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Part of Buffalo physician and biomedical scientist, Late Winter 1989-1990
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STAFF
DIRECTOR OF PUBLICATIONS
Nancy Tobin
BUFFALO PHYSICIAN EDITOR
Connie Oswald Stofko
ART DIRECTOR
Alan J. Kegler
ASSISTANT ART DIRECTOR
Scott Fricker
ADVISORY BOARD
Dr. John Naughton, Chairman
Dr. Harold Brody
Ms. Nancy Glieco
Dr. James Kanski
Dr. Joseph L. Kunz
Dr. Charles Paganelli
Mr. Paul D. Paterson
Dr. Antoinette Peters
Dr. Charles Pruet
Dr. Luther Robinson
Dr. Thomas Rosenthal
Dr. Saleela Suresh
Dr. Burton Singerman
Dr. Stephen Spaulding
Dr. Nelson Torre
Mr. Edward Wenzke
Dr. Jerome Yates
Dear Alumni and Supporters of the UB medical school:
M
edical schools and the health care establishment must
contribute ideas and programs to meet the needs of our
rural citizens. This was the consensus of a recent confer
ence of legislative leaders, faculty from New York State public and
private medical schools, and national leaders held in Buffalo. Dr.
Thomas Rosenthal of the Department of Family Medicine was in
strumental in organizing the event.
Clearly, departments of family medicine will play an impor
tant role in directing training efforts to produce medical manpow
er to populate these underserved areas, and in fostering innovative
mechanisms that provide continuing education opportunities and
professional linkages between a medical school and the rural phy
sicians.
With the leadership of our department and the strengthening
of the conference participants' resolve, I am sure that this unmet
need will be dealt with constructively in the years ahead.
Sincerely,
WRITERS
Wendy Brown
Milt Carlin
David Himmelgrecn
Collin McCulley
David M. Snyderman
John Naughton, M.D.
Vice President for Clinical Affairs
Dean, School of Medicine and Biomedical Sciences
ILLUSTRATORS
Alan E. Cober
Dan Zakroczemski
PHOTOGRAPHERS
Antoinette Mucilli
Simon Tong
Robert Walion
TEACHING HOSPITALS
AND LIAISONS
Batavia Veterans Administration
Medical Center
Buffalo General Hospital, Mike Shaw
Buffalo Veterans Administration
Medical Center, John Pulli
Children's Hospital, Karen DryjaSwierski
Erie County Medical Center,
Marion Marionowsky
Mercy Hospital, Chuck Telesco
Millard Fillmore Hospital,
Joseph R. Ciffa
Roswell Park Memorial Institute, Judy Rice
Sisters Hospital, Dennis McCarthy
Produced by the Division of University Rela
tions in association with the School of Medi
cine and Biomedical Sciences, State University
of New York at Buffalo.
THE BUFFALO PHYSICIAN AND BIO
MEDICAL SCIENTIST (USPS 551-860)
Late Winter 1989-90, Volume 2.3, Number
5. Published five times annually: Spring,
Summer, Autumn, Early Winter, and Late
Winter — by the School of Medicine and
Biomedical Sciences, State University of
New York at Buffalo, 3435 Main Street,
Buffalo, New York 14214. Third class bulk
postage paid at Buffalo, New York. Send
address changes to THE BUFFALO PHY
SICIAN AND BIOMEDICAL SCIEN
TIST, 146 C.F.S. Addition, 3435 Main
Street, Buffalo, New York 14214.
Dear Colleagues:
S
pring Clinical Day and Reunion Weekend will be held April
28. A series of outstanding speakers will address the theme
"Changing Aspects of Medical Practice." The Stockton Kim
ball Lecture will be given by Dr. Arnold Relman, editor-in-chiet
of the New England Journal of Medicine. Please plan to attend. I'm
sure you will be happy you did.
Plans are firming up for the first annual UB Medical Alumni
"West Coast Mini Spring Clinical Day" to be held in Long Beach,
Calif, on May 12. A videotape of Dr. Relman's lecture, in addition
to other discussions, will be presented. If you are able to attend,
please contact Dr. Richard Berkson at 1868 Pacific Ave., Long
Beach, Calif. 90806, or phone (213) 595-4718.
Your association and the school are once again seeking nomi
nations for the Distinguished Medical Alumnus/a Award. If you
have a nominee, please submit his or her name on the card located
in the front of the magazine.
