EPIDEMICS IN AMERICAN HISTORY

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thelivyjr
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EPIDEMICS IN AMERICAN HISTORY

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HEALTHLINE

The Most Dangerous Epidemics in U.S. History


Written by the Healthline Editorial Team

Medically reviewed by Deborah Weatherspoon, PhD, MSN, RN, CRNA on September 29, 2016

A look back

As medicine advances, there are fewer infectious disease outbreaks, or epidemics.

An epidemic is when an infectious disease spreads within a community or area during a specific time period.

Learn about the biggest outbreaks to spread across the United States, and where we are now.

1633-1634: Smallpox from European settlers

Smallpox came to North America in the 1600s.

People had symptoms of high fever, chills, severe back pain, and rashes.

Starting from the Northeast, smallpox wiped out entire Native American tribes.


Over 70 percent of the Native American population dropped.

In 1721, 844 of the 5,889 Bostonians who had smallpox died from it.

End:

In 1770, Edward Jenner developed a vaccine from cow pox.

It helps the body become immune to smallpox without causing the disease.

Now:

After a large vaccination initiative in 1972, smallpox is gone from the United States.

In fact, vaccines are no longer necessary.

1793: Yellow fever from the Caribbean

Philadelphia was once the nation’s capital and its busiest port.

One humid summer, refugees leaving a yellow fever epidemic in the Caribbean Islands sailed in, carrying the virus with them.


Yellow fever causes yellowing of the skin, fever, and bloody vomiting.

Five thousand people died, and 17,000 fled the city.

End:

The vaccine was developed and then licensed in 1953.

One vaccine is enough for life.

It’s mostly recommended for those 9 months and older, especially if you live or travel to high-risk areas.

Now:

Mosquitoes are key to how this disease spreads, especially in countries like Central and South America and Africa.

Eliminating them has been successful in controlling yellow fever.

While yellow fever has no cure, someone who does recover from the illness becomes immune for the rest of their life.

1832-1866: Cholera in three waves

The United States had three serious waves of cholera, an infection of the intestine, between 1832 and 1866.

The pandemic began in India, and swiftly spread across the globe through trade routes.

New York City was usually the first city to feel the impact.

An estimated two to six Americans died per day during the outbreak.


End:

It’s unclear what ended the pandemics, but it may have been the change in climate or quarantines.

The last documented outbreak in the United States was in 1911.

Immediate cholera treatment is crucial, as it can cause death.

Treatment includes antibiotics, zinc supplementation, and rehydration.

Now:

Cholera still causes nearly 130,000 deaths a year worldwide, according to the CDC.

Modern sewage and water treatment have helped eradicated cholera in some countries, but the virus is still present elsewhere.

You can get a vaccine for cholera if you’re planning to travel to areas that are high-risk.

The best way to prevent cholera is to wash hands regularly with soap and water, and avoid drinking contaminated water.

1858: Scarlet fever also came in waves

Scarlet fever is a bacterial infection that can occur after strep throat.

Like cholera, scarlet fever epidemics came in waves.

During the 1858 epidemic, 95 percent of people who caught the virus were children.


End:

Older studies argue that scarlet fever declined due to improved nutrition, but research shows that improvements in public health were more likely the cause.

Now:

There is no vaccine to prevent strep throat or scarlet fever.

It’s important for those with strep throat symptoms to seek treatment as quickly as possible.

Your doctor will typically treat scarlet fever with antibiotics.

1906-1907: “Typhoid Mary”

One of the biggest typhoid fever epidemics of all time broke out between 1906 and 1907 in New York.

Mary Mallon, often referred to as “Typhoid Mary,” spread the virus to about 122 New Yorkers during her time as a cook on an estate and in a hospital unit.

About five of those 122 New Yorkers passed away from the virus.

Annually, 10,771 people passed away from typhoid fever.


Medical testing showed that Mallon was a healthy carrier for typhoid fever.

Typhoid fever causes sickness and red spots to form on the chest and abdomen.

End:

A vaccine was developed in 1911, and an antibiotic treatment for typhoid fever became available in 1948.

Now:

Today typhoid fever is rare.

But it can spread through direct contact with infected people, as well as consumption of contaminated food or water.

1918: “Spanish flu”

This mutating influenza virus actually doesn’t come from Spain.

It circulates the globe annually, but seriously affected the United States in 1918.

The flu would return later in 1957 as the “Asian flu” and cause nearly 70,000 deaths before a vaccine became available.


End:

After the end of World War I, cases of the flu slowly declined.

None of the suggestions provided at the time, from wearing masks to drinking coal oil, were effective cures.

Today’s treatments include bed rest, fluids, and antiviral medications.

Now:

Influenza strains mutate every year, making last year’s vaccinations less effective.

It’s important to get your yearly vaccination to decrease your risk for the flu.

1921-1925: Diphtheria epidemic

Diphtheria peaked in 1921, with 206,000 cases.

Diphtheria causes swelling of the mucous membranes, including in your throat, that can obstruct breathing and swallowing.

Sometimes a bacterial toxin can enter the bloodstream and cause fatal heart and nerve damage.

End:

By the mid-1920s, researchers licensed a vaccine against the bacterial disease.

Infection rates plummeted in the United States.

Now:

Today more than 80 percent of children in the United States are vaccinated.

Those who contract the disease are treated with antibiotics.

1916-1955: The peak of polio

Polio is a viral disease that affects the nervous system, causing paralysis.

It spreads through direct contact with people who have the infection.

The first major polio epidemic in the United States occurred in 1916 and reached its peak in 1952.

Of the 57,628 reported cases, there were 3,145 deaths.


End:

Three years later, Dr. Jonas Salk developed a vaccine.

By 1962, the average number of cases dropped to 910.

The CDC reports that the United States has been polio-free since 1979.

Now:

Getting vaccinated is very important before traveling.

There’s no cure for polio.

Treatment involves increasing comfort levels and preventing complications.

1981-1991: Second measles outbreak

Measles is a virus that causes a fever, runny nose, cough, red eyes, and sore throat, and later a rash that spreads over the whole body.

It’s a very contagious disease and can spread through the air.


In the early 20th century, most cases involved children, due to inadequate vaccination coverage.

End:

Doctors began to recommend a second vaccine for everyone.

Since then, each year has had fewer than 1,000 cases.

Now:

The United States experienced another outbreak of measles in 2014 and 2015.

The CDC reports that this outbreak was identical to the measles outbreak in the Philippines in 2014.

Be sure to get all the vaccinations your doctor recommends.

1993: Contaminated water in Milwaukee

One of Milwaukee’s two water treatment plants became contaminated with cryptosporidium, a parasitic disease that causes dehydration, fever, stomach cramps, and diarrhea.

About 403,000 became ill, and more than 100 people died, making it the largest waterborne outbreak in United States history.


End:

Most people recovered on their own.

Of the people who passed, the majority had compromised immune systems.

Now:

Improved water filtrations helped eradicate this disease, but an estimated 748,000 cases of cryptosporidium still occur each year.

Cryptosporidium spreads through soil, food, water, or contact with infected feces.

Be sure to practice personal hygiene, especially when camping.

2010, 2014: Whooping cough

Pertussis, known as whooping cough, is highly contagious and one of the most commonly occurring diseases in the United States.

These coughing attacks can last for months.

Infants too young for vaccination have the highest risk for life-threatening cases.


Ten infants died during the first outbreak.

End:

A whooping cough outbreak comes every three to five years.

The CDC reports that an increase in the number of cases will likely be the “new normal.”


Now:

The occurrence of the disease is much less than it was.

The CDC recommends that pregnant women get a vaccination during the third trimester to optimize protection at birth.

1980s to present: The leading cause of early death

First documented in 1981, the epidemic we now know as HIV first appeared to be a rare lung infection.

Now we know that HIV damages the body’s immune system and compromises its ability to fight off infections.


AIDS is the final stage of HIV and the 6th leading cause of death in the United States among people 25 to 44 years old.

HIV may be transmitted sexually or through blood/body fluids from person to person.

It can be transmitted from mother to unborn baby if not treated.

Now:

While there is no cure for HIV, you can decrease your risk through safety measures like making sure your needles are sterilized and having protected sex.

Safety measures can be taken during pregnancy to prevent the disease from being transmitted from an infected mother to child.

For emergencies, PEP (post-exposure prophylaxis) is a new antiretroviral medicine that prevents HIV from developing within 72 hours.

Education

Educating yourself about current disease outbreaks can help you understand what precautions you should take in order to keep you and your family safe and healthy.

https://www.healthline.com/health/worst ... -history#1
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Re: EPIDEMICS IN AMERICAN HISTORY

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Live Science

20 of the worst epidemics and pandemics in history


By Owen Jarus - Live Science Contributor, All About History

20 MARCH 2020

Throughout the course of history, disease outbreaks have ravaged humanity, sometimes changing the course of history and, at times, signaling the end of entire civilizations.

Here are 20 of the worst epidemics and pandemics, dating from prehistoric to modern times.

1. Prehistoric epidemic: Circa 3000 B.C.

About 5,000 years ago, an epidemic wiped out a prehistoric village in China.

The bodies of the dead were stuffed inside a house that was later burned down.

No age group was spared, as the skeletons of juveniles, young adults and middle-age people were found inside the house.


The archaeological site is now called "Hamin Mangha" and is one of the best-preserved prehistoric sites in northeastern China.

Archaeological and anthropological study indicates that the epidemic happened quickly enough that there was no time for proper burials, and the site was not inhabited again.

Before the discovery of Hamin Mangha, another prehistoric mass burial that dates to roughly the same time period was found at a site called Miaozigou, in northeastern China.

Together, these discoveries suggest that an epidemic ravaged the entire region.

2. Plague of Athens: 430 B.C.

Around 430 B.C., not long after a war between Athens and Sparta began, an epidemic ravaged the people of Athens and lasted for five years.

Some estimates put the death toll as high as 100,000 people.


The Greek historian Thucydides (460-400 B.C.) wrote that "people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath" (translation by Richard Crawley from the book "The History of the Peloponnesian War," London Dent, 1914).

What exactly this epidemic was has long been a source of debate among scientists; a number of diseases have been put forward as possibilities, including typhoid fever and Ebola.

Many scholars believe that overcrowding caused by the war exacerbated the epidemic.

Sparta's army was stronger, forcing the Athenians to take refuge behind a series of fortifications called the "long walls" that protected their city.

Despite the epidemic, the war continued on, not ending until 404 B.C., when Athens was forced to capitulate to Sparta.

3. Antonine Plague: A.D. 165-180

When soldiers returned to the Roman Empire from campaigning, they brought back more than the spoils of victory.

The Antonine Plague, which may have been smallpox, laid waste to the army and may have killed over 5 million people in the Roman empire, wrote April Pudsey, a senior lecturer in Roman History at Manchester Metropolitan University, in a paper published in the book "Disability in Antiquity," Routledge, 2017).


Many historians believe that the epidemic was first brought into the Roman Empire by soldiers returning home after a war against Parthia.

The epidemic contributed to the end of the Pax Romana (the Roman Peace), a period from 27 B.C. to A.D. 180, when Rome was at the height of its power.

After A.D. 180, instability grew throughout the Roman Empire, as it experienced more civil wars and invasions by "barbarian" groups.

Christianity became increasingly popular in the time after the plague occurred.

4. Plague of Cyprian: A.D. 250-271

Named after St. Cyprian, a bishop of Carthage (a city in Tunisia) who described the epidemic as signaling the end of the world, the Plague of Cyprian is estimated to have killed 5,000 people a day in Rome alone.

In 2014, archaeologists in Luxor found what appears to be a mass burial site of plague victims.

Their bodies were covered with a thick layer of lime (historically used as a disinfectant).

Archaeologists found three kilns used to manufacture lime and the remains of plague victims burned in a giant bonfire.

Experts aren't sure what disease caused the epidemic.

"The bowels, relaxed into a constant flux, discharge the bodily strength [and] a fire originated in the marrow ferments into wounds of the fauces (an area of the mouth)," Cyprian wrote in Latin in a work called "De mortalitate" (translation by Philip Schaff from the book "Fathers of the Third Century: Hippolytus, Cyprian, Caius, Novatian, Appendix," Christian Classics Ethereal Library, 1885).

5. Plague of Justinian: A.D. 541-542

The Byzantine Empire was ravaged by the bubonic plague, which marked the start of its decline.

The plague reoccurred periodically afterward.

Some estimates suggest that up to 10% of the world's population died.


The plague is named after the Byzantine Emperor Justinian (reigned A.D. 527-565).

Under his reign, the Byzantine Empire reached its greatest extent, controlling territory that stretched from the Middle East to Western Europe.

Justinian constructed a great cathedral known as Hagia Sophia ("Holy Wisdom") in Constantinople (modern-day Istanbul), the empire's capital.

Justinian also got sick with the plague and survived; however, his empire gradually lost territory in the time after the plague struck.

6. The Black Death: 1346-1353

The Black Death traveled from Asia to Europe, leaving devastation in its wake.

Some estimates suggest that it wiped out over half of Europe's population.


It was caused by a strain of the bacterium Yersinia pestis that is likely extinct today and was spread by fleas on infected rodents.

The bodies of victims were buried in mass graves.

The plague changed the course of Europe's history.

With so many dead, labor became harder to find, bringing about better pay for workers and the end of Europe's system of serfdom.

Studies suggest that surviving workers had better access to meat and higher-quality bread.

The lack of cheap labor may also have contributed to technological innovation.

7. Cocoliztli epidemic: 1545-1548

The infection that caused the cocoliztli epidemic was a form of viral hemorrhagic fever that killed 15 million inhabitants of Mexico and Central America.

Among a population already weakened by extreme drought, the disease proved to be utterly catastrophic.

"Cocoliztli" is the Aztec word for "pest."

A recent study that examined DNA from the skeletons of victims found that they were infected with a subspecies of Salmonella known as S. paratyphi C, which causes enteric fever, a category of fever that includes typhoid.

Enteric fever can cause high fever, dehydration and gastrointestinal problems and is still a major health threat today.

8. American Plagues: 16th century

The American Plagues are a cluster of Eurasian diseases brought to the Americas by European explorers.

These illnesses, including smallpox, contributed to the collapse of the Inca and Aztec civilizations.

Some estimates suggest that 90% of the indigenous population in the Western Hemisphere was killed off.


The diseases helped a Spanish force led by Hernán Cortés conquer the Aztec capital of Tenochtitlán in 1519 and another Spanish force led by Francisco Pizarro conquer the Incas in 1532.

The Spanish took over the territories of both empires.

In both cases, the Aztec and Incan armies had been ravaged by disease and were unable to withstand the Spanish forces.

When citizens of Britain, France, Portugal and the Netherlands began exploring, conquering and settling the Western Hemisphere, they were also helped by the fact that disease had vastly reduced the size of any indigenous groups that opposed them.

9. Great Plague of London: 1665-1666

The Black Death's last major outbreak in Great Britain caused a mass exodus from London, led by King Charles II.

The plague started in April 1665 and spread rapidly through the hot summer months.

Fleas from plague-infected rodents were one of the main causes of transmission.

By the time the plague ended, about 100,000 people, including 15% of the population of London, had died.

But this was not the end of that city's suffering.

On Sept. 2, 1666, the Great Fire of London started, lasting for four days and burning down a large portion of the city.

10. Great Plague of Marseille: 1720-1723

Historical records say that the Great Plague of Marseille started when a ship called Grand-Saint-Antoine docked in Marseille, France, carrying a cargo of goods from the eastern Mediterranean.

Although the ship was quarantined, plague still got into the city, likely through fleas on plague-infected rodents.

Plague spread quickly, and over the next three years, as many as 100,000 people may have died in Marseille and surrounding areas.


It's estimated that up to 30% of the population of Marseille may have perished.

11. Russian plague: 1770-1772

In plague-ravaged Moscow, the terror of quarantined citizens erupted into violence.

Riots spread through the city and culminated in the murder of Archbishop Ambrosius, who was encouraging crowds not to gather for worship.


The empress of Russia, Catherine II (also called Catherine the Great), was so desperate to contain the plague and restore public order that she issued a hasty decree ordering that all factories be moved from Moscow.

By the time the plague ended, as many as 100,000 people may have died.

Even after the plague ended, Catherine struggled to restore order.

In 1773, Yemelyan Pugachev, a man who claimed to be Peter III (Catherine's executed husband), led an insurrection that resulted in the deaths of thousands more.

12. Philadelphia yellow fever epidemic: 1793

When yellow fever seized Philadelphia, the United States' capital at the time, officials wrongly believed that slaves were immune.

As a result, abolitionists called for people of African origin to be recruited to nurse the sick.

The disease is carried and transmitted by mosquitoes, which experienced a population boom during the particularly hot and humid summer weather in Philadelphia that year.

It wasn't until winter arrived — and the mosquitoes died out — that the epidemic finally stopped.

