South Carolina experienced its first serious outbreak of influenza during the spring of 1918. This outbreak occurred at a military base, Camp Sevier, which was located near Greenville. Following this outbreak, influenza disappeared from the state during the summer of 1918.

In late September, the disease returned in a deadly form. By September 27th, when federal authorities demanded that all local officials provide accurate assessments of influenza in their communities, one hundred cases had been reported in Newberry.

By early October, the disease had spread into the upper reaches of the state. Officials estimated that there were 1,500 cases. In Charleston and Newberry the disease was epidemic. By October 11th, state officials reported that “the disease is prevalent throughout the State, especially in the northern part.” By the 18th, the situation had deteriorated and there were over 30,000 reported cases in the state. Charleston officials reported that the city had over 775 cases.However, as state officials were often incapable of collecting accurate reports during the height of the pandemic, the actual death toll was probably higher than reported.

On October 25th, the Public Health Service noted some "improvement in conditions, with a daily decrease in the number of new cases." Officials believed that the pandemic was rapidly approaching its crest. State officials confirmed by noting “All reports indicate continued improvement throughout the State. The most significant improvement is becoming manifest in the Northern Peedee and Santee River sections. Reports from Clarendon, Williamsburg, and Georgetown Counties show that the epidemic is under control there. It is estimated that 80,000 cases have occurred." Official estimates maintained that there were about 3,000 deaths at that point. However, because inconsistent and inaccurate reporting took place, the actual number of deaths was probably much higher.

In 1918, Columbia had two hospitals. Columbia Hospital had about 100 beds, while Baptist Hospital had less than fifty. The city’s population was about 37,542 at the time. Influenza cases quickly overwhelmed the city's two hospitals.

On October 8th, city officials ordered that the public schools in Columbia be closed. The Court of Common Please and the South Carolina Supreme Court quickly followed suit. Wearing gauze masks was not mandatory but city officials strongly encouraged this practice (wearing masks does little to prevent the spread of influenza). One of the cty's largest employers, Pacific Mills, sponsored a food delivery system for its workers, most of whom were unable to leave their homes.

Segregation meant that medical care was divided by the color line. A local African American minister served as the chairman of the “colored Red Cross.” He also headed a motor pool which delivered food specifically prepared s for African American patients.

The University of South Carolina became a hospital. The infirmary, the gymnasium and Woodrow Hall all housed influenza patients. Classes were suspended. Across the state, Winthrop College, Greenville Women's College, Converse College and Anderson College were all placed under strict quarantine with no one allowed to leave the campus. The Citadel was also closed and students were sent home.

Eucapine, Vick’s Vapo-Rub and other patent medicines became popular and were widely advertised as cures. By the end of October, the city was running low on Vick’s. Although the selling of alcohol was illegal in the state, doctors often advocated that patients be given alcohol. Ultimately, the governor was forced to release alcohol which had been seized by the state. This alcohol was then distributed to patients. None of these treatments cured influenza.

1918, Camp Jackson, South Carolina. During the epidemic, the camp’s hospital was expanded, allowing it to treat more than 5000 flu victims throughout the time of the crisis. [Credit: The National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, D.C. (NCP 1310) National Museum of Health and Medicine]

Because young adults were most susceptible to this form of the influenza virus, military camps were struck especially hard by the pandemic. At Camp Jackson, the camp's residents had already endured epidemics of measles and meningitis when influenza struck in mid-September. Several hundred soldiers quickly fell ill with influenza and were admitted to the Base Hospital. More became infected and the hospital was soon overflowing with men who were too ill to stand. A large section of the camp became an extension of the hospital. More than 5,000 persons were treated for influenza and at least 300 died from the disease.

Influenza remained a threat throughout the winter and spring of 1919. By the summer, the disease had begun to disappear.

Fears regarding a resurgence of the pandemic were not uncommon, however. A year after the pandemic, a PHS officer stationed in Columbia sent a telegram to Surgeon General Rupert Blue. The telegram read: “Reports indicate existence [of] influenza [in] mild epidemic form [in] South Carolina. Slow spread and modified virulence marked feature. No Great Concern felt but if disease continues spread considerable suffering will be occasioned by total lack nurses who will undertake epidemic duty. [The] Secretary [of the] State Medical Association wishes to know what material help can be expected from service if epidemic becomes serious. Please advise me [on] this and recommend approved control measures so can secure press editorial over state covering rational measures. Does bureau desire daily report case incidence or will weekly synopsis serve?”

Akin's willingness to provide daily reports provides a sharp contrast with attitudes before the pandemic; in 1917 and earlier, state officials never bothered to report the presence of influenza. The government did attempt to control the information, which was released regarding influenza so Akin's question to the press was typical for this period.

As evidence of the seriousness with which the Public Health Service now regarded outbreaks of influenza, Surgeon General Blue responded that same day. His telegram read: “General relief [for] influenza not available under current epidemic appropriation which provides during this year [for the] control [of] interstate spread only. Consequently [we are] unable [to] render intrastate assistance. Application for nursing assistance should be made direct to local Red Cross chapter or Division Manager. Bureau desires daily report influenza cases and influenza and pneumonia deaths.”

Despite these reports, South Carolina did not experience a resurgence of the pandemic.