In his recent article Dr. Brian Dolan looks at the politics of protests during the 1918 influenza epidemic in San Francisco.
“On April 17, 2020, San Francisco Mayor London Breed did something that had not been done for 101 years. She issued an order that face masks be worn in public as a measure to help prevent the spread of infectious disease in the midst of a pandemic. This act promptly raised questions about how things were handled a century ago. The media soon picked up on the antics of an “Anti-Mask League” that was formed in San Francisco to protest this inconvenience, noting some historical parallels with current public complaints about government overreach. This essay dives deeper into the historical context of the anti-mask league to uncover more information about the identity and possible motivations of those who organized these protests. In particular it shines light on the fascinating presence of the leading woman in the campaign—lawyer, suffragette, and civil rights activist, Mrs. E.C. Harrington.” Read the full story in Perspectives in Medical Humanities (UC Medical Humanities Consortium, May 19, 2020)
This is a guest post by Aaron J. Jackson, M.A, Ph.D. Candidate, UCSF History of Health Sciences.
From time to time, events in the
present so closely resemble events from the past that the aphorism “history
repeats itself” seems feasible. This can be demonstrated by comparing the
current crisis of the novel coronavirus with the influenza pandemic of 1918-1919.
The similarities are compelling. Like the SARS-CoV-2 coronavirus, the variety
of H1N1 influenza that swept across the world in 1918 and 1919 produced a
significant shock. It spread like wildfire, was frustratingly resistant to
contemporary therapeutics, exhibited novel characteristics, and forced
governments to resort to what some considered to be heavy-handed public health
interventions. Bay Area residents in 1918 were required to wear masks and
practice social distancing, just as they are required to do so today. Such
historical similarities are not, however, proof that history repeats itself.
But they do provide interesting opportunities for comparison between the past
and the present—opportunities that hold the potential to make the past more relatable
by building connections through common circumstances. And perhaps, through that
understanding, an opportunity for hope to shine in dark times.
This post is not an exhaustive
study comparing 1918 and 2020. Rather, it focuses on responses to crises and
specifically the ways that communities innovatively addressed shortages of
personal protective equipment (PPE). So, of course, it will be about war,
pandemics, socks, and sheet protectors. Naturally.
When the United States declared
war on the Imperial Government of Germany in April 1917, the nation was
woefully unprepared for the conflict. The war represented an unprecedented
crisis—one that required the federal government to assume new powers in order
to coordinate the resources of the entire nation. President Woodrow Wilson’s
administration worked with Congress to institute a draft to raise an army,
enacted strict economic control measures to conserve and direct resources
towards the production of war materiel, and passed laws that infringed on civil
liberties, all in the name of the war effort. To ensure public support for
these moves, the government mounted a massive propaganda campaign that appealed
to a specific version of American patriotism, appealing to citizens’ sense of
Mustering an army of sufficient size presented significant challenges. The men not only had to be inducted into military service—either by volunteering or being drafted—they required hundreds of training camps, transportation to those camps, equipment to train with, uniforms to wear. Once at the camps, they required food, shelter, and medical support. Military training was and remains a dangerous business, but the most significant medical problem at the cantonments was disease.
As tens of thousands of American
recruits assembled at Army camps across the United States, they unwittingly
brought diseases with them, which found ample opportunity to spread in cramped
camp conditions. Most of these infections fell into the category of “common
respiratory unknown disease”—an unofficial designation among military recruits
who learned to add C.R.U.D. to the lexicon of military acronyms they learned.
The crud largely consisted of the common cold and other respiratory infections,
but cases of measles, mumps, and chicken pox were also common. Most cases of
the crud cleared up without need for treatment, but the prevalence of these
infections and the fact that new waves of infections would spring up with every
new trainload of recruits had the effect of masking a more dangerous threat.
Army physicians first identified more than 100 soldiers who had developed a
rather severe flu-like illness in March 1918. Within a week, the number of flu
cases at Fort Riley was over 500 and climbing. The H1N1 virus that caused the
influenza pandemic of 1918-1919 had arrived, but the nation was focused on the
war. And as American troops began arriving in France and moving into the front
lines—many of them no doubt bringing the virus with them—medical personnel
tasked with supporting the war effort shifted their focus from induction
screening and camp illnesses to other health concerns.
