The 1918 influenza epidemic hit Pittsburgh hard, giving the city the highest “Spanish flu” death rate in the nation. According to the Proceedings of the National Academy of Sciences, Pittsburgh had an estimated 861 flu-related deaths per 100,000 people in the general population between Sept. 14, 1918, and May 31, 1919.

The flu virus first appeared in the U.S. at Fort Riley, Kan., in March 1918. A more deadly wave arrived in the country in the second half of August, spreading like flames through crowded army barracks of World War I soldiers.

By Oct. 4, the disease had reached Pittsburgh’s temporary army barracks on the Oakland campuses of the University of Pittsburgh and what is now Carnegie Mellon University, with one soldier (Charles N. Patterson, 29, of Aspinwall) dead, another dying and a third in serious condition. Military authorities took over part of Magee Hospital to handle the volume of flu cases they anticipated.

By the next day, the whole city was under quarantine. State officials ordered bars and entertainment venues closed, including the county’s 1,400 saloons and Pittsburgh’s 165 cinemas. By Oct. 15, the city had 4,291 cases.

On Oct. 23, Pittsburgh officials ordered all schools, public and private, to close, and they told children to “keep off the streets.” Houses of worship were closed, and sporting events, from high school to college, canceled. Halloween was scrapped.

McKeesport passed the most stringent antivirus rules of the region, including a requirement that all homeowners open every bedroom window for three hours every day to air out houses.

But the sickness spread rapidly. In one 18-hour period alone, 4 p.m. Oct. 17 to 10 a.m. Oct. 18, Pittsburgh reported 746 new cases of the flu.

An examination of reports in Pittsburgh newspapers between April 5, 1918, and Nov. 15, 1919, offers some insight into how Pittsburgh was affected by that deadly flu virus and how people responded. Many of these responses will sound familiar to those living through the COVID-19 pandemic.

The 1918 virus’s exact origins are unknown. News reports about it came at first from Spain, leading to the nickname “the Spanish flu,” although the Spanish called it “the French flu.”

In its most virulent form, it damaged the lungs, allowing bacterial pneumonia to set in quickly, causing mucous membranes in the nose, stomach and intestines to hemorrhage. Victims’ faces would discolor, and their lungs would fill with fluid until they literally were “drowning in their own blood,” as a January 2003 article in PittMed put it. Death could come within hours or days.

Cities responded differently to the epidemic, with some, like St. Louis, recommending that people stay home, rest and avoid drinking alcoholic beverages, and others, like Philadelphia, going ahead with large public gatherings. Philadelphia held a war bond parade attracting some 200,000 people, causing a surge in virus cases.

Some cities — although not Pittsburgh — mandated the wearing of masks.

Six of Pittsburgh’s 12 ambulances, serving a population of between 534,000 and 580,000, broke down because they were used so much that no one had time to repair them. Meanwhile, emergency calls were coming in “hour by hour, from every corner of the city,” according to the Pittsburgh Daily Post.

Washington Park, Lower Hill District, 1903-1906. (Historic Pittsburgh)

The U.S. Marine Hospital in Arsenal Park, Lawrenceville, 1910. (Historic Pittsburgh)

The local hospitals overflowed. Makeshift hospitals with tents and cots were set up all over:

• Room for 300 patients in Washington Park and recreation center in the Hill District (roughly where the Pittsburgh Scout Shop is now), although the outdoor tents might not have offered much respite from temperatures that dipped into the 40s.
• 100 to 150 beds (figures vary) at the Kingsley House social services center at Fulton Street and Bedford Avenue in the Hill District (now part of the property on which PPG Paints Arena stands).
• 300 beds at the Allegheny County Courthouse annex on Ross Street, Downtown.
• The U.S. Marine Hospital at Penn Avenue and 40th Street (then part of Arsenal Park), Lawrenceville.
• Up to 100 cots at the Concordia Jewish social club in Oakland (now the University of Pittsburgh’s O’Hara Student Center).

The Hays borough building in what is now the Hays neighborhood of Pittsburgh was turned into a hospital with 35 beds.

Sewickley Valley schools and churches were turned into hospitals, as was the Edgewood public school auditorium. Westinghouse Electric employees helped build an emergency hospital in Turtle Creek within 40 hours.

Facial tissue had not yet been invented; the federal government urged people to cough and sneeze into handkerchiefs and not to spit. New York City imposed a $2 fine for each spitting incident.

Ads in local newspapers touted “cures.” These included “beaver oil,” “Bulgarian blood tea,” sarsaparilla and snake oil (that was the actual name). These advertisements appeared in the same font as regular news articles with no disclaimer, so they were often hard to distinguish from genuine news stories.

Medicated, tobaccoless cigarettes are the cure for the Spanish flu, according to this advertisement in The Pittsburgh Press, Oct. 24, 1918, page 5. (Post-Gazette archives)

An advertisement in The Pittsburgh Press, Nov. 3, 1918, page 39, touts “snake oil’ to cure the flu. (Post-Gazette archives)

Other local newspaper ads touted Vick’s VapoRub — still being sold today — or tobaccoless cigarettes to fight the scourge. Advertisements for facial veils appeared, costing between $1 and $2.98 each.

