By Katharine Cornell Gorka, Director, Civil Society and the American Dialogue. This piece first appeared in American Greatness, and published here with permission.
Good public health policy is good economic policy. An epidemic run wild will destroy an economy just as surely as a ruined economy will destroy lives.
Political leaders at all levels of government will soon have to make one of the gravest calculations of their lifetimes: identifying the singular point of equilibrium between the physical and economic health of their constituents. They will have to discern that precise moment when health risks for their citizens have declined to the point that they may prudently begin removing restrictions they’ve placed on social and economic activities.
Where the disease is not prevalent, that may be a relatively easy call. But where the viral outbreak remains a very real and potent danger, opening up the economy too soon could have disastrous long-term economic consequences, as well as lethal health effects.
Much hangs on getting these decisions right. And, as citizens, we are not mere spectators in this drama. Our names may not be on the marquee, but we are more than bit players.
It is we, the people, who confer power on our leaders. By our votes, we have put those leaders in office, and when this is over, we will have to judge whether those we elected proved worthy of the trust we placed in them. Did they take good counsel? Did they balance the needs of all citizens? Were they arbitrary or equitable in deciding which activities to prevent and which to allow? Did they take advantage of our vulnerability to take just a little more power for themselves?
COVID-19 has tested not just how our mayors, governors and federal officials manage a pandemic, but also how they manage our freedom. It is a truism that, once people have power, they seldom want to give it up. That all-too-human trait does not recede, even in the midst of a national emergency.
George Washington was an exception. He rejected the prospect of being crowned king. He said no to a third term in office. His decisions conform perfectly with fundamental American values.
Our founders recognized the dangers inherent in the allure of power. They acknowledged man’s natural inclination to seek power and set out to constrain it. Hence the separation of powers, the checks and balances, and the division of power between the national government and state governments. The system they designed was brilliant, and it has worked remarkably well up to now. But these are extraordinary times.
Never in the history of the United States have Americans given up so much of our freedom. For the most part, we have done so willingly because we believed it was for our own good and for the good of the more vulnerable among us.
Yet now that the number of fatalities and hospitalizations is running far lower than projected, many complain that this shutdown was unwarranted. A strong argument can be made that those in power did only what they thought was necessary, however, given the limited information available about the disease at the time.
The uncertainty about the nature of the virus and what seemed like a very real potential for rampant death led President Trump and America’s governors to place extreme restrictions on our activities, and we accepted them. That we willingly conceded our freedoms to the leaders we elected and that we trust them to return those freedoms is a true test of what makes America exceptional.
The good news is that the government America’s Founder designed—a republic in which power resides with its citizens—is sufficiently agile and resilient that it can adapt even to an unforeseen crisis such as the COVID-19 pandemic. As the National Coronavirus Recovery Commission noted in its preliminary report released this week, “The American system of federalism provides the appropriate governing structure for responding to a crisis with as many different facets and variable effects as we are seeing with COVID-19.”
But that also means that we do not get to blithely leave the fate of our country in the hands of those we elected. They are our representatives, not our rulers.
As Thomas Jefferson wrote to Edward Carrington on January 16, 1787, “The people are the only censors of their governors.” It is we, America’s citizens, who ultimately bear responsibility for how our leadership handles this crisis—that is what government by the people, for the people, and of the people means.
Thus, if we still value our freedom and have not sacrificed it to the fear of disease, in the weeks and months ahead we must ensure that we remain engaged and informed. We must fully understand the limited powers of our government officials. We must know our history well enough to understand why the Framers of the Constitution designed the government that they did. (And if we do not know it, this is the perfect time to learn it.) Finally, we must care enough about our freedom to demand we get it back—fully—once this crisis has passed.
This piece originally appeared in American Greatness
Paul Plante says
The Spanish Influenza of 1918 is widely regarded by historians as the “forgotten pandemic.”
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.
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.”
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.”
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.
– From THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919
Author: Rachel Goatley
How to Cite: Goatley, Rachel. 2015. “THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919”. The Virginia Tech Undergraduate Historical Review 4. DOI:
http://doi.org/10.21061/vtuhr.v4i0.34
Published on 01 May 2015
Paul Plante says
Where we have been in the past before we became real stupid and started calling elected public servants “our leaders,” and then vesting them with authority over our very lives, when we know beforehand they are not competent to protect and promote our health and well-being, which is a clear sign that a good percentage of people in America who think of those people as their “leaders” and cede that power to them are self-deceived or mentally ill, to wit:
From “The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia – Richmond, Virginia”:
August 1918 was a scorcher in tidewater Virginia.
