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The 1918 influenza pandemic was a worldwide pandemic spread by A/H1N1 influenza virus which is believed to have spread through as much as a fourth of the world's population and to have killed tens of millions between January 1918 and December 1920. Though the origin of the outbreak is not known for certain, the disease was popularly called the "Spanish influenza" or "Spanish flu", partly because reports of the high death toll in Spain had not been censored as they had from other parts of the world.

The deadliness of the virus itself was compounded by the ongoing Great War and the spread of other infections through ill-equipped sick wards and military camps. Birmingham was hit hardest during the second week of October 1918, well after some large coastal cities and areas with military camps, but also ahead of many of Alabama's smaller cities. Though the city and county had held out false hopes that it could avoid the contagion, once it was clear that it was spreading, decisive action was taken to shut down schools, theaters, churches and large public gatherings. Significantly, the 1918 Alabama State Fair, which had just gotten underway, was shuttered.

Despite those efforts, the epidemic hit hard in the area. Around 10,000 cases were reported in the county, with tens of thousands of unreported cases suspected. Of those, it is thought that around 600 deaths were caused by the disease. The shutdown was extended to the end of October, but then rescinded as the number of newly-reported cases fell to manageable levels. The city experienced a second, smaller outbreak after schools reopened and Armistice Day was widely celebrated in November. A third outbreak occurred in January 1919, but was less severe.

Reported cases

Confident reports of H1N1 cases in Jefferson County began to appear in the first week of October 1918. By Monday October 7 four deaths were attributed to the epidemic in the course of two days, and 50 new cases were reported that morning. Jefferson County Health Officer Judson Dowling stated his suspicion that many more cases had not been reported because they had either not been attended by a physician, or even if they had, physicians had been working non-stop without finding time to submit reports.

By the next afternoon, six more deaths had been recorded and another 284 cases reported, bringing the total number of reported cases above 1,000. Dowling continued to believe that there were probably 10 unreported cases for each that was reported countywide. On the following day, four more deaths and 810 new cases were reported in the city, with abundant evidence that communities across the county were experiencing the effect despite delays in official reporting. On Thursday October 10 there were 10 more deaths and as many as 2,000 more cases, bringing the city's death toll to 60 and the number of cases to nearly 4,200.

The number of new cases declined for the first time on Friday, October 11 when 600 new cases were reported. On Saturday only 350 new cases appeared, though that was followed by 416 reports on Monday. The number of deaths continued to grow as people diagnosed earlier succumbed. Twenty-three deaths from influenza were recorded on Monday, October 14. Tuesday brought 250 new cases and 17 burial permits. The death toll peaked on Wednesday when 31 burial certificates were issued. By October 21 the city had seen at least 7,100 reports of Spanish influenza, with another 2,100 reported in the rest of the county.

On October 25 a total of 417 new cases were reported, but it turned out that 200 of them were from one physician who had been too busy to make daily reports, and represented his entire month's worth of diagnoses. At that time the total of all reported cases in Birmingham was 9,039, of which 315 led to death.

Official responses

On October 7 Governor Charles Henderson issued a proclamation advising municipalities to close schools, theaters, and churches, and to cancel public events. The Birmingham Board of Education closed city schools for two weeks beginning on Tuesday, October 8, and the same action was taken by Jefferson County Schools and the Bessemer Board of Education.

Dowling worked with the Jefferson County Board of Health, the Birmingham City Commission, and the City Attorney to draft a public health ordinance that would force theaters, churches and places of public assembly to shut down, as well as to cancel the ongoing 1918 Alabama State Fair. In his address to the City Commission's October 8 meeting, Dowling referred to the reduced capacity of medical aid due to the war effort and stated that, "the only way of limiting the disease is to limit the public gatherings." Another physician and member of the Alabama Board of Health, D. F. Talley, communicated that U.S. Surgeon General Rupert Blue had recommended that all places of assembly be closed temporarily. He concluded that, "it is serious to close these places, but it will be a thousand times more serious to let them operate and not close them."

