Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library

Influenza Encyclopedia

The American Influenza Epidemic of 1918-1919:

A Digital Encyclopedia

Lowell, Massachusetts

50 U.S. Cities & Their Stories

As in many Massachusetts cities and towns, Lowell responded immediately to State Health Commissioner Eugene R. Kelley’s September 20 request to receive reports of influenza cases and deaths. Going one step further, Lowell’s Board of Health made the disease reportable on September 20 and immediately filed the city’s first official case and informed the state.1,2 Taking no chances, several hospitals in the city banned visitors the next day. But the nature of this infectious beast was explosive and by September 24, the number of new cases reported daily exceeded 100.3

Two days later, Mayor Perry D. Thompson called a meeting to see how to minimize the spread of infection in Lowell. The leaders Mayor Thompson drew together were members of the Board of Health, the School Department, and the Public Safety Committee. Together, they decided to close schools, theaters, and movie houses for at least the rest of the week, to add beds for influenza cases at several hospitals, and open an emergency hospital devoted entirely to influenza cases. After the meeting, Thompson called theater managers to his office, where they pledged hearty cooperation for the goal of influenza prevention.4

Mayor Thompson also contacted Major-General H. P. McCain, commanding officer at Camp Devens, only 18 miles from the city, to discuss ways to prevent the spread of infection between the military and civilians.5 By this time, there were at least 10,000 stricken at the camp, which made national headlines daily because of the devastating sickness and loss of life, and the desperate race to supply the camp with enough medical personnel. Camp Devens men weren’t paying social calls in any Massachusetts towns by that time.6

On September 29, the Board of Health and the Public Safety Committee met again and this time included Charles E. Simpson, the district’s State Department of Health representative. One result was a ban on public gatherings, excluding church services. They also determined that the city’s new isolation hospital, still under construction, was the best place to set up the emergency hospital. When officials tapped this unfinished isolation hospital as an emergency influenza hospital and declared its readiness an easy task, they were overly optimistic, as events later proved.7

Over the next week, the Board of Health ordered more social restrictions and exceptions. For example, while undertakers limited the seating at funerals, poolrooms, bowling alleys and bars were allowed to remain open. It wasn’t until October 7 that the Board ordered these gathering spots, along with large department stores, closed by 5 p.m. Days later, the Board agreed to a 6:30 p.m. closing time for both stores and bars for the convenience of people just getting out of work.8,9

Initially, Lowell’s churches made voluntarily changes as the emergency developed. At the end of September, when the State Emergency Health Committee requested that churches cancel services, Lowell’s Catholic churches shortened their services, and Protestant churches cancelled many of their weekly social gatherings.10 However, a week later, most Protestant denominations cancelled services entirely and Catholic Church services continued in an abbreviated form.11

Recognizing that homecare was as critical as hospital care, three Health Department nurses, two school nurses, and nine from the Lowell Guild joined forces at the end of September, when each nurse procured an automobile and list of homes to visit.12 The motor vehicle branch of the Public Safety Committee proved to be a reliable source of transportation for the nurses in the weeks to come, and soon each nurse averaged 21 visits a day.13 Sisters of the city’s various convents worked with the League of Catholic Women and the Knights of Columbus and they also conducted hundreds of home visits.14

The Red Cross helped provision the isolation hospital and eventually supplemented its nursing staff to achieve a nurse/patient ratio of 1:30.15 Public kitchens sprang up as well, including several organized by the Women’s Welfare Committee of the Lowell Federation of Churches. 16,17 And the Social Service League coordinated the efforts of several organizations to provide medical care, food, and other supplies to those in need. 18

The Board of Health began to meet daily, sometimes twice daily, laboring to orchestrate plans for increasing bed capacity at existing hospitals and hurrying completion of the emergency hospital for adults, and another for children connected to the Chelmsford Street Hospital.

Even as the daily report of new cases surpassed 500, the Board of Health suspected the actual number was higher, and members pleaded with physicians to report all cases. Physicians resisted at first, fearing the added work of physically placarding and unplacarding houses. The Board compromised by waiving the physical activity of placarding. Nonetheless, the Board expected physicians to speedily report accurate infection data to the Board of Health.19,20,21 However, to report or not to report became a moot point when the state made influenza a reportable disease effective October 4, superseding any local preferences.