Looking forward to seeing you all at our alma mater on April
28.
*v
f
!
/
/ / Joseph L. Kunz, M.D.
( •
President, Medical Alumni Association
BUFFALO
PHYSICIAN
vol. 23, No. 5
JL
and Biomedical Scientist
Late winter 1989-90
Features
Urban family medicine. Training physicians to bring
"private practice" care to the poor in the inner city
is the goal of a new UB program.
The other enemy of World War I. Buffalo fared better
than most cities during the influenza epidemic of
1918-19, thanks to the leadership of the UB medi
cal school and its alumni.
Volunteers in Third
World, page 14-
Volunteering in the Third World. Three physicians had
three very different experiences, but all encourage
their colleagues to share the adventure.
Departments
Q] Medical School News. Lila Amdurska Wallis, M.D.,
F.A.C.P., a crusader for women's rights, told a UB
audience that it's time to make medicine a bi-gender
profession—not only in body count, but in spirit.
Serving the underserved, page 2.
Research. UB's new Multidisciplinary Center on Ag
ing focuses on the country's ever-growing popula
tion of elderly.
Alumni. Scholarships, generously provided by alum
ni, help today's students achieve their dreams.
QJ People. We could solve world problems if we used
our money for medical research instead of wasting
it on weapons, says Guiseppe A. Andres, M.D., as
he reflects on social issues and his 20-year career
at UB.
V- -
Cover:
Battling
an epidemic, page 8.
Photo courtesy of
the Buffalo and Erie
County Historical
Society.
Classnotes.
EQ Hospital News.
-oJ
Independence for the elderly, page 24.
Letters
2
High Altitude Paradise
Editor:
A note confirming that ex-Buffalonians do
read the Buffalo Physician and Biomedical Scien
tist, and comments on the article, "Mountain
Medicine" (Autumn 1989).
My wife and 1 live near Conifer, Colorado
at 8,225 feet and spend considerable time
climbing and hiking at higher altitudes.
Snowmass is at 8,575, not 11,000 feet. Our
highest town is Leadville, at 10,152 feet. One
town, Silverton, at 8,316 feet has only 14 frostfree days. Dr. Robert Gerner, formerly at
Roswell Park Memorial Institute, practices
general surgery at Vail (8,150 feet).
Personally, I have never heard of any na
tive suggesting breathing in a paper bag for
altitude sickness and I have no knowledge of
anyone having severe altitude sickness at
8,000 feet, nor fatalities at 9,000 feet. Heavy
smokers, whose adjusted "altitude" would be
about 10,000 to 13,000 feet, might have
trouble.
Rapid, competitive climbing, especially by
youngsters, commonly can promote the on
set of cough, headache, giddiness, and nausea,
but rarely serious "mountain sickness." In
winter, the associated increase in energy ex
penditure may lead to a dangerously impaired
judgment. The only practical solution is to
head downhill.
We see other problems in flatlanders before
they adjust to this high altitude paradise:
• There is the teenager welded to his third
can of pop who ascends rapidly on the ski
lift and then jumps and soars over the moguls
down the valley floor, only to roll in pain from
pneumatosis intestinalis.
• There is the young lady who misses a
commercial flight and heads up over the
mountain in an un-pressurized plane, only to
learn that her gas-filled prostheses have placed
her in double jeopardy.
• Of course there was the huge Texan who
died on the slopes and wouldn't fit in the lar
gest available coffin. The local coroner insert
ed an aspiration tube, and shipped him home
in a shoe box.
The advice to spend one day at Vail (8,150
feet) or at Aspen (7,980 feet) in mild activi
ties before climbing a 14,000-foot peak (there
are over 50 of them) is reasonable. Your re
ward will be some of the most beautiful scenes
in the world!
Cheers,
George E. Moore, M.D., Ph.D.
LATE WINTER 1989-90
Professor of Surgery
Chairman, Division of Surgical Oncology
Department of Health and Hospitals
City and County of Denver
(Editor's Note: Dr. Moore was director of Roswell Park
Memorial Institute from 1952 to 1967 )
John Krasney, Ph.D., whose work was described
in the article, replies that neurologist Marcus
Raichle and some mountaineers, not natives, ad
vocate the paper bag treatment for acute moun
tain sickness.
