For a city of only 60,000, Charleston had a fairly large public health infrastructure, with six hospitals to serve its population. Nevertheless, Charleston faced some significant public health obstacles. For one, the budget of the city’s Health Department was woefully low, only $0.31 per capita, and less than any other American city of its size. Other regional cities, such as Jacksonville, Savannah, and Augusta, spent twice that amount annually.1 Several diseases were endemic, including recurrent problems with typhoid, malaria, and pellagra (especially among the city’s African American population).
The first cases of influenza in the Charleston area were reported on September 16 among sailors at the nearby Charleston Naval Training Station. Naval officials there quickly instituted measures to control the spread of the disease, including a prohibition on sailors entering Charleston except under special circumstances, an outright ban on naval personnel entering any city theaters whatsoever, and the elimination of recreational and entertainment gatherings at the station. To help identify and isolate cases, medical officers undertook an inspection of all sailors at the station; they found approximately 350 cases. A few days later, army officials announced a raging influenza epidemic at Camp Jackson outside Columbia, some 110 miles northeast of Charleston. As of yet there were no reports of cases within Charleston proper, although Health Officer Dr. J. Mercier Green expected that to change soon enough. “Everything comes in the course of time,” he told reporters. “We’ll be hearing of it before long.” In the meantime, he tried to calm the public’s fear of the disease they had learned was spreading quickly down the coast. “I dare say most anything in the line of grippe would be classified by the patient as Spanish influenza just now,” Green joked. “That’s the way people are. If they must be sick, they intend to be sick with the proper thing.” He quickly added that real influenza, however, while it fortunately tended to be an illness of short duration, was no laughing matter.2
Meanwhile, Charleston was in the midst of a growing typhoid epidemic. In early September, thirteen cases of typhoid suddenly appeared in the city. Authorities were baffled as to the source of infection. In the past, typhoid outbreaks in the city had been linked to contamination from privy vaults. In this case, however, a number of the cases were from homes in the central section of Charleston, areas served by water and sewer lines. A few days later, the outbreak was traced to milk tainted by unsterilized bottles.3
As the typhoid problem was being brought under control, the influenza epidemic was gathering steam across the East Coast. Trying to prevent its spread into South Carolina, Governor Richard Manning asked the State Board of Health to ban the upcoming Ringling Brothers circus tour, scheduled to make appearances across the state with a troupe of elephants dressed as surgeons and Red Cross nurses.4 State Health Officer Dr. James A. Hayne informed Governor Manning that the Board of Health could not discriminate against the circus, and could only prevent its tour if it closed all other forms of traveling entertainment as well. The Board thus wisely chose to leave the ultimate decision with Governor Manning, who managed to negotiate with the circus for a limited tour across South Carolina. In Charleston, Ringling Brothers agreed to limit its appearances to October 4 and 5.5
On October 1, with the epidemic growing more severe, Health Officer Green asked all Charleston physicians to report their influenza cases. Of the public, he asked that people cover their coughs and sneezes and rest in bed until well if they should develop symptoms of the disease. Green worried that Charlestonians might not take the epidemic seriously. Debating the proper name of the epidemic sweeping down the coast and across the nation, one resident told reporters that he did not care what it was called, “so long as it doesn’t get me. Anyway, the Spanish influenza isn’t near as harmful as German influence.” Green disagreed. “No other communicable disease which assumes epidemic proportions spreads so rapidly or attacks indiscriminately so large a portion of the population,” he told the public. “Past epidemics have been characterized by a profound prostration out of all proportion to the intensity of the disease.”6 German influence did not kill, but epidemic influenza certainly could.
