Prevent Influenza

 Influenza in Miami County and the world

With biographies of Martha Ann Brooks and Anna Otiker

 “Spanish Influenza is rampant in the United States and, according to the statements given out by the public press, it has now reached practically every state in the union.  Never within the recollection of people living today has there been an epidemic so widespread or so disastrous in its results.”  The American Journal Of Nursing, November 1918, Vol XIX, No.2 p.83


   Spanish Influenza was sudden and horrifying. A typical victim would be between the ages of twenty and forty.  They felt fine as they started their day in the morning.  Heading out to their job, whistling while they approached the workplace.   A sudden high fever would appear, along with what seemed like cold symptoms.  They would feel their sinuses begin to itch and progress into a stuffy nose and they would begin to feel their body ache. Then nausea would appear and they would be horrified as they tasted the vomit erupting from their throats and experienced the incontinence of loose and foul-smelling stools.  Hemorrhaging would begin from their eyes, ears, nose, and mouth and soon they would develop pneumonia with their lungs filling up with fluid.  They would turn blue and then black as they struggled for air while their breathing was ineffective because they were drowning with the fluid filling their lungs.  Death would come and steal them away by dusk.  Left behind were wives, or husbands, or sweethearts.  Children were abandoned as death took away their parents.   Funeral parlors were overwhelmed and bodies piled up.  Cities ran out of caskets.  It was 1918 and the deadliest communicable disease of the twentieth century was a raging killer.  The Spanish Influenza did not target the very young and the very old like most flu.  Young adults with the strongest immune systems had the highest death rate. As a result, it left in its wake a population of orphans. The disease is believed to have caused an overreaction of the body’s immune system which caused the lungs to fill with white blood cells and smother the victim. Twenty-five million Americans got the flu. The Smithsonian Institute estimates that 670,000 of these people died from it.  How did this epidemic affect WWI and what happened when it reached the sleepy little communities located within Miami County Indiana?

     More United States soldiers died from the flu than were killed in battle. Influenza was the leading cause of Army hospitalizations for both officers and enlisted men.  It was the leading cause of death for US Army troops as over 23,000 Army soldiers’ deaths were the result of the Spanish Flu.   It is ironic that half of the number of deaths of our Army soldiers during a war was actually from a communicable disease.  Hind sight tells us that the first confirmed case was in Fort Riley, Kansas in March of 1918, but the American Journal Of Nursing reported at the time that the epidemic began in New England at a military camp named Camp Devans near Boston and spread down the Atlantic seaboard. The flu then made its way westward not stopping till it reached the Pacific coast.  This was actually the second wave of the flu and it took a mere eight weeks to sweep through the country in September and October of 1918.

      While it was prevalent in military training camps, civilians were also stricken.  On October 1, 1918, the United States surgeon general decided the flu warranted a national response so he contacted the Red Cross to request it provide nurses and emergency supplies wherever needed.   When the US entered World War I in April 1917, President Woodrow Wilson assembled a War Council of business and government leaders to take charge of the American Red Cross. Wilson's action violated the American Red Cross charter's provisions for organizational governance but was in keeping with his policy of instituting temporary government control of railroads and agriculture to mobilize resources to win the war. The War Council quickly revamped the organization and recruited eight million female volunteers through the registering of nurses in the Reserve Home Defense of Nurses.  These reserve home defense nurses were utilized during the high needs of the influenza pandemic. While The Red Cross response occurred mostly on local levels and effectiveness varied between locations, they did the following:

  • Supplied two million dollars in equipment and medical supplies to hospitals.
  • Established kitchens to feed flu sufferers and houses for convalescence.
  • Transported people, bodies, and supplies.
  • Recruited more than 18,000 nurses and volunteers to serve alongside Public Health Service workers and local health authorities.
  • Distributed pamphlets and circulars on how to care for flu victims and flu prevention.
  • Directed its chapters to form influenza committees to work with local and regional health authorities and Red Cross Divisions.