The First World War introduced a bevy of new ways to mangle and maim human bodies. From high-velocity rifle rounds and machine guns to high-explosive artillery shells, flamethrowers, hand grenades, aerial bombardment, and chemical weapons, the U.S. Army Medical Corps understood that the hospital system it established in France had to be prepared first and foremost for trauma care, which posed significant challenges. Not only did modern weapons cause extensive damage, the risks of sepsis and gangrene in an era before the discovery of antibiotics were high. Complicating this, European battlefields tended to stretch across agricultural land, teeming with bacteria after years of fertilization. Soldiers wounded on the front lines thus ran an extremely high risk of bacterial infection. To address this, the Medical Corps and its affiliates prioritized training Army health care workers in antiseptic wound care.
The experiences of the personnel of Base Hospital No. 30 are instructive in this regard. Base Hospital Thirty was the military hospital unit assembled from physicians, surgeons, and nurses associated with the University of California’s School of Medicine—the precursor to UCSF. Organized with the help of the American Red Cross Society shortly after Congress declared war, the unit spent more than a year training for the anticipated challenges of running a hospital for wounded soldiers in France. The unit’s nurses received orders to depart San Francisco on December 26, 1917 and reported to Army cantonment camps along the East Coast to help care for soldiers who had fallen ill with the crud, gaining invaluable experience in nursing soldiers and recognizing disease presentation. The unit’s surgeons practiced the ancient technique of wound debridement—removing foreign objects and cutting away dead and dying flesh to produce a clean wound—and attended clinical instruction that prepared them for the types of injuries they would face. And the unit’s corpsmen trained in the production and use of the Carrell-Dakin solution, a novel antiseptic more effective than carbolic acid and iodine but also a solution that required careful training and preparation. Thanks to training like this, the base hospital system was able to treat more than 300,000 sick and wounded soldiers with remarkably low mortality rates compared to previous wars.
Indeed, the medical apparatus and personnel organized to support the American Expeditionary Forces were well prepared for the anticipated hazards of the war. But in one of the remarkable parallels to the current coronavirus crisis, their job was perhaps made more difficult by the failure of American logistics in providing adequate personal protective equipment. But the shortage in 1918 was not one of N95 masks; rather, it was a matter of needing socks.
Today, the Occupational Safety
and Health Administration defines PPE as “equipment worn to minimize exposure
to hazards that cause serious workplace injuries and illnesses.”[i]
Under this definition, and in the context of soldiering, a good pair of socks
certainly applies. Trench warfare was a dirty business. It also tended to be
cold and wet—the perfect climate for a condition known today as “trench foot.”
Afflicted soldiers’ feet would go numb, swell, develop sore and infections, and
in extreme cases become gangrenous, possibly requiring amputation. Obviously,
this ran the risk of keeping soldiers from the front lines and thus undermining
the war effort. But ensuring a plentiful supply of clean dry socks somehow
slipped through the cracks of the Army’s logistical efforts to prepare for the
war. Fortunately, the American Red Cross and thousands of civilian volunteers
found ways to meet the challenge.
Beginning in 1917, the Red Cross put out calls for knitted garments, especially socks. The organization distributed officially-endorsed knitting patterns and free wool to anyone willing to “knit your bit.” The Priscilla War Work Book contains roughly a dozen such patterns ranging from socks to coats and winter hats.[ii] But the demand was greatest for socks. Across the country, knitters worked individually at home and collectively in social groups to try to keep up with the demand. Those who could not knit were urged to purchase or donate wool for the cause. Some organizations turned to mechanical solutions. The Seattle Red Cross utilized a knitting machine to produce long wool tubes that could be cut into 27-inch lengths, requiring only the toes to be stitched by hand.[iii] In this way, those behind the front lines were able to support the war effort by providing the PPE the soldiers needed to keep themselves in fighting shape.
Celebrating the end
of the First World War in San Francisco, November 11, 1918. Image from The San Francisco Chronicle files.
The knitting campaign continued
until the war ended with the declaration of the armistice on November 11, 1918.