The voluntary nature of Lowell’s church closings changed, too, when Massachusetts mayors received a telegram from Henry B. Endicott, Chairman of the State Emergency Health Committee. In it, Endicott asked mayors to order churches closed on Sunday, October 13. Lowell’s Mayor Perry D. Thompson was only too happy to comply, and consequently issued an edict through the Board of Health.22 Catholic churches, the only ones still holding services, defied the edict, though fear of infection made attendance at these services low.23

Defiant churches weren’t the only difficulty. Although the emergency hospital for children opened on October 3, problems loomed in the city’s attempt to ready the isolation hospital for adult influenza patients. Gas and electricity were installed, but what to do with sewage, since there were no connections yet to the city sewer system? Apparently officials didn’t delegate this decision, because Mayor Thompson and Dr. Simpson, the State Board of Health representative, decided together to dispose of the emergency hospital’s sewage in underground receptacles.24

Finally, on October 9, one 25-bed ward of the isolation hospital opened, just as Dr. C. F. Eskey, Assistant Surgeon of the Public Health Service, arrived in Lowell to take general charge of Lowell’s fight with influenza.25 One of his first encounters with the Board of Health included witnessing a dispute among physicians in attendance at the board’s October 11 daily meeting. On the agenda was a physician demand for a clear procedure when admitting patients to the isolation hospital. At the heart of the matter were two issues. First, can the head of the municipal charities division appropriately rule on a patient’s admissibility, since a review of medical rather than financial criteria for admitting critical patients is the norm? Second, does the admitting physician retain responsibility for the patient? After disagreeing for a day on these issues, the Board reached an agreement that was encapsulated as “official rules” published in community newspapers the next day, just in time for the opening of the emergency hospital’s second ward.26 The rules stated that patients must be acute cases of influenza or pneumonia and, once admitted, that their care was entirely in the hands of hospital staff. They directed city physicians to call the emergency hospital’s physician in charge to arrange admission. Mayor Thompson also weighed in with a remark that the hospital ought to be in the hands of an outside physician to allow local physicians to remain in their private practices.27

This outside physician was none other than Dr. C.R. Eskey of the United States Public Health Service. Once instated, he put in long hours at the hospital whipping it into shape, earning the respect of Lowell’s physicians.28 Eskey also participated in the daily Board of Health meetings on influenza, where his constant but necessary requests for adequate nursing staff were relayed to the Red Cross and other organizations recruiting nursing volunteers.

The issue of organizing volunteer teachers also paralyzed the Board of Health’s decision-making apparatus. At the October 13 meeting, members discussed, but couldn’t decide whether to recruit teachers to canvass the community for unreported cases. When the Board stalled, two outside officials took action the next day. Charles E. Simpson, the State Health Department’s district representative, and Hugh J. Molloy, Superintendent of Schools, called all teachers to an organizing meeting and the canvass commenced, in some cases with the help of school boys acting as interpreters. Within five days, the Board of Health received 15,000 out of 25,000 canvass cards from city teachers, with more expected.29,30,31

The Lowell Sun detailed a significant finding in its Sunday, October 16 editorial: nurses, charitable services representatives, and teachers were the ones who brought Lowell’s true plight to light, and this couldn’t have been done without home visits. Poverty, lack of English and sometimes lack of a healthy adult in the home were barriers to better health for many of Lowell’s residents. It was through these points of contact at home that agencies found those in need and arranged for their care, and that of their families.32,33

In the meantime, while Dr. Eskey struggled to locate enough staff to open a third ward at the emergency hospital, newspapers reported Boston’s plan to lift its influenza bans at midnight, October 19. This sent ripples through Lowell’s religious and retail organizations, which brought pressure to bear on the Board of Health to lift Lowell’s influenza orders.34 Churches openly defied officials when Lowell’s Federation of Churches passed a resolution recommending churches to hold Mass on Sunday. However, the Board of Health held firm with the closing orders, and the Federation of Churches reversed its recommendation. Services at Protestant and Catholic churches remained in suspension.35

By October 23, the daily number of new cases was reduced to 100, and the topic of lifting the bans came up daily at Board of Health meetings. Not surprisingly, members couldn’t agree on when to set the date. Instead, they personally inspected the city’s theaters and places of amusement, only to discover alarming conditions in most theaters. The managers were told to clean up and improve ventilation in preparation for a second inspection on October 26.36

In the midst of this face-off with theaters, Lowell’s epidemic dwindled to nothing. With relief, the Board of Health set all closure orders to lift on Monday, October 28, with special dispensation for churches to hold regular services on the 27th. Theaters opened individually, as they passed a final health inspection.37

In anticipation of another round of infections, on December 17 the Board of Health and Mayor Thompson met with the Red Cross and League of Catholic Women for a planning session. They were pleased to learn that the relief mechanisms at various Lowell agencies were still intact for that very reason, so no extra measures were needed.38 The flu did make another appearance in Lowell starting the last week in December and persisted though the end of February 1919, but without the ruthless vigor of the autumn 1918 wave.


