Three Day Fever: Official and Personal Responses to the 1918 Influenza Pandemic

Influenza, The Spanish Flu, The Three-Day Fever. This disease was known by various monikers, but whatever it was called, it was the deadliest pandemic in history, outnumbering even the Middle Age’s Black Plague in the number of deaths. While it is true that every year some are hospitalized – and die – because of Influenza, it is often seen as not much worse than the common cold. Between 1918 and 1919, however, it is estimated that this disease killed between 50 and 100 million people around the world. In the United States alone, the dead from Influenza numbered around 675,000 people.

This thesis demonstrates how the public, as well as health officials, responded to the disease. It reviews Spanish Influenza origination theories using evidence from various sources including those of biologists and epidemiologists. Two of the most prevalent of these theories are discussed: Asian-origin and United States-origin. It follows a general timeline facing four outbreaks of the disease within the United States: Philadelphia, Boston, New Orleans, and San Francisco. Newspaper clippings, detailing an almost day-by-day account of the New Orleans outbreak, aims to show how society was impacted and the way that officials responded to the epidemic at the time. Many historians have written about this disaster in terms of what happened, how it happened and where the strain of the viral pandemic originated. This report also discusses these aspects, but it will also include sociological effects. It uses letters, newspapers, and other genealogical documents to demonstrate these effects. This report mainly focuses on the pandemic within the United States; other areas are discussed in relation to the origin of the pandemic strain.

ORIGIN OF THE PANDEMIC STRAIN

The 1918-1919 Influenza pandemic struck in at least three different waves. The first occurred in the spring of 1918 and, “was relatively mild and caused few deaths.”[1] The second and third waves, which caused the majority of the fatalities associated with this strain of Influenza, occurred during the fall of 1918 and the spring of 1919 and while it did affect all ages within the population, “roughly half of those who died were young men and women in the prime of their life, in their twenties and thirties.”[2]. In the four months of the second wave, Influenza “was responsible for most of its tens of millions of deaths.”[3]

Historians, epidemiologists, biologists as well as other academics and intellectuals have contributed theories as to the origin of the 1918 pandemic Influenza strain and outbreak. A British scientist, by the name of J.S. Oxford, theorized that the first instance of the pandemic outbreak occurred in 1916 at a “British Army post in France.” [4] He based this claim on reports of a disease known by the British physicians at the time as “purulent bronchitis,” stating that the autopsy reports of the soldiers whom died during this outbreak “b[ore] a striking resemblance to those killed by Influenza in 1918.”[5] Dr. Edwin Jordan, a former editor of The Journal of Infectious Disease, “spent years reviewing evidence from all over the world” and his work, sponsored, and published in 1927 by The American Medical Association, is “generally considered the best of several comprehensive international studies of the pandemic.”[6] Oxford’s theory of “purulent bronchitis” did not hold up against Dr. Jordan’s tests and research. Dr. Jeffrey Taubenberger, an American Virologist known for sequencing the pandemic Influenza virus, was also able to help dispel Oxford’s theory. He originally theorized that the virus had existed for at least two to three years prior to the pandemic outbreak. If proven, this theory would have vindicated Oxford and lent some evidence to his theory. However, further research led Taubenberger to the conclusion that the virus had “emerged only a few months” before the original outbreak. [7]

Other “medical historians and epidemiologists” have pushed a theory of origination in Asia, citing an outbreak of “pulmonary disease in China” prior to the Influenza pandemic of 1918 or Chinese and Vietnamese laborers whom had been transported from Asia to aid in work relief in Europe and Canada during World War I as supporting evidence.[8] The original theory from Dr. Jordan was also the Asian origin of the Influenza pandemic of 1918. In February and March of that year, cases of outbreaks of “an influenza-like disease” were reported in British India, however, these cases were noted to have “died out without giving rise to further epidemic spread.”[9] In China, there were similar reports in March, April, as well as May of 1918. The Chinese reports depicted a larger area of infection, however, much like the Indian outbreak, the outbreaks in China appeared to be “of the ordinary form’ [and] without an unusual death rate.”[10] Similarly, Chinese scientists at the time “stated they believed these outbreaks were endemic disease unrelated to the pandemic.”[11] Dr. Jordan ruled out these cases of “pulmonary disease,” noting that contemporary scientists had diagnosed these cases as pneumonic plague and that by 1918, the “plague bacillus could be easily and conclusively identified in the laboratory.”[12]

