An Epidemic Checked: A Chronicle of the 1918 Influenza Pandemic in Dayton, Ohio
An Epidemic Checked: A Chronicle of the 1918 Influenza Pandemic in Dayton, Ohio
by Jackie Frederick
Rumors about cases of Spanish influenza surfaced in the wake of the constantly moving World War I troops, but most Americans did not become concerned about these reports until the disease struck their own city. In the fall of 1918, the citizens of Dayton began to take notice of this epidemic. In today's world, where there are flu shots, antibiotics, and standard sanitary procedures, it is hard to imagine the steps that had to be taken to protect the city's population from what we now consider a commonplace disease. Dayton was fortunate to be one of only five cities in the state that had a full-time health officer,[i] and the responsibility for the curtailment of the disease fell to this official. A combination of the citizens' readiness to make sacrifices and to promptly volunteer (a common practice during World War I), along with the health commissioner's quick involvement and control, resulted in an atmosphere of cooperation that enabled the people of Dayton to defend themselves against the disease and the panic that often accompanied it.
The influenza epidemic that struck Dayton was part of a worldwide pandemic that "is regarded as one of the greatest human catastrophes of all time."[ii] It is estimated that between twenty to thirty million people died throughout the world, with over 500,000 deaths in the United States. The pandemic hit in three waves—one in the spring of 1918, one in the fall of 1918, and one in early 1919. While many diseases are dangerous to the elderly and young, an unusual characteristic of this pandemic was that the largest segment of the population that it affected was the one made up of those in the prime of their lives, between the ages of twenty to forty. The second wave of this pandemic was the worst and the one that most affected those living in the city of Dayton.[iii]
It is surmised that the disease known as "Spanish Influenza" actually made its first appearance at a military camp in the United States in March of 1918 and did not begin to surface in Spain until May of that year. Spain "had no wartime censorship to keep its health problems concealed from the world;"[iv] therefore, when the disease struck Spain, word began to spread and people began to call it Spanish Influenza, assuming that this is where it had started. In the United States, influenza was not a "reportable disease" until the fall of 1918. This circumstance, along with the fact that the war crowded out all other news, made it difficult to track the spread of the disease until that time.
Spanish influenza was an airborne disease that had no available vaccine. Consequently, it spread easily in the overcrowded conditions of most military camps.[v] The first emergence of the disease in Ohio was in September of 1918 at Camp Sherman, a military camp near Chillicothe, Ohio. During that month, eighteen men at the camp succumbed to the disease, including one from Montgomery County.[vi] One of Dayton's first responses to the epidemic was to send nurses to Camp Sherman and other Dayton military hospitals located at Wright Field and McCook Field. The medical officers at these local encampments placed urgent requests to the Dayton Chapter of the Red Cross for nurses to help with the increasing number of cases among the soldiers. The women of Dayton responded promptly to this emergency. In response to just one call, ten nurses left for Camp Sherman while an additional thirty-five women volunteered for training. Nurses were in more demand than doctors because there was no drug or medical procedure in existence to treat the disease. The only known cure was "warm food, warm blankets, fresh air, and ...TLC—Tender Loving Care."[vii] In addition to nurses, there was a great need for dressings and bandages. A shortage of these provisions had already been created by the war effort, but the women of Dayton repeatedly pitched in and answered all the calls put out by the Red Cross for both manpower and supplies.[viii]
The disease spread beyond the confines of the military camps, and on October 5, 1918, the Dayton Daily News ran an article declaring it "should be studied by every person in Dayton, by reason of the prevailance in our midst of the influenza."[ix] The article included the following warnings issued by the Division of Sanitation of the Navy Department:
Protect yourself from infection, keep well, and do not get hysterical over the epidemic.
Beware of those who are coughing and sneezing.
Avoid crowded streetcars—walk to the office if possible.
Keep out of crowds—avoid theaters, moving picture shows, and other places of public assembly.
Do not travel by railroad unless absolutely necessary.
Do not drink from glasses or cups which have been used by others.
Avoid close, stuffy, and poorly ventilated rooms.[x]
The article advised the people of the community to stay at home and not try to go to work if they became sick. They should also "boil their handkerchiefs and keep away from others"[xi] to protect others within the household. These precautions made it apparent that the government and local authorities took the threat of this epidemic seriously and hoped to impede its advancement as quickly as possible.
