“Spanish influenza does not exist in Minneapolis and never has, but it probably will reach here during the fall,” city Health Commissioner Dr. H. M. Guilford told residents on September 19, 1918. 1 The statement was both boastful as well as cautionary, as Guilford would have been well aware of the havoc influenza had wreaked across the East Coast. Ten days later, on the evening of September 29, civilian, military, and school officials jointly declared that influenza had made its way into Minneapolis. The first case, which appeared on September 27, was later identified in a man who had visited his son in Camp Dix, New Jersey. Approximately 150 cases were reported in the city, the vast majority among cadets and soldiers from University of Minnesota Student Army Training Corps units or the small detachment at the Dunwoody Institute Training Camp, and the rest among sixteen nurses from the University Hospital reported to be suffering from a mild form of the disease. The ill cadets were transferred to the Fort Snelling hospital, while medical officers on campus conducted physical examinations of all men in an attempt to identify cases as early as possible. To help deal with the situation, the university postponed regular enrollment until October 9, hoping that the influenza situation would clear up by then. 2

By October 7 the number of civilian cases in Minneapolis had jumped to 46, with seven deaths having already occurred. No one knew for sure the extent of the epidemic since influenza was not made a reportable disease until October 8.3 On the other side of the river in St. Paul, health officers claimed only a few cases of grippe but no cases of Spanish influenza, making a distinction that – as many other communities discovered in the early days of their epidemics – did not truly exist. Like his counterpart in Minneapolis, however, St. Paul health officer Dr. B. F. Simon notified residents that the city would be visited by epidemic influenza sooner or later, and warned everyone to take care if they began to feel ill.4

Both cities braced for what they expected would soon arrive. In Minneapolis, the City Hospital was placed off-limits to visitors, and an entire ward was given over to the care of influenza patients. Within a few days, as it became clear that the epidemic that had struck East Coast cities would now hit Minneapolis as well, private hospitals volunteered to relieve City Hospital of all its non-influenza patients so that it could concentrate entirely on the care of those suffering from the epidemic. Health Commissioner Guilford encouraged physicians to report cases accurately and recommended that patients isolate themselves. Medical authorities urged residents to avoid public gatherings as much as possible.5 St. Paul went a bit further, announcing a tentative plan to close schools, churches, and places of amusement should it become necessary. As St. Paul’s Mayor Laurence Hodgson, told residents, “With more than half our doctors and nurses in war service, we dare not take any chances with a possible epidemic here....” In the meantime, all cases in St. Paul – six of them confirmed – were placed under isolation in the contagious ward of the City Hospital, where all visitors except those calling on the dying were prohibited.6

It was the University of Minnesota, however, that took the most drastic measures. Due to the presence of influenza in the Twin Cities and among Student Army Training Corps cadets in the school, University officials made the decision to postpone the start of the fall semester until at least Wednesday, October 9. As that day approached, however, the University went even further, announcing that only those students inducted into the Student Army Training Corps (S.A.T.C.) would be admitted. All civilian students, including all female students as well as males found physically unfit for service and those who had not signified their intent to enter the corps, were prohibited from entering the campus. Students pursuing technical and scientific studies would be allowed to register for classes provided they were enrolled in reserve corps. University President Marlon L. Burton said that the action was merely protective, and was not intended to create a hardship for students.7

If female and non-S.A.T.C. students were inconvenienced, so were the cadets. Due to the growing epidemic on campus and in the wider community, all cadets were confined to the campus, with no leaves of absences or passes granted. Making fun of their plight, a large group of student-soldiers vented their frustrations by staging a mock funeral for “Old Man Influ Enza,” who they buried while singing “We’ve got Spanish Influenza… That’s why we can’t get out,” to the tune of “John Brown’s Body.”8 The University did not re-open to non-military students until October 23.9

Despite their proximity to one another, the timing of the epidemic was rather different in each of the Twin Cities. By the first days of October, Minneapolis’s civilian and military authorities estimated approximately 1,000 cases of influenza, which included over 500 sick army soldiers at Fort Snelling Hospital. Guilford guessed that at least 300 civilian cases had not yet been reported. In St. Paul, by contrast, officials claimed that all was clear. “There is no epidemic here, particularly among the civilian population,” St. Paul Mayor Hodgson told reporters on October 8, “and the situation appears to be in excellent control. Every corner is being watched.”1 Hodgson was essentially correct for the time being, even though his statement was primarily aimed at preventing fear and panic, which, according to the superintendent of the City and County Hospital, were as dangerous as the disease itself.11

