The osteopathic physicians who remained on the US home front worked tirelessly despite the absence of antivirals, antibiotics, advanced imaging modalities, a lack of influenza vaccine, and stiff opposition from allopathic physicians. Their care had a significant impact on the health of their patients. In a retrospective, self-reported questionnaire-based study, osteopathic physicians reported 1/40 the losses of traditional physicians in a review of 100,000 cases.⁵ The influenza mortality rate for the global population during the 1918 pandemic was estimated at 2.5%, but it varied widely by region.⁶ Census data from the time and health commissioner reports established a 27% morality rate for Boston, 5% to 6% mortality rate in 148 other US regional reports, and a 34.5% mortality rate for pneumonia in army camps.⁷ 

Of patients with serious influenza complications such as pneumonia, one-third fewer died while in the care of osteopathic compared with allopathic physicians.⁸ The discrepancy between influenza and pneumonia mortality rates is attributed to the incorporation of manipulative medicine in contrast with questionable medical treatments, including vomiting and bloodletting.⁸ An editorial in The Osteopathic Physician in January 1919 opined: 

The success of osteopathic physicians in handling the deadly pandemic came with significant expense to the lives of physicians and their families from working in close contact with infected individuals. Deaths of influenza were not the only cause of physician morbidity and mortality during the influenza pandemic. For example, R.M. Wolf, DO, was seriously injured in a motor vehicle accident that occurred after being overcome by exhaustion from caring for influenza patients.^10,11 Laura Cleland, DO, and her unborn child died of influenza during her pregnancy.^10,11 Lieutenant Malcolm Cunningham, DO, died of influenza while caring for influenza-infected soldiers.¹¹ 

The worst of the pandemic ended by spring 1919, but the complete pandemic continued through 1920. 

Colleagues who died of influenza- or pneumonia-related illness were recognized by official journals through 1921 (Table).^10-12 Reports and obituaries of physician deaths were obtained from The Journal of the American Osteopathic Association and The Osteopathic Physician from the years 1918 to 1921.^10,11 The actual number of osteopathic physician deaths of influenza may differ and remains unknown. 

Other physician mortality of unspecified cause during this time includes the following reported deaths; influenza as the cause of death remains a possibility for them^10-12: 

C.R. Atzen, DO (Omaha, NE), Benjamin B. Baldwin, DO, Ralph Barrenger, DO (Oregon, IL), Albert R. Bell, DO (Washington, NC), Ori Coppernol, DO (Alliance, NE), L. Malcolm Cunningham, DO (Astoria, OR), Sara Agnes Davidson, DO (Canada) (Montreal, Quebec), Walter S. Dressell, DO (Carrollton, IL), Warren Dressel, DO, Bessie Duffield, DO (Knoxville, TN), Louisa Dutcher McKone, DO (Kansas City, MO), Albert A. Fisher, DO (Chicago, IL), Walter J. Ford, DO (Seattle, WA), S.J. Fryette (Madison, WI), Mathias Hook, DO (Grand Junction, CO), C.M.T. Hulett (Chicago, IL), Frank L. Johnston, DO, Seth Y. Kennedy, DO (Gloversville, NY), J.A. Kerr, DO (Wooster, OH), J. R. Klippelt, DO (Lebanon, MO), M.A. Lane, DO (Kirksville, MO), A.O. Lash, DO, John H. Lucas, DO (Chicago, IL), Dora Wyland McAfee, DO (Chariton, IA), T.H. McCall, DO (Atlantic, NJ), J.L. McClanahan, DO (Paola, KS), Mattie Moffet, DO (Windsor, MO), Nellie Morelock, DO (Rifle, CO), Ralph Moses, A.L. Nelson, DO (Sioux City, IA), Augusta Priscilla Musick, DO (Omaha, NE), E.E. Raynor, Johanna Miller Robson, DO (Hasting, NY), Maude Russell, DO (Fort Worth, TX), Orr Sanders, DO (Fargo, ND), Thomas Sellards, DO (Ann Arbor, MI), Wm. M. Smiley, DO (Albany, NY), James Alvin Stewart, DO (Denver, CO), B.V. Sweet, John W. Sylvester, DO (Cleveland, OH), F.M. Thomas, DO (Flagler, CO), Agnes Ussing, DO (Cranford, NJ), M.R. Wallace, DO (Oakland, CA), Harvey John Wentworth, DO (Appomattox, VA), T. Wildsmith, DO (Philadelphia, PA), Frank L. Wilt, DO. We believe that because of a possible typographic error, T.H. McCall and F.H. McCall (Table) may be the same person but do not have evidence to support removing either name from the respective lists. 

In a review of the obituaries, 20 osteopathic physicians were specifically found to have died of influenza-related complications, as listed in the Table. An additional 46 osteopathic physicians were listed without any cause of death in any of the journals. Comparing these numbers with the AOA membership of approximately 2800 osteopathic physicians equates to a 2.4% mortality rate from influenza, pneumonia, and unlisted causes. This relatively low death rate is surprising considering the lack of PPE both available at the time and recommended within the journals. In contrast, much attention was given to good hygiene and nutrition throughout the journals. 

As of April 13, 2020, 17 US physicians,¹³ osteopathic and allopathic, have died of COVID-19, out of 500,000 practicing physicians in the United States,¹⁴ providing a COVID-19 physician mortality rate of 0.0003%. With the continued attention to nutrition and hygiene that osteopathic physicians originally emphasized, combined with modern health care advances and personal protective equipment use, physician mortality during pandemics will continue to be reduced. 

As modern medicine faces a new nemesis in COVID-19, it is our hope that osteopathic physicians look to their heritage of dedication, innovation, and manipulative medicine in pursuit of health for patients. May those who have lost their lives, both then and now, be remembered. 

We are grateful for material provided from the Museum of Osteopathic Medicine in Kirksville, Missouri.