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Influenza Epidemic in Minnesota, 1918

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Influenza quarantine sign

Minnesota State Health Department, influenza quarantine sign, not dated. Minnesota Department of Health, Reports and Miscellaneous Records, 1872–2002. Posters, Circulars, and Reporting Forms, undated and 1890s‒1940s.

“I had a little bird, its name was Enza. I opened the window, and In-Flu-Enza!” Children innocently sang this rhyme while playing and skipping rope during the 1918 influenza pandemic that caused an estimated fifty million deaths worldwide. 675,000 of these were in the United States; over 10,000 were in Minnesota.

The influenza virus that caused the worldwide pandemic originated in Haskell County, Kansas, in early 1918. By March, 100 soldiers at Camp Funston, Kansas, now Fort Riley, became ill with the flu. As the soldiers were deployed to fight in World War I, they carried the virus with them and spread it rapidly worldwide.

The first flu case in Minnesota was reported in Wells in the last week of September in a soldier who had returned home on leave (train travel was effective in spreading the virus). Additional cases were quickly reported in other areas of the state. It produced high death rates among children younger than five years old, adults sixty-five years and older, and, more unusually, people between twenty and forty years old.

Signs of the disease appeared quickly, and a victim could be healthy in the morning and dying by late evening. Extreme and agonizing symptoms included cough, exhaustion, general body pain, chills, fever, congestion, and bleeding from body orifices. Victims could develop highly unusual, devastating lung damage resulting in pneumonia, cyanosis (blue skin), and quick death, or secondary bacterial pneumonia. The intensity and speed of the disease stunned doctors.

The flu, also known as the grip or grippe, occurred in three waves in 1918: March to early summer; the fall; and winter extending into early 1919. The highest mortality occurred during the second wave, when returning troops brought the virus home. Although named the Spanish flu, it did not originate in Spain. Spain, however, was the first country to report cases since its newspapers were not under war censorship.

The hospital at Fort Snelling admitted its first case of influenza on September 27. Within ten days, 850 patients had been admitted, most with the flu. Two hundred of those developed pneumonia, with sixty-one deaths. Most of the patients were men under the age of twenty who had enrolled in the Students’ Army Training Corps (SATC) at the University of Minnesota. Close contact in classrooms and barracks was likely the cause of the explosive spread of the infection. The epidemic peaked there around October 15.

From November 5 through November 16, 1918, the Aitkin Base Hospital admitted 158 patients. Upon admission, 122 were diagnosed with influenza and twenty-seven with pneumonia. Seven people with the same last name from Andersonville, probably a family, were admitted on November 5—five with influenza and two with pneumonia.

To reduce the spread of the flu, health officials directed Minnesotans to rest, use handkerchiefs, and go to bed and contact a doctor if symptoms arose. They discouraged standing in crowds, spitting on floors and sidewalks, and sharing drinking cups and towels. Government officials throughout the state closed public spaces in an attempt to prevent the spread of the flu. Schools, libraries, dance and pool halls, theaters, bowling alleys, churches, and lodge halls were shuttered. Public events such as parties, meetings, and funerals were banned. After children in Bemidji flooded a school playground on the Sunday after school was closed, the mayor authorized ten men to patrol the city to ensure the stay-at-home ban was respected.

The epidemic affected multiple areas of community life. In St. Paul, operating elevators in buildings with less than seven stories was prohibited to reduce human contact. Streetcar drivers were directed to keep their windows open so that fresh air could circulate; the number of riders allowed was reduced. Retail businesses could not advertise sales and their hours were regulated. Postal carriers and the Boy Scouts delivered influenza information to homes, stores, and offices, but compliance with the regulations was variable. On the night before the public events ban went into effect in Minneapolis, people gathered in lines outside theaters despite the risk of disease exposure. While some protested the changes, monetary cost, and income loss while complying with the rules, others blatantly defied them. Minneapolis and St. Paul health officials were inconsistent in managing the epidemic in their cities.

Dr. Henry Bracken, the secretary of the Minnesota State Board of Health during the epidemic, expressed frustration with the shortage of nurses and doctors to care for the sick. One-third of doctors were already supporting the war effort, and others were in northern Minnesota caring for forest fire victims. Others were sick themselves, had died from the flu, or feared exposure to the disease.

Burial of the dead was complicated by a shortage of coffins. Undertakers, grave diggers, pall bearers, and clergy were also ill and dying. The Warren Sheaf in Marshall County reported that influenza claimed the life of a couple who were married on October 23. The bride died on Thursday afternoon, October 31, and the groom died the following morning. They were buried in the same grave. The priest who married them died on November 2, ten days after the ceremony.

