Brookline in the Flu Pandemic of 1918-19 (Part 1 of 2)

The great flu pandemic of 1918-19 killed tens of millions of people worldwide, including an estimated 45,000 in Massachusetts and 675,000 in the United States. Its impact was felt everywhere, including in Brookline.

More than 125 residents of the town died. Schools were closed for four weeks right after the beginning of the school year. Homes of the afflicted were quarantined. Public gatherings at churches, meeting halls, soda fountains, billiard parlors, bowling alleys, and funerals were banned.

At the same time, quick reaction by local authorities was credited with limiting the impact more than in other communities. And at an open air hospital on Corey Hill, new methods of care were developed, methods that medical personnel then took to facilities elsewhere in the state and around the country.

This first of a two-part look at Brookline in the 1918-19 pandemic tells the story of Camp Brooks, the open air hospital on Summit Avenue. Erected literally overnight in September 1918, the camp became a focal point in Massachusetts' battle against the deadly disease.

Part 2 will look at the impact of the flu pandemic on the town of Brookline as a whole.

Camp Brooks and the Influenza Outbreak of 1918

Boston was one of the epicenters of the pandemic. After first appearing elsewhere in the spring of 1918, influenza erupted late that summer in more virulent form among merchant marine trainees in Boston Harbor. (There were major outbreaks around the same time in the port cities of Freetown, Sierra Leone and Brest, France.)

Noted surgeon William A. Brooks had opened the Brooks Hospital at the corner of Summit Avenue and Lancaster Terrace in 1915. At the time of the flu outbreak Brooks was both Surgeon-General of the Massachusetts State Guard and medical director of the recruiting service of the Shipping Board. He was called in to deal with the sick seamen.

I knew that the hospitals in Boston at that time were pretty well congested [he later wrote], and did not see how we could possibly place as many sick persons as we had.

Under Brooks' direction, the Brookline company of the Massachusetts Guard was called out on the afternoon of September 9, 1918 to erect a tent camp on the east side of Corey Hill between the Brooks Hospital and Corey Hill Park. Town Engineer Henry Varney and other town officials also pitched in. By just after midnight, the camp had been laid out, tents had been set up, sewage connections had been made, lights and water had been turned on, and the first patients had been admitted.

Researchers Richard A. Hobday and John W. Cason, writing about Camp Brooks in the May 2009 issue of the American Journal of Public Health, described conditions at the hospital:

The treatment at Camp Brooks Hospital took place outdoors, with “a maximum of sunshine and of fresh air day and night.” The medical officer in charge, Major Thomas F. Harrington, had studied the history of his patients and found that the worst cases of pneumonia came from the parts of ships that were most badly ventilated. In good weather, patients were taken out of their tents and put in the open. They were kept warm in their beds at night with hot-water bottles and extra blankets and were fed every few hours throughout the course of the fever. Anyone in contact with them had to wear an improvised facemask, which comprised five layers of gauze on a wire frame covering the nose and mouth. The frame was made out of an ordinary gravy strainer, shaped to fit the face of the wearer and to prevent the gauze filter from touching the nostrils or mouth. Nurses and orderlies were instructed to keep their hands away from the outside of the masks as much as possible. A superintendent made sure the masks were replaced every two hours, were properly sterilized, and contained fresh gauze.

Other measures to prevent infection included the wearing of gloves and gowns, including a head covering. Doctors, nurses, and orderlies had to wash their hands in disinfectant after contact with patients and before eating. The use of common drinking cups, towels, and other items was strictly forbidden. Patients’ dishes and utensils were kept separate and put in boiling water after each use. Pneumonia and meningitis patients used paper plates, drinking cups, and napkins; paper bags with gauze were pinned to pillowcases for sputum. Extensive use was made of mouthwash and gargle, and twice daily, the proprietary silver-based antimicrobial ointment Argyrol was applied to nasal mucous membranes to prevent ear infection.

Thirty-five of the 351 patients treated at the hospital died, a much lower rate, according to Brooks, than in indoor hospitals despite the fact that the open air hospital took in some of the worst cases. Only eight of the more than 150 doctors, nurses, aids, orderlies, and other workers at the camp developed influenza, and five of those were thought to have been exposed to it outside the camp.

The combination of fresh air, sunlight, and a "high standard of personal and environmental hygiene" employed by the Camp Brooks staff may have played a large part in their success compared to other hospitals, report Hobday and Cason. And, indeed, those same standards and plan of organization were adopted successfully elsewhere. "[A]s members of 'The Brooks Teaching Units,' these doctors, nurses, and aids have established military hospitals in eight other cities in our Commonwealth," reported the Boston Medical and Surgical Journal in December 1918. "The strict adherence of the members of these hospital personnel to these military orders contributed in very large part to the success of the undertaking."

The Camp Brooks tent hospital remained in place for a little more than a month, until the worst of the epidemic had passed in Boston. A year later, with support from throughout the state, Brooks established the Brooks Cubicle Hospital on Corey Hill to provide a more permanent facility to apply the same principles of treatment that had been used at Camp Brooks.

Further Information

The Influenza Pandemic 1918 (The American Experience, PBS)

• The Great Pandemic: The United States in 1918-19 (U.S. Department of Health and Human Services)
• Influenza 1918 (The American Experience, PBS)
• The Open-Air Treatment of Pandemic Influenza (Richard A. Hobday and John W. Cason, American Journal Public Health, May 2009)
• The Origin of Camp Brooks and the Open-Air Treatment of Influenza (William A. Brooks, Journal of the Boston Society of Civil Engineers, December 1918)
• The Open Air Treatment of Influenza (William A. Brooks, American Journal of Public Health, October 1918)