The Hill in History
1918 Flu Pandemic Pushed Hill Toward Modern Health Care
By Deacon Lile '09
The catastrophic 1918 outbreak of the "Spanish" flu altered the course of world history, changed modern medicine and left a profound footprint on the world's population. However, the virus that caused it almost certainly did not originate in Spain, or anywhere else in Europe for that matter. Epidemiological evidence suggests that the virus first appeared in Haskell County, Kan. The disease was unlike any other flu virus in recorded history. Its victims became violently ill as the disease progressed rapidly through the body, and in many cases proved to be lethal. Un-like any other flu outbreak, it possessed an uncommon propensity to kill the healthiest and most vibrant individuals.
Scientists and historians now believe that the virus spread from Haskell County to nearby Camp Funston, from which soldiers could easily transport it all over the world. This was probably where the 1918 flu virus began its devastating journey that would eventually wreak havoc across six continents and claim as many as 100 million lives worldwide. This early outbreak also represents the first of many historical overlaps between the great influenza and World War I — inseparable events in 20th-century history. In a purely biological sense, the massive trans-Atlantic movement of troops provided thousands of vehicles to transport the virus.
The flu's rapid movement to every corner of Upstate New York in September and October 1918 is an important aspect of its overall devastation. By the end of 1918, the epidemic had caused at least 17,160 deaths among at least 386,628 cases upstate. On Oct. 9, Clinton's former health officer estimated to the Clinton Courier that there were already 200 severe cases of influenza in town and lamented the lack of effective control or treatment. Obituaries, and some local notices, suggest that at least 21 Clinton residents died of influenza. Public schools closed for two weeks; at one point Clinton's residents were asked not to use telephones unless they were dealing with a flu emergency.
VIRUS TARGETED HEALTHY YOUTH
The virus's mechanism of action remains somewhat mysterious, but the vast majority of researchers believe that the 1918 flu usually killed by causing an overreaction of the immune system called a cytokine storm: A cascading release of cytokines floods the body with fluids and immune defenses. In this way, the "Spanish" flu literally turned a person's immune system against itself. Because of this, healthy individuals with strong immune systems — including young adults of college age — were the most likely people to suffer a severe case. Patients commonly coughed up copious amounts of blood and bled from the ears, nose and mouth. In particularly grim cases, patients turned blue. This symptom reflected a loss of oxygen in the bloodstream as the lungs filled with liquid. Patients this sick almost invariably drowned in their own fluids.
As this killer sped toward Hamilton College in the early fall of 1918, the campus was engrossed in wartime fervor. Frederick Carlos Ferry had begun his term as College president in July 1917, amid the international chaos of World War I. Ferry had then been opposed to transforming the Hamilton campus into a training ground for student soldiers; however, by the summer of 1918, plans were in place to begin the organization of Hamilton's Student Army Training Corps (SATC). The War Department was to assume control of the college curriculum and schedule; fraternity houses were to be converted to officers' quarters. By the time students arrived on campus in September 1918, the Board of Trustees and the War Department had already enacted many of these changes. Within a month, 169 of the 243 students at Hamilton had enrolled in the SATC, and the military program dominated life on the Hill.
When the flu first appeared in Clinton during the final week of September, the Hamilton community was completely unprepared. Due to their age and the unique biology of the virus, college students were particularly at risk. Furthermore, the close quarters of on-campus housing at Hamilton provided ideal conditions for contagion. To make matters worse, the College had no infirmary and possessed no nursing staff to speak of. The College's fixation with wartime preparations had left little opportunity to construct temporary care facilities or otherwise prepare.
The first recorded outbreaks at Hamilton College occurred Sept. 28. One of the first students to fall ill was Albert Strever Embler. He had enrolled at Hamilton Sept. 19. On Oct. 2 Embler was the disease's first casualty on campus. He had been on the Hill for only three weeks, but several faculty members referred to him as "a young man of promise." The speed with which Embler died was a tragic and chilling display of the "Spanish" flu's potency and virulence.