By then, more than 5,000 people had died.

13. Flu pandemic: 1889-1890

In the modern industrial age, new transport links made it easier for influenza viruses to wreak havoc.

In just a few months, the disease spanned the globe, killing 1 million people.

It took just five weeks for the epidemic to reach peak mortality.


The earliest cases were reported in Russia.

The virus spread rapidly throughout St. Petersburg before it quickly made its way throughout Europe and the rest of the world, despite the fact that air travel didn't exist yet.

14. American polio epidemic: 1916

A polio epidemic that started in New York City caused 27,000 cases and 6,000 deaths in the United States.

The disease mainly affects children and sometimes leaves survivors with permanent disabilities.

Polio epidemics occurred sporadically in the United States until the Salk vaccine was developed in 1954.

As the vaccine became widely available, cases in the United States declined.

The last polio case in the United States was reported in 1979.

Worldwide vaccination efforts have greatly reduced the disease, although it is not yet completely eradicated.

15. Spanish Flu: 1918-1920

An estimated 500 million people from the South Seas to the North Pole fell victim to Spanish Flu.

One-fifth of those died, with some indigenous communities pushed to the brink of extinction.


The flu's spread and lethality was enhanced by the cramped conditions of soldiers and poor wartime nutrition that many people were experiencing during World War I.

Despite the name Spanish Flu, the disease likely did not start in Spain.

Spain was a neutral nation during the war and did not enforce strict censorship of its press, which could therefore freely publish early accounts of the illness.

As a result, people falsely believed the illness was specific to Spain, and the name Spanish Flu stuck.

16. Asian Flu: 1957-1958

The Asian Flu pandemic was another global showing for influenza.

With its roots in China, the disease claimed more than 1 million lives.


The virus that caused the pandemic was a blend of avian flu viruses.

The Centers for Disease Control and Prevention notes that the disease spread rapidly and was reported in Singapore in February 1957, Hong Kong in April 1957, and the coastal cities of the United States in the summer of 1957.

The total death toll was more than 1.1 million worldwide, with 116,000 deaths occurring in the United States.

17. AIDS pandemic and epidemic: 1981-present day

AIDS has claimed an estimated 35 million lives since it was first identified.

HIV, which is the virus that causes AIDS, likely developed from a chimpanzee virus that transferred to humans in West Africa in the 1920s.

The virus made its way around the world, and AIDS was a pandemic by the late 20th century.


Now, about 64% of the estimated 40 million living with human immunodeficiency virus (HIV) live in sub-Saharan Africa.

For decades, the disease had no known cure, but medication developed in the 1990s now allows people with the disease to experience a normal life span with regular treatment.

Even more encouraging, two people have been cured of HIV as of early 2020.

18. H1N1 Swine Flu pandemic: 2009-2010

The 2009 swine flu pandemic was caused by a new strain of H1N1 that originated in Mexico in the spring of 2009 before spreading to the rest of the world.

In one year, the virus infected as many as 1.4 billion people across the globe and killed between 151,700 and 575,400 people, according to the CDC.


The 2009 flu pandemic primarily affected children and young adults, and 80% of the deaths were in people younger than 65, the CDC reported.

That was unusual, considering that most strains of flu viruses, including those that cause seasonal flu, cause the highest percentage of deaths in people ages 65 and older.

But in the case of the swine flu, older people seemed to have already built up enough immunity to the group of viruses that H1N1 belongs to, so weren't affected as much.

A vaccine for the H1N1 virus that caused the swine flu is now included in the annual flu vaccine.

19. West African Ebola epidemic: 2014-2016

Ebola ravaged West Africa between 2014 and 2016, with 28,600 reported cases and 11,325 deaths.

The first case to be reported was in Guinea in December 2013, then the disease quickly spread to Liberia and Sierra Leone.

The bulk of the cases and deaths occurred in those three countries.

A smaller number of cases occurred in Nigeria, Mali, Senegal, the United States and Europe, the Centers for Disease Control and Prevention reported.

There is no cure for Ebola, although efforts at finding a vaccine are ongoing.

The first known cases of Ebola occurred in Sudan and the Democratic Republic of Congo in 1976, and the virus may have originated in bats.

20. Zika Virus epidemic: 2015-present day

The impact of the recent Zika epidemic in South America and Central America won't be known for several years.

In the meantime, scientists face a race against time to bring the virus under control.

The Zika virus is usually spread through mosquitoes of the Aedes genus, although it can also be sexually transmitted in humans.

While Zika is usually not harmful to adults or children, it can attack infants who are still in the womb and cause birth defects.

The type of mosquitoes that carry Zika flourish best in warm, humid climates, making South America, Central America and parts of the southern United States prime areas for the virus to flourish.

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Re: EPIDEMICS IN AMERICAN HISTORY

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Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library

Influenza Encyclopedia

The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia - Richmond, Virginia


August 1918 was a scorcher in tidewater Virginia.

Drilling in uniform in the heat and humidity of Petersburg, 25 miles south of Richmond, must have been grueling for the nearly 48,000 soldiers of Camp Lee. 1

Little did they know that, as bad as the conditions were, they were about to get a whole lot worse.

For only a few weeks later, influenza arrived in camp.

The first case of influenza appeared in a new inductee, who was admitted to the camp infirmary on the evening of Friday, September 13 with symptoms of severe respiratory disease.

Camp doctors were not sure of the illness, but they suspected influenza.

Within a few hours, ten more cases of the new malady were reported in different parts of the camp.

By the morning of September 17, that number had grown by 500.

Two days later, there were over 1,000 cases in Camp Lee, more than could be tended to in the camp hospital.

Medical personnel now knew they were dealing with a quickly growing influenza epidemic.
2

In an attempt the keep the disease contained to the camp, the commanding general, Brigadier General Charles A. Hedskin, forbid all public gatherings within the camp, and closed the YMCA building, the Knights of Columbus hall, and the movie houses.

Visitors were also prohibited.

The camp designated a squad room in each barracks as an infirmary; a curtain made from a halved sheet was hung around the head of each cot in an effort to contain germs, and each sick man carried through the camp had to don a gauze mask.

Hedskin, did not think a general quarantine of the camp would prove effective given that the disease was already so rampant all along the East Coast.

More important, the general believed, a quarantine would delay troop training sessions. 3

Eager to prepare his troops for battle, Hedskin pushed the soldiers to train hard, and many returned to their duties before fully recovering from influenza.

The crowded camp conditions, combined with over-exerted soldiers, were a recipe for disaster.

The only safe place in the camp seemed to be the officers’ training school, which had been strictly quarantined.
4

Meanwhile, knowing that soldiers from Camp Lee regularly came to Richmond for entertainment and fearing that they would bring the disease with them, city health officer Dr. Roy K. Flannagan and Virginia Health Commissioner Ennion G. Williams met to discuss methods on preventing a potential epidemic among civilians.

The two men decided that, for the time being, a public education campaign was the best way to deal with the threat.


Posters and pamphlets were printed for distribution in the schools, urging the public to refrain from putting their fingers, foreign objects, or common drinking cups in their mouths, and to cover their coughs and sneezes.

As of yet there were no reported cases of influenza in Richmond, although Flannagan and Williams fully realized that, since influenza had only become a reportable disease in Virginia earlier that year, it was possible that physicians had neglected reported cases. 5

On September 28, as the epidemic at Camp Lee increasingly grew worse and as several hundred cases appeared in Richmond, Flannagan requested that the War Camp Community Service’s dances and entertainments for the soldiers from Camp Lee be cancelled.

The Department of Health also advised Richmonders to refrain from inviting soldiers into their homes for Sunday dinner, as had become the custom.


“So far as I can understand,” Flannagan complained, “there is no quarantine at Camp Lee."

"Hundreds of soldiers from that camp daily visit Richmond and these must, to a greater or lesser extent, spread the disease.”

For now the measures were only recommendations, although Flannagan noted that if not followed he indeed would issue a public health edict outright banning the dances as well as closing movie houses.

For the time being, in addition to these recommendations, Flannagan settled on a simple policy of forbidding sick children from attending school. 6

As in Camp Lee, Richmond’s epidemic took off like gangbusters.

Within a few days the city had over 600 cases.

Already Richmond’s nurses were being overrun.

A roster of 75 nurses had been mustered, but still dozens of calls for help had gone unanswered.


Flannagan plead for every man or woman, white or African American, with any nursing experience to lend assistance, and enlisted the help of the Red Cross to gather as many graduate and practical nurses as possible.

Believing that the key to controlling the outbreak lay not necessarily in social distancing but in proper ventilation, he ordered that all churches and theaters ensure a steady supply of fresh air to their congregants and patrons.

Those that did not do so were threatened with closure. 7

Some called for the barring of Camp Lee soldiers from entering Richmond, but military officials there stated that such a move would have little effect on the city, given that the civilian population was already well seeded with cases. 8

Meanwhile, Flannagan and Williams traveled to Richmond schools to give lectures on influenza prevention and treatment to schoolchildren. 9

It did not take long for Flannagan and Williams to change their minds.

On October 5, with outbreaks in nearly every community across Virginia and over 2,000 cases in Richmond, the State Department of Health issued a recommendation advising local health departments to ban all public gatherings and close churches, theaters, movie houses, and other such places.

Schools closures were not recommended; instead, teachers were asked to monitor students and to send home sick children.
1

That same day, upon Flannagan’s request, the city’s board of directors issued a closure order, adding public and private schools to the state’s list.

The order went into effect on October 6.

Richmond’s soft drink parlors and drugstore soda fountains, having enjoyed a one-day reprieve, were added to the list the next day.

The Virginia State Fair, scheduled to open on October 7, was initially exempted from the order because Flannagan believed that visitors would not be subjected to any more risk there than if they were walking around the streets of downtown Richmond. 11

State health officials disagreed, and ordered the fair closed as well. 12

Richmond was shut tight.

With social distancing measures in place, officials turned their attention to the city’s healthcare system and its overworked nurses and physicians.

Flannagan divided Richmond into four sectors and assigned a doctor and nurses and volunteers to each to eliminate duplicate efforts.

The Richmond Academy of Medicine and Surgery issued an appeal for all specialists to lend their aid, as did the Red Cross and the Visiting Nurses’ Association.


The latter worked with Richmond’s churches to establish soup kitchens to feed families too sick to feed themselves or where the primary breadwinner had fallen ill and the family had lost those wages.

At the request of the United States Public Health service, the Red Cross had 15,000 pamphlets printed with recommendations on how to keep healthy.

The city council appropriated $15,000 so that John Marshall High School, now unused, could be converted to a 500-bed emergency hospital. 13

The hospital was up and running the next day, with ten nurses on duty.

By 10:00 am there were already 55 patients in beds and 30 more on their way. 14

It was scarcely the end of the first week in October, and already health officials estimated there were 10,000 cases within city limits, and predicted as many as 1,500 deaths in the next six weeks. 15

Among the cases was Dr. Lawrence T. Price, director of the emergency hospital, now at home resting.

In his place temporarily served Dr. E. C. L. Miller of the Medical College of Virginia (now part of Virginia Commonwealth University). 16

State Health Commissioner Williams fell ill a few days later, and was confined to his home as well. 17

Several other city officials were also down with influenza. 18

One city commissioner exclaimed that he was “fearful of the greatest calamity that has befallen the city since the war.” 19

Richmond would be lucky, some experts estimated, if it experienced 30,000 cases total and a six percent death rate. 20

Richmond’s resources were being taxed to the limit.

Milk was in short supply, partly owing to the number of sick dairy and distribution employees and partly due to physicians recommending it as nourishment for the ill.

The shortage had grown so severe that city inspectors visited the Richmond jail to select inmates for work in the dairies.

Some even expected the city the take over the dairies. 21

More than milk, nurses were desperately needed.

Doctors at the John Marshall emergency hospital were so frantic that they temporarily put aside their prejudice and issued an open letter to all residents asking for nurses of any race or gender. 22

Some called for mandatory service, but state Attorney-General John R. Saunders stated that there was no official authority by which nurses could be commandeered for epidemic work. 23

With the emergency hospital at capacity, the city opened Bellevue Junior High School for overflow white patients and the Baker School for African American patients.

A group of 22 black physicians met to organize the staff for Baker, and elected Dr. William H. Hughes as their chief, with the others volunteering their services. 24

Fortunately, the crest of the epidemic had been reached.

As the second half of October rolled by, conditions continued to improve.

On October 16, the John Marshall hospital was still full of recovering patients, although doctors there expected to release an increasing number of them to complete their convalescence at home.

By October 28, the hospital had just 180 patients – about a third the number of the previous week – and announced it was no longer accepting new patients except in extreme circumstances.

The remaining patients were relocated to a central area in the building so that the rest of the facility could be cleaned in preparation for the imminent reopening of Richmond’s schools. 25

Both Flannagan and Acting State Health Commissioner Dr. Garnett, in charge of the state’s epidemic control measures while Ennion Williams recovered from his bout with influenza, were optimistic that the epidemic was truly over and that the closure order and gathering ban soon could be removed.

On October 29, Garnett announced that conditions across Virginia had improved enough to allow local communities to decide when to remove their restrictions.
26

The next day, Flannagan notified the city administrative board that churches would be allowed to hold Sunday services on November 3, and that the other restrictions would be removed Monday, November 4.

Flannagan admitted that he expected the number of new daily cases to rise slightly as a result, but believed that proper ventilation in public places and care on the part of residents would keep the situation in hand. 27

Richmonders – and especially business owners – eagerly awaited what they assumed would be the board’s rubber stamp endorsement.

The situation immediately grew more complex than that, however.

A group of physicians from the Richmond Academy of Medicine and Surgery sent the administrative board a letter asking that discussion of removing the restrictions be tabled until the Academy could first discuss the epidemic at its upcoming meeting, scheduled to take place the evening of October 31.

Dr. Thomas Murrell, head of the Academy, added that he believed lifting the bans at present would be a mistake.

The administrative board, concerned with Murrell’s misgivings and Flannagan’s statement that there would be a slight rise in new cases, temporarily tabled the discussion.


Ennion Williams, now fully recovered from influenza and back at his post, expressed his dismay at the situation.

He believed that the state board of health clearly had placed authority to remove the closure order in the hands of local health departments, not in city councils and especially not in the Richmond Academy of Medicine and Surgery. 28

The next day the administrative board reconvened, with several ministers and theater owners and managers present.

Almost immediately Flannagan – in Charlottesville tending to his sick brother – telephoned the board to reverse his previous recommendation to rescind the closure order, citing the opinions of several Academy of Medicine and Surgery physicians as the reason for changing his mind.

With leading physicians and now the health officer against reopening, the administrative board once again tabled the matter, leaving Richmond’s public gathering spots closed and many of its clergy, theater owners, and even school officials upset.

At least one theater owner, on Flannagan’s previous word that theaters would be allowed to reopen on November 4, had arranged for a show.

Now, he grumbled, he would lose $3,500.

Ministers argued that holding Sunday services would not endanger the health of the community.

The head of a private school complained that Flannagan had explicitly told him it would be safe to notify pupils and parents that their school would reopen on Monday, November 4.

He had sent letters to parents and now had to scramble to notify them of the mistake. 29

The administrative board debated the issue once again on November 2, this time behind closed doors.

Members were split as to whether or not to lift the closure order, but in light of Flannagan’s withdrawal of his recommendation they let the matter rest.

Meanwhile, Flannagan found himself beset by angry theater owners, two of which traveled to Charlottesville to complain to the health officer in person.

Flannagan now waffled.

In a letter to chief city commissioner Graham Hobson, he stated that he believed the closure order safely could be lifted, but that delaying action would improve public health.

Flannagan told Hobson he was not “irrevocably committed” to lifting the closure order. 30

No one, it seemed, wanted to take charge of the situation for fear that the epidemic would return in force.

Two days later, the administrative board voted to lift the closure order and gathering ban effective immediately.

Flannagan had returned to Richmond, where he stated that conditions no longer warranted “any further penalizing of the public.”

Influenza and pneumonia would continue to circulate throughout the winter, he added, but Richmond’s epidemic was over.

If the city waited until the disease was completely gone to reopen its businesses, it would be waiting for a very long time.


On the other side of the debate was the Academy of Medicine and Surgery and other like-minded physicians and nurses, who told Commissioner Hobson that lifting the order would be “nothing short of a public calamity” that would result in the deaths of hundreds.

After a lengthy debate, the administrative board was still split.

One commissioner requested that he be given more time to deliberate his vote.

Hobson denied the request and his vote was counted as an abstention.

The result was a break in the deadlock: the board voted two-to-one to lift the closure order effective immediately. 31

Proprietors of affected establishments were elated, and went to work straightaway to prepare for business once again.

The school board, initially prepared to admit pupils that day, scrambled to set a new date for schools to reopen – Wednesday, November 6.

The John Marshall and Baker emergency hospitals were in various stages of being fumigated and cleaned and were almost ready for classes but would not reopen for several more days.

