The Influenza Epidemic of 1918

Carla R. Morrisey, RN, BSN

Although millions of lives were lost worldwide, the "Spanish" Influenza epidemic of 1918 is hardly more than a footnote in the written accounts of World War I. The technical aspects of the epidemic and its destructiveness can be gleaned from contemporary medical records and journals, yet one must turn to oral accounts and personal diaries to realize the impact this pandemic had on the lives of those who lived through it.

This article is based on an oral history provided by Josie Mabel Brown, a Navy nurse who served at Great Lakes Naval Hospital during the height of the epidemic, and this year celebrates her 100th birthday.

Though it now seems merely a folk-memory, the Influenza epidemic of 1918 was the third greatest plague in the history of mankind. The most devastating epidemic since the Middle Ages, it took over 21 million lives and affected over half the world's population1 Logically, one would think that an epidemic of this proportion would have left an indelible imprint on the American people, yet it never inspired awe, not in 1918 and not since.

As one searches for explanation as to why Americans took little notice of the epidemic and then quickly forgot what they did notice, a mystery and a paradox emerge. The formal histories, magazines, newspapers, and military journals notably ignored the epidemic. Little was noticed and recorded for later generations. However, if one turns to personal reminiscences, to collections of old photographs, albums of family letters, and autobiographies of people who were not in authority, it is apparent that the individual was frightened and his life dramatically changed.

What mystery and paradox surrounded the epidemic? The mystery was the complacency the American people displayed as a group toward the epidemic. The paradox was the common individual's clear acknowledgment that the epidemic was the most influential experience of his life.

Why did Americans pay so little attention to this scourge, and why has history been so silent? No infection, no war, no famine has ever killed so many people in so short a time. Its sheer devastation is incomprehensible. The flu killed millions of people in 1 year or less. In the United States alone, 550,000 died within the 16-week period from October 1918 to February 1919.2

To understand this lack of attention, one must look at the years preceding the outbreak. Lethal epidemics were not as unexpected and therefore not as impressive as they might be in the more technologically advanced surroundings of today. The terror of typhoid, yellow fever, diphtheria, and cholera were well within living memory. Most Americans had lived through the typhoid and small pox epidemics of 1876 and 1890.3

Beyond this complacent acceptance of epidemics as a part of life, one must rely almost entirely on speculation in finding further answers.

If the "Spanish Influenza" had settled down as a permanent source of misery in the country, then possibly Americans might have granted this variety of flu the notoriety is deserved. But the devastation came, scooped up its victims, and all but disappeared within a few short months. If the flu had lingered like syphilis and cancer, or left disfigured and crippled reminders for decades to come, notoriety probably would have been forthcoming. If the flu had been a disease that evoked a memory of terror, Americans might have panicked. This complete absence of fear, which until 1918 had inflicted no more than a few uncomfortable days of cold-like symptoms, is reflected in a statement by A.J. McLaughlin, then Assistant General of the U.S. Public Health Service:

An epidemic of yellow fever with the loss of thousands of lives spared over a considerable territory would throw the whole country into a panic. A dozen cases of plague in a seaport town would cause the same kind of excitement; but it is remarkable to see the placidity by which the people have generally taken the almost sudden loss of 500,000 (sic) lives.4

The nature of the disease and its contagiousness encouraged forgetfulness as well. The swiftness of its spread and its ability to flourish then disappear before it had any real effect on the economy made it easier for people to accept. Rabies, which struck very few and was fatal to those who contracted it, was much more frightening than influenza which infected the majority of the people but killed only 3 percent of the Nation's population.

World War I perhaps best explained the relative indifference to the pandemic. The 5 Nov 1918 issue of The New York Times suggested that "war had taught the people to think in terms other than the individual interest and safety, and death itself had become so familiar as to lose its grimness."5 Such an explanation may seem quite naive, but most of those who died were young adults of the same age as those lost in combat. The obituary columns of influenza victims became one and the same blur with the war casualty list.

Many people looked upon the influenza simply as a subdivision of the war. The flu was bringing death to the people at home, just as the "Huns" brought death to the doughboys in France. The people of 1918 appeared to gain some dignity from their "battle" with flu if they thought of it in terms of war. A disease that certainly had to be met and conquered was described by one author in heroic, war-like terms when he stated, "It is hard to make people actively aware of the fact that every nation under the canopy of heaven is at war with disease and death, and the human toll is vastly greater than that of any conflict of arms."6

As Allied troops were engaged in their last great push across France and Belgium, it was the crumbling European empires and Woodrow Wilson's peace terms that made the headlines. In November 1918, after 2 successive weeks in which the country had lost 9,000 to the flu, The New York Times stated that: "Perhaps the most noticeable peculiarity of the influenza epidemic is the fact that it has been attended by no trace of panic or even excitement."7

