Influenza Encyclopedia

Four days later, a handful of cases suddenly cropped up at the Benson Polytechnic School in an army training detachment of some 300 student-soldiers housed in the city’s commercial district. The school, founded in 1908, had only just moved to its new location at Northeast 12th and Hoyt less than a month before, and was now in the midst of a major public health crisis. Both Portland Health Officer Dr. George H. Parrish and the commanding officer of the school, Major Robert A. Roos, were notified of the cases. Major Roos immediately placed the school under quarantine, revoking all passes and prohibiting cadets from either leaving campus of outsiders from entering. The four confirmed cases and six suspected cases were placed in isolation. From the Vancouver Barracks, officials ordered Portland entertainment venues off-limits to all uniformed army personnel. Military police were dispatched to the city to notify all theater owners and managers of the new order and to round up any servicemen who were sitting in the audience. Theater owners complied so well that a group of Marine Corps officers was denied entry a few days later when they attempted to see a show, despite the fact that the order applied only to soldiers and not Marines. Local officials, both military and civilian, fully expected the epidemic to hit Portland, but hoped that these combined preventive measures would help keep cases of influenza in Portland to a minimum.2

Meanwhile, Portland officials braced for the impending epidemic. On October 6, Health Officer Parrish met with theater owners and developed a campaign to have lanternslides on influenza prevention and treatment shown before movies. Within a few days a small number suspected cases began to crop up around the city. Parrish personally visited each of them, only to declare that all had colds and not influenza.3 This was a common occurrence in many cities at the start of the epidemic, when cases often appeared milder, when doctors were uncertain just how severe the epidemic form of the disease could become, and when health officers were perhaps eager to assure the public – and maybe themselves as well – that the epidemic would spare their city.

Whether these cases were really colds or the start of Portland’s epidemic we will never know. It matters little though, as state and local officials assumed influenza was well on its way and did not rest on their heels. On October 8, after receiving United States Surgeon General Rupert Blue’s circular recommending the use of closure orders, and well aware of the destruction the epidemic was visiting on cities across the United States, the Oregon Board of Health notified communities across the state that all schools, churches, and places of public amusement were to be closed immediately upon the appearance of the epidemic in their locales. In Portland, Parrish urged school officials to ventilate the classrooms and to have teachers provide instruction on influenza prevention and treatment to their students. School Superintendent D.A. Grout went further, and ordered an end to all school assemblies, including gym class, and warned students not to congregate in groups. Concerned that his city was on the verge of an epidemic, Parrish cancelled the trip he planned to take to Chicago to attend the annual conference of the American Public Health Association so that he could remain in Portland and monitor the situation.4

The next day, October 9, Portland officials met to consider preemptively issuing a general closure order. Aside from the cases at Benson Polytechnic, which had by now increased to 30, there were still no confirmed civilian cases of “Spanish” influenza in Portland. The dozen or so new cases of influenza that had cropped up were all dismissed as old-fashioned grippe and not the epidemic form of the disease. Influenza was not yet a reportable disease, however, and thus Parrish had no way of knowing just how widespread the epidemic might be in his city. At the meeting, Portland’s Mayor George Luis Baker announced that he would do everything in his power to check the spread of the epidemic, but stated that he was not in favor of closing schools, churches, theaters, and other places until the situation demanded such action. Mayor Baker, a self-made man who started shining shoes and selling newspapers in San Francisco at age 9, was a wily politician with close ties to Portland’s business community. He was not ideologically opposed to shutting businesses if necessary, but he did not relish the idea. A closure order, he said, “is a very serious measure… and with the few cases which have been authenticated here so far, there seems to be no need of immediate action.” Portland officials agreed, and decided to postpone enacting any measures for the time being.5