Children with symptoms of influenza or coming from homes where there was an active case of influenza would not be allowed to return to their classrooms.

To make up for the three weeks of lost instruction time, the school board voted to shorten vacations and to lengthen the school year. 32

The unexpected vacation had come at a price.

As Flannagan predicted, influenza was not yet gone from Richmond.

By early-December, the disease had reached near-epidemic levels once again.

Hospitals, just recovering from the epidemic workload and now near capacity once again, announced that they would not accept any more influenza patients, leaving victims to be cared for at home or in a private facility.

Commissioner Hobson refused to consider establishing another emergency hospital, calling it an unnecessary expense.


When Price proposed opening the unused top floor of City Home Hospital to influenza patients, Hobson expressed forbade it.

“I will not permit and you are directed not to receive any influenza patients at the city home,” he told Price.

“These institutions have run $10,000 over their appropriations and must not take any more.”

Hobson asserted that many of those treated previously at the John Marshall emergency hospital, despite being “amply able” to pay for their treatment, had instead left the city to foot the bill. 33

Flannagan assured the public that, because far fewer were dying, no restrictions would be put in place.

He warned residents to keep their bodies and their homes clean, and to avoid crowding on streetcars or in homes.


Most affected were the poorer sections of Richmond, as well as the well-to-do West End neighborhoods only lightly touched by the epidemic in October. 34

This latter fact was, as Flannagan realized, the key.

As he wrote in his annual report to Mayor George Ainslie, influenza was now “playing return engagements everywhere, and nothing that is done by health departments, whether of Army, Navy, State or City, seems to do more than to temporarily check it."

"Renewed assaults by it apparently mean to take in the whole susceptible population.” 35

The disease simply had to run its course.

Perhaps not surprisingly, Murrell and the Academy of Medicine and Surgery were unhappy with Flannagan’s position.

He, along with many other physicians, wanted to see Richmond’s schools closed once again, claiming that many of the new cases were among children.

Superintendent of Schools Albert Hudgins Hill disagreed, arguing that the situation did not warrant another closing.

According to his attendance figures, the absentee rate had increased by only about five percent.

Only a quarter of these, Hill surmised, were actually home with influenza, while the others were absent due to parents’ fears or teachers turning away students from infected homes.

The schools already had to struggle to make up lost time; the Christmas break was now limited to only a week.

A second closure would make it impossible for schools to properly educate students. 36

On December 14, the Administrative Board tabled Murrell’s suggestion until it could consult with Flannagan, expected to return the next day from the American Public Health Association meeting in Chicago. 37

The attendance rate in Richmond’s public schools continued to drop.

Before the epidemic, the average daily attendance across the school district was approximately 24,000.

By December 18, that number had declined to 15,705.

Some 4,000 students were excluded from school because there was an active case of influenza in their home.

That still left nearly 4,300 students absent either because of illness or because of overly concerned parents.

Altogether, nearly a quarter of the city’s public school students were absent as the Christmas break approached; in some classrooms, fifty percent of the students were absent.

With the Christmas holiday break just around the corner, Richmond officials decided not to issue a forced closure order. 38

By the time the children returned from their holiday break, the influenza situation had improved greatly.

Between the start of the outbreak and the end of the year, a total of 20,841 cases of influenza were reported.

Of these, 946 victims died as a result of influenza or pneumonia, nearly a quarter of all of Richmond’s deaths for the entire year.
39

The disease rolled on into 1919, adding 132 deaths by early-February. 40

Overall, Richmond’s death rate due to the epidemic was 508 per 100,000, higher than the average amongst Southern and Midwestern cities, but slightly lower than that of most other East Coast communities.

As Flannagan wrote in his department’s annual report to the mayor, despite anticipating influenza’s arrival in Richmond, “no amount of forethought, in the absence of a sufficient number of doctors and nurses, could have prepared us for the tidal wave of disease and death that all but overwhelmed the city.”

Such was the assessment of Richmond’s epidemic by Dr. Roy Flannagan.
41

Notes

1 The average strength of Camp Lee in August 1918 was 47,695, and for September was 52,598. See “Table 8. Strength of specified camps, total enlisted men, by months, Sept. 1, 1917 to Dec. 31, 1919, inclusive,” in Maj. Gen. M. W. Ireland, ed. The Medical Department of the United States Army in the World War, Vol. 15: Statistics, Part Two – Medical and Casualty Statistics (Washington, DC: United States Government Printing Office, 1925), 32.

2 “Base Hospital Filled by Influenza Epidemic,” Richmond Times-Dispatch, 17 Sept. 1918, 7; “One Thousand Soldiers Will Become Citizens,” Richmond Times-Dispatch, 19 Sept. 1918, 2.

3 “Strange Malady Causes Camp Lee Quarantine,” Richmond Times-Dispatch, 15 Sept. 1918, 8; “Base Hospital Filled by Influenza Epidemic,” Richmond Times-Dispatch, 17 Sept. 1918, 7.

4 “Larger Base Hospital Planned for Camp Lee,” Richmond Times-Dispatch, 29 Sept. 1918, 10. The veterinary staff had been quarantined as well, but unfortunately did not fare as well. See “Influenza Responsible for 167 Deaths at Camp,” Richmond Times-Dispatch, 10 Oct. 1918, 3.

5 “Crusade against Spanish Influenza is Being Waged by State Health Officers,” Richmond News-Leader, 18 Sept. 1918, 1.

6 “Spanish Grip in Modified Quarantine,” Richmond News-Leader, 28 Sept. 1918, 1; “Spanish Influenza Makes Gains in Richmond; Cases Total 340, Doctors Busy,” Richmond News-Leader, 30 Sept. 1918, 2; “May Close Movie Houses to Protect Public Health,” Richmond Times-Dispatch, 29 Sept. 1918, 10.

7 “Influenza Safeguards Taken by Dr. Flannagan,” Richmond Times-Dispatch, 2 Oct. 1918, 14.

8 “Influenza Responsible for 167 Deaths at Camp,” Richmond Times-Dispatch, 3 Oct. 1918, 3.

9 “With 466 Cases Reported, Authorities Are Closely Watching Fly Situation,” Richmond News-Leader, 1 Oct. 1918, 1.

10 “Influenza Situation Considered Grave,” Richmond Times-Dispatch, 5 Oct. 1918, 10.

11 “Epidemic Forces Drastic Action,” Richmond Times-Dispatch, 6 Oct. 1918, 1.

12 “Turns Schools into Grip Hospitals; Soda Founts Closed,” Richmond News-Leader, 7 Oct. 1918, 1.

13 “Quickly Organize to Fight Plague of Spanish Grip,” Richmond News-Leader, 8 Oct. 1918, 1;

14 “Hospital Head is Stricken Down,” Richmond News-Leader, 9 Oct. 1918, 1.

15 “Flu Besieges City; 10,000 Cases Here,” Richmond Times-Dispatch, 8 Oct. 1918, 10.

16 “Hospital Head Is Stricken Down,” Richmond News-Leader, 9 Oct. 1918, 1.

17 “More Doctors and Nurses Stricken Ill with Malady that Grips the Community,” Richmond News-Leader, 10 Oct. 1.

18 “Influenza Deaths to Date Total 112 out of 3,853 Cases Reported Officially,” Richmond News-Leader, 11 Oct. 1918, 1.

19 “Turn Schools Into Grip Hospitals; Soda Founts Closed,” Richmond News-Leader, 7 Oct. 1918, 1.

20 “Flu Besieges City; 10,000 Cases Here,” Richmond Times-Dispatch, 8 Oct. 1918, 10.

21 “City Probably Will Take Over Operation of Dairy Business, with Jail Help,” Richmond News-Leader, 12 Oct. 1918, 1.

22 “Doctors Beg for Nurses, Men and Women Alike,” Richmond News-Leader, 12 Oct. 1918, 1.

23 “Influenza Deaths to Date Total 112 out of 3,853 Cases Reported Officially,” Richmond News-Leader, 11 Oct. 1918, 1.

24 “Peak of Grip Epidemic is Reached Here,” Richmond News-Leader, 14 Oct. 1918, 4.

25 “Doctors Think Influenza Situation Here Continues to Improve,” Richmond News-Leader, 16 Oct. 1918, 1; “Grip Patients No Longer Admitted,” Richmond News-Leader, 26 Oct. 1918, 9; “Epidemic Tide Continues to Ebb,” Richmond News-Leader, 29 Oct. 1918, 15.

26 “Epidemic Tide Continues to Ebb,” Richmond News-Leader, 29 Oct. 1918, 15.

27 “Will Lift Ban at Midnight Saturday,” Richmond News-Leader, 30 Oct. 1918, 1.

28 “Defers Action on Lifting the Ban,” Richmond News-Leader, 31 Oct. 1918, 1.

29 “Board Tables Flannagan’s Original Letter,” Richmond News-Leader, 1 Nov. 1918, 1.

30 “Ban Will Not be Lifted Tomorrow,” Richmond News-Leader, 2 Nov. 1918, 1.

31 “Ban is Lifted, Board Voting Two to One in Favor,” Richmond News-Leader, 4 Nov. 1918, 1.

32 “Open Schools at Date to be Fixed,” Richmond News-Leader, 4 Nov. 1918, 1; “Pupils from Grip Homes Barred,” Richmond News-Leader, 5 Nov. 1918, 13. John Marshall High reopened on Thursday, November 7, and Baker School on Monday, November 11. See “High School’s Opening is Tomorrow, Richmond News-Leader, 6 Nov. 1918, 2.

33 “Influenza Patients Will Not Be Received In City Hospitals Until Notice,” Richmond News-Leader, 5 Dec. 1918, 16.

34 “Influenza Again Is Almost an Epidemic” Richmond News-Leader, 2 Dec. 1918, 1.

35 Roy K. Flannagan, “Report of the Chief Health Officers, in Annual Report of the Health Department of the City of Richmond, Va., for the Year Ending December 31, 1918 (Richmond: Clyde W. Saunders, 1919), 7.

36 “Sees No Reason for Closing Public Schools at This Time on Account of the Influenza,” Richmond News-Leader, 13 Dec. 1918, 1.

37 “Closing of Schools Is Deferred by the Administration Until Dr. Flannagan Returns,” Richmond News-Leader, 14 Dec. 1918, 1,13.

38 “Only 87 Cases Reported up to Noon,” Richmond News-Leader, 18 Dec. 1918, 1.

39 Roy K. Flannagan, Annual Report of the Health Department of the City of Richmond, Va., 1919, printed by Clyde W. Saunders, City Printer, 7.

40 “January Deaths Less than Half as Many as in October,” Richmond News-Leader, 7 Feb. 1919, 7.

41 Roy K. Flannagan, Chief Health Officer Richmond, in 1918 City Health Report

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Re: EPIDEMICS IN AMERICAN HISTORY

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THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919

Author: Rachel Goatley 

How to Cite: Goatley, Rachel. 2015. “THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919”. The Virginia Tech Undergraduate Historical Review 4. DOI:

http://doi.org/10.21061/vtuhr.v4i0.34

Published on 01 May 2015

The Spanish Influenza of 1918 is widely regarded by historians as the “forgotten pandemic.” 1

Though it killed between thirty million and one hundred million individuals, around five percent of the world’s population, the Spanish Flu has been largely ignored in the historical discussion of worldwide disease. 2

Comparable to the immense mortality of the Black Death on the Eurasian continent in the fourteenth century, the Spanish Flu did not discriminate among its victims.

According to historian Alfred Crosby, “the flu...ignored the differences between rural and urban, patrician and peasant, capitalist and proletarian, and struck them all down in similar proportions.”
3

The prevailing question remains: if this deadly virus afflicted such a large portion of the world population, why has the memory of this global pandemic been erased?

One possible answer to this debate lies in another global event that occurred simultaneously with the outbreak of the Spanish Influenza World War I.

A large percentage of the global population lived in countries embroiled in the war.

In the fall of 1918, when the deadliest wave of influenza began creeping across the continents, members of vulnerable populations were more interested in broadcasts of battles than news of the flu.

Though the fatality of World War I gripped the attention of nations across the globe, the Spanish Influenza of 1918 actually reaped much more devastating effects among international populations without the aid of firearms or tanks.

Historiography existing by epidemiologists and other researchers have focused upon the Spanish Influenza of 1918 in a national or international context.

This broad interpretation of history allows historians to examine the immense impact of the flu on the global population, but fails to create a local history of the disease among different cultures.

In addition, examining pandemics from solely national or international perspectives only presents the outbreak as a disease of the masses, rather than a volatile individual experience.

Some historians, such as Alfred Crosby, even suggest that local history of the Spanish Influenza is inconclusive or unproductive.

He explains, “Their chronicles are poorly kept and usually no more than anecdotal.” 4

This statement is arguably false, as evidenced by the well-documented events of the Spanish Influenza in local newspapers such as those published in Southwest Virginia.

While local newspapers did not display specific statistics of the Spanish Influenza, they did provide a thorough understanding of the spread of disease throughout a particular region.

Local history also demonstrates the efficacy of municipal governments in the battle against the flu.

According to historian John M. Barry, “some local authorities might take some action [against the flu], but no national figure could.”
5

Unlike national and state officials, local officials, especially those in Southwest Virginia, possessed the prime concoction of smaller constituencies and fluctuating power.

This granted their preventative health measures greater effectiveness, and contributed to the quelling of the epidemic in the region.

The particular strain of flu that infected the global population in 1918 was unusually severe.

This is demonstrated not only by the mortality rates of those infected, but also in the symptoms displayed by the sick.


For example, many ill individuals experienced violent epistaxis, or nosebleeds.

One infected young woman spewed blood from her nose one foot across her bed linens. 6

The destruction of infected patients’ lungs was also terrifically severe.

According to historian Tom Quinn, “some victims coughed up as much as six pints of pus a day.”
7

Following death, autopsies often revealed that patients coughed so hard that they tore apart abdominal muscles and rib cartilage. 8

Yet another cruel symptom of the influenza was the secondary disease associated with the strain, which most often acted as the cause of death — pneumonia.

The form of pneumonia accompanying the Spanish Flu often featured a blueness of the skin, termed heliotrope cyanosis in the medical world.
9

This was later determined to be caused by a lack of oxygen in the blood, “as patients literally drowned from fluid in their lungs.” 10

The Spanish Influenza of 1918 was also unprecedentedly lethal.

Unlike the majority of past strains of the influenza, the mutated virus of the Spanish Influenza was unusually deadly among young adults (Figure 1).
11

According to Susan Kingsley Kent, “unlike its predecessors, which tended to take infants and the elderly, this strain of influenza preferred men and women aged fifteen to forty-five, victims in the prime of their lives.” 12

In his book America’s Forgotten Pandemic, Alfred Crosby presents a great analogy between the Spanish Influenza and the concurrent conflict of 1918: “like war, it preferred young adults as victims.” 13

The deaths of so many able-bodied adults had drastic social and economic ramifications around the globe.

The Spanish Influenza of 1918 left no area of the world unaffected.

At the time, contemporaries mistakenly referred to this deadly strain of influenza as the “Spanish Influenza” or the “Spanish Grippe” because they believed the virus to have evolved in Spain.
14

Restrictions on the press of nations involved in World War I contributed to the misnomer.

In the earliest months of the virus in the spring of 1918, the Spanish press cited an outbreak of influenza among the civilian population and the infection of the monarch, King Alphonse XIII. 15

At the time, Spain was one of the few nations releasing international news reports.

According to historian Tom Quinn, “within the censorship of the press of combatant nations across war-torn Europe, the only country that publicly mentioned the new disease was neutral Spain.” 16

The assumption that the influenza of 1918 emerged in Spain was far removed from reality.

Recent historians and epidemiologists actually traced the origins of this particular strain of flu to a single physician’s office in the United States, located in Haskell County, Kansas, in the southwestern portion of the state.
17

With the aid of primary sources from local newspapers and manuscript collections, historians even pinpointed the initial advancement of the Spanish Influenza between civilian and military populations.

Over the holiday season of 1917-1918, a young soldier named Dean Nilson visited his family in Haskell County where he unknowingly contracted the flu. 18

He then carried the virus to Camp Funston, now known as Fort Riley, an army base located three hundred miles away. 19

From there, he infected many fellow troops who were drafted into the United States Army and sent overseas.

These debilitated soldiers then spread the flu amongst other military bases and eventually to the front lines in Europe.

Using a combination of historical and public health sources, scholars have tracked the progression of the virus, and now divide the flu season of 1918-1919 into three distinct waves of disease.

Of these waves, the second was the most deadly.
20

After abating in severity over the warm spring and summer months, the Spanish Influenza mysteriously mutated in Europe, becoming an especially virulent strain of the disease in early fall.

This second wave of the Spanish Influenza emerged in the United States in August 1918.

