1918 vs. 2020
In the midst of the 2020 Covid-19 pandemic, we take an in-depth look at the 1918 influenza epidemic in Western North Carolina through newspaper clippings, advertisements, ephemera, photographs, and oral history and place the events of 1918 into context with our present-day response to the coronavirus pandemic.
1918 vs. 2020:
Epidemics Then & Now in WNC
To Prevent Influenza, Illustrated Current News, October 18, 1918
National Library of Medicine #A108877
March 30, 2020
THE SPANISH LADY
In the midst of WWI, North Carolina began fighting an invisible enemy, one that eventually killed far more Americans than died on the battlefields – a new strain of influenza, referred to as “The Spanish Lady,” because of a rumor that Patient Zero came from Spain.
In reality, because Spain remained neutral during WWI the Spanish media also did not have to contend with wartime censors who controlled the messaging surrounding the flu in for the morale of both troops and civilians.
The Spanish media, however, freely reported on the epidemic beginning in late-May 1918. One week later, King of Spain Alfonso XIII contracted the illness, which further fueled rumors.
Because Spanish news outlets were the only media reporting on the epidemic, the public assumed the epidemic began in Spain.
In Spain, the highly contagious virus was called “The Soldier of Naples,” which was a popular – and very catchy (get it – “catchy”) song at the time. But Spaniards protested the name “Spanish flu” for the deadly disease as it falsely stigmatized the Spanish people.
Though still unsure of where the virus began, researchers have suggested France, China, Britian, and the United States.
And, in fact, the first known case of the 1918 flu was reported at Camp Funston at Fort Riley, a military base in Kansas in March 1918.
Albert Gitchell, an army cook at the camp, was hospitalized with a high fever and became one of the first registered cases. By the end of March, over 1,100 soldiers at the camp were ill and 38 had died.
Photo: Flu victims in an American emergency hospital near Fort Riley, Kansas, in 1918. Photograph: AP Photo/National Museum of Health
Newspaper Clipping: The Manhattan (KS) Mercury Sun, March 1, 1998
March 26, 2020
The Review, September 19, 1918
Mother Jones, March 21, 2020
THE SECOND WAVE
The first patient in North Carolina, William A. Wright, is likely to have contracted the virus from a port in Wilmington prior to September 19th.
Just a few days later, on September 21, Wright, a 29-year-old with two sons passed away. It quickly became apparent that the young and healthy were not immune to dying from this strain of influenza.
The Wilmington Star, September 23, 1918
In 1918, Wilmington delayed the start of the school year by several weeks, closed theaters, bars, and churches, and the newspaper published guidelines for staying healthy – among them: stay home, wash your hands, and cover your cough.
“The illness sometimes lasted seven to ten days. It hit suddenly with chills, a high fever, upset stomach, weakness, and other symptoms. It continued until the patient either recovered or died. Influenza struck without regard to class and race, but the majority of victims were young adults between the ages of twenty and forty. Pregnant women had an especially hard time. Each day local newspapers listed names of citizens who had died since the last issue.”
In 1918, Philadelphia ignored warnings of influenza spread among soldiers and a parade to support the war effort drew 200,000 people. Within three days, the hospitals in the city were full. By the end of the week 4,500 residents were dead.
In St. Louis, within two days of the first cases of influenza occurring, the city closed schools, playgrounds libraries, courtrooms, and churches. The city mandated staggered work schedules and limited streetcar transport. They banned gatherings of more than 20 people. The death toll in St. Louis was half that of Philadelphia.
Proceedings of National Academy of Sciences, 2007
In early October, “8,000 cases of Spanish influenza ha[d] been reported in North Carolina, with known deaths resulting from pneumonia following the influenza exceeding 50.” Six thousand of those cases were in Wilmington. [Asheville Citizen, October 5, 1918]
“Certain sections of the downtown business districts yesterday seemed to harbor premature Halloween celebrators…. Yesterday was the first time that Ashevilleians have appeared generally with the white mouth and nose coverings.”
