1918-1920 Influenza Pandemic in the Wiregrass

By Phillip Williams. MA History. MLIS. 28 November 2020.

During this time of COVID-19, looking back on how our people lived through previous pandemics provides us with some degree of comfort. Knowing that our ancestors survived the 1918-1920 Influenza Pandemic allows us to feel that many of will also get through this present pandemic. The 1918-1920 Influenza Pandemic killed 50 million to 100 million world wide. It disrupted families and left the world with many widows, widowers, orphans, and childless parents.

There are many parallel experiences between the 1918-1920 Influenza and COVID-19. Bans on public gatherings, schools being shut down, churches being shut down, mask wearing, and many other experiences are shared between the two. Just like today, some people called the 1918-1920 pandemic mere hysteria and falsely blamed the media for it. Annual traditions had to be canceled, or at least modified, during the pandemic of one hundred years ago. Evidence abounds that our ancestors often grew fatigued in carrying on the fight against the disease, and also, that those fatigued lapses in judgement had consequences.

Luckily, Georgia's COVID deaths still (about 9,000 in late November 2020) lag behind the 74,108 documented deaths from the 1918-1920 Influenza Pandemic. Florida has grown significantly since 1920. It is no longer the rural quasi-frontier state that it was back in 1920. Florida had only 968,470 people at the time of the 1920 census. Florida's current population is estimated to be about 21,477,737 people. Florida had 5,902 documented influenza deaths during the 1918-1920 pandemic. In comparison, Florida's current death count for COVID is 18,000.

The 1918-1920 Influenza Pandemic had a number of names. The most common name is the Spanish Influenza, as many thought Spain was the country of origin of the disease. Other names include "the Brazilian flu", "the German flu", "the Bolshevik disease", and in Spain "the Naples Soldier."

There have been quite a few histories written about the pandemic, but very few of them deal with the southeastern United States. None of them deal with the Wiregrass region of South Georgia and North Florida outside of a short article "The Effect of the 1918 Spanish Influenza Pandemic on Mortality Rates in Savannah, Georgia" by Plaspohl et al.,^[1] and a recently published undergraduate thesis Pestilence and Poverty: The Great Influenza Pandemic and Underdevelopment in the New South, 1918-1919 by Andrew Kishuni.^[2] Several local historical societies and newspapers have begun to do retrospective accounts of the 1918-1920 Influenza Pandemic as a way to put COVID into a historical context. There is much left for historians to uncover about 1918-1920 Influenza Pandemic throughout the United States, but especially in rural areas of the southeast. Newspaper digitization will help to fill in that gap in knowledge

The article by Plaspohl, Dixon, and Owen examines the death records for Savannah-Chatham County for the time period between 1917-1919. The study found that 114 documented flu-related deaths in Chatham County during October 1918 and a total of 223 flu-related deaths for the entirety of 1918. There had only been 9 flu-related deaths in Chatham County during 1917. In 1919, there were 84 flu-related deaths in Chatham County. Savannah-Chatham County is one of the few areas in Georgia that had had quality death records before the state vital records department got fully funded in 1919. The Kishuni thesis covers the responses to the pandemic in Jacksonville, Florida, Savannah, New Orleans, and Nashville, Tennessee.

Documenting the Pandemic:

It is difficult to ascertain an accurate number of deaths (let alone cases) of the 1918-1920 influenza pandemic that occurred in the Wiregrass region of Georgia due to several reasons. Firstly, there was no test for influenza in 1918.

Death Certificates and Conceptualization of Disease:

Georgia first required state-wide registration of births and deaths following the passage of bill in 1914, but it was not properly funded where it could be enforced until late 1918, well after the October 1918 wave of the pandemic. The law was passed in early October 1918 and established a department of vital statistics and an epidemiological department. There are some death certificates for South Georgia from before January 1919, but they are so few in number and rarely include known influenza deaths.

Making the situation of determining the deaths due to influenza even more complicated is the conceptualization of disease in the 1910s is different from that of the present. Diagnosing influenza was not an exact science and influenza was not always the primary cause of death. As part of the research for this article, the death certificates for 1919 and 1920 for Berrien County, Brooks County, Colquitt County, Cook County, Echols County, Lowndes County, and Thomas County have been surveyed. Deaths related to influenza, flu, pneumonia, la grippe, catarrh, and flumonia have been noted.

Flumonia, la grippe, and catarrh were used in the time period for the disease that we would now typically call influenza, which term was used on a death certificate or in newspaper accounts of a person's sickness varied from doctor to doctor and county by county. These different terms used back then make it difficult to determine deaths from influenza during the pandemic. Some doctors considered grippe different influenza, while others considered them to be the same disease. Additionally, pneumonia often followed an influenza infection. It was typically the pneumonia that followed that ended up killing a person. Some doctors would list influenza as a contributing cause of a death when pneumonia was the ultimate cause, but sometimes pneumonia was listed alone. Other diseases and conditions seemed to be exacerbated by influenza. Pregnancy, heart problems, and tuberculosis are among the conditions listed as the primary cause of death with influenza listed as a contributing cause. Underlying conditions were just as much of a problem during the influenza pandemic as they are with COVID-19.

In addition to the text cause of death section of death certificates, a numeric code denoting the cause of death was supposed to be put on death certificates. The code references those listed in the International List of Causes of Death, Revision 2 (1909) which can be found here. During the time period, the code for influenza was 10 and the code fore pneumonia was 92. Making everything even more confusing, some death certificates will have pneumonia written as the cause of death, but have the code as 10.

Some doctors filled out death certificates more completely than other doctors. This leads to the amount of data about each fatality to vary significantly. There was also a drastic difference over time in the number of deaths in Georgia that had death certificates associated with them. It was estimated that in January 1919 only 23.16% of deaths in Georgia had a death certificate. By December 1919 that number had increased to 72.36% of deaths having a death certificate associated with them.^[3] Those estimates were for a state level. It is unknown how those rates varied from county to county. It would be reasonable to expect that rural counties with lower populations would lag behind better funded counties.

The spreadsheet containing the information derived from the survey of death certificates for the selected counties can be found here. The spread also contains deaths that were identified through newspaper coverage. The names of the victims are listed.

Below is the death certificate for Charles C Williams who died in Gadsden County, Florida during the pandemic. Georgia used deaths certificates of a similar format.

State Board of Health Reports:

The state board of health reports give us a glance at the influenza pandemic at the state level, but little clarity at a county level. The 1918 Georgia board of health report regarding influenza deaths can be summarized as:^[4]
1918: 30,768 influenza deaths, and 45,064 deaths state wide from all communicable diseases including influenza.
September 1918: 46 influenza deaths.
October 1918: 15,405 influenza deaths.
November 1918: 9,616 influenza deaths.
December 1918: 5,701 influenza deaths.
The data for the 1918 report starts in April 1918. From April 1918 to August 1918 there were no reported influenza deaths.

The 1919 Georgia report for the same can be summarized as:^[5]
1919: 7,147 influenza deaths, and 29,379 deaths state wide from all communicable diseases including influenza.
January 1919: 3,754 influenza deaths.
February 1919: 1,844 influenza deaths.
March 1919: 718 influenza deaths.
April 1919: 178 influenza deaths.
May 1919: 86 influenza deaths.
June 1919: 8 influenza deaths.
July 1919: 28 influenza deaths.
August 1919: 41 influenza deaths.
September 1919: 116 influenza deaths.
October 1919: 165 influenza deaths.
November 1919: 113 influenza deaths.
December 1919: 96 influenza deaths.

The 1920 Georgia report for the same can be summarized as:^[6]
1920: 36,193 influenza deaths, and 61,451 deaths state wide from all communicable diseases including influenza.
January 1920: 850 influenza deaths.
February 1920: 22,139 influenza deaths.
March 1920: 10,690 influenza deaths.
April 1920: 1,695 influenza deaths.
May 1920: 199 influenza deaths.
June 1920: 19 influenza deaths.
July 1920: 41 influenza deaths.
August 1920: 36 influenza deaths.
September 1920: 132 influenza deaths.
October 1920: 153 influenza deaths.
November 1920: 114 influenza deaths.
December 1920: 125 influenza deaths.

Given the limits of the methodology of the reporting system in 1918, it is difficult to know how accurate the number 30,768 influenza deaths actually is. If that number is accurate, it would mean more people in Georgia died in the early 1920 wave than who died in the Fall 1918 wave of the pandemic.

The 1921, 1922 Georgia reports are given for the sake of having a comparison for non-pandemic years. 1921 can be summarized as:^[7]
1921: 620 influenza deaths, and 19,971 deaths from all communicable disease including influenza.
January 1921: 93 influenza deaths.
February 1921: 106 influenza deaths.
March 1921: 120 influenza deaths.
April 1921: 73 influenza deaths.
May 1921: 13 influenza deaths.
June 1921: 14 influenza deaths.
July 1921: 7 influenza deaths.
August 1921: 9 influenza deaths.
September 1921: 4 influenza deaths.
October 1921: 59 influenza deaths.
November 1921: 63 influenza deaths.
December 1921: 59 influenza deaths.