Drilling in uniform in the heat and humidity of Petersburg, 25 miles south of Richmond, must have been grueling for the nearly 48,000 soldiers of Camp Lee.
Little did they know that, as bad as the conditions were, they were about to get a whole lot worse.
For only a few weeks later, influenza arrived in camp.
The first case of influenza appeared in a new inductee, who was admitted to the camp infirmary on the evening of Friday, September 13 with symptoms of severe respiratory disease.
Camp doctors were not sure of the illness, but they suspected influenza.
Within a few hours, ten more cases of the new malady were reported in different parts of the camp.
By the morning of September 17, that number had grown by 500.
Two days later, there were over 1,000 cases in Camp Lee, more than could be tended to in the camp hospital.
Medical personnel now knew they were dealing with a quickly growing influenza epidemic.
In an attempt the keep the disease contained to the camp, the commanding general, Brigadier General Charles A. Hedskin, forbid all public gatherings within the camp, and closed the YMCA building, the Knights of Columbus hall, and the movie houses.
Visitors were also prohibited.
The camp designated a squad room in each barracks as an infirmary; a curtain made from a halved sheet was hung around the head of each cot in an effort to contain germs, and each sick man carried through the camp had to don a gauze mask.
Hedskin, did not think a general quarantine of the camp would prove effective given that the disease was already so rampant all along the East Coast.
More important, the general believed, a quarantine would delay troop training sessions.
Eager to prepare his troops for battle, Hedskin pushed the soldiers to train hard, and many returned to their duties before fully recovering from influenza.
The crowded camp conditions, combined with over-exerted soldiers, were a recipe for disaster.
The only safe place in the camp seemed to be the officers’ training school, which had been strictly quarantined.
Meanwhile, knowing that soldiers from Camp Lee regularly came to Richmond for entertainment and fearing that they would bring the disease with them, city health officer Dr. Roy K. Flannagan and Virginia Health Commissioner Ennion G. Williams met to discuss methods on preventing a potential epidemic among civilians.
The two men decided that, for the time being, a public education campaign was the best way to deal with the threat.
Posters and pamphlets were printed for distribution in the schools, urging the public to refrain from putting their fingers, foreign objects, or common drinking cups in their mouths, and to cover their coughs and sneezes.
As of yet there were no reported cases of influenza in Richmond, although Flannagan and Williams fully realized that, since influenza had only become a reportable disease in Virginia earlier that year, it was possible that physicians had neglected reported cases.
On September 28, as the epidemic at Camp Lee increasingly grew worse and as several hundred cases appeared in Richmond, Flannagan requested that the War Camp Community Service’s dances and entertainments for the soldiers from Camp Lee be cancelled.
The Department of Health also advised Richmonders to refrain from inviting soldiers into their homes for Sunday dinner, as had become the custom.
“So far as I can understand,” Flannagan complained, “there is no quarantine at Camp Lee.”
“Hundreds of soldiers from that camp daily visit Richmond and these must, to a greater or lesser extent, spread the disease.”
For now the measures were only recommendations, although Flannagan noted that if not followed he indeed would issue a public health edict outright banning the dances as well as closing movie houses.
For the time being, in addition to these recommendations, Flannagan settled on a simple policy of forbidding sick children from attending school.
As in Camp Lee, Richmond’s epidemic took off like gangbusters.
Within a few days the city had over 600 cases.
Already Richmond’s nurses were being overrun.
A roster of 75 nurses had been mustered, but still dozens of calls for help had gone unanswered.
Flannagan plead for every man or woman, white or African American, with any nursing experience to lend assistance, and enlisted the help of the Red Cross to gather as many graduate and practical nurses as possible.
Believing that the key to controlling the outbreak lay not necessarily in social distancing but in proper ventilation, he ordered that all churches and theaters ensure a steady supply of fresh air to their congregants and patrons.
Those that did not do so were threatened with closure.
Some called for the barring of Camp Lee soldiers from entering Richmond, but military officials there stated that such a move would have little effect on the city, given that the civilian population was already well seeded with cases.
Meanwhile, Flannagan and Williams traveled to Richmond schools to give lectures on influenza prevention and treatment to schoolchildren.
It did not take long for Flannagan and Williams to change their minds.
On October 5, with outbreaks in nearly every community across Virginia and over 2,000 cases in Richmond, the State Department of Health issued a recommendation advising local health departments to ban all public gatherings and close churches, theaters, movie houses, and other such places.
