Spanish Medical Aid Committee

Spanish Medical Aid Committee

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In July 1936, Isabel Brown, at the Relief Committee for the Victims of Fascism in London, received a telegram from Socorro Rojo Internacional, based in Madrid, asking for help in the struggle against fascism in Spain. Brown approached the Socialist Medical Associationabout sending medical help to Republicans fighting in the Spanish Civil War.

Brown contacted Hyacinth Morgan, who in turn saw Dr Charles Brook. According to Jim Fyrth, the author of The Signal Was Spain: The Spanish Aid Movement in Britain, 1936-1939 (1986): "Morgan saw Dr Charles Brook, a general practitioner in South-East London, a member of the London County Council and founder and first Secretary of the Socialist Medical Association, a body affiliated to the Labour Party. Brook, who was a keen socialist and supporter of the people's front idea, though not sympathetic to Communism, was the main architect of the SMAC. At lunch-time on Friday 31 July, he saw Arthur Peacock, the Secretary of the National Trade Union Club, at 24 New Oxford Street. Peacock offered him a room at the club for a meeting the following afternoon, and office facilities for a committee."

At the meeting on 8th August 1936 it was decided to form a Spanish Medical Aid Committee. Dr. Christopher Addison was elected President and the Marchioness of Huntingdon agreed to become treasurer. Other supporters included Peter Spencer, Leah Manning, George Jeger, Philip D'Arcy Hart, Frederick Le Gros Clark, Lord Faringdon, Arthur Greenwood, George Lansbury, Victor Gollancz, D. N. Pritt, Archibald Sinclair, Rebecca West, William Temple, Tom Mann, Ben Tillett, Eleanor Rathbone, Julian Huxley, Harry Pollitt and Mary Redfern Davies.

In his autobiography, All My Sins Remembered (1964), Peter Spencer, 2nd Viscount Churchill, explained what happened: "Finally, a group of us - three well-known medical men, a famous scientist, several trade unionists, and one communist - formed a committee for the purpose of collecting money for medical supplies to be sent to the Spanish Government forces."

Leah Manning later recalled: "We had three doctors on the committee, one representing the TUC and I became its honorary secretary. The initial work of arranging meetings and raising funds was easy. It was quite common to raise £1,000 at a meeting, besides plates full of rings, bracelets, brooches, watches and jewellery of all kinds... Isabel Brown and I had a technique for taking collections which was most effective, and, although I was never so effective as Isabel (I was too emotional and likely to burst into tears at a moment's notice), I improved. In the end, either of us could calculate at a glance how much a meeting was worth in hard cash."

According to Kenneth Sinclair-Loutit, who was chosen to head the British Medical Unit sent to Spain, the Communist Party of Great Britain played an important role in the establishment of the Spanish Medical Aid Committee. In his autobiography, Very Little Luggage, he describes being taken by Isobel Brown to be briefed by Harry Pollitt, the leader of the CPGB. However, Sinclair-Loutit insisted: "I was going to Spain with a medical unit supported by all shades of decent opinion in Britain. I felt that I had a very heavy reponsibility towards its members and towards those who were sending us. We were a small unit and I was not going to do anything behind the backs of its members... I went on to say that a party fraction was being established in the Unit and since I was sure that its members had the work as much to heart as the rest of us it was hard to see why it had seemed necessary to create it." He then went on to complain about the addition of CPGP member, Hugh O'Donnell, to the unit.

Peter Spencer added: "The Medical Aid Committee soon produced results, and before long we had not only collected medical supplies but also had a team of doctors and trained nurses, ambulance drivers and medical orderlies, all of them volunteers... In August, when our first medical aid unit left for Spain, I went with it."

Reginald Saxton, one of the doctors recruited issued a statement in December 1936 that said: "We are going to help the wounded of both sides... We cannot of course park on both sides, so we shall go out on the side of the government, with whom we have sympathy as the democratically elected Government of Spain. We have no sympathy with the rebels whom, we believe, are trying to establish a military dictatorship over the Spanish people."

One of the first to volunteer was Richard Rees: "I arrived in Barcelona in April 1937 in a mixed state of exaltation and despair and wearing a brand-new ambulance driver's outfit in which a cynical friend in London had pretended to mistake me for one of Hitler's Brownshirts. My exaltation sprang from the thought that I was preparing to risk my life for socialism, or the European working class, or something, and my despair from a more down-to-earth appreciation of my motives."

The First British Hospital was established by Kenneth Sinclair Loutit at Grañén near Huesca on the Aragon front. Other doctors, nurses, administrators and ambulance drivers at the hospital included Archie Cochrane, Penny Phelps, Rosaleen Ross, Winifred Bates, Aileen Palmer, Peter Spencer, Patience Darton, Annie Murray, Julian Bell, John Boulting, Roy Poole, Richard Rees, Nan Green, Lillian Urmston, Thora Silverthorne and Agnes Hodgson.

Archie Cochrane was fairly critical of the original team of doctors and nurses. He claimed things improved after the arrival of Alex Tudor-Hart and Reginald Saxton: "When the mobile team finally arrived in Albacete only four of its original members remained - Kenneth (Sinclair-Loutit), Thora (Silverthorne), Aileen (Palmer), and myself - a situation which I feel reflected the inadequacy of the original selection process. There were, of course, others from subsequent waves of volunteers. I was glad that Reggie Saxton and Keith Anderson were there. Recent arrivals included Dr Tudor Hart, who had some surgical experience, Joan Purser, a nurse, and Max Colin, a mechanic."

Archie Cochrane, Reginald Saxton and Alex Tudor-Hart eventually joined the 35th Medical Division Unit, attached to the French Battalion the XIV International Brigade. This involved supporting Republican troops at the Battle of Jarama in February 1937. This included setting up a field hospital in a country club, at Villarejo de Salvanés using the bar as a theatre, and operating on three table-tops.

Roy Poole, one of the a, told the Reading Chronicle in 1937: "It's jolly hard work of course. Often you don't get more than five hours to your night. We have had as many as 150 cases to handle in a day. I reckon that I alone have driven my ambulance over 11,000 miles on truly villainous roads - not bad going in about three months. Before we arrived on the scene the wounded had to be dragged down from the mountains on mules."

A fellow ambulance driver, Richard Rees, found dealing with badly wounded soldiers very difficult: "This man was an American International Brigader at whose feet a grenade had exploded. His eyes, I think, were destroyed, as his face certainly was; and there appeared to be no part of the front of his body from head to feet that was not disfigured and in pain. It had been decided that he should be carried down to the courtyard every day to get the sun, and Robert and I had to do it. He kept up an almost ceaseless and barely intelligible lamentation even when undisturbed, and I find my memory jibs at recalling the effort it required to grasp him round the waist and haul him from his bed on to a stretcher. In pulling back the bed-clothes, if the sheet brushed against his foot he would scream, My toes! My toes! Damn you! and it seemed beyond the limit of horror that a man whose face and body had been pulped should be sensitive even in his toes. This was my first lesson, which was later to be heavily reinforced at the front, in the distinction between squeamishness and sympathy. I never lost my squeamishness about wounds, but my capacity for sympathy became almost atrophied. What I felt was more like horror than sympathy or pity."

On 29th August 1937 Dr. Reginald Saxton wrote to his father about his experiences in Spain: "On that front things have gone very badly indeed. The work we had in June and July was very heavy and there must have been tremendous losses of men, but the Government has gained a certain amount of territory on the various fronts on which it has attacked. I know those two attacks we had through our front line hospital 900 in five days, and 2,000 in three weeks. The war doesn't look like ending for a long time yet."

Conditions in the hospitals were extremely poor. According to Rosaleen Ross: "Existence is a misery. Rain is coming in. Rats run across the floor. Our rations are tinned meat, chick peas and five almonds each. We are afraid to undress night or day because of the bombing. We have no milk, eggs or potatoes for the typhoid patients (Yet owing to good nursing only 8 per cent died). I cannot say enough about the splendid way Ada Hodson, Patience Darton and Lillian Urmston are working. How Ada makes us laugh when she tries to drink the peculiar liquid which is neither tea, coffee nor cocoa, but a mixture of all."

The doctors and nurses suffered several bombing raids. Thora Silverthorne explained in a letter to her family: " We have become accustomed to air raids although they still worry me a great deal: I dread them. The planes were over last night, dropped bombs but did no damage. Considering the number of raids surprisingly little damage is done. The swine deliberately attempt to bomb hospitals - it's inhuman. The other day, an English nurse who works in a village some distance from here came along to stay the night with us for a change. She was very shocked. She'd had a nasty experience the day before. She was sitting talking to a comrade when a bomb was dropped quite near them. She was thrown off her chair and her companion was killed. Then she saw a bunch of kiddies killed by another bomb."

Richard Rees, like many of those working for the British Medical Aid Unit, became very disillusioned with the way that the Communist Party of Great Britain had taken control of the operation. For example, Kenneth Sinclair Loutit, was replaced as chief administrator by party loyalist, Alex Tudor-Hart. In his autobiography, A Theory of my Time (1963) Rees argued: "After six months in Spain I was beginning to feel that there was no place for me as an organiser unless I was a Communist or prepared to be a Communist stooge." Rees resigned from the BMAU and joined the Quakers' Spanish relief organisation in Barcelona.

Dr. Reginald Saxton told the authors of We Cannot Park on Both Sides (2000): "We had at that time no transfusion syringes and no satisfactory needles. I collected, however, two sets of instruments to enable me to dissect a vein and insert a cannula (a thin tube). The blood was poured into a funnel and led by a rubber tube to a cannula."

Norman Bethune, a doctor serving with the Mackenzie-Papineau Battalion, observed that a frequent cause of death in war is medical shock brought on by loss of blood. Bethune decided the best way of dealing with this problem was to administer blood transfusions on the battlefield and developed the world's first mobile medical unit. Bethune worked closely with Saxton on this strategy. As Patrick Reade points out: "Up to 3,000 samples of blood were processed by these mobile labs, which included autoclaves, incubators, fridges and ovens. This was a major contribution to the medical welfare of the Republican war effort."

According to Paul Preston: "Saxton worked out new methods for blood transfusions, thereby saving many lives. He also classified the blood of every brigadier who might be a potential casualty or donor and, wherever possible, of locals. One of the greatest contributions to military medicine of the Republican medical services, and one in which Saxton played a significant role, was the organisation that permitted early treatment at forward field hospitals, backed up by mobile surgical hospitals."