The 1922 report can be summarized as:^[8]
1922: 6,612 influenza deaths, and 24,999 deaths from all communicable disease including influenza.
January 1922: 179 influenza deaths.
February 1922: 508 influenza deaths.
March 1922: 1,243 influenza deaths.
April 1922: 789 influenza deaths.
May 1922: 89 influenza deaths.
June 1922: 20 influenza deaths.
July 1922: 34 influenza deaths.
August 1922: 86 influenza deaths.
September 1922: 155 influenza deaths.
October 1922: 83 influenza deaths.
November 1922: 312 influenza deaths.
December 1922: 3,114 influenza deaths.

A new influenza pandemic was on the verge of happening in December 1922. In 1923, Georgia had 7,140 deaths from influenza with most of those happening in January to March 1923. December 1923 only had 50 influenza deaths state wide.^[9] The yearly total of influenza deaths for 1924 was only 1,223.^[10] Tabulating the data from the above reports gives us 74,108 documented deaths from influenza in Georgia from April 1918 to December 1920. This leaves us with deaths from the first wave of the pandemic that occurred before April 1918 and any deaths not reported due to varying degrees of county officials complying with the state vital statistics law being unreported.

Board of health reports for Florida are also available, but unlike the Georgia reports county level data is given for the 1918 wave. A mortality summary for Florida can be found here. The Florida report for 1918 at the state level can be summarized as:^[11]

1918: 4,114 influenza deaths.
September 1918: 85 influenza deaths.
October 1918: 2,172 influenza deaths.
November 1918: 934 influenza deaths.
December 1918: 383 influenza deaths.

Monthly deaths for 1919 and 1920 are not available in the Florida reports for those years. The annual deaths from influenza in Florida are as follows:^[12]

1919: 920 influenza deaths.
1920: 868 influenza deaths.
1921: 84 influenza deaths.
1922: 189 influenza deaths.

This gives us 5,902 documented influenza deaths for Florida from 1918-1920.

Newspapers:

Besides death certificates, newspapers are the other major variety of primary sources for this article. Even though there were few death certificates in 1918, some counties were keeping track of vital statistics. Those statistics were compiled by The Atlanta Constitution for a time period in late October 1918. The methodology of the data collection for those statistics appears to have varied. The data listed as being for Covington in Newton County was actually for all of Newton County. Some cities had information represented in every daily report, but others were listed in the daily reports only once or twice. Albany, Georgia is the only major city not listed once in the daily reports from The Atlanta Constitution. A spreadsheet compiled from the daily reports published in The Atlanta Constitution can be found here.

The Valdosta Daily Times for the period of the pandemic no longer exists. The Valdosta Times, the weekly version of the newspaper exists for the time period between January 1919 to December 1919.

The Thomasville Times Enterprise was heavily consulted as it one of the few newspapers for the time period in South Georgia that has been digitized. The Moultrie Observer, The Worth County, The Bainbridge Post Search-Light, and The Tallahassee Democrat have also been digitized and were all heavily consulted.

Epidemiology of the Pandemic:

Symptoms:

The incubation period (the time between exposure to the virus and the onset of symptoms) for the influenza virus responsible for the pandemic is estimated to have been 24 to 48 hours. The initials symptoms were typically fever, headaches, and muscular pains, which were then followed by coughing and breathing problems.^[13] As respiratory issues progressed cyanosis (the blueish discoloration of skin due to low oxygen levels in the blood) soon hit victims leaving their faces blue and their feet black. The respiratory problems were caused by the victims lungs filling with fluid. By the fourth or fifth day of the onset of conditions, the damaged state of the lungs left the victims highly prone to bacterial pneumonia infections. It is estimated that about 20% of cases of the disease were mild ones that people recovered from without lasting complications.^[14]

W-Shaped Mortality Curve:

One of the unusual aspects of 1918-1920 pandemic is that it killed so many people between 20 and 40 years of age. This led to what is called a W-shaped mortality curve. Most influenza viruses have mortality curves that go up for the demographic groups of people under 14 and for people 60 and above. People between 40 and 60 did not die as much in comparison to adults between 20 and 40. One reason that has been put forward to explain this phenomenon is an earlier influenza virus of a similar variety that gave people between age 40 and 60 partial immunity to the 1918-1920 virus. The 1889-1890 Russian Flu pandemic that spread to the entire world is considered to be a likely candidate for that earlier pandemic, but so far no suitable samples from victims of the 1889-1890 pandemic have been found to allow for a genetic comparison.^[15]

Below is a chart of the mortality curve for the 1918 pandemic and one for previous non-pandemic years. It was produced by the CDC for an article that can be found here.

Waves of the Pandemic:

There are considered to be four waves of the pandemic in the United States. Not all waves hit every region equally, or at the same time. Other parts of the world had their own "first wave" etc. at different times than the United States:

• First Wave: (March 1918-April 1918): The earliest documented case is at Camp Funston, Kansas from 4 March 1918.

• Second Wave: (Late August 1818-December 1918): This was the deadliest wave of the four and peaked in October 1918.

• Third Wave: (January 1919-June 1919): In some areas there was no gap between the "third" wave and the second wave.

• Fourth Wave: (January 1920-April 1920): Some areas of the United States began experiencing another outbreak as early as December 1919.

There are many who theorize that the pandemic might have been underway well before March 1918, and possibly as early as 1915 in Europe. Also, the exact nature of the relationship between the outbreak of encephalitis lethargica from 1915-1926 and the 1918-1920 Influenza Pandemic is debated. It is theorized that encephalitis lethargica might have been caused by the influenza virus or at least made people more prone to suffer from encephalitis lethargica. It seems likely that by early 1918 the virus that caused the pandemic was already spreading around the world.^[16] Unless medical samples from those earlier suspected cases our discovered, we might never know for certain when the pandemic started due the limits of diagnosis during the time period.

We might never know the geographic origins of the pandemic with absolute certainty. We do know that it had the ability to infect pigs as well as humans. Through genetic analysis of samples from victims of the 1918-1920 Influenza Pandemic, we know that it is of the H1N1 variety, but we still do not know where it made the shift into a human host. Likewise, we are not sure which of the following actually happened:

1. An avian flu virus directly infected a human host, and then went on to infect pigs.

2. A swine flu virus directly infected a human host.

3. An avian flu virus infected a pig, experienced an antigenic shift, and then infected a human host.

Timeline:

• 30 August 1918: Macon: 71 new cases of pneumonia reported at Camp Wheeler during the past week.

• 2 September 1918: Camp Wheeler plays a baseball game against Camp Gordon during the Labor Day weekend.

• 13 September 1918: Macon: 12 deaths from pneumonia reported at Camp Wheeler. Cases numbers reported as being the highest among any training camp with the exception of Camp Shelby at Hattiesburg, MS.

• 18 September 1918: Atlanta: Quarantine at Camp Gordon following a breakout.

• 27 September 1918: Ambrose (Coffee County): John James Phillips dies from influenza. Earliest known victim in Coffee County.

• 29 September 1918: Atlanta: Quarantine at Camp Jessup.

• 30 September 1918: Thomasville: The body of Clay B. Fleming who died at Camp Eustis, Virginia arrives in Thomasville for burial in Laurel Hill Cemetery.

• 30 September 1918: Coolidge (Thomas County): Bennie Louette Alligood dies from influenza. Earliest known victim in Thomas County.

• 1 October 1918-5 October 1918: Donalsonville: Southwest Georgia Fair is held.

• 3 October 1918: Donalsonville: War Relic Train visits the Southwest Georgia Fair.

• 4 October 1918: Brunswick: 26 people die from the the flu in one night.

• 4 October 1918: Quincy: War Relic Train stops in the town and draws large crowds from the county.

• 4 October 1918: Pearson: Flu outbreak with numerous people sick.

• 4 October 1918: Americus: Soldiers from Souther Field not allowed to attend public gatherings in town as a precaution. No known cases.

• 5 October 1918: Pensacola: War Relic Train stops in town.

• 6 October 1918: Barwick: Stores closed and the entire town shut downs due to an outbreak.

• 7 October 1918: Douglas: Schools and churches closed down. Ban on public gatherings.

• 7 October 1918: Thomasville: Two week ban on all public gatherings. Schools, churches, and theaters shut down.

• 8 October 1918: Tallahassee: Public gatherings banned. Schools, churches, and theaters shut down.

• 8 October 1918: Bainbridge: Schools and churches closed down.

• 9 October 1918: Thomasville: Date of the planned performance by the Ringling Brothers Circus before cancelation.

• 10 October 1918: Americus: 50 cases are reported.

• 10 October 1918: Dothan: The Ringling brothers performance at Dothan, AL is canceled due to the pandemic.

• 10 October 1918: Tifton: Schools shut down and public gatherings banned.

• 10 October 1918: Norman Park: Norman Institute closes for several days.

• 11 October 1918: Moultrie: The Methodist Church begins holding open air services.

• 11 October 1918: Thomasville: Cases reported in the city.

• 11 October 1918: Douglas: Coffee County Fair canceled.

• 13 October 1918: Valdosta. Paul Walton Harrell dies in Valdosta. He is the earliest known death from the pandemic in Valdosta.

