Since the nation crossed a grim milestone of one million covid deaths on May 13, 2022, we are examining how the toll from this pandemic compares to the influenza outbreak of 1918-19 in Cecil County.
COVID-19
The first COVID-19 case was identified in Cecil County on March 20, 2020, and the first virus-related death on March 31, 2020, according to the Health Department. Over the ensuing 26-months, the mortality count has ticked upward, the disease taking 259 lives as of May 20, 2022.1 This results in 2.51 COVID-19 deaths per 1,000 people since the county has a population of nearly 104,000..2
Influenza Pandemic of 1918-19
One-hundred-four years earlier another mysterious pathogen ripped across Cecil County. This time about 23,000 people lived here as reports of cases trickled in slowly in early September 1918. But the virus pummeled the county by the end of the month, taking a major deadly toll.
The first influenza cases involved 17-year-old Edith E. Gorrell on September 18, 1918, and her 15-year-old sister Irene on September 20. The young girls, the daughters of James Gorrell of North East, worked at a catsup canning factory in Newark that autumn. After becoming infected, they returned home to North East.3
Cecil County Death Count 1913 – 1920
Once the pathogen exploded locally, many residents became gravely ill, and an appalling number of deaths occurred. By the end of 1918, Cecil County had recorded 158 excess deaths, a 44 percent increase in mortality over the previous six-year average. But the virus kept Maryland in its clutches with another concentrated wave in the winter of 1919. Over that frosty season, the county reported 28 excess deaths, an increase of eight percent. This metric, excess deaths, measures how many lives were lost beyond what would have been expected.
During the time the novel pathogen raged across the county in 1918-19, a rough indicator is that of these 186 excess deaths 163 were directly attributed to influenza or pneumonia. This gave the county a virus-related death rate of about 7.1 per 1,000 people and an overall death rate of 22.4 for all causes in 1918 and 16.8 in 1919. For the six-year average before 1918, the annual mortality rate was 15.64
Comparison
While it is difficult to estimate the precise toll of the disease over 100-years-ago, the excess deaths above the expected mortality level provide one measure for assessing suddenly shiting health outcomes. The county recorded 163 excess deaths when the population stood at just over 23,000.
Comparing events that occurred more than a century apart has its perils. For example, the population of Cecil County in 1918 was about twenty-two percent of what it is today, meaning that influenza cut a much bigger, lethal swath through the county in a short, concentrated period of a few months. In terms of the raw mortality count, COVID-19 has taken more lives than the influenza pandemic did, but the population is far larger. From 1918 to 1919, there were 163 excess deaths. Thus far, in 2022, there have been 259 COVID-related deaths and the data on excess deaths has not been developed. In 1918-19, the death rate for influenza-related cases was about 7.08 cases per 1,000 people, while the rate for the current pandemic is 2.49.
Measure
1918-19
2020-Present
Excess Deaths
186
TBD
Virus-Related
163
259
Total Deaths
902
TBD
Virus-Related Death Rate pre/1000
7.08
2.49
County Population
23,009
103,905
Estimate of Key Death Metric Comparing COVID-19 with the influenza pandemic of 1918-19
Endnotes
Cecil County Reports First Coronavrius Death, Delaware Business Journal, April 1, 2020[↩]
Annual Report of the State Board of Health of Maryland for the year ending December 31, 1918, Table 8, Birth Rates, Death Rates, and Rate of Increase in 1918, p 9[↩]
When the Spanish Influenza appeared in Cecil County in the autumn of 1918, the man on the frontline of the battle here was Dr. H. Arthur Cantwell. The young clinician, an alumnus of the Jacob Tome Institute, graduated from the University of Maryland School of Medicine in 1906. After interning at the University Hospital and the Kernan Hospital for Crippled Children in Baltimore, the doctor returned home to Charlestown to open a general practice of medicine and surgery in his mother’s home.