By then, the nation was in the midst of the first wave of the influenza
pandemic. On October 9, 1918, San Francisco’s hospitals reported 169 influenza
cases. A week later, there were more than 2,000 and the city’s Board of Health
issued recommendations for social distancing.[iv]
With so many health care professionals supporting the war effort, the Bay
Area’s medical infrastructure was stretched to the limit and cities put out
calls for volunteers. Hospital space soon became a valuable commodity and many
facilities, including the Oakland Municipal Auditorium, were converted into
temporary hospitals, and public health officials began recommending the use of
face masks, which they later made mandatory.[v]
But it is important to remember that these were local efforts to respond to the
pandemic. The federal government, which had mustered the resources of the
entire nation to fight the war in Europe, was unwilling to do the same to
combat the pandemic at home, leaving it up to local authorities, medical
institutions, and volunteer organizations to make do as best they could.
Unfortunately, we find ourselves
in a similar situation today. As the novel coronavirus took on pandemic
proportions, stores of PPE for frontline healthcare workers reached critical
levels. Before the pandemic, China produced approximately half the world’s
supply of medical masks. As the infection spread in China, their exports
stopped, and the resulting shortage spurred competition between institutions
and governments to secure PPE, which only exacerbated the situation.
Thankfully, a multidisciplinary team at UCSF found a way to be a part of the
solution, echoing the efforts of American knitters from over a century ago.
Noting the need for face shields, experts at UCSF specializing in biochemistry, engineering, logistics, medical workplace safety, and 3D model design came together in March 2020 to develop something that could help address the PPE shortage. By April, the team completed designs for three different models of 3D-printable face shield frames that, when combined with rubber bands and transparent document protectors, serve as functional and reusable face shields. They then collected seventeen 3D printers from across the university and turned the UCSF Makers Lab in the Kalmanovitz Library into an ad hoc face shield factory that can produce more than 300 shields each day—enough to supply UCSF’s front-line health care workers and then some.[vi] Extra shields are distributed to Bay Area hospitals. Moreover, like the Red Cross with the distribution of the Priscilla War Work Book, the UCSF team is sharing their plans in an open source repository so that others can emulate their efforts.[vii] This allows those with access to 3D printers and a few dollars’ worth of office supplies to contribute to the ongoing PPE shortage by producing face shields that have been designed, tested, and vetted by experts at one of the nation’s leading medical institutions.
Certainly, there are remarkable
similarities to be drawn between the modern crisis and those in the past. Once
again, the government was unprepared for a crisis despite advanced warning.
Once again, people are working in the front lines to save others despite
inadequate supplies. And once again, like the First World War and the influenza
pandemic of 1918-1919, the coronavirus pandemic is a devastating event likely
to be measured in the tally of lives lost. In the face of such grim statistics,
it is easy to fall into cynicism and say that history is repeating.
In 1905, philosopher George
Santayana explored the notion of progress—the idea that things move toward
improvement—and stated that “those who cannot remember the past are condemned
to repeat it.”[viii]
This is likely the origin of the aphorism “history repeats itself.” But Santaya
was not making a hopeless argument; rather, he noted that if progress is to be achieved,
it will be because humans not only record the past, they engage with it, learn
from it, and seek to understand it. And how that is achieved depends on the
ability to draw relatable connections with the past that emphasize human
agency. In 1918, knitters took up their needles. Today, a team of scientists,
engineers, and others figured out how to make face shields using 3D printers
and office supplies. These may seem like small contributions in the grand
scheme of things, but they are important examples of positive human agency in
the face of crisis.
Schappel Barsaloux and the American National Red Cross, The Priscilla War
Work Book: Including Directions for Knitted Garments and Comfort Kits from the
American Red Cross, and Knitted Garments for the Boy Scout. Boston, Mass.:
The Priscilla Publishing Company, 1917. Available at the HathiTrust Digital
This is a guest post by Griffin Burgess, ZSFG Archivist.
The first San Francisco City and County Hospital located on Potrero Avenue was completed in 1872, but it was far from the city center and difficult to get to, which made it less than ideal for emergency cases.
At the time, City Hall housed the police prison, which included an infirmary. This infirmary always had a physician present, so the police and the public became used to using the prison infirmary for emergencies. In 1877, the city formally changed the prison infirmary to the Receiving Hospital and put the Department of Public Health in charge of it.
While the Receiving Hospital provided emergency care to anyone who needed it and played an important role in providing care to the people of San Francisco, the city had no ambulances. To help with this, the police department purchased Chicago-style police patrol wagons, which could carry a stretcher and transport the sick or injured.