Hans Zinsser, an American bacteriologist and physician, first theorized that Asian laborers taking over jobs during World War II brought the disease over to France and Britain and from there to the United States.[13] Evidence used to support this theory include reports, in the early spring months of 1918, of an “influenza-type illness” noticed among Chinese workers “unloading ships in Marseilles.”[14] Australian Professor Dennis Shanks conducted a study to determine if this was the case. The conclusory report from this study was published in the Journal of the Chinese Medical Association. Shanks reviewed official mortality lists collected through The Commonwealth War Graves Commission as well as the French Military of Defense “for all-cause (Britain) and pneumonia/influenza (France) mortality, respectively.”[15] He claims that although there is evidence “that the 1890-92 pandemic, as well as subsequent influenza pandemics, arose in China” the results from the data collected “indicated that influenza mortality in Chinese and Southeast Asian laborers […] lagged other co-located military units by several weeks.”[16] In his conclusory findings, Shanks reported “there is no evidence in the mortality records reviewed that supports the hypothesis that the 1918 influenza pandemic originated in China or Southeast Asia,” and that “based on such clinical reports and recent genomic information, it seems most likely that the influenza virus […] had been circulating within the armies of the First World War for months-to-years” before the outbreak of the 1918 pandemic.[17]

In April 1918, reports of “wrestler’s fever” started coming from Tokyo, Japan and a similar sickness “attacked about 40 percent of the operatives in the Fuji cotton spinning factory in June.”[18] Despite the similarities between these two outbreaks, Japanese authorities appear to be in agreement that the “true onset of the [influenza] pandemic was the latter part of August,” and that the earlier cases could be attributed to the yearly influenzal season.[19] Dr. Jordan lent credibility to this by noting that a U.S. naval training camp in San Diego, and a U.S. submarine base in San Pedro, California began reporting cases “following the visit of Japanese” troops.[20]

Outbreaks in early 1918 in France, India, and the United States were the only possible origins left for the so-called Spanish Influenza. Both France and India were soon discarded as Jordan came to the conclusion it “was highly unlikely that the pandemic began in any of them.”[21] Left with only the United States as an origin of the Influenza Pandemic, Jordan reported that “One could see influenza jumping from Army camp to camp, then into cities, and traveling with troops to Europe.”[22]

The consensus among contemporary scientists and modern historians for the first case attributed to the pandemic Influenza was Private Albert Gitchell at Camp Funston, Kansas, in March of 1918. However, evidence from Dr. Loring Miner suggests that the virus had already claimed victims as early as mid-January of the same year. [23] Dr. Loring Miner was a local “country doctor” in Haskell County, Kansas whose practice spanned “hundreds of square miles.”[24] In January 1918, a patient presented to Miner with what appeared to be “common, if unusually severe, influenza symptoms, including headaches and body aches, coughs, and high fevers.”[25] As the patients continued to come in – one after the other – Miner went to work in researching what could be the cause of so violent an outbreak of Influenza. He took blood samples as well as urine and sputum samples and contacted the U.S. Public Health Service, writing to their weekly Journal, Public Health Reports, “but his was the lone voice of warning.” [26] However, deeming this particular outbreak so unusual, Miner “formally warned national public health officials.” [27] Miner’s warning went largely disregarded as health officials “offered him neither assistance nor advice.”[28] Within the “first six months of 1918, Miner’s warning of ‘influenza of severe type” was the only warning and reference to influenza “anywhere in the world.”[29] Miner noted that the cases were in fairly isolated areas such as individual farms, and that the disease had an unnerving preference for “the strongest and healthiest of his patients.”[30] However, had it not been for the war, John Barry, a renowned historian on the pandemic Influenza, claims that the disease, with a “shed” rate of “no more than seven days […] might well have failed to spread to the outside world.”[31]

The average age of Influenza-related death, as conveyed through a report concerning the “Age-specific Mortality” of the Influenza Pandemic of 1918, was 28. This report was funded by the Social Science and Humanity and Research Council of Canada, the Canadian Institutes of Health Research, and the Natural Sciences and Engineering Research council of Canada and its findings were written by, Alain Gagnon, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David J.D. Earn, and Joaquin Madrenas. Gagnon and his counterparts utilized the theory, known as “antigenic imprinting,” to establish that “an early life exposure to influenza during the previous Russian flu pandemic of 1889–90” may be the cause of the increased mortality within this age group.[32] Antigenic imprinting, also known as Original Antigenic Sin, is a term that was coined in the 1950’s by Thomas Francis, Jr. “to describe the imprinting by the initial first influenza A virus infection on the antibody response to subsequent vaccination.”[33] A simpler understanding of this term has recently been surmised as “first flu is forever,” meaning that once influenza has been contracted the person afflicted will always be more susceptible to contract another variation.[34]

