Alexander W. Peters, MD, MPH, is currently a surgery resident at Weill Cornell Medical Center. He was a Senior at Rye Country Day School in Rye, New York, when he wrote this paper for Mrs. Anne Simpson’s United States History course in the 2002/2003 academic year.

As of June 16, 2003, seven and a half months after the Severe Acute Respiratory Syndrome (SARS) virus first appeared, 8,460 cases were reported worldwide. Of these, 799 resulted in death, none of which was in the United States.¹ However, nearly every day during that time period, including during the weeks of the War in Iraq, articles concerning the disease and its spread were displayed prominently on the front page of The New York Times, a prominent newspaper of historical record. This is true even though SARS had barely touched the lives of New Yorkers. In contrast, in 1918, when a medically similar disease struck during World War I and killed millions of people—including one out of every one hundred New Yorkers—the degree of reportage in The New York Times was significantly different.

The Spanish Flu, as it was called, is estimated to have killed from between 20 million to upwards of 100 million people worldwide, and to have infected more than one-fifth of the world’s population in 1918.² Yet, it hardly received any coverage in The New York Times. Even at the height of the epidemic in the fall of 1918, when doctors in New York City reported thousands of new cases every day, the disease found its way to the front page of The New York Times on only 4 occasions; moreover, only two of these articles were concerned specifically with the epidemic in New York City. As a result, and in sharp contrast to the experience with SARS today, The New York Times’ readership in 1918 was poorly informed as to the severity of the disease. There are at least three significant reasons that may account for this apparent failure in reportage.

First, in the early 1900s, people expected death to occur more regularly and might have viewed it more submissively than we do today. Even though thousands of Americans were dying from the outbreak, it was not necessarily seen as a cause for alarm. Second, in the minds of Americans, World War I was the primary American—and global—concern. Furthermore, because of the myopic approach of the New York City Health Commissioner and his repeated urgings against panic and concern, the epidemic only began to scare New Yorkers long after it had engulfed New York, long after it had engulfed the world.

It is thought that the virus initially developed in a military encampment—Fort Riley, Kansas—when a member of the camp’s cooking staff entered the infirmary on March 11, and was followed by a stream of infected soldiers.³ By the end of the month, over a thousand cases had come into the infirmary and 48 men had died of influenza.⁴ The New York Times, however, took little note of the outbreak.

Army camps, especially in times of war, tend to be overcrowded and thus make ideal environments for infectious diseases to spread. For example, this was the case in Camp Devens, Massachusetts, where 45,000 men lived in lodgings originally built for 35,000.⁵ In 1918, when 1.5 million soldiers traveled to Europe, “the conditions were absolutely perfect for the spread of infectious disease” both nationally and internationally.⁶ As men transferred to camps around the country, and then to Europe and the rest of the World, they brought the “Spanish Lady” with them wherever they went.

Even though the virus spread in the United States, it is theorized that it came to New York via Europe. In the era of the outbreak, many people claimed that the Germans released the virus from within the city by means of theaters and other public areas as a form of biological warfare. As the head of the Health and Sanitation Section of the Emergency Fleet Corporation speculated in The New York Times in September 1918:

We know that men have been ashore from German submarine boats...it would be quite easy for one of these German agents to turn loose Spanish Influenza germs in a theater or some other place where large numbers of persons are assembled.⁷

That is considered a rather fantastic explanation and there is a more plausible alternative. On August 12, a Norwegian ship carrying 200 passengers arrived at New York Harbor; several of its passengers were afflicted with the flu during the voyage. It is most commonly believed that these were the first influenza cases in New York City. Upon arrival, it is thought that the ill passengers had recovered from the highly infectious flu, and were merely suffering from the more benign flu-induced pneumonia.⁸ Public health officials of New York City failed to recognize the potential threat; they placed none of the incoming passengers under quarantine.⁹ Both Dr. Royal Copeland, The New York City Health Commissioner, and Dr. Leland Cofer, the health officer of the port where the ship arrived, felt that “there was not the slightest danger of an epidemic of Spanish Influenza in New York.”¹⁰ Despite their optimism, however, the disease slowly began to spread throughout New York City and the first documented cases that spawned within the city were reported on September 18, 1918.¹¹ By the end of that month, at least 297 people had died from either influenza or pneumonia that resulted from the flu;¹² yet this was only a glimpse of what was about to come.

