1	Introduction Commissioner Brenda M. Harvey Maine Department of Health & Human Services
2	Welcome Governor John E. Baldacci
3	1918 Pandemic Influenza in Maine Lessons Learned Dora Anne Mills, MD, MPH Director, Maine CDC (formerly Bureau of Health) Maine Department of Health & Human Services Major General John W. (Bill) Libby Maine’s Adjutant General and Commissioner Department of Defense, Veterans & Emergency Management
4	Saturday September 7, 1918
5	WW I June 28, 1914 Assassination of Archduke Ferdinand of Sarajevo sets in motion the wheels of war.
6	WW I August 1, 1914 Germany declares war on Russia, then two days later, on France.
7	WW I “It is a war against all nations. American ships have been sunk, American lives taken, in ways which it has stirred us very deeply to learn of…
8	WW I but the ships and people of other neutral and friendly nations have been sunk and overwhelmed in the waters in the same way…
9	WW I The challenge is to all mankind. Each nation must decide for itself how it will meet it…
10	WW I Our motive will not be revenge or the victorious assertion of the physical might of the nation, but only the vindication of right, of human right, of which we are only a single champion.”
11	WW I President Woodrow Wilson (1856-1924) 28^th President of the U.S. War Message to Congress April 2, 1917
12	WW I April 6, 1917 United States enters WW I against Germany.
13	WW I June, 1917 First American troops land in France.
14	WW I November 30, 1917 Harold Andrews from Portland, 24 years old, first man from Maine to die in WW I. Died in France
15	WW I Later, linden trees along Baxter Boulevard in Portland are planted to honor him.
16	Saturday September 14, 1918
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18	Wednesday September 19, 1918
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22	Saturday September 21, 1918
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27	Monday September 23, 1918
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30	Wednesday September 25, 1918
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32	Maine 1892 Vital Records (births, deaths, marriages, and divorces) are first collected and maintained by the State.
33	Maine 1885 Maine State Board of Health created with strong support from Maine Medical Association.
34	Maine 1917 Maine Board of Health becomes the Maine Department of Health Appropriation increases from $8,000 to $30,000.
35	Maine 1918 Maine Department of Health has: Physician Commissioner – Leverett Bristol, MD, DrPH
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38	Women’s Suffrage Women’s right to vote
39	Women’s Suffrage January 10, 1918 U.S. House passed Women’s Suffrage by one more vote than needed to make the 2/3 majority.
40	Cartoon supporting women's suffrage This cartoon, and many others, were drawn by William Ourcadie which was a pseudonym for Frederic W. Freeman. It supports women's suffrage and was published by the Suffrage Referendum League of Maine circa 1917 in the Daily Eastern Argus.
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42	Thursday September 26, 1918
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45	Maine 1918 Who had authority to quarantine and ban public gatherings?
46	Maine 1918 Local Boards of Health
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51	Friday September 27, 1918
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56	Maine Boys Who Have Died of Spanish Influenza at Camp Devens as of September 27^th Carroll Fuller, 22, Westbrook Alphonse Dame Jr., Westbrook Joseph N. Houle, Westbrook Harvey Miller, Westbrook Albert Richardson, Orr’s Island Clifford Doughty, Chebeague Island Cecil Brown, Norway William Snow, Norway Adams Forrest, Cumberland Mills George Carpier, Biddeford Cecil Grant, Houlton Albert Moody, Solon Ned Cyr, Van Buren Melvin Ames, South Bancroft Hollis Parsons, York Beach Frederick MacDonald, Vanceboro Thomas Currier, Sanford Chester Fletcher, Wilton Herbert Barnfield, Freeport Earl Robbins, Livermore Falls Frank Stevens, Kennebunk William B. Clark, 31, Norway Oscar S. Marden, Winterport Clyde Cilley, East Thorndike Harry B. Putnam, 31, Portland Olin Liscomb, Bar Harbor
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64	Saturday September 28, 1918
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77	Monday September 30, 1918
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82	Tuesday October 1, 1918
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93	Maine 1917 What was the most common cause of death in 1917?
