This story was originally published Feb. 15, 1998.

Who would die next?

In October 1918, in Lancaster County and around the world, families mourned as the Spanish flu took their loved ones.

Mary Sullivan remembers the day the doctor didn’t come, as he had every day since she had been ill with the flu during that warm October of 1918.

She was 21 - still known by her maiden name, Mary Kreider - and was working in a government plant inspecting artillery shells to be shipped to U.S. forces fighting "The Great War" in Europe when she got sick. At first she tried to keep working, lying across a couple of chairs so she could watch the shells as they passed. But soon she was so sick she was sent home.

One of her girlfriends, a woman named Katherine, also was sick. And both women were treated by the same doctor; the physician would treat Katherine, then come to Mary’s house and treat her. While he was there, he’d update Mary on her friend’s condition.

The day the doctor didn’t show up, Mary asked her mother where he was.

Her mother replied that the doctor would no longer be coming. He was dead from the flu.

And so was Katherine.

They were just two of the hundreds who died in Lancaster County in that ghastly month, killed by the deadliest epidemic in history.

By the end of October 1918, local officials estimated that 301 people had died from the "Spanish influenza" - so-called because the disease was erroneously thought to have originated in Spain.

But the official figures may have understated the toll. According to local newspaper records, more than 600 died during October from the flu or from the pneumonia that often followed it.

At the height of the epidemic, schools, churches, stores and saloons were shut down. Local hospitals had patients in hallways and offices. Funeral homes were overwhelmed with too many dead and too few coffins; and the state health commissioner decreed that no train or automobile traveling through Lancaster was allowed to stop.

Few remember the illness which killed nearly 700,000 in the United States and 30 million worldwide that fall. Most of those who experienced the epidemic have died; those who are still alive have rarely revisited those days. It’s as if they are trying to banish the horrible period from their memories.

But the events of nearly 80 years ago are too stark to forget.

"When one of my friends died, we would sit on the porch and watch the funeral procession go by," says Mary Sullivan, now 100, who in 1918 lived in the 200 block of Pine Street.

"Then, the next week, someone who had been a pallbearer at the funeral would be dead."

The 1918 influenza epidemic - or "pandemic," as worldwide epidemics are called - was, according to some experts, the worst plague in history.

More people died in one year from the Spanish flu than died in the four years the Black Death raged through Europe in the Middle Ages. And more than half of the American servicemen who died in World War I were felled by Spanish flu, not enemy bullets.

It was the deadliest flu ever recorded. It struck suddenly, affecting people on the street with aches and pains, nausea and delirium. The victim’s fever could spike to 105 degrees; the intense fevers made many victims’ hair fall out. The lungs would fill with a bloody fluid, literally drowning many flu victims. Death could come within hours.

Those who survived the flu often ended up catching pneumonia, which was just as deadly.

The first wave of the disease appeared early in March 1918 at Fort Riley, Kansas, and spread to military camps throughout the country. Soldiers who were traversing the world were thought to have spread the disease to every corner of the globe.

One of the first to die in Lancaster County was a soldier, home on leave. Lt. Thomas R. Ferguson of Kirkwood, a doctor who was serving in the medical corps, died Oct. 1, 1918, at Lancaster General Hospital from pneumonia, preceded by the flu.

That same day, the Reformed Theological Seminary - now Lancaster Theological Seminary - had to close, because half of the 29-member student body was ill with the flu.

By the next day, Oct. 2, the flu was beginning to level Lancaster County.

Hundreds were reported sick in the rural areas. Schools were dismissed and some stores and industrial plants had to close.

Yet there was little indication what was to come, and few precautions were taken. The LancasterCounty Fair was going on, as were war bond rallies. Both attracted thousands - who likely helped spread the disease.

By Friday, Oct. 4, the epidemic was out of control.

Four were reported dead from the flu; there were 600 cases in the city alone. In response, the Lancaster City Board of Health, led by James Shand, ordered all "public places" - including theaters, movie houses, saloons, dance halls, schools, churches and Sunday schools - closed.

The board also announced that all funerals were to be private - only relatives allowed - and that visiting people with the flu was prohibited.

The epidemic was starting to reach out into the county. Health officials in Quarryville, Millersville and Ephrata ordered businesses, industry, schools and churches closed.

But none of it stopped the spread of the disease.

