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Spanish Influenza in Mississippi(1918)

By Louie Matrisciano

The Influenza Epidemic of 1918 reached the Delta of Mississippi in the first week of October. In Warren County, Mississippi, death registers listed many individuals who fought for their lives, not in the Great War, but in crowded apartments, over-filled hospitals and one-room houses in the Mississippi Delta. Arthur Neal, Katie Alice Williams and Mary Elizabeth Guider died between November 9, 1918 and November 10, 1918, later victims of the disease. These Warren County, Mississippi residents all shared the primary cause of death, Influenza. Warren County experienced many deaths listing the primary cause of death as Influenza. The Warren County Death Register also listed secondary causes of death such as typhoid fever, bronchitis and pneumonia. This essay will reveal the how the virus impacted and changed the people of three Delta communities: Vicksburg in Warren County, Greenville in Washington County and Clarksdale in Coahoma county.[1]

    Mississippi’s war at home against the Influenza epidemic began in the latter parts of September; however, it wasn’t until October when the total number of influenza deaths began to surge across the state. Historical records were not kept by county to show the number of deaths by the Influenza virus in 1918, according to the representatives of Mississippi’s State Department of Archives and History. Therefore, this essay will use state Influenza statistics and county death rates to infer death by influenza in 1918 in selected Delta counties. By examining the number of Influenza deaths in the state in January of 1918, reports indicated that there were 46 white cases and 52 Negro cases. However, by October of 1918, that number increased to 1,057 white cases and 1,873 Negro cases in the state. Furthermore, by the following month, in November, there were only 458 cases white cases reported, a considerable drop in the number of cases compared to the 1,507 Negro cases reported in the state. The Influenza virus had a greater impact and longer duration for the Negro population in the State of Mississippi.

    The total deaths due to influenza for the year 1918 were remarkable because for the first time in history the disease made such drastic mortality rates. The total number of deaths was 6, 219 representing a total death rate of 310.6 per 100,000 population for the year 1918. For the previous year of 1917, only 442 deaths occurred, making a total death rate of 32.4 for the state in 1917. Among the white population for the year 1918, 1,985 deaths occurred, compared to 201 deaths among the white race for the year 1917, which represents a total white death rate of 226.7 and 23.2 respectively for the biennial period. The Negroes suffered a much larger death rate, the total for the year 1918 being 4,234 and for the year 1917, 241 deaths. These totals reduced to rates are 376.0 and 21.7 per 100,000 for the years mentioned. During the year 1913, 293 deaths are charged to Influenza and 182 deaths for the year 1914. The total rates due to this disease per 100,000 population for this period (1913-1914) are 15.6 and 9.6 in the order mentioned. It will be seen, therefore, that Influenza had not been classed as a very disastrous disease until the year 1918, when all previous records were broken. Also, the deaths from Influenza occurred largely during the latter four months of 1918. Up until the Epidemic of 1918, the number of deaths to Influenza was relatively small in comparison to the number of deaths that were recorded in 1918; therefore, Influenza was disastrous in the manner of how it overtook the population of Mississippi so quickly.[2]

   Josephine Bishop Tibbs, a former-care giver in Jackson, Mississippi recalled how the disease took hold of her in 1918, as statistics showed it being the highest cause of death for that year:

and I went home sick with the flu and I remember my mother praying; and she had some Solorn liniment
in the house and she gave me a few drops of Solorn liniment on some sugar. And you know, that broke that
flu upon me. I’m here to tell the tale.

As the disease took hold of the counties in and around the Delta, the Tibbs interview showed a rare glimpse of local treatment for the Influenza Pandemic of 1918:

Solorn liniment is good...I hope the Solorn liniment people hear that

Josephine was asked about the epidemic aspect of the Flu: if it was a scary time? was she aware of what was going on in the rest of the country with the Epidemic? were there a lot of deaths?
I remember it looked like people were dying every which-a-way with the flu.
So I thought I was very fortunate.

Josephine did not recall the city of Jackson issuing any curfews like the ones during the yellow fever epidemics:
“I don’t imagine so. I don’t remember anything like that.” [3]

    However, a local Delta newspaper provided a clearer understanding of the warnings issued by local government leaders and medical experts during the Influenza Epidemic of 1918. Some communities in the Delta instructed their citizens what to do and what not to do during this outbreak. The commissioners of Vicksburg, Mississippi sent out orders on the recommendations of Dr. G.Y. Hicks, county health officer, and Dr. Alverson, city physician, as a precautionary measure to prevent, if possible, the rapid spread of influenza in Vicksburg. The order will apply to all public gathering places where people assemble in large numbers, and will affect all equally. [4]
    Despite numerous government, medical, and social warnings about Influenza, the virus spread throughout the Delta, and along with it, death rates increased as well. This increase can infer that Influenza contributed to the rise of death rate per 1,000 populations. In the year 1918 in Warren County, Mississippi, the total death rate was 25.7 per 1,000 people. This rate was computed on a total of 30, 437 deaths for the year 1918. The total death rate in 1918 showed a 2.2 percent increase from 23.5 percent in 1917, which was computed on a total of 23,579 deaths. The white death rate for Warren County in 1918 was 19.5 per 1,000 people, which was computed on a total of 10,177 deaths for the year. The white death rate illustrated an increase of 5.2 percent from 14.3 percent in 1917, which was computed on a total of 8,048 deaths. The Negro death rate for Warren County in 1918 was 28.3 per 1,000 population, which was computed on a total of 20,260 deaths for the year. The Negro death rate illustrated an increase of .9 percent from 27.4 percent in 1917 based on 15,531 deaths. In summation, the year 1918 experienced 962 deaths of which 220 were white and 742 were Negroes; compared to 1917, which experienced 880 deaths of which 162 were white and 718 were Negroes. When Warren County is compared to urban areas in its county, defined by having a population of 2,500 or more at the time of the 1910 Federal Census was taken, death rates of Warren’s urban areas actually showed a decrease in the percent of deaths per 1000 population. Vicksburg’s total number of deaths in 1918 were 693 or 32.4 percent urban death rate per 1000 persons of which 203 were white and 490 were Negroes. The cities total number of deaths in 1917 were 704 or 33.0 percent urban death rate per 1,000 persons of which 149 were white and 555 were Negroes.

