The 1918 Spanish Flu Pandemic in America

Updated on July 8, 2020
dougwest1 profile image

I am a retired engineer, small business owner, and have authored over sixty books on history and various topics.

Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C., during the influenza pandemic of 1918.
Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C., during the influenza pandemic of 1918.

Introduction

What started as a simple flu outbreak in rural Kansas in 1918 spread across the globe in less than two years to become the most lethal pandemic that the world has known. Called the Spanish flu, even though it had nothing to do with Spain, it would claim the lives of over 600,000 Americans, about five times the number lost in the First World War. Suffering from the virus was not limited to America; before the virus faded mysteriously in the spring of 1919, it had killed over 50 million worldwide. Most influenza epidemics target the very young or the elderly, but not this one; healthy adults in their prime fell prey to the deadly scourge, robbing many children of their parents. Medical science was virtually helpless to arrest the disease. By 1918 science only had a crude understanding of what a virus was and only meager tools to conquer the sub-microscopic invader. Medical treatments ranged from bags of garlic and onions strung around the neck, bleeding the patient, an assortment of strange smelling poultices, opium, alcohol, and anything else doctors could do to ease the suffering of their patients. Just as suddenly as the mysterious virus exploded into every corner of the world, it quickly faded from view – much to the rejoicing of mankind. However, its legacy still lives as our yearly seasonal flu.

Emergency hospital during influenza epidemic at Camp Funston, Kansas.
Emergency hospital during influenza epidemic at Camp Funston, Kansas.

The Outbreak

At the southwest corner of the state of Kansas not far from where it intersects with Colorado and Oklahoma lies Haskell County. During its heyday it was part of the Santa Fe Trail where thousands of “prairie schooners” filled with families made their way west. By 1918, it was a nearly treeless stretch of prairie where many still lived in sod houses, making their livings raising crops, cattle, and hogs. In early 1918 a severe flu outbreak swept through the county, alarming the local physician Loring Miner. Concerned about the severity of the flu outbreak, Miner alerted the U.S. Public Health Service.
A continent away from this sleepy corner of Kansas, in Europe, a bloody war had raged for the last four years. United States President Woodrow Wilson had managed to keep America out of the war, but the aggression of the Germans against American shipping forced his hand, placing the country squarely in the European war in 1917. To defeat the Germans and their allies America began sending troops to France to fight in the trenches of Europe. To prepare for the Great War, young men were sent to training camps spread throughout the United States where they were turned from raw recruits into well trained men ready for battle in the trench warfare that defined the Great War. Camp Funston, part of Fort Riley located in central Kansas, was one of those training camps. The brave and patriotic farm boys of Haskell County did their part and joined the army, making their way to Camp Funston. With the recruits came a silent and lethal stowaway – a deadly new strain of influenza that humans had no natural immunity to.
On March 4, 1918, the first soldier reported to the infirmary with flu-like symptoms. Soon, thousands of young men took up residence at Camp Funston and within two weeks, 1,100 soldiers were admitted to the hospital with the flu, while thousands more were riding out the illness in their barracks. As the soldiers were shipped to other camps for additional training or deployment, the flu went with them. When the soldiers ventured out from their bases for a little rest and relaxation, they spread the flu to the citizens. The initial outbreak that swept through the nation at first didn’t set off many alarm bells; though easily spread, it killed few. The very young and the very old were the most vulnerable to death from the disease, sparing healthy men and women in their prime of life.

Trench warfare during World War I.
Trench warfare during World War I.

The Spanish Flu

As the soldiers, or dough boys as they were called, landed in France so did their unseen cargo. By April, the flu had spread through armies on both sides of the conflict. Due to wartime censorship, the combatant countries published little news about the epidemic to avoid hurting the morale of the troops. Spain declared itself neutral in the war; however, it was not immune to the virus. When the flu swept through the country the Spanish King, Alfonso XIII, became gravely ill. With no press censorship, the Spanish press wrote freely about the progress of the disease. Simply because it wrote about the flu outbreak, the western nations tagged Spain with the problem and named the influenza outbreak the “Spanish flu.” This first wave of the flu had been mild, though very contagious. Some experts even doubted if this new disease was even influenza. As the peak of summer began to fade, so did the disease. Unknowingly, this was the calm before the storm.

