Influenza Encyclopedia

On October 3, the Herald commented on the first influenza death in the city; a 30-year old salt worker, who had only arrived in Grand Rapids from Manistee, Michigan three weeks earlier, had died in a boarding house. Six other cases were reported in the city. Grand Rapids Health Officer Dr. Clyde C Slemons told the public that influenza was not unlike the common cold, and that those who began to feel ill should remain indoors and call a physician. He added that he did not anticipate a large number of cases in the city, and expected the epidemic to pass quickly.2 By October 7, however, some 75 cases had been reported, although it was not entirely clear if all were in fact influenza. Slemons indicated that some might have been colds, since it was difficult to distinguish between bad colds and mild influenza, especially during the onset of first symptoms.3 Most of these cases were among workers at the local picric acid plant, a factory that produced explosives for use in munitions.

Across Michigan cases were mounting, and state authorities realized that they needed to take quick action if they were to have any hope of keeping the epidemic in check. On October 9, health officers of the larger cities of the state met with Dr. Richard M. Olin, Executive Officer of the Michigan Board of Health. Together, the health officers decided that a public education campaign would be the best course. They also recommended that cases be reported promptly, that sick children be excluded from school, that people be advised to avoid crowds and to stay at home if feeling ill, and that theaters, schools, churches, and newspapers be used to disseminate information on avoiding and treating influenza. For the time being, the decision whether or not to close public places would be left up to local authorities. As Olin stated, however, this did not preclude statewide action from his office.4

By mid-October, there were an estimated 150 cases in Grand Rapids, and city officials and residents alike began to worry that the city had no adequate means to care for the growing number of ill. No emergency hospital had been established, and, should the epidemic grow worse, nurses would be in short supply. The Grand Rapids News pointed out that some cases were being cared for in hotels and boarding houses, where they could not be properly isolated. This would soon become a pet issue for the News. On October 14, the City Commission, aware of the problems, directed City Manager Fred H. Locke, a former salesman who had been appointed to the position in May, and the Department of Public Welfare to take any action necessary to procure hospital accommodations. Locke spent the next few days surveying the city for suitable buildings. In the meantime, he found almost 100 beds in city sanitaria.5

Slemons was still optimistic about Grand Rapids’ prospects. Some 350 cases had been reported to his office since September 30, but he believed that half of them were not likely to be influenza. He placed great confidence in the measures the city had taken thus far, namely the educational campaign and keeping sick children out of school. Slemons also noted the better housing situation in Grand Rapids as compared to other cities. “We haven’t the congested quarters of the eastern cities where the epidemic first appeared,” he told reporters.6 For these reasons, he believed that Grand Rapids would not suffer the same fate.

On Friday, October 18, Governor Albert Sleeper ordered a meeting between the members of the state Board of Health, health officials of large Michigan cities, prominent citizens, and other state officials. Many communities across the state had already voluntarily issued closure orders, but the two largest cities – Grand Rapids and Detroit – had not. Governor Sleeper and State Board of Health Executive Officer Richard Olin believed that, with influenza now rapidly becoming epidemic in virtually every Michigan town, Grand Rapids and Detroit needed to be brought into the fold. As Olin stated, the two cities should “draw a tight line along health rules to aid in the suppression of the influenza epidemic in other localities.” The following day, Sleeper and Olin announced the statewide closure order. All theaters, movie houses, churches, lodges, pool and billiard halls were ordered closed, and all non-essential public meetings and gatherings were prohibited. The decision of whether or not to keep schools open was left to local authorities. Where complete supervision was available, Olin and the state Board of Health encouraged schools remain open. Slemons disagreed with the order, arguing that Grand Rapids had but a few influenza cases.7

The order went into full effect on the morning of Sunday, October 20, which the Herald called the “Bluest of all the blue Sundays in civic history,” with a city full of people with no churches or theaters to attend. Clergy members encouraged home prayers. No doubt residents obliged. Many more turned to shopping, making downtown merchants happy by delivering a banner day of sales. Others took to their cars for a country drive, the closure order coinciding with the lifting of the ban on Sunday motoring. Even theaters workers were not entirely disrupted as a result of the state’s order, and all male employees of the Consolidated Theater Company were temporarily placed in positions at the picric acid plant, while female employees were given jobs in the Haskelite factory (which manufactured mold-bonded plywood for the city’s furniture-making businesses) or at local knitting mills.8

Although compliance with the order was reported to be high, not everyone was happy about the situation. Mostly, people were confused about what exactly constituted a gathering and what they were allowed to do during the crisis. As a result, Slemons quickly found himself very busy answering requests to be allowed to remain open or questions about the specifics of the order. Ministers asked to be allowed to hold church functions. Musicians asked to be allowed to teach private lessons. Others called to ask if they could play handball within an enclosed court. Slemons announced that there could be no deviation from the state’s rule. “When business men are closing up to their great financial detriment, those engaged in sports and in teaching should not ask favors when lives are at stake,” he told the public.9