There are four main theories presented through this report: First, the elderly were not affected by the pandemic strain as much as younger generations due to previous exposure to a similar Influenza strain (Russian Influenza of 1889-90). Secondly, due to the rise in tuberculosis among men during WWI, the higher death toll from the pandemic Influenza among the younger generation can be attributed to an already weakened immune response. Thirdly, the high rate of death among younger adults can be attributed to an overactive immune response “at the height of immunocompetency,” and lastly, T-cell dysregulation can be attributed to the higher occurrence of deaths among young adults.[35]

The first theory can be explained using the antigenic imprinting theory and what is known as the “honeymoon’ period for infectious diseases” which occurs between the ages 4 and 14, but they claim that while this does aid in explaining why the elderly were not affected it does not lend any insight into the “sharp increase in mortality” above the age of 14.[36] Serum samples of Influenza patients showed “minimal immunological responses against the current viral strain,” but there was an immunological response directed toward strains encountered as children. In simpler terms, the samples did not show an antibody response to the pandemic influenza strain which made them more susceptible to contracting the virus. However, the samples did show an antibody response to strains that were contracted as children. This is likely due to the extremely fast mutation rate among the Influenza virus family. However, as explained by the fourth theory, if a person was exposed to a virus that was more similar to the pandemic strain (H1N1) in the decades before 1889-90 Influenza season they would be “more immunologically experienced” and this might therefore explain the drop in the deaths of the elderly adults during the 1918 pandemic.

The second theory is reliant on a higher mortality rate among males during the 1918 pandemic. While immunocompromising tuberculosis combined with an already deadly wave of Influenza no doubt contributed to a vast amount of deaths, this cannot and does not account for the entire trend of young-adult mortality in connection with the pandemic Influenza.

For the third theory, Gagnon and the other scientists cited a study in which monkeys were inoculated with a reconstructed 1918 Influenza virus. The result was a “dysregulated antiviral response” which not only failed to protect them from the 1918 pandemic strain it also left them vulnerable to a “highly pathogenic respiratory infection” which eventually resulted in death. [37]  This is actually largely consistent with other histories suggesting that the Influenza was not the ultimate cause of the deaths during 1918-1919; Pneumonia, most specifically bacterial, was the leading cause of the deaths contributing to Influenza.[38]

The fourth theory also articulates a relationship between pneumonia and the dysregulation of the T-cell immunological responses; “the immuno-pathologic effects might have increased susceptibility to lethal secondary bacterial pneumonia.”[39] They argue that this final theory “explicitly implicates exposure to the 1889-90 influenza pandemic.”[40] It is this final theory, the increased risk of contracting pneumonia, largely in conjunction with the first theory, decreased antibody response to strains of a similar origin, that Gagnon and his colleagues claim in support of their argument.

SOCIAL AND FAMILIAL EFFECTS

Imagine waking up one morning to a child with a cough and a headache, by the end of the day they are sweating bullets with a 102-degree and steadily increasing fever. You are frantically trying to get the only doctor in town, however, he is busy with many other patients experiencing the same symptoms. He finally arrives and it is well after 10 P.M., he does what he can but by the morning your child had died. This was a terrifying reality for many during the years of 1917-1919. At the peak of the Influenza pandemic in 1918, many major cities had closed almost completely, with schools and other public facilities functioning as makeshift hospitals. In an age of medical advancement, they knew that Influenza was spread through contact with infected persons’ “spittle” and signs popped up in newspapers and on streets denouncing spitting in public.

On the morning of March 11, 1918, at Camp Funston, now Fort Riley, in Riley County, Kansas, a Private, by the name of Albert Gitchell, went into the medic complaining of cold-like symptoms including a sore throat, a headache, and fever. Over 100 more soldiers had reported similar symptoms by the time it was noon and from there it spread rapidly across the country jumping from military base to base. What has largely been ignored in this consensus, is the fact, that in January of 1918, about 300 miles away from Camp Funston, Dr. Miner had already warned health officials to the “influenza of severe type.” [41] Despite this, in February 1918, Dean Nilson “a young soldier […] came home to Jean, Kansas on leave from Camp Funston,” where earlier that week, around about 12 people had just come down with the influenza.[42] Around the same time, Ernest Elliot of Sublette, Haskell County, Kansas, left to visit his brother at Camp Funston. When Elliot left for his trip, his child had just fallen ill. Elliot was well within the “shedding” timeframe of seven days. By February 28, the Copeland newspaper stated that “most everybody over the county is having lagrippe or pneumonia.”[43] One important contribution to the spread of the pandemic at Camp Funston, was the lack of health code enforcements. A lack of proper “clothing and bedding and inadequate heating” left the soldiers huddled next to stoves in bunches all night, throughout the harsh winter.[44] This, coupled with the colds bound to have already been making rounds, led to weakened immune systems ripe and ready for the Influenza virus to take hold. In the month of March, 233 patients developed Pneumonia, of which 48 died.[45] From Camp Funston, the disease traveled across the United States, its accelerated pace no doubt due to the war taking place and the movement of troops between bases and overseas.

