Influenza Encyclopedia

The Influenza Epidemic

The first cases of influenza in the Charleston area were reported on September 16 among sailors at the nearby Charleston Naval Training Station. Naval officials there quickly instituted measures to control the spread of the disease, including a prohibition on sailors entering Charleston except under special circumstances, an outright ban on naval personnel entering any city theaters whatsoever, and the elimination of recreational and entertainment gatherings at the station. To help identify and isolate cases, medical officers undertook an inspection of all sailors at the station; they found approximately 350 cases. A few days later, army officials announced a raging influenza epidemic at Camp Jackson outside Columbia, some 110 miles northeast of Charleston. As of yet there were no reports of cases within Charleston proper, although Health Officer Dr. J. Mercier Green expected that to change soon enough. “Everything comes in the course of time,” he told reporters. “We’ll be hearing of it before long.” In the meantime, he tried to calm the public’s fear of the disease they had learned was spreading quickly down the coast. “I dare say most anything in the line of grippe would be classified by the patient as Spanish influenza just now,” Green joked. “That’s the way people are. If they must be sick, they intend to be sick with the proper thing.” He quickly added that real influenza, however, while it fortunately tended to be an illness of short duration, was no laughing matter.2

Meanwhile, Charleston was in the midst of a growing typhoid epidemic. In early September, thirteen cases of typhoid suddenly appeared in the city. Authorities were baffled as to the source of infection. In the past, typhoid outbreaks in the city had been linked to contamination from privy vaults. In this case, however, a number of the cases were from homes in the central section of Charleston, areas served by water and sewer lines. A few days later, the outbreak was traced to milk tainted by unsterilized bottles.3

As the typhoid problem was being brought under control, the influenza epidemic was gathering steam across the East Coast. Trying to prevent its spread into South Carolina, Governor Richard Manning asked the State Board of Health to ban the upcoming Ringling Brothers circus tour, scheduled to make appearances across the state with a troupe of elephants dressed as surgeons and Red Cross nurses.4 State Health Officer Dr. James A. Hayne informed Governor Manning that the Board of Health could not discriminate against the circus, and could only prevent its tour if it closed all other forms of traveling entertainment as well. The Board thus wisely chose to leave the ultimate decision with Governor Manning, who managed to negotiate with the circus for a limited tour across South Carolina. In Charleston, Ringling Brothers agreed to limit its appearances to October 4 and 5.5

On October 1, with the epidemic growing more severe, Health Officer Green asked all Charleston physicians to report their influenza cases. Of the public, he asked that people cover their coughs and sneezes and rest in bed until well if they should develop symptoms of the disease. Green worried that Charlestonians might not take the epidemic seriously. Debating the proper name of the epidemic sweeping down the coast and across the nation, one resident told reporters that he did not care what it was called, “so long as it doesn’t get me. Anyway, the Spanish influenza isn’t near as harmful as German influence.” Green disagreed. “No other communicable disease which assumes epidemic proportions spreads so rapidly or attacks indiscriminately so large a portion of the population,” he told the public. “Past epidemics have been characterized by a profound prostration out of all proportion to the intensity of the disease.”6 German influence did not kill, but epidemic influenza certainly could.

By the first days of October there were an estimated 350 influenza cases in Charleston and one death. Several of Charleston’s institutions, if not all of its residents, heeded Health Officer Green’s warnings and leapt into action. The local chapter of the Southern Division of the American Red Cross appointed a director general of civilian relief to prepare for the impending epidemic. It also appropriated funding to pay for graduate and practical nurses, nurses’ aides, and other related expenses. The College of Charleston suspended all campus activities and dismissed its student body. The Citadel, a military college located in Charleston with close connections to the army and to the SATC, had closed on September 29 for fear of its students contracting influenza from soldiers. The city’s public schools promised to have principals report cases of influenza in the schools and to send ill students home. In the meantime, school officials prepared for a possible closure in the coming days.7

It came just two days later, on October 5,when the Board of Health ordered closed all public and private schools, churches, theaters, movie houses, and other places where people congregate, and prohibited social gatherings and meetings.8 Health Officer Green also called on the streetcar operator, Consolidated Company, to keep its trains well ventilated. Ventilation was not the only problem: within a few days, the company had so many conductors, motormen, and mechanics ill with influenza that they it had trouble simply keeping enough cars in service. As a result, service on several city lines and on the Navy Yard line was curtailed.9

Charlestonians might have been expected to avoid social gatherings, but they were nonetheless called upon to participate in the fourth Liberty Loan drive to be held the second week of October. After issuing the closure order and gathering ban, the Health Department fielded a large number of inquiries about the Liberty Loan meetings. Despite the 212 new influenza cases reported in the previous two days, Health Officer Green told the public that it was their patriotic duty to attend the meetings. Some Americans were at war, facing enemy bullets. Those still at home, he said, should therefore “make martyrs of ourselves… by facing a possible illness in order to help our country in time of need…. We may contract influenza. But if we do, we shall have done so in a splendid cause.” Drawing on the imagery of trench warfare, Green added that staying away from the Liberty Loan campaign “savors suspiciously of lagging behind while others go ‘over the top.’”1 It was good patriotic advice for a nation at war, but not the best public health guidance for a community in the midst of an epidemic.

