As the nation copes with the coronavirus pandemic, we’re bringing back to your attention this 2018 piece about the 1918 flu pandemic that swept the globe and how it affected Knoxville.

For four weeks in the fall of 1918, Knoxville fought the Spanish flu. The contagious illness killed an estimated 132 people and closed schools, churches, theaters and pool rooms for almost a month.

Doctors first called the illness the “old-fashioned gripe,” but there was nothing familiar about this strain of fast, often fatal, influenza. While it often started as a cold accompanied by a headache and joint pain, patients developed fever, hallucinations and bleeding from the nose, stomach, intestine and sometimes ears. They coughed up blood as their skin turned blue, then black.

People who survived could develop a lingering “hacking cough” that could turn into sometimes fatal pneumonia. During autopsies, doctors found people died with fluid-filled lungs.

Another difference was who got sick. Rather than prey on babies, the elderly and the very weak — as most strains of flu do — this one hit young, previously healthy people in their prime. Most patients were between 21 and 40 years old. More than 90 percent of victims across the United States were younger than 65. All told, the epidemic dropped America's average life expectancy by 12 years.

“Spanish flu” was a misnomer, as the flu took its toll on many countries. But since the flu outbreaks happened during World War I, they were among the “bad news” many countries’ newspapers — including the United States’ — suppressed. Spain was a neutral party in World War I with no strategic need to hide its vulnerabilities. So most flu news came from wire services in Spain and, thus, tagged the flu with the country's name, too.

In a way it was the war that brought the pandemic to East Tennessee. Soldiers, many of whom arrived here on trains from other parts of the country, trained at the University of Tennessee and at Chilhowee Park. Soldiers who got sick likely spread the disease in their barracks and in town.

The flu comes to town

“Many soldiers” were so sick, the Knoxville Sentinel reported on Oct. 5, that makeshift hospitals were set up at Chilhowee and in UT’s Reese Hall. Red Cross nurses were called in to tend to the unreported number of quarantined soldiers. The military also inoculated soldiers with a “serum” it hoped would prevent them from getting ill.

Initially, authorities didn’t seem overly concerned. Only about 350 civilians, in a city of about 75,000, were sick in early October, and they didn’t seem very ill.

Dr. W.R. Cochrane, secretary of Knoxville’s board of health, told reporters the illness “will not be likely to get any worse if due precautions are taken.” Doctors warned everyone to stay out of crowds but get plenty of fresh air and keep spaces ventilated.

But more people did get sick. On Oct. 9, three people had died. That day, 197 soldiers and 604 civilians were ill. Soon, Knoxville General, the city’s only permanent hospital, would be overwhelmed — not only by patients, but also from lack of doctors and nurses as many themselves fell ill.

Patients also crowded the 40-bed Riverside Hospital, operating in an old home, and a small black-only hospital at Knoxville College. The inadequacy of the hospitals to accommodate the flu patients hastened the construction of Fort Sanders Hospital in 1920.

Closing down Knoxville

At midnight Oct. 9, 1918, the city board of health ordered schools, churches, theaters and pool rooms to close. They’d remain closed for weeks, not opening again until Nov. 3 and Nov. 4.

The University of Tennessee and Knoxville Business College canceled classes. UT President Brown Ayres ordered students living off campus not to visit friends in dormitories but to “spend as much time in the open air.” If they got ill, students living in boarding houses or rented rooms were told to call Ayres if they needed a doctor.

The five-day East Tennessee Division fair at Chilhowee Park ended after three days. The only public meetings allowed were Liberty Loan war bond fundraisers or Red Cross meetings.

By mid- to late October of 1918, the flu had hit Knoxville hard. Employees were too sick to work at local factories; coal production in Tennessee and Kentucky dropped because so many miners were ill.

Railroad officials in Knoxville had trouble filling work crews for the L & N and Southern railroads. Red Cross workers at the Southern Railway canteen wore “gauze masks” as they greeted soldiers leaving trains for training camp.

Streetcars kept windows open and disinfected each car at night. Newspapers ran tips of how to prevent getting sick alongside advertisements touting the benefits of Vicks VapoRub and other over-the-counter medications.

Dr. E.L. Bishop of the state board of health condemned “promiscuous kissing … especially that of the nonessential variety,” adding that a “kiss of infection … may truly be the kiss of death.”

Read the Bible or a library book

The papers printed pastors’ sermons so worshippers, dealing with a world in turmoil in addition to possible fatal illness, could read them. The Rev. Robert Gammon urged families to hold home services.

“If nothing more is done than reading the Bible as a family it will be beneficial,” Gammon said. “Let us not think that because our church doors are closed for the sake of safety, that we may not carry out our usual sabbath program. Let us have 10,000 services in Knoxville next Sunday instead of 10,000 people in 75 congregations.”

The Lawson McGhee Library stayed open so people could check out books. Librarians reported more and more people were reading, likely because they couldn’t go to theaters to watch movies. But the library didn’t want anyone to linger. Chairs were removed from tables and windows were open to keep fresh air circulating.

But more people got sick. Newspapers reported that 1,950 people had the flu and five people died by Oct. 12. The numbers aren’t exact; some people didn’t call a doctor, and some physicians didn’t always report the number of their patients. By Oct. 15, the number of sick people rose to 2,943, including five doctors too ill to care for others.

The American Influenza Epidemic of 1918: A Digital Encyclopedia

As fewer soldiers in camps were getting ill, more civilians were. “The malady has reached into every section of the city and has taken its toll,” the Sentinel reported on Oct. 19. “In the county there are few communities which are free from the disease, and in many instances entire families have been stricken. Neighbors have come to the rescue and acted as nurses for the afflicted families until at least one of the members could recuperate from the disease in order to help the others stricken.”

Burials were 'plantings'

Smaller communities around East Tennessee were hit hard as well. In tiny Coalfield, a Morgan County town of 500, more than 90 percent of residents were infected, the state reported.

And for the national Centers for Disease Control and Prevention’s Pandemic Influenza Storybook, a project by the agency at the pandemic’s 90th anniversary in 2008, Robert Lynn Davis told of how his father, a disabled logger named Arthur Duery Davis, was put to work digging graves in Blount County.

“There was no time to build coffins, since the bodies were put in the ground as soon as possible,” Davis said. “My father always referred to the funerals as ‘the plantings.’ One story in particular he re-told many times is as follows: ‘One morning at 6 a.m., I was set to work digging three graves for a family of six that lived down the road from my home. Around 9 a.m., the doctor sent word to dig yet another grave. Then around lunchtime, I got word to dig yet another grave, and by 4 p.m., I was instructed to dig the final grave for that entire family.' ”

In the 2008 state summit on pandemic flu, Secretary of Health and Human Services Mike Leavitt read from one Tennessee doctor’s medical journal:

“The man who dug his neighbor’s grave today might head the funeral procession next week. No telling who will be next.”

As October ended, the epidemic waned. More than 9,500 Knoxvillians were reported ill; 132 died — nearly as many as died in combat during the war. Statewide, however, more than twice as many people died from the flu than in the war.

1918 tips for Spanish flu prevention