     First demands for nurses came from military camps and then the requests began to come from civilian hospitals.  As hospitals overflowed the public health nurses and visiting nurses assumed the main responsibility for providing care.  The cities, with their ghettos of immigrants, became Petri dishes of flu.  Nurses visited tenement houses that were overcrowded and they visited row houses full of sickness.  Away from the cities, the nurses called on farmhouses, log cabins and mountain shacks which were all filled with families stricken with flu.  They changed bed linens, bathed patients, and assessed the sick as they took temperatures, counted pulses and listened to lungs.   Nurses fed the ill soups and other liquid nourishment.  Sometimes under the direction of a doctor, but other times relying on their own experience and knowledge, they made do with what they had on hand.  Ice packs reduced fever.  By applying mustard plasters and administering cough syrups they attempted to open airways.   They stepped into the role of educators as they taught families about basic hygiene, explaining to people the importance of covering their mouths during coughs and spitting into handkerchiefs.  They told them how they must boil soiled linens and open their windows to allow fresh air to enter their homes.  And when a family lost a loved one, it was the nurses that gave comfort to those that were left behind while washing and preparing the dead body for removal.

“The patient’s nose and throat discharges should be received only in material that can be burned, like old muslin, gauze or paper napkins.  As soon as they are soiled these handkerchief substitutes should be placed in strong paper bags and afterward burned,” ~ American Red Cross Textbook on Home Hygiene and Care of the Sick by Jane A Delano, RN


      In no other epidemic was the mortality of nurses so great and did so many nurses become ill.  Many nurses died from the flu because of exposure and the fact that the nurses were extremely fatigued from caring for so many patients.  To prevent this exposure gauze face masks were created.   They were a stitched mask with four strings.  Nurses carried one bag for fresh masks and one bag for soiled bags. Masks had to be boiled and dried at the end of each day.  Each nurse had about sixteen masks.  As time went on because so many nurses became sick disposable masks were made of six layers of folded gauze and the isolation garb was advanced from crepe aprons to long sleeved “all over” gowns.  In the civilian population, home care nurses wore gowns over their clothes that were left in the homes of the sick for re-use.  But soon the visiting nurses ran out of them and had to use long sleeved aprons carried outside the homes wrapped in newspaper.  The nurses did not place these aprons in their nursing bags.

“The Call is for anyone who has a pair of hands and is willing to help where the need is greatest,”  ~ American Journal Of Nursing, November 1918.

       By December 1918, the American Red Cross, with such a dire need for nurses, began to send nurses they had chosen not to select earlier, which included black nurses and married women, out into the communities and into influenza-ridden military camps. Most nursing school trained graduate nurses were overseas caring for soldiers in war-torn areas, which resulted in married women who had stopped nursing re-entering the field and retired nurses stepping back into their uniforms.   All types of women volunteered as nurses and aides during WWI.  Most were single but many married women with children also volunteered as time passed and the need increased.  Most of the women were age 25-35 but some younger women and some older women stepped forward as well.

       As a result of the nursing shortage during WWI, the position of the nurse aide was created. Thousands of women had been trained to help using a curriculum titled “Home Hygiene and Care of the Sick” offered by the Red Cross.  It had been created because, since the knowledge of germs had only been discovered a couple of generations ago, many people were still ignorant about how to prevent the spread of infection.  When the women were taking the Red Cross course they believed they were obtaining skills to be used in their homes to care for family members.  However, because so many of the nurses were overseas the need became so great they were called into war work to assist the nurses in the military hospitals.  They were used as nurses’ aides during the flu epidemic.   The course was offered more frequently and in the twenty months prior to February 28, 1919, over 5,000 classes were held by The Red Cross in “Home Hygiene and Care of the Sick” during which 80,000 students were enrolled and over 60,000 certified upon the completion of the courses.