Dr. Reginald Saxton later explained how the system worked on the battlefield: "In this laboratory we had blood donors and I used to do blood grouping. We gathered quite a lot of volunteers to be blood donors. We were a medical unit working for the army and were insulated very much from the civilian troubles that existed. Just occasionally, civilian difficulties would overflow into our work. Getting together volunteer blood donors meant contact with the various civilian organizations that might help or provide us with these donors. There was a little bit of antagonism between them. The Socialist Party would be a bit edgy about the Communist Party or the Republican Party, i.e. who is really going to organize it, who is the more important of these three organizations? Feelings of resentment between these groups interfered to a large extent with the welfare side of the hospital."

On 25th September 1938, Juan Negrin, head of the Republican government, announced for diplomatic reasons that the International Brigades would be unilaterally withdrawn from Spain. However, General Francisco Franco failed to reciprocate and German and Italian forces remained to continue the struggle.

The British Medical Unit also returned home. Jim Fyrth, the author of The Signal Was Spain: The Spanish Aid Movement in Britain, 1936-1939 (1986) argued: "How willing was the British Establishment to learn from the Spanish experience? There were those who were put off because the new ideas were coming from the wrong side, and there were those who were conservative because the medical and military Establishments had almost always been conservative. But there were others who, whatever their politics, had ears for those who had been in Spain, especially as it looked ever more likely as the months passed that Britain, too, would soon be at war."

Jim Fyrth points out that when Kenneth Sinclair-Loutit returned to "St Bartholomew's Hospital in the summer of 1937 to complete his training, he found that a number of influential people wanted to hear about his medical experiences." He also adds that the medical journal, The Lancet, carried reports from Reginald Saxton about his blood-transfusion work.

I was enjoying the last days of that 1936 July when Mary Redfern Davies, a Cambridge contemporary, rang up to ask me to make out a list of Medical supplies to the value of one hundred pounds. What had provoked this odd request was that the Committee for the Relief of the Victims of Fascism had received cash gifts earmarked for Spain. It seemed that the Army had just mutinied in an attempt to overthrow the Popular Front Government. I did the job with Mary in Hennekey's over a couple of Tio Pepes. Twenty-four hours later Mary told me that the Relief Committee had doubled the quantities as more earmarked money had come in. The Committee's secretary then wanted to see us so we went round and found her all bemused; she now had about nine hundred pounds and while we were there more came in bringing the total over the thousand - in those days that amount of money would have kept me for two years. I suggested that if it went on like this once she got over two thousand pounds she could buy a vehicle and stuff it with whatever the Spaniards might ask for.

There is nothing like activity to put a stop to introspective thinking: I had not come to terms with the seeming failure of Truda's all important visit. I soon had no need to bother anymore about myself, because within twenty-four hours the Committee for the Relief of the Victims of Fascism had bowed out and a Spanish Medical Aid Committee had been formed with me as one of its founder members. It was a solid affair with the Medical Advisor to the TUC, eminent Quaker worthies, some labour and liberal MPs, a couple of peers, a charming Italian-born peeress, and several Secretaries-General of major Trade Unions all ready to meet 3 times a week. This group represented a cross-section of all that was progressive and contactable in an England bent on enjoying the high summer of 1936.

The Committee started work on the first of August. Three weeks later I left London with a unit of twenty volunteers and the equipment for an advanced field hospital. The eminent doctors who had helped set it up were unable to abandon their London jobs and go to Spain themselves. I had no such constraints and was happy to volunteer for an emergency that, in the general conception, could not very well persist for more than a few weeks. I welcomed the intensity of activity as it counterbalanced the unanalyzed void of Truda's departure. About a week before we were due to leave for Spain, the Committee appointed me Administrator of the Field Unit. To have established the equipment list for a mobile hospital, then to procure and pack it all within three weeks, was in itself a remarkable logistic feat made possible by three forces working in concert. These same forces were to make possible our victory in the war of 1939/45. The first force in this triad was the energy of young people working together for something they really wanted to do; the second factor has been called "working-class solidarity" and the third is often referred to disparagingly as the "old boy network". These last two forces are isometric; upper class solidarity is the mirror image of the working class network.

When I was trying to buy drugs, dressings, sterilisers, hospital ward equipment, kitchen stores and field cookers - all on the same day, I seemed to get a lot of miraculous help. The Committee's Peers would telephone the top of a supplying company, while the warehousemen, hearing that it was for Spain, would service no other orders until ours were satisfied. There was a catalytic agent in all this ferment or, to change the metaphor, a current that passed by a selective circuit through our working group. It had an expediting effect, it resolved knotty questions and simplified debates. A determined minority can have a decisive influence in a democracy, the more so if it keeps a low profile. This phenomenon is, often enough, used by forceful minorities, and, often enough, it is deplored by the disappointed majority. This quiet but powerful mechanism has not been studied sufficiently.

On August 8 1936, a group of doctors, medical students and nurses met in London to consider ways of sending medical help to the Spanish republic. A month earlier, the civil war had broken out. One of those at the meeting was a young doctor, Reggie Saxton, who has now died aged 92.

Out of that meeting came the Spanish Medical Aid Committee and, on August 23 the first unit left for Spain. The English hospital was set up in a farmhouse at Grañen in Hesca, about 18 kilometres behind the Aragón front.

On September 29 1936, Reggie reached Grañen, where, he recalled, "there was only dirt and filth and rats and a stinking courtyard". Reggie became a popular figure at the Grañen hospital, dispensing poultices and pills from his knapsack, but was itching to help the war effort at a time when the main fighting was moving elsewhere.

The Spanish Civil War too had an impact on left-wing medical politics. The SMA, like others on the left, moved quickly to give practical aid to the Republic. Most notably this was through the creation, in late summer 1936, of Spanish Medical Aid, largely on the initiative of Charles Brook. The Association dominated Spanish Medical Aid. Its president was Christopher Addison; its chairman H.B. Morgan; its vice-chairman Hastings; and its honorary secretary Brook - all prominent SMA members. Originally conceived as a supplier of medical aid and equipment to the democratic forces in Spain, the positive response to Spanish Medical Aid allowed it, Brook later recalled, to initiate a "far more ambitious project - the dispatching of a fully-equipped and adequately staffed Medical Unit to the battle front". This was the First British Medical Unit, which served on the Aragon front.

Practical activity abroad was complemented by agitational and propaganda work at home. Addison, `contrary to the advice tendered by some people in high places', chaired a large meeting at the Albert Hall in support of Spanish Medical Aid. On a rather smaller scale, Dr Cedric Hill, previously in charge of a front line dressing station in Spain, organised an appeal for funds for pro-Republican German and Spanish doctors stranded in France. Edith Summerskill and Stella Churchill were among the sponsors of the "National Women's Appeal for Food for Spain", while in 1938 the Glasgow branch devoted its energies to canvassing doctors and chemists for medical supplies for Spain. And, returning briefly to medical refugees, Spanish Medical Aid successfully brought to Britain professionals who would have been in danger had they remained in Spain. These included Joseph Trueta, who had worked during the Civil War in a Catalan hospital. The experience he gained and the skills he developed were later to be used extensively in the Allied armies, a further example of the `beneficial' effects of war for medicine. He left Spain for Britain in 1939, published a number of articles on the impact of civilian bombing based on his experiences in Barcelona, and in 1949 became Nuffield Professor of Orthopaedic Surgery at Oxford.

The Association was actively involved in providing practical help to the Spanish Republic, and perhaps because of the nature of such aid seems to have avoided the sectarian conflicts which bedevilled the rest of the labour movement." It also drew two particular lessons from the war. The first concerned blood transfusion. In MTT in late 1937 Sinclair-Loutit, administrator of the First British Medical Unit, described the new technique of having available chilled blood, ready for transfusion. From such surgical advances, he went on to make more general points. Despite the war, research continued, with surgeons free from the "tyranny of the Old Men". The experience of a year at the front illustrated how "medicine, given freedom, and support from the State, has surged ahead". Even in war, it found "time and peace to make the world richer by its research". The significance of chilled blood was not missed by the Spanish Medical Aid Committee, which sent three refrigerators to the British Unit in autumn 1938

Another SMA member who had served at the front, Reginald Saxton, took up these points. In spring 1939 he gave detailed plans, based on his Spanish experiences, of the requirements of a blood transfusion service should Britain become involved in war. The current situation, however, gave little cause for optimism. The authorities had "learnt little from our experiences of actual war". A national blood transfusion service prepared for the onset of conflict while augmenting peace-time arrangements, was required. Only then would experience gained in Spain `enable us to make of it something of inestimable value in the practice of modern surgery'. Saxton continued to emphasise these points, for example in August 1940 when deploring the authorities' slowness in adopting methods which had proved `invaluable in Spain'. In later recollections of Saxton's plans, both Murray and Hilliard credited him with the formulation of the service which the government adopted and integrated into the NHS.

Of the "unofficial" responses to the Civil War, probably the most important, and certainly the earliest, was the Spanish Medical Aid (SMA) campaign, launched in August 1936 by the Socialist Medical Association with backing from the communists and rank-and-file Labour Party members. Due to the urgent sense of crisis in which it was born and its avowed humanitarian aims the SMA was never treated as harshly by the labour movement as many other "unofficial" organisations were. Indeed, initially the SMA was regarded as part of labour's own operations - TUC Chairman Arthur Findlay had been present at the departure of the first unit. The SMA was only abandoned when it was plain that it would not be subservient to the NCL.

Finally, a group of us - three well-known medical men, a famous scientist, several trade unionists, and one communist - formed a committee for the purpose of collecting money for medical supplies to be sent to the Spanish Government forces. We called it the Spanish Medical Aid Committee. I had already talked to a prominent Labour leader, who later became a peer, and he had told me that the British public was not interested in Spain. When I told him that I wanted to collect money to send medical supplies he had smiled and assured me that I would get nowhere with such an idea. He knew the British public. He had years of experience. I had none. "I'll try, anyway," I said. "If I can't do more I'll send a box of bandages to Spain." As it turned out it only took a few weeks to prove how wrong he was about the British public; or had he been asked by the British Government, as later I thought might have happened, to play down Spain as much as possible?

