WAR AND DISEASE: THE POLITICS OF PUBLIC HEALTH IN THE STATE OF UTAH

DURING THE 1918-1919 INFLUENZA PANDEMIC

by

JANET CANNON DUBOIS

B.G.S., Brigham Young University, Provo, 2010

A thesis submitted to the

Faculty of the Graduate School of the

University of Colorado in partial fulfillment

of the requirements for the degree of

Master of Arts

History Program

2017

ii

This thesis for the Master of Arts degree by

Janet Cannon Dubois

has been approved for the

History Program

by

Rebecca Hunt, Chair

Michael Kozakowski

Chris Agee

Date: December 16, 2017

iii

Dubois, Janet Cannon (MA History Program)

War and Disease: The Politics of Public Health in the State of Utah During the 1918-1919

Influenza Pandemic

Thesis directed by Associate Professor Rebecca Hunt

ABSTRACT

This historical examination looks at the uses of power by different entities to deal with and

control the influenza pandemic in the state of Utah during the 1918-1919 influenza

pandemic. Surprisingly, the story is not a narrative about the power of the Mormon Church.

The Utah State Board of Health relied on the direction of the federal government. The state

board of health’s firm leadership set in place restrictions and regulations and was vital in

dealing with problems faced by local Utah communities. The board of health relied on local

authorities to follow through with these mandates. Bans and restrictions were lifted after

many weeks, but the flu continued to manifest itself in Utah. Individuals in Utah were

forced to step up and take responsibility for their own health. Lessons learned include the

need for direction from federal government, followed by state and then local direction

when a disease pandemic occurs. However, these government entities cannot continue to

curtail the rights of individuals, businesses and communities for an indefinite period.

Though governing entities may not always give the best direction, they are essential to

keeping order and providing guidance to the society they have stewardship over at least

during the initial onslaught of the disease.

The form and content of this abstract are approved. I recommend its publication.

Approved: Rebecca Hunt

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ACKNOWLEDGMENTS

Early ideas for this this thesis began on a trip with my sister to Cabo San Lucas,

Mexico. My sister, Dr. Lisa Cannon-Albright, Chief, Division of Genetic Epidemiology in the

Department of Internal Medicine at the University of Utah School of Medicine, had

contributed to a paper titled, “Evidence for a Heritable Predisposition to Death Due to

Influenza.” I had recently written a paper on the historiography of the 1918-1919 influenza

pandemic. We had some great conversations during the week. She agreed to help me gain

access to the Utah Population Database through her department. Lisa spent countless hours

over a five-week period while I worked with her in Utah, answering questions, guiding my

research, and helping me gain access to medical and public health journals from 1918 and

1919. She spent more than a year mentoring and advising me when I had ongoing

questions. Partial support for all data sets within the Utah Population Database (UPDB) was

provided by Huntsman Cancer Institute, Huntsman Cancer Foundation, University of Utah,

and the Huntsman Cancer Institute’s Cancer Center Support grant, P30 CA42014 from the

National Cancer Institute.

I would also like to thank Rebecca Hunt, Michael Kozakowski, and Chris Agee for

reading several versions of this thesis and suggesting changes to improve the quality of the

finished product. Each of these professors also taught me valuable lessons during my time

in class with them.

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TABLE OF CONTENTS

CHAPTER

I. INTRODUCTION ................................................................................................................................ 1

II. INFLUENZA AND THE AMERICAN MILITARY .................................................................................. 10

III. FEDERAL AND STATE POWER......................................................................................................... 19

IV. THE PRESS AS GOVERNMENT MESSENGER TO AMERICA ............................................................. 25

V. OPPOSITION AND THE STRUGGLE FOR CONTROL ......................................................................... 27

VI. THE POWER OF ORDINARY PEOPLE AND THE INFLUENCE OF THE MORMON CHURCH ............... 31

VII. STATE EXPECTATIONS OF LOCAL AUTHORITIES ............................................................................ 34

VIII. LOCAL AUTHORITY........................................................................................................................ 41

IX. AMERICAN INDIANS ...................................................................................................................... 52

X. BUSINESS ELITES INTERVENE ........................................................................................................ 56

XI. PLANNING FOR THE FUTURE ........................................................................................................ 62

XII. CONCLUSION ................................................................................................................................ 64

BIBLIOGRAPHY………………………………………………………………………………………………………………………………. 68

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LIST OF FIGURES

FIGURE

1. Image of Roy Parkin Nelson and Family…………………………………………………………………………………….....1

2. Utah Influenza Death Count by Date, August 1918 - January 1919………………………………………………39

3. Utah Influenza Deaths by Month, August 1918 - January 1919…………………………………………………...40

4. Delta Town Proclamation…………………………………………………………………………………………………………….44

1

CHAPTER I

INTRODUCTION

Roy Parkin Nelson was born in April 1897 in Randolph, Utah, the oldest child of

Samuel and Zipporah Parkin Nelson. He grew up on a large ranch, and in 1917, he left

home to attend the Agricultural College in Logan, Utah. When America entered the war in

Europe, Roy wanted to enlist, but his parents discouraged him. They finally realized he

would be drafted and so relented.1 He enlisted in the United States Army on July 15, 1918.

Roy was attached to Company B, Training Detachment, at the University of Utah as a

student officer.2 In his last letter home on October 9, Roy said he did not feel well, but told

his mom not to worry. Some days later, Roy’s family was notified that he was very ill. His

1 “A Short Sketch of the Life of Roy Parkin Nelson,” Contributed by Greg Ford, November 8, 2015, with permission https://familysearch.org/photos/artifacts/20423053?p=11180511&returnLabel=Roy%20P%20Nelson%20(K241-9ZK)&returnUrl=https%3A%2F%2Ffamilysearch.org%2Ftree%2Fperson%2FK241-9ZK%2Fmemories. 2 “Teachers Volunteer as Flu Nurses,” Salt Lake Telegram, October 17, 1918, accessed November 15, 2016, Utah Digital Newspapers.

Figure 1. Roy Nelson (center, back) with his family in 1918. Courtesy Greg Ford.

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father left for Salt Lake City to visit his son at Fort Douglas. Government officials and

military leaders at Fort Douglas were concerned about containment and stopping the flu

outbreak and had put in place regulations to protect soldiers and the nearby community.

There was a strict quarantine in place at Fort Douglas that required visitors to get a special

permit from the military commandant to enter the military post.3 Because so much red

tape was involved, it was some time before the father could see his son at the isolation

hospital. Roy was not conscious and died a few minutes after his father arrived at his

bedside. Regulations and red tape kept a father from communicating with his son before

he died of disease rather than warfare. It is surprising that regulations were not waved so

that a father could visit a dying son when it was apparent that quarantine was not

sufficient to stop the spread of the disease.

In his 1986 book, Pandemic Influenza 1700-1900: A Study in Historical

Epidemiology, David Patterson discusses the distinctive features of the 1918 pandemic by

remarking on three key characteristics: no disease ever killed so many humans; it “spread so

explosively,” and it killed many who were between the ages of twenty and forty.4 Scientists

and historians estimate that 50-100 million people died, worldwide, in ten months.5 Some

modern historians find it impossible to imagine that troop and civilian movements, as a

result of World War I, were not factors in the spread of the disease. Dr. Alfred Bollet, in his

book, Plagues and Poxes: The Impact of Human History on Epidemic Disease, proclaims,

3 “Teachers Volunteer as Flu Nurses,” Salt Lake Telegram, October 17, 1918, accessed November 15, 2016, Utah Digital Newspapers. 4 K. David Patterson, Pandemic Influenza 1700-1900: A Study in Historical Epidemiology (Totowa, NJ: Rowman and Littlefield, 1986), 91. 5 Patterson, Pandemic Influenza, 91.

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“Warfare…precipitate[s] the rise and fall of diseases.”6 Historians and other scholars have

written about the ways the 1918-1919 influenza pandemic influenced World War I, both on

the home front and the battlefront. The conflation of war and epidemic opened new

perspectives on political, social, and economic circumstances in America, on the Homefront.

New evidence about components of the pandemic has come to light over the years and old

evidence has been interpreted in new ways. This has provided an evolution in theories

related to subjects like the unusually high death rate for young adults during the influenza

outbreak and the value of “nonpharmaceutical interventions” in communities and given rise

to tropes like historical memory and political power.7 In his book, Epidemic and Peace, 1918,

published in 1976, Alfred W. Crosby proposed many of the ideas, questions and hypotheses

that subsequent historians still talk about in their histories today.8 As the world has faced

epidemics like the new strain of flu that emerged in China in 1957, academic historians have

realized it is important to learn from these outbreaks of the past. Because the influenza

pandemic of 1918 killed so many millions world-wide, it is vital that we understand its

impacts on governments, communities and institutions in 1918. By learning how those in

authority administered the fight against the pandemic, and looking at how all those

involved reacted, we will be better prepared to deal with a future global pandemic, mitigate

its spread and minimize the loss of life.