Beginning in October of 1918, the influenza became a regular topic in the Dayton Daily News. Although the front page usually was reserved for coverage of the war, the other pages often contained articles on the number of cases and deaths, ways to prevent catching the disease, products being sold to treat the symptoms (Vicks Vaporub had trouble keeping their product on the shelves during this period[xii]), and even as a theme in the cartoons. "Polly and Her Pals," a popular comic strip centered on a stylish female character and her not so contemporary family, frequently referred to the disease. For example, one episode had her wearing "bacteria bibs" for protection, while another one found her bemoaning the fact that they never caught anything as "fashionable" as the Spanish Influenza.[xiii] It was rare that a day passed by without a mention of the disease somewhere within the newspaper.
About this same time, Dayton's Health Commissioner, Dr. A. O. Peters, began his crusade to keep the people of Dayton calm and to get them to work together to combat the spread of the disease. He warned the public that most of the cases in Dayton were due to the negligence of people that, when they or another family member were ill, did not take the proper precautions to keep the disease from spreading. He claimed that the deaths so far were caused by pneumonia, which developed because the patient returned to normal activities too soon. He recommended that anyone suspected of contracting the disease should be isolated from the rest of the family. Only one other person, who should wear a gown and mask when entering the room, should attend to the patient, and this person should wash his/her hands after leaving the room. He indicated that people were becoming unnecessarily frightened.[xiv] He wanted them to understand that some simple precautions and sanitary measures could protect them from the disease.
Despite everything, the number of cases kept increasing in the city, the state, and the country. On October 10, 1918, the State Department of Health required that influenza be included in the list of reportable diseases. Because the disease spread so quickly, the department set up a system that required the city health officers to mail a daily letter each evening that included the number of deaths and cases for that day. In turn, officials tallied these letters and reported the results to the federal government by telegraph the following morning. This system enabled the authorities in Washington to receive a continual update on the status of the disease throughout the country.[xv]
It was now necessary to takes steps beyond just warning and educating the public. Dr. Peters began to put some restrictions in place in Dayton. On October 8, 1918, he issued orders closing the schools, theaters and churches. The following day, he ordered the closing of all saloons, soda fountains, and poolrooms. (The fact that the churches were closed before the saloons was cause for many heated discussions in temperance circles.) He closed these establishments, along with anyplace people tended to gather, until further notice. The order applied "to all places where non-essential activities [were] carried on, and where a considerable number of persons [was] congregating."[xvi] The main objective of these closings was to safeguard the workforce involved in producing items for the war effort. It was crucial to keep a healthy workforce to support the needs of our fighting troops.
The ban did not affect activities that took place outside.[xvii] Despite the fact that the restrictions did not apply to the games, cancellations were a common occurrence for football and baseball because some teams did not have enough well players to put on the field. The Dayton Triangles, a professional football team, was able "to keep a team on the field" and "avoid 'flu cancellations',"[xviii] but a local college, St. Mary's, and Steele High School often had problems scheduling games because of sick players.[xix] Churches took advantage of the sanction of outdoor events and scheduled alfresco services. Convinced of the benefits of fresh air, officials often encouraged outdoor activities. After the lifting of a wartime ban that prohibited the use of gasoline on Sundays, the State Health Commissioner urged people to go for drives on Sunday because he believed that fresh air "was one of the best preventives of the disease."[xx]
Dr. Peters continued to investigate ways to prevent the disease from circulating. He ordered all perpendicular drinking fountains closed. He understood that a fountain that directed the water away from its source, rather than allowing it to fall back into it, was more hygienic and could help thwart the spread of the disease. Many public places were without water because of the closure of their drinking fountains.[xxi]
