The Flu Epidemic of 1918
1998 marked the 80th anniversary of the worst epidemic of infectious disease ever to strike Adams County-the so-called "Spanish Influenza" of 1918.
The story of the spread of that infection is inextricably involved with the history of World War I; without the massive, worldwide troop movements of that last summer and fall of the Great War, the disease could never have spread from the world's great port cities to rural areas such as Adams County with such devastating speed. Nor were military authorities innocent of complicity in this spread, as they put the war effort ahead of everything else-including public health concerns-and tried to divert responsibility for the epidemic to the enemy, as we shall see. Even Hastings was not free of bickering and finger-pointing among public officials, as they sought to deal with the crisis-always endeavoring to walk the fine line between precaution and panic.
The first factor in the epidemic was, of course, the influenza virus itself. Over time, that particular virus has shown an amazing ability to modify its outer protein "coat," so that antibodies produced in response to infection by the virus (or a flu shot) last year, or the year before, are useless against it. On a number of occasions over the last century, these "antigenic shifts," as specialists in immunology call them, have been particularly drastic-resulting in peaks of epidemic influenza The 1918 outbreak was simply the worst of these. And we need to exonerate Spain of any responsibility. As non-combatants in World War I, they lacked military censorship. Therefore, when reports of influenza started coming out of Spain in the summer of 1918, the rest of the western world quickly labeled it the "Spanish Influenza." The undisclosed facts were, influenza was epidemic in American army camps in March and April of 1918. There were many secondary cases of pneumonia, killing a high proportion of these previously-healthy young men. The disease was then "exported" back to Europe, among the 865,000 United States soldiers who crossed to England and France in the summer of 1918. There were 700 influenza deaths in London alone, in July of 1918! Surely, something big was brewing "over there." And as the discharged soldiers came home, they brought it back. Flu cases were diagnosed among servicemen stationed in Philadelphia in July, and among those in barracks in New York and Boston by late August.
In the face of this evidence of brewing disaster, what did the authorities do? As little as possible. To win the war was THE thing. When a Norwegian vessel with 200 active flu cases and three dead men on board docked in New York on August 12, the city health commissioner announced that all of the sick put ashore had pneumonia, not flu, and added, "You haven't heard of our doughboys getting it, have you? You bet you haven't, and you won't." I'm sure the irony in that statement was totally unintentional. The chief surgeon of the New York port of embarkation was even more blunt: "We can't stop this war on account of Spanish or any other kind of influenza." The same day that the first civilian case of flu was admitted to Boston City Hospital (September 3) 3,000 sailors and shipyard workers marched down the streets of Boston in a "Win-the-War-for-Freedom" parade-no doubt spreading the disease in their wake. As late as October 4, with money for the war effort running short, the Chicago health department gave the okay for a huge Liberty Loan parade, assuring the participants they would not catch the disease if they went home, stripped, rubbed their bodies dry, and took a laxative! To say that the authorities were still in a state of denial is to put it mildly. Nor was the German enemy itself without suspicion. It was suggested that German U-boats were landing infected agents on American soil. And as the fall epidemic spread, the U.S. Public Health Service was obliged, under political pressure, to waste its limited resources on investigating whether Bayer, producing aspirin under what had originally been a German patent, was poisoning its customers with flu germs.
So, the disease continued to spread among the military camps-and the soldiers, or the railroad men involved in their transport, quickly brought it back to the heartland. The first note of the disease in Adams County appeared in the Hastings Tribune of October 2: two cases had been diagnosed "in railroad men." The same day, Earl Debord of Kenesaw was noted as having died of influenza "in naval school," and William Ahern of Hastings died of the same cause at Camp Grant, Illinois. They were among at least ten influenza deaths among Adams County servicemen in that October alone. (Overall, 21 of 34 deaths among Adams County servicemen during the war were flu deaths.) The first civilian death from influenza in the area seems to have been Reverend S. DeFreese of Glenvil, on October 2. He was only 35. On October 9, the Tribune reported the first Hastings death from flu, Mrs. Nina Robare. She had visited her husband at Camp Funston, Kansas-the same army camp at which two Adams County soldiers died of influenza the following week. Camp Funston was also where the 147 men constituting Nebraska's draft quota for October were to have been inducted-until the progressive spread of the epidemic postponed their mobilization.