6 Alfred Jay Bollet, M. D. Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing, 2004), 1. 7 Richard J. Hatchett, Carter E. Mecher, and Marc Lipsitch, “Public Health Interventions and Epidemic Intensity during the Influenza Pandemic,” Proceedings of the National Academy of Sciences of the United States of America, 104, no. 18 (May 1, 2007): 7582. 8 Alfred W. Crosby, Epidemic and Peace, 1918 (Westport, CT: Greenwood Press, 1976).

4

One way to approach the history of the pandemic is to study a specific geographic

area hit hard by the influenza during the second and third waves in 1918 and 1919. As David

Kyvig and Myron Marty suggest in their book, Nearby History: Exploring the Past Around

You, “Careful examination of what happened to particular families and communities can

clarify and illustrate the broader picture.”9 The advantage of choosing Utah as a case study

is that digitized copies of Utah death certificates, many Utah newspapers based in large and

small cities, and a pedigree based database of family histories with attached source

documents are all available online at no cost. I also gained access to the Utah Population

Database, “an extensive set of Utah family histories, in which family members are linked to

demographic and medical information” with the help of Dr. Lisa Cannon-Albright, Chief,

Division of Genetic Epidemiology in the Department of Internal Medicine at the University

of Utah School of Medicine.10 1918 and post-1918 era academic articles, especially in

medical journals and public health bulletins were another valuable resource. The

combination of these research sources provided a goldmine of information on the

pandemic in Utah and the nation.

During the pandemic in Utah, state and community public health officials,

policymakers, and other officials and elite businessmen, boosters and everyday Utahans

played a part in making decisions that influenced the health care, economy, transportation,

and personal aspects of life including social life, education and religion. The Utah State

9 David E. Kyvig and Myron A. Marty, Nearby History: Exploring the Past Around You (Lanham, MD: AltaMira Press, 2010), 9. 10 University of Utah Health Care, accessed November 19, 2016, http://healthcare.utah.edu/huntsmancancerinstitute/research/updb.

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Board of Health under the direction of Dr. Theodore Beatty, and with the support of

governor Simon Bamberger, set in place policies that impinged on the perceived missions,

rights, freedoms, and authority of citizens, businesses, service providers, and other

institutions. Public health was a relatively new area of governance for the state, so it is

understandable that lines of authority would have been unclear and contested during the

crisis. State health officials tried to consolidate and assert their authority. They tried to get

citizens, private doctors and local governments to follow their advice. On a human level, a

mixture of precaution, patience, and compassion, while putting aside fear, was essential to

getting through eight long months of bans and restrictions, illness and death. The politics of

disease forced disagreements between several groups in Utah during the influenza

epidemic in 1918-1919. The argument can be made that state and community officials felt

compelled to issue mandates they believed would slow the spread of the disease and curtail

the number of deaths. Their mission was to protect the health of the citizens of Utah.

Public health was a relatively new area of governance, not only in Utah, but in

America in 1918, though the American Public Health Association was organized in 1872.11 A

pioneer in the “new public health” of the time was Charles-Edward Amory Winslow, author

of The Evolution and Significance of the Modern Public Health Campaign, published in 1923.

Dr. Winslow originated the health exhibits at the American Museum of Natural History in

New York City in 1910. He promoted the idea that good personal hygiene was essential to

health and that the physician should be a valuable resource for the well patient in the

11 Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 181, 185.

6

prevention of disease and the early discovery of disease for medical intervention.12 So, in

the era before and during the 1918 pandemic, it was unusual for a person to see a physician

regarding the prevention of disease. The doctor was called when the patient suffered from

pain or illness.13

By 1918, public health authorities did know enough about how disease spread to

focus attention on the responsible pathogen. Public health officials focused more on

personal hygiene and dependable, safe remedies (or therapies) and less on cleaning up the

environment. States and many local communities had public health departments or

boards.14 Many schools had health services for the children who attended. Some schools

provided smallpox vaccinations, and vision and hearing tests. Recommendation notes were

sent home to parents when children needed to see a doctor or dentist. Unfortunately, many

children still had the same medical or dental problems when they were examined the next

year.15

Protecting the health of Utah’s citizens was not the only motivation for restriction

and regulation during the pandemic. There were other motivations as well. These included

keeping businesses vital to the war effort and to the subsistence of citizens open and

operating. At the request of federal leaders, the people of Utah, like the people of other

states had made sacrifices in their personal lives to help the war effort in the years leading

up to the pandemic.

12 C.-E.A. Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven: Yale University Press, 1984), 57. 13 Starr, The Social Transformation of American Medicine, 141. 14 Starr, The Social Transformation of American Medicine, 181, 185. 15 Starr, The Social Transformation of American Medicine, 187-189.

7

Life in America and in Utah changed in many ways when the United States entered

the war in Europe. In November 1916, Woodrow Wilson was reelected president of the

United States. As American president, he had tried for more than two years to keep the

United States from entering the war. The conflict in Europe was an important issue during

the campaign for reelection.16 Many Americans did not want to become entangled in the

European war. On March 18, 1917, three American ships were sunk by German submarines.

Only a few weeks earlier, Wilson had learned that the German foreign secretary was

working to engage Mexico as an ally in the war against the United States.17 At the urging of

President Wilson, the United States Congress declared war on Germany on April 6, 1917.18

Everyday life for Americans began to change almost immediately with the introduction of

federally mandated programs, plans and procedures instituted to support the war effort.

Once America entered the war, there was a suspension of what life had been before.

For the most part, Americans accepted the new regulations, requirements, and

restrictions initiated by the federal government to help win the war. The government

established a Committee on Public Information on April 11, 1917 to “sell the war.”19 The

federal authorities were not above using popular movie stars of the time, like Douglas

Fairbanks and Mary Pickford, to promote Liberty Loan Campaigns to raise money to fight

the war. The first draft registration took place on June 5, 1917; all American males aged

16 David M. Kennedy, Over Here: The First World War and American Society (New York: Oxford University Press, 2004), 12. 17 Kennedy, Over Here: The First World War and American Society, 10. Barbara W. Tuchman, The Zimmermann Telegram: America Enter the War, 1917-1918 (New York: Random House, 1958), 180-1. 18 Neil M. Heyman, Daily Life During World War I (Westport, CT: Greenwood Press, 2002), xiii-xiv. 19 Donald M. Goldstein and Harry J. Maihafer, America in World War I: The Story and Photographs (Washington, D.C.: Brassey’s, 2004), 105.

8

twenty-one to thirty were required to register. Mark Sullivan, in his book, Our Times: The

Turn of the Century, 1900-1925, Over Here, decried “the use of organized propaganda by

the government to bring about mass movements” and termed the all-male draft

registration “a surrender of their persons to the government.”20 Many Americans had been

collecting food and clothing for the beleaguered Belgians under the direction of Herbert

Hoover since soon after the war began in 1914. In August 1917, President Wilson appointed

Hoover as Food Administrator for the war effort. Hoover’s job was to persuade Americans

to waste less food, so that surpluses could be used to feed America, including the American

military and the Allies. Hoover had the full weight of the law behind him when

“manufacturers and dealers” were concerned, but propaganda and persuasion were the

tools he used to encourage the average American to voluntarily support the war effort.21 He

declared ‘“FOOD WILL WIN THE WAR,”’ and urged Americans to demonstrate their

patriotism “by eating less.”22 In October, the federal government began to fix prices on

goods like steel.23 In December, the government decreed that electric advertising signs be

turned off on Thursdays and Sundays to conserve resources for the war effort.24 The same

month, the government took control of the railroads to expedite shipments of important

goods to Europe. Americans were asked to donate scrap metal and the use of metal for

non-essential production was halted.25 Not only did the government take control of some

20 Mark Sullivan, Our Times: The Turn of the Century, 1900-1925, Over Here. vol. 5 (New York: Charles Scribner’s Sons, 1971), 300-301. 21 Sullivan, Our Times: The Turn of the Century, 1900-1925, 408, 410, 418. 22 Tammy M. Proctor, Civilians in a World at War, 1914-1918 (New York: New York University Press, 2010), 89. 23 Sullivan, Our Times: The Turn of the Century, 1900-1925, 634. 24 Sullivan, Our Times: The Turn of the Century, 1900-1925, 635. 25 Goldstein and Maihafer. America in World War I, 106, 108.

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industries, it mandated the reduction of alcoholic content in beer.26 A government poster

published during World War I encouraged Americans to save and donate fruit stones and

nut shells for the manufacture of gas masks.27 From food restrictions to victory gardens,

many of these regulations or suggestions touching regular Americans were voluntary.