On August 12, the Bergensfiord, a Norwegian vessel, arrived in New York Harbor with two hundred cases of influenza onboard.
21

New York authorities refused to quarantine the ship, allowing the infected sailors to disembark.

This action proved to be deadly.

By August 27, the influenza appeared on the Commonwealth Pier in Boston — a major receiving port for military personnel during World War I — and infected nearly seven thousand soldiers.
22

From there, the influenza spread to Fort Devens, Massachusetts, where the epidemic exploded.

By October, cases of the Spanish Influenza among the United States population rose so precipitously that they interrupted the monthly draft contingent.

On October 7, 1918, the Provost Marshal General of the United States Army cancelled the homefront conscription of 142,000 young men.
23

Though chief military personnel postponed the draft of over 100,000 soldiers due to the flu epidemic, President Woodrow Wilson refused to halt the transit of troops to the front lines in Europe. 24

This action most certainly facilitated the further spread of the second wave of disease into virgin territories, decimating both civilian and military populations abroad.

At the same time, the Spanish influenza continued to ravage most regions of the United States.

The Spanish Influenza first arrived in the state of Virginia in September 1918 at the army base Camp Lee (now known as Fort Lee) in Prince George County near Petersburg, Virginia. 25

According to Alfred Crosby, the influenza dispersed from Camp Devens to Camp Lee around September 23. 26

From Camp Lee, local soldiers disseminated the influenza virus to Southwest Virginia during hometown visits.

The Spanish Influenza first emerged in Tazewell County during the week of October 4, while in Wise County it appeared sometime before October 16.

The transmission of the Spanish Influenza to soldiers from the area was significant because young men drafted into the United States military from rural regions often suffered worse during disease epidemics than soldiers from urban areas due to their weaker immune systems.


For historian Tom Quinn, “in the USA it was noted that raw recruits from army camps who arrived from remote rural areas were far more likely to be affected severely by influenza and die.” 27

Thus, the advancement of the violent influenza to bucolic counties also proved to be especially lethal among nonmilitary citizens within the region of Southwest Virginia.

Similar to most other regions in the United States, Southwest Virginia was struck by the deadly second wave of the Spanish Influenza in the fall of 1918.


Transmitted from army camps near Appalachia, the flu even spread to the most remote, rural areas of the region.

In order to disseminate knowledge concerning the prevention of the spread of the deadly influenza, public health officials in the United States employed the information medium with the highest broadest audience — newspapers. 28

Local health officials in Southwest Virginia also used small town newspapers to document the escalation and impact of the virus on the populations in the region.

This case study on the flu’s significance in Southwest Virginia is based on such sources.

The local newspapers of two counties in the area — Big Stone Gap Post in Wise County and Clinch Valley News in Tazewell County provide descriptions of prevention tactics, treatment, and the aftermath of the particularly fatal flu season of 1918-1919.

These sources also furnish an intimate perspective on the effects of a global pandemic, such as economic burdens, public health measures, and government intervention, in one of the poorest regions of the country, largely ignored by historians of the United States.


Wise County

The Spanish Influenza arrived in Wise County, Virginia, in October 1918.

Located in extreme Southwest Virginia, Wise County sits on the Kentucky border.

The largest town in the county during the influenza pandemic was Big Stone Gap, also the hub of the local newspaper in the nineteenth and early twentieth centuries, the Big Stone Gap Post.

The particularly virulent strain of Spanish Influenza was first mentioned in the Post on October 2, 1918.


Editors warned of the impending emergence of the virus in Southwest Virginia: “Spanish influenza probably will soon be here, there, and everywhere.”

This article designated influenza as a “spray-borne disease” spread by sneezes and coughs.

It also suggested a simple prevention method commonly prescribed by the US Surgeon General at the time, Dr. Rupert Blue, who advised avoiding “crowded, ill ventilated places.”

However, the most striking inclusion in the article from October 2 is the statement pertaining to the nature of seasonal influenza.

The Big Stone Gap Post described the virus as a “seldom menace of life.”

Clearly, the inhabitants of Wise County did not anticipate the enormity of the deadly flu season of 1918-1919.
29

Placed into historical context, the apathetic responses of both the newspaper editors and the local public health officials in Wise County were not unusual.

In the early twentieth century, influenza was a common, seasonal occurrence throughout not only Virginia, but the entire United States.

Wise County clearly possessed experience with the flu, or “grippe,” as it was often called.

As early as January 1917, the Big Stone Gap Post warned Virginians of the impending annual flu season.

The Virginia Board of Health mentioned simple precautionary actions, such as breathing fresh air, and also promoted the evidence of germ theory. 30

In January the following year, the Big Stone Gap Post ran advertisements for “Rexall Cold Tablets,” a medication that promised to “arm...against Grippe, Influenza, Bronchitis, Cold in the head, Catarrh and Pneumonia.” 31

Based on these newspaper clippings and the initial response of locals, the annual influenza outbreak in Southwest Virginia had never been as serious as the viral pandemic that struck in the fall of 1918.

One week following the initial lackadaisical acknowledgement of the Spanish Influenza in the local newspaper, the Board of Health in Wise County implemented much more serious prevention tactics to restrict the spread of the virus to the region.

Adhering to advice outlined by Surgeon General Blue, on October 9 the local government closed nearly all public gathering places, especially churches, schools, and theaters.
32

By October 16, precautionary measures became even more rigid as influenza finally reached the county.

Following a town council meeting, the local government voted to allow hired civil servants to enforce the sanitary laws laid out by the Board of Health.

According to the front page of the Big Stone Gap Post, “special officers will be employed to enforce the ordinance always in existence against spitting on the sidewalks, and to prevent the forming of crowds on the streets...or at any other point within the town limits.”
33

The local government even took a step further and granted permission for Boy Scouts to report violations against the ordinances and imposed fines ranging from ten to twenty-five dollars on offenders. 34

Members of the Wise County government were evidently beginning to understand the magnitude of the disease situation, and attempted to control unsanitary public actions.

The local Board of Health in Wise County adopted a variety of methods to spread information regarding the prevention of the flu.

The Big Stone Gap Post not only published health warnings from Surgeon General Blue, but they also relayed information from the Red Cross.
35

One of the more unique forms of sanitation publicity employed by the State Board of Health of Virginia appeared in a newspaper article on November 13, 1918.

This passage described the creation of an “Influenza Catechism” for school children.

Described as an “attractive publication,” the State Board of Health created the guide “in the hope that youngsters...follow the simple precautions it offers in connection with the prevention of the ‘flu.’” 36

Another common tool used for the dissemination of knowledge about the Spanish Flu in both national and local newspapers was illustrations.

These simple visuals were easily understood by nearly all Americans because they did not necessarily require the viewer to be literate.


Graphic visuals are still an important tool in spreading sanitation knowledge today.

The current and recognizable “Cover your Cough” posters issued by the Centers for Disease Control mimic visuals from the Spanish Influenza, such as the one published on the front page of the Big Stone Gap Post on the first day of October 1919 (Figures 2 and 3).

Unlike the gradual infection of individuals in Southwest Virginia in September and October, the Spanish Influenza was ravaging vulnerable troops at military bases throughout the United States in the fall of 1918.

The Big Stone Gap Post published a startling figure on October 9: the mortality rate of American soldiers at army camps had reached nearly thirty-five percent on September 27, 1918.

This was a thirty percent increase from the previous week.
37

In this initial onset of the second wave of the flu, civilian populations seem to have been infected at a much slower rate.

On October 16, Big Stone Gap Post declared 60,000 cases of Spanish Influenza in Virginia so far, and only two or three cases of the virus in the local area. 38

An explanation for these large discrepancies in infection rates between military and civilian populations lies in the geographic location of the infected area.

While military bases boasted thousands of constantly mobile individuals, the rural region of Southwest Virginia was a less populated area with fewer traveling persons.

However, the flu did not forsake the area for long.

The quickly multiplying infection rates in Wise County within a one week period in October showcase the immensely contagious nature of the Spanish Influenza.

On October 23, the Home Service Section Chairman of the local American Red Cross congratulated the people of Big Stone Gap for preventing a major scourge of the virus on the public.
39

This statement became null and void just one week later.

On October 30, the Big Stone Gap Post published an article describing the region of Southwest Virginia as “the worst afflicted of any part of the state.”
40

Later articles attributed this to the rural nature and the excessive levels of poverty within the region.

An article on November 20 described the depressing state of affairs in many counties of Southwest Virginia.

According to the reporter, it was difficult for volunteers to reach the poor in many rural areas because of the inadequacy of railroad lines.

Also, due to the horrific mortality rates associated with the Spanish Influenza, these rural areas experienced a shortage of coffins and undertakers.

Finally, this reporter relayed accounts of neighbors abandoning the sick because of excessive fear of the virulent influenza. 41

In other poor areas in the region, reports circulated that hungry dogs often snapped at pallbearers carrying the corpses of influenza victims. 42

These accounts not only showed the extent of the affliction upon impoverished areas, but they also demonstrated the social stigma attached to the Spanish Influenza in the United States.

National, state, and local authorities gathered support for the treatment of the Spanish Influenza by appealing to the patriotism of civilians for volunteerism during the disease crisis.

As stated in America’s Forgotten Pandemic, “enthusiasm [for the war] was successfully substituted for preparation and efficiency in the battle with the flu.” 43

Dispersed among World War I liberty bond advertisements in the Big Stone Gap Post, local Board of Health officials in Wise County requested the assistance of fellow civilians in the fight against the flu.

On the front page of the Big Stone Gap Post on October 16, 1918, the Central Committee on the influenza epidemic in Wise County pleaded for help by comparing public health assistance to military service: “to all those, both men and women, who have so longed for the glamor and glory of service in France, let us say that the opportunity has been brought home to you to show just how truly you desire to sacrifice yourself on the altar of your country.” 44

One week later, on October 23, the Big Stone Gap Post published an annotated version of Surgeon General Blue’s precautionary measures and home remedies against the flu.

In another appeal to American nationalism to prevent the further spread of the Spanish Influenza, the editors of the newspaper stated the Surgeon General “believes that a patriotic service will be performed if the public heeds to his advice.” 45

Also related to the patriotic appeal by public health officials was the circulation of anti-German sentiment in regards to the spread of the flu throughout the United States.

According to historian Tom Quinn, “foreigners were blamed for spreading the disease deliberately a paranoid fear induced by the rising death toll” associated with the Spanish influenza.
46

Susan Kingsley Kent expands on this idea: “the war served as an obvious metaphor [for the flu] in which Germans and germs were equally feared.” 47

One of the most interesting inclusions in the news coverage of the outbreak was the insinuation that German soldiers purposefully spread the disease to the United States as a weapon of war. 48

Anti-German sentiment also emerged following the decision by the Provost Marshal General of the United States Army to cancel the October draft of 142,000 men on account of the flu epidemic. 49

This directly affected many young men throughout Southwest Virginia, who were hoping to participate in the international war.

The Big Stone Gap Post briefly displayed this belief in a short quip about the influenza inhibiting war efforts on October 16: “Spanish influenza must be pro German, if one can judge by the way it is holding up the October draft contingent”. 50

The request for nurses in Southwest Virginia mimicked the patriotic call for general volunteerism among civilians during the Spanish Influenza pandemic.

Just as was evident throughout the entire nation at this time, Wise County lacked adequate numbers of nurses and physicians to treat the sick.

Therefore, the local Influenza Committee in Big Stone Gap requested the help of any and all available women in medical care: “Let every woman who can volunteer for public nursing in the crisis that is surely coming, and prove herself worthy of the greater sacrifices of those noble ones abroad, to whom our danger would hardly seem a grievance.” 51

On October 30, the local chapter of the American Red Cross also called for “largely increasing our membership” through the recruitment of more nurses in the area. 52

While the order for nurses during the Spanish Influenza pandemic was especially prevalent, the request for physicians was conspicuously missing.

This can be attributed to the absence of a proper cure for the virus.

Due to the inadequacy of an efficient antidote, the soothing care provided by nurses was in high demand during the plague of the Spanish Influenza.

According to Susan Kingsley Kent, “with physicians unable to make much of a difference during the pandemic, nursing care turned out to be one of the most effective treatments.” 53

Scholar Alfred Crosby also tackled this theme, stating that “TLC — Tender Loving Care — to keep the patient alive until the disease passed away: that was the miracle drug of 1918.” 54

Similar to sick citizens throughout the country, residents of Southwest Virginia requested the aid of nurses in the area.

On the front page of the Big Stone Gap Post on November 6, the local newspaper editors relayed a message from the Virginia State Board of Health regarding the recruitment of nurses.

This article once again invoked nationalistic pride during World War I: “the need is most urgent and any nurses who can serve in this capacity should have the satisfying consciousness of performing a real patriotic duty.” 55

Tales of nursing heroism emerged in Southwest Virginia not long after the onslaught of the Spanish Influenza.

On November 27, the Big Stone Gap Post featured a story about Miss Agnes D. Randolph, a state nurse from Richmond stationed within the mountainous region.

According to the article, Nurse Randolph had to not only tend to three generations of sick in an eight-member family, but the city nurse also had to “clean up, cook, feed the pigs and chickens, get the cow from the hills and punish the children when they needed discipline.”

Though her task was monumental, the nurse “felt she had received more than her reward” following an expression of gratitude from the family.
56

By the first week of November, Wise County officials believed their stringent precautionary measures against the Spanish influenza had been successful.

On November 6, the town council of Big Stone Gap thanked the temporary Central Committee created by the Board of Health to combat the Spanish Influenza epidemic in the county and dissolved the task force.

According to the announcement, “on advice from the Board of Health, which believes that the crisis has passed, the council now deems it wise to relieve this committee of its duties.” 57

Five days previous, the Virginia State Board of Health had declared that restrictions on public places “may be lifted to a large extent in most communities in Virginia, depending upon the prevalence and severity of the epidemic in those communities.” 58

Based upon this report, the Wise County town council voted to reopen public schools on November 28, Thanksgiving Day. 59

However, this action was clearly premature, as the influenza virus resurged throughout the communities of Wise County in early December.

On December 18, the Big Stone Gap Post announced the creation of an “Influenza Committee” by the auxiliary chapter of the Red Cross in Wise County.
60

This committee was established not only to replace the disbanded Central Committee of the town council, but also to address the reemergence of the deadly Spanish Influenza throughout the county.

By January 1919, the deadliest wave of the Spanish Influenza was finally relinquishing its grip upon the inhabitants of Wise County.

Public places not yet reopened were allowed to resume business in January following the lift on the influenza ban by the town council.

On January 1, 1919, the local Amuzu Theater finally started showing films and productions again.

To combat apprehension toward large public gatherings, the Amuzu Theater hoped to reassure guests by thoroughly disinfecting the cinema with “’Formaldehyde Gas’ before and after every show.”

Owners of the Amuzu Theater also proclaimed “that this theater has taken every necessary precaution for proper ventilation.”
61

Many churches in Wise County were also allowed to resume religious services.

Resentment toward the Boards of Health for closing religious institutions existed in many counties of Southwest Virginia.

The Big Stone Gap Post published the contents of an open letter from a Christian churchgoer in the Scott County newspaper the Gate City Herald on New Year’s Day.

The editorial appeared in the newspaper on the same day the lift on the influenza ban was announced in Wise County.

Titled “As to Closing the Churches,” this editorial not only berated local officials for shutting down congregational religious services, but also blamed the scourge of the Spanish Influenza on the overall immorality of Americans in the early twentieth century.
62

The socioeconomic impacts of the particularly fatal strain of flu that attacked world populations in 1918 were visible in Virginia not long after the decline in infection.

According to historian Tom Quinn, “by late October, industry and commerce around the world were severely damaged” by losses from the flu.
63

As reported in data released by the “Virginia Anti-Tuberculosis Association in co-operation with the medical and philanthropic authorities in Wise County,” “there were 10,000 more deaths in Virginia in 1918 than in 1917, most of this increase was due to influenza and pneumonia." 64

These drastic demographic changes and the particularly violent nature of the influenza in the young adult population greatly impacted the primary sector of the economy and the retrieval of raw materials in Southwest Virginia.

Officials in Richmond declared the mining and lumber industries in the region of Southwest Virginia particularly hard-hit by the flu epidemic.
65

On October 16, the Big Stone Gap Post broadcasted news from the tiny mining town of St. Charles, in Lee County, Virginia, the most southwestern county in the state.

According to the report, “some of the mines in that section have been forced to close because there are not enough well men to operate them.” 66

The closing of mines and lumber yards was not only nationally significant because it hindered the war effort on the home front, but also locally significant because it impacted the lives of thousands of already impoverished individuals in Southwest Virginia.

The consequences of the Spanish Influenza of 1918 on the population were almost instantly observable in Southwest Virginia.

Starting with the deaths of local boys stationed at military camps within the United States, the mortality rates of influenza quickly spread among the civilian population, especially young adults.

Officials in Virginia cited evidence of this situation as early as January 1919, when the Spanish Influenza was still ravaging certain parts of the state.


