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. S. —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 hot 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.