Dr. Peters permitted the soda fountains and saloons to reopen on October 11 "to sell goods but require[d] that there shall be no congregating of the individuals."[xxii] Strict regulations on what they could sell and hours of operation were enforced. Saloons could only sell bottled drinks that had to be consumed elsewhere. Patrons of soda fountains could only purchase ice cream in closed containers and refreshments in bottles. They could not buy ice cream in cones, and nothing could be eaten on the premises. A warning went out to all patrons in all establishments that they must "keep moving." Those places that did not conform were closed entirely.[xxiii]
Due to an increasing number of cases, the Red Cross put out many more calls for help. Although Caucasian females were the standard of the nursing profession, the agency was now willing to accept volunteers of either race or gender. According to a Chapter History from that time period, they had “about forty nurses [who] were kept busy all of the time” with "one nurse contend[ing] that she had 513 Influenza cases."[xxiv] In addition to nurses, they needed volunteers to go into homes affected by the malady to help with meals and other simple tasks. A quote contributed to Mrs. Frank Blum of the Red Cross stated that, "A woman with her normal share of common everyday 'horse sense' ought to be able to do many things for the sick."[xxv] Requests for nurses also strained the resources of Visiting Nurses Association. They had sent three of their nurses to Camp Sherman and two of them to Wilbur Wright Field, thus leaving them shorthanded to respond to the numerous calls from the citizens of Dayton. To handle the shortage, if there was a family member who was still able to assist others in the home that were sick, the Association resorted to giving instructions only, rather than sending someone to the home. If an entire family was down with the illness, they were told to go to the hospital.[xxvi]
Hospitals in the city were overtaxed. At Miami Valley Hospital over half of the occupants were those stricken with influenza. Ninety-six out of the 401 patients who died at the hospital in 1918 died from the disease. Fifty-seven of the student nurses and five of the regular nursing staff came down with the illness. The overcrowding caused by the influx of influenza patients forced the administration of the hospital to remove all nursing students and nurses who came down with the disease to the new wing of the Nurses Home for treatment. Nurses whose cases progressed into pneumonia "were transferred to the sun parlors on the third floor and during nice weather were wheeled out on to the brick roof adjoining where they were kept night and day."[xxvii] (Additional evidence of the belief that fresh air helped cure the disease.) St. Elizabeth Hospital had similar problems. During the months of October and November they treated a total of 454 cases of influenza. The administrators set aside four floors for the treatment of these patients. A doctor who found himself as a patient at the hospital claimed, "unless the nurses and sisters secure more assistance, I don't see how the hospital can keep up."[xxviii] The hospital sent out a call to "any young woman between the ages of 18 and 30, having the necessary one-year high school experience and contemplating entering the nursing profession"[xxix] to come forward immediately to help them in their crisis.
Restrictions even applied to those who succumbed to the illness. All funerals of influenza victims had to be private funerals with only relatives allowed to be present. During this era, it was a common custom to hold funerals at a residence, but the health commissioner now discouraged this practice. Even though a ban prohibited churches from holding Sunday services inside the church, the health commissioner did not object to funerals being held inside a church. He was aware that the mourners would not be in as close quarters as they would be in the home. Thus, there would be less chance for the spread of germs. All caskets had to remain closed unless a glass shield was provided.[xxx]
The ban on congregating in public places continued in Dayton until November 2, 1918 at which time '"the situation in the city…[was] sufficiently improved to warrant a partial lifting of the ban."[xxxi] All public places with the exception of schools reopened. Adults, now free from any restrictions on their whereabouts, came and went as they pleased. The schools remained closed due to reports of an increase in cases and severity among children. Orders from the health department barred children under sixteen from attending school, church, or the movies until further notice. At the same time he lifted the ban for adults, Dr. Peters issued a warning to the public to dress warmly as "custodians of buildings where public gatherings are to be held are requested to see to it that there is plenty of ventilation, without draft, and with a flood of outside air pouring into the building," and the streetcar operators would be following orders to keep their ventilators open.[xxxii] Exposure to the November air might necessitate those going out to put on some additional clothing, but again he thought exposure to this air served as a preventative to the disease. Officials reminded all places serving food that they must continue the sterilization of dishes and utensils ordered earlier.[xxxiii]