However, federal bureaucracy grew exponentially to support the war. John Barry, in his

book, The Great Influenza: The Epic Story of the Deadliest Plague in History, asserts the

“Wilson…had created great bureaucratic engines to focus all the nation’s attention and

intent on the war.”28 Federal government agencies provided direction and resources during

the war, but relied, for the most part, on state and local agents to enforce regulations and

restrictions.29 All these changes, whether forced or voluntary, were viewed by patriotic

American citizens as necessary sacrifices in the face of war. In Utah, Church of Jesus Christ

of Latter-day Saints leaders and civic leaders, including Governor Simon Bamberger,

supported President Wilson by urging Utahans to provide money and resources to support

the war in Europe.30 So, the federal government was already exercising power over many

aspects of American business and life. War with its regulations and demands had already

permeated life when the flu arrived in Utah in October 1918. Amazingly, most Americans

heartily supported the government, perhaps feeling it was their patriotic duty to help the

United States ensure that Germany did not undermine European democracy.

26 Sullivan, Our Times: The Turn of the Century, 1900-1925, 639-640. 27 Anne-Catherine Fallen and Kevin Osborn, eds., Records of Our National Life: American History at the National Archives (Washington, D.C.: Foundation for the National Archives, 2009), 156. 28 John Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Penguin Books, 2004), 300. 29 Barry, The Great Influenza, 309-312. 30 Richard D. Poll, ed. Thomas G. Alexander, Eugene E. Campbell and David E. Miller, associate editors, Utah’s History (Logan, UT: Utah State University Press, 1989), 424.

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CHAPTER II

INFLUENZA AND THE AMERICAN MILITARY

Large numbers of influenza cases appeared in the military before they appeared in

the civilian population. The first wave of the flu hit army camps in America in March 1918.

Symptoms came on suddenly and included body aches and fever, physical weakness and

exhaustion, sneezing and a cough, and a cold in the head with inflammation of the nose and

throat.31 Other symptoms varied: sometimes there was vomiting, diarrhea or constipation.

The most dangerous occurrence was the development of pneumonia in the patient. The

influenza spread from person to person by “contact infection…through droplets driven into

the air in coughing and sneezing.”32 The second wave began in August 1918 on the East

coast and spread west. A third wave appeared in the Spring of 1919 in many states in

America.

Military doctors had early experience with the flu and learned valuable information

that could be shared with the civilian community. As a result, the government was in a

knowledgeable, potentially helpful position from the start. Lieutenant J.J. Keegan, M.D. of

the United States Navy, provided the first early warnings to civilian American doctors,

through the Journal of the American Medical Association, about the degree of contagion

and the possibility for the spread of influenza across America. Dr. Keegan was a navy

physician attached to the United States Naval Hospital in Chelsea, Massachusetts.33 He was

one of the doctors at the American battlefront for the disease. When the naval base was

31 Therapeutics: “Epidemic Influenza,” Journal of the American Medical Association 71, (Oct. 5, 1918):1136. 32 Therapeutics: “Epidemic Influenza.” Journal of the American Medical Association 71, (Oct. 5, 1918):1137. 33 J.J. Keegan, “The Prevailing Pandemic of Influenza,” Journal of the American Medical Association 71 (Sep. 28, 1918):1051.

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overwhelmed by flu cases in August and September 1918, Dr. Keegan and his colleague, Dr.

Milton J. Rosenau, took specimens from two ill sailors and “introduce[d] the filtrate of the

washings” into the nasal passages of nine volunteer sailors.34 These military men were

essentially guinea pigs, though Dr. Keegan points out that none of them became ill.35

Epidemiologists like Chester A. Darling, lauded Keegan for his observations and experiments

proclaiming that the military could study the flu “under controlled conditions.”36 Perhaps

Dr. Keegan felt the seriousness of the epidemic warranted experimenting on “willing”

military men. He did explain, after all, that the flu demonstrated a “high degree of

communicability” and expressed his concern that it would soon “spread all over the United

States.”37 He further advised that for between five and ten percent of the patients, the flu

evolved into a serious case of pneumonia that could lead to death.38 Keegan estimated that

thirty to forty percent of the American people would become sick with influenza and that

the disease would last “four to six weeks in each community.”39 Keegan appears to have

been a knowledgeable doctor with the best interests of his patients at heart. He was also

concerned about what the epidemic could do to the civilian public. He had credibility,

because of his close association with and treatment of hundreds of patients. Other doctors

and epidemiologists relied on knowledge gained from Keegan’s experience working for the

government during the epidemic.

34 Keegan, “The Prevailing Pandemic of Influenza,” 1051. Nancy K. Bristow, American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic Oxford: Oxford University Press, 2012, 33. 35 Keegan, “The Prevailing Pandemic of Influenza,” 1055. 36 Chester A. Darling, Ph.D., “The Epidemiology and Bacteriology of Influenza,” American Journal of Public Health 8, no. 10 (October 1918):754. 37 Keegan, “The Prevailing Pandemic of Influenza,” 1051. 38 Keegan, “The Prevailing Pandemic of Influenza,” 1052. 39 Keegan, “The Prevailing Pandemic of Influenza,” 1055.

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At a time when there were no known cures or sure treatments for the flu, medical

doctors in America could rely on the federal government to study the disease and to

provide vaccines. Government funds and research led to a vaccine, labeled Navy, created

from “strains of influenza bacilli” from some of Dr. Keegan’s patients.40 However, Dr. Rupert

Blue, Surgeon General of the United States Public Health Service (USPHS) and the American

Public Health Association knew that the vaccines were very unreliable in the fight against

the flu. Nancy Bristow, in her book, American Pandemic: The Lost Worlds of the 1918

Influenza Epidemic, argues that vaccines were used by state and local officials as a

“prophylaxis against fear…or…to facilitate research.41

The federal government, under the direction of Blue oversaw the fight against the

influenza epidemic in America. Blue had jurisdiction over all state health agencies. He

determined that centralization and coordination of health agencies was paramount to

keeping health resources from being completely overwhelmed by the spread of influenza in

an area. From the beginning, Blue used his position to monitor and control the flu outbreak

in America. By the middle of September, he had determined through a telegram survey

that the flu had arrived in Newport News, Virginia, New London, Connecticut, Fort Morgan,

Alabama, Boston, New York City, New Orleans and Philadelphia.42 The only one of these

cities not situated on the ocean was Philadelphia, but it had a naval yard.43 The remaining

40 Timothy Leary, M.D., “The Use of Influenza Vaccine in the Present Epidemic,” American Journal of Public Health American Journal of Public Health 8, no. 10 (October 1918):754. 41 Bristow, American Pandemic, 97. 42 “Takes Steps to Stop Influenza Spread: Surgeon General Blue Says It Can Be Controlled Only by Intelligent Action of Public,” New York Times, September 14, 1918, accessed November 8, 2016, ProQuest Historical Newspapers: The New York Times. 43 Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (Cambridge: Cambridge University Press 1989), 57.

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cities were harbor cities that received ships from Europe, where the illness was rampant.

Blue used the Associated Press to share a summary of ways to fight the flu, until doctors

received a “special bulletin” he had prepared on treatments.44

In 1918, doctors in most countries, including the United States, were required by law

to notify public health departments about outbreaks of certain illnesses, including smallpox,

typhoid fever, and pneumonia. Unfortunately, influenza was not one of the illnesses.45

Health statistics for Utah show that 1918 was the first year influenza cases were recorded

by state government. In that year, 43,089 cases of influenza were reported.46 The Fall 1918

pandemic led to the establishment of influenza as a reportable disease in Utah. According

to Crosby, this was the case for many states in America. Crosby further asserts that many

physicians were slow to recognize “that Spanish Influenza…was truly a dangerous disease

and should be reported with speed and accuracy.47

Early on the USPHS issued short-term policy changes and mandates to the states to

slow the spread of the illness. Blue knew it was vital to have one person in charge in each

state in the nation to lead a coordinated effort against the flu. Most states had a public

health department in 1918. The head of the public health department in each state was

appointed director and was assigned to act as liaison with the USPHS. All contacts between

states and the federal government were made through this director.48 The ultimate

44 “Takes Steps to Stop Influenza Spread,” New York Times. 45 Richard Collier, Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919 (New York: Athenaeum, 1974, 46. 46 State of Utah Open Data Catalog, https://opendata.utah.gov/Health/Total-Reported-Diseases-Utah-1910-1919/j3xq-ydp7/data, accessed November 6, 2016. 47 Crosby, America’s Forgotten Pandemic, 204. 48 Crosby, America’s Forgotten Pandemic, 49-50.

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responsibility for coordinating efforts in the fight against the flu rested directly on the

shoulders of Dr. Blue for all of America and on the shoulders of Dr. Theodore Beatty in Utah.

