Pandemic Overload (1918) – WIF Medicine

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Facts About

the Spanish Flu

Pandemic 1918

A Little Perspective

Spanish flu, the deadliest pandemic of the 20th century, struck the world in a series of waves, and left between 50 and 100 million people dead in its wake. It may have appeared in the trenches of World War I in Europe as early as 1916, according to some researchers. It first appeared in the United States in the spring of 1918. Numerous contending theories of its source of origin continue to be debated. Some say it began in the United States, some say in Europe, and still others argue it originated in Asia. There is no debate over its impact, though, with one-third of the world’s population contracting the disease during its peak in 1918-19. It continued to appear well into 1920, though with significantly less impact.

Differing from other forms of influenza, the virus had a significant impact on young, otherwise healthy adults, who usually had stronger immune systems. It struck the wealthy and the poor. Franklin Delano Roosevelt contracted the illness. The King of Spain nearly died of it. A young nurse in Toronto, Amelia Earhart, contracted the disease, which damaged her sinuses to the point surgery was required. The scars left her with sinus problems for the rest of her life. In the United States, 675,000 Americans died from the flu, most of them during the deadly second wave in 1918. That year American average life expectancy dropped by 12 years as a result of the flu. Here are 10 facts about the Spanish flu pandemic at the end of the First World War…

10. Nobody knows for certain where it originated

While there is some disagreement among scholars over the place of origin, the consensus is that Spanish flu did not originate in Spain. When the pandemic spread rapidly across Europe in 1918, wartime censorship conditions affected most news reports. Censorship did not apply to neutral Spain. News reports of the flu’s virulence there appeared in newspapers and magazines, with references to “this Spanish flu.” The name stuck. Reports of the disease in Spain increased substantially when King Alphonso XIII contracted the flu in the spring of 1918. Ironically, as reports of the King’s illness and being near death for several days increased references to the Spanish flu in Western newspapers, the Spanish referred to the disease as the French flu.

Since the pandemic (and in part during it), China, Great Britain, the United States, and France, as well as Russia, have all been suggested as the disease’s starting point. The first case in the United States appeared in March 1918, at a Kansas army post. More recently, researchers identified potential cases as early as 1916, at army receiving and marshaling stations in France. Another earlier outbreak occurred at a British Army base in Aldershot in the early spring of 1917. The UK staging camp at Etapes, in northern France, saw 100,000 troops go through daily, either returning from the front or on their way to it, in densely crowded conditions. Hundreds exhibited symptoms of the pandemic flu during the spring and fall of 1917, a fact later identified by army pathologists.

9. More American soldiers died of Spanish flu than in combat during World War One

Americans were stunned at the casualties suffered by their troops during the First World War, though in comparison to the European combatants they were low. Mobilization placed 4.7 million American men in uniform. Of those, about 320,000 became ill and recovered, or suffered wounds in combat from which they survived. 116,516 American troops and sailors died during the war. Combat deaths totaled 53,402. The rest — 63,114 — died of disease, with most of the deaths occurring from the Spanish flu in the camps in the United States, in Europe, and in ships bound for Europe. Once such ship was a former German liner. In 1917 the United States converted the German steamship Vaterland, interned in New York, into a troopship, renamed USS Leviathan.

On September 29, 1918, Leviathan departed New York for the French port of Brest, carrying 9,000 American doughboys, and a crew of 2,000 sailors (one of the sailors was a young New Yorker named Humphrey Bogart). Spanish flu appeared in the ship during the crossing. When Leviathan arrived at Brest it carried 2,000 men already diagnosed with the Spanish flu, which wreaked havoc in the crowded conditions aboard, and overwhelmed the ship’s medical facilities and personnel. 80 men died during the crossing, many more after landing ashore in France, during the height of the pandemic. A similar outbreak occurred on the ship’s return voyage to the United States.

8. It affected the Treaty of Versailles

The combat during World War One came to an end via an armistice, which began at 11 a.m. on the 11th day of November, the 11th month of the year, 1918. Many issues of the war remained unresolved. The leaders of the Allied nations agreed to meet in Paris in early 1919 to discuss the issues facing Europe. Woodrow Wilson, then President of the United States, went to Europe to join the discussions, present his famous 14 Points, and to argue for the establishment of the League of Nations. He favored more lenient terms for Germany than those proposed by the leaders of France, Italy, and Great Britain. Wilson intended to use American prestige to obtain less punitive measures against the Germans, especially in the form of reparations.

