The Influenza Pandemic of 1918 and Missouri’s Response

Susan Sykes Berry

Edited by: Diane Mutti Burke, Christina Loya, and Sandra I. Enríquez

The Spanish Influenza pandemic of 1918-1919 occurred just as World War I was winding down. The name, Spanish Influenza, likely derives from the King of Spain’s diagnosis, followed by a sensationalized report of his illness. Unlike many wartime countries, Spain was neutral in the Great War and had no press censorship. The pandemic unfolded in three main waves; the first occurred in the early spring of 1918. This wave was highly contagious but not terribly deadly. The second wave started in the fall of 1918 and was unusually fatal for the young and healthy. If a person displayed symptoms in the morning, they could be dead by nightfall. Doctors had no effective treatments, and the luckiest patients were those who had the care of a nurse. Good nursing care provided a reduction in the mortality rate. The final wave came in the spring of 1919. At its conclusion, the worldwide estimated death toll was between 50 to 100 million people.

In Missouri, the entire state was on a wartime schedule. Neither wartime fundraising nor the movement of troops across the country slowed down war production. As a result, public health officials had only a few interventions available to them to fight epidemics, and the most effective was quarantine. Unfortunately, quarantine was very difficult to enforce due to the necessity for factories to keep running to supply the war effort. Still, the cities that effectively responded to the pandemic relied on military principles and organization. Missouri had examples of both an effective response in St. Louis, and an ineffective response in Kansas City, with varied solutions statewide.

State Capital-Jefferson City

The first reported flu case in Jefferson City appeared on October 8, 1918. It affected the secretary of the State Council of Defense, Frank Robinson.1 On October 10, the State Board of Health ordered schools to close, canceled church services, and prohibited gatherings of more than 14 people. Businesses were ordered to follow special cleaning routines; factories monitored the temperatures of workers, and coughing and sneezing were discouraged in public places. The State Prison reported more than 100 cases. They obtained a pneumonia serum from the “Mayo Sanitarium in Rochester, Minnesota, and quickly inoculated all of the convicts.” 2 On November 21, the Board of Health stated that “Cities could remove the drastic measures intended to limit the disease’s spread.” 3 Even though businesses and churches reopened, schools remained closed until December 31.4 But Jefferson City still experienced cases well into December. According to journalist Bob Piddy, “by the end of January, the city death toll was at least 34, plus 26 prison inmates.” 5

Southern Missouri and the Ozarks

In Joplin, the city held a Liberty Loan Parade on October 8, 1918. The Red Cross began mobilizing nurses and calling for volunteers. On October 9, the Joplin City Council and the commissioner of health and sanitation, Dr. R.B. Tyler, closed all churches, schools, and theaters; this included a ban on meetings of more than 25 people.6 By October 18, the Red Cross asked the city “to establish an isolation hospital because of 74 new cases referred to nurses in two days.” 7 By the end of October, the sick included at least seven doctors, including the commissioner of health and sanitation; but nothing stopped the celebrations for the end of the war on November 11, 1918. As these celebrations did not seem to have any effect on new cases, the City Council and the doctors ended the bans on November 15. Joplin had a ban in place for 39 days, and “from October 1 to November 7, the Globe reported 386 cases of flu and pneumonia, with 68 deaths.” 8

Springfield’s mayor, J.J. Gideon, ordered the town closed on October 1. The broad ban closed churches, schools, libraries, pool halls, theaters, and any public place where people gathered. However, the shutdown mandate didn’t affect businesses. About three weeks after the closings, a pastor was arrested for holding church services, but then released without charges when officials learned that violation of the mayor’s proclamation carried no punishment.9 The mayor ended the ban on November 2. The final count of “influenza deaths in the autumn of 1918 and winter of early 1919 hover around 260.” 10

The Ozarks local newspaper The Van Buren Current Local, reporting in the Van Buren and Ellsinore area, published an article about the Spanish Flu on November 7. This article stated, “There are several instances where whole families are sick in bed at one time as ‘ye correspondent’ and wife and two boys were all down at once with the malady, we are in position to know how it goes. Both local doctors here have been on the go both day and night.” 11 By the end of November, the newspaper editor noted only two deaths and that “the influenza situation here is improving somewhat.” 12

Another Ozarks town, Midco, financially benefited from the outbreak of World War I. The U.S. government paid more than half the cost of building a chemical plant for Mid-Continent Iron Company. In return, the plant supplied chemicals to the government. Hundreds of workers were needed to operate the plant, mostly single men; as a result, Midco was a booming town as the flu hit the Ozarks. Gene Oakley, a Carter County historian, stated, “The flu hit the town at a time when the houses were crowded, and there were many men in Midco who had no one to care for them. In some cases, whole families were virtually wiped out. People died by the score in the worst tragedy to ever strike the young town.” 13 Midco would not survive much past the end of the war, and by 1921, the company was bankrupt.