    It should be noted that in Warren County, the death rate per 1,000 persons was higher than that of the state of Mississippi’s average, which was 15.2 percent computed on 30,437 deaths in 1918 and 11.9 percent computed on 23,579 in 1917. Also, when broken down by race, white and Negro death rate statistics of 1918 and 1917 for Warren County both illustrated the same increase in death rates compared to the state averages. The total white death rate for the year 1918 for the state, of 11.6, stands out therefore conspicuously as the highest death rate among the white population of any single year in the history of statistical records in the state because of the increase mortality from pneumonia and influenza. The total Negro death rate for the year 1918 for the state of 18.0 represents a much higher death rate among Negroes than occurred for any previous years. No doubt the increased number of deaths due to influenza and pneumonia had something to do with this increase in Negro mortality.

    An interesting correlation between the rise of Influenza deaths among white and Negro cases was the rise in pneumonia deaths for the month of October 1918 across the state. The number of white cases with pneumonia was 158 and the number of Negro cases was 309. [5] Arthur Neil, Katie Alice Williams and Mary Elizabeth all of Warren County, incidentally, had pneumonia as one of their secondary causes of death. Historical death records did not show if that was a complication due to the Influenza virus or a misdiagnosis of death. [6]

    The Vicksburg Evening Post was the major newspaper publication in Warren County, Mississippi at the time of the Influenza Epidemic of 1918. Beginning in October, the newspaper’s coverage of the virus was scarce. Most articles appeared in the second section on the last page of the paper. Any articles that surfaced closer to page one regarding the virus and epidemic were solely documenting what was happening in the larger Northern cities. Although Influenza cases were few in the Delta city of Vicksburg, the Evening Post kept an observant eye on the number of cases developing in the larger northern cities, especially Boston and Chicago. As the Friday, October 4, 1918 Post printed on its pages: “Spanish Influenza still unconquered in Chicago Districts” or “Whole Families Die in Boston,” kept Southern health workers and citizens abreast to the developments of this strange malady making its way toward the south. Boston, Massachusetts reported that this “medieval plague” threatens to overwhelm the whole country.[7]

    The Vicksburg Evening Post treated the Influenza threat with many precautionary measures and tried not to garner possible panic. The precautions that were taken for university students prevailed first. Delta students that were in larger cities started to return home. Vicksburg students that were ill due to the malady, as it was referred too, remained at the Industrial Institute and College at Columbus, Mississippi. The authorities that closed the institution were very optimistic that the prevailing influenza would not render their college closed for more than a few weeks and the pro-active measures taken to send Vicksburg students home were the wise course of action to prevent further cases.[8] The Industrial Institute and College experienced a total of 147 Influenza cases, nine of whom developed pneumonia. There were no deaths reported at I.C.C. However, the institution was ill-equipped to handle the disease and converted the Industrial College into a hospital and asked for assistance from Camp Shelby. Camp Shelby supplied the institution with two doctors, two nurses and four orderlies for service. After exhausting all applications for assistance, the institution called upon volunteer help—many of whom where girls from the Normal College. This essay will further detail the manner in which Delta communities handled the Influenza disease at the A& M College in Starkville.[9]

    By the following week, the Vicksburg Evening Post had a front page article that reported “Several Cases of Flu in Vicksburg; Churches, School, Movies Closed.” The medical community in 1918 presented a very compelling argument that Vicksburg should not make the mistakes of their neighboring cities by allowing a tremendous number of cases to develop and then try to lock the stable door after the horse has been stolen, reported Dr. G.Y. Hicks county health officer to the Vicksburg commissioners.
By sending out precautionary recommendations, the commissioners and local health officers hoped to reduce the rapid spread of Influenza in Vicksburg. When a few cases of the virus had been reported in widely scattered parts of the city, it was brought to the attention of the county health officers who advocated action, which local government leaders responded to at once. The county health officer stated plainly to the city leaders that their recommendations were presented solely in the interest of public health, as a precaution, and not on account of the few cases in Vicksburg. Dr. Hicks noted in the Vicksburg Evening Post on October 7, 1918:

I want to go on record as advocating the closing of every public gathering place now and at once as a precautionary measure. Not because of the number of cases here now, for there only a few, which developed in the last few days, but because of the number of cases that we are certainly going to have unless some action is taken.
    Dr. Alverson, the city physician in Vicksburg at the time of the Influenza Epidemic in 1918, concurred with the county health officer’s recommendations and suggested that all hotels and pool rooms (public gathering places) have their floors washed with a disinfecting solution and the spittoons flooded with a disinfectant kept constantly in them, to end the spread of germs. Every measure that the city of Vicksburg could take would prevent the spread and would lessen the number of severe cases at any one time. Those measures, Dr. Alverson pointed out, would also prevent the development of many serious cases too.
    The county health officer and the city physician provided the citizens of Vicksburg simple measures to protect their selves against the virus. These preventive measures may have served to either prevent or lessen an attack of influenza. Among the best, was to use a daily throat and nose spray of Dobell’s solution or a weak solution of Listerine. Keep the mouth and nose as clean as possible. Eat light and nourishing foods, keep the windows of your sleeping apartments open and be out in the open air as much as possible.[10] In addition an order was issued that all places in the city which dispensed drinks of all kinds that they must be served in destructible cups made of paraffined paper or cardboard, which could be immediately burned after use.[11] Heeding such warnings and recommendations, the city of Vicksburg experienced only a slight increase in new reported cases of Influenza. Under the orders of the State Board of Health, doctors of the city and county had to report daily the number of new cases they had diagnosed in the previous 24 hour period. Citing reasons for daily reports, the health authorities found no other way to keep accurate accounts with the Influenza Epidemic in the city and county. Physicians are to report their findings to the city clerk.[12] Dr. W.S. Leathers of the US Public Health Service had continued correspondence with State Board Health officials citing the importance of knowing the local conditions and recognized the heavy responsibility placed upon the county health officers at that time.[13]

    As of Wednesday, October 9, 1918, there was no marked spread of the disease in the Vicksburg and Warren County areas. Dr. Hicks, the County Health Officer, felt the ready acceptance of the “close down orders” had greatly helped the situation and reduced the chances of the virus spreading across the city and county. Dr. Hicks made a comment that the slowness of the development of the virus would make the presence of influenza somewhat longer in the city; however, the city had an advantage if it were spread out over a longer period of time because the situation could thus be more readily handled by the local physicians and health authorities. Also, the presence would tend to lessen the development of large numbers of extremely severe cases with complications, which nearly always follow the rapid development of an epidemic due to crowded public places.[14] The Influenza virus in the city of Vicksburg had developed at a very slow pace which was exactly what the authorities wanted. The fewer cases the city had at any one time gave them the ability to handle them more easily and effectively. The physicians were reporting regularly to city clerk, daily and from October 9 to October 10, 1918, the city had only twenty new cases of the Influenza virus.[15]

    However, Dr. Dicks, the county physician and representative of the State Board of Health, reported that there had been but 59 new cases between October10 and October11, 1918 in the 24 hour period. That made 123 cases for the whole city since the first case was diagnosed. That was considered remarkable and furnished a valuable report on the excellent measures that were enacted by the authorities early on during this malady. It was believed that if such measures were not taken, there would have been many hundreds of cases here and some of them extremely severe. It should be noted that the number of physicians reporting to the city clerk increased because communication of the State Board of Health’s orders to report new cases every 24 hours became more apparent.

