Tag: Eli Lilly

Reflections and Remedies: The 1918 Influenza Outbreak in Indiana

United States Public Health Service leaflet, n.d., in Randi Richardson, “A Month in the Year of a Flu Epidemic in Monroe County,” October 7, 2019, accessed Monroe County History Center.

As many Hoosiers begin scheduling their vaccines, one cannot help but consider the similarities between the COVID-19 pandemic and the 1918 influenza outbreak, which spread through the state barely more than 100 years ago. The 1918 pandemic was initially confined to soldiers in Indiana bunking together in close quarters as they received training and prepared for deployment during World War I. The flu quickly spread beyond those confines and, in a turn of events eerily similar to the COVID-19 pandemic, touched almost every aspect of Hoosier lives. At the beginning of both pandemics, what was once thought to be only a minor respiratory infection quickly spiraled out of the control of even the most dedicated public health officials.

U.S. Surgeon General, Rupert Blue, n.d., in Sarah Richardson, “How Surgeon General Rupert Blue Became America’s Heroic Microbe Hunter,” accessed history.net.

On September 19, 1918, Surgeon General Rupert Blue from the United States Public Health Service requested a report on the prevalence of influenza in Indiana.[1] Two weeks later, on October 8, known civilian and military cases within Indianapolis had already exceeded 2,000. The rapid spread of influenza prompted closures of public spaces while factories stayed open to support the war effort. Local pharmaceutical business Eli Lilly & Company also remained open, with approximately 100 employees working tirelessly, if ultimately unsuccessfully, to produce an influenza vaccine to help combat the infection and prevent its spread.[2] To meet the staffing demands needed to continue production, the U.S. Employment Service published various advertisements to recruit women who could assist with the preparation and packaging of the influenza vaccine, as well as other medicinal products produced by the company.[3]

In late 1919, Eli Lilly & Company began production of a saline vaccine that was purported to treat both influenza and pneumonia. This combination vaccine was initially created by Dr. Edward C. Rosenow from the Mayo Foundation in 1918, and he put it to use extensively that year. The formula created by Dr. Rosenow was considered a “mixed, polyvalent” vaccine because it combined various types of pneumococci, streptococci, staphylococci, and influenza bacilli, all of which had been isolated from individuals with cases of influenza as well as associated complications.[4] Drawing from Rosenow’s success in combining various bacterial strains, Eli Lilly produced their vaccine using his same methods and formula. The company hoped to create an unlimited supply for distribution to the public as prophylaxis prior to each successive year’s flu epidemic.[5]

Advertisement from the Women’s Division, U.S. Employment Service calling for women to apply for positions at Eli Lilly & Co. to assist with preparing and packaging of medical supplies, October 20, 1918, accessed Proquest.com.

Unfortunately, the World Health Organization concluded that Dr. Rosenow, researchers at Eli Lilly, and countless others across the United States and Europe were targeting the wrong pathogens. At the time of the pandemic, influenza was believed to result from a bacterial pathogen. It was not until 1933, when researchers at London’s National Institute for Medical Research isolated the influenza virus, that scientists realized why earlier attempts to develop an influenza vaccine had failed.[6] With the identification of the causative virus and U.S. Army soldiers participating in the clinical testing, the first influenza vaccine was developed at the University of Michigan by Thomas Francis and Jonas Salk and was licensed for public use in 1945.[7]

Despite the lack of a vaccine, city-wide closures kept cases within Indianapolis low. Red Cross volunteer nurses were able to be sent elsewhere in the state to assist other communities. When minor surges of influenza recurred, Indianapolis Board of Health Secretary Dr. Herman G. Morgan advocated for masking mandates and for individuals with symptoms of colds or influenza to be barred from public transportation and public spaces. He argued that mask requirements would “permit the business and social activities to continue with as little hindrance as possible.”[8]

Temporary hospital in Terre Haute during the flu outbreak, 1918, in Dawn Mitchell, “Here’s how Indianapolis escaped the 1918 flu with one of the lowest death rates,” last updated January 9, 2019, accessed IndyStar.com.

As with the COVID-19 pandemic, Dr. Morgan was forced to issue a statement explaining that while he understood the masks were restrictive and bothersome, which led to much of the public outcry against them, they allowed the city to maintain as close to normal operations as possible without requiring significant closures as had been ordered months earlier. As cases decreased dramatically following these orders, the mask mandate was rescinded after only a month, and businesses were able to reopen to the public. However, the Board of Health recommended “that every care and precaution should be taken by individuals to protect their health, as the danger of infection is by no means passed.”[9]

Fort Wayne Sentinel, December 7, 1918, 7, in April Ludwig, Jessica Brabble, and E. Thomas Ewing, “Flu Masks in Indiana During the 1918 Epidemic,” accessed Social Science Research Council.