• 15 October 1918: Cairo: Schools and churches ordered close by the mayor.

• 16 October 1918: Valdosta: Georgia-Florida Fair postponed; it had been scheduled to run from 21 October to 27 October 1918.

• 16 October 1918: Lenox: 16 school children dead from the disease.

• 17 October 1918: Valdosta: Valdosta Board of Health orders that all schools, theaters, and churches to be closed. South Georgia State Normal College (Modern Valdosta State University) closes.

• 17 October 1918: Pinehurst: Schools in the city closed and public gatherings banned. 35 cases had been reported.

• 17 October 1918: Waycross: The city has been quarantined, but a canteen was still serving soldiers.

• 19 October 1918: Norman Park: Norman Institute reopens.

• 21 October 1918: Albany: Board of health announces a ban on public gatherings, schools, theaters, and churches are ordered to be closed.

• 21 October 1918: Americus: Citizens to be required to wear flu masks when out in public. 80 new cases and two deaths reported.

• 21 October 1918: Macon: Mask mandate goes into effect.

• 25 October 1918: Waycross: The Ringling Brothers Circus have their final performance for the season.

• 26 October 1918: Moultrie: Schools are closed.

• 28 October 1918: Thomasville: Flu ban lifted.

• 4 November 1918: Moultrie: Schools reopen.

• 5 November 1918: Valdosta: Flu ban lifted. Churches, schools, and theaters reopen. There were 250 cases over five or six weeks, and 4 or 5 deaths.

• 12 November 1918-16 November 1918: Moultrie: Colquitt County Fair held.

• 15 November 1918: Americus: The flu ban gets extended again. It has been in place for nearly six weeks.

• 18 November 1918-23 November 1918: Georgia-Florida Fair held in Valdosta.

• 18 November 1918: Colquitt County. Newspapers report that the flu is sweeping the county and it is worse than it was in October.

• 22 November 1918: Americus: Flu ban still in effect. 81 cases and 1 death reported.

• 26 November 1918: Valdosta: A new flu outbreak reported.

• 26 November 1918: Moultrie: Schools closed and public gatherings banned. Hundreds of cases reported.

• 27 November 1918: Coolidge: The school is closed again due to a second outbreak. Two teachers and several students sick.

• 29 November 1918: Moultrie: Moultrie Methodist Church's Sunday School room used as an emergency hospital.

• 1 December 1918: Americus: Flu ban lifted after 8 weeks.

• 8 December 1918: Bainbridge: Churches and theaters open again for the first time in nine weeks. Schools will open after Christmas.

• 10 December 1918: Thomasville: Flu Ban reinstated. Gatherings banned until 1 January 1919.

• 13 December 1918: Valdosta: Schools in Valdosta closed again.

• 15 December 1918: Americus: Flu ban put back into effect.

• 25 December 1918: Valdosta: Christmas dance of 30 people held at a hotel in violation of a ban on public gatherings.

• 27 December 1918: Thomasville: Flu ban lifted. Only 3 cases still undergoing treatment in Thomas County.

• 29 December 1918: Cairo: Schools to be closed until 1 February.

• 30 December 1918: Moultrie: Schools reopen for the first time since November.

• 11 January 1919: Howell (Echols County): 45 cases and one death reported.

• 12 January 1919: Moultrie: Whole families have the flu. The town plans to build a hospital.

• 16 January 1919: Thomasville: A third ban implemented. Public gatherings banned and schools closed again Many houses have quarantine signs up.

• 22 January 1919: Tallahassee: Schools are ordered closed.

• 22 January 1919: Americus: Flu ban put back into effect. It now limits the number of customers in stores to those that can be waited upon the staff at one time.

• 24 January 1919: Douglas: Many Deaths reported in newspapers.

• 8 February 1919: Americus: Ban on churches lifted due to decrease in new cases. Schools still closed.

• 7 February 1919: Pearson: Has been under a flu ban for three weeks.

• 9 February 1919: Thomasville: Sawmills in the area begin to operate again.

• 12 February 1919: Americus: Flu ban lifted. Public gatherings allowed.

• 21 February 1919: Valdosta: New cases are being reported again.

• 1 March 1919: Thomasville: Flu ban lifted.

• 7 March 1919: Pearson: Schools open after having been closed for 6 weeks.

After March 1919 the influenza pandemic was quiet in south Georgia for the rest of the year. In September 1919, some cases were reported in Georgia, but none of those appear to have been in South Georgia. During the summer of 1919, health officials across the United States debated the likelihood of a recurrence of pandemic. Advertisements for various flu remedies appeared in newspapers on a daily basis during the last half of 1919 and early 1920. By January 1920, reports of a second wave of pandemic began to appear in newspapers throughout South Georgia and articles warned people to be prepared.

• 28 January 1920: Thomasville: 7 cases reported in Thomas County.

• 4 February 1920: Americus: 6 cases reported

• 8 February 1920: Thomasville: Thomas County reports that there is not a pandemic going on.

• 11 February 1920: Thomasville: Schools, churches, and theaters closed. Public gatherings banned.

• 11 February 1920: Camilla: 50 cases reported within 24 hours.

• 17 February 1920: Moultrie: No flu ban, despite increasing cases and 1 death.

• 24 February 1920: Waycross: 49 new cases in the last 48 hours making for a total of 205 cases. Schools and churches still opened.

• 25 February 1920: Thomasville: Flu ban to remain in force for another two weeks.

• 25 February 1920: Cairo: Mayor and chief of police have influenza. The town decides to stay open to avoid panicking people.

• 29 February 1920: Camilla: Schools reopen after having been closed for two weeks.

• 1 March 1920: Adel: Public order for five minutes of prayer at 6:00 pm everyday until the pandemic is abated.

• 6 March 1920: Thomasville: Flu ban will still not be lifted.

• 6 March 1920: Moultrie: Conditions improving less than 50 cases reported in Colquitt County.

• 10 March 1920: Cairo and Quitman: Both putting a flu ban.

• 10 March 1920: Bainbridge: Flu ban to remain in effect.

• 10 March 1920: Monticello: Flu ban lifted.

• 14 March 1920: Thomasville: Flu ban to remain in effect.

• 14 March 1920: Homerville: Schools closed a week before and will remain closed.

• 18 March 1920: South Georgia State Normal College (Modern Valdosta State University) closes.

• 19 March 1920: Axson: Schools suspended for the term. Time will be made up in the fall.

• 21 March 1920: Thomasville: Flu ban is lifted.

• Late March 1920: Valdosta: Several different articles across south Georgia report Valdosta as not having a single case of influenza. Death certificates contradict the reports from the Valdosta Board of Health mentioned in these articles. The pandemic was active in Valdosta.

The 1918-1919 Wave in South Georgia and North Florida:

South Georgia and North Florida were for the most part spared the Spring 1918 wave of the pandemic that hit the Midwest, Northeast, and Western Europe in Spring 1918. Of the various waves of the pandemic, the wave that hit world wide in Fall 1918 was the deadliest.

The earliest documented case of the pandemic occurred in Camp Funston, Kansas on 4 March 1918. An article in January 1918 from The Atlanta Constitution noted that there had been a mysterious increase in pneumonia cases and deaths all over the United States during the Winter of 1917:

Pneumonia has hit the American public harder this winter than usual. It has been in first place among diseases afflicting training cams, both in point of number of cases and fatality yet reports of health authorities in practically al parts of the country all parts of the country show that it also is more prevalent among civilians than it ordinarily is. Physicians say furthermore that pneumonia is causing more deaths this year than perhaps even before, the number of deaths from the malady in New York, for instance having been to date about double that during the corresponding period last year. The comfortless explanation for this is, not that the disease is more deadly this year than formerly, but that there simply are more cases. Why there should be more cases of pneumonia this winter than last or the winter before, nobody seems to know.^[17]

As previously mentioned, the conceptualization of influenza in the 1910s is drastically different from today. There were many cases of pneumonia and nearly 150 deaths therefrom reported at Camp Wheeler near Macon, Georgia from November 1917 to January 1918. The deaths from pneumonia at Camp Wheeler were theorized in November 1917 to be due to an after effect from a measles outbreak going on at the camp. The measles outbreak was in turn blamed upon young soldiers coming in from areas where they had never been exposed to measles during their childhoods.^[18] Then on 14 January 1918, Major Augustus Peabody Gardner, son-in-law of United States Senator Henry Cabot Lodge, died at Camp Wheeler from pneumonia. He was 52 years of age, well-travelled, and said to have been previously in good health.^[19] Sporadic pneumonia deaths continued to occur at Camp Wheeler until early May 1918. We will most likely never know if the pneumonia epidemic at Camp Wheeler was truly caused by the after effects of a measles epidemic or if it was possibly a leading edge of what was to come. United States military camps during the period of mobilization in 1917-1918 were a hot bed of disease. Soldiers would be moved to other training camps for eventual deployment, new trainees would arrive every day from rural areas who probably never previously traveled more than 50 miles from their own homes.

