Health & Healthcare

Overview
Essay
Items

With a growing population, the Lehigh Valley opened hospitals in Allentown, Easton, and Bethlehem.  In 1872, in response to the Valley’s growing workforce and accompanying on-the-job injuries, St. Luke’s Hospital in Bethlehem was the first hospital in the region to begin caring for patients. The Hospital’s annual reports from 1874 to 1932 can be found on this site, as well as other items related to healthcare.  For information on how the region responded to the 1918 Flu Pandemic, see the “Lehigh Valley Public Health and the Great Influenza Epidemic of 1918: Enduring Lesson or Forgotten Episode” essay.

Lehigh Valley Public Health and the Great Influenza Epidemic of 1918: Enduring Lesson or Forgotten Episode

By James Higgins

At the turn of the 20th century, the health infrastructure of Allentown and Bethlehem defied any easy generalization. The cities combined the adoption of modern theory and practice in medicine and sanitation with a desire to cling to traditions like cesspools and an unfiltered, spring-fed water supply, all with mixed results. This mix reflected the larger matrix of new technologies and the pre-modern that prevailed throughout society. Standing in the center of the cities in 1900, an observer would notice telephone and telegraph cables crisscrossing madly overhead, electric trolleys clanking past, and doctors on their rounds. At the same instant, citizens were relieving themselves in holes in their backyards, horses rather owned the streets, and immigrants were stuffed into apartments that were almost indescribably cramped and dirty.

The rapid and unplanned growth of cities had contributed to periodic epidemics of disease, especially those caused by waterborne pathogens. Indeed, some of the foulest drinking water in the state flowed through Allentown and South Bethlehem. Allentown's 45,000 residents had constructed some 9,000 cesspools over porous limestone.[1] Human excrement percolated through the ground and into the springs that served as the city's water supply. Allentown suffered two major typhoid outbreaks, the last of which, in 1902, sickened hundreds and killed nearly 70. Try as it might, the health department could not persuade the city to build a water treatment plant or sewage system that would preclude the need for the cesspools. South Bethlehem, meanwhile, experienced the incongruity of possessing a hospital that rivaled many big-city institutions of that era, but saw many of its possible community-wide benefits nullified by over-crowding and a near-absence of sanitary measures. Bad water made the city almost the worst place in Pennsylvania to deliver and raise children as many died from summertime dysentery caused by untreated water. Unfiltered drinking water from the Lehigh River was a mix of Allentown's upstream runoff and anything else, including sewage, the Two Bethlehems could dump into the overburdened body of water. Further, industrial operations, unconstrained by any safety mandates, appeared to produce almost as much human wreckage as pig iron or lumber. And one must remember that epidemics and industrial disasters were set against a backdrop of common, but deadly childhood diseases like measles, pertussis (whooping cough), and scarlet fever.

To combat these scourges, Allentown and Bethlehem, in fits and starts that mirrored efforts by cities across the country, adopted public health measures and built hospitals. In 1873, Bethlehem's leading citizens, with money-raising efforts kept alive by prominent women, had constructed, equipped, and staffed, adjacent to South Bethlehem, St. Luke's Hospital, an institution whose reputation for excellence and modern techniques made it an incongruent addition to the rough and tumble community.

Its greatest non-paying customer was Bethlehem Steel which annually transported hundreds of men to the hospital without paying, a situation St. Luke's regarded as intolerable by the turn of the century.[2] After 1910 Bethlehem had community nurses visiting the sick at home, private doctors who could use the facilities at St. Luke's, and a baby milk station that did double duty as a pre- and postnatal clinic for the children of the city's poor.