Based on reports from the Bureau of Vital Statistics, the state of Virginia initially recorded 5,999 victims from the Spanish Influenza in 1918.

The majority of these were young adults. 67

This created a demographic crisis, which not only impacted economic industries in the region, but also created a large number of orphans within Southwest Virginia.

Similar conditions were present throughout the entirety of the United States following the influenza pandemic of 1918.


Local health officials in Wise County were well prepared for the following flu season after their experience with the unprecedented mortality rates associated with the strain of 1918.

By the fall of 1919, the Big Stone Gap Post published numerous accounts on the increasing knowledge surrounding the pandemic of the previous year.

Though contemporaries of the Spanish Influenza still did not yet understand the transmitting agent of disease, American epidemiologists had isolated the origins and waves of the deadly pandemic.

On September 17, 1919, the Big Stone Gap Post addressed the impending flu season in depth.

Editors of the newspaper reported that the influenza infection of 1919 would not be as lethal as the previous year’s.

An article in the paper also announced that physicians and epidemiologists realized that the virus did not originate in Spain, as previously thought.

However, the most significant inclusion in the front page article on the Spanish Influenza was the brief statement on prevention: “the most promising way to deal with a possible recurrence of the influenza epidemic is, to sum it up in a single word, 'Preparedness.'”

And now it is the time to prepare.”
68

Tazewell County

Similar to Wise County, Tazewell County, Virginia, had comparable experiences with the Spanish Influenza pandemic of 1918-1919.

Also located in far southwestern Virginia, the County of Tazewell borders West Virginia along the ridge of the Appalachian Mountains.

The local newspaper that served the area during the influenza pandemic was the Clinch Valley News, named after the Clinch River that flows through the region.


Before the second wave of the Spanish Influenza even reached the United States, the Clinch Valley News was broadcasting the report of a deadly influenza outbreak in the German Army on the Western Front. 69

Initial evidence of the Spanish Influenza in Tazewell County emerged in Jewell, a small coal-mining town, sometime in the week preceding the Clinch Valley News weekly edition on October 4, 1918. 70

Not long after the emergence of the disease in Virginia, local health officials in Tazewell County enacted public sanitation measures to curb the spread of the flu.

Relaying advice from the Virginia State Board of Health, the Clinch Valley News published “How To Save Yourself From Influenza” on October 11, 1918.


These recommendations followed the guidelines generally associated with respiratory illnesses, and mentioned avoiding crowds, covering coughs or sneezes with a handkerchief, and remaining in bed for the duration of the illness. 7

On October 25, the opening article in the Clinch Valley News included these same prevention measures, but also described symptoms, treatment, and precautions associated with the Spanish Influenza. 72

Judging by front page location of the article, residents in Tazewell County were very concerned by the spread of the deadly virus.

The first few weeks of the Spanish Influenza pandemic in Tazewell County were relatively quiet.

The virus was slow to infect residents in the rural locations of Southwest Virginia.

The first casualties amongst locals did not even occur in the county — young male troops stationed at American military bases were the earliest Tazewell residents to contract the disease.

According to information published in the Clinch Valley News on October 11, 1918, the deaths of three influenza-stricken Tazewell County soldiers were also the first casualties of World War I from the area.

Sidney M. B. Coulling, William E. Peery Jr., and Sergeant Estil Hurt did not live to see action in the war.

Instead, the three young soldiers died at army camps of complications with influenza from a secondary infection of pneumonia.

Sidney M. B. Coulling’s death reflected the swift and cruel nature of the Spanish Influenza.

He died within two weeks of enlisting. 73

In the words of the Clinch Valley News editor, “now, in an unexpected way the war has been brought home to us in this dreadful epidemic, as deadly as German bullets.” 74

In the first few weeks of October, Spanish Influenza was ravaging army camps throughout the nation and along front lines.

However, initial flu infection rates were slow to emerge in Tazewell County.

As of October 18, the influenza pandemic in Tazewell County was described as a mild form. 75

But by October 25, the Clinch Valley News stated, “influenza has been claiming heavy tolls at Richlands and vicinity.” 76

According to newspaper accounts on that same day, “the epidemic of influenza is just getting a good start in Tazewell.” 77

In order to prevent the further circulation of the flu virus, many areas in the county prohibited large public gatherings “to escape the death toll that has been taking in so many communities.” 78

Following recommendations from the US Surgeon General, the Town of Tazewell Board of Health took precautionary measures and closed all public places on October 11, 1918. 79

This included not only schools, but also theaters and churches.

By October 18, the Virginia Board of Health estimated that there were at least two hundred thousand cases of the Spanish influenza in the state.
80

Following the greater dispersion of the Spanish Influenza in the fourth week of October, Tazewell County officials pondered stricter ordinances to prevent the further spread of the virus.

On October 25 in an editorial titled “Strict Quarantines Should Be Established,” an anonymous author rallied for the implementation of “rigid precautions,” such as a town quarantine restricting all visitors. 81

Though this suggestion would have possibly contained the virus to the outskirts, placing a quarantine on an area as large as Tazewell County was quite infeasible.

Therefore, the quarantine was never implemented.

Unlike Wise County officials who imposed stringent laws on society, such as fines for spitting in the street, the officials in Tazewell County relied mainly upon public health recommendations and the honorable sanitary actions of individuals.

Just as all regions of the United States, Southwest Virginia was also affected by the lack of available nurses and physicians to treat the Spanish Influenza.

Due to America’s involvement in World War I, most health care providers were stationed overseas or at major military bases.

This inhibited the treatment of Spanish Influenza victims among the civilian population within the continental United States.

Calls for volunteer nurses appeared in most newspapers across the country, including the small local ones published in Southwest Virginia.

Members of the Board of Health in Tazewell County released information regarding the need for nurses in the region as early as October 18, only a few weeks after the first cases of influenza were reported in the area. 82

By November 8, the futile appeal for nurses in the Clinch Valley News reflected the desperate disease situation that had developed in Tazewell County.

Citizens of the small town of Raven pleaded to the local Board of Health to send medical aid as their town physicians were all off supporting the war effort.

Their reports included statistics of two deaths per day within the miniscule rural population. 83

Unlike the Big Stone Gap Post, the Clinch Valley News also briefly addressed the Spanish Influenza in the African American community of Southwest Virginia.

The only mention of non-whites during the flu pandemic in Tazewell County occurred on November 1, 1918.

According to local reports in the Clinch Valley News, the black population of Tazewell County appeared to be affected by the Spanish Flu in the same fashion as whites. 84

The brief statement regarding the epidemic among different races in Tazewell County is significant because few sources exist that describe the Spanish Influenza among the African American population.

In addition, historians and epidemiologists of the Spanish Influenza pandemic of 1918 continue to ignore the context of the virus among minority populations even more than local perspectives.

By early November, Tazewell County health officials assumed the brunt of the second wave of influenza was subsiding.

On November 1, the Tazewell County Board of Health prematurely reopened all public places, including schools.
85

This inopportune action greatly affected infection rates of Spanish Influenza throughout the county.

Based on the increasing publication of sickness and deaths in the “Local News” section of the Clinch Valley News in the papers of November 8 and November 15, the Board of Health clearly responded too quickly to the slight decline in infection rates in late October. 88

By November 29, the flu was once again raging throughout the county, and the local newspaper described at least fifteen new cases of disease. 87

On December 6th, editors of the Clinch Valley News confessed their mistake: “the statement made by the papers recently that the ‘flu’ had abated, seems to have been somewhat premature.” 88

One week later, the mayor of Tazewell, A. C. Buchanan, stated in the Clinch Valley News that “it was probable the schools and other places would be closed [again], owing to the rapid spread of the influenza.” 89

An editorial published on the same front page described the common sentiment held by citizens of Tazewell to “better err if at all on the safe side” and reclose public places. 90

However, the Board of Health and Town Council of Tazewell County refused to reclose schools, churches, and businesses within the area.

The editor of the Clinch Valley News clearly respected the beliefs of citizens within the county, and included a critical statement following the public health announcement: “Whether the authorities have proceeded wisely or unwisely, remains to be seen."

"Whether precaution is better than cure, however, is not a question at all."

"Time will tell.”
91

As in Wise County, the local government in Tazewell County appealed to inhabitants’ patriotism to volunteer in the treatment of the flu.

Alfred Crosby describes the exceptional level of civic volunteerism in the treatment of the Spanish Influenza as a “by-product of the war spirit.” 92

One aspect of information shared between the Big Stone Gap Post and the Clinch Valley News was the inclusion of false rumors surrounding the emergence of the influenza in the United States.

Crosby also states that “the people of the US were stark raving patriotic” in the year of 1918.
93

Similar to inhabitants in Wise County, many Tazewell County residents believed the influenza was spread to the United States as a by-product of the German war effort.

Nationalistic appeals were present in the Clinch Valley News not only during the continuation of both World War I and the height of the pandemic, but also after the armistice in November and the decline of the deadliest wave of the Spanish Influenza.

During the final wave of disease in March 1919, the Clinch Valley News equated citizens ignoring flu prevention methods to the unpatriotic rejection of the League of Nations. 94

As evidenced in articles within the local newspapers of the Big Stone Gap Post and the Clinch Valley News, patriotic appeals to follow influenza prevention and treatment methods were particularly effective among the population of Southwest Virginia.

The economy of Tazewell County in the early twentieth century was primarily based upon mining and railroads.

Thus, the ravaging flu of the 1918-1919 season greatly affected production outputs and industrial transport and shipping.

Effects of flu on the economy of Tazewell County were visible early after the onset of the epidemic because of the prevalence of mining industries within the area.


Multiple publications of the Clinch Valley News in the fall and winter of 1918 reference the impact of the Spanish Influenza pandemic on local mines.

For example, editors of the Clinch Valley News mentioned the consequences of the influenza pandemic among coal miners within the small town of Jewell on October 4. 95

This date is significant because it is the same day as the initial announcement of infection within the county.

Two weeks later, the ramifications of the great influenza infection rates among the coal mining population were presented as front page headlines in the local newspaper.

On October 18, in the article “The Influenza Spreads Fast,” the Clinch Valley News discussed the hindering of coal production within the region.

According to reports by the Fuel Administration, coal retrieval within Appalachia “report[ed] reductions, ranging from 15 per cent to 50 per cent of the regular output [sic].”

By December 6, the Clinch Valley News released information that mines within the local area might shut down due to a lack of healthy workers. 96

The effects of the influenza pandemic among the mining population of Southwest Virginia exacerbated the impoverished situation of many residents within Tazewell County.

An additional effect of the Spanish Influenza pandemic discernible not long after the end of the final wave of the outbreak was the presence of a great number of orphans throughout Southwest Virginia.

On May 30, 1919, the Clinch Valley News published an appeal by the Children’s Home Society of Virginia.

The article included a statement about the large number of orphaned children in the state due to the fatality of the Spanish Influenza pandemic: “the recent epidemic of influenza is sending hundreds of motherless or fatherless children to our doors.” 97

The unusually high mortality rate among young adult victims of this particular influenza outbreak explains the large number of orphaned children in Southwest Virginia, as well as the entire United States.

According to Susan Kingsley Kent, “the heavy toll influenza took on the adult population left scores of orphaned children in almost every community.” 98

Similar to locals in Wise County, Virginia, residents of Tazewell started preparation for the impending flu season of 1919 much earlier than in previous years.

By the summer and early fall, the Clinch Valley News was reporting prevention methods to diminish the severity of the imminent flu season.

The experience with the deadly Spanish Influenza in the previous year led to the presence of unusually high amounts of precautionary measures published in newspapers.

The immense number of articles related to public health measures reflected borderline paranoia within the population of the United States.

On September 12, 1919, the Clinch Valley News warned of the potential return of the Spanish Influenza and reiterated sanitary practices, such as avoiding the common drinking cup.
99

By the official start of flu season in October, Board of Health members in Tazewell County advertised the statewide campaign for influenza prevention. 100

Clearly, public health advocates not only of national, but also of state and local institutions understood the enormity of the disease circumstances of 1918 and were prepared to forestall a similar situation in the approaching months.

Conclusion

The Spanish Influenza pandemic of 1918 has been largely forgotten by the population of the United States.

Whether this is due to the concurrent event of World War I or the immense anguish experienced by victims, this significant disease outbreak has essentially vanished from American history.

Historian Nancy Bristow cites this exodus as “precisely an American tendency to rewrite the past to make it more tolerable.” 101

The existing explorations into this historic event rely heavily upon an international or national context of disease as well as data from statistics on mortality rates.

While mortality rates are an important aspect of the consequences of the Spanish Influenza pandemic of 1918, they fail to tell the whole story.

The most valuable sources in the history of the Spanish Influenza are the personal reactions of individuals and the public health responses implemented by provincial authorities.

The overall lack of historical scholarship on the local context of the Spanish Influenza buries thousands of personal accounts and perspectives.

While exploring individual manuscript collections and local newspapers is tedious work, they do present an astounding glimpse into the distinctive reactions and events of the Spanish Influenza pandemic within specific localities.

Overall, the Spanish Influenza of 1918 was a momentous event in American history that necessitates further research in order not only to understand the varied reactions of different communities in the United States, but also to comprehend the exhaustive consequences of localized disease outbreaks worldwide.

About The Authors

Rachel Goatley graduated from Virginia Tech with a bachelor’s degree in history in spring 2014.

She is currently a graduate student studying archives and records management in the School of Information and Library Science at the University of North Carolina-Chapel Hill.

TO BE CONTINUED ...
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Re: EPIDEMICS IN AMERICAN HISTORY

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THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919, concluded ...

Author: Rachel Goatley 

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Notes

1 Alfred Crosby, America’s Forgotten Pandemic: the Influenza of 1918 (Cambridge: Cambridge Univ. Press, 1989).

2 Paul Kupperberg, The Influenza Pandemic of 1918-1919 (New York: Chelsea House, 2008), 64.

3 Crosby, America’s Forgotten Pandemic, 323.

4 Crosby, America’s Forgotten Pandemic, 66.

5 John M. Barry, The Great Influenza: the Epic Story of the Deadliest Plague in History (New York: Viking, 2004), 257.

6 Richard Collier, Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919 (New York: Atheneum, 1974), 68.

7 Tom Quinn, Flu: A Social History of Influenza (London: New Holland Publishers, 2008), 132.

8 Barry, The Great Influenza, 2.

9 Susan Kingsley Kent, The Influenza Pandemic of 1918-1919 (Boston: Beford/St. Martin’s, 2013) 2.

10 Nancy K. Bristow, American Pandemic: Lost Worlds of the 1918 Influenza Epidemic (Oxford: Oxford University Press, 2012), 45.

11 Kent, The Influenza Pandemic, 3.

12 Kent, The Influenza Pandemic, 2.

13 Crosby, America’s Forgotten Pandemic, 21.

14 Collier, Spanish Lady, 40.

15 Barry, The Great Influenza, 171.

16 Quinn, Flu: A Social History, 125.

17 Kuppererg, The Influenza Pandemic,, 23.

18 Barry, The Great Influenza,, 95.

19 Kent, The Influenza Pandemic, 52.

20 Kent, The Influenza Pandemic, 44.

21 Crosby, America’s Forgotten Pandemic, 29.

22 Crosby, America’s Forgotten Pandemic, 39.

23 Crosby, America’s Forgotten Pandemic, 49.

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44 “Preparing to Combat with Influenza Epidemic”.

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47 Kent, The Influenza Pandemic, 5.

48 Kent, The Influenza Pandemic ,5..

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68 “Will the Flu Return?,” Big Stone Gap Post, Sept. 17, 1919, accessed November 20, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

69 “Hun Offensive Falls Down,” Clinch Valley News, July 19, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

70 “Pneumonia is Playing Havoc in Army Camps,” Clinch Valley News, Oct. 4, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

71 “How to Save Yourself from Influenza,” Clinch Valley News, Oct. 11, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-2/.

72 “Save Yourself and Others,” Clinch Valley News, Oct. 25, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

73 “For Their Country’s Sake,” Clinch Valley News, Oct. 11, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

74 “The War Brought to Our Doors,” Clinch Valley News, Oct. 11, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-2/.

75 “The Influenza Spreads Fast,” Clinch Valley News, Oct. 18, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

76 “Pounding Mill News,” Clinch Valley News, Oct. 25, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

77 “Strict Quarantines Should be Established,” Clinch Valley News, Oct. 25, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-4/.

78 “The Influenza Spreads Fast”.

79 “The War Brought to Our Doors”.

80 “The Influenza Spreads Fast”.

81 “Strict Quarantines Should be Established”.

82 “The Influenza Spreads Fast”.

83 “Raven,” Clinch Valley News, Nov. 8, 1918, accessed December 18, 2013. http:// chroniclingamerica.loc.gov/lccn/sn85034357/1918-11-08/ed-1/seq-1/#.