Although the Centers for Disease Control and Prevention reported that approximately 50 million people worldwide and 675,000 people in the United States died due to the 1918 influenza pandemic, Indianapolis reported one of the lowest death rates in the nation, with only 290 per 100,000 people.[10] Indiana reported 3,266 total deaths, primarily among people 20 to 40 years of age, which is unusual compared to modern influenza mortality, with the highest mortality rates among young children and the elderly.[11] It is argued that such success was due to the coordinated efforts of city officials, who presented a united front for controlling the disease and explaining their positions clearly and persuasively to the public, even in the face of challenges from local business owners.

Perhaps the most remarkable aspect of Indianapolis’s fight against the flu pandemic was the relative lack of knowledge regarding appropriate treatments for the condition. While in 2023, vaccines, antivirals against influenza, and antibiotics to treat opportunistic bacterial infections are standard practice, individuals during the 1918 influenza pandemic sought help wherever it could be found, whether from a physician, homeopath, naturopath, practitioners of traditional medicine, or others.[12]

In the early 1900s, there was far less distinction between traditional practices and medical science, and the most significant concern was to prevent or treat the illness by drawing on known characteristics of components used in formulations to treat other conditions. However, these treatments, such as mercury, arsenic, and strychnine, were not always safe or effective and often bordered on dangerous or even fatal. Medical professionals today advise a very different course of action, arguing that simple hydration, supportive care, and staying in quarantine are the best remedies against the infecting influenza virus and preventing its spread to others.

Newspaper article from 1918 reporting shortages of Vick’s VapoRub due to high demand for its reported efficacy in treating influenza, in Scott Woodsmall, “Lessons learned from the Spanish Flu,” accessed republictimes.net.

Although Surgeon General Blue mentioned some successes in other countries regarding the use of “salts of quinine and aspirin” to treat acute attacks, he and Dr. Morgan encouraged individuals to follow “ordinary rules of good health” and cover their noses and mouths when coughing or sneezing rather than making any recommendation in favor of a specific medication or pharmaceutical remedy.[13] He, along with Dr. John Hurty, Secretary of the Indiana State Board of Health, also warned against alleged manufactured or homemade “cures” for the disease, recommending that individuals be aware of potential scams and instead focus efforts on avoiding people exhibiting signs or symptoms of infection.[14]

One “treatment” that gained popularity in Indiana during the 1918 influenza pandemic was Wilson’s Solution or “Anti-Flu,” developed as a preventative treatment for the Spanish Influenza. This product was developed by Robert C. Wilson, a college professor and head of the department of pharmacy at a southern university in Georgia. Consumers were encouraged to use a couple of drops of Wilson’s Solution on a handkerchief, which could then be carried with them and inhaled “when entering crowds or public places.”[15] It was believed that the antiseptic properties of the Solution’s vapors would kill the influenza germs in the nose and throat. Wilson’s Solution was sold by local drug stores in Indiana and distributed by Kiefer-Stewart, a wholesale drug firm in Indiana. Local druggists reported that this drug was difficult to keep on shelves due to high demand. Although the exact components of the Wilson’s Solution are unknown, Wilson’s Solution still in use today as a sinus rinse to treat sinusitis and chronic rhinosinusitis.[16] Regardless of what the product contained, it was marketed only as a preventative therapy and not as a cure for influenza. Consumers who contracted the flu were advised to contact their doctor immediately.

Influenza circular from the Indiana State Board of Health, n.d., in Dawn Mitchell, “Here’s how Indianapolis escaped the 1918 Spanish flu with one of the lowest death rates,” last updated January 9, 2019, accessed IndyStar.com.

One such treatment that has gained attention for its potential role in increasing mortality during the 1918 influenza pandemic is one that many Americans today regularly take for its cardiovascular benefits – the seemingly benign aspirin. As a licensed pharmacist, I was trained in school about the concerns associated with administering aspirin to children for whom there is a suspicion of a viral illness, such as chicken pox or influenza, due to a risk of Reye syndrome. This can initially manifest as personality changes or recurrent vomiting before progressing to coma or death with associated brain swelling and fat accumulation in the liver. For adults, toxicity usually presents as abnormal consciousness and respiratory distress.

