The Spanish Influenza of 1918 is widely regarded by historians as the “forgotten pandemic.”1 Though it killed between thirty million and one hundred million individuals, around five percent of the world’s population, the Spanish Flu has been largely ignored in the historical discussion of worldwide disease.2 Comparable to the immense mortality of the Black Death on the Eurasian continent in the fourteenth century, the Spanish Flu did not discriminate among its victims. According to historian Alfred Crosby, “the flu...ignored the differences between rural and urban, patrician and peasant, capitalist and proletarian, and struck them all down in similar proportions.”3 The prevailing question remains: if this deadly virus afflicted such a large portion of the world population, why has the memory of this global pandemic been erased? One possible answer to this debate lies in another global event that occurred simultaneously with the outbreak of the Spanish Influenza World War I. A large percentage of the global population lived in countries embroiled in the war. In the fall of 1918, when the deadliest wave of influenza began creeping across the continents, members of vulnerable populations were more interested in broadcasts of battles than news of the flu. Though the fatality of World War I gripped the attention of nations across the globe, the Spanish Influenza of 1918 actually reaped much more devastating effects among international populations without the aid of firearms or tanks.
Historiography existing by epidemiologists and other researchers have focused upon the Spanish Influenza of 1918 in a national or international context. This broad interpretation of history allows historians to examine the immense impact of the flu on the global population, but fails to create a local history of the disease among different cultures. In addition, examining pandemics from solely national or international perspectives only presents the outbreak as a disease of the masses, rather than a volatile individual experience. Some historians, such as Alfred Crosby, even suggest that local history of the Spanish Influenza is inconclusive or unproductive. He explains, “Their chron- icles are poorly kept and usually no more than anecdotal.”4 This state- ment is arguably false, as evidenced by the well-documented events of the Spanish Influenza in local newspapers such as those published in Southwest Virginia. While local newspapers did not display specific statistics of the Spanish Influenza, they did provide a thorough understanding of the spread of disease throughout a particular region. Local history also demonstrates the efficacy of municipal governments in the battle against the flu. According to historian John M. Barry, “some local authorities might take some action [against the flu], but no national figure could.”5 Unlike national and state officials, local officials, especially those in Southwest Virginia, possessed the prime concoction of smaller constituencies and fluctuating power. This granted their preventative health measures greater effectiveness, and contributed to the quelling of the epidemic in the region.
The particular strain of flu that infected the global population in 1918 was unusually severe. This is demonstrated not only by the mortality rates of those infected, but also in the symptoms displayed by the sick. For example, many ill individuals experienced violent epi- staxis, or nosebleeds. One infected young woman spewed blood from her nose one foot across her bed linens.6 The destruction of infected patients’ lungs was also terrifically severe. According to historian Tom Quinn, “some victims coughed up as much as six pints of pus a day.”7 Following death, autopsies often revealed that patients coughed so hard that they tore apart abdominal muscles and rib cartilage.8 Yet an- other cruel symptom of the influenza was the secondary disease associated with the strain, which most often acted as the cause of death— pneumonia. The form of pneumonia accompanying the Spanish Flu often featured a blueness of the skin, termed heliotrope cyanosis in the medical world.9 This was later determined to be caused by a lack of oxygen in the blood, “as patients literally drowned from fluid in their lungs.”10
The Spanish Influenza of 1918 was also unprecedentedly lethal. Unlike the majority of past strains of the influenza, the mutated virus of the Spanish Influenza was unusually deadly among young adults (Figure 1).11 According to Susan Kingsley Kent, “unlike its predecessors, which tended to take infants and the elderly, this strain of influenza preferred men and women aged fifteen to forty-five, victims in the prime of their lives.”12 In his book America’s Forgotten Pandemic, Alfred Crosby presents a great analogy between the Spanish Influenza and the concurrent conflict of 1918: “like war, it preferred young adults as victims.”13 The deaths of so many able-bodied adults had drastic social and economic ramifications around the globe.