It wasn’t long before the office shifted to North East, a move that helped build the budding practice. There the twenty-three-year-old worked seven days a week, treating every type of case imaginable, from minor distress to heart attacks, cancer, and gunshot wounds. His colleagues in the medical fraternity in the town consisted of Dr. Phillip B. Housekeeper who received his medical diploma in 1868; Lewis F. Hamrick (1901), and T. A. Worrall (1870).1
Appointed County Health Officer
Months before the Spanish Flu struck, the county commissioners appointed the North East physician to a term as the Cecil County Public Health Officer.2 It was April 1918, months before the first bout of the Spanish Flu struck, a small outbreak occurring that summer. But the most serious wave lurked until autumn before it hit. And there was a third less severe eruption that resulted in additional deaths early in the winter of 1919.
Months before the Pandemic struck, he was appointed to a term as the Cecil County Health Officer.
As an up-to-date graduate of a university medical school, Dr. Cantwell understood the era’s theories on contagions. But like all medical professionals in 1918, he didn’t know that influenza was a virus as the science hadn’t developed that information. Thus, there was no vaccine, test, or therapy to treat this strain of influenza. However, his knowledge of germ theory and the way microbes spread through droplets in the air was solidly grounded in the science of the time.
Public Health Officer Monitors Pandemic
In the early days of the outbreak, news of the deadly pandemic swirling around military camps and large cities, the new health officer read newspaper accounts about the plague sweeping across the nation and studied whatever bulletins the Maryland Board of Health and U.S. Surgeon General Blue provided. The clinician recognized that medical therapeutics could not stop the microscopic killer; only the public health measures of containment, good hygiene, isolation, and quarantine would reduce the suffering, something we now call social distancing. This information he shared with Cecil’s old hands at medicine during County Medical Society meetings.
“Coughs and Sneezes Spread Diseases – As Dangerous as Poison Gas Shells”. U.S. Public Health ad on dangers of the Spanish Flu epidemic during World War I. (Source: U.S. Public Health Service, via Wikipedia)
One State Health Department bulletin informed local authorities that an “extra-containment zones” had been established around government reservations in Maryland, including Aberdeen Proving Ground. The emergency regulation established a five-mile boundary for containment, authorized the appointed of five additional deputy state health officers, and the publication of circulars with instructions on sanitary requirements for anyone in the zone.
When the second wave struck here in September and October, the county’s physician, took charge as the contagion ripped across northeastern Maryland. Dr. Cantwell was the point person responsible for protecting and promoting public health; never before in the history of Cecil County had the health officer been thrust into the forefront of a major community-wide health emergency, a global pandemic.
In these turbulent times, with the virus killing over 100 people here and infecting many more, he provided strong leadership at the helm of the emergency as people from the Susquehanna River to the Sassafras fell victim to the Spanish Influenza. With the area in a near state of emergency, doctors being overwhelmed by the calls for help and nurses falling ill, he acted swiftly, promptly calling the shots that reduced the suffering in Cecil County.
Dr. Cantwell Acted Swiftly
As the number of cases swelled, Dr. Cantwell hoped to stamp out the spreading germs with a quarantine. On October 2, 1918, the local Board of Health issued the order — all places where people assembled were to shutter their doors for an indefinite period beginning that Wednesday. In addition to shutting down schools, houses of worship, moving picture theaters, and all places of public assembly, the authorities also banned public funerals. Struggling to keep a lid on things, he also arranged to have information printed that alerted the public to good hygiene practices that would slow the spread of the viral killer.
When the physician ordered the closure of public places, there were no complaints, even if most people didn’t understand the danger of influenza. The streets suddenly grew quiet and still, with few exceptions, as the newspaper columns filled with obituaries. What we call social distancing now is all they had to prevent the spread of the viral killer.
Six days later, the Maryland Board of Health followed along, issuing a statewide directive. Noting that public gathering places where large numbers were likely to congregate played an essential part in the dissemination of the disease. The Maryland Health Officer added that as the virus showed alarming signs of assuming severe proportions, the situation called for serious measures.
Finally, toward the end of October, the suffering and deaths declined. And on October 27, the Cecil County Board of Health lifted the ban on public assembly, announcing that church services, schools, and public assembly could resume for the first time in several weeks. To a significant degree, Cecil County activity stopped or slowed for 25 days, but the people adjusted.
