In the waning days of September 1918, Dr. Max C. Starkloff, Health Commissioner for the city of St. Louis, actively monitored the news from Boston – at the center of the nation’s influenza epidemic – and watched the contagion as it spread westward. Not one to dodge grim reality, Starkloff understood that influenza would soon find its way to St. Louis. Quickly, he prepared the city for that inevitability. His first action was to issue a request through the influential St. Louis Medical Society that physicians voluntarily report to his office any and all cases of influenza they discovered. Next, he wrote an article in the St. Louis Post-Dispatch detailing how best to avoid influenza and the deadly pneumonia that often accompanied this new form of the disease. He warned residents to avoid fatigue, alcohol, and crowds, and to get plenty of fresh air and to avoid those who are ill.1
For the time being, Starkloff did not believe that greater action was necessary, though he kept a sharp eye on developments at Jefferson Barracks, a military training camp approximately ten miles from the city. A few dozen men there had developed influenza by October 1, prompting the commander to discontinue all public entertainment and bar all gatherings, to prohibit visitors from entering buildings occupied by draftees and enlisted men, and revoking passes to travel outside the barracks. A few days later, the initial 40 mild cases had swelled to 500, overwhelming the small staff of nurses on base. Dr. C. E. Freeman, the chief surgeon at the barracks, issued an urgent plea for every nurse and nurse trainee from St. Louis he could get.2 Unfortunately, the ban on visitors to Jefferson Barracks did not apply to two-term Congressman Jacob E. Meeker, who visited the facility on October 9 during his re-election campaign. Seven days later, the 40-year old Meeker died of influenza at Jewish Hospital in St. Louis, believed to have been contracted at Jefferson Barracks. Just hours before his death, Meeker married his secretary of six years. Wedding attendants wore gauze masks.3
Meanwhile, St. Louis physicians began reporting their first cases of influenza. On October 5, a family with seven cases was identified, purportedly the first in the city. By the next day, approximately fifty cases were reported. Realizing the seriousness of the situation, Starkloff requested that the upcoming Liberty Loan drive be cancelled. He also asked the Board of Alderman to pass an emergency bill declaring influenza a contagious disease – thus giving the mayor legal authority to take declare a state of public health emergency – and providing for stiff fines for physicians who failed to report cases of the disease.4 For the time being, Starkloff believed that sick individuals should self-isolate, but that more widespread action was not yet necessary.
Alarmed by the rapidly growing number of influenza cases in the early days of October, however, Starkloff abruptly changed his mind about the need for a sweeping closure order and gathering ban. On October 7, Starkloff called Mayor Henry Kiel, representatives from the United States Public Health Service, the Red Cross, the St. Louis medical community, business interests, city hospitals, and the public school system to his office to discuss the most effective way to fight the city’s nascent epidemic. Several present were against the prospect of mass closures. With over one hundred civilian cases in the city and 900 cases at Jefferson Barracks, however, Starkloff urged them to consider drastic action in order to halt the spread of the disease. After some debate, the group agreed. They conferred Starkloff with legal authority to make public health edicts. They also agreed to a sweeping closure order. Starting on October 8, St. Louis’s theaters, movie houses, pool halls and other public amusement venues would be closed, and all public gatherings banned. Schools would close on October 9, giving them one day to inform and prepare students. Starkloff closed churches after holding a separate meeting with Mayor Kiel on October 8.5
The closures came none too early. Although St. Louis’s influenza epidemic was not yet severe, physicians, nurses, and medical supplies were in short supply due to the war effort. By October 11, City Hospital was full, mostly the result of private hospitals that refused to accept influenza patients. The local chapter of the Red Cross faced a severe nursing shortage, and was already having difficulty securing volunteer ambulance drivers; the city had to press police patrol cars into service.6 To ameliorate the situation, the Nursing Committee of the Red Cross presented Starkloff with a comprehensive plan for districting the city and for recruiting and assigning nurses, aides and helpers from the Red Cross, the health department, the public school system, and the various visiting nurse groups. Starkfloff gladly accepted the plan and the help.7 The Nursing Committee also appealed to physicians to give wide publicity for this assistance. For the rest of the epidemic, the Red Cross and other agency nurses provided home nursing – often free of charge – and distributed linens and supplied community kitchens with foods and milk for the sick. The Red Cross motor corps recruited volunteer drivers and automobiles to supplement ambulances and chauffeur nurses from one quarantined house to the next. Through this volunteer system, approximately 40 nurses cared for 3,096 patients who otherwise had no access to private nursing, for a total of 14,339 nursing visits.8
