A look back at the 1918 flu pandemic and its impact on Minnesota

The new warnings from the Centers for Disease Control and Prevention about the expanding spread of the coronavirus have Minnesota officials scrambling to combat the likely spread of the disease into this state. These efforts are being underscored by Gov. Tim Walz, who recently announced that “We are preparing for not if, but when, we end up with a case in Minnesota.”

More than 100 years ago, Minnesotans contended with a deadly virus for which there was no effective treatment, the misnamed “Spanish flu” pandemic of 1918. The influenza reached here just as World War I was coming to an end. On Sept. 28, 1918, Dr. H.M. Braken noted the rapid spread of the disease in a brief but disturbing telegram to his colleagues at the Minnesota Board of Health. “Severe influenza Faribault County Wells Village — 100 cases reported following return of soldier from containment.” Bracken’s telegram was the first report that the worldwide epidemic had finally reached Minnesota.

Considered the worst public health catastrophe since the bubonic plague of the 13th century, the influenza moved swiftly throughout this country, killing more than 500,000 Americans, nearly 10 times the number of battlefield deaths suffered by U.S. troops during World War 1.

Reports censored in military

The pandemic had erupted as the war was reaching its climactic months in 1918. In an effort to maintain morale while the fighting was still under way, the three allied powers —  England, France and the United States — strictly censored reports of the outbreak of the illness among their troops. Because Spain was not a combatant, its news reports about the disease were not censored. As a result, the epidemic was linked to Spain and became known as the Spanish flu.

The virus was spread in this country by U.S. soldiers who contracted the illness in the training camps and brought it with them back to their home communities. The containment mentioned in H.M. Bracken’s telegram referred to an Army camp where the unidentified soldier had been stationed before he returned to Minnesota.

Gruesome reports soon began to circulate about the effects of the influenza as it took hold of its victims’ bodies. One commentator observed that “most did not die from the flu per se, but rather from a deadly form of pneumonia that often accompanied it. And many of those who died did so with extraordinary ferocity and speed, for this was no ordinary pneumonia. As their lungs become unable to transfer oxygen to the blood, they turned a strange color, a condition called cyanosis. Some victims turned so dark that rumors began to fly that the disease was not influenza, but the Black Death.”

An Army camp physician wrote about the “purplish reddish greyish ashen color of the patient’s face — chiefly around the lips but sometimes over the entire body. … Hemorrhage was everywhere. Every sheet, towel, pillowcase, gown whether on a patient, doctor, nurse or orderly was purplish red. Many who died literally drowned in the bloody waters inside their own bodies.”

With U.S. soldiers living together in close quarters, the army camps quickly became huge incubators for the influenza virus. On Oct. 1, Army officials announced that 20,000 new cases had been reported in the camps during the previous 48 hours. While many of the cases were relatively mild with good prognosis for recovery, an increasing number were progressing to life-threatening pneumonia. Fort Dix in New Jersey was particularly hard hit. There, 61 soldiers had died from the disease.

The first influenza death in Minnesota occurred on Sept. 30 at Fort Snelling, where 42 cases of the disease were confirmed. The University of Minnesota Hospital and the General Hospital in downtown Minneapolis were both reporting a surge in new cases. As the disturbing news began emanating from the area hospitals, local medical authorities began a concerted effort to educate members of the public about the steps they could take to avoid the flu — particularly if someone in their home was ill with the disease.

Dr. H.W. Hill, the executive secretary of the Minneapolis Public Health Association, cautioned that ill individuals should be kept in bed as long as their temperature persisted. “So far as possible, every patient should have a separate bed,” Hill said. “One influenza patient may infect another with his particular complications and make the attack worse. Disinfect during the attack all discharges particularly from the nose and the mouth, handkerchiefs, bed linens and eating utensils.”

Fort Dodge in quarantine

At Fort Dodge in Iowa, where many Minnesota soldiers were being trained, 500 men had come down with the disease. The fort was under strict quarantine, with guards posted at the post entrances to keep out all visitors except those carrying a military pass. Post officials had wired an urgent request to the Red Cross for 5,000 gauze masks used as a precautionary device for all patients and their attendants.

By the first week in October, civilian and military officials were estimating that the number of confirmed cases in Minneapolis had reached 1,000, with more than of half of those at Fort Snelling’s military hospital. Dr. G.H. Guilford, the city’s health commissioner, predicted that the epidemic had not yet crested here, with a marked increase in civilian cases expected over the next few weeks. Minneapolis General Hospital was under virtual quarantine, with two floors of the facility reserved for flu cases.

