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What Once Was

Washington’s Lost Month: the 1918-19 Spanish Influenza Epidemic in the District of Columbia

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By Matthew B. Gilmore*

It all began (we now believe) in Kansas. But news reports of the influenza epidemic, also known as the grippe, first trickled in from Europe.

"Precautions against Influenza,” February 3, 1920. National Archives. (From the series General Correspondence, ca. 1915- 1925. Records of Naval Districts and Shore Establishments, 1784-2000 National Archives. [https://tinyurl.com/y87esq2m]

“Precautions against Influenza,” February 3, 1920. National Archives. (From the series General Correspondence, ca. 1915- 1925. Records of Naval Districts and Shore Establishments, 1784-2000 National Archives. [https://tinyurl.com/y87esq2m]

 

During the spring and into summer of 1918 reports came in. “Berlin is sneezing” ran one headline in the Baltimore Sun in June. The disease took on a new name “Spanish Influenza” — most European news was censored due to the war, but Spain was neutral, and news flowed more freely.

Public concern may have been tempered by a vague sort of familiarity; there had been the “Russian influenza” epidemic in 1889-‘90. [1] But those too young to remember the experience (and those who hadn’t been born) 30 years previous could not know what to expect. The drumbeat of reports from Europe continued. Germans called it “Flanders Fever.” “Did they Breed It Themselves,” asked one headline.

By early September it had crossed the Atlantic and struck Boston; by September 11 it was reaching “serious proportions.” Victims included not just common soldiers but prominent government figures too — Franklin Delano Roosevelt, Under Secretary of the Navy, contracted influenza which progressed to pneumonia.

Franklin D. Roosevelt, "Victim of Spanish Influenza." (Washington Times, Sep. 20, 1918; p.1.)

Franklin D. Roosevelt, “Victim of Spanish Influenza.” (Washington Times, Sep. 20, 1918; p.1.)

It struck Washington, DC in September. The first casualty died on the 28th — widowed railway man John William Clore from Culpeper, Virginia. He died at Sibley Hospital. [2] The day previous Health Officer William C. Fowler had visited the first suspected cases of influenza, that of Lt. Arthur Henne and his wife. [3]

Despite its severity, the influenza pandemic of 1918-‘19 seemingly has disappeared from Washington, DC’s memory. Washington’s government, as those of all cities across the country were overwhelmed. The only readily available account of the epidemic (besides the dry statistics of government reports) is that of District of Columbia Commissioner Louis Brownlow. Brownlow’s account appears in the second volume of his autobiography, in a chapter titled “Problems mount.” His two commissioner colleagues were laid up with the disease, leaving him with sole executive responsibility. Brownlow had close experience with the epidemic — a cousin of his visiting Washington early in September was stricken. Brownlow himself had a milder case. [4]

On September 26th Health Officer Fowler sought to allay public concerns as influenza crept up on Washington: “Sleep with your windows open and you will be in little danger.” (Washington Post, Sep. 27, 1918.)

By October 4th the Commissioners were forced to take drastic action; they published rules enacting restrictions on public gathering and public gathering places. Churches were closed, as well as playgrounds. Not exactly a quarantine, but close — churches, schools, theaters — all closed. The regulations instructed physicians to report incidences of the disease and set up quasi-quarantine conditions for patients to observe: not to appear on the public streets, in schools, churches, stores, or places of amusement, nor ride the streetcars. Additional rules applied to those nursing sick patients. A fine of $50 was instituted for the first offence, rising to $100 for repeated offenses.

Brownlow asked that citizens refrain from private gatherings too. Businesses were prohibited from opening until 10 a.m. so as to relieve congestion on streetcars carrying commuters to work. Government agency employees were given staggered work shifts to lessen crowding. The start of the work day was spread out from 7:30 to 9:30 a.m. Engraving and Printing started at 7:30; Agriculture, Commerce, Interior, Patent Office, and the Post Office started at 8:30; Treasury and Pension office at 9:30; and Labor starting at 8 a.m. [5]

“Regulations for the prevention of epidemic influenza (Spanish influenza) in the District of Columbia, October 4, 1918.” Washington Post, Oct. 5, 1918.