It does seem likely that the second wave was present at Camp Wheeler by late August 1918. 71 new cases of pneumonia were reported Camp Wheeler during the last week of August 1918.^[20] During the week ending 6 September 1918, 12 deaths from pneumonia were reported at Camp Wheeler and were reported to have mainly been from newly recruited Black trainees.^[21] The race of many of the victims could explain why these deaths were not noticed as being influenza deaths. On Labor Day in September 1918, Camp Wheeler played a baseball game against Camp Gordon of Atlanta, and that afternoon Camp Gordon played a second baseball game against Camp Jessup.^[22] On 18 September, Camp Gordon was put under quarantine due to an outbreak of "Spanish Influenza."^[23]

Below is an image of Camp Wheeler circa 1918 courtesy the Library of Congress.

Meanwhile in Florida, influenza was first recognized at Pensacola in 11 September 1918.^[24] Cases were also already being reported in Perrine, Miami-Dade County, Florida by 9 September 1918.^[25]

By the end of September influenza was the cause of 26 deaths in Duval County (Jacksonville), Florida and 14 deaths in Escambia County (Pensacola), Florida.^[26] Jacksonville was home to the army training camp, Camp Johnston, and Pensacola was home to Naval Air Station. Duval County and Escambia County would be among the hardest hit counties in Florida during the late 1918 wave of the pandemic. Duval County suffered 736 deaths in October 1918, and 859 deaths for all of 1918. Escambia County suffered 241 deaths in October 1918, and 282 deaths for all of 1918.^[26]

There is no clear evidence of the identity of any case zeros for counties in South Georgia and North Florida. Mobilization for World War I was at its peak and packed trains were going through the area every day. Due to their location in the interior, Wiregrass counties in Georgia and Florida had generally been afforded some level of protection from previous pandemic of influenza and yellow fever. More than likely influenza entered the area by rail through either the inland transportation hubs of Macon and Atlanta, or the seaports of Jacksonville, Pensacola, and Savannah.

The earliest mentions of the local impact of the influenza pandemic in the Wiregrass deal with soldiers from the area getting the disease at various camps across the country. Clay Bramen Fleming (27 February 1898-26 September 1918) of Thomasville was among the first victims of the disease who was from South Georgia. He had been serving at Camp Eustis near Newport News, Virginia. His body arrived in Thomasville on 30 September 1918.^[27] Fleming's body was soon followed by the body of Raymond Barter (16 October 1893-28 September 1918). He had been an aviator at a camp on Long Island, New York when he died from the disease.^[28] Wilce Mimms (23 October 1893-28 September 1918) who died at Camp Jackson, South Carolina was next.^[29] William Fambrough (1884-4 October 1918) of Boston, Georgia was working as an electrical contractor in Baltimore in early October 1918. He died in a Baltimore hospital and his body was shipped back to his home in South Georgia.^[30] The bodies kept coming. Thomasville was not alone in their suffering. The bodies of young men, soldiers and businessmen, began coming into their hometowns all over the United States in October 1918. Young men who were considered to have been at their peak physical condition. Struck down, not by bullets, bombs, or gas, but by a virus unseen.

The dire levels of the spread of the disease elsewhere led to calls for people to volunteer to be nurses. Virginia Lee Howell of Thomasville was one such volunteer. She left for Camp Jackson, South Carolina on 5 October 1918, just before the virus started to appear in South Georgia.^[31]

While the deaths of soldiers from Spanish Influenza were making headlines in late September 1918, it is likely that the virus was already in South Georgia. On 27 September 1918, The Douglas Enterprise and Coffee County News reported several deaths from symptoms that would soon become familiar to many. Judge Walter Clarence Bryan (25 June 1873-24 September 1918)'s took Douglas by surprise. "The deceased was taken ill in his office last Friday [20 September 1918] afternoon, at first seeming to be suffering from a bad cold. Fever appeared and before he left his office for home, at time he was delirious. The symptoms grew worse hour by hour, and in a short time pneumonia developed, ..."^[32] Robert Lexon Kight (23 September 1880-24 September 1918) of Broxton, died suddenly from pneumonia after having been sick only a few days. Randal Jesse Sapp (23 August 1907-25 September 1918), also of Broxton, also died after a few days of illness from pneumonia.^[33] Mrs. Louise Smith Wooten (29 October 1894-24 September 1918) of Douglas, took sick while visiting her parents at Broxton and died after a few days.^[34]

Then John J. Phillips (23 November 1883-27 September 1918) died at Ambrose from influenza.^[35] His death is among the earliest deaths in the Wiregrass clearly attributed to influenza during the fall wave of the 1918 pandemic. The headline for The Douglas Enterprise of Friday, 4 October 1918 read "All Stores Ordered Closed Tuesday," but it was not on account of the influenza pandemic. Instead it was so the city could focus on the Liberty Loan Drive as part of the war effort.^[36] Liberty Loan Drives were happening in just about every major town in early October 1918. These events drew large crowds and it is likely that the virus was spread at these events. The situation would change drastically before that Tuesday arrived as The Douglass Enterprise reported. The Douglas City Council had met on Monday, 7 October 1918 and put ban on all public gatherings was put into effect. The city police were ordered to disperse anybody violating the ban. Schools, churches, and theaters were also ordered closed.^[37] Another headline read "Death's Harvest This Week Takes Many Good Citizens.". The article contain nine obituaries for influenza victims in Coffee County and mentioned that there were several others that they had been unable to print.^[38] The same issue also mentions that Coffee County superior court had been adjourned because of influenza pandemic.

Other early victims of the disease were appearing elsewhere in the Wiregrass.

At Coolidge, Thomas County, Georgia, Bennie Louette Alligood (30 August 1914-30 September 1918) died.^[39] She was daughter of Rev. Joseph B. Alligood. A short time later the exact same house was visited by death again. This time it took Rev. Delmar C. Whigham (2 December 1889-11 October 1918) the son-in-law of Rev. Joseph B. Alligood.^[40] By 16 October 1918, there would be 156 cases in Coolidge.

Sixty miles to the southwest of Coolidge, an outbreak was also beginning at Florida State Hospital for the Insane at Chattahoochee. The first documented death from influenza at the hospital occurred on 4 October 1918. The patient was 71-year old James Badger Horn. Census records show that he been at the hospital since at least 1910. It is doubtful that a 71-year old patient at a state hospital for the insane had been doing much traveling before his death. The influenza virus had to have made its way into the hospital before 4 October 1918. Death certificates for Gadsden County show that 16-year old David Dean died from influenza on 18 September 1918, and likewise, Henry Lee Cowart died on 7 September 1918 from pneumonia from influenza. Charles Coleman Williams of Quincy died on 3 October 1918. Williams' death certificate has him as having been sick with pneumonia for three days and sick with Spanish Influenza for 10 days.

Those early Gadsden County cases would be followed by a flood of other cases. From October 1918 to December 1918, death certificates show that there 120 patients and three workers at the Florida State Hospital for the Insane who died from influenza or whose deaths were directly caused by influenza. During that same time period, there were 250 people who died from influenza in all of Gadsden County.^[41] The hospital and the community got hit incredibly hard by the pandemic. The hospital deaths account for 2.9% of influenza deaths during the Fall 1918 wave of the pandemic. Gadsden County (including hospital deaths) account for 6.1% of all deaths in Florida during the Fall 1918 wave of the pandemic. The only counties in the state with more deaths from influenza in that time period were Duval County (859 deaths), Hillsboro County (518 deaths), and Escambia County (282 deaths).

For a full listing of Gadsden County influenza and pneumonia related deaths for 1918 please see the spreadsheet located here. The list has been augmented with what information can be found through census records, newspaper accounts, etc. to provide more information about the victims.

Twenty-five miles west of the Florida State Hospital for the Insane, another influenza outbreak was occurring across the Chattahoochee River at the Florida Industrial School for Boys near Marianna, Jackson County, Florida. Of the 267 students at the school 264 of them fell sick within 48 hours.^[42] Few details as to the timing of the outbreak or the individual boys who died at the school are known. None of the boys or the workers had death certificates issued. The report of Dr. Guy Albert Klock of the United States Public Health Service who was sent to the school to investigate the conditions states that the only records being kept by the superintendent Thomas Jefferson Boone were the intake/outtake ledgers for the boys school. Klock's report stated that 11 children died and 2 employees by the time he had visited on 30 October 1918. The ledgers for the school listed few causes of deaths for it students, and for the time period only has one death.^[43]

The conditions at the school during the outbreak are described in graphic detail in a series of articles that resulted from the public outrage that resulted after Dr. Klock's report was published. Before the outbreak had even started the boys were poorly clothed despite clothing be held in the school's storage area. The boys stunk from their clothes having not been changed in six months, were lice infested, encrusted with dirt, and some went around naked. Nurse Harts Field (probably a pseudonym) of the Florida State Hospital for the Insane arrived at the reform school to help with the situation on 23 October 1918 and found 64 sick boys covered in filth. She requested help to get the boys washed and dressed in clean clothes, but had to result three days later to putting clean clothes over the boy's fever-ridden and filth covered bodies. Her attempts to get medicine for a mortally sick boy were quashed by inaction by the acting superintendent. She later said that if "[Dr. Klock] could have seen the deplorable sight that [she] met with a week before he reached the institute, he would have been shocked beyond words.^[44] The boys were also poorly fed. The boys had been forced to eat spoiled meat. One boy was flogged for refusing to cook peas full of worms. The building that was being used as a hospital once the outbreak occurred lack bedding. The sick rested naked on the cement floor of the building with corn husks as bedding and had dirty woolen sheets.^[45] The malnourishment and unsanitary conditions more than likely contributed to what happened once infections started.

