Citation
War and disease : the politics of public health in the state of Utah during the 1918-1919 influenza pandemic

Material Information

Title:
War and disease : the politics of public health in the state of Utah during the 1918-1919 influenza pandemic
Creator:
Dubois, Janet Cannon
Place of Publication:
Denver, CO
Publisher:
University of Colorado Denver
Publication Date:
Language:
English

Thesis/Dissertation Information

Degree:
Master's ( Master of arts)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
College of Liberal Arts and Sciences, CU Denver
Degree Disciplines:
History
Committee Chair:
Hunt, Rebecca
Committee Members:
Kozakowski, Michael
Agee, Chris

Notes

Abstract:
This historical examination looks at the uses of power by different entities to deal with and control the influenza pandemic in the state of Utah during the 1918-1919 influenza pandemic. Surprisingly, the story is not a narrative about the power of the Mormon Church. The Utah State Board of Health relied on the direction of the federal government. The state board of health’s firm leadership set in place restrictions and regulations and was vital in dealing with problems faced by local Utah communities. The board of health relied on local authorities to follow through with these mandates. Bans and restrictions were lifted after many weeks, but the flu continued to manifest itself in Utah. Individuals in Utah were forced to step up and take responsibility for their own health. Lessons learned include the need for direction from federal government, followed by state and then local direction when a disease pandemic occurs. However, these government entities cannot continue to curtail the rights of individuals, businesses and communities for an indefinite period. Though governing entities may not always give the best direction, they are essential to keeping order and providing guidance to the society they have stewardship over at least during the initial onslaught of the disease.

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University of Colorado Denver
Holding Location:
Auraria Library
Rights Management:
Copyright Janet Cannon Dubois. Permission granted to University of Colorado Denver to digitize and display this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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W AR AND DISEASE : THE P OLITICS OF PUBLIC HEALTH IN THE STATE OF U TAH DURING THE 1918 1919 I NFLUENZA P ANDEMIC by J ANET C ANNON D UBOIS B.G.S., Brigh am Young University, Provo , 2010 A thesis submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment o f the requirements for the degree of Master of Arts History Program 2017

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ii This thes is for the Master of Arts degree by Janet Cannon Dubois has been approved for the History Program b y Rebecca Hunt, Chair Micha el Kozakowski Chris Agee Date: December 16, 2017

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iii Dubois, Janet Cannon (MA History Program) W ar and Disease: The P olitics of Public Health in the State of U tah During the 1918 1919 I nfluenza P andemic Thesis directed by Associate Profess or Rebecca Hunt ABSTRACT This historical examination looks at the uses of power by different entities to deal with and control the influenza pandemic in the state of Utah during the 1918 1919 influenza pandemic. Surprisingly, the story is not a narrative a bout the power of the Mormon Church. The Utah State Board of Health relied on the direction of the federal government . The state board of health set in pla ce restrictions and regulations and was vital in dealing with problems faced by loc al Utah communities. The board of health relied on local authorities to follow through with these mandates. Bans and restrictions were lifted after many weeks, but the flu continued to manifest itself in Utah. Individuals in Utah were forced to step up and take responsibility for their own health. Lessons learned include the need for direction from federal government, followed by state and then local direction when a disease pandemic occurs. However, these government entities cannot continue to curtail the rights of individuals, businesses and communities for an indefinite period. Though governing entities may not always give the best direction, they are essential to keeping order and providing guidance to the society they have stewardship over at least duri ng the initial onslaught of the disease. The form and content of this abstract are approved. I recommend its publication. Approved: Rebecca Hunt

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iv ACKNOWLEDGMENTS Early ideas for this this thesis began on a trip with my sister to Cabo San Lucas, Mexico. My s ister, Dr. Lisa Cannon Albright, Chief, Division of Genetic Epidemiology in the Department of Internal Medicine at the University of Utah School of Medicine , had contributed to a paper titled, Influe nza . I had recently written a paper on the historiography of the 1918 1919 influenza pandemic. We had some great conversations during the week. She agreed to help me gain access to the Utah Population Database through her department. Lisa spent countless hours over a five week period while I worked with her in Utah, answering questions , guiding my research, and helping me gain access to medical and public health journals from 1918 and 1919. She spent more than a year mentoring and advising me when I had on going questions. Partial support for all data sets within the Utah Population Database (UPDB) was provided by Huntsman Cancer Institute, Huntsman Cancer Foundation, University of Utah, 42014 from the National Cancer Institute. I would also like to thank Rebecca Hunt, Michael Kozakowski, and Chris Agee for reading several versions of this thesis and suggesting changes to improve the quality of the finished product. Each of these professor s also taught me valuable lessons during my time in class with them.

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v TABLE OF CONTENTS CHAPTER I. INTRODUCTION ................................ ................................ ................................ ................................ 1 II. INFLUENZA AND THE AMERICAN MILITARY ................................ ................................ .................. 10 III. FEDERAL AND STATE POWER ................................ ................................ ................................ ......... 19 IV . THE PRESS AS GOVERNMENT MESSENGER TO AM ERICA ................................ ............................. 25 V. OPPOSITION AND THE STRUGGLE FOR CONTROL ................................ ................................ ......... 27 VI. THE POWER OF ORDINARY PEOPLE AND THE INFLUENCE OF THE MORMON CHURC H ............... 31 VII. STATE EXPECTATIONS OF LOCAL AUTHORITIES ................................ ................................ ............ 34 VIII. LOCAL AUTHORITY ................................ ................................ ................................ ........................ 41 IX. AMERICAN INDIANS ................................ ................................ ................................ ...................... 52 X. BUSINESS ELITES INTERVENE ................................ ................................ ................................ ........ 56 XI. PLANNING FOR THE FUTURE ................................ ................................ ................................ ........ 62 XII. CONCLUSION ................................ ................................ ................................ ................................ 64

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vi LIST OF FIGURES FIGURE 1. Image of Roy Parkin Nelson and F amil y . ...1 2. Utah Influenza Death Count by Date, August 1918 January 1919 3. Utah Influenza Deaths by Month, August 1918 January 1919 .44

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1 CHAPTER I INTRODUCTION Roy Parkin Nelson was born in April 1897 in Randolph, Utah, the oldest child of Samuel and Zipporah Parkin Nelson. He grew up on a large ranch , and in 1917, he left home to attend the Agricultural College in Logan, Utah. When America entered the war in Europe, Roy wanted to enlist, but his parents discouraged him. They finally realized he would be drafted and so relented. 1 He enlisted in the United States Army on July 15, 1918. Roy was attached to Company B, Training Detac hment, at the University of Utah as a student officer . 2 In his last letter home on October 9, Roy said he did not feel well, but told 1 permission https://familysearch. org/photos/artifacts/20423053?p=11180511&returnLabel=Roy%20P%20Nelson%20(K24 1 9ZK)&returnUrl=https%3A%2F%2Ffamilysearch.org%2Ftree%2Fperson%2FK241 9ZK%2Fmemories . 2 Teachers Volunteer as Flu Nurses, Salt Lake Telegram , October 17, 1918 , accessed November 15, 2016, Utah Digital Newspapers. Figure 1 . Roy Nelson (center, back) with his family in 1918. Courtesy Greg Ford.

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2 father left for Salt Lake City to visit his son at Fort Douglas. Government officials and military leaders at Fort Douglas were concerned about containment and stopping the flu outbreak and had put in place regulations to protect soldiers and the nearby community. There was a strict qua rantine in place at Fort Douglas that required visitors to get a special permit fro m the military commandant to enter the military post. 3 Because so much red tape was involved, i t was some time before the father could see his son at the isolation hospital. Roy was not conscious and died a few minutes after his father arrived at his bedside. Regu lations and red tape kept a father from communicating with his son before he died o f disease rather than warfare. It is surprising that regulations were not waved so that a father could visit a dying son when it was apparent that quarantine was not sufficient to stop the spread of the disease. In his 1986 book, Pandemic Influenza 1700 1900: A Study in Historical Epidemiology, David Patterson discusses the distinctive features of the 1918 pandemic by remarking on three key characteristics: no disease it killed many who were between the ages of twenty and forty. 4 Scientists and historians estimate that 50 100 mi llion people died, worldwide, in ten months. 5 Som e modern historians find it impossible to imagine that troop and civilian move ments, as a result of World War I, were not factors in the spread of the disease. Dr. Alfred Bollet, in his book, Plagues and Pox es: The Impact of Human History on Epidemic Disease , proclaims, 3 Salt Lake Telegram , October 17, 1918, accessed November 15, 2016, Utah Digital Newspapers. 4 K. David Patterson, Pandemic Influenza 1700 1900: A Study in Historical Epidemiology ( Tot owa, NJ: Rowman and Littlefield, 1986), 91. 5 Patterson, Pandemic Influenza , 91.

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3 6 Historians and other scholars have written about the ways the 1918 1919 influenza pandemic influenced World War I, both on the home fro nt and the battlefront. The conflation of war and epidemic opened new perspectives on political, social, and economic circumstances in America, on the Homefront. New evidence abou t components of the pandemic has come to light over the years and old evidenc e has been interpreted in new ways. This has provided an evolution in theories related to subjects like the unusually high death rate for young adults during the influenza outbreak and given rise to tropes like historical memory and political power . 7 In his book, Epidemic and Peace, 1918 , published in 1976, Alfred W. Crosby proposed many of the ideas, questions and hypotheses that subsequent historians still talk abo ut in their histor ies toda y. 8 As the world has faced epidemics like the new strain of flu that emerged in China in 1957, academic historians have realized it is important to learn from these outbreaks of the past. Because t he influenza pandemic of 1918 killed so many million s world wide, i t is vital that we understand its impacts on governments, communities and institutions in 1918. By learning how those in authority administered the fight against the pandemic, and looking at how all those involved reacted, we will be better prepare d to deal with a future global pandemic, mitigate its spread and minimize the loss of life. 6 Alfred Jay Bollet, M. D. Plagues and Poxes: The Impact of Human History on Epidemic Disease (New York: Demos Medical Publishing, 2004), 1. 7 Richard J. Hatchett, Carter E. M Proceedings of the National Academy of Sciences of the United States of America , 104, no. 18 (May 1, 2007): 7582. 8 Alfred W. Crosby, Epidemic and Peace, 1918 (Westport, CT: Greenwood Press, 1976).

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4 One way to approach the history of the pandemic is to study a specific geographic area hit hard by the influenza during the second and third waves in 1918 and 1919. As David Kyvig and Myron Marty suggest in their book, Nearby History: Exploring the Past Around You 9 The advantage of choosing U tah as a case study is that digitized copies of Utah death certificates, many Utah newspapers based in large and small cities, and a pedigree based database of family histories with attached source documents are all available online at no cost. I also gain ed access to the Utah Population Database , with the help of Dr. Lisa Cannon Albright, Chief, Division of Genetic Epidemiology in the Depa rtment of Internal Medicine at the University of Utah School of Medicine. 10 1918 and post 1918 era academic articles, especially in medical journals and public health bulletins were another valuable resource. The combination of these research sources provid ed a goldmine of information on the pandemic in Utah and the nation . During the pandemic in Utah , s tate and community public h ealth officials , policymakers, and other officials and elite businessmen , boosters and everyday Utahans played a part in making de cisions that influenced the health care, econ omy, transportation, and personal aspects of life including social life, education and religion . The Utah S tate 9 David E. Kyvig and Myron A. Marty, Nearby History: Exploring the Past Around You (Lanham, MD: AltaMira Press, 2010), 9. 10 University of Utah Health Care, accessed November 19, 2016, h ttp://healthcare.ut ah.edu/huntsm ancancerinstitute/research/updb.

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5 Board of Health under the direction of Dr. Theodore Beatty, and with the support of governor Simon Bamberger, set in place policies that impinged on the perceived missions, rights, freedoms, and authority of citizens, businesses, service providers, and other institutions. Public health was a relatively new area of governance for the state, so it is unde rstandable that lines of authority would have been unclear and contested during the crisis. State health officials tried to consolidate and assert their authority. They tried to get citizens, private doctors and local governments to follow their advice. On a human level, a mixture of precaution, patience, and compassion, while putting aside fear, was essential to getting through eight long months of bans and restrictions, illness and death. The politics of disease forced disagreements between several groups in Utah during the influenza epidemic in 1918 1919. The argument can be made that state and community officials felt compelled to issue mandates they believed would slow the spread of the disease and curtail the number of deaths. T heir mission was to prot ect the health of the citizens of Utah. Public health was a relatively new area o f governance , not only in Utah, but in America in 1918 , though the American Public Health Association was organized in 1872 . 11 A me was Charles Edward Amory Winslow, author of The Evolution and Significance of the Modern Public Health Campaign , published in 1923. Dr. Winslow originated the health exhibits at the American Museum of Natural History in New York City in 1910. He promote d the idea that good personal hygiene was essential to health and that the physician should be a valuable resource for the well patient in the 11 Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982) , 181, 185.