When President Ferry addressed the Board of Trustees less than two weeks later, he reported that 50 students had contracted the virus and two had died. The 50 students represented more than one-fifth of Hamilton's student body, and President Ferry included only cases that were severe enough to warrant reporting. Data precisely detailing the disease's impact after Oct. 12 is difficult to find, but considering that the Courier reported a large number of cases into November, it seems likely that the disease continued to afflict Hamilton students for several weeks after Ferry's report.
It is clear that the 1918 outbreak overwhelmed the Hamilton community. In order to provide comfortable housing for scores of sick students, the administration converted Carnegie Residence Hall into a makeshift infirmary. The War Department requested that a temporary facility be created to house the sick officers involved with the SATC, and the Sigma Phi fraternity house became that infirmary. The situation became so severe that Hamilton's administration needed healthy students to volunteer to care for the sick. Volunteering in this capacity was an extremely brave thing to do: Students who volunteered knew they were exposing themselves to an incredibly contagious and dangerous disease.
One of the first to volunteer was sophomore Robert Farrell, an aspiring physician. Farrell had a history of charitable involvement through his church in Utica, and benevolent work was not uncommon for him. Unfortunately, Farrell contracted the flu just a few days after beginning his volunteer work. His condition quickly worsened, and he died Oct. 6.
CHANGE OUT OF CATASTROPHE
The tragedy of Robert Farrell's death directly contributed to some of the changes in Hamilton's policy on student health care. Farrell's father was a prominent physician in Utica, and he believed that the best way to honor his son was to start a fund at the College. Dr. Farrell created the Robert Macalister Farrell Nursing Fund "to provide for the cost of hospital care of undergraduates." The fund first appeared in Hamilton's 1919 course catalogue and remained through 1953.
The presence of health care information in Hamilton's course catalogue itself reflected the College's newfound emphasis on student health after the 1918 influenza outbreak. Prior to 1919, the catalogue did not mention medical facilities or health care services on campus. In 1919, the catalogue included a full-page medical services section for the first time in its history. Besides the Farrell fund, the 1919 course catalogue mentioned a new resident physician, available to meet with students by appointment or during a weekly open hour, as well as an infirmary at the YMCA building (now Couper Hall) on campus.
These new services preceded major developments in the College's health care facilities and personnel. At a Board of Trustees meeting in the spring of 1920, President Ferry recommended that the College put together a committee for sanitation and health with a licensed physician to oversee medical services on campus; the board unanimously approved the new committee. Two months later, this committee recommended that the freshman class undergo thorough physical examinations upon arriving on campus. This recommendation, and its subsequent approval, provided the foundation for Hamilton's modern system of mandatory health forms and vaccinations.
The role of the campus physician continued to expand until 1921, when Hamilton began to include physicians' fees in the Board of Trustees' annual budget. One of the physicians who sat on Hamilton's board was Dr. James Glass of Utica. In 1922, the board appointed Dr. Glass and President Ferry to a "special committee on the infirmary." The makeshift medical facilities in the YMCA building were found to be inadequate, and the board created the committee to formulate a plan for building a suitable infirmary at Hamilton.
Following an appropriation of $5,000 and a donation of instruments from Dr. Glass, Hamilton opened its Knox Infirmary (in what is now Minor Theater) in May 1924. This state-of-the-art facility represented the culmination of Hamilton's five-year push toward modernizing its health services; the tragedy of 1918 provided the impetus for these substantial changes. Directly and indirectly, Hamilton had completely modernized its health care system as a result of the flu's devastation.
Deacon Lile '09 wrote his senior history thesis on the 1918 flu pandemic and its impact on Oneida County, Central New York and Hamilton College. This column is excerpted and adapted from his thesis. Lile also was awarded the Kirkland Endowment Essay Prize for an essay based on the thesis.