Medicine, Media and Mystery

 Despite its enormous impact on the world, however, few people seem to be aware of its history or significance. The disease took at least half a million American lives—ten times as many as died during World War I—but only in the hardest-hit cities did news of the pandemic ever reach the newspapers’ front pages. 

One can’t help but wonder if the people of 1918 were aware of the size of what they were facing. Evidence seems to suggest that they were not. Was it lack of medical knowledge, an intentional focus on World War I, or another factor that caused the downplay of this historical event? 

One hundred plus years later, information about the flu pandemic is still hard to find. David Brown, in the Washington Post, called the influenza epidemic “the 20th century’s most readily forgotten global disaster, and almost certainly the deadliest epidemic in recorded history.”

Pandemic Arrives in Milwaukee

In October of 1918, Milwaukee was a thriving city with a large immigrant population, much of it German, Polish or Irish.  Many businesses were based on the production and sale of beer. 

Milwaukee’s location on Lake Michigan was also beneficial to its economy, as was the city’s proximity to Chicago and the Great Lakes Naval Station. 

Milwaukee was a lively town with a variety of political leanings: A number of socialist candidates held or had held public office.

At the same time, the alcohol temperance movement had gained power and would soon bring about the passage of the 18th amendment to the U.S. Constitution, which implemented national prohibition of alcohol.

The print media of that time reflected this diversity. There were daily and weekly newspapers of various political and religious stripes, and many were published in foreign languages such as German or Polish. 

In the midst of this cultural mélange, the flu pandemic occurred, killing rich and poor alike. Schools, churches, museums, theaters and movie houses were closed down in an effort to stem  the tide of disease. Yet print media coverage of this epidemic was minimal compared to coverage of World War I. In some publications it wasn’t mentioned at all. Why wasn’t this disaster, which killed more than World War I or the sinking of the Titanic, given more space and concern? 

This article is about the facts of the 1918 flu epidemic and its coverage in the print media of Milwaukee in October of 1918, and will consist of three parts:

• Part One, “Medicine,” is an overview of the epidemic and some of its effects locally and nationally. It will include state and city public health statistics on reported cases and deaths. In order to check the accuracy of statistics, the number of obituaries, burial licenses and ads for funeral homes which appeared for the entire month of October of 1917 were counted.  The same types of notices were then noted for October 1918, when the epidemic was at its peak. The difference between the two sets of numbers suggests that official statistics underrepresent the number of people who died of contracting influenza.
• Part Two, “Media,” compares two newspapers during the period of Oct. 13-20, 1918. The Milwaukee Sentinel was a mainstream newspaper, and The Milwaukee Free Press a socialist one. 
• Part Three, “Mystery,” explores possible reasons for the type of coverage—or lack thereof—that the epidemic received. 

Part One: Medicine

Contagious fatal disease was a part of everyday life in 1918.  Diphtheria, pneumonia and tuberculosis were common and often caused death.     

Crowded conditions and poor sanitation enabled disease to spread quickly in urban areas. Although the U.S. Public Health Service existed, and most large cities—including Milwaukee—had public health departments, the people running them were unprepared for any serious epidemic.

Part of the problem was scientific. The pandemic of 1918 antedated modern virology and immunology as well as antibiotics. While germ theory was generally accepted by this time, microbiology was an infant science. There was an awareness that small microorganisms called viruses played a role in the spread of contagious disease. But viruses were too small to be seen by the microscopes of the time and were not yet cultivable. 

The lack of speedy communication was another problem. As the epidemic occurred before the introduction of the commercial use of radio, facts about the epidemic had to be sent by mail, telegraph or rail. Posters and pamphlets were printed and sent out under the U.S. Surgeon General’s name, but many newspapers carried little about flu other than advertisements for quack remedies.

The involvement of the United States in World War I contributed to the spread of flu in more ways than one. In Wisconsin, the health conditions uncovered in military recruits were disturbing: Forty percent of the volunteers between the ages of twenty-one and thirty were unfit to serve. In general, the pandemic struck the armed forces earlier and more severely than civilians. Naval personnel, clustered on the eastern coast and in ports throughout the country, were especially effective in spreading the flu when shipped to other bases.

In addition, World War I drained the country of health care workers. The war brought together masses of young men in crowded camps and ships, and assembled civilians in patriotic rallies and parades. Its demand for doctors and nurses left civilian sectors short of health professionals. One source estimates that some 50,000 of America’s 140,000 physicians of that time were stationed in Europe.

The government was slow to accept the reality of the epidemic, and the military even slower. At the Great Lakes Training Station—about 50 miles south of Milwaukee—flu first appeared the week of Sept. 11. Within seven days, there were 2,600 men in a hospital prepared for 1,800. At one point, there were between 75 and 100 deaths per day. All “liberty” for those at the station was canceled on Sept. 19 but it was too late. The epidemic started in Chicago three days later. By the end of October, one in every five U.S. servicemen nationwide had the flu.