When we got to work it soon appeared that our Medical Aid Committee provided one of the few outlets in England for popular feeling about Spain. Except for the communists recruiting for the International Brigade very little was being done in England at that time. Our committee put appeals in the newspapers and money began to pour in from the very beginning. Although the British Press had muzzled itself on the Spanish situation, so that to get anything like accurate news you had to read foreign newspapers, plenty of people in Britain were thinking for themselves. The next twelve months were the beginning of a real political education for me. I learned about the practical workings of political parties, and something also about international politics in action. I began to speak at meetings up and down England. I soon saw how strong popular sympathy was for the Spanish people who were struggling not only against Moroccan troops and generals in revolt, but against the power wielded abroad by Juan March, the Spanish financier, who was already installed at Mussolini's side in Rome...

The Medical Aid Committee soon produced results, and before long we had not only collected medical supplies but also had a team of doctors and trained nurses, ambulance drivers and medical orderlies, all of them volunteers.

As far as I myself was concerned I had worked hard to put the thing over but soon there was no need to put it over. Popular enthusiasm was pushing us. Now I found myself at international conferences in Paris, and I was beginning to find that I was not afraid of being a public speaker (extemporary speaking is something nearly all actors dread) and that people really seemed quite ready to listen to me. I had to go through some tough platform ordeals, though, such as being heckled by opponents at meetings in London ; but the knowledge of popular support, and above all the fact that I believed in what I was doing, made me forget about what is usually known as self-consciousness.

In August, when our first medical aid unit left for Spain, I went with it. There was some discussion in our committee, I can remember, as to what name I should go under in Spain or whether I should go at all. It was clear that many of the excellent members of our committee, although fully in support of the Spanish cause, still had lurking suspicions as to the fate of a full-blown aristocrat presenting himself in the Catalonia of the Civil War, where the F.A.I., the popular organization of the anarchists, was very much in evidence. I found the English mentality interesting. We seemed to have no scruples in allowing young nurses and doctors and medical students to go into the danger and presumed turmoil of Spain, but when it came to sending a real live lord it was another matter. I appreciated their concern for me but I took a different view. First, I didn't feel like letting all those young people go to Spain if it was unsafe for me to go myself. Secondly, there were my own feelings. If the people I was trying to help were so stupid as to bump me off on account of so unsubstantial a thing as a title, then my ideas as to what human life could be about were so far from the mark that it might be as well if I were put out of my misery quickly before the title became a millstone around my neck.

The other consequence of the Spanish appeal was the SMAC. Isabel Brown asked Sinclair-Loutit and another student to see Dr Hyacinth Morgan, the Medical Adviser to the TUC and Medical Officer to the Union of Post Office Workers. At a second meeting he agreed to do what he could to set up a committee. Morgan was a wise choice. He not only had close connections with the Labour and trade union movements, but was also a Roman Catholic, having been born of Irish parents in the West Indies.

Morgan saw Dr Charles Brook, a general practitioner in South-East London, a member of the London County Council and founder and first Secretary of the Socialist Medical Association, a body affiliated to the Labour Party. Peacock offered him a room at the club for a meeting the following afternoon, and office facilities for a committee. Although it was the first day of the Bank Holiday weekend, Brook managed to summon a number of people by telephone and postcard and to bring the press. (Those present variously recall between twenty and sixty people being there.)

Brook spoke of the need for medical aid. It was agreed to set up a committee and to send personnel as well as medical supplies to Spain. The committee had a people's front character. Morgan was elected Chairman and Brook Secretary. Isabel Brown, mindful of the English love of titles, proposed Christina, Lady Hastings (Marchioness of Huntingdon), a left-wing, Italian-born aristocrat, as Treasurer. With her, Viscount Churchill and J.R. Marrack, Professor of Biochemistry at Cambridge, were joint Treasurers. Dr Somerville-Hastings, a surgeon and a member of the LCC, was Vice-Chairman, and Dr Christopher Addison MP, was President. Most of the Committee were doctors, members of the Socialist Medical Association, including Philip D'Arcy Hart, who had been on holiday in Spain, marooned in San Sebastian during the initial fighting and evacuated in a British destroyer. Isabel Brown handed up £50 from her committee, and was elected. So were Ellen Wilkinson MP, Leah Manning, President of the National Union of Teachers, and Arthur Peacock. Lord Faringdon, a left-wing Labour peer and Frederick Le Gros Clark, a well-known nutrition expert and peace campaigner who had been blinded in the First World War, were among those co-opted. Later members of the committee included Janet Vaughan, Professor Julian Huxley, Victor Gollancz and Sir Walter Layton, owner of the News Chronicle, Megan Lloyd George MP, D.N. Pritt MP, Eleanor Rathbone, Independent MP for the Combined English Universities, the Earl of Listowel, Sir Archibald Sinclair MP, leader of the Liberal Party, Rebecca West and the veteran leader of the 1889 dock strike, Ben Tillett. William Temple, Archbishop of York, later of Canterbury, gave his support.

Whilst I had been absent from London, the Committee, with which I was to be most closely associated during the Spanish war, had been formed. Isabel Brown, a dedicated communist, had been receiving sums of money from all over the country to be used for Spanish relief. Medical aid was urgently needed doctors, nurses, trucks and their drivers, and supplies of all kinds. Isabel set about finding people willing to sit on an all-party committee who would undertake the task of raising funds, interviewing personnel, and sending all these things and people to Spain. She brought together the Spanish Medical Aid Committee. We had three doctors on the committee, one representing the T.U.C., and I became its honorary secretary. It was quite common to raise £1,000 at a meeting, besides plates full of rings, bracelets, brooches, watches and jewellery of all kinds. Isabel and I had a technique for taking collections which was most effective, and, although I was never so effective as Isabel (I was too emotional and likely to burst into tears at a moment's notice), I improved. In the end, either of us could calculate at a glance how much a meeting was worth in hard cash.

That evening Isobel Brown took me to the CPGB's King Street Headquarters. Harry Pollit, about whom I knew but little and whom I had never seen before, turned out to be a warm friendly man with a manner that made personal contact easy. He had with him someone called Campbell who, in contrast to Pollit, seemed curmudgeonly; I felt he disapproved of me and my accent. Since Pollit's manner encouraged the direct approach, I led off by saying that, as he probably must have heard, I was going to Spain with a medical unit supported by all shades of decent opinion in Britain. We were a small unit and I was not going to do anything behind the backs of its members. They would always know what was happening, and I needed to know that nothing would be going on behind my own back. Pollit commented that this seemed to him an entirely right attitude, but why did I feel the need to express it to him? An old hand, like Pollit, would not have returned the ball to an apprentice player like me unless he had wanted the rally to continue. Thus encouraged I went on to say that a party fraction was being established in the Unit and since I was sure that its members had the work as much to heart as the rest of us it was hard to see why it had seemed necessary to create it. I had nothing to hide and nor conceivably could they. I was ready to demonstrate this by making my administration entirely open. With one exception, everyone in the unit had either been pre-selected or approved, by me. Pollit asked who the exception was, and when I said O'Donnel, he let out a laugh in which Cambell did not join. As I did not seem to be getting very far I then played my only other card saying, "If you won't let them come out into the open let me come inside. Let me join you, as we can't have a Unit being pulled two ways". This did indeed provoke Cambell who was emphatic saying that the Party was not a darts club a man can just walk into at will when it suited him. To which I remarked that this was exactly what I felt about the Unit. Pollit seemed to be enjoying himself and came back with a friendly bit about the lad having a point. He went on to say that the Unit was a real Popular Front activity. He asked Campbell to get that well across to O'Donnel and, turning to me he said something like, "The world's very far from perfect. You'll have to take the rough with the smooth out there". Turning to Cambell he said, "I am going to give him something to show that, in the spirit of today, we trust him." To me he added, "Keep it in a safe place like inside your belt. Only use it if you really need to. The party will always back that Medical Unit; you've helped a lot by coming to see us". He went to his desk and typed a few lines, reciting them as he did so, requesting that I should be given every help. He signed it and put a rubber stamp on it. Then, to my surprise, he cut the document down to minimum size with a pair of scissors. When he put in my hands I realised that it was not typed on paper but on a piece of white silk.

That evening Mary Redfern Davies very neatly opened the seam of a leather belt and slipped in the little bit of silk. Until typing these words in 1995, the only people outside Pollit's office to know of the existence of that scrap of silk have been myself, Mary Redfern Davies and Thora Silverthorn. It is just possible that when O'Donnel was told to behave himself, he was also told that I was carrying a word from Harry Pollit. I was to have reason to consider this a year later.

So on the 23rd of August 1936 a friendly group of relative strangers, dressed in khaki drill from Millet's Army Surplus stores, arrived at Victoria Station. Our destination was Barcelona. For me it was a completely overwhelming occasion; I was dropping with physical fatigue. Seeing us off, we were faced with a galaxy of Mayors in their robes and chains, Trade Union Banners, the leader of the Parliamentary Labour Party Arthur Greenwood, and 10,000 others - all on parade. It was an immensely impressive experience for the staff of that First British Medical Unit. Our little group had not realised before that what we were doing was considered so important. Such a send-off provoked in us all the beginnings of our sense of collective responsibility. One thing that sticks out in my mind about that journey was the solicitude the railway men showed to us everywhere, in England as in France.

Everyone liked and admired Aileen Palmer, an Australian, for her friendliness, devotion, and hard work. Everyone trusted her, although she was a self-confessed party member. Another self-confessed party member was Thora Silverthorne, a highly skilled surgical theatre sister. Despite a hard streak, she was friendly and amusing. I also liked Ruth Prothero, a charming, migrant doctor from Vienna. I talked fluent German and she introduced me to some of her Swiss and German friends. Margot Miller, another Australian, was a journalist and party member. She was a robust, efficient hard worker and later became a well known writer of detective stories. I enjoyed her company. A fifth female member of the original party I never did get to know. She was a complete loner and soon separated from us.

The males were worse than the females. Lord Peter Churchill was a good public relations figure, a fair administrator, and a friendly person; but I was worried that his fairly obvious homosexuality or bisexuality might run the unit into legal trouble, although I knew little of the laws in Spain. Kenneth Sinclair-Loutit, the official leader of the unit, was a likeable medical student and an obvious secret party member, but I did not think that he would be a good leader. He had a weak streak. O'Donnell, the chief administrator, who had made the bad speech in Paris, was even worse when I met him. I thought him stupid, conceited, and erratic. I certainly did not like the idea of his being in charge. The quartermaster, Emmanuel Julius, also seemed second rate and rather schizoid. The only surgeon, Dr. A. Khan, who was studying in the UK for the FRCS, was reserved, non-political, and rather worried. Of the other two male doctors, one was an American, Sollenberger, and the other, Martin, a former member of the Royal Army Medical Corps. I took a poor view of them both. In addition there were two other medical students.