Recommendations for limiting dosing and frequency of aspirin were lacking in 1918, which likely contributed to otherwise healthy young adults succumbing to influenza.[17] Given the lack of sophisticated medical knowledge at the time to distinguish drug toxicities from general illness, it is therefore unsurprising that aspirin overdose was not linked to influenza as a contributing factor in the deaths of individuals in Western countries.

Daily Tribune (Terre Haute), October 11, 1918, 7, in April Ludwig, Jessica Brabble, and E. Thomas Ewing, “Flu Masks in Indiana during the 1918 epidemic,” accessed Social Science Research Council.

As medical science advances, new knowledge of diseases and safe and effective treatments emerge. The hope is that medical professionals and the public learn from the past and continue to seek answers to questions that once seemed to have no possible solution. In 2020, Eli Lilly was once again at the forefront of a pandemic, undertaking the “world’s first study of a potential COVID-19 antibody treatment in humans” by early June. The company was also integral in early Covid testing, piloting a drive-through program in Indiana.

While the 1918 flu pandemic will likely never be traced to a definitive cause for why it was one of the deadliest the world had seen until the COVID-19 pandemic, research into factors that contributed to the increased mortality is a promising avenue for building an understanding of how we might approach treatment options in the future.

For a bibliography of sources used in this post, click here.

Notes:

[1] “Indianapolis, Indiana,” The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia, accessed https://www.influenzaarchive.org/cities/city-indianapolis.html#.

[2] “Indianapolis, Indiana,” The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia.

[3] “Classified Ad 11 — no Title,” Indianapolis Star, October 20, 1918.

[4] “Influenza-Pneumonia Vaccine,” (1919), American Druggist and Pharmaceutical Record (1893-1922), 67 (12), 86, accessed https://www.proquest.com/docview/189108336?parentSessionId=5cr0scJFezskdS2R9pRBAIv8OzA959Vs3Dl%2FgtRdhd0%3D&accountid=7398#.

[5] “Influenza-Pneumonia Vaccine,” (1919).

[6] “History of the Influenza Vaccine: A Year-Round Disease Affecting Everyone,” World Health Organization, accessed https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination.

[7] Ibid.

[8] “Flu Mask Order Stands; Option is Permissible,” Indianapolis Star, November 24, 1918, 1, accessed https://www.proquest.com/docview/374979130?accountid=7398.

[9] Ibid.

[10] “1918 Pandemic (H1N1) Virus,” Centers for Disease Control and Prevention, accessed https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html; Terry Housholder, “Flu Pandemic a Century Ago Hit Northeast Indiana Hard,” KPCnews.com, March 29, 2020, accessed https://www.kpcnews.com/columnists/article_3eaae40e-bfca-5b02-b7bd-4e641e452daf.html; “Indianapolis, Indiana,” The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia.

[11] Housholder, “Flu Pandemic;” Jill Weiss Simins, “War, Plague, and Courage: Spanish Influenza at Fort Benjamin Harrison & Indianapolis,” Untold Indiana, July 11, 2017, accessed https://blog.history.in.gov/tag/spanish-flu/.

[12] Laura Spinney, Pale Rider: The Spanish Flu of 1918 and How It Changed the World (New York: PublicAffairs, 2017).

[13] Celeste H. Jaffe, “The Spanish Influenza Epidemic in Indianapolis in 1918: A Study of Civic and Community Responses,” (Master’s Thesis, Indiana University, 1994), 44.

[14] Jaffe, 45.

[15] “Thousands Now Using Anti-Flu Treatment: New Solution Discovered By Georgia College Professor Designed To Kill Deadly ‘Flu’ Germ–First Used It To Protect Own Family–Just A Few Drops Inhaled From Pocked Handkerchief Disinfects Nose And Throat,” Indianapolis Star (1907-1922), Nov 20, 1918, accessed https://www.proquest.com/docview/751674358?parentSessionId=lfB6tV2GiV4OxiNGjM82VWZLbWGhtpwmeqKdm8Hb8bo%3D&accountid=7398.

[16] Ravneet R. Verma and Ravinder Verma, “Sinonasal Irrigation After Endoscopic Sinus Surgery – Past to Present and Future,” Indian Journal of Otolaryngology and Head & Neck Surgery 75, no. 3 (2023): 2694.

[17] Starko, 1407.

