A hundred years ago, the nation faced a daunting question: How to deal with a burgeoning epidemic? The news the past few weeks has brought that century-old epidemic of Spanish flu back into the public consciousness, as people look to the past for help with the present.

Influenza — the name comes from the medieval Italian phrase “influentia del freddo” or influence of the cold — was a seasonal infection that tended to hit in winter months. Also called the “grippe,” one severe epidemic hit Jasper County in 1890. Instead of lasting two or three days, this attack lasted two weeks. No treatment was available.

Physicians treated influenza and other infectious diseases with quarantine. For home owners, it meant staying in their houses. For the indigent, cities such as Joplin had “pest houses,” where infected persons were confined. Prior to 1920, the Provident Association monitored those under the supervision of the city physician. Miss Wathena Hamilton, the association secretary, visited quarantined homes and pest houses to provide food and information.

During the 1899 smallpox outbreak, Joplin’s pest house and detention camp was set up along Shoal Creek in Newton County, which created conflict with Newton County residents, especially when victims of the outbreak washed clothes in the creek.

Great Epidemic

A new flu variety emerged when a cook at Camp Funston on the Fort Riley reservation in Kansas reported ill on March 11, 1918. According to A.A. Hoehling’s book, “The Great Epidemic,” the cook appeared at Hospital Building 91 at breakfast with a “bad cold.” Within a few minutes three more victims appeared. The nurse called the surgeon on duty. He didn’t wait to be formally dressed, but rousted his motorcycle driver, hopped in the sidecar and rushed to the building. By noon he had 107 patients, all with similar symptoms. Cases of influenza had regularly appeared from the camp’s start in September 1917 but skyrocketed in March.

This first wave was swift. According to John Barry, in a Smithsonian Magazine account, “Within two weeks, 1,100 soldiers were admitted to the hospital, with thousands more sick in barracks.” In that outbreak, 38 died. Outbreaks occurred in 24 of 36 Army camps. Most soldiers recovered. The virus passed from the military to the civilian population, ran through the spring and died down by May.

There is some thought the infection originated with men around Haskell, Kansas, which suffered a severe outbreak of the grippe in January 1918. It was unusual and severe enough that a local doctor notified the U.S. Public Health Service. However, nothing came of the report.

Influenza suddenly reappeared in the summer in Spain. King Alfonso XIII came down with it, and as Spain was a neutral nation without wartime censorship, coverage of the king’s illness and general influenza outbreak made the newspapers. As the infection spread, it became known as the Spanish flu.

But in the U.S., wartime censorship played a tragic role. According to Barry, President Woodrow Wilson’s Committee on Public Information had an adviser who wrote in a memo, “Truth and falsehood are arbitrary terms. ... The force of an idea lies in its inspirational value. It matters very little if it is true or false.”

When paired with the Sedition Act, which made it punishable by up to 20 years in prison to “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the form of government of the United States ... or to urge, incite, or advocate any curtailment of production in this country of any thing or things ... necessary or essential to the prosecution of the war,” public health officials felt constrained to minimize health risks and lie about the consequences of the growing influenza epidemic.

Flu cases were diagnosed during the summer but without much drama. However, starting in August, the situation changed drastically. A U.S. naval intelligence officer in Switzerland reported a new virulent influenza outbreak locally named the “black plague.” The influenza virus had mutated.

Virulent second wave

Its return was documented by three cases reported on the Commonwealth Pier on Aug. 27 in Boston. The next day, there were eight cases; the next day, 58 cases. By Sept. 1, Camp Devens outside of Boston had in its 1,200-bed hospital 84 patients in a camp of 45,000 soldiers. On Sept. 7, a patient was admitted delirious and screaming. The next day, there were 12 more from his company. At the camp’s peak of infection, 1,543 fell ill in one day. Men stayed in their barracks because there was no room in the hospital. What appeared as an ordinary flu in a couple of hours became pneumonia, with the patient turning blue from lack of oxygen and with death imminent. Said one doctor at the camp, “We have been averaging about 100 deaths a day. ... For several days there were no coffins, and bodies piled up something fierce.”

Because of wartime censorship, news about the epidemic was restricted. Three East Coast camps were hit by mid-September.

Philadelphia was particularly hard hit as the city’s public health director was determined to minimize the news of the epidemic. Flu spread from the Navy Yard into the general population. Deaths among sailors and civilians alike increased but he asserted he would “nip the epidemic in the bud.” Reporters wrote stories on the situation, but editors wouldn’t run them nor print letters from doctors. A massive Liberty bond parade went ahead as scheduled on Sept. 28 in spite of doctors’ concerns. Within a few days the city’s sick population mirrored the military camps. The director did, at last, close schools and ban public gatherings, but more than 12,000 Philadelphians died, most within six weeks.

While Philadelphia officials dismissed the risk, officials in St. Louis acted aggressively, shutting down sporting events and closing schools, theaters and saloons and suspending Sunday church services.

A study later done for the Proceedings of the National Academy of Sciences and published in 2007 found that cities such as St. Louis that acted early and aggressively had less steep epidemic curves and significantly fewer deaths.