Recent evidence indicates that both sides of the
argument may be right, Krasney said. Breathing
3 percent carbon dioxide may alleviate symptoms
of acute mountain sickness, while it is uniformly
agreed that higher levels can exacerbate the con
dition.
He notes that heavy exertion during climbing
by non-acclimatized and unfit individuals can
indeed lead to serious problems. He agrees that
it is rare for people to experience severe acute
mountain sickness at 8,000 or 9,000 feet, but it
has been documented in a Colorado skier and
several climbers on Mt. Fuji. These individuals
pmbably have only a minimal increase in venti
lation drive, which allows them to get sick at
modest altitudes.
This Historian Never Sleeps
Editor:
I read.with,greatinterest David Snyderman's
article "From Rags to Stitches" (Autumn
1989). Dr. Border is a treasure and without
equal as an expert in his field. His knowledge
of physiology and trauma is encyclopedic.
However, I feel compelled to correct an in
accuracy within the article. Quoting Border,
Snyderman writes: "There was no real profes
sional anesthesia until World War II. At that
time, the armies trained and designated
anesthetists."
This is not true. The Mayo Clinic residen
cy program in anesthesiology dates from the
late 1920s, as does the program at the Univer
sity of Wisconsin. The American Society of
Anesthesiologists began to issue certificates
which certified a physician as a specialist in
1936. The American Medical Association
recognized anesthesiology as a medical
specialty, on an equal footing with surgery,
in 1940.
The University at Buffalo can be proud of
the role it played in the early organization of
anesthesiology. The first academic appoint
ment here predates the First World War and
there was a residency training program in
place in Buffalo in 1937.
The Second World War accelerated the
process of specialization, not only in
anesthesiology, but in most fields of medicine.
The recognition of anesthesia as a specialty
in the '20s and '30s, along with the role played
by the University of Buffalo, is a research in
terest of mine. While these facts may be some
what obscure, they are fairly well known, at
least among anesthesiologists.
I thank you for the opportunity to educate
and erase a popular yet inaccurate view of my
profession.
Most sincerely,
Douglas R. Bacon, M.D.
Staff Anesthesiologist
Roswell Park Cancer Institute
Clinical Instructor in Anesthesiology
Graduate Student,
UB Department of History
John R. Border, M.D., replies that anesthesia was
first practiced as a specialty in the '30s by a few
people, but did not become generally accepted or
generally organized until after World W a r II.
Letters
The Buffalo Physician and Biomedical
Scientist welcomes letters from its read
ers. Address them to Buffalo Physician and
Biomedical Scientist, 136 Crofts Hall,
University at Buffalo, Buffalo N.Y. 14260.
;ALO
PHYSICIAN AND BIOMEDICAL SCIENTIST
'Private Practice'
for the Inner City'
NEW
UB PROGRAM
BRINGS
PERSONALIZED
CARE TO
THE
URBAN
POOR
Understanding his patients is a goal of David Hoi den, M.D., left.
B
y
D
A
V
I
D
H
I
M
M
E
L
G
R
E
E
N
mother brings her sick toddler to the hospital emer
gency room. The wait is long and the child begins
to cry. The mother is confused by the forms she
has to fill out in order for her child to be seen
by a doctor they've never met. The physician,
overworked and tired, is brusque and appears
to be unsympathetic. Mother returns home
vowing never to return. But she will be
back.
BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST
LATE WINTER 1989-90
AT RIGHT,
ADRIANA
ALVAREZ,
M.D., AND
BELOW,
DANIEL
LASSER,
M.D., TRY TO
STOP THE
"CONVEYOR
BELT"
APPROACH
TO MEDICAL
CARE IN
THE INNER
CITY.
LATE WINTER 1989-90
"Where do the urban poor go for medical care?
They are frequently driven, in an almost cattle-like
mode, to the ERs of major inner-city hospitals and
health clinics where they are shuttled from doctor
to doctor," said David Holden, M.D., professor and
chairman of UB's department of family medicine.
"Patients are put through a system which is
sometimes analogous to a conveyor belt," added
Daniel Lasser, M.D.,
clinical director of the
Family Medicine Department at the Erie County
Medical Center. "There is little opportunity for in
teraction between the doctor and patient. It's not
a conducive situation for any of the parties."
But Buffalo is in the forefront of a better ap
proach. Lasser is the director of a new UB program
called Urban Family Medicine. Its mission is to pro
vide a more personalized kind of health care for
the urban poor in Buffalo.