Minneapolis could wait no longer. On the evening of October 9, Guilford ordered a temporary ban on all unnecessary public meetings until he could meet with city and state officials to determine if more sweeping measures needed to be implemented. Two days later, the health department ordered all schools, churches, theaters, movie houses, dance halls, and pool and billiard halls closed indefinitely, effective at midnight on October 12. The measure was unanimously endorsed by the city council, which was quick to point out that the city Department of Health had full authority to issue the closure order with or without the consent of Minneapolis’s mayor or council.12 In St. Paul, officials decided that the influenza situation did not yet warrant a sweeping closure order. Instead, they encouraged residents to avoid crowds, arguing that a “self-constituted quarantine established by the citizens is more likely to prevent a spread of the disease here than any official action that could be taken.”13 The reasoning was that the city had guarded so carefully against the incursion of the epidemic that there would be no need to close public places unless there was a marked increase in the number of new cases. With no deaths yet among children of school age, St. Paul Health Commissioner Dr. B. F. Simon stated that there was no foundation for issuing a school closure order.14 What he failed to realize, of course, was that closing schools was not only aimed at preventing illness in children, but also in their families.

Minneapolis Closes Shop

Not everyone supported Minneapolis’s decision to close public places, however. The assistant secretary of the Minnesota Board of Health, Charles E. Smith, believed that children were better off remaining in schools where they could be supervised by nurses and teachers instead of “playing in the streets.” The school board was caught unawares by the suddenness of the closure order, and felt that it should have been consulted first. Nonetheless, it approved the measure and directed schools to shut their doors.15

By far the most vocal opponent was state Board of Health Executive Officer Dr. Henry M. Bracken. Having heard grumbling from the state Board of Health offices over its decision to issue the order, Guilford and several members of the Minneapolis City Council called on Bracken to explain his position on the closure of public places. “If you really want my opinion, the time to have asked for it was before you acted, not after,” Bracken tartly responded. It was only the opening salvo in what soon became a complete dressing down of Minneapolis officials. Bracken conceded that the city had a right to issue the closure order, but added that such action was not called for by the situation. The only schools and colleges that should be closed, he argued, were those that were already closed when the epidemic made its first appearance. Now, he feared, influenza would be spread by people going from one community to another. “Do you think that any program of shutting up a few things is going to stop this epidemic?” Bracken rhetorically asked the city council. He finished his tirade by praising St. Paul for not panicking: “Thus far St. Paul has seen fit to follow my advice…. But what Minneapolis has done is like picking feathers out of the tail.” A few members of the City Council attempted to take issue with Executive Officer Bracken, but, perhaps anticipating a long and useless argument, the rest of the body moved for a quick adjournment of the meeting. Before that could happen, however, Guilford received a telegram from United States Surgeon General Rupert Blue, informing cities of the impending epidemic and suggesting that they consider closing schools, theaters, and other public places should influenza become a serious problem in their community. There were an estimated 1,865 cases in Minneapolis.16

Despite the arguments occurring at the higher levels of city and state government, Minneapolis residents seemed willing to cooperate with the closure order. On the eve of the day it was to go into effect, downtown theaters were packed with patrons eager to see one last show. By the next day, however, newspapers reported the streets of downtown were “practically deserted,” and that streetcar crowds were much smaller than usual for a weekend night.17 In order to keep the weekday commuter crowds to a minimum, Guilford developed a plan to stagger work hours. Guilford met with representatives of the Civic and Commerce Association to discuss his proposal, and the group agreed to regulate the opening and closing hours of retails stores, office buildings, and wholesale houses. To further help, housewives were encouraged to do their shopping before noon or just after, thus relieving congestion on the streetcars during the evening rush.18

St. Paul may not have officially enacted a closure order, but unofficial social distancing suggestions were certainly followed, out of both fear as well as encouragement from authorities. Motion picture theaters, for example, saw their ticket sales drop drastically when more than half the normal number of patrons ventured to the movies. Executive Officer Bracken, who was against formally closing amusement spots, suggested that movie houses show their films at intervals an hour apart rather than continuously, thus eliminating the danger of waiting crowds. St. Paul Health Commissioner Simon believed that the influenza situation, mild as it still was in his city, had improved greatly, especially in the schools. Still, he requested that all city churches and fraternal organizations postpone any gatherings other than regular services. The request was reported to have been met with “hearty obedience.”19