Still, to merely scan the front pages of those old newspapers is to realize, even as the epidemic broke out in Adams County, that the war remained the top story. Literally surrounding the story of Mrs. Robare's death that October 9, are bulletins from the Allied advance in France, the draft numbers for the county, a notice of the death of former Nebraska governor James Dawes-of pneumonia-and a headline screaming, CRISIS NEARS ON 4TH LIBERTY LOAN. The public health issues raised by the epidemic were still a distant second in public interest. Thus, it's hardly surprising to find disagreements among local officials on how to best respond to the outbreak. The first casualty of these was the city physician, Dr. J. V. Beghtol. On Sunday morning October 6, he and Mayor Madgett had spoken by telephone regarding the possible need to close public gathering places, to fight the spread of the epidemic. The doctor had advised the mayor that Omaha and other cities in the eastern part of the state had closed theaters and other public places, and expected that Hastings would have to do the same. He deferred any final recommendation, however, until after a combined meeting of the board of health and city council scheduled for that afternoon. The mayor apparently wasn't satisfied with this; he contacted the president of the ministerial association, and issued a proclamation, announced from all the pulpits of the city that Sunday morning, that the churches and theaters were to be closed until further notice. The scheduled afternoon meeting then took place; Dr. Beghtol testified that, over the intervening hours, he and Dr. J. W. Straight, health inspector for the schools, had investigated the situation-and found only four confirmed cases of flu in the city. Given this data, the decision of the board was that schools and other public places remain open. Understandably, the mayor took offense at what he considered Dr. Beghtol's "flip-flop" on the issue. Dr. Beghtol, in response, took offense at the mayor's indulging "his penchant for issuing proclamations and edicts," and resigned. Dr. J. W. Brown was appointed in his place. The epidemic was barely underway, and local nerves were already fraying. Two days later, 35 cases of flu were recorded in Hastings.
Thursday October 10, the decision was reversed. Mayor Madgett, this time acting as chairman of the board of health, issued an order "closing theaters, churches, schools, pool rooms and card rooms as a precautionary measure against influenza." Military pickets were posted around the perimeter of the Hastings College campus, to prevent resident students from leaving. But students living at home in Hastings were still allowed to come and go-"if there is no sickness of any kind in the home." Obviously, irrational compromises in policy were still the order of the day. Irrational "home remedies" were, as well, ranging from garlic amulets to baking powder in water, as recorded in the Tribune. There were 81 recorded cases in Hastings by October 14; 198 cases four days later. Drs. Brown and J. H. Hahn were themselves reported ill with influenza. The obituary columns of the Tribune were littered with flu victims. And, mirroring the epidemic worldwide, these were primarily previously-healthy people in their twenties and thirties. Flu has always disproportionally killed the very young and the very old; the 1918 epidemic killed a hefty share of people in the prime of life. Secondary bacterial pneumonia, particularly with the germ that came to be known as Hemophilus influenzae, a common pathogen in younger people, probably played a major role. But as previously noted, the flu virus itself was particularly aggressive that year. On October 21, the Nebraska State Board of Health placed a ban on all public gatherings, indoors and outdoors.
The disease continued to rage in private. There was a drastic shortage of home nursing care. Given that there was no effective medical treatment for influenza, this was even more devastating than any lack of access to a physician. Instances were recorded where whole families were stricken with the disease and, one member having died, an undertaker was called to remove the corpse, but no one could be found to stay in the home overnight or do anything for the sick members. A call went out from the Red Cross for volunteers to help in caring for influenza patients. Mrs. Alice Brooke and Mrs. Margretta Dietrich set up feeding kitchens in their own homes, organized volunteers to deliver food, and personally visited hundreds of local homes at the height of the epidemic. Other volunteer nurses included Mrs. Herman Stein, Mrs. C. B. Hutton, Mrs. Fred Parker, and Miss Georgia Holmes. The Hastings woman's club, through its president, Mrs. S. B. Lyman, also organized a diet kitchen "where food suitable to the needs of invalids is being prepared and may be secured daily at cost." By the 6th of November, this diet kitchen had provided assistance to 76 flu victims. Though the Hastings schools reopened that same day, deaths due to the flu continued to be recorded.
Rural doctors were taxed to the limit by the epidemic. Dr. Nowers of Kenesaw, for example, labored for days with little sleep, caring for 500 flu victims, giving not only medical attention but going into homes where all members were unable to care for themselves and ministering to their needs, when it was impossible to obtain outside help. Fear of contracting the disease prevented even the most kind-hearted of county residents from volunteering to drive the doctor from house to house, let alone assist him in caring for patients.
