10/20/2009 5:30:00 PM The Killer Flu of 1918 How the Verde Valley stared down a pandemic
Courtesy Jerome Historical Society
Jerome residents wearing mandated facemasks during the pandemic. The town and eventually the Verde Valley were quarantined, a move credited with controlling the spread of the virus, though 60 people died. Worldwide, death estimates range from 50 million to 100 million.
The Jerome cemetery is dotted with 1918 graves.
By Helen Peterson Doctorate at NAU
With news reports about a possible swine flu epidemic and constant references to the Spanish Influenza epidemic of 1918, a look into what happened in the upper Verde Valley during the 1918 outbreak might provide insight into an epidemic.
In the early fall of 1918 the Verde District was a busy place. Mines in Jerome and the smelter in Clarkdale were producing large quantities of copper in support of the World War I war effort. In fact, headlines from the European front were encouraging as the Allied forces were slowly making progress against the Germans and the Central Powers. Based on a count of food rationing cards in August 1918, administrators estimated the population of the Verde District to be more than 20,000 with about 9,000 people in Jerome, 4,400 in Clarkdale, 2,300 in Verde, the initial name of the town of Clemenceau, and 1,700 in Cottonwood. Officials believed these counts were low as they did not include the large numbers of single men, especially in Jerome, who ate exclusively in restaurants and did not have ration cards.
Schools opened and authorities claimed record enrollments. Jerome started school on Aug. 26, 1919, with about 700 students. The Clarkdale School began Sept. 3 with about 100 students. The Clarkdale Indian School had 32 scholars and commenced the same day as the Clarkdale public schools. Cottonwood schools opened their doors on Sept. 9, and Verde started Sept. 16 with a school building that could house 150 students, but neither school district listed student populations.
The Verde District, that early fall, had widespread recreation and gatherings that provided social opportunities for residents. There were dances at both Clarkdale's and Cottonwood's Bungalow clubhouses. The Clarkdale band performed free Saturday evening concerts. Churches conducted services, even though some did not have pastors, and church choirs rehearsed regularly. On Sept. 16, the ethnic Mexican populations held large Independence Day celebrations, including a circus and parade in Clarkdale. Moreover, on Sept. 21, another circus came to the Verde area. Baseball tournaments played out the rivalry between soldiers from Fort Whipple in Prescott and the Jerome miners. Each town had groups of women who met weekly, twice a week in Clarkdale, to wind bandages for the Red Cross war effort.
The first mention, locally, of the Spanish flu is in Clarkdale. A very brief Sept. 21 article, buried on the fourth page of the Jerome newspaper, revealed that Professor D.W. Gilliland, teacher in charge of the Indian School in Clarkdale, had the flu. He apparently made a full recovery and the impact on the Native American community, with whom he had close contact, was not disclosed.
More urgent Spanish flu information emerged in early October. On Oct. 4, 1918, a nationally run article stated that about 175,000 people throughout the United States were sick, 105,000 of them were on army bases. The contagion was moving from east to west across the country and resulted in a death rate of one in 27 cases. Boston was the worst hit with its 80,000 cases and 1,900 deaths while Camp Grant in Illinois reported 118 new cases that day. The War Department issued orders that soldiers were not to congregate in any gathering of 25 or more people in an attempt to halt the spread of the flu among the army. This command arrested plans for boxing and wrestling matches among soldiers temporarily stationed in Jerome as well as prohibited the soldiers from attending local dances or movies.
Saturday, Oct. 5, brought initial reports of sickness in Jerome. The first case began the day before and by noon on the fifth, there were 10. Two of the patents had already developed pneumonia, the deadliest stage of the flu. Dr. A.C. Carlson, Jerome's health officer, banned public gatherings in the city. Movie houses closed their doors, dances were cancelled, no crowds could congregate on the streets, and poolrooms had to limit the number of customers in their halls. The sick were isolated in a separate ward of the hospital or in their homes while Dr. Carlson advised local doctors to report any illness suspected to be the flu. Carlson stated that he did not believe any illness had yet developed in the Verde District outside of Jerome. Fort Whipple in Prescott reported 12 soldiers ill and eventually, the epidemic would hit the base very hard, but that is another story.