Across the United States from the east coast to the west, cases of pandemic Influenza were being reported in military camps: Camps Oglethorpe and Gordon in Georgia, Camps Sherman and Hancock in Oregon, Camp Doniphan in Missouri, Lewis in Washington, and Logan in Texas, to name a few.[46]  On June 22, 1918, “the City of Exeter [,a passenger ship,] arrived in Philadelphia” with 28 patients “so desperately ill with pneumonia they had to be taken to a hospital immediately,” and in the Gulf of St. Lawrence, the Somali docked with 89 patients ill from Influenza. [47] Despite the steady income of Influenza reports they were largely ignored and garnered only “a modicum of attention.”[48] By the time the disease had reached Europe it was known as the “Spanish Influenza.” The surprisingly high number of reported deaths in Spain, from which the disease earned its nickname, was likely due to the fact that during World War I, Spain was a neutral country. The press had fewer restrictions on what they could and could not report. Thus, they reported heavily about a disease others did not want to fully acknowledge during wartime. In countries at war, the number of deaths reported were not as high. It was more beneficial for a country at war not to disclose, what might be perceived as a weakness, the number of deaths attributed to a Pandemic.

At the end of August and the beginning of September 1918, the pandemic virus mutated, and “epidemics of unprecedented virulence” broke out in Freetown, Sierra Leone; Brest, France; and Boston, Massachusetts within the span of a week.[49] Influenza had made its way to the East Coast. In September 1918, approximately “85,000 citizens of Massachusetts had contracted Influenza.”[50] The first reported case of this “second wave” was at Fort Devens in Massachusetts. Fort Devens was built to house at maximum 35,000 soldiers. In 1918, the number of soldiers stationed at Fort Devens exceeded this by 10,000.[51] Out of the 45,000 soldiers, about one fifth “got sick and hundreds died, sometimes within hours of complaining of flu symptoms.”[52] On September 7, a soldier in the Camp was sent to the hospital where he was diagnosed with meningitis. The following day, approximately 12 more soldiers reported sick, were hospitalized under the diagnostic suspicion of meningitis. Health officials at the Fort failed to connect these cases of “meningitis” with the reported cases of influenza and therefore no effort to quarantine patients was made. Within the following days influenza exploded among the population at Fort Devens.[53] On September 16, the New Orleans Times-Picayune reported 1,000 cases of Influenza at Fort Devens, four days later, on September 20, this number had risen to 5,000.[54]^,[55] By September 22 around “19.6 percent of the entire camp was on sick report, and almost 75 percent of those […] had been hospitalized.”[56] From Fort Devens influenza “spread to camps Upton, New York and Lee, Virginia.”[57]

In Boston, on August 27, “sailors of the Receiving Ship at Commonwealth Pier reported to sick-bay” with what was diagnosed as Influenza.[58] The Receiving Ship was both a dorm and mess-hall for soldiers and sailors who were between assignments and could house a maximum of 7,000 men. In other words, it was a breeding ground in the port city. By the end of August, in the span of 3 days, there were roughly 66 more cases and once again higher health officials were notified to the epidemic outbreak.[59] The epidemic at Commonwealth Pier flooded the medical facilities and patients were re-routed across the Bay to Chelsea Naval Hospital where “within 48 hours” of their transfer, two medical officers had both joined the masses of patients.[60] The majority of these patients were fully recovered in a week or two but about 7 percent “developed a severe and massive pneumonia” – called influenzal pneumonia. This particular outbreak of the influenza epidemic held a mortality rate of about 60 to 70 percent.[61]

Massachusetts ignored the warnings against large gatherings and, in Boston, on September 3, “[four thousand] men, including 1,000 sailors from Commonwealth Pier and 2,000 civilian navy and shipyard workers, marched down the main streets of Boston.”[62] The next day influenza was reported at the Navy Radio School at Harvard and on September 5 “the state Department of Health released the news […] to the newspapers.”[63] Dr. John S. Hitchcock warned in an interview with the Boston Globe, “unless all precautions are taken the disease in all probability will spread to the civilian population of the city.”[64] Dr. Hitchcock was the head of the communicable disease section of the Massachusetts State Department of Health. Hitchcock’s warnings went unheeded and that very night, “thousands of sailors and civilians packed into a drill hall to hear Admiral Wood’s speech.” By September 8, the first three deaths attributed to Influenza in Boston occurred: “a Navy man, a merchant marine, and a civilian,” and on September 20, the New Orleans Times-Picayune, reported that Boston had reached 11 deaths in total – 8 from Influenza and 3 from pneumonia.[65] Three days later, on September 23, the death toll had increased to twenty.[66] By September 26, “[one hundred and twenty-three] Bostonians died of the flu and 33 succumbed to pneumonia.”[67]