This obedience, along with the unusually mild form of the disease and the still low death rate, gave St. Paul officials great hope that their city would be spared the epidemic horror witnessed in other cities. The Superintendent of the City Hospital asserted that many of the cases in his facility were not even influenza, bur rather bad colds. Simon happily told reporters that between midnight of September 30 and the evening of October 18, only 34 St. Paul residents had died of pneumonia or influenza, evidence that the epidemic situation in St. Paul was not serious. He attributed much of the good news to the number of people who had taken to walking to and from downtown rather than taking public transportation.20 When some officials began pushing for a general closure order similar to that Minneapolis had enacted recently, Simon countered with his findings, arguing that the situation in St. Paul – already quite good – was steadily improving, and that such an order was unnecessary.21

In Minneapolis, the situation was not nearly as salubrious. By October 19, the number of cases in the city had reached nearly 3,000. Guilford, uncertain of what to do next, proclaimed that the chief preventative of influenza was cleanliness. When the Retailer’s Association presented information that influenza germs lurked in dust, the City Council ordered all streets to be flushed with water. Having never truly supported the closure order, the Board of Education voted to re-open public schools beginning on October 21. The move was vehemently opposed by Guilford, who made it known that he intended to challenge the move. A legal battle soon ensued.

Influenza Battleground: Minneapolis Schools

At the heart of the matter was the question of whether or not Guilford and the Board of Health had the legal authority to order schools closed. Henry Deutsch, an attorney and a member of the school board, believed that the answer was no. “If the health department has such authority,” he told reporters, “it is beyond my knowledge. At any rate, we are going to test it.” Another board member, C. E. Purdy, also an attorney, argued that Guilford acted well within his jurisdictional rights, as vested in him by the state legislature. Guilford himself certainly believed this, stating that Section 17 of the 1899 law creating the Minneapolis Department of Health gave him the authority to close schools in times of epidemic. In case Deutsch and those of like mind did not realize that, Guilford threw down the gauntlet: “The direct snapping of the fingers of the board of education in the face of the health department is a matter that requires the attention of the courts.” And if the justice system were not enough, Guilford added that he “intend[ed] to use the police force if necessary.”22

To those who argued that schoolchildren would be better served in their classrooms where they could be monitored, Guilford responded with some cold statistics. At least 3,500 cases had been reported to him in the last two weeks, he told reporters. There were approximately 50,000 children in Minneapolis schools, and only thirty school nurses to monitor and examine all of them. Under normal circumstances or during other epidemics, he stated, this number might be adequate to care for all the children. But the highly contagious nature of influenza made it impossible for only a handful of school nurses to ensure the health of so many schoolchildren.

Rebutting this position was B. B. Jackson, Superintendent of Schools, who argued that the leading medical authorities across the nation had determined that epidemic influenza was not a children’s disease, that cases among children had only become a problem in two city districts (Van Cleve and Seward), and, most important, that the entire school district staff – some 2,000 people including janitors – could be mobilized to provide important flu safety instruction to children for them to take home to their families. “Our three physicians and 31 nurses, together with the watchfulness of our 1,700 teachers, should not have been made a negative quantity,” Jackson responded, “but an effective agency at this time.” He added that children would not be able to mingle as freely in classrooms as they would at home or in the streets, and that keeping them in schools had the added benefit of ensuring that they spent most of their day in dry and well heated buildings. Lastly, Jackson addressed the financial loss that the school system faced as a result of the closure. Individual businesses were not closed out of a concern for their pecuniary losses. Yet, Jackson argued, the closure was costing the school system $12,000 per day in salaries, which had to be paid whether or not school was in session.23

The battle was just beginning. On the morning of Monday, October 21, as children assembled outside of their schools, Guilford met with city attorney Charles Gould to decide whether to seek a court order closing the schools or to use the police to arrest members of the Board of Education. The school board was prepared for the latter: “We shall fight to the last ditch,” said the Board spokesman. “We shall not close the schools if they arrest us and fine us.” Many parents did not feel the same. The newspapers reported that the majority of Parent-Teacher Associations interviewed were not in favor of the schools re-opening, and that many of them had telephoned their protests to the school board. School officials denied having received any such calls.24

