The Flu Epidemic of 1918

America's Experience in the Global Health Crisis

Sandra Opdycke

• Publisher: Routledge
• Year: 2014
• Topic: History
• eBook ISBN:
  9781135133511
• Subtopic: North American History
• Index: History

In 1918, a devastating world-wide influenza epidemic hit the United States. Killing over 600,000 Americans and causing the national death rate to jump 30% in a single year, the outbreak obstructed the country's participation in World War I and imposed terrible challenges on communities across the United States.

This epidemic provides an ideal lens for understanding the history of infectious disease in the United States. The Flu Epidemic of 1918 examines the impact of the outbreak on health, medicine, government, and individual people's lives, and also explores the puzzle of Americans' decades-long silence about the experience once it was over. In a concise narrative bolstered by primary sources including newspaper articles, eye-witness accounts, and government reports, Sandra Opdycke provides undergraduates with an unforgettable introduction to the 1918 epidemic and its after-effects.

Critical Moments in American History is a series of short texts designed to familiarize students with events or issues critical to the American experience. Through the use of narrative and primary documents, these books help instructors deconstruct an important moment in American history with the help of timelines, glossaries, textboxes, and a robust companion website.

CHAPTER 1

No Ordinary Flu

The Epidemic of 1918

It seems to be a plague, something out of the Middle Ages.

Did you ever see so many funerals, ever?

Katherine Anne Porter¹

During the last two weeks of October 1918, more than 9,000 people died in New York City from a single cause. During the same two weeks, about 7,500 people died in Philadelphia, and another 4,400 in Chicago.² These Americans did not die in fires or floods or earthquakes, but in a different kind of calamity: the great influenza epidemic of 1918.

This epidemic, which peaked during the final months of World War I, swept three times around the globe in just over a year—a relatively mild first wave that began in the winter of 1918, a devastating second wave in the fall, and a third and final wave that started late in the year and ran into 1919. By the time the third wave was over, the epidemic had infected about one-quarter of the world’s population and killed an estimated 50 million people. In the United States alone, recent estimates put the death toll at 675,000.³ That is more than all the U.S. soldiers killed in combat in all the wars of the twentieth century, including World War I, World War II, Korea, and Vietnam.

Any epidemic can be terrible for those who experience it. But the outbreak of 1918 was especially shocking, for two reasons. First, influenza seemed like such a familiar and unthreatening disease. Every year, thousands of people came down with it, and after feeling miserable for a few days, nearly all of them recovered. People did die of the flu, especially the very young and the very old. But no one thought of this disease as one of the great epidemic killers.

The second reason the 1918 epidemic came as a shock was the fact that in the past few decades, great strides had been made in identifying and controlling more than a dozen of the epidemic diseases that had haunted earlier generations, including cholera, plague, typhoid, yellow fever, and typhus. In this heady atmosphere, it was easy to believe that the conquest of all infectious diseases lay just around the corner. So how could influenza, a “garden variety” disease, suddenly be killing millions of people, in defiance of all the tools of modern science? Vincent Vaughan, dean of the University of Michigan medical school, must have spoken for many when he said in 1918:

We are inclined to boast that the age of pestilence has passed, but … I dare say that the world has never before known a pestilence more widespread, more intensive and appalling in its progress, or more destructive to life, than this epidemic.⁴

As influenza swept the country, Americans saw their efforts to prosecute the war disrupted, their communities engulfed by death and disease, and their faith in science and progress severely tested. As long as the experience lasted, it was all-consuming. And yet—as will be discussed in Chapter 7—once the epidemic ended, it seemed almost to vanish from public memory. For decades, historians scarcely mentioned it, few novelists wrote about it, and survivors rarely talked about it with their children. In recent years, the epidemic has begun to receive more attention, but even today many Americans know very little about this monumental event in our history.

THE PATH OF THE EPIDEMIC

When and where did the 1918 flu epidemic begin? Opinions differ on that point, but many authorities trace the start to an outbreak in Haskell County, Kansas, in February 1918. Influenza needs a sizable population to keep it going, and the Haskell population was small. So under ordinary circumstances, the outbreak might have burned itself out right there. But 10 months earlier, the United States had entered World War I, and as the country scrambled to mobilize and train the enormous army it had promised to deliver to the battlefields of Europe, hundreds of thousands of young men were crowded into hastily constructed camps all across the country. As the soldiers moved from home to camp, and then from one camp to another, they created a huge pool of potential victims among whom the flu virus could circulate.

So a few soldiers returning from leave in Haskell County brought the flu to nearby Camp Funston (see Figure 1.1). Influenza is one of the most contagious of all diseases, since for the first several days after being infected, the victims spray flu germs into the air every time they talk or sneeze or cough. Under these circumstances, a crowded army barracks is a near- ideal location for transmitting the disease. And the military policy of frequent transfers from one camp to another, along with the accelerating shipment of soldiers to Europe, only increased the chances for transmitting the disease. Within weeks, the flu spread from Funston to a dozen other military camps around the country, and from these camps to the surrounding communities. Thus began the first wave of the great flu epidemic of 1918.

One would assume that a disease that spread so quickly and so far would generate a lot of public attention. But the outbreak lasted no more than a few weeks in any single locality, and it caused most of its victims only mild discomfort. In fact, many of them probably never even called a doctor. Even if they had, influenza was not a “reportable” disease like tuberculosis or cholera, so doctors had no obligation to notify the local health department about the cases they saw. Any actual deaths from flu would have been recorded locally, but the country’s system for reporting vital statistics to Washington was so undeveloped that it was hard to get a national overview of what was going on.