Other groups helped as well. The St. Louis Tuberculosis Society transformed its clinics into influenza information centers, and eight of its members visited factories to give short talks on preventive influenza care. The Society also printed thousands of educational flyers and enlisted the library and department stores to distribute the information.9 Police patrolmen made sickness surveys of their districts and took measures to assure that patients received medical care.1 Public school personnel chipped in as well. Initially, school system officials opposed the idea of closing schools. Once Starkloff ordered the closure, however, its leaders rallied.11 In addition to loaning school nurses and physicians to the war on influenza, school officials moved quickly to encourage all 2,500 teachers to volunteer at the health department. Many of them did. Ironically, the school system’s first move was to call a large meeting of teachers and principals to coordinate volunteer activities, with special dispensation for the gathering from Starkloff.12 Theater owners and other business owners were not so fortunate. They, too, intended to meet to discuss ways to join the fight against influenza, but Starkloff prohibited that meeting.13
Not everything worked smoothly. Due to miscommunication between the health department, schools, and police about the best way to close schools, many parents mistakenly sent their children to their classes as usual on he morning after the proclamation. School authorities believed the order would go into effect after pupils were assembled and notified. The police had a different understanding, and some officers prevented children from entering their school buildings.14
To rectify the communication and coordination problems, Starkloff created a Bureau of Information and put his trusted Assistant Health Commissioner, Dr. G. A. Jordan, in charge. In normal times, Jordan managed the health department’s sanitary section. Now, he and every other physician at the health department worked to stem the influenza crisis, some by supplying free care at police stations.15 Jordan shouldered much of the department’s influenza communications with the press and rendered decisions about the many day-to-day policy and enforcement questions.16 He also issued warnings to any establishment not complying with the closure orders.
On October 15, as the total number of influenza cases reached over 3,00, the city’s Isolation Hospital began accepting influenza patients in order to relieve congestion at City Hospital.17 With the mounting case tallies, Starkloff revised his plan. Meeting with downtown retailers, the Health Commissioner asked store owners and managers to stop advertising Saturday sales in order to reduce weekend crowding.18 Several days later, on October 20, Starkloff issued a new order restricting downtown business hours to 9:30 am to 4:30 pm in the busy downtown section of St. Louis bounded by Olive Street, Washington Avenue, and Fourth and Twelfth Streets. Saloons in this zone likewise had to follow the new hours. The energetic Health Commissioner announced to the city that the closure orders and gathering bans would not be lifted until the epidemic was completely stamped out, whether that be in a week or a month.19
The business community immediately vocalized its opposition to the restricted business hours. Only two days later, Starkloff bowed to the pressure and rescinded the business hour restriction, citing the hardship he felt it caused for small business owners.20 Mayor Kiel, however, under pressure from not only the business community but religious leaders as well, advocated lifting the gathering bans entirely, starting with a two-day trial. Starkloff broached this idea to his advisory committee on October 24, but the physicians on the panel did not agree; they argued against lifting the ban until new cases dropped below 150 a day. Kiel, understanding that that medical advice took precedent over financial concerns, gave way.21 Displeased clergy and business owners – theater owners especially – continued pressing for a change.