Both men worked tirelessly to determine the most effective methods for fighting the

influenza across the nation and in Utah. Because early estimates of fatality rates were as

high as three to five percent of patients, their job was to mitigate as much as possible the

spread of the disease.49 On October 4, Blue exhorted each state health officer, by telegram,

to “close all public gathering places” once the flu arrived.50 Unfortunately, the October 4

injunction came one day before the Utah State Fair (September 28-October 5), the perfect

breeding ground for the spread of the influenza ended.

At the fortieth Utah State Fair at the end of September 1918, the war was a key focal

point. The federal government had already determined that “state fairs [were]…a distinct

part of the national defense regime.”51 The federal railroad commission, led by William

McAdoo, instituted a reduced fare between Salt Lake City and outlying areas to promote

tourist and business trips to Salt Lake City during the week.52 A fair ad in the Salt Lake

Telegram included a picture of a bald eagle at the top and at the bottom; the statement,

“Uncle Sam wants all Utahans to be there and take part in this great harvest festival.”53 An

ad in the Logan Republican showed two German sailors looking in horror through a

49 “Weapons Against Influenza,” American Journal of Public Health American Journal of Public Health 8, no. 10 (October 1918):787. 50 Crosby, America’s Forgotten Pandemic, 74. 51 “Cheap Rate Granted for Utah,” Salt Lake Tribune, August 4, 1918, accessed February 7, 2017, Utah Digital Newspapers. 52 “Cheap Rate Granted for Utah,” Salt Lake Tribune, August 4, 1918. “Dates for Tickets to Utah Fair Fixed,” Salt Lake Herald, September 5, 1918, accessed February 7, 2017, Utah Digital Newspapers. 53 “Utah State Fair Ad,” Salt Lake Telegram, August 17, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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periscope at the United States War Exhibit.54 On the first night, there was a parade followed

by a liberty loan mass meeting, to raise money for the war. Many daily opportunities were

available for the visiting public for the duration of the fair: vaudeville acts, fireworks, free

moving pictures, horse races, carnival attractions, and all kinds of domestic, agricultural and

horticultural exhibits.55 In 1917, Earl Jay Glade, secretary of the Utah state fair had

contacted the federal government seeking items for a war exhibit that would stir “patriotic

spirit.”56 As early as February 1918, the fair committee, together with Governor Bamberger,

began advertising and promoting the government exhibit, which included films showing life

in the military and the efforts of the American farmer to produce and conserve food as part

of the war effort.57 It is clear from newspaper articles and state fair ads using war and

patriotic rhetoric and images that the federal government exhibit would support it’s “one

national aim of preserving popular rule for the world.”58 City boosters like the

Manufacturers’ Association of Utah urged merchants and manufacturers to use the fair as a

means for advertising and building up business.59 During the last weeks of September and

first week of October, there does not seem to have been too much concern about the

spread of influenza in Utah.

54 “Utah State Fair Ad,” Logan Republican, October 1, 1918, accessed November 7, 2016, Utah Digital Newspapers. 55 “Utah State Fair Ad,” Salt Lake Herald, September 29, 1918. “Welcome! Multitude Surges to Utah’s Big State Fair,” Salt Lake Herald, September 29, 1918, accessed November 7, 2016, Utah Digital Newspapers. 56 “Death Dealing Implements of U. S. Asked for Fair,” Salt Lake Telegram, February 19, 1918, accessed November 7, 2016, Utah Digital Newspapers. 57 “Place is Selected for Federal Exhibit,” Salt Lake Tribune, May 21, 1918. “Big War Show to be Staged at State Fair,” Salt Lake Herald, July 27, 1918, accessed November 7, 2016, Utah Digital Newspapers. 58 “Big War Show to be Staged at State Fair,” Salt Lake Herald, July 27, 1918, accessed November 7, 2016, Utah Digital Newspapers. 59 “Utah Merchants Urged to Advertise,” Salt Lake Herald, September 14, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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The federal government could not have known that in providing full support for the

fair, it was setting the stage for the spread of disease not only in Salt Lake City, but in Utah

and surrounding states. It is ironic, that the Utah Board of Health exhibit at the fair was

titled, “How the State is Kept Healthy,” when many in the state would soon be very

unhealthy.60 Dr. Beatty was busy promoting the Utah state board of health exhibits at the

Utah State Fair. Both the state and the federal government were responsible for “keeping

the populace healthy as a war necessity.” 61 State officials urged every person who visited

the fair to pay close attention to the health messages.62

Those persons with specialized knowledge or experience became the early leaders in

the fight against the flu in Utah. Dr. Theodore B. Beatty was the Utah state health

commissioner. He had received his medical degree from Rush Medical College in Chicago,

Illinois and worked in a New York City hospital before moving to Utah in 1889 and joining

the staff at St. Mark’s Hospital in 1891. Beatty was the Salt Lake City health commissioner

from 1893 to 1894. In 1898, he became secretary to the State Board of Health. Beatty was a

forward-thinking advocate for public health in Utah. He standardized forms listing causes of

death, advocated “clean water and improved sanitation,” and established “most of the

divisions of today’s State Health Department in Utah.”63 Dr. Ralph Richards, prominent Salt

Lake City surgeon and professor of surgery at University of Utah Medical School, said, Dr.

60 “Welcome! Multitude Surges to Utah’s Big State Fair,” Salt Lake Herald, September 29, 1918, accessed November 7, 2016, Utah Digital Newspapers. 61 “Bennion Receives Key of Patriotic Exposition,” Salt Lake Herald, October 1, 1918, accessed February 7, 2017, Marriott Library Digitized Newspapers. 62 “Bennion Receives Key of Patriotic Exposition,” Salt Lake Herald, October 1, 1918. 63 W. Dee Halverson and David M. Walden, St. Mark’s Hospital, 1872-1997: A 125 Year Legacy of Quality Health Care in Utah (Salt Lake City, UT: Heritage Associates, 1997), 42-43.

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Beatty “did more for the improvement of health of the people of Utah than any other

medical man who ever practiced within the borders of the state.”64 Dr. Beatty had the

necessary credentials, but did not yet realize the fearful job that awaited him and many

other health officials across the nation. On September 27, a New York Times article

lamented the fact that health authorities had persuaded Americans that the disease would

be less extensive and dangerous, because Americans were better fed and had less “mental

strain” than war weary Europeans. The same day, Dr. Beatty, announced that the state of

Utah was free of influenza cases.65 But this statement would not be true in Utah in less than

a week. The Times article also accused health authorities of waiting too long to put

restrictive measures in place, hinting that getting American troops to Europe was a factor in

the omissions.66

The New York Times article was in fact on track. American military leaders were

concerned about outbreaks of flu in crowded army and navy training camps. On September

27, General Enoch Crowder, who oversaw the draft, announced that all draftees scheduled

to report between October 7 and 11 should not do so. General Crowder made it clear that

the reason was the influenza epidemic in military camps. He suggested that the draftees

would not be asked to report until the flu was curtailed. President Wilson met with General

Peyton March, Army Chief of Staff, on October 8 to discuss the situation. General March

64 Martin Kaufman, Stuart Galishoff, and Todd L. Savitt, eds., Joseph Carvalho, III, editorial associate, Dictionary of American Medical Biography (Westport, CT: Greenwood Press), 1984, 636. Halverson and Walden, St. Mark’s Hospital, 43. 65 “State is Free of Influenza Say Doctors,” Salt Lake Herald, September 28, 1918, accessed November 7, 2016, Utah Digital Newspapers. 66 “Topics of the Times: A Danger Too Late Realized,” New York Times, September 27, 1918, accessed November 8, 2016, ProQuest Historical Newspapers: The New York Times.

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was against slowing or stopping the movement of American troops to Europe, despite the

death tolls in camps and on ships from influenza. President Wilson agreed that American

soldiers must continue to be trained and sent to France and draftees began reporting to

duty again on October 23. Meanwhile, in Europe 70,000 U.S. troops “reported sick” in

October and a third of those suffering with influenza perished.67

67 Bollet, Plagues and Poxes, 107.

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CHAPTER III

FEDERAL AND STATE POWER

The United States federal government exercised power to minimize the spread of

the disease and the impact on soldiers when influenza began to disrupt military training and

fighting, but did they do enough? Carol Byerly, in her book, Fever of War: The Influenza

Epidemic in the U. S. Army during World War I claims that the decisions made by the

government, including ignoring advice from medical officers, led to high rates of mortality

from influenza. Army medical officers, who had been doctors in private life, worried about

the health of soldiers and asked for policy changes to keep them healthy. Medical officers

suggested ways to quell the spread of the illness, like setting up quarantine camps, reducing

crowded conditions in living spaces, and setting up initial camps where new recruits could

be screened for infection before going to training, but the government did not follow these

suggestions. The War Department had other overriding concerns. Byerly accuses the

American government of failing to protect the health of American soldiers during World

War I. She points out that 30,000 American soldiers died in training camps in the United

States before they could be shipped off to fight in Europe. The government decided the

rights of the individual in the military had to be overruled by the need to meet the greater

good.68 In President Wilson’s defense, Crosby asserts that quarantine in army training

camps was not possible because soldiers and supplies were desperately needed in Europe

and the needs of the war could not be curtailed.