In August, the sickness reappeared in Switzerland in a more deadly form. A U.S. Navy Intelligence officer in a report classified as “Secret and Confidential” warned that “the disease new epidemic throughout Switzerland is what is commonly known as the black plague, although it is designated as Spanish sickness and grip.”

Camp Devens outside Boston during World War I.
Camp Devens outside Boston during World War I.

The Second Wave of the Flu

The flu epidemic ping-ponged around the globe until it returned to the shore of America, first making its ugly presence know at Camp Devens, an army training camp 35 miles from Boston. The enormous camp housed 45,000 soldiers in training. On the first of September 1918, the hospital at the camp was relatively quiet, but the second week into the month things changed drastically. Soldiers began to report to the hospital ill with what was first diagnosed as meningitis. As more fell ill and their symptoms progressed the diagnosis changed to influenza.

As the outbreak spread through the camp, the hospital, which could only accommodate 1,200 patients, was overwhelmed. Doctors and nurses fell ill at an alarming rate, forcing the hospital to not accept any new patients, no matter how sick they appeared to be. As an army report noted, “the influenza…occurred as an explosion.” This strain of the flu was much more deadly than the first. A physician at the hospital wrote to a colleague of the situation, “These men start with what appears to be an ordinary attack of LaGrippe or influenza, and when brought to the hospital they very rapidly develop the most vicious type of pneumonia that has ever been seen…”

As word of the epidemic at Camp Devens reached Washington, the acting Surgeon General of the army, Dr. Victor Vanghn, went to the camp for a firsthand inspection. He reported on the disturbing scenes at the hospital, “Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood.” As September was starting to draw to a close the deadly flu outbreak was starting to subside. During that horrendous month, 14,000 flu cases were reported, about a quarter of the camp, with 757 deaths.

The Public Mis-Information Campaign

The truth became one of the biggest casualties during the war years, including 1918. President Wilson wanted complete control over the information flow regarding the war as well as the flu pandemic. Wilson created the Committee on Public Information. To further control the narrative of the war, at Wilson’s urging Congress passed the Sedition Act, which provided lengthy prison terms for those found guilty of “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the form of government of the United States…or to urge, incite, or advocate any curtailment of production in this country of anything or things…necessary or essential to the prosecution of the war.” With the heavy hand of the federal government upon them, public health officials, determined to be loyal patriots and stay out of jail, began to bend the truth as needed.

Liberty Loan campaign poster from World War I.
Liberty Loan campaign poster from World War I.

Philadelphia, Pennsylvania

The virulent second wave of the flu erupted throughout the nation. From Alaska to the southern tip of Florida, the scourge ravaged the countryside. In early September, a navy ship from Boston arrived at Philadelphia with many infected sailors. Within days the flu broke out at the Navy Yard and spread into the city. To calm the citizens, the city’s public health director, Wilmer Krusen, pronounced he would “contain this disease to its present limits, and in this we are sure to be successful. The city was ripe for an epidemic, crowded with an extra three hundred thousand war time workers at the shipyard and the munitions plant. Housing for the new workers was nearly non-existent, forcing many people to share living spaces. Nearly half of the city’s doctors and nurses had been called away for the war, leaving the overcrowded city poised for a major health crisis. Over the next few weeks many fell ill with the disease and fatalities began to increase. As the epidemic moved through the city, the newspaper and Krusen told the citizens not to fear, everything was under control.

To fund the war effort, the federal government had launched a nationwide campaign called the Liberty Loan, a war bond selling program to the public. Pressure was placed upon the public against those who were “unpatriotic” and didn’t purchase a war bond. To rally the public behind the war and sell more bonds, a big Liberty Bond Parade was scheduled for September 28. Local doctors pled with Krusen to cancel the parade, fearing that, as the hundreds of thousands of onlookers crowded the parade route, the contagion would spread rapidly. Krusen downplayed the epidemic and the parade proceeded as planned. With a two to three day incubation period, just like clockwork, the people of the city began to fall ill in droves, forcing Krusen to concede the epidemic “now present in the civilian population was…assuming the type found in” army camps. As the health crisis deepened, Krusen was forced to close the schools and ban all public gatherings. At the peak of the epidemic 759 Philadelphians would die in a single day. Reminiscent of the fourteenth century black death plague, priests went through the city with horse drawn carts calling out for the residents to bring out their dead. Mass graves were dug for the poor and before the virus had exhausted the supply of human hosts, 12,000 would die.