In 1893, The World Columbian Exposition and Fair was held in Chicago, Illinois. The new publisher of the San Francisco Chronicle, Michael de Young, attended the fair and saw the working display of the new Studebaker horse-drawn ambulance. When the fair that he organized in San Francisco the next year needed an ambulance, he sent away for a Studebaker ambulance to serve the fair’s hospital.
The first San Francisco ambulance in front of Park Emergency Hospital on Stanyan Street, circa 1910.
After the fair, the Studebaker sat in a warehouse until two members of a women’s society group, Theresa Fair Oelrichs and her sister Virginia Fair, bought it and donated it to the Receiving Hospital. It was up to the city to buy the horses, which was done after a bit of politicking.
The director of the Receiving Hospital, Dr. George Somers, insisted that the ambulance be staffed by interns so that medical care could be provided immediately and en route to the hospital, a unique idea at the time. The ambulances were staffed by male nurses until WWII, when former medical corpsmen began working ambulances. Paramedics were introduced in 1973.
Ambulance in front of the temporary Central Emergency, built after the 1906 earthquake. From left to right: James O’Dea, Annie Andrew, Dr. Fred Zumwalt, Theresa Gile, Charles Bucher RN, William Sullivan, John Thoma (in ambulance).
The 1906 earthquake and fire destroyed much of the city, including City Hall and the Receiving Hospital located in its basement. A new, temporary Central Emergency building in Jefferson Square on Golden Gate Avenue was the first structure completed after the quake.
Ambulance in front of the temporary Mission Emergency building at 23rd St. and Potrero Ave. Circa 1915.
The first Mission Emergency opened in 1909 at 23rd and Potrero. It was later demolished when the red brick San Francisco City and County Hospital was completed and the new Mission Emergency at 22nd and Potrero was opened in 1917.
In 1912, the Emergency Service received its first automobile ambulance. It was stationed at Park Emergency Hospital so that drivers, who until then had only driven horse-drawn ambulances, could learn to operate it on the relatively empty roads of Golden Gate Park.
Ambulance beside Mission Emergency at 22nd and Potrero Ave, completed in 1917. Photo circa 1920.
Not all of the drivers adjusted well to the switch to automobiles, however. “One of the Park Emergency ambulance drivers eventually required transfer to another City department. On his transfer orders, the hospital’s surgeon wrote, ‘… after numerous attempts to convince him to the contrary, this driver still persists in trying to stop the automobile ambulance by pulling back on the steering wheel as hard as he can and screaming at the top of his lungs, ‘Woooh there!’ I feel he is better suited for a department that still uses horses.'” (From Catastrophes, Epidemics and Neglected Diseases by F. William Blaisdell and Moses Grossman, page 134).
Ambulance at Central Emergency Hospital, circa 1930s.
The new City and County Hospital was one of the most modern complexes in the country and Mission Emergency soon became the hospital best equipped to care for the severely sick and injured, with updated operating rooms, staff, and equipment. By the end of the 1930s, all of the city’s ambulances were taking emergency cases to Mission Emergency rather than the Central Emergency hospital in Civic Center.
It’s been a busy start to spring here at UCSF A&SC: new events and exhibits coming up, lots of researchers, and of course many new collections. As is prone to happen during times like these, there is a pile of new materials sitting on my desk, just waiting for me to enter into our database and (eventually) our library catalog. Here are a few that I am particularly excited about:
Clark Sturges papers (MSS 2017-09)
Just in time for the 50th anniversary of the Summer of Love, we recently were given the papers of Clark Sturges that relate to his profile of Dr. David E. Smith. Smith founded the Haight Ashbury Free Medical Clinic in 1967 in response to the medical needs of many of the young people who came to San Francisco during the Summer of Love. Sturges completed the book in 1993, and the papers are composed mainly of taped interviews, research notes, and correspondence.
Steven Deeks papers (MSS 2017-10)
Another recent acquisition is the papers of Dr. Steven Deeks. The Deeks papers are primarily concerned with his involvement in the controversial baboon bone marrow transplant to an AIDS patient in 1995. While the transplant was not successful, it illustrates the sense of desperation of people with AIDS at that time–and also the highly innovative approaches that UCSF and SFGH doctors and researchers were taking at that time to combat the disease.