Schools closures were not recommended; instead, teachers were asked to monitor students and to send home sick children.
That same day, upon Flannagan’s request, the city’s board of directors issued a closure order, adding public and private schools to the state’s list.
The order went into effect on October 6.
Richmond’s soft drink parlors and drugstore soda fountains, having enjoyed a one-day reprieve, were added to the list the next day.
The Virginia State Fair, scheduled to open on October 7, was initially exempted from the order because Flannagan believed that visitors would not be subjected to any more risk there than if they were walking around the streets of downtown Richmond.
State health officials disagreed, and ordered the fair closed as well.
– Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library
Influenza Encyclopedia
Paul Plante says
Wise County
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.”
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.
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.
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.”
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.
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.
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.’”
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.
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.
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.”
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.”
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.
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 soothing 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.”
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.
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.
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.”
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.”
Based upon this report, the Wise County town council voted to reopen public schools on November 28, Thanksgiving Day.
However, this action was clearly premature, as the influenza virus resurged throughout the communities 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.
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.”
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 Post published 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.
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.
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.”
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.
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.”
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.
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.”
– From THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919
Author: Rachel Goatley
How to Cite: Goatley, Rachel. 2015. “THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919”. The Virginia Tech Undergraduate Historical Review 4. DOI:
http://doi.org/10.21061/vtuhr.v4i0.34
Published on 01 May 2015
Paul Plante says
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.
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.
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.
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.
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.
But by October 25, the Clinch Valley News stated, “influenza has been claiming heavy tolls at Richlands and vicinity.”
According to newspaper accounts on that same day, “the epidemic of influenza is just getting a good start in Tazewell.”
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.”
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.
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.
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.
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 developed 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.
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. 88
By November 29, the flu was once again raging throughout the county, and the local newspaper described at least fifteen new cases of disease.
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.”
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.”
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.
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 authorities 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.”
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.
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.
By the official start of flu season in October, Board of Health members in Tazewell County advertised the statewide campaign for influenza prevention.
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.
– From THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919
Author: Rachel Goatley
How to Cite: Goatley, Rachel. 2015. “THE SPANISH INFLUENZA IN SOUTHWEST VIRGINIA 1918-1919”. The Virginia Tech Undergraduate Historical Review 4. DOI:
http://doi.org/10.21061/vtuhr.v4i0.34
Published on 01 May 2015
Paul Plante says
From “The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia – Richmond, Virginia”:
With social distancing measures in place, officials turned their attention to the city’s healthcare system and its overworked nurses and physicians.
Flannagan divided Richmond into four sectors and assigned a doctor and nurses and volunteers to each to eliminate duplicate efforts.
The Richmond Academy of Medicine and Surgery issued an appeal for all specialists to lend their aid, as did the Red Cross and the Visiting Nurses’ Association.
The latter worked with Richmond’s churches to establish soup kitchens to feed families too sick to feed themselves or where the primary breadwinner had fallen ill and the family had lost those wages.
At the request of the United States Public Health service, the Red Cross had 15,000 pamphlets printed with recommendations on how to keep healthy.
The city council appropriated $15,000 so that John Marshall High School, now unused, could be converted to a 500-bed emergency hospital.
The hospital was up and running the next day, with ten nurses on duty.
By 10:00 am there were already 55 patients in beds and 30 more on their way.
It was scarcely the end of the first week in October, and already health officials estimated there were 10,000 cases within city limits, and predicted as many as 1,500 deaths in the next six weeks.
Among the cases was Dr. Lawrence T. Price, director of the emergency hospital, now at home resting.
In his place temporarily served Dr. E. C. L. Miller of the Medical College of Virginia (now part of Virginia Commonwealth University).
State Health Commissioner Williams fell ill a few days later, and was confined to his home as well.
Several other city officials were also down with influenza.
One city commissioner exclaimed that he was “fearful of the greatest calamity that has befallen the city since the war.”
Richmond would be lucky, some experts estimated, if it experienced 30,000 cases total and a six percent death rate.
Richmond’s resources were being taxed to the limit.
Milk was in short supply, partly owing to the number of sick dairy and distribution employees and partly due to physicians recommending it as nourishment for the ill.
The shortage had grown so severe that city inspectors visited the Richmond jail to select inmates for work in the dairies.
Some even expected the city the take over the dairies.
More than milk, nurses were desperately needed.
Some called for mandatory service, but state Attorney-General John R. Saunders stated that there was no official authority by which nurses could be commandeered for epidemic work. 23
Fortunately, the crest of the epidemic had been reached.