The 1918 Spanish Flu-The Philadelphia Story | Mysteries of the Microscopic World (Part 2 of 3)

Kansas City, Missouri

The story of Philadelphia was by no means unique as the flu spread its misery throughout the nation and the world. Kansas City, Missouri, located just over 100 miles due east of Camp Funston, the epicenter of the original flu outbreak, experienced a severe outbreak with one of the nation’s highest death rates. The disease flared up in the city in September 1918 and didn’t retreat until the early spring of 1919. The flu first appeared at the city’s two army motor corps schools, quickly jumping into the civilian population. By late September, the commandant of the motor corps placed the two schools under strict quarantine as the number of sick grew dramatically. Like most cities caught in the grip of the virus, denial by public health officials was common. In early October as the cases mounted, the Kansas City Health Director Dr. E.H. Bullock acknowledged the city was experiencing a much higher than normal level of flu activity, but he said it was not dangerous yet. Kansas City was known for its rampant municipal corruption; “practically every member of the health and sanitary department (held) their jobs by the grace of the bosses,” according to an article in a 1918 edition of the Kansas City Star. The city’s mayor, James Cargill, declared influenza a public emergency and authorized the Board of Health the authority to open hospitals and enforce health code regulations. In early October, the Board ordered all schools, theaters, and churches closed, and limited public gatherings to no more than 20 people. Saloons and cabarets were allowed to remain open as long as they adhered to the 20-person rule.

Things did not go smoothly in Kansas City. In addition to Health officer Bullock calling the shots, the Director of the Contagious Disease Department, Dr. A.J. Gannon, took a lead role. Bullock and Gannon locked horns immediately. The animosity within the health department board severely hampered the city’s response to the outbreak. Gannon acted unilaterally, attempting to limit the number of riders in street cars, sending his inspector to the street cars to check compliance. The inspectors reported the streetcars were “not fit for beasts, let alone human beings.” Next Gannon ordered the inspection of the city’s saloons. Finding them all unsanitary, he ordered them closed until they could comply with health codes. Dr. Gannon’s theory of the genesis of the flu in Kansas City was: “the epidemic had its start (here) by girls kissing soldiers in the army schools and cantonments…There is a lot of kissing…and if a ban should be placed on it there would be less influenza.” Through October and into November, the citizens lived under the aggressive closure rules.

The restrictions were starting to pay off and by the first week of November the case numbers were starting to drop significantly. Merchants and businessmen were pressuring members of the city council and the mayor to re-open the city. Mayor Cargill believed the regulations imposed by the health authorities had been ineffective and had unfairly punished the business community. The mayor told the public, “Business has borne the burden of the epidemic too long.”

After the Thanksgiving holiday, the Board of Health removed Dr. Gannon from his post. Gannon’s authoritative demeanor and his proclivity to overstep his authority had ruffled too many feathers. Gannon made a convenient scapegoat for the city’s failure to adequately respond to the epidemic. An editorial in the paper described the situation, “The utter futility of the present hospital and health board coping with the influenza epidemic so long as it is a politically controlled body and forced to accept the dictates of political bosses.” Additionally, Gannon had been reporting inaccurate case tally reports, often reporting only half the number of cases. Cases began to spike, and the city kept the schools closed until further notice and officials asked parents to keep their children home and off the streets. The citizens came up with many clever ways to prevent the flu: wearing skunk oil vials around the neck, smoking, drinking, eating rock candy, and one lady ate a cake of yeast a day as prophylactic.

By the start of the new year fresh cases had dropped dramatically, though still well above seasonal flu averages, but things were getting better. By the spring of 1919, the influenza epidemic had left the city, leaving 2,300 dead and many grieving families. When the numbers were finally counted and analyzed, they showed Kansas City had been hard hit by the flu, with a death rate of 580 per 100,000, much higher than the national average. The actual numbers were probably grimmer as not all deaths were reported or associated with the flu.