    Gradually as the number of physicians who reported to the city clerk increased, the number of Influenza cases increased. By October 12, 1918, there was a slight increase in the number of new cases of Influenza in the last 24 hour period, which was no more than expected. Once again, the low number of new cases reported was attributed to the rigid orders issued by the health authorities early on and the hearty cooperation of the citizens of the city and county. The situation looked encouraging to the local health authorities as the number of new cases was not excessive.[16] However, none of the churches would reopen, although it was rumored that the Catholic Church intended to celebrate Mass on the campus of St. Xavier’s convent. Father Prendergast requested the Post to state that this was false, and there would not be any public celebration of Mass in Vicksburg.[17] The subject came up as to when the schools should be opened and the local government decided not to consider the opening of the schools at the time of this editions printing. Yet, the local government leaders felt they would be able to make a more definitive announcement for school opening by the middle of the coming week.[18]

    Although there had been no deaths in the community following the Influenza outbreak, individuals who died on Mississippi’s Delta soil were to have different funeral arrangements. The Vicksburg Evening Post printed the order issued by the State Board of Health and sanctioned by local authorities. According to the orders issued, all funeral services held in the city of Vicksburg were to be private in character and none of the bodies would be taken to any churches since all public meeting places were closed.[19] However, in a matter of time there were to be a number of deaths in Vicksburg. Within a week of the orders by the State, three deaths were blamed due to complications of the virus. In addition, eighty new cases were reported.

    In light of the rise in Influenza cases, there was no relaxation of the measures taken to protect the citizens of Vicksburg and Warren County. The local government and medical authorities generally agreed there should be a tightening of all precautionary orders. Both parties felt that it would have been a grave mistake to lessen in any manner the measures that had already been taken to keep the number of cases in this territory at a minimum. In addition to the measures passed by the local government, the members agreed to add a few new precautionary orders. Among them was the closing of all pool rooms in the city, which would do away with the possibility of crowds gathering around tables, to either watch or play. Some mention was made of the fact that an apparent distinction had been made between certain places where a crowd might gather and others, so the local government decided to shut the pool rooms. Also, the local government issued an order for all stores to be close at 6pm daily, except on Saturdays, when they could remain open until 9pm. This had a double purpose; it would prevent citizens from exposing themselves unnecessarily on the streets after dark and also serve as a conservation measure to reduce the amount of fuel that was used. Both new orders by the local government were accepted by the proprietors of the businesses affected.

    As the wave of closings continued, there were inquiries regarding the holding of lodge meetings. The local government authorities indicated that the fraternal organizations and societies, secret or otherwise, came under the same regulation as the churches and schools, which meant no meetings were to be held for the present.

   As a measure of preparedness and not from any immediate need, the State Board of Health, under the cooperation of local medical authorities, had the high school building fumigated and disinfected. This measure was taken in case an emergency arose where the number of hospital rooms were needed for a greater number of cases than the Vicksburg institutions could handle. Mr. Golden, the custodian, completed the orders issued and stated that there were three large rooms, the rest hall, the drawing room and the domestic art room that could all be equipped with cots at a moment’s notice if measures needed to be taken. The kitchen was also in perfect readiness for the preparation of sick dietaries. Dr. Hicks, county health officer, requested a general wearing of Influenza masks, which served as a very useful purpose in the prevention of contracting Influenza germs. When Dr. Hicks commented on the masks, he praised a small number of boys who already set a very good example by wearing masks that were provided by the Red Cross.[20]

    As preparations were made to contain the territory for the worst case scenarios by the Mayor and local government leaders, the city and county medical authorities, the Home Service of the Red Cross called for attendants to wait on families who were down with Influenza. They did not need to be nurses and they could be white or black.[21] Previous local city board meetings secured the services of a number of African American nurses. These nurses were not trained, but a number of them had some experience in nursing.[22] The African American nurse called upon by the Mayor did not infer a shortage crisis in the health care fields, but to assist the health officials when they were needed. People who came as attendants had the responsibilities of simple services for patients who had no nurse, such as giving them water, carrying them food, and waiting on them in any way. There were a number of women in Vicksburg who could do this service, persons who had no infection in their own homes. Women who preformed this kind of work were to be paid a liberal price of compensation and all attendants were furnished with masks and Red Cross aprons and given simple instructions in regards to treating the Influenza. It should be noted that the Red Cross made a special appeal to the African American women of this community who are able to perform this kind of service to enroll at once and help the citizens of Vicksburg who needed such assistance.[23]

    By October 21, 1918, Dr. Hicks, the County Health Officer, was very encouraged with the influenza situation. The local board of health found that the disease was not spreading rapidly and that was one of the best features of the situation. The doctors reported their cases more accurately for the purpose of the daily record and in that manner tabulated statistics for a given 24 hours were more accurate. At the recommendation of the Mayor, under the encouraging reports from the health officials, he allowed at least one drug store to be open late for the purpose of filling prescriptions. Mr. Heckler, of the Block-Hazlip Company at Clay and Washington streets, stated that he would remain open every night until 1am and all night, at any time that the city leaders considered it necessary. In competition, The Bryan Drug Company, had a prescription clerk at their store every night until 11pm. It now seemed that there could be no further complaints about patients being compelled to wait several hours to have their prescriptions filled.[24]