The Spanish Influenza of 1918 left no area of the world unaffected. At the time, contemporaries mistakenly referred to this deadly strain of influenza as the “Spanish Influenza” or the “Spanish Grippe” because they believed the virus to have evolved in Spain.14 Restrictions on the press of nations involved in World War I contributed to the misnomer. In the earliest months of the virus in the spring of 1918, the Spanish press cited an outbreak of influenza among the civilian population and the infection of the monarch, King Alphonse XIII.15 At the time, Spain was one of the few nations releasing international news reports. According to historian Tom Quinn, “within the censorship of the press of combatant nations across war-torn Europe, the only country that publicly mentioned the new disease was neutral Spain.”16
The assumption that the influenza of 1918 emerged in Spain was far removed from reality. Recent historians and epidemiologists actually traced the origins of this particular strain of flu to a single physician’s office in the United States, located in Haskell County, Kansas, in the southwestern portion of the state.17 With the aid of primary sources from local newspapers and manuscript collections, historians even pinpointed the initial advancement of the Spanish Influenza between civilian and military populations. Over the holiday season of 1917-1918, a young soldier named Dean Nilson visited his family in Haskell County where he unknowingly contracted the flu.18 He then carried the virus to Camp Funston, now known as Fort Riley, an army base located three hundred miles away.19 From there, he infected many fellow troops who were drafted into the United States Army and sent overseas. These debilitated soldiers then spread the flu amongst other military bases and eventually to the front lines in Europe.
Using a combination of historical and public health sources, scholars have tracked the progression of the virus, and now divide the flu season of 1918-1919 into three distinct waves of disease. Of these waves, the second was the most deadly.20 After abating in severity over the warm spring and summer months, the Spanish Influenza mysteri- ously mutated in Europe, becoming an especially virulent strain of the disease in early fall. This second wave of the Spanish Influenza emerged in the United States in August 1918. On August 12, the Ber- gensfiord, a Norwegian vessel, arrived in New York Harbor with two hundred cases of influenza onboard.21 New York authorities refused to quarantine the ship, allowing the infected sailors to disembark. This action proved to be deadly. By August 27, the influenza appeared on the Commonwealth Pier in Boston—a major receiving port for military personnel during World War I—and infected nearly seven thousand soldiers.22 From there, the influenza spread to Fort Devens, Massachusetts, where the epidemic exploded. By October, cases of the Spanish Influenza among the United States population rose so precipitously that they interrupted the monthly draft contingent. On October 7, 1918, the Provost Marshal General of the United States Army cancelled the homefront conscription of 142,000 young men.23 Though chief military personnel postponed the draft of over 100,000 soldiers due to the flu epidemic, President Woodrow Wilson refused to halt the transit of troops to the front lines in Europe.24 This action most certainly facilitated the further spread of the second wave of disease into virgin territories, decimating both civilian and military populations abroad. At the same time, the Spanish influenza continued to ravage most regions of the United States.
The Spanish Influenza first arrived in the state of Virginia in September 1918 at the army base Camp Lee (now known as Fort Lee) in Prince George County near Petersburg, Virginia.25 According to Alfred Crosby, the influenza dispersed from Camp Devens to Camp Lee around September 23.26 From Camp Lee, local soldiers disseminated the influenza virus to Southwest Virginia during hometown visits. The Spanish Influenza first emerged in Tazewell County during the week of October 4, while in Wise County it appeared sometime before October 16. The transmission of the Spanish Influenza to soldiers from the area was significant because young men drafted into the United States military from rural regions often suffered worse during disease epidemics than soldiers from urban areas due to their weaker immune systems. For historian Tom Quinn, “in the USA it was noted that raw recruits from army camps who arrived from remote rural areas were far more likely to be affected severely by influenza and die.”27 Thus, the advancement of the violent influenza to bucolic counties also proved to be especially lethal among nonmilitary citizens within the region of Southwest Virginia.
Similar to most other regions in the United States, Southwest Virginia was struck by the deadly second wave of the Spanish Influenza in the fall of 1918. Transmitted from army camps near Appalachia, the flu even spread to the most remote, rural areas of the region. In order to disseminate knowledge concerning the prevention of the spread of the deadly influenza, public health officials in the United States employed the information medium with the highest broadest audience—newspapers.28 Local health officials in Southwest Virginia also used small town newspapers to document the escalation and impact of the virus on the populations in the region. This case study on the flu’s significance in Southwest Virginia is based on such sources. The local newspapers of two counties in the area—Big Stone Gap Post in Wise County and Clinch Valley News in Tazewell County provide descriptions of prevention tactics, treatment, and the aftermath of the particularly fatal flu season of 1918-1919. These sources also furnish an intimate perspective on the effects of a global pandemic, such as economic burdens, public health measures, and government intervention, in one of the poorest regions of the country, largely ignored by historians of the United States.
