Influenza 1918-19: Fear and courage in another outbreak

WASHINGTON - It started with the death of John W. Clore, 30, a widower, on Sept. 21, 1918, at the old Sibley Hospital in Washington.

Four days later, John Janes, 33, who ran a candy store and restaurant, died at home.

On Sept. 27, three people died - Amos Matticks, 33, Grayson B. Coffman, 20, and Pearl Morgan, 33.

Six more died on the 29th. Seven succumbed the next day and 27 on Oct. 5.

These were the initial victims in Washington of the great influenza pandemic that swept the world in 1918 and 1919.

Vastly larger and deadlier than the current Ebola outbreak, it killed an estimated 50 million people worldwide and more than half a million in the United States. It is considered among the worst epidemics in human history.

But its appearance almost a century ago bore similarities to today, and engendered the same kind of fear, courage and tragedy that comes with the spread of a terrifying illness.

Nurses and doctors were severely hit. Protective gear, but only in the form of gauze surgical masks, was widely used. Many who thought they had the flu turned out to have something else.

A viral illness, like Ebola, the 1918-1919 flu caused high fever, sore throat, a cough and sometimes a serious nosebleed, the U.S. Department of Health and Human Services wrote in a history of the pandemic.

"I had a cough that tore my very innards out," one victim recounted in a diary, historian Nancy K. Bristow reported in a supplement to the medical journal Public Health Reports in 2010.

The illness could spread quickly and suddenly, via coughing, sneezing or talking. Pneumonia was the most serious and deadly complication. The disease could kill in a day, or two weeks.

The pandemic broke out near the turbulent close of World War I.

Washington, one of the cities most affected, was packed with young federal war workers, soldiers, sailors and Marines that fall. Indeed, many of the flu's victims were people in their teens, 20s and 30s.

Hundreds of federal workers were living three or four to a room in private homes and boardinghouses around the city and suburbs, according to newspaper reports of the time.

The city was a "harvest field" for the flu germ, one newspaper editorial warned.

Beyond the city, thousands of soldiers were crowded into bases such as Camp Meade, now Fort Meade, in Maryland, and Camp Humphreys - now Fort Belvoir - in Virginia.

There, and at many other military installations, infections spread so rapidly that the government postponed a call-up of new fighting men.

The state of medicine was more primitive. At the time, influenza was incorrectly thought to be caused by bacteria, according to the HHS history. (The virus was not isolated until the 1930s, experts have said, and a vaccine was not available until the 1940s.)

In the face of the epidemic, the surgeon general of the Army urged the public to avoid wearing tight shoes, tight clothing or tight gloves: "Seek to make nature your ally, not your prisoner."

People were told to chew food well and to drink two glasses of water in the morning to prevent the accumulation of "waste products of digestion."

One newspaper correspondent thought that eating raw onions could prevent disease, as it had during the Civil War.

A doctor advised drinking daily one to three glasses of "clabber" - soured, thickened milk. The lactic acid in the milk was said to destroy flu germs.

Potions such as Father John's "body builder" and Gude's Pepto-Mangan were advertised to strengthen the system against the infection.

At one point, so many people were wearing unsightly protective masks that a local department store started selling chiffon "anti-flu" veils - "a becoming and easy way to prevent yourself from getting the 'flu.' "

Meanwhile, schools and churches were closed. Federal offices went to staggered schedules to alleviate commuter crowding. People were told to avoid crowds altogether.

Streetcar operators in Washington were urged to keep windows open, regardless of the weather.

Funeral rites, often held at home, could be crowded and therefore dangerous, and those who were not close family members of the dead were advised to stay away.

On Sept. 28, Congress appropriated $1 million, a substantial sum in those days, to fight the outbreak.

The death toll climbed. On Oct. 1, the deaths of Richard Keys, 28, and Susie Keys, 23, who lived in a tiny house in Washington's Georgetown neighborhood, were reported. Their relationship was not listed.

On Oct. 2, the District of Columbia government announced that "the epidemic … has not yet assumed alarming proportions … panic should be avoided."

On Oct. 3, Col. Charles E. Doerr, commandant of the hospital at Camp Humphreys, died. The … base had logged more than 1,800 flu cases in less than a month.

The District's health office opened a hotline on which flu cases could be reported and medical advice provided. On Oct. 4, the Library of Congress closed.

On Oct. 5, the deaths of John G. Meinberg Jr. 23, and his sister, Lena, 28, who lived near the Marine Barracks in the city, were reported.

Their parents, John and Elizabeth, had just returned home from the funeral of their daughter, who had died Oct. 2, when they were called to Georgetown University Hospital to be with their son when he died on Oct. 5.

There were at least 31 deaths that day.

By the middle of the month, more than 50 people were dying daily, and coffins and gravediggers were in short supply.

Washington officials reportedly seized a shipment of coffins headed for Pittsburgh, and the Army assigned soldiers to dig graves.

One grave dug at Arlington National Cemetery was for Army nurse Lillian Aubert, 30, who was buried with honors the morning of Oct. 9, according to a news report.

She had died three days before at Walter Reed Army Hospital, where she had cared for hundreds of flu patients. Six Army nurses served as honorary pallbearers. Members of the medical corps carried Aubert's casket.

Toward the end of October, the number of cases and deaths began to drop, according to an anthology of the epidemic's impact on American cities compiled by the University of Michigan and the Centers for Disease Control and Prevention.

Schools, churches and theaters reopened Nov. 4.

On Nov. 7, after the various preventive measures had taken hold, only six deaths were reported.

The flu would return on and off through 1919, but to a much lesser extent. In the end there were more than 2,800 deaths in Washington, according to the anthology, and 33,000 cases.

"Across the nation, hundreds of thousands of personal tragedies … changed the lives of those who survived," three physicians wrote in the public health journal. "Children were orphaned, a disproportionate number of young adults died, and for a brief period fear, suspicion, and panic prevailed.

"Yet even in this trying context," they wrote, "the historical record reveals that many Americans responded courageously during the crisis."