    By the end of the month of October, the city of Vicksburg in Warren County, Mississippi took several precautionary measures to prevent widespread disease. These measures and orders by local city, medical and State officials limited the number of cases and more importantly deaths across this territory. In the last week of October, the Influenza Epidemic was front page news. Despite what started out as stories about a “strange malady,” it became apparent that this “germ” was much more than previous thought. The citizens of Vicksburg and its surrounding county had a grand total of only 1,336 cases and 16 deaths caused by the Influenza virus. Although cases continued to surface well into 1919 in the Delta city of Vicksburg, fewer died of it as a primary cause. Influenza became part of the secondary listings as marked in death registers in Warren County, Mississippi.[25]

    Greenville, in the Delta town just 82 miles north along the Mississippi River, experienced the Epidemic in larger numbers of cases and deaths. State death rate statistics will once again infer that the Influenza virus contributed to the rise of a death rate per 1,000 people. In the year 1918 in Washington County, Mississippi, the total death rate was 23.0 per 1,000 people. This rate was computed on a total of 30,437 deaths for the year 1918. The total death rate in 1918 showed a 10.8 percent increase from 12.2 percent in 1917, which was computed on a total of 23,579 deaths. The white death rate for Washington County in 1918 was 24.1 per 1,000, which was computed on a total of 10,177 deaths for the year. The white death rate illustrated an increase of 13 percent from 11.1 percent in 1917, which was computed on a total of 8,048 deaths. The Negro death rate for Washington County in 1918 was 22.9 per 1,000 people, which was computed on a total of 20,260 deaths for the year. The Negro death rate illustrated an increase of .9 percent from 27.4 percent in 1917 based on 15,531 deaths. In summation, the year 1918 experienced 1,128 deaths of which 176 were white and 952 were Negroes, compared to 1917, which experienced 595 deaths of which 81 were white and 514 were Negroes.

    Also, when Washington County was compared to urban areas in its county, defined by having a population of 2,500 or more at the time of the 1910 Federal Census was taken, death rates of Washington’s urban area showed a significant increase in the percent of deaths per 1,000 population. The city of Greenville’s total number of deaths in 1918 was 375 or 33.3 percent urban death rate per 1,000 population of which 111 were white and 257 were Negroes. The cities total number of deaths in 1917 were 237 or 21.4 percent urban death rate per 1,000 population of which 60 were white and 177 were black. As previously noted in the Warren county statistics comparing the State of Mississippi’s death rate per 1,000 people, broken down by race as well, between 1917 and 1918, Washington County statistics are all significantly higher than that of the state’s averages as well. I previously noted the State’s averages in the aforementioned text in Warren County.[26]

    The Weekly Democrat-Times, and the Daily Democrat-Times were the city of Greenville’s newspaper publication at the time of the Influenza Epidemic of 1918. The initial coverage of the disease was not widespread and the readers of the Greenville papers had few direct quotes from their Mayor, city physicians and local health authorities regarding the course of action that was taken to prevent the widespread outbreak of Influenza. The Democrat-Times spent a considerable amount of time providing information about the origin, symptoms and possible treatment for the disease. As the disease took hold of this Delta community, the newspaper focused on community needs and how the disease impacted its citizens.       Beginning on October 3, 1918, the Democrat-Times ran a story buried in the back of the paper about a “Spanish Flu.” The story was a summary from a bulletin from the Mississippi State Board of Health in regards to Spanish Influenza. The public was informed of the symptoms of the disease. In understanding symptoms, the reader needed to keep in mind that mild cases might occur and make it difficult to diagnosis accurately, but these mild cases will serve as a means of spreading the disease just as well as the more serious cases. For this reason any case of influenza was placed under the rule. In case of doubt in the diagnosis, the patient was isolated until the condition of the patient could be determined. It was imperative that the physicians of the state use their own opinion and judgment relative to handling such cases, rather than follow the advice and usual expressions of the laity.

    The State Board of Health went on to tell the readers of the Democrat-Times that the seriousness of Influenza stemmed from the fatal complications such as pneumonia and meningitis. Although treatment was simple, because of the apparent danger of problems associated with the disease, it was exceedingly important that proper care and treatment be sought after promptly. The most important treatment was rest in bed from the onset of the disease until all symptoms were eradicated. The patient was to be given fresh air and plenty of food. As long as the patient had fever, the case was regarded as serious and kept in bed. Since bronchopneumonia had a tendency to occur, all patients were placed in well ventilated and warm rooms. Quinine and aspirin were used successfully when secondary illness arose in Influenza patients.[27]

    Taking cues from the State Board of Health’s issuance of the symptoms of Influenza and heeding the precautionary measures to reduce the chance of being exposed the virus, the acting health officer Dr. A. J. Ware declared the Spanish Influenza disease was now an epidemic in the city, although no numbers were published in the local newspapers. The city board of health recommended to the city council the seriousness of the conditions and recommended to the city council that an ordinance be adopted at once that closed all places of public gatherings: theaters, churches and all schools of the city. Students that were boarding in Greenville were allowed to remain, but were quarantined while day pupils from the city were not allowed to attend any schools.[28] Parents of students from Greenville away at college at the time of the Epidemic were reassured by Dr. W.S. Leathers, executive officer of the State Board of Health in Jackson, Mississippi, that reports received from every college in the state indicated everything for the betterment of conditions was being done at the time and with the strict quarantine in effect, there was “no need for alarm.”[29]

    On Tuesday, October 8, 1918, a temporary closing ordinance was adopted by the city council which passed a resolution stating the Board of Health of Greenville declared that the disease called Influenza had became an epidemic in the city and all places of public gathering were closed during the epidemic. In the resolution, all temporary closings would remain until the Board of Health in Greenville declared the disease ended. The ordinance stated that it was unlawful for any owner, manger, proprietor, pastor, teacher, or other executive of any theater or church to assemble or to attempt to cause to assemble, any crowd or aggregation of persons during the aforementioned epidemic. Any person violating any provision of this ordinance was to be guilty of a misdemeanor and punished according to the city of Greenville ordinances.[30] The Democrat-Times ran this closing ordinance in its entirety twice during the month of October. The ordinance was also in aggregate forms throughout sections of the newspaper as reminders about schools and churches activities being cancelled or postponed. The U.S. Public Health Service also issued an Official Health Bulletin on Influenza, which ran in the October 17, 1918 edition of the Daily Democrat-Times . This Bulletin was a national response to a request for definitive information regarding Spanish Influenza and reinforced the warnings of the Greenville ordinances. The Surgeon General, Rupert Blue, of the US Public Health Service was interviewed for the report.[31]

