Dr. Copeland and the 1918-19 Pandemic
EMU alumnus was New York City’s health commissioner during the deadly outbreak
The influenza pandemic of 1918-19 was the deadliest outbreak of disease in history. Epidemiologists estimate that the pandemic killed about 650,000 people in the United States, and 50 to 100 million people worldwide. When a new strain of influenza tore through American military bases, cities, and towns in the fall of 1918, modern medicine was still in its infancy, and scientists did not even know what caused influenza. (They thought it was caused by bacteria; the true culprit -- a virus -- was discovered only in 1931.) The new strain was so deadly that many questioned whether it even was the flu. Physicians and nurses had no means to cure the illness or to alleviate its symptoms. The nation’s best hope was to try to slow the spread of infection. Among the leaders of this fight was an EMU alumnus, Dr. Royal S. Copeland, the Health Commissioner of New York, America’s largest city.
Royal Samuel Copeland was born in Dexter, Michigan, in 1868. He studied literature and history at the Michigan State Normal School (as EMU was then called) in 1886, before continuing his education at the Homeopathic Medical School of the University of Michigan and in Europe. In 1890 he set up a private medical practice in Bay City, and in 1895 he returned to the University of Michigan as a professor of ophthalmology and otology. He became a leading national advocate for homeopathic treatments, but he also embraced scientific advances in medicine and developed a specialty in eye surgery. Drawn to politics as well as medicine, he served a term as mayor of Ann Arbor. In 1908 Copeland became Dean of the New York Homeopathic Medical College, and in April 1918 New York City Mayor James Hylan appointed him as Health Commissioner.
The Outbreak
Just four months later, in August 1918, ships carrying passengers and crew infected with the new influenza began to arrive in New York from Europe. Copeland quarantined the sick and assured the public that there was no danger of an outbreak. In this regard he was not unusual: public officials and journalists in all of the nations engaged in World War I minimized reports of the epidemic in order to maintain morale. (The 1918 influenza became known as the Spanish flu because Spanish newspapers reported openly on the epidemic in Spain, which remained neutral in World War I. The so-called Spanish flu probably originated in Kansas.) But as illness began to spread among New York’s population in September, Copeland responded aggressively. Under his leadership, the Health Department ordered that anyone believed to have had contact with an infected person be quarantined in their home, with an official quarantine notice posted on the door. Train passengers arriving at Pennsylvania and Grand Central Terminals were inspected for signs of illness. The department created 150 community centers throughout the city to coordinate medical and social services. Copeland’s team distributed signs and pamphlets explaining how infection spread, and they recruited school teachers, theater owners, and newspaper publishers to tell their audiences to avoid crowds, wash their hands frequently, and not sneeze, cough, or spit in public venues. Small theaters with poor ventilation were shuttered, barbers were ordered to wear masks, and hundreds of citizens were arrested for violating an anti-spitting law.
Copeland’s greatest concern was the rush hour crowds on the subway. He told The New York Times in a November 1918 interview, “After all, there is not much danger from theatres and churches; people who are sick do not go much to the theatre or to church. But sick people do go to work.” Shutting down the subway was impossible, but Copeland decreased crowding by imposing a staggered schedule on stores and offices, spacing out opening and closing times in fifteen-minute intervals. He also ordered transportation companies to keep windows open on subway cars in order to improve ventilation.
Unlike many other cities, New York kept its schools open so that teachers could monitor students for signs of illness and refer symptomatic children to school nurses and physicians for diagnosis and care. Copeland remarked, “Now, how much better has it been to have those children under the constant observation of qualified persons than to close the schools, let the children run [in] the streets and assemble when and where they would and if they get influenza, to let them get it under conditions of which the Health Department had no knowledge….”
Copeland's Legacy
Historians differ in their judgments of Copeland’s efforts. In "The Great Influenza," John M. Barry depicts Copeland as an ambitious, unscientific politician whose reaction to the crisis was slow and ineffective. However, in an analysis of 43 American cities’ responses to the 1918-19 epidemic, Howard Markel and his colleagues argue that New York was the quickest of the 43 cities studied to implement public health measures to combat the spread of the disease. Markel and colleagues credit this rapid response with New York City’s relative success in fighting the disease: NYC’s mortality rate, 452 dead per 100,000 population, ranked 15 out of the 43 cities studied, and was the lowest on the Eastern seaboard.
The people of New York must have been pleased with Copeland’s work, because they elected him to the United States Senate in 1922 (with Franklin D. Roosevelt as his honorary campaign manager). New Yorkers re-elected Copeland in 1928 and 1934. While in the Senate he became one of the country’s most popular physicians, dispensing health advice in a daily newspaper column, a radio show, and a book, "Dr. Copeland’s Home Medical Book." He died in June 1938, just 15 days after completing a successful five-year effort to write and pass the Federal Food, Drug, and Cosmetic Act, his greatest accomplishment in the Senate.
What lessons might Dr. Copeland’s fight against influenza have for our current struggle against COVID-19? For Markel and colleagues, one important lesson is that early and sustained public health efforts can slow the advance of a pandemic, buying time for the development of medical treatments, reducing strain on hospitals, and decreasing deaths. Copeland would have agreed, as he credited New York City’s success in 1918 to its strong Health Department, which had been educating the public about health and improving public health laws for two decades. For Barry, the most important lesson of 1918 is that governments must tell the truth in a crisis. Newspapers and governments observing war-time censorship initially minimized the outbreak, but people could see for themselves that a terrifying new illness was killing neighbors and relatives. Barry argues that this misrepresentation helped create panic and undermined trust in public institutions. Although Copeland initially minimized the threat of the pandemic, he quickly righted course. Throughout the fall of 1918, Copeland sought to calm New Yorkers with current case statistics and prevention advice. As influenza cases started to fall in late October and in the months that followed, Copeland repeatedly warned New Yorkers not to give in to a sense of false security but to “Stop, look, listen, and take care” to guard against a resurgence of the pandemic.
By James Egge, head of the History and Philosophy Department at EMU and a professor of history.