When the "Spanish" Flu Hit Grinnell...

As the centennial of the 1918 flu pandemic approaches, a growing number of publications are reporting on this most deadly epidemic, estimated to have afflicted some 500 million worldwide, killing somewhere between 50 and 100 million people. Despite the passage of time and the development of scientific epidemiology, much remains unknown about the 1918 flu. Even its place of origin—Spain according to the name attached to the disease at the time—remains unsure; the latest research indicates that the flu may well have begun in Kansas...or any of several other places around the world. Moreover, the rather sudden ebbing of the disease in late 1918 was not the result of any medical cure; the best theory is that the H1N1 virus at the root of the epidemic itself mutated to a less virulent strain, leading to a break in the deadly march of the illness. Welcome as the disappearance of the disease was, the fact that medicine did not solve the illness raises the unhappy prospect of the virus reappearing some day with even more deadly consequences than prevailed in 1918.

Most writing about the 1918 epidemic embraces a  broad perspective. In this post, however, we will focus upon the flu as it presented itself here in Grinnell. When did it reach Grinnell, and with what consequences? At a time when Grinnell was in the process of building two modern hospitals, how did Grinnell and its citizens respond to the flu outbreak? And what impacts did the epidemic leave behind in Grinnell?

A 1910 postcard of Grinnell's city hospital (6th and Elm), the only hospital when the 1918 flu hit town
(Digital Grinnell)

***

Although news of the "Spanish" flu had been around for months, Grinnell entered autumn, 1918 without much evident concern about the illness. Several locals had died during the summer months, but there was nothing irregular in their deaths, and none of them seemed linked to the dreaded flu. The first inkling of impending trouble came with an October 1st editorial in the Grinnell Herald that reprinted an article from the Journal of the American Medical Association. Although the writer encouraged readers to practice careful isolation of victims of the flu so as to prevent transmission, in other respects the editorial preached calm. The illness now named "Spanish influenza," the writer allowed, 

should not cause any greater importance to be attached to it, nor arouse any greater fear than influenza without the new name...It has already practically disappeared from the Allied troops. The course of the disease is similar to the condition which has always been called influenza, except that it seems in some cases more severe, that it shows an extraordinary degree of contagiousness, and that it is complicated or followed, in perhaps as many as 5 per cent of cases, by bronchophenuomia [sic].

Folks need not be overly concerned, the editorial continued, because "Medical authorities of the Army, the Navy and the Public Health service are thoroughly alive to the condition, and are taking active measures to control it."

John M. Barry, writing about the 1918 epidemic in a recent Smithsonian Magazine, blames public officials for downplaying the seriousness of the disease until the epidemic had gotten out of hand. Certainly there was little in the brief Grinnell Herald editorial to prepare the town for the viral storm that was about to blow through Poweshiek County.

***

Since the flu virus was not identified by microbiologists until 1933, diagnosis in 1918 depended mainly upon symptoms, especially, perhaps, upon the prompt lethality of the disease. Complications often gave victims pneumonia, so that it is difficult to say with certainty who was Grinnell's first fatality from the 1918 epidemic as many deaths were attributed to pneumonia. It seems likely, therefore, given the fact that the disease appeared in epidemic form among American troops long before it reached Grinnell, that Grinnellians first came face to face with Spanish influenza through the young men who contracted the disease in military barracks far from central Iowa.

Already in late September, for example, the Grinnell Herald reported the death of Fred Leroy, 23 years of age. Having enlisted in the army in 1917, Leroy fell ill at Camp Dix, New Jersey where his unit was headquartered; he was dead within a week, a victim, the newspaper reported, of "pneumonia following attack of Spanish influenza." There soon followed numerous obituaries of other Grinnellians in uniform, most having been felled by the flu and its complications rather than by enemy action.