In the month of October, the Spanish Flu ripped through the city and infected thousands of people, both young and old, every day. By the end of the month, reports existed of more than ninety thousand cases.¹³ Physicians, however, had difficulty reporting the overwhelming number of cases and many of those infected lay at home without having consulted a doctor. Under these exceptional circumstances, many cases went unreported. Consequently, as of October 27th, the Public Health Committee of the Academy of Medicine had estimated that “418,781 persons [had] been afflicted with influenza since it first appeared in the city.”¹⁴ In a city of approximately 3.2 million people,¹⁵ this meant that at least l in every 8 New Yorkers had had or currently had the Spanish flu.

Even when the flu—a flu that eventually killed more Americans than all the wars of the 20th century combined—had engulfed the city, a quantitative analysis of The New York Times suggests that it was not reported as a preeminent issue of the day. Not only was the flu never the main headline of The New York Times (which was usually about the war), but also, in all of October, the flu’s most deadly month, the epidemic was reported on the front page of the paper only three times. In fact, from mid-September through October, the majority of articles concerning the Spanish Flu in New York were not even near the front of the paper with the headline news. These articles ranged from reports on the number of new cases, to the epidemic’s economic impact on various industries, to attacks on the New York City Health Commissioner. Still, of the 142 varied articles written between September 15 and November 15, 1918, at least 110 were 10 or more pages into the paper; over 35 articles were at least 20 pages into the paper, with an occasional article placed near page 40. Even with death sweeping the city, the magnitude of the epidemic was minimized in The New York Times, leaving its readership ignorant.

Between September 15 and November 15, the epidemic’s most virulent months, news of the flu did make the front page of the newspaper on four occasions. However, in half of those instances, the articles did not report on the state of the epidemic in New York. On September 27, 1918, an article entitled “Influenza Stops Flow to the Camps of Drafted Men” appeared on the front page of The New York Times.¹⁶ Part of this article discussed the spread of the disease in U.S. Army camps. The main focus of the article, however, was a decision by General Enoch H. Crowder, the Provost Marshall in charge of the Selective Draft, to cancel a draft of nearly 150,000 men scheduled for mid-October due to the spread of the flu.¹⁷ The article failed to make any note of the disease in New York City. The second front-page article was published on October 11, 1918, and was entitled “Redouble Efforts as Wilson Urges Pushing the Loan.”¹⁸ It told of how President Woodrow Wilson was urging the Treasury Department to further endow the Fourth Liberty Loan, which funded the national efforts against the flu.¹⁹ This article is perhaps more related to the flu in New York than the September 27 article in that it dealt with the effect of flu on the general populace. There were, however, two articles on the front page of The New York Times that did deal directly with the Spanish Flu in New York City. Published on consecutive days, October 5 and 6, the two articles had a common subject: the emergency regulation of business hours that the health department put in place to prevent the spread of the epidemic.²⁰ The health department believed that by staggering the opening and closing times of businesses, and thus staggering people’s commutes, subway cars and trains—places where the flu spreads rapidly—would be less crowded.²¹ These two articles clearly were more newsworthy than other common reports of the course of the disease in New York City because they told of the new drastic regulations that might temporarily affect the lives of New Yorkers. It is unclear, however, why the other two articles made the front page, especially since there were other articles in those two months about the effect of the flu on the army and about the Fourth Liberty Loan that were deeper into the paper. One might conclude that a cancellation in the draft, as well as a plea made to the Treasury Department by President Wilson himself, may have been more newsworthy than the other articles written on the same subjects.

Furthermore, there is a definite relationship between the death rate per week and the number of articles printed daily concerning the epidemic. First, the curve representing the number of articles published per day is very similar in form to the death rate curve; the peak in the number of articles, however, occurs earlier in October than does the peak of the death rates. This similarity suggests that the press response did, to an extent, accurately reflect the course of the disease. Second, one can infer from the data that the number of articles peaked before the death rate peaked because the epidemic seemed most shocking and most severe when large numbers of cases were first being reported in early October; the death rate peaked when those infected began to die a short time later. In general, The New York Times’ response did, to a degree, mirror the significance of the disease; however, the articles were typically printed several pages into the paper, minimizing their newsworthiness. As a result the urgency of The New York Times’ response did not accurately parallel the severity of the epidemic. At least three factors explain the paper’s poor coverage of the influenza outbreak.

