Ghosts of 1918 flu pandemic hang over Montana today

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    HELENA, Montana (Independent Record) — The pandemic hit Montana hard.

No effective vaccine was in place. People ignored quarantine orders as state health officials pressured local authorities to close bars, churches, schools and other places where crowds normally gathered.

Doctors and nurses were in short supply and exhausted by the caseload. Some Montana counties had no medical personnel at all. One city required some public workers to wear face masks, but made it optional after receiving complaints that the masks were causing headaches and eyestrain.

No one was immune as even the lieutenant governor became ill. Native American populations were hit hard.

Although this may sound familiar, this is not from 2020, nor 2019.

Two articles — “Montanans and the most peculiar disease,” published in 2016, and “No more war, no more plague,” published in 2018 — looked at the 1918-1919 Spanish Influenza pandemic in Montana, which killed somewhere between 4,100 and 5,000 residents. With Montana battling the coronavirus pandemic, which, as of Friday, has infected 88,635 residents and killed 1,086 since March, these two articles strike an even more ominous tone than when they were first published.

It all happened more than 100 years ago.

“The more things change, the more they stay the same,” said Eve Byron, public information officer for the Montana Historical Society, which had published the articles in its quarterly magazine, Montana the Magazine of Western History.

And two of the five writers, Todd S. Harwell and Dr. Greg Holzman, are on the front lines as Department of Public Health and Human Services (DPHHS) employees dealing with today’s coronavirus pandemic.

There were an estimated 675,000 influenza deaths in the United States from the 1918-1919 pandemic. One-third of the world’s population, which was 500 million, were infected and more than 50 million people died.

Montana was ranked as one of the four hardest hit states.

A look back and into the present
Some of the authors said in recent telephone interviews they are struck by some of the similarities between 1918 and 2020.

“We learned a little, probably not enough. It faded into memory pretty quickly,” said Steven D. Helgerson, the former state medical officer for DPHHS, who co-wrote the “No more war, no more plague” article with Harwell and Holzman.

Pierce C. Mullen, who along with Michael L. Nelson, wrote “Montanans and the most peculiar disease,” was more abrupt in his assessment.

“I don’t want to get on my soapbox, but there are eerie similarities between 1918 and the present,” he said.

Mullen, a former history professor at Montana State University, said the 1918-1919 pandemic serves as “an eerie ghost hanging over the present.”

Mullen said he was lured to the project by Nelson, a research librarian who was looking over western history, who believed telling the story of the 1918 flu pandemic was important for Montana.

Holzman, the state medical officer, said there are a lot of similarities and there is a lot to learn, but there are a lot of differences too. He especially has been something of a public face during the COVID-19 pandemic, often speaking at news conferences with then-Gov. Steve Bullock about the coronavirus surge in the state.

He noted the first wave of the 1918 pandemic did not hit Montana hard, but the second wave had a much stronger impact. He said the 1918-1919 pandemic is where the idea of closing down cities came from.

Holzman said there was “tons of misinformation” during the 1918-1919 pandemic.

“I think we tried to address that, but that has been very challenging,” he said of the COVID-19 pandemic hitting now. He said one challenge has been public health providers being a calming presence so that people feel comfortable.

He said some agencies have done well with that while others, usually because of size and staffing, have done worse.

“It’s good for public health to be part of the community before any kind of challenge,” he said.

During the pandemic of 1918, America was celebrating the end of World War I. There was tension between some Treasure State residents and German-Americans who balked at entering a war against Germany. And there were Irish-Americans living in Montana who did not want an alliance with England to fight the war.

The Montana Legislature passed a sedition act in 1918 that was used to imprison dozens of Montanans who had been less than enthusiastic about the war effort.

“The patriotism stimulated by the declaration of war was intense; the xenophobia accompanying the patriotism was zealous,” Harwell, Helgerson and Holzman wrote.

Helgerson said this led to racial tensions and assigning blame for the pandemic.

Mullen was more abrupt.

“I think there is an undertow of racism that would reinforce some people’s thinking of letting the epidemic take its course and letting those who will suffer, suffer,” he said.

1918 flu targeted the young
Helgerson said what was really shocking about the virus was its propensity for causing illness and death of people in their early 20s until their 50s.

The highest mortality rate was among 25- to 34-year-olds and that 75% of the deaths during the pandemic were in people 15-34. It noted that 11% occurred in people 45 and older.

“What was really striking about the virus in this pandemic was its propensity of causing illness and death in persons in their early 20s until their 50s,” Helgerson said. “There was something about it that really zeroed in on young adults.”

Mullen and Nelson write in their article that about 5,000 Montanans, or 1% of the state’s population, died from August 1918 to June 1919.

“It was a severe loss to Montana, for the majority of those who died were between 18 and 40 years of age, the age group that included Montana’s current and future leaders,” they wrote.

In the Helgerson, Harwell and Holzman article, they report that 908 Montanans died from Oct. 20-Nov. 2, 1918. In October, November and December there were a total of 3,391 deaths.

Harwell noted that as the country was not paying attention to the troops, many who were suffering from the flu as the ships returned from World War I. He said the response was much quicker with COVID-19, noting that within two weeks of late December 2019, countries had mapped out a genome.

“In 1918 we did not even know there was a virus,” he said.

Harwell, public health and safety division administrator for DPHHS, said when the war ended a lot of Montana communities let down their guard and incorrectly thought the number of flu deaths had turned the corner.

“The lesson they learned is they were not out of woods,” he said. “It takes time to get through these things.”

The state Health Board passed a resolution at its Feb. 18, 1918, meeting that let health officers close theaters, schools, churches and any other public gathering place when an epidemic of a reportable, communicable disease of other diseases occurred.

