Primary Source: The 1918 Spanish Flu Pandemic

COVID-19, more commonly known as the coronavirus, has made landfall in the United States, prompting local governments to scramble to enact measures to contain it.

Health workers move COVID-19 patient Carl Goodman to a hospital in Nebraska, February 17, 2020. (Facebook)

In many ways, this echoes the Spanish Flu pandemic and response from over 100 years ago. While COVID-19 is not an influenza virus and targets a different segment of the population than the Spanish Flu did, “What the current situation does have in common with 1918,” writes New York Times science and medicine writer Gina Kolata, “is the tenor of public concern.”

The American Red Cross removes a victim from a house in St. Louis, 1918. (St. Louis Post-Dispatch)

In 1918, the United States and much of the world were at war. The Great War, now known as World War I, was the perfect environment for the influenza virus to spread. Soldiers, who lived in cramped quarters with unhygienic conditions, fell victim quickly, and their movement around the globe spread the disease rapidly. (Ironically, the Spanish Flu is believed not to have started in Spain at all. The country was neutral in World War I, so its press wasn’t censored, allowing it to more accurately report the number of cases. By comparison, Spain looked particularly hard-hit, and the name stuck.)

With COVID-19 now officially a pandemic, how is the United States reacting? In what ways are we living in the echoes of the Spanish Flu pandemic from 100 years ago, and in what ways have we improved (or worsened)? Finally what lessons can we apply to the current pandemic?

Soldiers gargle saltwater in an attempt to prevent infection at the War Garden at Camp Dix, New Jersey, 1918.

A newspaper warns of “grip.” (May 8, 1918)

The Spanish Flu hit the United States in three waves, the first in the spring of 1918. Military camps were affected first and the disease spread outward from there, but because of World War I censorship, the federal government ordered the press and local leaders to downplay the flu’s effect. In Ogden, Utah, The Standard ran a small story on page 4.

Effect of Grip and Pneumonia

Grip has become epidemic in the city. One school reports every child as having been afflicted.

The disease is not confined to the children. Grown ups are suffering headaches, sore throats, heavy eyes and fever.

There is nothing alarming in the malady, except that grip frequently lays the foundation for pneumonia.

At the annual session of physicians in New York on Tuesday, reference was made to new types of pneumonia developed last winter and also to the large number of cases of the disease in the army. An Ogden physician says the pneumonia which has been following grip in the east is difficult to diagnose and does not readily yield to treatment.

Children attend school in masks, 1918. (Florida Memory)

A doctor is horrified at what he sees in a military camp. (September 29, 1918)

The first wave of influenza, which resembled typical flu epidemics, subsided by July, prompting a U.S. Army medical bulletin to claim that the “epidemic is about at an end…and has been throughout of a benign type.” In September, a far deadlier mutation struck the United States, at Fort Devens near Boston. Once it invaded the camp it spread with remarkable speed. Dr. Roy Grist, a physician at the hospital, wrote to a friend what he witnessed.

Camp Devens is near Boston, and has about 50,000 men, or did have before this epidemic broke loose. It also has the base hospital for the Division of the Northeast. This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. All assemblages of soldiers taboo.

These men start with what appears to be an attack of la grippe or influenza, and when brought to the hospital they very rapidly develop the most viscous type of pneumonia that has ever been seen. Two hours after admission they have the mahogany spots over the cheek bones, and a few hours later you can begin to see the cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I don’t know. My total time is taken up hunting rales, rales dry or moist, sibilant or crepitant or any other of the hundred things that one may find in the chest, they all mean but one thing here — pneumonia — and that means in about all cases death. . . .

It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle.

Soldiers returning from World War I are treated in a makeshift hospital in Boston, 1918. (Creative Commons)

A nurse describes her work at an overwhelmed camp hospital. (October 17, 1918)

With so many able-bodied doctors pulled away to war, citizens back home were hit hard by both the virus and a shortage of medical professionals. Anyone who had any kind of medical training was pressed into service, including former Haskell Institute student Lutiant Van Wert. Van Wert volunteered as a nurse in Washington D.C., and wrote a letter to her friend Louise, still studying at Haskell, describing her work. Even in this dark time, Lutiant was able to find some dark humor in the matter (or is it?), as seen in her first paragraph.

Dear friend Louise:

So everybody has the “Flu” at Haskell? I wish to goodness Miss Keck and Mrs. McK. would get it and die with it. Really, it would be such a good riddance, and not much lost either!

As many as 90 people die every day here with the “Flue”. Soldiers too, are dying by the dozens. . . .

Our chief duties were to give medicines to the patients, take temperatures, fix ice packs, feed them at “eating time”, rub their back or chest with camphorated sweet oil, make egg-nogs, and a whole string of other things I can’t begin to name. I liked the work just fine, but it was too hard, not being used to it. When I was in the Officer’s barracks, four of the officers of whom I had charge, died. Two of them were married and called for their wife nearly all the time. It was sure pitiful to see them die. I was right in the wards alone with them each time, and Oh! The first one that died sure unnerved me — I had to go to the nurses’ quarters and cry it out.

