"A Situation as Grave as the Presbyterian Hospital Has Ever Faced": The Spanish Flu in New York, 1918-19

Presbyterian Hospital circa 1918, looking east from Madison Avenue.

How did New York City’s hospitals deal with the worldwide influenza pandemic of 1918, the so-called “Spanish flu”?  Some idea of how they were affected can be found in the annual reports of Presbyterian Hospital, which had been the main clinical partner of Columbia’s College of Physicians and Surgeons since 1911. It remains the medical school's closest affiliate as NewYork-Presbyterian Hospital.

Though historians date the start of the epidemic’s worst phase in North America to late August 1918, it doesn't appear to have affected Presbyterian Hospital until after October 1. The hospital’s annual report for 1918 – which covered the period Oct. 1, 1917 through September 30, 1918 – has no mention of the epidemic at all.

The 1919 report, however, has quite a lot of detail about the impact of the epidemic on the operations of the hospital.

Presbyterian president William Sloane began his report with:

In October, 1918, when so many members of our Medical and Nursing Staffs were absent on war service, the influenza epidemic suddenly came upon us creating a situation as grave as the Presbyterian Hospital has ever faced. In this crisis the Medical Wards were temporarily placed at the disposal of the patients suffering from this disease — some 850 in all — while in the emergency, medical cases were admitted to the Surgical Wards...We record with deep sorrow the death of one of our House Physicians, Dr. John R. Perkins, who fell a victim to the dread disease. Ninety of our nurses contracted the influenza.

The report also notes that during the epidemic only emergency cases were admitted for surgery. The School of Nursing, then operated by the Hospital, suspended classes as its students were pressed into full-time service on the wards.  According to Anna C. Maxwell, Director of the school, ninety students came down with influenza, while only one died.

While the hospital treated 850 influenza cases in 1918-19, the epidemic doesn’t seem to have greatly increased its overall patient census. In 1917-18, it had 4,380 patients admitted while in 1918-19, there were 4,734 admissions.  The increase was more substantial in the out-patient department: 16,867 patients treated in 1917-18; 18,156 in 1918-19.

However, Presbyterian’s visiting nurse service saw its visits increase from 1,816 in 1917-18 to 2,650 in 1918/19. Patient deaths soared from 312 to 458 in the same period – an increase of about 45%.

Financially, the influenza epidemic appears to have had no adverse effect. In fact, the hospital’s deficit actually declined from $64,964 in 1917-18 to $64,055 the following year.

Medical historians also note that while the number of both influenza cases and deaths peaked in October, 1918, the disease in North America continued to circulate into 1920 with sporadic but intense outbreaks.[1]  Presbyterian’s report for 1920 confirms this, at least for New York City.  While the President’s report makes no mention of it, an outbreak in early 1920 figures prominently in the report of the Director of the Medical Service, Dr. Warfield T. Longcope.  He writes:

The routine work of the Hospital has been conducted…with only one important interruption: namely, the epidemic of influenza in January and February, 1920. Reports of the recurrence of the epidemic in one or two cities gave warning of a return of the disease in New York, and, consequently, every possible preparation was made to meet this emergency, should it arrive. These preparations were scarcely completed when patients with influenza applied in great numbers for admission to the Hospital. All four medical wards were reserved exclusively for influenza patients. These wards were cubicled, and all the attending physicians and the members of the nursing staff who worked in them were gowned and masked. The severity of the epidemic was such that it was necessary to have practically the entire attending staff on duty at the time. Later in the epidemic, two surgical wards were used for convalescent patients.

Because 1920 marks the year Presbyterian went to a calendar year reporting period (Jan. 1-Dec. 31), that year’s report has statistics for 15 months rather than 12 (Oct. 1, 1919-Dec. 31, 1920) making it hard to compare statistics for the 1918 outbreak versus that for 1920.  However, the fact that the hospital had 394 deaths for 1920 as opposed to 458 for 1918-19 suggests that the latter outbreak was not as severe, at least as experienced by Presbyterian Hospital.

Unfortunately, NewYork-Presbyterian Hospital no longer publishes annual reports -- the last was in 2010 -- perhaps making the task of the historian a century hence much more difficult.

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Sources: The 1919 and 1920 Presbyterian Hospital annual reports (including the report of the School of Nursing) can be found here: https://archive.org/details/annualreportofpr5155pres/page/n5/mode/2up

[1] See, for instance, the Wikipedia article on “Spanish flu,” section 2.1.4: https://en.wikipedia.org/wiki/Spanish_flu#Fourth_wave_of_1920 (accessed Sept. 29, 2020)

Image: Presbyterian Hospital circa 1918, looking east from Madison Avenue.  The hospital occupied this site bounded by Madison & Park Avenues, East 70th & 71st Streets from its opening in 1872 until its move to Washington Heights in 1928.