94	Maine 1917 Infectious diseases, with Tuberculosis the most common cause.
95	Maine 1917 Tuberculosis: Killed over 900 Mainers in 1917 Accounted for more deaths than from all cancers
96	Maine 1917 Other common causes of death: Pneumonia Diarrhea Whooping Cough Diphtheria Typhoid Fever Polio Meningitis
97	Wednesday October 2, 1918
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104	Thursday October 3, 1918
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112	Friday October 4, 1918
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126	Saturday October 5, 1918
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137	Maine 1918 Two-Pronged Economy Natural Resource-Based (lumber, granite, lime, and ice) Factories (wood, textiles, shoes, shipbuilding)
138	Maine 1918 Industries with Largest Numbers of Wage Earners in 1918 Paper, Wood, Lumber Woolen Goods Cotton Textiles Boot and Shoes Shipbuilding
139	Maine 1918 Most of Maine’s textile factories are in Lewiston and Biddeford
140	Maine 1918 Maine Textile Factories Half of the workers are women 80% of the workers are from Quebec
141	Maine 1918 Two-Pronged Economy Natural Resource-Based (lumber, granite, lime, and ice) Factories (wood, textiles, shoes, shipbuilding)
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145	Monday October 7, 1918
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153	Tuesday October 8, 1918
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161	Thursday October 10, 1918
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166	Monsignor McDonough St. Patrick's Church, Lewiston (aka Marc Mutty, Portland Diocese) Dr. Epstein Chair of Lewiston Board of Health (aka Dr. Don Hoenig, State Veterinarian)
167	Maine 1918 Lewiston population ~30,000 Auburn population ~16,000
168	Maine 1918 ~47% of Lewiston’s population is French American
169	Maine 1918 Franco-Americans in Lewiston 1850 – None 1870 – 689 1880 – 4,500 1920 – 14,815
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172	Maine 1917 16,337 babies born. Born to Foreign-Born Parents: 1 in 5 in Maine >1 in 3 in Lewiston ~1 in 2 in Biddeford
173	Maine 1917 Countries Parents Born In: France and French Canada (~70% statewide) Ireland England Italy Russia Scotland
174	Monsignor McDonough St. Patrick's Church, Lewiston (aka Marc Mutty, Portland Diocese) Dr. Epstein Chair of Lewiston Board of Health (aka Dr. Don Hoenig, State Veterinarian)
175	Aftermath of Meeting
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179	Friday October 11, 1918
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181	Saturday October 12, 1918
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189	Monday October 14, 1918
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195	Tuesday October 15, 1918
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212	Saturday October 19, 1918
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217	Monday October 21, 1918
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222	Tuesday October 22, 1918
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225	Maine 1918 Did you know the Maine Anti-Tuberculosis Association was formed in 1911 and became the Maine Public Health Association in 1920?
226	Maine 1918 1911 – Maine Anti-Tuberculosis Assoc. 1920 – Maine Public Health Assoc. 1950 – Maine Tuberculosis Assoc. 1960 – Maine Tuberculosis & Health Assoc. 1972 – Maine Lung Association 1986 – American Lung Assoc. of Maine
227	Thursday October 24, 1918
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234	Saturday November 2, 1918
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237	Thursday November 7, 1918
238	Maine 1917 In 1917, what was the Maine county with the highest number of births, birth rate, and population gain (births minus deaths)?
239	Maine 1917 Aroostook
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241	Monday November 11, 1918 11:00 AM
242	WW I November 11^th, 1918 11:00 a.m. Armistice is signed!
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244	WW I November 11^th: 1938 became a Federal holiday 1954 became Veterans Day
245	Monday November 18, 1918
246	Maine 1918 Le Madawaska, November 18^th The hand of God has struck our population. A great number of families have seen the death of a mother, a father, brothers, sisters. The losses are numberless and everywhere there is sorrow. Few are the families who have not been affected. Never has such a calamity visited our region.
247	Maine 1918 Le Madawaska, December The influenza was brought to Madawaska region by a trainload of soldiers from Nova Scotia. The train left with 500 soldiers in good health, and arrived in Edmundston the 26^th of September with six soldiers suffering from influenza.
248	Tuesday November 19, 1918
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250	Maine October-November Influenza Deaths Madawaska Area Communities St. Jacques 24 St. Francois 25 Ste. Anne 23 Clair 9 St. Basile 42 St. Leonard 26 Lac Baker 12 St. Hilaire 27 St. Andre 30 Edmundston 42
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253	Tuesday December 3, 1918
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256	Aftermath of 1918 Pandemic
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259	Maine 1918 Emergency Influenza Committee: Filled 120 calls for nurses to 50 communities 23 doctors to 26 communities Opened 23 emergency hospitals in 18 communities.
260	Maine 1918 A number of communities provided their own nurses and doctors, and opened their own hospitals at their own expense.