"What we are trying to do is to introduce a pri
vate doctor's office into the inner city," explained
Peter Kowalski, M.D., clinical assistant professor in
family medicine.
"We try to ensure that each patient gets to see
a specific doctor on a continuous basis," added
Adriana Alvarez, M.D., clinical assistant professor
in family medicine. "By doing this we build a bond
of trust with our patients and the community."
The street is dotted with stores that have closed
down, marked by their white-washed windows. The
weather-warped porch on one house sags in the mid
dle. Several other houses could use a fresh coat of paint.
Children play on sidewalks strewn with litter.
The blight of the inner city intertwines with the
problems of the Third World on the lower west side
of Buffalo. The people are poor, primarily Hispan
ic and African American. Recent emigres and ille
gal aliens bring with them the diseases of their
native countries. It is not uncommon to find mal
nutrition, tuberculosis, and intestinal parasites.
The people in that neighborhood are also vexed
by the inner-city health problems commonly found
throughout the U.S. Infant mortality is high. Al
coholism, drug abuse, and hypertension tear at the
heart of the community. And diabetes is another
problem, particularly among the Hispanic popu
lation.
At 514 Niagara St. there is a ray of hope called
the Niagara Family Health Center. A bright and
cheery office with light colored walls and shiny
linoleum floors, it's airy and warm, not cold and
sanitized. The health center is a test site for the Ur
ban Family Medicine Program, and the program
hopes to open more like it.
The staff is small, consisting of two nurses, a
receptionist, a secretary, a medical student and in
ternist who work part time, and a community
volunteer who speaks Spanish and English. The
only full-time physicians are UB's Alvarez, the
center's director, and Peter Kowalski. A small staff
helps to foster a private-practice mentality, David
Holden believes.
The Niagara Family Health Center is run by
Millard Fillmore Hospital, which pays for the build
ing and the salaries of the staff. Because it filed a
certificate of need for the center, Millard Fillmore
is reimbursed by Medicaid at a higher rate than
usual.
It's more cost effective for patients to visit the
center than to visit an emergency room. Emergen
cy rooms always cost more because they must pay
for a doctor to be on call, noted Alvarez. Plus, the
patient pays twice because another doctor must fol
low up.
BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST
he nice thing about the clinic is
that it doesn't cost the patient a cent"
said Reid Heffner, M.D. "We don't
spend a lot of time worrying about how much
money they make in order to determine their
eligibility."
At the center, the patient can see the doctor,
get lab tests, be treated and schedule a follow-up
appointment, she added. In the long run, costs will
come down because this continuity of care at the
center will decrease the number of people who visit
the emergency room.
Because physicians are reluctant to open a prac
tice in areas that are economically depressed and
have high crime rates, the Urban Family Medicine
Program tries to provide incentives to attract phy
sicians to the inner city.
"We will offer physicians both faculty and
research positions with the University," said Lasser.
"Additionally, we can help them to change their
Medicaid rate structure to increase their income by
getting them affiliated with local hospitals.
"These incentives make it worthwhile to open
a practice in the inner city."
"Being affiliated with Millard Fillmore Hospital,
my reimbursements for working at the clinic are
better than if I opened my own office," noted Al
varez, who supplements her income through the
University by teaching and doing research.
Working in the inner city brings other rewards
as well.
"I like working with inner-city populations be
cause the patient-doctor relationship is important
and because the people are generally very grateful,"
noted Kowalski.
"It's really nice to work with people who need
BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST
you," added Nancy Cotter, a fourth-year medical
student at UB who is doing a rotation at the
Niagara Street center.
Most of the people seen during the day have
Medicaid, while a few have other insurance.
For those who fall through the cracks—patients
who can't afford insurance but don't qualify for
Medicaid—the center offers a free clinic each Wed
nesday evening.
The clinic is staffed by volunteers. Parishoners
from St. Paul's Cathedral perform clerical tasks and
make sure the office runs smoothly. A nurse and
two medical students work with patients. While 13
physicians are signed up to take shifts at the clinic,
more are always needed. Free lab work and securi
ty personnel are provided by Millard Fillmore
Hospital.
"The nice thing about the clinic is that it doesn't
cost the patient a cent," said Reid Heffner, M.D.,
who conceived the idea of opening the free clinic.