Although the illness confined her to bed for weeks and caused much of her hair fall out, Mary Sullivan didn’t have a particularly bad case.

But the disease cut through her family like a scythe.

While she was an only child, she had numerous aunts, uncles and cousins. Nearly everyone came down with the flu.

One uncle was a traveling salesman who came home from a trip with the flu. His wife got into bed with him to provide comfort. Soon both were dead. The family held a double funeral.

A cousin was the head man at the shell plant where she worked. Soon he, too, was dead.

"Someone in my family was dying every week," she said.

Mary remembers that when someone died, the coffin often would be propped up in the front window so people could pass by and pay their respects - without being exposed.

"People stayed away," she says. "They would put food on the front porch to help families who were too sick to cook, but never come inside."

Mary’s stepfather was deathly afraid of the illness, but her mother exposed herself to the virus by helping members of the family who were ill.

"I don’t know how she didn’t get sick," Mary says. "She tended to all of the family, and even had to clean up bowls of blood" - bloody vomit - "from underneath the beds. But she never got it. I don’t know why."

On Monday, Oct. 7, it seemed like everyone had the flu.

The city board of health reported 2,516 new cases that day. The newspapers reported that 12 had died over the weekend. The health board, however, insisted that there was no cause for alarm.

At the same time, the board ordered all the streets in Lancaster cleaned at once. And the Pennsylvania Department of Health banned all trains and automobiles from stopping in Lancaster.

By mid-October, there were an estimated 300,000 cases in Pennsylvania. Philadelphia was the hardest-hit city not only in the state, but in America; according to some estimates, nearly 13,000 people died in that city alone. "Death carts" roamed the streets, picking up corpses that had been left on front porches or abandoned in gutters.

Health officials were scrambling for something, anything, to stem the tide of the epidemic. They issued guidelines advising citizens to avoid mental and physical stress, eat a variety of foods, avoid crowds and get as much fresh air as possible.

The state Health Department also issued a directive on how to prevent the flu: fill a nasal dropper with a solution including iodine and dose a few times daily.

People were seeking any remedy they could get their hands on.

Local drugstores were selling out of everything from aspirin to whiskey. Smithgall’s Pharmacy on West Lemon Street dispensed 788 prescriptions that month for all kinds of flu-related symptoms, according to George Smithgall II, the son of the pharmacy’s founder (and brother of mayor Charlie Smithgall).

A few of the most widely prescribed medications contained heroin, said Smithgall, who still has the prescription records from October 1918.

Mary Sullivan remembers people in her family wearing bags of camphor around their necks to ward off the disease.

And in the local newspapers, an advertisement for "tobacco-free" cigarettes called "Smo-ko" stated that the product killed the influenza germs.

"The smoke you inhale carries a healing and pleasant disinfectant," stated the ad.

By the middle of the month, Mary Sullivan’s flu was getting better. The situation in Lancasterwas growing worse.

Between Saturday, Oct. 12, and Monday, Oct. 14, 66 people died, according to the newspapers. "Undertakers and grave diggers are worked almost to death," read the Oct. 14 report in the Lancaster Intelligencer. "Whole families are being taken to hospitals."

Medical workers, many of whom had gone to Europe to help in the war effort, were in extremely short supply; the local Red Cross issued an emergency plea for nurses. More than 1,200 new cases had been reported over the weekend. And the supply of coffins was running short.

Philip Jones, now 88, recalled in a newspaper article last summer the sight of coffins stacked up at Lancaster Train Station after having been shipped here.

Fred F. Groff Funeral Services in Lancaster, which conducted 27 funerals in September, 1918, handled 165 funerals in October - an average of more than five each day.

Approximately 90 percent of those deaths were listed as being caused by pneumonia, according to Robert F. Groff Jr., grandson of Fred F. Groff and current co-owner of the business.

Groff remembers hearing how all of the funeral directors in town had to work together during the epidemic in order to handle the dead.

At Kearney A. Snyder Funeral Home, 25 funerals were conducted in October, 1918, up from an average of six to eight a month prior to the epidemic.

"I can remember as a kid, my dad had an older gentleman who worked here who used to talk about it," said Kearney Snyder. "When the flu came around, (the funeral home) had major problems trying to accommodate everyone."

Panic was setting in. Health officials blamed the newspapers for causing alarm; the newspapers struck back with editorials blasting health officials for not doing enough to stop the spread of the disease.