Photograph of Fred Leroy (1895-1918) (Grinnell Herald, October 1, 1918)

The newspaper so often reported these fatalities that at the end of yet another October obituary of a Grinnell soldier the writer concluded with this somber reflection:

The dread influenza seems more to be feared than the bullets and shells of the Hun, and is making sad havoc in the ranks of the Poweshiek soldiery. We shudder when we think, who will be next.

News of civilian flu victims also began to appear on the pages of the town's newspapers. For example, the same Grinnell Herald issue that reported on the death of Fred Leroy also carried a brief article about Lorna Palmer, no soldier but a teacher at the Iowa School for the Blind in Vinton: "Brilliant College Graduate Passes to the Great Beyond." The Herald soberly acknowledged that "Miss Palmer had been sick but a week and was a victim of the prevailing influenza." Although the paper did not say it directly, Palmer's death proved that the dreaded flu was killing not only soldiers far away but also civilians in rural Iowa. It seemed inevitable that the flu would soon take up residence in Grinnell.

That autumn numerous Grinnellians died from illnesses like pneumonia that might well have followed an attack of influenza, but the first Grinnell citizen whose death the obituary directly blamed on the flu virus was Hallie Denlow Raymond (1897-1918).  Like Fred Leroy and Lorna Palmer, Hallie Raymond was young—as many of that year's fatalities were—and her death (October 14) came quickly, within a week of infection. Although the casket of Fred Leroy had been open for the funeral in his wife's parents' home in Grinnell, by the time Hallie Raymond was buried in Hazelwood Cemetery October 16, the quarantine had come into effect. Consequently, Raymond's "funeral service [was] held only at the grave on account of the character of the disease" (Grinnell Herald, October 18, 1918). The death certificate, however, specified not influenza but pneumonia as the cause of death, influenza being mentioned only as contributory, indirect confirmation of the difficulty that medical professionals encountered when diagnosing the disease.

Death Certificate for Hallie Raymond (1883-1918)
(https://www.familysearch.org/ark:/61903/3:1:3Q9M-CS6V-L981-F?i=2616&cat=2558528)

Regrettably, Hallie Raymond's death was not an isolated event, but rather the harbinger of more death. Three days later James Creamer, Deodoro Lucis and Carrie May Taylor died; on the 18th Samuel Anderson, and on the 19th Alfred McNabb and Chris Watson. On the 23rd, one-year-old Lus Abila died, and on the 24th another one-year-old, Pearl Rucker. The following day three-year-old Ione Garver died. Altogether in October ten Grinnell residents died from infection with influenza.

Public officials, perhaps sensing the wave of illness coming their way, imposed a quarantine on Monday, October 14: schools were closed, movies shut down, and no meetings—not even public funerals—were permitted. Grinnell College was allowed to continue, but only under the condition that the campus itself be quarantined from the town. The Herald, reporting on this development, nevertheless urged calm: "While there are quite a number of cases of influenza in the city and vicinity, and some of the people are very sick, there have so far been but few complications with pneumonia or other diseases. Many of the afflicted persons have recovered or are convalescing" (October 15, 1918, p. 1). According to the newspaper, altogether "only about 50 cases" had been reported in town, and another 50 in the surrounding countryside. In other words, a quarantine was prudent but not urgent.

Grinnell Herald October 18, 1918

If Grinnell officials were tempted to abandon the quarantine, the Iowa State Board of Health short-circuited any attempt at lessening the quarantine. On the 17th the Board issued an order demanding that all Iowa municipalities observe a strict quarantine, even if locals thought the situation not too threatening. Grinnell's mayor posted the Board's order in the newspapers, merely acknowledging the state's action.