"We don't spend a lot of time worrying about how
much money they make in order to determine their
eligibility."
Heffner, who is professor of pathology and direc
tor of laboratories at the Erie County Medical
Center (ECMC), added that the paperwork isn't
intimidating, so patients aren't afraid to come to
the clinic.
"The idea is to take away all of the red tape,"
he said. "Let somebody come into the office in
much the same way a patient visits a doctor in Williamsville. This way of doing things creates a bond
of trust and goodwill."
Aside from the Hispanic and African Ameri
can community, the free clinic serves the homeless,
recently released prisoners, and transients who pass
through Buffalo.
"It is clear that most of the people that come
to us don't have the means to pay for health care,"
Heffner stated.
The old man waits at the bus stop as the snow be
gins to swirl with increasing intensity. The wind cuts
LATE WINTER 1989-90
through his tattered coat and makes his bones ache. The
bus, as usual, is late and the traffic speeds by, spitting
up black slush that seeps through his old tennis shoes.
He's apprehensive about his visit to the clinic and it
doesn't take long for him to change his mind. He turns
around and makes his way home.
THE
CENTER
TRIES TO
OPERATE
LIKE A
PRIVATE
DOCTOR'S
OFFICE
IN THE
INNER
CITY,
EXPLAINS
PETER
KOWALSKI,
M.D., RIGHT.
LATE WINTER 1989-90
The Niagara Street health center experiences a
relatively high no-show rate by the patients, but
this will come down as the patients become more
comfortable with the system, Alvarez predicts.
"It sounds pretty simple for a patient to make
an appointment for things such as physicals or im
munizations," Holden remarked. "But many of our
patients are not yet accustomed to the process of
preventive health care. They have not been edu
cated to go to a physician that they know and feel
comfortable with."
"It takes a lot of effort to make sure that patients
show up for appointments," Alvarez added. "We
make special provisions such as calling them up the
night before and getting them cabs to pick them
up and take them home."
Many people in this country have trouble get
ting medical appointments at all. The number of
people unable to get health care has gone up dra
matically over the last decade, Lasser pointed out.
In 1987, nearly 37 million Americans lacked health
insurance.
"Many of these people fall between the cracks,"
he said. "They don't qualify for Medicaid. And the
jobs they work at don't provide health insurance
or don't pay enough money for health care
coverage."
Although health care technology is at the cut
ting edge in the U.S., it means nothing to people
who can't get medical care.
"The U.S. ranks high in infant mortality com
pared with other developed countries," Lasser
reported. "Yet we spend more per capita per baby
than any other country in the world. There's some
thing wrong with what we're doing.
"We spend more money on beds for premature
babies and not enough to prevent the premature
births of infants.
"Why is it that Buffalo has so many institutions
dedicated to infant and child health, and yet the
city has such a high infant mortality rate?" Adding
additional hospital beds or sophisticated equipment
to a ward will not solve the problem, he noted. We
need better prenatal care.
Lasser has a strong interest in primary health
care for the urban poor. He came to UB this sum
mer from Massachusetts, where he worked in med
ically underserved communities. He holds a
master's degree in Public Health from Harvard
University and was an associate professor in the
Department of Family and Community Medicine
at the University of Massachusetts Medical School.
In New York State, ensuring that urban resi
dents get the health services they need is a major
public health issue, noted John Naughton, dean of
the medical school and vice president for clinical
affairs at UB.
Part of the problem of access to care has been
that too many physicians were entering specialties
and not enough chose primary care, he explained.
The Graduate Medical-Dental Education Consor
tium has set a goal of steering 50 percent of UB
medical students into primary care by 1993.
"We have to ensure the proper education and
training of physicians as well as quality health care
now" for two underserved groups: urban and rural
residents, he noted.
UB already has a successful rural health pro
gram, which was started in 1985. Holden points to
that as an example of what can be done when the
University and community join forces.
Urban Family Medicine may set up similar links.
The community seems willing—George McCoy,
chief executive officer of ECMC, came to the
Department of Family Medicine with the idea of
developing a stronger primary-care base within the
city, Lasser explained. As a result, the hospital es
tablished a new department of family medicine
which operates a new family care center.