Speaking on behalf of the State Fair Association, Victor Hanson pledged to abide by the Commission's decision, but also touted efforts made to "sprinkle the grounds with an antiseptic to kill the germs," and the establishment of an on-site hospital tent. Attorney B. M. Allen made a case that the Lyric Theatre was doing "war work" through the presentation of newsreels and advertising war bonds, and that it was well ventilated. By contrast, the management of the Strand Theatre and associated houses told the Commission that they would close, "whether an ordinance was passed or not," and would no reopen until the Board of Health proclaimed that it was safe to do so. Similarly the manager of Loew's Bijou said that his theater had not opened that day and, "would be opened when all danger is over and not before." The managers of the Alcazar, Colonial, Odeon One, Odeon Two, PrincessTheatre, Rialto and Trianon theaters followed suit. The touring companies of actors remained lodged in town pending rescheduling of dates in other cities.

After the ordinance passed, all public entertainments and large meetings were officially closed down at midnight for a period of two weeks. Many anticipated visitors to the State Fair, unaware of the measure, arrived at Birmingham Terminal Station and the L & N Station and ended up, "wandering aimlessly up and down the streets" until their return trip. The Birmingham News published the text of several pastors' planned Sunday sermons for the benefit of those missing church services.

A similar ordinance was passed by the Bessemer Board of Aldermen. The orders did not affect public transportation or business houses, but Dowling warned that, "exposure to other persons in crowded cars and in closed rooms and poorly ventilated quarters will exact a heavy toll of sickness," and urged the public to take, "drastic steps" to protect themselves and others. Anyone with any symptoms was requested to remain isolated from others until the symptoms were relieved.

A planned "Liberty Loan Parade" to promote war bonds had already been postponed from October 5 due to rain, and was eventually canceled in light of the epidemic. Dowling himself wrote to all the members of the City and County Health Officers' Association of Alabama that their conference planned for October 10–11 was cancelled. Various fraternal organizations cancelled their regular meetings. Some "essential" services remained in operation, such as the telephone exchanges. The Southern Bell Telephone & Telegraph Co. scrubbed floors and walls and employed trained nurses to respond to any reports of symptoms and coordinate isolation. Those precautions proved insufficient as 115 of the 400 operators fell ill. Manager George Knox urged the public not to send "unnecessary messages."

On Wednesday, October 9 the county courts suspended hearings, and the Jefferson County Board of Revenue authorized Dowling to take steps to, "concentrate all cases of influenza that cannot be cared for in homes." Per his order, Central High School and Industrial High School were converted for use as temporary hospitals for white and African-American patients, respectively. The American Red Cross participated in setting up and staffing the new wards, and the public was urged to lend cots and bedding to outfit them, in a campaign led by Bossie Hundley called the "Red Cross Linen Shower". Calls for volunteers to help tend to the sick and to drive patients in private cars were also put out. Hillman Hospital remained full, and the temporary hospitals admitted about 40 patients each in their first few days, though Dowling was still concerned that many bedridden patients were suffering in homes with no one there to care for them.

One measure not taken was any attempt to officially quarantine all reported cases, as the epidemic was already widespread and well-publicized, and the county did not have sufficient forces to manage such a system beyond the voluntary isolation of those with symptoms. Dowling had recommended that the Birmingham Railway, Light & Power Company order all streetcars to run with open windows. A suggestion to delay stores from opening until 10:00 to stagger commuter traffic was not taken up. The Red Mountain Sanatorium, which housed tuberculosis patients, was closed to visitors.

Once the number of new cases began to drop in mid-October, Dowling urged that the public still seek fresh air and avoid crowded streetcars or gatherings. Anyone sneezing or coughing should remain at home and faithfully use handkerchiefs. He characterized the city's status on October 13 saying, "Birmingham has the epidemic well in hand, but Birmingham must 'sit steady in the boat' and drive home every precaution in order that a final victory might be won over the plague." To that end, he recommended that even as the numbers of newly-reported cases fell, that the city's restrictions be extended for an additional two weeks to prevent a resurgence. The City Commission accepted the recommendation and extended the shutdown for two additional weeks.

A stockpile of more than 1,000 quarts of seized moonshine whiskey stored at the Federal courthouse was discussed as a potential supply of disinfectant. As fears of infection subsided the public returned to stores and restaurants while theaters and other amusements remained closed. The City Commission cautioned against retailers advertising major sales that would draw crowds. On October 30 the Commission formally lifted its public health order, effective at midnight.

When the number of infections rose again in late November, and again in January, some called for schools to be closed again. Dowling believed it would not be necessary if parents kept sick children at home and school officials were vigilant. Some doctors recommended publicly that concerned parents hold their children out as a precaution. The later outbreaks never rose anywhere close to the level of the initial epidemic.

Notable deaths

References