The staff of Union Hospital in the 1930s. Seated: Dr. H. A. Cantwell, Miss Mary Delancy, Dr. J. H. Bates, Dr. Winfred Morrison; standing: Dr. Milfred Sprecher, Dr. Richard Dodson, Dr. Vernon McKnight, Dr. H. V. Davis, Dr. Jacob Greenwald (source: Union Hospital — Celebrating the First 100 Years!) 3
For the annual report for the state, Dr. Cantwell reported that 2,073 communicable disease cases occurred in the county, in comparison to 264 incidents in 1917. Also, his report indicates that there were 85 deaths in 1918. Early the next year, there were about 25 additional deaths.4
After leading the county’s fight against this unprecedented pandemic, Dr. Cantwell resigned as the health officer in Dec. 1921, the commissioners appointing Dr. William G. Jack to the vacancy. 5
The clinician’s practice and reputation continued to grow in the decades ahead. Instrumental in the continuing modernization of Union Hospital, he was the chief of surgery from 1921 to 1954.
Providing Care for 50 Years
After decades as a caregiver, he had grown from the young doctor in town to the senior practicing physician in Cecil County. On the fiftieth anniversary of tending to the ills of residents, more than 1,000 people packed the North East Elementary School, turning out to honor the respected caregiver. On this special occasion Mrs. Mary Belle Heverin Reynolds, his first baby delivery on September 29, 1907, was present, as well as his first patients, Mrs. Curtis Reed and her daughter, Mrs. Frank Conway, Sr., of North East. Mrs. Reed remarked that several people told her that it was awful taking her to a young doctor barely out of school.
This is your favorite Doctor, Dr. H. Arthur Cantwell, (Source: Morning News, June 11, 1956)
Dr. Cantwell recalled that his first operation was performed on John Benjamin’s father. “I was still in school and was on vacation when I was called. He was accidentally shot while gunning. He had blown away part of the calf of his leg. After stopping the bleeding, we took him to the old Union Hospital where Dr. Mitchell permitted me to operate. There is no comparison between medicines of today and that of yesteryear. It is wonderful how the different drugs of today have caused the medical profession to progress,” he remarked. ((“1000 Countian’s Honor Doctor Who Practiced for 50 Years.” News Journal. (Newark), June, 11, 1950.))
Dr. Cantwell, 89, died on December 20, 1972. Part of his lasting legacy was leading the county’s fight again the Spanish influenza as the public health officer.
Polk’s Medical Register and Directory of North America. 10th ed. Baltimore, MD: R. L. Polk & Co. Publishers, 1908. https://babel.hathitrust.org/cgi/pt?id=coo.31924108425525&view=1up&seq=17.[↩]
Cecil County Commissioners, Minutes of Meetings, April 9, 1918, p 75[↩]
Union Hospital, “Celebrating 100 Years: Union Hospital, 1908 – 2008), p.27[↩]
When the Spanish Flu of 1918 spread from the battlefields of Europe to North America, it struck swiftly with its devastating sweep across the nation. Since treatments, vaccines, and antibiotics didn’t exist, the lethal contagion quickly overwhelmed the early 20th-century healthcare system. To aggravate matters, the Great War had thinned the ranks of medical clinicians, and many remaining practitioners became ill themselves.
From the onset of the pandemic in Cecil County, the sick and ill relied on the ladies to provide palliative care. They took charge of caring for the stricken in the “flu homes,” sitting up all night will ill family members and neighbors. This day-to-day care in the sick homes required constant attention, providing the person down with the flu liquids and nourishment, keeping the room ventilated, making sure they were warm enough, and administering whatever remedies doctors could provide to alleviate suffering. As the contagion rampaged across the county, the work was especially hard as frequently entire households became infected.
Nurses Face the Ultimate Test
The first nursing class graduates (1914). L to R: Mary King, Alice Denver, Stella Graves, Georgia Miller. Miss Graves died while fighting the contagion. (Source: Dorothy Robinson Collection at the Historical Society of Cecil County)
While women at home provided most of the care, some acute cases needed hospitalization, so they were admitted to Union Hospital. This put the institution’s nurse, student nurses, matron, and orderly on the frontline, the war already having weakened their ranks. Miss Maida G. Campbell, R.N., the superintendent, and three pupils, Adelia McGready, Ella Alderson, and Laura Storey, enlisted in the overseas service of the Red Cross.