Dr. Nicholas Albert Baltzell, the attending physician for the school, attempted to justify some of the conditions by claiming the institute was not properly funded nor properly supplied. He also said that during the time of the outbreak at the school that he had just recently recovered from influenza himself, and that ever other physician for size or eight miles during the outbreak was sick with influenza.^[46] Others also noted that conditions were aggravated by how deeply the school and surrounding community had been impacted. Because of of pandemic, the school had lacked somebody to run the water pump system, this caused the sewer system to malfunction. The building where the boys were being cared for on the cement floor had been a dining hall until being pressed into service due to lack of space in the dorms for the sick. One of the school matrons had to be left for several hours where she died because everybody who was not sick was too being taking care of the people were were sick.^[47]

The influenza outbreak led to calls for immediate action to reform the reform school. On 2 November 1918, the terrible conditions at the school led to the juvenile justice system across the state completely halting the sending of boys to the school until the problems were fixed.^[48] Superintendent Boone was fired on 7 November 1918.^[49] Tragedy again struck the school when in early November several boys burned to death at the school.^[50] These deaths could be the four white boys who deaths are accounted for on the ledger during the period of 4 November 1918 to 8 November 1918. The records were so poorly kept that we may never know how many died form influenza at the Florida Industrial School for Boys.

Based upon a survey of deaths certificates for Jackson County, Florida, there was a death from Spanish Influenza on 15 September 1918, 23-year old Essie McCrarie. Three deaths occurred during the first week of October, and then there were several deaths everyday in the county for just about every day until early December. The state reported 136 influenza deaths for Jackson County during the Fall 1918 wave of the pandemic.^[51] The survey of death certificates suggests the deaths from the boys school were most likely not included in that total number.

Flu Bans and Shut Downs:
During the first week of October 1918, reports of influenza deaths and cases begin to trickle in to newspapers across the Wiregrass Region. By the second week of October action begin to be taken by local officials to combat the spread of the disease.

On 6 October 1918 the town of Barwick (located on Thomas County/Brooks County line) was shutdown due to an outbreak. The situation was so dire that the drug stores were closed because the pharmacist and the clerks were all sick. The town's lone doctor was also sick. Calls were put out state wide for pharmacists, doctors, and nurses to help the situation developing in Barwick.^[52] During the next two weeks, Albany, Bainbridge, Cairo, Douglas, Pinehurst, Tallahassee, Thomasville, Valdosta, and Waycross all issued orders that banned public gatherings. Churches, schools, and theaters were also shutdown in these cities. These orders were typically called flu bans at the time. In response to the pandemic, the Moultrie Methodist Church began holding open air services.^[53]

Many of these shutdowns lasted only a few weeks and cities were soon reopened. These were then often followed by new flu bans. The cycle of flu bans being lifted and then reinstated continued in some cities all the way until March 1919.

Moultrie begin reopening in early November. On 2 November 1918, the Grand Theater begin showing movies again after the building was "thoroughly cleaned, fumigated, and ventilated.^[54] Colquitt County Schools and Colquitt County Superior court reopened on 4 November 1918.^[55] Schools in Colquitt County were shutdown again on 26 November 1918.^[56] The schools in Colquitt County reopened again on 30 December 1918.^[57]

The flu ban in Valdosta was lifted on 5 November 1918.^[58] A new flu ban was put in place in Valdosta by at least 13 December 1918^[59] , and was still in place during the rest of the holiday season. On Christmas day, thirty young people in Valdosta got into trouble with the city court after they held a dance at one of the local hotels.^[60] It is not known when the flu ban in Valdosta was again lifted; although there is some evidence that some parts of the flu ban had been lifted in late December. City Marshall, Oscar Teck Hill, remained busy in early January enforcing the health rules in Valdosta that had been put in place by local officials. Many people were still visiting the homes of sick friends and relatives despite orders not to go into homes where sick people were. Marshall Hill inspected one house and found fourteen people there visiting the sick person.^[61]

The original two-week flu ban in Thomasville that started on 7 October 1918 was eventually extended all the way until 28 October when it was lifted.^[62] A second flu ban in Thomasville was instated on 10 December 1918 and was scheduled to end on 1 January 1919.^[63] The ban was ended a few days early due to a decrease in new cases on 27 December 1918.^[64]A third Thomasville flu ban put in place on 16 January 1919.^[65] This third flu ban ended up being the longest one for Thomasville. It was not lifted until 1 March 1919.^[66] During the third ban, people began placing quarantine signs on their houses as a warning to any potential visitors to show that people in the house were sick.^[67] Thomasville also made where if people who were sick with the flu did not stay at home that the people would either be punished with a $100 fine (equivalent to $1,377 in 2020), 60 days in jail, or three months on the street gang.^[68] In order to not too severely disrupt the education of the students of Thomasville, teachers began making rounds to houses of their students and leaving homework assignments.^[69] At the end of the flu ban, the home study program was deemed a success due to the efforts of the mothers of the students.^[70]

The following is a spreadsheet compiled from daily reports printed in The Atlanta Constitution from 19 October to 27 October 1918. The number of new cases for each day is listed. Many cities in Georgia did not send in reports everyday.

Albany, Georgia is one of the larger cities that never had any reports posted in The Atlanta Constitution. It is unknown why that happened.

The following is a spreadsheet compiled from daily reports printed in The Thomasville Times-Enterprise from 16 October to 5 November 1918, another period from 15 December to 25 December 1918, and another period from 19 January to 2 February 1919. It only covers Thomas County, Georgia. The number of new cases for each day is listed.

Fairs and the Flu:

October was normally the beginning of the fair season in the Wiregrass. Several fairs were postponed due to outbreak of the flu across Georgia. These fairs most likely contributed to the spread of the pandemic and could easily be called "super spreader events."

The first fair of the season was held in Donalsonville (modern Seminole County, Georgia). The Southwest Georgia Fair was held from 1 October 1918 to 5 October 1918. One of the exhibits of note during the air was the War Relic Train. It had the latest in modern weaponry on display that was being used to fight the Germans in addition to war trophies that had been brought home. The train toured from town to town in order to keep up enthusiasm for the war and promote the Fourth Liberty Loan Drive. The train was scheduled to only be at the fair for 2 hours on 3 October 1918.^[71] The train was expected to draw "everybody within twenty-five miles or more... ."^[72] The next morning the train was in Quincy, Gadsden County, Florida, drew large crowds, and helped raise $105,000 (equivalent to about $1,600,000 in 2020 for the Liberty Loan Drive.^[73] Some researchers have speculated that the train is what brought the influenza pandemic to Gadsden County, but as previously mentioned in a different section,^[74] that there had already been several deaths from influenza in the county before the train ever arrived. The crowds that gathered in Quincy that day certainly did not help with suppressing the spread of the disease. The train continued onwards to draw crowds in other towns.

Below are several photographs from touring War Relic Trains (and the crowds they drew in) across the United States from around the same time period. For more information about War Relic Trains please consult Shirley Wadja's article "America’s World War I Trophy Trains: War Relics as Propaganda" which can be found here.

Meanwhile in Douglas, Georgia, the Coffee County Fair Association were facing a difficult decision in early October 1918. The president of the association, Judge Walter Clarence Bryan, had died in late September 1918 from conditions that fit the description of a victim of the pandemic. Deaths and cases were quickly mounting up in the Coffee County area, and the fair was going to be held in only a few weeks. Due to the conditions, the remaining leaders of the Coffee County Fair Association decided it would be best to cancel the fair entirely and announced their decision on 11 October 1918.^[75]

Other cities made different decisions. In Atlanta on 7 October 1918, the city council announced a two-month ban on public gatherings and also closed churches, movie houses, schools, and many other popular venues. One event was exempted from that order. The Southeastern Fair that was scheduled to run from 12 October to 19 October. ^[76] The Southeastern Fair did require that all attendees wear a mask, so the situation was not as bad as it could have been. They asked people to make the masks at home, but also had masks to be given out that were provided by the Red Cross.^[77] Some noted humorously that The Southeastern Fair would resemble a Turkish harem and used it to promote attendance. The same writer noted that wearing a mask would alleviate the fear of being recognized by your neighbor while out in public with whomever you pleased to be with.^[78]

The Georgia State Fair in Macon was scheduled to run for ten days starting 30 October 1918, but was postponed due the influenza pandemic on 27 October 1918.^[79]
It was eventually rescheduled to run 11 November 1918 to 21 November 1918. It ended up drawing a crowd of 20,000.^[80] On 20 November 1918, the city of Macon had 104 new cases. Days before the fair started Macon had also ended their mask mandate. When the fair ended an editorial from The Macon Telegraph declared that "The influenza is probably worse in Macon right now than it ever has been."^[81]