As the second half of October rolled by, conditions continued to improve.
On October 16, the John Marshall hospital was still full of recovering patients, although doctors there expected to release an increasing number of them to complete their convalescence at home.
By October 28, the hospital had just 180 patients – about a third the number of the previous week – and announced it was no longer accepting new patients except in extreme circumstances.
The remaining patients were relocated to a central area in the building so that the rest of the facility could be cleaned in preparation for the imminent reopening of Richmond’s schools.
Both Flannagan and Acting State Health Commissioner Dr. Garnett, in charge of the state’s epidemic control measures while Ennion Williams recovered from his bout with influenza, were optimistic that the epidemic was truly over and that the closure order and gathering ban soon could be removed.
On October 29, Garnett announced that conditions across Virginia had improved enough to allow local communities to decide when to remove their restrictions.
– Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library
Influenza Encyclopedia
Paul Plante says
From “The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia – Richmond, Virginia”:
The next day, Flannagan notified the city administrative board that churches would be allowed to hold Sunday services on November 3, and that the other restrictions would be removed Monday, November 4.
Flannagan admitted that he expected the number of new daily cases to rise slightly as a result, but believed that proper ventilation in public places and care on the part of residents would keep the situation in hand.
Richmonders – and especially business owners – eagerly awaited what they assumed would be the board’s rubber stamp endorsement.
The situation immediately grew more complex than that, however.
A group of physicians from the Richmond Academy of Medicine and Surgery sent the administrative board a letter asking that discussion of removing the restrictions be tabled until the Academy could first discuss the epidemic at its upcoming meeting, scheduled to take place the evening of October 31.
Dr. Thomas Murrell, head of the Academy, added that he believed lifting the bans at present would be a mistake.
The administrative board, concerned with Murrell’s misgivings and Flannagan’s statement that there would be a slight rise in new cases, temporarily tabled the discussion.
Ennion Williams, now fully recovered from influenza and back at his post, expressed his dismay at the situation.
He believed that the state board of health clearly had placed authority to remove the closure order in the hands of local health departments, not in city councils and especially not in the Richmond Academy of Medicine and Surgery.
The next day the administrative board reconvened, with several ministers and theater owners and managers present.
Almost immediately Flannagan – in Charlottesville tending to his sick brother – telephoned the board to reverse his previous recommendation to rescind the closure order, citing the opinions of several Academy of Medicine and Surgery physicians as the reason for changing his mind.
With leading physicians and now the health officer against reopening, the administrative board once again tabled the matter, leaving Richmond’s public gathering spots closed and many of its clergy, theater owners, and even school officials upset.
At least one theater owner, on Flannagan’s previous word that theaters would be allowed to reopen on November 4, had arranged for a show.
Now, he grumbled, he would lose $3,500.
Ministers argued that holding Sunday services would not endanger the health of the community.
The head of a private school complained that Flannagan had explicitly told him it would be safe to notify pupils and parents that their school would reopen on Monday, November 4.
He had sent letters to parents and now had to scramble to notify them of the mistake.
The administrative board debated the issue once again on November 2, this time behind closed doors.
Members were split as to whether or not to lift the closure order, but in light of Flannagan’s withdrawal of his recommendation they let the matter rest.
Meanwhile, Flannagan found himself beset by angry theater owners, two of which traveled to Charlottesville to complain to the health officer in person.
Flannagan now waffled.
In a letter to chief city commissioner Graham Hobson, he stated that he believed the closure order safely could be lifted, but that delaying action would improve public health.
Flannagan told Hobson he was not “irrevocably committed” to lifting the closure order.
No one, it seemed, wanted to take charge of the situation for fear that the epidemic would return in force.
Two days later, the administrative board voted to lift the closure order and gathering ban effective immediately.
Flannagan had returned to Richmond, where he stated that conditions no longer warranted “any further penalizing of the public.”
Influenza and pneumonia would continue to circulate throughout the winter, he added, but Richmond’s epidemic was over.
If the city waited until the disease was completely gone to reopen its businesses, it would be waiting for a very long time.
On the other side of the debate was the Academy of Medicine and Surgery and other like-minded physicians and nurses, who told Commissioner Hobson that lifting the order would be “nothing short of a public calamity” that would result in the deaths of hundreds.
After a lengthy debate, the administrative board was still split.
One commissioner requested that he be given more time to deliberate his vote.
Hobson denied the request and his vote was counted as an abstention.
The result was a break in the deadlock: the board voted two-to-one to lift the closure order effective immediately.
– Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library
Influenza Encyclopedia
Paul Plante says
From “The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia – Richmond, Virginia”:
Proprietors of affected establishments were elated, and went to work straightaway to prepare for business once again.
The school board, initially prepared to admit pupils that day, scrambled to set a new date for schools to reopen – Wednesday, November 6.
The John Marshall and Baker emergency hospitals were in various stages of being fumigated and cleaned and were almost ready for classes but would not reopen for several more days.
Children with symptoms of influenza or coming from homes where there was an active case of influenza would not be allowed to return to their classrooms.
To make up for the three weeks of lost instruction time, the school board voted to shorten vacations and to lengthen the school year.
The unexpected vacation had come at a price.
As Flannagan predicted, influenza was not yet gone from Richmond.
By early-December, the disease had reached near-epidemic levels once again.
Hospitals, just recovering from the epidemic workload and now near capacity once again, announced that they would not accept any more influenza patients, leaving victims to be cared for at home or in a private facility.
Commissioner Hobson refused to consider establishing another emergency hospital, calling it an unnecessary expense.
When Price proposed opening the unused top floor of City Home Hospital to influenza patients, Hobson expressly forbade it.
“I will not permit and you are directed not to receive any influenza patients at the city home,” he told Price.
“These institutions have run $10,000 over their appropriations and must not take any more.”
Hobson asserted that many of those treated previously at the John Marshall emergency hospital, despite being “amply able” to pay for their treatment, had instead left the city to foot the bill.
Flannagan assured the public that, because far fewer were dying, no restrictions would be put in place.
He warned residents to keep their bodies and their homes clean, and to avoid crowding on streetcars or in homes.
Most affected were the poorer sections of Richmond, as well as the well-to-do West End neighborhoods only lightly touched by the epidemic in October.
This latter fact was, as Flannagan realized, the key.
As he wrote in his annual report to Mayor George Ainslie, influenza was now “playing return engagements everywhere, and nothing that is done by health departments, whether of Army, Navy, State or City, seems to do more than to temporarily check it.”
“Renewed assaults by it apparently mean to take in the whole susceptible population.”
The disease simply had to run its course.
Perhaps not surprisingly, Murrell and the Academy of Medicine and Surgery were unhappy with Flannagan’s position.
He, along with many other physicians, wanted to see Richmond’s schools closed once again, claiming that many of the new cases were among children.
Superintendent of Schools Albert Hudgins Hill disagreed, arguing that the situation did not warrant another closing.
According to his attendance figures, the absentee rate had increased by only about five percent.
Only a quarter of these, Hill surmised, were actually home with influenza, while the others were absent due to parents’ fears or teachers turning away students from infected homes.
The schools already had to struggle to make up lost time; the Christmas break was now limited to only a week.
A second closure would make it impossible for schools to properly educate students.
On December 14, the Administrative Board tabled Murrell’s suggestion until it could consult with Flannagan, expected to return the next day from the American Public Health Association meeting in Chicago.
The attendance rate in Richmond’s public schools continued to drop.
Before the epidemic, the average daily attendance across the school district was approximately 24,000.
By December 18, that number had declined to 15,705.
Some 4,000 students were excluded from school because there was an active case of influenza in their home.
That still left nearly 4,300 students absent either because of illness or because of overly concerned parents.
Altogether, nearly a quarter of the city’s public school students were absent as the Christmas break approached; in some classrooms, fifty percent of the students were absent.
With the Christmas holiday break just around the corner, Richmond officials decided not to issue a forced closure order.
By the time the children returned from their holiday break, the influenza situation had improved greatly.
– Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library
Influenza Encyclopedia
Paul Plante says
From “The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia – Richmond, Virginia”:
Between the start of the outbreak and the end of the year, a total of 20,841 cases of influenza were reported.
Of these, 946 victims died as a result of influenza or pneumonia, nearly a quarter of all of Richmond’s deaths for the entire year.
The disease rolled on into 1919, adding 132 deaths by early-February.
Overall, Richmond’s death rate due to the epidemic was 508 per 100,000, higher than the average amongst Southern and Midwestern cities, but slightly lower than that of most other East Coast communities.
As Flannagan wrote in his department’s annual report to the mayor, despite anticipating influenza’s arrival in Richmond, “no amount of forethought, in the absence of a sufficient number of doctors and nurses, could have prepared us for the tidal wave of disease and death that all but overwhelmed the city.”
Such was the assessment of Richmond’s epidemic by Dr. Roy Flannagan.
– Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library
Influenza Encyclopedia