I did not have very close contact with the drivers. Harry Forster, a cheerful London taxi driver, proved a great success as an electrician on one occasion, but he moved on all too quickly. Alec Wainman, a Quaker photographer, was a charming, if neurotic, character, whom I liked but never got to know. Leslie Preger, an open communist, was rather a shocker. He admitted that he had only got into the unit because he had claimed that he spoke Spanish and knew about first aid. Both claims were false, but no one seems to have checked. The remaining drivers were the two Charlies, Hunt and Hurling. They were two young, extrovert, working class volunteers who wanted adventure and women. I enjoyed their presence at first, but they quite definitely disliked me, particularly my Cambridge accent. Fortunately they were not permanent. They motored backwards and forwards between London and Spain, so that I saw them only infrequently.

In July 1937 I got in touch with the committee in England that was sending medical supplies and personnel to work in the hospitals. I agreed to write news for them, to visit the hospitals and find out what the personnel needed in their work, deliver supplies to them and take photographs.

Then began for me a time of hard work, intense living and an education in the wonders of the human mind and behaviour. The personnel of the British Medical Unit was scattered about Spain from Murcia to Aragon. My first problem was transport... Many a time I waited on the Madrid road and begged a ride. Once I made the mistake of thinking that telegraph wire would make a good seat. I sat at the back of the truck and every time it went over a bump I went up in the air and came down hard on my coil of wire. For days afterwards I could not sit down in comfort. Another time I put up an umbrella to keep off the driving rain; that was the last of the umbrella. On these journeys I used to carry a blue flannel dressing gown which I wrapped round my shoulders and head in the manner of a shawl, until the happy day when I bought a real sheepskin jacket with the wool inside. It probably looked just as funny but I kept warm. I reached the Teruel Front in January by ambulance, truck and car.' The roads were so deep in snow that at one hill we had to get out and, roping the ambulance, six of us let it clown the hill while the driver tried to guide it straight....

When the famous Ebro offensive of 1938 began I went up to that front. I found our people working in a large cave in the side of a mountain. It was not far from the river and only the worst cases were brought in there. Men died as I stood beside them. It was summer time and they had been in long training before they crossed the Ebro. Their bodies were brown and beautiful. We would bend over to take their last whispers and the message was always the same: "We are doing well. Tell them to fight on ... till the final victory."

It is so hard to make a man, and so easy to blast him into death. I shall never forget the Ebro. If one went for a walk away from the cave there was the smell of death.

I arrived in Barcelona in April 1937 in a mixed state of exaltation and despair and wearing a brand-new ambulance driver's outfit in which a cynical friend in London had pretended to mistake me for one of Hitler's Brownshirts. My exaltation sprang from the thought that I was preparing to risk my life for socialism, or the European working class, or something, and my despair from a more down-to-earth appreciation of my motives: I was making use of Spain as an escape from an impasse in England. I was in Barcelona just long enough to learn that Orwell and his wife were in danger of imprisonment or worse as "Trotskyists", and then proceeded to Valencia where the comrades in charge of the British medical aid services turned out to be an English peer, who might have come straight from Pall Mall, and an Anglo-Italian peeress, who might have come straight from the Lido. With an English friend, Robert Wheeler, I was drafted to an American-run hospital about fifty miles from Madrid, and for the next month or so I spoke to scarcely anyone except Americans, nearly all of whom came from New York and, to my surprise, talked Yiddish among themselves. There were not many patients in the hospital, but there was one whom everyone dreaded handling and of course it was to Robert and myself, as newcomers, that the job was given.

Existence is a misery. We are afraid to undress night or day because of the bombing.

We have no milk, eggs or potatoes for the typhoid patients (Yet owing to good nursing only 8 per cent died). How Ada makes us laugh when she tries to drink the peculiar liquid which is neither tea, coffee nor cocoa, but a mixture of all. Lillian's morale is never destroyed; I admire her.... By now Dr Saxton has started a canteen in which we sell mouldy bread and jam, cognac and Malaga wine.

We felt cut off. We even lost our radio. I cannot remember whether it was broken, stolen, or confiscated, but its loss increased our sense of isolation. The most political subject discussed was the problem of secret communist meetings and separate reports to the committee and the British Communist party. I was by this time on friendly terms with Sinclair-Loutit, Thora Silverthorne, and Aileen Palmer, and I think I raised the subject with them, pointing out that although we accepted that the communists and secret communists made up most of the unit, we did not think it reasonable for them to hold secret meetings. These were undoubtedly disruptive. I pointed out that three people had already left the unit, possibly because of this. For a time a compromise was reached, in which I was allowed a seat on their committees. I was able to speak but not to vote. Later O'Donnell came up and denounced this, but I think finally the secret meetings were given up. There was also a lot of criticism of Dr Sollenberger as a disruptive element, but he did not leave until much later.

We have become accustomed to air raids although they still worry me a great deal: I dread them. Then she saw a bunch of kiddies killed by another bomb. Its really awful but I can assure you its absolutely true - the nurse told me all about it. Poor dear, she was badly shaken up.

Peter Churchill - he did not use his title in Spain - found a suitable flat to be used as offices and rest centre. Later, a second base was found in Valencia. There was a political problem. At that time, each political group had its own militia, and the strongest political influence in Catalonia was the Anarchist Federation (FAR The POUM (Workers' Party of Marxist Unity, an ultra-left party of former Communists and former followers of Trotsky, led by Andres Nin) also had its base in Barcelona. But the Unit decided to link with the United Socialist Party of Catalonia (PSUC), which was affiliated to the Communist Inwrnational and included both Socialists and Communists, and with the Socialist trade union federation, the UGT, with which groups the SMAC and the members of the Unit were more in sympathy.

Where should they set up the hospital? Churchill lead been one of the youngest staff officers in the 1914-18 war and, using his experience, he took a Michelin map and chose Granen, about eighteen kilometres behind the Aragon front, near Huesca. Granen was the railhead for Barcelona and Lerida, and also a road junction. It had good access to the whole front, and if they had to retreat there was more than one way out.

Churchill and Sinclair-Loutit drove to Granen to find suitable accommodation for a hospital, going in Cochrane's car, which was "liberated' by Anarchists during the expedition. They were helped by Churchill's friend, Stanley Richardson, who had joined him on the way and was a fine interpreter.

The rest of the Unit travelled up by road on 3 September. Thora Silverthorne had had the foresight to fill a case with sweets, and these made them popular with children on the way.

The farm buildings chosen were very suitable for a small hospital: they had been lived in by a small landowner and doctor of fascist sympathies. There was even a sort of surgery, but the place was deep in filth and the attics held the debris of generations. For days everyone - nurses, doctors, drivers and all - were removing barrowloads of muck and were busy cleaning and scrubbing. Water had to be fetched by cart from the river. Harry Forster revealed remarkable skills. He fixed up heating stoves for sterilisers, a washing machine for laundry and reflectors for the lights in operating theatres. The wiring was primitive; there was no main fuse, but, working on an open circuit, he extended power to the whole hospital, dim thought it was when finished. The cleaning had to go on for weeks, but after the first few days there were twenty-five beds available (eventually forty, and seventy in emergencies), and two operating theatres, with nurses ready in starched uniforms.

On the first day, thirty cases arrived. In the first month, the hospital dealt with 811. A letter from Sinclair-Loutit to the Lancet (28 November 1936) recorded that by November the Unit had dealt with 1,523 cases and the ambulances had covered 14,000 miles. The hospital then had a surgical, a medical and a VD ward, two theatres and a reception room. The work was spasmodic. When there was fighting, they worked under pressure. On 25 October Thora Silverstone wrote to her family that the previous week there had been a "terrific rush" - 200 wounded had been brought in in three days. On 25 November she wrote, "the attack on Huesca has actually begun ... we've been doing major operations and working 14-hour days." In between there were long lulls. During the rushes the nurses worked with great dedication and courage under conditions of stress and shortages for which their training had given them no preparation.

There was a high mortality rate from penetrating head wounds. Many patients were Germans - refugees from Hitler who had formed the first Thaelmann Centuria of the International Brigades, which included Ludwig Renn, author of the famous pacifist novel Der Krieg, and whose leader was Hans Beimler, former Communist Deputy to the Reichstag, who was shortly afterwards killed in the defence of Madrid. The Unit was impressed by their bravery, and had plans, should the enemy break through, to join up with them. Casualties included refugees whose villages were being bombed by Franco's planes, and who were coming in from the mountains with wounds and foot ulcers. One was a blind woman in her eighties whose house had been destroyed while she was in the fields, but who only said, "Well, I've lost my house, but there's many a woman who has lost her children." Each day one of the nurses took her turn to care for the refugees and bathe their feet. Rebel casualties were given the same treatment as government wounded. When the villagers heard that one of Franco's young Moorish soldiers had been brought in with a gangrenous leg after lying for days in the sierra, they wanted to lynch him, but, though he was past saving, the hospital performed the amputation and gave him the best treatment until he died.

At first the methods were, in Sinclair-Loutit's words, "pure 1914". There was a first-aid post at the front with two drivers in attendance with stretcher-bearers and one of the nurses. The ambulances went up to the front, by night when they could, along roads that were little more than cow-tracks, and brought in the wounded. Those who were in fit condition were given an anti-tetanus injection and sent by train to hospitals in Barcelona or Zarimora. Those who could not be sent were treated at Grarien. When there was fighting there were too few ambulances, too few members of the team and no X-ray equipment. Urgent calls went to the Committee in London; reinforcements and a second unit were sent. In the end, as Sinclair-Loutit recalled, "Granen was remarkably efficient, rendering real surgical and medical service. It was unique for at least 100 kilometres." It was also the germ of a new kind of front-line mobile hospital.

Life was hard. Thora Silverthorne wrote home (25 November 1936), "We live a very enclosed life; our wireless has been taken away: (censorship of news!), papers from England don't arrive very frequently and we are altogether cut off." It was a new and anxious experience to feel the ground move under their feet when bombs fell. When beds were needed for the wounded, staff slept on stretchers or mattresses on the stone floors of the granary buildings.