The number of cases among children dwindled, and they returned to school on Monday, November 11, 1918; however, the schools dismissed the students within an hour because of the celebrations taking place as word of the signing of the armistice ending World War I began to spread. Officials ordered the closing of saloons again, not as a precaution against the disease, but as a preventative against drunken celebrations. Parades formed spontaneously, and the citizens began to plan for more formal celebrations. The city's safety director asked for a ban on confetti as he believed it might help spread the disease.[xxxiv]
In early December, Dr. Peters issued an order closing the grade schools again because of an increase in the number of cases in grade school children. He also declared children under fourteen to be forbidden from any public place. While the children enjoyed an extended holiday vacation, they could not spend their time paying a visit to Santa because of the ban and a decree that no department store, church, or school Santas would be allowed that year. (Children were not the only ones affected by a change in the usual Christmas traditions—mistletoe sales fell because of the fear of the "bothersome little 'flu' germ…in the Dayton air.") One circumstance that made a significant impact on everyone's holiday mood was that no influenza deaths were reported on Christmas Day.[xxxv]
New Year's Eve brought the removal of all restrictions except the one on the use of confetti during the holiday celebrations. Children under fourteen could now go to public places again, and the recommencement of school on January 6 would end all bans on school attendance. In addition, an announcement that the children would not have to attend school beyond the normal summer deadline relieved the fears of students who worried that part of their summer vacation would be lost to make up for the time they were not able to attend (the ban had closed the grade schools for 31 days and the high schools for 22 days). Instead of extending the school year as some other communities chose to do, in the Dayton schools, the spring vacation was shortened from one week to one day, and that was the extent of the additional time requested to make up for the schools' closings during the epidemic.[xxxvi]
With the official reopening of all the schools and all the restrictions lifted on gathering in public places, Dr. Peters proclaimed a victory in checking the epidemic in the city. While there would still be some lingering cases and deaths, there would be no further need for any bans or limitations. On January 1, 1919, Dayton health officials reported in the paper that there had been 572 deaths from the disease since October and over an estimated 40,000 to 50,000 cases in the city. The Fourteenth Census of the United States in 1920 reported that the population of Dayton had grown from 116,577 in 1910 to 152,559 in 1920.[xxxvii] If the estimated influenza cases are correct, it is safe to assume that approximately a third of the population probably had contracted the disease. Even though the epidemic put a strain on the city, Dr. Peters recognized an "indirect benefit" that came from the epidemic. He noted "the fact that the epidemic ha[d] resulted in a campaign of education intended to teach the people the need of ventilation, better sanitary conditions and the fearful results of overcrowding" in addition to the "responsibility for one's health."[xxxviii] The effort put forth by the citizens of Dayton and its health commissioner not only contributed to the halt of the disease, but it also lead to a new awareness of the importance of hygiene as a method of prevention. As an end result, Daytonians overcame the problems caused by epidemic through a combination of education, commitment, and cooperation.
[i] "Governor Urges Health Reform in Biennial Message,” The Ohio Public Health Journal Vol. X (1919): 9.
[ii] Pascal James Imperato, M.D., What to Do About the Flu (New York: E.P. Dutton, Inc., 1976), 67.
[iii] William Ian Beveridge, Influenza: The Last Great Plague (New York: Prodist, 1978), 31.
[iv] Alfred W. Crosby, Jr., Epidemic and Peace, 1918 (Westport, Connecticut: Greenwood Press, 1976), 26.
[vi] "Influenza and Pneumonia Deaths in Ohio in October and November, 1918," The Ohio Public Health Journal Vol. X (1919): 70.
[viii] "Woman Rally to Hospital Call," Dayton Daily News, 4 October 1918, 22; "Local Nurses Enter Service at Chillicothe," Dayton Daily News, 8 October 1918, 11.
[ix] "Division of Sanitation, Navy Department, Issues Some Instructions as to How to Successfully Fight 'Influenza'," Dayton Daily News, 5 October 1918, 1.
[xii] "Notice, Retail Druggists, No More Vaporub Direct. Buy it from Jobber," Dayton Daily News, 23 December 1918, 5
[xiii] Cliff Sterret, "Polly and Her Pals—Nature Had Already Provided for Pa," Dayton Daily News, 14 October 1918, 9; Cliff Sterrett, "Polly and Her Pals—Pa’s Thankful There’s a Law of Compensation," Dayton Daily News, 6 November 1918, 10.
[xiv] "Unique Alarm in Influenza Outbreak Here," Dayton Daily News, 5 October 1918, 4.