The Spanish Influenza arrived in Wise County, Virginia, in October 1918. Located in extreme Southwest Virginia, Wise County sits on the Kentucky border. The largest town in the county during the influenza pandemic was Big Stone Gap, also the hub of the local newspaper in the nineteenth and early twentieth centuries, the Big Stone Gap Post. The particularly virulent strain of Spanish Influenza was first mentioned in the Post on October 2, 1918. Editors warned of the impending emergence of the virus in Southwest Virginia: “Spanish influenza probably will soon be here, there, and everywhere.” This article designated influenza as a “spray-borne disease” spread by sneezes and coughs. It also suggested a simple prevention method commonly prescribed by the US Surgeon General at the time, Dr. Rupert Blue, who advised avoiding “crowded, ill ventilated places.” However, the most striking inclusion in the article from October 2 is the statement pertaining to the nature of seasonal influenza. The Big Stone Gap Post described the virus as a “seldom menace of life.” Clearly, the inhabitants of Wise County did not anticipate the enormity of the deadly flu season of 1918-1919.29
Placed into historical context, the apathetic responses of both the newspaper editors and the local public health officials in Wise County were not unusual. In the early twentieth century, influenza was a common, seasonal occurrence throughout not only Virginia, but the entire United States. Wise County clearly possessed experience with the flu, or “grippe,” as it was often called. As early as January 1917, the Big Stone Gap Post warned Virginians of the impending annual flu season. The Virginia Board of Health mentioned simple precautionary actions, such as breathing fresh air, and also promoted the evidence of germ theory.30 In January the following year, the Big Stone Gap Post ran advertisements for “Rexall Cold Tablets,” a medication that promised to “arm...against Grippe, Influenza, Bronchitis, Cold in the head, Catarrh and Pneumonia.”31 Based on these newspaper clippings and the initial response of locals, the annual influenza outbreak in Southwest Virginia had never been as serious as the viral pandemic that struck in the fall of 1918.
One week following the initial lackadaisical acknowledgement of the Spanish Influenza in the local newspaper, the Board of Health in Wise County implemented much more serious prevention tactics to restrict the spread of the virus to the region. Adhering to advice outlined by Surgeon General Blue, on October 9 the local government closed nearly all public gathering places, especially churches, schools, and theaters.32 By October 16, precautionary measures became even more rigid as influenza finally reached the county. Following a town council meeting, the local government voted to allow hired civil servants to enforce the sanitary laws laid out by the Board of Health. According to the front page of the Big Stone Gap Post, “special officers will be employed to enforce the ordinance always in existence against spitting on the sidewalks, and to prevent the forming of crowds on the streets...or at any other point within the town limits.”33 The local government even took a step further and granted permission for Boy Scouts to report violations against the ordinances and imposed fines ranging from ten to twenty-five dollars on offenders.34 Members of the Wise County government were evidently beginning to understand the magnitude of the disease situation, and attempted to control unsanitary public actions.
The local Board of Health in Wise County adopted a variety of methods to spread information regarding the prevention of the flu. The Big Stone Gap Post not only published health warnings from Surgeon General Blue, but they also relayed information from the Red Cross.35 One of the more unique forms of sanitation publicity employed by the State Board of Health of Virginia appeared in a newspaper article on November 13, 1918. This passage described the creation of an “Influenza Catechism” for school children. Described as an “attractive publication,” the State Board of Health created the guide “in the hope that youngsters...follow the simple precautions it offers in connection with the prevention of the ‘flu.’”36 Another common tool used for the dissemination of knowledge about the Spanish Flu in both national and local newspapers was illustrations. These simple visuals were easily understood by nearly all Americans because they did not necessarily require the viewer to be literate. Graphic visuals are still an important tool in spreading sanitation knowledge today. The current and recognizable “Cover your Cough” posters issued by the Centers for Disease Control mimic visuals from the Spanish Influenza, such as the one published on the front page of the Big Stone Gap Post on the first day of October 1919 (Figures 2 and 3).
Unlike the gradual infection of individuals in Southwest Virginia in September and October, the Spanish Influenza was ravaging vulnerable troops at military bases throughout the United States in the fall of 1918. The Big Stone Gap Post published a startling figure on October 9: the mortality rate of American soldiers at army camps had reached nearly thirty-five percent on September 27, 1918. This was a thirty percent increase from the previous week.37 In this initial onset of the second wave of the flu, civilian populations seem to have been infected at a much slower rate. On October 16, Big Stone Gap Post declared 60,000 cases of Spanish Influenza in Virginia so far, and only two or three cases of the virus in the local area.38 An explanation for these large discrepancies in infection rates between military and civilian populations lies in the geographic location of the infected area. While military bases boasted thousands of constantly mobile individuals, the rural region of Southwest Virginia was a less populated area with fewer traveling persons.