84 “Notes of North Tazewell,” Clinch Valley News, Nov. 1, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

85 “The Lid is Taken Off,” Clinch Valley News, Nov. 1, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

86 “Local News,” Clinch Valley News, Nov. 8 and Nov. 15, 2013, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

87 “Local News,” Clinch Valley News, Nov 29, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-4/.

88 “Influenza Still Raging,” Clinch Valley News, Dec. 6, 1918 , accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-4/

89 “Schools May Close Again,” Clinch Valley News, December 13, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

90 “Better Close Down,” Clinch Valley News, December 13, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

91 “Decline to Close Schools,” Clinch Valley News, December 13, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

92 Crosby, America’s Forgotten Pandemic, 116.

93 Crosby, America’s Forgotten Pandemic, 46.

94 “A Revolt Against the Doctors,” Clinch Valley News, March 28, 1919, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-2/.

95 “Pounding Mill News,” Clinch Valley News, October 4, 1918, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

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98 Kent, The Influenza Pandemic, 99.

99 “Will Influenza Return?” Clinch Valley News, September 12, 191, accessed December 18, 2013. http://chroniclingamerica.loc.gov/lccn/ ... d-1/seq-1/.

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101 Bristow, American Pandemic, 193.

https://vtuhr.org/articles/10.21061/vtuhr.v4i0.34/
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Re: EPIDEMICS IN AMERICAN HISTORY

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NCBI

US National Library of Medicine

National Institutes of Health

Public Health Rep. 2010; 125(Suppl 3): 134–144.

doi: 10.1177/00333549101250S316

PMCID: PMC2862342

PMID: 20568575

“It's as Bad as Anything Can Be”: Patients, Identity, and the Influenza Pandemic

Nancy K. Bristow, PhDa

SYNOPSIS

Americans were stunned when pandemic influenza hit the United States in 1918.

Recent advances in bacteriology and public health allowed Americans to imagine a future free of infectious disease, even as their familiarity with influenza tempered their fears of it.

They soon realized this influenza was something unprecedented, as it shocked them with its pace, virulence, mortality patterns, and symptoms.

Patients endured and frequently succumbed to a miserable illness, their suffering often made worse by the chaotic circumstances the epidemic produced in families and communities and shaped in significant and sometimes discriminatory ways by their gender, class, and race.


While the nation's public culture soon forgot the epidemic, it lived on in lives changed irrevocably by its consequences.

As they face present and future influenza pandemics, Americans can learn from this earlier experience, guarding against identity-based discrimination and acknowledging and remembering the grief and loss fellow citizens suffered.

In 1939, the writer Katherine Anne Porter published what would become her best known work, the novella Pale Horse, Pale Rider.

Her story follows 24-year-old Miranda through her romance with a young soldier named Adam, the narrative soon interrupted by Miranda's struggle with influenza.

From the beginning of the novella, Porter alludes to the surrounding epidemic, but only slowly submerges Miranda in the symptoms of the disease, allowing the severity of her situation to dawn on the reader only gradually.

Finally, though, Miranda acknowledges she is ill.

Though her neighbor's response is initially only a simple exclamation of “Horrors,” and a recommendation that she go to bed “at once!”, her later description of Miranda's influenza as “a plague, a plague, my God” suggests the fear her illness provokes in those around her.

As Miranda slowly succumbs, the reader learns of a broader crisis surrounding her, as Adam explains the seriousness of the epidemic unfolding beyond the walls of her room: “It's as bad as anything can be. .. all the theaters and nearly all the shops and restaurants are closed, and the streets have been full of funerals all day and ambulances all night.” 1

But Porter does not limit the reader to Miranda's surroundings.

Following the conversations of her characters, and later Miranda's internal dialogue, Porter allows her readers to follow Miranda's complex and unfamiliar path through her sickness, beginning with a shadowy sense of foreboding and loss as the illness develops.

When Miranda descends into fevered dreams, passing back and forth from consciousness to unconsciousness, Porter lets her readers experience the peace and the terror, the coherence and the confusion, through which her patient passes: “Her mind split in two, acknowledged and denied what she saw in the one instant, for across an abyss of complaining darkness her reasoning coherent self watched the strange frenzy of the other coldly, reluctant to admit the truth of its visions, its tenacious remorses and despairs.”

As death approaches, Miranda is briefly freed from her fears and finds comfort, “tranquility,” “an amazement of joy,” and relaxes, “questioning nothing, desiring nothing, in the quietude of her ecstasy.”

But death is not to be hers.

In the end, Miranda returns from the brink of death, but does not celebrate her recovery, returning to the living, instead, with a sense of distance and of loss. 1

Pale Horse, Pale Rider survives as one of the few American literary accounts of the worst influenza pandemic in recorded history, a catastrophe that struck the world in the fall of 1918.

When the outbreak began, Porter was a journalist, writing for the Rocky Mountain News in Denver.

Porter suffered a very serious case of influenza during the epidemic, and lost her fiancé to the disease during her own illness.

Porter was sick enough that the newspaper prepared her obituary, and her recovery was slow and troubled. 2

Though fictionalized, her autobiographical novella follows Porter's experiences closely, and reclaims for us the experiences of patients and their loved ones as they faced the traumas of the epidemic.

These were stories largely left untold in the annals of this catastrophe.

As historians have explored the epidemic of 1918, the experiences of the patients themselves have remained almost entirely in the background.

This is understandable.

While influenza that fall was a national, indeed international, phenomenon, and one that carried significant consequences in the public life of the United States, for those who became ill with the disease and for the families and friends who were their most immediate caregivers, influenza was a drama acted out in private.

Even for those who suffered in public spaces — in the hallways of city hospitals, in the tents of hastily constructed emergency wards — their travails were intensely private experiences, rarely documented in any public way.


Even doctors admitted that the chaos of the epidemic often prevented their maintaining proper records of their patients' illnesses.

And yet the story of the patients who suffered from influenza and the loved ones who tended them must be central to any real understanding of the influenza pandemic.

As the historian Roy Porter has suggested, the history of medicine is incomplete without a “patient-oriented history,” a history that documents the patient's experiences as well as the beliefs and behaviors that framed those experiences.

Such a history, Porter makes clear, serves to “restore to the history of medicine its human face.” 3

This essay seeks to capture the contours of this human face.

“THE WHOLE WORLD SEEMS UP-SIDE-DOWN”

For Americans facing influenza, the story of the epidemic was essentially a story of suffering — of patients tormented by an agonizing and often deadly disease, of caregivers frightened and confused by the horror unfolding in their midst, of families fractured by grief and loss, and of communities subjected to the chaos of the epidemic.

It is difficult, perhaps impossible, to comprehend the trauma of the epidemic from the distance of decades.

Even at the time, commentators frequently acknowledged that the epidemic strained the imagination, confronting them with scenes so foreign to their experience that words failed them.


“You have no idea what havoc this Influenza has wrought every where,” one letter writer explained in mid-October. 4

“You cannot imagine how it has scourged the country,” lamented another. 5

Or as one Red Cross worker who had seen Camp Dodge, a military post in Des Moines, Iowa, changed in a day, suggested simply, “Words cannot convey the situation.” 6

An unexpected scourge

An unimaginably dreadful experience, the ordeal of the epidemic was heightened by the ways in which it surprised its victims.

Americans of the early 20th century were not unfamiliar with epidemics, and life-threatening illnesses from tuberculosis to polio remained common features of their lives.
7–10

Health conditions were especially bad in the cities, where more than one in 10 newborns died before the age of one, and poorer urban residents suffered particularly dismal health circumstances.

The southern states wrestled with their own health blights, such as malaria and parasitic ailments, and for the most part, did not benefit from promising developments emerging in public health. 8,11

By the early 20th century, these promising developments were many, and were not limited to the arena of public health.

In the late 19th century, the new field of bacteriology had verified germ theory and in succeeding decades, discoveries of the causal relationship between specific microorganisms and particular diseases seemed to promise the elimination of several illnesses that had long plagued American health.

Public health measures evolved alongside these scientific gains and contributed in significant ways to the efforts to identify, track, and eliminate particular disease agents and to educate the public on measures to aid in their control.

By 1918, life expectancy was on the rise as Americans employed a vast arsenal of vaccines, anti-toxins, and public health measures such as quarantines, mosquito control, and the regulation of water and milk supplies against several major afflictions.
8

Taken together, these successes encouraged at least some Americans to imagine infectious disease might soon be a thing of the past. 11–13

The New York Health Department declared in its popular maxim, “Public health is purchasable."

"Within natural limitations a community can determine its own death-rate.”
11

Not every disease, however, was so easily controlled, and influenza was one of those that continued to torment Americans.

Despite reports in 1892 that the influenza microbe had been discovered by Dr. Friedrich Johann Pfeiffer in Berlin, influenza remained a mystery to scientists and a common plight for Americans.

Indeed, influenza was a disease whose visitations, even deadly ones, were assumed.

The nation, along with much of the world, had faced a significant epidemic in 1890 and another more limited epidemic outbreak in the winter of 1915–1916.

Even in non-epidemic years, Americans expected influenza to bring significant sickness to their communities.

And yet despite this familiarity, or perhaps precisely because of it, influenza did not generate fear or garner much public attention, a reality that many physicians and public health officials lamented.
14–17

As The New York Times reported in 1901, “Influenza has apparently become domesticated with us.” 18

As a result of this complacent attitude, when the first wave of the epidemic swept through the United States in the spring of 1918, it went almost entirely unnoticed and unheralded.

But when influenza struck the nation in its second wave in the late summer of 1918, it was quickly obvious that nothing had prepared Americans for the scourge they now found in their midst.

This disease was different, first of all, in the efficiency and pace of its spread.

Arriving in the United States in Boston on August 27, within a few weeks influenza had spread to neighboring communities, and by the end of October American cities from Buffalo to Birmingham and from Pittsburgh to Portland were drowning in a sea of disease.
19

In turn, this new incarnation of influenza was shockingly infectious, recording a morbidity rate of roughly 28%. 2

Gone, too, was the annual visitor that sickened many but killed few and picked its fatalities from among the elderly and the very young.

This influenza brought death to an estimated 550,000 Americans and perhaps 50 million people worldwide, and struck with sufficient ferocity among young adults to lower life expectancy in the United States by 12 years.
2,20,21

Such a disease soon created a profound sense of disturbance, disorder, and chaos in the lives of Americans.

As one correspondent described the situation, “The whole world seems up-side-down."

"So many people around here have died, and so many are sick.” 22

“The worst sickness I ever had”

It was not just the numbers or patterns of infection that shocked Americans, though.

This influenza was unfamiliar, and often horrifying, in its symptoms as well.

While a small percentage of sufferers escaped with mild cases, enduring only the usual aches, fever, and cold-like symptoms of the more familiar influenza, the remaining victims endured illnesses that bore only scant resemblance to a normal case of the flu.

For some the problem was Spanish influenza itself, a disease that, in its worst cases, advanced with shocking rapidity and brought very high fevers, head and body aches, prostration, edema in the lungs, and belabored breathing.

Though for some these initial symptoms passed without complications in a week or so, for others the suffering grew worse.

Delirium and unconsciousness often followed, and as the lungs filled, a blue or purple coloring overcame the extremities and the face.


For some, too, bloody fluids drained from the nose, creating a grisly scene for families and caregivers.

Death soon followed.

Some patients died in a day, though most endured a longer illness — perhaps three or four days, a week, or 10 days of crisis.

Others suffered what at first appeared to be a standard influenza infection, but an infection that soon paved the way for pneumonia, which ravaged the lungs and again brought death to many.

Even for those lucky enough to recover, the illness might last several weeks and leave long-term health problems in its wake.

Occasionally patients documented their encounters with influenza, providing a window into the world of distress the epidemic's victims suffered.

Franklin Martin kept a diary for his wife, Isabelle, during a postwar tour of Europe, and when he sickened during the third wave of the epidemic, managed to continue recording his experiences. 23

On January 12, 1919, on board a ship headed home, he noted that he had “felt chilly all day and after noon went regularly to bed.”

Though he went to lunch the next day, he was still cold, and returned to bed that afternoon, and despite “all the blankets I could get was still cold.”

With a fever of 105, his condition soon worsened.

“About 12 o'clock I began to feel hot."

"I was so feverish I was afraid I would ignite the clothing."

"I had a cough that tore my very innards out when I could not suppress it."

"It was dark; I surely had pneumonia and I never was so forlorn and uncomfortable in my life.”

Fearing the worst, Martin planned his own funeral.

“Then I found that I was breaking into a deluge of perspiration and while I should have been more comfortable I was more miserable than ever.”

Daybreak found him in a wretched state: “When the light did finally come I was some specimen of misery — couldn't breathe without an excruciating cough and there was no hope in me.”

Others shared Martin's perspective that Spanish influenza had been a terrible experience.

One soldier, who claimed he had suffered only “a slight touch of it,” nevertheless maintained, “It certainly is the worst sickness I ever had.” 24

Or as another victim, Clifford Adams, stated succinctly, “I got to the point where I didn't care whether I died or not.” 25

A PUBLIC AND PRIVATE CRISIS

The effects of the epidemic were heightened exponentially by the ripple effects of scarce medical resources and lack of social services to support families battling with the illness or the deaths of primary breadwinners.

Deaths from influenza also taxed communities' abilities to bury the dead, heightening the stress of grieving families.

A crisis of medical and social resources

The misery of patients was often worsened by the shortage of available medical care.

When the epidemic struck, it assaulted a nation strained by the demands of war, including the scarcity of medical help caused by the military service of doctors and nurses.

In Philadelphia, for instance, 26% of the city's doctors were in the ranks of the military; an even higher percentage of nurses was absent.

At one of the city's hospitals, three-quarters of the medical and surgical staff were unavailable due to military service. 2

The shortages were often made more serious by rural circumstances, leading the Red Cross to call special attention to the difficulties in Kentucky where “the unbeatable combination” of isolation, “bad roads,” limited railroad links, and a shortage of nurses created an especially dire situation. 26

In cities and rural hamlets alike, wartime shortages made certain that countless families in desperate need found themselves unable to acquire the aid of any health-care professional.

Within families, too, the already difficult situation of an influenza illness was often worsened by epidemic conditions as multiple family members sickened simultaneously, creating chaos in the home.

Reports during the epidemic repeatedly cited cases of entire families stricken by the disease.

As one nurse in New Jersey described her experience during the epidemic, “I had whole families down with it at once.”

Detailing one such case, she continued, “The father and eight children in one home and then the [pregnant] mother came down with it, and labor came on ahead of time."

"The man got up and staggered round the house, just keeping up the fire and giving milk and medicine.” 27

With entire families bedridden, disorder often followed.

“Many distressing scenes were witnessed by the nurses,” explained a report on the Emergency Nursing Service in New York City during the epidemic.

“In one family two children were found dead, and the father and mother and three other children so ill that they were unconscious of the fact.” 28

A report from the Red Cross in Baltimore acknowledged that such circumstances were not uncommon: “Conditions were found by the nurses in most cases visited to be of most serious nature, requiring immediate attention."

"Several cases reported revealed the fact that there were not only two and three sick patients in one bed at a time but a dead body as well.” 29

As families faced multiple illnesses, the ability to take care of one another was often severely compromised.

Struggling against a terrible sickness in the context of the epidemic, families suffered the “torments of Hell” as they agonized over the condition of their loved ones or suffered the grief of a family member's death. 5

In the epidemic's aftermath, the Reverend Francis J. Grimke, a leading advocate for African American rights and the minister of the Fifteenth Street Presbyterian Church in Washington, D.C., worried about “the large numbers that have been sick — the large numbers that have died, the many, many homes that have been made desolate — the many, many bleeding, sorrowing hearts that have been left behind.” 30

As Grimke suggested, for many Americans the trauma of the epidemic only grew as families mourned members lost to influenza.

Communities and families in disarray

The pain of loss was often exacerbated by the realities of community and familial disarray survivors confronted.

At the height of the epidemic, for instance, many communities were overwhelmed by the sheer quantity of dead bodies, and struggled to handle them in accordance with popular custom.

“I can to this day see the ‘cords' of bodies stacked in the Base Hospital."

"They were dying faster than the bodies could be taken care of,” one soldier remembered years later. 31

Again and again, accounts of the epidemic described bodies “piled up like cords of wood,” awaiting the respectful treatment normally accorded the dead. 32

In some cases, shortages of caskets, undertakers, morgue space, or gravediggers led to ghoulish scenes, while in others bodies sat unclaimed by families so stricken by the flu themselves that they could not shoulder the responsibility for their dead. 33–35

All of these problems came together in Philadelphia, perhaps the city hardest hit by the epidemic.

