I had a little bird,
Her name was Enza,
I opened up the window
And in flew Enza
—Childhood rhyme

It crept into the city like a shadowy burglar in the late summer of 1918, and when it left, in March of 1919, it trailed a line of corpses 20,000 strong.

The great flu pandemic killed 50 million to 100 million worldwide and about 700,000 around the United States in 1918 and 1919. Philadelphia received a devastating blow. At one point, during a six-week period in the fall of 1918, one Philadelphian was dying of the flu every five minutes.

On Oct. 12, 1918, the insidious disease killed 800 in the city, the highest one-day toll.

Deep into the outbreak, the city posted street-side warnings: “Spit Spreads Death.”

And that was pretty much the whole of government acknowledgment that things weren’t going well. There was no real public recognition of the magnitude of the disaster. It just faded away.

» READ MORE: More than 12,000 Philadelphians died in the flu pandemic of 1918. My aunt was one of them

Now the Mütter Museum of the College of Physicians of Philadelphia — who else? — is preparing its most ambitious exhibition ever to bring the deadly outbreak out of the shadows and tell the story of disease, government obfuscation, public heroism, and the legacy of death.

Anti-spitting sign posted on top of the Fourth Liberty Loan sign, probably on Market Street, with Philadelphia City Hall in the background, October 1918.
From “What the Health Department Has Done to Curb the Epidemic of Influenza,” Monthly Bulletin of the Department of Public Health and Charities of the City of Philadelphia, vol. 3, nos. 10–11 (October–November 1918). Historical Medical Library of The College of Physicians of Philadelphia
Anti-spitting sign posted on top of the Fourth Liberty Loan sign, probably on Market Street, with Philadelphia City Hall in the background, October 1918.

The exhibition, titled appropriately, "Spit Spreads Death: The Influenza Pandemic in Philadelphia,” opens Oct. 17 for a multiyear run. A parade commemorating the fallen and acknowledging the heroism of public health workers and the many volunteers will take place Sept. 28. It is being produced by the U.K.-based artist collective Blast Theory.

“There are no monuments to the flu,” said Robert Hicks, director of the museum and the college’s vast historical library. “The war ends. The war is the thing that overshadows everything and the government had a lot to do with the fact that the flu doesn’t get acknowledged. President Wilson never made a public utterance about the flu because he did not want to divert public attention away from World War I and the last great push to win the war.”

In Wilson’s view, nothing was more important than waging and winning the war, except, perhaps, paying for it. So it was that on Sept. 28, 1918, after the city was already in the grips of pestilence, the fourth Liberty Loan parade kicked off down Broad Street with the aim of raising funds for war bonds.

More than 200,000 people lined Broad Street that day to cheer on the war effort, and unwittingly to spread disease.

Emergency hospital during influenza epidemic, Camp Funston, Kansas, probably early 1918,
OHA 250: New Contributed Photographs Collection, Otis Historical Archives, National Museum of Health and Medicine
Emergency hospital during influenza epidemic, Camp Funston, Kansas, probably early 1918,

It’s not that no one knew the dangers of large public gatherings convened in the midst of contagion. Doctors knew. But the city declined to publicly talk about those dangers, perhaps because the federal government did not wish anything to hinder funding efforts.

A group of frantic doctors went to the press. Surely the public would be alerted by the newspapers.

“There were physicians that warned the city that the parade was a bad idea and they were told, ‘We’re going to do the parade,’" said Hicks. "Then the physicians said, “We’re going to put public notices in the newspapers warning people.' No newspaper would run them. This was all part of the hyper-charged patriotism of World War I. We’ve never seen censorship in this country like we did in World War I, exercised from the president on down. We had no federal agency stepping in to do a big thing or make the big announcement.”

Fourth Liberty Loan Subscriber Honor Emblem for people who bought war bonds during the Fourth Liberty Loan campaign in 1918.
Mütter Museum of The College of Physicians of Philadelphia
Fourth Liberty Loan Subscriber Honor Emblem for people who bought war bonds during the Fourth Liberty Loan campaign in 1918.