Some communities did not postpone their fall fairs at all. The Colquitt County Fair was held from 12 November 1918-16 November 1918. They proudly advertised it as "A Fair That Has Not Been Postponed."^[82] It was going to be the first time the Colquitt County Fair was to be held and the county was determined to see it through. Many aviators and airships from Souther Field were on exhibition during the fair. On the biggest day of the fair, 12,000 people were in attendance. ^[83] The Metropolitan Shows which had been among entertainers at the Colquitt County Fair left Moultrie for Valdosta on Sunday, 17 November 1918.^[84] The Moultrie Observer also documents many of its own citizens traveling to Valdosta over the next few days after the Colquitt County Fair. An aviator from the military air training center at Souther Field near Americus is also reported as having left Moultrie for the Georgia-Florida Fair in Valdosta.^[85]

During the days after the Colquitt County Fair, case numbers began to rapidly increase. Nearly 400 hundred students were absent from school and three teachers were sick in the days after the fair.^[86] The situation continued to get worse. In order to provide help to the sick the Methodist church in Moultrie was temporarily converted into a hospital as the town did not yet have one. It was ran by two Red Cross nurses from Atlanta, who were to be assisted by a team of local volunteer nurses.^[87] The experiences of those volunteer nurses were traumatic. One of the nurses, Mrs. C. E. Anderson, began having a mental break down while work at the emergency hospital. She was sent to Georgia State Hospital for the Insane at Milledgeville in mid-December 1918.^[88]

Obituaries for Colquitt County document that at least 27 people died from influenza in Colquitt County in the month after the fair. The local papers rarely documented deaths in the Black community, so getting even an approximate idea of the total deaths in Colquitt County for 1918 is difficult. For the time period between the start of October 1918 to the end of December 1918, there is a total of 44 in-county deaths from influenza documented by The Moultrie Observer. Of those only three were Black, and only one was named.

In Valdosta, the Georgia-Florida Fair was originally all set to occur in later October. The latest advancements in military technology were going to be exhibited as a way to raise money for Liberty Bonds. With less than a week to go before the fair was to open, the organizers announced on 16 October 1918 that the fair was going to be postponed until mid-November.^[89] The next day, Valdosta instituted a ban on public gatherings soon began dealing. The ban on public gatherings was lifted in Valdosta on 5 November 1918. The reports of the re-opening of Valdosta state that there were 250 cases over the previous five or six weeks, and 4 or 5 deaths.^[90] The accuracy of those statistics is unknown due The Valdosta Daily Times being unavailable during that time period. Another limitations of the report is if those numbers represent all of Lowndes County or merely the city of Valdosta.

The Georgia-Florida Fair was eventually held from 18 November 1918-23 November 1918. Exhibits included military displays that drew large crowds. On 26 November 1918 a new outbreak was being reported in Lowndes County.^[91]

Fighting the Flu and Flu Masks:
A variety of methods of combatting the disease begin being suggested by medical authorities. Among them were:^[92]

• "Don't travel on a train, it's dangerous. If you must go in a train sit by an open window; also a wear a flu mask."

• "Don't attend indoor gatherings unless it is positively necessary."

• "All non-essential indoor meetings should be tabooed."

• "No child with a cough or sneeze should be permitted in school. Certainly no teacher should be so careless of her pupils' health as to face them all day while suffering from a 'cold.'"

• "In case of emergency non one should enter school or any indoor gatherings without a pocket handkerchief to 'Cover that Cough.'"

• "Do not drink or eat at public places such as soda fountains or restaurants unless you know these places sterilize their utensils after each use."

• "Remember if there is a sickness in the house isolate your patient and have the attendant wear a flu mask; this is the way to prevent all the family taking down at once and lowers the virulence of the disease."

The importance of wearing flu masks was stressed by many different medical authorities. This led to masks being mandated by various institutions and communities. As mentioned elsewhere, flu masks were required for attendees going to The Southeastern Fair at Atlanta. In order to promote mask wearing, the humorous benefits of wearing a mask were noted. A writer for The Atlanta Constitution noted the following about the coming fair and masks usage: "Think of the women whose teeth fail to fit - she may be beautiful in a mask; think of the man whose whose wife knocked out a few of his front teeth - he may be handsome again, in a mask; think of the agony that jealous wives and husbands will suffer as they wander around the grounds stealing searching glances at the masked faces that pass."^[93] In Thomasville, it was pointed out that "if a man wears a flu mask, he can quit shaving for a week or so and see how long his beard will grow."^[94]

Instructions for making simple flu masks were sent out by the United States Health Service and printed in newspapers across the country.^[95] When Thomas County Superior Court reopened in late October 1918, jurors were required to wear flu masks.^[96] In late October 1918, students and teachers at Moultrie public schools were required to wear masks when they attended school.^[97] In order to meet the demand for masks that were suddenly needed when the mask mandate for the schools was announced that Friday that was to go into effect on Monday, on that Saturday volunteers met at the Red Cross work room in Moultrie and were trying to get 800 masks made before the night was out.^[98] Once enough masks for the school children were produced, the Red Cross planned to make more mask for the general public. The Red Cross planned to charge the public and the school children five cents per mask to cover the cost of the materials.^[99]

Some communities like Americus, issued a mask mandate after a sudden increase in cases.^[100] The Red Cross was to provide the masks to the citizens of Americus for free.^[101]

Below are clippings from three newspapers that tried to promote mask wearing. They can be found in:

"People Urged to Wear 'Flu' Masks," Thomasville Daily Times Enterprise, 19 October 1918.
"'Flu' Masks Are Popular Among Many Citizens of Americus," Americus Times-Recorder, 16 October 1918.
"WEAR A MASK," The Moultrie Daily Observer, 19 October 1918.

Fake News and Fake Cures:
Then there were some in October 1918 who thought the whole pandemic was over blown, not as bad as people thought, and would not have been bad at all if it was not for the media. Their words have many parallels to sentiments expressed by some in these days of COVID. A day after the mask mandate in Americus was announced an editorial from the Americus Time-Recorder went on at length about "Hysteria and Influenza." The following are excerpts:^[102]

"Practically all of the deaths from influenza result because the malady developed into pneumonia, due probably to carelessness on the part of the victim. This particular epidemic of influenza, which has swept the country and produced more than half a million cases of sickness, is the worst the nation has ever known. But it is not half as bad as people have been willing to believe.
...
If the newspapers of the country had not printed anying [sic] at all about influenza, if the first reports had not been so exaggerated as to excite a general alarm, it is more than probable that the epidemic would never have become so widespread."

In the span of a sentence the writer went from saying it was the worst pandemic the nation had known to date, but also not as bad as people thought. As exhibited above, falsely blaming the media for the spread of the pandemic is nothing new.

As the influenza pandemic wore on, ads for unproven ways to prevent or cure the pandemic became a pandemic in itself. By 1919, memories of the horrors of the pandemic during the previous winter were used in advertising by reminding people about what they had experienced. Various cures were marketed as a way to prevent another winter 1918-1919. At this point in American history, there was nothing legally stopping anybody with a product or service to sell from making miraculous claims about what they had to offer. The Pure Food and Drug Act (1906) only required that distributors accurately label the contents that made up their products. It was not until the Federal Food, Drug, and Cosmetic Act (1938) that selling products with false therapeutic claims actually became illegal. Until then, companies were able to say their products could cure anything they wanted to say it cured.

Calotabs, as seen below, were a laxative. Peruna contained pepsin (a digestive aid) and hypophosphites.

Home remedies for influenza were also printed in newspapers during the time.

Below is a section newspaper clippings advertising a variety of different products and services that were said to prevent or treat influenza. There were many other remedies advertised besides these.

"Get Ready For Flu," Thomasville Daily Times-Enterprise, 26 November 1919.
"Recommend Remedy for Influenza," Tallahassee Democrat, 25 October 1918.
"The Chiropractic Way to Avoid 'Spanish Influenza,'" Bainbridge Post Search-Light, 14 November 1918.
"Plank's Chill Tonic," Tallahassee Democrat, 26 May 1919.
"Spanish Influenza, Resembles Old Fashioned Grippe," Tallahassee Democrat, 26 October 1918.
"Avoid Influenza," Thomasville Daily Times-Enterprise, 23 December 1919.
"Influenza More Deadly Than War," Brunswick News, 14 November 1919.
"No 'Flu' For You!" Tallahassee Democrat, 22 November 1918.
"To the Public," Tallahassee Democrat, 6 February 1919.
"The Great Influenza Tornado is About Spend," Tallahassee Democrat, 7 March 1919.
"Avoid 'Flu' by Sterilizing Your Nose," Atlanta Constitution, 30 December 1919.

The 1920 Wave in the Wiregrass:
As it turned out, the great influenza tornado was not spent. Of the various waves of the 1918-1920 Influenza Pandemic, the one that hit in the early part of 1920 is the best documented across the state of Georgia. The county health departments that had been established across the state by new laws had the entire of year of 1919 to get on to their feet. Death certificates were becoming routinely issued on the county level by late 1919. Because of this we have the names of most of the victims in Georgia from 1920. There appears to still be a divide between the Black and white communities in the state as far as the rate of doctors being compliant with the vital records law. Nevertheless, death certificates provide better documentation of the pandemic in the Black community when compared to newspapers from the same time period.

