Tag: spanish flu

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COVID-19 Cases in Cecil County Compared to Influenza Pandemic of 1918-19

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

total deaths cecil county
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.

Measure1918-192020-Present
Excess Deaths186TBD
Virus-Related163259
Total Deaths902TBD
Virus-Related Death Rate pre/10007.082.49
County Population23,009103,905
Estimate of Key Death Metric Comparing COVID-19 with the influenza pandemic of 1918-19
Endnotes
  1. Cecil County Reports First Coronavrius Death, Delaware Business Journal, April 1, 2020[↩]
  2. U.S. Census Bureau, Population Estimate[↩]
  3. Deaths, Cecil Democrat, September 28, 1918[↩]
  4. 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[↩]
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Women Were the Caregivers During the Spanish Flu Pandemic of 1918

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

These young women made up the first nursing school class at Union Hospital.
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
Union Hospital School of Nursing Class of 1918 during the Spanish Flu
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. 

For more see

Not the First Time Cecil County was Shut Down

Salem County Shut Down During Flu Epidemic of 1918

Upcoming Articles

Part II – Cecil County Practitioners on the Front Line.

Part III — The Fallen Nurses

Union Hospital graduates of the school of nursing in 1914
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
  1. 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/.[↩]
  2. “Tenth Annual Report of the Union Hospital of Cecil County.” Vol. 10. Elkton: Union Hospital, 1918.[↩]
  3. National Campaign Ordered, Capital Gazette: Annapolis, Oct. 15, 1918.[↩]
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Not the First Time Cecil County was Shut Down

This isn’t the first time that Cecil County has been shut down by a pandemic. In the autumn of 1918, a deadly virus, the so-called Spanish Flu, swept across the nation. As this grim situation unfolded 102-years ago, many public health officials advised that the spread of the disease called for drastic action, a general shut down. In voicing these professional judgments, the medical men added that only critical wartime work should go on, while other activities should cease for not less than ten days to minimize the possibility of further contagion.

This halt of business, they added, would give exhausted physicians fighting the deadly infection a chance to catch up with the overtaxing situation while better managing care for the sick.

These measures seemed extreme to many, the statements of public health officers being greeted with skepticism. The doctors countered that since so many people were being brought down by influenza that most activity would cease anyway due to community spread.

As the number of cases increased daily, Cecil County’s Public Health Officer, Dr. H. Arthur Cantwell, took decisive action to quarantine the virus, hoping to stamp out the germs spread. On October 2, 1918, the local Board of Health ordered all places where people assembled 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, he also banned public funerals. Emphasizing the importance of this action, Hugh W. Caldwell, Superintendent of Schools, added that this action would check the spread of the Spanish Influenza.

the spanish flu
A message from the U.S. Dept. of Health in 1918 (National Institutes of Health)

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. All across the county, meetings or assemblies were called off as places closed their doors to visitors. And as a new week got underway, Cecil County residents adjusted to the new normal and there was good cooperation, as public assemblies stopped and many business owners became gravely sick.

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 officers 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 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 completely air out the buildings. To a significant degree, Cecil County activity stopped or slowed for 25 days, but the people adjusted.

In some ways, the events we are living through during the pandemic of 2020 mirror the public interventions instituted here in the autumn of 1918 when the Spanish Flu struck hard. Today as our nation’s public health officials try to slow the spread of the coronavirus, we hear about quarantines, social distancing, sheltering-in-place, warnings not to gather in groups, and the shuttering of non-essential activities. While we may use different terms, these public health concepts were familiar to physicians in 1918 as the words and actions of these practitioners from different ages have the same goals.

To prevent the Influenza. (U.S. Public Health Service, via the National Institutes of Health)
For more on the Spanish Flu see

Cecil Grappled with the Spanish Influenza of 1918

Influenza Precautions Then and Now