Grand Rapids soon came under criticism – both from within as well as from without – for not doing enough to protect against the spread of influenza. The Board of Education decided that Grand Rapids’ schools would not close, as children would be in more danger out of school than they would be in classrooms. Many parents were not happy with the decision, especially given that half the schools in the state were already closed. Parents had the option of keeping their children out of school if they were worried about the danger of influenza, and many of them did so.1 Several members of the Board of Supervisors were likewise unhappy with the decision to keep schools open, and they began agitating for their closure.11 Concerned that residents across the state (and especially in Grand Rapids and Detroit) might not be following the spirit of the closure order, on October 22, Governor Sleeper issued a statement clarifying the matter: all types of public places of amusement and loitering were to be closed.12 Although he initially opposed the closure order, Slemons was duty-bound to enforce it, and he railed against those who he called “reckless” for disobeying Governor Sleeper’s directive.13

On the other side of the debate where those who held that the closure order was an onerous burden, or who simply believed that it provided little or no protection against the spread of epidemic influenza. Members of the city’s seventeen Christian Reformed churches, with their emphasis on regular church attendance, were particularly upset by the closure order. They argued that schools, which met five days a week and contained physically undeveloped children more susceptible to disease, were kept open while churches, which met only once a week, were ordered closed.14 High school football teams continued to practice, but bemoaned that their games had been cancelled. They even offered to play spectator-less games, to no avail.15

By November 1, reports were circulating that Governor Sleeper was considering allowing churches to reopen. Immediately, his office was flooded with requests from health officers, physicians, mayors, and city and county officials asking for the entire closure order to be rescinded. Two days later, after a conference with health officials, Sleeper announced that the ban on gatherings would be removed by November 7 or 8 if better conditions continued. The governor held good to his promise, and lifted the closure order effective Thursday, November 7.16

With in increase in social interaction came an increase in the number of new cases reported to the Grand Rapids health department. Initially, Slemons did not feel that the situation was alarming. He even told residents they had nothing to fear from the upcoming Victory Parade (to be held on Saturday, November 16), since it was an outdoor event.17 As Thanksgiving approached, however, and as the number of new cases began to rise again, Slemons was forced to consider the possibility of issuing a local closure order and social gathering ban. He was as reluctant to turn to such measures, as residents were to live under them. The general consensus was, let sick individuals take personal responsibility for isolating themselves rather than put healthy people out of work and strip the public of its entertainment venues. An editorial in the Grand Rapids News summed it up best. Influenza was once again raging in Grand Rapids, and drastic action was necessary, the paper told its readers. But, the editor added, “We can close all the public places of amusement and business we want to, but so long as individual intercourse is allowed between sufferers of the flu and those not exposed, we will have a danger of contagion hard to combat.” The News called for the compulsory quarantine of the homes of all sick individuals.18

State Executive Health Officer Olin was not convinced that a second closure order was unnecessary. It was only after theater owners across Michigan assured him that they would cooperate in a statewide campaign against influenza that he reconsidered. Perhaps not surprisingly, the idea for the campaign came from Grand Rapids, where sentiment against another closure order was strong both among officials as well as laypeople. There, Slemons and the general manager of Consolidated Theaters devised a plan to have Michigan movie theaters display posters and show lantern slides on influenza prevention and treatment. Theater owners were also to make it a rule to request patrons with a cough or with other obvious influenza symptoms to leave with a full refund. Churches were asked to aid the campaign by providing important public health risk communications to their congregations.19 But education was only half of the plan; the other half was voluntary home quarantine. On Monday, December 9, the Health Department posted influenza warning placards on the homes of all known cases of the disease, forbidding all visitors except for family members. These family members, however, could leave the home at will. Lastly, City Manager Locke strongly urged the use of face masks for everyone while in public.20 The hope was that this combined effort would forestall more drastic intervention by the state.

Just a day later, however, State Olin, after consulting with other state health officers at the American Public Health Association’s annual meeting in Chicago, telephoned his assistant secretary with orders mandating the strict home quarantine of all cases of influenza in the state. The penalty for failure to obey was set at not more than $100 or a jail sentence of not more than 90 days.21 In a battle over authority, Slemons, who was also in Chicago, made it clear that the new quarantine order would not go into effect in Grand Rapids until he deemed it necessary. The next day, Olin clarified that the quarantine order had not been finalized, and that the state Board of Health had not yet taken action.22

Residents may have welcomed Slemons’ standing up to Olin, but they did not think much of the city’s response to the second peak of the epidemic. Certainly the News did not, which printed a scathing attack on City Manager Locke and the health department for mishandling the epidemic. “Petty arguments and dissentions, conflicting authorities, the shifting of responsibility and pass of the buck is the order of the day at the city hall,” it printed. “People who call for help and guidance get no satisfaction.” The News was especially angry that no separate isolation hospitals had been established in the city, resulting in numerous cases in hotels, boarding houses, and public lodging places that were not being properly isolated.23