Forced to Close

The postponement lasted one day. On the afternoon of October 10, Mayor Baker met once again with local officials, as well as with state and federal health authorities. This time Portland had no choice but to close places of public gathering, the result of a state Board of Health order handed down to all Oregon communities that same day. Interestingly, the Board took Surgeon General Blue’s recommendations as an actual order, or at least let local communities perceive it as such. The Board’s letter to Portland began with the powerful words “By the order of the surgeon general of the United States public health service…” In his early-October circular, Surgeon General Blue had not ordered local communities to close their public places, instead only recommending that they consider doing so. With the exception of a handful of communities, and mostly where local officials had expressly asked for federal assistance, the United States Public Health Service showed little interest in nationalizing local campaigns against the epidemic. None of this mattered to Portland, however, as the order came directly from the state, which had the legal authority to force such measures. Baker immediately complied, ordering the city’s schools, theaters, dancehalls, and churches closed, and prohibiting all meetings, parades, or other gatherings effective the morning of October 11. Undoubtedly all of Portland’s 36,000 schoolchildren – several hundred of whom did not learn of the order until they arrived at school – and most of its 1,000 teachers were glad to hear the news. A few large groups of Portland’s schoolchildren, freshly released from the drudgery of their usual daily schedule, descended upon the city’s libraries to meet up with friends. As a result of this, the libraries were closed later that day, although circulation services continued.6

Portland health officials and physicians were confident that they could handle the situation, as thus far there were still only a relatively small number of reported cases. No one knew for sure, however, just how many residents were ill with influenza. Mayor Baker announced that the number stood at fifty. Parrish suggested that there were an additional fifty on top of that. Dr. Robert Holt, the state Board of Health OCityfficer, maintained that there were approximately 200 cases in Portland. The exact number mattered less than the trend, though, and within a day local physicians were busy answering calls from the ill and their loved ones. Thus far only two deaths had resulted from the epidemic: one man, who contracted influenza while in Denver, died after jumping from his window at Samaritan Hospital while delirious with fever; the other was a soldier who had recently arrived in Portland from Camp Fremont, California. Parrish and his health officers still refused to believe that most of the suspected cases were true influenza, however, instead diagnosing the vast majority of them as severe colds. Parrish described the flu situation in Portland as excellent, telling residents that the city was “in a fair way to escape a widespread epidemic of this influenza.”7

Within a few days, Health Officer Parrish began to change his tune, if only slightly. On the morning of October 16 he reported to the City Council that scores of residents were in need of emergency care, and that the city hospitals lacked the space to accommodate them. The City Council immediately agreed to make the city Auditorium available for use as an emergency hospital for those unable to afford their care. At the same time, however, Parrish refused to accept or admit that reports of large numbers of new cases – 460 reported to date – were in fact influenza cases. He continued to maintain that the majority of these cases were simply bad colds. Two days later, when the number of reported and alleged cases crossed the one thousand mark, Parrish still maintained that only ten percent were actually influenza. The Oregon Daily Journal reported this large number of cases under the headline “Health Condition in Portland Is Almost Normal,” neatly overlooking the fact that the number of cases of respiratory disease in the city, whether one believed them to be due to influenza or the common cold, had spiked so dramatically that the city’s auditorium had to be converted into an emergency facility.8 It was a stunning example of citywide denial.

For the next several weeks, discussions surrounding the epidemic turned to complaints about the closure order and questions of when it might be lifted. After receiving several petitions claiming that children were safer in schools where they could be kept in sanitary conditions and carefully watched by their teachers, the state Board of Health held a meeting to decide if schools should be re-opened. In executive session it ruled that they would remain closed the time being.9 Portland’s Christian Scientists petitioned the State for permission to hold church services, claiming that they were safe from the malady due to their beliefs. When that did not work, they added that they wished to see all churches re-opened. “That now, when woe and pestilence are abroad, and the whole world is torn with strife,” said one of their representatives, “the police power of the state should not be used to prevent Christian worship in the churches, but that all should be able to exercise their constitutional right to worship God according to the dictates of their own consciences.” The president of the Board of Health, Dr. A. C. Seeley, passed the proverbial buck, claiming that the State was merely carrying out the orders of the federal government.1 When another minister chimed in to complain about the closing of churches, Parrish testily responded that if they “want to do a real act of humanity they will put on caps, gowns and gauze masks and offer their services as nurses at the municipal hospital.”11

By the final days of October the epidemic seemed to be on the wane, at least to Parrish and other local health officers. State health officer Seeley was not so certain. No one contemplated removing the restrictions on crowding, however, out of fear that the disease might make an even stronger comeback. In fact, officials redoubled their efforts to stamp out the epidemic. After receiving complaints from theater owners that department stores were sources of crowding, Parrish ordered that stores halt all special sales. He also ordered all windows removed from streetcars, both to increase ventilation and to discourage their use altogether.12 In early-November, city officials discussed the possibility of closing all stores but ultimately decided against it. Instead, business hours were restricted and staggered to alleviate congestion on streetcars.13