Digging into History: Hoosier Archaeologist Glenn A. Black

Glenn Black, 1959. Image courtesy Glenn A. Black Laboratory of Archaeology Photographs and the Trustees of Indiana University

Glenn A. Black (1900-1964), native of Indianapolis, became one of Indiana’s leading archaeologists in the midst of the Great Depression. He was essentially self-taught, having only a small amount of formal training with Henry C. Shetrone of the Ohio Historical Society (now Ohio History Connection). Black’s work redefined archaeological field methodology, and brought systematic excavations and innovative technology to the field.

Black began his archaeological career by serving as a guide for Warren K. Moorehead and Eli Lilly Jr. in May 1931. Impressed with Black’s knowledge, they encouraged him to become an archaeologist. Lilly funded Black’s work with his own money initially, and later arranged for him to be paid through the Indiana Historical Society’s archaeological department. Lilly also helped Black with his formal training, sending him to Columbus, Ohio from October 1931 to May 1932 to train with Henry C. Shetrone. During this training, Black married Ida May Hazzard, who joined in his digs. He became especially close with Eli Lilly, forming a bond that would last for the rest of his lifetime.

Lilly and Black on Lilly’s boat on Lake Wawasee in 1951. Photo courtesy Angel Mounds Historic Site

Black and Lilly worked together on many projects, but one of their more controversial projects concerned the Walam Olum, a historically disputed story of the creation of the Delaware tribe. Lilly and Black “had a hunch that the Walam Olum may possibly have in it the key that will open the riddle of the Mound Builders.” In short, they were “trying to connect the prehistoric people who had built the great mounds of the Ohio Valley with the historic Delaware tribe.”

The Walam Olum story was first told by Constantine Samuel Rafinesque in 1836. Rafinesque announced that he had acquired some “tablets” that depicted the “ancient record of the peopling of North America that had been written by the early Lenape (Delaware) Indians and passed down in the tribe for generations.” He had translated the tablets into English, and called it the “Walam Olum” or “painted record” in Lenape. In the years following his death, notable historians, linguists, and ethnologists believed that it “contained crucial evidence for prehistoric Amerindian migrations and the identity of the mysterious Midwestern Mound Builders.” Lilly and Black believed in this theory, and began analyzing the Walam Olum with a team of experts. Their report, published in 1954, claimed “all confidence in the historical value of the Walam Olum.” More recently, historians believe that the Walam Olum was a hoax created by Rafinesque to prove his belief that the Indians came to North America from the Old World.

Nowlin Mound Site, 1935. Image courtesy Glenn A. Black Laboratory of Archaeology Photographs and the Trustees of Indiana University

In 1934, Black was asked by the Indiana Historical Society to excavate the Nowlin Mound in Dearborn County. Ida joined him on this dig, as she was “deeply interested in delving into the archaeological as her talented husband.” It was here that his intensely methodical process of excavating is evident. In his report on the mound, he wrote, “If the results of any excavation are to provide an unimpeachable historical record of a prehistoric work, too much stress cannot be placed upon methodical technique and exactness of detail, no matter how trivial the feature may be.” He felt very strongly about following a methodical excavation system, believing that it would lead to improved results and a better historical record.

“if the description of the methods used in staking and surveying the mound seems unnecessarily extensive, it should be remembered that a mound once dug is a mound destroyed; if the story it has to tell be lost on the initial attempt it is lost forever.”

Works Progress Administration (WPA) excavation of Y-7-C at Angel Mounds. Image courtesy Glenn A. Black Laboratory of Archaeology Photographs and the Trustees of Indiana University

In 1938, the Indiana Historical Society purchased Angel Mounds with the help of Eli Lilly. Lilly contemplated purchasing the site since 1931, but when the site was in danger of being incorporated by the City of Evansville in 1938, he acted. The Works Progress Administration (WPA) conducted excavations from 1939-1942, and IU’s field program excavated beginning in 1945 (work temporarily ceased during WWII). Black held his students in the field program to very high standards.

In a letter to his students, Black wrote:

You will be living for ten weeks in very close association with your fellow students and you will be expected to get along with one another in an agreeable manner. This is one of the very few field camps which accepts mixed groups. As such we are under constant surveyance by those in this neighborhood and at the University who do not believe in girls attending field schools. I do not subscribe to this thesis but that I may be proved right, and my critics wrong, I am dependent on you. I expect the girls be ladies and the boys gentlemen and all of you to be discreet and orderly at all times. It is requested that you do not wear shorts on the dig—they are neither practical or appropriate.