People wearing their masks during the 1918 flu pandemic in San Francisco.
People wearing their masks during the 1918 flu pandemic in San Francisco.

San Francisco, California

Especially hard hit by the flu epidemic was the “City by the Bay,” San Francisco, located on the shores of the Pacific Ocean. The city had experienced explosive growth since the gold rush days of the 1840s, becoming one of the nation’s leading cities. Dr. William C. Hassler, chief of San Francisco’s Board of Public Health, was an early advocate of taking strong preventive measures against the flu; however, he believed the epidemic was an east coast problem and might not make it to the city. Reality set in when Dr. Hassler learned of an infected man returning to the city from a trip to Chicago and ordered him quarantined in late September 1918.

Despite the knowledge that the flu was spreading westward, the city did little to prepare. Caught in the war’s patriotic fervor, there were numerous parades and rallies. By the middle of October, over 4,000 cases had been reported, forcing city officials to close schools, theaters, and other public places. Medical professionals were quickly overwhelmed with the sick, and one doctor reported see 525 patients in one day.

Desperate for a cure, several vaccines were hastily introduced, which were either totally ineffective or more dangerous than the flu. A law was passed that required wearing a gauze mask in public to prevent the spread of the influenza. The mayor proclaimed the virtues of the mask, “Wear a mask and save your life! A mask is 99% proof against influenza.” The wearing of a mask quickly became a symbol of wartime patriotism. The mayor told the public that “conscience, patriotism, and self-protection demand immediate and rigid compliance” to the mask order. While most of the San Franciscans wore their masks, many did not, and they were fined $5 by the police.

With cases in decline and pressure mounting from citizens and business leaders, Mayor Rolph annulled the mask order at noon on November 21. The city rejoiced with the lifting of the mask ordinance, littering the streets with the hated masks. The newspaper described the day, “The sidewalks and tunnels were strewn with the relics of a tortuous month.”

The new freedom of the citizenry was short lived when Hassler informed Mayor Rolph in December that the influenza had returned with a vengeance. This time the wearing of masks was not mandatory, businesses did not close, and large gatherings were permitted. By mid-January, the disease had not abated, and the mask order was once again mandatory. As in the rest of the country and the world, the third wave of the flu was less severe and began to recede. By the first of February, the city began to return to normal. The city did not fare well from the epidemic, however, with 45,000 cases and over 3,000 deaths. The death rate in San Francisco turned out to be one of the highest in the nation.

Figure 9 - "The Big Four" decision makers at the Paris Peace Conference (from left to right) David Lloyd George of Britain, Vittorio Emanuele Orlando of Italy, Georges Clemenceau of France, and Woodrow Wilson of the United States.

The Third Wave

Just as abruptly as an ocean wave pounds the beach and then recedes back into the deep, so was the cycle of the flu epidemic. By the spring of 1919, the flu had spread throughout the world, burning through its human fuel. Cities and towns everywhere began to reopen and heal the wounds caused by the deaths of so many. The third wave of the flu, which ran through the spring of 1919, was mild compared to the deadlier second wave. The world had much to rejoice about as the Great War ended in November 1918, and by the spring of 1919 the flu was in full retreat.

The flu was still present in Europe when the Versailles Peace Conference was held in April 1919 in Paris. Attending the conference was U.S. President Woodrow Wilson and leaders from the many nations of the world. The conference was the stage where the victorious Allied nations set the peace terms for the defeated Center Powers. During the conference President Wilson suddenly became weak and confused and retreated to his sick bed. Wilson had all the classic symptoms of the flu: high fever, intense coughing fits, diarrhea, and other serious symptoms. Though some historians believe the president had a minor stroke, which led to his confusion, most believe he had the Spanish flu. The flu was present in the city at that time, taking the life of Wilson’s young aide. Wilson’s apparent confusion during the remainder of the conference has been attributed to a common lasting effect of the Spanish flu. Wilson’s chief usher recalled the president’s puzzling behavior, “We could but surmise that something queer was happening in his mind” and that “he was never the same after this little spell of sickness.” The outcome of the treaty imposed heavy war reparations and restrictions on Germany, leading may historians to conclude the heavy-handed treaty led Germany down the road to the Second World War.