However, the flu did not forsake the area for long. The quickly multiplying infection rates in Wise County within a one week period in October showcase the immensely contagious nature of the Spanish Influenza. On October 23, the Home Service Section Chairman of the local American Red Cross congratulated the people of Big Stone Gap for preventing a major scourge of the virus on the public.39 This statement became null and void just one week later. On October 30, the Big Stone Gap Post published an article describing the region of Southwest Virginia as “the worst afflicted of any part of the state.”40 Later articles attributed this to the rural nature and the excessive levels of poverty within the region. An article on November 20 described the depressing state of affairs in many counties of Southwest Virginia. According to the reporter, it was difficult for volunteers to reach the poor in many rural areas because of the inadequacy of railroad lines. Also, due to the horrific mortality rates associated with the Spanish Influenza, these rural areas experienced a shortage of coffins and undertakers. Finally, this reporter relayed accounts of neighbors abandoning the sick because of excessive fear of the virulent influenza.41 In other poor areas in the region, reports circulated that hungry dogs often snapped at pallbearers carrying the corpses of influenza victims.42 These accounts not only showed the extent of the affliction upon impoverished areas, but they also demonstrated the social stigma attached to the Spanish Influenza in the United States.
National, state, and local authorities gathered support for the treatment of the Spanish Influenza by appealing to the patriotism of civilians for volunteerism during the disease crisis. As stated in America’s Forgotten Pandemic, “enthusiasm [for the war] was success- fully substituted for preparation and efficiency in the battle with the flu.”43 Dispersed among World War I liberty bond advertisements in the Big Stone Gap Post, local Board of Health officials in Wise County requested the assistance of fellow civilians in the fight against the flu. On the front page of the Big Stone Gap Post on October 16, 1918, the Central Committee on the influenza epidemic in Wise County pleaded for help by comparing public health assistance to military service: “to all those, both men and women, who have so longed for the glamor and glory of service in France, let us say that the opportunity has been brought home to you to show just how truly you desire to sacrifice yourself on the altar of your country.”44 One week later, on October 23, the Big Stone Gap Post published an annotated version of Surgeon General Blue’s precautionary measures and home remedies against the flu. In another appeal to American nationalism to prevent the further spread of the Spanish Influenza, the editors of the newspaper stated the Surgeon General “believes that a patriotic service will be performed if the public heeds to his advice.”45
Also related to the patriotic appeal by public health officials was the circulation of anti-German sentiment in regards to the spread of the flu throughout the United States. According to historian Tom Quinn, “foreigners were blamed for spreading the disease deliberately a paranoid fear induced by the rising death toll” associated with the Spanish influenza.46 Susan Kingsley Kent expands on this idea: “the war served as an obvious metaphor [for the flu] in which Germans and germs were equally feared.”47 One of the most interesting inclu- sions in the news coverage of the outbreak was the insinuation that German soldiers purposefully spread the disease to the United States as a weapon of war.48 Anti-German sentiment also emerged following the decision by the Provost Marshal General of the United States Army to cancel the October draft of 142,000 men on account of the flu epidemic.49 This directly affected many young men throughout Southwest Virginia, who were hoping to participate in the international war. The Big Stone Gap Post briefly displayed this belief in a short quip about the influenza inhibiting war efforts on October 16: “Spanish influenza must be pro German, if one can judge by the way it is holding up the October draft contingent”.50
The request for nurses in Southwest Virginia mimicked the patriotic call for general volunteerism among civilians during the Spanish Influenza pandemic. Just as was evident throughout the entire nation at this time, Wise County lacked adequate numbers of nurses and physicians to treat the sick. Therefore, the local Influenza Committee in Big Stone Gap requested the help of any and all available women in medical care: “Let every woman who can volunteer for public nursing in the crisis that is surely coming, and prove herself worthy of the greater sacrifices of those noble ones abroad, to whom our danger would hardly seem a grievance”51 On October 30, the local chapter of the American Red Cross also called for “largely increasing our membership” through the recruitment of more nurses in the area.52