“Regulations for the prevention of epidemic influenza (Spanish influenza) in the District of Columbia, October 4, 1918.” Washington Post, Oct. 5, 1918.

On October 7th Congress closed its public galleries, not to be reopened until November 4th. Only one Congressman succumbed — Jacob E. Meeker of Missouri, dying in St. Louis having married his secretary on his deathbed.

Fowler and U.S. Public Health Service Commissioner Rupert Blue set up a nursing service for tending to the sick at home. It was strongly emphasized that this was not to be considered a charity but was an emergency measure due to the lack of medical personnel to cope with the situation. Open to all, it was just a phone call away — main exchange 6000, branch 364.

Rupert Blue, Surgeon General of the United States Public Health Service (undated). photo--Library of Congress, Prints and Photographs Div.

Rupert Blue, Surgeon General of the United States Public Health Service (undated). photo–Library of Congress, Prints and Photographs Div.

A separate hospital facility to treat influenza patients was established at 602-12 F Street, NW. Staffed by the Red Cross and set up especially for young women war workers assumed to be without close relatives in the city, it had only 100 beds. The hospital quickly proved inadequate and was relocated to a War Department tempo at 18th Street and Virginia Avenue, NW.

The Influenza Hospital as shown in Rupert Blue’s report, “Epidemic Influenza and The U. S. Public Health Service.” (The Modern Hospital, vol. XI, no. 6, Dec. 1918.)

The Influenza Hospital as shown in Rupert Blue’s report, “Epidemic Influenza and The U. S. Public Health Service.” (The Modern Hospital, vol. XI, no. 6, Dec. 1918.)

“Aerial view of the Navy Department and Munitions Building, Washington, D.C.” (circa 1920). photo--Library of Congress, Prints and Photographs Div. The temporary influenza hospital is the almost triangular building west of the Pan American Union building and on the north side of Constitution Avenue. The site today is the location of the Organization of American States adminisitration building.

“Aerial view of the Navy Department and Munitions Building, Washington, D.C.” (circa 1920). photo–Library of Congress, Prints and Photographs Div.
The temporary influenza hospital is the almost triangular building west of the Pan American Union building and on the north side of Constitution Avenue. The site today is the location of the Organization of American States adminisitration building.

The Surgeon General’s office planned home nursing services throughout the city. Women with some nursing experience were asked to volunteer to nurse the sick in the apartment building in which they lived.

That day the Evening Star published rules to combat the spread of influenza.

Surgeon General of the Army, “Rules for Personal Defense Against Spanish Influenza.” Evening Star, Oct. 4, 1918; p.19.

Surgeon General of the Army, “Rules for Personal Defense Against Spanish Influenza.” Evening Star, Oct. 4, 1918; p.19.

Newspaper advertisements offered alternative cures, such as the illustrated “Laxative Bromo Quinine.”

“‘Bromo Quinine’ for Spanish Influenza.” Evening Star, Oct. 15, 1918; p. 22.

“‘Bromo Quinine’ for Spanish Influenza.” Evening Star, Oct. 15, 1918; p. 22.

On October 8th there were calls for more nurses. Col.  Harry Stoll (H.S.)  Mustard centralized the nursing corps under his command –- nurses from the Public Health Service, Red Cross, Instructive Visiting Nurse Society, and Washington Diet Kitchen. Government telephone handset devices were equipped with medicated gauze over the mouthpiece. The stress was beginning to hit all kinds of operations. On the 9th the telephone company requested people restrict their phone calls to only those essential because so many operators were out sick. (Dial phones didn’t exist back then.) [6]

By October 20th masks moved from telephone handsets to faces; face masks were reported to be common as noted by the Evening Star headline,  “Gauze Masks Now Cover Many Faces.” The 25,000 masks provided by the Red Cross had been quickly snatched up. To meet the demand, do-it-yourself instructions were published that day in the Star.