As October drew to a close, the number of new influenza cases diminished, though nowhere near the 150 per day mark Starkloff desired. Mayor Kiel, insistent that the restrictions be lifted as soon as possible, pressured his health commissioner into calling another advisory board meeting.22 Starkloff’s direct supervisor, Director of Public Welfare John Schmoll, looked for a compromise and proposed gradually easing the restrictions. In particular, Schmoll wanted to see churches reopened soon.23 After some debate and the weighing in of medical experts, the group decided that the bans would continue.24
In fact, Starkloff enacted even stricter measures. Starting on November 2, he placed policemen in department stores and five-and-ten shops to keep crowds moving.25 A week later, on November 9, he issued a sweeping proclamation immediately closing all non-essential stores, businesses, and factories for four days in a drastic attempt to stamp out the epidemic once and for all.26 As Starkloff explained later in his annual report, the November 10 was a Sunday and November 11 was Armistice Day; in reality, his ban only affected the city’s economy for one-and-a-half days. That fact did not placate business owners. The Retailer’s Association and the Chamber of Commerce complained loudly, and even the Federal government, concerned about war production, bore down on Starkloff. Someone even checked with the City Attorney to see if Starkloff’s had legal authority to issue the proclamation.27 He did. In spite of the furor, people and businesses generally complied, though the beleaguered health commissioner did amend the proclamation to allow work on war contracts to continue.28
The closure order and gathering ban was kept in place on Armistice Day, November 11. Starkloff lauded the fact that the stores were all closed, thus forcing downtown celebrants to remain outdoors where, he believed, it was decidedly more difficult to contract influenza. Mayor Kiel announced that a more formal celebration of peace would be announced after the epidemic was over and the closure orders removed.29 The next day, Starkloff and his medical advisory board agreed to lift the ban gradually over the course of the coming week. Commercial businesses were allowed to open beginning November 13, with St. Louis’s 100,000 schoolchildren returning to their classrooms the day after that. The ban on public meetings would remain in place until Monday, November 17. Starkloff was quick to point out to businesses and the public that the state of public health emergency was still in effect, allowing him to reinstate the measures if necessary.30
For the next two weeks, the infection rate gradually declined, lulling residents into what proved to be a false sense of security. Keeping a vigilant eye on new case tallies, Starkloff spotted a spike on November 27, when more than 700 cases were reported for the previous 24-hour period, half of them children.31 After a hurried conference with other health department personnel, city officers, and public school authorities, Starkloff announced that he was closing schools once again. Because so many of the recent influenza victims were children, Starkloff banned children under 16 years of age from places of amusement, stores, or any other locations where people congregate. For the city’s adults, all public gatherings, conventions, and banquets were barred. Stores were barred from advertising special sales.32 As before, retailers, theater owners, unions, and mass transportation companies rushed to protest the economic hardship this second round of orders would cause. Sick with a bad cold, and with the epidemic on the rise again, Starkloff was in no mood for protest. Exhausted, the health commissioner took to his bed for rest, leaving Assistant Health Commissioner Jordan in charge.33 Jordan quickly set to work enforcing his boss’s orders, including the closure of five theaters caught admitting children.34
By December 5, it became clear that the percentage of influenza cases in children under 16 years of age was decreasing, prompting Superintendent of Schools Dr. J. W. Withers to seek permission to reopen St. Louis’s high schools. Examining the data, Starkloff agreed to allow junior and senior high school students to report for class on Monday, December 9.35 Two weeks later, the number of new cases fell below 125 per day – Starkloff’s criteria for lifting the ban. On December 20, the health commissioner lifted the remaining bans, with two exceptions. First, kindergarten through 10th grade classes remained closed, and children under 12 years of age were barred from places of amusement and allowed in downtown stores only before noon and only if accompanied by a parent or guardian. Second, large and unusual public gatherings were still prohibited. The Globe-Democrat reported, possibly with some glee, that the health department cited the Christmas party of its archrival, the Post Dispatch, as the type of gathering now banned.36
By the end of the year, the daily tally of new cases was consistently under 50. Starkloff lifted all restrictions on December 28 and announced schools would reopen on January 2.37 For the rest of the winter, St. Louis continued to experience low numbers of influenza cases, but the tallies – now compiled as weekly data – remained quite low. Perhaps the real sign of recovery was the resumption of the city’s traditional economic rivalry with the Windy City. When Chicago Health Commissioner John Dill Robertson, citing the recent influenza epidemic, announced in early-February that his city was the safest in the United States, St. Louis businesses jumped at the opportunity to prove him wrong. Launching an advertising campaign, the St. Louis Chamber of Commerce created circulars for its members to send to out-of-town customers showing that St. Louis had a lower epidemic death rate than did Chicago, and that it was therefore the healthier city.38
Led by a strong-willed and capable health commissioner who had the foresight to act quickly and decisively, and supported through home nursing by an organized local Red Cross, St. Louis fared well in its battle against influenza. Despite persistent pressures from various constituents, Health Commissioner Max C. Starkloff and Mayor Kiel moved beyond their differences to execute an open-minded, flexible approach to social distancing measures. Among their innovations was a health officer (Jordan) dedicated almost exclusively to stakeholder communications, an advisory committee, and age-appropriate restrictions for children.