By Oct. 7, there were more cases; nevertheless Dr. Carlson was cautiously optimistic. With only 10 additional sick, he felt Jerome might avoid the worst of the epidemic. Placing further restrictions, he ordered the schools closed for a week, forbade pool and card playing as well as urged residents not to mingle in large or small groups. The opening of an Americanization School for foreigners was delayed. At this point, Dr. Carlson denied that there had been any fatalities from the flu.
Clarkdale reported six cases of the flu on Oct. 7. Three of the sick were school children. Yavapai County health officials placed restrictions similar to those in force in Jerome: school closed for an indefinite time, the movie house shut down, church services stopped, band concerts ended, pool halls closed, and public gatherings of any sort banned including a Knights of Columbus benefit dance and Red Cross bandage making. Likewise, Cottonwood and Verde closed their schools until the danger of the epidemic passed although the Red Cross women of Verde still met stating that a mere flu bug was not going to stop them from supplying surgical dressings to the war effort.
Oct. 9 brought an account that the danger of the epidemic was nearly over. So far, only 25-30 cases had developed in Jerome and Dr. Carlson felt that the restrictions had stopped further spread of the infection. He was not ready to lift restrictions, but expressed hope that the worst of the flu had passed. Clarkdale also reported no new cases, but noted two new cases the following day. Citizens of Cottonwood cleaned their streets, alleys and outhouses as preventative measures against the flu.
The first Spanish influenza fatalities in Jerome occurred Saturday, Oct. 12. The two men were both miners and were in their mid-30s. Each was apparently healthy prior to contracting the flu. Schools remained closed, church services were cancelled for the following day; however the Alianza Hispana held their regular meeting that night and asked for a complete membership attendance as there was business of importance to conduct.
On Monday, newspaper reports continued to claim that the epidemic was fading in spite of ever increasing numbers listed. Authorities reassured the public that they had the disease under control although they estimated 125 cases in Jerome, a significant jump from the previous Thursday. The United Verde Hospital was full and doctors set up temporary hospitals in three school buildings. Three more fatalities occurred over the weekend. Health officers ordered all soda fountains and soft drink stands closed, and police were to prevent people from gathering on the streets. To thwart further spread of the flu, a "clean the camp" campaign started where citizens were to remove all trash and debris from their homes, yards and stables and place it on the curb for free pickup. Subject to inspection, anyone who did not clean his or her quarters would be prosecuted. Outside the area, California reports stated that 4,000 of its citizens had influenza, an increase of over 2,000 from the day before.
By Tuesday, Oct. 15, the town of Jerome was under quarantine. No one could leave or enter without a special permit. Health officials directed the United Verde and Pacific Railroad to cease carrying passengers in or out of the city, and they suspended shuttle service between Jerome and other Verde District towns. Guards stood at all entrances to town to prevent cars from entering or leaving town. Even with these measures in place, doctors still proclaimed the epidemic under control. They believed that the spread of the flu in the crowded conditions of Jerome could be much worse. There were six additional fatalities that day, but fewer new cases and with recovery of a number of patients, there were about 75 cases of flu in town. The quarantine, authorities stated, was to protect residents from newcomers who arrived ill and endangered the progress of their flu fight.
Wednesday showed a marked decrease in new patients in Jerome, but an increase in Clarkdale. Only two new cases emerged in Jerome, although five more people passed away. Officials declared that if Jeromites continued to follow the regulations in place, the epidemic would be over. There were 41 patients in the temporary hospital and the regular hospital was still at capacity, but doctors expected to release several patients who had recovered. Authorities exhorted parents to keep their children inside and ordered merchants to use water when sweeping sidewalks to reduce billowing dust that would spread the disease. Clarkdale, meanwhile, was struggling with its own epidemic. Ten new cases had emerged bringing the total in town to about 40. Doctors converted the country club building into an emergency hospital. The first influenza related fatality for Clarkdale occurred.