Directions for making gauze face masks. “Thousand Recruits Aid Red Cross Fight.” Evening Star (Sunday Star), Oct. 20, 1918, section 1, p. 15.

Directions for making gauze face masks. “Thousand Recruits Aid Red Cross Fight.” Evening Star (Sunday Star), Oct. 20, 1918, section 1, p. 15.

Despite earlier optimism, there was still a struggle to cope. The health authorities still needed automobiles to transport volunteers doing home nursing duty. And 10 teachers, sisters of the Notre Dame Academy at North Capitol and K Streets, NE, volunteered in the nursing effort.

Harry Stoll Mustard, United States Public Health Service. Evening Star, Oct. 4, 1918; p.19.

Harry Stoll Mustard, United States Public Health Service. Evening Star, Oct. 4, 1918; p.19.

Col. Mustard [7] belonged to the United States Public Health Service. As the man in charge of coping with the emergency, on October 12th, he established four medical relief stations for the District: Curtis School at 32nd and O Streets, NW was to serve District west of 16th Street; Wilson Normal School at 14th and Harvard Streets for northwest Washington east of 16th Street and northeast Washington north of P Street; Wester School at 10th and H Streets, NW for the area south of P Street and north of the center line of the Mall; Van Ness School at 4th and M Streets, SE for the rest of the District. (Post, Oct. 12, 1918.) Seventy-Six Army and Navy doctors were allocated to these stations to deal with the sick. A fifth station was established at Armstrong Manual School.

Deployed out of those schools were a cadre of 40 trained nurses and hundreds of volunteers. Little mention of their heroic effort was made at the time or subsequently.

An unusual small tribute to nursing effort appeared in the Nov. 9, 1918 edition of the Star. Mary E. Lent was the supervising director of nursing for the U.S. Public Health Service in charge of 40 trained nurses and hundreds of volunteers. An unusual small tribute to that nursing effort was published in November. Mary E. Lent was the supervising director of nursing for the U.S. Public Health Service in charge of 40 trained nurses and hundreds of volunteers.

An unusual small tribute to nursing effort appeared in the Nov. 9, 1918 edition of the Star. Mary E. Lent was the supervising director of nursing for the U.S. Public Health Service in charge of 40 trained nurses and hundreds of volunteers.
An unusual small tribute to that nursing effort was published in November. Mary E. Lent was the supervising director of nursing for the U.S. Public Health Service in charge of 40 trained nurses and hundreds of volunteers.

By October 18th, as the Post reported that day, though 91 deaths in the previous 24 hours, officials spun a positive view, characterizing the situation as “well in hand.” Five days later, on the 23rd, under the headline “Think Influenza Receding Here,” the Star wrote that officials reported that only 23 deaths had occurred in the previous 24 hours, down from 71 the day before and only 392 new cases, compared to 772.

Public congregate spaces would not yet be reopened, despite public pressure to do so. The scope of the ongoing relief efforts was indicated by resources thrown at the problem. Lt. Howard L. Fisk, in managing transportation of nurses for home visits had 150 automobiles and the need for 100 more. Nurses would be dispatched to care for critical patients, then relief was sent for the next shift at 9 a.m.

"Walter Reed Hospital Flu Ward." (1918 or 1919). photo--Library of Congress, Prints and Photographs Div. Very few images exist documenting influenza patient treatment; fresh air was the most common prescription.

“Walter Reed Hospital Flu Ward.” (1918 or 1919). photo–Library of Congress, Prints and Photographs Div. Very few images exist documenting influenza patient treatment; fresh air was the most common prescription.

October 25th saw only 22 deaths — “Influenza Deaths Reach New Low” as headlined by the Star that day –- but 484 new cases, an increase of 179. The increase in statistics, however, was credited to doctors finally getting a chance to do their paperwork. And the filing system Mrs. William A. McAdoo had instituted at the Department of the Treasury was described with admiration and thought worthy of emulation. A card was created for each case of a sick employee. A volunteer would visit and record what was needed. In some cases, hot meals would be delivered three times a day; meals were prepared at a central kitchen at the old Emergency Hospital at Ohio Avenue and D Street NW. Red Cross nurses gave yeoman service during the crisis.

"Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C., during the influenza pandemic of 1918." photo--Library of Congress, Prints and Photographs Div.

“Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C., during the influenza pandemic of 1918.” photo–Library of Congress, Prints and Photographs Div.

The number of influenza cases increased, the deaths mounted but the epidemic crested in late October. By November 4th restrictions on public assembly were lifted despite the epidemic, which had only receded.

Reappearance

When a new outbreak threatened in December of 1918, people were more prepared to respond. Representatives of the U.S. Public Health Service, the Red Cross, and its DC affiliate met on the 29th to prepare nursing resources to deal with the disease. (Star, Dec. 29, 1918.) The hospital at 612 F Street was reopened and staffed with nurses from Nitro, West Virginia.

Health Officer Fowler was unreasonably optimistic (or at least his public proclamations were) throughout the entire episode. Back on October 4th as the city was being quarantined, a Star reporter recorded that Fowler felt that the situation would be in hand in a day or two.

The following summer the Post quoted Fowler that “I anticipate some return, but I don’t believe it will be serious” in response to reports he was planning an emergency hospital for influenza patients in to fall. (Jul. 18, 1919.)

But influenza had only loosened its grip. It returned in 1919-1920. A June 1920 report provided to the District Commissioners stated:

“Influenza. — Influenza made its reappearance in the District of Columbia in the early part of September 1919. It did not, however, assume epidemic proportions until the first part of January, 1920. This epidemic, which was not comparable in extent or seriousness with that of the previous year, subsided by April 1, 1920. While the outbreak was of a milder type than the original epidemic, it, however, resulted in a very large number of cases and deaths.

. . . . . . .

“In view of the fact that experience during the greater epidemic proved quite clearly that little, if any, good was to be expected from the general closing in large cities of public places, such as churches, schools, and places of amusement, it was decided to place no restriction on these places ; consequently they were allowed to remain open during the entire time of the outbreak.” [8]

Conclusion

Despite decades of research the 1918-‘19 pandemic remains much a medical mystery. Recent historical research suggests an origin in Haskell County, Kansas, then travelled to Europe with American troops. [9] Death toll estimates range widely from 50 to 100 million worldwide. It is estimated that 650,000 people died in the United States. The greatest unsolved mystery is why its victims were its victims. Influenza usually was most fatal to the young and the old; but in the case of the Spanish Influenza, “nearly half of the influenza-related deaths in the 1918 pandemic were in young adults 20–40 years of age, a phenomenon unique to that pandemic year.” Recent research suggests that early exposure to the Russian influenza strain in 1889 and 1890 led to a hyperactive immunological response — victim’s own immune systems killing them. [10]

Washington was overcrowded and in upheaval due to war workers for the Great War, with an influx of approximately 20,000 people, pushing the population well past the 400,000 mark. The Health Officer’s 1919 summary of the epidemic has (seemingly) the precision of hard numbers detailing the toll of the influenza:

“General mortality. — The total number of deaths occurring during the calendar year 1918 was 9,582, as compared with 6,687 for the preceding year. The death rate increased from 16.89 to 22.95. The figures show that 2,895 more deaths occurred in 1918 than during the preceding year. This remarkable increase was due to the epidemic of influenza which prevailed throughout the entire country during the latter part of the calendar year. Influenza was responsible for 2,028 deaths of the deaths recorded and pneumonia 1,298 deaths. It is believed that the deaths from pneumonia were largely the result of the influenza.” [11]

But throughout the report the numbers vary, and doubt is specifically cast on the completeness of the number of cases. The total number of cases of influenza reported to the health department from October 1, 1918, to February 1, 1919, was 33,719. However, “about 60 per cent of the number of cases which actually occurred and received medical attention” went unreported, leading officials to approximate 51,150 cases. [12] Despite the deaths, Washington’s population continued to climb, from 331,069 in 1910 to 437,571 in 1920.