When discussing 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. Only five cities – Grand Rapids, Minneapolis, Indianapolis, Milwaukee, Toledo, and Columbus – had better outcomes.
1 “Doctors Here Must Report Influenza,” St. Louis Globe-Democrat, 20 Sept. 1918, 2; “Pneumonia Cases 10 per cent of Winter Deaths; How to Avoid It,” St. Louis Post-Dispatch, 21 Sept. 1918,11.
2 “Fear of Grip Spread Puts Lid on Barracks,” St. Louis Globe-Democrat, 1 Oct. 1918, 2; “500 Have Influenza in Army Camp Here,” St. Louis Globe-Democrat, 4 Oct. 1918, 1.
3 “Jacob E. Meeker, Congressman, Dies of Influenza,” St. Louis Post-Dispatch, 16 Oct. 1918, 1.
4 “Family of 7 Here Ill with Influenza,” St. Louis Post-Dispatch, 5 Oct. 1918, 3; “No Quarantine Here against Influenza, Says Dr. Starkloff,” St. Louis Globe-Democrat, 6 Oct. 1918, 8. Unfortunately, Starkloff’s rapid response was partially undone by a slow-moving Board of Alderman, which waited until October 14 to pass the ordinance. By that time, there were nearly 2,600 cases of influenza in St. Louis. See “424 new influenza cases in St. Louis,” St. Louis Post-Dispatch, 14 Oct. 1918, 4.
5 “To close schools and theaters to check influenza,” St. Louis Post-Dispatch, 7 Oct. 1918, 1; “Influenza quarantine placed on city and schools, theaters, churches are to be closed,” St. Louis Globe-Democrat, 8 Oct. 1918, 1.
6 “Spanish Influenza Kills Thirteen More Here;Total Now 49,” St. Louis Globe-Democrat, 11 Oct. 1918, 5.
7 “559 new influenza cases and 32 deaths,” St. Louis Post-Dispatch, 18 Oct. 1918, 3.
8 Max C. Starkloff, Annual Report of the Division of Health of the Department of Public Welfare, City of St. Louis for the fiscal year 1918–1919 (St. Louis, 1919). Transcript of annual report located at http://bioterrorism.slu.edu/StarkloffReport.pdf (Accessed May 25, 2010).
9 “503 new cases of influenza in 24-hour period,” St. Louis Post-Dispatch, 11 Oct. 1918, 3; “Influenza publicity plans,” St. Louis Post-Dispatch, 18 Oct. 1918, 4.
10 John C. Crighton, The History of Health Services in Missouri. (Omaha: Barnhart Press, 1993), 174.
11 “To Close Schools and Theaters to Check Influenza,” St. Louis Post-Dispatch, 7 Oct. 1918, 1.
12 “559 New Influenza Cases and 32 Deaths,” St. Louis Post-Dispatch, 18 Oct. 1918, 3.
13 “192 New Cases of Influenza in Day Indicate Spread,” St. Louis Post-Dispatch, 9 Oct. 1918, 1.
14 “Influenza Closing Order Extended to all Churches,” St. Louis Post-Dispatch, 5 Oct. 1918, 1.
15 “192 new cases of influenza in day indicate spread,” St. Louis Post-Dispatch, 9 Oct. 1918, 1.
16 Max C. Starkloff, Annual report of the Division of Health of the Department of Public Welfare, City of St. Louis for the fiscal year 1918–1919. Transcript of annual report located at http://bioterrorism.slu.edu/StarkloffReport.pdf (Accessed May 25, 2010)
17 “69 Have Died Here from Influenza,” St. Louis Post-Dispatch, 15 Oct. 1918, 6.
18 “32 die in day here of influenza, making 120 since October 7,” St. Louis Globe-Democrat, 18 Oct. 1918, 4.
