France hospital base

Scene of a surgical ward in Rouen, France in 1918. 

ST. LOUIS ( -- You should know the name Dr. Max C. Starkloff.

He was the St. Louis City Health Commissioner that led the way in 1918 with aggressive actions during the Spanish influenza pandemic. These public health actions taken by Starkloff would later be known as social distancing, a term we’re hearing used more often as we learn about COVID-19. 

Dr. Max Starkloff

Oct. 8, 1918 - Dr. Max Starkloff ordered the closure of schools, movie theaters, saloons, sporting events and other public gathering spots.

Starkloff was the St. Louis City Health Commissioner for 30 years. 

In 1918, the H1N1 virus infected a third of the world’s population and killed 50 million worldwide. It had a mortality rate of 2.5%. According to the CDC, the Spanish flu hit younger people, age 20-40, especially hard which was unique for this virus. 

The first case of Spanish flu is believed to have been contracted at a military base in Kansas. With soldiers taking trains as they were deployed during World War I, it wasn’t long until the virus spread. "Influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons," a 2010 study reported.

Jefferson Barracks was hit first in St. Louis with influenza on October 1. Within a week, 800 soldiers were hospitalized.

With a population of 687,000 in 1918, St. Louis was the nation’s fourth largest city. Not long after the outbreak at Jefferson Barracks, those living in the city started suffering from influenza.

And on October 7, Starkloff took aggressive action and began to shut down the city. With the backing of then-Mayor Henry Kiel, Starkloff closed city schools, theatres, moving picture houses, and places of amusement. He also banned public gatherings of more than 20 people.

The following day, he closed churches for the first time in the city’s history. That earned him the ire of Archbishop John Glennon, who protested that decision, but he eventually temporarily suspended the weekly Mass obligation for Catholics.

Starkloff also closed the municipal court, playgrounds, library reading rooms, pool halls, fraternal lodges and limited the use of public transportation, at the time that meant streetcars. Busy downtown department stores, like Famous-Barr, operated under restricted hours.

The local chapter of the American Red Cross was praised for how it handled the pandemic. The nursing services committee divided the city into districts and assigned nurses, aides and volunteers to each district. The chapter even sent nurses, aides and volunteers to neighboring towns in Missouri to help.

The Red Cross operated five ambulances around the clock and could transport as many as 100 patients a day.

Red Cross ambulance 1918 Spanish flu

Nov. 28, 1918 - The influenza closure order was reinstated after a sudden and large increase in the number of new cases. There were 707 new cases in a 24-hour period that ended at noon on November 28. The second issuance order closed the city schools (public, parochial, and private). It also banned all public gatherings, conventions, and banquets. Streetcars could carry only twenty standing passengers in addition to those seated.

(In the photo: The American Red Cross in St. Louis ran five ambulances every day to transport sick patients.)

They also distributed a four-page pamphlet that advised people on how to protect themselves including the catchy phrase “cover up each cough and sneeze, if you don’t you’ll spread disease.” The pamphlets were printed in eight languages: English, Polish, Russian, Yiddish, Hungarian, Italian, Bohemian (Czech) and Spanish.

The St. Louis chapter of the American Red Cross was later described as a “model chapter.” Public health officials praised the chapter’s efficient work that allowed them to help more patients.

All of the actions resulted in St. Louis experiencing one of the lowest influenza rates of cities compared to its size. Of the 31,500 who got sick in St. Louis only 1,703 died.

For more information on how St. Louis and Kansas City handled the Spanish flu differently, you can read more here.

Starkloff’s grandson, Max Starkloff, is co-founder of Paraquad, an independent living center for those with disabilities.

Copyright 2020 KMOV (Meredith Corporation). All rights reserved

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