The quarantine made sure to exempt business from any restrictions, and newspapers continued to huckster the usual array of goods and services, rarely alluding to the sickness that was becoming increasingly evident. Even before the quarantine was instituted, an advertisement in the October 11th issue of the Grinnell Herald attempted to take advantage of the epidemic. A small ad headlined by the all-capital letters ("SPANISH INFLUENZA") alleged that the "sneezing, the racking cough and the inflammation in chest and throat of Spanish Influenza is swiftly relieved by the old-fashioned cold remedy of goose-grease and turpentine." With the addition of menthol, wintergreen and "other healing oils" a Fort Dodge company produced something called "Men-Tho-Eze." "As Spanish Influenza is still spreading," the advertisement acknowledged, "there should certainly be a 30-cent jar of Men-Tho-Eze ready at hand in your home—preparedness pays." At the height of the epidemic, Men-Tho-Eze published additional advertisements in the Grinnell Herald. In early January, 1919 the local Marinello hair salon in the Spaulding Block published a small advertisement in the Scarlet and Black, urging readers to purchase the firm's "scalp treatments for falling hair caused by Spanish Flu."

Image taken from icollect247.com (https://www.icollect247.com/itempage/uniqueid/121710)

The steady drum beat of illness overwhelmed Grinnell's inadequate hospital facilities. The city's lone hospital, opened in 1908 at 6th and Elm, could not meet the demand for beds, which led the Red Cross to establish an auxiliary hospital for non-infectious cases in the home of Dora Pottle at 1405 Park Street. Even this addition proved insufficient, with the result that many victims remained in their homes, nursed by family members who not infrequently themselves soon fell ill. The Red Cross, therefore, begged for volunteers—especially any women who had been trained as nurses—to visit and help treat victims in their homes.

Headlines from articles in the Grinnell Herald, October 18 and October 22, 1918

Within a week of having imposed the quarantine, city officials were feeling optimistic. An article in the October 22 Grinnell Herald bore the headline "Flu On the Decline." Acknowledging that "the health situation in this community is not the best," the writer nevertheless asserted that "there is at least grounds for hope that the Spanish influenza has reached its zenith and has begun to decline." According to the report, over the preceding two days fewer cases had been reported, and "most of these are in a light form."

On the down side, cases of typhoid fever seemed to be multiplying. "Physicians are at a loss to know the cause of the typhoid which has broken out," the newspaper reported. Sixteen cases, several of which were deemed "serious," were known in town, but the origin and transmission of the disease remained a mystery.

Grinnell Herald November 22, 1918

The outbreak of typhoid fever was unexpected, and complicated efforts of health officials to deal with the blizzard of flu-related cases. An October 1st article in the Grinnell Herald was headlined "Typhoid Cases Numerous," and proceeded to identify six persons hospitalized with typhoid. The article concluded by advising residents to boil all their drinking water, to pasteurize all milk, to get vaccinated against typhoid, and to "Swat the everlasting fly." Typhoid continued to spread, however, and three October death certificates assigned cause of death to typhoid: 23-year-old Morgan Lee; 4-year-old Effie Sergeant; and 8-year-old Edward Waters.

The persistence of typhoid fever cases led the city council in November to invite to town Dr. John Hamilton to investigate. Hamilton's report, summarized orally for the city council in late November and delivered in full to the city in mid-December, counted a total of about thirty cases reliably identified as typhoid. Because the bacillus is often transmitted by water or milk, Hamilton carefully examined both supplies, and gave high marks to the city's water supply. Although he found no specific evidence to confirm his suspicion, Hamilton thought it likely that the milk supply had become contaminated, perhaps by having individuals who either had typhoid or who were nursing typhoid victims handling milk bottles. For this reason, he recommended that bottles remain in the hands of the suppliers who could regularly sanitize them. The most difficult to control—human waste—was also the most likely source of the problem: transmission of the bacillus through the feces of those infected. With a complete sanitary sewer system in place in Grinnell, Hamilton wrote, the city ought to eliminate all outdoor privies and bring all sewage into a central system for complete treatment. Efforts should be especially arduous in fly season, since flies were easy and frequent vehicles of typhoid infection.

Local dairies were quick to pick up on Hamilton's point about milk, adjusting their advertising to point out that their products were pasteurized or that their bottles were not subject to infection from being left with customers.