Georgia had 36,193 state-wide influenza deaths in 1920 and Florida had 868 state-wide influenza deaths that same year.

Another resource that helps with studying the 1920 wave is the the 1920 federal census was held on 1 January 1920. This allows to get an idea of who was living where, with whom they were living, and wear they were working during the outbreak. Similarly to the United States at the time of the 2020 census, in 1920 the country was on the verge of a wave of a pandemic. There were many people who appear in the 1920 census that did not live too many weeks beyond census day.

The 1920 wave was a wave of denial. Counties were hesitant to admit that the pandemic had returned, and some even lied about having had influenza deaths. People were still fatigued from the events of 1918-1919, and seem less willing to go along with new flu bans.

Reports of an influenza outbreak in Chicago begin creeping into newspapers in the Wiregrass in mid-January 1920. Reports of local cases of influenza were not mentioned in local newspapers until late-January. On 28 January 1920, seven cases of influenza were reported in Thomas County in the Thomasville newspaper.^[103] Thomas County death certificates show that there had already been a death from influenza weeks before when Mary Emily MacLean (1846-6 January 1920) had died. Her obituary gave term "grippe" and pneumonia as the causes of her death. She has been sick about a week and her death was unexpected.^[104] The difference between influenza and grippe was fluid. Some places considered it to be the same disease as influenza, but other saw them as different. Between the date of MacLean's death and the announcement of 7 flu cases on 28 January, death certificates show that there were three pneumonia related deaths in Thomas County. January had an increase of pneumonia deaths in comparison to November 1919 and December 1919. There were no pneumonia deaths in Thomas County in September 1919 and October 1919.

Dr. John B. Schreiber, Thomas County health commissioner, was adamant in an article in The Atlanta Constitution on 6 February that there was "no epidemic of influenza in Thomas County" and claimed there were also fewer cases of colds and grippe than usual.^[105] That was apparently not the case. Days later on 11 February 1920 a flu ban was enacted. Schools returned to the home study system that was used in 1919 and public gatherings were also banned.^[106] The flu ban was renewed several times over the next month. The Thomasville flu ban as finally lifted on 21 March 1920.^[107] Newspapers continued reporting flu cases and deaths in Thomas County for a few more weeks after the ban was lifted. Between January 1920 and the end of May 1920 there were 49 deaths in Thomas County due influenza and/or p pneumonia based upon death certificates.

An influenza outbreak was occurring in neighboring Colquitt County by February. The leaders of the county were against having another flu ban like the ones of 1918-1919.^[108] Between January 1920 to the end of May 1920, 27 influenza and pneumonia deaths in Colquitt County. Ware County also experienced a rapid increase in influenza cases in February 1920. Like Colquitt County, they decided to stay open.^[109] Ware County death certificates were not surveyed as part of the research for this article. By late February 1920, Cairo was also suffering from an influenza outbreak. Both the mayor and chief of police of the town were among the sick, but it was decided to not close Grady County down to avoid causing a panic.^[110]

The situation in Cairo eventually got worse, as did the influenza situation in many town in the Wiregrass. By 10 March 1920, Bainbridge, Cairo, and Quitman had joined Thomasville in adopting flu bans. Across the state line in Madison County, Florida, the flu ban in Monticello was lifted around the same time.^[111] Those policies were emblematic of how the influenza pandemic was handled in the Wiregrass in 1920. One county would institute a flu ban while a neighboring county would be ending their own. One county would wait until cases number got out of hand before instituting a flu ban. There was no coordination going on between the different counties. In fact, there seems to have been competition.

In late March, Valdosta was proudly proclaiming to other towns that they did not have any active cases of flu and had not had any cases for the entire season. They admitted there had been a few cases of la grippe, but said no cases of pneumonia had occurred and that nobody had died from any of the la grippe cases. The article continued by saying that "there had never been a time when there has even been a thought of establishing a quarantine or place a ban amusements, churches, schools or any other public gathering. In the view of the prevalence of influenza in the neighboring cities the situation in Valdosta is regarded as something unusual and for which the people are thankful."^[112] That was in fact very, very far from the truth. Between January and when that article ran in the newspapers of neighboring counties on 26 March 1920, according to death certificates Lowndes County had suffered 10 deaths clearly labeled as caused by influenza. Most of those ten deaths were in Valdosta. During that same time period, Lowndes County had also suffered 10 deaths from pneumonia. Four additional influenza and/or pneumonia related deaths occurred in Lowndes County between 27 March 1920 and 5 April 1920. Furthermore, South Georgia Normal College (modern day Valdosta State University) had also closed on account of influenza during the week before that article ran.^[113]

Appendix:
Below is a spreadsheet containing deaths related to influenza pandemic for Brooks County, Colquitt County, Cook County, Echols County, Lowndes County, Thomas County, and Tift County. The information has been compiled from newspapers and death certificates. Resources have been exhaustingly search for the period from 1918-1920.

Below it is a similar spreadsheet for a selection of Wiregrass counties in Florida. Only the death certificates for the time period between September 1918 to December 1918 have been surveyed.

References:

1. Sara Plaspohl, Betty T. Dixon, and Nyssa Owen, "The Effect of the 1918 Spanish Influenza Pandemic on Mortality Rates in Savannah, Georgia, " The Georgia Historical Quarterly 100, no. 3 (2016): 332-339.

2. Andrew Kishuni, "Pestilence and Poverty: The Great Influenza Pandemic and Underdevelopment in the New South, 1918-1919" (undergraduate thesis, University of Central Florida, 2020).

3. Annual Report of the Georgia State Board of Health for 1919, (Atlanta: Byrd Printing Company, 1919), 21-23.

4. Annual Report of the Georgia State Board of Health for 1918, (Atlanta: Byrd Printing Company, 1919), 53.

5. Annual Report of the Georgia State Board of Health for 1919, (Atlanta: Byrd Printing Company, 1919), 64.

6. Annual Report of the Georgia State Board of Health for 1920, (Atlanta: Dickerson Roberts Printing Company, 1921), 64.

7. Annual Report of the Georgia State Board of Health for 1921, (Atlanta: Index Printing Company, 1922), 50.

8. Annual Report of the Georgia State Board of Health for 1922, (Atlanta: Byrd Printing Company, 1923), 27.

9. Annual Report of the Georgia State Board of Health for 1923, (Atlanta: Stein Printing Company, 1924), 23.

10. Annual Report of the Georgia State Board of Health for 1924, (Atlanta: 1925), 34-35.

11. Thirtieth Annual Report of the State Board of Health of Florida, 1918, (Jacksonville: Jacksonville Printing Company, 1919), 179-181.

12. Thirty-Second Biennial Report of the State Board of Health of Florida, 1921-1922, (Jacksonville: The Record Company, 1923), 247.

13. James E. Hollenback, "The 1918-1919 Influenza Pandemic: A Pale Horse Rides Home From War," Bios 73, no. 1 (2002): 22-23.

14. Gina Kolata, Flu: The Story of the Great Influenza Pandemic and the Search for the Virus that Caused It, First eBook Edition (New York: Farrar, Straus and Giroux, 2011), 15-17.

15. Gina Kolata, Flu: The Story of the Great Influenza Pandemic and the Search for the Virus that Caused It, First eBook Edition (New York: Farrar, Straus and Giroux, 2011), 257-263.

16. Gina Kolata, Flu: The Story of the Great Influenza Pandemic and the Search for the Virus that Caused It, First eBook Edition (New York: Farrar, Straus and Giroux, 2011), 250-257.

17. "The Pneumonia Menace," Atlanta Constitution, 5 January 1918.

18. "Gorgas Inspects Wheeler Hospital," Atlanta Constitution, 24 November 1917.

19. "Pneumonia Claims Maj. A. P. Gardner," Atlanta Constitution, 15 January 1918.

20. "New Pneumonia Cases Reported At Wheeler," Atlanta Constitution, 7 September 1918.

21. "Training Camp Health Conditions Improve," Atlanta Constitution, 14 September 1918.

22. "Gordon Will Play Both Wheeler and Jessup Labor Day," Atlanta Constitution, 1 September 1918.

23. "Quarantine at Camp for Spanish Influenza," Atlanta Constitution, 18 September 1918.

24. Andrew Kishuni, "Pestilence and Poverty: The Great Influenza Pandemic and Underdevelopment in the New South, 1918-1919" (undergraduate thesis, University of Central Florida, 2020), 28.

25. "Perrine Young People Came to Miami Beach Last Thursday Evening," Miami News, 10 September 1918.

26. Thirtieth Annual Report of the State Board of Health of Florida, 1918, (Jacksonville: Jacksonville Printing Company, 1919), 179-181.

27. "Clay B. Fleming Buried Here Today," Daily Times-Enterprise, 30 September 1918.

28. "Body of Raymond Barter Laid to Rest Here This Morning," Daily Times-Enterprise, 2 October 1918.

29. "Funeral of Wilce Mimms Will Be Held Tomorrow at Summer Hill," Daily Times-Enterprise, 30 September 1918.