       On the bottom of page five of “The History of the Miami County Chapter American Red Cross Peru, Indiana” the following is found;

 “Nurses Survey:  The nurse's enrollment was taken up by the Council of Defense.  In September 1918, this department was turned over to the Red Cross, but as the work had been practically completed, there was no record kept simply a cleaning up of the general work which was done by the vice-chairman.  During the influenza epidemic, two nurses were sent out through the influence of the Miami County Chapter, namely Miss Martha Ann Brooks and Miss Anna Otiker.”

Who were Martha Ann and Anna, what did they do, and what became of them?

   During the fall of 1918 newspapers were printing statements from The Red Cross urging nurses to come forward to serve flu-stricken areas.  The mining communities of Kentucky and Ohio were hit even worse than most areas.  Some nurses were needed to travel to hard-hit communities but nurses were urged to remain in place until sent to another area by the Red Cross.  The Red Cross declared caring for flu victims as war work.  Women were also sent to Army camps.  Since the flu was spread by air droplet when an infected person sneezes or coughs, the close quarters of the military bases coupled with the worldwide travel taking place during WWI caused the flu to become prevalent in the army camps.  Anna and Martha Ann were likely sent to an army camp in the Midwest.   But in spite of correspondence with Camp Benjamin Harrison, Camp Sherman, Camp Taylor and Camp Grant, where they served and what they did has not been discovered.  In fact, no nurses by the names of Anna Otiker or Martha Ann Brooks were discovered in the Miami County records.   It is likely that the two women were nurse aides trained in the “Home Hygiene and Care of the Sick” course and certified by the Red Cross.

“I saw hundreds of young stalwart men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood,” ~Dr. Victor Vaughan acting Surgeon General of the Army upon visiting Camp Devens near Boston; Early September 1918.

     Anna Otiker was born in Ohio in 1862 to a Swedish immigrant father and an Irish immigrant mother.  Her father, Henry H. Otiker, was a farmer who served in the Civil War. By 1870 the family, consisting of Anna, her father and mother along with her sister Sophia and brother Henry ,was living in Miami County on a farm in Richland Township.   In 1874 her father was elected to the school board.   In 1880 the family had expanded to add sisters Elizabeth, Margaret and Zoe along with brothers Alexander and Ralph.  They lived in Paw Paw which, although prosperous in the late 1840s, would have been a mere ghost town by 1880.  After spending time as a substitute mail carrier and a dry goods store clerk, Anna settled down into the skill set of a dressmaker by 1920.   She grew up as a childhood friend of Indiana author Ross Lockridge, Sr. They exchanged letters throughout their lives, and in fact, he sent her a beautiful lavender silk scarf from Paris.  Anna died in 1951 at Logansport Hospital from complications of arteriosclerotic heart disease.  She had been in the hospital three years due to Cerebral Arteriosclerosis.  She was buried in Paw Paw Cemetery in Peru Indiana. 

No “Miss” Martha Ann Brooks could be discovered in the 1918-time frame in Miami County, Indiana.  There was one Martha Ann with Brooks as her maiden name who was married long before 1918 and would have no longer gone by that surname after marriage.  There was also a “Mrs.” Brooks whose given name was Martha Ann.  She is a likely candidate as she is in the same age range as Anna Otiker.   There may have been a typo in the Red Cross report and “Miss” inadvertently typed instead of “Mrs.”.    For this reason, Mrs. Frank Ellsworth Brooks was dubbed by this writer as “candidate one” but the identity of the Miss Martha Ann Brooks remains unconfirmed.   Nevertheless, Miami County resident, Martha Ann Moeck was born in 1862 in Prussia and came to the United States when she was eleven.  By 1880 the Moeck family was living in Peru, Indiana.  Martha Ann’s father’s name was Albert and her mother’s name was Minnie.   Her three brothers, Gustave, George, and Franklin were living with them.   Her father was a wagon maker.  In 1909 she married a man 12 years her junior.  He was a widower with three small sons.  Her husband, Frank Ellsworth Brooks was employed by the railroad.   After her marriage, Martha Ann often used the first letter of her maiden name as her middle initial.   She died in 1943 of cancer and is buried in the Lutheran Cemetery in Peru, Indiana.   One problem with her being the person who served as a nurse during the flu is that of her German origin.  She may not have been trusted in the military camps of the day due to her German heritage. 