People began carrying flasks again, which had been outlawed due to Prohibition – though rather than alcohol, the flasks contained mouthwash. [Asheville Citizen, October 16, 1918]
North Carolina was slow to respond with basic measures like temporary hospitals and quarantine areas and relied on volunteers to treat the sick.
Asheville Citizen, October 11, 1918
Asheville-Buncombe Technical Community College, April 6, 2020
Photograph by Anne Chesky Smith
By October, there were at least 600 confirmed cases in Asheville according to the Asheville Citizen.
Schools in the area were closed; church services were cancelled; street car schedules were reduced.
October 5, 1918
October 5, 1918
November 16, 1918
The Charlotte Observer
December 7, 1918
January 15, 1919
Without a vaccine, worldwide public health efforts focused on quarantine, hygiene, and limiting public gatherings. Newspaper advertisements and articles emphasized washing hands, avoiding crowds, and wearing masks. The ad here referred to those who did not wear masks as “dangerous slacker[s].” However, a shortage of masks in 1918 resulted in people making their own masks from home.
Berkeley Daily Gazette, October 23, 1918, MyHeritage.com
Though in March 2020 public health officials discouraged healthy individuals from wearing face masks because they were in short supply, by the beginning of April, the CDC began officially recommending “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.” Though homemade masks do not prevent the spread of disease as well as N95 masks, homemade versions can help prolong the efficacy of these lifesaving masks for health professionals and “slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.”
“The most horrific symptoms really were you could bleed not only from your nose and mouth, but from your eyes and ears. People were turning so dark blue from lack of oxygen that, in the book I quote one doctor writing a colleague saying that he could not tell white soldiers from African American soldiers.” – John M. Barry
Doctors, media outlets, and advertisers offered advice on how to prevent contracting the virus – with varying degrees of scientific evidence.
Some advertisers took advantage of people’s fears by promising their product as a preventative or treatment for the disease, like the for Laxative Bromo Quinine made by E.W. Grove – pharmaceutical magnate and builder of the Grove Park Inn in Asheville.
Newspaper Clippings: Asheville Citizen, October 1918
October 16, 1918 – “A leading doctor in the state of Georgia, who has passed unscathed through a serious yellow fever epidemic is authority for the statement that a little sulphur placed in the shoes each day is a positive preventative for Spanish influenza. The use of sulphur in this manner is not an altogether new thing in this city, for at least one colored woman in the city has been using it since the present epidemic started here.” Asheville Citizen
“I met many traveling men, and one in particular from Memphis, Tenn., who told me one evening that he had nursed yellow fever and cholera in all its stages, had assisted in burying the dead, and that the only precaution he ever took was to sprinkle sulphur in his shoes every morning during the epidemic and that he had never contracted the disease: furthermore, every one he told about it and who had tried it, not a single one had the disease.”
When the flu arrived in Asheville, hospitals were unprepared for the number of patients, and so, the American Red Cross, which had grown exponentially since the US had entered the war, began to open temporary emergency hospitals in public spaces across the region.
In October, the old Asheville high school building on Woodfin Street was converted to a hospital that could treat 100 white patients. The Veteran’s Hospital in Oteen loaned beds and other furnishings to equip the school as a medical facility.
The Masonic Temple was offered as an annex to the main hospital for the treatment of black patients. The annex would accommodate “fifteen or more.”
Also located at the Masonic Temple was the Red Cross emergency kitchen, supplying food to flu patients and their families. Care was taken to ensure that patients treated at the temple did not come in contact with food preparation areas.
Newspaper Clippings: Asheville Citizen, October 22, 1918
October 22, 1918 – Masonic Temple offered as an annex to the main emergency hospital in the old Asheville high school to treat black patients during segregation. [E.M. Ball Collection, D.H. Ramsey Library, University of North Carolina – Asheville Special Collections}
Asheville Citizen, October 1918
“Influenza is frequently complicated by the development of pneumonia and in these cases of pneumonia it is frequently necessary to use stimulate to carry the patient through.” – Col. Charles W. Stiles
The coronavirus pandemic has revived interest in the role design has played fighting infectious diseases. Most famously, the trailblazing modern architecture of the early 20th century — open to nature and filled with light and air, as practiced by designers such as Alvar Aalto and Richard Neutra — reflected au courant ideas about health and wellness, especially in combating the scourge of tuberculosis (which also influenced bathroom design).