One month later, on October 16, 1918, Private Jacob Henry Snyder died on tour in France. Jacob Snyder was 21 years old when he died of “Bronchial Pneumonia” after a bout of Influenza.[68] Snyder was born to Harriet Ann Murray and Wesley Snyder in March 1896 and raised in Pennsylvania.[69] Nearly two years after his death in 1918, on November 6, 1920, The Daily Courier, in Connellsville, Pennsylvania reported the arrival of his body stating that Snyder had been “very well known in [Normalville]” and that “he [had been] a member of Company K, 164^th Infantry.”[70] In 1918 the total population of Pennsylvania was approximately 8.524 million people.[71] In Philadelphia, the first reported case occurred on September 11 at the Philadelphia Naval Yard. By September 18, health officials began publishing recommendations against spitting, coughing, and sneezing in public and on September 21, they made the disease reportable. Despite the rising number of Influenza cases and deaths, Philadelphia did not cancel or reschedule parades and large gatherings and on September 28, the Fourth Liberty Loan Drive ran a parade in Philadelphia city. Two hundred thousand people would be in attendance.[72] At the beginning of October, 635 cases of influenza were reported in a single day and by the end of the first week “as many as 2,600 were reported to have died.”[73] The following week the cases doubled to more than 4,500 and by the end of October, “nearly 11,000 people died from the disease.”[74]

On October 30, 1918, at the other end of country in San Francisco, California, Jim Fedo, a 20-year-old soldier, was coming back from his older brother’s funeral, when he sat down to pen a letter to his siblings. He had, just weeks before, signed papers with the military and was awaiting the call to duty. His brother Frank, aged 28, passed away from a heart attack secondary to Influenza after a week sickness. In the following letter, Jim discusses how Influenza affected his family and San Francisco.

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San Francisco, California

October 30, 1918

Dear Lee and Family,

I received your letter today, after I got back from the funeral. And it comforted me very much. And I’m very glad everyone is alright at home. Well, Frank was buried today and I was the only blood relation there, and Alice is still sick in bed, so she couldn’t even go to his funeral. She got pneumonia to but in a light form, and is recovering very nicely. And the babys are alright. One is at a neighbors place. […] [Frank was buried at] the Holy Cross Cemetery, and a priest held service at the grave, as they don’t allow services in a church now on account of the epidemic.

Alice didn’t know Frank passed away until the undertakers had already taken him away, and then the doctor told her. […]

He had shut his sand bunkers down before he got sick on account of lack of business. You know the government stoped pretty near all street work. But he had an old Friend of his running the truck while we was both sick. And he has said to Alice before that if something should ever happen to him that this man should run the truck for her. […] The truck hasn’t worked since Frank got so sick and it won’t work the rest of the week. As the man that drove now and his wife were at Frank’s bed side all the time he was in danger. And so was I. But I was very weak from being sick myself so I could not stay up nights. The doctor didn’t like to see me get out of bed as soon as I did. I got the Flu a little before Frank did. I went to bed Monday noon, the 21 and Frank stayed in bed the next morning and never got up after that. And the 28th 2:30 PM. he passed away.

His pneumonia was getting better, but then his heart gave out. I’m staying up with Alice tonight to give the lady that takes care of her a rest as she sure needs it. So I’m passing my time writing this letter. Alice doesn’t know she got pneumonia. We didn’t tell her and last night or rather this morning her brother passed away with pneumonia. 3:00 AM. and she doesn’t know that either yet. And we won’t tell her until she get stronger as things are bad enough the way they are now. Her brother left a wife and three children all sick in the hospital. The children are 1, 2, and 9 years old. […] He was 35 years old but its best Alice doesn’t know it now as she has enough worrys.

She sure was a true wife to Frank. I sure pity the poor woman in bed and couldn’t even go to the funeral, and I try not to get tears in my eyes when she sees me. I’ve been taking it as brave as I could for her sake. I have to give her some medicine every 2 hours and she likes to see me near here. You know as anybody almost would at this time. […]

Well, Alice is sleeping just now and she hasn’t any fever at all now. The doctor comes here once a day now. He has a car and drives steady all day in the city to cover all his patience and last night he didn’t get through until way after midnight. And all hospitals are full to the brim. They have converted nearly all school and public places into hospitals now as you might know how the epidemic effects this city. There were 14 funerals besides ours in that one cemetery today.