Figure 1.1 A crowded influenza ward at Camp Funston, Kansas, 1918. New Contributed Photographs, Otis Historical Archives, National Museum of Health and Medicine.

The result is that much of what we know about the spring wave of the flu epidemic comes from individual institutions that kept good records. For instance, we know that 1,000 workers at the Ford Motor Company got flu in March 1918. So did 500 of the 1,900 inmates at California’s San Quentin prison.⁵ But little of this information was published at the time. Furthermore, even though so many people caught the disease, their symptoms were too mild to generate much interest in the local press. As a result, many Americans were probably never even aware that an epidemic was happening, and those who did know soon forgot about it.

But though the epidemic was forgotten in the United States, it had not disappeared; it had gone to Europe on the American troopships. Starting at the French port of Brest, where the U.S. soldiers disembarked, the epidemic was soon surging through not only the American Expeditionary Force (the U.S. divisions in Europe), but also through the armies of France, Great Britain, Italy, Austria, and Germany. When soldiers went on leave, they took the flu with them, and by June it was spreading among European civilians as well.

The progress of the disease was not widely publicized at the time, since no belligerent country wanted to announce to the world the vulnerability of its soldiers, or even of its civilians. Thus, during the early summer of 1918, when American newspapers mentioned the flu epidemic at all, they focused almost entirely on how hard it was hitting the enemy. For instance, the New York Times explained that the only reason flu was such a problem among the German soldiers was because of their hunger and exhaustion. At the same time, American readers were assured (falsely) that there was, as one newspaper headline proclaimed, “No Influenza in Our Army.”⁶

By May 1918, the disease was prevalent throughout the United States and Europe, but thanks to wartime censorship, there were still very few stories about it in the papers. Only when influenza hit neutral Spain in June was it given full press coverage and explicitly acknowledged as an epidemic. As a result, many people got the impression that the epidemic had actually begun in Spain. It was this historical accident that led to its becoming known as “Spanish flu.”

The first wave of the epidemic spread rapidly around the rest of the world, but however far it traveled, it nearly always remained as harmless as it had been in the United States. One army doctor at the front described it in his diary as “a mild epidemic of ‘three-day fever’.”⁷ Then something changed. In late August, the Journal of the American Medical Association warned its readers that a new “acute influenza-like disease is passing over Europe.”⁸ Of course, with all the wartime traffic across the Atlantic and around the United States that year, it was inevitable that any new flu strain that established itself in Europe would soon find its way to every corner of the United States. And that is exactly what happened.

Besides being widely known as Spanish flu or the Spanish Lady, the 1918 epidemic acquired a variety of local names, including La Grippe (France), Blitzkatarrh (Germany), Great Cold Fever (Thailand), Trancaso (meaning “blow from a heavy stick”) (Philippines), Coquette (Switzerland), Bombay Fever (Sri Lanka), Bolshevik Disease (Poland), Flanders Grippe (England), Naples Soldier (Spain), the Black Whip (Hungary), and the Blue Death (USA, North Carolina).⁹

The first recorded cases of the epidemic’s second wave in the United States appeared on August 27 in a vast navy barracks in Boston called Commonwealth Pier. On that day, two sailors reported sick with what turned out to be influenza. Commonwealth Pier was a perfect place for the disease to multiply, with 7,000 sailors all sleeping and eating in the same crowded, ill-ventilated building. So it is hardly surprising that the day after the first two men developed flu, eight more cases appeared. The day after that, there were 58. Meanwhile, the disease was spreading into the surrounding towns, and soon thousands of flu cases—and several hundred flu deaths each week—were being reported among Boston civilians.¹⁰ Influenza also exploded among the soldiers at Camp Devens, a huge and crowded army camp just outside the city.

Late in September, J. J. Keegan, a navy physician based in Boston, wrote a brief article for the Journal of the American Medical Association, alerting doctors around the country to the “severe and rapidly spreading” epidemic in New England. Reminding his readers that “in pandemics of this nature, influenza is the most contagious of diseases,” Keegan warned that the flu would probably soon sweep the whole United States.¹¹

By the time Keegan’s article appeared on September 28, his prediction had already come true. Fostered by the transfers from one infected military camp to the next, and by continual interaction between each camp and its surrounding towns, the flu was racing across the country. By late September, there were at least 20,000 cases of flu in the nation’s training camps.¹² At the same time, the epidemic had spread to virtually every American city. And from the cities, it reached outward to the surrounding towns and villages.

In fact, Keegan’s only error had been in limiting his predictions to the United States. At almost the exact time that the epidemic was devastating the United States, the same virulent new strain was being carried to countries all around the world. In the African port city of Freetown, a handful of dock workers contracted the disease when a ship from Europe spent a few days in the harbor. Days later, virtually all the workers in the port were down with influenza, and within a week flu was being reported in dozens of inland towns and villages.¹³ The same story was repeated on every continent. A few cases would develop, usually around a port or a mi...

Table of contents

• Cover
• Half Title
• Critical Moments in American History
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Series Introduction
• List of Figures and Tables
• Acknowledgments
• Timeline
• Introduction
• 1 No Ordinary Flu: The Epidemic of 1918
• 2 America in 1918: The Epidemic's Social Context
• 3 Fighting Two Wars at Once: Flu in the Military
• 4 A Caregiver's Nightmare: Trying to Treat Influenza
• 5 Communities on Their Own: The Civilian Experience
• 6 After the Storm: The Legacy of 1918
• 7 The Long Silence: Suppressing the Memory
• 8 Feeling Vulnerable Again: Fears of Another 1918
• Documents
• Bibliography
• Index