Tag Archives: Public Health

March 31, 2020

Quarantines in Salem

By daseger

I’m pretty familiar with the origins of the quarantine, having taught classes on or in the era of the Black Death for twenty years: quaranta (40) days that ships were required to anchor in the harbor off Venice before they could unload their passengers and cargoes to prevent the passage of plague in the fourteenth century. The Black Death came to Europe by sea, in ships: it was external. The circumstances in which we find ourselves prompted me to look at Salem’s quarantines, as Salem was a mini-Venice in its day, an entrepôt for worldly goods coming from far, far away. And by the time of Salem’s heyday, everyone knew that deadly germs could accompany those precious commodities. The plague was over (until its reappearance in the later nineteenth century) but other plagues persisted: smallpox, yellow fever, cholera, influenza, scarlet fever.

Puck Magazine drawing from 1883, showing the NYC Board of Health attempting to ward off the arrival of Cholera.

Disease operates like war in history: it dramatically intensifies the size, scale and power of the government in reaction. Quarantines are evidence of the government’s powers and/or ability in the face of crisis, and they leave a record. Massachusetts experienced several smallpox epidemics in the seventeenth and eighteenth centuries, provoking both quarantine measures and medical relief in the form of inoculation. In Salem, smallpox was still considered threatening enough to provoke the establishment of a designated hospital and committee to deal with it in the eighteenth century, but it was by no means as frightful as the disease which was often simply referred to as the “pestilence”: yellow fever. Maybe I’m wrong, but the public discourse at the time seems to imply that smallpox is containable, yellow fever, not at all.

Salem Gazette

Strict maritime quarantines were implemented as soon as any news of yellow fever was reported, particularly after the dreadful epidemics in Philadelphia in 1793 and New York in 1795, and the concurrent epidemics in both cities and Boston in 1798. The last two years of the eighteenth century marked a turning point in Salem’s public health history, with the appointment of a new inspector of police: apothecary Jonathan Waldo. In several long articles in the Salem Gazette, Waldo asserted that the dreadful pestilence was not only an external threat, but one that was festering right in Salem, and thus a series of quarantine and hygiene regulations must be implemented as soon as possible. Salem needed to clean up its act.

First, a new Board of Health, the Overseers of the Poor, or some other body should be empowered with the mandate to enforce the necessary regulations, which included: confiscation of “corrupted” properties for the “public good”, with compensation to the owners, the establishment of a “pest house”(another one: Salem already had two by my count), “suitable” privies, “so situated as to incommodate their next neighbor as little as possible”, proper cisterns for butchers, docks and flats to be kept clean, no dead animals are to be thrown into the streets or the river, no storage of hides, fish, and beef for prolonged periods of time, and “the public streets, wharves and enclosures should be kept in a good wholesome state of cleanliness, especially during the hot season.” And so you see, we can learn a lot about societies in the midst of, or facing, a contagion! Once the hot season arrived, the city imposed a maritime quarantine on all incoming vessels. Another apothecary (who interests were even more wide-ranging than those of Waldo), Scottish exile James Tytler, published his Treatise on the Plague and Yellow Fever in Salem in this same, fevered, year of 1799.

Library of Congress

As the map above (from Alexander Keith Johnston’s Physical Atlas: a Series of Maps & Notes Illustrating the Geographical Distribution of Natural Phenomena) depicts, I always associated yellow fever with the south: the Caribbean, and New Orleans, in particular. But this was not strictly the case. I have no access to the City of Salem archives—some seem to be up in the Phillips Library up in Rowley; some remain here in Salem, in City Hall I presume—but fortunately a predecessor of mine from the Salem State History Department, Charles Kiefer, created an inventory and finding aids for the municipal records from 1681-1832 in the 1970s which is preserved in the Salem State Archives. According to Kiefer’s notes, most of Waldo’s recommendations went into effect in the first decade of the nineteenth century, with the additional improvement of paved streets. These notes also reference the first outbreak of what would be the new threatening disease of the nineteenth century, cholera, with a very early outbreak for Salem in 1812. I was surprised to read of the implementation of a maritime quarantine against cholera by the Salem Board of Health as late as 1885: I thought it was all about railroads at this point. There were influenza alerts (but not quarantines as far as I can tell) in 1890 and (of course) 1918, a late smallpox scare in 1912 which brought out police guards, and several scarlet fever quarantines in the twentieth century. Despite the fact that it was revealed to be contagious in the 1880s, I don’t see any quarantine measures used by Salem authorities to combat the most endemic of nineteenth- and early-twentieth century diseases: tuberculosis. There was clearly increasing concern and focus on preventative public health, hygiene, and housing, an updated Waldo regimen if you will, but no extreme measures.