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6 prevention of disease and the early discovery of disease for medical intervention. 12 So, in the era before and dur ing the 1918 pandemic, it was unusual for a person to see a physician regarding the prevention of disease. The doctor was called when the patient suffered from pain or illness. 13 By 1918, public health authorities did kno w enough about how disease spread t o focus attention on the responsible pathogen. Public health officials focused more on personal hygiene and dependable, safe remedies (or therapies) and less on cleaning up the environment. States and many local communities had public health departments o r boards. 14 Many schools had health services for the children who attended. Some schools provided smallpox vaccinations, and vision and hearing tests. Recommendation notes were sent home to parents when children needed to see a doctor or dentist. Unfortunat ely, many children still had the same medical or dental problems when they were examined the next year. 15 and regulation during the pandemic. There were other motivations as well. Thes e included keeping businesses vital to the war effort and to the subsistence of citizens open and operating. At the request of federal leaders, t he people of Utah, like the people of other states had made sacrifices in their personal lives to help the war effort in the years leading up to the pandemic . 12 C. E.A. Winslow, The Evolution and Significance of the Modern Public Health Campaign (New Haven: Yale Univ ersity Press, 1984), 57. 13 Starr, The Social Transformation of American Medicine, 141. 14 Starr , The Social Transformation of American Medicine , 181, 185. 15 Starr , The Social Transformation of American Medicine , 187 189.

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7 Life in America and in Utah changed in many ways when the United States entered the war in Europe. In November 1916, Woodrow Wilson was reelected president of the United States. As American pre sident, he had tried for more than two years to keep the United States from entering the war . The conflict in Europe was an important issue during the campaign for reelection. 16 Many Americans did not want to become entangled in the European war. On March 1 8, 1917, three American ships were sunk by German submarines. Only a few weeks earlier, Wilson had learned that the German foreign secretary was working to engage Mexico as an ally in the war against the United States. 17 At the urging of President Wilson, t he United States Congress declared war on Germany o n April 6, 1917. 18 Everyday l ife for Americans began to change almost immediately with the introduction of federally mandated programs , plans a nd procedures instituted to support the war effort. Once Americ a entered the w ar , there wa s a suspension of what life had been before. For the most part , American s accept ed the new regulations, requirements, and restrictions initiated by the federal government to help win the war . The government established a Committe e on Public Information on April 11, 1917 to . 19 The federal authorities were not above us ing popular movie stars of the time, like Douglas Fairbanks and Mary Pickford , to promote Liberty Loan Campaigns to raise money to fight the war. The fir st draft registration took place on June 5, 1917; all American males aged 16 David M. Kennedy, Over Here: The F irst World War and American Society ( New York: Oxford University Press, 2004 ) , 12. 17 Kennedy, Over Here: The First World War and American Society, 10. Barba ra W. Tuchman, The Zimmermann Telegram: America Enter the War, 1917 1918 ( New York: Random House, 19 58 ) , 180 1. 18 Neil M. Heyman, Daily Life During World War I ( Westport, CT: Greenwood Press, 2002 ) , xiii xiv. 19 Donald M. Goldstein and Harry J. Maihafer, America in World War I: The Story and Photographs ( ) , 105 .

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8 twenty one to thirty were required to register. Mark Sullivan, in his book, Our Times: The Turn of the Century, 1900 1925, Over Here , the all male draft a 20 Many Americans had been collecting food and clothing for the beleaguered Belgians under the direction of Herbert Hoover since soon after the war began in 1914 . In August 1917, President Wilson appointed to waste less food, so that surpluses could be used to feed America, including the Am erican military and the Allies. Hoover had the full weight of the law behind him when were concerned, but propaganda and persuasion were the tools he used to encourage the average American to voluntarily support the war effort . 21 H e 22 In October, t he federal government began to fix prices on goods like steel. 23 In December , the government decreed that electric advertising signs be t urned off on Thursdays and Sundays to conserve resources for the war effort . 24 The same month, the government took control of the railroads to expedite shipments of important goods to Europe. Americans were asked to donate scrap metal and the use of met al for non essential production was halted. 25 Not only did the government take control of some 20 Mark Sul livan, Our Times: The Turn of the Century, 1900 1925, Over Here . vol. 5 (New York: Charles 301. 21 Sullivan, Our Times: The Turn of the Century, 1900 1925, 408, 410, 418. 22 Tammy M. Proctor, Civilians in a World at War, 1914 1918 (New York: New York University Press, 2010), 89. 23 Sullivan, Our Times: The Turn of the Century, 1900 1925, 634. 24 Sullivan, Our Times: The Turn of the Century, 1900 1925, 635. 25 Goldstein and Maihafer. America in World War I , 106, 108.

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9 industries, it mandated the reduction of alcoholic content in beer. 26 A government poster published during World War I encouraged Americans to save and donate frui t stones and nut shells for the manufacture of gas masks. 27 From f ood restrictions to victory gardens , m any of these regulations or suggestions touching regular Americans we re voluntary. However, federal bureaucracy grew e xponentially to support the war. Jo hn Barry, in his book, The Great Influenza: The Epic Story of the Deadliest Plague in History , asserts the 28 F ederal government agenc ies provided dire ction and resources during th e war , but relied , for the most part, on state and local agents to enforce regulations and restrictions. 29 All these changes, whether forced or voluntary, were viewed by patriotic American citizens as necessary sacrifices in the face of war. In Utah, Church of Jesus Christ of Latter day Saints leaders and civic leaders, including Governor Simon Bamberger , supported President Wilson by urging Utahans to provide money and resources to support the war in Europe. 30 So, t he federal gov ernm ent was already exercising power over many aspects of American business and life . War with its regulations and demands had already permeated life when the flu arrived in Utah in October 1918. Amazingly, most Americans heartily supported the government, perhaps feeling it was their patriotic duty to help the United States ensure that Germany did not undermine European democracy . 26 Sullivan, Our Ti mes: The Turn of the Century, 1900 1925, 639 640. 27 Anne Catherine Fallen and Kevin Osborn, eds., Records of Our National Life: American History at the National Archives (Washington, D.C.: Foundation for the National Archives, 2009), 156. 28 John Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Penguin Books, 2004), 300. 29 Barry, The Great Influenza, 309 312. 30 Richard D. Poll, ed. Thomas G. Alexander, Eugene E. Campbell and David E. Miller, associate editors, H istory (Logan, UT: Utah State University Press, 1989), 424.

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10 CHAPTER II INFLUENZA AND THE AMERICAN MILITARY Large numbers of influenza cases appeared in the military before they appeared i n the civilian population. The first wave of the flu hit army camps in America in March 1918. Symptoms came on suddenly and included body aches a nd fever, physical weakness and exhaustion, sneezing and a cough, and a cold in the head with inflammation of t he nose and throat. 31 Other symptoms varied: sometimes there was vomiting, diarrhea or constipation. The most dangerous occurrence was the development of pneumonia in the patient. The oplets driven into 32 The second wave began in August 1918 on the East coast and spread west. A third wave appeared in the Spring of 1919 in many states in America. M ilitary doctors had early experience with the flu and le arned valuable information that could be shared with the civilian community. As a result, the government was in a knowledgeable, potentially hel pful position from the start. Lieutenant J.J. Keegan, M.D. of the United States Navy , provided the first e arly w arnings to civilian American doctor s , through the Journal of the American Medical Association , about the degree of contagion and the possibility for the spread of influenza acros s America . Dr. Keegan w as a navy physician attached to the United States Naval Hosp ital in Chelsea, Massachusetts . 33 He was one of the doctors at the American battlefront for the disease. When the naval base was 31 , Journal of the American Medical Association 71 , (Oct. 5, 1918):1136. 32 Therapeutics: Journal of the American Medical Association 71 , (O ct. 5, 1918) :1137 . 33 Journal of the American Medical Association 71 (Sep. 28, 1918):1051.

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11 overwhelmed by flu cases in August and September 1918, Dr. Keegan and his colleague, Dr. M ilton J. Rosenau, took specimens from two ill sailors and d] the filtrate of the nasal passages of nine volunteer sailors. 34 These military men were essentially guinea pigs, though Dr. Keegan points out that none of them became ill. 35 Epidemiologists like Chest er A. Darling, lauded Keegan for his observations and experiments proclaiming that the military could 36 Perhaps military men. H e did explain , after all , 37 He further advised that for between five and ten percent of the patients, the flu evol ved into a serious case of pneumonia that could lead to death . 38 Keegan estimated that thirty to forty percent of the American people would become sick with influenza and that 39 Keegan appears to have been a knowledgeable docto r with the best interests of his patients at heart. He was also concern ed about what the epidemic coul d do to the civilian public . He had credibility, because of his close association with and treatment of hundreds of patient s. Other doctors and epidemiologists rel experience working for the government during the epidemic. 34 Keegan , revailing Pandemic of Influenza, . Nancy K. Bristow, American Pandemic: The Lost Wo rlds of t he 1918 Influenza Epidemic Oxford : Oxford University Press, 2012, 33. 35 Keegan , 36 Chester A. Darling, Ph.D. , , American Journal of Public Health 8, no. 10 (Octobe r 1918) :754. 37 Keegan, emic of Influenza, 1051. 38 Keegan, 39 Keegan,

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12 At a time when there were no known cures or su re treatments for the flu, medical doctors in America could rely on the federal government to study the disease and to provide vaccines. Government funds and research led to a vaccine, labeled Navy, created 40 However, Dr. Rupert Blue, Surgeon General of the United States Public Health Service (USPHS) and the American Public Health Association knew that the vaccines were very unreliable in the fight against the flu . Nancy Bristow, in her book, American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic , argues that vaccines were used by state and local officials as a 41 The federal gov ernment, under the direction of Blue oversaw the fight against the influenza epidemic in America . Blue had jurisdiction over a ll state health agencies . He determined that centralization and coordination of health agencies was paramount to keeping health resources from being completely overwhelmed by the spread of influenza in an area. From the beginning, Blue used his posi tion to monitor and control the flu outbreak in America. By the middle of September, h e had determined through a telegram survey that the flu had arrived in Newport News, Virginia, New London, Connecticut, Fort Morgan, Alabama, Boston, New York City, New Orleans and Philadelphia. 42 The only one of these cities not situated on the ocean was Philadelphia, but it had a naval yard. 43 The remaining 40 Timothy American Journal of Public Health American Journal of Public Health 8, no. 10 (October 1918):754. 41 Bristow, American Pandemic , 97. 42 Action of Pu New York Times , September 14, 1918, accessed November 8, 2016, ProQuest Historical Newspapers: The New York Times. 43 Alfred W. Crosby, (Cambridge: Cambridge University Press 1989), 57.

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13 cities were harbor cities that received ships from Europe, where the illness was rampant. Blue used the Associated P ress to share a summary of ways to fight the flu, until do ctors receive d 44 I n 1918, doctors in most countries , including the United States, were required by law to notify public health departments about o utbreaks of certain illnesses , including smallpox, typhoid fever, and pneumonia. U nfortunatel y, influenza was not one of the illnesses . 45 Health statistics for Utah show that 1918 was the first year influenza cases were recorded by state government. In that year, 43,089 cases of influenza were reported . 46 The Fall 1918 pandemic led to the establishment of influenza as a reportable disease in Utah . According to Crosby, this was the case for many states in America. Crosby further asserts that many physicians we re slow to recognize truly a dangerous disease and should be reported with speed and accuracy. 47 Early on the USPHS issued short term policy changes and mandates to the states to slow the spread of the illness . Blue knew it was v ital to have one person in char ge in each state in the nation to lead a coordinated effort against the flu . Most states had a public health department in 1918. The head of the public health department in each state was appointed director and was assigned t o act as liaison with the USPHS . All contacts between states and the federal government were made through this director. 48 The ultimate 44 Takes Ste New York Times . 45 Richard Collier, Plague of the Spanish Lady: The Influenza Pandemic of 1918 1919 (New York: Athenaeum, 1974, 46. 46 State of Utah Open Data Catalog, https://opendata.utah.gov/Health/Total Reported Diseases Uta h 1910 1919/j3xq ydp7/data, accessed November 6, 2016. 47 Crosby, , 204. 48 Crosby, , 49 50.