This man was an American International Brigader at whose feet a grenade had exploded. In pulling back the bed-clothes, if the sheet brushed against his foot he would scream, "My toes! My toes! Damn you!" and it seemed beyond the limit of horror that a man whose face and body had been pulped should be sensitive even in his toes. What I felt was more like horror than sympathy or pity. Or rather, I learned to my shame, that pity is not incompatible with a feeling of reproach against a man for having got wounded. He seems a bird of ill omen, a bearer of evil tidings. "Look what has happened to me. It could happen to you too.

It's jolly hard work of course. Before we arrived on the scene the wounded had to be dragged down from the mountains on mules.

We've a very nice set of English chauffeurs with us. I should say English speaking there are also Americans and there was a Canadian. One of them John Boulting, who used to have long hair, states that he came to tea with you with Bill Ball before he left for Spain. In the last two battles our chauffeurs who have to go right up near the front line with their ambulances have had heavy casualties - 4 killed, 2 missing, I wounded, I seriously ill.

The group had been in Albacete a few days when Neumann, a delegate from Andre Marty, came to tell them they were being attached to the XIVth Brigade under its Medical Officer (MO) Dr Dubois, a courageous and flamboyant Pole, trained in France, whose real name was Domanski. This was the Franco-Belgian Brigade, but at the time Number One British Companywas part of it, commanded by George Nathan, a former British army officer, known as a fine soldier and something of a dandy. They were also, to their surprise, handed insignia of military rank. Tudor Hart, as the oldest and most experienced doctor - he had qualified at St Thomas's Hospital in 1931 and had been in the Communist Party since 1929 - was put in charge over Sinclair-Loutit, who had gained experience of organisation in wartime conditions while managing the unit at Granen. Sinclair-Loutit would have liked to continue as an administrator and the appointments caused embarrassment and bad feeling for a time among some members of the team. But before very long Sinclair-Loutit was elected as their Political Delegate by the group, and this gave him the rank necessary to administer a military hospital.

Being halfway between Valencia and Madrid, the hospital was often used as a port of call by nondescript people who had come to Spain with vaguely helpful or cryptically political intentions. One of these, a young English Communist or fellow traveller, found some priest's vestments in our disused chapel. He amused himself by dressing up and playing the fool in them, intending no doubt to do some anti-religious propaganda. Then he began to ring the chapel bell. Whereupon an old man working in the garden rushed in with bulging eyes, chattering teeth, almost foaming at the mouth, and snatched the rope away from him. This presumably showed that the bell was an intolerable reminder of hated religious tyranny. But I suppose it is also possible that it was a protest against sacrilege. If it had merely been because the bell was normally used for some other purpose, such as a fire alarm, the old man's frenzy would be inexplicable.

After six months in Spain I was beginning to feel that there was no place for me as an organiser unless I was a Communist or prepared to be a Communist stooge. It would have been easy to get back into the front line ambulance service before the battle of Teruel, and equally easy to take the frequently offered advice: "A man like you is wasted out here. You ought to be back in England doing propaganda." In the end I did neither. I went back to England, but not to "do propaganda", an activity for which I had developed an insuperable distaste. I got in touch in London with the Quakers' Spanish relief organisation and returned to Barcelona to work for it...

Within Spain, however, from mid-1937 to the end of the war in the spring of 1939, the prestige of Stalinism was such that any foreigner who was not a Communist was made to feel at best an outsider and at worst a potential victim of the political police. In this shadowy and impalpable but all-pervading reign of terror the business-like Quaker organisation was an oasis of sanity. Its atmosphere was not particularly inspiring, but it was almost the only foreign organisation in which you knew for certain that everybody had a definite job and was doing it and in which there were no nondescript hangers-on with nominal jobs or none but who nevertheless seemed to be in some mysterious way "on the inside". It was the one organisation in which you felt sure that nobody was a Stalinist heresy-hunter.

A Moor ... had been shot in the leg and so immobilised somewhere in the mountains... Five days before they found him... (he was a) starving wizened little chap with this horrible septic leg... he came in and the leg was crawling with maggots... the Spanish surgeon had to amputate... he was hardly fit to stand an amputation... After the operation he was weaker still, nevertheless the local Anarchist military chief came in and cross examined the poor fellow... He died within a day or so.

Everyone liked and admired Aileen Palmer, an Australian, for her friendliness, devotion, and hard work. They motored backwards and forwards between London and Spain, so that I saw them only infrequently.

Another busy day. A German's leg amputated during the night, and a number from the Battalion of Death (Anarchists) with minor wounds from Tardienta in the a.m. The German had been seven days without food, and his leg was alive with maggots as he had been lying among the fascist wounded. We have had about a dozen fascist wounded prisoners here, treated exactly as other patients, to their astonishment. Also officials who interviewed them questioned them politely.

Later in the day a fair number of wounded were brought in from the Carlos Marx battalion. A lung case and one with 11 perforations in the abdomen were admitted to the ward. A very busy day. The Political Commissar, on the eighth day after his perforated stomach, began vomiting and haemorrhaging. A very bad patient, possibly his own fault, as he drank water from the ice bag. He has been given blood transfusions and all manner of things but he will probably die. It is a hard job getting used to the ward in these conditions. Two hernia operations were done today as well.

How willing was the British Establishment to learn from the Spanish experience? There were those who were put off because the new ideas were coming from the "wrong side", and there were those who were conservative because the medical and military Establishments had almost always been conservative. But there were others who, whatever their politics, had ears for those who had been in Spain, especially as it looked ever more likely as the months passed that Britain, too, would soon be at war.

When Sinclair-Loutit returned to St Bartholomew's Hospital in the summer of 1937 to complete his training, he found that a number of influential people wanted to hear about his medical experiences. Sir Girling Ball, the Dean of Bart's, spent a long time questioning him, and Sinclair-Loutit wrote articles in the St Bartholemew's Hospital Journal on medicine in Republican Spain, These showed the way in which the organisation of front-line services and the triage principle could be applied in case of air raids on London. Others who showed interest included Lord Horder, the King's Physician, and Wing-Commander Hodsoll, Inspector General of Air Raid Precautions. These people were Conservatives, but they were also pragmatists.

Two who were particularly interested in the Spanish experience were E.M. Cowell and P.H. Mitchener. They listened to Sinclair-Loutit, and Cowell visited Trueta in Barcelona in 1938, together with other doctors. In 1939 he and Mitchener used the Spanish lessons in their Organisation and Practice in Air-Raids. Later, Cowell was General in charge of the RAMC in North Africa and Mitchener a leading surgeon in his service.

As war loomed, some British doctors became interested in the idea of blood banks. On 7 May 1937 the Manchester Guardian, and on 5 June the Lancet, carried accounts of Duran-Jorda's service. That month the Summer Meeting of the Association of Clinical Pathologists heard a report of the Spanish transfusion organisation. Duran Jorda published a monograph in 1937 and, through 1937 and 1938 and into 1939, the Lancet carried reports from Saxton about his blood-transfusion work. Further advances in the USSR and the USA were also reported.

Spanish Medical Aid Committee - History

The Influenza Pandemic of 1918

The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.

The Grim Reaper by Louis Raemaekers

In the fall of 1918 the Great War in Europe was winding down and peace was on the horizon. The Americans had joined in the fight, bringing the Allies closer to victory against the Germans. Deep within the trenches these men lived through some of the most brutal conditions of life, which it seemed could not be any worse. Then, in pockets across the globe, something erupted that seemed as benign as the common cold. The influenza of that season, however, was far more than a cold. In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children. It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influenza during the pandemic, ten times as many as in the world war. Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy (Deseret News). An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby). 1918 would go down as unforgettable year of suffering and death and yet of peace. As noted in the Journal of the American Medical Association final edition of 1918:

"The 1918 has gone: a year momentous as the termination of the most cruel war in the annals of the human race a year which marked, the end at least for a time, of man's destruction of man unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918).

An Emergency Hospital for Influenza Patients

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. In 1918 children would skip rope to the rhyme (Crawford):

I had a little bird, Its name was Enza. I opened the window, And in-flu-enza.

The influenza pandemic circled the globe. Most of humanity felt the effects of this strain of the influenza virus. It spread following the path of its human carriers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people (Brown). The Great War, with its mass movements of men in armies and aboard ships, probably aided in its rapid diffusion and attack. The origins of the deadly flu disease were unknown but widely speculated upon. Some of the allies thought of the epidemic as a biological warfare tool of the Germans. Many thought it was a result of the trench warfare, the use of mustard gases and the generated "smoke and fumes" of the war. A national campaign began using the ready rhetoric of war to fight the new enemy of microscopic proportions. A study attempted to reason why the disease had been so devastating in certain localized regions, looking at the climate, the weather and the racial composition of cities. They found humidity to be linked with more severe epidemics as it "fosters the dissemination of the bacteria," (Committee on Atmosphere and Man, 1923). Meanwhile the new sciences of the infectious agents and immunology were racing to come up with a vaccine or therapy to stop the epidemics.

The experiences of people in military camps encountering the influenza pandemic:

An excerpt for the memoirs of a survivor at Camp Funston of the pandemic Survivor

A letter to a fellow physician describing conditions during the influenza epidemic at Camp Devens

A collection of letters of a soldier stationed in Camp Funston Soldier

The origins of this influenza variant is not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized. The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918). However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. Wilson had just given his 14 point address. There was virtually no response or acknowledgment to the epidemics in March and April in the military camps. It was unfortunate that no steps were taken to prepare for the usual recrudescence of the virulent influenza strain in the winter. The lack of action was later criticized when the epidemic could not be ignored in the winter of 1918 (BMJ, 1918). These first epidemics at training camps were a sign of what was coming in greater magnitude in the fall and winter of 1918 to the entire world.

The war brought the virus back into the US for the second wave of the epidemic. It first arrived in Boston in September of 1918 through the port busy with war shipments of machinery and supplies. The war also enabled the virus to spread and diffuse. Men across the nation were mobilizing to join the military and the cause. As they came together, they brought the virus with them and to those they contacted. The virus killed almost 200,00 in October of 1918 alone. In November 11 of 1918 the end of the war enabled a resurgence. As people celebrated Armistice Day with parades and large partiess, a complete disaster from the public health standpoint, a rebirth of the epidemic occurred in some cities. The flu that winter was beyond imagination as millions were infected and thousands died. Just as the war had effected the course of influenza, influenza affected the war. Entire fleets were ill with the disease and men on the front were too sick to fight. The flu was devastating to both sides, killing more men than their own weapons could.