Well, this is about all I can think of just now. And I don’t feel like writing anymore. So I’ll try and tell you more next time as then maybe I can think clearer. […]

Give my love to all, your loving Bro. Jim[75]

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The population of San Francisco at the beginning of 1918 was around 550,000, “less than one-third that of Philadelphia.”[76] On September 24, 1918, the San Francisco Chronicle reported that the “First Influenza Case” was discovered in the City of Angels – Los Angeles.[77] Edward Wagner, a civilian arriving from Chicago was quickly “ordered […] to the San Francisco hospital” and the “house where he had been staying was quarantined” as well.[78] At the Mare Island Naval Yard the next day, September 25, “one case of Spanish Influenza was discovered on the navy yard tug” – a soldier returning home from leave in Oklahoma became ill on the train.  Four days prior, on September 21, Dr. William C. Hassler, Chief Health Officer of San Francisco, “suggested that precautions against flu should be taken and […] persuaded the commandant of the Navy Training Station of Yerba Buena Island to impose a quarantine.”[79]

This quarantine would later be extended to include Mare Island as well, with “men being refused leave until the threatened danger from Influenza is no longer feared,” but not before its first case was known.[80] Hassler changed his tune not long after, however, doubting that it would even reach the city. Two days before the city “closed all the schools, theatres, and churches,” Hassler was still reassuring the populace that the disease would not be a threat stating, “If ordinary precautions are observed there is no cause for alarm.”[81] The California State Board of Health “made influenza a reportable disease,” giving California health officials the “legal power to isolate cases of the disease” – in other words, legally-sanctioned quarantine.[82] The San Francisco Board of Health issued a number of recommendations advising residents to avoid large crowds and public places.

Despite the recommendations and the rising death toll from Influenza, on September 28, the Fourth Liberty Loan Drive in San Francisco launched a parade of “10,000 escorting an effigy of the Kaiser nailed into a coffin” and the following two weeks saw the festivities continued as the “city indulged itself in rallies, marches, and speeches.”[83] Sixteen thousand people rallied together at the Bethlehem Shipbuilding Corporation and on October 6 an estimated “150,000 gathered at Golden Gate Park. Another 50,000 would gather at the “steps of the Chronicle Building” to hear Lucien Muratore, a French tenor, sing the Star-Spangled Banner.[84] On October 14, Hassler and all of the other hospital superintendents in the San Francisco area decided to use the San Francisco Hospital as an “isolation institution for pandemic patients only.”[85] Current and future patients would be relayed elsewhere for treatment. Three hundred and seventy-eight new cases of Influenza with the total case count around 991 were reported the same day. The following day, on October 15, the San Francisco Examiner reported 207 new cases in the city.[86] By the weekend of October 19, “over 4,000 new cases” had been reported.[87] Three thousand five hundred and nine “flu and pneumonia cases” were admitted to the hospital during the span of the epidemic and at least 26 percent of these cases perished.[88]

On October 17, as the number of reported cases continued to climb, Dr. Hassler met with San Francisco’s Mayor James Rolph, various owners of amusement parks and dancehalls, and officials from the Red Cross, Army, and Navy, to discuss possible mitigation and containment methods. Some, Dr. Hassler included, were in favor of at least a short-term closure of all business likely to attract large crowds. After further discussion, the Board ordered the closure of “all of San Francisco’s amusement and public gathering places and schools.”[89] They decided against the closure of churches, at that time, recommending instead that gatherings either be discontinued or held outside in the open air. However, by October 20, “even church services were forbidden.”[90] Almost one month to the day from the first report, on October 22, 1918, Frank Fedo would contract Influenza. One week later, on October 28, as recounted by his brother Jim Fedo in the letter above, Frank died of a heart attack secondary to pneumonia brought on by Influenza. He was 28 years old.[91] He left behind a widow, Alice, who at the age of 25, was left with two young children to care for, Frank Jr., aged 28 months and Marie, 14 months. Jim notes that her brother had also just died and implied the stress that the young widow would face in the coming years. In the 1920 United States Census, Alice Fedo is listed as widowed and living with her two children in San Francisco.[92] By 1930, she had remarried.[93]

In New Orleans, on September 16, 1918, an oil tanker carrying at least 5 crewmembers sick with Influenza arrived in the port. Dr. William Robin, New Orleans city health inspector, immediately quarantined the ship, prohibiting them from moving – either docking or leaving, until all cases concerning influenza were gone.[94] Within two days at least 5 more crewmembers had contracted influenza and the men were sent to Belvedere Hospital in New Orleans.[95]