Then, on November 6, the city launched an ambitious plan to use schoolteachers as observers and to spread information about influenza prevention and treatment. Why they waited nearly a month – and until the epidemic seemed to be on the wane – to do so is anyone’s guess. The program was voluntary but it was hoped that most of Portland’s 1,000 teachers would take part. The city was divided into districts with principals serving as precinct captains. In addition to providing information about influenza to residents and making home visit, these teacher-volunteers were to police their districts to ensure that all public health regulations were being followed carefully. They were to placard homes of the ill with signs reading “INFLUENZA IN THIS HOME,” keep crowds from forming on streetcars, and to observe restaurants for crowding. Teachers were advised, “not to hurt anybody’s feelings, but [to] teach them their shortcomings.” They were given full authority as deputy health officers.14

Portland Re-Opens

Many of the program’s central points were short-lived, as a few days later Mayor Baker issued a proclamation lifting Portland’s closure order effective Saturday, November 16. The dramatic shift in attitude came after state and local health officers received reports of dramatically reduced new case tallies across Oregon. There was some concern that the recent celebrations of the false armistice might lead to a spike in new cases. When the spike failed to materialize, Baker pressed to remove the order, meeting with Parrish as well as representatives of local business interests. Technically, Baker did not have the authority to lift the restrictions; such a decision was up to the state Board of Health. But state health officer Seeley, was in attendance at the meeting and gave his sanction, all but removing any concern that the other members of the Oregon Board of Health would disagree with Baker’s move. Just in case, Baker issued a public statement to cover himself. “The ban in the first place was placed on Portland by order of the board of health, which order I was obliged to follow out,” he wrote. “In view of the conditions as I now see them, I shall refuse to take any further responsibility for maintaining the ban unless forced to do so by the state board of health… or unless I am convinced before that date that the disease has taken another turn for the worse.”15 The Board agreed that it was time to lift the ban.

The lifting of epidemic restrictions was met with the ringing of bells and the blowing of whistles in many American cities. Portland’s re-opening on November 16 was a more laid-back affair. As the Daily Journal put it, the “flu lid” did not go off “in the form of an explosion… it just naturally oozed off, gently and quietly, like an oyster.” The only bells would be the ringing of church bells the following morning, a sound not heard for five straight weeks. The Journal joked about the joy of schoolchildren who would return to their classrooms on Monday morning, going “back to the grind with additional hours of daily incarceration to make up for lost time!” Movie house and theater owners certainly had reason to be joyful even if children did not. So did candy shop proprietors, soda fountain owners, and lunch counter operators, all of whom counted on the additional business movie and theatergoers brought. Those eager to get a head start on their holiday shopping were happy they could once again ride the streetcars in comfort – “without an Arctic breeze,” as the Journal put it – now that the windows were replaced.16

Portland only received a brief respite, however. Within a week or two the number of new cases began to slowly rise. At first Parrish tried to pin the increase on the recent damp weather and, once again, on colds masquerading as influenza. He claimed that new cases were averaging about the same as they had at the time the closure order was lifted. By early-December it was clear that Portland’s influenza situation was not clearing up as fast as officials had hoped. The city’s hospitals were filled to capacity, and plans to close the temporary Auditorium Municipal Hospital that week had to be abandoned. Parrish now blamed irresponsible individuals and physicians for the situation, arguing that the epidemic would have been over by now otherwise and threatening the city’s residents with a new round of closures. “I believed that Portlanders had been educated to the dangers of the disease,” he told residents. “Evidently they have to, and so it may again be necessary to plunge the city into gloom, both economic and social.”17 Even though Seattle was experiencing the same phenomena, it never occurred to him that perhaps the closure order was lifted too soon, or that Portland’s experience was typical of many American cities.