Although the Lowell’s Board of Health met at least once daily during the autumn 1918 influenza crises, none appeared willing to assume the role of crisis leader. After their early success at tapping a location for the emergency hospital, Board of Health members seemed more involved in minutiae such as setting hospital admission rules than making command decisions. Neither did Mayor Thompson take sustained charge as Lowell’s chief executive. In spite of these organizational problems at the municipal level, individual charities and other public agencies organized swift, effective relief efforts focusing on home visits and nourishment for patients and their families.

Fortunately, influenza didn’t have quite the hold on Lowell that it could have, considering its proximity to Camp Devens and its thousands of infected victims. Lowell’s total excess death rate for the second wave of influenza was 523 per 100,000 in population. Nearby Fall River, Massachusetts, often clumped with Lowell in contemporary news reporting as ‘the mill towns with uncontrolled influenza,’ experienced a higher excess death rate of 621 per 100,000.39


1Massachusetts. State Board of Health. Fourth annual report of the State Department of Health of Massachusetts. Public Document No. 34 (Boston: Wright & Potter Printing co., 1919), 187.

2“Spanish flue,” The Lowell Sun, 20 Sept. 1918, 1.

3“120 new cases of influenza here,” Lowell Courier-Citizen, 24 Sept. 1918, 1.

4“Schools closed,” The Lowell Sun, 26 Sept. 1918, 1.

5“Lowell’s schools and theaters close down,” Lowell Courier-Citizen, 27 Sept. 1918, 1.

6For a complete discussion of Camp Devens’ experience with the 1918 influenza pandemic, see Byerly, Carol R. Fever of war. (New York: New York University Press, c. 2005)

7“Lowell’s contagious hospital buildings about to be turned over to city,” The Lowell Sun, 29 Jan. 1919, 8, 9.

8“The Sabbath real day of rest in Lowell yesterday,” Lowell Courier-Citizen, 7 Oct. 1918, 1.

9“Monday’s reports on the epidemic more encouraging,” Lowell Courier-Citizen, 15 Oct. 1918, 1.

10“Epidemic well in hand so far,” Lowell Courier-Citizen, 30 Sept. 1918, 1.

11“The Sabbath real day of rest in Lowell yesterday,” Lowell Courier-Citizen, 7 Oct. 1918, 1.

12“Epidemic well in hand so far,” Lowell Courier-Citizen, 30 Sept. 1918, 1.

13“Work of nurses in local epidemic,” Lowell Courier-Citizen, 12 Oct. 1918, 1.

14“Sisters busy on mission of mercy visiting patients,” Lowell Courier-Citizen, 11 Oct. 1918, 1.

15“No abatement of epidemic,” Lowell Courier-Citizen, 8 Oct. 1918, 1.

16“Work of nurses in local epidemic,” Lowell Courier-Citizen, 12 Oct. 1918, 1.

17“Emergency kitchen,” Lowell Courier-Citizen, 12 Oct. 1918, 7.

18“Lowell theatre managers want ban on epidemic lifted,” Lowell Courier-Citizen, 17 Oct. 1918, 1.

19Lowell, Mass. Board of Health. Fifty-first annual report of the board of health of the city of Lowell for the year 1918 (Lowell: Buckland printing company, 1919?), 12.

20“Taking steps to fight epidemic,” Lowell Courier-Citizen, 1 Oct. 1918, 1.

21“Fear epidemic may strike Lowell hard,” Lowell Courier-Citizen, 30 Sept. 1918, 1.

22“Influenza cases make new increase,” Lowell Courier-Citizen, 12 Oct. 1918, 1.

23“Fewer influenza cases in Lowell Saturday and Sunday,” Lowell Courier-Citizen, 14 Oct. 1918, 1.

24“Epidemic slows up,” Lowell Courier-Citizen, 3 Oct. 1918, 1.

