*Pandemic Flu in a Small Town:*
Western Pennsylvania in 1918-1920
By: Gottin_Himmel
04 June 2014

Most of the written accounts of the 1918 influenza pandemic recount the course of the disease in urban areas. With the possible exception of Gunnison, Colo., rural areas have been overlooked.

Newspaper accounts of the flu are scarce, and detailed government reports are nearly nonexistent for the small towns along the tributaries of the Allegheny River northeast of Pittsburgh. Pennsylvania's two major cities, Philadelphia and Pittsburgh, were both devastated by the pandemic and their newspapers spewed volumes of ink as they tolled the death count. Philadelphia is noteworthy because of its very visible onslaught of the flu, but Pittsburgh actually had a much higher mortality rate based on the sheer numbers of people who died.

Fortunately for modern-day researchers, historic preservationists have been busy inventorying graveyard headstone data in the cemeteries found in or near the towns along Red Bank Creek, which meanders across three counties before it meets the Allegheny River. An exhaustive, and exhausting, perusal of these inventories reveals the march of H1N1 through the area.

Now a quiet back water, the valley was a busy mining, lumbering and industrial corridor in the early 20th century. The railroad was built in the area in the 1870s to speed coal, iron ore, timber and farm produce to the Pittsburgh markets. This was the Industrial Age's equivalent of intercontinental air travel.

The pandemic reached Philadelphia in September 1918. Three weeks later, the first cases emerged in Pittsburgh. Within days, people started getting sick in the Red Bank Valley, most likely the result of northbound rail passengers getting off at stops along the way. These towns had populations of perhaps 500 to 1,500 people at the time.

The iron-making and lumbering towns near the mouth of the creek at its confluence with the river seem to have escaped the worst death rates. However, a larger town just upstream and a couple of miles inland was not so lucky.

In 1918, Rimersburg had a population of just under 1,200 people but was a major trade hub for the farms and industries around it. Of the approximate 4,000 graves in its main cemetery, 67 of them hold confirmed or likely victims of the flu and its aftermath. That mortality count excludes the few soldiers who likely died in World War One. Most military deaths are found in a veterans' cemetery just up the road.

A few miles upstream lay one of the largest towns in the valley, New Bethlehem, population about 1,500 in 1918. The first likely flu deaths occurred in the third week of October and the last sometime in late 1920. All told, the community's two cemeteries harbor more than 20 likely flu victims. While this toll is comparatively light, two towns only a mile or two upstream experienced very high mortality rates. It is likely that New Bethlehem, a major rail, timber and coal center, was the epicenter for the spread of the disease to these towns.

The first, Alcola, has two cemeteries containing 23 likely victims of the pandemic, this in a small community that had perhaps 300 people. A mile or so farther upstream, Hawthorn's cemeteries have the graves of another 12 victims, again in a town with perhaps 500 people at the time.

Several miles above Hawthorn, the creek's valley narrows and there are no large towns until you reach Summerville, another rail, lumber and farm hub. With a population of perhaps 700 or 800 at the time, it lost 27 residents.

As related in urban doctors' accounts in the early stages of the pandemic, people were at first baffled by this terrifying new disease. The few existing newspaper clippings from the time bear phrases such as "the shocking death of a well-known young local man from a virulent pneumonia" and "the entire family was carried off within one day by suspected diphtheria."

Infants and very young children were dying of "croup" until the medical community spread the word that the deaths were caused by a bafflingly lethal new influenza.

Smaller farming and lumbering communities tended to escape the worst of the flu, and the farther away from the rail line, the lower the death rates. While the automobile was a common fixture on town streets, farmers and lumbermen still relied on horses, oxen, wagons and sleds for transportation. Trips into town were a weekly or monthly event, undertaken on mud roads.

Gazing into a necessary crystal ball because of the lack of newspaper coverage, it is likely that New Bethlehem escaped relatively unscathed despite its larger population because of the town's doctors. Telephones were still rare, but the telegraph connected them with the larger world. Pittsburgh newspapers arrived on the morning trains. Doctors, bankers and sawmill owners likely understood the significance of the news and took action.