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14 responsibility for coordinating efforts in the fight against the flu rested directly on the shoulders of Dr. Blue for all of America and on the shoulders of Dr. Theodore Beatty in Utah. Both men worked tirelessly to determine the most effective methods for fighting the influenza across the nation and in Utah. Because e arly estimates of fatality rates were as high as three to five percent of patients , their job was to mitigate as much as possible the spread of the disease. 49 O n October 4 , Blue exhorted each state health officer, by telegram, 50 Unfortunately, the Octobe r 4 injunction came one day before the Utah State Fair (September 28 October 5) , the perfect breeding ground for the spread of the influenza ended . At t he fortieth Utah State Fair at the end of September 1918 , the war was a key focal point. The federal gov part of the national defense regime. 51 The federal railroad commission , led by William McAdoo, instituted a reduced fare between Salt Lake City and outlying areas to promote tourist and bus iness trips to Salt Lake City during the week. 52 A fair ad in the Salt Lake Telegram included a picture of a bald e ag le at the top and at the bottom; the statement, 53 An ad in the Logan Republican showed two German sailors looking in horror through a 49 American Journal of Public Health American Journal of Public Health 8, no. 10 (October 1918): 787. 50 Crosby, 74. 51 Salt Lake Tribune , August 4, 1918, accessed February 7, 2017, Utah Digital Newspapers. 52 Cheap Rate Granted for Utah Salt Lake Tribune , Da tes for Tickets to Utah Fair Fixed Salt Lake Herald , September 5, 1918 , accessed February 7, 2017, Utah Digital Newspapers. 53 Utah State Fair Ad Salt Lake Telegram , August 17, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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15 periscope at the United States War Exhibit. 54 O n the first night , there was a parade followed by a liberty loan mass meeting , to raise money for the war . Many daily opportuniti es were available for the visiting public for the duration of the fair : vaudeville acts, fireworks, free moving pictures, horse races, carnival attractions, and all kinds of domestic, agricultur al and horticultural exhibits . 55 In 1917, Earl Jay Glade, secre tary of the Utah state fair had contacted the federal government seeking items for a war exhibit that would 56 As early as February 1918, the fair committee, together with Governor Bamberger , began advertising and promoting the gover nment exhibit , which included films showing life in the military and the efforts of the American farmer to produce and conserve food as part of the war effort . 57 It is clear from newspaper articles and state fair ads using war and patriotic rhetoric and ima ges 58 City boosters like the means for advertising and building up business. 59 During the last week s of September and first week of October, there does not seem to have been too much concern about the spread of influenza in Utah . 54 Logan Republican , October 1, 1918 , accessed November 7, 2016, Utah Digital Newspapers. 55 Utah State Fair Ad, Salt Lake Herald , September 29, 1918 Welcome! Fair, Salt Lake Herald , September 29, 191 8, accesse d November 7, 2016, Utah Digital Newspapers. 56 Death Dealing Implements of U. S. Asked for Fair Salt Lake Telegram , February 19, 1918 , accessed November 7, 2016, Utah Digital Newspapers. 57 Place is Selected for Federal Exhibit Salt Lake Tribune , May 21, 1918 Big War Show to be Staged at State Fair Salt Lake Herald , July 27, 1918, accessed November 7, 2016, Utah Digital Newspapers. 58 Big War Show to be Staged at State Fair Salt Lake Herald , July 27, 1918, accessed November 7, 2016, Utah Digital Newspapers. 59 Utah Merchants Urged to Advertise Salt Lake Herald , September 14, 1918 , accessed November 7, 2016, Utah Digital Newspapers.

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16 The federal government could not have known that in providing full support for the fair, it was setting the stage for the spread of disease not only in Salt Lake City, but in Utah and surrounding states. It is ironic, that the Utah Board of Health exhibit at the fair was te would soon be very unhealthy. 60 Dr. Beatty was busy promoting the Utah state board of health exhibits at the Utah State Fair. Both the state and the federal go vernment eeping the populace healthy as a war necessity 61 State offici als urged every person who visited the fair to pay close attention to the health messages. 62 Those persons with specialized knowledge or experience became the early leaders in the fight against the flu in Utah . Dr. Theodore B. Beatty was the Utah state heal th commissioner. He had received his medical degree from Rush Medical College in Chicago, Illinois and worked in a New York City hospital before moving to Utah in 1889 and joining the staff at S Beatty was the Salt Lake City heal th commissi oner from 1893 to 1894. In 1898, he became secretary to the State Board of Health. Beatty was a forward thinking advocate for public health in Utah. He standardized f orms listing causes of death, advocated 63 Dr. Ralph Richards , prominent Salt Lake City surg eon and professor of surgery at University of Utah Medical School , said , Dr. 60 Welcome! Salt Lake Herald , September 29, 1918, accessed November 7, 2016, Utah Digital Newspapers. 61 Bennion Receives Key of Patriotic Exposition, Salt Lake Herald , October 1, 1918, accessed February 7, 2017, Marriott Library Digitized Newspapers. 62 Bennion Receives Key of Patriotic Exposition, Salt Lake Herald , Octob er 1, 1918 . 63 W. Dee Halverson and David M. Walden, 1997: A 125 Year Legacy of Quality Health Care in Utah (Salt Lake City, UT: Heritage Associates, 1997), 42 43.

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17 Beatty h of the people of Utah than any other 64 Dr. Beatty had the necessary credentials , but did not yet realize the fearful job that awaited him and many other health officials across the nation . O n September 27, a New York Times article lamented the fact that health authorities had persuaded Americans that the disease would s The same day, Dr. Beatty, announced that the state of Utah was free of influenza cases. 65 But this statement would not be true in Utah in less than a week. The Times article also accused health authorities of waiting too long to put restrictive measures in plac e , hinting that getting American troops to Europe was a factor in the omissions . 66 The New York Times article was in fact on track. American military leaders were concerned about outbreaks of flu in crowded army and navy training camps. On September 27, Ge neral Enoch Crowder , who oversaw the draft, announced that all draftees scheduled to report between October 7 and 11 should not do so. General Crowder made it clear that the reason was the influenza epidemic in military camp s . He suggest ed that the draftee s would not be asked to report until the flu was curtailed. President Wilson met with General Peyton March, Army Chief of Staff, on October 8 to discuss the situation. General March 64 Martin Kaufman, Stuart Galishoff, and Todd L. Savitt, eds., Josep h Carvalho, III, editorial associate, Dictionary of American Medical Biography (Westport, CT: Greenwood Press), 1984, 636. Halverson and Walden, St. 43. 65 Salt Lake Herald , September 28, 1918, acce ssed November 7, 2016, Utah Digital Newspapers. 66 New York Times , September 27, 1918, accessed November 8, 2016, ProQuest Historical Newspapers: The New York Times.

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18 was against slowing or stopping the movement of American troops to Europe, despite the death tolls in camps and on ships from influenza . President Wilson agreed that American soldiers must continue to be trained and sent to France and draftees began reporting to duty again on October 23. M eanwhile, in Europe 70,000 U.S. troops October and a third of those suffering with influenza perished. 67 67 Bollet , Pl agues and Poxes, 107.

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19 CHAPTER III F EDERAL AND STATE POWER The United States federal government exercised power to minimize the spread of the disease and the impact on soldi ers whe n influenza began to disrup t military training and fighting, but did they do enough? Carol Byerly , in her book, Fever of War: The Influenza Epidemic in the U. S. Army during World War I claims that the decisions made by the government, including ignoring a dvice from medical officers, led to high rates of mortality from influenza. A rmy medical officers, who had been doctors in private life, worri ed about the health of soldiers and asked for policy changes to keep them healthy. Medical officers suggested ways to quell the spread of the illness, like setting up quarantine camps, reducing crowded conditions in living spaces, and setting up initial camps where new recruits could be screened for inf ection before going to training, but the government did not follow these suggestions. The War Department had other overriding concerns. Byerly accuses the American government of failing to protect the health of American soldiers during World War I. She points out that 30,000 American soldiers died in training camps in th e United States before they could be shipped off to fight in Europe. T he government decided the rights of the individual in the military had to be overruled by the need to meet the greater good. 68 Crosby asserts that quarantin e in army training camps was not possible because soldiers and supplies were desperately needed in Europe and the needs of the war could not be curtailed. 68 Caro l R. Byerly, Fever of War: The Influenza Epidemic in the U. S. Army during World War I (New York: New York University Press, 2005), 7 8, 41 2, 48, 53 4.

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20 During the second wave of the pandemic in October 1918, the United States Army countermanded the con scription of 142,000 men and put off the enlistment of 78,000 new recruits because of the epidemic. 69 Ultimately, government leaders in the United States put concerns for the outcome of the war before the pandemic until the situation was grave. The First Wo rld War ended the month after the War Department began to realize the devastating effects of minimizing the severity of the threat and not following through with safeguards to protect soldiers. Bollet advises that thousands of troop deaths by disease could have been averted if the draft had been suspended and troop shipment s had ceas ed for a time . American military leader, General John Pershing in Europe was begging for more soldiers. 70 Ultimately, President Wilson and his military leaders made decisions con cerning the lives of both pro spective soldiers and established soldiers based on their perceptions about how to win the war. Bollet suggests that p erhaps the continued arrival of American troops in France not only boosted the fighting force, but boosted th e morale of the other Allied soldiers leading to a timelier end to the war and thus saving more lives than those lost to the flu. 71 Not only did t he United States federal government exercise power to minimize the spread of the disease among the military, b ut it also exercised power to minimize the spread of disease among civilians. On October 11, Surgeon General Blue urged all states to make influenza a reportable disease. 72 Fed eral involvement ramped up as Blue called for 69 Crosby, , 31, 49. 70 Bollet , Pl agues and Poxes, 107 108. 71 Bollet , Plague s and Poxes, 108. 72 Salt Lake Tribune , October 12, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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21 railroad ticket agents across Ameri ca to deny ticket sales to potential passengers who exhibited flu symptoms and to remove ill patients from trains as soon as they exhibited symptoms. Just a few days earlier, passengers on the Oregon Short Line train in Utah had noticed a family of six wit h flu like symptoms and hurriedly left the car where the family was riding. The conductor ordered the family to remain in the car until the train arrived in Salt Lake City late at night. The next morning the family was taken by ambulance to a hospital. 73 On October 24, the state of Nevada announced it would stop all passenger trains at the Utah Nevada border and quarantine any sick passengers. 74 Blue was addressing situations that were already taking place across the nation , but each state was also doing th e same to protect its citizens . To get on top of the spreading epidemic, Blue also urged state public health boards to contact each community in their state to determine how many doctors and nurses were available in that community and to send help where i t was needed most urgently, because of the shortage of medical personnel. 75 In Utah, many physicians and nurses joined the alone, twenty doctors and forty five nurses left to help in the war effort. 76 On October 16, 77 73 Salt Lake Telegram , October 11, 1918, accessed November 8, 2016, Utah Digi tal Newspapers. 74 Salt Lake Herald , October 24, 1918, accessed November 7, 2016, Utah Digital Newspapers. 75 Salt Lake Tribune ns in Salt Lake Tribune, October 13, 1918, accessed November 7, 2016, Utah Digital Newspapers. 76 Halverson and Walden, 56 57. 77 Salt Lake Telegram , October 17, 1918, accessed Nov ember 15, 2016, Utah Digital Newspapers.

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22 78 By October 22, Blu e required each state health director to send a wi re report daily to Washingto n, D.C. on the situation in his jurisdiction . In each state, c ities with populations over 1500 were required to report the number of flu cases and deaths each day to their state health director . The government pa id for the se reports . 79 Utah state officials followed through on these federal mandates , but instituted their own mandates as well . Early in October Dr. Beatty issued a statement ordering physicians to immediately report in fluenza cases to his department and urging stricken victims to go to bed im mediately if they felt they had contracted the flu. 80 He asked all Utah town leaders to close schools and ban public gatherings in the ir town s . 81 Fort Douglas , an army training camp i n Salt Lake County, was not quarantined by Washington , D.C. officials , so local authorities quarantined it for the protection of the soldiers . If a soldier was seriously ill, only one relative could visit him. 82 Beatty knew that t he 1907 compiled laws of Ut ah, state health board statute, title 29, allowed for the enforcement of quarantines in fighting against the spread of disease. State attorney general, Dan B. Shields, Governor Bamberger and Secretary of State, Harden 78 Salt Lake Telegram , October 17, 1918, accessed November 15, 2016, Utah Digital Newspapers. 79 Salt Lake Tribune , October 22, 1918, acces sed November 7, 2016, Utah Digital Newspapers. 80 Salt Lake Tribune , October 4, 1918, accessed November 7, 2016, Utah Digital Newspapers. 81 Ogden Standard , October 5, 1918, accessed November 17, 2016 Utah Digital Newspapers. 82 Salt Lake Telegram , October 15, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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23 Bennion stood firmly behind Beatty. 83 T he state board of health made a plea for doctors and nurses to go to communities without medical personnel to give aid. 84 Salt Lake City Mayor W. Mont Ferry and Utah Red Cross Director Robert Shields supported Beatty by notifying hospitals that surgeries th at could be postponed for the foreseeable future should be p ostponed. This would allow doctors and nurses to focus their full attention on flu patients. 85 S tate board of health officials began to visit industrial plants to be sure that owners were doing all they could to protect workers , so plants could stay open to support the war effort. 86 The board of health encouraged b usinesses to operate with open windows and asked large businesses to appo int one employee whose duty it wa s to check each employee for sig ns of the disease daily . 87 On October 19, Beatty announced a ban on weddings, proclaiming that only immediate family members could attend. 88 He also declared that bride and groom and guests must wear masks and no one should kiss, as kissing spread the flu. 89 In October, Beatty considered assigning private physicians to geographic zones to conserve resources and help the most patients in the shortest amount of time. He realized this would be a complex undertaking and that people would be upset 83 Salt Lake Telegram , October 10, 1918 accessed November 7, 2016, Utah Digital Newspapers. 84 Salt Lake Telegram , October 9, 1918, accessed November 7, 2016 , Utah Digital Newspapers. 85 Salt Lake Herald . October 14, 1918, accessed November 17, 2016, Utah Digital Newspapers. 86 Salt Lake Herald , October 12, 1918, accessed November 7, 2016, Utah Digital Newspapers. 87 Salt Lake Telegram , October 11, 1918, accessed November 7, 2016, Utah Digital Newspapers. 88 Salt Lake Telegram , October 18, 1918, accessed November 7, 2016, Utah Digital Newspapers. 89 Salt Lake Herald , October 19, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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24 by not having acc ess to their family doctor. 90 A solution did not come until November when the state board of health divided Salt Lake County into five zones and assigned one resident or assistant county physician to each zone to care for the poor victims of the flu. 91 90 Salt Lake Telegram , October 21, 1918, accessed November 7, 2016, Utah Digital Newspapers. 91 Salt Lake Telegram , November 4, 1918, accessed November 7, 2016, Utah Digital Newspapers.

