Quarantine, medical care, community: How Morris County overcame the 1918 influenza pandemic

Nurses of the Red Cross Chapter of Morristown, taken at the Morristown Green, May 30, 1917, Morristown, NJ.

By Jeffrey V. Moy, North Jersey History and Genealogy Center

The 1918 Influenza Pandemic was one of the most virulent outbreaks of the modern era, killing more people during its deadliest months than had died during four years of fighting in World War I.

That virus spread within both urban and rural locations with equal ferocity, hitting the affluent and impoverished, and the young and old. But it elicited the most severe symptoms in young adults.

Despite its widespread devastation, the pandemic is rarely taught in American schools. And although each new epidemic is unique, medical professionals and public officials often have relied on similar methods of containment when confronted with a strain to which no immunity or vaccine exists. 

“Board of Health Takes Action”, during a special Sunday meeting attended by Morristown’s board of health and a panel of physicians, all public gatherings were cancelled until further notice and sanitary guidelines sent to restaurants and bars upon the discovery of 100 cases and several deaths from influenza. The Jerseyman, Oct. 11, 1918. North Jersey History & Genealogy Center Historical Newspapers Collection.

The 1918 strain was an H1N1 virus of avian origin, and unlike the seasonal flu, which is confined to the nose and throat, the 1918 variant infected the upper respiratory tract before passing to the lungs, where it frequently led to bacterial pneumonia or other secondary infections. 

Its deadliness was due to the lack of either immunity or a vaccine with which to inoculate the population, and since antibiotics had not yet been invented there was no effective method of treating secondary bacterial infections. Thus, the primary tools of containment were isolating the sick, quarantining the general population, good hygiene, the liberal use of disinfectants, and limiting public gatherings to deprive the virus of new victims. 

Street car conductor in Seattle not allowing passengers aboard without a mask, 1918. National Archives and Records Administration photograph.

Although people referred to the illness as “Spanish Flu,”  this was partly attributed to wartime efforts among the federal government and the press to suppress news that could alarm the public and negatively affect the war effort.

Similar censorship occurred among other warring countries. Because neutral Spain was the sole European nation to retain a free press, when King Alfonso XIII fell ill along with his fellow citizens in late May, other countries were quick to give a name to the silent assassin that had been slowly moving throughout their own cities and towns.  

Ursala Nelthorpe, V.A.D. of Scawby England, at work in the Pathological Laboratory of the American Red Cross Hospital in Evraux France, ca.1918. As germ theory and virology replaced traditional miasma theory of infectious disease, disinfectants, surgical masks, and other tools were employed to slow their spread. Dr. Jennie Beaver Collection, NJH&GC.

Historians and infectious disease specialists have attempted to trace the virus’ origins from France, to the Middle East, China or Vietnam. Some evidence indicates it may have first jumped from farm animals to humans in the United States.

Historian John M. Barry cited Haskell County, Kansas, as a potential source of the outbreak, given its abundance of pig farms. The animals are known to incubate avian diseases before transferring them to humans. That county also is located along a major migratory path of 17 bird species, and was near a military installation that later sent troops to locations in Europe, where the disease was first reported. 

“American wounded being evacuated and receiving instructions,” ca.1918, Dr. Jennie Beaver Collection, NJH&GC.

Dr. Laning Miner of Kansas first reported an unusual strain of influenza in January 1918, which was characterized by flu symptoms followed by pneumonia. The first U.S. soldiers were stricken with this illness on March 4 at Camp Funston in Central Kansas.

Within two weeks, 1,100 soldiers had occupied hospitals, with thousands more ill in their barracks. However, despite their suffering, relatively few died of this contagious but mild strain. As soldiers moved throughout the country, 24 of 36 camps suffered outbreaks, infecting thousands more as the war effort moved overseas.

While it may be impossible to trace the origin of the mild early 1918 variant, it nevertheless illustrated how quickly H1N1 virus’ could spread in a brief period.

Ward 15 of the American Red Cross Hospital in Evreux France, taken by A.R.C. photographer. Dr. Jennie Beaver Collection, NJH&GC.

The disease itself occurred in three phases. The first was known as “three-day fever” and was mild, with most victims recovering within a few days; its first recorded appearance in Western Europe was in March 1918, before traveling to Poland by July.