In addition to the speed with which it spread, the 1918 flu had another unusual characteristic. Unlike most diseases of the time, this flu tended to victimize those in the prime of life. Rather than killing the old and sick, it slaughtered healthy young men and pregnant women. Data from life insurance companies indicates that the average age of death of the flu victims was 33, not the usual 55 or 60 of policyholders. The Actuarial Society of America estimated that the deaths in the U.S. represented an economic waste of $10 million (That’s $187 million in today’s dollars). These statements were made at the end of 1918, before the pandemic even had run its course.

A number of changes were instituted in hopes of stopping the wave of influenza. On Sept. 13, 1918, Surgeon General Rupert Blue issued a statement outlining symptoms and advising bed rest, quinine and aspirin for the sick. Blue suggested the Armed Forces halt shipment of sick soldiers or those exposed to the virus and quickly remove healthy troops from infected zones.  But Blue, Surgeon General of the world’s most powerful nation, had little actual authority. He could not force cooperation; he could only ask for it. 

Belatedly, on Oct. 7, draft calls for 142,000 new recruits were canceled until further notice.

In most cities, schools and places of entertainment were closed down.  Laws were passed outlawing smoking, spitting and coughing in public places. Church and social meetings were canceled, as were many touring shows, concerts and conventions. In some parts of the country, courts were convened and other public meetings were held only in the open air.

Then as now, many of the volunteers contracted and died of the disease. Doctors, nurses and volunteers were praised as heroes in newspaper obituaries. 

But the families of military flu victims were often not told the true circumstances and were told instead that their loved ones had “died on the field of honor.” One colonel banned the publication of the names of 525 deceased, and then committed suicide the following day. Nearly 80 percent of the U.S. war casualties were caused not by bullets, shells or shrapnel but by influenza.             

By May of 1919, after only six months, the epidemic subsided. The Great War continued to occupy the media’s attention until the armistice.         

The flu strain that affected a billion people wasn’t isolated until 1997. Pathologist Jeffery Taubenberger, molecular biologist Ann Reid and their colleagues at the Armed Forces Institute of Pathology succeeded in collecting flu genes from the lungs of an Army private who died of flu in 1918. They determined that the virus was a mutation that evolved in American pigs, a classic “swine flu.”  Further research at the University of Wisconsin School of Veterinary Medicine suggests that the virus processed proteins in a way that allowed the virus to attack cells outside the lungs and trachea. (Normal influenza virus stays within the respiratory tract.) If true, this finding would help explain why the 1918 virus was so deadly.

Part Two: Media

The official number of people who died of influenza in Milwaukee county in 1918 was 1,292, out of a statewide total of 7,066. Many who died of the flu or its complications yet were not officially counted. In order to have a comparative method for estimating deaths due to influenza, I also examined The Milwaukee Sentinel of 1917, the year before the epidemic. 

Although death notices did not usually specify a cause of death, the astounding increase in numbers from one year to the next support the conclusion of an epidemic at work.

Sunday, Oct. 13, 1918

“Warning Comes From East—Milwaukee Physician, on Duty at Influenza Stricken City, Tells of Danger” proclaims a headline on the front page of the Sentinel. The article beneath it consists of a letter written by Dr. V.A. Chapman, describing his work in Pennsylvania. Chapman mentions the flu’s impact on the war effort and ends his letter thus: “I hope that Milwaukee will awaken to the serious nature of this thing in time to take all preventive measures.

Further coverage is found throughout the Sentinel. Larger than any headline, however, is an illustrated ad for “Dr. Hartman’s World Famous Peruna,” which proclaims Peruna to be “the greatest disease preventing and health restoring remedy known to science.” The ad is actually quite informative and offers a free book in response to a postcard request.

“Peaceful Sunday Now Inaugurated to Fight Malady—Health Department Arranges to Give Influenza a Hard Battle —All Schools Are Closed—Total Number of Deaths from Disease Since Sept. 1 Fifty-seven” reads one headline. The rest of the article reports that church services have been canceled, and theaters remain closed.

Immediately to the right of this story is another article which would be amusing if it weren’t so contradictory. “All Dressed Up No Place To Go—Crowds Fill the Downtown Street, as All Amusement Places Are Closed…Streets were Filled with the Usual Hosts of People.” This article notes that Sheriff Patrick McManus “issued orders Saturday afternoon closing every road house in the county.” It would seem that all such places were allowed to remain open and full to capacity as long as there were “no entertainment or music” and as long as a “no loitering” placard was posted.

The Milwaukee Free Press’  headline was forthcoming about the epidemic: “Grippe May Peril City for 10 Days—Little Hope of Early End, Says Health Head—Dr. Ruhland Warns Citizens to Redouble Efforts to Stamp Out Epidemic.” The story outlines health department guidelines for downtown (“No Loitering Permitted”) and the need for more nurses. One small boxed article reports “8 Dead, 445 New Cases, Day’s Record.” 