On November 22, Captain F. L. Smith, medical director of the Northern Military District of the Home Guard, reported on his tour of the towns and hospitals in his area. He closed the schools in Kimberly and Aitkin. By then, the epidemic had ended in McGregor, but Brookston had thirty-three flu and ten pneumonia cases in the hospital, with sixty people being treated at home. Eight people were in the Floodwood hospital and 160 patients had been treated in Automba—eighty with the flu and fifteen with pneumonia. A good portion of the area had also been severely damaged by the forest fires.

In 1920, the Minnesota State Board of Health reported that there had been 257 influenza deaths in 1917 (before the new strain of the virus entered the state). That number jumped to 7,521 in 1918 and 2,579 in 1919. The majority of the deaths occurred from October 1918 through January 1919—October, 2105 deaths; November, 3,260; December, 2010; January, 1012. During that same period, Minneapolis, St. Paul, and Duluth reported 1,103, 944, and 327 deaths, respectively. The number of deaths due to influenza dropped dramatically by the spring of 1919.

In May 1919, the Office of Indian Affairs, Department of the Interior, reported that the Native American population in Minnesota was 5,792. From October 1, 1918, to March 31, 1919, there were 1,633 influenza cases in this hard-hit group. Eighty-five deaths resulted, with a fatality rate of five in 100. (The data were likely incomplete, and it is unknown whether the deaths of Native Americans were included in the state total.)

Since there was no effective vaccine or antibiotics to treat flu complications, people turned to home and commercial remedies. A Dr. Delmore in Roseau County advised eating squirrel soup. Gargling with disinfectant solutions and wearing gauze masks to prevent exposure to cough and sneeze droplets was common. Quarantine to prevent exposure was the primary means of managing the epidemic.

In 1918, viruses were unknown, and the cause of influenza was incorrectly attributed to a bacterium known as Pfeiffer’s bacillus. It wasn’t until the 1930s that scientists proved that the flu is caused by viruses.

Editor’s note: A pandemic is not equivalent to an epidemic. In an epidemic, a disease affects large numbers of people within a relatively local community, such as a city or county or state. In a pandemic, a disease affects people across a broader area, such as a nation or continent. Therefore, the sections of this article that refer to the worldwide influenza crisis of 1918 use the word pandemic; those that refer to the spread of influenza inside Minnesota, including the title, use the word epidemic.

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Bakeman, Mary. “Aitkin Base Hospital Report, November 1918.” Minnesota Genealogical Journal no. 50 (September 2013): 4927‒4930.

Barry, John M. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York City: Penguin Books, 2005.

Barry, John M. “The Site of Origin of the 1918 Influenza Pandemic and its Public Health Implications.”
Journal of Translational Medicine 2, no. 3 (January 20, 2004).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC340389

Brady, Tim. “Fire and Flu.” Minnesota Medicine 88, no. 1 (January 2005): 28‒31, 45.

Brown, Curt. Minnesota 1918: When Flu, Fire, and War Ravaged the State. St. Paul: Minnesota Historical Society, 2018.

CDC—Centers for Disease Control and Prevention. History of the 1918 Flu Pandemic.
https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/1918-pandemic-history.htm

Dowd, Susan. “The Spanish Influenza in St. Paul in 1918, the Year the City found the ‘Wolf’ at its Door.” Ramsey County History 40, no. 1 (Spring 2005): 19‒23.
Eighth Biennial Report (New Series) of the State Board of Health and Vital Statistics of Minnesota, 1918‒1919. Minneapolis: Syndicate Printing, 1920.
https://quod.lib.umich.edu/f/flu/3420flu.0014.243/4/--eighth-biennial-report-new-series-of-the-state-board

Eyler, John M. “The State of Science, Microbiology, and Vaccines Circa 1918.” Public Health Reports 125, Supplement 3 (2010): 27–36.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862332

Filzen, Darlene. “The Influenza Pandemic of 1918: An Overview and its Effect on Brown County, Concentrating on New Ulm.” 2003.

“Flu Masks made by Red Cross Ladies.” Bemidji Daily Pioneer, November 14, 1918.

“Flu Verse Sets In.” Bemidji Daily Pioneer, November 9, 1918.

Hennepin History Museum Blog. World War I and the Influenza Pandemic.
https://hennepinhistorymuseumblog.wordpress.com/2018/07/27/world-war-i-and-the-influenza-pandemic

Hörzer, Thomas. “The Spanish Influenza Pandemic in St. Paul, Minnesota: A Microhistorical Approach.” PhD dissertation, Karl-Franzens University of Graz, 2015.
“Influenza Claims Newly Married Couple.” Warren Sheaf, November 27, 1918.
https://chroniclingamerica.loc.gov/lccn/sn90059228/1918-11-27/ed-1/seq-1
“Influenza Lid Clamped Tight All Over City.” Minneapolis Sunday Tribune, October 13, 1918.
Influenza Encyclopedia. The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia. “Minneapolis, Minnesota.” University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library.
https://www.influenzaarchive.org/cities/city-minneapolis.html

Lund, Alice. “The 1918 Flu—My Memories of Early Falun Township.” County of Roseau Centennial, 1895‒1995. Roseau, MN: Roseau County Historical Society, 1994.

