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As October wore on and the death toll increased, Blue established a network of emergency hospitals and a national system of emergency soup kitchens. Throughout the pandemic, PHS appointed 64 commissioned officers solely for influenza duty and employed 1085 doctors and 73 nurses. In addition to providing desperately needed physicians and nurses to various locales, PHS also conducted experiments in the hopes of developing a vaccine. Incarcerated soldiers quarantined at Boston and San Francisco volunteered as subjects in a series of trials aimed at studying the effects of influenza. The volunteers were repeatedly exposed to hospital patients exhibiting influenza-like symptoms in an attempt to make them contract the disease - Although the 118 men failed to develop influenza, they all received full pardons in recognition of their participation.

Assessing the Toll

As the number of new cases diminished in November and early December, PHS began assessing and tabulating influenza's terrible toll across America. W.H. Frost, a PHS Surgeon and statistician, and a team of inspectors conducted door-to-door surveys in ten US cities and towns to calculate morbidity and mortality. Their findings, although based on a relatively small sample, were the first to uncover the virus's unique tendency to strike the 20-40 age group. This age category, typically the strongest and healthiest segment of the population, sustained an extremely high number of deaths that modern epidemiologists have not been able to explain.

Subsequent studies conducted by Edgar Sydenstrikcer and Selwyn Collins, statisticians with PHS, helped establish the US death count of 550,000 and the 21 million count worldwide. These figures, as Crosby points out, probably underestimate the actual number of deaths due to poor reporting and inaccurate diagnoses.

The pandemic exposed the need for a stronger and expanded federal role in safeguarding the nation's health. "The present epidemic has demonstrated," according to the Surgeon General, "the imperative need of a permanent organization, within the Public Health Service, available with each emergency." Blue proposed a comprehensive health program in which national health functions would be centralized within PHS. The goal was to foster a healthy working relationship between federal and state agencies to nurture a "Cooperative administrations for future interactions."

Despite high mortality rates and the need for increased appropriations, the 1918 pandemic faded to stimulate extensive influenza research or a dramatic increase in permanent funds for PHS. Aside from the emergency funding, Congress made no other special appropriations, and the survivors and victims of influenza had no monuments erected on their behalf. Blue's appeal for a permanent mechanism to prevent and control diseases such as influenza was quickly forgotten as postwar America sought to heal its war wounds and seek a return to "normalcy."

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