The ‘Spanish flu’ pandemic that swept the globe towards the end of the First World War was the most deadly in history. It took in the order of 50 million lives – a figure that has generally been under-reported. This included a published death toll of 675,000 in the United States alone. The pandemic took the military by surprise and required the diversion of vast resources into attempts to halt its spread. In the last months of the summer of 1918, just as military physicians were preparing to return to civilian life, the first information about what was about to be unleashed was received by the US Surgeon General’s office. Dr William Henry Welch was sent to investigate a disease that had struck Camp Devens in Massachusetts before spreading to camps in New York and Virginia. By the time Dr Welch arrived at Camp Devens on 23 September, 12,604 cases of Spanish influenza had been officially reported among the 45,000 troops in the camp. On that day 66 men, all of them probably in peak physical fitness, had died.
The Americans recognised they were facing an emergency. The 300 regular nurses were not nearly enough to cope with the tidal wave of patients they were caring for the sick troops. Worse still, Dr Welch found that many were becoming infected themselves; as many as 90 of the 300 were incapable of work. A Volunteer Medical Service Corps was established. Eventually over 72,000 doctors would volunteer their services. The American Red Cross mobilised their personnel across the nation, through their 700 local organisations, or ‘chapters.’ The number of doctors and nurses that actually died from the influenza was, fortunately, relatively low. It is estimated that some 220 nurses and 210 doctors died as a result of the disease.
There was a huge feeling of relief when the pandemic finally ebbed away and gratitude to the medical staff who had done so much to fight the disease. Badges were struck to celebrate their efforts, including one based on an earlier design produced for the National Association for the Study and Prevention of Tuberculosis (later the National Tuberculosis Association and now the American Lung Association). It is the oldest voluntary public health agency in the United States and among its earliest campaigns was one in 1909 against spitting.
- Do not spit.
- Do not let others spit.
- If you have a cough, and must spit, use a paper napkin or a piece of newspaper, and put it in the stove.
… 19. And last as well as first, DO NOT SPIT.
In 1915, the Association launched the Modern Health Crusade, originally to involve children in the Christmas Seal Campaign. Any child who sold ten or more Seals was given a “Crusader certificate of enrolment” on which was printed a list of health rules such as “keep windows open” and “get a long night’s sleep.”
To celebrate its ‘Crusaders’ the Association printed badges, which were distributed to the children. (images 1 & 2). They were designed to be distributed to children who had shown outstanding achievements in fighting Tuberculosis. “The award of titles and presentation of badges should be carried out with ceremony. Crusade health teachings are probably imprinted for life on the minds of boys and girls who are formally dubbed knights and knights banneret.” In 1917 the National Association inaugurated a movement for the creation of correct habits for health among school children, known as the “Modern Health Crusade”. The organisation claimed that seven million American children had signed up, with many more participating in foreign countries, including France, Italy, Czechoslovakia and China.
A special badge was struck by the Association to celebrate the work done to fight the ‘Spanish flu’, with the image altered to include the dates 1918 – 1919 (image 3). It is not clear whether these were given exclusively to children, or were also ‘awarded’ to the medical staff who had contributed so much during the pandemic. There has been some criticism of the term ‘crusader’ for being exclusionary – suggesting that the disease is the fault of the foreigner, the Jew or the ‘other’. Today the term ‘crusader’ would have too many negative connotations to be used. But it would be surprising if the current Covid 19 pandemic did not trigger similar attempts to celebrate the achievements of the medical staff, or even the wider public.