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25 CHAPTER IV THE PRESS AS GOVERNMENT MESSENGER TO AMERICA In 1918, the primary source for news for the average American was the newspaper. Association visited Salt Lake City in June 1918 to speak to business and newspaper men at messenger from the government to the people . 92 Thomson claimed that newspapers were powerful, because they 93 Thomson was specifically referring to war propaganda, like promoting Liberty Loans and the Red Cross. He 94 On ce the influenza epidemic arrived in full force in October, newspapers were the source of basic and vital information about the progress of the flu, including how officials were doing in their fight against the crisis. Local newspapers in Utah carried dail y lists of the names of the dead with their addresses and ages and sometimes the names of the ill. This news must have been very disheartening to read day after day. Bylines like 20,000 Influenza Cases in Utah greeted readers each day. 95 92 Salt Lake Herald, June 26, 1918, accessed December 7, 2016, Utah Digital Newspapers. 93 Salt Lake Herald, June 26, 1918, accessed December 7, 2016, Utah Digital Newspapers. 94 Salt Lake H erald, June 26, 1918, accessed December 7, 2016, Utah Digital Newspapers. 95 Ogden Standard Salt Lake Telegram , October 23, 1918, accessed December 7, 2016, Utah Digital Newspapers.

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26 Some newspapers railed against the restrictions brought about by the entrance of the United States into the war and the pandemic. , a Salt Lake City papers. 96 without specifically naming him, for refusing to lift bans on churches and theatres after thousands of citizens had poured into the streets to celebrate the end of the war together. 97 98 The editors of the paper were , freedom from social restrictions should be restored as soon as possible. 96 Utah Digital Newspapers, accessed April 7, 2017, https://digitalnewspapers.org/newspaper/?paper=Goodwin%27s+Weekly . 97 The Spectator Goodwin's Weekly , November 16, 1918 , accessed April 7, 2017, Utah Digital Newspapers. 98 The Spectator Goodwin's Weekly , November 16, 1918 , accessed April 7, 2017, Utah Digital Newspapers.

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27 CHAPTER V O PPOSITION AND THE STRUGGLE FOR CONTROL Once the flu did arrive in Utah, a nyone making unsubstantiated , unauthorized or incorrect claims that threa tened the figh t to mitigate and stop the spread of influenza came under fire from the state government, specifically Beatty . In July 1917, Dr. Woods Hutchinson, President of the American Academy of Medicine was pr onounced famous physician author by the Salt Lake Tribu ne and by the Ogden Standard 99 In 1917 President Wilson sent Hutchinson to the Europe an Front , where he remained for about one and one half years, to observe the fitness of the military medical services. Hutchinson procl 100 Perhaps this experience caused the press in Utah to give credence to his words when h e visited Utah and consulted with state officials and physicians in October 1918. While in U tah, h , and small number of very poor residents was a best case scenario for a shorter epidemic with the possibility of fewer fatalities than Eastern areas of the United States. 101 Almost i ill patient did not need to call his doctor and that doctors and nurses could do nothing for 99 Milita ry Training May Free Schools of S ome of Absurdities of Past Piute Chieftain , June 7, 1917 Why I Becoming a Disgrace to Catch a Disease Salt Lake Tribune , July 8, 1917 Science Explains What Happens When Y our Skin Goes on Strike Salt Lake Tribune , October 7, 1917 , accessed November 22, 2016, Utah Digital Newspapers. 100 Wonderful Advance in the Army Medical Corps Ogden Standard , December 29 , 1917 B e Dinner Speaker Salt Lake Tribune , October 1, 1918 , accessed November 22, 2016, Utah Digital Newspapers. 101 Influenza Spreads and State Authorities Call for Help in Caring for the Afflicted, Ogden Standard , October 16, 1918, accessed November 22, 2016, Utah Digital Newspapers. Dr. Hutchinson had published such books as Preventable Diseases (1909), Exercise and Health (1911), A Handbook of Health (1911), Common Diseases (1913), Civilization and Health (1914) and The Doctor in War (1918).

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28 patients . 102 He called rning the disease. 103 Beatty also disputed s, particularly that climate was an important factor in the spread of the disease. He reiterated that the flu wa s spread by contact. 104 Beatty characterized onal newspaper wr a medical expert. 105 Beatty felt so strongly that statements by Hutchinson would be injurious to the public health that he wrote a letter to the Salt Lake Tribune on October 17 proclaiming that Hutchinson was misleading Utahan s . 106 In an open let ter to the public print ed in the Ogden Standard , Beat ty accused Hutchinson of making assertions that were 107 He further asserted that members of the med ical profession did not view 108 If Beatty could help it, no unauthorized person would usurp his power as state appointed public health director. Even though the press had painted Hutchinson as an experienced and knowledgeable authority, he did not h ave the power of government behind him and it was not his responsibility to keep the people of Utah health y . That power 102 Nurse at Dee Hospital Dies and Three O ther Deaths of Same Disease Are Reported Ogden Standard , October 16, 1918 Influenza is Old La Grippe, Avers Expert Salt Lake Herald , October 16, 1918 , accessed November 22, 2016, Utah Digital Newsp apers. 103 Ogden Standard , October 16, 1918, accessed November 22, 2016, Utah Digital Newspapers. 104 Influenza's Hold on State Grows Salt Lake Telegram , October 16 , 1918, acc essed November 7, 2016, Utah Digital Newspapers. 105 Hold on State Grows Salt Lake Telegram , October 16 , 1918, accessed November 7, 2016, Utah Digital Newspapers. 106 the Flu is Real Menace, Dr. Beatty Declares , Salt Lake Tribune , October 17, 1 918 , accessed November 22, 2016, Utah Digital Newspapers. 107 'Flu' Real Menace Says Dr. Beatty of Utah Ogden Standard , October 17, 1918 , accessed November 22, 2016, Utah Digital Newspapers. 108 T. B. Beatty, 'Flu' Real Menace Says Dr. Beatty of Utah Ogden Standard , October 17, 191, accessed November 22, 2016, Utah Digital Newspapers.

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29 and authority belonged to Beatty. Hutchinson used the pr ess to gain credibility and Beatty used it to establish both his and his medical credibility and take away Physicians were not only duty bound to help their patients, but it was vital that they be advised when their patients became ill so that all could be done to protect other family and community members , p articularly children . When the state Board of Health stepped in to advise school officials to close schools , school board officials challenged what they considered to be a hasty decision. A fight between government officials ensued. Dr. Edward Rich, a memb er of the Ogden school board of education, asserted that children could best be protected from the flu if they arrived at school every day and could receive immediate attention from the school nurse if they developed symptoms. As an example, he pointed to the recent smallpox epidemic. The schools had been closed then and the smallpox had turned epidemic in a ve ry short time. Not only did Beatty face the opposition of boa rd of education members, but Dr. Samuel G. Paul, Salt Lake City health commissioner call ed hysteria, 109 He pointed to the latest United States Public Health Bulletin sent out by S urgeon General Blue that claimed, 110 Paul openly opposed Beatty. Beatty defended his action by saying it was better to act to curtail the epidemic tha n to wait until it was any more widespread. 111 109 Ogden Standard , October 10, 1918 , accessed November 17, 2016, Utah Digital Newspapers. 110 Ogden Standard , October 10, 1918, accessed November 17, 2016, Utah Digital Newspapers. 111 Ogden Standard , October 10, 1918, accessed November 17, 2016, Utah Digital Newspapers.

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30 The superin tendent of the Ogden school district defied the order to close schools in Ogden. 112 Beatty continued to stand his ground by adding public libraries and public funerals to the list of closings and bans. 113 Utah State Board of Health bans were reinforced by f ed eral authority o n the very day Beatty came und er fire. Surgeon General Blue advised all state boards of health to call on municipal authorities to enforce the ban of public gatherings and school closures where influenza was in evidence. Utah Governor Simon Bamberger put his full support behind Beatty in maintain ing bans and closures. So now Beatty and Bamberger, with the support of the federa l government, stood against Paul and Rich. Though, Blue, Beatty, Paul and Hutchinson were all medical doctors, they h ad different ideas on how to win the fight. Ult imately, Blue and Beatty , as federal and state government leaders had the final say in controversial decisions, because they had the power and authority of their positions behind them. 112 Ogden Standard , October 10, 1918, accessed November 17, 2016 Utah Digital Newspapers. 113 Salt Lake Herald , October 10, 1918, accessed November 17, 2016, Utah Digital Newspapers.

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31 CHAPTER VI T HE PO WER OF ORDINARY PEOPLE AND THE INFLUENCE OF THE MORMON CHURCH The core beliefs of Mormons are enumerated in thirteen Articles of Faith penned by the prophet Joseph Smith in 1842 We believe in being subject to kings , presidents, rule rs, and magistrates, in obeying, honoring, and sustaining the law. 114 For devout Mormons, it is essential to obey the law of the land. Thus, it was incumbent upon Mormons to obey bans and restrictions put in place by the state and national government. O rdina ry men and women of Utah went forward and did what they had to do to cope and even survive during the pandemic. Important to the Mormon culture was an times of trouble. It is not surprising then that on October 26, Mormon President Joseph F. Smith , together with his two counselors, asked Mormon women to take care of their own family members who contracted the flu. This was done to allow the Red Cross nurses to serve peop le not of the Mormon faith during the epidemic. The First Presidency felt that many Mormon women were skill ed and competent nurses and could take care of their ill family members themselves . In this way, health authorities and the Red Cross could use dwind ling resources more effectively in the state . 115 The statement by Mormon church leaders is one of the few interventions by church leadership during the epidemic. Church 114 Joseph Smith, History of the Church of Jesus Christ of Latter day Saints, vol. 4, Period I : History of Joseph Smith the Prophet (Salt Lake City, UT: Deseret Book Company, 1978), 535, 541. 115 Influenz Salt Lake Telegram , October 26, 1918 , accessed November 22, 2016, Utah Digital N ewspapers.

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32 leaders allowed government leaders to direct the fight against the flu and members of the Church worked together to get through a challenging and difficult time. During the Fall of 1918, Charles Hyrum Goates was a thirty seven year old husband and father of five working as the farm manager at the Utah State Industrial School in Ogden. He was from a close Lehi, Utah Mormon family living in Ogden. Two of his brothers were nine year den was very ill with the malady. Charles died three days later, and his father and younger brother picked up his body at the railroad station for burial in Lehi. On October 24, year old year old daughter had died. George returned to Ogden again to collect the body of Elaine. During this week when four family members died, George and his son, Franz had not been able to finish harvesting thei r beet crop source of income. Winter had set in early and the ground was frozen. As George and Franz set off for the fields , they knew it would be a difficult job to wrest the beets from the frozen earth. They passed many of their neighbors driving wagon loads of beets to the sugar beet factory. All greeted them and expressed their condolences. Father admitted to son that he w ished the harvested beets were his own. When they Their neighbors had gathered together and harvested the beet crop and were delivering it

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33 to the factory in the ir behalf. 116 Similar incidents happened all over Utah as ordinary citizens like George Goates, who lost a son and three grandchildren in one week, continued to march forward and do what they had to do, and neighbors stepped up to fill in the gaps and help w ith things they could not do. 117 No politics were involved, no ulterior motives, only the power of compassion and charity. 116 Vaughn J. Featherstone, , Ensign , July 1973, 36 37. 117 Family Search, accessed April 7, 2017, https://familysearch.org/tree/pedigree/K2WD QB8/landscape .