    Greenville’s Democrat-Times made a plea for nurses to aid the city of Starkville; later, the city of Clarksdale made a similar request in their newspaper. At the onset of the disease in early October, the A. & M. College was stricken by the disease where six-hundred boys were ill and several deaths had occurred, which was reported in the State News sections. In the Democrat-Times an urgent plea was sent for all graduate nurses and nurses’ aides to assist in ending the Spanish-Influenza on campus. In the aforementioned text, the city of Vicksburg only requested students be returned from I.C.C. and no request was made for nurses to be sent, since the disease at the time did not pose a serious threat. Vicksburg did not send nurses to Starkville either. The Democrat-Times reported that salaries were to be paid to nurses and expenses paid for nurses’ aides who were accepted, regardless of race. The Red Cross Influenza Committee also organized assistance for families in Greenville, when the disease became more serious. The committee requested nurses, aides and other volunteers for Greenville as the disease progressed.[32] Neighbors and church societies rendered great assistance in prepared meals for the sick. Volunteer housekeepers and caretakers for children were needed to relieve mothers who were in bed with the disease. Masks were furnished and were provided without cost by applying for them.[33]

    Within seven days of the Red Cross Influenza Committee call for community assistance, the Democrat-Times published that in various sections of the city, diet kitchens were set up and broth and other nourishing foods were sent to influenza patients, daily. In comparison to the local Red Cross committees of Vicksburg and Clarksdale, the Democrat-Times reported a number of men volunteered to nurse the sick at night. It was encouraged that more men volunteer at night to assist in tending to the nursing needs of the ill. The Red Cross issued that all African American volunteer nurses were to be paid for their services which were in great demand among the sick. The Red Cross Influenza Committee reminded the Democrat-Times readers that its purpose was to provide assistance whenever called upon, but in order to fulfill its duty, the Committee relied upon the volunteers of the community to supply the demand at critical times in the city.[34] One of the demands on the Red Cross was buttermilk. The Committee requested gallons of buttermilk for the nourishment of Influenza patients. The Red Cross went through ten gallons on a daily basis during the Epidemic in Greenville. The Committee held empty jars on reserve to fill when donations were made to them.[35]

    By late October 1918, the influenza situation was improving among the white citizens of Greenville. However, such was not the case amongst the African American population. Great numbers of African American families were badly afflicted. In one family, ten cases were found which left not one well-member to tend to the sick. There was still a great need for bedding, fruits and other nourishing foods for sick patients.[36] In efforts to help reduce the illness from spreading and assist in families that were already affected, the local African America church leaders took steps to look after the suffering in their church locality. An African American church committee was appointed to oversee the reports of the local ministers.[37] A new Emergency Hospital was also opened for the African American people with Influenza. The house was large, well ventilated and was intended to reach more promptly and properly care for African American patients more attentively. This new hospital was opened under the direction of the local Red Cross chapter.[38]

    Aside from the city council’s ordinance on temporary closings and the State Board of Health warning on symptoms, prevention and treatment, as well as, the U.S. Public Health Service, the Democrat-Times newspaper did not have wide spread coverage from city leaders and local health officials regarding their course of action, physician documentation, and daily updates on number of cases or deaths. Although the Democrat-Times did not have such figures in the public record of their newspaper, it did not infer that the city leaders or health authorities did not record the disease’s impact in other publications, such as the State Board of Health reports by county, though this author found no such records. Many of the human-interest stories in the Democrat-Times centered around what was cancelled or postponed, such as the Ringling Brothers Circus, which cancelled all dates in the South because of the epidemic.[39] Also, a notice from the Sanatorium was published which requested that no flowers were allowed to be sent to the patients and no inquiries as to the conditions of patients over the phone except by family members. The Sanatorium experienced serious overcrowding. These two measures were taken to reduce the interruptions and increase time spent tending to the sick.[40]

    Even with the numerous warnings and cautionary ordinances enacted by city leaders, under the guidance of the State Board of Health and local health officers, the disease spread at an alarming rate. In Coahoma County, Mississippi, 74 miles north of Washington County and 156 miles North of Warren County, the city of Clarksdale made preparations for the Influenza virus in their community. State death rate statistics will once again infer that the Influenza virus contributed to the rise of death rate per 1,000 populations. In the year 1918, in Coahoma County, Mississippi, the total death rate was 23.7 percent per 1,000 people. This rate was computed on a total of 30,437 deaths for the year 1918. The total death rate in 1918 showed a 2.0 percent increase from 21.7 percent in 1917, which was computed on a total of 23,579 deaths. The white death rate for Coahoma County in 1918 was 17.6 percent 1,000 people, which was computed on a total of 10,177 deaths for the year. The white death rate illustrated an increase of 1.2 percent from 16.4 percent in 1917, which was computed on a total of 8,048 deaths. The Negro death rate for Coahoma County in 1918 was 24.4 percent per 1,000 people, which was computed on a total of 20, 260 deaths for the year. The Negro death rate illustrated an increase of 2.0 percent from 22.4 percent in 1917 based on 15,531 deaths. In summation, the year 1918 experienced 966 deaths of which 80 were white and 886 were Negroes, compared to 1917, which experienced 868 deaths of which 73 were white and 795 were Negroes. Also, when Coahoma County was compared to urban areas in its county (urban area previously defined in Washington County Statistics), death rates in Coahoma’s urban area showed an increase in the percent of deaths per 1,000 people. The city of Clarksdale total number of deaths in 1918 was 152 or 25.3 percent urban death rate per 1,000 people, of white 28 were white and 124 were Negroes. The city’s total number of deaths in 1917 were 142 or 24.6 percent urban death rate per 1,000 people, of which 26 were white and 116 were Negroes. As previously noted in Warren County statistics comparing the State of Mississippi’s death rate per 1,000, broken down by race, between 1917 and 1918, Coahoma County statistics were all significantly higher than that of the state’s averages as well. Earlier in this essay, the author noted the State’s averages in Warren County.[41]

    In Coahoma County, the Clarksdale Daily Register ’s headline on October 7, 1918 was “Schools Ordered Immediately Closed.” The Register printed the message from the Mayor, J.W. McNair which told the citizens of Clarksdale of the impending threat of the Influenza virus sweeping across the country. He felt precautionary measures should be in place before the virus took hold of their community. In his message, he was authorized by the US Government, through the State Board of Health, to close all schools, theaters, churches and other places of public gathering, effective immediately. The proactive placement of the Mayor’s message on the front page of the Daily-Register served to warn the citizens of Clarksdale and reinforced the city’s position to keep the cases of Influenza at a minimum. At the time of the Mayor’s message, Clarksdale, Mississippi had only a few reported cases of the disease.[42]

