Small towns like this one in, Laredo, Texas did not escape the epidemic, with cars parked on the square. [Credit: The Library of Congress]

Texas first reported the disease as being present in the state on the 23rd of September. However, the disease was probably present in the state before that date. As early as September 12th, newspapers were reporting that fears of the disease spreading into the state were common. On September 23rd, state officials reported the presence of influenza in Williamson County, Kaufman County and Bosque County. By the 4th of October, thirty-five counties reported influenza; these counties reported anywhere from one to tow thousand cases. A week later, the disease was reported present in seventy-seven counties, with the number of cases varying from one to four thousand cases per county. During the week of the 18th, the state failed to report; this failure may have been because officials were overwhelmed. On the 25th, the state reported a total of 26,062 cases and 517 deaths since the beginning of the pandemic. By October 29th, the state had reported 106,978 cases and 2,181 deaths in just the state's urban centers. Because state officials were so overwhelmed and because it was difficult for states to collect data, these numbers were probably inaccurate. The actual number of cases and deaths was probably much higher.

Churches, like this Mexican church at the smelter in El Paso, Texas could be used for convalescing flu patients. c.1907 [Credit: The Library of Congress]

In El Paso, a quarantine was imposed on October 26th. A day later, a PHS officer glumly noted "there has been a great deal of protest...how the situation will end I do not know...the question is what will the health officer be able to do with the lawyers, who no doubt by tomorrow will be ready to advise their patrons to open up their places of business."

Like many southern states, Texas segregated its medical care. Mexican residents of the state were often treated in their own hospitals and communities as were African Americans. In late October, PHS Officer J. Wiappan who was stationed in El paso noted, with some relief, that "the disease seems to be abating even in the Mexican quarter of the town. A Mexican nurse was to-day placed on duty."

In 1918, the Texas State Board of Health made the following suggestions on how to prevent flu outbreaks in schools: "Every day ... disinfectant should be scattered over the floor and swept. All woodwork, desks, chairs, tables and doors should be wiped off with a cloth wet with linseed, kerosene and turpentine." "Every pupil must have at all times a clean handkerchief and it must not be laid on top of the desk." "Spitting on the floor, sneezing, or coughing, except behind a handkerchief, should be sufficient grounds for suspension of a pupil." "A pupil should not be allowed to sit in a draft. A pupil with wet feet or wet clothing should not be permitted to stay at school."

Child of migrant keyworker near Jefferson, Texas. This child was ill with influenza. Had a high fever but was receiving no medical attention. Created in 1939. [Credit: The Library of Congress]

The Dallas Morning News maintained that surviving the flu required "medical attention, good nursing, fresh air, nutritious food, plenty of water and cheerful surroundings."

The disease peaked in the state during the fall. Influenza remained pervasive during the winter and spring, although the situation had improved. By the summer, the disease had begun to disappear from the state.

A year after the pandemic, concerns about influenza still ran high in Dallas. On January 25, 1920, the Texas Director of Public Health sent a telegram to Surgeon General Blue saying: "Two hundred twenty one cases influenza here yesterday. Control measures limited to general advise regarding crowds ventilation sneezing coughing keeping fit private funerals stop. Closing schools theaters and wearing masks not advocated here as last year's experience in other large cities does not indicate advantage. Does service suggest additional measures?" Before 1918, no public health official would have seen this situation as serious; however, the 1918 pandemic had made most officials eager to veer on the side of caution when it came to influenza. The Surgeon General responded to this request, saying simply "Service has no additional measure to suggest." The outbreak quickly ended.