[xv] "Controlling the Influenza Epidemic in Ohio," The Ohio Public Health Journal, Vol. IX (1918): 452.
[xvi] "Churches, Schools, Movies, Saloons Ordered Closed," Dayton Daily News, 9 October 1918, 1.
[xviii] "The Dayton Triangles—A War Year: 1918," by PFRA Research, In Related Articles: The Dayton Triangles (Dayton, Ohio: Carillon Historical Park Miami Valley Sports Committee, 2003 – [cited 26 February 2003]); Available from http://www.daytontriangles.org/1918season.htm.
[xix] "Ban on Amusements Does Not Effect Outdoor Games," Dayton Daily News, 9 October 1918, 20.
[xx] "Auto Riding Will Check Spanish 'Flu'," Dayton Daily News, 18 October 1918, 8.
[xxi] "Believe Wave of Influenza on the Wane," Dayton Daily News, 10 October 1918, 19; "Recurrence of Epidemic Not Expected Here," Dayton Daily News, 21 November 1918, 17.
[xxii] "Epidemic is Believed on Down Grade," Dayton Daily News, 11 October 1918, 1.
[xxiii] Ibid., 26; "Epidemic Improved Over Last 48 Hours," Dayton Daily News, 12 October 1918, 6.
[xxiv] David Lefkovitz and Mary B. Matthus, "The Montgomery County Chapter of the American Red Cross, Commencing with its Origin and Following Through the Period of the War Up to May 1, 1919," 1 May 1919, Folder F-3, Box 1, Records of the American Red Cross, Dunbar Special Collections, (Wright State University).
[xxv] "Many Nurses Enroll Here for Service," Dayton Daily News, 10 October 1918, 5; "Appeal for Nurses in Influenza Homes," Dayton Daily News, 29 October 1918, 13.
[xxvi] "Annual Report." January, 1919. Visiting Nurses Association. Dunbar Special Collections (Wright State University).
[xxvii]“"Twenty-ninth Annual Report of the Miami Valley Hospital," For the year ending 31, December 1918, 22 and 28, Miami Valley Annual Reports 22-38, 1911-1927, Archive Collection (Craig Memorial Library, Miami Valley Hospital, Dayton, Ohio).
[xxviii] "Aid is Needed at Hospital to Curb 'Flu'," Dayton Daily News, 9 December 1918, 12.
[xxx] "Quarantine to Continue for Another Week," Dayton Daily News, 16 October 1918, 18.
[xxxi] "Ban Lifting is Left with State," Dayton Daily News, 31 October 1918, 18.
[xxxii] "Official Order for Lifting Ban is Promulgated," Dayton Daily News, 1 November 1918, 13; "Warm Clothing Should be Worn," Dayton Daily News, 30 November 1918, 9.
[xxxiv] "Epidemic Has Spent is Force," Dayton Daily News, 10 November 1918, Second News Section 1; "Schools Dismiss," Dayton Daily News, 11 November 1918, 10; "Confetti Throwing May Be Banned," Dayton Daily News, 13 November 1918, 10.
[xxxv] "Grade Schools Will Not Open Here Tuesday," Dayton Daily News, 9 December 1918, 1; "Prevalance of Influenza Fast Running Course," Dayton Daily News, 22 December 1918, Part One 19; "Santas Will Not Visit in Stores," Dayton Daily News, 16 December 1918, 2; "Mistletoe Loses Its Favor; Kissing Ban Because of 'Flu'," Dayton Daily News, 23 December 1918, l; "Report No 'Flu' Deaths Christmas," Dayton Daily News, 26 December 1918, 2.
[xxxvi] "New Year's Eve Revelers Will Be Unrestrained." Dayton Daily News. 31 December 1918. 1; "Restrictions Off, Children Are Free on New Year's Eve." Dayton Daily News. 31 December 1918. 1; "Vacation Over; Flu Ban Raised; Schools Reopen." Dayton Daily News. 6 January 1919. 7.
[xxxvii] Fourteenth Census
[xxxviii] "Flu Quarantine May Be Lifted Coming Sunday." Dayton Daily News. 30 October 1918. 10; "572 Deaths in 1918 Traced to 'Flu' Epidemic." Dayton Daily News. 1 January 1919. 1.