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34 CHAPTER VII S TATE EXPECTATIONS OF LOCAL AUTHORITIES During the epidemic, the state board of health expected local Utah c ommunity officials to advis e and inform the local public in the best way to avoid the flu and to put in place restrictions and regulations mandated by the state agency . Beatty did not take lightly any loss of life or spread of disease he felt was caused by carelessness or even recklessness . He made it clear that he would place blame on town officials that did not follow board of health mandates . On November 7 , the state board of health, satisfied the disease had run its course, lifted restrictions on public gatherings in the towns of Tremonton and Green River. 118 Meanwhile, in some other outlying c ommunities, like Sego in Grand County, and Eureka in Juab C ounty, the crisis was heating up. Eureka, a mining town with a population of 3500, had thirty deaths in tw o weeks. Only about thirty percent of the miners were reporting to work each day; some were ill, and others were caring for the ill. The high school was turned into an emergency hospital and most of the dead in Eureka were the heads of families. 119 At the Ch ief Consolidated Mining Company, five shift bosses had died. On November 6, there were over 200 cases of flu reported, thirty were expected to die, and twenty bodies were at the undertaker. 120 In Sego, a town with a population of 250, 102 people had the flu. 121 The American Fuel Company was forced to close because of the 118 Epidemic Loses Badly in Fight , o nly 28 Cases, Sal t Lake Herald , November 8, 1918 , accessed November 22, 2016, Utah Digital Newspapers. 119 Utah Community Scourge Stricken Salt Lake Tribune , November 7, 1918, accessed November 22, 2016, Utah Digital Newspapers. 120 Influenza Still Claims Victims, Richfie ld Reaper , November 9, 1918, accessed November 22, 2016, Utah Digital Newspapers. 121 Only 7 Cases of Influenza Are Reported, Salt Lake Herald , November 11, 1918, accessed November 22, 2016, Utah Digital Newspapers.

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35 epidemic. 122 Dr. Beatty contended that Eureka and Sego had not followed the recommendations of the state board of health. Sego did not close its schools until a week later than ordered and Eureka town residents did not take the disease seriously. 123 In an October 11, editor C. E. Huish accused the Salt Lake newspapers of yellow journalism and deliberately trying to stir up fear. He made light of people imagining themselves to be ill and said schools and public places should not be closed. 124 When town officials in Eureka were accused of negligence by Beatty, they lashed out at him . In a letter signed by the mayor, city marshal, city board of health and other city leaders, they de nied explained that they had followed every order, that the town board of health had not been influenced by the newspaper and that the people of Eureka have cooperated in every way to fight the epidemic. They blamed the high number of deaths on lack of nurses, denseness of population in the mining camp, and small homes with large families. 125 Beatty denied criticizing the Eureka board of health. His denial was important, b ecause the Eureka board of health was an extension of his office. It was important for him to support them, while at the same time pointing out that town residents were heedless to restrictions. He blamed the citizens of the town who did not take the threa t of the disease seriously and did not cooperate with the town doctor, Dr. Laker. He also blamed the newspaper editor for 122 Epidemic is Definitely on Decline, S alt Lake Telegram , November 5, 1918, accessed November 22, 2016, Utah Digital Newspapers. 123 Utah Community Scourge Stricken, Salt Lake Tribune , November 7, 1918. Epidemic Loses Badly in Fight , o nly 28 Cases, Salt Lake Herald , November 8, 1918, access ed November 22, 2016, Utah Digital Newspapers. 124 Took Hysterical Action, Eureka Reporter , October 11, 1918, accessed November 7, 2016, Utah Digital Newspapers. 125 Strong Language Used in Letter from City Officers, Salt Lake Telegram , November 9, 1918 , a ccessed November 22, 2016, Utah Digital Newspapers.

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36 mocking the closing orders from the state board of health and downplaying the seriousness of the situation. 126 In early November, the r eported number of new cases of the flu and of deaths caused by the flu began to decrease . T he State Board of Education began to press the State Board of Health to reopen the schools. Beatty remarked that reopening the schools would suicidal 127 He under stood that the premature ending of sanctions, like lifting the ban on school closings could lead to a resurgence in the disease if it happened too soon. An announcement in the Salt Lake Herald on November 6 claimed that Beatty had agreed to let c ity school s reopen and bans would be lifted on November 11, because the number of influenza cases was declining every day. 128 Dr. Beatty used the Salt Lake Telegram , to deny the claims. Robert J. Shields, Red Cross manager for the Salt Lake City chapter, came to Beatt Salt Lake Herald 129 Shields asserted that hundreds of parents had told him the schools should not be reopened and that if they were reopened, they would not send their children . Shields also ar gued that t he many t eachers who were act ing as nurses need ed a vacation before schools reopen ed. Shields speculated that many cases we re not being reported and that this was the reason the epidemic seemed to be declining. 130 126 Physician Maintains His Rebuke of Editor Was Merited, Salt Lake Telegram , November 9, 1918, accessed November 22, 2016, Utah Digital Newspapers. 127 Schools are to Remain Closed, Epidemic Shows Slight Decrease, Salt Lake Tribune , November 2, 1918 , accessed November 22, 2016, Utah Digital Newspapers. 128 ext Monday, Salt Lake Herald , November 6, 1918, accessed November 22, 2016, Utah Digital Newspapers. 129 Theatres to Reopen Soon, Says Beatty, Salt Lake Telegram , November 6, 1918, accessed November 22, 2016, Utah Digital Newspapers. 130 Theatres to Reopen Soon, Says Beatty Salt Lake Telegram , November 6, 1918, accessed November 22, 2016, Utah Digital Newspapers.

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37 Though Beatty felt some hope fro m the apparent lull in flu cases and deaths, he continued to stress constraint and adherence to safeguards during an optimistic early November when the Salt Lake public appeared to forget that the flu was still a huge concern. Salt Lake newspapers reported large crowds in stores in the city. 131 Utahans were optimistic that t he war in Europe was coming to an end. O n November 4, the Salt Lake Telegram, quoted 132 October had been a devastating month for influenza deaths; there were 287 deaths reported in the state. 133 This number of deaths is relatively small, when you consider that almost 20,000 Americans died of the flu across the nation during the same period. 134 An d, i n fact , there was a drop in the number of influenza deaths in Utah between Novem ber 1 and November 10 , but November proved to be the deadliest month , overall, during the eight month time frame from September 1918 to April 1919 with 428 reported deaths statewide. 135 Figure 2 shows number of deaths in Utah from influenza reported on specific dates from August 1, 1918 to January 30, 1919. There were three reported death s from influenza in August and three in September. In October, t he flu began to kill in ea rnest . On October 31, the number of reported deaths was twenty one, clearly a peak. In early November, the 131 Epidemic of Pneumonia is on Wane Here, Salt Lake Herald , November 3, 1918, accessed November 7, 2016, Utah Digital Newspapers. 132 Scourge Crisis is Passed in Utah, Salt Lake Telegram , November 4, 1918, accessed November 22, 2016, Utah Digital Newspapers. 133 Hunt sman Cancer Institute, University of Utah, accessed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/ . 134 Ann Hagedorn, Savage Peace: Hope and Fear in America, 1919 ( New York: Simon and Schuster, 2007 ) , 6. 135 Huntsman Cancer Institute, University of Utah , accessed April 10 , 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/ . See Figure 2 and Figure 3 .

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38 number of reported deaths began to drop, until November 17 (seven deaths reported.) No doubt the huge celebrations across the state on Armistice Day led to the resurgence of the disease and consequently a resurgence in death rates beginning November 18. It may be that Thanksgiving Day celebrations on November 28 also led to a resurgence of the disease and death rates. Figure 3 indicates that November w as the deadliest month for Utah, followed by January and October.

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39 Figure 2. Utah Influenza Death Count by Date, Aug. 1918 Jan. 1919, accessed April 10 , 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/up db/ .

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40 Figure 3 . Utah Influenza Deaths by Month, Aug. 1918 May 1919, accessed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/ .

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41 CHAPTER VIII L OCAL AUTHORITY For the most part, l ocal authorities in comm unities, both large and small, relied on state mandates and accepted help sent from the state board of health . In 1896, t he first Utah state legislature passed legislation requiring that a board of health be created in each county and that a county health officer be designated. 136 Many communities in Utah had at least a part time designated health officer. Beatty relied on officials in each community to keep him informed. On October 9 , he asked officials in each community where the influenza had struck to con tact him immediately, by phone or wire, and to take steps to close schools and places of amusement. 137 He also asked physicians to report cases to city and local health boards rather than to his department directly. 138 By delegating some authority and requirin g communication on the s ituation in each community, Beatty kept a handle on the situation across the state. He did not work alone; there were six other members of the State Board of Health and the board employed sanitary inspectors . 139 During the epidemic th ese inspectors, among them nurses like A. H. Smith, travelled to hard hit communities to assist in the fight against the flu. 140 Beatty understood that he could not manage the epidemic in the entire state on his own and he sought help locally. 136 Robert E. Parson, A History of Rich County . Utah C entennial County History Series ( Utah State Historica l Society: Rich County Commission, 1996 ) , 282, 284. 137 Salt Lake Herald Ogden Standard , October 10, 1918, access ed November 10, 2017, Utah Digital Newspapers. 138 Salt Lake Herald , October 5, 1918, accessed November 17, 2016, Utah Digit al Newspapers . 139 Open the Town Goodwin's Weekly , December 7, 1918, accessed November 17, 201 6, Utah Digit al Newspapers . 140 Traveling Nurse Returns, Salt Lake Tribune , December 9, 1918 , accessed November 17, 2016, Utah Digit al Newspapers .

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42 In Salt Lake C ity, government officials overlooked business contracts, p rivacy and personal rights to manage the spread of the disease. In October 1918 , officials from the Red Cross, Salt Lake County Medical Society, local hospitals, and the Short Line Railroad Company met for a conference with Salt Lake City mayor, W. Mont Ferry, to make emergency plans to handle and minimize the spr . These o fficials at the meeti ng asked the state board of health to feder prevent the movement of ill patients from outlying areas to Salt Lake City by railroad to help slow the spread of disease. 141 City o fficials were concerned that and that their ill employees would be transported to Salt Lake City on the railroads. 142 Mayor Ferry suggested rooming houses as hospitals became overcrowded. 143 On two consecutive October days , state board of health inspector s and doctors visited 157 homes in Salt Lake City where at least one person had the flu. 144 T he individual rights of residents were intruded upon as d oor to door visits by city health officials to find the ill and to supply facts and advic e on how to deal wi th influenza in the home were 141 Red Cross Acts to Stop Spread of 'Flu' in City, Salt Lake Herald . October 14, 1918, accessed November 7, 2016, Utah Digit al Newspapers . 142 Red Cross Acts, Salt Lake Herald . October 14, 1918, accessed November 17, 2016, Utah Digital Newspapers . 143 Red Cross Acts, Salt Lake Herald . October 14, 1918. Flu Continues to Spread , 26 Homes Report Disease, Salt La ke Tribune , October 14, 1918, accessed November 17, 2016, Utah Digit al Newspapers . 144 Influenza Gets 1200 Patients in State Salt Lake Herald , October 12, 1918 , accessed November 17, 2016, Utah Digital Newspapers .

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43 made . 145 State health officials felt justified in overstepping not only individual rights, but the rights of businesses to stop the spread of disease. Smaller communities like Park City and Ophir, Utah put drastic measures in pl ace to protect residents from the flu. Park City officials announced that any person entering town must obtain a permit and then be examined. For the most part, Park City had managed to escape the flu and officials wanted to keep it that way. 146 Beatty voice d support for communities with zero or few cases of influenza setting up a quarantine. 147 On October 18, the mining town of Ophir declared that no one could enter the community for any reason until the epidemic was over. The disease had not reached the town yet. 148 Ophir health officer, Zeno G. Logan, commanded that watchmen be assign ed to guard the entrance to Ophir C a nyon to keep people from entering. 149 For Ophir the quarantine may have worked. Ophir reported one influenza death during the pandemic. 150 Many offi cials in towns outside Salt Lake City immediately obeyed the gathering bans mandated by the state board of health, some adding recommendations on how business should be conducted during the epidemic . Despite action by town officials, cites 145 Eugene R. Kelley, M.D. and B.W. Carey, American Journal of Public Health 8, no.10 (October 1918): 746. 146 Ogden Standard . October 17, 1918, accessed November 17, 2016, Utah Digi tal Newspapers. 147 Ogden Standard , October 30, 1918, accessed November 22, 2016, Utah Digital Newspapers 148 Ogden Standard , Octob er 19, 1918, accessed November 17, 2016, Utah Digital Newspapers. 149 Ogden Standard , October 29, 1918, accessed November 17, 2016, Utah Digital Newspapers. 150 Huntsman Cancer Institute, University of Utah, acc essed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/ .