Influenza seemed unimportant compared with the news on the front pages of the city's newspapers. Suffragette agitation was rising as a Senate vote on the rights for women drew near, and Eugene V. Debs was on his way to jail for allegedly violating the Espionage Act.8 On the last day of August 1918, Babe Ruth made the headlines as he pitched a three-hitter and banged out a long double to win the American League pennant for the Boston Red Sox.9 It was apparently of no consequence that on the same day the first cases of flu were recognized among Navy personnel in Boston and 26 sailors died.10

The interweaving of the war and pandemic seems almost to resemble a pattern of insanity. On 11 Sept 1918 Washington officials disclosed that the Spanish Influenza had arrived in the city. On the next day 13 million men, precisely the age most likely to die of the flu, lined up all over the United States and crammed into city halls, post offices, and schools to register for the draft. "It was a gala flag-waving affair everywhere including Boston where 96,000 registered than sneezed and coughed on one another."11

The epidemic did not kill the ranks of the famous and powerful. Perhaps if Woodrow Wilson or someone of like stature had died, the world might have remembered. It killed the daughter of General Edwards of the 26th Division of the American expeditionary Forces, but not the general.12 It killed the daughter of Samuel Gompers, president of the American Federation of Labor, but left America's most powerful labor leaders alive.13

On the level of organization and institutions, the Spanish Influenza had little impact. It did spur great activity among medical scientists and their institutions, but this was the single great exception. It did not lead to great changes in government, armies, and corporations. It had little influence on the course of political and military events because it affected all sides equally. Democrats and Republicans alike fell ill; doughboy, Tommy, Piolee, and Boche all got sick at once.

The influenza among the American troops of World War I was astonishingly contagious, and as General Pershing kept cabling for replacement troops in the battle of Meuse-Argonne, Army Chief of Staff, Peyton March, stated that the "epidemic has not only quarantined nearly all camps but has forced or suspended nearly all draft calls."14 The American soldier at the front found himself engaged in mortal combat with two opponents, the German Army and the Spanish Influenza. It was obvious that the flow of troops slowed and the death rate among the men in the trenches was high but that was true for all; the Germans were in mortal combat with two opponents as well.

The Spanish Influenza did not make a permanent impact on the masses, but what of the individuals in the American society? As a child I would often listen to stories recounted by my great aunt, Josie Mabel Brown, and with a child's mind they seemed to be fairy tales of a war and an epidemic told by a very old lady. However, as I grew and learned, Aunt Joe's stories were seen in a very different light. Here was an articulate 100-year-old woman, a Navy Nurse in the first decade of the 20th century, who lived through the Influenza Epidemic of 1918 and had been telling me over the year of the frightening devastation.

Josie had just graduated from Centenary Hospital School of Nursing when she received notification from the War Department that she was to report to Great Lakes Naval Training Center in Illinois. Josie was in a theater the day she received the telegram but in the weeks to follow most public gathering places would close. The theaters and saloons closed, and for almost 16 weeks in the fall of 1918 there were "churchless Sundays."15 With a casket of chicken and case, Josie boarded the train for Great Lakes to treat sailors suffering from what was thought to be cerebrospinal meningitis. After all, influenza, flu, old man grippe, whatever you called it, it was a homey, familiar illness. "There were 6,000 boys sick and dying of influenza and we thought it was meningitis."16

With a room of 42 beds and twice that many sick sailors, Jose often worked 18 hours a day. "As the boys were brought in we would put winding sheets on them even if they weren't dead. You would always leave the left big toe exposed and tag it with the boy's name ran, and next of kin."17 As one boy lay dying in bed, one waited on the stretcher on the floor for the bed to empty. Each morning as the ambulance drivers would bring in more sick boys they would carry the dead bodies out. The morgue was stacked to the ceiling with bodies because the casket makers could not make boxes fast enough. Josie often said she felt sorry for the poor boy on the bottom. However, as the weeks dragged on truck loads of caskets left daily for the train station to destinations listed on the "tag" as next of kin.