25“Fewer cases of influenza reported yesterday, in city,” Lowell Courier-Citizen, 10 Oct. 1918, 1.

26“More cases reported and deaths increased to 18,” Lowell Courier-Citizen, 11 Oct. 1918, 1.

27“Influenza cases make new increase,” Lowell Courier-Citizen, 12 Oct. 1918, 1.

28“The epidemic subsiding,” Lowell Courier-Citizen, 18 Oct. 1918, 1.

29“Fewer influenza cases in Lowell Saturday and Sunday,” Lowell Courier-Citizen, 14 Oct. 1918, 1.

30“House to house grippe epidemic canvass,” The Lowell Sun, 16 Oct. 1918, 5.

31“The epidemic subsiding,” Lowell Courier-Citizen, 18 Oct. 1918, 1.

32“Fighting the influenza,” The Lowell Sun, 16 Oct. 1918, 6.

33“Health board report on relief work,” The Lowell Sun, 25 Oct. 1918, 1, 12.

34“Lowell theatre managers want ban on epidemic lifted,” Lowell Courier-Citizen, 17 Oct. 1918, 1.

35“Churches want to open on Sunday,” Lowell Courier-Citizen, 18 Oct. 1918, 8.

36“Steady improvement in epidemic is noted,” Lowell Courier-Citizen, 25 Oct. 1918, 1.

37“Votes to lift ban but warns public to use precaution,” Lowell Courier-Citizen, 26 Oct. 1918, 1.

38“Only two new cases of influenza reported at city hall today,” The Lowell Sun, 17 Dec. 1918, 8.

39Markel H, Lipman HB, Navarro JA, Sloan AJ, Michalsen JR, Stern AM, et al. Nonpharmacuetical interventions implemented by U.S. cities during the 1918-1919 influenza pandemic. JAMA. 2007;298:647.

Click on image for gallery. A bird’s-eye view of Lowell from Fort Hill Park.
Click on image for gallery. The Lowell Textile School, as seen from across the Merrimack River. Today, the school is known as the Lowell Technological Institute.
Click on image for gallery. Memorial Hall of the Lowell City Library.

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Atlanta, Georgia

Timeline of Events

Excess Death Rate (per 100,000) Daily EventsClick day to view details. Selected Event
200Excess Death Rate (per 100,000)
Total Excess Death Rate ###
Total Deaths per 100,000 population over duration of epidemic (roughly 1918 September 14 through 1919 February 22).

September 18, 1918

The Second Infantry Replacement regiment at Camp Gordon–approximately 15 miles northeast of Atlanta–is placed under quarantine because of the many influenza cases that have developed within its ranks.

September 21, 1918

Other units at Camp Gordon are placed under quarantine. This means approximately half of the soldiers at the camp are prohibited from leaving. All soldiers are barred from congregating.

September 22, 1918

The United States Public Health Service tells Atlanta residents that they are not in danger from the influenza epidemic now that Camp Gordon has been quarantined.

October 3, 1918

The Georgia State Board of Health issues a warning about influenza, now widely prevalent throughout the state. The Board informs communities that they should expect many more cases of the influenza in the coming days.

October 5, 1918

In cooperation with the United States Public Health Service, the American Red Cross appoints W. Frank Persons, the director general of civilian relief, to assist local health services with financial aid, nurses, and supplies.

The first influenza-related death is reported to Dr. J. P. Kennedy, City Health Officer. The quarantine at Camp Gordon seems to be keeping cases out of Atlanta, but Dr. Kennedy fears that people traveling on trains will infect the local populace.

October 6, 1918

The Atlanta Board of Health makes influenza a reportable disease. Health Officer Kennedy estimates several hundred cases in Atlanta. The Red Cross opens workrooms to volunteers for the first time in the Atlanta chapter’s history. This is to help fill the need for 100, 000 influenza masks requested by Camp Gordon.

October 8, 1918

The Atlanta City Council, after hearing from the Board of Health, issues an order closing theaters, movie houses, schools, churches, dance halls, and billiard rooms. The order will be in place for two months unless the epidemic subsides before then. All public transportation must be run with windows wide open, temperature notwithstanding, except in the case of a heavy rain. Students report to school at the regular time this morning to retrieve books and homework before being dismissed.

October 9, 1918

The Fulton County Board of Health and county school Superintendent J. W. Simmons together decide to close county schools for thirty days, subject to change as conditions develop. The editor of the Atlanta Constitution proposes that out-of-school boys be put to work harvesting cotton crops, which would alleviate the labor shortage caused by the war as well as keep the boys outside in the fresh air and sunshine.