The parade went on, as planned, and people died, perhaps for lack of warning. Nancy Hill, project manager for the Mütter, said there was a “dramatic spike” in flu-related deaths following the parade, although it is difficult to say that the parade in and of itself was the cause.

“The parade was a pivotal moment when awareness shifted,” she said. Once the patriotic frenzy focusing on money for war bonds died down, she said, people looked around and realized they had slipped into a “bring out your dead situation.”

The Mütter intends to commemorate the fallen on Sept. 28, the 101st anniversary of the ill-conceived Liberty Loan parade, with a four mile march from the Navy Yard to City Hall, produced by Blast Theory.

The parade will feature large, illuminated floats and a musical score created by Pulitzer Prize-winning composer David Lang (who had family members struck down by the flu) and the Crossing, the Grammy-winning choral group. The music, interlaced with the names of those who died on the most fatal day, Oct. 12, will be streamed over the cellphones to parade participants.

Influenza precaution sign at Naval Aircraft Factory, Philadelphia Navy Yard, 1918
Naval History and Heritage Command, Washington, D.C.
Influenza precaution sign at Naval Aircraft Factory, Philadelphia Navy Yard, 1918

With the illuminated glow from cellphone screens and luminous movable platform walls, the parade should create a somber efflorescence at dusk — at least that’s the hope.

(Members of the public are invited to sign up to participate in the parade at www.spitspreadsdeath.com.)

Blast Theory is also making a film of the event, which will be on view in the museum exhibition, along with numerous digital interactive exhibits that allow exploration and sorting (by neighborhood or block, for example) of 20,000 death certificates; artifacts; more than 200 photographs; documents; oral histories; and public health information.

Emergency hospital during influenza epidemic, Camp Funston, Kansas, probably early 1918.
OHA 250: New Contributed Photographs Collection, Otis Historical Archives, National Museum of Health and Medicine
Emergency hospital during influenza epidemic, Camp Funston, Kansas, probably early 1918.

“Each death certificate opens a window into the life of a person who is otherwise unknown,” Hicks said. “For example, we learned about Eliza Boney, an African American woman who was born in North Carolina and who ‘kept house for husband’ in North Philadelphia. She was in the early stages of pregnancy when she died just before her 20th birthday. Eliza is one of many who are not in the history books, but this exhibition will honor her memory.”

“Blast Theory has worked very hard to make sure this is not a funerary march,” said Hill, the project manager. “We want to commemorate those who died in 1918, who often didn’t get the burials, the funerals, anything they may have wanted. We also want to honor modern public health workers. We want to make sure we draw a parallel between this woman out and on the ground and wearing a Liberty Loan button in 1918 and the nurses in our emergency rooms today who will be the first to know when this happens again. They’re putting themselves in harm’s way of another new virus like this.”

In that same vein, the Mütter will host a health fair in Mifflin Square park in South Philadelphia on Sept. 7. Free flu shots will be offered there, at the parade, and at other times during the exhibition.

During the flu epidemic of 1918, a victim, wrapped in a blanket, is escorted by a policeman.
Temple Urban Archives
During the flu epidemic of 1918, a victim, wrapped in a blanket, is escorted by a policeman.

The only mark the flu left in the city, Hicks noted, is in the cemeteries, where gravestone after gravestone bears a death date of a bleak day in the fall of 1918.

The dead speak eloquently in their silence, but here they speak alone. No policies for public health management were altered as a result of the disaster. Hospital protocols remained the same. After all, the epidemic was over by March of 1919, why plan for the past?

Only medical researchers, who engaged in a relentless pursuit for the origins and treatment of the flu, stuck to it. They determined that it was a virus in the 1930s and developed a vaccine by the 1940s. Along the way they made some other discoveries pursuing flu virus research — we owe them penicillin.

“The most visible lasting effect is just gravestones,” said Hicks. “One of the things people should ask is, ‘Is there a city plan, an emergency response plan?’ They should ask what that means.”