Nursing was nine-tenths of the battle in recovering from the influenza. Since there were only palliatives for the flu and the pneumonia it developed into, doctors were not the essential ingredient in fighting the disease. With often no time to treat her patients with anything more than sips of "hot wiskey," Josie would work endless hours trying to relive the high fevers and nosebleeds before the lungs filled with blood and faces turned blue.18

As the months of sickness continued, Josie's coworkers were stricken and died. She too fell ill in the spring of 1919, but by then the worst of the influenza had past. One thing Josie has never forgotten were the winding sheets. "Those awful, awful sheets! You know the city of Chicago ran out of sheets and all those poor boys ever got were a winding sheet and a wooden box."19

A child did not have to lose parents to be forever marked by the Spanish Influenza. Francis Russell, in a beautifully written account of his childhood in 1918, shows the emotional and psychological stress that was ever present in the family during the epidemic. Mr. Russell was 7 years old and lived on top of Dorchester Hill from which he could see all of Boston and its harbor. He bought thrift stamps at 25 cents each as his part in the Liberty Bond Drive; had birthday cakes without frosting so the Belgians would not starve; and ate peaches to save the stones and baked them so they could be used in gas masks.20 He watched the funeral processions pass by on Walk Hill Street and the coffins pile up in the cemetery chapel and saw Pigeye Mulvey set up a circus tent to hold the coffins that kept coming faster than gravediggers could dig.21

In October the schools closed because of the flu and russell played all day. On frosty mornings he would watch the girls jump rope and sing;

I had a bird and his name was Enza
I opened the window and
In-flu-enza.22

He would sit and listen to the clop of horses' hooves in the fallen leaves as the carriages pulled funeral processions by his house. One day he and two friends sneaked into the cemetery and watched a funeral.23 Even 7-year-old Francis, as he walked home that evening, became conscious for the first time of the irreversible rush of time. "And I knew that life was not a perpetual present, and that even tomorrow would be part of the past, and that for all my days and years to come I too must one day die."24

"The Spanish Influenza inspired no songs, no legends, no works of art. Even fundamental facts about the epidemic were meager. To this day no one can say with certainty where the disease began, where it ended, or even which virus was at fault."25 One lading authority has summed it up: "The resemblance to the disappearance of the Cheshire Cat in Alice in Wonderland is striking. And to this day too, flu remains one of the great medical imponderables."26

Today, just as in 1918, many authorities tend to regard the ravages of the flu not as a challenge but as an uncomfortable truth. In Richard Collier's commentary on the Spanish Influenza there is a quote by author and critic H.L. Mencken which is sadly true even today. "The epidemic is seldom mentioned, and most Americans have apparently forgotten it. This is not surprising. The human mind always tries to expunge the intolerable from memory, just as it tries to conceal it while current."27 Mencken's observations may well be the reason why the American people responded to the Influenza Epidemic of 1918 with such ambivalence; an ambivalence that was truly a "mystery" and a "paradox."


Bibliography

Allen FL: Only Yesterday. New York, Harper & Row Publishers Inc, 1931.

Brown JM: Interview April 1981.

Hoehling AA: The Great Epidemic. Boston, Little Brown & Co 1961.

Marks G., Beatty WK: Epidemic. New York, Charles Scribner's Sons, 1976.

Price A: After-war public health problems. The New York Times, 5 Nov 1918, p. 22.

Russell F: A journal of the plague: The 1918 influenza. Yale Review XLVII:219, 1958.

The influenza epidemic. Science LVII (suppl x), 16 Feb 1923.

The Public Health Service Reserve. Scientific American 86:343, 30 Nov 1918.

The United States Public Health service and the influenza epidemic. Science XLVIII:487-491, 15 Nov 1918.

Williams RC: The United States Public Health Service. Washington, DC, Whittel and Shipperson Press, 1951.


Footnotes

1. Marks, G. Beatty W: Epidemic, New York, Charles Scribner's Sons, 1976, p. 272.

2. Marks, p. 274.

3. Marks, p. 210.

4. Williams RC: The United States Public Health Service. Washington, DC, Whittel and Shipperson Press, 1951, p. 327.

5. Price A: After-war public health problems. The New York Times, 5 Nov 1918, sec 1, p. 22, col 2.

6. The Public Health Service. Scientific American 86:343, 30 Nov 1918.

7. Price, sec 1, p 22, col 2.

8. Allen F: Only Yesterday. New York, Harper & Row Publishers Inc., 1931, p. 43.

9. Allen, p 3.

10. Hoehling AA: The Great Epidemic. Boston, Little Brown & Co, 1961, pp 24-25, 99-100.

11. The Public Health Service, p 343.

12. Hoehling, p 153.

13. Hoehling, p 158.

14. Hoehling, p 138.

15. Hoehling, p 40.

16. Brown J: Interview April 1981.

17. Brown, interview.

18. Brown, interview.

19. Brown, interview.

20. Russell F: A journal of the plague: The 1918 influenza. Yale Review XLVII:232, 1958.

21. Russell, p 231.

22. Russell, p 233.

23. Russell, p 231.

24. Russell, p 229.

25. Collier, p 304.

26. Collier, p 304.

27. Collier, p. 304.


Source: Morrisey, Carla R. "The Influenza Epidemic of 1918." Navy Medicine 77, no. 3 (May-June 1986): 11-17.