The battle against pathogens reshaped the inner working of buildings, too. Take that familiar annoyance for New Yorkers: the clanky radiator that overheats apartments even on the coldest days of the year. It turns out that the prodigious output of steam-heated buildings is the direct result of theories of infection control that were enlisted in the battle against the great global pandemic of 1918 and 1919.
The Spanish Influenza, which caused just over 20,000 deaths in New York City alone, “changed heating once and for all.” That’s according to Dan Holohan, a retired writer, consultant, and researcher with extensive knowledge of heating systems and steam heating. (Among his many tomes on the topic: The Lost Art of Steam Heating, from 1992.) Most radiator systems appeared in major American cities like New York City in the first third of the 20th century. This golden age of steam heat didn’t merely coincide with that pandemic: Beliefs about how to fight airborne illness influenced the design of heating systems, and created a persistent pain point for those who’ve cohabitated with a cranky old radiator.
Health officials thought (correctly) that fresh air would ward off airborne diseases; then as now, cities rushed to move activities outdoors, from schools to courtrooms. When winter came, the need for fresh air didn’t abate. According to Holohan’s research, the Board of Health in New York City ordered that windows should remain open to provide ventilation, even in cold weather. In response, engineers began devising heating systems with this extreme use case in mind. Steam heating and radiators were designed to heat buildings on the coldest day of the year with all the windows open. Anybody who’s thrown their windows open in January, when their apartment is stifling, is, in an odd way, replicating what engineers hoped would happen a century ago….
“Emergency Call is issued for Doctors, nurses and workers both white and colored to keep people in Asheville from dying from starvation and lack of other attention.”
“Volunteer at Once – Work will be paid for when necessary but we appeal first to your patriotism.”
“Asheville chapter of the American Red Cross made intensive and intensive preparations yesterday afternoon … to aid the health department of the city in combating the epidemic of influenza.”
Asheville Citizen, October 13, 1918
With many doctors overseas attending to US troops, those that remained could not serve all the patients inflicted with influenza.
Most nurses, too, were stationed overseas. Communities in Western North Carolina – and across the country – had to rely on volunteers who were willing to risk their health to practice nursing. Female volunteers also cared for children whose parents were ill and prepared food to feed the poor.
Though segregation prevented black and white patients from being treated in the same facility, white patients readily accepted the help of black nurses.
“The office will be a place to which people may appeal their needs for doctors, nurses, medical supplies, nurses aids, necessary help in sick families, food…. The office cannot promise miracles….”
Photograph: Asheville, NC, American Red Cross Nurse Uniform from 1918. Collection of the WNC Historical Association.
From RawStory.com, April 19, 2020: National Public Radio reporter Tim Mak wrote an extensive Twitter thread after researching the way the flu outbreak spread throughout the United States in the early 20th century.
It began in San Francisco in Sept. 1918, he explained, and people were successfully wearing masks and cases were dropping. By November, public health officials said the city could reopen.
“Residents rushed to entertainment venues after having been denied this communal joy for months. The mayor himself was fined by his own police chief after going to a show without a mask,” said Mak.
Another wave of the virus came in Dec. 1918 and the health officials told people to start wearing masks again, but people refused. Businesses were worried about their Christmas sales, so they opposed the efforts, as did the Culinary Workers Union. Residents were over it, and they’d already been dealing with it for months. Police began fining or arresting people for not wearing masks, which sparked lawsuits from people claiming it was their Constitutional right to risk their own lives.
After the San Francisco Chronicle came out against mandatory masks, the death rate continued to climb, said Mak.