By the first days of October there were an estimated 350 influenza cases in Charleston and one death. Several of Charleston’s institutions, if not all of its residents, heeded Health Officer Green’s warnings and leapt into action. The local chapter of the Southern Division of the American Red Cross appointed a director general of civilian relief to prepare for the impending epidemic. It also appropriated funding to pay for graduate and practical nurses, nurses’ aides, and other related expenses. The College of Charleston suspended all campus activities and dismissed its student body. The Citadel, a military college located in Charleston with close connections to the army and to the SATC, had closed on September 29 for fear of its students contracting influenza from soldiers. The city’s public schools promised to have principals report cases of influenza in the schools and to send ill students home. In the meantime, school officials prepared for a possible closure in the coming days.7
It came just two days later, on October 5,when the Board of Health ordered closed all public and private schools, churches, theaters, movie houses, and other places where people congregate, and prohibited social gatherings and meetings.8 Health Officer Green also called on the streetcar operator, Consolidated Company, to keep its trains well ventilated. Ventilation was not the only problem: within a few days, the company had so many conductors, motormen, and mechanics ill with influenza that they it had trouble simply keeping enough cars in service. As a result, service on several city lines and on the Navy Yard line was curtailed.9
Charlestonians might have been expected to avoid social gatherings, but they were nonetheless called upon to participate in the fourth Liberty Loan drive to be held the second week of October. After issuing the closure order and gathering ban, the Health Department fielded a large number of inquiries about the Liberty Loan meetings. Despite the 212 new influenza cases reported in the previous two days, Health Officer Green told the public that it was their patriotic duty to attend the meetings. Some Americans were at war, facing enemy bullets. Those still at home, he said, should therefore “make martyrs of ourselves… by facing a possible illness in order to help our country in time of need…. We may contract influenza. But if we do, we shall have done so in a splendid cause.” Drawing on the imagery of trench warfare, Green added that staying away from the Liberty Loan campaign “savors suspiciously of lagging behind while others go ‘over the top.’”1 It was good patriotic advice for a nation at war, but not the best public health guidance for a community in the midst of an epidemic.
As early-October rolled on, the number of new cases continued to rise. Between noon of October 8 and noon of October 9, Charleston physicians reported 132 new influenza cases to the Health Department. As the case tallies mounted, the demand for nursing care skyrocketed. But, as in nearly every other community, there simply were not enough to handle to massive caseload. The Charleston chapter of the American Red Cross urged local women to volunteer their services. “Anyone accustomed to taking temperature and pulse can be of service,” the secretary of the chapter told the public.11 The Red Cross had previously given courses in home nursing as well as in dietetics, specifically in preparation for a possible epidemic or similar emergency when the brunt of nursing care would fall to the public. Many Charleston women had availed themselves of the courses. Unfortunately, few of them now came forward to volunteer.12
A week later, the Red Cross announced that it, in conjunction with Charleston officials, had divided the city into separate administrative districts. Each of these districts would be headed by at least one trained nurse who would direct volunteer workers. Residents were notified that they should telephone the nearest district headquarters if they had a case of influenza that required care. The hope was that this districting would help make the Red Cross’s care services more efficient, as the small number of available nurses and volunteers would not have to work the entire city, only a discrete district. Every little extra bit of efficiency the Red Cross could squeeze out of the system would help, as the situation had become dire. In one case, a young child lay in bed for three days without assistance, both of his parents delirious with influenza. In another case, an entire family was stricken with the disease. Two members had died, and the other three were prostrate with fever and unable to remove the bodies or care for themselves.13
By late-October, over 5,500 Charlestonians had been stricken with influenza. This was the official tally. Health Officer Greene assumed that the real number was double that, since he suspected that overworked physicians were drastically underreporting cases. The epidemic seemed to be waning, though, and the last few days of the month saw no new reported cases.14 Green was hopeful that the worst was over, but was in no hurry to see the social distancing measures lifted quite yet. In fact, hearing of the State Board of Health’s decision to lift the closure orders across South Carolina on November 3, Green wrote State Health Officer James Hayne to request that Charleston be excluded from such a move. “It would be a great mistake to have this quarantine lifted too early and undo what it has been so hard to accomplish,” he wrote.15 Hayne agreed to keep Charleston under the restrictions, even as he ordered them lifted in most other areas of the state on November 3.16
Not everyone shared Health Officer Greene’s beliefs. Particularly upset were members of Charleston’s clergy. The Bishop of Charleston, William T. Russell, protested the continued closure of churches while circus parades were allowed. How would American soldiers in Europe feel if they knew loved ones back home could not pray for them, he asked. “This consolation is denied them by a drastic law of dubious scientific value… [and] in answer to their protestations they are flippantly told by a health officer: ‘It is better to be restless than to rest,’” he wrote in a letter to the editor of the Charleston News and Courier.17 Other clergy felt similarly, and also expressed their extreme disappointment in the closing of their churches.18
No doubt Bishop Russell and his colleagues were none too thrilled with their city’s heavy – and officially sanctioned – reliance on whiskey as an influenza curative. In mid-October Governor Manning assented to allow Charleston Mayor, Tristram Hyde, to distribute whiskey to help fight the epidemic. Bootleg whiskey confiscated by the police was placed under the control of Health Officer Greene and his office, to be dispensed to physicians for their use while making their rounds of the city, or to sick individuals holding a valid prescription from their doctor.19 The demand for liquor far outstripped supply, however, and Greene worried that there would not be enough to treat the new rise in pneumonia cases. Daily, residents lined up at the dispensary window for their quart, sometimes waiting for hours. Some complained that the amount given was too small to be effective, especially when an entire family was sick. At least one man complained that he had to wait in line with African Americans. When a private citizen donated a number of quarts of whiskey to the Health Department, Greene announced that his office would happily accept all such assistance.20 Meanwhile, police busily poured thousands of gallons of confiscated whiskey into the sewers.21
Finally, with new cases on the wane, Health Officer Greene announced that the closing order and gathering ban would be lifted at midnight on November 6. Children were happy to learn that schools would not reopen for an additional week. Unfortunately for them, their usual Christmas holiday break was reduced from ten days to three in order to make up some of the lost classroom time, requiring students to attend school on New Year’s Day.22 Adult Charlestonians were thrilled to know that they could once again return to their normal routines, comforted by the knowledge that the epidemic was over. As the days of November rolled by, few new cases were reported, giving Health Officer Greene confidence in his decision to lift the closure.