In fact, Locke and the Director of Public Welfare, Dr. A. E. Davidson, had been working on obtaining proper accommodations for influenza cases, although they were initially slow to do so. Davidson had requested that every hospital in the city set aside one floor or the equivalent to be used as an isolation ward. As Locke put it, it would be foolish to take over “an old building, barn, or other shack for these patients,” which could not be given proper care and treatment in such places.24 Under pressure from the public and facing a shortage of space in the hospitals, the city changed its tune and quickly arranged for the use of the old sanatorium building. It had space for 60 beds, would be staffed by nurses provided by the city’s hospitals, and provisioned by the local chapter of the Red Cross. The beds were desperately needed, since the hospitals were filled nearly to capacity. The YMCA offered its building, with space for 200 patients, to the city if necessary. The City Council welcomed the news, and expressed its approval of the handling of the situation by Davidson and Locke, the latter telling the council that the city could not possibly be expected to take care of all patients, but that he had done his best to procure hospital space for as many cases as possible after it became apparent that influenza was resurging.25

The News was not so sure this was the case, and immediately contacted each city hospital to enquire about available bed space for influenza patients. Butterworth, Blodgett, and St. Mary’s Hospital were unable to take any more patients. DeVore Hospital had space for approximately fourteen more patients. When the News contacted a local hotel about the situation there, the proprietor stated, “hardly a day goes by that we are not confronted with the influenza problem. We cannot throw these people out in the street and yet we must get them out.” The News found that nearly every hotel in Grand Rapids had been begging Locke to take care of their ill guests, to little avail.26 What the News failed to realize, however, was that with so few hospital beds available, and with the power to requisition hotels if need be, there was little reason or incentive to remove these cases to other facilities. In another scathing editorial, the newspaper attacked city hall for its failure in handling the epidemic crisis, and for its inability to act or even to provide answers. The city commissioners, it wrote, “are about as united on most problems as a barber shop quartet is on harmony.” It complained that Slemons and the rest of the Health Department were largely inaccessible. A mandatory quarantine should have been put in place, the editorial complained, instead of a weak, voluntary one. A hospital for contagious diseases should have been built long ago. The health and the welfare departments were “relics of bygone days, working in the dark with worn out tools.” The city may have been saving money, wrote the News, but lives were being lost.27

The next day, Friday, December 14, Slemons announced that 253 new cases had been reported for the day. With cases on the rise again, and with a severe shortage of hospital beds, the Health Officer announced a new set of anti-influenza measures. Public and private schools were ordered closed effective the following Monday until after the holiday period. To some extent this was a mere recognition of a de facto situation, as attendance was said to be down anyway. Stores and shops were warned that customers could not be allowed to congregate on their premises. Public elevators were restricted to carrying half the normal number of passengers per trip. All dance halls, skating rinks, lodge halls, and public meeting places were closed, and no private dance parties were allowed. Churches could remain open, as could theaters, provided the latter were well ventilated and prohibited the entry of anyone under the age of 16.28

Countering the charges leveled by the News, Slemons insisted that every single application for admission to an isolation hospital had been placed, and that every indigent case had been taken to DeVore Hospital. As to the issue of a mandatory quarantine, the health officer argued that such a policy would mean lives lost, since neighbors were caring for many of the ill. If they were not allowed entry into the homes of the ill, patients would die. “To prevent neighbors aiding such families would be criminal,” he told his detractors. He would insist that persons ill with influenza remain in their homes, but could not prevent caretakers from attending to them.29

Within a few days, the influenza situation in Grand Rapids had greatly improved. The old sanitarium building, now converted to an emergency hospital, began taking cases, as did several of the city’s private hospitals. Volunteer nurses from Mt. Mercy Sisters of Mercy as well as nurses from the Visiting Nurses Association’s infant clinic offered their services. At the same time, the number of new cases began to decrease steadily. As the epidemic waned, Slemons expressed his optimism that the worse was over, but, like nearly all his counterparts across the nation, was careful to warn residents that influenza cases would continue throughout the winter. Nevertheless, he believed that the situation had improved enough to warrant the removal of the remaining measures. At midnight on Christmas Eve, the ban on dances, ice-skating, and public gatherings was lifted. With the war over and the worst of the epidemic past, Grand Rapids celebrated “the merriest, brightest, and most thankful Christmas the world has ever known.”30

Conclusion

Between September and December 1918, over 2,500 of the 138,000 residents of Grand Rapids fell ill with either influenza or pneumonia. Of that number, 295 died.31 It is remarkable that this number was not higher given the very slow response to the epidemic by Health Officer Slemons and the health department. In fact, it took Grand Rapids seventeen days from the time the excess death rate first exceeded twice its average number – a marker which should have signaled to health officials that something was amiss – to finally respond with closures and public gathering bans, and even then it was done at the direction of the state Board of Health and not out of local initiative. Furthermore, Grand Rapids did not close its schools until mid-December, long after influenza had first appeared in the community. Yet in the end, Grand Rapids did better than nearly every other large American city. Its total excess death rate for the deadly second and third waves of the epidemic combined was only 211 per 100,000, a quarter of that for Pittsburgh and two-thirds that of St. Louis, often hailed as the model city for its handling of the epidemic.