68 Carol R. Byerly, Fever of War: The Influenza Epidemic in the U. S. Army during World War I (New York: New York University Press, 2005), 7-8, 41-2, 48, 53-4.

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During the second wave of the pandemic in October 1918, the United States Army

countermanded the conscription of 142,000 men and put off the enlistment of 78,000 new

recruits because of the epidemic.69 Ultimately, government leaders in the United States put

concerns for the outcome of the war before the pandemic until the situation was grave. The

First World War ended the month after the War Department began to realize the

devastating effects of minimizing the severity of the threat and not following through with

safeguards to protect soldiers.

Bollet advises that thousands of troop deaths by disease could have been averted if

the draft had been suspended and troop shipments had ceased for a time. American

military leader, General John Pershing in Europe was begging for more soldiers.70

Ultimately, President Wilson and his military leaders made decisions concerning the lives of

both prospective soldiers and established soldiers based on their perceptions about how to

win the war. Bollet suggests that perhaps the continued arrival of American troops in France

not only boosted the fighting force, but boosted the morale of the other Allied soldiers

leading to a timelier end to the war and thus saving more lives than those lost to the flu.71

Not only did the United States federal government exercise power to minimize the

spread of the disease among the military, but it also exercised power to minimize the

spread of disease among civilians. On October 11, Surgeon General Blue urged all states to

make influenza a reportable disease.72 Federal involvement ramped up as Blue called for

69 Crosby, America’s Forgotten Pandemic, 31, 49. 70 Bollet, Plagues and Poxes, 107-108. 71 Bollet, Plagues and Poxes,108. 72 “1000 Cases of Influenza Reported in Utah,” Salt Lake Tribune, October 12, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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railroad ticket agents across America to deny ticket sales to potential passengers who

exhibited flu symptoms and to remove ill patients from trains as soon as they exhibited

symptoms. Just a few days earlier, passengers on the Oregon Short Line train in Utah had

noticed a family of six with flu-like symptoms and hurriedly left the car where the family

was riding. The conductor ordered the family to remain in the car until the train arrived in

Salt Lake City late at night. The next morning the family was taken by ambulance to a

hospital.73 On October 24, the state of Nevada announced it would stop all passenger trains

at the Utah - Nevada border and quarantine any sick passengers.74 Blue was addressing

situations that were already taking place across the nation, but each state was also doing

the same to protect its citizens.

To get on top of the spreading epidemic, Blue also urged state public health boards

to contact each community in their state to determine how many doctors and nurses were

available in that community and to send help where it was needed most urgently, because

of the shortage of medical personnel.75 In Utah, many physicians and nurses joined the

United States military or the Red Cross to serve during the war. From St. Mark’s Hospital

alone, twenty doctors and forty-five nurses left to help in the war effort.76 On October 16,

Blue offered Beatty the position of “acting assistant surgeon general” which he accepted.77

73 “Doctor Dies of Influenza”, Salt Lake Telegram, October 11, 1918, accessed November 8, 2016, Utah Digital Newspapers. 74 “Health Agents Optimistic Over Influenza Drop,” Salt Lake Herald, October 24, 1918, accessed November 7, 2016, Utah Digital Newspapers. 75 “Flu Continues to Spread; 26 Homes Report Disease,” Salt Lake Tribune, October 14, 1918. “Fifty Towns in Grip of Influenza,” Salt Lake Tribune, October 13, 1918, accessed November 7, 2016, Utah Digital Newspapers. 76 Halverson and Walden, St. Mark’s Hospital, 56-57. 77 “Teachers Volunteer as Flu Nurses,” Salt Lake Telegram, October 17, 1918, accessed November 15, 2016, Utah Digital Newspapers.

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This new position was “a means of expanding [Beatty’s] powers of authority during the

epidemic.”78

By October 22, Blue required each state health director to send a wire report daily to

Washington, D.C. on the situation in his jurisdiction. In each state, cities with populations

over 1500 were required to report the number of flu cases and deaths each day to their

state health director. The government paid for these reports.79 Utah state officials followed

through on these federal mandates, but instituted their own mandates as well. Early in

October Dr. Beatty issued a statement ordering physicians to immediately report influenza

cases to his department and urging stricken victims to go to bed immediately if they felt

they had contracted the flu.80 He asked all Utah town leaders to close schools and ban

public gatherings in their towns.81 Fort Douglas, an army training camp in Salt Lake County,

was not quarantined by Washington, D.C. officials, so local authorities quarantined it for the

protection of the soldiers. If a soldier was seriously ill, only one relative could visit him.82

Beatty knew that the 1907 compiled laws of Utah, state health board statute, title 29,

allowed for the enforcement of quarantines in fighting against the spread of disease. State

attorney general, Dan B. Shields, Governor Bamberger and Secretary of State, Harden

78 “Teachers Volunteer as Flu Nurses,” Salt Lake Telegram, October 17, 1918, accessed November 15, 2016, Utah Digital Newspapers. 79 “Disease is Checked, Dr. Beatty Reports,” Salt Lake Tribune, October 22, 1918, accessed November 7, 2016, Utah Digital Newspapers. 80 “Preparing Here for Spanish Influenza,” Salt Lake Tribune, October 4, 1918, accessed November 7, 2016, Utah Digital Newspapers. 81 “State Health Board Issues a Warning that Influenza Has Appeared in this State,” Ogden Standard, October 5, 1918, accessed November 17, 2016 Utah Digital Newspapers. 82 “Scores of Influenza Patients in Utah Suffer for Lack of Nurses,” Salt Lake Telegram, October 15, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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Bennion stood firmly behind Beatty.83 The state board of health made a plea for doctors

and nurses to go to communities without medical personnel to give aid.84 Salt Lake City

Mayor W. Mont Ferry and Utah Red Cross Director Robert Shields supported Beatty by

notifying hospitals that surgeries that could be postponed for the foreseeable future should

be postponed. This would allow doctors and nurses to focus their full attention on flu

patients.85 State board of health officials began to visit industrial plants to be sure that

owners were doing all they could to protect workers, so plants could stay open to support

the war effort.86 The board of health encouraged businesses to operate with open windows

and asked large businesses to appoint one employee whose duty it was to check each

employee for signs of the disease daily.87 On October 19, Beatty announced a ban on

weddings, proclaiming that only immediate family members could attend.88 He also

declared that bride and groom and guests must wear masks and no one should kiss, as

kissing spread the flu.89 In October, Beatty considered assigning private physicians to

geographic zones to conserve resources and help the most patients in the shortest amount

of time. He realized this would be a complex undertaking and that people would be upset

83 “350 Residents of Salt Lake Flu Victims,” Salt Lake Telegram, October 10, 1918 accessed November 7, 2016, Utah Digital Newspapers. 84 “State Board of Health Issues Drastic Order Effective Immediately,” Salt Lake Telegram, October 9, 1918, accessed November 7, 2016, Utah Digital Newspapers. 85 “Red Cross Acts to Stop Spread of 'Flu' in City,” Salt Lake Herald. October 14, 1918, accessed November 17, 2016, Utah Digital Newspapers. 86 “Influenza Gets 1200 Patients in State,” Salt Lake Herald, October 12, 1918, accessed November 7, 2016, Utah Digital Newspapers. 87 “Doctor Dies of Influenza,” Salt Lake Telegram, October 11, 1918, accessed November 7, 2016, Utah Digital Newspapers. 88 “Wage War on Flu to Cut Death Rate, Urges Dr. Paul,” Salt Lake Telegram, October 18, 1918, accessed November 7, 2016, Utah Digital Newspapers. 89 “Brides Masked and 'Kissless,' Beatty Decrees,” Salt Lake Herald, October 19, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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by not having access to their family doctor.90 A solution did not come until November when

the state board of health divided Salt Lake County into five zones and assigned one resident

or assistant county physician to each zone to care for the poor victims of the flu.91

90 “Fear of Disease Prevents Care of Scores of Victims,” Salt Lake Telegram, October 21, 1918, accessed November 7, 2016, Utah Digital Newspapers. 91 “County Divided into Flu Zones,” Salt Lake Telegram, November 4, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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CHAPTER IV

THE PRESS AS GOVERNMENT MESSENGER TO AMERICA

In 1918, the primary source for news for the average American was the newspaper.