“Today we serve best by preventing sickness. Cure of sickness and alleviation of suffering must never be neglected; not in cure, however, but in prevention lies the hope of modern sanitary science, of modern medicine and of modern nursing.”

~ American Red Cross Textbook on Home Hygiene and Care of the Sick by Jane A Delano, RN page 11, 12

     In the Midwest, The Red Cross supplied more than a quarter of a million dollars’ worth of hospital supply items to bases Benjamin Harrison, Sherman and Taylor to care for soldiers with flu and resulting pneumonia. The capacity for patients of these three bases was 4,290, however they had 16,167 cases of flu and pneumonia to care for at one point during the epidemic.  The Red Cross sent 11,000 bed sheets, 11,000 towels, 13,100 pillowcases, 8,000 pajamas, 2,500 pill cups, 7,000 wash clothes, 4,500 handkerchiefs, 25,000 paper cups, and 50,000 masks.   Also, medicines and medical supplies were sent as needed.    The Red Cross also fed and housed 400 people daily who were grief-stricken relatives of critically ill soldiers.  Newspaper articles in the fall of 1918 gave hints for flu care which had been issued by the Indiana State Board of Health:

“If one feels a sudden chill followed by a headache, backache, muscular pain, fatigue, and fever GO TO BED AT ONCE.  Make sure to have enough bed covers to stay warm.  Open all windows in the bedroom except during rainy weather.  Take medicine to open bowels freely.   Consume nourishing food every four hours (eggs, egg and milk, or broth) Stay in bed till the physician says it is safe to get up.  Allow no one else to sleep in the same room.  Protect others by sneezing or coughing into a handkerchief which should be boiled or burned.  Have anyone taking care of you wear a mask.”

Articles went on to explain directions for making a mask:

“Masks are to be made from four to six folds of gauze and should cover the nose and mouth and tie behind the head.  The masks must be kept clean and put on outside the sick room.  They must be boiled 30 minutes every time after taking off.”

     State officials urged people to avoid crowds in the same way one would avoid a bad smell.  They implored citizens to cover their mouth with a handkerchief when coughing or sneezing.   Spitting was forbidden and all sputum was to be carefully handled.   All public meetings including church were to be avoided.  In November of 1918 many deaths in Indianapolis were reported with schools closing their doors and people were mandated to wear masks in public places. 

“I had a little bird, his name was Enza.  I opened the window and influenza!” ~ children’s playground song circa 1918

    On the twenty-fifth of September in 1918 the local paper announced that the Spanish Flu had reached Peru, Indiana.  It could not be determined whether travelers brought the flu to Miami County or the weather should be blamed because the symptoms were much like a bad cold that kept holding on. Nevertheless, by this date, there were a number of cases that doctors had diagnosed as Spanish Flu and both doctors and pharmacists were very busy. 

     By October seventh, Peru and Miami County schools, churches, theaters and moving picture shows were ordered closed.  
A ban was placed on all public gatherings by the County Health Department after receiving notice from the State of Indiana who in turn received their directive from the National level. Almost every city and town in the country received the same directions. The tone of the newspaper coverage changed on October eleventh when they issued a serious warning.  Several thousand cases of flu were reported in Indiana and several hundred deaths had occurred. The paper explained that infection was spread by oral and nasal secretions and the person who coughed, sneezed or spit were dangerous.  The only meetings or gatherings allowed were to be Red Cross or Liberty Loan in nature.  Outdoor activities and outside sporting activities were allowed. All people with colds were to stay at home because the symptoms of colds were similar to the symptoms of the flu.  The next day the county health officer in Miami County ordered all homes with flu or suspected flu to be flagged in order to attempt to contain the disease. This direction also came from the State which ordered Quarantine Placards be placed on all houses that have people in them with flu.  There were ninety cases of flu in Miami County not including cases in towns.  Two days later it was learned that the Robinson Circus had settled into winter over with the Wallace Winter Quarters.  Normally they would be doing shows in the warmer southern areas but were not doing so this year due to the southern states being so hard hit with influenza.  Health authorities had shut down the gatherings of people for the circus shows.  By the end of October five hundred cases of Influenza were reported in Miami County with one hundred being in Peru.  This was much milder than many communities were experiencing.   People were admonished that this was due to county health regulations and precautions, therefore it was important to continue to follow these rules.  Four people had died in Peru and an additional fourteen deaths had occurred from flu throughout the county.  A number of additional deaths had occurred from pneumonia which developed after the flu.  Four of the deaths from secondary pneumonia were circus employees.  County Farm deaths were not reported to county health officials.  People were again reminded not to congregate in pool halls or cigar rooms. Schools, movie picture shows, theaters, churches were all banned.  On the last day of October, the paper reported that while the quarantine was not yet raised it was expected to be over soon.

