Influenza Epidemic in Minnesota, 1918

“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, which 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 unusual, 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.