Mount Sinai Beth Israel and the 1918 Influenza Epidemic – An Update

In a previous blog post, we looked at Beth Israel Hospital’s role in the 1918 Influenza Epidemic. Since then, we’ve done further research into the World War I correspondence in the Beth Israel records, as well as the Beth Israel Board of Directors and Committee minutes, which both provided rich details to supplement this history.  

In early March 1918, influenza had reached New York. By March 25, 1918, an unknown correspondent (likely Louis J. Frank, Beth Israel Hospital superintendent) wrote that there was “quite an epidemic in the City of Grippe,” referring to New York City as literally the “City of the Flu”. As World War I continued on, many Beth Israel workers had joined the war effort, and their correspondence with the hospital describes the epidemic on the front lines. The first wave of the flu was relatively mild, and on May 13, 1918, Dr. Alfred A. Schwartz of the American Expeditionary Force, reported as much from France: 

“I have been appointed Otolaryngologist to the contagious disease wards at the camp hospital and altho [sic] the title sounds like work, there must first be complications to the infectious diseases, and secondly…there must be some patients to have the diseases, and fortunately there is little to do.”  

As the second, more deadly wave swept the world, the topic of influenza became more pressing in the correspondence, and was increasingly addressed in the Board minutes. In the November 17, 1918, minutes, the Board noted that back on the home front in New York, Beth Israel attended to “50 to 60 cases of Influenza a day during the height of the epidemic and…our records of cures was high, and our record of deaths was very low.” This is a significant deviation from the previous blog post, which stated that only twenty-nine patients total were treated during the epidemic at Beth Israel. Sources conflict on this point. 

Staffing was amongst the most pressing issues at this time – with much of the medical staff overseas, Louis J. Frank, himself recovering from the flu, commented in a letter from October 23, 1918: “Our whole force is gone. If you were to come back today, you wouldn’t find a familiar face…From a house staff of 15 we have been reduced to a staff of five, and of the five, three have been laid up on account of influenza.” He goes on to describe the issue of hiring enough nurses, which was making him “frantic.” Superintendent Frank was a proponent of the conscription of women, “especially those women who have the vote,” to counteract staffing shortages in nursing in the war and at home. 

The Board of Directors’ minutes reflect similar staffing concerns. The minutes for November 17, 1918, stated: “During the epidemic the Surgical Staff consisted of one man, the others became infected with the disease. On the Medical side we only had two men, the others also sick.” This appears to have resulted in redeployment of other clinical workers, and the Board resolved on “the discontinuance of the work of the Polio Department on account of the epidemic of Influenza and Pneumonia to release the doctors and nurses connected with the clinic for the more important work.” The minutes also noted that the “pupil nurses” from Beth Israel Training School for Nurses (today’s Phillips School of Nursing at MSBI) “after their day’s work was over, did extra work in the district on these cases, spending an hour or two on emergency cases requiring special care.”  

The close of 1918 marked a turning point. With the War over, and a dwindling number of cases following the peak of the second wave, the end was in sight. In a letter from November 27, 1918, Superintendent Frank wrote: 

“Things are getting into shape at the Hospital. We were considerably upset on account of the War, shortage of help, doctors, nurses, the Influenza epidemic, and the general anxiety, but with victory came a relaxation and we are now awaiting the homecoming of you men who have done so much to achieve this victory.” 

The Board also noted, grimly, on November 17, 1918, that Beth Israel was “the only Hospital [in New York City] that didn’t lose a nurse, a doctor, or an employee by death.” On January 19, 1919, the Board moved to give House Staff and pupil nurses bonuses for their contributions and made especial note of the nurses’ service: “pupil nurses…after their trying [work and school] day of 12 and many times 14 hours, went out in the tenement houses and did extra work for several hours. Of course, this work was not for patients of the Hospital, but it was nevertheless our work, for they were the poor sick of our neighborhood.” 

On November 23, 1919, the Board made note of the U.S. Public Health Service’s prediction that the influenza epidemic would return. Fortunately, this never came to pass. By 1920, the virus mutated to cause only ordinary cases of the seasonal flu, and the epidemic was effectively over. 

Sources:  

More resources on Mount Sinai Health System Hospitals and World War I are available here.

Mount Sinai 100 Years Ago – The More Things Change…

Whenever you look back to the past, it is easy to find it all very strange, but a longer look allows us to see the threads that connect that time to this. Some of those threads are strong and enduring and others fray and end.

One of those strong threads that tie the Mount Sinai of 100 years ago to the Mount Sinai of 2020 is research and discovery. In 1920, Mount Sinai was dealing with the last wave of a deadly worldwide pandemic that had started in 1918 but still lingered. Some Mount Sinai physicians spent a great deal of time working on a “peculiar disease” that followed the epidemic. This was popularly called the ‘sleeping sickness,’ but doctors termed it epidemic encephalitis. Another Mount Sinai physician was lending his expertise as a member of a national commission that was established to deal with the ravages of empyema, which too often followed post-influenzal pneumonia. Other physicians were doing research on gastric diseases, leukemia, surgical innovations and cardiac problems – all topics that Sinai doctors continue to pursue.