    Although the city of Clarksdale initially had few reported cases, the newspaper kept the people of the city abreast to the developments of the disease elsewhere around the country, especially the South. In Atlanta, Georgia despite drastic measures taken by local health officials, unofficial reports from a score of larger cities in the South showed more than 50,000 cases reported among the civilian population and hardly a single army camp had escaped. Soldiers at Camp Gordon, Georgia ,where some 1400 cases had developed, were ordered to sleep in the open. Army physicians relied on fresh air as one of the surest preventive measures taken. The mild weather, by October 1918, was still prevailing, made the disease less fatal than in the East, and the death rate was comparatively less.[43]

    In addition the preventive measures issued by the State Board of Health, the county and city health boards took further steps to combat the spread of Influenza, by asking every doctor in the county to report immediately any cases of the disease. The County Health Officer Dr. S.D. Robinson announced the situation was treated very thoroughly and there was not any concern for the people to become panicked. Dr. Robinson stated that thirty new cases of influenza were reported in Clarksdale on October 7 for a total of 21 new cases in the county. The people of Clarksdale were aware that every step was being taken to prevent the spread of this malady in their community, as local health authorities reinforced the State Board’s message. As the physicians reported cases to the county health board, the number of cases started to increase. There were about 50-75 cases in Clarksdale and 100 cases in the county, as of October 8. As Dr. Robinson stated, there was no need for excitement because reports by physicians were done as precautionary measure to stop the spread of Influenza.[44]

    Despite the local ordinances of no public gathering, the Clarksdale Daily Register on October 7 printed on the front page above the Mayor’s message that the Sousa Band would be in Clarksdale Wednesday, October 9th. Dr. Robinson stated in a notice to the public that as long as the meeting was held in the open air, the band was permitted to perform by the State Board of Health. Director of Publicity, Ed A. Dalton announced that Liberty Loan headquarters in St. Louis advised him that as long as the meeting planned for Coahoma County was held in the open air, the State Board of Health would not interfere. Sousa’s band was scheduled to appear in the city at 6:30 a.m. on Wednesday October9th and remain until 2pm the same day. However, Marshal W.K. Herrin reported that in an effort to prevent the spread of Influenza, there was not going to be a parade that was previously scheduled to be held.[45]

    John Philip Sousa, in Marching Along, wrote that during the epidemic, he received orders from the Treasury Department to visit cities on behalf of Liberty Loan. However, before he and his band left for the tour, a quarantine was imposed and all band members were to stay in the station, per the orders of the medical director. He did not question the directive of the medical officer; no one ever questioned the mandate of the medical officer. Sousa and his band remained in quarantine until it was raised. The battalion surgeon, Dr. A.H. Frankel, made preparations before the troops left for the scheduled cities. He converted one rail car into a sick bay and placed the hospital corps in charge. Dobell’s Solution was on hand and other medical stores to prevent the “flu” from taking hold on the band. Dr. Frankel was commended to the commandant by Sousa for the tireless effort he ensued to keep the men healthy. Sousa remarked, “We left home with three-hundred and fifty officers and men. We returned home with three-hundred and fifty officers and men.” This was credited to the battalion surgeon who began the tour as a junior lieutenant, but returned home and was promoted to senior.[46]

    Although the cities in the Delta all adhered to the same State Board of Health order for public closures, the Daily Register was the first paper to note how the disease impacted services into the city. The railroads were hit hard by Influenza; agents, dispatchers and others were brought down by the ravages of the disease. According to reports from railroad lines, many dispatch agents and other railroad men were stricken with Influenza in early October. Many of the employees were ill with the disease, but no deaths have ensued. Some of the employees were confined to their homes at various points, but many of the employees were not seriously affected. It was noted that hopefully the disease would run its course and leave the area.[47]

    The Daily-Register reported on the malady around the state; in comparison with the city and county, the numbers of deaths and reported cases were quite less. The scarcity of physicians and trained nurses was one of the major complications of the epidemic. However, Dr. W.S. Leathers, executive officer of the State Board of Health in Jackson, believed the rigid quarantine in force at the time would break the back of the Epidemic in a comparatively short time and lessen the demand placed on existing health professionals. All measures were to stay in force until he was certain it was safe to remove any restrictions. Pneumonia followed influenza in a number of cases reported to the State Board of Health. This pattern had caused some concern among health experts. The concern for the disease did not wane, however, and all precautionary measures were still in place, while the officials of the Mississippi State Fair still organized events for the exposition. Also, exhibits arrived daily and when the Fair opened, it was predicted that attendance records would be broken. Officials were hopeful the influenza epidemic would subside before October 21.[48]

    According to Dr. S.D. Robinson, county health officer, the Influenza situation in Coahoma County was very mild, and the doctor stated that conditions were not alarming, but that on the contrary the physicians had the epidemic under control. There were more than 66 new cases reported after Tuesday October8 by 13 physicians within the county and there were more than 74 cases on Wednesday October9 reported by 18 physicians. Dr. Robinson stated that the epidemic in Clarksdale appeared to be under control and if the current progress continued, he did not foresee any alarming consequences. Dr. Robinson believed anyone who became infected and reported to their physician promptly would not suffer any hardships as a result of coming in contact with this disease.[49]

    During the Epidemic, local physicians in Delta communities made daily reports to the city clerk, who in turn wired them to the State Board of Health, who wired them to the Surgeon General of the Public Health Service in Washington. However, concern was noted by an unidentified state health official that “the method of reporting morbidity and mortality in effect in Mississippi at this time was of no immediate value in the collection of information of current conditions.” The system used by the State provided for the reporting of only mortalities from reportable diseases before the end of a calendar month. Morbidity was not reported. Also, it was soon apparent that reports sent in by physicians were incomplete in many cases and seldom more than sixty percent of the counties reported in any one day. Dr. Leathers wired to the local physicians that it was very important that the State Board of Health in Jackson knew about the local conditions as accurately as possible. Since the medical profession had seen a diminishing number among doctors and nurses because of the World War I, it was imperative that every measure was taken to prevent the spread of this disease. Dr. Leathers felt the importance of gathering influenza data would help the Surgeon General act “intelligently with reference to this matter.