Patients recuperate in a hospital in Camp Funston, Kansas, 1918. (National Museum of Health and Medicine)

Neighbors beg, “Please, let me put him in a macaroni box.” (1982)

It didn’t take long for the virus to escape the military camps and ravage the rest of the population. Officials scrambled to ban large gatherings and promote good hygienic practices, but by October it seemed as if any contact with a sick person spread the disease further. In 1982, Louise Apuchase recalled what the flu did in her neighborhood.

We were the only family saved from the influenza. The rest of the neighbors all were sick. Now I remember so well, very well, directly across the street from us, a boy about 7, 8 years old died and they used to just pick you up and wrap you up in a sheet and put you in a patrol wagon. So the mother and father screaming. “Let me get a macaroni box.” Before, macaroni, any kind of pasta used to come in these wooden boxes about this long and that high, that 20 lbs. of macaroni fitted in the box. “Please, please, let me put him in the macaroni box. Let me put him in the box. Don’t take him away like that.”

A funeral procession for a Spanish Flu victim proceeds through Dover, Connecticut, 1918. (J.G. Whorwell)

A infant barely escapes with her life. (2008)

The Spanish Flu was a virus classified H1N1 (which appeared again in 2009 as the Swine Flu) and was particularly deadly, killing up to 50 million around the world. Among the symptoms was high fever and delirium, which almost killed infant Ethel Hubble Harter in 1918. Ninety years later, Harter told the story of her near-death experience.

I was born in April 1918. My father was a miner and traveled around Virginia to work in the mines. When I was just 8 months old, my parents moved to the High Coal Camp in West Virginia. Both my parents became ill with the pandemic flu in November and December of 1918. Miraculously, I did not contract it. My mother became sick first and my father had to stay home and take care of her because there were no doctors in the area and many others in the camp were caring for their own families. My father said there was “many a night” he thought my mother wouldn′t live.

Then, just as she was recovering, he fell ill. My father had it worse and it was all my mother could do to care for my father and take care of me in her weakened state. My parents told me that one morning mother had gone to the kitchen for something and I was left in the room in my baby bed with my father next to the wood stove for warmth. I woke up crying and my father, delirious and confused from a high fever, ran over and grabbed me up thinking I was a wild cat screaming and attacking his family. He had just lifted me over his head to throw into the fire when mother ran into the room and grabbed me away from him. The family survived and I′m thankful that mother had enough strength that day to save me, too.

Ethel Hubble Harter. (CDC)

A South Beach, Washington hospital limps through the Christmas holidays. (December 25–27, 1918)

While the second wave of influenza hit Boston first, within months it was ravaging the West Coast. In the state of Washington, hospitals dealt with the inundation of flu victims through Christmas and the winter season. At South Beach Hospital, handwritten records reflect how impacted the health care system became.

A newspaper pleads the public to take sanitary measures. (October 16, 1918)

The federal government had little to say about the pandemic, and in fact, President Woodrow Wilson neglected to mention it at all in his State of the Union address in December. With little direction from Washington D.C., state and local officials struggled to put together a response, resulting in a patchwork of initiatives to educate the public and to slow the spread. In Madison, Wisconsin, the Wasau Daily Record reported Health Officer B.L. Schuster’s plea for cleanliness.

Health Officer B.L. Schuster made an appeal today for clean public eating places, saloons, soda fountains, etc. He said, “The public has a right to demand clean food, served in a clean manner. The public should not patronize places where food or drinks are not handled in sanitary manner. Due to the approaching cold weather, the fly nuisance indoors is becoming more troublesome. They should, however, be excluded from all places where food and drinks are served. Glasses and dishes should be thoroughly cleansed by washing in running water, preferably hot or boiling water. Water which is not running soon becomes stagnant and contaminated by the secretions on glasses caused by contact with the lips. . . .”

The wish to wear gauze masks as a precaution against influenza became universal in the city today. Nearly every person in homes where there were patients ill with the disease asked for them. Volunteer workers also made use of them. The only fact which made their widespread use impossible at this time was that there were not enough women to make them. The health officer as a result appealed to women who have some spare time for this work to apply at the Red Cross rooms at the Y. M. C. A. building for materials and to assist in their making.

Red Cross volunteers assemble gauze masks at Camp Devens, 1918. (Fort Devens Museum)

A concerned local official cancels a meeting. (October 3, 1918)

The U.S. Food Administration had already had its hands full coordinating a rationing campaign for the war, but the flu interrupted its activities. In Wilburton, Oklahoma, 300 cases of flu prompted official Jack Kelley to send a telegram to his Oklahoma City headquarters, informing them that he had to cancel an upcoming meeting.