In 1918, people were more acquainted with death than they are today; the deaths of young children were frequent, and life expectancies were shorter. At the turn of the century, 30% of children in major cities, such as Chicago and New York, did not live past the age of one year.²² Today we view the death of a young family member or friend as unusual, tragic, and often shocking, whereas in early 1900 America, death was a more accepted part of life. It is reasonable to expect that the generation that witnessed the flu was more accustomed to death than our generation is today because their frequent exposure to death desensitized them to its impact. This acceptance of death was perhaps further heightened by the numbing casualty rates of World War I. Therefore, in the fall of 1918, when large numbers of people in New York City and the rest of the country began to die, it was tragic, but not unspeakable, nor unfamiliar. This may have been one reason why the epidemic was able to sweep through the city and kill thousands without being considered especially newsworthy.

Moreover, at the same time that the Spanish Lady struck New York—as well as the rest of the United States—the nation, and the world, was focused on one of the most brutal and grueling wars of the 20th century, World War I. Although the epidemic afflicted far more people worldwide than the Great War did, and therefore in hindsight may seem to us to be a more significant event, in times of war national priorities are skewed and the national focus is distorted. To patriotic Americans, winning the War was associated with national pride; although it was also a global issue, stopping the flu epidemic clearly did not invoke the same sentiment. Eradicating the flu did concern some Americans, but the war and American soldiers were always first and foremost in the eyes of the general public. As a result, nearly every day the headline of The New York Times told of the war and its progress. Even on October 23, 1918, when an unprecedented five thousand new cases were reported the previous day, the paper’s headline read: “Haig pushes forward on a 25-mile front, crosses Scheldt; French move on Ghent; Wilson consults Allies on Germany’s Note.”²³ On that day, the first article pertaining to the epidemic in New York City was eight pages from the front.

The New York Times’ disproportionate response was also largely due to the manner in which Dr. Royal S. Copeland, the New York City Health Commissioner, approached the epidemic from when it began in New York. From the time the Spanish Flu reached New York City on the Norwegian ship in August, through its height in mid-October, Dr. Copeland played down its importance and subtly denied its severity. As a result The New York Times did not feel an urgent need to report on the epidemic. In turn the citizens of New York interpreted his response to mean that there was no cause for extreme alarm.

Dr. Copeland was an optometrist with little training in public health,²⁴ and thus may have lacked experience in handling epidemics. He at first naively believed that the epidemic was solely a side effect of European malnutrition and squalor. When the first cases arrived from Norway in August, Copeland is famously quoted to have said: “You haven’t heard of our doughboys getting it, have you? You bet you haven’t, and you won’t...No need for our people to worry over the matter.”²⁵ “The public has no reason for alarm.”²⁶ Yet as conditions worsened in late September and New York City residents began contracting the disease Copeland still confidently claimed that the “situation was well in hand in all five boroughs, and said there was little fear that the disease would spread to any great extent.”²⁷ Even when the number of new cases doubled over a 24-hour period in late September, Copeland acknowledged the potential seriousness of the disease but stated that in comparison to other cities, such as Boston, which reported fifty thousand cases, New York was in fine shape.²⁸ Nonetheless, as the number of new cases continued to increase, Copeland continued to take few precautions aside from warning against coughing and sneezing in public. Despite 999 cases reported in a single day in early October, he refused to close schools, as Philadelphia officials had advised him, to prevent the spread of influenza.²⁹

By the end of the first week of October, however, Dr. Copeland’s claims were being questioned. The New York Times reported on October 7, in an article sub-headed “Dr. Copeland Denies It,” that the former Health Commissioner, Dr. S.S. Goldwater, challenged Dr. Copeland’s claims. Buried seven pages into the paper, the article stated that Dr. Goldwater was “of the opinion that conditions are far worse than the public is aware and that unless help comes from the government, should the epidemic spread, there will be danger that many will suffer for lack of care.”³⁰ In response, Copeland remained optimistic. According to the article, Copeland argued that the disease was under control and that the number of new cases reported daily had increased by only three, now reaching 2,073 per day.³¹ Two weeks later, however, as the epidemic reached its height, even John Hylan, the Mayor of New York City, claimed that the health department had acted irresponsibly. In an article published in The New York Times on October 21, Mayor Hylan stated, “The Health Department failed to check the spread of the disease” when it did not attempt to quarantine the city’s first victims.³² Still, this article appeared on page 12.