Coal mining companies, owned by far-distant entrepreneurs, were not as scrupulous and their small "patch towns" were harder hit. All ethnic groups were equally affected, but the Italian, Polish, Ukrainian and Lithuanian headstones stand out among the Scots-Irish and German majorities.

There are possible links between the outbreak there with the higher mortality rates in nearby Alcola and Hawthorn. Two people died in New Bethlehem two days before a related family died in Hawthorn, for example.

Similarly, the higher loss of life in Summerville appears to have been tied to at least two women who were volunteer nurses in the swamped Pittsburgh hospitals. It is not known for certain, but it is likely that they were members of their town's Red Cross chapter who willing walked into the H1N1 storm. Their ages do not match up with any of the children who died in Summerville, but it is possible that they were aunts who came back for a visit from the city and spread the contagion to their families.

The hill farms and communities fared better. The railroads did not reach them for another 10 years, and even those were minor spurs. Even today, a drive on paved roads is tricky. A hundred years ago, a 20-mile trip would take a day or more.

The age distribution in this region matches closely with published data in most of the rest of the United States, Canada, France and the UK. The majority were born sometime after 1873 and were in their 20s and 30s when they died in 1918 and 1919.

Infant and child mortality were also very high, outstripping the expected death rates in an era when childhood immunizations were nonexistent. Germ theory was understood and compulsory public education through the 8th grade had caused a dramatic drop in infectious disease deaths in the years before 1918. However, H1N1 was not identified as the flu culprit until many years after the fact.

Higher rates of miscarriages, stillbirths and neonate deaths persisted until at least 1920, if the cemetery records tell the true story. Pregnant women were especially vulnerable to the ravages of the disease, and if they survived, their children were likely to be frail and sickly. Children who caught the flu, were born during the pandemic or shortly thereafter, appear to have been more likely to die early.

The death rate among all survivors was higher for a decade or more after the pandemic, based on the cemetery data. There are echoes of their post-flu fate written on tombstones from 1922, 1923 and up until about 1930. Death was a constant neighbor in the coal regions, when boys as young as 12 went to work in the mines, but the mortality rate was still unusually high in these years.

Much of the material written about the 1918 flu pandemic only deals with the milder first wave in the spring of 1918, the far deadlier second wave in the fall of 1918 and the winter of 1919, and sporadic outbreaks through the remainder of 1919. However, most fail to examine a less-publicized and smaller fourth wave that took place in 1920. Perhaps people were absorbed in the aftermath of the war and were tired of dealing with the previous wave of flu victims. Nevertheless, this disease did not abruptly end in 1919.

Across a two-county region in 1920, more than 30 people, and perhaps many more unreported cases, succumbed to H1N1. These deaths were often in more remote areas located away from the flu epicenters of 1918-1919. In one instance, a minister and his family, who were natives of one of the towns, all died in Erie County, some 80-90 miles away in 1920. Other deaths happened in isolated farming communities 15 or 20 miles away from the rail lines. Infant deaths were noticeably higher that year as well.

Some sources maintain that a prior flu epidemic in 1889-90 conferred some degree of immunity on the people who caught it and recovered. This does not seem to be the case among the 1918-1920 victims in the Red Bank Creek valley. A majority of the deaths occurred among people born about 1893 and afterward. Perhaps it was another strain that was circulating in 1889. Perhaps the town's explosive growth in the 1890s and early 1900s accounted for the higher rate in the later pandemic. Like so much about the unusually virulent 1918 H1N1 strain, a lot is open to conjecture because there is simply not enough hard data available.

There was a noticeable uptick in deaths in 1915 and 1916 among people in their 20s and 30s, as well as a higher rate of infant deaths. This small clue may well serve to support the theories that the H1N1 strain was already circulating and growing more virulent in the years leading up to the storm of 1918-1920.

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