Already in effect in Jerome for two days, county health authorities extended the quarantine Thursday to include all Verde District towns. No one could leave or enter Jerome, Clarkdale, Cottonwood or Verde without special permission. Officials strictly enforced the quarantine and arrested one man for attempting to travel between Jerome and Cottonwood. At some point, although it is not clear when, health officials also required residents to wear facemasks, especially when out in public or caring for the sick. News from Jerome still was upbeat even though several new cases surfaced.
Over the next few days, news reports continued to be positive although the epidemic still had a sturdy grip on the lower Verde towns. Jerome documented few new cases and two fatalities. On Oct. 23, Clarkdale showed 16 new cases in the preceding 24 hours and 100 cases total. Town leaders were ready to convert another building into an emergency hospital if numbers increased further. Cottonwood had two new patients and Mrs. Newcomb allowed her new seven-room house to be used as an emergency hospital. In Verde, two new cases also developed and an emergency hospital established. Apparently a number of the women in Verde fell ill and a special emergency hospital was set up in the Catholic Church to treat them, perhaps a result of scoffing at regulations. Officials in each town claimed with confidence that they were winning against the epidemic and they felt the worst had passed. This constant positive and overly optimistic outlook appears to be their means of quelling panic and fear concerning the flu outbreak.
By the end of October, towns were still reporting additional flu patients. Jerome counted six new cases, as well as 10 fatalities since the 23rd. A town survey discovered that about 320 residents had or had recovered from the flu. Since this did not include fatalities, authorities believed the total number of flu cases in Jerome to be closer to 400, much lower than other places with similar population. Clarkdale, with 106 patients in the hospital, reported that 30 new cases developed over the preceding 24 hours making the total count for that town about 300 cases. Two infants had succumbed to the disease. The Justice of the Peace also canvassed Clarkdale looking for unreported flu cases, especially among the "foreign population," most likely referring to the town's large ethnic Mexican population. In Verde, concern was for the Native American encampment. There were 12 Indians ill and two infants had died, presumably from the flu. Along with an ethnic Mexican smelter worker, these were the first three influenza fatalities in Verde.
On Saturday, Nov. 2, the flu still spread through the Verde District. Jerome had three new cases, two fatalities and 90 patients in its emergency hospital. Clarkdale suffered with 26 new cases, the death of an infant and 132 individuals recuperating in its hospitals. The Verde Native American community reported no new cases, but two Indians passed away and one more was not expected to make it through the night. In addition, five new cases emerged in Verde and one more soul died.
After a month of battling the flu nonstop, Dr. Walsh, head of the Jerome emergency hospital, suffered a collapse from overwork. Likewise, a town nurse responsible for the care of those not in the hospital, collapsed as well. Both needed rest and then were anticipated to be back to work.
The following week brought a slight decline of flu in Jerome, but an increase in the severity of the epidemic in some valley towns. Throughout the week, Jerome reported 19 new cases, 9 deaths and a release rate from the hospital that was greater than admittance, leaving 51 flu patients. Town officials were cautiously optimistic and expressed hope that county authorities would permit them to lift the quarantine. They were not going to relax any other measures since they wanted to prevent a second wave of the epidemic, something Flagstaff and Winslow had experienced. Hunters were given a special permit to travel in the Verde District, which could indicate that food was low, although there are no official reports of food shortages. Cottonwood was the least affected by contagion. It had only two new cases and by the end of the week, all patients headed home and the hospitals stood empty. Verde experienced 15 new cases and 5 fatalities. There were 65 patients in the hospitals scattered between the infirmary, school, amusement hall and old commissary. The Verde Native American community suffered 5 losses, but there was no count of the number of total cases. Clarkdale reported about 80 new cases and 7 deaths. Since there seemed to be no abatement of the epidemic, town officials instated a mask order where all those on the streets or in public places had to wear masks.
The polling place for the Nov. 5 elections was disinfected hourly and, despite restrictions on gathering, about 300-400 people on Nov. 7 formed a victory parade, including the United Verde Copper Company Band, to celebrate the end of the war (which was not officially declared until Nov. 11.)
The Native American settlement located outside Clarkdale remained flu free.