As the Pennsylvania Council of National Defense reported, “It is doubtful whether the city of Philadelphia, at any time in its history, has been confronted with a more serious situation than that presented in connection with the care and burial of its dead during the recent epidemic.” 36

Early in the epidemic, the result was a horrific situation in which “decomposing human bodies rotted in crowded mortuaries” and in the city's morgues. 37

In turn, restrictions on public gatherings in many cities and towns meant families were not able to give their loved ones what they considered a proper funeral, and were left to grieve entirely in private.

Again, Philadelphia was an especially exaggerated example.

Because the epidemic was so serious in that city, the restrictions covering funerals were particularly prohibitive.

Orders required that services for anyone dying of influenza be private, that “only the immediate adult relatives of the deceased who may not at the time be sick with epidemic influenza” might attend, and that no church or public building could be used if the body was to be included in the service. 38

Similar rules applied in other cities and towns throughout the country.

For many families, then, the pain of their losses was coupled with an inability to fulfill their full responsibilities to their loved ones or to grieve with the support of their community.

In addition to public chaos, many survivors suffered the disruption or complete destruction of their family unit.

Children left without parents, for instance, presented both a pressing problem for communities and an unspeakable tragedy for the orphans.

In some cases, if the children were old enough, they faced early adulthood, taking charge of their own lives and those of their siblings in the wake of the epidemic.

In most cases, though, orphans became the responsibility of extended families or faced institutionalized care. 39

As the writer Mary McCarthy recounted of her experiences as an orphan, even those children taken in by relatives sometimes suffered from the rejection of unfeeling families and a sense of being abandoned, unwanted, and helpless. 40

THE POWER OF SOCIAL IDENTITY

Though the influenza virus did not discriminate among its victims, in a country in which identity mattered, Americans' suffering was often shaped not only by the disease, but also by their “place” in the society: by their gender, class, and race.

Even in the private suffering of patients and their families, the power of social identity shaped the vastly varied experiences of the epidemic.

Gender and social roles

In an age of strict adherence to gender roles, the loss of even one parent could plunge families into disarray as survivors were left to handle not only their own responsibilities but also those of their spouses.

Men who lost wives sometimes found themselves responsible for children, a role for which many were not prepared or socially sanctioned.

For Lillian Kancianich, who was born just a few months before the epidemic in 1918, her mother's death meant the break-up of her home.

Because local custom discouraged older men from living alone in a household with children, her older sister Christine was sent first to boarding school, and later to live with her mother's relatives in Minnesota.

Lillian would not find a stable home for two years.

“No one adopted me,” she recalls.

“I just went from home to home … I had six different homes.”

Kancianich eventually settled in to live with relatives, and was able to see her father every day.

Even so, the loss of her mother had an enormous impact on her life.

As she explained decades later, the flu epidemic and her mother's death “changed my life completely… ."

"It had to.” 41

The story of Kancianich demonstrates not only the familial dislocation caused by the epidemic, but also the powerful impact social identity sometimes played in shaping individuals' experiences of the scourge.

At first glance the epidemic would seem to have challenged social norms.

Morbidity and mortality rates make clear that influenza was not selective in its victims.

Social identity — a person's gender, class, or racial status, for instance — affected neither the likelihood of infection nor one's chances of surviving the attack.

In the end, though, social identity did matter.

Though the virus struck indiscriminately and the entire nation suffered, the experience of the disease and the epidemic was often shaped by a person's perceived “place” in the society.

As Kancianich discovered, gender often played a substantial role in shaping Americans' experiences with the epidemic.

In this case, the meaning of her mother's death was shaped by the assumptions of her community that without her mother in the home, it was inappropriate for her father to raise his daughters, a common view that left countless children without homes.

The loss of a father often led to different costs, leaving the remaining family members scrambling to make a living.

As one Red Cross worker in Kentucky explained, “A large number of cases were reported where the mother was left with a large family of children without any means of support: left really to the mercy of the meager assistance that sympathetic neighbors might give." 42

In some cases, the problem was solved by a woman's transition from the home to the workplace.

With a common refrain, a woman widowed in Vermont during the epidemic explained years later, “My husband die [sic] from pneumonia at the time of the influenza… ."

"It was hard for me to get along after he die [sic].”

As was common for working-class families, this woman soon went to work, in this case crocheting altar linens.

She recognized her good fortune in having this skill: “I always say it is lucky for me that I learn to do this work."

"How else then could I support myself and three children, except that I scrub floors and do hard work all the time?” 43

For many others, such work was all that kept them from complete destitution.

Other families solved this crisis by sending children to work.

For Melvin Frank, for instance, life was irrevocably altered by his father's bout and eventual death from influenza.

“By whatever name, the disease was a killer and scarcely any household in our north side neighborhood was unaffected,” he explained.

“It brought eventual tradegy [sic] to our house.”

Frank recounted his father's cardiac asthma, a condition aggravated by his influenza in 1918.

Eventually his father became a “bed patient,” and the entire family suffered over his condition, and when he was finally hospitalized, the family became still more depressed.

“Gloom descended,” Frank remembered.

“A sob was close to the surface.”

Though his death came in June 1920, long after his exposure to influenza, Frank's father was nevertheless a victim of the epidemic, and his passing no less tragic for its delay.

Upon learning of his father's death, Frank found himself “reeling” from the news, “for my world had tumbled in.”

Like many other young people in that time, Frank found himself prematurely grown, told that he was now “the man of the family” at the tender age of 12.

A week after the funeral, Frank went to work, his childhood over as he assumed the role of breadwinner. 44

The epidemic and the crisis of poverty

As these stories make clear, in addition to gender, class also had a profound impact on Americans' experiences during the epidemic.

For the poorest families, the basic problems of the epidemic were worsened by material need.

With no financial cushion, lost wages, even for a short time, might mean hunger, cold, or even homelessness.

The story of the [D] family in Minneapolis reflected how easily the epidemic could derail the fortunes of a family already living in poverty.

This family first appeared in the records of the Associated Charities of Minneapolis in 1916, when the family sought help with their rent and furniture payments.

Though they had left Georgia for Minnesota in 1915 in hopes of both a better climate and employment, by March of 1916 Mr. [D] had yet to find a steady job, and records suggest the family rarely experienced financial stability.

In December 1918 influenza struck, infecting first the father and later the remaining family members — his wife and five children.

By December 28, the father had “been out of work for three weeks” due to his own illness and then that of his relatives, and the family was in need of groceries.

For the first two weeks the family had managed on their meager savings and on money sent from a relative.

After that, though, the family became frantic, and approached the Society of the Friendless for aid.

Soon the Associated Charities of Minneapolis would resume their responsibility for the family.

By December 30, though Mr. [D] had assured case workers that he would return to work, relapses in the family had made such a return impossible.

“He had dared not go to work that morning and leave the six of them sick,” the report explained.

At this point, the situation became desperate: “They were absolutely without coal and he had borrowed a pailful from the woman downstairs."

"The groceries were also gone."

"He had tried his best to get credit at the grocery but had been unable.”

Calling his workplace that day, Mr. [D] discovered he had lost his position.

At that point, “Mr. [D] broke down and cried, saying everything was against him, just when he was trying to get back on his feet, everything went wrong.” 45

Though the [D] family's problems did not originate with the epidemic, it was clear that their already insecure situation was worsened by their bout with influenza, a consequence suffered by many poorer Americans. 46

As working-class families faced desperate conditions brought on by the epidemic, charities recognized an ideal opportunity to intervene in working-class homes.

Targeting the poor as a particularly problematic population, middle-class distributors of charity regularly distinguished between the “deserving” and “undeserving” poor and attempted to use the distribution of aid as a mechanism for shaping the behavior of their clients. 47

At its best, this effort might take the form of education on “the value of cleanliness, of sanitation, of ventilation, of isolation” in fighting illness. 48

At times, though, the relationship could prove considerably less friendly, as appeals to the charity system could involve working-class families in extensive dealings with charity organizations and even the local justice system, as evidenced in the case of a poor immigrant family in Minneapolis.

In this case, initiated by the illness of the mother, the male member of an unmarried couple appealed to the Children's Protective Society (CPS) in late November 1918 for help during the woman's bout with influenza, seeking in particular boarding for their one-year-old child.

In mid-December, a social worker discovered on a visit to the home that the couple was not married, and from here the case record discusses repeatedly the couple's unmarried status.

Later entries in the record develop further the theme of immorality in the home.

On January 20, for instance, the social worker noted that the man's “breath smelt strong of liquor.”

The woman of the household, by this point, had recovered from influenza, but the caseworker noted on January 23 the “very dirty condition” of the room, and the “very careless” appearance of the woman, whom she described further as “dirty” with her “hair uncombed.”

Four days later the case appeared in Juvenile Court, where the woman was described as “totally ignorant of any moral laws, altho [sic] not what you could term a common prostitute.”

With the interpreter unable to attend the hearing, the clients' ability to defend themselves was surely compromised, and on February 3 the court ruled that the man would be required to pay the board for the couple's child, and that the woman's two older children would be temporarily removed to an orphanage.

As the case record explained, the woman “would be expected to show improvement and desire to live more cleanly.”

Later that month, the woman announced that she was now married, and began the lengthy process of reclaiming her children.

It was June before she succeeded.

The children remained in temporary custody of the CPS for six months, and the case did not close permanently until June 1925, six and a half years after the first contact between the family and the CPS. 49

As this case illustrates, poor families often could not weather the epidemic without aid, but sometimes discovered this aid came with a price.

Enforcing and resisting Jim Crow

Just as gender and class assumptions framed some Americans' behaviors and experiences during the epidemic, race, too, often came into play.

White Americans, for instance, maintained segregation during the epidemic with the same insistence they had prior to the crisis, leading to particularly inadequate resources for fighting the disease in African American communities.

In Baltimore, the leading black newspaper, the Afro-American, told the story of the struggle to get one unidentified local resident, discovered “unconscious,” into the “overcrowded Provident Hospital,” an effort that proved unsuccessful.

The meaning of this story, and others like it, was clear to the paper.

“This is one of the extremely sad cases that are the pitiable result of the jim crow [sic] policy practiced in white hospitals of the city, and the woeful lack of larger quarters in Provident,” it argued, and concluded, “The need for a colored hospital large enough to supply the needs of the city and well equipped for all emergencies has never before been felt so keenly.” 50

Other commentators focused on the persistence of white supremacist attitudes in the midst of the crisis.

An opinion piece in the same newspaper pointed out the tendency of some white people to view the epidemic through a racist lens.

When African Americans were rumored to be suffering less seriously from influenza, one writer argued, some white people found a way to translate this strength into a racial weakness.

“But when a lady on the Eastern Shore of Maryland heard that influenza germs were having relatively little effect on colored people, she is reported to have said, ‘Well, that proves that they are not human like the rest of us,’” the report concluded. 51

Though the influenza virus did not discriminate among its victims, the same, it seems, could not be said for all Americans.

As people reacted to the emergency of the epidemic and the disorder and chaos it created, they often did so on the basis of existing beliefs about differences among and between Americans.

When this happened, they often shaped not only their own experiences, but those of others as well, too often making more difficult the already demanding circumstances of the epidemic.

It is important to note that some Americans refused to accept this double-victimization, choosing to battle discrimination alongside the epidemic.

Poor families, for instance, sometimes resisted the interventions of the courts and charity organizations. 52,53

In turn, African Americans often offered a critique of the racism they encountered, both in the pages of their newspapers and on their pulpits.

In an especially powerful challenge to the ideology of white supremacy, the Reverend Grimke of Washington, D.C., found in the epidemic God's effort to awaken the white community to their sins against their fellow black Americans, in obvious violation of His laws.

“During these terrible weeks, while the epidemic raged,” Grimke argued, “God has been trying in a very pronouncedly conspicuously and vigorous way, to beat a little sense into the white man's head.”

Stating his case more bluntly, Grimke continued:

“In this terrible epidemic, which has afflicted not only this city but the whole country, there is a great lesson for the white man to learn."

"It is the folly of his stupid color prejudice."

"It calls attention to the fact that he is acting on a principle that God utterly repudiates, as He has shown during the epidemic scourge; and as He will show him when He comes to deal with him in the judgment of the great day of solemn account.” 30

Unwilling to accept a world, or a God, that accepted white supremacy, Grimke offered his parishioners an explanation of the influenza epidemic that resisted subjugation and granted them a meaningful role in God's plan for the nation.

MAKING SENSE OF THE EPIDEMIC

Grimke was not alone in his efforts to make sense of the epidemic.

As Americans suffered through the worst epidemic in their history, they sought to explain it in ways that made the unknown knowable and that granted some sense of meaning to the personal and national tragedy.

Like Grimke, many Christians turned to religion and found meaning for their suffering in their beliefs.

If some, like the Reverend Grimke and the evangelist Billy Sunday, saw in the epidemic evidence of God's punishment for the nation's evil ways, others found solace in the notion of Christian salvation. 2,30,54,55

For others, the epidemic was described as a “plague,” offering a subtle critique of the narrative of medicine's triumphs. 56,57

For still others, only comparisons to a range of natural disasters seemed to do justice to both the horror and the power of the epidemic.

Some believed it was like a storm, that “struck like a cyclone,” 58 while others described it as a “conflagration” or a terrible tide that had “suddenly swept the country and prostrated communities in its destructive course.” 39,59

For many, though, the epidemic was too unfamiliar to suggest a likeness to any known disaster.

Instead, “It was like a horrible nightmare,” something so awful only the imagination could have conjured it, or even something “more terrible than I could have imagined.” 27,60

It was the war, though, that for many Americans provided the most fitting cues for interpreting the epidemic.

Occasionally the link between the epidemic and the war was a direct one, as some Americans were quick to connect the growing epidemic with the ongoing struggle in Europe and to blame the Germans for the health crisis. 61

Such an association made the inexplicable comprehensible, casting influenza as nothing more than another weapon of the enemy, another battle in the ongoing war. 62

Even when Americans did not assume a literal connection between the war and the epidemic, the war often continued to serve as an important rhetorical device, as Americans relied heavily on military metaphor as they sorted out the meaning of the epidemic.

From the beginning of the epidemic, Americans employed the language of the military contest as a means to voice their control and power over the epidemic.

Describing the onset of influenza as an “attack” and an “invasion,” and influenza as “the enemy” and “as dangerous as poison gas shells,” Americans again and again characterized their responses in the language of a military mobilization, language that was active and that implied the nation was on the move against the scourge. 62–65

Nurses became an “army in nurses' blue,” and “led a fight against the dread disease until it was routed,” 66,67 while physicians became soldiers, “the line of first defense,” ready to protect Americans and defeat the epidemic. 68

As Susan Sontag suggested about the function of military metaphors used to describe disease, during the influenza epidemic Americans employed the imagery of a military struggle to explain and familiarize the crisis, and to suggest their own control over it. 69

Perhaps because the nation was literally at war in 1918, the military metaphors seem to have functioned in some other ways as well during the epidemic.

Even as the connection to martial language gave Americans a mechanism for articulating their power in relation to the disease, it also allowed them to acknowledge the unique and awful character of both Spanish influenza and the epidemic.

Often it was through a direct comparison to the war that Americans articulated the shock and horror that accompanied the epidemic, a comparison in which the epidemic was judged the more severe of the two catastrophes. 70–72

Using the familiarity of the war, as well as the unprecedented scale of its ghastliness, provided Americans with a mechanism for communicating just how significant the epidemic had been.

In doing so, Americans may have found in this rhetorical device one other function, charging the epidemic not only with importance, but also with meaning and value. 2

Coupling influenza with the war in this metaphoric relationship, Americans drew upon the contemporary idiom of wartime culture in an attempt to imbue the seemingly meaningless losses from the epidemic with value.

Again and again Americans celebrated the memory of those who died, and sought through the use of the martial comparison to make those deaths heroic rather than tragic, meaningful rather than empty.

This was perhaps most common in descriptions of the deaths of nurses and doctors who died while serving others.

Noteworthy, though, is how commonly the language of martyrdom was applied to those who had simply died in the epidemic.

As an editorial in a training camp newspaper illustrated as it suggested the importance of the deaths recorded in the epidemic, “Who shall say that those in the service of the army who were felled by the disease are not just as much entitled to a place on the nation's honor roll as those who fell in battle?” 73

Or as a chaplain suggested at the funeral of soldiers who died in the epidemic at Camp Sherman in Ohio, “It is sweet to die for one's country."

"These men are as true martyrs as those who have died in the trenches.” 74

Even as Americans embraced military rhetoric in the most traditional manner, using it as a means to depict their energetic response and their ultimate control over influenza, this language also allowed them to voice the enormity and severity of the epidemic, to acknowledge its nearly overwhelming horror, and to imbue their experiences and their losses in the epidemic with valor and meaning.

FORGETTING AND REMEMBERING

As the epidemic eased in 1919, the nation soon turned its attention to other business.

With a war just ending and a postwar world to navigate, most Americans had little interest in memorializing or even remembering the epidemic.

As the years passed, World War I gained a prominent place in Americans' cultural memory as cities and towns memorialized its victims in public monuments and writers of the Lost Generation used the war as foreground for their fiction.