As early-October rolled on, the number of new cases continued to rise. Between noon of October 8 and noon of October 9, Charleston physicians reported 132 new influenza cases to the Health Department. As the case tallies mounted, the demand for nursing care skyrocketed. But, as in nearly every other community, there simply were not enough to handle to massive caseload. The Charleston chapter of the American Red Cross urged local women to volunteer their services. “Anyone accustomed to taking temperature and pulse can be of service,” the secretary of the chapter told the public.11 The Red Cross had previously given courses in home nursing as well as in dietetics, specifically in preparation for a possible epidemic or similar emergency when the brunt of nursing care would fall to the public. Many Charleston women had availed themselves of the courses. Unfortunately, few of them now came forward to volunteer.12

A week later, the Red Cross announced that it, in conjunction with Charleston officials, had divided the city into separate administrative districts. Each of these districts would be headed by at least one trained nurse who would direct volunteer workers. Residents were notified that they should telephone the nearest district headquarters if they had a case of influenza that required care. The hope was that this districting would help make the Red Cross’s care services more efficient, as the small number of available nurses and volunteers would not have to work the entire city, only a discrete district. Every little extra bit of efficiency the Red Cross could squeeze out of the system would help, as the situation had become dire. In one case, a young child lay in bed for three days without assistance, both of his parents delirious with influenza. In another case, an entire family was stricken with the disease. Two members had died, and the other three were prostrate with fever and unable to remove the bodies or care for themselves.13

By late-October, over 5,500 Charlestonians had been stricken with influenza. This was the official tally. Health Officer Greene assumed that the real number was double that, since he suspected that overworked physicians were drastically underreporting cases. The epidemic seemed to be waning, though, and the last few days of the month saw no new reported cases.14 Green was hopeful that the worst was over, but was in no hurry to see the social distancing measures lifted quite yet. In fact, hearing of the State Board of Health’s decision to lift the closure orders across South Carolina on November 3, Green wrote State Health Officer James Hayne to request that Charleston be excluded from such a move. “It would be a great mistake to have this quarantine lifted too early and undo what it has been so hard to accomplish,” he wrote.15 Hayne agreed to keep Charleston under the restrictions, even as he ordered them lifted in most other areas of the state on November 3.16

Not everyone shared Health Officer Greene’s beliefs. Particularly upset were members of Charleston’s clergy. The Bishop of Charleston, William T. Russell, protested the continued closure of churches while circus parades were allowed. How would American soldiers in Europe feel if they knew loved ones back home could not pray for them, he asked. “This consolation is denied them by a drastic law of dubious scientific value… [and] in answer to their protestations they are flippantly told by a health officer: ‘It is better to be restless than to rest,’” he wrote in a letter to the editor of the Charleston News and Courier.17 Other clergy felt similarly, and also expressed their extreme disappointment in the closing of their churches.18

No doubt Bishop Russell and his colleagues were none too thrilled with their city’s heavy – and officially sanctioned – reliance on whiskey as an influenza curative. In mid-October Governor Manning assented to allow Charleston Mayor, Tristram Hyde, to distribute whiskey to help fight the epidemic. Bootleg whiskey confiscated by the police was placed under the control of Health Officer Greene and his office, to be dispensed to physicians for their use while making their rounds of the city, or to sick individuals holding a valid prescription from their doctor.19 The demand for liquor far outstripped supply, however, and Greene worried that there would not be enough to treat the new rise in pneumonia cases. Daily, residents lined up at the dispensary window for their quart, sometimes waiting for hours. Some complained that the amount given was too small to be effective, especially when an entire family was sick. At least one man complained that he had to wait in line with African Americans. When a private citizen donated a number of quarts of whiskey to the Health Department, Greene announced that his office would happily accept all such assistance.20 Meanwhile, police busily poured thousands of gallons of confiscated whiskey into the sewers.21

Finally, with new cases on the wane, Health Officer Greene announced that the closing order and gathering ban would be lifted at midnight on November 6. Children were happy to learn that schools would not reopen for an additional week. Unfortunately for them, their usual Christmas holiday break was reduced from ten days to three in order to make up some of the lost classroom time, requiring students to attend school on New Year’s Day.22 Adult Charlestonians were thrilled to know that they could once again return to their normal routines, comforted by the knowledge that the epidemic was over. As the days of November rolled by, few new cases were reported, giving Health Officer Greene confidence in his decision to lift the closure.

In the end, over 6,000 cases of influenza - ten percent of the city’s population - were reported in Charleston during the course of the epidemic. Despite the large number of illnesses and deaths, some good did come from the epidemic. The large number of cases highlighted the need for more public health and patient care resources in Charleston. The local chapter of the Red Cross Motor Corp and its auxiliaries had driven a staggering 1,196 miles during the epidemic, going out on over 3,500 individual calls to check on influenza victims and bring severe cases to the hospital. An additional ambulance was ordered to help in the event of a future public health crisis. Home nurses had been severely overtaxed by the epidemic, highlighting the need for more nurses to be trained.23 Child welfare advocates called for increased medical inspections of students, starting a petition to appoint at least one physician and one visiting nurse to each school.24 At the state level, Hayne announced that the South Carolina Board of Health would ask the General Assembly for $93,000 to improve health facilities and for disease-prevention work.25 Perhaps then, the devastation wrought by the influenza epidemic was somewhat tempered by the renewed resolve Charlestonians felt to improve their city’s faltering public health and patient care system.