The remaining group of emerging professionals, the eleven “pupil nurses,” provided the bulk of the institutional care. These young, unmarried ladies in the training program exchanged their labor for free instruction that led to a nursing diploma. In between caring for the sick during regular times, they occasionally attended physician lectures and received practical, supervised experience related to medical procedures, medications, and nursing care. It was a bargain for the institution, a cheap source of labor.1 This band, the class of 1918, embarking on their chosen career encountered the ultimate test of their profession that autumn at the forefront of the desperate struggle, they too falling il. They also heard about alumnae dying from the disease while performing patriotic duties in faraway places.
Elkton’s new hospital also faced an unprecedented public health emergency. For the first time in its ten-year history, admissions barely increased in 1918. The managers attributed this to the reduced ranks of surgeons and the influenza pandemic, which incapacitated the nursing staff. The virus also hampered recruiting for the training school2
Spanish Flu Strikes Hospital
The staff of the Union Hospital in 1918 (Source: Tenth Annual Report of the Union Hospital of Cecil County, personal collection)
To help alleviate the burden placed upon the severely overworked doctors and nurses of the country who were working night and day, U.S. Surgeon General Rupert Blue ordered health departments to mobilize all available resources for the national struggle on Oct. 15. Local Authorities should make use of untrained women to relieve overworked nurses, he advised.3
In the grim world turned upside down in 1918, when the deadly virus stalked victims, they met the dual upheavals — World War I and the virulent contagion sweeping unchecked across the land. At the epicenter of this battle, the overstretched caregivers turned out to be the class minted by a pandemic. Each was forcefully reminded of what a medical career meant — the personal sacrifice, the risk of death, and the shortage of help in an overextended healthcare system when the contagion raged out of control with no cures available. These young nurses did their duty while facing great suffering, sacrifice, exhaustion, and risk in the grueling battles.
Ladies on the Front Line
In this topsy-turvy world, a time of great dread and misery, women stood on the front line of this awful struggle, delivering care to family and neighbors in the home. They lived through a global tragedy, one of the worst ever to take place.
Part II – Cecil County Practitioners on the Front Line.
Part III — The Fallen Nurses
Union Hospital School of Nursing Graduates in 1914. This was the first class to graduate. (L to R) — Mary King, Alice Denver, Stella Grave, and George Miller. Miss Graves died while performing her duties as a nurse during the epidemic. (Source: Dorothy Robinson Collection at the Historical Society of Cecil County)
Endnotes
Admin. “Union Hospital Nurses Served on the Battlefield During World War I -.” Window on Cecil County’s Past, November 13, 2018. https://cecilcountyhistory.com/world-war-i/.[↩]
“Tenth Annual Report of the Union Hospital of Cecil County.” Vol. 10. Elkton: Union Hospital, 1918.[↩]
National Campaign Ordered, Capital Gazette: Annapolis, Oct. 15, 1918.[↩]
One-hundred-two years ago, a mysterious killer, the so-called Spanish Influenza, came calling in Cecil County Reports of the outbreak in northeastern Maryland first trickled in from Aberdeen Proving Ground in the middle of September 1918 as the virus took a deadly toll.
Within weeks, the flu exploded locally, as the sickness got a firm grip on Cecil County, expanding at an alarming rate. Ripping across the area, many residents became gravely ill, and an appalling number of deaths occurred. Nonetheless, this wasn’t an occasion for panic public health officials stated, although the spreading disease called for drastic steps.1,2,3
Local physicians on the home front for this fight braced for the battle with the deadly bug. Throughout October, physicians kept on the move, rushing from home to home day and night while snatching brief rest periods. They found it necessary to give daily attention to only the most critically ill as the medical men received more calls than they could handle, their ranks already thinned by military duty. Also, many of the remaining doctors were incapacitated for periods as they too fell victim to the malady.
Physicians warned that “precaution” was the best way to avoid the Spanish Influenza. They advised not to congregate in crowded places, nor use common towels or drinking cups. Also, people should wear clothing appropriate for the temperature, sleep with windows open as fresh air was a good germicide, and not allow oneself to become fatigued. Regular habits, good food, and exercise were excellent preventatives, they concluded.4
All Places of public assembly closed
Hoping to stamp out the spreading germs, the Cecil County Board of Health acted promptly, ordering all public places where people assembled to shutter their doors beginning Wednesday, October 2, 1918. Such a quarantine, the shutting down of schools, houses of worship, theaters, and all public gatherings, was new, but people cooperated, newspapers reported.