William A. Thomson, advertising bureau director for the American Newspaper Publishers’

Association visited Salt Lake City in June 1918 to speak to business and newspaper men at

the Commercial Club. In his speech, Thomson declared, “the newspaper… acts as a

messenger from the government to the people.”92 Thomson claimed that newspapers were

powerful, because they “reache[d] everybody, everywhere, every day.”93 Thomson was

specifically referring to war propaganda, like promoting Liberty Loans and the Red Cross. He

mentioned that half the stories in American newspapers were devoted to the war or “war

propaganda.”94 Once the influenza epidemic arrived in full force in October, newspapers

were the source of basic and vital information about the progress of the flu, including how

officials were doing in their fight against the crisis. Local newspapers in Utah carried daily

lists of the names of the dead with their addresses and ages and sometimes the names of

the ill. This news must have been very disheartening to read day after day. Bylines like

“Twenty-Six Deaths Have Occurred in Salt Lake” and “20,000 Influenza Cases in Utah”

greeted readers each day.95

92 “Newspaper Held Great Aid to War Work,” Salt Lake Herald, June 26, 1918, accessed December 7, 2016, Utah Digital Newspapers. 93 “Newspaper Held Great Aid to War Work,” Salt Lake Herald, June 26, 1918, accessed December 7, 2016, Utah Digital Newspapers. 94 “Newspaper Held Great Aid to War Work,” Salt Lake Herald, June 26, 1918, accessed December 7, 2016, Utah Digital Newspapers. 95 “Twenty-Six Deaths Have Occurred in Salt Lake,” Ogden Standard, October 17, 1918. “20,000 Influenza Cases in Utah,” Salt Lake Telegram, October 23, 1918, accessed December 7, 2016, Utah Digital Newspapers.

26

Some newspapers railed against the restrictions brought about by the entrance of

the United States into the war and the pandemic. Goodwin’s Weekly, a Salt Lake City

newspaper that called itself “A Thinking Paper for Thinking People” was one of these

papers.96 Five days following the Armistice, an article in the paper called Beatty “ridiculous”

without specifically naming him, for refusing to lift bans on churches and theatres after

thousands of citizens had poured into the streets to celebrate the end of the war

together.97 The paper further indicated that “equally reliable medical authorities to those in

Salt Lake” say that bans on gatherings are not necessary.98 The editors of the paper were

concerned that with the war’s end, freedom from social restrictions should be restored as

soon as possible.

96 Utah Digital Newspapers, accessed April 7, 2017, https://digitalnewspapers.org/newspaper/?paper=Goodwin%27s+Weekly. 97 “The Spectator,” Goodwin's Weekly, November 16, 1918, accessed April 7, 2017, Utah Digital Newspapers. 98 “The Spectator,” Goodwin's Weekly, November 16, 1918, accessed April 7, 2017, Utah Digital Newspapers.

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CHAPTER V

OPPOSITION AND THE STRUGGLE FOR CONTROL

Once the flu did arrive in Utah, anyone making unsubstantiated, unauthorized or

incorrect claims that threatened the fight to mitigate and stop the spread of influenza came

under fire from the state government, specifically Beatty. In July 1917, Dr. Woods

Hutchinson, President of the American Academy of Medicine was pronounced “famous

physician author” by the Salt Lake Tribune and “world’s foremost physician author by the

Ogden Standard.”99 In 1917 President Wilson sent Hutchinson to the European Front, where

he remained for about one and one-half years, to observe the fitness of the military medical

services. Hutchinson proclaimed that the medical profession had “practically wiped out

disease in war.”100 Perhaps this experience caused the press in Utah to give credence to his

words when he visited Utah and consulted with state officials and physicians in October

1918. While in Utah, he indicated that Utah’s exceptional climate, lack of tenement housing,

and small number of very poor residents was a best-case scenario for a shorter epidemic

with the possibility of fewer fatalities than Eastern areas of the United States.101 Almost

immediately, a “prominent [and unnamed] physician” disputed Hutchinson’s claims that an

ill patient did not need to call his doctor and that doctors and nurses could do nothing for

99 “Military Training May Free Schools of Some of Absurdities of Past,” Piute Chieftain, June 7, 1917. “Why It’s Becoming a Disgrace to Catch a Disease,” Salt Lake Tribune, July 8, 1917. “Science Explains What Happens When Your Skin Goes on Strike,” Salt Lake Tribune, October 7, 1917, accessed November 22, 2016, Utah Digital Newspapers. 100 “Wonderful Advance in the Army Medical Corps,” Ogden Standard, December 29, 1917. “Dr. Hutchinson to Be Dinner Speaker,” Salt Lake Tribune, October 1, 1918, accessed November 22, 2016, Utah Digital Newspapers. 101 “Influenza Spreads and State Authorities Call for Help in Caring for the Afflicted,” Ogden Standard, October 16, 1918, accessed November 22, 2016, Utah Digital Newspapers. Dr. Hutchinson had published such books as Preventable Diseases (1909), Exercise and Health (1911), A Handbook of Health (1911), Common Diseases (1913), Civilization and Health (1914) and The Doctor in War (1918).

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patients.102 He called Hutchinson to task for “encouraging carelessness” concerning the

disease.103 Beatty also disputed Hutchinson’s decrees, particularly that climate was an

important factor in the spread of the disease. He reiterated that the flu was spread by

contact.104 Beatty characterized Hutchinson as a “sensational newspaper writer” and not a

medical expert.105 Beatty felt so strongly that statements by Hutchinson would be injurious

to the public health that he wrote a letter to the Salt Lake Tribune on October 17

proclaiming that Hutchinson was misleading Utahans.106 In an open letter to the public

printed in the Ogden Standard, Beatty accused Hutchinson of making assertions that were

“calculated to seriously interfere with the health authorities of the state.”107 He further

asserted that members of the medical profession did not view Hutchinson as a “medical

authority.”108 If Beatty could help it, no unauthorized person would usurp his power as state

appointed public health director. Even though the press had painted Hutchinson as an

experienced and knowledgeable authority, he did not have the power of government

behind him and it was not his responsibility to keep the people of Utah healthy. That power

102 “Nurse at Dee Hospital Dies and Three Other Deaths of Same Disease Are Reported,” Ogden Standard, October 16, 1918. “Influenza is Old La Grippe, Avers Expert,” Salt Lake Herald, October 16, 1918, accessed November 22, 2016, Utah Digital Newspapers. 103 “Nurse at Dee Hospital Dies and Three Other Deaths of Same Disease Are Reported,” Ogden Standard, October 16, 1918, accessed November 22, 2016, Utah Digital Newspapers. 104 “Influenza's Hold on State Grows,” Salt Lake Telegram, October 16, 1918, accessed November 7, 2016, Utah Digital Newspapers. 105 “Influenza’s Hold on State Grows,” Salt Lake Telegram, October 16, 1918, accessed November 7, 2016, Utah Digital Newspapers. 106 T. B. Beatty, “Don't be Misled; the “Flu” is Real Menace, Dr. Beatty Declares,” Salt Lake Tribune, October 17, 1918, accessed November 22, 2016, Utah Digital Newspapers. 107 T. B. Beatty, “'Flu' Real Menace Says Dr. Beatty of Utah,” Ogden Standard, October 17, 1918, accessed November 22, 2016, Utah Digital Newspapers. 108 T. B. Beatty, “'Flu' Real Menace Says Dr. Beatty of Utah,” Ogden Standard, October 17, 191, accessed November 22, 2016, Utah Digital Newspapers.

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and authority belonged to Beatty. Hutchinson used the press to gain credibility and Beatty

used it to establish both his and his medical colleagues’ credibility and take away

Hutchinson’s. Physicians were not only duty bound to help their patients, but it was vital

that they be advised when their patients became ill so that all could be done to protect

other family and community members, particularly children.

When the state Board of Health stepped in to advise school officials to close schools,

school board officials challenged what they considered to be a hasty decision. A fight

between government officials ensued. Dr. Edward Rich, a member of the Ogden school

board of education, asserted that children could best be protected from the flu if they

arrived at school every day and could receive immediate attention from the school nurse if

they developed symptoms. As an example, he pointed to the recent smallpox epidemic. The

schools had been closed then and the smallpox had turned epidemic in a very short time.

Not only did Beatty face the opposition of board of education members, but Dr. Samuel G.

Paul, Salt Lake City health commissioner called Beatty’s school closing decree a form of

“hysteria,” claiming there is “certainly no good reason whatever for closing down the public

schools.”109 He pointed to the latest United States Public Health Bulletin sent out by

Surgeon General Blue that claimed, “The disease is too mild to make it advisable to stop all

the activities of a city.”110 Paul openly opposed Beatty. Beatty defended his action by saying

it was better to act to curtail the epidemic than to wait until it was any more widespread.111

109 “City Schools Closed After Official Advices are Received from the State Board of Health,” Ogden Standard, October 10, 1918, accessed November 17, 2016, Utah Digital Newspapers. 110 “City Schools Closed After Official Advices are Received from the State Board of Health,” Ogden Standard, October 10, 1918, accessed November 17, 2016, Utah Digital Newspapers. 111 “City Schools Closed After Official Advices are Received from the State Board of Health,” Ogden Standard, October 10, 1918, accessed November 17, 2016, Utah Digital Newspapers.