College Towns

Columbia closed schools and churches on October 6. On the 7, the University suspended all classes and events, apart from the Student Army Training Corps. The city set up five emergency hospitals and asked for community volunteers to serve as nurses. “Any woman who is willing to help is requested to telephone Dr. Noyes’ (Guy Lincoln Noyes, then-dean of the School of Medicine) office and to tell the number of hours she can work,” an October 9 advertisement in the Evening Missourian stated. “Even those who have had no nursing experience can be used. Mrs. Selbert, then-superintendent of the emergency hospital, will teach them what to do and how to do it.” 14

On October 12, the death of Poe Ewing, a teenager at the Student Army Training Corps, marked the first loss in Columbia.15 The Columbia Board of Health closed all public schools, forbade any public gatherings, and quarantined 75 homes that same day. Although the prohibition of public gatherings slowed down the rise in influenza cases, Columbia’s ministers and other leading citizens demanded an end to the ban. On November 16, Columbia resumed its social activities despite the protests and warnings from four doctors on the board of health.16

When cases continued to increase the board of health tried a stricter quarantine on November 27. All public gatherings were banned, and a limit of 6 people in businesses. All schools shut down again and did not fully reopen until December 30. These measures helped the city and Boone County record only 150 deaths. Established at the epidemic’s beginning, the University of Missouri emergency hospitals also had a very low death rate; over 1000 cases, but only 14 deaths.17

Schools, churches, and theaters also closed in Maryville on October 12. Public gatherings were limited to 20 people. The Fifth District Normal School in Maryville, one of five state teachers’ colleges across the state (now Northwest Missouri State), closed a day before the city and remained closed until November 26. After reopening efforts began, students attended school on Saturdays to make up for time missed. In addition, “Maryville mandated that homes with positive cases display identification cards so delivery drivers were aware of infections and could limit their exposure.” 18 The student newspaper, The Green and White Courier, had many articles about the Spanish Influenza that recorded the illness and deaths among the students. It also made mention of a physician stationed in the administration building for prevention and care.19

The State Normal School, now known as Southeast Missouri State University, was located in Cape Girardeau. In a legislative report from 1919, this was noted:

During the prevalence of the epidemic of influenza this fall, the value of a hospital was fully demonstrated in the experience of this school. For the care of the students of the S.A.T.C. [Student Army Training Corps] Unit in the Normal School, the government required that the school should provide a hospital. The Board of Regents rented a building just on the edge of the campus which will accommodate about 25 or 30 patients at one time. With the aid of this building, and good nursing provided largely by the women on the faculty volunteering to nurse the sick students, the school has been able to handle about 200 cases of influenza, without allowing a single case to develop into pneumonia and without the loss of a single life. Captain Miller, the military inspector who was here yesterday, said that the record of the school in the care of its students during the epidemic of influenza is equaled by that of only one other school in the Ninth Military District of the S.A.T.C.20

Kansas City and St. Louis

Kansas City was under the control of Democratic bosses Tom Pendergast and Joe Shannon. Most Kansas Citians know about Pendergast and his work as the leader of a Kansas City political organization known as the “Pendergast machine.” 21 According to the State Historical Society of Missouri, “the Pendergast machine controlled local government and the Democratic Party in Kansas City and Jackson County, Missouri, during the Progressive Era and Great Depression. He finally lost power after a series of political scandals.” Lesser-known political figure, Joe Shannon, considered himself a Jeffersonian Democrat. Shannon’s faction became known as “The Rabbits,” while Pendergast’s group dubbed themselves “The Goats.” According to Shannon’s biography from the Missouri Valley Special Collections, “clashes between the two factions at the primaries caused Shannon and Pendergast to realize that they were splitting the Democrats at the polls, so they devised the fifty-fifty rule.” 22 This divided all city and county patronage between the two leaders. The compromise ensured that a Democrat would be elected mayor, but in return, Pendergast and Shannon shared the appointment of the patronage jobs. Although the bosses shared the jobs, they often did not cooperate with one another. This contributed to the uncoordinated approach upon which Kansas City suffered.

Mayor James Cowgill, Dr. E.J. Bullock, head of General Hospital and Health Director, W.P. Motley, the President of the Health Board, and Dr. A.J. Gannon, head of contagious diseases, were the main figures trying to cope with the epidemic. The city issued the first ban on gatherings on October 7, but after business complaints, the ban was removed a week later. A stricter ban that prohibited public gatherings, was issued on October 17. Dr. Gannon tried to get cooperation from the streetcars, theaters, and business owners, but was met with little success. Since any orders on closings had to come from the Health Board, Dr. Gannon had very little power to enforce the orders. The second ban would last until November 14, when the mayor removed all restrictions. Still, on November 11, when the War ended, over 100,000 people participated in a citywide celebration. Dr. Gannon only remained the head of contagious diseases until November 27. Gannon was fired in a secret meeting of the Health Board by W.P. Motley. By December 5, Mayor Cowgill telegrams the U.S. Public Health Department stating “Assistance is needed at once from your department to help control the influenza epidemic in Kansas City. May we hope for immediate response?” 23 A federal doctor arrived on December 11, but left on December 18, without doing much. By December 23 all restrictions were ended.