On September 21, 1918, the New Orleans Times-Picayune, reported that three days after the oil tanker had arrived, on September 19, a United Fruit Company steamer, the S. S. Metaphan arrived from Colón, Panama with 11 confirmed influenza cases.[96] The steamer was also placed under immediate quarantine after being allowed to dock. No one except the soldiers were allowed off and Dr. Robin, took throat cultures of everyone aboard the steamer. The following day the state Board of Health made the disease reportable.[97] The soldiers – at least four of whom were taken in an ambulance – were transported to “Jackson Barracks and placed in quarantine there.”[98]

On September 22, Dr. Oscar Dowling, President of the Louisiana Board of Health, in consultation with Dr. Victor Blue, the Surgeon General of the United States Health Service, released 48 of the passengers from quarantine after determining them to be “non-carriers who were free from fever.”[99] The remaining two passengers sick with Influenza were told to either remain on board the steamer or report to the hospital for treatment. The released passengers were each given a letter for “the health officer of the state to which he was bound,” stating that the passenger had been “examined bacteriologically” and found to be free of Influenza.[100]

The same day the Times-Picayune also reported that Albert Bloom, a banker and “familiar figure in financial circles in New Orleans” had died “after an illness of a few days with pneumonia.”[101] The following day, “the isolation wards of the Charity Hospital were placed under quarantine” when a nurse along with another patient fell sick with Influenza, contracted a week after 4 sailors had been admitted with the disease.[102]

On September 24, the newspapers confidently reported that “no new cases of influenza ha[d] been reported in New Orleans.”[103] New Orleans reported the first local death contributed to Influenza on September 29, 1918.[104] By the end of the first week of October, Dr. Robin, in consultation with Mayor Martine Behrman, ordered the closure of all schools, theatres, and churches and declared that all public gatherings were prohibited.[105] In the next year, New Orleans reported a total of approximately 54, 000 and around 3,500 of these perished.

The pandemic Influenza affected families and society around the country.

“An uncle of my mom lived in rural Minnesota. He was newly married and his wife was expecting their first child. The wife’s family, (parents, brothers, and sisters), living in a neighboring community, all had the flu. It was so bad that the local doctor was staying at the house with the family. The newlyweds went for a visit on a Sunday to see her sick family. Within a week, the young expectant mother was sick and gave premature birth to a stillborn baby. She died the following day (6 March 1919). Noone went to the funeral as people were not allowed to gather in groups due to the difficult winter and flu season.”[106]

The Osceola Tribune, of Osceola, Iowa, reported on the 23 of January 1919 the obituary of Lawrence McNair.

“Lawrence, the little four year old son of Mrs. Paul McNair, passes away at the family home eight miles northeast of Osceola last Wednesday morning at 1 a. m. from an attack of the influenza. This indeed is a sad affair as the father had passed away on the Friday before his little son was taken with the same disease. Little Lawrence was laid to rest in the Catholic cemetery near Woodburn. This family have the deepest sympathy of the entire community in their bereavement.”[107]

A few days later, on the 29^th of May, another son, Oscar McNair also died of the disease.[108] These two accounts recreate the emotional turmoil that families were put through as a result of the disease.

In fact, on January 5, 1919 Private Guy Curtis Hedrick died from “Bronchial pneumonia” after contracting influenza. Guy Hedrick was a 21-year-old. He had been “in the service just four months […] when this dread disease b[r]onchial pneumonia lay hold on him and he was sent to the base hospital at Ft. Riley.”

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[1]“Death from 1918 Pandemic Influenza during the First World War: A Perspective from Personal and Anecdotal Evidence.”

[2] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[3] “Death from 1918 Pandemic Influenza during the First World War: A Perspective from Personal and Anecdotal Evidence.”

[4] Barry, John M. “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[5] Barry, John M. “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[6] Barry, “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[7] Barry, John M. “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[8] Barry, “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[9] Jordan, Epidemic Influenza; A Survey.

[10] Jordan, Epidemic Influenza; A Survey.

[11] Barry, “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[12] Barry, “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[13] Jordan, Epidemic Influenza; A Survey.

[14] Barry, “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[15] Shanks, “No Evidence of 1918 Influenza Pandemic Origin in Chinese Laborers/Soldiers in France.”

[16] Shanks, “No Evidence of 1918 Influenza Pandemic Origin in Chinese Laborers/Soldiers in France.”

[17] Shanks, “No Evidence of 1918 Influenza Pandemic Origin in Chinese Laborers/Soldiers in France.”

