Sorrow visited the Clarence Twyman family that night, Dec. 10, 1918, a personal tragedy amid global and virus-driven havoc.

At 9 p.m., at the St. Joseph house on North Eighth Street, the stock buyer and his wife lost their 3-year-old daughter, Susan, to an influenza outbreak. An hour and a half later, their daughter Helen, age 1, also died of the flu.

Such were the grim times, their burial took place the next afternoon, the two bodies taken to the cemetery in the same hearse.

About 50 million people died worldwide from the so-called Spanish Flu. As Americans celebrated the end of the Great War, barely a month earlier, they began to come to grips with a virus that spread, in part, because of the movement of military personnel throughout the United States and to foreign battlefields.

Eventually, 675,000 Americans would die from the flu outbreak. Put another way, the death toll amounted to every man, woman and child in St. Joseph, nine times over.

Dr. Brian L. Hoffman of Park University in Parkville, Missouri, studied St. Joseph death certificates from 1910 to 1923, tracking the pandemic at its height and amassing statistics for comparison.

He found, among other things, that the median age of individuals who died of pneumonia and influenza stood in the mid-50s in 1916. In the two years following, this number dropped to the mid-20s, so prevalent were the young deaths.

Between 1910 and 1914, during the peak periods for deaths from these diseases, about 112 St. Joseph residents died, on average. The season that began in late 1918 had 530 deaths from these diseases.

While most studies about the pandemic took a macro view of the worldwide event, Hoffman focused his research, published in 2011, on a single medium-sized city.

“This study is one of very few that measures the impact of 1918-1919 influenza in a particular location in the central United States,” he wrote.

These impacts not only weighed on the families in the city that lost loved ones, they swept through all aspects of local life.

St. Joseph’s school district closed its doors from Oct. 8 to Nov. 18 in 1918, hoping to keep students apart and slow the spread of the flu.

Dr. Hasbrouck DeLameter, the city health officer, did not necessarily agree with the strategy.

“The children are just as safe from the disease in school as out, as the school nurses are proving protectors in guarding the health of the students,” he told News-Press Now on Nov. 2. “The schools will not again be closed unless everything else in the city is also shut up.”

The next day, the schools closed again until Dec. 30.

Dr. Jeff Sherwood, a St. Joseph specialist in infectious diseases, trained in the discipline during the 2009 H1N1 pandemic, which the Centers for Disease Control said resulted in 274,304 hospitalizations and 12,469 deaths. He recalled the references made to the 1918 pandemic, whose virus proved a genetic forebear to the outbreak nine years ago.

“There were some concepts that you could sort of say were taken from the 1918 pandemic, like concepts of social distancing, so those things were applied back then as far as avoiding congregate settings and keeping your children home from school if they’re sick,” Sherwood said.

“Those types of concepts, we still apply today pertaining to flu and respiratory viruses.”

He added that public health officials remain vigilant about possible widespread flu events.

“I’ve heard it said that the only thing that’s predictable about the flu is that it’s unpredictable,” the St. Joseph doctor said.

“I do think that there’s still ongoing surveillance and concern that there could be a pandemic again. In many ways, I would say we’re more interconnected now than we were in 1918 as far as global travel, so I think there are risks that something like this could happen.”

Ken Newton can be reached at ken.newton@newspressnow.com. Follow him on Twitter: @SJNPNewton.