Grinnell Herald November 29, 1918

Grinnell Herald December 10, 1918

For those citizens who were worried about the water, regardless of the expert's opinion, Colfax's Fry Bottling Company had a solution—bottled mineral water, "Safe against the Typhoid Germ," as the company's advertisements noted.

Concerning though they were, typhoid cases shrank in importance when compared to the inroads made by flu. All the same, officials were anxious to lift the quarantine and, encouraged by the hope that the disease had passed its peak, announced the end of the quarantine, effective October 28.

Grinnell Herald October 25, 1918

Alas, the optimism was short-lived. At an emergency meeting of the city's Board of Health on the very day that the quarantine was to be lifted, the Board rescinded the earlier order and reimposed the quarantine. According to the newspaper report, "quite a number of new cases of the disease [flu] were reported by the physicians of the city, so many in fact that the board considered the better policy to be on the safe side" (Grinnell Herald October 29, 1918).

Grinnell Register October 28, 1918

In an effort to get a better handle on the dimensions of the illness and apparently at the instigation of the Grinnell schools leadership, on Monday, October 28 the town's teachers, exiled from their classrooms by the quarantine, proceeded to canvas all quarters of the city in search of hard numbers on the extent of the epidemic. The results of the survey were published in the next day's Grinnell Herald. Not counting the 15 households that did not respond, the survey found 70 cases of "active" flu in town, and 159 "convalescing" cases. Another 21 individuals were reported to be suffering from typhoid. Teachers figured that 105 Grinnell families—which must have represented about 10% of the town's approximately 5000 residents—were dealing with at least one case of flu.

Within a couple of days, teachers were back on the streets to count the city's ill another time. On November 1st, the Herald published results of a survey undertaken the preceding day. The latest canvas reported 19 "new cases," and a total of 42 "active cases" along with 54 cases of people who were convalescing from the flu. According to this tabulation, 32 Grinnell families were struggling with at least one case of flu. Rephrasing the numbers, the second survey found that 73 fewer Grinnell families had a flu victim to care for. There were still 16 persons suffering from typhoid fever.

Grinnell Herald November 5, 1918

Authorities decided to lift the quarantine on November 4th, but the disease's hold on Grinnell proved tenacious, the plague continuing unabated through the Thanksgiving season. John Crosby, a thirty-year-old painter died November 4th, and on the 9th and 10th two more children passed. In the days before Thanksgiving (November 28 that year), a whole string of deaths were registered: one on the 19th, one on the 20th, one on the 22nd, one on the 23rd, three on the 24th, two on the 25th, two on the 27th, one on the 29th and one on the 30th.

Although most death certificates identified pneumonia as the cause of death, often with flu as a contributing factor, newspaper obituaries were more willing to assign primary responsibility for death to influenza. When Fred Plum died November 22, for example, his death certificate cited pneumonia as cause of death, with flu as a complication. The Herald obituary, however, blamed influenza, pointing out that 22-year-old Fred was not the only one suffering from the contagious disease; his wife and child were so ill with the flu that they could not attend Fred's funeral. Within a week, the flu pulled down Fred's sister, Hazel. "When the flu broke out in the Plum family," the newspaper reported, "Mrs. J. W. Plum, Charlie Plum, and Myron Plum were all stricken at the same time. Hazel was a wonderful help to her father in caring for the sick ones until she herself was taken..." (Grinnell Herald November 26, 1918).

Something similar happened in numerous other families. The same issue of the Herald that reported on Hazel Plum's death published a brief report on the Ernest Lawrence family, all of whose members were reported to be suffering through the illness. "Both Mr. and Mrs. Lawrence have been hardly able to move around and the four children have also been afflicted...." Only the volunteer help of a neighbor kept the ill family members hydrated and alive.