Dear Sir:

On account of the enormous amount of Spanish Influenza here it is impossible to call any public meetings. There are three hundred cases in this town and neighborhood. So as the ginners are very busy I made it a point to call on each one in the county in person and explain the importance of obeying all rules and regulations laid down by this administration.

Yours for the Loan,
Jack Kelley
Lat. County Food Admn.

Administrator Jack Kelley’s telegram, October 3, 1918. (National Archives)

The Federal Government earmarks a pittance. (October 1, 1918)

When the federal government did act, it was a case of too little, too late. On October 1, Congress passed a joint resolution making $1 million available for aiding state and local boards of health, the equivalent of $17.5 million today. By contrast, the Trump administration declared a national emergency on March 13, 2020, making $50 billion available to states and territories.

Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That to enable the Public Health Service to combat and suppress “Spanish influenza” and other communicable diseases by aiding State and local boards of health, or otherwise, including pay and allowances of medical and sanitary personnel, medical and hospital supplies printing, clerical services, and rent in the District of Columbia and elsewhere, transportation, freight, and such other expenses as may be necessary, there is appropriated, out of any money in the Treasury not otherwise appropriated, $1,000,000, to be available until June thirtieth, nineteen hundred and nineteen.

President Woodrow Wilson addresses Congress, January 8, 1918. (Associated Press)

Images from the pandemic. (1918–1919)

In the United States, the flu infected about 29.5 million, a little more than 1 out of every 4 people. It killed 500,000 to 675,000.

A letter carrier wears a mask in New York, October 19, 1918. (National Archives)
Police officers in Seattle don masks, December 1918. (National Archives)
A streetcar conductor in Seattle stops a man without a mask from boarding, 1918. (National Archives)
A Cincinnati, Ohio trolley poster urges citizens to keep their windows open to prevent the spread of influenza, November 8, 1918. (National Archives)
The Police Court Officials of San Francisco hold a session in the open, as a precaution against the spreading influenza epidemic, November 29, 1918. (National Archives)
An emergency hospital at Brookline, Massachusetts takes care of influenza patients, October 1918. (National Archives)
A man at Love Field in Dallas, Texas, has his throat sprayed as a preventive treatment against influenza, November 6, 1918. (National Archives)
A health campaign poster from the U.S. Public Health Service urges citizens to shield their coughs and sneezes, 1918.
(U.S. Public Health Service)
November 2, 1918 (Gordon Brewster)
A chart comparing cases of influenza and pneumonia in 1917 and 1918, at Camp Beauregard in Louisiana. (National Museum of Health Otis Historical Archives)

A city cautiously lifts its quarantine. (November 15, 1918)

By mid-November, the number of cases had dropped to the point where some cautious local leaders felt comfortable letting their towns and cities return to a more normal life. They still recommended vigilance, however. In the small town of Pullman, Washington, officials appealed to their citizens’ patriotic side by making reference to the Kaiser of Germany, whom the Allies had just defeated four days prior in World War I. A weaker strain of the flu would return in the third wave in the spring of 1919.

Quarantine Is Lifted

The ban is off, yet the danger is not over, and I kindly ask every one to join in a campaign to keep this influenza under the same stringent submission you would the Kaiser, for just as surely it will get you as the Kaiser, if you give it a chance.

There will be services at the various churches Sunday, but if you are not feeling well stay at home for your own protection as well as that of others.

The schools will open Monday. Watch your children carefully and if they are not well by all means keep them at home.

Theaters, lodges and pool rooms will also begin operations Monday and we hope within the next few weeks to see Pullman the same busy, happy little city she was before this awful epidemic struck us.

J. L. GILLELAND,
City Health Officer.

The Pullman Herald announces the end to the city’s quarantine, November 15, 1918. In the same issue, it announced two more deaths from influenza. (Library of Congress)

The World Health Organization labels the COVID-19 outbreak as a “pandemic.” (March 11, 2020)

Over 100 years later, the United States and the world are faced with another pandemic. COVID-19 originated in Wuhan, China, at the end of 2019, and has since spread to at least 114 countries. On March 11, 2020, the World Health Organization announced that the disease was officially a pandemic, and challenged the world to act.

WHO has been assessing this outbreak around the clock and we’re deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction.

We have therefore made the assessment that COVID-19 can be characterised as a pandemic. Pandemic is not a word to use lightly or carelessly. It’s a word that, if misused, can cause unreasonable fear or unjustified acceptance that the fight is over, leading to unnecessary suffering and death. . . .

We cannot say this loudly enough or clearly enough or often enough; all countries can still change the course of this pandemic. . . . Several countries have demonstrated that this virus can be suppressed and controlled. The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same; it’s whether they will.

W.H.O. Director General Tedros Adhanom Ghebreyesus addresses a press conference about the update on COVID-19 in Geneva, Switzerland, February 24, 2020. (Associated Press)

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Noel C. Cilker

Noel C. Cilker

I’m a writer, interested in history’s stories and the links between then and now.

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