While the order for nurses during the Spanish Influenza pandemic was especially prevalent, the request for physicians was conspicuously missing. This can be attributed to the absence of a proper cure for the virus. Due to the inadequacy of an efficient antidote, the sooth- ing care provided by nurses was in high demand during the plague of the Spanish Influenza. According to Susan Kingsley Kent, “with physicians unable to make much of a difference during the pandemic, nursing care turned out to be one of the most effective treatments.”53 Scholar Alfred Crosby also tackled this theme, stating that “TLC—Tender Loving Care—to keep the patient alive until the disease passed away: that was the miracle drug of 1918.”54 Similar to sick citizens throughout the country, residents of Southwest Virginia requested the aid of nurses in the area. On the front page of the Big Stone Gap Post on November 6, the local newspaper editors relayed a message from the Virginia State Board of Health regarding the recruitment of nurses. This article once again invoked nationalistic pride during World War I: “the need is most urgent and any nurses who can serve in this capacity should have the satisfying consciousness of performing a real patriotic duty.”55 Tales of nursing heroism emerged in Southwest Virginia not long after the onslaught of the Spanish Influenza. On November 27, the Big Stone Gap Post featured a story about Miss Agnes D. Randolph, a state nurse from Richmond stationed within the mountainous region. According to the article, Nurse Randolph had to not only tend to three generations of sick in an eight-member family, but the city nurse also had to “clean up, cook, feed the pigs and chickens, get the cow from the hills and punish the children when they needed discipline.” Though her task was monumental, the nurse “felt she had received more than her reward” following an expression of gratitude from the family.56
By the first week of November, Wise County officials believed their stringent precautionary measures against the Spanish influenza had been successful. On November 6, the town council of Big Stone Gap thanked the temporary Central Committee created by the Board of Health to combat the Spanish Influenza epidemic in the county and dissolved the task force. According to the announcement, “on advice from the Board of Health, which believes that the crisis has passed, the council now deems it wise to relieve this committee of its duties.”57 Five days previous, the Virginia State Board of Health had declared that restrictions on public places “may be lifted to a large extent in most communities in Virginia, depending upon the prevalence and severity of the epidemic in those communities.”58 Based upon this report, the Wise County town council voted to reopen public schools on November 28, Thanksgiving Day.59 However, this action was clearly premature, as the influenza virus resurged throughout the communi- ties of Wise County in early December. On December 18, the Big Stone Gap Post announced the creation of an “Influenza Committee” by the auxiliary chapter of the Red Cross in Wise County.60 This committee was established not only to replace the disbanded Central Committee of the town council, but also to address the reemergence of the deadly Spanish Influenza throughout the county.
By January 1919, the deadliest wave of the Spanish Influenza was finally relinquishing its grip upon the inhabitants of Wise County. Public places not yet reopened were allowed to resume business in January following the lift on the influenza ban by the town council. On January 1, 1919, the local Amuzu Theater finally started showing films and productions again. To combat apprehension toward large public gatherings, the Amuzu Theater hoped to reassure guests by thoroughly disinfecting the cinema with “’Formaldehyde Gas’ before and after every show.” Owners of the Amuzu Theater also proclaimed “that this theater has taken every necessary precaution for proper ventilation.”61 Many churches in Wise County were also allowed to resume religious services. Resentment toward the Boards of Health for closing religious institutions existed in many counties of Southwest Virginia. The Big Stone Gap Postpublished the contents of an open letter from a Christian churchgoer in the Scott County newspaper the Gate City Herald on New Year’s Day. The editorial appeared in the newspaper on the same day the lift on the influenza ban was announced in Wise County. Titled “As to Closing the Churches,” this editorial not only berated local officials for shutting down congregational religious services, but also blamed the scourge of the Spanish Influenza on the overall immorality of Americans in the early twentieth century.62
The socioeconomic impacts of the particularly fatal strain of flu that attacked world populations in 1918 were visible in Virginia not long after the decline in infection. According to historian Tom Quinn, “by late October, industry and commerce around the world were severely damaged” by losses from the flu.63 As reported in data released by the “Virginia Anti-Tuberculosis Association in co-operation with the medical and philanthropic authorities in Wise County,” “there were 10,000 more deaths in Virginia in 1918 than in 1917, most of this increase was due to influenza and pneumonia.”64 These drastic demographic changes and the particularly violent nature of the influenza in the young adult population greatly impacted the primary sector of the economy and the retrieval of raw materials in Southwest Virginia. Officials in Richmond declared the mining and lumber industries in the region of Southwest Virginia particularly hard-hit by the flu epidemic.65 On October 16, the Big Stone Gap Post broadcasted news from the tiny mining town of St. Charles, in Lee County, Virginia, the most southwestern county in the state. According to the report, “some of the mines in that section have been forced to close because there are not enough well men to operate them.”66 The closing of mines and lumber yards was not only nationally significant because it hindered the war effort on the home front, but also locally significant because it impacted the lives of thousands of already impoverished individuals in Southwest Virginia.