    The Influenza of 1918 had dramatic impacts on the state of Mississippi and the localities of the Delta. The three aforementioned counties and cities followed the orders from the State Board of Health administered by county health officers, in order to minimize the impacts of the Epidemic in their communities. It should be noted that Warren County and Coahoma County had full-time health officers, which made a difference in the manner the disease was handled in each county. Washington County’s health officer, Dr. Ware, was only the acting health officer at the time of the Epidemic. This might infer that his ambition and dedication to his position were not fully committed to Washington County’s plight in 1918. As a result of the Epidemic spreading across the country, beginning on October 1, 1918, the County Health officers were requested to make monthly reports to the State Board of Health. These reports included topics, but not limited to, dealing with education, work and school related inspections, vaccinations, and quarantines. For the first time in the work of the State Board of Health, the new form of reporting gave the County Health Officer an opportunity to indicate in a more detailed way the activities the county had been engaged in doing health work. It was of interest that the County Health Officers were very receptive in making these reports to the Board of Health. During the months July, August and September of 1918, every Health Officer in the state had made a monthly report of county health work to the Board of Health even though it was not required at the time. In addition to an increase in reporting practices by the County Health Officer to the State Board, the development of full-time Health Departments in the Delta was created at a faster rate compared to the eastern counties of Mississippi. The organization of the county health departments for Coahoma (October1, 1920), Washington (July 1, 1923) and Warren (October 1, 1927) all marked a change of direction for the state. With the Delta Counties lead, the movement toward full-time Health Departments was underway.[50]

    During the formative or pioneer stage in Mississippi, the State Board of Health underwent a series of movements fighting specific diseases.[51] Intensive county health work in Mississippi began on November 4, 1914 with Prentiss County for the relief and control of soil pollution diseases, especially hookworm infection. In the early stages of county health work in Mississippi, attention was concentrated almost entirely upon hookworm disease and sanitation.[52] Following these social-health battles, the State Board made the conclusion that in order to be more effective in waging a fight against such diseases, it was imperative for a local agency to take over the task and make it a more local concern. A full-time county health department was the agency of preference. County health departments were funded by subsidies from the State Board of Health, the local appropriating bodies and federal and other agencies. Harrison County in Mississippi employed a full-time health officer in 1917, but this was seen as an outcome from World War I. The measures taken by that health officer/agency were deemed successful and that county has maintained an agency since its inception. The Harrison County Health Department is the oldest existing full-time department in the State.
    Making a full-time county health service a permanent fixture in county government was not stressed upon prior to 1924. It was during the Influenza Epidemic that the State Board of Health began to work more closely with the local health officials. The State Board of Health realized a greater need in efficiency and health practices; hence, health departments were organized on a permanent basis with “adequate support and trained personnel as evidence was presented that substantial results were found.” It could be argued there was a cause and effect relationship in the creation of the local health department and the Epidemic of 1918. From the work of Harrison County’s health officer, the development of the full-time health agency had persistently grown.

    In September of 1929, the American Journal of Public Health recognized the county health department program in Mississippi. In an editorial that appeared, the American Journal noted, “...the richer and more complacent northern and eastern areas of the country have much to learn from their sister states below the Mason and Dixon’s line...” Since the state of Massachusetts was the first state in the Union to create a public health department, the recognition given to the Southern States by the American Journal was affirmation that although stereotyped by their Northern brethren, southern states were able to achieve significant progress in the area of public health after the Epidemic of 1918. By 1938, thirty counties, representing fifty-three percent of the population and forty percent of the area of the State, were serviced by a full-time local health service. [53] The scope of the work had broadened to comprise practically all the major problems of preventive medicine. The modern county health unit of the state, relative to the date of publication, included, but was not limited to, in its program “the following activities: control of communicable diseases, prevention of soil pollution and related diseases, and inspection of public utilities.”[54]

    The Influenza Epidemic of 1918 lasted well into 1919, but statistics and newspaper coverage reported the disease’s impact was primarily in the early part of October and lasted for 28 days in the three Delta localities. The month of October had the most devastating mortality rates in the year 1918. The Reports and articles illustrated that both races experienced high mortality rates; however, the latter displayed longer durations and higher mortality rates of the disease. The research did not uncover mortality rates among social classes, income levels or gender due to Influenza. The physician reports documenting the disease did not break down the demographics, but only race. The Influenza case report that was sent to the State Board listed: “No. of cases to date, No. of deaths to date, No. of new cases, No. of cases discharged, No. of cases under treatment, No. of deaths, No. of cases pneumonia, No. of pneumonia deaths and Physicians name and county.”[55] Treatment for patients of the disease varied from each locality (from aspirin to buttermilk), but each community used quarantining to try to prevent the spread of the disease.

    Although detailed death records were incomplete, the Epidemic brought about a greater need for cooperation between local, state and federal health agencies as seen in the coordination between the U.S. Public Health Service, the State Board of Health and the local county health officials. Newspapers covered the recommendations of these agencies which showed a unilateral commitment to eradicate the disease in the Delta. A greater trust and need for qualified local health officers arose from the Epidemic and brought forth a permanent health department in these and other Delta communities. Though devastating with the surge in deaths in these communities, the forced changes in the health and medical professions can be seen as a more positive advancement toward better health for these Delta communities, as well as the state of Mississippi. The efforts of these agencies combined with the climate of the South, the disease was not as deadly as higher populated cities in the North. It was not until the winter of 1928-1929 that Mississippi suffered another serious, though milder onset of influenza, occurred. This time 4,093 deaths and 264,000 cases were documented.[56]




[1]Warren County Death Register, NO B.

[2]Mississippi Board of Health Biennial Report, Report of State Board of Health, 1917-1919, 42-44; 47-48; 64-65.

[3]Tibbs, Josephine B. Interview by Charlotte Capers. Tape Recording. Jackson, MS, 13 December 1972.

[4]“ Several Cases of Flu In Vicksburg; Churches, Schools, Movies Closed,” Vicksburg Evening Post, October 7, 1918, p.1.

[5]Mississippi Board of Health Biennial Report, Report of State Board of Health, 1917-1919, 42-44; 47-48; 64-65.

[6]Warren County Death Register, NO. B.

[7]“ Story of ‘Flu’ Epidemic Here,” Vicksburg Evening Post, October 8, 1918, part two, p.3.

[8]“I.C.C. Is Closed By An Epidemic of Influenza,” Vicksburg Evening Post, October 4, 1918, p.7.

[9]Mississippi Normal College, Biennial Report of the Board of Trustees, 1917-1919, 21. The Institute is now Mississippi University for Women, a coeducational liberal arts school.

