On September 27, the PHS reported that, as of September 21, there were 61 cases in New York City. The epidemic had undoubtedly begun well before the 21st. By October 4th, the PHS was reporting that “outbreaks have occurred at Buffalo and at New York City." On October 11th, the PHS said that “Epidemics have been reported from Maybrook town (Orange County), Montgomery (Orange County), North Tonawanda, and Oswego. School and theaters had not been closed.” By October 18th, state officials admitted that influenza was prevalent throughout the state.

Although state authorities were too overwhelmed by the pandemic to keep accurate records, they did attempt to record deaths. By late October, New York City, Albany, Buffalo, Schenectady and Syracuse reported elevated death rates. During the week of November 1st, the PHS reported a total of 12,357 deaths in New York City. For the previous six weeks a total of 30,736 deaths were reported. The actual number of influenza-related deaths during this period was probably much higher.

1918, Because service workers, who frequently came into contact with the public, were at a greater risk of contracting influenza, they often wore masks in attempt to ward off the disease. The masks, however, were ineffective in preventing the spread of influenza. [Credit: National Archives and Records Administration]

For 1918, the overall death rate in New York State was among the highest ever recorded for the state. In Rochester, during the height of the pandemic, there were at least 213 deaths in the course of one week. Stella Altman, a Rochester native, was nine years old when she, her mother, and three younger siblings became ill. As the family's only healthy member, her father cared for everyone. Recalling the epidemic, Altman said “There were no help to be found anywhere; everyone was too busy caring for their own families.” Altman’s mother died but the children were all too ill to attend the funeral.

Nearby Buffalo was the tenth largest city in the US. Influenza first struck the city at the end of September. By the second and third weeks of October, the disease had become epidemic in the city.

On October 7th, The Buffalo Evening News reported that there was “a minimum of doctors and nurses in the city, and if...the disease should reach epidemic proportions, the city would be handicapped in combating it.” The city's doctors and nurses had volunteered in record numbers for military services, leaving Buffalo's health care system stretched very thin. The Acting Health Commissioner for the City, Franklin Gram, said that “it was no uncommon matter to find persons who had waited two or three days after having repeatedly phoned or summoned physicians, suffering and dying because every physician was worked beyond human endurance.” Several of the city's physicians died from the disease, including Dr. George Gorrill, the superintendent of Buffalo State Hospital. In an attempt to provide citizens with medical care, the junior and senior classes of the University of Buffalo Medical school were pressed into service on October 16th. Shortly afterwards, the sophomore class was directed to join them. All nurses, including those who had married and left the profession, were also required to report for duty.

Central High School was converted into an emergency influenza hospital. The Children’s Aid Society Building and the Neighborhood House and College Creche Society Shelter were both occupied by children whose parents were hospitalized with influenza.

c.1900. Throngs of people attend the Labor Day Parade on Main St. in Buffalo, New York. During the pandemic, the city limited gatherings of more than 10 people in attempt to limit the spread of the disease. [Credit: The Library of Congress]

City officials banned all public gatherings of more than ten people. Theaters, churches, schools, saloons and dance halls were all closed. The mayor also prohibited public funerals and, in an attempt to limit the spread of influenza, burials were required to occur within twenty-five hours of death. Although wearing masks did little to prevent the spread of the disease, workplaces such as the Larkin Company, the Curtis plant, the Seneca Iron and Steel Company, the National Biscuit Company (later Nabisco) and the Lenox Hotel all required their employees to wear masks.

Schenectady was the hardest hit city in the Capital district. Cases of entire families suffering with influenza were not uncommon. The Stein family of South Center Street was typical. On October 3rd, a charity worker visited the family and discovered the youngest child, a baby, dead in a crib. The remaining seven members of the family were seriously ill. The family was transported to a local hospital. The city's major employer, General Electric, reported absentee rates of over 50 percent.

Downstate, in New York City, Lillian Wald, one of the nation's foremost advocates of public health nursing, reported that “dignified and discerning women stood on the steps at Altman’s and Tiffany’s Fifth Avenue shops and accosted passers-by.” These women were asking people to assist in the fight against influenza.

In Brooklyn, Michael Wind remembered that “when my mother died of Spanish influenza, we were all gathered in one room, all six of us, from age two to age twelve [Wind was six]. My father was sitting beside my mother’s bed, head in his hands, sobbing bitterly. All my mother’s friends were there, with tears of shock in their eyes. They were shouting at my father, asking why he hadn’t called them, hadn’t told them she was sick. She had been fine yesterday. How could this have happened?” Unable to care for his family in the absence of their mother, Wind’s father took his children to the Brooklyn Hebrew Orphan Asylum. The Asylum was soon filled with 600 children, most of them orphaned by the pandemic

Influenza rates gradually declined across the state during the late fall. The disease, however, remained prevalent throughout the state during the winter and spring. By the summer of 1919, influenza had slowly began to disappear from the state.