The schools re-opened, but only for half a day. Meeting that morning, the school board voted to close schools in the afternoon. They were, as the Morning Tribune cleverly put it, “aided to a decision” by Guilford’s order to Chief of Police Lewis Harthill to close the schools immediately. Wishing to avoid a confrontation, Harthill wisely took it upon himself to meet with the school board in person before taking action. The gist of the tête-à-tête, as one school board member put it, was “a diplomatic invitation to the school board to surrender unconditionally.” Another member, full of radical fervor, called forth images of the birth of the nation. “Progress has always been accompanied by revolution against constituted authority,” he said, “especially when the authority has been as autocratic as in this case.” But Patrick Henry he was not, and in the end, facing arrest, the school board agreed to re-close the schools.25

Guilford could not say exactly how long the schools would be closed, but estimated at least two weeks and possibly as long as two months. The day after schools re-closed, Superintendent of Schools Jackson notified teachers that the Board of Education had voted to convert the first two weeks of the coming closure period into a holiday, adding that they could dispose of their time as they saw fit until at least November 4. If the schools re-opened immediately after that date, then the total three missing weeks would be made up by keeping the schools open during one week of Christmas vacation and by teaching on all occasional holidays after that. If schools were kept closed for two months – the maximum suggested by Guilford – children would likely be required to attend school year-round.26

Influenza by the Numbers

St. Paul officials must have watched the legal battle in Minneapolis with some amusement. With no closure order of their own, they did not have to worry about such problems. The only measure they were required to follow was the statewide public gathering ban passed by the Minnesota Board of Health at its October 21 meeting.27 Furthermore, the death rate from the epidemic seemed to be declining. On October 23, Simon proudly announced that there had only been 1,442 suspected cases of influenza in St. Paul since the epidemic had begun. It was a typical report from Simon, who was always sure to characterize cases as “suspected,” or to dismiss them outright as “bad colds.” Nevertheless, Simon slowly readied his city for the possibility of another spike in cases. On October 22, Simon and the City Council banned all public dances and special public meetings.28 A week later, Simon announced plans to limit the number of passengers on streetcars. The difficulty was determining a number that would achieve the goal of keeping public transportation crowd-free, but would also not cause problems for cars crossing city lines. For example, it would cause confusion and resentment if a St. Paul-bound streetcar were forced to off-load passengers upon reaching the city limit in order to comply with a different regulation in St. Paul than was in use in its neighbor.

In Minneapolis, officials first wanted to put more streetcars into service to relive congestion. The city attorney pointed out that it would take time to legally compel the streetcar company to increase the number of cars, whereas an order limiting the number of passengers on each car could be put in place immediately by fiat. On October 30, Simon announced that 84 passengers would be the new magic number, agreed to by both St. Paul and Minneapolis officials. Lastly, a citizen’s committee was appointed to make a survey of city facilities and resources for use if the epidemic grew worse. The committee was charged with compiling a list of all available doctors and nurses, initiating and supervising an educational campaign, surveying hospitals and buildings that could be used as emergency hospitals, and monitoring medical supplies.29

By the start of November, it was becoming clear to all that St. Paul’s influenza situation was not improving, and in fact had grown worse. Over 3,000 cases to date had been reported, with nearly 2,000 of them currently under isolation either at homes or in hospitals. From across the city, private individuals called in to the health department, pleading with officials to close public places. A Citizen’s Committee member introduced a resolution asking Simon and the St. Paul Board of Health to close theaters. Simon, not necessarily opposing such a move, responded that closing theaters would require closing other places of business in order to make the preventive measures effective. The next day, the resolution – which now added all places of amusement to the list – was reintroduced by committee chair S. W. Dittenhoffer, who commented that closing such venues would do the most immediate good. Representatives of theaters and movie houses opposed the resolution, arguing that any closure order should be made universal if it were implemented at all. The committee tabled the resolution for the time being, agreeing to take up the matter once again at its next meeting. That meeting came on November 3, where the committee almost unanimously voted not only to recommend the closure of all theaters, movie houses, churches, schools, poolrooms, and soda fountains in St. Paul, but also to grant the health department sweeping authority in closing any place where there was less than six feet of separation between people.30

Almost predictably, the St. Paul closure order quickly ran into problems. Although he opposed the closing of public places, Simon nevertheless agreed to issue the order as per the committee’s recommendation. The day before the order was to go into effect however, the city attorney determined that Simon did not have the legal authority to issue a general closing order. According to the city charter, such authority rested with the Commissioner of Public Safety, who could close places of public amusement upon the recommendation of the health commissioner. That man, Henry McColl, quickly announced a similar edict, effective the morning of November 6. McColl’s order, however, was limited to places of public amusement and could not be widened to a general closure order of all public places without the passage of emergency legislation by the City Council.31