Some families found themselves not only without a hospital room but also without a doctor, so that their illnesses passed largely unseen by the public. For the few Mexicans then living in Grinnell, this must have been the usual experience. When in early November little one-year-old Aurora Baldingro fell ill, for example, her family cared for her without a doctor, as the child's death certificate proved. E. B. Wiley, the local health officer who signed the certificate, attributed death to influenza, adding "probably [my emphasis-DK], from what we get from the parents." In other words, Wiley had not seen the child before her death, and had to depend upon the parents' report to assign cause of death. The same thing had happened with Deodoro Lucis, who died October 17, pneumonia being cited as cause of death. But Dr. E. E. Harris could not say how long the illness had lasted, since he only saw Lucis the day before he died.

Death Certificate for Aurora Baldingro (1917-1918)
(https://www.familysearch.org/ark:/61903/3:1:3Q9M-CS6V-L9VY-8?i=2629&cat=2558528)

Consequently, when December arrived, Grinnell was still struggling with influenza, and some citizens expressed dissatisfaction with the way that authorities were handling the crisis. In a statement published in the Grinnell Herald December 10, Mayor White attempted to calm the waters. He said that, as of that morning, doctors reported a total of 65 influenza cases, new and old, and urged Grinnellians to avoid giving expression to wild rumors about the disease. "We may have the presence of this unwelcome visitor for a year," the mayor said, no doubt surprising and frightening his critics. Continuing on to his main point, the mayor allowed that Grinnell would "not be able to control [the flu] except by the cooperation of citizens." Urging people not to visit neighbors or friends afflicted with the flu until the victims were pronounced well, White hinted that, in the absence of voluntary cooperation, he might re-impose the quarantine. In the meantime, the mayor promised to post in city offices up-to-date counts of flu cases at least once a week.

Grinnell Herald December 27, 1918

Deaths from pneumonia and influenza continued, but apparently without significantly depressing local business. As an article in the December 27th Herald pointed out, the quarantine had interfered with the delivery of goods to local merchants, and the health scare had kept some people out of the business district. But merchants had managed to overcome these difficulties. Neither the unusually warm autumn weather nor the snow just prior to Christmas did much to undermine Christmas shopping, which most businessmen thought as good as, or even better than, 1917's holiday trade.

***

As residents of Grinnell hung new calendars in their homes, savoring the beginning of 1919, influenza crept quietly away. Although a spate of new cases emerged in late winter, the flu seemed less potent, and the fear of deadly illness dissipated. No one knew why the flu abandoned Grinnell; it certainly wasn't because physicians had figured out how to cure or prevent it. An early attempt at vaccination had been made on the college campus when in mid-October men in the Students Army Training Corps were inoculated, but the results of this effort were less than startling: after the mass vaccination SATC men continued to fall ill and die, leaving others to wonder at the effectiveness of the proposed remedy.

Easier to appreciate was the opening of Grinnell's two new hospitals—St. Francis Hospital on the east side of town in February and Grinnell Community Hospital on the west side in August. The new facilities provided more beds and much better conditions with which to fight epidemics. Consequently, when in winter 1920 another wave of flu—although not the same virus that had overwhelmed the town in 1918—appeared, Grinnell's hospitals coped well with the demand for beds and care.

Undated photo of Grinnell Community Hospital, a 45-bed facility that opened in August, 1919
(Digital Grinnell)

The 1918 uptick in typhoid also left a mark upon Grinnell. Pasteurized milk products gained a new foothold among Grinnell consumers, and helped drive the dairy industry toward 100% pasteurization. Similarly, largely because of the report of Dr. Hamilton, the city moved forward in requiring all city residences to abandon outdoor privies and connect to the city sewer system, changing forever the appearance of residential Grinnell and raising the expectations and responsibilities of city government.

All the same, the deadly course of the 1918 epidemic left its most somber imprint in Hazelwood Cemetery, many of whose gravestones bear witness to the lethal legacy of the 1918 epidemic. Some families lost several members as the virus hop-scotched from one victim to another, their grouped grave markers confirming in stone their common fate. As elsewhere, the 1918 flu preferred not the youngest and not the oldest, stealing away instead many of Grinnell's healthiest, prime-age population. These sturdy young people endured the brief rage of the virus, their lives cut short before they could understand what had deprived them of the future they intended to live.