In the end, over 6,000 cases of influenza - ten percent of the city’s population - were reported in Charleston during the course of the epidemic. Despite the large number of illnesses and deaths, some good did come from the epidemic. The large number of cases highlighted the need for more public health and patient care resources in Charleston. The local chapter of the Red Cross Motor Corp and its auxiliaries had driven a staggering 1,196 miles during the epidemic, going out on over 3,500 individual calls to check on influenza victims and bring severe cases to the hospital. An additional ambulance was ordered to help in the event of a future public health crisis. Home nurses had been severely overtaxed by the epidemic, highlighting the need for more nurses to be trained.23 Child welfare advocates called for increased medical inspections of students, starting a petition to appoint at least one physician and one visiting nurse to each school.24 At the state level, Hayne announced that the South Carolina Board of Health would ask the General Assembly for $93,000 to improve health facilities and for disease-prevention work.25 Perhaps then, the devastation wrought by the influenza epidemic was somewhat tempered by the renewed resolve Charlestonians felt to improve their city’s faltering public health and patient care system.
1 J. Merceir Green, “Report of the Health Officer,” in City of Charleston, Year Book, 1916 (Charleston, 1917), 195.
2 “The Spanish Flu at Training Camp,” Charleston Evening Post, 17 Sept. 1918, 11; “Spanish Flu Is under Control,” Charleston Evening Post, 19 Sept. 1918, 9; “Spanish Flu Not Seen Here,” Charleston News and Chronicle, 19 Sept. 1918, 6.
3 “Epidemiologist Summoned Here,” Charleston Evening Post, 10 Sept. 1918, 4; “Typhoid Caused by Milk,” Charleston News and Courier, 15 Sept. 1918, 24.
4 “Governor Moves to Stop Circus,” Charleston Evening Post, 21 Sept. 1918, 1.
5 “Circus Problem up to Governor,” Charleston Evening Post, 27 Sept. 1918, 13; “Circus Tours Limited,” Charleston Evening Post, 30 Sept. 1918, 4.
6 “Influenza Cases Must Be Reported,” Charleston News and Courier, 2 Oct. 1918, 2; “Spanish Flu is Nothing Unique,” Charleston Evening Post, 27 Sept. 1918, 11; “Influenza Cases Must be Reported,” Charleston News and Courier, 2 Oct. 1918, 2.
7 “College Closes for the Present,” Charleston News and Courier, 4 Oct. 1918, 8; “Red Cross to Help Fight Influenza,” Charleston News and Courier, 4 Oct. 1918, 6; “No General Sway of Flu Locally,” Charleston Evening Post, 30 Sept. 1918, 4.
8 “Churches, Theaters, Lodges and Schools Are Ordered Closed,” Charleston News and Courier, 6 Oct. 1918, 10.
9 “Flu Affects the Cars,” Charleston News and Courier, 9 Oct. 1918, 7.
10 “Health Officer Explains Order,” Charleston News and Courier, 9 Oct. 1918, 8.
11 “Nurses Needed at Home,” Charleston News and Courier, 10 Oct. 1918, 2.
12 “Women Implored to Give Their Aid,” Charleston News and Courier, 16 Oct. 1918, 10; “Nurses Are Needed by Red Cross Here,” Charleston News and Courier, 16 Oct. 1918, 10.
13 “City Districted to Fight Epidemic,” Charleston News and Courier, 17 Oct. 1918, 3.
14 “Flu Epidemic Abating Here,” Charleston News and Courier, 26 Oct. 1918, 2; “Flu Quarantine Won’t End Sunday,” Charleston News and Courier, 29 Oct. 1918, 8.
15 “Flu Quarantine Won’t End Sunday, Charleston News and Courier, 29 Oct. 1918, 8.
16 “Epidemic Checked,” Charleston News and Courier, 1 Nov. 1918, 3.
