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In a single week in October, 4500 died in Philadelphia and 3200 died in Chicago. Surgeon General Blue reacted to the growing public health crisis by embarking on a four-part strategy. First, and foremost, state and municipal public health departments were urged to report weekly if not daily on their local conditions. The telegraph and the weekly Public Health Reports became essential tools to help PHS obtain the latest news concerning the pandemic's development.

Second, six million pamphlets warning people of the Spanish Influenza, the Three Day Fever, and The Flu were produced and circulated through local health departments. Posters, distributed widely with the aid of the Post Office Department, the Federal Railroad Administration, and the Red Cross, sought to educate the general public and medical community of the dangers of influenza. Alfred Crosby, in his 1989 history of the event, America's Forgotten Pandemic, states that "if influenza could have been smothered by paper, many lives would have been saved in 1918."

Third, an influenza director appointed to each state coordinated local disbursement of funds. In most cases, PHS appointed the state's chief health officer to direct the movement of physicians and nurses to more severely affected areas. Last, Blue called on the Volunteer Medical Service Corps (VMSC)---a backup of volunteers for PHS---to submit lists of doctors available for influenza work. More than 600 physicians volunteered and became Acting Assistant Surgeons with a monthly stipend of $200, plus $4 per diem.

This hastily constructed health force needed a large infusion of money, and in late September, Senator John Weeks of Massachusetts called for an appropriation of one million dollars to "combat and suppress Spanish influenza." The measure passed in both houses of Congress without a single dissenting vote. Blue remarked that the appropriation would hopefully establish "an important precedent" for future funding and show not only the importance of PHS but also the "importance of protecting the health of all Americans at all times."

With the funds and organizational machinery in place, Blue issued an order on October 5 to state and local health officials to close or suspend all places of public activity. Across America, health departments followed the Surgeon General's order and closed schools, churches, saloons, theaters, and most places of public assembly. Many local health departments required citizens to wear flu masks in public while city councils enforced ancient anti-spitting ordinances. The fight against influenza permeated every aspect of life, even infiltrating children's songs.

I had a little bird
And its name was Enza
I opened the window
And in-flew-Enza.

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