The consequences of the Spanish Influenza of 1918 on the population were almost instantly observable in Southwest Virginia. Starting with the deaths of local boys stationed at military camps within the United States, the mortality rates of influenza quickly spread among the civilian population, especially young adults. Officials in Virginia cited evidence of this situation as early as January 1919, when the Spanish Influenza was still ravaging certain parts of the state. Based on reports from the Bureau of Vital Statistics, the state of Virginia initially recorded 5,999 victims from the Spanish Influenza in 1918. The majority of these were young adults.67 This created a demographic crisis, which not only impacted economic industries in the region, but also created a large number of orphans within Southwest Virginia. Similar conditions were present throughout the entirety of the United States following the influenza pandemic of 1918.
Local health officials in Wise County were well prepared for the following flu season after their experience with the unprecedented mortality rates associated with the strain of 1918. By the fall of 1919, the Big Stone Gap Post published numerous accounts on the increasing knowledge surrounding the pandemic of the previous year. Though contemporaries of the Spanish Influenza still did not yet understand the transmitting agent of disease, American epidemiologists had isolated the origins and waves of the deadly pandemic. On September 17, 1919, the Big Stone Gap Post addressed the impending flu season in depth. Editors of the newspaper reported that the influenza infection of 1919 would not be as lethal as the previous year’s. An article in the paper also announced that physicians and epidemiologists realized that the virus did not originate in Spain, as previously thought. However, the most significant inclusion in the front page article on the Spanish Influenza was the brief statement on prevention: “the most promising way to deal with a possible recurrence of the influenza epidemic is, to sum it up in a single word, “Preparedness.” And now it is the time to prepare.”68
Similar to Wise County, Tazewell County, Virginia, had comparable experiences with the Spanish Influenza pandemic of 1918-1919. Also located in far southwestern Virginia, the County of Tazewell borders West Virginia along the ridge of the Appalachian Mountains. The local newspaper that served the area during the influenza pandemic was the Clinch Valley News, named after the Clinch River that flows through the region. Before the second wave of the Spanish Influenza even reached the United States, the Clinch Valley News was broadcast ing the report of a deadly influenza outbreak in the German Army on the Western Front.69 Initial evidence of the Spanish Influenza in Tazewell County emerged in Jewell, a small coal-mining town, sometime in the week preceding the Clinch Valley News weekly edition on October 4, 1918.70
Not long after the emergence of the disease in Virginia, local health officials in Tazewell County enacted public sanitation measures to curb the spread of the flu. Relaying advice from the Virginia State Board of Health, the Clinch Valley News published “How To Save Yourself From Influenza” on October 11, 1918. These recommendations followed the guidelines generally associated with respiratory illnesses, and mentioned avoiding crowds, covering coughs or sneezes with a handkerchief, and remaining in bed for the duration of the illness.7 On October 25, the opening article in the Clinch Valley News included these same prevention measures, but also described symptoms, treatment, and precautions associated with the Spanish Influenza.72 Judging by front page location of the article, residents in Tazewell County were very concerned by the spread of the deadly virus.
The first few weeks of the Spanish Influenza pandemic in Tazewell County were relatively quiet. The virus was slow to infect residents in the rural locations of Southwest Virginia. The first casualties amongst locals did not even occur in the county—young male troops stationed at American military bases were the earliest Tazewell residents to contract the disease. According to information published in the Clinch Valley News on October 11, 1918, the deaths of three influenza-stricken Tazewell County soldiers were also the first casual- ties of World War I from the area. Sidney M. B. Coulling, William E. Peery Jr., and Sergeant Estil Hurt did not live to see action in the war. Instead, the three young soldiers died at army camps of complications with influenza from a secondary infection of pneumonia. Sidney M. B. Coulling’s death reflected the swift and cruel nature of the Spanish Influenza. He died within two weeks of enlisting.73 In the words of the Clinch Valley News editor, “now, in an unexpected way the war has been brought home to us in this dreadful epidemic, as deadly as German bullets.”74
In the first few weeks of October, Spanish Influenza was ravaging army camps throughout the nation and along front lines. However, initial flu infection rates were slow to emerge in Tazewell County. As of October 18, the influenza pandemic in Tazewell County was described as a mild form.75 But by October 25, the Clinch Valley News stated, “influenza has been claiming heavy tolls at Richlands and vicinity.”76 According to newspaper accounts on that same day, “the epidemic of influenza is just getting a good start in Tazewell.”77 In order to prevent the further circulation of the flu virus, many areas in the county prohibited large public gatherings “to escape the death toll that has been taking in so many communities.”78 Following recommendations from the US Surgeon General, the Town of Tazewell Board of Health took precautionary measures and closed all public places on October 11, 1918.79 This included not only schools, but also theaters and churches. By October 18, the Virginia Board of Health estimated that there were at least two hundred thousand cases of the Spanish influenza in the state.80
Following the greater dispersion of the Spanish Influenza in the fourth week of October, Tazewell County officials pondered stricter ordinances to prevent the further spread of the virus. On October 25 in an editorial titled “Strict Quarantines Should Be Established,” an anonymous author rallied for the implementation of “rigid precautions,” such as a town quarantine restricting all visitors.81 Though this suggestion would have possibly contained the virus to the outskirts, placing a quarantine on an area as large as Tazewell County was quite infeasible. Therefore, the quarantine was never implemented. Unlike Wise County officials who imposed stringent laws on society, such as fines for spitting in the street, the officials in Tazewell County relied mainly upon public health recommendations and the honorable sanitary actions of individuals.