“The costs of this delay appear to have been significant; by the time Philadelphia responded, it faced an epidemic considerably larger than the epidemic St. Louis faced,” the study concluded.

With the transit of soldiers across the country and the heightened war economy, the disease spread rapidly. Military camps across the country felt the impact as the disease hit young adults hardest, a seeming contradiction to how the flu had targeted victims in the past. Later research concluded the disease stirred what was termed a “cytokine storm,” a reaction of the immune system against the virus that inflamed the patient’s lungs along with fluid buildup, which can lead to pneumonia. Young people with the strongest immune systems tended to have the strongest reactions — with fatal consequences.

Other cities were hit quickly and hard. The first Joplin case was a soldier from Arkansas who was removed from a Missouri and North Arkansas Railroad train in September. Local newspapers began to take notice of the illness. The Monett Times reported national figures of 23,000 soldiers stricken as of Sept. 24, with 390 deaths. It carried a short article on the best medical advice to prevent the flu, mainly not coughing or sneezing on others, washing hands, not using utensils of others, general cleanliness and avoidance of crowds.

By the beginning of October, it was felt again at Camp Funston and in Southwest Missouri. Inductions from Arkansas were suspended for October. On Oct. 1, Springfield’s mayor closed all schools and theaters and prohibited public gatherings.

Joplin hit

It fully hit this area about a week later. The suddenness of the outbreak could be gauged by the fact that on Oct. 8 — the same day the city held a large Liberty bond parade down Main Street — the Globe reported that the Red Cross ordered mobilization of nurses to combat influenza. The war had called into military service many doctors and nurses so that the Red Cross was asked to call for volunteers to supplement nursing staffs.

The next day, all Joplin schools, churches and theaters were closed, and any gathering of at least 25 people was prohibited by the Joplin City Council after a meeting with Dr. R.B. Tyler, commissioner of health and sanitation. He reported 54 cases on Oct. 8 with no deaths, but by Oct. 10, there were 94 cases and three deaths. Camp Funston reported 1,430 new flu cases the same day. The camp’s death toll by the end of the third week of October was 861. (More U.S. soldiers died from influenza in World War I than were killed in combat.)

The Masonic convention scheduled for that week was postponed indefinitely, as was the Rotary convention. The only gatherings permitted were Liberty bond campaigns at the Liberty lot on the southwest corner of Fourth and Main streets.

On Oct. 10, the Barry County board of health called for suspension of all public gatherings “to include schools, churches and all other in-door gatherings, and thus save as far as possible, the inception or spread of Spanish influenza.” On Oct. 11, the Baxter Springs (Kansas) News reported schools had not been closed there as yet.

A week later, the epidemic was in full force in Southwest Missouri. Nevada closed its schools with 200 students sick. Cottey College was quarantined. Churches and places of amusement were closed. Monett’s cigar factory closed indefinitely as half its workers had the flu. A letter published in the Baxter News from Ray Shields, a soldier at Camp Funston, reported five ambulances and five trucks in the camp were busy day and night “taking them out of here by the hundreds.” While he was well, he saw men keel over as they waited in the mess line. The flu was spreading fast.

On Oct. 18, the Globe questioned Dr. Tyler’s distinction in listing deaths from influenza separate from deaths by varieties of pneumonia. Tyler’s accounting was different from that of Harry Covey, inspector in the health department, and from city physicians. Various doctors reported the deaths from pneumonia as being a result of the influenza infection. That same day, the Red Cross discussed asking the city to establish an isolation hospital because of 74 new cases referred to nurses in two days. At an Oct. 19 meeting of physicians, the board of health and other officials, doctors recommended wide publicity of the illness lest the public become more fearful as infections increased.

In one day, there were seven area soldiers whose obituaries listed the cause of death as influenza. Families with the flu were quarantined. By Oct. 24, 391 cases had been reported in the area with 22 deaths. A more stringent ordinance was passed. For example, restaurant customers were required to finish a meal in 30 minutes, and all business hours were limited from 5 a.m. to 7 p.m.

On Oct. 24, Jasper’s mayor said no public meetings of any kind were allowed, nor were schoolchildren allowed on the city streets. By Oct. 25, seven Joplin physicians, including Tyler, had come down with influenza and/or pneumonia.

From Oct. 1 to Nov. 7, the Globe reported 386 cases of flu and pneumonia with 64 deaths.

Back to normal

As suddenly as it arrived, it was over.

In the first week of November, Mayor Jesse Osborne opposed lifting meeting bans though the number of new cases had subsided. Schools were still closed, though Tyler and some doctors thought the danger had passed.

The spontaneous outbreak of public gatherings at news of the armistice on Nov. 11, 1918, without an increase in new cases seemed to prove the epidemic ended. On Nov. 15, the council, on advice of the city’s physicians, rescinded its influenza bans, though quarantine rules were still in effect. The ban had been in effect for 39 days. The only lingering mention of the flu were patent medicine ads claiming to be able to prevent infection. Life was back to normal.

By the time it was over, the 1918 influenza pandemic had caused 500,000 to 675,000 deaths in the United States and 50 million to 100 million deaths worldwide.

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