13 Comments | tags: Archives, Black Death, Coronavirus, Current Events, ephemera, maps, Public Health, Quarantines, Yellow Fever | posted in Current Events, History, Salem

March 28, 2020

Sisters in Service: Salem 1918

By daseger

When your focus is on historical women, as mine has been for these 2020 #salemsuffragesaturday posts, sometimes you find their stories are somewhat segregated from what is going on at a particular time, and sometimes it is clear that their stories are absolutely integral and central to what is going on at the time. Salem’s experience of the Influenza Epidemic of 1918 is illustrative of the latter case: nurses were not only on the front lines of this strike; they constituted primary care. And there were simply not enough professional nurses to go around in the context of both war and contagion, particularly in the panic months of September and October. Salem was actually well-positioned to meet the challenges of a contagious epidemic: it had a brand new, state-of-the-art hospital with its own nursing program and several charities which focused on “public health nursing”: the Woman’s Friend Society (still thriving today) operated a “District Nurse” (later Visiting Nurse) program under the direction of Superintendant Miss Pauline Smith, and the Committee on Prevention of Tuberculosis had an “Instructive Nurse”, Miss Teresa Trapeney, on staff. The City had been battling the “Great White Plague” for quite some time, but it had to supplement its forces to deal with the “Spanish Flu”.

The 1910 Associated Charities of Salem Annual Report in 1910 features a rendering of the new Salem Hospital on Highland Avenue, which was opened in 1917; Boston Daily Globe advertisement, October 2, 1918; the Woman’s Friend Society on Hawthorne Boulevard.

Before I delve into that response, a few words about the nature and mortality of the 1918 Influenza Epidemic, in general and in Salem. There have been quite a few references to it over the past few weeks, as people naturally want a historical precedent for any crisis, but many of these references have been incorrect, even wildly incorrect. For example, President Trump’s March 24 assertion that: You can’t compare this [COVID-19] to 1918 where close to 100 million people died. That was a flu, which — a little different. But that was a flu where if you got it you had a 50/50 chance, or very close, of dying. Maybe the 100 million estimate can be overlooked as global mortality estimations are all over the place—everywhere from 20 million to 100 million—but that mortality rate assertion is ridiculous: the real number is in the neighborhood of 2.5%. The president’s sloppy statement misrepresents both the nature of the threat and the heroic efforts that were made to combat it: it is dehumanizing. I’ve NEVER understood the vagueness of the general mortality numbers until I delved into the research for this post: it is very clear from the Massachusetts records that there was both epidemic influenza as well as influenza-triggered respiratory diseases, predominately pneumonia, in 1918. Some accounts and estimates only include the primary category; others include both: these figures from 1917-1918 illustrate the connection between the two diseases and their notable increase over the year.

This same source, the Commonwealth of Massachusetts’ annual reporting of the state’s vital statistics for 1918, lists 151 deaths from influenza and 102 for pneumonia in Salem for 1918, but this is an under-representation of the threat: the daily papers report as many as 1500 cases during some days in late September. Another factor which likely bears on all of the Massachusetts statistics is the fact that the Board of Health did not rule influenza a “reportable disease” until October 2, well into the epidemic. The Annual Report of the Salem Hospital for 1918 notes the 40% increase in patients over the year, and offers the assertions that a larger increase might have been made if during the Influenza epidemic in September and October, it had been possible to secure additional nurses to replace those who were ill. This increase affords conclusive proof of the claim of the hospital authorities that it was not meeting the needs of the community. Salem Hospital could not meet the needs of its community in the fall of 1918 not only because it had insufficient nurses: many of the nurses who were on staff, in addition to physicians, came down with influenza themselves, and so the decision was made to establish a separate, emergency hospital to limit the spread of the contagion. Tent cities sprung up all over eastern Massachusetts in the fall of 1918, but in Salem one gets the impression that that was never a consideration: this was only four years after the Great Salem Fire—which prompted the establishment of several tent cities—after all. I can’t determine whether they were asked or they volunteered, but the Sisters of St. Chretienne, recently established in the former Loring Villa in South Salem, offered up their newly-expanded building as the emergency influenza hospital, and themselves as nurses. Consider their situation: they themselves had been displaced from their Convent-Noviate on Harbor Street by the Fire in 1914, had purchased and overseen the expansion and transformation of the residential Loring Villa into a school, and had just opened that school when the epidemic hit! Only their fellow St. Chretienne sisters across the Atlantic found themselves in a more challenging situation, in the midst of the major war zone of World War I.

Influenza tent hospitals in Lawrence (top two–including the “mask room”: they had MASKS then!) and Brookline (more masks on display), September 1918, Lawrence History Center Digital Collections and Brookline Historical Society; The St. Chretienne Academy in South Salem, now part of the South Campus of Salem State University, served as Salem’s emergency influenza hospital in the fall of 1918, Salem State University Archives and Special Collections.

Both education and health care were encompassed within the mission of the Sisters of St. Chretienne, and their fellow sisters from Salem’s other Catholic orders, the Sisters of Charity of the Immaculate Conception and the Sisters of Notre Dame, also served as nursing aides during that fevered fall of 1918. The situation called for a sacred-secular collaboration, as the Sisters were joined by the Woman’s Friend Society and its District Nurses as well as individual Salem women answering Governor Samuel McCall’s call that able-bodied people with any medical training volunteer their services. After several intense weeks in late September and early October, the influenza “crest” (rather than curve) appeared to be subsiding—or at least that was the story in the press—but by years’ end, it appeared to be on the rise yet again: in Salem, Miss Julia E. Pratt, the matron of The Seamen’s Widow and Orphan Association on Carpenter Street, found that the majority of her charges were infected with the persistent influenza, and across Massachusetts, the call went out once again: to women.