     On the ninth of November, Denver and Mexico schools in Jefferson township re-opened after being closed for four weeks due to flu.  But by the twentieth, it was noted that after lifting the bans for two weeks 175 more cases of flu were reported in Peru.   And by the twenty-third, the influenza epidemic was reported to be increasing in Peru and Miami County.  People were urged again to avoid crowds and postpone meetings as thirty-six new cases of flu had been reported in twenty-four hours.  Two hundred cases had erupted in November with a total of six deaths in the city of Peru since the first of November.    People were encouraged to stay out of dimly lit, poorly ventilated public places and to let plenty of fresh air into the living and sleeping rooms in their homes at all times.  In fact, the city of Peru was placed under quarantine by order of the Board of Health.  It was reported on the twenty-seventh that eight members of one family had the flu.  This unfortunate family had nine family members and their 17-year-old son was hospitalized.  Only the mother had remained healthy. On the last day of November, Amboy reported worsening flu.  Schools had not been banned but many students were absent due to either being ill or afraid to attend due to the epidemic.  Several new cases of flu were being reported on a daily basis. Mexico public school and orphans school were closed as were Chili, Gilead, Akron and Roann Schools.   They were expected to remain closed for one week.

      In the middle of December, it was reported that the November death rate of flu or secondary pneumonia as a result of the flu was fifteen for November 1918.  This did not include deaths at Wabash Railroad Employees Hospital.  The situation in Peru was not as serious as earlier in the fall but people were urged to continue to take precautions throughout the entire winter.  The disease was not expected to run its course until spring.   People were reassured by the third week December that Miami County was not as hard hit as the surrounding counties but cautioned that new cases continued to develop daily and precautions were to be maintained by all.  By the end of the month, the paper was reporting that only two new cases of flu had appeared that week and both were in homes that already had cases of the disease. No new homes were stricken with the disease.

“It cannot be too strongly emphasized that the chief agent in the spread of human disease is man himself.  And the human hand is the great carrier of disease germs both to and from the body.”    ~ American Red Cross Textbook on Home Hygiene and Care of the Sick by Jane A Delano, RN page 19

   The Spanish Influenza of 1918 had a major impact on the outcome of WWI.  Not only did many soldiers die from the disease, but President Wilson is believed to have been ill with the flu when the Treaty of Versailles was negotiated and therefore less able to negotiate what he believed to be a fair treaty for all parties.  The flu also left many orphans to grow up without intact family units, and left no choice except for many young women to remain single throughout their lives due to the lack of young men left alive in their age group.  But an even more significant result of the flu epidemic that fateful fall was the revelation that most people did not understand personal and family hygiene.  This resulted in an increase in education of the general public on how germs are spread.  In the long run, Americans improved their overall health and lengthened their lives as a result of this horrible disease.  The medical community rallied to gain a better understanding of how the flu works.  They also learned more about immunity, bacteria, and viruses because of this epidemic.  Therefore, out of this tragic loss of life grew progress from which society continues to benefit.

Use a handkerchief

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Article written and submitted by: Mary Rohrer Dexter

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