That first Sunday, a striking, unrivaled silence fell on Cecil County, not a church bell ringing while on the streets few people, automobiles, or other vehicles were around. Six days later, the Maryland Board of Health issued a statewide order, noting that public gathering places where large numbers were likely to congregate played an essential part in the dissemination of the disease. The health official added that as the virus showed alarming signs of assuming severe proportions, the situation called for serious measures.5
The pandemic also hit the patriotic campaign to sell liberty bonds to finance the war. The drive was underway when the Board of Health shut things down, including several fairs, which involved having a squadron of airplanes fly over the gatherings.
With shortages of nurses already existing across the nation because of the war, the burden on Union Hospital was particularly hard.6 A month before the outbreak, the institution’s superintendent, Miss Campbell, and three of the nurses, Miss McGready, Miss Alderson, and Miss Storey, enlisted in the overseas service of the Red Cross. In October, it was reported that the hospital was full of patients while the virus incapacitated many staff members, reducing the institution’s ability to admit and care for the gravely ill.7
Doctors, Nurses, Druggists & Undertakers
Others contributing to the brave, untiring fight needed to handle the crisis were overstretched. Druggists compounding medicines for the afflicted labored long hours, but supplies of quinine, aspirin, and other essential drugs and patent medicines held out. The undertakers of Cecil County were on the go day and night. But the funeral directors reported shortages of caskets, the manufacturers being unable to keep up with the enormous demand across the nation. And the pandemic filled cemeteries in its wake, the gravediggers digging so many graves that they were worn out.
Many businesses shut down on account of illness. The Jewelry store of J. J. Minster closed for several days while in North East, editor Geo. O. Garey up against the flu shut the publication down for eight days.8 This was the first time in its 36 year history that it had missed an edition.
On the Octoraro Branch Railroad, some freight trains failed to run because crews were ill. Also, trains operated without mail clerks or express messengers in some cases, and section crews maintaining the rails operated with reduced numbers.9
As October faded into November, those in touch most closely with the epidemic – the doctors, nurses, undertakers, and druggists – noted that the emergency showed a marked improvement.10 These brave Cecil County caregivers had put up a heroic, untiring fight and they reported that “victory was now theirs,” few new cases being recorded. And on October 27, the Cecil County Board of Health lifted the ban on public gatherings.
Obituaries published in the Cecil Democrat by month in 1918. Once the Archives opens for research we will visit Annapolis and pull the death certificates from the pandemic here to provide more reliable data on the impact of the Spanish Influenza in Cecil County
“Hands of Death Still Sadly Felt, Influenza Epidemic Claims Many More Cecil County Victims,” Cecil County News, October 16, 1918[↩]
Rising Sun, Town Pierced by Flu, Oxford Press, Oct. 17, 1918[↩]
“Spanish Influenza, Is This Mysterious Infection a New Kind of German Offensive,” Midland Journal (Rising Sun), Oct. 4, 1918[↩]
“Uncle Sam’s Advice on Flu, U.S. Public Health Service Issues Official Health Bulletin on Influenza,” Cecil County News, Oct. 12, 1918[↩]
“All Meetings in Maryland Closed,” Cecil County News, October 6, 1918[↩]
Union Hospital of Cecil County, 1918. Tenth Annual Report Of The Union Hospital Of Cecil County, Elkton, MD.. Tenth Annual Report. Elkton: Union Hospital of Cecil County, pp.25-27.[↩]
“Nurses Wanted,” classified advertisement, Cecil County News, October 2, 1918[↩]
“Minor Locals,” Cecil County News, Oct. 16, 1918[↩]
Fighting the Flu, Physicians, Nurses, and Red Cross Workers Busy Day and Night,” Oxford Press, October 10, 1918[↩]
“Cecil County Letter,” Cecil County News, Oct. 24, 1918[↩]
In the autumn of 1918, World War I was nearing an end, and Cecil County was looking forward to the doughboys returning home from the trenches of Europe. But no one was prepared for the crisis that was about to strike the home front. Hitting suddenly, the Midland Journal reported on October 4, 1918, that the Spanish Flu or “some other creepy, shivery, feverish, disagreeable malady was fairly epidemic in Rising Sun, numerous person, some very serious, were on the sick list.”
