St. Louis City Health Commissioner Dr. Max C. Starkloff, the 1918 Flu Pandemic, and his pioneering role in saving lives

Foresthill

EOG Addicted
Just saw this today on the stltoday.com website.

The title of this story should include Max Starkloff as he was essential in dealing with the Flu brought by the soldiers to Jefferson Barracks located just outside St. Louis City.

Note: Even though this story appears long, it really isn't. It has several pictures I decided to include. Easy read. (bolding in story below by me)

The story, originally posted on the Missouri Historical Society website, follows:

March 20, 2020
St. Louis Soldiers and the 1918 Influenza Pandemic

by Mikall Venso | Military & Firearms Curator




[As it reached American ports along the east coast in the fall of 1918, Spanish influenza appeared in headlines alongside the uplifting news of American and Allied victories in World War I battles in France. No one could have anticipated the devastating impacts of a virus that would ultimately claim 11 million more lives than the war itself.


Newly drafted men arriving at Camp Funston, ca. 1918. Soldiers Memorial Military Museum Collections.

While the virus was initially believed to originate in Spain, modern scientific analysis offers a multitude of theories for the source. One of the earliest outbreaks occurred at Camp Funston at Fort Riley, Kansas, in March 1918. Camp Funston was the training camp for draftees from Missouri, Kansas, and a few other states during the build-up that would send about 2 million doughboys overseas. The flu spread rapidly among soldiers and sailors of all nations before returning to the US with homeward-bound troops in the fall.

Newspaper accounts from fall 1918 are filled with reports of St. Louisans at military training centers or port cities who had contracted “the Spanish flu.” Stories also document the growing scale and reactions of impacted communities along the east coast and, with each passing week, communities farther inland.

(Max) Starkloff was the son of a physician who had lived through the 1849 cholera epidemic.

In St. Louis, City Health Commissioner Dr. Max C. Starkloff was following the news. He shifted the focus of the Health Department’s monthly bulletins from the dangers of spoiled milk, houseflies, and venereal disease to those of the impending pandemic. Starkloff was one of the first to correctly identify influenza as a virus that was spread via contact or airborne particles at a time when microscopes of the era couldn’t even see it. By advocating for isolation and the elimination of public gatherings, he embraced the concept of what today we’re calling social distancing.

Officials needed accurate information to assess the situation and successfully advocate for difficult measures such as closures and quarantines. Starkloff’s first action was getting the Board of Aldermen to pass an ordinance requiring the city’s doctors to report influenza cases. Without these numbers, effective solutions couldn’t be developed or implemented quickly enough to lessen the impact of the virus.

St. Louis Republic, October 9, 1918. Missouri Historical Society Collections.

The first cases within the city arose at Jefferson Barracks in September 1918. Social events and public gatherings at the post were quickly halted, though new inductees continued to pass through the Barracks en route to training centers and overseas service.

By October 3, surgeon Dr. C. E. Freeman reported 500 cases of influenza at the post hospital. As the doctor requested more medical assistance, the situation quickly deteriorated. Just eight days later, 1,320 cases and 21 deaths were reported. After visiting troops at Jefferson Barracks a week earlier, Missouri congressman Jacob Meeker died from the influenza in mid-October. By the time the epidemic ended at the post, a total of 74 soldiers had lost their lives to disease.

Starkloff’s efforts at curtailing spread in the city by reducing person-to-person contact would ultimately earn him a reputation as both a pioneer and a savior of many lives in St. Louis. Armed with new data, Starkloff ordered “all theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions,” to close on October 7. They were to remain closed until further notice.

All churches were ordered closed three days later. Staggered business hours and shifts at factories helped to reduce congestion. The Saint Louis Art Museum was forced to close, as were many non-essential bus lines. However, saloons remained open, which angered the Women’s Christian Temperance Union. (and the John Kelly's of the day -- just kidding John -- and checking to see if you read this far -- he, he)

When the numbers of reported cases continued, but at a lower rate than other cities of comparable size, Starkloff believed he was on the right track. Wanting to further limit exposure, he dramatically increased the closures by issuing an order to close all but essential businesses for four days beginning November 9.

The restrictions were considered excessive by many businesses and industries who protested the order. Following an afternoon meeting with the Chamber of Commerce the same day as the initial order, Starkloff submitted a new order exempting more than 30 industries deemed essential to the city’s operations. The order and full list can be found in Commissioner Starkloff’s 1918–1919 Annual Report in the St. Louis Public Library archives:

“The Honorable Mayor has proclaimed that Spanish Influenza is, or probably will become epidemic in the City of St. Louis.​
In view of this proclamation, and in view of the fact that the present limited restrictions have not resulted in stamping out the disease in this City, under the power vested in me by the Charter of the City of St. Louis, after such proclamation, I hereby order that all business places be closed and discontinued, and remain closed and disconnected for a period of four days, beginning Saturday morning, November 9th, with the exception that the following essential industries shall be allowed to continue:​
1. Automobile accessories and automobile repair shops​
2. Baker’s supplies​
3. Banks​
4. Construction-buildings, etc.​
5. Coffin manufacturers​
6. Cold storage​
7. Drugs-wholesale and retail​
8. Fuel and ice​
9. Garage and stables (livery)​
10. Hotels and restaurants​
11. Laundries​
12. Lodging houses​
13. Newspapers​
14. Office building service​
15. Producers and dealers in food products, not including candies​
16. Public utilities​
17. Public offices​
18. Police Courts to hear confined cases only​
19. Physicians and Dentists​
20. Perishable articles in process of manufacture​
21. Railway offices​
22. Rolling mills and furnaces​
23. Red cross​
24. Railway supplies​
25. Restaurants limited to seating capacity​
26. Surgical supplies​
26 1/2. Special castings​
27. Storage houses​
28. Street cars limited to seating capacity​
29. Transfer companies and general hauling​
30. Telephone and telegraph companies​
31. Undertakers and Embalmers​
32. Warehouses​
33. Wagon repair and horseshoe shop​
34. Yeast Manufacturers”​
The following day, additional exemptions were granted to businesses that were helping the war effort by producing equipment and materials under government contracts. No one knew that Germany would surrender on November 11, 1918, amid the expanded closures. The celebrations that followed the end of the war were largely postponed until after the closures and quarantines started to be lifted two days later.

Giving into pressure from the business community and churches, restrictions were relaxed. Some were re-imposed in late November as a second and third wave of infections arrived.

While cases of influenza continued to grow following the end of Starkloff’s dramatic action, active cases peaked at 1,467 on December 3, steep declines eventually followed, and St. Louis reported one of the lowest mortality rates of all the major cities across the country.

In his 1919–1920 Annual Report, Commissioner Starkloff listed a total of 34,909 influenza cases and 4,006 deaths from influenza and pneumonia for the local epidemic. Worldwide, more than 50 million people lost their lives. But in places like St. Louis where early forms of social distancing were imposed, impacts were lessened and many lessons were learned. Those lessons resonate as we face very similar questions and challenges today.]
 
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