The opposition was hardly quiet on the matter. State health officer Bracken, calling Minneapolis’s closure order a joke, immediately declared that St. Paul’s order would have no effect on the epidemic. He preferred the use of isolation and quarantine to limit the spread of influenza, and praised St. Paul for having implemented a systematic quarantine policy. On October 5, the day the closure order was formally announced, the newspaper reported that St. Paul still had 2,243 active cases under home quarantine with some nearly 1,600 cases having been released from quarantine that morning.32 Despite this, St. Paul’s death rate from the epidemic had already climbed beyond that of its neighbor, Minneapolis.33

Bracken was hardly the only critic of the closure order, although he remained the most vocal. In a long and contentious meeting – and the first one held since the start of the epidemic – the Ramsey County Medical Society refused to endorse the order. Instead, the members urged St. Paul to maintain its policy of isolation, turn to the use of face masks, and establish a six-foot “safety zone” around each individual in public places. No suggestion as to how the safety zone would be put into practice or endorsed was made. Simon sarcastically told the Medical Society that if the safety zone was implemented, members should prepare for their hair to grow long and to do their own shaving, as the six feet of separation would apply equally in barbershops as it would in concert halls and department stores. Bracken, present for the meeting, gave his opinion that the peak of the epidemic in St. Paul had been reached, and that the city could expect an almost immediate decline in the number of new cases being reported.34 In retrospect, Bracken turned out to be correct. What he could not possibly know, however, was whether or not St. Paul would experience a second peak of the epidemic, as was the case in nearly ever other Midwestern city.

With the closure order finally in place, St. Paul moved on to the issue of ending the epidemic and providing care and services for those in need. The closure of schools released 16 nurses, and it was hoped and expected that all school nurses would volunteer their services. To feed those unable to feed themselves due to the epidemic, the Citizens’ Committee voted to provide a central city public kitchen at the Mechanic Arts High School. It also sent food directly to some especially needy families. The Wilder Day Nursery was organized to take in children left temporarily parentless because of influenza-stricken parents. These efforts occurred none too soon: by the end of the first week of November officials at City Hospital were reporting that approximately fifty to sixty children could not be discharged because their parents were too ill to care for them.35 And the situation was growing dire. At least 113 families called the Citizens’ Committee because they were unable to get physicians, and the hospitals were in desperate need of extra help.36

In Minneapolis, the epidemic was slowly declining. The military installations in the city, where many of the city’s earliest cases were discovered, were also the first to feel the relief. By late-October, daily reports showed no new cases at the Midway Aviation School, Fort Snelling, or the Dunwoody navy training units, and only small numbers of new cases in the University of Minnesota S.A.T.C. But even in the city itself the numbers were dwindling. On October 27, Guilford reported only 39 new civilian cases of influenza, by far the lowest number reported since the early days of the epidemic. Guilford was not as optimistic as the numbers suggested, however, believing that the tally was artificially low on account of physicians not including Sunday cases.37 The next day he announced that the closure order would remain in place for at least another week, and that only an unforeseen major abatement of cases would cause him to lift it before then. “Reports of the last two or three days cover too short a space of time to give them much weight,” he told reporters.38 Despite the lighter daily case totals, hospitals were still overrun with patients. At City Hospital, nearly half of the nursing staff had contracted influenza in the last three weeks. Owing to the call for nurses from other states and the devastating Cloquet forest fire that occurred in northeastern Minnesota in October (which killed over 450 people), substitutes were difficult to find, and the hospital had to stop taking new patients for a lack of staff. Desperate to find help, hospital officials sent an urgent appeal for help to the Great Lakes Naval Training Station outside of Chicago.39

Despite the frantic situation in the city’s hospitals, owners of amusement venues saw the epidemic’s abatement and pressed for a relief of their strictures. A group of about one hundred men representing theater interests marched on the City Council to appeal for the re-opening of their businesses. As their chief spokesman put it, they had been patient and loyal to the cause, but the long closure had thrown at least a thousand people out of work. Guilford only partially conceded, stating that if there were a further decrease of at least fifty-percent in the number of new influenza cases by November 16, he would lift the closure order from theaters, churches, schools, and all other businesses.40 Until that date, however, Guilford kept the city on a tight leash. When news of the “false armistice” of November 7 reached Guilford’s desk, he immediately closed very saloon, café, and soda fountain in the city for the evening, not only to prevent celebratory Minneapolitans from gathering indoors but to prevent St. Paul crowds – who were now under their own closure order – from coming to Minneapolis for entertainment.41