Taken from 5th Ave. and 99th St. looking east over the new buildings. The building facing with the flag pole is the 1904 main building.

Another main theme from 100 years ago, as in every decade of Mount Sinai’s existence, was the physical changes being made on campus. The world war and epidemic had delayed the progress of the largest expansion plan ever envisioned by The Mount Sinai Hospital. First suggested in 1913, it was only in 1922 that all of the new buildings were completed and the renovations of older spaces finished. This resulted in a new Private Pavilion (our current Kravis Children’s Hospital), a new pediatric pavilion and pediatric clinic building, a larger employee dormitory, a larger laboratory building, and a new auditorium to accommodate Mount Sinai’s increasing educational efforts. The growth in the number of beds called for a larger house staff than before and allowed for the growth of new specialty services.

While these themes have echoes with our current year, as does the perennial nursing shortage of that era (among many others), there was much that was unique to Mount Sinai in 1920. In February of that year, Mount Sinai leaders held an event to celebrate the staff that had served in the World War I Mount Sinai affiliated unit, Base Hospital No. 3. Special commemorative medals were given to each veteran.

The other topic of great interest in 1920 was the re-structuring of the medical staff to combine the in-patient and out-patient services under the in-patient chief of service. The Dispensary and the ward service had been two separate entities with limited overlap. The change allowed the clinic physicians to follow their patients when admitted to the hospital wards, and the ability to round and work with the in-patient staff made it more appealing to community physicians to take on clinic work. In the 1920 Annual Report, it was noted that the combined medical staff now numbered 250 physicians.

Certainly, times change. Institutions changes. Medicine changes. But even 100 years later, at Mount Sinai, some things never change.

Mount Sinai in a time of Epidemic – Typhus, 1915

Mount Sinai physicians have a long tradition of making important contributions to the scientific literature. A good example is the following case from the 1910s, when typhus swept the world, killing thousands of people.

In 1910, Nathan Brill, MD, a doctor in the Department of Medicine, published a description of what he thought was the endemic form of typhus; this became known as Brill’s Disease. (Later Hans Zinsser showed that it was not endemic, but a mild recrudescent form of epidemic typhus and the name was changed to Brill-Zinsser disease.) In 1913, Harry Plotz, MD, an intern working in Mount Sinai‘s Pathology Laboratory, believed that he had discovered an organism that caused typhus.  He published a Letter in JAMA in 1914 outlining his research.

Harry Plotz, MD as a Mount Sinai intern in 1915

Since this was such an important public health problem, in 1915, Mount Sinai’s Trustees took the unusual step of agreeing to fund a trip to gather blood specimens in the Balkans, where there was a typhus outbreak – and the early stages of World War I.  As noted in Wikipedia: “disease ravaged the armies of the Eastern Front, where over 150,000 died in Serbia alone. Fatalities were generally between 10% and 40% of those infected and the disease was a major cause of death for those nursing the sick.”

The research results of this trip were described by the physicians Harry Plotz and George Baehr in a 1917 paper in the Journal of Infectious Diseases. The details of the trip itself are described in the 1916 Annual Report of The Mount Sinai Hospital  This narrative also describes an additional trip by Dr. Peter Olitzky to Mexico, also funded by Mount Sinai, when the researchers in Europe were taken prisoner by the Austro-Hungarian government. This lengthy quote provides the Trustee President of Mount Sinai’s description of the events of 1915-16:

In pursuance of my remarks of last year in regard to the typhus expedition to Serbia, I wish to state that Drs. George Baehr and Harry Plotz after many difficulties established a laboratory at Belgrade in a hospital directed by the American Red Cross. Thirty-six hours before the bombardment of Belgrade, they left for Uskub and there set up a laboratory in the Lady Paget Hospital, and shortly thereafter the town was occupied by the Bulgarians. Very soon afterwards they were invited by the Bulgarian and Austrian Governments to work under their auspices. They then left for Sofia and afterwards went to Vienna, Lemberg and into Russia….

Because of the fact that Drs. Baehr and Plotz during the first six months of their stay in Europe, practically did not come in contact with typhus fever, it was considered important to send a second expedition into Mexico to determine the cause of the Mexican typhus fever, and to carry on other work which at that time we were not sure could be carried on in Europe. The second expedition consisted of Drs. Peter K. Olitzky and Bernard S. Denzer, accompanied by Mr. Irving Brout, a laboratory helper, and the expedition was under the guidance and care of Dr. Carlos E. Husk, a prominent surgeon attached to the staff of the American Smelting & Refining Co. The expenses of the expedition were defrayed in part by Trustees of the Mount Sinai Hospital and in part by the American Smelting & Refining Co.

