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RETURN OF A KILLER?
DURING WORLD WAR I, SPANISH INFLUENZA CAUSED THE DEATHS OF THOUSANDS HERE AND MILLIONS WORLDWIDE. EXPERTS SAY THE KILLER FLU COULD STRIKE AGAIN.

In the fall of 1918, one of the greatest killers in human history swept through Buffalo, paralyzing the city like the worst imaginable blizzard.

The Spanish influenza epidemic killed 2,806 people here in short order, roughly 550,000 Americans in all and, by the time it ended, at least 30 million others worldwide.

The lethal virus, arriving in the fourth year of World War I, ravaged the healthy and infirm alike. Among soldiers, far more would die from influenza than in battle.

The pandemic, now virtually forgotten, ranks as perhaps the most sensational medical event ever to occur in Buffalo.

It's a slice of history worth remembering and taking to heart. As a new century approaches, experts warn that an equally virulent virus can strike again -- with similar devastating effect.

The first time around, Buffalo made a juicy target for the deadly disease.

"This city fared better than some others, but it was a terrible time," said Deborah Bruch Bucki, a nurse who has written about the virus' tear through this region.

With more than 475,000 residents, Buffalo was the 10th-largest U.S. city. It was a rail center through which large numbers of troops passed, bringing the virus with them. And it was home to many immigrants from Eastern and Southern Europe, individuals particularly vulnerable to the strain of the virus on the loose.

The first case of influenza hit the area in late September. Illness reached epidemic proportions in mid-October. By the end of the year, there were nearly 29,000 confirmed cases.

In many instances, a moderate case of the flu shifted into a serious complication of the lungs, such as pneumonia, followed by death.

Individuals often began with fever, chills, headache, muscle aches, loss of appetite and fatigue. Later, the lungs filled with fluid. A cough produced frequently thin, rusty-colored sputum. Delirium, sometimes violent, was frequent.

Health authorities warned people not to panic. But to make matters even more volatile, hardly anyone was left to fight the scourge.

Dr. Francis E. Fronczak, Buffalo's health commissioner and a nationally known expert on public health, was serving with the Army overseas, as were many other local doctors and nurses.

Those few left behind found themselves working day and night with little sleep. Many took sick with the flu, too. Some died.

Buffalo General Hospital reported a 100 percent increase in the number of sick days that its staff used in 1918.

The head of the Buffalo City Hospital, Dr. Walter Goodale, on Oct. 11 told newspaper reporters covering the story that he and his forces were unable to cope with the situation.

Dr. Bucki said it's remarkable that the community didn't drown in hysteria. "The virus came so quickly that people didn't realize how contagious and dangerous it was," she said.

So many residents were dying over such a short time span that priests conducted funerals in assembly-line fashion. On Oct. 20 alone, 138 persons died from complications of the flu.

St. Stanislaus Cemetery, the primary burial ground for the Polish community, couldn't dig graves quickly enough. Coffins and bodies remained in the open for days awaiting burial.

Across the state in New York City, more than 20,000 people would die that fall.

Buffalo, like many other cities, shut down. Local leaders announced a regionwide quarantine, strict measures to curtail spread of the disease that came close to a declaration of martial law.

Mayor George S. Buck restricted public assemblies of more than 10 people. He prohibited public funerals where influenza had occurred and mandated that burial occur within 24 hours.

There were orders to close all soda water fountains, five-and-10-cent stores, pool rooms, bowling alleys and swimming pools.

Except for health personnel, non-family members were prohibited from visiting the homes of people with the flu.

For a time, Buffalo became a community without streetcars, theaters, stores, dance halls, libraries, saloons or schools. Social gatherings were canceled. Few people went out unless they had to. When they did, often they wore surgical masks.

Acting Health Commissioner Franklin Gram even advised residents to stop shaking hands. "Even at the expense of appearing discourteous, don't do it," he warned.

Churches tried to get around the restrictions by conducting outdoor services. But the mayor's order was for the most part strictly enforced. Police officers made sure of that, handing out fines to businessmen and others who violated the mandate.

Buffalo teetered on the brink of panic. But a timely counterattack by health authorities and the overwhelming dominance of war news in people's day-to-day lives helped stem the hysteria.

"Every resource on hand was used to fight this," said Dr. Bucki, who recently completed her doctorate in nursing.

Gram ordered draft board physicians to stop giving physical examinations to draftees and to start fighting the epidemic.

Junior and senior class medical students at the University of Buffalo Medical School were pressed into service. Shortly afterward, Gram ordered the sophomores, too, to work at Buffalo City Hospital.

The District Nursing Association issued a call for nurses who had married and retired from the profession.

"It was no uncommon matter to find persons who had waited two or three days after having phoned or summoned physicians, suffering and dying because every physician was worked beyond human endurance," Gram later wrote.

Gram eventually ordered all area hospitals to set aside half their beds for influenza patients. If the hospital executives didn't obey, he told them, he'd commandeer their institutions.

Beds were in such short supply that the third floor of Central High School -- now Hutchinson-Central Technical High School -- was converted into an influenza ward.

The tough measures worked.

Thousands of residents came down with the flu in 1918, but the death rate in Buffalo was lower than the 10 percent mortality rate nationwide.

The pandemic came in three waves, the virulence increasing with each new assault.

Doctors focused on containing the virus' spread. They couldn't even explain why the disease was such a killer. "It was like another war on a different battlefield," Dr. Bucki said.

The only parallel in human history is the Black Death.

What made the 1918 Spanish influenza pandemic more unusual was its ability to kill healthy young adults so quickly. Most of the dead worldwide were between 20 and 40 years old.

Even more chilling is expert speculation that it will happen again.

Influenza occurs in epidemics. There are limited ones each year, and huge ones a few times every century. The disease has appeared in epidemic form several times since 1918 -- in 1957 and 1968, for instance -- and it has caused much sickness and death.

But the flu has never returned with the virulence of its 1918 strain.

Unlike the measles and other diseases, the virus that causes the flu can change itself. That's why the formula for flu vaccines changes every year.

Scientists fear the appearance of a yet-unseen strain of the virus as lethal as the one in 1918.

Few people would have built-in immunity to the unusual strain from past exposure. Worse, it would take months to develop and distribute a vaccine to ward off infection. A pandemic charging around the globe could kill millions of people before the vaccine arrived.

"Another virulent strain could be devastating if it happened again," said Dr. Timothy F. Murphy, chief of infectious diseases at Veterans Hospital.

"We know more about the influenza virus and have treatments for it," he added. "But we would not be a whole lot better off handling it today than they were in 1918."