This reportedly was not enacted in the first wave of the Spanish influenza, but was used later by many county and city health officers.

The stories from a century ago are heartbreaking, much like they are today as some families lost several members to the flu. A neighbor found the bodies of a family of five in Miles City after they became so ill they starved to death. Three Madison County sisters, Winnie, Ruth and Jennie Stalcup, who were 26, 27 and 32 respectively, died and two brothers who lived in Roy were found dead on Christmas Eve. The death certificate read: “Apparently influenza. Found dead in bed with his brother who was also dead.”

The researchers also write about a rancher who was so flustered that he asked a passing doctor to examine his family. The doctor said he would do it later. The cowboy pulled out his six gun and told the doctor to look at the family “right now.”

The doctor did as he was told, examined the family, wrote a prescription and the rancher apologized and paid the bill.

The flu came in waves
The flu came in three waves. The first was January through June 1918, the second came in the fall of 1918 and the third wave hit in the spring of 1919.

There were 53 influenza deaths during the first wave. The stories note that 25 counties had no documented flu-related deaths. It was during the second and third waves, 4,187 deaths occurred. There were 908 deaths from Oct. 20 to Nov. 2, 1918.

There was no detailed analysis of Montana death records looking at the impact of the epidemic on the state, the researchers said. There is some variance in the numbers as one article states nearly 5,000 Montanans died while the other says it is more like 4,100.

The article by Helgerson, Harwell and Holzman notes that in 2017 they pored over death records from 1918 and 1919, to find deaths associated with influenza, which the authors note was also called “flu, grippe and la grippe.”

What complicated matters was that there were other health issues to deal with as there were reports in 1918 of smallpox (1,104 cases), typhoid fever (179), 309 cases of diphtheria, 1,609 reports of scarlet fever, 218 cases of tuberculosis and 12,086 cases of the measles.

There were also 17 cases of infantile paralysis, or polio, reported between 1918 and 1919, but in 1920 the number jumped to 27, the majority of which occurred in Ravalli County.

The Mullen-Nelson article says the Spanish Influenza made its first Montana appearance in September 1918 in Scobey and in early November it had spread rapidly to rural areas. An increase in cases was seen after the celebration of the Peace Armistice of World War I, as people from rural areas gathered in towns to celebrate.

The Harwell, Holzman and Helgerson article notes that the first death in Montana occurred Jan. 16, 1918, at the Carbon County poor farm in Red Lodge. They reported that Silva Whitmore died. She was 103.

Mullen and Nelson write about Pamelia Clark, superintendent of Faces Mahon Deaconess Hospital in Glasgow, expressing concern.

“I will try to tell you something of the situation, for it is dreadful,” she wrote. “Do you know this is the most peculiar disease I have ever seen? Some persons hardly know they are sick until they’re dying.”

Dr. William F. Cogswell of the state Board of Health worked with U.S. Public Health Service and the American Red Cross to bring eight physicians and seven nurses to Montana to help.

The report also notes that American Indians had higher mortality rates from the flu than other groups, likely due in part to a scarcity of medical facilities on reservations. A recent state report on the 2020 pandemic noted that 19% of the cases were American Indians, who make up nearly 7% of the state’s population.

And Butte “suffered terribly,” Mullen and Nelson wrote, saying that one-third of the deaths in the second wave occurred in Butte-Silver Bow.

It was reported that in Butte “undertakers no longer garage their dead wagons, but them in the street as calls are so frequent, twenty and more per day.”

Harwell, Holzman and Helgerson wrote that health officials in Butte reported during the first week of March 1918 that 20% of the city’s population was ill with influenza and colds.

By the end of the month, nearly 1,400 Butte miners were afflicted with colds, grippe or pneumonia and consequently unable to work. Lt. Gov. William Wallace McDowell, visiting Butte on behalf of Gov. Samuel Stewart, also came down with a severe case of la grippe.

Mullen said it coursed through its victims fast, adding there were some cases of people “OK in the morning but dead at night.”

In November 1918, the Army released a vaccine with a warning it was “experimental.” The Montana state Board of Health decided not to use it. However, it used a vaccine produced out of Minnesota, at what later would become the Mayo Clinic.

They said this vaccine was also experimental. “It will do no harm and may do good,” they wrote. “We do not urge you to take it, but we wish to be in a position to furnish it if wanted.”

It was mainly dispensed in Havre, where nearly 300 people were inoculated on Dec. 2, 1918.

A stronger support system
Holzman said the medical community is better prepared today with respirators, ventilators and some treatments.

“It’s not perfect, but the supportive care is much stronger,” he said.

Harwell agreed, and also said the medical community and others have gathered much information from this latest experience adding that hopefully, when all of this is over, “we can learn from this for the future and what we can do better.”

Holzman said there was room for improvement in how Montana responded in 1918, but there were a lot of external factors.

“There are definitely lessons to be learned, as there will be lots of lessons learned from this pandemic also,” he said.

Mullen said the pandemic has been so devastating this time around because it “got so damn politicized.”

“If the federal government had gotten its act together not so many people would have died,” he said, adding there is no national plan, just a crazy quilt pattern of state by state.

Holzman said it was just a matter of time before the next pandemic hits, noting there was a pandemic in 2009. He said it is a common comment in public health circles that once this is over, it’s not if it will happen again, but when. He noted the world has become much more mobile, which will help spread the disease.

He said hopefully the next pandemic will not be for years, but perhaps those in charge will come up with ways to address them earlier and stop them.

“These things will continue to happen for a lot of different reasons,” he said.

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