures and partnered with Hidden City Philadelphia on walking tours.

Influenza (along with pneumonia) is one of the top 10 causes of death in the United States, killing tens of thousands of people every year and sickening far more. The effectiveness of the flu shot varies year to year, as the virus mutates and makes it harder to predict which strain will be circulating. Many just don’t take the flu seriously.

“People just think of the flu as a mild upper respiratory infection, when it’s a killer,” said Dr. Paul Offit, a vaccine expert and pediatrician specializing in infectious diseases who sits on the Food and Drug Administration committee that selects the strains for the annual flu shot.

Offit had recently spoken with a woman concerned about dying from the coronavirus, he said, “And I think that’s probably the same fear people had back then, about influenza, that they could do nothing.”

Misinformation in newspapers and government censors helped the flu spread in 1918. Today, with additional help from the internet, misinformation drives fear of new illnesses like the coronavirus and fuels the anti-vaccination movement.

Michael Yudell, a historian and ethicist of public health, sees the anti-vaccination movement in part as a failure of public health to effectively push back against that misinformation. But history, he said, can help serve as a reminder of the threat certain diseases posed before vaccinations.

“We can look at the history books for that information,” Yudell said. “We don’t need to turn to CNN to see that. At least we shouldn’t have to.”

© 2020 The New York Times Company

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