During the negotiations for the treaty, which took place in Paris rather than the Palace of Versailles for which it was named, Wilson came down with the Spanish flu. Several members of his entourage suffered through the flu during the voyage to France. Wilson’s illness was covered up, though he became severely ill in Paris, unable to attend multiple sessions of the negotiations. His physician, Navy Admiral Cary Grayson, wrote of the President as “violently sick.” When Wilson did partially recover and returned to the negotiations, several participants wrote of his lack of attention, fatigue, and listlessness. He failed to ease the reparations imposed by the Allies on the Germans, and the resulting Treaty of Versailles created conditions in Germany that led to the rise of Adolf Hitler and the war which followed the War to End All Wars.

7. The federal government did little regarding the flu’s impact

In the United States, the federal government did relatively little to combat the Spanish flu, other than issue advisories telling Americans of the dangers presented by the illness. Congress adjourned in the fall of 1918, with the second wave of the pandemic at its peak. The Supreme Court did the same. The United States Public Health Service, then an agency within the Department of the Treasury, issued posters warning against spitting on sidewalks. It also advised workers to walk to work, which seems strange to modern eyes, until one considers that most commuting at the time involved streetcars or railroads. It also warned Americans to avoid becoming over-fatigued.

Before Woodrow Wilson went to Europe, Edith (the President’s wife) sent 1,000 roses to young women serving in the war effort in the District of Columbia, who were sickened by the flu. That was about the extent of the federal effort. Battling the effects of the pandemic, the lost work hours, burying the dead, and combating the spread of the disease was left in the hands of local governments, which responded in varying ways across the country. Some imposed severe restrictions on movement, crowds, and schools, easing them as the pandemic passed through their communities. Others continued to promote large gatherings to support Liberty Bond drives, including a parade in Philadelphia after which thousands died in the city from the rapid spread of influenza which ensued.

6. Some cities made wearing masks mandatory, with criminal penalties

The first wave of Spanish flu in America occurred in the spring of 1918. Compared to what came in the second wave it was mild. The second wave came in September 1918, in the Eastern cities, and gradually moved westward. San Francisco escaped the first wave, and its Chief of the Board of Health, Dr. William Hassler, assured citizens of the city the second wave would not affect them. On September 24, a recent arrival from Chicago became ill with the flu. By mid-October over 4,000 cases were in the city. That month the city passed an ordinance making the wearing of gauze masks mandatory, with Hassler touting them as 99% effective in stopping the spread of the flu between persons.

In truth, the masks were likely of little benefit, and on November 21, 1918,  the city rescinded the order to wear them. Several other cities issued similar orders, with varying degrees of punishments for violators. In San Francisco, violators went to jail. The city suffered 2,122 deaths during the lethal second wave. The third wave struck in December, and lasted through the winter, raising the death toll in San Francisco to over 3,500 out of a population of about half a million. Nearby Oakland was similarly hit. Oakland also enacted an ordinance requiring masks, virulently opposed by the city’s tobacco store owners. One such owner designed a mask with a flap over the mouth, allowing smokers to enjoy their cigars, cigarettes, and pipes while remaining in compliance with the law.

5. The 1918 baseball season was shortened, though not because of the flu

Major League Baseball shortened its season in 1918 in response to the American war effort. The last game of the regular season was played on September 2, 1918. Teams played just over 120 games that year. When the season ended, the second wave of Spanish flu was underway on the East coast. The league champions, the Boston Red Sox of the American League and the National League’s Chicago Cubs, met in the World Series. Public health officials in both cities argued against playing the World Series due to the crowds gathering during the course of an epidemic, but baseball went ahead. Boston’s only concession to the flu came in an agreement to play in Fenway Park, rather than in the larger Braves Field, where they had played in the preceding World Series.

During the World Series a young Red Sox pitcher started two games, winning both, despite suffering from the flu at the time. He started in the outfield in the other four games. His name was George Herman Ruth. Throughout the games he lay down between innings, weakened by the fever and body aches symptomatic of the flu. Some of his teammates assumed Ruth was simply suffering from a bad hangover, a common problem of ballplayers of the day. But throughout the series, Ruth was notably absent between games, even spending time on the train to Chicago in his sleeper, rather than consorting with teammates. The Red Sox won the series four games to two. It was the only World Series in history played entirely in September. That winter, Ruth was sent to the Yankees.

4. Franklin Roosevelt contracted the flu while returning from France

Franklin Delano Roosevelt served as Assistant Secretary of the Navy in the Wilson Administration, and in that capacity went to Europe in 1918. His mission included the coordination of naval activities against the German U-boat threat, and arranging for convoying and port facilities used by US Navy ships. In September 1918 he returned to the United States aboard USS Leviathan. Upon arrival FDR was carried off the ship on a stretcher, having contracted the flu either in France or, what is more likely, aboard the ship. Leviathan’s crew had been exposed to and ravaged by the flu on several voyages. FDR returned to the United States deathly ill, and required several weeks convalescence at his family’s Hyde Park home before resuming his duties.