William S. Merimer, Robert Lorenson, Glenn A. Black, William R. Adams, Vernon Helmen, 1946. Image courtesy Glenn A. Black Laboratory of Archaeology Photographs and the Trustees of Indiana University

In the spring of 1939, Black moved to a house on the Angel Mounds site and began supervising the excavations. He and Lilly used the WPA to supply workers to excavate from 1939-1942. Two-hundred and seventy-seven men and 120,000 square feet later, Black and the WPA recovered and processed more than 2.3 million archaeological items. From 1945-1962, students worked at the site in the summer to extend the work of the WPA. The years 1945-1947 were used as “trial runs” of the program, and the first official class began in June 1948. Stemming from this work, an organization was created in 1948 called The Trowel and Brush Society. This society limited membership to students enrolled in the Angel Mounds Field School, but created an honorary category for those who were unable to join formally, but had “contributed to American Archaeology in general and Indiana Archaeology in particular.” The purpose of this society was “to promote good techniques in archaeological research; to maintain contact between students who attend Indiana University’s Archaeological Field School.”

Through his excavations, Black concluded that Angel Mounds existed long before the discovery of America, and was most likely still a “lively community during and after the period of DeSoto,” and does not have evidence to suggest that the site was visited by white men. He believed that Angel Mounds was the site of the “farthest north existence of an agricultural Indian folk who were a part of the long settled tribes of southern and southeastern United States.” An encyclopedia entry about Angel Mounds estimates that the community flourished between AD 1050 and 1450 and that the settlement was geographically and culturally central during Angel Phase, the portion of time from AD 1050-1350 characterized by the Mississippian culture’s use of ceramic, of which there is plenty at Angel Mounds.

Proton Magnetometer, 1959. Image courtesy Glenn A. Black Laboratory of Archaeology and the Trustees of Indiana University

Even after concluding this from his excavation, Black said in 1947 that “There’s plenty here to keep me busy the rest of my life.” In 1958, Black became interested in locational devices to detect features of the mounds. He saw that the use of a proton magnetometer was announced in Britain by the Oxford University Research Laboratory for Archaeology and the History of Art. Reportedly the device was successful in locating features at Roman sites. Black began looking for one to use at Angel Mounds. In September 1960, the Indiana Historical Society purchased a magnetometer instrument for use at Angel Mounds. The purpose of this project was “to evaluate the application of the proton magnetometer to the problem of locating subsurface features on archaeological sites in this part of the world, and to extend the work begun by the Oxford Group.”

Magnetometry Survey, 1962. Image courtesy Glenn A. Black Laboratory of Archaeology and the Trustees of Indiana University

In 1946, the site was transferred to the State of Indiana. After Black’s death in 1964, the Indiana Historical Society and the Indiana Department of Natural Resources transferred the site to Indiana University in an attempt at “making Indiana university the archaeological center of the state” and to use the site as a research and teaching facility. In 1964, Angel Mounds was registered as a national historic landmark. Today, the Indiana State Museum and Historic Sites Corporation manages the site.

Black’s other notable achievements included: vice-president and president of the Society for American Archaeology; Archaeology Divisional Chairman for the Indiana Academy of Science; member of the National Research Council; awarded an honorary doctorate by Wabash College.

Glenn Black died September 2, 1964 in Evansville, following a heart attack. Lilly used the Lilly Endowment to create the Glenn A. Black Laboratory of Archaeology after his friend’s death, dedicating it on April 21, 1971. When Black died, he was almost done with his report on the Angel Site. Former student James A. Kellar and editor Gayle Thornbrough finished it. The Indiana Historical Society published it in 1967 in two volumes, titling it Angel Site: An Archaeological, Historical, and Ethnological Study. The sections that Black completed before his death include the “historical background, chronological account of its excavation, ethnological relationships, and the ecology of the area.” After his death, Kellar wrote the section that dealt with material that had been recovered from the site. Indeed, plenty at Angel Mounds to keep him busy for the rest of his life.

Learn more about Lilly and Black’s investigation into the Walam Olum, see Walam Olum, or Red Score: The Migration Legend of the Lenni Lenape or Delaware Indians: A New Translation, Interpreted by Linguistic, Historical, Archaeological, Ethnological, and Physical Anthropological Studies.

Check back for information about IHB’s forthcoming marker dedication ceremony honoring Glenn A. Black.