19 “276 new cases of influenza reported,” St. Louis Post-Dispatch, 21 Oct. 1918, 3.
20 “Order Fixing 9:30 to 4:30 as Business Hours for Downtown Stores Rescinded,” St. Louis Post-Dispatch, 23 Oct. 1918, 3.
21 “Mayor Voted down in Effort to Take off Influenza Ban,” St. Louis Globe-Democrat, 25 Oct. 1918, 1.
22 “Influenza Causes 33 Deaths in Day,” St. Louis Globe-Democrat, 29 Oct. 1918, 8; “Meeting Friday to discuss lifting of closure order,” St. Louis Post-Dispatch, 30 Oct. 1918, 3.
23 “Schmoll in Favor of Reopening Churches,” St. Louis Post-Dispatch, 31 Oct. 1918, 10; “Kiel and Starkloff Disagree on Ban,” St. Louis Globe-Democrat, 31 Oct. 1918, 5.
24 “Influenza ban not to be lifted at this time,” St. Louis Post-Dispatch, 1 Nov. 1918, 13.
25 “Police to be put in stores ‘to keep crowd moving,’” St. Louis Post-Dispatch, 2 Nov. 1918, 1.
26 “Closing order in force, and is generally obeyed,” St. Louis Post-Dispatch, 9 Nov. 1918, 1; “Thousands out of work under 4-day decree,” St. Louis Globe-Democrat, 9 Nov. 1918, 1.
27 “New Closing Law Upheld by One of Charter’s Framers,” St. Louis Globe-Democrat, 9 Nov. 1918, 2.
28 Max C. Starkloff, Annual report of the Division of Health of the Department of Public Welfare, City of St. Louis for the fiscal year 1918–1919. Transcript of annual report located at http://bioterrorism.slu.edu/StarkloffReport.pdf (accessed May 25, 2010)
29 “City Cheerful on First Day Under Influenza Ban,” St. Louis Post-Dispatch, 11 Nov. 1918, 5.
30 “Stores, Factories, Churches, Shows are to Reopen,” St. Louis Post-Dispatch, 12 Nov. 1918, 1.
31 “Influenza Likely to Close Schools Again,” St. Louis Post-Dispatch, 27 Nov. 1918, 1.
32 “Schools Closed, Children Barred from Theaters,” St. Louis Post-Dispatch, 28 Nov. 1918, 1.
33 “Influenza Closing Order is Renewed as New Cases Increase,” St. Louis Globe-Democrat, 28 Nov. 1918, 18; “Board to Enforce Influenza Rules; 1,159 New Cases,” St. Louis Globe-Democrat, 1 Dec. 1918, 1.
34 “Five Movie Theaters Closed by Dr. Jordan,” St. Louis Globe-Democrat, 2 Dec. 1918, 1.
35 “6639 New Influenza Cases Here Last Week,” St. Louis Post-Dispatch, 8 Dec. 1918, 6B.
36 “Influenza ban lifted, except as to children,” St. Louis Post-Dispatch, 20 Dec. 1918, 1; “Lifting of Influenza Ban is Promised for Today by Dr. Starkloff,” St. Louis Globe-Democrat, 20 Dec. 1918, 1; “Flu Ban, with Few Exceptions, Will be Lifted This Morning,” St. Louis Globe-Democrat, 21 Dec. 1918, 1.
37 “Flu ban is Entirely Lifted by Health Board,” St. Louis Post-Dispatch, 28 Dec. 1918, 1.
38 “St. Louis Healthier Place Than Chicago,” St. Louis Globe-Democrat, 8 Feb. 1919, 4; “’Healthiest City’ Claim of Chicago to be Combated,” St. Louis Post-Dispatch, 9 Feb. 1919, 6.
|200||Excess Death Rate (per 100,000)|
September 20, 1918
City Health Commissioner Dr. Max C. Starkloff requests that physicians report all influenza cases to his office.
September 21, 1918
Health Commissioner Starkloff prints an article in local newspapers detailing how to avoid influenza and pneumonia. He advises avoiding alcohol, fatigue, and crowds, and warns against visiting the ill unless absolutely necessary.