[18] Jordan, Epidemic Influenza; A Survey.

[19] Jordan, Epidemic Influenza; A Survey.

[20] Jordan, Epidemic Influenza; A Survey.

[21] Barry, John M. “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[22] Barry, John M. “The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications.”

[23] Kupperberg, Paul. The Influenza Pandemic of 1918-1919.

[24] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[25] Kupperberg, Paul. The Influenza Pandemic of 1918-1919.

[26] Kupperberg, Paul. The Influenza Pandemic of 1918-1919.

[27] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[28] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[29] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[30] Kupperberg, Paul. The Influenza Pandemic of 1918-1919.

[31] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[32] Gagnon, Alain, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David JD. Earn, and Joaquín Madrenas. “Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality.”

[33] Monto et al., “The Doctrine of Original Antigenic Sin.”

[34] Monto et al., “The Doctrine of Original Antigenic Sin.”

[35] Gagnon, Alain, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David JD. Earn, and Joaquín Madrenas. “Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality.”.

[36] Gagnon, Alain, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David JD. Earn, and Joaquín Madrenas. “Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality.”

[37] Gagnon, Alain, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David JD. Earn, and Joaquín Madrenas. “Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality.” PLoS ONE 8, no. 8 (August 5, 2013).

[38]National Institutes of Health. “Bacterial Pneumonia Caused Most Deaths in 1918 Influenza Pandemic.”

[39] Gagnon, Alain, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David JD Earn, and Joaquin Madrenas. “Age-Specific M

[40] Gagnon et al., “Age-Specific Mortality During the 1918 Influenza Pandemic.”

[41] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[42] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[43] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

[44] Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books, 2005.

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[46] Crosby, Epidemic and Peace, 1918.

[47] Crosby, Epidemic and Peace, 1918.

[48] Crosby, Epidemic and Peace, 1918.

[49] Crosby, Epidemic and Peace, 1918.

[50] Crosby, America’s Forgotten Pandemic: The Influenza of 1918.

[51] Barry, The Great Influenza.

[52] Campbell, Disasters, Accidents, and Crises in American History: A Reference Guide to the Nation’s Most Catastrophic Events.

[53] Barry, The Great Influenza.

[54] “Prohibit Soldiers From Assembling”

[55] “Influenza Epidemic Declared on Wane”

[56] Barry, The Great Influenza.

[57] Crosby, Epidemic and Peace, 1918.

[58] Crosby, Epidemic and Peace, 1918.

[59] Crosby, Epidemic and Peace, 1918.

[60] Crosby, Epidemic and Peace, 1918.

[61] Crosby, Epidemic and Peace, 1918.

[62] Crosby, Epidemic and Peace, 1918.

[63] Crosby, Epidemic and Peace, 1918.

[64] O’Neal, The Influenza Pandemic of 1918.

[65] “Influenza Epidemic Declared on Wane”

[66] “Influenza Taking Large Death Toll”

[67] Kolata, Flu.

[68] Pennsylvania, WWI Veterans Service and Compensation Files, 1917-1919, 1934-1948

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[74] Kolata, Flu.

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[76] Crosby, Epidemic and Peace, 1918.

[77] “First Influenza Case Is Discovered in S.F.”

[78] Crosby, Epidemic and Peace, 1918.

[79] Crosby, Epidemic and Peace, 1918

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[90] Crosby, Epidemic and Peace, 1918.

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[95] “Influenza Patients Removed From Steamer.”

[96] “Fruit Steamer with Influenza Aboard Arrives.”

[97] “Ship Quarantined, Influenza Feared.”

[98] “Fruit Steamer with Influenza Aboard Arrives.”

[99] “Health Officers Release 48 From Ships Sick List”

[100] “Health Officers Release 48 From Ships Sick List”

[101] “Banker Dies After Few Days Illness”

[102] “Influenza Cases in Charity Hospital”

[103] “No Cases in Orleans”

[104] “Influenza Goes in Orleans Home to Get Victim.”

[105] “Schools Closed; Churches Also Will Suspend.”

[106] Love, Lori. “GAA (Genealogy Addicts Anonymous).” Accessed January 25, 2018.

[107] Karen Johnston Brewer. “GAA (Genealogy Addicts Anonymous).” Accessed January 25, 2018. “The Osceola Tribune” Osceola, Iowa. January 23, 1919, Page 1. LAWRENCE McNAIR DIED: Father And Son Pass Away Inside of A Few Days

[108] Karen Johnston Brewer. “GAA (Genealogy Addicts Anonymous).” Accessed January 25, 2018. “The Osceola Tribune” Osceola, Iowa. January 29, 1919.