Finally in late October, as new cases and deaths increased in New York City, Dr. Copeland began to take a more proactive stance against the Spanish Flu. He advocated precautions against the spread of disease³³ and he divided the city into health districts to organize the fight against the epidemic.³⁴ Despite thousands of deaths and up to 4,000-5,000 new cases reported daily, the epidemic was still not front-page news.³⁵

There is an additional aspect, however, that suggests why the epidemic received so little attention. In 1918, the Spanish Flu was the greatest health crisis ever to reach American soil. Roaring through the country, the epidemic “baffled medical science at every turn...after a century of stunning progress, the rising authority of medical science vanished in a matter of a few horrific weeks.”³⁶ In only a few months, more than 600,000 Americans died from the epidemic. Americans, not wanting to remember the death brought by the Spanish Lady, simply tried to forget the horror of it. As survivor H.L. Mencken wrote, “The epidemic is seldom mentioned and most Americans have apparently forgotten it. This is not surprising. The human mind always tries to expunge the intolerable from memory.”³⁷

By the time the Spanish Flu left New York City, it had killed more than 30,000 New Yorkers—1 in every 100 people in the city³⁸ —and infected many more. Yet in the flu’s two most virulent months in New York City, it seemed to be almost nonexistent in the public eye. While The New York Times did report on it every day during the height of the outbreak, most of the coverage either minimized or buried the importance of the epidemic; in hindsight, it is evident that The New York Times failed to inform the public of its magnitude. Perhaps because Americans at the time were more accepting of death, or because the end of World War I dwarfed the issue, or because officials in New York downplayed the seriousness of the epidemic, during the ephemeral life of the virus The New York Times treated the issue as a relatively minor problem in the grand scheme of New York City and American life. It is likely that as a result of this failure, New Yorkers were uninformed and therefore unprepared to take preventative measures against the Spanish Flu. In marked contrast, as we examine SARS as a current public health issue, we see the ways in which communication in public health and the handling of public health crises have evolved in the 85 years since 1918. In 1918, we did not have the means to organize a global response to fight the flu. Today, however, institutions such as the World Health Organization can disseminate information and organize a faster and more effective response to disease. In 1918, when 5,000 people died of the flu in a week in New York City, the city was not placed under quarantine; as of June 2003, although fewer than 1,000 people throughout the world have died from SARS, entire countries had been put under quarantine-like regulations to prevent the spread of the virus. History has both taught us lessons from our mistakes, and prevented them from recurring. Not since the “Spanish Lady” has an epidemic of such magnitude swept the country, or the world.

Notes

¹ Cumulative Number of Reported Probable Cases June 16, 2003, World Health Organization, June 16, 2003 <https://www.who.int/csr/sars/country/2003_06 16/en>

² Gina Kolata, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused it Location Unknown: G.K. Hall and Co., 1999, p. 15

³ Lynette Iezzoni, Influenza 1918: The Worst Epidemic in American History New York, NY: T.V. Books, L.L.C., 1999, p. 2

⁴ Ibid., p. 23

⁵ Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (New York: Cambridge University Press 1989) p. 4

⁶ Iezzoni, p. 33

⁷ Head of the Health and Sanitation Section of the Emergency Fleet Corporation, Lieut. Col. Philip S. Doane, in “Think Influenza Came In U-Boat,” New York Times (19 September 1918) p. 11, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

⁸ Crosby, America’s, p. 29; Iezzoni, p. 40, 59; “Spanish Influenza Here,” New York Times (14 August 1918) p. 1; and “No Quarantine Here Against Influenza,” New York Times (15 August 1918) p. 6, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

⁹ Ibid.