Death Toll

After the third wave, and possibly a fourth wave in 1920, the flu evolved into a less lethal seasonal flu. By the time the deaths were counted or, in many developing countries, not counted, the world had lost between 50 to 100 million citizens. The best estimate for the U.S. was a loss of 675,000. In the U.S. between two and 2.5 percent of those infected died. For comparison, the death rate for seasonal flu is 0.1 percent and the preliminary death rate for coronavirus disease (COVID-19) is approximately one percent. Developing nations suffered more from the pandemic, with a higher mortality rate than the western nations. For instance, in Mexico, the death rate from the Spanish flu was nearly double that of the U.S. Russia and Iran saw seven percent the population die, while the flu decimated the Fiji Islands, killing four percent of the population in just 16 days.

Why Was the Second Wave So Deadly?

Several questions remain unanswered about the Spanish flu outbreak even today. One of the more pertinent questions is why the second wave of the flu was so deadly. The clear change in the age distribution and death rates indicate that there was a distinctive difference between the first and second waves of the flu. Most people who recovered from the first wave of infections were immune to the more deadly second wave, indicating they were the same strain of the flu. Since the more virulent flu appeared to have come from the war ravaged areas of Europe, this led researchers to conclude the harsh living conditions the troops were subject to on the battlefield made it a breeding ground for a more deadly strain. The killing fields were awash with chemicals, some of which -- for example, Mustard gas -- were mutagenic, meaning they were capable of inducing changes in live organisms, including viruses. With an abundant supply of human hosts – men in the trenches and packed into medical hospitals -- highly virulent strains came to dominate the viral population through natural selection, since they are most likely to survive and reproduce.

Combined influenza and pneumonia mortality, by age at death, per 100,000 persons.
Combined influenza and pneumonia mortality, by age at death, per 100,000 persons.

Why Did the Virus Attack Healthy Adults?

Another open question from the 1918 pandemic is why the second wave caused deaths in healthy adults in the prime of life. Men were more susceptible than women, unless they were pregnant, then they perished at an alarming rate. The peak age in the middle group was 28 years – robbing young families of a parent. One explanation is that young adults have the strongest immune systems, which at first thought would make them the least likely to die from the virus, but the reality of the situation proved to be a different story. As the virus invaded the body of the young adults the immune system went to war, releasing chemicals called cytokines and other microbe-fighting toxins. The “cytokine storms” did battle with the virus in the lungs, which ferociously damaged the victim’s lungs. This overzealous immune response ultimately caused more damage than the virus it was intended to destroy.

References

Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Penguin Books. 2018.

Berg, A. Scott. Wilson. Penguin Group. 2013.

Spinney, Laura. Pale Rider: The Spanish Flu of 1918 and How it Changed the World. PublicAffairs. 2017.

McKinsey, D. S., McKinsey, J. P., & Enriquez, M. (2018). “The 1918 Influenza in Missouri: Centennial Remembrance of the Crisis.” Missouri Medicine, 115(4), 319–324.

West, Doug. The 1918 Spanish Flu Pandemic In America: A Short History. C&D Publications. 2020

Influenza Encyclopedia. The American Influenza Pandemic 1918-1919: A Digital Encyclopedia. Produced by the University of Michigan Center for the History of Medicine and Michigan Publishing, University of Michigan Library. Accessed June 9, 2020. https://www.influenzaarchive.org/about.html

“U.S. COVID-19 death rate is 1.3%, study finds” Health Affairs. Accessed June 13, 2020. https://medicalxpress.com/news/2020-05-covid-death.html

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

Comments

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    • dougwest1 profile imageAUTHOR

      Doug West 

      3 weeks ago from Missouri

      Mike:

      Thanks for the read. There are many similarities between the 1918 pandemic and today's. Rather scary.

    • Readmikenow profile image

      Readmikenow 

      3 weeks ago

      Excellent article. Filled with valuable information. Enjoyed reading it.

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