Despite his rhetoric, Parrish was just as eager to avoid another set of closures as the common layperson or business owner. He therefore issued a set of rules he hoped would quell the epidemic without creating undue hardship. The main thrust of the new order was to prevent crowding and promote ventilation: theaters could seat patrons only to capacity, department stores had to keep their aisles clear and inspect their employees for signs of illness, and streetcars were required to have their top and bottom windows bolted open. The Portland and the Multnomah County medical societies endorsed Parrish’s action, passing a resolution of agreement and pledging to back it up fully. The physicians in attendance also expressed their outrage that “certain interests had used their influence to intimidate the health bureau when endeavoring to enforce the closing law,” a jab, perhaps, at the theater owners and merchants who had pressed city officials for the removal of the closure order. They forgot that Mayor Baker had done so only with Seeley’s sanction.18

When Parish’s new set of anti-crowding rules did not produce the desired effect, Mayor Baker turned to more drastic measures. On December 11, the Mayor presented the City Council with a resolution calling for the complete quarantine of all suspected cases and family members. Baker’s rationale was that irresponsible individuals were not remaining at home to recover as they should have been, and thus spreading the disease. Parrish agreed that the epidemic’s continuance was largely the result of individual failings, but strongly disagreed with the use of quarantine, arguing that they had proven impractical in the past. He also worried that locking up an entire family with only one ill member would soon result in the whole family coming down with influenza. He advocated that one person be assigned to take care of the ill person and that the rest of the family members get plenty of fresh air and exercise. “We have tried other things and have not succeeded,” Baker responded, adding “I am responsible for the conduct of the health department and I have decided to give the quarantine idea a trial.” Retailers and theater owners certainly liked the idea, as it placed the onus on the ill and meant their places of business could remain open.19

The City Council passed the resolution, placing influenza on the list of quarantineable infectious diseases. Portland police and the county guards were called on to help the health department’s twenty officers enforce the quarantine, although private physicians were warned that they did not have the authority to forbid patients to leave their homes. The next day, health inspectors and police officers were busy placing the white and red placards on the homes of the ill. The penalty for violating quarantine – either leaving or entering a placarded home – was a fine of $5 to $300 and five to ninety days in prison. Instantly many cases of influenza turned into the common cold as people tried to avoid the quarantine. One woman, surprised to wake up to find her home under quarantine, called the health department in anger to ask why a placard had been tacked to her front door. She was told that her family physician had reported her son as having influenza. “Well, I’ll certainly call him up and roast him,” she angrily replied, “as my boy only has a slight cold and he got up this morning and went to school.” A man who found himself placed under home quarantine called the health department and claimed that he was not only strong enough to go to work, but “plenty strong enough to come up to the health office and ‘clean’ the health officer.”20

One expected side effect of the quarantine was a drop-off in the number of cases of influenza reported by unscrupulous physicians. It was widely believed that many city doctors were over-diagnosing influenza in the hopes of making a few extra dollars from patients. Officials hoped that this practice would end with the use of quarantine, and that the new case tallies would show a sudden decrease. Alas, these results did not materialize in the days immediately after the quarantine order went into effect. Some physicians did attempt to change their former reports of cases in order, but only to relieve their patients of the onerous burden of quarantine. The health department announced that it would be happy to assist physicians who had made honest mistakes, but that it would give no consideration to those trying to help get their patients out of quarantine. Evidently the health inspectors thought the latter was more common, as the health department roundly ignored all requests made by physicians.21 Portland’s quarantine, like any other throughout history, was far from perfect.

By late-December the epidemic again appeared on the wane. Plans were made to close the Auditorium Municipal Hospital and to transfer the few remaining patients to downtown sanatorium. Parrish noted that quarantine signs were rapidly being taken down across the city as patients recovered. Schools reported normal attendance when students returned to school on January 2 after their holiday break. Then, suddenly, new cases once again began to rise. January 4 saw 276 new cases reported, an increase over the 246 reported the day before. This time, Mayor Baker blamed the resurgence on under-heated apartments, and he introduced an ordinance in the city council compelling building managers to provide adequate heat to their units or face a $500 fine.22 The resolution passed, bringing warmth to apartment dwellers but little protection from influenza.

E. A. Sommer and the Consolidated Health Board

New cases continued to mount throughout early-January. Exasperated by all of its failed attempts to stamp the epidemic out, on January 9 city, county, and public school health officials created a special five-man Consolidated Health Board, led by Dr. E. A. Sommer of the Portland School Board, and charged it with leading the campaign to end the disease once and for all. Sommer quickly took control. He commandeered all local hospitals, banned public dancing, ordered that all patients who could be treated at home not be taken to a hospital, and vowed to prosecute all doctors who failed to report cases promptly. He ordered the Benson Polytechnic School, the epicenter of the city’s epidemic, be converted into an emergency hospital with room for 150 patients. The next day the Consolidated Health Board determined that it would be more expedient to utilize unused space in local hospitals. An extra two hundred beds were crammed into the corridors and rooms of Portland’s hospitals to accommodate additional cases, and private rooms and nurses were banned. Policemen were stationed at city hospitals to ensure that no visitors entered the buildings. As soon as patients were well enough to be moved, they would be transferred to the Couch School to convalesce, freeing up beds in the hospitals for more cases. In the schools, an additional fifty nurses would be used to monitor students for signs of illness. Those who became ill were to be sent home immediately and the house placed under quarantine. Sommer was confident that with these efforts, and with the cooperation of Portlanders, “results should be secured at an early date.”23