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44 with few resourc es suffered. Proclamations like this one in Delta , Utah began to app ear in communities all over the state : Figure 4. This p roclamation appeared in the Millard County Chronicle on October 10, 1918. Mayor Thurston of Delta also asked busine sses in his town to encourage customers to conduct their business quickly and to refrain from stay ing in stores longer than wa s necessary . 151 When large numbers of residents fell ill, Delta city officials closed the sugar factory and began using it as a hosp ital. 152 Lack of medical help in Delta was a critical problem. Dr. Charles A. Broaddus reported to Camp Kearny in Southern California in late September, leaving his Delta practice behind. 153 Other communities faced shortages of medical personnel as well. In Bi ngham, a mining town in south we st Salt Lake county, both 151 Spanish Influenza is Suspicioned in Delta, Millard County Chronicle , October 10 , 1918, accessed November 17, 2016, Utah Digital Newspapers . 152 Disease is Checke d, Dr. Beatty Reports, Salt Lake Tribune . October 22, 1918, accessed November 17, 2016, Utah Digital Newspapers . 153 Spanish Influenza is Suspicioned in Delta, Millard County Chronicle , October 10, 1918. Influenza on Wane ; Deaths in Utah Drop Salt Lake Herald , October 16, 1918 , accessed November 17, 2016, Utah Digital Newspapers .

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45 Dr. John Anderson and Dr. Hageman reported for military duty in the medical department of the United States army before October. 154 By the middle of Oc tober, entities like the Red Cross and businesse s also established emergency hospitals in communities and sent health officials to assess conditions . In Bingham, Captain J. N. Dolph , national field director of military relief for the Red Cross , set up hospitals in the Bingham city hall and the Commercia l Club Building. 155 The Utah Public Health Association sent Ruth Ward and Esta Ensign to Bingham before there was any indication the flu had arrived to survey the camp for victims and to educate people in prevention tactics. 156 The camp still had three physici ans, Dr. F red E. Straup, Dr. Daniel H. Ray and Dr. John F. Flynn. 157 The Utah Copper and American Smelting and Refining C ompany utilized the Garfield Club as an emergency hospital , purchased an ambulance, and into a traveling hospit 158 Not only were the companies concerned about the loss of business , they were concerned about their employees . 159 Because there was a shortage of doctors and nurses, it was easier to care for the seriously ill in one place, rather than visiting many home s where the ill lived. It was a matter of conserving resources. 154 Dr. J. Anderson Left for Army Press Bulletin , October 4, 1918, accessed November 22, 2016, Utah Digital Newspapers . 155 Fifty Towns in Grip of Influenza, Salt Lake Tribune , October 13, 1918. Influenza on Wane; Deaths in Utah Drop, Salt Lake Herald , October 16, 1918. Bingham Doctor Claims Cure for the Influenza Press Bulletin , November 8, 1918, accessed November 17, 2016, Utah Digital Newspapers . 156 Health Workers are N ow in Camp Press Bulletin , October 11, 1918, accessed November 17, 2016, Utah Digital Newspapers . 157 Town Board Holds Meeting, Press Bulletin , October 11, 1918 , accessed November 17, 2016, Utah Digital Newspapers . 158 The Utah Copper Makes Hard Fight on Influenza , Press Bulletin , November 8, 1918 , accessed November 22, 2016, Utah Digital Newspapers . 159 The Utah Copper Makes Hard Fight on Influenza , Press Bulletin , November 8, 1918 , accessed November 22, 2016, Utah Digital Newspapers .

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46 Despite all the help from the Red Cross and the mining companies, Bingham city health officer, H enry N. Standish sought help from county and state health authorities on November 8, when the s itua tion intensified . 160 Sometime before November 15, t he state board of health sent Dr. W.S. Harrison, an assistant surgeon for the United States health service sent to Utah by Blue, to help with the situation in the town. Harrison who had travelled the sta te to help hard hit communities said he had not seen any town in Utah in such a bad state. 161 O n November 11 , when peace was announced, Mayor Q. B. Kelly called for a public holiday in Bingham. He asked businesses to close . The mayor and Police Chief A lbert E. Pautsch encouraged town residents to celebrate and there were large crowds in the streets. The mines close d for half a day and many residents went to S alt L ake City to celebrate. 162 Just four days later, Mayor Ke lly and city health officials turned Socie ty Hall into an emergency hospital that could serve eighteen patients because of an increase in cases . 163 On November 19 , the Bingham town board called an emergency meeting and passed new regulations. Among the new regulations: all businesses must close by s residents of Bingham must wear masks in public places. Bingham was the f i rst in the state to pass a compulsory mask wearing order. 164 A nyone not obeying the new 160 Influenza Increasi ng Here in Bingham, Press Bulletin , November 8, 1918 , accessed November 22, 2016, Utah Digital Newspapers . 161 Influenza Situation in Bingham Very Serious, Press Bulletin , Lifting of Ban is Still in Abeyance Salt Lake Tribune , Novemb er 15, 1918, accessed November 17, 2016, Utah Digital Newspapers . 162 Big Victory Celebration, Press Bulletin , November 15, 1918, accessed November 17, 2016, Utah Digital Newspapers . 163 Emergency Hospita Press Bulletin , November 15, 1918 . Additional Cots at Society Hall Press Bulletin , November 22, 1918, accessed November 17, 2016, Utah Digital Newspapers . 164 Bingham First to Wear Masks Press Bulletin , November 29, 1918, accessed November 22, 2016, Utah Digital Newspapers .

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47 regulations was arrested by city health officer Standish and fi ned five dollars to twenty five dollars by the Salt Lake County C ourt . 165 At a town council meeting on December 4, the council decided to keep the mask regulation. 166 Two days later, the local newspaper, the Press Bulletin ree vaccination, rather than compulsory was the strategy of the Salt Lake Health Department . 167 At the Bingham town council meeting on December 11, Utah State Health department inspector Schwartz suggest ed to the board that masks were not necessary and the council lifted the mandatory regulation on mask wearing . The council opened town churches and movie theatres as directed by the state board of health, but did stipulate that those attending church or the movies must wear masks. 168 By December 20, the epidemic had improved enough that the Bingham town board had set a meeting to talk about raising the ban on public gatherings in the town. 169 By October 10, thirty two Utah towns had reported cases of influenza. 170 Fifty towns in Utah had reported the presenc e of the disease by October 13. 171 Ten days later, the state health department revealed that 138 Utah towns had reported the existence of the flu in 165 County Co urt Cases Press Bulleti n, November 22, 1918. Enforcing the Mask Regulation Press Bulletin , Local Health Officer is Now Very Busy Press Bulletin , November 22, 1918, accessed November 17, 2016, Utah Digital Newspapers . 166 Masks wil l Still be Worn in this Camp , Press Bulletin , December 6, 1918, accessed November 17, 2016, Utah Digital Newspapers . 167 Utah State News Pres s Bulletin , December 6, 1918, accessed November 17, 2016, Utah Digital Newspapers . 168 Ban o n Masks is Raised Pr ess Bulletin , December 13, 1918, accessed November 17, 2016, Utah Digital Newspapers . 169 Press Bulletin, December 20, 1918 12 20, accessed November 17, 2016, Utah Digital Newspapers . 170 Salt La ke Telegram , Oct ober 11, 1918, accessed November 21 , 2016, Digital Newspapers. 171 Salt Lake Tribune , October 13, 1918, accessed November 17, 2016, Utah Digital Newspapers .

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48 their communities. 172 Less than three weeks after the arrival of the influenza in Utah, it had reached 138 comm unities. 173 This must have been very frightening. When the local government in a community did not obey state mandated restrictions, that community was chastised and reminded by Beatty that he would step in . J.J. Fitzgerald, mayor of Park City allowed the to wn pool halls to remain open because they had collected so much money for the fourth Liberty Loan drive. An angry Beatty warned that 174 He stressed that unless all pool hal ls and other public places were closed immediately, he would send state health officials to do the job. 175 The Park City newspaper, the Park Record , eporting to Beatty that the pool halls were still open and that the town was about to reopen its schools. up and 176 Beatty must have been in a position of authority over Dr. Edward P. LeCompte , city physic ian in Park City . 177 When he heard that Park City might o pen its schools and other public places, he contacted LeCompte and assured him 172 Salt Lake Tel egram , October 23, 1918, accessed November 22, 2016, Utah Digital Newspapers. 173 Ogden Standard , October 4, 1918, accessed November 7, 2016, Utah Digital Newspapers. 174 Salt Lake Telegram , October 24, 1918, accessed November 17, 2016, Utah Digital Newspapers. 175 Salt Lake Telegram Park Recor d , October 25, 1918, accessed November 17, 2016, Utah Digital Newspapers. 176 Park Record , October 25, 1918, accessed November 20, 2016, Utah Digital Newspapers. 177 Edward P. LeCompte household, 1920 U.S. Census, Park City , Summit, Utah, accessed 31 July 2017, https://familysearch.org/ark:/61903/3:1:33S7 9RFW 9WR?i=27&cc=1488411 , citing ED 126, sheet 14B, line 69, family 319, NARA microfil m publication T625 (Washington D.C.: National Archives and Records Administration, 1992), roll 1867; FHL microfilm 1,821,867.

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49 that if the schools or any public places opened, they would face prosecution by the state. 178 The newspaper article expressed a thinly veiled message of contempt for outsiders who tried to control life in Park City and for any Parkite who would tattle to state authorities about what local authorities were planning and doing. Park City was n ot only defiant regarding state mandated restrictions, but also faced local power struggles b etween those in authority and local physicians when designing plans to fight the flu . In early October, Park City town leaders placed a quarantine on strangers coming to town. On October 25 , local physicians, Drs. Snow and Barta insisted that the quarantin e should be lifted , because they believed it was not effective. Town leaders agreed, but city physician, LeCompte was against lifting the traffic quarantine. When the mayor and the city health board along with local physicians voted, LeCompte was the only person in favor of keeping the traffic q uarantine. 179 L ocal civic and health officials dis agree d on a community plan, each fe e ling that his ideas would best benefit the community. While Park City was defiant and faced power struggles within the community , the city officials of Delta were obedient to state mandates and worked together , but faced opposition from residents . When the city council ordered businesses to conduct all business outdoors, a pharmacist complained to the State Board of Health. He did n ot want to dispense medicine outside and threatened to close his drug store. Beatty urged the town council to move business back in doors and ask customers to wear gauze masks. The town 178 Park Record , October 25, 1918, accessed November 20, 2016, Utah Digital Newspapers . 179 City Open to O utside Traffic Park Record , October 25, 1918 , accessed November 20, 2016, Utah Digital Newspapers .

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50 council complied. 180 In this case a citizen resisted local authority and local authority reached a solution by complying with state government authority. When state h ealth board authorities learned about an alarming number of influenza cases in a community, they sometimes rushed in to take over, not waiting for local authori ties. This was the case in Millard C ounty when the towns of Fill more, Scipio, Holden and Kanosh were qua rantined by the state board of h ealth , because there were so many influenza cases . Under the order, no one could enter or leave these four t owns without authorization from city board of health officials. Any one given permission to enter one of these towns was required to be quarantined for three days. 181 The state board of health even exercised authority over the judicial system in the Fifth Judicial Court by prohibiting court cases being heard in Fillmore, the county seat. To keep the wheels of justice turning, Judge D. H. Morris travelled to Salt Lake City to hear motions on pending cases since most of the attorneys involved lived in Salt Lake City. 182 Onc e the state implemented the quarantine, it was taken very seriously and it appears that the Fillmore board of health was reluctant to lift it. An incident in December 1918 , when the Fillmore town quarantine was still in effect, illustrates how carefully th e quarantine was enforced . Millard County S heriff Cass Lewis was wearing a mask, but did not stop for the quarantine guard with a red flag as he entered the town on county business . The guard reported to the town marshal that the s heriff did not stop. A wa rrant for the 180 State Improving Salt Lake Tribune , October 28, 1918 , accessed November 17, 2016, Utah Digital Newspapers . 181 Salt Lake Telegram , October 24, 1918, accessed November 17, 2016, Utah Digital Newspapers . 182 Salt Lake Telegram, October 24, 1918, accessed November 20, 2016, Utah Digital Newspapers .

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51 arrest of Sheriff Lewis was issued by the Fillmore town marshal after the marshal explained that the sheriff should have stopped and explained his business to the guard. N o one from the city board of health could be found to sign the warrant . Lewis insisted he had work to do in Delta and left Fillmore. 183 183 Millard County Chronicle, December 19, 1918, accessed November 20, 2016, Utah Digital Newspapers .

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52 CHAPTER IX AMERICAN INDIANS It is important to mention that there is a huge gap in scholarship concerning the American Indian experience in Utah during the influenza pandemic. For American Indians the government story is completely different, because they were outside state authority . It seems logical that reservations were areas where the federal government should have had the ability to disseminate news and implement regulatio ns during the epidemic. In Utah, the state did not play a role on reservations. I could find no evidence that the Utah State Board of Health placed quarantines, as they did in some localities, on Indian Reservations during the epidemic, perhaps because a s tate agency did not have jurisdiction. It is hard to say whether the state chose not to quarantine or did not have the power to quarantine. Niall P.A.S. Johnson and Juergen Mueller suggest, in their article, Global Mortality of the 1918 were ignored during the fight against influenza. 184 Utah American Indians were devastated by the epidemic, but only six Utah death certificates for Indians are recorded as flu deaths in 1918 1919. 185 Records are difficult to find, but there were Indian Reservations in at least San Juan (Navajos), Millard (Paiutes), Juab (Goshute), Duchesne and Uintah counties in 1918 1919. On 8 June 1918, there was an eclipse of the sun. For the Navajos, the eclipse began to die. Navajos believed this meant that illness was in the area and humans would 184 1920 Bulletin of the History of Medicine 76, no. 1 (Spring 2002): 108. 185 Huntsman Cancer Institute, University of Utah, accessed November 7, 2016, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/.

