The influenza pandemic of 1918 infected approximately one-fourth of the population of the United States and killed an estimated 675,000. Globally, roughly 500 million people were infected, with a death toll estimated at between 20 million and 50 million. Influenza mortality rates in 1918 accounted for ten times the number of civilians and twice as many military personnel worldwide who died on all fronts during World War I.
South Carolina did not escape the pandemic. By October 15, approximately 50,000 cases had been reported within the state. By the time the epidemic receded, some 14,250 South Carolinians had died from complications associated with the influenza. The pandemic first struck during the spring of 1918 in the form of a mild flu. By autumn, the full brunt of the influenza arrived. Ninety-nine percent of deaths associated with influenza are caused by complications from pneumonia. In 1918 the mortality rate for influenzal pneumonia was sixty to seventy percent. From October 22 to December 31, 1917, thirty-nine cases of influenza were reported at Camp Jackson in Columbia, with no fatalities. In comparison, by November 30, 1918, officials recorded 8,255 cases of influenza within the camp, with 412 fatalities.
Influenza patients quickly overwhelmed the state’s meager medical system. On September 31, the Surgeon General’s Office in Washington authorized Dr. F. Simpson to take charge of South Carolina’s efforts to control the epidemic and appropriated funds to establish emergency hospitals and employ as many health officers as needed. Columbia had just 150 hospital beds in 1918, forcing the conversion of three buildings at the University of South Carolina into emergency hospitals to receive influenza victims. Charleston was at significant risk from the flu due to its constant influx of military personnel. In response, Charleston’s Board of Health banned assemblies of more than five people and ordered all stores to close by sundown. The Citadel was also closed on September 30. From October 5 to November 6, the city health department counted 5,643 cases of influenza and pneumonia within the city limits, as well as 229 influenza-related deaths. In the upstate mill town of Clinton, approximately 600 people were affected, from a population of roughly 3,600. Influenza first appeared in Greenville on October 4 with an infection rate of 1,000 per day over the following four days. In Spartanburg, influenza first struck on September 20. Eleven days later, Spartanburg’s Board of Health closed all public gathering places.
Fortunately, by the middle of December, cases of influenza were quickly disappearing, and mortality rates fell back to normal by the beginning of 1919. The pandemic forced South Carolina, and the rest of the country, to reevaluate its public health organizations and better equip them for future public health crises. The pandemic, despite its horrific consequences, helped guide South Carolina toward a future of improved sanitation, increased public health care, and social awareness.
Charles, Allan D. “The Influenza Pandemic of 1918–1919: Columbia and South Carolina’s Response.” Journal of the South Carolina Medical Association 73 (August 1977): 367–70.
Crosby, Alfred W. America’s Forgotten Pandemic: The Influenza of 1918. New York: Cambridge University Press, 1989.
Year Book, 1918, City of Charleston, South Carolina. Charleston, .