In St. Paul, business owners and others affected by the closure order similarly appealed to their officials to be allowed to re-open. Representatives of organized labor, theater and movie house owners, and poolroom, bowling alley, and saloon proprietors appeared before the Citizens’ Committee on the evening of November 11 to urge the lifting of the ban. Before they even reached the committee’s offices, the group was told that the matter was closed, and that it was entirely up to the city health department to decide when the restrictions would be lifted. This line was reiterated at the formal meeting, much to the consternation of business owners, who railed against the order. When some in the room called out against Simon for closing their business, Simon acidly responded that he was only doing what the community had wanted. “If it had not been for the agitation launched against the health department by this committee, and a certain morning paper of St. Paul, which all but branded us as murders for keeping the town open,” he told the crowd, “St. Paul would never have been closed.” Now that it was, he added, it would remain so until either the epidemic abated or the Citizens’ Committee recommended removing it.42 In the meantime, many saloon owners and liquor dealers were said to be ignoring the order completely, doing an almost normal business via their side doors. Simon promised to investigate each report.43

The Twin Cities Re-Open

It mattered little that some saloons remained open, as both St. Paul’s and Minneapolis’s influenza measures were lifted on Friday, November 15. Vaudeville and burlesque and movie houses immediately prepared for their matinee crowds. As people walked the streets and passed the re-opened theaters, they stopped in disbelief. As one newspaper put it, the crowds “hesitated, still uncertain as to whether or not one huge joke was in the process of being perpetrated, walked up to the cashier’s cage, and then, satisfied that it was all true, entered joyously.” Entertainment-starved residents entered in droves, filling nearly every theater – especially those in Minneapolis, which had been closed for over a month – to capacity. Churches were allowed to hold regular services that Sunday, and schools re-opened on Monday in both cities. The public gathering ban, however, was a state order and therefore still in effect, and, Minnesota health officer Bracken told local officials, would not be lifted until the next board meeting at the earliest.44 In the end, the state ban on public gatherings was not lifted until December 14, when officials realized that a lack of funds with which to enforce the order had made it essentially a moot point.45

Neither city was in the clear yet. As Twin Cities’ residents celebrated the end of the closure orders and the (hopeful) end of the epidemic, they quickly found themselves facing a new problem: a strike by local telephone operators. On the very same day that the orders were lifted, some 1,200 female telephone operators of the International Brotherhood of Electrical Workers marched down the streets of St. Paul, protesting against low wages.46 The strike paralyzed the phone system. Worse, it made it tremendously difficult for influenza-stricken Minneapolis and St. Paul to administer emergency aid to needy residents. Across the Twin Cities, severely ill residents desperately tried to call for ambulances, nurses, and physicians. In St. Paul, one school nurse visited a home only to find a mother and child violently ill and prostrated by influenza. For several hours she tried to call for help, to no avail. Eventually the nurse, who had unknowingly contracted influenza but was as yet asymptomatic, also fell ill in the same home. It took nearly seven hours before a call for help could be placed. Another woman, a mother trying to get help for her sick baby, was found ill by nurses from the Citizens’ Committee. As a result of the telephone strike, the relief work of the Citizens’ Committee was brought to a standstill. One nurse called the day of the strike “the worst day of the epidemic for everybody.” A member of the Citizens’ Committee called the strike “nothing short of criminal,” adding that there was probably more actual suffering on the day of the strike than on any other day of the epidemic.47

Another Peak

Over the course of the last weeks of November, the epidemic in both St. Paul and Minneapolis slowly subsided. But by early-December, both cities once again began experiencing a rise in cases, common in cities throughout the Midwest and West. In St. Paul, this second peak was short-lived, lasting only for a few days in mid-December.48 In Minneapolis, however, the situation initially appeared more severe. There, the second peak of the epidemic first manifested in the city’s schools. On December 3, Guilford and the health department closed half a dozen schools because of the increase in influenza cases among the student body and in their families. In some of these schools, more than twenty percent of the students were absent due to illness. More than half of all the new cases being reported in Minneapolis were among children.49 The next day, fourteen more schools were closed, and officials busied themselves trying to obtain figures on absentee rates and illness in the city’s remaining 54 schools. By December 9, the situation in the schools had grown severe enough for the school board to vote to close all public schools until January 1. Guilford told the public that even with enough school nurses on hand it would be impossible to handle the new peak of the epidemic without closing the schools. He estimated that thirty to forty-percent of the new influenza cases in Minneapolis were among school children, and that about twenty percent of all school-aged children in the city were infected. On December 10, children across the city were once again sent home for another extended holiday.50