Sommer did not stop there, however. Over the course of the following two days his Consolidated Health Board enacted and refined a host of other regulations. Public dances, originally slated to be banned altogether, would be allowed under draconian rules: only one person for every twenty square feet of floor space, with each dance to last five minutes or less with at least a four minute intermission. The number of passengers on streetcars was to be strictly regulated, and all cars were required to have their windows open at all times. Screens were to be placed between patrons in public eating-places. Overcrowding in theaters and movie houses was prohibited. Lastly, the committee recommended the passage of a face mask ordinance.24

A draft face mask resolution was drawn up, mandating their use by all persons entering a shop, store, poolroom, theater, office building, taxicab, or streetcar, and setting the penalty for failure to comply at a whopping $500 fine and 60 days in jail. The debate over the resolution was heated, and frequently required Baker to call for order. The influenza committee, an advisory committee of business interests, and the many members of the medical community present all supported the resolution. Standing in opposition were several former and current council members, one of whom managed to strip the resolution of its emergency status, relegating the measure to a 38-day waiting period before it could go into even go into effect. Another councilman called the draft ordinance “autocratic and unconstitutional,” adding that it was “class legislation, and under no circumstances will I be muzzled with a mask like a hydrophobia dog.” After several hours of discussion, the ordinance failed when one of the opposing councilmen declared that mask use should be voluntary and that he would therefore not support the measure. Later, one person present characterized the meeting as “the greatest menagerie I have seen since I visited the New York Zoo – including the monkey cage.”25

Sommer’s proposed mask ordinance was quashed, but he did not give up entirely. Instead, he turned to their voluntary use. He announced to families with ill members that a “modified quarantine” would be acceptable if only one member, masked whenever in contact with the patient, cared for the influenza victim. That would allow the other family members to come and go as they pleased.26 He implored churchgoers to wear masks while at their Sunday services. “The disease is so easily spread,” he told them, “that all persons going to church without protection are endangering the lives, not only of themselves, but of all others in attendance.” At least one pastor took matters into his own hands, requiring congregants of his First Presbyterian Church to wear their masks in order to be admitted. The pastor of Westminster Presbyterian Church called for a the universal use of masks as well as a return of the closure order, arguing that the epidemic had already cost the city millions and thus needed to be stamped out as soon as possible.27

Flu Fatigue

But masks in Portland, as in other cities where their use was either advocated or mandated, were unpopular. So were the various and failed attempts by a host of political figures, health officers, physicians, and civic organizations. The city was tiring of its battle with influenza and the battles between the multitudes of experts. The Daily Journal, up until this point a supporter of the various efforts to knock out the flu, printed a long and darkly humorous editorial of sorts poking fun of the situation, especially the recent fight over face masks. The health officials, the school officials, the women’s organizations, and the medical societies all met separately and decided what should be done, the Journal mocked. Meanwhile, the “little ‘flu’ germ wandering into the meeting with an onlooker, found the nice, warm, stuffy air to his liking, and chuckled to himself as his listened to the discussions of the eminent gentlemen.” The article joked that when one flu germ asked another how he had arrived at the meeting the response was, “I came via Dr. Wiseman’s coat pocket. This nice smelly mask was in there and I have found it much to my liking.” One local church leader blasted the city’s leaders for not doing more. “We have a right to expect more than we are getting from our public leaders and officials,” he said. “The toll of the disease is taken daily, broken homes and hearts fill the city, losses incalculable are incurred, while city commissioners, health officers and doctors do nothing.”28 The epidemic was taking its toll on everyone, including the healthy.