Streetcar employees used watering cans of disinfectant to sprinkle the aisles of the cars and even soak the legs of seated riders in careless efforts to disinfect between rows of seats. Streetcar windows were supposed to be open in all but the heaviest rains. Even in that case, state health officials said that if the windows were closed, then the motorman’s door and the conductor’s door had to be open on every car.

The acting surgeon general of the army published a list of do’s and don’ts for the flu. These included “smother your coughs and sneezes,” “don’t let the waste products of digestion accumulate — drink a glass or two of water on getting up,” chew food well, wear loose clothing and “when the air is pure, breathe all you can — breathe deeply.”

It was not uncommon for both parents in a family to die from the deadly flu, leaving orphans. The state government tried to tally and take care of the children. On Dec. 18, Pennsylvania officials said the virus had orphaned at least 45,000 children in the state and left thousands more with only one parent.

Flu decimates a North Side family, as reported in The Pittsburgh Press, Oct. 31, 1918, page 18. (Post-Gazette archives)

In Pittsburgh, a North Side millworker, 43, his wife, 42, and 3-year-old daughter died in less than a week, leaving two sons, 6 and 12, in the hospital and three other children in the care of an aunt.

The Rosalia Foundling Asylum at Cliff and Manilla streets in the Hill District appealed to the public to adopt Babette Mignon, whose mother had died of the flu when the baby was 6 months old and whose father couldn’t be found. “She has been pronounced by the custodians of the home as one of the most beautiful children ever sheltered there,” according to a page 2 story in Pittsburgh’s Gazette-Times, a forerunner to the Post-Gazette.

In Altoona, a man, his wife and her brother comprising the whole family died within a week. In Juniata, now part of Altoona, a husband died on a Friday, his wife the following Sunday, and their 6-year-old daughter was still sick. Also in Altoona, a man and two of his sons died within three days while his wife, a daughter and another son lay ill.

A 12-year-old seriously ill with the disease wandered in a daze from his Hill District home to 17th Street and Penn Avenue in the Strip District, where a patrolman found him and sent him to St. Francis Hospital in Lawrenceville, where UPMC Children’s Hospital is now.

The Rosalia Foundling Asylum in the Hill District tries to find a guardian for a baby orphaned by the flu, as reported in the Gazette Times, Nov. 15, 1918, page 2. (Post-Gazette archives)

A Dec. 18, 1918, article in The Pittsburgh Press, Dec. 18, 1918, page 18, cites the number of Pennsylvania children orphaned by the flu. (Post-Gazette archives)

The divorce of a McKean couple was not granted because the husband had to prove his wife had deserted him, but all the witnesses were unavailable: One died in World War I, one was serving in the army, and the two others had died of the flu. At the time, Pennsylvania only allowed divorce in cases where one person was at fault, which required witness statements and other proof.

A police officer found a 12-year-old wandering around Downtown in a daze from illness, according to this page 6 item of the Oct. 27, 1918, Pittsburgh Post. (Post-Gazette archives)

The (Harrisburg) Evening News reported a shortage of coffins on Oct. 23, 1918, page 1. (Newspapers.com)

A Homestead man believed to be mentally damaged by the flu shot and killed himself.

In Harrisburg, a railroad conductor, 34, died while his wife was giving birth to twins. The babies died less than two hours later. The mother lay in critical condition, knowing that the infants were dead but asking for her husband, whose death doctors were trying to keep from her. The couple had three other children, ages 6, 8 and 10.

A man and his newborn twins die within moments of each other, according to this page 1 article in the Oct. 17, 1918, (Harrisburg) Evening News.

Deaths came so quickly that communities ran out of coffins. A hundred had to be rushed to Wheeling, W.Va. Harrisburg undertakers said they were holding bodies for up to eight days waiting for coffins and that they might have to start using wooden boxes or sheets.

There was such a shortage of gravediggers that one man in Harrisburg had to dig his own wife’s grave so the funeral could take place at the scheduled time. In Tioga County, 11 baby flu victims were buried in a mass grave.

The virus spared no one, especially people between the ages of 20 and 40. This pattern is not well understood. Usually, flu viruses tend to kill the very young and the very old.

The Allegheny County jail warden fell critically ill. Eight Pittsburgh public school teachers died. On one newspaper page, more than two columns of small type listed all the professional athletes the epidemic had killed. In one instance, about 20 firefighters from three companies in the same building on Eighth Street were out with the virus, leaving just one captain to handle the day shift.

Western Pennsylvania doctors and nurses left the region to tend the afflicted in Boston and Philadelphia or wherever they were needed. These front-line workers suffered with their patients. Two young nurses from Mount Oliver and Johnstown fell ill while working at the former Columbia Hospital in Wilkinsburg and later died. The hospital, at Penn Avenue between West Street and South Tremont Avenue, is now the Pennwood Nursing and Rehabilitation Center.