Just as before, the second school closure order angered Superintendent of Schools Jackson – as well as many private citizens – even though this time the Board of Education had voted to support Guilford rather than face another run-in with the health department and the city attorney. Jackson said that closing schools without forcing other possible sources of contagion was “unjust and bound to be ineffectual in eradicating influenza.” He vowed that the board of education would run its own schools after December 30. As it turned out, Jackson got his wish a day early when Guilford agreed to allow schools to re-open on December 30. All students would be required to undergo a thorough examination to ensure that he or she was free of illness before being allowed to return to the classroom. No student who had been ill in the past ten days, or who came from houses where a family member was ill, would be allowed to return to school. To make up for the seven weeks in total lost during the entire epidemic, all non-essential studies were dropped from the curriculum.51

Over the course of January, the influenza situation in the Twin Cities steadily improved. During the first week of January, the number of new influenza cases across the state had dropped so much that the Minnesota Department of Health directed reports of cases sent to the Division of Preventable Diseases at the University of Minnesota rather than their downtown St. Paul offices. St. John’s Hospital, which had been used exclusively for influenza patients, was completely free of influenza cases by January 8. In Minneapolis, the disease appeared to linger in the schools. At the end of the first week of January, ten-percent of the student body was reported absent, nearly twice the usual amount for that time of the year. When officials investigated, however, they found that at least half of the absences were not due to illness, but rather to worried parents.52 Although small numbers of cases still cropped up in both cities, the epidemic was essentially over in Minneapolis and St. Paul.

Aftermath

As the epidemic subsided, residents of the Twin Cities – just like their counterparts across the United States – began to deal with the aftermath of the devastating event. The St. John’s Hospital in St. Paul, used exclusively for influenza cases, had been so overtaxed by the crisis that the building had to be renovated and repainted. Across both cities, special attention was paid to child welfare, particularly for those children left without a parent as a result of the epidemic. In St. Paul, the Council of Home Defense, in cooperation with other charities, sent workers to affected homes to ensure that children were receiving adequate care, being fed a proper diet, and clothed properly for the cold Minnesota winter.53 In one home, a Salvation Army worker found a young boy half starved and dressed in dirty rags, his delirious mother both drunk and suffering from a long standing mental disease exacerbated by the recent loss of her husband to influenza.54

Both cities also turned their attention to public relations work. Tourism and convention travel were big business for many cities in the early-twentieth century, and many American cities tried their best to put a positive spin on their epidemic outcome, several cities claiming to have had the best record during the period. It all depended on which report or study was cited. In Minneapolis, officials – with help from the city’s newspapers – reported a death rate of only 2.1 per thousand, and claimed that their city had fewer influenza and pneumonia related deaths than any other large city in the country. St. Paul disputed this claim. Officials there announced that St. Paul was the nation’s healthiest city, arguing that 186 of the people who had died in their city were non-residents who had been brought to city hospitals for health care. In addition, soldiers who had died at the base hospital at Fort Snelling or the Air Service Mechanic’s School were unfairly credited to the local health board’s tallies.55 In fact, Minneapolis did much better during the crisis than had St. Paul. Using the official United States Census Bureau weekly influenza and pneumonia death counts from the beginning of the fall wave of the epidemic through the end of February 1919, Minneapolis had an excess death rate of 267 per 100,000, while St. Paul had a number nearly 55 percent higher: 413 per 100,000.

At first glance, it seems very odd that two cities that bordered one another and essentially shared a large metropolitan population should have had such different epidemiologic experiences. But it must be remembered that St. Paul took a decidedly different tack with respect to closing places of public amusement than did its neighbor. Minneapolis issued its closure order in mid-October, and it kept those measures in place for over a month. When the epidemic again began to spike, schools were closed once more. St. Paul, by contrast, did not issue a closure order until November 6, some six weeks into their epidemic, and removed those orders only a short time later.