And still it marched on. The week of January 12-19 saw the largest number of new influenza cases in Portland since early-November, some 1,847 altogether. The city seemed helpless to stop the epidemic, which was now about to enter its fourth month. Neither Parrish nor Sommer had been able to quell the rising tide of cases or deaths, despite trying a host of measures ranging from a general closure order to quarantine. Finally Colonel G. M. Magruder of the United States Public Health Service was called in to aid the city’s fight against influenza. Magruder was formerly in charge of the Camp Lewis extra-cantonment zone in Washington, and now, along with twenty-two trained nurses from the camp, was tasked with applying the methods and tactics he used to help there to Portland. Magruder was a strong advocate of face masks, basing his belief in their efficacy on what he considered to be sound, logical judgment. “Wearing of masks is not the result of scientific investigation, but is a common sense measure,” he told reporters upon his arrival in town.29 At least he seemed eager to help. The same could not be said for his nursing counterparts, who were assigned to work in either local hospitals or at the Visiting Nurse Association: when they arrived in town three immediately left the city, two took up private cases, and five failed to report for duty. According to Sommer, the nurses “did not want floor work, they all wanted to be superintendents, and if a superintendency was offered, it was declined.”30

In the last week of January, the number of new cases began to decline, indicating that perhaps the epidemic was finally drawing to an end. On January 26, Sommer tentatively declared that the peak of the second wave of the epidemic appeared to have passed in Portland. He was bolstered in his opinion by the number of prescriptions for influenza treatments being filled by city druggists. Over the course of the next few days Sommer became more confident that the end of the epidemic was nigh. A slight increase in cases reported on January 28 did not change his mind. “In spite of the increase, I believe we have the disease under control,” he told reporters.31 Finally, on January 31, Sommer officially declared the epidemic over. He cautioned the public to expect small numbers of cases to continue, and warned that every precaution be taken to avoid a third wave. But for now, at least, Portland’s bought with the deadly plague appeared to be over. City officials were still worried that the disease would make another comeback. To prepare for this possibility, the City Council passed a mask ordinance that would go into effect in thirty days, in time for a third wave if one erupted. This time there was little opposition to the measure. Sommer recommended that the public not wait for a month to pass before donning their masks.32 Ten days later the City Council suspended the mask ordinance when it became clear that a dreaded third wave had not materialized.33 Portlanders breathed – freely and unencumbered by masks – a collective sigh of relief.

Conclusion

Portland’s influenza epidemic experience was in many ways unique. Eastern cities generally suffered a rapid, steep spike in cases in the first few weeks of the epidemic, followed by a sharp decline in cases. Their epidemics caused large numbers of cases and deaths, but were over relatively quickly. Midwestern cities tended to have double-peaked but overall less severe epidemics. In the West, cities experienced variations on those two themes. In Portland, however, the epidemic, while it certainly had its peaks and dips, was generally a long, arduous slog over the course of many months. As a result, Portland experienced a cumulative excess death rate (that is, the death rate during the entire epidemic period above and beyond the normal deaths one would expect) of 505 per 100,000 people, even though none of its peaks climbed above 60 per 100,000.

The city was also unique for the myriad players involved in the war against the epidemic. Most cities had just one health officer in charge of controlling the epidemic. Portland had four: Parrish, Seeley, Sommer, and Magruder. Each had different ideas on just which measures would be most effective, and each had a different interpersonal style. What they all shared, however, was a common belief that the reason for the length of the city’s epidemic rested with the careless and selfish people of Portland.

To some extent this was a theme common in many cities, where officials exhorted residents to take personal precautions to avoid crowds, to remain at home if they felt ill, to cover their mouths and noses when sneezing or coughing, to wear their flu masks, etc. Rarely was the populace directly blamed for the continuance of the epidemic, though. There was a basic understanding that while individual action could or should help end the epidemic quicker, to be sure. But it was also understood that the disease had a natural course that would have to be run out before it ended. In Portland, by contrast, the sheer length of the epidemic and the frustration over the inability to stamp it out quickly led many officials to blame the citizenry. As Sommer stated at end of the city’s bout with influenza, “The biggest thing we have had to fight in the influenza epidemic has been apathy, or perhaps the careless selfishness of the public.”34 Sommer may not have been completely wrong, however, in blaming the public for the length of the epidemic. Unfortunately we have little quantitative and even less qualitative evidence to determine the level of community compliance with the many public health measures enacted in Portland during the fall and winter of 1918 to 1919. But one can assume that Portlanders were just as frustrated by the lingering of the disease as health officials were, and therefore perhaps less likely to comply with public health edicts and recommendations over the course of several months.