The second, more virulent strain, was first recorded later that year in August, and most acutely affected young adults, many of whom developed pneumonia two days after their flu symptoms emerged. The third and final, equally dangerous wave, resurfaced over the winter of 1919 and abated by spring. 

One certainty is the impact of modern transportation on the speed with which influenza spread within nations and across the globe. In his study of the virus in New Jersey, Dr. Henry A. Davidson noted: “When humans travelled by foot, horse, or sailboat, the flu germ moved slowly. With the introduction of the steamship and the train, the flu gathered speed and saw more of the world.”

Soldiers leaving Morristown for training in Sea Girt, NJ, July 25, 1917. Large crowds frequently gathered at train stations to send off sons, fathers, brothers, and husbands as they set off to war. Modern transportation systems also hastened the spread of infectious disease faster than they could in previous generations. NJH&GC Photograph Collection.

Reports of the 1918 strain varied across the United States, and in the northeast it reached Philadelphia and St. Louis in September. The Sept. 26, 1918, edition of the Dover Advance reported a quarantine of Camp Dix following the deaths of 54 soldiers during the first week of an influenza outbreak.

The virus reached Morris County with a ferocity no one was prepared for. Since the outbreak was reported in Morristown on Oct. 1, the Daily Record noted 388 cases involving influenza and 25, pneumonia, resulting in 10 deaths. Soon after appearing at Picatinny Arsenal during the first week of October, influenza had sickened 300 of its 1,000 employees and the base was placed under quarantine.

“Death Rates from Influenza Low: Deaths from out of town patients swell mortuary list,” The Jerseyman, October 25, 1918. Reporters noted that the number of Morristown’s native influenza fatalities was probably inflated due to the number of hospital patients arriving from neighboring towns. Nevertheless, amidst the quarantine, a number of public and social events made the front page, including weddings, soldiers deploying to other towns, and dances at the Whippany River Club.

One early hurdle to containing the outbreak was a determined lack of will by political leaders and the press to declare a public emergency. Congressional passage of the Sedition Act lent authority to the Committee on Public Information to police public statements during wartime, and promised lengthy prison sentences for anyone convicted of speaking, writing, or publicizing anti-government sentiment or speaking out against the war. 

Most newspapers accepted a broad interpretation of the law and complied without coercion. In an Oct. 4, 1918 editorial, the Madison Eagle blamed “fad emulation” for artificially inflating the number of influenza cases in town, declaring that:

Humankind are somewhat like sheep in that they flock in the same general direction and are unceremoniously scared by the same bugaboos. Fashions change in ailments as in clothes and books. Just now the Spanish influenza is the popular fad. It’s easy to get and very awful when one gets it, but a good many people who think they have it and so report are deluding themselves and causing epidemic lists to swell unnecessarily… The principal danger at the present appears to be in the mental attitude of the public at large. This attitude is distinctly panicky, which is unfortunate, for you can, by trying hard, almost scare yourself to death, even if you are not seriously ill.

Red Cross nurses march on Park Place in Morristown, NJ, carrying banners and accompanied by a brass band. Cars are parked at the curb and people stand among them watching the parade, April 6, 1918. NJH&GC Photograph Collection.

Another hurdle to halting the spread of influenza was the disconnect between the recommendations of medical professionals and those in charge of implementing public policy.

When the virus was first detected in Philadelphia on Sept. 12, 1918, officials mounted a major public relations campaign against sneezing, coughing, and spitting in public, which were all known disease vectors.

However, two weeks later city leaders acted against the advice of physicians when they approved a massive Liberty Loan parade in support of soldiers fighting overseas. Over 200,000 people gathered downtown, and the close proximity of so many individuals undoubtedly contributed to the additional 20,000 infections Philadelphia suffered over the next two weeks. 

A nurse collects water while working in a field hospital while wearing a mask as protection against influenza, September 13, 1918. National Archives and Records Administration photograph.

Starting on Oct. 1, the New Jersey Board of Health required all local boards to report their influenza and pneumonia cases to Trenton, to better coordinate a statewide response. As the breadth and severity of the epidemic took hold in Morris County, public health officials, political leaders, and physicians acted to halt its spread by closing public facilities and limiting person-to-person contact.

Bernards Township’s health department acted to stem the number of infections in early October by closing all schools, churches, theaters, movie houses, dance and pool halls, libraries, saloons, hotels, and other public places. Officials also delivered informational packets to each home in an effort to educate residents on steps they could take to remain healthy. 