With the military patients coming home from the war with battle wounds and mustard gas burns, hospital facilities and staff were taxed to the limit. This created a shortage of physicians, especially in the civilian sector as many had been lost for service with the military. Since the medical practitioners were away with the troops, only the medical students were left to care for the sick. Third and forth year classes were closed and the students assigned jobs as interns or nurses (Starr,1976). One article noted that "depletion has been carried to such an extent that the practitioners are brought very near the breaking point," (BMJ, 11/2/1918). The shortage was further confounded by the added loss of physicians to the epidemic. In the U.S., the Red Cross had to recruit more volunteers to contribute to the new cause at home of fighting the influenza epidemic. To respond with the fullest utilization of nurses, volunteers and medical supplies, the Red Cross created a National Committee on Influenza. It was involved in both military and civilian sectors to mobilize all forces to fight Spanish influenza (Crosby, 1989). In some areas of the US, the nursing shortage was so acute that the Red Cross had to ask local businesses to allow workers to have the day off if they volunteer in the hospitals at night (Deseret News). Emergency hospitals were created to take in the patients from the US and those arriving sick from overseas.

The pandemic affected everyone. With one-quarter of the US and one-fifth of the world infected with the influenza, it was impossible to escape from the illness. Even President Woodrow Wilson suffered from the flu in early 1919 while negotiating the crucial treaty of Versailles to end the World War (Tice). Those who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales, funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers (Deseret News). Bodies pilled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers (Knox). The conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages.

In 1918-19 this deadly influenza pandemic erupted during the final stages of World War I. Nations were already attempting to deal with the effects and costs of the war. Propaganda campaigns and war restrictions and rations had been implemented by governments. Nationalism pervaded as people accepted government authority. This allowed the public health departments to easily step in and implement their restrictive measures. The war also gave science greater importance as governments relied on scientists, now armed with the new germ theory and the development of antiseptic surgery, to design vaccines and reduce mortalities of disease and battle wounds. Their new technologies could preserve the men on the front and ultimately save the world. These conditions created by World War I, together with the current social attitudes and ideas, led to the relatively calm response of the public and application of scientific ideas. People allowed for strict measures and loss of freedom during the war as they submitted to the needs of the nation ahead of their personal needs. They had accepted the limitations placed with rationing and drafting. The responses of the public health officials reflected the new allegiance to science and the wartime society. The medical and scientific communities had developed new theories and applied them to prevention, diagnostics and treatment of the influenza patients.

‘Wear a Mask and Save Your Life!’

The PSA in the Chronicle appeared on October 22, just over a week before San Francisco had scheduled its mask ordinance to begin on November 1. It was signed by the mayor, the city’s board of health, the American Red Cross and several other departments and organizations, and it was very clear about its message: “Wear a Mask and Save Your Life!”

For the most part, San Franciscans listened.

“Red Cross headquarters in San Francisco made 5,000 masks available to the public at 11:00 A.M., October 22. By noon it had none,” wrote the late historian Alfred W. Crosby in America&aposs Forgotten Pandemic: The Influenza of 1918. 𠇋y noon the next day Red Cross headquarters had dispensed 40,000 masks. By the twenty-sixth 100,000 had been distributed in the city… In addition, San Franciscans were making thousands for themselves.”

The Second Decade: Expanding Nationwide

During the second decade, roughly from 2004 to 2014, we focused on expanding to new frontiers on a state-by-state basis, accomplishing policy reform in both Washington and Vermont.

In addition, from 2001 to 2006 we defended Oregon’s law against U.S. Attorney General John Ashcroft who attempted to block it by authorizing federal drug agents to prosecute doctors who prescribed life-ending medication to help terminally ill patients die. In January 2006, the US Supreme Court voted 6 to 3 in favor of Death with Dignity in the case of Gonzales v. Oregon, ruling that former Attorney General John Ashcroft overstepped his authority in attempting to prosecute Oregon’s physicians and pharmacists.

In 2008, we successfully led the coalition for Yes on I-1000, Washington State’s Death with Dignity campaign, to a 58 percent to 42 percent victory. The Washington Death with Dignity Act went into effect in March 2009.

In 2011, we partnered with with Patient Choices Vermont to help pass Death with Dignity legislation through the state legislature. We also established a steering committee in Massachusetts to explore a ballot initiative in 2012. The effort transitioned into Death with Dignity 2012, the group that successfully put the issue on the ballot. The measure, Question 2, was narrowly defeated 51 percent to 49 percent.

In 2013, the Vermont legislature passed and Governor Shumlin signed Act 39, the Patient Choices and Control at the End of Life Act, the first Death with Dignity statute in the US adopted through the legislative route.

In late 2014, we began working with legislators in California to draft a Death with Dignity bill. The California End of Life Option Act ultimately passed in September 2015 and Governor Brown signed it on October 5. The law went into effect on June 9, 2016.

Contagion: Historical Views of Diseases and Epidemics

Offering valuable insights to students of the history of medicine and to researchers seeking an historical context for current epidemiology, this collection contributes to the understanding of the global, social–history, and public–policy implications of disease.

The collection provides general background information on diseases and epidemics worldwide, and is organized around significant “episodes” of contagious disease.

These materials include digitized copies of books, serials, pamphlets, incunabula, and manuscripts — a total of more than 500,000 pages — many of which contain visual materials, such as:

The collection also includes two unique sets of visual materials from the Center for the History of Medicine at Harvard’s Francis A. Countway Library of Medicine.

Library materials and archival materials are supplemented by explanatory pages that introduce concepts related to diseases and epidemics, historical approaches to medicine, and notable men and women.

The Bulletin includes information on all aspects of USMLE, such as eligibility requirements, scheduling test dates, testing, and score reporting. You must review and become familiar with the Bulletin before completing your application for USMLE Step 1, Step 2 (CK and CS), or Step 3. Start reading the Bulletin of Information »

Check out the Frequently Asked Questions. If you still can't find answers, contact us.

Influenza Encyclopedia

When the Norwegian vessel Bergensfjord steamed into New York City’s harbor on August 11, 1918, an unusual welcoming committee awaited on shore. The ship held 11 crew and ten passengers infected with a new and particularly aggressive form of influenza. On the pier were ambulances and health officer for the Port of New York, who immediately whisked the ill sailors to a city hospital. Sailors who had become ill during the voyage but were now recovering as well as those in contact with the sick while on board where put under close surveillance by New York City Department of Health nurses.1 New York – no stranger to epidemics – had a long-standing tradition of disease surveillance, isolation, and quarantine, and it was this mechanism that went into immediate effect.

Over the course of the next several weeks, more ships bearing ill sailors arrived at New York harbor. On August 16, the Nieuw Amsterdam arrived in New York from Rotterdam, with 22 passengers aboard sick with influenza. On September 4, a French liner Rochambeau arrived with 22 new cases of influenza on board two victims had already died at sea. The city’s health department placed all the ill men in isolation at the Willard Parker Hospital on East 16th Street and at the French Hospital on W. 34th Street.2 In an attempt to lessen the likelihood of influenza spreading to New York’s population, health commissioner Dr. Royal S. Copeland placed the entire Port of New York under quarantine on September 12. The difficulty, Copeland admitted, was that other East Coast ports may not be as rigid in their methods of disease control, therefore allowing influenza to enter New York from another city.3 A few days later, 23 new cases were discovered among sailors from the United States Navy.4 Then, on September 16, thirteen seamen were discovered ill with influenza and transferred from their naval training ship to the Kingston Avenue Hospital in Brooklyn. Copeland told the public that there was no need for alarm.5

Still, Copeland tightened the city’s disease control measures. On September 17, the city’s Board of Health added influenza to the list of reportable diseases, thus, according to the sanitary code, requiring all cases to be isolated.6 Copeland announced that homes with cases would be quarantined while the patient recovered, while cases in tenements would be isolated in a city hospital. The move came none too soon: three civilian and two military cases were discovered the next day and placed under isolation.7 Copeland worried that the disease would spread to New York’s schoolchildren, and he cautioned schools to send home children who were sneezing or coughing in class. To the general public, he had signs printed and distributed warning of the dangers of influenza, how to prevent it, and how to treat it.8 He also met with representatives from theaters, movie houses, and public transportation to enlist the aid of managers in preventing the spread of influenza.9 Meanwhile, Dr. William H. Park, head of the city’s Bureau of Laboratories, busied himself and his staff with trying to identify the causative microbe in the hopes of developing a vaccine.1

By September 24, New York had well over 100 new cases of influenza with which to deal. Copeland worried about the growing number of cases and his ability to isolate them all. Given that the case rate was likely to rise quickly, hospitals would soon no longer be able to place cases in isolation wards general wards would have to be opened to influenza patients. He sent instructions to hospitals on how to handle epidemic caseloads.11 Four days later, city physicians reported an additional 324 cases, with Brooklyn being the worst hit borough. Copeland remained calm, telling reporters and residents that there was no cause for alarm. New York had experienced a total of approximately 1,000 influenza cases thus far, he said, only a tiny percentage of the city’s 5.6 million population. He did ask the city government for $5,000 with which to fight the growing epidemic, however. The Board of Estimate, so impressed with Copeland’s appeal and the seriousness of the situation, appropriated five times that amount, and gave the health commissioner $25,000 in emergency funds.12

Unlike the health commissioners of other American cities, Copeland’s strategy for combating the epidemic was not to issue closure orders, but rather to quickly identify and isolate those who fell ill. He reiterated to the public the need to put sick family members in their own room while they recovered and to limit contact with that person for the duration of their illness. Health officials isolated as many cases as they could in city hospital wards. Examination rooms were established at Pennsylvania and Grand Central stations, where a nurse and physician team at each could examine all passengers who arrived feeling ill. Those found to be suffering from influenza were removed to a hospital or put in the care of friends and not allowed to continue on public transportation.13 New York’s schools, which had a long-standing program of child health monitoring and care, were kept open. Under the direction of Dr. S. Josephine Baker, director of the Department of Health’s Bureau of Child Hygiene, school physicians inspected children each morning and sick students were sent home. In school, classes were kept separate from each other, and all students were instructed to go straight from school to their homes at the end of the day and not to mingle or form crowds.14 “We have no intention at this time of closing the schools,” Copeland stated, “as I believe that the children are better protected in the schools than they would be in the streets.”15 New York’s schools remained open for the duration of the epidemic.