It was first decided to go to Aguascalientes, but after the expedition reached Matehuala it was determined to remain there, as even at that distance from the border the danger, because of dis- turbances of international conditions, was very great. Early in March, because of the increasing danger in which the men were placed, they were requested to return. The members of the expedition did not, however, leave, because Dr. Olitzky had been stricken with a severe attack of typhus fever. Very shortly thereafter, the plants of the American Smelting & Refining Co. throughout Mexico were closed down, and Dr. Olitzky had to be removed to Laredo, Texas. Just before the departure Dr. Husk, who had been of the greatest aid in the accomplishment of a remarkable piece of work within four weeks, also fell ill of typhus fever, and was brought into Laredo in a very serious condition. Dr. Olitzky after going through a most dangerous attack of the disease, recovered, but unfortunately it proved impossible to save Dr. Husk’s life.

During the course of this expedition the same germ was found in the typhus fever cases in Mexico as had been found in New York and as was found by the members of the European expedition in Serbia, Bulgaria, Austria and Russia. Apart from that, the typhus germ was cultivated repeatedly from lice, which have in recent years been considered the agent in transferring typhus fever from one person to another. Some further scientific studies were made, and vaccination done on a rather large scale. The results of the vaccination cannot be determined at the present time because of the unsettled conditions in Mexico.

In the end, no successful vaccine has been developed for typhus, but antibiotics and public health measures have made it a treatable, rarely fatal disease in the U.S.

The story of typhus and Mount Sinai is important because it shows the institution’s commitment to research and developing new treatments during times of crisis. As shown here, this commitment is not solely from the medical and scientific staff, but also from the Trustees and supporters of Mount Sinai. When times are dire, as in today’s COVID-19 pandemic, Sinai finds a way to enable the work to get done to advance medical knowledge and improve the treatment of patients.

100 Years Ago: World War I Ends for Mount Sinai Unit

On January 11, 1919, the Mount Sinai Hospital affiliated unit, U.S. Army Base Hospital No. 3 was officially relieved of duty. The war was over for them. All told, they had treated 9,127 patients with 172 deaths (54 surgical and 118 medical, the latter due mainly to pneumonia related to the influenza epidemic that swept the world in 1918). On March 5th, the doctors and nurses returned to New York City. The enlisted men returned two and a half weeks later.

A ward at Base Hospital No. 3

The Hospitals of the Mount Sinai Health System in the First World War

Nurses and doctors of St. Luke’s Hospital Evacuation Hospital No. 2

April 2017 is the 100th anniversary of the entry of the United States into World War I. Like many institutions in American society, the American hospital system and its doctors and nurses were rapidly mobilized to join the war that had been raging in Europe since the summer of 1914. The Mount Sinai Archives has now installed a display in the Annenberg Building north lobby outlining the activities of the hospitals in the Mount Sinai Health System.

In New York City, The Mount Sinai Hospital, St. Luke’s Hospital and The Roosevelt Hospital (today’s Mount Sinai West) all contributed to the war effort by establishing overseas units affiliated with their respective hospitals, and many doctors at Beth Israel Hospital volunteered individually. The records, photographs and correspondence on display in these cases reflect the experience of a war that defined a generation.

For the medical officers and administrators in charge of overseas hospital units, organizing effective hospital service on a scale never before seen was an immense logistical challenge. And for the individual doctors and nurses working with patients, who saw at close hand the terrible destruction inflicted by new methods of trench warfare and aerial combat, all while dealing with a world-wide pandemic of influenza, the war was an experience of medicine at its most fundamental, as they struggled under harsh conditions to relieve human suffering.

The items on display include images of the staff from the hospitals in their World War I roles; a scrapbook from Marion Moxham, a nurse from Ireland who joined with the Mount Sinai unit, Base Hospital No. 3; letters home from physicians to the Beth Israel Hospital administration; dog tags; a medal that was awarded to members of the Mount Sinai unit; images of the wounded and wards of St. Luke’s Evacuation Hospital no. 2 and a photo of the mascot of the Roosevelt Hospital group.

Memorial Day

The cemetery at Base Hospital No.3 for Americans who died at the hospital.  circa 1918

The cemetery at Base Hospital No.3 for Americans who died at the hospital, 1918

Memorial Day is set aside to remember the servicemen and women who have died while in service to their country. Ceremonies started after the Civil War and it became a national holiday after World War II.  Since injury and death are a part of war, doctors and nurses have always been witnesses to the ravages of battlefields.  The image above shows the American cemetery at Base Hospital No. 3, the Mount Sinai Hospital-staffed unit that served in France.

While the deaths happened abroad, the biggest impact was felt at home. It was not only families that marked their losses, but institutions as well.  By World War II, service flags were a familiar patriotic symbol.  The photo below shows Mount Sinai’s flag hanging from 1184 Fifth Avenue.  The number on the bottom shows how many Mount Sinai doctors, nurses, staff and trustees were in the service at that time.  The gold star at the top showed how many had died. By the end of the war, Mount Sinai’s numbers had grown to 802 served, nine dead.

The Mount Sinai Hospital service flag, 1944

The Mount Sinai Hospital service flag, 1944

Those nine are recognized here:

  • Nils Carson
  • Sydney C. Feinberg, MD
  • Andrew Goldstein
  • Jerome W. Greenbaum, MD
  • Eugene M. Holleb, MD
  • Goodell G. Klevan, MD
  • Bernard Ritter, MD
  • Helen Rogers, RN
  • Stanley J. Snitow, MD