Just as all regions of the United States, Southwest Virginia was also affected by the lack of available nurses and physicians to treat the Spanish Influenza. Due to America’s involvement in World War I, most health care providers were stationed overseas or at major military bases. This inhibited the treatment of Spanish Influenza victims among the civilian population within the continental United States. Calls for volunteer nurses appeared in most newspapers across the country, including the small local ones published in Southwest Virginia. Members of the Board of Health in Tazewell County released information regarding the need for nurses in the region as early as October 18, only a few weeks after the first cases of influenza were reported in the area.82 By November 8, the futile appeal for nurses in the Clinch Valley News reflected the desperate disease situation that had devel- oped in Tazewell County. Citizens of the small town of Raven pleaded to the local Board of Health to send medical aid as their town physicians were all off supporting the war effort. Their reports included statistics of two deaths per day within the miniscule rural population.83
Unlike the Big Stone Gap Post, the Clinch Valley News also briefly addressed the Spanish Influenza in the African American community of Southwest Virginia. The only mention of non-whites during the flu pandemic in Tazewell County occurred on November 1, 1918. According to local reports in the Clinch Valley News, the black population of Tazewell County appeared to be affected by the Spanish Flu in the same fashion as whites.84 The brief statement regarding the epidemic among different races in Tazewell County is significant because few sources exist that describe the Spanish Influenza among the African American population. In addition, historians and epidemiologists of the Spanish Influenza pandemic of 1918 continue to ignore the context of the virus among minority populations even more than local perspectives.
By early November, Tazewell County health officials assumed the brunt of the second wave of influenza was subsiding. On November 1, the Tazewell County Board of Health prematurely reopened all public places, including schools.85 This inopportune action greatly affected infection rates of Spanish Influenza throughout the county. Based on the increasing publication of sickness and deaths in the “Local News” section of the Clinch Valley News in the papers of November 8 and November 15, the Board of Health clearly responded too quickly to the slight decline in infection rates in late October.886 By November 29, the flu was once again raging throughout the county, and the local newspaper described at least fifteen new cases of disease.87 On December 6th, editors of the Clinch Valley News confessed their mistake: “the statement made by the papers recently that the ‘flu’ had abated, seems to have been somewhat premature.”88 One week later, the mayor of Tazewell, A. C. Buchanan, stated in the Clinch Valley News that “it was probable the schools and other places would be closed [again], owing to the rapid spread of the influenza.”89 An editorial published on the same front page described the common sentiment held by citizens of Tazewell to “better err if at all on the safe side” and reclose public places.90 However, the Board of Health and Town Council of Tazewell County refused to reclose schools, churches, and businesses within the area. The editor of the Clinch Valley News clearly respected the beliefs of citizens within the county, and included a critical statement following the public health announcement: “Whether the authori- ties have proceeded wisely or unwisely, remains to be seen. Whether precaution is better than cure, however, is not a question at all. Time will tell.”91
As in Wise County, the local government in Tazewell County appealed to inhabitants’ patriotism to volunteer in the treatment of the flu. Alfred Crosby describes the exceptional level of civic volunteerism in the treatment of the Spanish Influenza as a “by-product of the war spirit.”92 One aspect of information shared between the Big Stone Gap Post and the Clinch Valley News was the inclusion of false rumors surrounding the emergence of the influenza in the United States. Crosby also states that “the people of the US were stark raving patriotic” in the year of 1918.93 Similar to inhabitants in Wise County, many Tazewell County residents believed the influenza was spread to the United States as a by-product of the German war effort. Nationalistic appeals were present in the Clinch Valley News not only during the continuation of both World War I and the height of the pandemic, but also after the armistice in November and the decline of the deadliest wave of the Spanish Influenza. During the final wave of disease in March 1919, the Clinch Valley News equated citizens ignoring flu prevention methods to the unpatriotic rejection of the League of Nations.94 As evidenced in articles within the local newspapers of the Big Stone Gap Post and the Clinch Valley News, patriotic appeals to follow influenza prevention and treatment methods were particularly effective among the population of Southwest Virginia.