Guilford issued an urgent call for all new cases to be reported to the city health department so the spread of the disease could be tracked. The flu makes its appearance, he explained, when a patient experiences a sudden sensation of weakness, muscle aches and a high fever of from 101 to 105 degrees. Then the temperature subsides for a brief period and then reappears as patient succumbs to pneumonia. If the influenza virus progresses this far, death is likely, Guilford said.

The city’s health commissioner noted that the disease was extremely contagious and passed from person to person “at the speed of an express train” with the germs spread through discharges from the nose and throat.

Huge strain on medical personnel

The surging epidemic put a huge strain on the state’s medical personnel, particularly now that many health workers were away from home, serving in the military. The U.S. Surgeon General began running ads in the local papers in an effort to recruit more nurses. One ad in the Minneapolis Journal, entitled “The Nation Needs Nurses to Check Influenza,” stated that “owing to the rapid spread of the present epidemic, the safety of this country demands that all patriotic nurses, nurses’ aides, or anyone with experience in nursing place themselves a once at the disposal of the government.”

In the southwestern Minnesota town of Wabasso, the community’s only physician, Dr. Frank Brey, worked virtually around the clock while the epidemic was at its peak. “It probably took five years off his life,” noted one of his neighbors. Brey hired a driver who drove him from one town to another in a horse and buggy. The doctor slept while he was on the road and the driver slept in a cot in the doctor’s office while he was waiting to drive Brey on his rounds.

The Wabasso physician did what he could to ease the distress of his patients, even packing some of them in ice to bring down their fevers, but it often had little effect. “There was nothing, really, that anyone was able to do,” noted the neighbor.

As cases of the disease were reported with increasing frequency, communities throughout the state began taking steps to ban all public gatherings.

New Ulm’s ban took effect on Oct. 15. In his public announcement, J.H. Vogel, the town’s public health officer, noted, “Within the last few days, a number of cases of Spanish Influenza have appeared in this city, and the disease appears to be spreading rapidly. It became apparent that unless measures were taken to present the spreading of the disease, we would have to look forward to quite an epidemic in this city. “ Vogel’s notice, issued by New Ulm’s Board of Health, went on to declare that, for the time being, “all schools, theatres and moving pictures houses, dance halls, bowling allies and other places where people congregated” were to be closed.

The City of Minneapolis began taking steps to ban public gatherings on Oct. 11. That same day, a new U.S. Army dispatch reported that that flu deaths in the army camps were inching up toward 8,000. In Minneapolis, the epidemic was on the upswing as reports of new cases poured into the city’s health department. On Oct. 10, the agency’s head, Dr. H.M. Guilford, announced that the city’s 221 new cases represented a 50 percent increase over the previous day’s report. At General Hospital 40 nurses had been stricken, forcing hospital officials to scramble to fill the vacancies created when so many of their own staff members were too ill to work.

The Minneapolis ban, ordered by the City Council, took effect at 12 a.m. on Sunday morning, Oct. 13. It applied to all churches, schools, theaters, and dance halls. In his testimony to the council prior to its votes on the ban, Guilford said, “it (the flu) is not controllable by the usual means. … It spreads in crowds and quarantine is of little value. The main thing is to keep people from getting close together. I don’t want to scare the people, but it looks as though we will have a great many deaths from it in Minneapolis.”

St. Paul slower to declare a ban

Across the river, St. Paul had not yet enacted its own ban by the end of the month. The Pioneer Press expressed anguished frustration about the lack of an effective response to the epidemic in its city. In a Nov. 3 editorial entitled “In Heaven’s Name Do Something!” the paper declared, “St. Paul enters a new week of the pneumonia surge with its confession of hopelessness repeated and nothing preventive or remedial in sight. From the medical side of authority comes the aggravating assurances that the conditions in St. Paul are better than in other cities and the disease is on the wane. It seems like a flimsy and incompetent apology for the inaction which is gradually arousing resentment in every quarter.”

Prompted in part by the Pioneer Press’ strongly worded editorial, the St. Paul City Council did enact its own ban on public gatherings that following day, on Nov. 4. But there was dissent about the council action from one influential source, Dr. H.M. Bracken, the head of the State Board of Health. Bracken, calling the Minneapolis ban “a joke,” said he did not believe the closing order would do much to halt the spread of the disease. The state health official predicted that the epidemic would soon crest and then burn itself out. By mid-November, that year’s influenza wave in Minnesota did start subsiding, as Bracken predicted that it would. There was a slight uptick in the incidence of the disease in early December, but that wave soon dissipated as well. In 1918, 125,000 cases of the flu were reported in Minnesota, causing 7,260 deaths.