September 28, 1918
Dr. G. A. Jordan, Assistant Health Commissioner, orders that caskets of influenza victims must remain closed. Commander Wilson of Navy Recruiting Station announces that he will stop sending honor guards to funerals of deceased sailors if people do not comply with the order.
October 1, 1918
The commanding officer at Jefferson Barracks, within the St. Louis city limits, issues an order discontinuing all public entertainment, prohibiting soldiers from leaving, and barring civilians from visiting enlistees and draftees.
October 3, 1918
Health Commissioner Starkloff issues advice that people with colds stay in bed until recovered. He believes St. Louis will have its share of influenza cases, and that the best way to avoid the disease is to stay away from crowds.
October 4, 1918
More than 500 of the 6,000 men at Jefferson Barracks are sick with influenza, and the chief surgeon requests more doctors from Washington, D.C. and more nurses from St. Louis. Soldiers may only enter their own barracks.
The City Council considers an emergency influenza bill. If passed, it would grant Mayor Henry Kiel the authority to declare an epidemic state of emergency, thus granting Health Commissioner Starkloff power to issue public health edicts and to impose heavy fines on physicians who fail to report influenza cases. Passage of the bill is expected.
October 5, 1918
The first civilian influenza cases appear in St. Louis: seven cases within one African American family are reported. As a result of the worsening influenza situation, the planning meeting for the Liberty Loan drive was cancelled at request of the Red Cross and the Health Department. The Red Cross is preparing leaflets on influenza prevention and care to be distributed to residences.
October 6, 1918
Health Commissioner Starkloff announces that enforced quarantine will not be used for influenza, as it is impractical. Instead, the Health Department will try to isolate the ill.
The vocational training detachment at Lodge Barracks (at Belt and Etzel Avenues) is closed to outsiders as a precaution. Trainees are not allowed to leave except for their daily hike. None have influenza yet, and the quarantine is precautionary only.
October 7, 1918
After meeting with Health Commissioner Starkloff and other health officials, Mayor Kiel directs the City Counselor to prepare an order to close all schools and public gatherings, theaters, and places of amusement. Officials at the Student Army Training Corps unit at Washington University place cadets under quarantine. They will not be allowed to leave campus until danger of the epidemic has passed.
October 8, 1918
After meeting with Mayor Kiel, Health Commissioner Starkloff issues a closure order, closing all schools, and places of public amusement, and banning public gatherings. After a second meeting with the mayor, Starkloff also closes churches, children’s playgrounds, and library reading rooms, and bans dancing at hotels, cafes, and cabarets. The United Railway Company instructs its conductors to keep open all streetcar transom ventilators.
October 9, 1918
Health Commissioner Starkloff warns that influenza is on the rise despite the precautions taken. He asks factories and mercantile businesses to have physicians examine employees and customers for symptoms of influenza. Municipal court sessions are suspended until further notice, and visitors to the City jail prohibited. Starkloff warns saloon owners that their establishments will be closed if they do not prevent crowding.
October 10, 1918
Police are instructed to enforce Health Commissioner Starkloff’s order to the letter, and to break up all unnecessary gatherings.
October 11, 1918
Police Chief Young orders that no gathering of any kind attended by ten or more persons will be permitted in any of the churches unless they are for the purpose of special war work, are inspected, and are granted authority to meet. Health Commissioner Starkloff announces that the closure order and gathering ban might be in place for a month. City Hospital is full with influenza patients, and private hospitals are refusing to accept influenza cases.
October 12, 1918
In contradiction to the statement made by Health Commissioner Starkloff yesterday, Mayor Kiel tells the public that the epidemic should be under control in eight to ten days, and that the closure order and gathering ban will be lifted soon after that.
October 14, 1918
Health Commissioner Starkloff announces that influenza conditions have improved slightly, but cautions against relaxing the city’s guard yet. Mayor Kiel says that at the current rate of improvement, there is a chance that the closing orders might be lifted or modified by the end of the week.
Congressman Jacob E. Meeker of the 10th District, in town as part of his re-election campaign, is taken to the Jewish Hospital with influenza. His condition is not considered serious.
Police stop all music performances in downtown hotels and restaurants.
October 15, 1918
At Mayor Kiel’s request, Health Commissioner Starkloff instructs the police not to interfere with Liberty Loan parades, since they only collect momentarily at the point of passage.