By the first days of October, New York’s epidemic started getting under way in earnest. On October 4, physicians reported 999 new influenza cases for the previous 24-hour period, bringing the total number of cases since the start of the epidemic to approximately 4,000. Nearly 700 of those cases were among the city’s schoolchildren. The Brownsville section of Brooklyn was particularly hard hit, and all of the borough’s hospitals were overcrowded. Still, Copeland was sanguine about the situation. Putting these figures in perspective, he told the public that Massachusetts – a state with half the population of New York City – had 100,000 cases of influenza. There was still no need to issue a closure order, he added.16

Yet, Copeland did not stand idly by and watch the epidemic unfold. On October 4, he and the board of health resolved that the epidemic of influenza, “while not alarming at the present moment, necessitates care on the part of the citizens of the City of New York.” In conjunction with business owners, the board therefore enacted a staggered schedule for all stores except those selling food and drugs in the hopes of reducing congestion on public transportation. Businesses that normally opened before 8:00 am or closed after 6:00 pm were not affected. All other stores and offices, however, were required to hold to a new schedule that staggered opening and closing times in fifteen-minute increments. Each of the city’s 46 theaters and movie houses was assigned a specific opening schedule between 7:00 pm and 9:00 pm to spread out the evening entertainment crowds. 17 That evening, the first of a series of explosions rocked the T. A. Gillespie Shell Loading Plant in the Morgan section of South Amboy, New Jersey, across the Raritan Bay from the southern tip of Staten Island. The explosion triggered a fire and more explosions that lasted three days, forcing the evacuation of South Amboy as well as nearby Perth Amboy and Sayreville. In the chaos of the mass exodus, thousands fled their homes, with many traveling to New York for refuge. The next afternoon, city officials closed the bridges and halted subway traffic, leaving thousands to cram aboard the ferries as they fought their way to and from home. On the very day that Copeland intended to begin a program to lessen congestion on public transportation, the Gillespie explosion caused the exact opposite. With little it could do to control the situation, the board of health delayed implementation of the staggered business hours until Monday, October 7.18

Meanwhile, new cases tallies continued to mount: 2,000 on October 9, then 3,100 on October 11, and some 4,300 on October 12.19 Copeland believed that dirty and crowded theaters were a major culprit in the spread of the epidemic, and on October 11 he announced that individual theaters would be allowed to remain open only if they were well ventilated, clean, and did not allow patrons to cough, sneeze, or smoke. A next day, the health department closed several theaters due to failure to meet the new sanitary codes. Several others closed because of low attendance.20

The surging cases taxed the city’s resources, and Copeland realized that he and the health department needed help in combating the epidemic. On October 12, he created a special Emergency Advisory Committee to assist him. Included were representatives of private and public city hospitals, institutional and home nursing, the Red Cross, merchants, social services, the United States Public Health Service, and the city’s Department of Education.21 One of the first orders of business was to divide the city into 45 districts (eventually increased to 150) to help distribute resources.22 As in nearly every community across the nation, the severe shortage of nurses and the care they provided was the most pressing problem. Community organizations across the city pitched-in, organizing volunteer nurses, collected food and supplies for needy families, and offering their automobiles for ambulance services and doctors’ calls. Lillian Wald, pioneer of the visiting nurse profession and champion for health care services for the poor, volunteered her formidable nursing organization, the Henry Street Settlement in the lower East Side of Manhattan, to manage home nursing across the city. The head of Mayor John Hylan’s Committee of Women on National Defense, Millicent Hearst (wife of newspaper tycoon William Randolph Hearst), was appointed chair of a special committee to help coordinate food relief and transportation for visiting nurses.23 The Red Cross, the Henry Street Settlement, the Brooklyn Visiting Nurses Association and several other volunteer organizations organized an Emergency Nurses’ Council to help recruit nurses and allocate medical care, and to organize volunteers for door-to-door canvassing of homes with influenza cases.24 New York University and Bellevue Hospital put their third-year medical students to work as volunteers in the cause.25 Across the city, people and organizations volunteered their services to help bring an end to the epidemic and to alleviate the suffering of the ill.

The epidemic continued to grow worse. On October 19, physicians reported 4,875 new cases of influenza. Some began to grow impatient, and took their frustrations out on Copeland and Mayor Hylan. In Staten Island, several shipbuilding companies reported a 40 per cent drop in productivity due to sick employees unable to show for work. Acting on behalf of the shipyards, Richmond Borough President Calvin Van Name implored Hylan to order Copeland to close Staten Island theaters, saloons, and other places of amusement in the hopes of bringing a swift end to the epidemic.26 Business owners prepared to counter any such move. A few days later, the deputy police commissioner asked Copeland to close movie houses and dance halls on Staten Island.27 One city doctor, a representative of the Medical Society of New York County, complained that the health department neglected to quarantine every passenger on the Bergensfjord when it arrived in August, and instead only isolated the sick crew.28 Former health commissioner and now Superintendant of Mount Sinai Hospital, S. S. Goldwater, protested Copeland’s decision to keep the city’s schools open during the epidemic. He believed that the “paper program,” as he called it, of monitoring students for illness was sound, but that there was “almost criminal laxity” in carrying out the program. As a result, he argued, sick children were not being excluded from school.29

Copeland would not budge. First, he believed that the epidemic would soon crest and then decline. He also believed that the school program was working, and cited evidence indicating that at least half of the absences in school were not due to illness but to overly concerned parents who decided to keep their children home.30 Mayor Hylan stood by his health commissioner. Responding to told Van Name and Goldwater, Hylan stated that he would not meddle with Copeland’s authority. “Dr. Copeland has been placed in charge of the Health Department,” he wrote to Van Name, “and I will not interfere with him at the behest of a former incumbent of the office who is attempting to take advantage of a very grave and serious condition that is a menace to the public health to advertise himself and to encumber the work that Dr. Copeland is seeking to accomplish.”31 Copeland responded to Van Name in a less acerbic tone. Citing death rates from Boston, Baltimore, Washington, DC, and Philadelphia – all cities that had enacted closure orders – Copeland wrote Van Name that New York City had weathered the epidemic thus far with much better results. He added that his department had closely monitored Staten Island’s epidemic and had worked to procure hospital beds, nursing care, and other resources for the community. “It is my judgment that when the history of the influenza epidemic in America is written,” he wrote, “as an official of the City of New York you will not be ashamed of the chapter devoted to the care of this metropolis.”32 Copeland did close several movie houses and dance halls in Staten Island for failing to maintain proper ventilation and sanitary conditions.33 As a nod to local power, he and the board of health amended the New York Sanitary Code to give each borough’s assistant sanitary superintendent the authority to close public places where food and drink were handled or stored if those places were found to be in an unsanitary condition. The board also made coughing and sneezing without covering your nose or mouth a misdemeanor.34

Volunteers, city workers, and health officials continued their work. The volunteers at the Winifred Wheeler Day Nursery at the East Side House Settlement (then located in Manhattan’s Upper East Side) created a day nursery to care for 100 children who could not go home because family members were too ill to care for them.35 Dr. H. G. MacAdam, chief of Department of Health’s Institutional Inspection division, personally took charge of finding lodging for influenza orphans. “I look on myself as the official ‘daddy’ of all these little ‘shavers,’ and will work day and night to see that they do not contract the influenza,” he declared.36 The women of the Emergency Committee and its affiliated organizations worked day and night to organize nurses and relief work. By late-October, these women were feeding and caring for over 3,000 New Yorkers each day.37

Copeland himself worked tirelessly on combating the epidemic, finding hospital beds for patients, ensuring theaters and movie houses were properly ventilated, allocating resources and manpower, and on trying to win over his detractors. With more than 2,000 bodies of influenza victims awaiting burial in Queens, Copeland arranged for 50 city street sweepers to work as gravediggers at Cavalry Cemetery, and had Brooklyn Borough President Edward Riegelmann dispatch an additional 25 men from his borough to assist.38 Eventually, the stress of working round-the-clock for five weeks straight took its toll on the beleaguered health commissioner he was unable to work on Sunday, October 27 and spent the entire day resting in bed with exhaustion. Copeland was back at work the next morning.39 His son, however, did not fare quite as well. Although he recovered, the 8-year-old fell ill with influenza in late-October. His school, the private Ethical Culture School at 33 Central Park West, had been closed since October 20 because of parents’ and teachers’ fear of influenza. Copeland said this was further proof that children were safer in schools than playing in the streets.40

By November, New York’s epidemic situation had improved sufficiently for Copeland to announce the disbanding of the Emergency Committee and a return to normal operating hours for businesses. On November 1, Copeland met with his Advisory Committee and representatives from the various nursing and relief agencies to receive their final reports and to thank the members for their hard work during the city’s epidemic.41 The next day, he announced that the staggered business hour plan would be removed, and on November 4 the board of health met and resolved to rescind the October amendments to the Sanitary Code. Beginning the evening of Tuesday, November 5, businesses could return to their normal hours.42 Smoking in theaters could resume, but establishments would still be required to maintain proper ventilation and to prevent crowding. Just over 700 cases were reported for the day, a drastic decline from the daily tallies of the previous weeks.43 New York’s epidemic was over.

November was a time for hope and renewal. With the end of the epidemic – although influenza continued to circulate for the next several months – New Yorkers could begin to piece their lives back together. On November 11, city residents celebrated the end of the Great War with wild abandon. In a victory parade, Mayor Hylan led a throng of city employees in a triumphant and jubilant march up Fifth Avenue as celebrants showered them in confetti. Among the marchers were more than 200 men and women from the Department of Health who were applauded by crowd for their role in ending the epidemic. “Look at the bunch that put the ‘flu’ out of business!” was the cheer.44

In an interview with the New York Times printed on November 17, Copeland recounted the story of New York’s recent epidemic and offered his argument for why the city had fared so well while other East Coast cities had been so hard-hit. First, he said, the health department worked to isolate the early cases coming from ships landing at the port. Once cases began to appear amongst the resident population and the disease gained a foothold in the city, the health department turned its full attention to combating the epidemic, organizing several advisory panels and committees and working in cooperation with volunteer organizations to allocate resources, recruit and direct nurses, and relieve the suffering of the ill and their families. Unlike other cities, he said, New York did not issue school closure orders. “They may have been just the right things to do in those places I don’t know their conditions,” he wrote. “But I do know the conditions of New York, and I know that in our city one of the most important methods of disease control is the public school system.” Three-quarters of New York’s one million schoolchildren live in tenements, he said, where their homes were frequently crowded and unsanitary and where their parents were primarily occupied in putting food on the table and keeping a roof over their heads. Those parents simply could not afford the time or money to provide proper medical attention. It was much better, therefore, to keep the schools open so that children could be monitored for illness by school physicians and nurses.