This headline seems to belie the flu statistics of the rival Milwaukee Sentinel. Contradictions abound in this paper as well. “Milwaukee Educator to be Buried Monday” (“Services will be private because of the health department’s ruling”) vies for space with an article announcing “4,000 Teachers to Attend Convention—Former President Taft to Address Wisconsin Educators at Annual Session Which Will Open Here on Nov. 7.” 

“‘Pray at Home’ Is Pastor’s Plea; Churches Close” is the headline on a Free Press article which describes activities Downtown in a manner very different from the news reports of the Sentinel. While the Sentinel narrative tells of crowds of civilians, this piece states: “Streetcar patronage has been hard hit, the usual crowds going downtown to movies and other amusement places being absent.” The article also notes the closing by police of the Soldiers’ and Sailors’ home in the Pabst building, “… Directresses of the home had been under the impression that because they entertain only soldiers and sailors they were exempt from the epidemic rulings.”

The front page of the Free Press Society/Leisure section trumpets the flu as well.  “Postpone Meetings Because of Epidemic—State Conference of Daughters of American Revolution to Be Held Nov. 14—Meeting of State Federation of Women’s Clubs Called Off—No Future Date Set.” 

Monday, Oct. 14, 1918

The Milwaukee Sentinel prints one column about the flu: “City Ready to Halt Further Grippe Spread—Arrangements Have Been Completed to Care for Patients at Improvised Hospitals—Appeal is Made for Red Cross Volunteers—Health Officials Are Confident That They Control Situation Created by Epidemic.”  The story is continued on page two, with a call or unpaid volunteers for members of the motor corps and “voluntary workers to do emergency service of that sort (kitchen, etc.) until paid workers can be found.”

Almost as an afterthought, one of the last paragraphs of the story reads: Permission to remain open provided no dancing would be done, was the order issued to the various sailors, soldiers and marines’ clubs by Dr. Ruhland (city Health Commissioner.) Approximately 1,000 sailors visited Milwaukee on Saturday and Sunday, intending to enjoy themselves after several weeks of quarantine.

The evening edition of the Monday Sentinel is a complete turnaround from the morning version. A small article on the front page carries this headline: “Few Empty Beds at Hospitals—Influenza Patients Tax Facilities at Institutions to the Utmost—Many Nurses Ill—St. Mary’s, Mount Sinai and County Hospitals Particularly Hard Hit.” Page three has three more stories: “Big Halls Made Into Hospitals,” “Dr. E. G. Grey Dies Fighting Influenza” and “Grippe Epidemic Stops Street Car Smoking.” 

The Sentinel’s editors do not comment on any aspect of the epidemic, but they publish letters which address it. One, from William A. Fisher, warns against “too much fear…The person who is in fear of this germ is lowering his vitality and is breeding the disease rather than dispelling it.” The other more passionate letter from Ralph Carlyle states that he is disgusted with the anti-influenza closing orders,” and accuses public officials of being “possessed with a mania for closing things.”  One can’t help but wonder if Mr. Carlyle was a tavern owner or regular patron.

The front page of Monday’s Milwaukee Free Press doesn’t even mention the flu by name. “Ruhland Seeks Ban on Sneezers—Health Commissioner Plans Request of New Council” is the ambiguous headline. The article states that an ordinance “forbidding coughing or sneezing without the use of handkerchiefs would probably be” requested by the health commissioner. Such a law, which would carry a penalty of a $500 fine and a maximum year in prison, had been enacted in New York City.

In addition, the health commissioner asks conductors of street cars not to permit any more people to board than could comfortably fit. Citizens are asked to have exact change ready to avoid overcrowding entrances. The managers of factories and mercantiles are asked to rearrange work schedules so employees could “arrive during a wider latitude and so avoid rush hour crowding.” The police and sheriff’s departments station men at principal downtown corners to prevent “overloading of cars.”

On the second page is a piece titled “Lid on Fun Sends Hundreds to Streets—Military, Navy, Civilians and—Just Girls Parade Downtown Thorofares—Seek Some Kind of Amusement.” The article focuses on the “crowds streaming up and down Grand Avenue and Wisconsin Street,” but tells the story from the beat cop’s point of view. Police “not only sought to enforce the ban on music, but were kept busy in efforts to move the crowds along.” The article describes “young people, mostly girls, many of whom with arms linked with sailors from Great Lakes.” It also notes that club owners “came to grief and were warned” about the ban on public gatherings.

There is an editorial on page four. “Another Chance for Milwaukee” exhorts the populace to “fall in line at once to obey the rules and join the fight against influenza.” Comparing the community to the boys at the front, the writer of the piece states that whether the flu ravages or spares Milwaukee “depends altogether upon the kind of response which the citizenship will

make to the rules and regulations of the health authorities.” The “other chance” of the headline is the chance to “show the nation… that the home defense of Milwaukee is adequate to any emergency.”

Tuesday, Oct. 15, 1918   

All is quiet on the front of the morning Milwaukee Sentinel.  There is no news about the flu until the third page. “Ban on Jackies [sailors] in Milwaukee—Asked to Remain Away While Influenza Epidemic is in Progress—Both Sailors and Soldiers’ Clubs Are Ordered Closed—Violations of Health Orders to Result in Much Additional Closing” reads the modest headline. 