30

The superintendent of the Ogden school district defied the order to close schools in

Ogden.112 Beatty continued to stand his ground by adding public libraries and public

funerals to the list of closings and bans.113

Utah State Board of Health bans were reinforced by federal authority on the very

day Beatty came under fire. Surgeon General Blue advised all state boards of health to call

on municipal authorities to enforce the ban of public gatherings and school closures where

influenza was in evidence. Utah Governor Simon Bamberger put his full support behind

Beatty in maintaining bans and closures. So now Beatty and Bamberger, with the support of

the federal government, stood against Paul and Rich. Though, Blue, Beatty, Paul and

Hutchinson were all medical doctors, they had different ideas on how to win the fight.

Ultimately, Blue and Beatty, as federal and state government leaders had the final say in

controversial decisions, because they had the power and authority of their positions behind

them.

112 “Ogden School Officials Defy Closing Order,” Ogden Standard, October 10, 1918, accessed November 17, 2016 Utah Digital Newspapers. 113 “Utah Bans All Meetings, Tries to Curb Influenza, Bars Amusement Doors,” Salt Lake Herald, October 10, 1918, accessed November 17, 2016, Utah Digital Newspapers.

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CHAPTER VI

THE POWER OF ORDINARY PEOPLE AND THE INFLUENCE OF THE MORMON CHURCH

The core beliefs of Mormons are enumerated in thirteen Articles of Faith penned by

the prophet Joseph Smith in 1842. Number twelve states, “We believe in being subject to

kings, presidents, rulers, and magistrates, in obeying, honoring, and sustaining the law.114

For devout Mormons, it is essential to obey the law of the land. Thus, it was incumbent

upon Mormons to obey bans and restrictions put in place by the state and national

government. Ordinary men and women of Utah went forward and did what they had to do

to cope and even survive during the pandemic. Important to the Mormon culture was an

ethos of communalism, a strong work ethic, and a belief in caring for one’s neighbor in

times of trouble. It is not surprising then that on October 26, Mormon President Joseph F.

Smith, together with his two counselors, asked Mormon women to take care of their own

family members who contracted the flu. This was done to allow the Red Cross nurses to

serve people not of the Mormon faith during the epidemic. The First Presidency felt that

many Mormon women were skilled and competent nurses and could take care of their ill

family members themselves. In this way, health authorities and the Red Cross could use

dwindling resources more effectively in the state.115 The statement by Mormon church

leaders is one of the few interventions by church leadership during the epidemic. Church

114 Joseph Smith, History of the Church of Jesus Christ of Latter-day Saints, vol. 4, Period I: History of Joseph Smith the Prophet (Salt Lake City, UT: Deseret Book Company, 1978), 535, 541. 115 “Influenza Mask Order Held in Abeyance,” Salt Lake Telegram, October 26, 1918, accessed November 22, 2016, Utah Digital Newspapers.

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leaders allowed government leaders to direct the fight against the flu and members of the

Church worked together to get through a challenging and difficult time.

During the Fall of 1918, Charles Hyrum Goates was a thirty-seven-year-old husband

and father of five working as the farm manager at the Utah State Industrial School in Ogden.

He was from a close Lehi, Utah Mormon family living in Ogden. Two of his brothers were

serving in the United States army when the flu arrived in Utah. On October 18, Charles’s

nine-year-old son Kenneth died of the flu. When Charles’s father, George, arrived in Ogden

to take his grandson’s body to be buried in the family plot in Lehi, he discovered Charles

was very ill with the malady. Charles died three days later, and his father and younger

brother picked up his body at the railroad station for burial in Lehi. On October 24,

grandfather George returned to Ogden to retrieve the body of Charles’s seven-year-old

daughter, Vesta. Before George reached Lehi, Elaine, Charles’s five-year-old daughter had

died. George returned to Ogden again to collect the body of Elaine. During this week when

four family members died, George and his son, Franz had not been able to finish harvesting

their beet crop – the family’s source of income. Winter had set in early and the ground was

frozen. As George and Franz set off for the fields, they knew it would be a difficult job to

wrest the beets from the frozen earth. They passed many of their neighbors driving wagon

loads of beets to the sugar beet factory. All greeted them and expressed their condolences.

Father admitted to son that he wished the harvested beets were his own. When they

arrived at the beet fields, they couldn’t believe their eyes. All the beets had been harvested.

Their neighbors had gathered together and harvested the beet crop and were delivering it

33

to the factory in their behalf.116 Similar incidents happened all over Utah as ordinary citizens

like George Goates, who lost a son and three grandchildren in one week, continued to

march forward and do what they had to do, and neighbors stepped up to fill in the gaps and

help with things they could not do.117 No politics were involved, no ulterior motives, only

the power of compassion and charity.

116 Vaughn J. Featherstone, “Now Abideth Faith, Hope and Charity,” Ensign, July 1973, 36-37. 117 Family Search, accessed April 7, 2017, https://familysearch.org/tree/pedigree/K2WD-QB8/landscape.

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CHAPTER VII

STATE EXPECTATIONS OF LOCAL AUTHORITIES

During the epidemic, the state board of health expected local Utah community

officials to advise and inform the local public in the best way to avoid the flu and to put in

place restrictions and regulations mandated by the state agency. Beatty did not take lightly

any loss of life or spread of disease he felt was caused by carelessness or even recklessness.

He made it clear that he would place blame on town officials that did not follow board of

health mandates. On November 7, the state board of health, satisfied the disease had run

its course, lifted restrictions on public gatherings in the towns of Tremonton and Green

River.118 Meanwhile, in some other outlying communities, like Sego in Grand County, and

Eureka in Juab County, the crisis was heating up. Eureka, a mining town with a population of

3500, had thirty deaths in two weeks. Only about thirty percent of the miners were

reporting to work each day; some were ill, and others were caring for the ill. The high school

was turned into an emergency hospital and most of the dead in Eureka were the heads of

families.119 At the Chief Consolidated Mining Company, five shift bosses had died. On

November 6, there were over 200 cases of flu reported, thirty were expected to die, and

twenty bodies were at the undertaker.120 In Sego, a town with a population of 250, 102

people had the flu.121 The American Fuel Company was forced to close because of the

118 “Epidemic Loses Badly in Fight, only 28 Cases,” Salt Lake Herald, November 8, 1918, accessed November 22, 2016, Utah Digital Newspapers. 119 “Utah Community Scourge-Stricken,” Salt Lake Tribune, November 7, 1918, accessed November 22, 2016, Utah Digital Newspapers. 120 “Influenza Still Claims Victims,” Richfield Reaper, November 9, 1918, accessed November 22, 2016, Utah Digital Newspapers. 121 “Only 7 Cases of Influenza Are Reported,” Salt Lake Herald, November 11, 1918, accessed November 22, 2016, Utah Digital Newspapers.

35

epidemic.122 Dr. Beatty contended that Eureka and Sego had not followed the

recommendations of the state board of health. Sego did not close its schools until a week

later than ordered and Eureka town residents did not take the disease seriously.123 In an

article titled “Took Hysterical Action,” published on page one of the Eureka Reporter on

October 11, editor C. E. Huish accused the Salt Lake newspapers of yellow journalism and

deliberately trying to stir up fear. He made light of people imagining themselves to be ill and

said schools and public places should not be closed.124 When town officials in Eureka were

accused of negligence by Beatty, they lashed out at him. In a letter signed by the mayor, city

marshal, city board of health and other city leaders, they denied Beatty’s claims. They

explained that they had followed every order, that the town board of health had not been

influenced by the newspaper and that the people of Eureka have cooperated in every way

to fight the epidemic. They blamed the high number of deaths on lack of nurses, denseness

of population in the mining camp, and small homes with large families.125 Beatty denied

criticizing the Eureka board of health. His denial was important, because the Eureka board

of health was an extension of his office. It was important for him to support them, while at

the same time pointing out that town residents were heedless to restrictions. He blamed

the citizens of the town who did not take the threat of the disease seriously and did not

cooperate with the town doctor, Dr. Laker. He also blamed the newspaper editor for

122 “Epidemic is Definitely on Decline,” Salt Lake Telegram, November 5, 1918, accessed November 22, 2016, Utah Digital Newspapers. 123 “Utah Community Scourge-Stricken,” Salt Lake Tribune, November 7, 1918. “Epidemic Loses Badly in Fight, only 28 Cases,” Salt Lake Herald, November 8, 1918, accessed November 22, 2016, Utah Digital Newspapers. 124 “Took Hysterical Action,” Eureka Reporter, October 11, 1918, accessed November 7, 2016, Utah Digital Newspapers. 125 “Strong Language Used in Letter from City Officers,” Salt Lake Telegram, November 9, 1918, accessed November 22, 2016, Utah Digital Newspapers.