Mary Lanning Memorial Hospital, then in only its third year of operation, had been primarily a surgical facility up to that point. For example, of the 46 admissions in October, 1918, 29 were surgical cases, mainly tonsillectomies, appendectomies, and gynecologic cases. The general rule had been that the hospital was not equipped to deal with patients suffering with contagious diseases. There were occasional exceptions-two cases of typhoid fever had been admitted in October, and pneumonia was the admitting diagnosis in a railroad switchman, on November 2. It's quite likely this was a complication of the flu. Then, on Friday November 14, this policy was changed, and an entire ward was set aside for treating influenza patients. (It would be interesting to know what was being said behind the scenes at the hospital, during those early weeks of the epidemic, but no record appears to exist.) Between November 14 and December 9, there were 60 admissions to the hospital, and 31 of these were for influenza. Two more were for "empyema with drainage"-patients aged 6 and 26 whose pneumonia had been complicated by the accumulation of pus in the chest cavity, requiring surgical drainage. These two young people spent an average of eleven and a half weeks in the hospital recuperating.
Others were not so fortunate. Obituary notices continued to appear in the newspapers. The Adams County Democrat of November 22 described the triple funeral at the Congregational Church of Mildred Hopp, her child, and her brother John Schmer. The same day, 31-year-old Patrick McCauley died at his farm home northwest of Hastings. At the time of his death, his 29-year-old wife Clotilda and their four children, ranging in age from one to nine, were also ill with influenza. His funeral was to have been held at the Assumption cemetery at 3 PM Sunday the 24thâbut at 1 PM that day, his wife also died of the disease. Their double funeral was postponed until Wednesday the 27th. It was a cloudy, gray day, with the temperature hovering around 30 degrees, and an 11-mile-per-hour wind to further chill the spirits. Nobody but the surviving family members came to the funeral; their friends and neighbors were too afraid of catching the flu. Try to imagine their loneliness, under that Nebraska November sky! The family would have to be broken up, of course; there was no public welfare system, no Social Security survivorship benefits, nothing but whatever words of comfort they received from that unintentionally private funeral. The three daughters were placed in the St. Thomas Orphanage in Lincoln; two became nuns-Margaret A/K/A/ Sister Rose Margaret, and Alice A/K/A/ Sister Alice Marie. Youngest daughter Helen eventually left the orphanage and married. One year-old Leonard remained behind in Hastings, to be raised by his grandmother.
Schools had reopened November 5. Students were supposed to wear masks to prevent the spread of respiratory disease, but this met with resistance. By the week of November 17, a quarter of the students were reported absent. Similarly, there was a major upswing in flu cases following the victory parade that marked the Armistice of November 11. It was becoming apparent that half-measures in behalf of the public health were as good as nothing at all. On Thursday December 5, 36 new cases of flu were reported to the city physician. All schools in the county, including Hastings College, were ordered closed until December 30. Churches and theaters were closed, and restrictions were placed on businesses' evening hours. The State Board of Health issued rules for handling influenza as an "absolutely quarantinable disease," with entire families remaining under quarantine in their homes "until four days after the fever disappears in the patient." Notices were printed to post on the doors of affected families' homes. No one other than an attending physician or nurse was allowed to enter. Now that the war was over, full attention was finally being paid to the enemy within. Whether these actions had the intended effect, or the epidemic was simply burning itself out, by mid-December, flu cases were sharply down. Effective Sunday, December 22, churches and theaters were allowed to reopen-but attendees were only allowed to sit in every other row! This restriction was lifted on Tuesday, January 7, 1919. At that time, only dancing remained under the ban, which was finally lifted on January 20.
There were no flu deaths in the first three weeks of February 1919, and the general assumption was that the epidemic was over. The last week in February, Dr. Brown filed what he no doubt assumed would be a summary report on the epidemic with the State Health Department-1,185 total reported cases of flu in the city of Hastings in 1918, with only 28 new cases in the six weeks since January 15. Alas, this assumption was wrong. The first week in March, there was a major recurrence of the flu in rural Adams County. 65 of 82 students in the Holstein school were absent with flu. On March 6, Dr. Mace of Roseland applied to the county clerk for 25 influenza quarantine cards. Wanda Township was the focus of another major outbreak. After going for about three weeks without admitting a case of influenza, 10 of 18 admissions to Mary Lanning the week of March 10-16 were flu cases. By the end of March, Hastings alone had suffered over 100 deaths from influenza and related complications.
During the first part of April 1919, deaths from influenza and pneumonia again averaged about two per week, into the first week of April. On April 7, the Tribune recorded the death of Nellie Davis of Bladen-one week after her wedding. She was the last apparent flu death in the area. But the complications from the disease trailed on-three more boys with empyema, ages 4, 11, and 15, were admitted to Mary Lanning between March 23 and May 19. They survived, but bore the surgical scars of the disease for the rest of their lives. The rest of the survivors in Adams County, though their scars were of a different sort, did the same.