“An op-ed ran in the local paper w/headline ‘What’s The Use?’ after a man got sick despite following public health guidelines,” he explained. “A promised vaccine turned out to be bogus. Hundreds of citizens congregated on Dec. 16 to debate a masking order.”
On Dec. 19, he explained that officials voted down an order that would make wearing a mask mandatory.
“The dollar sign is exalted above the health sign,” the public health officer said, according to Mak.
“Citizens were arrested/fined for not having masks on, but widespread disobedience of the order continue & large numbers of citizens refused to wear masks,” said Mak, noting that the protests still continued.
The worst rate of deaths from the flu pandemic was Dec. 30. Finally, the council reconsidered their vote and passed the order on Jan. 10. A whopping 600 new cases were reported just that day.
Long Beach Press, January 21, 1919
00:00 – Downtown Asheville has reopened and not everyone is wearing a mask
01:45 – Recent COVID-19 cases in one church, health officials urge caution
WLOS.com, May 27, 2020
“PRAY THEY DON’T SING: In late November 1918, after nearly two months without services, city health officer Dr. Carl V. Reynolds allowed churches to reopen, despite the continued emergence of new influenza cases. As a precaution, Reynolds requested that church leaders omit singing from their services.” Photo courtesy of the North Carolina Collection, Pack Memorial Library, Asheville
“SICK OF BEING SICK: In the winter of 1920, Asheville residents were faced once again with an influenza outbreak and temporary city shutdown.” Photo courtesy of the North Carolina Collection, Pack Memorial Library, Asheville; photo doctored by Scott Southwick
NOTES FROM HOME
Told by Debbie Crane
When I was just learning to read, I prided myself on reading anything that presented itself. It was on a late spring day in 1966 when I found myself reading the tombstones in a small mountainside cemetery in western North Carolina. I had gone to the cemetery with my mother, Jessie Crane, and my grandmother, Edna Breedlove Clampitt. I remember scampering up to my mother and asking her why several of the tombstones seemed to have the same date of death. She told me to ask my grandmother that question. I did and my grandmother told me the story of her family and the flu that swept across the country almost a half century before our journey to the cemetery.
In the late fall of 1918, Edna and her family (her pregnant mother, dad, and 5 siblings) were living in a cabin in Swain County, North Carolina.
Even today, Swain County is pretty much disconnected from the rest of the world. It is a long 2–hour drive from Asheville, North Carolina. In 1918, it was even more disconnected. No one there had heard about the flu. They pretty much lived their own lives farming, raising families, and “praising the Lord.”
One of my grandmother′s brothers, Wade Breedlove, had joined the army. The family was thrilled when he came home for a visit in November. They “put the big pot in the little pot” for his visit, which means that they cooked special meals and everyone came to visit. No one knew that their brother had brought an untimely death to visit. He became ill shortly after he returned to base, but he survived.
The rest of the family wasn′t so lucky. By mid–December, the whole family was terribly ill. They ached.
Their throats hurt. They coughed and coughed. My great–grandmother, Ida Mae Breedlove, gave birth even as she lay sick. My grandmother described one terrible night when the whole family sounded as if they were all drowning. In the morning, Ida and 2–year old Woodrow were dead. The newborn, named Paul, died days later. My grandmother was never sure if it was the flu that killed him, or if he simply starved to death in a household where everyone was just too weak to take care of him.
Eventually, the rest of the family got better and moved on as best as they could without the strong mountain woman who had been their center. Until the day she died, at age 93, my Grandma Clampitt never remembered being this ill again. She was a woman of deep personal faith who recalled a moment near Christmas that year when she thought she saw an angel. That moment gave her the will to go on.
“They coughed and coughed. My great–grandmother, Ida Mae Breedlove, gave birth even as she lay sick. My grandmother described one terrible night when the whole family sounded as if they were all drowning. In the morning, Ida and 2–year old Woodrow were dead. The newborn, named Paul, died days later. My grandmother was never sure if it was the flu that killed him, or if he simply starved to death in a household where everyone was just too weak to take care of him.”