30. "Will Fambough Died in Baltimore Hospital From Pneumonia," Daily Times-Enterprise, 5 October 1918.

31. "Miss Virginia Howell Leaves for Camp Jackson Tonight," Daily Times-Enterprise, 5 October 1918.

32. "Judge Bryan Passes Away," Douglas Enterprise and Coffee County News, 27 September 1918.

33. "Two Deaths at Broxton," Douglas Enterprise and Coffee County News, 27 September 1918.

34. "Sad Death of Mrs. Wooten," Douglas Enterprise and Coffee County News, 27 September 1918.

35. "Mr. J. J. Phillips, Ambrose," Coffee County Progress, 27 September 1918.

36. "All Stores Ordered Closed Tuesday," Douglas Enterprise and Coffee County News, 4 October 1918.

37. "Schools and Movie Closed," Douglas Enterprise and Coffee County News, 4 October 1918.

38. "Death's Harvest This Week Takes Many Good Citizens," Douglas Enterprise and Coffee County News, 4 October 1918.

39. "Coolidge Girl is Victim of Spanish Influenza," Moultrie Observer, 3 October 1918.

40. "Two Deaths From Pneumonia at Coolidge Saturday," Thomasville Daily Times-Enterprise, 14 October 1918.

41. Thirtieth Annual Report of the State Board of Health of Florida, 1918, (Jacksonville: Jacksonville Printing Company, 1919), 179-181.

42. Dale Cox, "The Pandemic of 1918 at Marianna's School for Boys," Dale Cox, Historian & Author (blog), 14 March 2020, https://twoegg.blogspot.com/2020/03/dozier1918.html

43. Erin H. Kimmerle, Ricard W. Estabrook, E. Christian Wells, and Antoinette T. Jackson, Documentation of the Boot Hill Cemetery (8JA11860), At the Former Arthur G Dozier School for Boys Marianna, Florida, (University of South Florida, 2012, 85-88.

44. "Boys at Reform School Never Washed and Many Nude," Lakeland Evening Telegram, 22 November 1918.

45. "The Boys Industrial School Again an Offender," Tampa Daily Times, 4 November 1918.

46. "The Reform School Not Quite So Bad as Represented," Tallahassee Democrat, 9 November 1918.

47. "State Board Whitewashes Itself For Conditions at Reform School," Tampa Morning Tribune, 19 November 1918.

48. "Judge Ordered Not to Send Children to 'Reform' School," Tampa Morning Tribune, 3 November 1918.

49. "Reform School Will be Aired," Tallahassee Democrat, 3 November 1918.

50. "The Reform School at Marianna," Tampa Daily Times, 13 November 1918.

51. Thirtieth Annual Report of the State Board of Health of Florida, 1918, (Jacksonville: Jacksonville Printing Company, 1919), 179-181.

52. "Barwick Quarantined," Atlanta Constitution, 6 October 1918.

53. "To Hold Services in the Open Air," Moultrie Observer, 11 October 1918.

54. "The Grand Theater...," Moultrie Observer, 1 November 1918.

55. "After having been...," Moultrie Observer, 4 November 1918.

56. "City Schools Are Suspended Indefinitely by the Board," Moultrie Observer, 26 November 1918.

57. "Schools Here Begin Spring Term Monday," Moultrie Observer, 28 December 1918.

58. "To Lift Flu Ban in Valdosta Today," Atlanta Constitution, 6 November 1918.

59. "Belleview," Ocala Banner, 13 December 1918.

60. "Thirty young people...," Pearson Tribune, 3 January 1919.

61. "Influenza Was There," Valdosta Times, 11 January 1919.

62. "Influenza Ban Will Be Lifted," Thomasville Daily Times-Enterprise, 24 October 1918.

63. "Public Meeting Spaces Again Ordered Closed to Prevent Influenza Spread," Thomasville Daily Times-Enterprise, 9 December 1918.

64. "Flu Ban Will Be Lifted," Thomasville Daily Times-Enterprise, 27 December 1918.

65. "Public Places Again Closed Because of Increased Danger From Influenza," Thomasville Daily Times-Enterprise, 16 January 1919.

66. "Flu Ban Lifted Saturday March First," Thomasville Daily Times-Enterprise, 27 February 1919.

67. "Many Houses Tagged With Quarantine Signs," Thomasville Daily Times-Enterprise, 16 January 1919.

68. "Thomasville is Fighting the Flu," Atlanta Constitution, 23 January 1919.

69. "Thomasville Teachers Visit House to House Conducting Studies," Atlanta Constitution, 2 February 1919.

70. "Card from Superintendent of Public Schools," Thomasville Daily Times-Enterprise, 1 March 1919.

71. "War Exhibit Train," Tallahassee Democrat, 25 September 1918.

72. "Southeast Georgia Fair Opens Today at Donalsonville," Bainbridge Post Searchlight, 25 September 1918.

73. "Relic Train Raised $105,000 at Quincy," Pensacola News, 5 October 1918.

74. Dale Cox, "Dozens rest in forgotten graves at Chattahoochee, Florida," Dale Cox, Historian & Author (blog), 14 March 2020, https://twoegg.blogspot.com/2020/03/fshspanishflu.html?m=1

75. "No Fair Will Be Held in 1918," Douglas Enterprise and Coffee County News, 11 October 1918.

76. "Public Gatherings Closed by City Council for Two Months," Atlanta Constitution, 8 October 1918.

77. "A Clean Bill of Health for the Southeastern Fair," Atlanta Constitution, 16 October 1918.

78. "Masks Will Make Fair Grounds Look Like a Great Harem," Atlanta Constitution, 15 October 1918.

79. "Georgia State Fair Off Because of 'Flu,'" Atlanta Constitution, 27 October 1918.

80. "Dorsey and Staff Visit Macon Fair,'" Atlanta Constitution, 16 November 1918.

81. "1918: When Spanish flu hit the Macon fair," 13WMAZ, 11 April 2020, https://www.13wmaz.com/article/news/local/spanish-flu-hit-macon-fair/93-a1c5b632-d51b-47ac-b6e3-50c1eb7c9902.

82. "Colquitt County Fair," Moultrie Observer, 5 November 1918.

83. "Doing the Right Thing Well," Moultrie Observer, 20 November 1918.

84. "The Metropolitan Shows... ," Moultrie Observer, 19 November 1918.

85. "Local Melange," Moultrie Observer, 20 November 1918.

86. "Absentees from School Today Number Nearly Four Hundred," Moultrie Observer, 21 November 1918.

87. "S. S. Room Will Be A Hospital," Moultrie Observer, 27 November 1918.

88. "White Woman Sent to the Asylum Today," Moultrie Observer, 14 December 1918.

89. "Georgia-Florida Fair Postponed," Thomasville Daily Times-Enterprise, 16 October 1918.

90. "To Lift Flu Ban in Valdosta Today," Atlanta Constitution, 6 November 1918.

91. "A New 'Flu' Outbreak In Lowndes County," Moultrie Observer, 26 November1918.

92. "Flu Hysteria is Dangerous Says Physician," Thomasville Daily Times-Enterprise, 26 October 1918.

93. "Masks Will Make Fair Grounds Look Like a Great Harem," Atlanta Constitution, 15 October 1918.

94. "And then too...," Thomasville Daily Times-Enterprise, 28 October 1918.

95. "People Urged to Wear 'Flu' Masks," Thomasville Daily Times Enterprise, 19 October 1918.

96. "Superior Court Will Hold Session Next Monday," Thomasville Daily Times Enterprise, 21 October 1918.

97. "School Children Will Wear Mask," Moultrie Observer, 18 October 1918.

98. "You are Wanted to Make 'Flu' Masks," Moultrie Observer, 19 October 1918.

99. "Red Cross Chapter to Supply Masks," Moultrie Observer, 19 October 1918.

100. "Americus Citizens Will be Forced to Wear Masks," Atlanta Constitution, 22 October 1918.
101. "Official Proclamation," Americus Times-Recorder, 22 October 1918.
102. "Hysteria and Influenza," Americus Times-Recorder, 23 October 1918.
103. "Three Cases of Influenza in Thomas County," Thomasville Daily Times Enterprise, 28 January 1920.
104. "Miss Mary Emily MacLean," Thomasville Daily Times Enterprise, 6 January 1920.
105. "No Flu in Thomas," Atlanta Constitution, 9 February 1920.
106. "Board of Health Recommends That City Be Closed," Thomasville Daily Times Enterprise, 11 February 1920.
107. "Flu Ban Remains Effective Thru Another Week," Thomasville Daily Times Enterprise, 16 March 1920.
108. "No Moultrie Ban," Atlanta Constitution, 17 February 1920.
109. "Flu in Waycross," Atlanta Constitution, 25 February 1920.
110. "Cairo Will not Close Up," Thomasville Daily Times Enterprise, 25 February 1920.
111. "Flu Conditions in Other Towns," Thomasville Daily Times Enterprise, 10 March 1920.
112. "Valdosta Hasen't Had Case of Flu," Worth County Local, 26 March 1920.
113. "Sumter City," Americus Times-Recorder, 18 March 1920.