On October 4th, The Public Health Reports issued their first report from Alabama, noting "an extensive epidemic is reported from Florence and vicinity."  By the time this report was issued, Florence had already been dealing with the pandemic for two weeks.  By October 11th, the PHS acknowledged that influenza was in "practically every county in the State."  On October 15th,  the PHS glumly noted that "25,811 cases of influenza had been reported in the State.”  Because state officials were often too overwhelmed by the pandemic to keep accurate records,   they often under-estimated the actual number of influenza cases and influenza-related deaths.  It seems likely, in other words, that there were more than 26,000 cases in the state during the week of October 15th.   

Skyline east from Southern Bell Telephone Co. Bldg., Birmingham, Alabama. C. [Credit: The Library of Congress]

In Birmingham the city reported 5,000 cases on October 5th.  The high point for deaths appears to have been the week of October 26th when 135 deaths were reported in Birmingham alone. 

According to a report sent to the PHS, the physicians in Florence “were overwhelmed with work.”  They were also “handicapped by inadequate transportation and two days behind in making calls; many patients [in the nitrate plant situated there] had been sick in bunk houses and tents for several days without nourishment, or medical and nursing attention, the sanitary conditions of the bunk houses were deplorable; the mess halls were grossly insanitary and their operation much hampered by the lack of help; the existing hospitals were greatly overcrowded with patients; and patients were waiting in line several hours for dispensary treatment, and were greatly delayed in obtaining prescriptions at the pharmacy.  The epidemic was so far progressed that the immediate isolation of all cases was impossible.  The most urgent indications seemed to be: 1.  Supplying all sick people with food.  2.  The organization of existing medical personnel for more effective work.  3. The establishment of emergency hospital facilities and the removal of the sickest patients to the emergency hospitals. The pharmaceutical force in the area was inadequate to handle the prescriptions, but fortunately many highly trained chemists were at the Plant awaiting the beginning of operations, and they gladly volunteered for this work.  The call was sent out for volunteer nurses and the response was immediate.  Too much credit cannot be given the Public Health nurses at this station for their heroic work.  On the night of October 2, one of them, assisted by two enlisted men, received and cared for 139 patients, among whom there was only one death in three days....a Public Health nurse was on duty for 48 hours with only two hours sleep.  This same nurse paid 900 nursing visits in Florence in the period of one week.  Similar instances of devotion to duty might be cited of all the nurses on the force."   

On Dec. 11, 1918, Robert Olesen, a PHS officer stationed in Montgomery, Alabama wrote to Surgeon General Rupert Blue.  His letter read:

Hotel Bienville, Mobile, Alabama c. 1900-1915. [Credit: The Library of Congress]

Sir:  I have the honor to forward herewith two newspaper clippings, one from the Montgomery Advertiser, the other from the Journal.  It will be noted that the local press has made capital out of the statement purporting to come from the Surgeon General of the PHS, particularly laying stress upon the sentence, ’the country need not fear that the influenza epidemic will return.  It has come and gone for good.’  Inasmuch as Montgomery is at present in the throes of a serious outbreak of influenza the Service representative has been endeavoring to have reasonable restrictions imposed for the protection of well people.  All efforts to use the newspapers for educative measures have proved unavailing.  In view of the statement from Washington the local newspapers and a few citizens take the stand that the undersigned is out of touch with headquarters and that the measures he has proposed are preposterous.  In consequence thereof the handling of the local situation has been rendered much more difficult." 

There is no record of Blue's reply but this type of criticism was not uncommon. 

Across Alabama, doctors worked tirelessly.   In one community, the local doctor was described as being  “on duty day and night. He only stopped at home long enough to snatch a bit and feed his horse for the next call or trip."  Following a common practice in many communities, the doctor wrapped the wheels of his horse drawn cart with cotton so people would not become alarmed when they heard his cart leaving during the night.    

 J.D. Washburn worked in a medical unit in Alabama during the war.  Looking back on the pandemic, he remembered   "We worked like dogs from about seven in the morning until the last patient of the day had been checked in or out - usually about 10 o'clock that night. The men died like flies, and several times we ran out of boxes to bury them in, and had to put their bodies in cold storage until more boxes were shipped in. It was horrible."

Soldiers in the state’s military camps suffered terribly.  A soldier who was stationed in Alabama during the height of the pandemic said “All I remember about it was I got a little temperature and I went on sick call and the doctor said, 'Go to the hospital, you got the flu,' When I walked in there the nurse says, 'That's your bed over there.' So I went over and sat down. And the greetings I got was from all these other GIs around there telling me: 'Hey, the guy who just left that bed died,' It didn't bother me. I went to bed."  He survived.

During the late fall, influenza rates slowly declined.  The disease remained pervasive throughout the state, however.  It was not until the early summer that influenza gradually disappeared.