At least 10 saloon keepers and six churches defied the city lockdown. The city on Oct. 16, 1918, sent notices to each of them, warning the saloon keepers that they would lose their liquor licenses if they didn’t comply.

Edward V. Babcock, a building supply salesman, served as Pittsburgh’s mayor from 1918 to 1922. (City of Pittsburgh)

After a month of the shutdown, the state health commissioner recommended lifting it on Nov. 9.

But on Nov. 2, Pittsburgh’s Mayor Edward V. Babcock issued a proclamation saying that city officials would no longer enforce the closings.

“[T]his ban has thrown over the community a depression and a pall that seriously retards the recovery to normal conditions …,” the proclamation read in part.

He said that small Pittsburgh businesses needed to go back to work and that other big cities had already lifted their bans. He also said that shutting down might not have done any good, because New York City had many fewer cases of the disease than Pittsburgh and it had not instituted a lockdown.

State officials sue Pittsburgh theater managers and bar owners who defied the state shutdown, according to the Pittsburgh Post, Nov. 5, 1918, page 1. (Post-Gazette archives)

In response, the Pennsylvania acting health commissioner, Benjamin Franklin Royer, said in a telegram that the proclamation sounded like the mayor was inviting “lawlessness and disorder.”

Later, Royer said, “A number of reckless wholesale and retail liquor dealers and some small business interests are putting dollars above human life. … Big business can well stand additional financial loss, and must stand it, if we are to continue getting volunteer help for the sick.”

He said the lockdown wouldn’t be lifted until the city had fewer than 100 cases per day.

The U.S. surgeon general even weighed in, urging Pittsburghers to follow the state’s restrictions.

Royer made it clear he would prosecute any saloon keepers who violated the shutdown, and few defied him. However, all the cinemas and theaters opened on Nov. 5, Election Day, and state officials moved in quickly — giving citations to 25 theater and cinema houses, one dancing academy and two cafes. The next day, state officials filed charges against another 30 motion picture houses, five theaters, two saloons, two dance halls and five billiard halls.

Royer lifted the ban at noon on Nov. 9 as scheduled. The city was still reporting more than 100 cases on some days, but the disease was clearly in retreat.

Pittsburgh schools gradually reopened between Nov. 11 and 18, even though Nov. 13 saw 257 new cases.

In spite of the pandemic, the city held a massive parade on Nov. 11 to celebrate the World War I armistice, with the mayor at the helm. The parade started at the Mon Wharf, then went down Grant Street to Fifth Avenue, down Fifth, swung onto Liberty Avenue, then onto Sixth Street and across the Sixth Street Bridge into the North Side. Crowd estimates were vague, citing “thousands,” but people fainted from the crush, and the din from cheers and banging on tin cans were such that speeches were not even attempted.

On Dec. 5, 1918, The Pittsburgh Press reported that the virus was on the wane: “Only” 24 people had died in one day from the virus or its complications (the Pittsburgh Post said 34 deaths).

The virus petered out in 1919 as people developed immunity or died.

The U.S. death toll was counted at about 675,000 in a national population of 103 million (655 deaths per 100,000 people in the population). Pittsburgh’s flu deaths are estimated to have been 4,500 to 6,000 in a population of between 534,000 and 588,000, or between 842 and 1,020 per 100,000 people in the population.

For context, U.S. COVID-19 deaths so far are about 196,000 in a national population of 331 million (59.2 per 100,000), and Allegheny County’s tally as of Sept. 16 was 363 in a county population of 1.2 million (30.3 per 100,000).

With no understanding of viruses, medical scientists of 1918 proposed crude, ineffective treatments for the flu, like this one reported in The Pittsburgh Press, Oct. 28, 1918, page 9. (Post-Gazette archives)

Today, there are antibiotics to ward off and treat opportunistic bacterial infections that may appear in the wake of viral illness. In the 1918 pandemic, there were no antibiotics, and people often died of pneumonia rather than directly from the flu virus.

Health workers now have a better understanding of viruses and how to test for them, although the highly infectious COVID-19 has no known cure and there is no vaccine to ward it off yet. It is not clear whether having the disease grants immunity from future bouts of it, something that researchers are trying to determine.

In 1918, medical science had not discovered viruses and, therefore, couldn’t test for them. Health workers frequently misdiagnosed the exact type of illness that the Spanish flu was, leading to ineffective treatments.

By 1919, an avalanche of major events in the United States — the end of World War I, deadly mob attacks on Black communities, anarchist bombings, a Constitutional amendment outlawing the sale and distribution of alcoholic beverages, a Constitutional amendment giving women the right to vote, major labor strikes and panic over the spread of communism — pushed the epidemic from the headlines, and it faded from the national consciousness.

Laura Malt Schneiderman: 412-263-1923, lschneiderman@post-gazette.com.