While the United States feted the war's conclusion the week of Nov. 10-16, the Verde District also had reason to celebrate. The quarantine of Jerome ceased and trains resumed carrying passengers into town. A town nurse took the temperature of every incoming traveler at Jerome Junction (today's Chino Valley) to prevent anyone who was sick from boarding the spur line that entered Jerome. She also handed out masks.
The number of patients dropped enough that Jerome closed its emergency hospital and moved all remaining patients to the regular United Verde Hospital. Only one new case arose all week, but five of the previously ill passed away. Even though the quarantine ended, all other measures remained in force and officials estimated that it could be two weeks to a month before schools reopened.
Verde and Cottonwood also had their quarantine lifted. Both towns experienced substantial lessening of the epidemic with Cottonwood nearly flu free and Verde only reporting 5 new cases for the week. Clarkdale remained sequestered and although flu cases were declining, there was still significant concern over the numbers. Midweek reports state that Clarkdale's total number of flu cases since the epidemic began was 538, higher than the total in Jerome. Officials intensified enforcement of the mask order with serious fines for offenders. The first time someone was caught unmasked in public, the fine was $10, a stiff amount since workers were earning between three and six dollars a day. The second offense resulted in a $50 fine and 30 days in jail.
There was flu in Clarkdale's Native American settlement starting with the Presbyterian missionary and his two sisters who were removed to the flu hospital. The next day six additional cases among the Native Americans appeared.
After six weeks, the influenza epidemic began to ease in the Verde District. Jerome, Cottonwood and Verde were all out of danger and the situation in Clarkdale was improving as well. During the week of Nov.17-23, there were about five new cases.
With merely 28 patients, the emergency hospital in the school closed, leaving only the clubhouse clinic open. Six flu-related deaths occurred in Clarkdale that week. The revised total of flu infections in Clarkdale was 600. There would be only a handful more fatalities in the Verde District due to the flu after this week.
Meanwhile, reports from the rest of Arizona show that much of the state was still suffering. Ajo, a mining area in southern Arizona with around 5,000 residents, had about 300 active cases and every doctor in town was ill. Phoenix did not enact non-meeting regulations similar to the Verde District and apparently the situation there was dire with the contagion widespread and still expanding.
Verde District officials and editors were justifiably smug about how well they had controlled the epidemic through their swift actions.
It is not clear exactly when schools reopened and other restrictions eased. Clarkdale students expressed their concern about graduating and their acceptance into colleges after missing so much of the school year due to closures. However, graduation occurred on time and several of the students did continue on to various schools. Overall, the Verde District reported about 1,500 flu cases with approximately 60 fatalities during the epidemic.
Several interesting items to consider emerge from this study. First, the Verde District was secluded and remote. Access to the area was limited so authorities could close the area down to prevent additional infections arriving from outside. In addition, a few local companies that had firm control over their employees dominated the area, making it easier to enforce regulations. Jerome had an up-to-date hospital constructed by the United Verde Copper Company staffed with competent doctors. These factors combined to keep the infection rate well below the one-third rates experienced worldwide.
Fatalities equaled the 1-in-27 case rates, but fell far below the 2.5 percent death rate that occurred internationally. The flu itself was not deadly; pneumonia that developed as part of the virus caused most of the losses.
Furthermore, fatalities were much higher in young adults. Internationally, about half of flu-related deaths happened in the 20-40 age bracket. In the Verde District, roughly 48 of the 60 fatalities were between 20 and 40. This higher percentage is due to the general age of the local population since mining areas had fewer families with young children and reduced elderly occupants. A vaccination was available by November and did reduce the infection rate by about 90 percent.
If another similar outbreak were to happen, conditions in the world and the Verde Valley have changed dramatically from the early 1900s. Healthcare and understanding of viral behavior have advanced significantly.
However, the response could follow that of 1918: closed schools, limitations on congregating and even quarantine, measures that did reduce the local infection rates. While the constantly optimistic attitude of the newspapers and officials in 1918 was probably forced, it may have helped to keep the populace from panicking.
With current access to all manner of information, our knowledge of an outbreak is far greater and the public reaction may be stronger.