17 “Getting Quart of Liquor,” Charleston News and Courier, 31 Oct. 1918, 3.
18 “Wants Churches Open,” Charleston News and Courier, 26 Oct. 1918, 5, and “A Minister’s Appeal,” Charleston News and Courier, 2 Nov. 1918, 4.
19 “Whiskey for the Flu Sufferers,” Charleston News and Courier, 17 Oct. 1918, 5.
20 “All Doctors Here Work to the Limit,” Charleston News and Courier, 20 Oct. 1918, 10; “Getting Quart of Liquor,” Charleston News and Courier, 31 Oct. 1918, 3.
21 “Flu Quarantine to Last a While,” Charleston News and Courier, 22 Oct. 1918, 10.
22 “No New Flu Cases Up to 12 Yesterday,” Charleston News and Courier, 7 Nov. 1918, 8; “Schools Open Monday,” Charleston News and Courier, 8 Nov. 1918, 3.
23 “Red Cross Chapter Chooses Officers,” Charleston News and Courier, 21, Nov. 1918, 10.
24 “Child Welfare Bureau,” Charleston News and Courier, 29 Nov. 1918, 8.
25 “Board of Health Wants Outlined,” Charleston News and Courier, 21 Dec. 1918, 1.
|200||Excess Death Rate (per 100,000)|
September 17, 1918
A number of influenza cases are discovered at the Charleston Naval Training Camp. Bluejackets are not permitted to come to the city unless there is a special reason, and they are forbidden from entering theaters.
September 19, 1918
Dr. J. Merceir Green, Charleston’s Health Officer, says there are no influenza cases in the city, but warns that the disease is on its way.
Naval Training Camp authorities tell reporters that there are approximately 350 sailors sick with influenza at the station, not the 1,000 rumored cases. Men stationed at the camp cannot come to town or attend any gatherings, though men stationed in town may do so.
September 21, 1918
South Carolina Governor Richard Irvine Manning calls on the State Board of Health to issue an order preventing the Ringling Brothers circus from touring the state, in light of the growing influenza epidemic. He feels there is a real danger of the circus spreading influenza across South Carolina. Military officials at Camp Jackson announce that influenza is raging at the camp, with many cases ending in complications.
September 25, 1918
Military officials announce that the influenza epidemic at the Naval Training Camp is under control. Gatherings for entertainment and recreation at the camp are still prohibited. Representatives of the African American branch of the local chapter of the Red Cross meet with the central committee to discuss the nursing shortage.
September 28, 1918
The Southern Division of the American Red Cross asks for an immediate report of city and county nurses available for epidemic service with influenza.
September 30, 1918
Governor Manning allows the Ringling Brothers circus to perform in Charleston on November 1 and 2. The circus has agreed to perform at only three cities in South Carolina.
October 2, 1918
Health Officer Green asks all Charleston physicians to report their influenza cases. He warns residents of the impending epidemic and provides a list of influenza symptoms, preventative measures, and treatments.
October 4, 1918
Health Officer Green reports there are approximately 350 influenza cases in Charleston. He asks movie house, theater, and public hall managers to keep doors and windows open during performances. He does not yet think the situation is critical enough to warrant a general closure order. School officials at the College of Charleston suspend all college exercises temporarily and dismiss the student body until further notice. Local hospitals can no longer adequately care for additional cases.
W. Frank Parsons is appointed director general of civilian relief by the American Red Cross, and will take charge of the efforts to aid the city’s public health services in combating influenza. Red Cross chapter headquarters, nursing committees, and all available channels to secure applicant registration for this service will be used. The Red Cross will pay $75 for graduate nurses and $50 for practical nurses and nurses’ aides, in addition to maintenance and expenses.
October 5, 1918
The Board of Health issues orders to close all churches, theaters, public and private schools, sewing circles, secret and fraternal lodges, and places where people congregate. Liberty Loan activities are expressly exempted from the provisions of the order. The Board calls on the police to see that residents comply with the order, and asks physicians to isolate cases if possible.
October 6, 1918
The Citadel furloughs its 375 cadets until further notice on account of the epidemic.
October 7, 1918
Widespread compliance with the recent closure order is reported amongst Charleston residents, clergy, and business owners.
October 8, 1918
The South Carolina Board of Health orders a statewide order against assemblies. Physicians are asked to report all cases of influenza to the State Board of Health.
October 9, 1918
The Consolidated Company (operator of Charleston’s streetcars) curtails service on several of its city lines due to influenza among conductors and motormen. In order to keep cars running to and from the Navy Yard, city lines will have fewer cars during the morning and evening rush hours.