What follows details the request that sailors and soldiers not be allowed to visit Milwaukee unless visiting family. The health commissioner was surprised by reports of “several thousand in Milwaukee on Sunday and most of the time was spent at the sailors and soldiers’ club where there was dancing and entertainment.” The article warns “unless there is a change in the attitude of some store keepers and the public, additional drastic measures may be taken.”

Other stories are on page three. “Nurse Dies After Attending Patient” and “Want Meetings—Politicians Ask Health Officer for Permit—Plan to Address Workingmen in Factories in City and County on All Issues” are the most prominent. Epidemic or not, 1918 was an election year, and local political parties were “straining at the leash in their anxiety to plead their cause before the voters.” A request had been made by both Republicans and Democrats for the health department to allow open air political meetings.                                                                                                   

On page four, a wire story from Washington carries the headline “Grip Falls Off in Army Camp±Influenza Unabated in Most Sections of Country—Federal Public Health Service Mobilizes Forces to Battle Spanish Malady.” The optimistic statement that flu is declining in army camps refers to only two days’ worth of statistics.

The evening edition of The Milwaukee Sentinel continues a course of under reportage. On page five is a small feature on nurses who have become ill while caring for others. One other feature article, on page six, is titled “20,000 Suffer With Influenza—Ruhland Says Percentage to Population is Low—No Cause for Alarm—Will Bar Jackies—Only Necessary Furloughs to Be Granted, Commandant Moffett Says.” Under a headline “Not Considered Alarming,” the article states that “the epidemic is well in hand, although not under control.”

Again, the ads are most informative and they are large. “Guard Against Influenza” proclaims one drugstore ad, which lists the prices of various antiseptics. And Gimbels exhorts customers to “Help Dr. Ruhland In His Fight Against Flu.” 

The Milwaukee Free Press gives the flu its due. “Grippe is Spreading, New Madison Cases—Not Safe to Open Schools or Theatres, Says State Health Officer—Surgeon General Orders Survey” is one headline. Numerous small articles follow: “Few Cases of Grippe in Appleton,” “Beloit Has Many Influenza Victims,” and “Marjorie Dake Among Many Grippe Victims.” 

To the immediate right of this column is another article with an even more dramatic headline: “Business May Be Closed If Public Crowds—Flu” Situation Critical. All But Druggists and Grocers May Shut Up.” The article outlines the ultimatum given by Ruhland in response to complaints of crowding in places of business. It also mentions the dispatch sent by Ruhland to Commander Moffat of the Great Lakes Naval Training Station, asking for a moratorium on sailor permits to visit Milwaukee.  Subheadlines are also serious: “Twelve Deaths Reported,” “Classes Are Postponed,” and “Red Cross Ready.”

The editorial page features a short opinion piece from the Detroit Free Press. It pokes fun at doctors who advocate warm climate, exercise, and good food to avoid illness. “Some Advice is Useless,” says the editorial, “This reminds one of the sarcastic advice on “how to retain health— don’t get sick.””

Wednesday, Oct. 16, 1918

The morning edition of The Milwaukee Sentinel is again lacking information about the epidemic, except for two small items on the front page. “Ruhland Reports 2,744 ‘Flu’ Cases—Health Commissioner, However, Estimates Unreported Number at 20,000—Great Lakes Sends Aid—Surgeon Gen. F. I. Ridge Arrives Here to Help Check Epidemic” is the headline several pages later. The surgeon general at the Great Lakes Station states “the epidemic at Great Lakes is wiped out, barring a few cases.” He goes on to say that health conditions at the station are “better now than they were before the epidemic started.” This article is placed next to an enormous ad for North Shore limited trains, which travel several times a day from Milwaukee to Chicago and—the Great Lakes Naval Training Station.

There is no other mention of the flu, except for a Boston Store notice. “To Assist in Safeguarding the Public Health—there will be no merchandise advertised until further notice, and all retail stores will close at 5 p.m. next Saturday.” This ad takes up a quarter of a page, as does another urging shoppers to “Buy Christmas Things As Early As Possible.” 

The evening edition of the Sentinel reads like a completely different paper. “Grippe Epidemic Spreads to Jail; 2 Inmates Die—North Milwaukee Institution Periled by Disease Gripping City—Potter Offers Aid—School Nurses, Doctors and Teachers to Assist Health Department.” And in another story the death of a local matron is announced. “Mrs. F. A. Vogel Called By Death—Brief Illness at Her Home, 128 Prospect Avenue, Proves Fatal—Husband At Bedside—Comes From Washington Where He Was With War Industries Board.” Mrs. Vogel was 37 years old and had married into one of Milwaukee’s wealthiest families. 

Page two is a cornucopia of flu stories. “Mourns for Husband; Kills Entire Family,” tells of a grieving Chicago widow who killed herself and her children after her husband died of flu. 

