Medical History: The Influenza Epidemic of 1918

by Dr. Mary Williams, R.N. D.C.

Influenza, which is commonly known as the flu, is a contagious viral disease. Most people are familiar with the flu and have had it at some point in their lives. In fact, it is so common that annually, the U.S. experiences what is called a "flu season." The 1918 flu pandemic was much more than the flu that people experience today. It came at a time when there were no effective flu vaccines and was a particularly deadly and virulent strain of the flu. It spread quickly and impacted the world like no other flu outbreak before it. The condition lasted roughly one year around the end of Word War I, and although it picked up the name the "Spanish Flu," as much as 25 percent of the world was affected by it.

Where it Originated

There is some question as to where the flu actually came from. Recent research points to China as the origin. One of the more telling pieces of evidence is that Chinese citizens hit by the flu did not die as often. This indicated that they had been living with the virus and developed an immunity or resistance before it spread worldwide. The name "Spanish Flu" came from news reports of millions who died in Spain from the flu.

The Flu

The 1918 flu pandemic unfolded in stages. The early wave was far more mild than the second and occurred during the spring months. During the first wave, people who became ill displayed symptoms that can normally be associated with the flu, such as developing a fever and experiencing fatigue and/or chills. There were few deaths, and recovery occurred within a few days of treatment. The last wave of the 1918 flu came during the later half of the year and was the deadliest. It is this wave that is remembered in history. People who became sick with the flu during this time did so quickly. In some cases, people died within a few short hours of catching the flu. One of the symptoms included lungs filled with fluid. As a result, the victims would be unable to breathe and would suffocate. During autopsies, medical professionals discovered the deceased victims' lungs were swollen and blue. This resulted in the nickname "Blue Death."

The Flu and the U.S.

According to some reports, the flu first hit the United States at Camp Funston in March of 1918. Many states were unprepared and ill-equipped to handle the flu. This was because there was a shortage of medical professionals. The primary shortage was a result of the war. Another reason for this shortage was the highly contagious nature of the disease: Medical staff often became ill themselves. Although requests were made for doctors and nurses, assistance rarely came, as the Public Health Service was short-staffed and most often unable to help. In addition to not having enough medical help, states found that there was also a hospital bed shortage. As a result, schools and community centers were often turned into hospitals.

Efforts were made to limit the spread of the flu through civilian behavior. Some states made wearing a protective mask mandatory, although this was often met with resistance. This was ineffective, however; officials generally were unaware that the flu was viral. Quarantines were put in place in some states; in others, people were advised to stay indoors. Some states even passed no-spitting laws. The flu impacted communities as schools closed, garbage remained in the street as workers became ill, businesses closed their doors, a shortage of caskets left bodies piling up in morgues, and telephone services collapsed.

Impact of the Flu Pandemic

Although it began to decline by November of 1918, the pandemic came to a complete end by the spring of 1919. In its wake, there were hundreds of thousands of orphaned children and widows. Additionally, approximately 675,000 Americans ultimately lost their lives to the disease, more than the number of Americans who died in World War I and World War II combined. Another side effect of the flu in the U.S. is that the life expectancy of the average American decreased by 12 years.

• Influenza: The Great Pandemic: This is a comprehensive website dedicated to the flu. It includes information about the Spanish Flu, where it began, who was affected the worst by the disease, the amount of lives lost, and efforts to stop it. Infection prevention tips can be found here as well as links to other articles about the pandemic.
• The Influenza Pandemic of 1918: Statistical information concerning the pandemic of 1918 is the subject of this Stanford University page. Visitors will also find letters from various people who were affected by the plague, why it was called the Spanish Flu, as well as information about the strain that the outbreak put on medical personnel.
• History Channel: 1918 Flu Pandemic: Go here to watch a video about the influenza plague of 1918 that asserts the origin of the flu as Fort Riley in Kansas. Accompanying the video is an article that covers facts about the flu and how the authorities tried to fight the pandemic when it broke out.
• 1918 Flu Pandemic That Killed 50 Million Originated in China, Historians Say: This article by National Geographic claims that the Spanish Flu came from China and spread to Canada and then Europe. According to the story presented here, Chinese workers carried the disease to the Western Front during World War I.
• The Blue Death: The story of William Henry Welch of John Hopkins University is the subject of this article. It covers the outbreak of the Spanish Flu at Camp Devens, from which it spread to several other cities. The article also speculates about the potential threat of a recurrence of the virus that caused the plague.
• Spanish Influenza in North America, 1918-19: Harvard University explains the three waves of the Spanish Flu epidemic that hit the United States. Additional links and citations are presented at the bottom of the page.
• The Flu of 1918: Click here to read a multi-page article by the Pennsylvania Gazette about the flu pandemic of 1918. It asserts that Philadelphia was the hardest-hit city in the United States.
• The Deadly Virus: Read about the history and view the government's archives of this event, including images, telegraphs, and documents.
• In 1918 Flu Pandemic, Timing Was a Killer: Scientists often wonder why this flu was so deadly. This article delves into the reasons as to why.
• Scientific Investigation of the 1918 Flu: This PBS article discusses efforts by scientists to uncover the origin of the virus responsible for the 1918 flu pandemic. It suggests that it may have begun as a form of avian flu.
• Lessons From the Spanish Flu, Nearly 100 Years Later: University officials discuss the spread of the Spanish Flu in this article by Michigan State University Today. Their projections indicate that a similar disease could kill fewer people as it spreads. The article also speculates on how this would affect the spread of the Ebola virus.
• University of Montana Memorial Row: The Influenza Epidemic: A short history of the influenza pandemic is the subject of this page. It also explains how the virus came to be known as the Spanish Flu as well as its arrival in the state of Montana.
• 1918 Influenza, the Mother of All Pandemics: Click this link to read a comprehensive account by the Centers for Disease Control regarding the flu pandemic of 1918. The PDF addresses where scientists think it came from, what animal it might have come from, and why it killed adults as well as the young and elderly. It also speculates about what to do if a pandemic of that magnitude makes a comeback.
• Toxic Traces: What Made the 1918 Influenza Virus So Deadly?: Research on a cure for a potential return of the 1918 influenza virus is the subject of this page by the National Institute of Allergy and Infectious Diseases. It focuses on breakthroughs made from experiments with mice, and it also talks about certain medical drugs that could inhibit the virus.
• What Made The Spanish Flu So Deadly?: Learn about the current research that has shed light on this devastating epidemic.