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Looking Back on an Epidemic - How Milwaukee fought the Spanish flu link
By George Wagner

While the Bubonic Plague killed a quarter of Europe’s population in the 14th century, the Spanish Flu of 1918 was more lethal. The wartime flu outbreak killed an estimated 25 million to 100 million people worldwide, 600,000 in the United States, 8,500 in Wisconsin and 1,600 in the city of Milwaukee. Unlike most flu seasons, this time those in the prime of life were most at risk—adults between the ages of 20 and 40.

Despite these alarming numbers, Milwaukee (and Wisconsin) had the lowest rate of infection of larger U.S. cities. That can be credited to a solid public health infrastructure that responded quickly to the threat.

This nastier strain usually brought typical influenza symptoms: fever, chills, muscle aches, headache, dry cough, lethargy. For the lucky, symptoms would subside after a few days or a week and not return. Many others, however, experienced serious complications—most often pneumonia—after briefly recovering. A good number of these pneumonias developed into what is called heliotrope cyanosis. The end would often come within 48 hours amidst gasping for breath, purple skin and coughing up blood.

Most ominously, the contagion was airborne. An infected person entering a crowded room could infect all present. Flu viruses could remain alive indoors for hours, infecting the unwary long after the carrier had departed. The virus could spread at will in crowded schools, churches, markets, theaters, offices and factories. To control the contagion, the sick were isolated and public places were closed.

On Oct. 10, as the deadly flu spread throughout Wisconsin, state Health Commissioner Harper ordered the closing of all public institutions. Steven Burg writes that Wisconsin was the only state to order the closing of all schools, churches, theaters, places of amusement and public gatherings. Most factories could remain open, although stores were required to curtail hours. Within a day nearly all local health boards, including Milwaukee, had complied.

Milwaukee sprang into action.
The Common Council conferred sweeping powers upon the health commissioner to combat the epidemic.
Temporary isolation hospitals were opened, including one at the Auditorium.
Health care workers and volunteers gave four-minute lectures to workers in factories.
Laid-off teachers went door-to-door throughout the city to inventory citizens’ health.
Notices were printed in papers.
Leaflets in several foreign languages were distributed.
Precautionary posters warning of contagion went up everywhere.
Businesses, such as billiard parlors, could be fined $100 a day if caught unlawfully opened.

In the October-November 1918 Bulletin of the Health Department, Ruhland wrote that these closings could do no more than “stagger the peak in incidence of infection.” But by avoiding the simultaneous large number of cases, he hoped to avoid the breakdown of the health infrastructure that had happened in Boston and Philadelphia, where thousands of new cases a day had overwhelmed the authorities.
The closings may have slowed the contagion’s spread, but isolating patients once they were sick was the only practice that seemed to make a difference.

Why did Milwaukee fare so well?
Certainly, the density of Milwaukee’s population would seem to have encouraged the contagion’s spread. Yet a solid public health system; quick and steadfast official decisiveness on issues of isolation and closings; cooperation across the public-private sector; massive volunteer efforts; a dedicated cadre of health professionals who stayed on the job; and a compliant public all added up to success.