Other stories are “Search for Grippe Germ Kills Doctor,” “Influenza Cases in New York Increase,” and “U. of W. Professor Dies. Another story, “Hints on Grippe Told To Jackies—U.S. Issued Circular, Telling How to Cure or Avoid Disease . . .” seems to directly refute the morning edition’s assertion that the epidemic had been “wiped out” at Great Lakes. “Keep away from others as much as possible while you have a cough,” it says.                                                                                                                                           

Two stories are in opposition to each other. “Plan to Segregate Influenza Patients” is only a few inches away from “Influenza Epidemic is Under Control.” 

The Milwaukee Free Press has flu news front and center. “18 Dead From Influenza, Is Day’s Record—Epidemic Has Not Yet Reached Its Height, Says Dr. Ruhland—20,000 Ill.” Other related stories dot the front page: “Dr. E. W. Roark, Plant Expert; Dies of Grippe,” and “Racine Orphan Asylum Head Pneumonia Victim.” The coverage continues with “Private Kuphal (“taken ill with pneumonia”) To Be Buried in Milwaukee,” “52 Die of Grippe At Kenosha in 72 Hours,” “Green Bay Undertaker Victim of Influenza,” and “Soo Line Agent Dies of Spanish Influenza.” More optimistic headlines proclaim “Grippe on Decrease in U.S. Army Camps” (this is a wire story from Washington, D.C.) and “Epidemic Situation More Encouraging, Says Harper.”

Also telling is a large ad announcing in boldface lettering “Potato Sale Called Off!—Because of the ruling of the Health Department that crowds be avoided the Potato Sale scheduled for today has been indefinitely postponed.” Page three carries a public service article titled “Read This if You Want to Prevent or Cure Influenza.” In the next column the First Trust Company of Milwaukee reminds “What will become of my real estate?”  The ad is very subtle and points out the company’s “facilities and diversified experience.” But the message is clear: property owners in a city saturated with flu should look to the disposal of their worldly goods before illness strikes.

Despite the cancellation of meetings, conferences, and conventions, the sports page announces “Jackies Will Meet Maroons on Saturday—Great Lakes Squad Out for Third Scalp of Big Ten Teams.” No one considered football games to be a threat to public health.

Thursday, Oct. 17, 1918

The first flu article in the morning edition of The Milwaukee Sentinel is on page four. “Public Museum Ordered Closed—Circulating Department of  Library Also Placed Under Ban By Ruhland—Violators Are Warned—Prosecutions Threatened of  Places Which Disobey Health Head’s Edicts.” The article lists orders determined at a “conference of business men, manufacturers, physicians and representatives of commercial associations” held the previous day. This piece states that on Wednesday 506 new cases of flu and sixteen subsequent deaths were reported.

Sandwiched between two detailed obituaries is the most significant piece of reporting on flu in this issue:

PERMISSION GIVEN TO REOPEN SAILORS’ CLUB

Mrs. Stewart, mother director of the Sailors, Soldiers and Marines’ Home club in the Plankinton hotel building has received permission from Health Commission [sic] Ruhland and Lieut. Robert Flood to open her club, with the restriction that no music or dancing is to be indulged in. The club was closed on Wednesday by order of the health department, but will be opened Thursday morning. All workers of the club are requested to be on hand Thursday morning.

“Caruso Cancels Date For His Concert Here” is at the top of page five, and announces the tour to be postponed “owing to the prevalence of influenza . . . indefinitely.” This caution on the part of Caruso or his manager perhaps explains why the tenor lived through the epidemic, and why his name is still recognized a hundred years later.

Boston Store changes the theme of its ad on page three.  “An Act of Common Defense” assures customers that “Our store is perfectly ventilated. The air is constantly being purified and changed. Our wide aisles permit crowds without congestion.  Safeguard your health in every way.” 

“A personal offer to those who fear Spanish Influenza” is on page seven. The ad that offers a money back guarantee on Kondon’s Catarrhal Jelly, a “soothing antiseptic . . . for INSIDE the nose and head.”

The epidemic is covered extensively in the evening edition of the Sentinel: “Ruhland Closes All Libraries.” The last paragraph notes “one downtown cafe furnished paper horns to its patrons as an entertainment incentive.  This has been ordered stopped.”  Other headlines on the front page include “Chicago Uses New Influenza Serum,” “Waukesha Woman Dies of “Flu” in East,” and “440 Flu Cases in Oshkosh.”  Page two also carries many flu stories: “Influenza Victims’ Funerals on Friday,” and “Influenza Causes an Advance [shortage] in Camphor.”

A number of retailers ignored the suggested ban on advertising of specific sale items, most notably Hahn’s and Gimbel’s.  Schuster’s, on the other hand, has a full page ad, “In Order to

Prevent the Spreading of a Possible Epidemic.” It announces the stores’ earlier closing time, and the owner’s adherence to health department directives.