For its part, Allentown adopted a nuisance code in 1867 that restricted the keeping and disposal of livestock while it curtailed operations like bone and fat rendering plants. After a twenty-five year pause, during which Allentown made few improvements in terms of public health and health care, and left patients in the hands of private practice doctors and the city's women, it created a Board of Health to enforce nuisance codes and quarantine the sick. These efforts were capped in 1899 by the decision to build a community hospital and nursing school with massive aid from the city's women.[3] Though Allentown Hospital was not, from a standpoint of personnel, as well appointed as St. Luke's, it was the first organization to gather medical staff and expensive new equipment under one roof and was a much better proposition than carting the city's sickest citizens to Bethlehem. The area's hospitals performed complicated medical procedures while its citizens used outdoor toilets and drank water fouled by those toilets, but it was this infrastructure that would have to hold the line against the greatest health threat in modern times.

The conflagration known as World War I had a profound impact in the Lehigh Valley as several firms were deeply involved in the war effort. Bethlehem Steel, far and away the most important of these firms, produced as many tons of finished war goods as did some of the major combatants. While the war effort ground on, an influenza virus began to mutate somewhere in the world. By August of 1918, what would come ot be known as the influenza epidemic of 1918-1919 burst from Africa and Western Europe, followed a week later by an explosive outbreak in Boston, Massachusetts. New England was left with tens of thousands dead and leaders in Allentown and Bethlehem watched the situation with dread.

The long Indian summer the valley sweltered through eased a bit in late September. The first cases of influenza were detected among steelworkers on September 28.[4] Bethlehem Steel's house doctor personally surveyed the situation in Boston and began to raise the alarm in Bethlehem, as he believed that a true epidemic was imminent. September 27 saw an additional eight steelworkers stricken and the following day Allentown and Bethlehem announced their intention to meet and work closely together to combat the flu. In reality, both cities would largely see themselves through the epidemic without assistance from the other. On September 30, an emergency hospital had been opened in a National Guard armory in Bethlehem while representatives from the U.S. Public Health Service and the state's medical inspector declared that Bethlehem was equipped like no other city in the country to handle the numbers of cases sure to follow.[5] Even so, with twenty-five sick men at the steel plant by October 1, the federal government was becoming convinced a quarantine of at least Bethlehem Steel was necessary. The Army Ordinance Department did not want to contemplate the effect the plant's closure would have on the allied war effort and pushed local and state officials to act to prevent such a calamity.[6] On October 4 a statewide quarantine was issued, but in Bethlehem it was backed by federal force. Sick steelworkers who had families could be cared for at home while single men would be moved immediately to St. Luke's. No one not connected with the firm would be allowed on the property and men were rigorously screened for any symptoms and sent immediately to the firm's small dispensary for observation. All private physicians in the city had to report cases of the flu and heads of households were threatened with jail for failure to report sick family members. Milkmen were ordered to report any bottles still sitting on steps from the day before as a sort of ad hoc attempt to prevent the deaths of entire families from neglect as other cities would witness.

By early November the epidemic had passed and Bethlehem, even with high numbers of working class people involved in an industry that predisposed people to respiratory illness, suffered only 105 dead out of a total population of about 40,000, a remarkably low number. Allentown did not fare so well as Bethlehem. Allentown passed the notification order and its own quarantine order on September 30, but the state ban on October 4 went much further and Allentown's Mayor A. L. Reichenbach delayed its implementation for four days. On October 11, Allentown had 415 cases and two deaths and Allentown Hospital, with no emergency back up, was eventually swamped with more than seven hundred cases. Dr. C. D. Schaefer, Surgeon-in-Chief of Allentown Hospital, begged the draft board to halt the induction of his doctors and further explained that twenty-eight of his nurses were so ill they could not rise from bed.[7] Pamphlets were printed in English, Italian, "Slavish" and Yiddish and distributed throughout the city to explain the dangers of the disease and what one could do to better one's chances of survival. Unfortunately, terrified immigrants who received little aid from the city sometimes fled their apartments with dead or dying relatives abandoned to their fates.

The end of the first week of November saw flu cases drop sharply in Allentown, but the damage the flu had wrought was terrible. Allentown's population was roughly 25% greater than Bethlehem, but the number of fatalities was 500% higher; out of 50,000 citizens, Allentown lost about 500. Such disparate results were a reflection of how the epidemic was handled and the resources that were available to the communities.