The historical silence over the epidemic seems inexplicable. Perhaps it has been erased from popular memory as simply too horrible and inexplicable to remember. Figures prominent in the struggle against the epidemic pass it over in silence (except Brownlow) in their later biographies and obituaries. Likely, it was overshadowed by the war just ended. The creation of a proper, fitting municipal memorial to the war took years to create. Authorized in 1924, it was not completed until 1931 and commemorates the 499 District war casualties. [13] But there is no memorial to the valiant nurses and volunteers who persevered through Washington’s worst epidemic — no memorial to the dead.

Worth noting, a relatively unrecognized outgrowth of the Spanish influenza epidemic was the creation of the Phillips Art Gallery. James Phillips was the much-beloved brother of Duncan Phillips. Both attempted to enlist in the Army but were rejected. James died at the crest of the epidemic on October 21, 1918. His brother Duncan, acutely feeling that loss, and that of their father, created the modern art collection as a memorial to them both. [14]

Acknowledgements

Thanks to members of the staff of the Library of Congress Serials department. Also, to Jeffrey S. Reznick, Chief of the History of Medicine Division, and Laura Hartman, Senior Rare Book Cataloguer, History of Medicine Division, National Library of Medicine

Footnotes

[1] “The Grip of The Pandemic.” Washington Post (Jan. 21, 1890; p. 4).

[2] “Influenza Kills Here.” Washington Post (Sep. 22, 1918; p. 3).

[3] “Move to Check Influenza in D.C.” Washington Times (Sep. 20, 1918, p.1).

[4] Brownlow thought this was the first case of influenza recorded in Washington, but evidently it was not.

[5] “Work Hours Changed.” Washington Post (Oct. 2, 1918; p. 1).

[6] Washington Times (Oct. 9, 1918; p.3).

[7] Mustard would serve as New York City’s Commissioner of Health from 1947 to 1950.

[8] Annual Report of the Commissioners of the District of Columbia, year ended June 30, 1920 (vol. I, Miscellaneous Reports; p. 32).

[9] John M. Barry, “The Next Pandemic: How the Horrific 1918 Flu Spread Across America.” Smithsonian Magazine (Nov. 2017).

[10] Jeffery K. Taubenberger & David M. Morens, “1918 Influenza: The Mother of All Pandemics.” Emerging Infectious Diseases [serial on the Internet] (Jan. 12, 2006, vol. 12, no. 1, pp. 15–22); Alain Gagnon, Matthew S. Miller, Stacey A. Hallman, Robert Bourbeau, D. Ann Herring, David J.D. Earn & Joaquín Madrenas, “Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality.” PLOS|one (2013); Ruth Craig, “Why Did the 1918 Flu Kill So Many Otherwise Healthy Young Adults?” (The Conversation, smithsonian.com, Nov. 10, 2017).

[11] Annual Report of the Commissioners of the District of Columbia, year ended June 30, 1919. (Report of the Health Officer, vol. III.)

[12] Annual Report of the Commissioners of the District of Columbia, year ended June 30, 1919. (Report of the Health Officer, vol. III.)

[13] https://web.archive.org/web/20080720121041/http://www.dcwatch.com/richards/020526.htm

[14] David M. Morens & Jeffery K. Taubenberger,. “Influenza and the origins of The Phillips Collection, Washington, DC.” Emerging Infectious Diseases [serial on the Internet] Jan. 2006, vol. 12, no. 1); “America’s First Museum of Modern Art.” (phillipscollection.org.)

References and Resources

See resource list published on author’s Washington DC History blog.

<https://matthewbgilmore.wordpress.com/what-once-was-washingtons-lost-month-the-1918-19-spanish-influenza-epidemic-in-washington-dc>

Matthew B. Gilmore is the editor of the H-DC discussion list and blogs on Washington history and related subjects at matthewbgilmore.wordpress.com. Previously, he was a reference librarian at the Washingtoniana Division of the DC Public Library for a number of years and chaired the Annual Conference on DC Historical Studies for four years.

© 2018 InTowner Publishing Corp. & Matthew B. Gilmore. All rights reserved.