What is intriguing is the different shape of the mortality curves of each city at the beginning of the epidemic. Each city experienced a first peak in excess deaths during the week of October 19 through October 26, with the peak occurring approximately on October 21 in both cities (weekly death data makes it difficult to pin-point the date with any greater accuracy). Minneapolis’s first peak, however, reached slightly higher than did St. Paul’s, despite Minneapolis’s use of various social distancing measures. Furthermore, the death rate in St. Paul declined slightly for the next week – again, despite the lack of public health measures in place – before significantly increasing into mid-November. This was uncharacteristic of nearly all other American cities for which epidemic mortality exists. More commonly, the death rate increased sharply during the initial weeks of the epidemic, and did not peak and decline until either public health measures were implemented or the disease began to run out of susceptible people to infect. The reason for this remains unclear.

Whatever the reason for the different outcomes of Minneapolis and St. Paul, state health officials were eager to avoid another such epidemic crisis in the future. In fact, in Minneapolis there were two crises: the epidemic itself, and the short jurisdictional and political battle fought between the school board and the Board of Health. On January 24, the two groups met for the first time since their standoff. On the agenda was the proposed state public health bill that would place the school health and hygiene work all cities over of 50,000 people under the purview of the Department of Public Welfare. While the meeting was said to be marked by “painstaking amiability,” the tension between the school board and Health Commissioner Guilford was clear to all present. At issue was the work of school nurses and their role as de facto health inspectors for children. Superintendent of Schools Jackson, who had wanted schools to remain open during the epidemic so that his nurses could monitor the health of the children, believed that school nurses were uniquely qualified to perform this task. Others on the school board agreed. Guilford, however, did not. He believed that the health department was better equipped to handle school inspections. When it became clear that no headway was likely to be made, the meeting adjourned.56 The severely strained relationship between the Minneapolis Board of Education and the Board of Health continued.

Epidemic Preparedness Planning

In the fall of 1919, after having dealt with the third wave of influenza the previous winter and spring, and about to deal with the fourth and last wave of the epidemic (which occurred in the late-winter and early-spring of 1920), the Minnesota Board of Health drafted a detailed plan for dealing with any future influenza epidemic. Drawing on the experience gained during the previous epidemic waves and the expertise of other authorities from across the country, the Board made several recommendations. One recommendation in particular cut straight to the heart of many of the problems encountered during the fall 1918 wave.

In the event of another epidemic, the Board of Health argued, authority in health matters should be centralized and accurate reports of vital epidemic statistics should be filed with this body. The public should be educated on proper respiratory hygiene, and taught not to cough or sneeze without covering the nose and mouth. Non-essential gatherings should be prohibited. Schools, however, should not be closed. Instead, the Board recommended keeping children in school so that they could be carefully monitored. Church services should be allowed to continue, but reduced to the lowest number possible. Theaters and movie houses might be allowed to remain open so long as proper ventilation was used and dangerous coughers were excluded. Dance halls and poolrooms, on the other hand, should be closed. The Board recommended good ventilation and anti-crowding measures on streetcars as well as the staggering of business hours. It also strongly recommended the early isolation of patients and the quarantine (with placards) of all homes with cases.

Perhaps most interesting, however, was the Board of Health’s consideration of the concepts today known as “protective sequestration” and “surge capacity.” The Board suggested that colleges, boarding schools, asylums, and other similar institutions consider sealing themselves off to the outside world in the event of another epidemic. In fact, there are several examples of institutions (and in one case an entire county) that prohibited the ingress and egress of people during the epidemic. The naval training station on Yerba Buena Island in San Francisco Bay, Princeton and Bryn Mawr Universities, the Western Pennsylvania School for Blind Children, and the Colorado mountain town of Gunnison all enacted protective sequestrations of their populations, and all experienced very low or no morbidity or mortality during the period they were closed to outsiders.57 The Board also recommended that, after measures of prevention, efforts be made to distribute the epidemic over a longer period of time so that health care providers and facilities do not become overburdened.58 Overall, the recommendations made by the Minnesota Board of Health showed a willingness not only to apply the latest techniques of epidemic protection and control to possible future public health crises, but also to think creatively about ways to mitigate the impact of another severe epidemic on the health care infrastructure.

These were critical issues to consider as the epidemic continued to deliver its lethal blow during the fourth and final wave of the winter of 1920. No one wanted a repeat of what had occurred in the fall of 1918, when tens of thousands of Twin Cities residents had fallen ill with influenza, and nearly 2,000 of them had died.59