The economy of Tazewell County in the early twentieth century was primarily based upon mining and railroads. Thus, the ravaging flu of the 1918-1919 season greatly affected production outputs and industrial transport and shipping. Effects of flu on the economy of Tazewell County were visible early after the onset of the epidemic because of the prevalence of mining industries within the area. Multiple publications of the Clinch Valley News in the fall and winter of 1918 reference the impact of the Spanish Influenza pandemic on local mines. For ex- ample, editors of the Clinch Valley News mentioned the consequences of the influenza pandemic among coal miners within the small town of Jewell on October 4.95 This date is significant because it is the same day as the initial announcement of infection within the county. Two weeks later, the ramifications of the great influenza infection rates among the coal mining population were presented as front page headlines in the local newspaper. On October 18, in the article “The Influenza Spreads Fast,” the Clinch Valley News discussed the hindering of coal production within the region. According to reports by the Fuel Administration, coal retrieval within Appalachia “report[ed] reductions, ranging from 15 per cent to 50 per cent of the regular out put [sic].” By December 6, the Clinch Valley News released information that mines within the local area might shut down due to a lack of healthy workers.96 The effects of the influenza pandemic among the mining population of Southwest Virginia exacerbated the impoverished situation of many residents within Tazewell County.
An additional effect of the Spanish Influenza pandemic discernible not long after the end of the final wave of the outbreak was the presence of a great number of orphans throughout Southwest Virginia. On May 30, 1919, the Clinch Valley News published an appeal by the Children’s Home Society of Virginia. The article included a statement about the large number of orphaned children in the state due to the fatality of the Spanish Influenza pandemic: “the recent epidemic of influenza is sending hundreds of motherless or fatherless children to our doors.”97 The unusually high mortality rate among young adult victims of this particular influenza outbreak explains the large number of orphaned children in Southwest Virginia, as well as the entire United States. According to Susan Kingsley Kent, “the heavy toll influenza took on the adult population left scores of orphaned children in almost every community.”98
Similar to locals in Wise County, Virginia, residents of Tazewell started preparation for the impending flu season of 1919 much earlier than in previous years. By the summer and early fall, the Clinch Valley News was reporting prevention methods to diminish the severity of the imminent flu season. The experience with the deadly Spanish Influenza in the previous year led to the presence of unusually high amounts of precautionary measures published in newspapers. The immense number of articles related to public health measures reflected borderline paranoia within the population of the United States. On September 12, 1919, the Clinch Valley News warned of the potential return of the Spanish Influenza and reiterated sanitary practices, such as avoiding the common drinking cup.99 By the official start of flu season in October, Board of Health members in Tazewell County advertised the statewide campaign for influenza prevention.100 Clearly, public health advocates not only of national, but also of state and local institutions understood the enormity of the disease circumstances of 1918 and were prepared to forestall a similar situation in the approaching months.
The Spanish Influenza pandemic of 1918 has been largely forgotten by the population of the United States. Whether this is due to the concurrent event of World War I or the immense anguish experienced by victims, this significant disease outbreak has essentially vanished from American history. Historian Nancy Bristow cites this exodus as “precisely an American tendency to rewrite the past to make it more tolerable.”101 The existing explorations into this historic event rely heavily upon an international or national context of disease as well as data from statistics on mortality rates. While mortality rates are an important aspect of the consequences of the Spanish Influenza pandemic of 1918, they fail to tell the whole story. The most valuable sources in the history of the Spanish Influenza are the personal reactions of individuals and the public health responses implemented by provincial authorities. The overall lack of historical scholarship on the local context of the Spanish Influenza buries thousands of personal accounts and perspectives. While exploring individual manuscript collections and local newspapers is tedious work, they do present an astounding glimpse into the distinctive reactions and events of the Spanish Influenza pandemic within specific localities. Overall, the Spanish Influenza of 1918 was a momentous event in American history that necessitates further research in order not only to understand the varied reactions of different communities in the United States, but also to comprehend the exhaustive consequences of localized disease outbreaks worldwide.
About The Authors
Rachel Goatley graduated from Virginia Tech with a bachelor’s degree in history in spring 2014. She is currently a graduate student studying archives and records management in the School of Information and Library Science at the University of North Carolina-Chapel Hill.
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