October 16, 1918
Congressman Jacob Meeker passes away at 7:05 am at the Jewish Hospital. It is assumed he contracted influenza while on a visit to Jefferson Barracks on October 9. When it became apparent that Meeker would not survive, he quickly married his secretary of six years.
October 17, 1918
Dr. M. C. Woodruff, chief diagnostician of the Health Department, estimates that 35-40% of the cases reported since October 7 have recovered, and that a large percentage of the remaining cases are convalescing.
October 18, 1918
At a meeting between representatives from the Red Cross, the Health Department, and other groups, a plan for the mobilization of nurses is adopted. The city will be divided into nine districts, which will be served by volunteer nurses. They will visit homes of patients and supervise the care of cases. The Red Cross will also enlist volunteers to go into homes of ill and do cooking, cleaning, and laundry. The expenses will be borne by the city.
October 21, 1918
New business hours (9:30 am to 4:30 pm) are put into effect for all retail stores except grocery and drugstores in the downtown district bounded by Olive Street, Washington Avenue, Fourth, and Twelfth Streets. Saloons in this district must observe the same opening and closing hours. Drugstores can sell only drugs and surgical appliances. Restaurants can remain open, but those operated in connection with a saloon cannot serve liquor.
October 22, 1918
The epidemic at Jefferson Barracks is virtually over; only four new cases reported yesterday.
October 23, 1918
Health Commissioner Starkloff rescinds the business hour restrictions, effective immediately, because he believes they are creating a hardship for small business owners. He requests that department stores voluntarily continue to follow restricted hours.
October 24, 1918
A conference of city officials, public health officers, key members of the medical society, Army medical officers, and Red Cross officials is held at the Health Department. This Influenza Advisory Committee voted unanimously to keep the closure order in place until such time as Health Commissioner Starkloff considered the epidemic situation to be well enough in hand to call another conference. No consideration will be given to lifting the order until the number of new daily cases drops below 150. Mayor Kiel wants the closure order lifted, saying that it is not fair to businesses or residents; he has been pressed constantly by business concerns to remove the ban. Nevertheless, the head of the Chamber of Commerce says that removing the closure order would be a “vital error.”
October 25, 1918
Archbishop Glennon inquires about the opening of churches. Health Commissioner Starkloff replies that they would not yet be allowed to reopen. Reverend Frederick F. Johnson, Episcopal Bishop Coadjutor of Missouri, expresses his dissatisfaction with the fact that churches are closed while stores are not.
October 26, 1918
Assistant Health Commissioner Jordan asks public school teachers to volunteer to do clerical work in the Health Commissioner’s office so that the men employed there can be released for outside work combating influenza.
October 28, 1918
Health Commissioner Starkloff announces he will grant permission to high school athletic coaches to practice if they agree to all use one field (with staggered practice times), rather than have their teams scattered across the city, and if no one else besides players and coaches will be allowed.
October 30, 1918
Health Commissioner Starkloff declares that the ban on public meetings applies to Halloween parties, and that no crowds will be allowed to gather on the streets.
Mayor Kiel requests convening the Influenza Advisory Committee on Friday, November 1, to discuss possibility of lifting the closure order and gathering ban. Starkloff replies that a meeting is not necessary because there is no chance he will lift the order, but he nevertheless consented to the meeting.
October 31, 1918
Health Commissioner Starkloff notifies police to prevent private Halloween gatherings in homes and hotels, as well as gatherings in the streets.
Director of Public Welfare John Schmoll recommends a modified closure order that would permit churches to hold Sunday services. Starkloff reiterates his stance that the measures will be kept in place.
November 1, 1918
The Influenza Advisory Committee meets to discuss the closure order. After much debate, Health Commissioner Starkloff holds fast to his position and refuses to life the order.
November 2, 1918
Health Commissioner Starkloff meets with a committee of the Associated Retailers, and decides to assign policemen to department stores and five-and-dime shops to keep the crowds moving.
November 8, 1918
Health Commissioner Starkloff institutes stricter epidemic controls. All mercantile establishments and all places of business not essential to supplying the means of sustenance are now included in the closure order. The revised order goes into effect tomorrow.