Oct. 20, 1918
My Dear Boy:
… Lee and I have been sick with Influenza and I wanted to get well before writing you so we would not give you any germs. There are a thousand or more cases in Hickory and there has been a number of deaths. The churches, schools, and all public gatherings…
…places have been closed over a week and still the disease rages. What is true here is true almost all over the State. The situation is very serious. The Drs are rushed and then can’t anything like get around. I will send you a bunch of Records and you can see the situation better than I can write it. The Annual conf. meets two weeks from Tuesday, some think it will be postponed indefinately [sic] if the situation doesn’t improve.
You see the preachers are not allowed to hold service and therefore the collections will be behind. It is raining today a very gloomy disagreeable Sabbath. I expect is will be hard on the sick.
Letter from Etta Eleanor Rankin Peeler to Corporal Lawrence T. Peeler, 20 October 1918,” UNC Libraries, accessed March 31, 2020.
“Those are the feelings I’m trying to get down, so, assuming I survive this, when I look back, I can see what it was like.”
– Peter Lipson
When the great influenza pandemic of 1918–1919 began, the most important sources of knowledge about epidemic influenza were studies conducted during and immediately following the previous pandemic, that of 1889–1990.
By 1918, the successful use of some vaccines, especially those against rabies, typhoid fever, and diphtheria, as well as the use of diphtheria anti-toxin, had raised high expectations for a vaccine against influenza. Those who already had a vaccine in hand were quick off the mark to promote their vaccines as sure preventives or cures for influenza. Drug manufacturers aggressively promoted their stock vaccines for colds, grippe, and flu. These vaccines were of undisclosed composition. As public anxiety and demand swelled, there were complaints of price gouging and kickbacks.
Preexisting vaccines of undisclosed composition were also endorsed by physicians such as M.J. Exner, who actively promoted in newspaper interviews and testimonials the vaccine developed some six years earlier by his colleague, Ellis Bonime. Bonime was a late champion of the tuberculin treatment of tuberculosis and an adherent of the opsonin theory of immune response and of the therapeutic use of vaccines. His vaccine was claimed to prevent pneumonia, influenza, and blood poisoning. Exner’s boosterism paid some dividends.
The State of Science, Microbiology, and Vaccines Circa 1918 by John M. Eyler, Public Health Reports, 2010
Sherman’s InfluenzaVaccine No. 38. Advertisement in the New Orleans Medical and Surgical Journal. Vol. LXXI, No. 6, December 1918.
American Journal of Public Health (AJPH), October 1918
New York Times, November 20, 2020
PREPARING FOR THE FUTURE
The epidemic hit a peak in October and November of 1918. At this time there were only two kinds of people living in North Carolina – those who were sick and those that cared for them.
By the New Year, the worst of the epidemic was over, but the damage had been done.
Nationally, the disease killed around 700,000, and some estimates suggest anywhere from 50 to 100 million deaths worldwide. It is esitmated that approximately 1 million North Carolinians caught the virus; it killed 13,644 in the state.
As the pandemic subsided, new hospitals were built around the state to make up for the lack of facilities. Health officials began promoting the importance of health education. The struggle to control the virus was the impetus for reorganizing and modernizing the state’s social health services beginning in 1919, so that if and when another outbreak occurred the state would be better prepared.
“That’s equivalent to 225 to 450 million people today,” said John Barry, who wrote a history of the 1918 flu and is on the adjunct faculty of Tulane University. “The numbers are staggering.”
North Carolina, Influenza, 1918
Number infected: ~1 million
Number killed: 13,644
Illustration from the October 1918 issue of the Health Bulletin (vol. 34, issue 10), published by the North Carolina State Board of Health. Accessed via The State Archives of North Carolina.
North Carolina, COVID19, 2020
In March 2020, Asheville’s River Arts District silo mural, which usually says, “Stay weird,” was changed to read, “Stay home” by anonymous request to muralists Ian Wilkinson and Ishmael. Photograph: Anne Chesky Smith