At the dawn of the epidemic, Dr. Max Starkloff was the City Health Commissioner for St. Louis, and Henry Kiel was the mayor. Mayor Kiel “granted unprecedented authority to Dr. Starkloff to implement closures of public places.” 24 The doctor closed schools, theaters, places of amusement, and limited public gatherings to 20 persons by October 7. The additional closures affected every aspect of daily life. There were not any children on playgrounds, nobody in attendance at lodge meetings, no reading at the library, no pool at pool halls, restricted hours at stores, and Municipal Court and churches closed.25

Dr. Starkloff faced pressure to ease restrictions from business interests, the clergy, and the mayor. Finally, Starkloff ended the restrictions for business hours on October 22. Throughout the rest of October and early November, conversations continued about easing the bans, but on November 9, Dr. Starkloff closed “all non-essential stores, businesses, and factories for four days.” 26 On November 12, the bans were gradually lifted over the next seven days, which included the reopening of public schools. All closures ended in St. Louis on December 28.

In discussions of the “the history of the tragic 1918 influenza epidemic, St. Louis is often held up as a model city. Because of the quick and sustained action by its leaders, St. Louis experienced one of the lowest excess death rates in the nation, just 358 per 100,000 people.” 27 However, responses to the 1918 flu epidemic varied throughout the state. In some cases, the government response was more robust than other locations. And while this resulted in slightly better or worse outcomes, the highly contagious disease resulted in a devastating loss at a time with few treatment options.28 As made evident through the varied responses throughout the state of Missouri with the current Covid-19 pandemic, localized responses matter. In the end, it is difficult to control the transmission of epidemic diseases fully.


  1. Bob Priddy, “Cole County History: Jefferson City vs. Pandemic of 1918, Part I”, accessed October 25, 2021,
  2. Ibid.
  3. Ibid.
  4. Ibid.
  5. Ibid.
  6. Bill Caldwell, “Joplin in the ‘Grippe’: Remembering the Spanish Flu Epidemic of 1918,” Joplin Globe, accessed October 25, 2021,
  7. Ibid.
  8. Ibid.
  9. Larry Wood, “Missouri and Ozarks History: Springfield’s Response to the 1918 Flu Epidemic,” Missouri and Ozarks History (blog), May 9, 2020,
  10. Mike O’Brien, “Covid 19 Reminds of 1918 Spanish Flu” (Ozarks Alive, April 1, 2020),
  11. Larry Wood, “Missouri and Ozarks History: Van Buren Suffers from 1918 Flu Epidemic,” The Rolla Daily News – Rolla, MO, November 6, 2016,
  12. Ibid.
  13. Andrew Sheeley, “WHEN SPANISH FLU HIT THE OZARKS: Ghost Town of Midco Shows Pandemic’s Impact on Rural Missouri,”, accessed October 25, 2021,
  14. Jessi Dodge and Laura Miserez, “Looking Back on Spanish Flu: ‘A Serious Epidemic of Influenza Is Impending,’” Columbia Missourian, accessed October 25, 2021,
  15. Ibid.
  16. Ibid.
  17. Ibid.
  18. Northwest Missouri State University, “Another Pandemic Impacted Northwest during 1918-1919,” accessed October 25, 2021, Magazine/201211Aflupandemic.htm.
  19. Ibid.
  20. “Missouri Disasters, 1785-Present,” accessed October 25, 2021,
  21. Kimberly Harper, Stephanie Kukuljan, and John W. McKerley, “Thomas J. Pendergast,” Historic Missourians, State Historical Society of Missouri, accessed November 30, 2021,
  22. Nancy J. Hulston, “Joseph B. Shannon: Congressman 1867- 1943,” Missouri Valley Special Collections Biography, 1999, accessed November 30, 2021,,%20Joseph%20B..pdf
  23. Susan Sykes Berry, “Politics and Pandemic in 1918 Kansas City” (Thesis, University of Missouri-Kansas City, 2010),
  24. David S. McKinsey, Joel P. McKinsey, and Maithe Enriquez, “The 1918 Influenza in Missouri: Centennial Remembrance of the Crisis,” Missouri Medicine 115, no. 4 (August 2018): 319–24.
  25. Ibid.
  26. “The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia,” in Influenza Encyclopedia, St. Louis, Missouri (University of Michigan Center for the History of Medicine and Michigan Publishing, n.d.),
  27. Ibid.
  28. Unfortunately, there are not any accurate statistics that account for the total number of deaths in Missouri during the flu epidemic of 1918. The problem is that some doctors called it pneumonia, some called it the flu, and some didn’t have a clue what it was. For these reasons, the number of excess deaths is used as a gauge.