Obituaries published throughout the county reflected the speed with which the airborne virus spread throughout towns, affecting both poor and wealthy alike. This small selection from the October 25, 1918 Jerseyman lists a British army officer stranded in the states after being separated from his wife, a twenty-nine year old wife and mother to three young children, and a twenty-six year old businesswoman.

Within weeks, quarantine and isolation had drastic effects on New Jersey’s downtowns. In its Oct. 23 issue, the Stanhope Eagle described Stanhope’s streets as having “a deserted appearance during the evening hours, and business during daylight hours [was] funereally lagging, both owing to the pressure of the epidemic.”

Despite obituaries listing victims from all levels of society, some editors reflected the biases of the era by blaming the disease on “the uncleanliness of [poorer] families in and around their homes, and the frequency with which foreigners congregate with each other. Germs soon accumulate in filth, and something like the present epidemic spreads them like wildfire.”

Some affluent families omitted or obscured the true cause of death in published obituaries, although death certificates painted a fuller picture. 

By contrast, the editors of the Oct. 19, 1918, Chatham Press blamed the epidemic’s spread on official negligence and called on “the people to abate the plague and repair the damage” by cooperating with local health authorities.

The most important tools, according to the Press, were to: Avoid crowds, refrain from coughing and sneezing in public, call a doctor if sick, consume fresh food and drink, and not worry. 

Patriotic American doctors and nurses supported the war effort in many ways; these healthcare workers established an American Red Cross hospital in Evreux France where they saved American, French, British, and even enemy German lives. However, the deployment of so many physicians overseas led to shortages trained personnel stateside during the 1918 pandemic. Dr. Jennie Beaver Collection, NJH&GC.

The deployment of so many trained doctors, nurses, and other fighting-age medical professionals to Europe’s battlefields further complicated treatment options in Morris County and across the nation.

At Morristown Memorial Hospital, 23 nurses fell ill, and with 11 doctors and 23 nurses deployed in the military and Red Cross, the facility quickly exhausted its available staff. Luckily, 125 volunteers from the community stepped in to cover various positions, at risk to both themselves and their families.

Medical tents setup to treat an influx of allied troops during World War I. When the epidemic hit Morristown, physicians established similar field hospitals near Morristown Memorial Hospital. Dr. Jennie Beaver Collection, NJH&GC.

When patients overwhelmed the facilities, affluent residents helped lead relief efforts. For instance, Adeline Havemeyer Freylinghuysen (Mrs. Peter Hood Ballentine) donated $80,000 (approximately $1.2 million in 2019 dollars) to construct a new building for infectious disease control.

Most members of the community soon learned that influenza did not discriminate with regards to income, religion, ethnicity, race, or gender, it came for everyone.

The Pathological Laboratory at Morristown Memorial Hospital. Pictured is Dr. Jennie Beaver, Morristown’s first doctor of infectious disease whose overseas service in France during World War I saved countless American lives. Dr. Jennie Beaver Collection, NJH&GC.

As the extended quarantine started having the effect of lowering infection rates, the influenza virus found itself contained within pockets of Morris County. Other cities had similar results.

St. Louis, which, unlike Philadelphia, acted quickly to impose quarantine and close public spaces, reduced its death rates to less than half of its neighbors. Nevertheless, when St. Louis witnessed a reduction in new cases after two months, it moved to lift restrictions and experienced a second wave of new infections. Cities that maintained quarantine saw no such relapse.

As months of quarantine seemed to tame the epidemic’s second wave, bans on public gatherings were lifted as citizens resumed planning weddings, parties, and sporting events. A resurgence of infections and deaths proved how difficult and unpredictable the virus could be. The Jerseyman, November 1, 1918. NJH&GC Historic Newspapers Collection.

On Nov. 2, the New Jersey State Director of Health approved reopening of schools, theaters, churches, and other public facilities despite the existence of new pneumonia cases. During the early weeks of November, new infections had decreased to the point that Hanover and Dover considered lifting the closure of public schools. But a resurgence in new cases led Dover’s Board of Health to again close all public facilities by Nov. 23, after 90 news cases emerged, of which 60 were school children. 

First Presbyterian Church, ca.1920. NJH&GC collections.