261	Maine 1918 Pandemic Impact in Maine
262	September 1918 – May 1919 46,948 reports of influenza in Maine.
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267	Maine 1918 52% of Maine Influenza Deaths in October, 1918
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271	WW I Maine lost 1,026 soldiers during World War I.
272	WW I ~550 (over half) of these soldiers died from influenza.
273	1918 Pandemic National Impact
274	1918 Pandemic in U.S. Highest US death rate – ever 675,000 deaths – mostly young adults 24,000 out of 34,000 US Army deaths in WW1 were from influenza Virtually all 5,000 US sailor deaths were from influenza
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276	1918 Pandemic Worldwide Impact 50-100 million deaths Killed 5-10% of world’s young adults
277	Maine 1919 Legislation Passed: Maine Department of Health Annual Appropriation increased from $30,000 to $76,000 (PL 1919, Chap. 172)
278	Maine 1919 Legislation Passed: Local Health Officers (LHOs): Appointment subject to approval of State Health Commissioner May take the place of a Local Board of Health If qualified in public health and working fulltime, State Health Department will pay 1/3 of salary
279	Maine 1919 Legislation Passed: LHOs “shall assist in the reporting, prevention, and suppression of diseases and all conditions dangerous to health” LHOs “shall be subject to the supervision and direction of the State Department of Health” Subject to approval of State Health Commissioner, towns may organize together to hire a joing LHO.
280	Maine 1919 Legislation Passed: Local Boards of Health Local Boards of Health “shall be exercised under the control and direction of the State Department of Health”
281	Maine 1919 Legislation Passed: State Department of Health May issue orders or rules to protect life and health, including in a real or threatened epidemic or disease
282	Maine 1918 Aftermath Isolation ward at Maine General Hospital (now Maine Medical Center)
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284	Influenza Aftermath Girls common jump rope song: I had a little bird And its name was Enza I opened the window And in-flew-Enza
285	Maine 1918 Aftermath Emergency Medical & Nursing Corps
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288	Maine 1918 Aftermath Improved Disease Surveillance
289	Maine 1918 Maine Department of Health has 6 Divisions: Communicable Diseases Diagnostic Laboratories Sanitary Engineering Public Health Education and Publicity Vital Statistics Administration
290	Maine 1918 Aftermath Evidence today - Bath
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296	"In Flanders fields the poppies..." In Flanders fields the poppies blow Between the crosses, row on row, That mark our place; and in the sky The larks, still bravely singing, fly Scarce heard amid the guns below
297	"We are the Dead" We are the Dead. Short days ago We lived, felt dawn, saw sunset glow, Loved, and were loved, and now we lie. In Flanders fields.
298	"Take up our quarrel with..." Take up our quarrel with the foe: To you from failing hands we throw The torch; be yours to hold it high, If ye break faith with us who die We shall not sleep, though poppies grow In Flanders fields.
299	Maine 1918 Aftermath Lessons Learned and Questions Asked
300	1918 Pandemic in Maine Chief Researcher & Graphics Elaine Lovejoy Maine CDC Assistant Researcher Jennifer Lovejoy
301	1918 Pandemic in Maine Other Research Contributors: Maine State Library Staff Maine Historical Society Jocelyn Leadbetter, Archivist, Maine Medical Center Bob Michaud, Maine Law & Legislative Reference Library Gordon Smith, Maine Medical Association Ed Miller, American Lung Association of Maine Don Lemieux, State Registrar, Maine CDC Jeannette Sherman & Rose Libby, Public Health Nursing, Maine CDC Peter Ogden, Maine Veterans Services Marla Davis MidCoast Hospital Caribou Public Library Many others – Thank You!!
302	Franklin Community Health Network Pandemic Team Richard Batt, President, Franklin Community Health Network Jan Bell, RN, Infection Control Leah Binder (co-chair), Vice President, Franklin Community Health Network David Robie, Director, NorthStar EMS Randall Gauvin (co-chair), PA-C Emily Brostek, Special Projects Sandra Richard, Healthy Community Coalition Jan Brinkman, RN, EMT-P, Education www.mainehealthforum.org/Avian-Bird-Flu.asp
303	Maine State Government Commissioner Brenda Harvey, Department of Health and Human Services, Adjutant General and Commissioner Major General John Libby, Department of Defense, Veterans and Emergency Management Deputy Commissioner Ned Porter, Department of Agriculture, Food and Rural Resources Commissioner Roland Martin, Department of Inland Fisheries and Wildlife Commissioner Michael Cantara, Department of Public Safety
304	1918 - 2006 Lessons Learned