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53 soon get sick. 186 The earliest record concerning large numbers of suffering America n Indians came in a November 16 , 1918 newspaper article. More than half the residents on the Goshute Reservation, near Gold Hill, on the Utah Nevada border, were ill and nine had died. In January 1912, President Taft had officially designated eighty acres for Goshute Indians in Skull Valley. 187 There were no available doctors or nurses near the reservation. Superintendent Frank of the reservation notified local U.S. Marshall, Aquila Nebeker about the situation. Nebeker sent an urgent plea for help to the stat e board of health, acknowledging that the disease was spreading rapidly. 188 In December, near Bluff, in southern Utah, range rider, R.E. Powell discovered an eight year old Indian boy in a teepee with the bodies of his five dead family members. A newspaper 189 These five deaths took place in San Juan county, and yet there is only one recorded death from influenza in the county from August 1918 to April 1919. The bodies of the dead were buri ed by Powell and two friends. 190 The deaths were not recorded in county records, perhaps because the men could not identify the bodies and had no other option, or perhaps because they were Indians. There are eye witness accounts of hundreds of Navajo Indian deaths in 186 Robert S. McPherson, A History of San Juan County: In the Palm of Time (Utah Centennial County History Series. Utah State Historical Society: San Juan County Commission, 1995), 273. 187 Ouida Blanthorn, A History of Tooele County (Utah Centennial County History Series. Utah State Historical Society: Tooele County Commission, 1998), 42 43. 188 Salt Lake Telegram Salt Lake Herald , November 17, 1918, accessed November 22, 2016, Utah Digital Newspa pers. 189 Salt Lake Herald , December 12, 1918, accessed November 22, 2016, Utah Digital Newspapers. 190 Salt Lake Herald Dying by Grand Valley Times , December 6, 1918, accessed November 22, 2016, Utah Digital Newspapers.

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54 the county. 191 192 Fifty year old John and his wife, Lula were Indian traders living in Indian Country. 193 According to Lee Reay in hi s book, Lambs in the Meadow , his father Will Reay was the Meadow (in Millard county) health officer during the epidemic. He helped his father put up a yellow quarantine sign at each end of town and visited the Indian camp (the Kanosh Indian Reservation) wi th him. He was a child, but remembered Indians begging his father for medicine, families grieving their dead and the smell of death in the camp. 194 About 300 Piute Indians lived on the reservation; in the Spring of 1919 less than 100 were still living; about 200 having died of the flu. 195 In December, the USPHS sent a Doctor Phillips to Fort Duchesne, Utah from Lawton, Oklahoma to aid Indians suffering from the flu. 196 There were seven Indian deaths in Randlett that month. 197 On December 28, the Duchesne Record re ported that the flu was killing many Indians. 198 Several factors could have combined to account for the lack of 191 Grand Valley Times , December 6, 1918, accessed November 22, 2016, Utah Digital New spapers. 192 Grand Valley Times , December 6, 1918, accessed November 22, 2016, Utah Digital Newspapers. 193 John Wetherill household, 1910 U.S. census, Bluff, San Juan, Utah, accessed 15 March 2017, https: //familysearch.org/ark:/61903/3:1:33S7 9YB7 9W4X , citing enumeration district (ED) ED 146, sheet 7B, family 29, NARA microfilm publication T624 (Washington D.C.: National Archives and Records Administration, 1982). 194 Lee Reay, Lambs in the Meadow (Provo, U T: Meadow Lane Publications, 1979), 65 67. 195 Stella H. Day and Sebrina C. Ekins, 100 Years of History of Millard County (Daughters of Utah Pioneers, Millard County, UT: Art City Publishing Co., 1951), 143. 196 Myton Free Press , December 26, 1918, accessed November 22, 2016, Utah Digital Newspapers. 197 Myton Free Press , December 26, 1918, accessed November 22, 2016, Utah Digital Newspapers. 198 Duchesne Record , December 28, 1918, accessed Nov ember 7, 2016, Utah Digital Newspapers.

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55 records of Indian deaths. Indians were not considered United States citizens, so their deaths were not required to be reported to the state. 199 In c ases where high numbers of Indians died in one area, there may not have been anyone to account for the dead. In 1919, the Office of American Indian Affairs, Department of the Interior provided information showing that there were 448 cases of the flu among Utah Indians, with seventy two deaths. The report does indicate that the morbidity reports are not complete for American Indians. A report in the May 1919 Public Health Reports, extremely severe among the American Ind 200 199 Garrick Bailey and Roberta Glenn Bailey, A History of the Navajos: The Reservation Years (Santa Fe, NM: School of American Research Press, 1986), 118. 200 Public Health Reports 24 (9 May 1919): 1008 1009.

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56 CHAPTER X B USINESS ELITES INTERVENE As t he holiday season approached , Salt Lake City businessmen and other prominent citizens reached out to Utah state an d Salt Lake C ity officials to offer suggestions and help in an endeavor of co operation . These men urged coordinated efforts between business owners and health officials. On November 20, businessmen and physicians met at the Salt Lake Commercial Club to di scuss solutions. They chose a committee of five businessmen to meet with Salt Lake City Mayor Ferry and Police Chief White and city health commissioner, Dr. Paul. Committee Chairman, James P. Casey was g eneral manager of the Salt Lake Herald newspaper, Edw ard P. Levy was manager of the Salt Lake Orpheum Theatre, Walter C. Lewis was manager of Walker Dry Goods Company, Milton E. Lipman was vice president and manager of L. & A. Cohn Dry Goods Store , and M onroe H. Hanauer was manager of Minne apolis Steel & Mac hinery Company in Salt Lake City. 201 These businessmen had the support of over fifty of their peers . On November 21, the committee met with Beatty, Paul , and the city commissioners. 202 They suggested requiring busine sses and offices to be open specific and sta ggered hours to alleviate the crowds in stores, on street cars , and in the 201 Salt Lake Herald Comes Back Ogden Standard , July 9, 1918 , accessed March 17, 2016 Utah Digital Newspapers Orpheum Manager Arrives in City Salt Lake Tribune , August 18, 1914 , accessed March 17, 2016 Utah Digital Newspapers . Big Store to Close at 6 on Saturday Salt Lake Tribune , July 11, 1916 , accessed March 17, 2016 Utah Digital Newspapers . accessed March 17, 2016 Utah Digital Newspapers . Conflict in Europe of S ome Benefit Salt Lake Tribune , September 1, 1915 , accessed March 17, 2016 Utah Digital Newspapers . Ad for Minneapolis Steel and Machinery Company, Salt Lake Mining Review , April 15, 1917, accessed March 17, 2016 Utah Digital Newspapers . "United States World War I Draft Registration Cards, 1917 1918," database wi th images, FamilySearch (https://familysea rch.org/ark:/61903/1:1:29JM BH8 : 12 December 2014), Monroe H Hanauer, 1917 1918; citing Salt Lake City no 3, Utah, United States, NARA microfilm publication M1509 (Washington D.C.: National Archives and Records Adm inistration, n.d.); FHL microfilm 1,983,913, accessed March 17, 2017. 202 All Join Fight to Combat Flu Salt Lake Telegram , November 21, 1918, accessed November 17, 2016 Utah Digital Newspapers .

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57 streets . All newspapers in Salt Lake City consented to refuse to run advertisements for sales that would cause crowds to assemble. Grocery stores would open at 8:00 a.m., offices at 9:00 a.m., and department stores and shops at 9:30 a.m. Closing hours were also staggered. Business owners who disobeyed the rules would be shut down. Because isolation was the most efficient way to keep the flu from spreading, James P. Casey , with the bl essing of Beatty, Paul and other city officials, announced that medical doctors and ordinary citizens who did not report new flu cases without delay would be fined $300. 00 or spend six month s in jail. 203 An important aspect of the new rules and restrictions was enforcement. If necessary, the city c ould hire up to 1000 temporary law enforcement officers. The hope was that obeying the new rules would obliterate the flu. Enforcing the new measures would require the cooperation of all, from police to policymaker s to everyday citizens. In early December, t he Board of Governors of the Commercial Club released the following statement: Resolved, that we fully indorse [sic] state and city board of health officers and the regulations adopted by them, and commend their efforts to the good will and hearty support of the public, and earnestly urge the rigid enforcement of all ordinances and regulations adopted to combat the epidemic, and the prompt and vigorous prosecution and punishment of all violations thereof. 204 It co uld not have been clearer that the members of the Commercial Club fully supported the health boards and officers. The stateme nt exhibited 203 Salt Lake Tribune , 20 N ov. 1918, accessed November 8, 2016 Utah Digital Newspapers . Salt Lake Tribune , 21 Nov. 1918, accessed November 8, 2016 Utah Digital Newspapers All Join Fight to Combat Flu, Salt Lake Telegram , November 21, 1918, acc essed November 8, 2016 Utah Digital Newspapers . 204 But One Flu Death Reported Thursday Salt Lake Tribune , December 6, 1918 , accessed November 22, 2016 Utah Digital Newspapers .

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58 health boards and officials. 205 On the other hand, t he Salt Lake C ity commissioners, led by Karl A. Scheid, seem to have been against more regulation. Scheid pointed out that Salt Lake City already had some of the strictest restrictions in the country. ake than in many other cities. 206 Though these businessmen, policymakers, and elected officials stepped in to make their views known and to exercise control, the ultim ate power still belonged to Beatty and the board of health. B ans on gatherings began on O ctober 10 . On December 6, the city and state boards of health announced that churches would be allowed to reopen on Sunday , Dec ember 8 . T hea tres would be allowed to open on Monday . Medical professionals would deliver educational talks at theatres and educ ational films would be used to inform the public on ways they could avoid the flu. This had been tried in other cities. Officials believed training individuals was an effective way to replace community restrictions that were no longer in place. Schools wer e to remain closed until at least December 31 , and dances and funerals were still not allowed. 207 Many of the restrictions remained in place, such as quarantine of the ill, staggered hours for businesses and crowd control on street cars and elevators. 208 James 205 But One Flu Death Reported Thursday Salt Lake Tribune , December 6, 1918 , accessed November 22, 2016 Utah Digital Newspapers . 206 But One Flu Death Reported Thursday Salt Lake Tribune , December 6, 1918 , accessed November 22, 2016 Utah Digital Newspapers . 207 Churches Will Open; Theatres Next Day Salt Lake Herald , December 7. 1918, accessed November 22, 2016 Utah Digital Newspapers . 208 Stringent Isolation Laws Still Effective Salt Lake Herald , December 8, 1918 , accessed November 17, 2016 Utah Digital Newspapers .

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59 citizens to remain cautious and thanked city and state health officials for the tremendous job they had done in managing the crisis. 209 es for an extended period. Businessmen were motivated to leave these problems behind and focus on the future. The war was over, but the influenza lingered. It is not coincidental that on November 21 a meeting of the Board of Governors, which included Mayor Ferry and Governor Bamberger, was held at the Salt Lake Commercial C lub. 210 The war had disrupted life, the economy , and business for eighteen months while the state and nation had focused on the role of America in the war. N ow that t he conflagration was no t foremost in business , they could attack other serious problems. The future of Utah was a key issue needed to be made to go forward . 211 The people of the state needed to be he althy to accomplish these goal s . Many groups had ideas on how to move forward once bans began to be lifted. theatres could reopen, discord developed. The Salt Lake Ministerial A ssociation leaders met to gather opinions from church pastors. On December 7, the Church of Jesus Christ of Latter day Saints and other area denominations announced they would not open their buildings for services on December 8 . The mayors of Murray, Sandy and Midvale, towns 209 Salt Lake Herald , Dec ember 7. 1918, accessed November 22, 2016 Utah Digital Newspapers . 210 Salt Lake Telegram , November 22, 1918, accessed November 17, 2016 Utah Digital Newspapers . 211 Commercial Club Plans Development Salt Lake Tribune , November 22, 1918, accessed November 17, 2016 Utah Digital Newspapers .