“Grippe Peril Shuts Library and Museum—With 506 New Cases Reported the Health Department Considers Taking More Drastic Action Today” trumpets the front page of the Free Press.  “Offers School Facilities,” “Danger Remains Acute,” and “Ridge Here to Aid.” 

Additional short articles include a wire article titled “Grippe At Highest Point of Epidemic—Death Rate in Big Centers Increases from 2 to 9 Percent.” This article states that the number of cases has gone into the millions, and death rates in Chicago and New York have tripled. It also notes that “it has been impossible for Surg. Gen. Blue…to gather anything like reliable data as to the actual number of individuals in the country who have been affected by the disease.”

Friday, Oct. 18, 1918

 A wire story from Washington is Friday’s first flu feature in The Milwaukee Sentinel. “Malady On Wane in Containments  --  Reports Show Gradual Decrease in New Cases and Deaths—Additional Ten Millions [sic] Asked in Senate to Fight Influenza” is the headline.

Page five carries half a dozen local flu stories such as “Appeals For Nurses  --  F. C. Morehouse Points Need of Volunteer Workers to Help Fight Influenza” and “Theatrical People Hit By Epidemic—Closing Order Causing Big Loss to Managers and Employees.” “Big Stores to Close at 6 P.M. on Saturday” lists the latest regulations for stores and advertisements: “Until further notice, no store is to use more than fifty pages of advertising space in any one newspaper on any one day.”

“City Seeks Plan to Care For Tots—Many Mothers Are Influenza Sufferers in Hospitals—Ambulance Calls Will Be Made at Night While Epidemic Lasts” is on page eight. And at long last, a column written by a physician about the flu epidemic is included on the editorial page.

The flu story on the front page of The Milwaukee Free Press is little more than a paragraph: “Epidemic Grows; 13, Day’s Dead—Influenza Spread Taxes Authorities With the Care of Many Babies.”  But the story is continued on page two. “Growing Peril Brings New Problem of  Children Who Have Been Temporarily Orphaned by Epidemic,” mentions a new complication—pneumonia. There is discussion of how the epidemic is affecting some businesses (“Cinema Men Protest”) and of the consequences of violations of the health department order: “Prosecutions may result.” In “Ridge Is Dubious,” the brigade commander at the Great Lakes Station offers the opinion that “the epidemic will last through the winter.”

Flu news even makes it to the sports section. “Famous Swimmer is Victim of Influenza,” proclaims the headline over a full length photo of Harry Elionsky in his Naval Reserve uniform. 

Saturday, Oct. 19, 1918

In this edition of the Sentinel, the contradictions are in the headlines, as well as in the stories. “Ruhland Asks for More Nurses—Appeals to Washington for Aid in Combatting Grippe Epidemic Here—Cases Show Decline—Seven Additional Deaths Are Reported—Teachers Ferret Out Victims” is the front page headline. The piece describes the need for more nurses and money.

Two headlines do not inspire optimism: “Epidemic Baffles Physicians” and “Disease is Hopeless.” Lieut. R. I. Ridge, who “handled the epidemic at Great Lakes” is quoted as saying “I don’t believe that there is such disease as influenza. It is an enigma to me.” 

Ridge’s speech is further covered on page four, headlined “Atropine Used to Check Influenza—Lieut. S. I. Ridge Tells Doctors About Remedy Tried At Great Lakes—Beats All Epidemics.” Ridge, in his address before the Milwaukee Medical Society recommended “atropine (an extremely poisonous alkaloid isolated from the plant commonly known as “deadly night shade.”) in almost criminal doses.” He went on to state that “There is no such thing as a contagious disease.” 

The headlines in the article, “Smokers Not Hit Much” and “Decrease on Friday,” seem to refute the wire story on page three. “Influenza Still Spreading in U.S.—Conditions in Army Camps and Among Civil Population Unimproved—Increasing in Wisconsin—New Cases in Ten Cities Are Reported From This State” is the news from Washington, D.C. This story is situated under an ad for Bayer Tablets of Aspirin. “Mother and Child Die of Influenza—Patrolman’s Wife Succumbs Shortly After Her Baby” is at the top of page four. 

The front page of Saturday’s Milwaukee Free Press also features the pessimistic speech of Lieut. Ridge. The story is headlined “Warns Epidemic is On Increase—Navy Medic Tells Doctors Grippe Wave Has Baffled Science.” “Medic Warns Grippe Wave is Spreading—Milwaukee Physicians Told That They May Expect No Letup in Epidemic for Some Time” runs directly down the page, with items beneath it. “Grippe Halts Plan for Co. L Military Ball,” “Epidemic Causes Xmas Sale to Be Postponed” and “Three U. of W. Students Dead of Influenza” are examples of the many different community stories run by the Free Press, stories that never appear in other Milwaukee publications.

 Part Three: Mystery

There are a number of ideas as to why the flu epidemic wasn’t better reported at the time of its occurrence, and why it isn’t better remembered today. Alfred W. Crosby, author of several articles and books about the 1918 flu, proposed the idea that the flu isn’t famous because nobody famous died of it. 