[10]“Several Cases of Flu in Vicksburg; Churches, Schools, Movies Closed,” Vicksburg Evening Post, October 7, 1918, p. 1,5.

[11]“ Funeral Services Must Be Private; Soda Founts Use Destructible Cups; Health Board Issues Orders Today,” Vicksburg Evening Post, October 11, 1918, p.5.

[12]“Doctors Must Report ‘Flu’ Cases Daily, “ Vicksburg Evening Post, October 9, 1918, p.4.

[13]Mississippi Board of Health Biennial Report, Report of the State Board of Health, 1917-1919, 183.

[14]“Doctors Must Report ‘Flu’ Cases Daily,” Vicksburg Evening Post, October 9, 1918, p.4.

[15]“About Twenty New Cases of ‘Flu,’” Vicksburg Evening Post, October 10, 1918, p. 2.

[16]“Slight Increase In Number ‘Flu’ Cases; Schools Not To Open,” Vicksburg Evening Post, October 12, 1918, p.5.

[17]“No Public Celebration of Mass Will Be Held,” Vicksburg Evening Post, October 12, 1918, p.5.

[18]“Slight Increase In Number ‘Flu’ Cases; Schools Not To Open,” Vicksburg Evening Post, October 12, 1918, p.5.

[19]“Funeral Services Must Be Private; Soda Founts Use Destructible Cups; Health Board Issues Orders Today,” Vicksburg Evening Post, October 11, 1918, p5.

[20]“Health Board Regulations Are Tightened,” Vicksburg Evening Post, October 16, 1918, p.6.

[21]“Attendants Wanted To Help Influenza Sick,” Vicksburg Evening Post, October 18, 1918, p.6.

[22]“Health Board Regulations Are Tightened,” Vicksburg Evening Post, October 16, 1918, p.6.

[23]“ Attendants Wanted To Help Influenza Sick,” Vicksburg Evening Post, October 18, 1918, p.6.

[24]“Board Reports No Deaths for Past 24 Hours,” Vicksburg Evening Post, October 21, 1918, p.5.

[25]“Fifty Cases, No Deaths, Is ‘Flu’ Report,” Vicksburg Evening Post, October 26, 1918, p.6.

[26]Mississippi Board of Health Biennial Report, Report of State Board of Health, 1917-1919. 56-58.

[27]“The Mississippi Board of Health Issues a Bulletin in Regard to Spanish Influenza,” The Weekly Democrat-Times, October 3, 1918 p.6.

[28]“The Schools and Theaters To Close,” The Weekly Democrat-Times, October 7, 1918, p.5.

[29]“‘Flu’ Epidemic Better, Is Word,” The Weekly Democrat Times, October 17, 1918, p.6.

[30]“The Temporary Closing Ordinance,” The Weekly Democrat-Times, October 8, 1918, p.7.

[31]“Uncle Sam’s Advice on Flu,” The Daily Democrat-Times, October 17, 1918, p.4.

[32]“A Call For Nurses to A.&M. College,” The Weekly-Democrat-Times, October 10, 1918, p.5.

[33]“Red Cross Stands Ready to Help,” The Daily Democrat-Times, October 14, 1918, p.1.

[34]“Red Cross Helping In Influenza Epidemic,” The Daily-Democrat Times, October 17, 1918,p. 1.

[35]“Red Cross Wants Buttermilk for Influenza Patients,” The Daily-Democrat Times, October 28, 1918, p.1.

[36]“Help for the Colored People,” The Weekly Democrat-Times, October 22, 1918, p. 1.

[37]“Colored Ministers Hold Meeting,” The Daily Democrat-Times, October 25, 1918, p. 4.

[38]“Emergency Hospital for Colored People,” The Daily Democrat-Times, October 25, 1918, p. 4.

[39]“ The Circus Cancels,” The Weekly Democrat-Times, October 9, 1918, p.5.

[40]“A Notice from the Sanatorium, “The Weekly Democrat-Times, October 12, 1918, p.6.

[41]Mississippi Board of Health Biennial Report, Report of State Board of Health, 1917-1919, 56-58.

[42]“Schools Ordered Immediately Closed,” Clarksdale Daily Register, October 7, 1918, p.1.

[43]“Influenza Spread Fast in Past 48 Hours,” Clarksdale Daily Register, October 8, 1918, p.1.

[44]“County Schools Are All Closed,” Clarksdale Daily Register, October 8, 1918, p.5.

[45]“Sousa’s Band Will Be Here Tomorrow,” Clarksdale Daily Register, October 8, 1918, p.5.

[46]John Philip Sousa, Marching Along (Boston: Hale, Cushman and Flint, 1928), 316-317.

[47]“Railroads Hard Hit By The ‘Flu,’” Clarksdale Daily Register, October 8, 1918, p.6.

[48]“State News,” Clarksdale Daily Register, October 9, 1918, p.5.

[49]“Influenza Shows Only Mild Increase In Coahoma County,” Clarksdale Daily Register, October 10, 1918, p.10.

[50]Mississippi Board of Health Biennial Report, Report of County Health Work, 1917-1919, 29-30. .”After January 1, 1919, all applicants for license to practice medicine in Mississippi had to graduate from a Class A medical school, as classified by the American Medical Association, also four new subjects were added to the examination to the existing eight: Physical Diagnoses; Histology and Bacteriology; Theory and Practice of Medicine; and Diseases of the Eye, Ear, Nose and Throat. It could be inferred the Epidemic brought about more rigorous requirements for applicants in the medical profession with the changes in medical laws.

[51]Felix J. Underwood and R.N. Whitefield, Public Health and Medical Licensure in Mississippi 1798-1937 (Jackson: The Tucker Printing House, 1938), 58.

[52]Mississippi Department Report, Report of the Board of Health of Mississippi, 1919-1921, 26.

[53]Felix J. Underwood and R.N. Whitefield, Public Health and Medical Licensure in Mississippi 1798-1937 (Jackson: The Tucker Printing House, 1938), 58-59, 62.

[54]Mississippi Department Report, Report of the Board of Health of Mississippi, 1919-1921, 27.

[55]Mississippi Board of Health Biennial Report, Report of the State Board of Health, 1917-1919, 184.

[56]Felix J. Underwood and R.N. Whitefield, Public Health and Medical Licensure in Mississippi 1798-1937 (Jackson: The Tucker Printing House, 1938), 79.

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