101.G.18.9B
Minnesota Department of Health, Division of Disease Prevention and Control, Communicable Disease Histories, Influenza
State Archives Collection, Minnesota Historical Society, St. Paul
http://www2.mnhs.org/library/findaids/hlth001.pdf
Description: Table A, Division of Vital Statistics, influenza death statistics by months and counties for the years of 1917‒1919.

109.K.11.4F
Minnesota National Guard, Home Guard Records, Administrative Files, 1917‒1919, Medical Director: Flu Epidemic, 1918
State Archives Collection, Minnesota Historical Society, St. Paul
http://www2.mnhs.org/library/findaids/gr00862.xml
Description: Medical director inspection reports of medical facilities caring for influenza patients.

Ott, Miles, AB; Shelly F. Shaw, MPH; Richard N. Danila, PhD, MPH; and Ruth Lynfield, MD. “Lessons Learned from the 1918‒1919 Influenza Pandemic in Minneapolis and St. Paul, Minnesota.” Public Health Reports 122, no. 6 (November‒December, 2007): 803-810. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997248/pdf/phr122000803.pdf

“Parents Must Keep Children Close to Home.” Bemidji Daily Pioneer, October 14, 1918.

“Re-Open City, Plea of Labor.” St. Paul Dispatch, November 10, 1918.

“Showing the Number of Deaths of Influenza Reported to the Bureau of Health during the Month by Wards, October, 1918 (table), November, 1918 (table).” St. Paul, Minnesota Bureau of Health Monthly Bulletin, vols. 7–10, 1918–1921.

US Army Medical Department, Office of Medical History. “Excerpts on the Influenza and Pneumonia Pandemic of 1918 from War Department Annual Report to the Secretary of War, Fiscal Year Ending June 30, 1919.” P2, General Hospital No. 29 (Fort Snelling, MN). Personal collection of the author.

US National Library of Medicine, National Institute of Health. “Influenza among American Indians.” Public Health Reports 34, no. 19 (May 9, 1919): 1008‒1009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1996915/

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Turning Point

The worldwide influenza pandemic arrives in Wells, Minnesota, in the last week of September 1918 when a solider returns home from a training camp.

Chronology

September 1918

The first influenza cases in Minnesota are reported in the last week of the month in Wells. Cases in North Branch and Minneapolis quickly follow.

October 12,1918

In a letter, Navy sailor Ignatius Hannon of Minneapolis writes that during his train journey from Chicago to Charleston, the flag-draped coffin of an influenza victim was unloaded at about every station; ten to fifteen were unloaded in big cities.

October 12,1918

Small fires combine to form the Cloquet, Duluth, and Moose Lake forest fires. The fires kill 450 people and burn 1500 square miles of land.

October 14, 1918

The Bemidji Daily Pioneer reports that Red Cross volunteers have made eighty-five gauze masks to prevent flu exposure and plan to make more.

October 14, 1918

In Bemidji, motion picture theaters, churches, and schools are closed due to the influenza. Ten men will canvass the city to ensure that children remain at home. HOME GUARD drill and Commercial Club meetings are also cancelled.

October 1918

The Bureau of Health in St. Paul receives reports of 3,238 influenza cases. There are 219 deaths, including 155 males and 64 females. One hundred and seventy-six of the victims are between twenty and thirty-nine years old.

November 9, 1918

Children repeat a rhyme to protect themselves from influenza: “Protect your schoolmates from disease, Use your handkerchief when you sneeze.”

November 10, 1918

Influenza patients at St. John’s Hospital in St. Paul occupy 144 of the 150 beds in the building.

November 11, 1918

The Allies and Germany sign an armistice ending World War I.

November, 1918

The Bureau of Health in St. Paul receives reports of 3,402 influenza cases. There are 385 deaths, including 201 males and 184 females. Two hundred and thirty-eight of the victims are between twenty and thirty-nine years old.

November, 1918

E. C. Rosenow of the Mayo Clinic's Division of Experimental Bacteriology develops an influenza vaccine that contains Pfeiffer’s bacillus, the bacterium suspected of causing influenza. It proves ineffective because it does not contain the influenza virus.

Spring, 1919

By May, the number of deaths in the state due to influenza dropped to 109 with thirty-eight in June.

October, 1919

Benjamin F. Simon, M.D., Chief Health Officer of St. Paul, reminds physicians that “every case of influenza should be immediately reported” to avoid another flu epidemic.

1930s

The influenza virus is isolated from infected pigs which is closely followed by the isolation of the flu virus from humans. This proves that a virus and not a bacterium causes influenza.