November 9, 1918
The stricter closure order goes into effect. At a long conference between the Chamber of Commerce and the health department, business owners agree to stand behind the order, but expressed hope that modifications to it might be made if necessary.
November 10, 1918
Several saloonkeepers are arrested for failing to close under the stricter order, and the police barricade at least one saloon after discovering twenty men inside drinking. After an hour siege, the police entered and arrested the bartender. At least fifteen clashes occur as a result of passengers trying to get onto streetcars when conductors would not let them, resulting in some broken windows.
November 11, 1918
Mayor Kiel announces that there will be no modification of the closure order for the purpose of Armistice Day celebrations.
November 12, 1918
The Health Department decides to allow all commercial businesses to re-open tomorrow, including theaters and movie houses. The ban on public gatherings will continue for several more days. Health Commissioner Starkloff points out that the state of emergency remains in effect, allowing him to reinstitute closure orders if need be.
November 13, 1918
The closure order is lifted this morning, and businesses reopen.
November 14, 1918
Schools reopen, with longer days and more intensive instruction to make up for the lost classroom time.
November 18, 1918
The public gathering ban, the last of the epidemic restrictions, is lifted.
November 23, 1918
Assistant Health Commissioner Jordan warns theaters and movie houses to maintain proper ventilation.
November 26, 1918
Influenza cases suddenly start to spike again, mostly in children. Health Commissioner Starkloff states that the cases appear to be mild and that there is no immediate reason to call the Influenza Advisory Committee to order or to consider another closure order.
November 27, 1918
Over 700 new influenza cases are reported for last 24 hours, the highest single day since the epidemic began. This prompts Health Commissioner Starkloff to declare that he has “practically made up his mind” to close schools again.
November 28, 1918
In a hurried conference between Health Department officials, city officers, and public school authorities, Health Commissioner Starkloff decides to close all public, private, and parochial schools immediately. Later in the day, Starkloff amends the order to bar children under 16 from attending places of amusement, stores, or places where people congregate. Public gatherings, conventions, and banquets for the general population allowed only by permit from the Health Department. Streetcars may only carry only 20 standing passengers in addition to those seated.
November 29, 1918
Health Commissioner Starkloff tells theaters and movie houses that they must obtain permits to remain open. This way, the Health Department can revoke the permits of theaters that admit children under 16.
The streetcar passenger limit rule proves difficult to enforce, as passengers insist on boarding and have even broken doors and windows when they have been excluded. Volunteers will observe streetcars to make sure they are following the regulations. Where violations are flagrant they will ask police to issue citations to conductors and motormen.
November 30, 1918
Superintendent of Schools J. W. Withers requests that high school principals and teachers volunteer at the Health Department to aid in combating the epidemic.
December 3, 1918
Health Commissioner Starkloff notes a distinct difference in the number of new cases between certain districts in the city: the area between Chouteau, Franklin, and Jefferson has far fewer new cases than the West End districts.
December 4, 1918
Health Commissioner Starkloff states no more permits for meetings will be issued because there have been too many applications for meetings that are unessential. In conference with Mayor Kiel, he decides that elementary and middle schools will not reopen until after the Christmas holiday.
December 5, 1918
In conference with school officials, Health Commissioner Starkloff grants permission for high schools to reopen.
December 9, 1918
High schools reopen for the two upper classes (mainly those over 16).
At Health Commissioner Starkloff’s urging, police begin enforcing ban on dancing in hotels and cafes, which had not been enforced since going into effect on November 27.
December 14, 1918
The business of the probate court was found to have increased 50% on account of all the influenza deaths. Guardianship paperwork has also increased dramatically, as a result of children being left orphaned.
December 20, 1918
Streetcar seating restrictions and the ban on public gatherings is removed, with two exceptions: 1) large and unusual gatherings (over 300 people) are allowed by permit only, and 2) children under 16 are still barred from entering downtown stores or places of amusement. Classrooms for all but high school juniors and seniors are still closed.
December 28, 1918
Health Commissioner Starkloff lifts all restrictions on public gatherings and the admission of children to theaters and downtown stores. Public schools will reopen on Thursday, January 2, 1919.
January 2, 1919
Schools reopen for the second time.