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60 very near Salt Lake City, along with the Salt Lake county physician, Dr. T.J. Howells, voiced concerns that the raising of the ban on churches and places of amusement in Salt Lake City would jeopardize the citizens of other cities in Sa lt Lake county . They came together in favor of a strict community quarantine , and especially as against those communities which 212 They voted s igned resolutions against both the city and state boards of health which they delivered to the state board of health. 213 Salt Lake county state board of 214 When school superintendents urged the state board of health to open schools, in addition to churches and places of amusement, the Salt Lake Tribune firmly reminded the public tha t the state board of health was the expert concerning the epidemic and that school officials were being irresponsible by suggesting the opening of public schools. 215 Ogden (north of Salt Lake City in Weber county) city leaders were so incensed when the Salt Lake City and Utah state boards of health lifted the quar antine in Salt Lake City, that the Ogden city board of health met to institute sanctions against anyone travelling to Ogden. With the blessing of M ayor T. S. Browning, t 212 Influenza Rules will be Rigidly Enforced Salt Lake Tribune , December 8, 1918 , accessed November 7, 2016 Utah Digital Newspapers . 213 Certificates Necessary in Trip to Ogden Sal t Lake Herald , December 8, 1918 , accessed November 22, 2016 Utah Digital Newspapers . 214 County Protests Flu Ban Lifting, Salt Lake Telegram , December 9, 1918, accessed November 22, 2016 Utah Digital Newspapers . 215 Keep Schools Closed, Salt Lake Tribune , December 10, 1918, accessed November 22, 2016 Utah Digital Newspapers .

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61 he railroad station, the interurban stations and all roads leading into the city. They endowed the guards with the power to turn away any person who did not have a travel permit signed by a physician in the last twenty four hours. 216 On December 9, the Salt Lake Herald , condemned Salt Lake County physician , Howells, and Ogden city health officer George Shorten, for working against Beatty and the state board of health . The newspaper applauded the state board of health for its leadership in fighting the pandemi c and lauded Beatty for looking to other states to see and study results of their actions . 217 During this time of contention, the Salt Lake Tribune wired newspaper editors across the United States and asked how their cities had handled the epidemic. Several responses made it clear that when schools were reopen ed , the number of cases among children increased and the schools were closed for a second time. 218 On December 12, Beatty was vindicated when Surgeon General Blue let Americans know the flu was recurring a nd schools should be closed as soon as a recurrence start ed credit, he had not allowed the schools to reopen despite pressure from school officials . 219 Public schools in Salt Lake City did not reopen until Monday, December 30, 1918. 216 Ogden Takes Steps to Restrict Entry; Drastic Rule Made Salt Lake Tribune , December 8, 1918 , accessed November 22, 2016 Utah Digital Newspapers Certificates Necessary in Trip to Ogden Salt Lake Herald , December 8, 1918 , accessed November 15, 2016 Utah Digital Newspapers . 217 Belated Action Salt Lake Herald , December 9, 1918, accessed November 22, 2016 Utah Digital Newspapers . 218 Cities Outline Methods Taken to Combat Influenza Epidemic Salt Lake Tribune , December 10, 1918, accessed November 22, 2016 Utah Digital Newspapers . Among these cities were Columbus, Ohio, Kansas City, and St. Louis, Missouri, Des Moines, Iowa, and Minneapolis, Minnesota. 219 Influenza Warning Issued by Surgeon, Salt Lake Telegram , December 12, 1918, accessed November 7, 2016 Utah Digital Newspapers .

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62 CHAPTER XI PLANNING FOR THE FUTURE Before the second wave of the epidemic had ended in the United States, i n December 1918, the American Public Health Association (APHA) held a meeting in Chicago . They estimated t hat 400,000 Americans had died in the previ ous three months and that most we re men ages twenty to forty. 220 One of the first orders of business was to create four committees with specific duties: and disperse a list of effective preventative plans, (3) stud y methods of treatment for those 221 Together these committees were given the task of finding the most complete information on the flu so that a national plan could be created to prevent the retur n of another influenza epidemic. The APHA goal was to and control outbreaks of influenza . 222 The organization announced it woul d partner with the Rockefeller F oundation to fight against f uture outbreaks of influenza. 223 Although doctors at the Chicago meeting disagreed on subjects from closings to vaccines , the APHA recommended isolation of victims with signs placed on homes where urvey and organization of Salt Lake Tribune lauded 220 Salt Lake Telegram , December 12, 1918, accessed November 22, 2016 Utah Digital Newspapers . 221 To Instruct in F ighting Flu Salt Lake Tribune , December 10, 1918, accessed November 7, 2016 Utah Digital Newspapers . 222 To Instruct in Fighting Flu Salt Lake Tribune , December 10, 1918, accessed November 7, 2016 Utah Digital Newspapers . 223 Million Cases of Epidemic, Ogden Standard , December 11, 1918, accessed November 22, 2016 Utah Digital Newspapers .

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63 the Utah S tate Board of Health, saying that state health officials had put the above restrictions in place before the American Public Heal th Association made the recommendations. 224 Important and long term changes in the reporting and containing of contagious and epidemic disease came about when the national government instituted new policies to protect civilian life. The pandemic led to the e stablishment of influenza as a reportable disease. At the December 1918 meeting of the APHA, members 225 This important policy change that has been in place for close to a cent ury now has most certainly diminished the magnitude of influenza epidemics that have occurred since the 1918 pandemic. Following the war, Surgeon General authority than the USPHS had du ring the pandemic to fight future epidemic disease. 226 224 Salt Lake Telegram , December 12, 1918, accessed November 22, 2016 Utah Digital Newspapers Utah Method Followed Salt Lak e Tribune , December 21, 1918, accessed November 7, 2016 Utah Digital Newspapers . 225 Utah Method Followed Salt Lake Tribune , December 21, 191 8, accessed November 7, 2016 Utah Digital Newspapers . 226 Crosby, , 312.

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64 CHAPTER XII C ONCLUSION Why is it important to understand the impacts of the influenza pandemic on the home and battle fronts of the First World War? One of the larger global issues facing us is l earning to contain infectious disease, so that we do not lose millions of lives in the future. The research of historians and other scholars can help us understand the kinds of tools we need to implement and the preparations we need to make at all levels o f government, in business, and in society to mitigate the spread of a virulent disease in a global context. As historians , medical professionals, and public health policy thinkers continue to research and write the narrative of the 1918 pandemic, they prov ide a template that reveals valuable lessons learned for use in the future. The federal government was already exercising power over many aspects of American business and life when the fl u arrived in America in 1918. T he government exercised power to mini mize the spread of the disease among the military and among civilians. Because l arge numbers of influenza cases appeared in the military before they appeared in the civilian population, the government was in a knowledgeable, potentially helpful position fr om the start. Surgeon General Blue sent military doctors under his supervision to help in Utah and other states. He advised state boards of health to call on muni cipal authorities to enforce ban s and restrictions. State authority was reinforced by federal authority. Beatty and the Utah State Board of Health worked under the direction of Surgeon General Blue and asked for and received help from the federal government.

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65 When the flu arrived in Utah, li nes of authority were unclear and contested. The Utah S tat e Board of Health, with the support of the governor , set in place policies that impinged on the perceived missions, rights, freedoms, and authority of citizens, businesses, service providers, and other institutions. S tate health officials attempted to get private doctors , citizens, and local governments to follow their advice. They worked to consolidate and assert their authority. During the epidemic, the state board of health expected local Utah community officials to advise and inform the local public in the best way to avoid the flu and to put in place restrictions and regulations mandated by the state agency. For the most part, local authorities in communities, both large and small, relied on state mandates and accepted help sent from the state board of health. By delegating some authority and requiring communication on the situation in each community, the board of health kept a handle on the situation across the state. State government officials overlooked business contracts, privacy and personal rights to manage the spread of the disease. They felt justified in overstepping not only individual rights, but the rights of businesses to stop the spread of disease. Anyone making unsubstantiated, unauthorized or incorrect claims that threatened the fight to mi tigate and stop the spread of influenza came under fire from the state government. When the local government in a community did not obey state mandated restrictions, that community was chastised and remin ded that the state board of health would get involve d. It appears that Utah Indian Reservations were the one exception in this matter, perhaps because a state agency did not have jurisdiction. At first the Utah public was open to mandated regulations and suggestions, but once they saw that these measures w ere not eliminating the epidemic in a timely manner, the

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66 public became less responsive. They may have grown tired of restrictions or since the flu was not stopped altogether, they may have perceived that the mandates were not working. Perhaps self interest was a factor. Some business owners displayed defiance by opening their doors despite restrictions. Some groups such as school boards and city councils felt they were better equipped to make decisions regarding their stewardships then state health official s. After more than a month of restrictions and bans, business elites reached out to Utah state and Salt Lake City officials to offer suggestions and help in an endeavor of co operation. These men urged coordinated efforts between business owners and govern ment health officials. They urged citizens to comply with regulations put in place by government officials to fight the flu. Clearly, they sanctioned short term government initiatives to halt the spread of disease. According to Crosby, in 1918, the United States Bureau of the Census Mortality Statistics 227 Unfortunately, seventeen states were not included in the gathering of statistics from death certificate s in 1918. 228 Utah was a registered state and recorded deaths from influenza and pneumonia per 1000 residents in September, October , November , and December of 1918 were 4.1. Only eight other states of the twenty four r egiste re d states had lower rates of death. The lowest was Michigan with 2.9 deaths per 1000 residents and the highest was Pennsylvania with 7.3 deaths per 1000 residents. 229 227 Crosby, Ameri , 204. 228 Crosby, , 204. 229 Crosby, , 210.

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67 Closures were in place for more than eight weeks in Salt Lake City, Utah. Salt Lak e City kept bans longer than many other American cities , among these Los Angeles, Denver, Indianapolis, and Des Moines. 230 The average city was shut down for five weeks . Following the reopening of Salt Lake C ity, citizens were urged to continue to be cautiou s and were trained by medical professional s and educational films in area theatres. Beatty and the Utah State Board of Health placed the responsibility to safeguard health squarely on the individual once the community restrictions began to disappear. 231 Salt Lake City, with a population of 118,110 reported only 319 deaths from influenza between August 1918 and May 1919. 232 Clearly, Dr. Be , as director of the Utah State Board of Health , in mandating and suggesting restrictions and bans, together w ith not backing down when he was challenged; standing firmly against opposition, contributed to the comparatively low death rates in Utah. Ultimately, the Utah State Board of Healt h, demonstrated tremend ous resolve in fighting the battle against the Spanis h Flu in Utah . Ultimately, the fight required interstate actor cooperation, including the governor, state board of health, community public health officials , policymakers, and other officials and elite businessmen, boosters and everyday Utahans. 230 Crosby, , 210. In Los Angeles, the reported death rate was 4.3 per 1000, in Denver, 5.8 per 1000, and in I ndianapolis, 3.3 per 1000 residents. Iowa was not a registered state, so there is no record for Des Moines. 231 Salt Lake Herald , December 7, 1918, accessed November 22, Salt Lake Tribune , December 7, 1918, accessed November 22, 2016 Utah Digital Newspapers. 232 Huntsman Cancer Institute, University of Utah, accessed April 10, 2017, https://healthcare.utah.edu/huntsmancancerinstitute/research/updb/ .

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70 Kennedy, David M. Over Here: The First World War and American Society . New York: Oxford University Press, 2004. Kyvig, David E. and Myron A. Marty. Nearby History: Exploring the Past Around You . Lanham, MD: Alta Mira Press, 2010. Leary, Tim American Journal of Public Health 8, no. 4 (October 1918): 754 55, 768. McPherson, Robert S. A History of San Juan County: In the Palm of Time. Utah Centennial County History Series. Utah Sta te Historical Society: San Juan County Commission, 1995. Patterson, K. David. Pandemic Influenza 1700 1900: A Study in Historical Epidemiology. Totowa, NJ: Rowman and Littlefield, 1986. Parson, Robert E. A History of Rich County . Utah Centennial County His tory Series. Utah State Historical Society: Rich County Commission, 1996. Poll, Richard D., ed. Thomas G. Alexander, Eugene E. Campbell, and David E. Miller, associate editors. . Logan, UT: Utah State University Press, 1989. Proctor, Tammy M. Civilians in a World at War, 1914 1918, New York: New York University Press, 2010. Reay, Lee. Lambs in the Meadow. Provo: Meadow Lane Publications, 1979. Roberts, Richard C. and Richard W. Sadler. A History of Weber County . Utah Centennial County History Series. Utah Historical Society: Weber County Commission, 1997. Smith, Joseph. History of the Church of Jesus Christ of Latter day Saints. Vol. 4. Period I: History of Joseph Smith the Prophet. Salt Lake City, UT: Deseret Book Company, 1978. Starr, Paul. The Social Transformation of American Medicine . New York: Basic Books, 1982. Sullivan, Mark. Our Times: The Turn of the Century, 1900 1925, Over Here . Vol. 5 New York: Journal of the American Medical Association 71 (Oct. 5, 1918):1137. Tomes, Nancy. "Destroyer and Teacher: Managing the Masses during the 1918 1919 Public Health Reports 125, Supplement 3: The 1918 1919 Influenza Pandemic in t he United States (April 2010): 48 62.

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71 Tuchman, Barbara W. The Zimmermann Telegram: America Enter the War, 1917 1918 . New York: Random House, 1958. American Journal of Public Health 8, no. 4 (October 1918): 787 8. Winslow, C. E .A. The Evolution and Significance of the Modern Public Health Campaign. New Haven, CT : Yale University Press, 1923.