Extended quarantine and fear amidst the second wave again emptied streets throughout Morris County, until the virus had no place to replicate. Another drop in cases by early December resulted in a second lifting of quarantine, with the exception of schools. Dover reopened churches, theaters, saloons, ice cream and pool parlors.

Crowds line up to enter the Lyon’s Park Theatre in Morristown on Sept. 4, 1916. NJH&GC photograph collections.

In an era before electronic communication, telecommuting, and remote learning, the lack of face-to-face interactions would have cut many families off from the world. When considering the lists of public institutions, private businesses, and organizations closed by the pandemic, one must remember that these places were vital to individuals’ access to information, entertainment, and sense of community. Newspapers and letters were left to carry the burden of communication.

Congress initially attempted to avoid raising taxes to pay for the war by first asking its citizens to lend their dollars to their government. Ads like these appeared on nearly every page of local newspapers, who patriotically donated the space for the war effort. The Jerseyman, Oct. 11, 1918.

The nation’s commitment to the war effort meant numerous factories and food producers remained open, which lessened some of the economic impact of the extended quarantine. Moreover, by 1918, Americans had become used to sacrificing food, finances, and a measure of individual liberty for the war effort.

People also tended to live closer to farms, producers of goods, employers, and churches and charitable groups organizing relief funds and food banks — all of which ameliorated the quarantine’s effect on some families.

Unemployment insurance did not exist, but people may have turned to community chests, funded by neighborhood donations, during economic downturns.

A tribute to Amabel S Roberts , who died while working at New York Presbyterian Hospital at Etretat France. Ms. Roberts was the first citizen of Madison to die overseas during the war. The Madison Eagle, Jan. 25, 1918.

The third and final wave appeared in January 1919, and ended that spring. New Jersey ultimately experienced 292,830 reported cases resulting in 10,963 deaths from flu and another 5,874 from pneumonia. Among these, Morris County suffered the highest death rate of any county in the state (7.7 percent), despite having fewer infections than either Essex or Middlesex counties.

Historian Richard Irwin characterized the 1918 pandemic, overall, as both “a medical and a social disaster,” possibly the third worst epidemic in recorded history, and the worst natural disaster in the 20th century.

Overall mortality in the developed world was approximately 2 percent. In Mexico, it was between 2.3 to 4 percent; In Iran and Russia, 7 percent; on the Fiji Islands, 14 percent. Some native villages in Alaska and Gambia were wiped out.

Flowers on the war memorial, Jan. 12, 1928. Morristown’s Cenotaph, or “empty tomb” commemorates the town’s war dead, including those whose remains were interred overseas. NJH&GC Photograph Collection.

Among those Americans who served in World War I, influenza claimed the lives of 63,114 — more than the 53,402 who died in combat.

Those fighting to contain the spread of influenza on the home front turned the corner when public officials worked with the press to publicize information about the virus’ existence, and began enforcing the recommendations of physicians.

Individual families and businesses sacrificed daily necessities and comforts, and the community pulled together to support the hospitals, religious institutions, and local organizations that conducted treatment prevention and relief efforts.

Each disease is unique, and those spread by casual person-to-person contact offer perhaps the biggest challenge to basic human nature.

Sources:

  • Historic Newspaper Collection,North Jersey History & Genealogy Center (NJHGC)
  • Photograph Collection, NJHGC
  • Richard T. Irwin, “Mortality in Morris: The Influenza Pandemic of 1918,” New Jersey Historical Commission research paper; Madison, NJ, 1995
  • John M. Barry, “How the Horrific 1918 Flu Spread Across America, Smithsonian Magazine, November 2017
  •  Henry A. Davidson, MD, “New Jersey and the Great Pandemic,” The Journal of the Medical Society of New Jersey, August 1957
  • ”The Deadly Virus: the Influenza Epidemic of 1918”, archives.gov
  •  Nina Strochlic and Riley D. Champine, “How Some Cities ‘Flattened the Curve’ During the 1918 Flu Pandemic,” National Geographic, March 27, 2020
  •  “Influenza Pandemic of 1918-1919”, Encyclopedia Britanica, March 30, 2020
  •  “1918 Pandemic,” CDC.gov

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4 COMMENTS

  1. A helpful reminder of how important a knowledge of history can be when looking for solutions to the problems of today.

  2. This is an excellent overview of a topic which is as mentioned rarely discussed in history classes. Thanks for doing such a well researched review.

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