Mark Jacobson papers (MSS 2017-12)
Finally, another collection that recently found its way to my desk is the papers of Dr. Mark Jacobson. The Jacobson papers are a hodgepodge of different materials, including calendars, index cards with patient symptoms and medication, a multitude of electronic records (including his PalmPilot), and this Triomune 30 box, which he picked up on a trip overseas. Dr. Jacobson also gave us a substantial number of books for our burgeoning AIDS History collection, and recently wrote a novel based upon his experiences that mentions the patient index cards in its foreword.
Before there was Levi’s Stadium, there was Candlestick Park—and before there was Candlestick, there was Kezar Stadium. In light of the Super Bowl 50 festivities happening on the Embarcadero right now—celebrating a game some 40 miles south of the city—it is good to remember that the original home to both of the Bay Area’s professional football teams is less than five blocks away from UCSF Parnassus.
UCSF aerial, 1959. Kezar in top right corner.
Built in 1924-1925, Kezar first served as a multi-purpose stadium hosting a myriad of sports, ranging from track and field to soccer to cricket. After the San Francisco 49ers inaugural season in 1946, the facility became primarily a football stadium, staging games for the next 25 years, including the Oakland Raiders first four home games in 1960. Though never home to a Super Bowl, Kezar did host two NFL conference championships, including the 49ers last home game there on January 3, 1971 against the Dallas Cowboys.
UCSF aerial, 1938. Kezar to left of frame.
UCSF aerial, circa 1955. Kezar in foreground.
In addition to football and other sports, Kezar stadium presented many other concerts and events, and had a memorable role as the home and workplace of the Scorpio killer in the first Dirty Harry movie. It was torn down in 1989, prior to the Loma Prieta earthquake, and rebuilt in its current incarnation as a much smaller, 10,000 seat venue (some 50,000 seats smaller than its original capacity of 59,942). It was recently renovated, and now features 1,000 seats from Candlestick Park.
Last week we looked at the Dental Department “Earthquake Class” of 1906. This week we have another unique dentistry story. It involves feuding faculty, buried treasure, and a surprise discovery!
The Dental Department / College of Dentistry of the University of California was established in 1881. San Francisco practitioner Samuel W. Dennis, MD, DDS, was instrumental in its founding; he gathered support from Medical Department faculty, corresponded with other dental programs in the country to create a curriculum, and recruited dental instructors. He served as the first dean of the school from 1881-1882 and was later reappointed, serving from 1883-1885.
Samuel W. Dennis
Disagreements concerning curriculum and the school’s administration quickly developed between Dennis and his fellow dental faculty members. Tensions continued to mount for the next fifteen years until a disgruntled Dennis left the college in 1896.
First faculty of the Dental Department, 1882. AR 2015-4 SOD records, box 1
When Dennis left, he took with him a number of the school’s early records, including receipts, announcements, lecture notes, and examples of course requirements and examinations. Apparently, he then buried the material in a lead box under a grove of eucalyptus trees in South San Francisco. When Dennis died in 1906 (some accounts say 1907) he had never revealed the exact location of the records.
From the “Treasure Chest” contents: Anatomy test, 1891. AR 2015-4 SOD records, box 1
In 1929, as workers were excavating an area on which the Bayshore Highway was to be constructed, they uncovered a heavy box. Inside they found old documents labeled “Dental Department of the University of California.” Luckily, one of the workers recognized the potential value of the discovery and returned the material to the university. Dean Guy S. Millberry began investigating the papers and came to the conclusion that they had to be the missing Dennis material.
From the “Treasure Chest” contents: Freshman student course requirements, undated. AR 2015-4 SOD records, box 1
The box came to be known as the “Treasure Chest.” Today, the box and its surviving contents are housed in the UCSF Archives and Special Collections as part of the School of Dentistry records, AR 2015-4.
– Sources for this post include a 1997 School of Dentistry history booklet titled “The Early Days,” published by the University of California. The booklet is available to researchers in the School of Dentistry records, AR 2015-4.
Children’s Hospital of San Francisco Training School for Nurses Little Jim yearbook, 1925, page 45, MSS 2006-17.