No similar phenomenon preserved a public memory of the epidemic, however.

As the historian Alfred Crosby has suggested, this was truly “America's forgotten pandemic.” 2

And yet for those whose lives were irrevocably changed by the epidemic, its consequences lived on in lives permanently shaped by that event.

It is perhaps Katherine Anne Porter's account that best captures the difficult aftermath of the epidemic for many patients and their families.

She concludes Pale Horse, Pale Rider with a vivid portrayal of the malaise, indeed depression, from which influenza victims often suffered in its aftermath. 1

As Miranda returns to consciousness, she formulates an ironic declaration of the promise of the future: “No more war, no more plague, only the dazed silence that follows the ceasing of the heavy guns; noiseless houses with the shades drawn, empty streets, the dead cold light of tomorrow."

"Now there would be time for everything.”

Though there would be “time for everything,” a profound sense of loss pervades Porter's words, as Miranda discovers that Adam has died of influenza, and his passing seems a particularly cruel trick.

“I wish you had come back,” she beseeches him.

“What do you think I came back for, Adam, to be deceived like this?” 1

Though life would go on, for Miranda and for countless Americans like her, those lives would be forever changed by their experiences in the epidemic.

As the writer Thomas Wolfe suggested in the autobiographical novel [/b]Look Homeward, Angel[/b], referring to his own family's situation in the aftermath of his brother's passing, “It was not, could never be, all right.” 75

Though the country moved on, and expected the epidemic's victims to move on as well, countless Americans continued to suffer their losses and their grief in the decades that followed, a reality likely made worse by their culture's failure to acknowledge it.

As we face the possibilities of a new pandemic, and seek to learn lessons from the experiences of 1918–1919, we would do well to remember the grief, dislocation, and loss such a catastrophe leaves in its wake, and attend with special care to those who might suffer in our midst, even as we guard against the injustices that lurk in the imposition of social hierarchies.

Acknowledgments

The author is grateful to the University of Puget Sound and the National Endowment for the Humanities for their financial support of this project. She also wishes to thank Alexandra Minna Stern and Howard Markel of the University of Michigan Center for the History of Medicine and the participants in “The 1918-1919 Influenza Pandemic in the United States: Historical Experiences and Lessons for Contemporary Public Health” workshop they organized and hosted. Finally, the author thanks her colleagues and students at the University of Puget Sound, especially Douglas Sackman, who generously provided comments on the broader project from which this essay is drawn.

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Re: EPIDEMICS IN AMERICAN HISTORY

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The Chestertown Spy

The 1918 Flu Epidemic on the Eastern Shore by Angela Rieck


March 26, 2020 by Angela Rieck

The 1918 “Spanish” influenza (ironically most scientists believe it started in the United States) is the most famous pandemic in America.

While we are living through our own pandemic, it is interesting to learn how our predecessors fared in the 1918 and 1919 influenza outbreak.


The 1918 virus differed from the current virus COVID 19.

The 1918 virus was an influenza and was especially lethal for those between the ages of 10 and 30.

Death from the 1918 flu came rapidly, usually within a week, some victims died the same day.

Within three days, pneumonia often followed and without antibiotics and ventilators, it proved fatal in 25% of the cases.


Those exposed to the spring 1918 influenza were immune to the deadly fall influenza.

Scientists still do not understand why the 1918 disproportionately impacted the young since most flu viruses’ prey on the very young and very old.

There are two theories.

One is that the flu produced a dangerously strong immune response called cytokine storm causing a lethal overreaction.

Other scientists believe that the older generation had been exposed to other flus, thus building antibodies.

Conversely, the COVID 19 virus is fatal to those with weakened immune systems and those over 60.

To learn how the 1918 pandemic impacted the Eastern Shore I researched newspaper articles, thesis papers, Public Health Statistics, the Internet and books on the 1918 Flu Epidemic.

While I was fortunate enough to find local papers from 1918 and 1919 stored in the Library of Congress, none were from Talbot or Kent county.

(The Star Democrat is missing digitized versions from those years.)

However, there are similarities among the counties.

Overall, I was struck by how little was reported.

There were few news stories; most not on the front page.

Articles were devoted to the war effort, shortages, crime and local news.

The first onslaught of this flu in the Spring of 1918 was virtually ignored, and for good reason, there were no influenza deaths in that Spring in either Kent or Talbot Counties, and only 5 reported cases.


There were two minor stories about a soldier’s flu, both on page 2.

“If your friend or your relative or your best beloved has a runny cold, don’t kiss him or don’t kiss her and don’t kiss them."

"They may have the 'Spanish Flu.'”

"Bacteriological investigation of the cases which have gotten into this country seem to indicate that there is nothing new or mysterious about this malady."

"Some of the cases are of what we would call grippe, some of common colds."

"The only serious thing about it, according to the New York Commissioner of Health, is its tendency to a resultant complication of pneumonia.”

- Evening capital and Maryland gazette, Annapolis, August 30, 1918.

Our predecessors could not have known what was coming.

Scientists now believe that over the summer the virus mutated into a deadly strain.

Everything changed in late September and early October when the first reports about this deadly influenza came out of Camp Meade in late September.

Eventually 25% of the 14,000 soldiers were infected and 800 died.

Of those who contracted pneumonia, the death rate climbed to 27%.

On September 27th the draft was halted.

From September 24th to October 5th, the disease spread rapidly on the Eastern Shore.

By October 5th the Surgeon General proposed shutting down schools and all social gatherings.

Movie Theaters and shows followed several days later.

Factories remained open to support the war effort.

By October there were 871 cases of the flu and corresponding pneumonia in Talbot County and 73 deaths.

In Kent County there were 371 cases and 61 deaths.


INFLUENZA HAS THE COUNTRY IN ITS GRIP! MANY HUNDREDS DIE OF PNEUMONIA CAUSED BY THE DISEASE Schools, Churches, Theatres And Other Crowd-Drawing Places Closed.

Spanish Influenza, or the old fashioned “grip,” is raging ail over the country and many deaths are occurring daily as a result of pneumonia developments.

Influenza has been brought to the Eastern Shore from Baltimore. Philadelphia, and Wilmington by our people visiting in those cities.

In some of the towns on the Shore, a number of deaths have occurred and in other towns hundreds of the people are seriously ill.

Schools, moving picture shows, churches, and all places where the public gathers in any very considerable number have been closed to prevent the spread of the disease.

In Worcester County there are a great many people ill and every precaution should be taken to prevent an epidemic.

Every caution against the spread of influenza must he observed by the public.

The Health officers warn because of the importance in this wartime effort to keep all our industrials up to the fullest capacity of their productiveness for the national interest.


- Snow Hill Democratic Messenger, October 5, 1918.

The surgeon general distributed guidelines.

Precautions included isolating the sick, cleaning their utensils in boiling hot water and soap, hand washing, wearing masks, and gargling.

HEALTH BOARD TELLS HOW TO HALT EPIDEMIC.

Stop the spread of influenza and pneumonia by obeying these ten new rules issued yesterday by the Board of Health.

I—Cough and sneeze in your handkerchief only.

Spitting is dangerous and unlawful.

2—Glass and eating utensils must be sterilized by washing in boiling water.

Your lips must not touch the mouthpiece of a public telephone.

3—Waiters should not touch your bread, the edge of your glass, cup, plate, knife, bowl or spoon

4 Wash your hands and face several times a day.

Don’t shake hands.

5.—Pneumonia and influenza germs come from mouth and nose.

Wash your face.

6—Do not kiss your child on the lips.

7—Do not visit one who has the “flu” or pneumonia.

8—Do not go to school or to work if you have a cold.

9 Avoid over-work, over-eating, worry, fatigue, lack of sleep.

Keep your windows open, rain or shine.

10—Get a competent doctor the minute you feel sick.

Report quickly all cases of either disease to the Department of Health.


- The Daily Banner, Cambridge MD (October 1918 & January 1919).

Imagine how it must have felt to suddenly hear about a previously unknown flu that in 10 days was killing our strongest population.

While the front page was filled with obituaries about those dying from the flu, news about the influenza was relegated to inside pages.

Unlike our 24-hour media cycle, there was little speculation, no summaries of deaths and frequent assurances that this was no different from other flus.

Even though in some cases, entire families were afflicted.

The worst was yet to come, 25% of all deaths on the Eastern Shore were attributed to the 1918 flu, and these deaths occurred from October through December.

Conflicting messages were widespread, for example on October 11th, the Cambridge Daily Banner reported that the Philadelphia Public Health director, Dr. Krusen, pronounced that the worst was over, the cold weather would kill the virus.

(He also gave permission for a large parade to sell war bonds on September 28th.)

However, on page 3, The Daily Banner also announced closings for the flu.

WORST IS PAST IN “FLU” EPIDEMIC

Clear Cold Weather Will Greatly Aid In Fighting Disease.

Philadelphia, Oct. 8.—Clear, cold weather, which Director Krusen says is the best destroyer of influenza germs, gave the city and state authorities unmeasured assistance in Philadelphia’s fight against the grip epidemic.

“I feel we’ve reached pretty nearly the top now,” said Director Krusen.

“Our organization is being amplified and perfected."

"Aid is coming from all sources and we soon will be able to be optimistic.”


- The Daily Banner, Cambridge, MD, October 08, 1918

That same day, another paper, The Midland Journal (Rising Sun) reported 20,000 new cases in the past 48 hours.

Obituaries of dozens of citizens who died from the flu were printed on the front page.

Children, soldiers, health care workers, politicians, even Woodrow Wilson (whose stroke was believed to be caused by the influenza), succumbed to this disease.

By October 12th, the consensus was that the flu was waning, and by October 25th most schools and social gatherings had reopened.

But that optimism was short-lived.

Despite the optimistic predictions, the death toll continued for the rest of 1918, by the end of 1918, there were 118 deaths in Kent County and 133 in Talbot County.

All told, 9% of the population got the flu in 1918 Talbot County and 6% in Kent County.

By December 13th, a third wave appeared, and it became apparent that the reduction in cases had been due to the quarantine, not the cold weather.

Reopening schools and meeting halls gave the influenza access to more victims.

Schools, theaters and meeting places were closed again and did not reopen until the end of January 1919.


By January, coal was scarce because coal miners had been decimated by the virus.

Deaths continued to mount until February and by March, it was gone.

INFLUENZA EPIDEMIC.

It seems we cannot get rid of influenza in Worcester County.

Alas the disease has broken out again in several sections of the county.

This is not only true in Worcester, but in many other sections of the State and the nation.


- Democratic Messenger, Snow Hill, December 14, 1918.

Health Notice

Owing to the apparent increase in influenza among school children and teachers, I deem it best to close the schools for the present week.

The moving picture theatre will also be closed for the same period of time.

While there is not as great danger attendant upon children collecting in crowds in the open air, I feel that it is my duty to urge parents to prohibit their children from going in crowds to skate.

If we find that crowds collect anywhere, we may be compelled to take some steps to prevent it.

During this period, as well as at all times, people should be very careful when coughing or sneezing, and hold something in front of their mouth when compelled to cough or sneeze.

It is in this manner that, diseases, especially influenza, is spread.

Visiting should not be practiced at this time, especially where any one is sick, unless you go to offer your assistance, then in cases of influenza, a mask should be worn, when working about the patients.


- E. E. WOLFF, M. D. City Health Physician. The Daily Banner, January 14, 1919, Cambridge.

Of course, where there was uncertainty, there were conspiracy theories.

It was rumored that the Germans deliberately brought this disease to America.

Is This Mysterious Infection a New Kind of German Offensive?

Is this new disease which has already killed hundreds and stricken thousands of our soldiers and civilians a new German war offensive?

If not, how did it happen that this epidemic appeared so suddenly and extensively in such widely scattered cities and army camps throughout the country?

Smitten as from a bolt from a clear sky thousands of Americans have been suddenly prostrated in many widely separated parts of the country, during the past ten days, by a disease which is called, apparently for want of a better name, “Spanish Influenza.”

Naturally, under all circumstances, there is much speculation regarding the matter.

Perhaps because there seems to be a rather natural disposition to ascribe about everything that is perfidious in the world today to Germany, some have ventured the guess that the disease may have been introduced and spread by German agents.

This theory, however, is generally considered as being not only entirely groundless but really absurd, for it seems hardly conceivable that, if Germany undertook an offensive of this kind, she would choose such a mild and humane sort of disease.

A much more plausible explanation would seem to be the simple fact that the recent cold snap caught the country entirely unprepared for such severe weather and, as a result of our unheated dwellings and other buildings and the inadequate clothing that was being worn, large numbers of people in different sections of the country contracted colds, which developed in many cases into pneumonia and resulted in an unusual number of deaths.

Almost always at this season of the year colds are frequent and they often result fatally, and it may well be that, but for the high tension of these strenuous war times, this epidemic would not have attracted unusual attention.

In any event there seems to be no occasion for special alarm or panic about the matter, for the disease is evidently one which the American medical profession is perfectly able to handle, and, moreover, effective measures are being taken, wherever it appears, to check it and destroy its power.


- The Midland Journal, Rising Sun, October 4th.

Prayer, quarantines, and hope were NOT the only alternatives available to residents of the Eastern Shore.

There were advertisements for patent medicines to cure the flu.

Most remedies involved a laxative.

Quinine (used for malaria) was tested and found ineffective.

Spanish Influenza or Grip by Dr. Lee H. Smith.

An old enemy is with us again, and whether we fight a German or a germ, we must put up a good fight, and not be afraid.

The influenza runs a very brief course when the patient is careful, and if we keep the system in good condition and throw off the poisons which tend to accumulate within our bodies, we can escape the disease.

Remember these three C’s — a clean mouth, a clean skin, and clean bowels, to carry off poisons from the system and keep the bowels loose, daily doses of a pleasant laxative should be taken.

Such a one is made of May-apple, leaves of aloe, root of jalap, and called Dr. Pierce’s Pleasant Pellets.

Hot lemonade should be used freely if attacked by a cold, and the patient should be put to bed after a hot mustard footbath.


- The Prince George’s Enquirer and Southern Maryland Advertiser. (Upper Marlborough, Md.) November 22, 1918

Some doctors continued to recommend whiskey.

Is Whisky Good For “Flu?”

Dr. A. A. Cairns, Chief Medical Inspector of the Bureau of Health, of Philadelphia, flatly differs with Coroner William B. Knight on the statement that whisky is an essential in fighting the influenza epidemic.

Giving his personal opinion of whisky as an influenza Remedy, Dr. Cairns said: “There are many physicians who do not use whisky at all in the treatment of influenza cases."

"In fact, whisky has been taken from the American Pharmacopeia as a medicine."

"Whisky is an old- time remedy that has gone out of practice.”


- The Midland Journal, Rising Sun, October 25th.

In hindsight it was a serious mistake to lift the quarantines so quickly.

However, given that the medical treatment at the time, which lacked antibiotics for pneumonia, ventilators and oxygen; there may have been very little that could have changed the course of the disease.

It was a vicious virus, and doctors, to this day, do not understand the reason for its power.

People died, not for the lack of facilities, but for the lack of medical knowledge (viruses were not discovered until the 30’s).

Vaccines were tried, but failed.

During this pandemic, residents were distracted by World War I.

Newspapers reported on bond rallies, rationing and supporting the war effort.

There was little time to ruminate on the deadly virus.

Eastern Shore residents were lucky in their isolation, without the 24-hour news cycle, they were able to live their lives and pray that the deadly virus would not descend upon them.

How many people on the Eastern Shore died from the 1918 flu?

The virus attacked so rapidly that some deaths were misclassified.


Worldwide estimates range from 50 to 100 million people…that is a very wide range.

It is estimated that over a half million Americans died.

The most deaths occurred in second wave in the fall.

The third and final wave from December through February was less deadly because scientists believe that the virus mutated to a less virulent form.

Ultimately the flu was devastating, in Talbot County 13% of the population and in Kent County almost 10% of the population had been infected.

(This may be an underestimation, since does not include the higher incidences of Tuberculous that have been attributed to the influenza.)

Lessons for us, are fewer.

We are lucky that COV19 is not as deadly as the 1918 influenza.

Public health experts are advocating isolation to “flatten the curve” and hope that the COVID 19 mutates benignly.

Some experts are questioning that approach because of the impact on the economy and the small population who is seriously impacted.

Vaccines and treatments are being vigorously studied, but treatments are months or years away.

All that we can do is wait and hope and pray as generations did before us.

While medicine has changed, humans have not.

Angela Rieck, a Caroline County native, received her PhD in Mathematical Psychology from the University of Maryland and worked as a scientist at Bell Labs, and other high-tech companies in New Jersey before retiring as a corporate executive. Angela and her dogs divide their time between St Michaels and Key West Florida. Her daughter lives and works in New York City.

https://chestertownspy.org/2020/03/26/t ... ela-rieck/
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