Epidemiologist Shirley Fannin takes a more psychological approach and asserts that “It was so awful while it was happening, so frightening, that people just got rid of the memory.” Unlike other infectious diseases like smallpox or polio, the flu left no physical reminders of its presence. It neither crippled nor scarred its victims, nor did it create chronic ill health.

The most obvious possibility for under reportage of the flu would be lack of information; that is, those producing newspapers simply did not know how serious the epidemic was, nor how many people were affected. 

According to the Wisconsin Report of the Bureau of Vital Statistics, “the disease was not as mild as was believed to be the case.” The report admits that “many physicians and local health officers failed to apply the prescribed measures of prompt notification of cases, isolation of patients and placarding of homes, thereby minimizing the effectiveness of precautions taken by the people themselves.”

It very well may have been that the leaders and the media of Milwaukee didn’t know how dangerous this epidemic was. But Milwaukee officials as a whole seem to have been unusually unconcerned, especially when compared to other cities. In Detroit, for instance, the commissioner of health notified commanders of all Army and Navy camps in the Midwest that as of Oct. 19, 1918, the city was off-limits to all military personnel “except those in perfect health and traveling on necessary military business.” In Washington, D.C., commissioner Louis Brownloeb banned all public gatherings. 

Most sources agree that the official numbers of the epidemic were low estimates. Lynette Iezzoni observes:

In the autumn of 1918, medical personnel were overwhelmed or non-existent. Exhausted (and often ill) doctors signed death certificates without even viewing the body. Hundreds of thousands were buried without death certificates altogether.

It is unclear what the sources were for the flu statistics that were reported in the Milwaukee Sentinel. Yet instinct would question the validity of statistics of only 81 dead from Sept. 1, 1918 through Oct. 15, 1918, as reported. If that figure is to be believed, then fewer than two people per day on average died of the flu in Milwaukee. But a look at the number of death notices and obituaries tells a different story.

“Death notices” are what we now call obituaries. They are paid for like advertisements and are located in the classifieds section of the newspaper. Burial licenses are part of the county public record, and include the numbers of those dead whose survivors couldn’t afford or didn’t purchase such a notice. This information is located in various parts of the paper. In 1919, The Milwaukee Sentinel no longer published this information.

The health department attributes 1,173 deaths to influenza between Sept. 22 and Dec. 31, 1918. Was the health department passing on honest information to the papers? Were the indigent who died at charity institutions and buried in “Potter’s Field” counted or reported? We will never know. It wasn’t until long after the epidemic subsided that Milwaukeeans were given accurate information about deaths due to influenza in their city. 

Another possibility for the shortage of epidemic news lies in the journalism practices of the time. Health and medicine features were not considered newsworthy in the first 21 years of the 20th century. A leading journalism textbook of the 1920s lists such “elemental news interests” as weather, combat, fire, religion, mystery, treasure, children and prominent persons, but fails to mention science, health, or medicine.

In addition, the newspaper held a monopoly on new or recent information. Printed matter was virtually all that was available.  There were no radios, photos, records, television, computers or cell phones. 

The business side of newspaper journalism may also have had an effect of flu coverage. By 1930, the newspaper shifted its dependence on advertising revenues to 74 percent. The price of a newspaper had to be low so the average person could afford it.  At the same time, the need for circulation demanded by advertisers required content which would attract the largest number of purchasers.  In other words, a newspaper had to please its advertisers as much—if not more—than it had to please its readers. Milwaukee newspapers were no exception.

One explanation for the lack of information surrounding the flu epidemic is that World War I shoved stories about the flu off the front page. The Milwaukee media bear this out. 

Main headlines are always related to the war. Headlines about the flu—if included on the front page at all—are smaller, and often placed below the fold. At first glance it would seem that this was what the readers wanted. But further research into the news publishing practices during World War I suggests that content of newspapers was not a by-product of public demand, but a carefully orchestrated government campaign.

In April of 1917, Woodrow Wilson issued orders that created the Committee on Public Information, America’s first large-scale government propaganda agency. At that time the government was also given control of land and cable telegraph lines out of the country. The Espionage Act in June of that year established postal censorship, and in October the Trading with the Enemy Act created an actual Censorship Board to coordinate and make recommendations about censorship. And the Sedition Act of 1918 made it a felony to “encourage either support for Germany and its allies or disrespect for the American cause.”  In Wisconsin, 92 people were indicted under the Espionage Act, convicted of criticizing the United States or the Allies, bonds, charities, the flag, uniforms, or food laws.

World War I news was not, then, what readers most desired and newspapers provided, but the result of government planning and intervention. In addition, the “spirit of patriotism”—i.e., the Committee on Public Information—imposed censorship on any discouraging war-related news such as influenza deaths. Indeed, the fact that uncensored news did come out of neutral Spain led to the epidemic’s misleading nickname: “Spanish influenza.”  And while nobody claims that World War I caused the influenza epidemic, there’s no doubt that the social, economic and political circumstances of the war certainly contributed to its severity.