October 10, 1918

Health Officer Kennedy urges physicians to report influenza cases, erroneously telling them that it is required by federal regulation.

October 12, 1918

Health Officer Kennedy reports that influenza conditions in Atlanta are better than in many other cities. He also reports that there has been no marked change in the influenza situation.

October 15, 1918

Health Officer Kennedy believes that banning public gathering for one more week is necessary. He states that public health precautions are impacting the effects of influenza, but more deaths from pneumonia complications are to be expected. He adds that many sick people do not have influenza as they believe, but rather coryza.

Southeastern Fair authorities and Georgia Board of Health Director Dr. T. F. Abercrombie issue an order that all fair attendees must wear an influenza mask.

The Atlanta Theater Managers’ Association decides to launch a group protest of the closure order. They feel that it is unfair that entertainment venues such as the Southeastern Fair can continue while theaters must be closed. The Association compared the cleanliness of their theaters to some unhealthy attractions at the fair. Health Officer Kennedy states that the danger from influenza will pass by the end of the week, and that the closure order can be lifted then.

October 16, 1918

Large crowds attend the Southeastern Fair. Many people are having difficulty obtaining the face masks required to enter. The Atlanta Red Cross announces that they will provide enough masks, free of charge, for all attendees.

October 17, 1918

Eighty telephone operators–15% of the workforce–are home sick with influenza, severely impacting the ability for important calls to be connected. Residents are asked to refrain from making unnecessary telephone calls.

October 18, 1918

Health Officer Kennedy tells the public that the influenza situation is not worsening, despite recent increase in cases. He adds that Atlanta has suffered less than other large cities, especially those in the Northeast.

The local chapter of the Red Cross puts out a call for one hundred volunteers to help assemble influenza masks at the “colored Red Cross work room at 167 Auburn Avenue.”

October 19, 1918

Health Officer Kennedy announces that influenza has reached its peak in Atlanta. He warns that the death toll will continue to rise over the course of the next week or two before it begins to subside.

October 22, 1918

Health Officer Kennedy is optimistic that theaters will be allowed to open by the end of the week, and that churches will soon be able to conduct indoor services without a permit.

October 25, 1918

Health Officer Kennedy indicates that the closure order will likely be rescinded, but that a special meeting of the Board of Health will need to occur first. H. M. Patterson, president of the board, did not say when the board would next meet. The Board of Education states will definitely not open schools before November 4.

October 26, 1918

The closure order and public gathering ban are lifted. Schools are scheduled to reopen on Monday, November 4.

October 28, 1918

Atlanta theaters reopen to large crowds.

November 4, 1918

Atlanta schools reopen.

November 9, 1918

After receiving a federal report, Health Officer Kennedy announces that only three other American cities (Grand Rapids, Cambridge, and Spokane) had lower death rates during the epidemic than Atlanta.

November 17, 1918

Reports indicate that influenza cases in Atlanta are increasing.

December 4, 1918

Acting School Superintendent Charles S. Culver announces that, because of the time lost during the closure order, the school year will end on June 20 instead of June 1.

December 13, 1918

Influenza cases are on the rise in Atlanta. Health Officer Kennedy tells residents to prepare for an increased death rate for the next several weeks.

December 17, 1918

The Atlanta Red Cross forms a committee to aid public health authorities in ending the influenza threat in the city. The public safety committee of the Atlanta Chamber of Commerce decides not to recommend another public gathering ban, and instead would like to urge individuals to take precautions against sneezing, coughing, and spitting in public, and to ventilate streetcars and places of public amusement. Health Officer Kennedy agrees with the recommendations.

December 20, 1918

Reports indicate that the recent spike in influenza cases is subsiding.

December 21, 1918

The Red Cross, Associated Charities, and Anti-Tuberculosis Society form a Clearing House Committee to reduce redundancy in the reporting of cases and the managing nursing care and post-epidemic charity. All reports made to the health department will now be routed to the secretary of the Clearing House Committee.

December 22, 1918

The epidemic continues to subside. Health Officer Kennedy states that even though physicians are not reporting every new case of disease, the lower death rate is reflected in the number of burial permits.

December 31, 1918

With the epidemic over, the Board of Health once again takes over requests for nursing and medical aid from the Clearing House Committee.