¹⁰ “No Quarantine Here Against Influenza,” New York Times (15 August 1918) p. 6, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

¹¹ “Negligent Doctors Arouse Copeland,” New York Times (27 October 1918) p. 14, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

¹² Great Britain, Ministry of Health, Reports on Public Health and Medical Subjects Number 4, Report on the Pandemic of Influenza 1918-19 in Crosby, America’s, pp. 60-61

¹³ “Negligent Doctors Arouse Copeland,” New York Times (27 October 1918) p. 14, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

¹⁴ Ibid.

¹⁵ Great Britain, Ministry of Health, Reports on Public Health and Medical Subjects Number 4, Report on the Pandemic of Influenza 1918-19 in Crosby, America’s, pp. 60-61

¹⁶ “Influenza Stops Flow to the Camps of Drafted Men,” New York Times (27 September 1918) p. 14, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

¹⁷ Ibid.

¹⁸ “Redouble Efforts as Wilson Urges Pushing the Loan,” New York Times (11 October 1918) p. 14, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

¹⁹ Ibid.

²⁰ “Drastic Steps Taken to Fight Influenza Here,” New York Times (5 October 1918) “Revise Time Table in Influenza Fight,” New York Times (6 October 1918) p. 14, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

²¹ Ibid.

²² “Infant Mortality,” Morbidity and Mortality Weekly Report (October 1, 1999) Centers for Disease Control and Prevention, June 19, 2003 <https://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4838a2.htm>

²³ Headline, New York Times (23 October 1918) p. 1, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

²⁴ Iezzoni, p. 59

²⁵ Iezzoni, p. 59; Crosby, America’s, p. 29; and “No Quarantine Here Against Influenza,” New York Times (15 August 1918) p. 6, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

²⁶ “Spanish Influenza,” New York Times (16 August 1918) p. 6, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

²⁷ “Spread of Influenza Checked in the City,” New York Times (23 September 1918) p. 9, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

²⁸ “New Influenza Cases in the City Doubled,” New York Times (28 September 1918) p. 10, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

²⁹ “New Gains in Grip Here,” New York Times (4 October 1918) p. 24, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

³⁰ “Experts Disagree on Epidemic Here,” New York Times (7 October 1918) p. 7, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

³¹ Ibid.

³² “Influenza Cases Drop 305 in City,” New York Times (21 October 1918) p. 12, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

³³ “Health Commissioner Copeland’s Rules for Combating the Influenza Epidemic,” New York Times (13 October 1918) p. 18, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

³⁴ “Health Districts in City,” New York Times (23 October 1918) p. 8, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

³⁵ “Negligent Doctors Arouse Copeland,” New York Times (27 October 1918) p. 14, February 2003-June 2003 <https://proquest.umi.com/pqdweb>

³⁶ Iezzoni, p. 17

³⁷ H.L. Mencken in Iezzoni, p. 17

³⁸ Great Britain, Ministry of Health, Reports on Public Health and Medical Subjects Number 4, Report on the Pandemic of Influenza 1918-19 in Crosby, America’s, pp. 60-61

Works Cited

Crosby, Alfred W., Epidemic and Peace 1918 Westport, Connecticut: Greenwood Press, 1976

Crosby, Alfred W., America’s Forgotten Pandemic: The Influenza of 1918 New York: Cambridge University Press, 1989

Cumulative Number of Reported Probable Cases June 16, 2003, World Health Organization, June 16, 2003 <https://www.who.int/csr/sars/country/2003_06_16/en>

Iezzoni, Lynette, Influenza 1918: The Worst Epidemic in American History New York, NY: T.V. Books, L.L.C., 1999

Influenza 1918 Prod. by Robert Kenno and Alla Savranskaia, Writ. by Ken Chowder, PBS Home Video, 1998

Kolata, Gina, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused it Location Unknown: G.K. Hall and Co., 1999

Morbidity and Mortality Weekly Report October 1, 1999, Centers for Disease Control and Prevention, June 19, 2003 <https://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4838a2.htm>

The New York Times 14 August 1918-15 November 1918, Proquest Historical Newspapers Proquest Information and Learning Company, Klingenstein Library. February 2003-June. 2003 <https://proquest.umi.com/pqdweb>