As for theaters and movie houses, Copeland said that the big, modern establishments were not places that spread influenza. The smaller, hole-in-the-wall theaters that had improper ventilation were problematic, and his department worked hard to close those establishments until the issues could be rectified. Those theaters that remained open were made “centres of public health education” through instructions on proper cough and sneeze etiquette, information on how influenza spreads, and instructions on how to properly treat and recover from the disease. By keeping theaters and places of amusement open, Copeland said, he helped maintain morale and kept the city from “going mad on the subject of influenza.”

Copeland’s greatest anxiety was public transportation, especially subways, which he believed were the most dangerous of all public places because of the tremendous crowding they caused. People who are sick, he argued, do not go to theaters or churches. They do, however, still go to work. Thus, he worked to make sure subways were well ventilated and he asked the board of health to pass the temporary staggered business hour amendment to the city’s sanitary code.

Ending the interview, Copeland compared New York to other East Coast cities. His city had done better than Boston, Washington, Baltimore, or Philadelphia, all places that had issued closure orders. Why? Copeland attributed it to New York’s long history of fine and efficient public health work and to a health department that had worked diligently for the previous two decades to alleviate unhealthy conditions in the streets, tenements, shops, and restaurants. “The fact that the death rate was kept down so low, and that the epidemic did not assume more alarming proportions,” he said, “is a wonderful tribute to the city’s health control in years past.”45 Through the tireless actions of Copeland and his staff at the health department, and through the amazing volunteer work of the city’s relief organizations, New York was able to weather its epidemic with a significantly lower morbidity and mortality rate than other nearby cities. Overall, from September 15 through November 16 – the period of New York’s epidemic – the city experienced nearly 147,000 cases influenza and pneumonia, which resulted in 20,608 deaths.46 These figures gave New York an excess death rate of 452 per 100,000 individuals, the lowest on the Eastern seaboard. Copeland could be proud of his city of the work he did.


1 “Early Manifestations of Influenza from Transatlantic Vessels Arriving at New York,” Box 146, Folder 1622, Record Group 90 – Records of the United States Public Health Service, National Archives and Records Administration, College Park, MD “Epidemiology and Administrative Control of Influenza. Address by Louis I. Harris, Director of the Bureau of Preventable Disease, New York City Department of Health, delivered at a meeting of the Eastern Medical Society, Oct. 11, 1918, and published in the New York Medical Journal,108:7 (26 October 26, 1918).

2 “Early Manifestations of Influenza from Transatlantic Vessels Arriving at New York,” Box 146, Folder 1622, Record Group 90 – Records of the United States Public Health Service, National Archives and Records Administration, College Park, MD.

3 “Quarantine Put in Force to Check Influenza Here,” New York American, 12 Sept. 1918, 1.

4 “To Fight Spanish Grip,” New York Times, 16 Sept. 1918, 16.

5 “Influenza Attacks 13 on Naval Training Ship,” New York American, 17 Sept. 1918, 11.

6 Minutes of Department of Health of the City of New York, 17 September 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY Sanitary Code of the Board of Health of the Department of Health of the City of New York (New York, 1920), 37-40. The sanitary code was reprinted in 1920 with the revisions and amendments made during the previous several years.

7 “New York Prepared for Influenza,” New York Times, 19 Sept. 1918, 11.

8 “66 Dead of Influenza in Naval Ranks,” New York American, 19 Sept. 1918, 3 “47 New Cases of Influenza are Reported,” New York American, 20 Sept. 1918, 11.

9 “F. D. Roosevelt Spanish Flu Victim,” New York Times, 20 Sept. 1918, 14.

10 “Influenza on Wane in City,” New York American, 21 Sept. 1918, 5.

11 “Find 114 New Cases of Influenza Here,” New York Times, 24 Sept. 1918, 9.

12 “New Influenza Cases in the City Doubled,” New York Times, 28 Sept. 1918, 10.

13 “85,000 in Bay State Ill with Influenza,” New York Times, 30 Sept. 1918, 9.

14 Baker, S. Josephine. Fighting for Life. (New York: The MacMillan Company, 1939), 155-56.

15 “$25,000 Voted to Fight Grip Epidemic Here,” New York American, 28 Sept. 1918, 11.

16 “Spanish Grip Seizes 999 in One Day Here,” New York American, 4 Oct. 1918, 11.

17 Minutes of Department of Health of the City of New York, 4 October 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY.

18 “Revise Timetable in Influenza Fight,” New York Times, 6 Oct. 1918, 1.

19 “Spanish Grip Here Jumps 60 per cent,” New York American, 9 Oct. 1918, 11 “157 in 3,077 New Cases of Grip Succumb,” New York American, 11 Oct. 1918, 13’ “Health Board Orders Masks as Grip Grows, New York American, 12 Oct. 1918, 13.

20 Minutes of Department of Health of the City of New York, 11 October 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY “Fight Stiffens Here Against Influenza,” New York Times, 12 Oct. 1918, 13. Initially, Copeland required that theaters not admit children 12 years of age or younger, but quickly rescinded restriction when it became apparent that most theater managers were following the new sanitary codes. See “Asks Experts’ Aid to Check Epidemic,” New York Times, 13 Oct. 1918, 18.

21 “Asks Expert’s Aid to Check Epidemic,” New York Times, 13 Oct. 1918, 18 Copeland to Lillian Wald, 12 October 1918, Reel 9, Box 11, Folder 5, Lillian D. Wald Papers, New York Public Library, New York, NY.

22 “Will District City in Influenza Fight,” New York Times, 15 Oct. 1918, 10.

23 “Emergent Aid Corps Named to Fight Grip,” New York American, 15 Oct. 1918, 11.

24 “Fight Stiffens Here against Influenza,” New York Times, 12 Oct. 1918, 13.

25 “Copeland Asks Aid in Influenza Fight,” New York Times, 16 Oct. 1918, 24.

26 “Copeland Refuses to Close Schools,” New York Times, 19 Oct. 1918, 24.

27 “Influenza on Wane in Manhattan,” New York American, 23 Oct. 1918, 11.

28 “Influenza Cases Drop 305 in City, New York Times, 21 Oct. 1918, 12.

29 “Asks Expert’s Aid to Check Epidemic,” New York Times, 13 Oct. 1918, 18.

30 “Copeland Refuses to Close Schools,” New York Times, 19 Oct. 1918, 24.

31 “City Reports Drop in Influenza Cases,” New York Times, 20 Oct. 9.

32 Copeland to Van Name, 4 Nov. 1918, Mayor John Hylan Papers, Correspondence Received, Department of Health, Box 72, folder 796, New York City Municipal Archives, New York, NY.

33 “Grip Wanes, But Copeland Urges Care,” New York American, 25 Oct. 1918, 9.

34 Minutes of Department of Health of the City of New York, 19 October 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY.

35 “Nursery Taken over By Women,” New York American, 25 Oct. 1918, 9.

36 “Dr. MacAdam Now ‘Daddy’ to Well Babies,” New York American, 28 Oct. 1918, 5.

37 “Sunday Grip Aid Given by Women,” New York American, 28 Oct. 1918, 5.

38 Copeland to Hylan, 29 October 1918, Box 72, folder 795, Mayor John F. Hylan Papers, Correspondence Received, Department of Health, Box 72, folder 796, New York City Municipal Archives, New York, NY.

39 “Dr. MacAdam Now ‘Daddy’ to Well Babies,” New York American, 28 Oct. 1918, 5.

40 “Copeland Satisfied by Influenza Tour,” New York Times, 30 Oct. 1918, 10.

41 “City Epidemic Bans Soon to be Removed,” New York American, 2 Nov. 1918, 11.

42 Minutes of Department of Health of the City of New York, 4 Nov. 1918, Department of Health Minutes, Book 13, New York City Municipal Archives, New York, NY.

44 New York Department of Health, “Our Part in the Victory Parade,” Staff News. 6:12 (1 December 1918), 8.

45 “Epidemic Lessons Against Next Time,” New York Times, 17 Nov. 1918, 42.

46 “Epidemic Lessons Against Next Time,” New York Times, 17 Nov. 1918, 42 Annual Report of the Department of Health of the City of New York for the Calendar Year 1918 (New York City: 1919), 210-11.

The following provides information on important advancements pertaining to Point 2 of the Governor’s Plan, to link and retain persons diagnosed with HIV in health care to maximize virus suppression so they remain healthy and prevent further transmission.

Letters From Commissioner Howard A. Zucker, M.D. J.D.
Please see below for an important message from New York State Department of Health Commissioner Zucker. The first letter details important background on U=U and the second summarizes this information and speaks to our commitment to continue to engage stakeholders as we move forward.

Dear Colleague Letter: Clinicians
Dear Colleague Letter: Stakeholders

The Prevention Access Campaign Statement can be found here:

Links to Relevant Articles and Information:

Please note:
The negligible risk of HIV sexual transmission with a sustained, undetectable viral load does not however extend to other activities documented to be associated with HIV transmission, namely: blood transfusions, transplants, breast-feeding and the sharing of syringes or drug preparatory paraphernalia/items. The evidence is either lacking or does not support the removal of prohibitions against these HIV risk associated events at this time.

Welcome to Archives at Yale

Archives at Yale contains finding aids from 10 libraries and repositories at Yale University. Finding aids describe the creation, content, context, and arrangement of archival materials, allowing users to identify and request materials relevant to their research. Use Archives at Yale to browse, explore, and discover Yale’s extraordinary collections of primary sources.

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Amanda Baudanza

Amanda Baudanza’s husband, TJ Baudanza, suffered a prolonged and painful death from colon cancer at the age of 32.

“The absence of the option of medical aid in dying in Massachusetts robbed my husband of peace of mind.”

Roger Kligler, M.D.

Roger Kligler is a retired physician in Falmouth, MA, living with prostate cancer.

“I want this option to be clearly authorized in Massachusetts in my lifetime—for me, for you, for everyone.”

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