By Oct. 15, the city had ground to a halt.

By order of the health board, most stores and manufacturers were closed; only food shops, hotels, drugstores, banks and newspapers remained open. The Lancaster Intelligencer that day apologized to its readers; there were many typographical errors because half the staff was sick or dead from the flu.

Officials were putting signs on infected people’s homes reading "Epidemic Influenza visitors keep out." Businesses and industries were required to fumigate, but formaldehyde was in short supply; the city sent a truck to Philadelphia to secure a shipment, but found only five barrels.

Thirteen of 46 Lancaster City police officers were off sick; 11 post office clerks and letter carriers were sick; city firemen, telephone operators and railroad workers also were hard hit.

Lancaster General and St. Joseph hospitals were filling up with flu patients, with some of the sick left in hallways and offices because there wasn’t enough room in the wards. An emergency hospital was established at the Moose Lodge, 200 E. King St. And the newspapers reported that "physicians are so pressed for calls for assistance that they couldn’t report how many cases they had."

During the height of the epidemic, health officials in many cities were guilty of wishful thinking.

In Philadelphia, officials assured the public the epidemic would never spread beyond military personnel. In Boston, city officials refused to ban patriotic parades; 1,000 in that city would die from the flu, many undoubtedly infected during those parades.

In Lancaster, health officials periodically announced that the situation was getting better. Then it would get worse.

As early as Oct. 9, the health board was announcing that the epidemic had crested. After ordering the city to virtually shut down on Oct. 15, the next day the board reversed its position, announced that the worst was over, and that factories and stores could open.

In one respect, the health board was right: the sheer number of flu cases did seem to be declining.

But the flu was getting deadlier.

Thirty-eight people died on Thursday, Oct. 17. The next day, 44 died. Then 34 on Saturday, and 51 on Sunday and Monday.

By repeatedly announcing that the epidemic was waning, health officials may have inadvertently fueled the fire. People grew careless, thinking the worst was over; then a new round would begin.

There were dozens of sad cases.

One was the Oscar Brinser family of Elizabethtown. In the early morning of Wednesday, Oct. 23, his 3-year-old daughter Helen died. In the afternoon, his 5-year-old son Eugene died. By nightfall, his wife, Elizabeth Vogel Brinser, had passed away.

Yet by the time the Brinsers died, the epidemic was indeed on the wane in the city - although areas of the county would be plagued throughout November.

As the month ended and the number of flu deaths dropped - from 28 on Tuesday, Oct. 29, to eight on Friday, Nov. 1 - the city struggled to return to normal.

Officials announced that schools, churches and other public gathering places would reopen on Oct. 30 - although Halloween celebrations were called off. This provoked a strong response from the acting head of the state Health Department, Dr. B. Franklin Royer.

Royer, who felt the epidemic could worsen if public places were allowed to open, ordered Lancaster to remain quarantined. Many local saloon-keepers ignored Royer; 17 were prosecuted by the state Attorney General’s Office.

In an effort to "teach Lancaster a lesson," Royer imposed his own quarantine on the city. Trains were forbidden to stop in Lancaster; police turned back automobiles and pedestrians trying to get into the city.

Lancaster officials went to court and got an injunction preventing Royer’s quarantine from being enforced, and the issue faded away - just as the Spanish influenza seemed to be fading.

Towns in the county - including Churchtown, Bird-in-Hand, Elizabethtown, East Petersburg and Intercourse - would struggle with outbreaks throughout the rest of the year; these outbreaks killed 31 the second week of November. But the virus had loosened its grip on the city.

The city health board placed the official number of October flu deaths at 301; the Intelligencer, which carried a "flu death list" every day in October, placed the number at 603.

The newspaper’s number may have been inflated - it contained many former county residents. But the "official" estimate may not have included all of those who died from the pneumonia which so often followed the flu.

One of the city’s final victims would be Mary Sullivan’s stepfather, who had been so terrified of catching the disease.

"I remember riding home on the street car, and getting off at James Street," says Mary. "I could hear him moaning and trying to breathe all the way from the trolley stop (half a block away).

"He was so sick, sicker than I had been," Mary said. "He had such a high fever, I remember him saying, "How are they going to bury me? I’m nothing but ashes."’

He was the 26th member of Mary’s family to succumb to the disease.