Illustration from Illinois Health News, October 1918 provides ways to prevent the spread of the flu of 1918. Source: Chicago Public LIbrary
Is This a New German Offensive
As this unprecedented epidemic swept across the nation and Maryland, the Rising Sun newspaper asked, “Is this new disease which has already killed hundreds and stricken thousands of our soldiers and civilians a new German war offensive 1? If not, how did it happen that this epidemic appeared so suddenly and extensively in such widely scattered cities and army camps throughout the country? Smitten as from a bolt from a clear sky, thousands of Americans have been suddenly prostrated in many widely separated parts of the country, during the past ten days, by a disease which is called, apparently for want of a better name, ‘Spanish Influenza.’”
“Naturally, under all the circumstances, there is much speculation regarding the maters,” the paper continued. “Perhaps because there seems to be a rather natural disposition to ascribe about everything that is perfidious in the world today to Germany, some have ventured the guess that the disease may have been introduced and spread by German agents. This theory is considered groundless and absurd, it seeming hardly conceivable that if Germany undertook an offensive of this kind, she would choose such a mild and humane sort of disease. Much more plausible explanation seems to be the fact that the recent cold snap caught the country entirely unprepared for such severe weather, and as a result of our unheated dwellings and the inadequate clothing, large numbers of people contracted cold. Regardless, there seems to be no occasion for special alarm or panic about the matter for the disease is evidently one which the American medical profession is perfectly able to handle and effective measures are being taken. 1.”
Despite the editor’s reasoning, the Spanish Flu invaded homes and businesses in every part of the county. In North East, the Cecil Star’s publisher, Mr. Garey, “fell under the influence of the flu, putting it [paper] completely out of business for eight days.” And since there was no help in the office, the North East publication missed an issue, the first time in 36 years 2
In Elkton, all the operators at the telephone exchange were seriously ill, so the phone company brought in operators from Salisbury 3. A similar situation existed in North East, the virus sweeping the office there, causing the exchange to shut down.
As the Spanish Flu hit, a Wilmington newspaper reported that Elkton’s dead were without coffins. Source: Evening Journal, Oct. 16, 1918
As September faded into October, the situation was “exceedingly grave,” with numerous deaths occurring. “One of the distressing features of the epidemic was that so many deaths occurred throughout the county that it had been impossible for undertakers to secure caskets from the supply houses on time,” so funerals were delayed. In other instances, undertakers called on local carpenters to make caskets 4. At the West Nottingham Cemetery, Eli Coulson, the superintendent, reported that he had opened three graves daily for the past two weeks.
Spanish Flu Shutdown Cecil County
As this was going on, the Cecil County Board of Health took action to quarantine the virus. Dr. H. Arthur Cantwell, the public health officer, ordered that all schools, churches, moving picture theatres, and places of public gathering be closed starting on October 2, 1918. He also banned public funerals. Emphasizing the importance of the action Hugh W. Caldwell, Superintendent of Schools added that it was the hope that this action would check the spread of the Spanish Influenza.
Toward the end of October, the suffering and deaths declined. And on October 27, the Cecil County Board of Health lifted the ban on public assembly, announcing that church services could resume for the first time in several weeks. With things returning to normal, Cecil County Schools Superintendent Caldwell added that schools would reopen on Monday, October. 28. He ordered the principals to secure formaldehyde for the schools, or if they couldn’t do that, they should open up the buildings to admit sunlight and air for several days.
All schools, churches, moving picture theatres and public gatherings were ordered closed. Source: Midland Journal, Oct. 2, 1918, via Library of Congress Online Newspapers.
Notes:
Over the next week, we will share a few more items on how Cecil County coped with the pandemic of 1918
We will also compile a tabulation of those killed in Cecil County to develop a better idea of the impact of the virus. This will include a list of those that died during the pandemic.
