Lessons learned by Marin Officials during the Influenza Pandemic, 1918–1919
by Lissa McKee
The first cases of the Spanish Influenza pandemic appeared in Marin County sometime before October 12 th 1918, when they were reported in the th , the Sausalito News. By October 17 Marin Journal reported an interview with the Surgeon General of the United States in which he described the symptoms of the disease and preventative measures. However, this was largely the extent of the federal role in responding to the disease, beyond quarantining troops at Forts Baker and Barry. The United State Public Health Services powers had only been broadened to managing investigations into human diseases in 1912 and the Communicable Disease Center, later the Center for Disease Control, was not established until 1946.
California’s public health care system consisted of the State Public Health Officer who guided county public officers who in turn coordinated with community health officers. But the front lines were held by doctors and nurses throughout the county, and, importantly, Red Cross nurses and care-giving volunteers. That same October 17 th issue of the Marin Journal reported the formation of the Marin county unit of the League for the Conservation of Public Health which promoted the involvement and coordination of all agencies to solve national health problem. Immediate events only emphasized the need to fulfill this progressive goal.
In the early days of October the authorities did not note any severe instances of the contagion among the eleven cases in northern Marin and several around Sausalito. Still, plans were formulated by the San Rafael city council, county supervisors, the county health officer Dr J.H. Kuser and City Health Officer Dr. W.F. Jones to establish an isolation hospital in San Rafael, if necessary. People were advised to gargle with antiseptics and get as much fresh air as possible. By October 24 th however, schools were closed in San Rafael and the city sent inspectors to examine properties for trash piles, in the belief that flu vectors were similar to those causing bacterial diseases. Gatherings were allowed out of doors, even though huge crowd were expected for an upcoming ball game at Douglass Playground.
By October 26, Mill Valley’s town physician Dr John Spottiswood had 54 cases under his care. Public gatherings in Mill Valley were henceforth prohibited, except for outdoor church services. Also by the 26th, Sausalito and Mill Valley’s town trustees were passing ordinances requiring people to wear masks when around other people. At the same time Sausalito’s trustees opened an emergency municipal hospital in the Ferguson Building on Bridgeway, with support from the Northwestern Pacific Railroad, Sausalito’s Volunteer Fire Department, and the Red Cross. The Red Cross provided nurses and coordinated the donations of 3,400 hand-made masks as well as clothing, furniture, bed linens and cooked food. On October 31st, county health officer Dr. Kuser and San Rafael’s city council had arranged for Hotel Rafael on Grand Avenue to be commandeered and refitted as an isolation hospital, to replace a rented hospital in the Herzog Building on 6th street. Mill Valley’s Dr Spottiswood became ill himself with the flu and was removed there. His condition was serious. Beyond the fever and respiratory infection, he was suffering from delirium and was not expected to survive. He eventually recovered but was not released from hospital until December.
In mid-November there was a general belief the crisis had passed. By November 14th 51 cases had been handled by the San Rafael emergency facilities, but authorities there considered that the disease was sufficiently under control, and so San Rafael schools were provisionally declared to be reopened by November 25th . By the 16th, Sausalito authorities gave permission for public gatherings at churches, theaters, motion picture houses, fraternal organizations and other meetings as long as masks were worn. The week of November 23 rd , citing no new cases, the Sausalito town trustees rescinded the mask ordinance. On the 27th, following a report from the San Rafael’s health officer Dr W. F. Jones that a sum of 264 cases had been reported to him, authorities concluded that the cases were declining and so lifted the influenza mask requirement. Businesses were allowed to resume operation and the isolation hospital at Hotel Rafael was scheduled for closure on December 1st .
The week of December 14th Mill Valley’s town trustees debated reinstating the mask ordinance but concluded that it was not necessary as it was still a requirement in the public schools. San Rafael’s board of health and city council did issue a new order to wear masks on December 19th though businesses were allowed to remain open as long as personnel wore masks when meeting the public. Subsequently, San Rafael’s schools were closed and arrangements made for students to continue their studies by correspondence. Similar arrangements were made for Tamalpais Union High School.
The resurgence of cases of influenza prompted Dr. Kuser to establish another emergency hospital on January 9th in the Cushing building on Fourth and Court Streets. The property had been acquired by the county the previous year and was being used as the Red Cross headquarters. The Red Cross, which continued to assist hospital care, then moved to the Peters Building at Fourth and C Streets. The Sausalito News reported on January 11 that the emergency hospital in Sausalito moved to the Town Hall on Princess Street and the town hall traded its location in the Ferguson Building. The article elaborated that there were separate wards for men and women. On January 14th, the Red Cross took over responsibility for the hospital from the town. Red Cross volunteers had been making pneumonia jackets and had distributed 81 in town for those being cared for at home (In this pre-antibiotic era, these jackets were sewn with oil silk or muslin and sometimes included a system of rubber tubing that circulated hot water to warm the chest).
That same week Sausalito’s board of town trustee’s held a special meeting where Dr Allen Vance, the town health officer, reported five new influenza cases that day and said that to abate them “masks should be worn, churches, schools and all meetings should be prohibited and that a quarantine placed on wherever there is someone sick with it.” Caroline Fiedler of the Red Cross recommended that all patients be sent to the isolation hospital as the risk of spread was greater if cared for at home. Vance noted that it was unknown how many cases were not being reported and believed that had the mask ordinance been enforced there would have been fewer deaths. The issue was being debated that same week in Mill Valley at a meeting of its town trustees. Though Red Cross committee members reported that they had cared for 80 cases since December 25th and 70 cases since January 1st as well as 13 new cases in the previous four days, three members of the public protested the mask ordinance, arguing that it was ineffective. Town attorney Harry Symonds responded that cases in San Francisco had declined with the use of masks and advised that “it would be well for the Board to take action if need be.”
The increase in infections led San Rafael’s City Council on January 13th 1919 to order again that masks be worn and that the police enforce the requirement. However, by February 1, 1919 the Sausalito emergency hospital was caring for only one patient and it was shortly thereafter closed. San Rafael schools re-opened on Monday, February 3 rd , after an 8-week closure. The regular Red Cross report in the February 13th issue of the Marin Journal presented a summary of their peace-time work and recommended that municipalities contribute to the organization’s public health service. Individual influenza cases continued to be reported in the news until May, but the crisis that had spurred officials and the medical community to organize had passed, leaving them to assess the experience.
In August 1928 the Association of Health Officers of Marin County was organized to establish effective measures to curb communicable diseases. They sought better cooperation by “physicians, sanitary boards, veterinarians, school nurses, visiting nurses and hospitals in reporting communicable diseases promptly.” The serious contagious diseases put forth at the Association’s inaugural meeting included poliomyelitis, scarlet fever, smallpox, diphtheria and epidemic meningitis. It’s clear that the reactive and uncoordinated management of the Spanish Influenza crisis was the motivating force behind the establishment of the Association of Health Officers of Marin County.
Originally published at https://annetkent.kontribune.com.