While Bethlehem was the consummate steel town, it had layers of protection that were either in place before the epidemic or were added to the existing health infrastructure shortly after the epidemic began. Allentown, however, rather ignored the epidemic's approach and once arrived, Allentonians had the unenviable choice of conducting themselves to a hospital that was treating patients in hallways or being cared for at home.

In an era when medical technologies were still limited in scope and effectiveness, containing an epidemic required quarantining victims and limiting all public interactions, techniques that had been used for centuries. These methods worked in spite of uncertainty about the causes and transmission of disease. In an 1882 smallpox epidemic in Bethlehem, barrels of tar were burned on street corners, streets were hosed down, and wallpaper was stripped from the rooms of the infected. These approaches probably did little good but caused no harm either. Bethlehem had considerable success in combating the Great Influenza because of the early recognition that disease had entered the community and the swift enactment of drastic measures to stop the spread of the disease. This, of course, was made possible by the military presence in the city as result of the importance of the steel mill to the Allied war effort.

The recent influenza epidemic provided an opportunity for combined Bethlehem–north and south Bethlehem had merged in 1917–Archibald Johnston stressed the importance of strong government in creating a healthy community. Johnston, a lifelong resident of Bethlehem, in his first mayor report argued against the libertarian attitudes of his constituency; they preferred no restrictions on the use of their property and low taxes, which also left city government with little to do. Using an argument that other progressives had used, he argued that health could not be just a private and individual matter. Contagion, such as the influenza, affected everyone rich or poor, clean or dirty. Johnston put forward a classic progressive platform of strong city government that had to the power make Bethlehem an attractive, safe, and healthy city. This program included city planning and property zoning regulations, insuring clean water, safely removing sewage, paving streets, and collecting garbage. He reassured his fellow citizens that rather than limiting their freedom, "the acts of the city with regard to public welfare shall actually enlarge the scope of individual opportunity."

In spite of the recent flu epidemic, Johnston was unable to carry out most of his reforms. With regard to public health, a study was done in 1925 by a New York physician, Haven Emerson. Interestingly, it was commissioned by the trustees of St. Lukes Hospital and Community Chest, not by the city. The report noted that little had changed:

The general situation is that of a community with ample means and without serious financial burdens which has either ignored or been wholly unaware of the possibilities of public service through a competent and professionally directed health bureau, which most other cities of similar size …have learned to trust. The prevailing attitude is apparently contentment with the present order and little or no interest or curiosity as to the possibilities of improvement which would be expressed in safer, longer, richer, happier lives. While a reasonably adequate public health service can not be had without paying or it, there would be little use in urging more expenditures until the people and their elected officers are convinced that competent professional direction of health protection is desirable.

 

Without much centralized direction or oversight, public health in Bethlehem was being administered by a variety of agencies, especially the Community Chest, that did not even coordinate activities with each other. The financial commitment of the city to public health was minimal. Apparently, the lessons of the Great Influenza had quickly been forgotten as Bethlehem turned away from disease and warm, and plunged head long into the roaring twenties.


[1] Report of the Board of Health of the City of Allentown, Pa., For the Year 1905. Page 6.

[2] After 1895, most of the Annual Reports of the Executive Committee of St. Luke's Hospital lamented Bethlehem Steel's lack of commitment to underwriting the health of its workforce and instead relying upon St. Luke's Hospital to provide nearly free service.

[3] Gordon Fister, Half- Century: The Fifty-Year of the Allentown Hospital, 1899-1949.(Allentown: Board of Trustees of the Allentown Hospital, 1949).

[4] Allentown Morning Call. September 29, 1918.

[5] Bethlehem Globe-Times. October 3, 1918.

[6] Morning Call. October 2, 1918.

[7] Letter dated October 17, 1918 from Dr. C. D Schaefer, Surgeon-in-Chief Allentown Hospital to Allen Hagenbach, Chairman of District Draft Exemption Board.