Then there’s the fame factor. Then as now, one of the accepted dictums of media is that celebrity news or deaths sells.  Babe Ruth, Mary Pickford, Woodrow Wilson and Franklin D. Roosevelt all caught the flu, but survived. 

Some suggest that the reason few “famous” people died of the flu had to do with the relative youth of its victims. At that time, men very seldom achieved any sort of power before the age of 40, and women’s lives and work were not considered important.  The sons and daughters of many prominent people died, but no one who was an actual “celebrity.” 

The Milwaukee papers illustrate this. Mrs. Vogel’s death made the front page, due to the local interest in her wealthy husband.  When well-known doctors died, their deaths also received newspaper space. But the thousands of anonymous people who died, many of them young, were not considered newsworthy.

Joann P. Krieg, looking at the influenza epidemic through the lens of literature, points out the possibility of survivor’s guilt as a reason for the lack of writing about the flu:

Americans on the home front appear to have felt guilty for making too much of the disease that was striking them down.. . . People became ill and recovered or died in a matter of a month--just about as long as some love affairs or marriages last in a time of war.

Crosby also suggests that those who lived through the epidemic were so traumatized by the experience that they collectively chose simply to forget. The only noted writer who wrote about the flu was Pulitzer Prize winning author Katherine Anne Porter, whose story “Pale Horse, Pale Rider” is a good a literary example of an event that has otherwise passed into history unnoted.  

No one has suggested the reason the flu was underreported was economic, but that is this author’s conclusion. The Milwaukee press may have carried only a small amount of flu news for fear of losing advertisers. Many of the merchants who advertised were adversely affected by early store closings.  These businessmen fought the city officials who were trying to implement these and other crowd control orders.

Also, In those days before strict enforcement of government regulation of advertising, one could make money marketing products to cure or prevent illness.  The Milwaukee media are loaded with ads for such products, and it is doubtful that the advertising department would turn down such revenue, regardless of the source or the products’ ill effects on community health. Similar tactics are now found on the internet.                                                                                                                                           

The Milwaukee Sentinel had a history of putting business interests before those of the public health. It editorialized, for instance, against the removal of sewage in the early part of the century, despite numerous cholera and typhus epidemics.

It wasn’t until 1891 that the state of Wisconsin began to require licensing for physicians, nearly 10 years after similar laws were passed in the neighboring states of Minnesota, Illinois and Iowa.  A few lawmakers blamed newspapers, particularly the Sentinel, for the delay in passing a medical licensing law. According to the chairman of the state committee on medical legislation, the Sentinel prostituted itself solely for “the revenue which it derives from quack doctors, mountebanks, and patent medicine men.”

There was also a strong anti-vaccination group in Milwaukee which successfully limited the use of smallpox preventive until the 20th century.   

The Milwaukee Free Press, in keeping with its concern for the common worker, provided more complete flu coverage than the Sentinel with its ties to the business community. But the Free Press—like many socialist newspapers—was under a good deal of scrutiny from the government and from mainstream organs.  Wisconsin editors displayed less tolerance for socialists than even for German-language papers. It was in the best interest of the Free Press to keep a low editorial profile.

Milwaukee was in 1918 a town famous for its breweries and taverns. German Americans brought the habit of beer drinking to America and dominated the large brewing industry. The Germanic names and origins of beer and ale brought even the nation’s most cherished beverages under suspicion of treason.  The owners of alcohol-related businesses were no doubt already concerned about the future, given the growing influence of the temperance movement in America. 

And they were right to be concerned. The Eighteenth Amendment was adopted in December 1917 and put into effect in January of 1920. Prohibition devastated the previously legal manufacturing, distribution, and retail liquor business, the seventh largest industry in the country.

The Great War, then, was a blessing for purveyors of alcohol and diversion. No one could expect young men going off to fight for freedom to not indulge in some of that freedom when off the battlefield. Owners of entertainment establishments did not want sailors—and their money—kept at the Great Lakes Station. 

Given that orders for closings of non-profit facilities were obeyed and not questioned while store and club owners were issued warnings but allowed to stay open; given that businessmen attended meetings at which these public health decisions were made; given that the editors of the newspapers did not address the issues in daily editorials and accepted ad revenue from any and all businesses; it is distinctly possible that non-interruption of commerce during the epidemic was more important to the Milwaukee media than the dissemination of information.

Why does this matter now? Because epidemiologists agree that we were overdue for another major epidemic. And the stakes are higher now. Richard Preston writes that a hot virus “lives within a twenty-four hour plane flight from every city on earth. All of the earth’s cities are connected by a web of airline routes…Once a virus hits the net, it can shoot anywhere in a day—wherever planes fly.”

Much medical progress has been made since the 1918 influenza epidemic. Further study of mass communication during epidemics is needed as well, to ensure that public health decisions are made and communicated effectively. Health care during epidemics should not be left to chance, as the 1918 flu epidemic illustrates; neither should mass communication.