Courtesy Otto Benesch Publishing Company
Dr. Max Starkloff
Just over 100 years ago, St. Louis and America faced one of the most challenging moments in its history: the Spanish influenza pandemic. Lessons learned back in late 1918 and early 1919—with St. Louis' strategy led by Dr. Max Starkloff, commissioner of public health—are now garnering headlines across the United States as “social distancing” becomes the buzzword of 2020 amid the coronavirus, or COVID-19, outbreak. But the story of Dr. Starkloff, and how he and St. Louis managed to prevent the deaths of thousands during the pandemic of 1918 through 1920 is far more complex.
The story going around right now is this: As the Spanish flu came back with returning American doughboys, victorious in World War I in Europe, it spread quickly. Philadelphia, refusing to listen to the latest medical advice, allowed a parade to continue as scheduled. The result: a skyrocketing and overwhelming death toll from the flu. Meanwhile, in St. Louis, under the ministrations of Dr. Starkloff, people practiced social distancing on a grand scale and “flattened the curve,” thereby saving countless lives and spreading out infections to prevent medical facilities from going over capacity. Overall, that's true, but 1918 was different than 2020.
First, when the flu pandemic broke out, Europe and America were still fighting the most costly and deadly war in human history, where nationalism and ethnicity played a greater role than ever in American politics. In St. Louis, anti-German sentiment had caused untold civic strife, perhaps best illustrated in the renaming of several streets in the city from Teutonic to more patriotic names. Anti-German violence had flared up, even resulting in murder in some American cities. As the United States fought to defeat the German Empire, the St. Louis commissioner of health, who was born Maximilian Carl von Starkloff, oversaw the response to the flu pandemic in the city. Perhaps it is a tribute to Mayor Henry Kiel’s strong leadership for standing behind the German-American doctor in challenging times. And what many people don’t realize is that there had just been a flu pandemic in 1915, and the flu broke out in 1919 and 1920. World War I did not even end until a month into the 1918 quarantine.
Dr. Starkloff waged his war on the Spanish flu with far less cooperation from the general public in St. Louis and with less stringency than we might believe. High school tennis tournaments continued, as long as no spectators were allowed in the stands. On October 10, 1918, Cleveland High School defeated McKinley, and Soldan bested Yeatman on the North Side. But when necessary, Dr. Starkloff used the full power invested in him. When business leaders attempted to meet to discuss shutting down their stores and theaters, he sent police to block the doors of their meeting places. He also took out full-page advertisements in local newspapers, explaining the scientific and medical background of the influenza virus. It's interesting to read how much doctors understood about the flu 100 years ago, particularly the importance of exercise and a balanced diet. (“Keeping the bowels free” is advice lost on the modern reader, however.)
Newspapers such as the St. Louis Star and Times even published instructions on how to make “flu masks.” There were long lists of canceled events, running the gamut of different religions and interests. But public resentment was building. One letter to the editor asked rhetorically if Dr. Starkloff was going to shut down all the bootleg entrepreneurs popping up in the wake of store closings.
By December 20, 1918, Dr. Starkloff had lifted the ban on visiting public places after approximately two months. The City Hospital on Lafayette Avenue had frequently been overwhelmed with patients; private hospitals had turned away flu victims, and public institutions had stepped up to fill the void. St. Louis and Chicago even managed to get into competition with each other off the baseball field in February of 1919, when Dr. Starkloff and the Chicago Chamber of Commerce engaged in a letter-writing feud. The death rate in St. Louis was 4.20 per 1,000 people, while in Chicago it was 4.77. Dr. Starkloff felt the need to remind Chicago that would have translated into 1,200 lives saved if the Windy City had instituted as stringent of measures as St. Louis.
But continuing through 1920, the flu struck all over St. Louis, even in the most isolated locations. One of the more notable cases befell the caretaker of the then-new water intake tower at the Chain of Rocks, Mr. and Mrs. Orville Gaubel, on January 20. They were stranded out on the tower, as there was too much ice on the Mississippi River to bring them in their weakened state over to the shore by boat. The other worker, William Maal, was diagnosed with just a cold, and was able to continue monitoring the amount of water being drawn into the tower. Dr. Brice Edwards, an employee of the health department, drove out daily to check on the couple. While the ice was too formidable to allow for the use of boats, it was too unstable for the doctor to drive out to the tower; he was forced to carefully pick his way over the ice floes, climb up the ladder, and into the tower to check on the flu victims.
On the same day of the water intake story, Mayor Kiel again issued an emergency order that released funds for the treatment of the flu in St. Louis. Outside visitors were banned from entering public buildings. Also, despite the myths of the “good old days” in St. Louis, violence continued throughout the various citywide flu pandemics. The front porch of the house owned by Frank Oliveri at 5728 Garfield was blown up by a bomb at 1 a.m. There were no suspects, and Mr. Oliveri claimed to have no enemies.
Just as the chaos began to settle from the flu pandemics in early 1920, National Prohibition began on January 17. The economic blow to St. Louis, as thousands of men lost their jobs throughout the city in the next year or two, would be the next challenge to face the local economy. Also, despite the comparisons between St. Louis and Philadelphia, an analysis of flu mortality rates by the St. Louis Federal Reserve in 2007 reveals that pretty much all cities in the Midwest fared much better than their East Coast counterparts throughout the flu pandemics from 1915–1919. Minneapolis–Saint Paul, for example, managed mortality rates much lower than St. Louis, and the major industrial centers of Ohio all held their own, as well. Regardless, the lessons of history remain the same: Listen to doctors and scientists, and stay inside during pandemics.