The California Pacific Medical Center’s historical timeline and UCSF History site prove quite useful for untangling this history. In 1875 the Pacific Dispensary for Women and Children was founded in San Francisco. It underwent a name change and became, more recognizably, the Women’s and Children’s Hospital. Under the leadership of the pioneering Dr. Charlotte Blake Brown (1846-1904) in 1882, the hospital began offering a two-year training program for nurses– the first official of its kind on the West Coast. And in 1887, it finds a new home at the intersection of California & Maple streets. At this point, “the two-story hospital has 25 private rooms, open wards, a cow barn, chicken yard, and laundry. Total cost, with furniture and equipment: $26,000.” The University of California Medical School (that’s us– UCSF!) begins partnering with Children’s Hospital in 1915 to teach medical students.
Group of nursing students, circa 1925, MSS 2006-17.
Which brings us just to about the time period of this collection. Donated by the granddaughter of Ruth Steuben, an alumna of the Children’s Hospital Training School for Nurses, the material covers the education of Steuben, roughly 1925-1929, and includes class notes, yearbooks, photographs, and a uniform apron. Digital copies of Steuben’s school records as well as photographs and letters from the mothers of children nursed by Steuben soon after her graduation are also included. Below, a photograph of Ruth with her graduating class, December 1927, from the Little Jim yearbook.
Class of December 1927, including Ruth Steuben. Children’s Hospital of San Francisco Training School for Nurses Little Jim yearbook, 1926, page 22, MSS 2006-17.
And a photograph of many of the same students at a nursing school reunion event in May 1948.
Reunion of nursing school graduates, May 1948, MSS 2006-17.
And now, for your further enjoyment: crossword puzzles! The 1948 Little Jim yearbook includes not one, but two crossword puzzles. The first was created by Adelaide Brown, M.D. (1868-1933) who was the daughter of Dr. Charlotte Blake Brown– both were longtime activists for women and children’s health.
Crossword puzzle by Adelaide Brown, M.D. Children’s Hospital of San Francisco Training School for Nurses Little Jim yearbook, 1925, page 48, MSS 2006-17.
Crossword puzzle. Children’s Hospital of San Francisco Training School for Nurses Little Jim yearbook, 1925, page 50, MSS 2006-17.
Use our slideshow below to view this beautiful panoramic photograph of San Francisco taken in the 1930s from the Parnassus campus of UCSF. The photograph is comprised of ten discrete photographs taped together to form an almost seamless panoramic image measuring 4.5″ x 54″ looking north and spanning west to east.
Click on a thumbnail to enlarge the images and see the slideshow.
A panoramic photograph taken from the UCSF Parnassus campus, circa 1933-1935, looking north and spanning west to east.
A portion of a panoramic photograph taken from the UCSF Parnassus campus, circa 1933-1935. This section looks to the west, depicting the Sunset neighborhood, the Pacific Ocean, and Golden Gate Park on the right.
A portion of a panoramic photograph taken from the UCSF Parnassus campus, circa 1933-1935. Looking northwest over Golden Gate Park, the hill of Marin are visible, as well as bare-looking Presidio, and the Golden Gate Bridge in the midst of construction.
A portion of a panoramic photograph taken from the UCSF Parnassus campus, circa 1933-1935. The old Kezar Stadium, former home of the SF 49ers and Oakland Raiders, is the foreground. Further back the towers of St. Ignatius Church on the USF campus are visible as well as downtown San Francisco to the right.
A portion of a panoramic photograph taken from the UCSF Parnassus campus, circa 1933-1935. Looking northeast, the photograph shows downtown and the East Bay in the distance.
Unfortunately, the photograph lacks accompanying information about its creation, however, several significant qualities have helped us to narrow down the date. Most significantly, in the second portion of the close-ups, on the right side, the unfinished Golden Gate Bridge is visible. The pylons closest to San Francisco can be seen, but not the suspension cables which, according to the Golden Gate Bridge Construction Timeline, puts the image somewhere in 1933-1935.
Other things of note include the presence of the original Kezar Stadium (former home of the SF 49ers and Oakland Raiders), the absence of the Bay Bridge (which was also under construction from 1933-1936), and the generally bare Presidio area.
What strikes you most about the photo? Let us know! We’d love to hear your insights into the old San Francisco landscape.