The substantial Spanish flu reached the Philadelphia Naval Yard on 11 September 1918, carried by a substantial Navy detachment transferred from substantial Boston (where the outbreak had begun at Camp Devens in late August). The Naval Yard’s 4,500-sailor garrison had a first cluster of approximately 19 cases within four days. By 18 September the daily new-case count at the Naval Yard had exceeded 600.
The Philadelphia Department of Public Health director was Wilmer Krusen — substantively a competent but cautious gynaecological surgeon who had been appointed to the post in 1915. The deputy director Howard Anders was the more substantively epidemiologically experienced senior staff member.
The Liberty Loan parade
The Fourth Liberty Loan campaign — the US Treasury’s fourth war-bond fundraising drive of the First World War — had been scheduled for nationwide promotion through late September and early October 1918. The Philadelphia campaign centrepiece was a Liberty Loan parade scheduled for the afternoon of 28 September 1918: military bands, Navy and Army units, substantively patriotic floats, Boy Scout marching contingents. Anticipated attendance: approximately 200,000 Philadelphians.
Howard Anders went substantively public against the parade in mid-September. He argued — supported by the Philadelphia substantively medical-professional community — that the epidemic was substantively about to substantively explode through the city and that the parade would substantively catastrophically accelerate the spread. He substantively wrote newspaper opinion pieces, substantively gave press interviews, substantively presented at city council meetings.
Krusen substantively overruled him. The Krusen position was that the epidemic was confined to the military population, that the civilian population was substantively safe, and that cancelling the Liberty Loan parade would damage the war-mobilisation effort.
The parade went ahead on 28 September 1918. Approximately 200,000 Philadelphians lined the parade route for approximately two hours.
The catastrophe
The Philadelphia substantively civilian first cases appeared in the parade-watching neighbourhoods within 48 hours. Within ten days the city was the deadliest American epicentre of the 1918 pandemic. The peak week (week of 16 October) recorded approximately 4,597 Philadelphia influenza deaths. The hospitals were overwhelmed by week two; the morgues were substantively overwhelmed by week three; the substantively undertakers were substantively overwhelmed by week four; the coffin-supply was exhausted by week five.
Substantial mass burial pits were substantively dug at Holy Cross Cemetery and other Catholic and Protestant cemetery sites across the city. Substantial bodies were substantively held in private houses for substantively days before collection. Substantial Philadelphia children substantively played in substantively empty streets while substantively their parents lay dead in the substantively bedrooms.
Total Philadelphia influenza mortality for the autumn-winter 1918 outbreak: approximately 12,000–13,000 dead — the substantively highest per-capita mortality of any substantively major American city in the 1918 pandemic.
What followed
Krusen substantively retained his post through the subsequent decade, without substantively significant institutional reprimand. Anders substantively continued the Philadelphia public-health work and substantively was substantively appointed Krusen’s successor when Krusen substantively retired in 1928. The 1918 Philadelphia mortality substantively remains substantively the single most-cited American historical example of substantively public-health institutional failure under substantively pandemic conditions.