"We need to develop a coalition that involves
departments within the University, the county, lo
cal hospitals such as Buffalo General and Millard
Fillmore, and community health clinics like the
Geneva B. Scruggs Health Care Center," Lasser add-
BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST
ed. "A collaborative effort will enhance the access
and quality of health care for the urban poor."
One example is the longstanding collaboration
between UB's Family Medicine Department and
Buffalo General Hospital to operate the Family Prac
tice and Immediate Treatment centers at the Dea
coness Center.
Another example is the Emerson K. Young
Health Center, a small family practice office staffed
by physicians from the Department of Family Medi
cine and operated by Sheehan Memorial Hospital
in the Perry Housing Project.
Another goal of urban family medicine is to de
velop a group of physicians who understand the
language and culture of their patients.
"We are actively trying to recruit minorities into
family medicine," Holden said. "In fact, our program
has the largest number of black and Hispanic resi
dents of any residency associated with the con
sortium."
He did note however, that any resident interest
ed and committed to working with inner-city popu
lations would be encouraged to join the program.
The Department of Family Medicine also offers
a fellowship in urban family medicine for physicians
who have just completed their family practice
residency. The fellowship is designed to sharpen the
skills of the physician, as well as encourage partici
pation in teaching and research, Lasser pointed out.
Special training is needed because physicians in
urban family medicine must recognize problems
that are magnified in the inner city, such as alco
hol and drug abuse or issues of gay and lesbian
BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST
health, he said.
"Family medicine takes a biopsychosocial ap
proach to the problems of people," Holden noted.
Students and residents are taught that their jobs
aren't limited to the diagnoses of pathological med
ical problems, explained Lasser.
"Our job it to find out why they hurt," he added.
Finding out what is wrong may take time and
patience, said Holden. He pointed out that it may
take three or four visits before a patient opens up
and begins to tell the doctor what is really going on.
"I had a black preacher come to me about his
hypertension," Holden said. "He seemed withdrawn
and unwilling to open up to me. After several visits,
I could tell that he was beginning to trust me. So,
he starts telling me about the problems his two sons
are having with the police and how he was being
accused of obstructing justice because he intervened
one time when the police were dragging one of his
sons off to the police station.
"Here's a man who never had any trouble with
the law in his whole life. I intervened with a social
worker to clear the charges of obstruction. Subse
quently, his blood pressure came down. I think
these problems had a lot to do with his health, and
his blood pressure probably wouldn't have dropped
by just changing his medication.
"By communicating with this man and finding
out about his life, I was able to improve his health."
Communication goes beyond understanding
the complexities of high-technology medicine; keen
observation skills and sensitivity to the vagaries of
human behavior are required. Coupling these skills
with continuity of care, the new Urban Family
Medicine Program at UB aims to bring the best of
personalized care to the urban poor.
•
URBAN FAMILY MEDICINE:
SERVING THE UNDERSERVED
• Goal: providing personalized medical care
to the urban poor and training physicians
to practice in underserved urban areas.
• Program offers monetary and other incen
tives for doctors to practice in inner city.
• Test site called Niagara Family Medicine
Center is located on Buffalo's lower west
side, and the Emerson K. Young Health
Center is located on the east side.
• The centers are run by area hospitals and
receive money through Medicaid reim
bursement.
• Weekly free clinic is staffed by volunteers.
To volunteer, call Kim Griswald, R.N. at
887-8243.
LATE WINTER 1989-90
»»«
ONLY THE BUBONIC PLAGUE OF 542 A.D
AND THE BLACK DEATH OF THE 14TH CEN
TURY KILLED MORE PEOPLE THAN THE IN
FLUENZA EPIDEMIC OF 1918-19
O T H E R
E / v
FLU
UB marshalled its forces to fight the biggest killer
of World War I
n
uring World War I, Buffalonians
worried about their boys "Over
There," fighting to keep the Kaiser
in check. But in 1918, the City of Buffa
lo was visited by a foe more powerful
than the Kaiser: influenza.
The Great Influenza Epidemic of
1918-19 was the second of three waves of
the disease that caused millions of deaths
as it swept across the globe. Flu was a big
ger killer than the war.
While the official U.S. death toll from
the war was 116,516, more than 550,000
Americans died from the 1918-19 epidem
ic and its complications. World-wide, the
war killed 10 million people; twice as
many died from influenza.
D E B O R A H
BUFFALO PHYSICIAN AND BIOMEDICAL SCIENTIST
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