Health Officer Green tells residents not to stay away from Liberty Loan drives, but instead to do all they can to support them.
October 10, 1918
The Charleston chapter of the Red Cross again asks for volunteers. All women with nursing experience are urged to volunteer for paid service in the city.
October 11, 1918
The YMCA “Friday Nighters” Bible clubs scheduled to start this week are postponed until further notice, in keeping with orders to restrict public gatherings. Health Officer Green tells churches that the gathering bans and closure order does not only apply to indoor services, but to open-air services as well.
October 16, 1918
The Red Cross chastises all the women who recently completed its home nursing course but have failed to volunteer during the epidemic. The Red Cross also needs volunteer ambulance drivers.
October 17, 1918
The Red Cross and the Health Department divide the city into districts to help control influenza and more efficiently direct medical resources. A trained nurse will be stationed at each headquarters and will direct volunteer workers.
Charleston Mayor Tristram Hyde receives approval from the state to distribute confiscated whiskey to the Red Cross for influenza treatment.
October 18, 1918
The Health Department honors about 100 prescriptions for whiskey, but several are refused. Health Officer Green tells those able to walk into Health Department offices asking for whiskey that they are well enough to not need it.
October 22, 1918
Despite a heavy court docket, the court term is postponed due to the epidemic. The next term will begin on the first Tuesday in December. About 40% of employees at the Bell Telephone exchange are out with influenza.
October 23, 1918
Health Officer Green says that the epidemic situation is improving.
October 25, 1918
Miss Laura Brown, president of the Graduate Nurses’ Association, appeals to all graduate or registered nurses to register at Red Cross headquarters until the epidemic subsides.
October 26, 1918
With the number of new cases being reported on the decline, Health Officer Green now feels confident that the influenza situation is abating.
October 28, 1918
The Superintendant of the Roper Hospital training school for nurses announces a new course for nurses’ aides.
October 29, 1918
Despite improvement in Charleston’s influenza situation, Health Officer Green does not think it is a good idea to lift the closure order yet. He writes to South Carolina Health Officer Hayne to ask that Charleston be excluded from the order lifting the statewide gathering ban on November 3.
The Citadel reopens.
October 30, 1918
William. T. Russell, Bishop of Charleston, protests the fact that churches must remain closed while two parades were held in Charleston despite the epidemic (an October 3 parade, said to be the largest in the city’s history, and a second parade and circus a day later).
State Health Officer James A. Hayne lifts the closure order across South Carolina, but allows local authorities to continue the order if conditions warrant.
October 31, 1918
Health Officer Green and the Board of Health decide to keep the closure order and gathering ban in place. A group of church ministers was present to request that churches be allowed to open, but the request was denied. Green expects the closure order will remain in place until at least November 7.
November 2, 1918
The new Victory Theater prepares to open its doors as soon as the closure order is lifted.
November 3, 1918
Bishop William T. Russell of the Cathedral of St. John the Baptist holds several masses despite influenza. He argues that spiritual law compels Christians to worship once a week, that many have concluded that church closures do not help prevent the spread of influenza, and that the epidemic is essentially over at this point.
November 4, 1918
Health Officer Green announces that the closure order and gathering ban will end at midnight on Wednesday, November 6. Movie houses will reopen Thursday. The Victory Theater will reopen on Monday, November 11. No date is set for schools reopening.
November 5, 1918
The special course offered for nursing aides at the Roper Hospital begins today with but one candidate; others will join later, once they complete their epidemic responsibilities.
November 6, 1918
The Charleston Board of Health and the Red Cross hold meetings to discuss routine business in the wake of the epidemic.
The municipal playgrounds are reopened, having been closed during the epidemic by the gathering ban.
November 7, 1918
All places of public assemblage reopen. The quarantine at the Charleston Naval Training Station continues. The situation there is improving, but medical authorities want to make certain the epidemic is over.
November 8, 1918
The Charleston Board of Education announces that public schools will reopen this coming Monday (11/11). The usual Christmas holidays will be cut from ten to three days as a means of making up lost time.
November 11, 1918
The Victory Theater reopens to a large crowd.
November 12, 1918
City schools of Charleston reopen a day later than planned. The opening was delayed an extra day in order to allow children to participate in the Armistice Day celebrations.
The Medical Society of South Carolina adopts a resolution commending the Charleston Board of Health for enacting the closure order and gathering ban.
November 20, 1918
The Board of Health commends Health Officer Green for his “zeal, fidelity, and activity in endeavoring to suppress the late fearful epidemic and recognizes that it was largely due to his firm insistence upon adherence to the quarantine regulations that the ravages of the disease were lessened in this city.”