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mocking the closing orders from the state board of health and downplaying the seriousness

of the situation.126

In early November, the reported number of new cases of the flu and of deaths

caused by the flu began to decrease. The State Board of Education began to press the State

Board of Health to reopen the schools. Beatty remarked that reopening the schools would

be “suicidal.”127 He understood that the premature ending of sanctions, like lifting the ban

on school closings could lead to a resurgence in the disease if it happened too soon. An

announcement in the Salt Lake Herald on November 6 claimed that Beatty had agreed to let

city schools reopen and bans would be lifted on November 11, because the number of

influenza cases was declining every day.128 Dr. Beatty used the Salt Lake Telegram, to deny

the claims. Robert J. Shields, Red Cross manager for the Salt Lake City chapter, came to

Beatty’s defense. He accused the Salt Lake Herald of printing “deliberate falsehoods.”129

Shields asserted that hundreds of parents had told him the schools should not be reopened

and that if they were reopened, they would not send their children. Shields also argued that

the many teachers who were acting as nurses needed a vacation before schools reopened.

Shields speculated that many cases were not being reported and that this was the reason

the epidemic seemed to be declining.130

126 “Physician Maintains His Rebuke of Editor Was Merited,” Salt Lake Telegram, November 9, 1918, accessed November 22, 2016, Utah Digital Newspapers. 127 “Schools are to Remain Closed, Epidemic Shows Slight Decrease,” Salt Lake Tribune, November 2, 1918, accessed November 22, 2016, Utah Digital Newspapers. 128 “City's Schools Will Reopen Next Monday,” Salt Lake Herald, November 6, 1918, accessed November 22, 2016, Utah Digital Newspapers. 129 “Theatres to Reopen Soon, Says Beatty,” Salt Lake Telegram, November 6, 1918, accessed November 22, 2016, Utah Digital Newspapers. 130 “Theatres to Reopen Soon, Says Beatty,” Salt Lake Telegram, November 6, 1918, accessed November 22, 2016, Utah Digital Newspapers.

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Though Beatty felt some hope from the apparent lull in flu cases and deaths, he

continued to stress constraint and adherence to safeguards during an optimistic early

November when the Salt Lake public appeared to forget that the flu was still a huge

concern. Salt Lake newspapers reported large crowds in stores in the city.131 Utahans were

optimistic that the war in Europe was coming to an end. On November 4, the Salt Lake

Telegram, quoted Beatty saying the “situation is better today than it has been at any other

time during the epidemic.”132 October had been a devastating month for influenza deaths;

there were 287 deaths reported in the state.133 This number of deaths is relatively small,

when you consider that almost 20,000 Americans died of the flu across the nation during

the same period.134 And, in fact, there was a drop in the number of influenza deaths in Utah

between November 1 and November 10, but November proved to be the deadliest month,

overall, during the eight-month time frame from September 1918 to April 1919 with 428

reported deaths statewide.135

Figure 2 shows number of deaths in Utah from influenza reported on specific dates

from August 1, 1918 to January 30, 1919. There were three reported deaths from influenza

in August and three in September. In October, the flu began to kill in earnest. On October

31, the number of reported deaths was twenty-one, clearly a peak. In early November, the

131 “Epidemic of Pneumonia is on Wane Here,” Salt Lake Herald, November 3, 1918, accessed November 7, 2016, Utah Digital Newspapers. 132 “Scourge Crisis is Passed in Utah,” Salt Lake Telegram, November 4, 1918, accessed November 22, 2016, Utah Digital Newspapers. 133 Huntsman Cancer Institute, University of Utah, accessed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/. 134 Ann Hagedorn, Savage Peace: Hope and Fear in America, 1919 (New York: Simon and Schuster, 2007), 6. 135 Huntsman Cancer Institute, University of Utah, accessed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/. See Figure 2 and Figure 3.

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number of reported deaths began to drop, until November 17 (seven deaths reported.) No

doubt the huge celebrations across the state on Armistice Day led to the resurgence of the

disease and consequently a resurgence in death rates beginning November 18. It may be

that Thanksgiving Day celebrations on November 28 also led to a resurgence of the disease

and death rates. Figure 3 indicates that November was the deadliest month for Utah,

followed by January and October.

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Figure 2. Utah Influenza Death Count by Date, Aug. 1918 – Jan. 1919, accessed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/.

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Figure 3. Utah Influenza Deaths by Month, Aug. 1918 – May 1919, accessed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/.

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CHAPTER VIII

LOCAL AUTHORITY

For the most part, local authorities in communities, both large and small, relied on

state mandates and accepted help sent from the state board of health. In 1896, the first

Utah state legislature passed legislation requiring that a board of health be created in each

county and that a county health officer be designated.136 Many communities in Utah had at

least a part-time designated health officer. Beatty relied on officials in each community to

keep him informed. On October 9, he asked officials in each community where the influenza

had struck to contact him immediately, by phone or wire, and to take steps to close schools

and places of amusement.137 He also asked physicians to report cases to city and local

health boards rather than to his department directly.138 By delegating some authority and

requiring communication on the situation in each community, Beatty kept a handle on the

situation across the state. He did not work alone; there were six other members of the State

Board of Health and the board employed sanitary inspectors.139 During the epidemic these

inspectors, among them nurses like A. H. Smith, travelled to hard hit communities to assist

in the fight against the flu.140 Beatty understood that he could not manage the epidemic in

the entire state on his own and he sought help locally.

136 Robert E. Parson, A History of Rich County. Utah Centennial County History Series (Utah State Historical Society: Rich County Commission, 1996), 282, 284. 137 “Two Victims of Influenza Dead in City,” Salt Lake Herald, October 9, 1918. “City Schools Closed After Official Advices are Received from State Board of Health,” Ogden Standard, October 10, 1918, accessed November 10, 2017, Utah Digital Newspapers. 138 “Influenza is Spreading Rapidly Here,” Salt Lake Herald, October 5, 1918, accessed November 17, 2016, Utah Digital Newspapers. 139 “Open the Town,” Goodwin's Weekly, December 7, 1918, accessed November 17, 2016, Utah Digital Newspapers. 140 “Traveling Nurse Returns,” Salt Lake Tribune, December 9, 1918, accessed November 17, 2016, Utah Digital Newspapers.

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In Salt Lake City, government officials overlooked business contracts, privacy and

personal rights to manage the spread of the disease. In October 1918, officials from the Red

Cross, Salt Lake County Medical Society, local hospitals, and the Short Line Railroad

Company met for a conference with Salt Lake City mayor, W. Mont Ferry, to make

emergency plans to handle and minimize the spread of the flu in Utah’s capital city. These

officials at the meeting asked the state board of health to “demand rigid enforcement of

federal laws” to prevent the movement of ill patients from outlying areas to Salt Lake City

by railroad to help slow the spread of disease.141 City officials were concerned that

businesses all over Utah had “contracts for medical attention in Salt Lake hospitals” and

that their ill employees would be transported to Salt Lake City on the railroads.142 Mayor

Ferry suggested he could procure city “rooming houses” for use as hospitals became

overcrowded.143

On two consecutive October days, state board of health inspectors and doctors

visited 157 homes in Salt Lake City where at least one person had the flu.144 The individual

rights of residents were intruded upon as door to door visits by city health officials to find

the ill and to supply facts and advice on how to deal with influenza in the home were

141 “Red Cross Acts to Stop Spread of 'Flu' in City,” Salt Lake Herald. October 14, 1918, accessed November 7, 2016, Utah Digital Newspapers. 142 “Red Cross Acts,” Salt Lake Herald. October 14, 1918, accessed November 17, 2016, Utah Digital Newspapers. 143 “Red Cross Acts,” Salt Lake Herald. October 14, 1918. “Flu Continues to Spread, 26 Homes Report Disease,” Salt Lake Tribune, October 14, 1918, accessed November 17, 2016, Utah Digital Newspapers. 144 “Influenza Gets 1200 Patients in State,” Salt Lake Herald, October 12, 1918, accessed November 17, 2016, Utah Digital Newspapers.

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made.145 State health officials felt justified in overstepping not only individual rights, but the

rights of businesses to stop the spread of disease.

Smaller communities like Park City and Ophir, Utah put drastic measures in place to

protect residents from the flu. Park City officials announced that any person entering town

must obtain a permit and then be examined. For the most part, Park City had managed to

escape the flu and officials wanted to keep it that way.146 Beatty voiced support for

communities with zero or few cases of influenza setting up a quarantine.147 On October 18,