FDR’s illness and its severity are often overlooked, largely because of his being later stricken with polio, which left his legs paralyzed. His flu is often described as a mild illness, though he left Leviathan with double pneumonia, high fever, and debilitating weakness. His distant cousin, former President Teddy Roosevelt, who had encouraged him to go to Europe, wrote him during his convalescence. “We are deeply concerned about your sickness, and trust you will soon be well,” wrote the former President, adding that, “We are very proud of you.” Had FDR not survived the flu, which killed so many Americans who went to Europe in 1918, the remainder of the 20th century would have been very different indeed.

3. The flu’s second wave was its deadliest by far

The second wave of influenza in 1918 swept across Western Europe and the United States from September through the end of the year and into January. It was the deadliest of the three main waves of the pandemic. In Philadelphia, America’s hardest hit city, about 16,000 died after city leaders refused to cancel a parade scheduled to promote the sale of Liberty Bonds. Cincinnati closed schools and businesses, shut down streetcars, and ordered the wearing of masks. For a time it closed all restaurants, though it allowed saloons to remain open. At one point in November, believing the worst to have passed, the city reopened businesses and schools. Within days the death rate skyrocketed, forcing the city to shut down again. Over 1,700 Cincinnatians succumbed to the flu in the fall of 1918.

Sailors at the Great Lakes Naval Training Center brought the flu to Chicago. In September Chicago’s Health Commissioner announced the flu was under control. At the end of the month there were fewer than 300 cases reported in the city. By mid-October the city reported 1,200 new cases per day. Chicago shut down schools, businesses, banned public gatherings, closed parks, and requested for churches to curtail services. Chicago reported over 38,000 cases of influenza, and 13,000 cases of pneumonia attributed to the flu, before restrictions were lifted in mid-November. One restriction imposed, vigorously opposed by conservative newspapers and businesses, had been the banning of smoking on streetcars and elevated trains. The Chicago Tribune opposed the ban and referred to the Health Commissioner who imposed it as “his highness.”

2. Authorities in Philadelphia announced the flu was no worse than seasonal flu and held a parade to sell war bonds

In mid-September 1918, influenza was present in all the major Eastern cities of the United States, with Boston suffering the highest number of cases. Philadelphia had seen some cases of the flu, though health officials in the city regarded it lightly. The city’s Health Commissioner, Wilmer Krusen, a political appointee, ignored the pleas of doctors and public health experts to ban large public gatherings. Krusen announced the flu was no worse than any seasonal flu, despite the evidence presented by other cities. The Health Commissioner warned the people of Philadelphia to be careful, covering their faces when they coughed or sneezed, and allowed the city’s scheduled Liberty Bonds parade to take place on September 28, a patriotic spectacle attended by an estimated 200,000 people.

By the middle of November, over 12,000 Philadelphians had died of influenza. The city’s morgue, designed to hold 36 bodies, was obviously overwhelmed, and bodies were stored in the city wherever space was found. A streetcar manufacturing company was hired to build simple wooden boxes to serve as coffins. In the tenements, whole families were stricken and died, undiscovered for weeks. Only three days after the parade, every hospital bed in the city was filled. Over 500,000 cases of the highly contagious flu struck Philadelphia before the end of the year. The final death count was over 16,000. In contrast to Philadelphia, the city of Milwaukee, which imposed the most stringent social distancing laws in the nation, also saw the lowest death rate of any city in the United States.

1. One-third of the world’s population contracted the flu during the pandemic

The 1918-20 influenza pandemic, the worst of the 20th century, caused at least 50 million deaths, and probably as many as 100 million across the globe. In remote Tahiti, 10% of the population died. In British ruled India more than 13 million citizens died, with some estimates ranging up to 17 million. German Samoa lost 22% of its population. American Samoa imposed a blockade, and escaped the pandemic unscathed. Brazil’s 300,000 dead included its President, Rodrigues Alves. In the United States over a quarter of the population contracted the flu during one of its several waves. Official death counts usually cite 675,000 American deaths, though some estimates include deaths on Indian Reservations and in Alaskan communities, and elevate the count to 850,000.

Bacterial pneumonia, a complication brought on by the flu, served as the primary killer. When the flu returned for its third wave in the late winter and early spring of 1919, rates of death were comparatively low. Sporadic outbreaks continued in the fall of 1919 and the winter of 1919-20. As the 1920s began the pandemic faded from memory, and remained largely forgotten until the coronavirus pandemic restored it to public attention. All the weapons used to control the spread of coronavirus — distancing, closing of schools, banning large crowds and gatherings, shutting down businesses, and others — were deployed against the Spanish flu. History shows that those communities which deployed them most stringently, throughout the first and second waves, were most successful saving lives.


Flu Pandemic Song – The Flying Fish Sailors


Pandemic Overload 1918

WIF Medicine

Alpha Omega M.D. – Episode #208

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Alpha Omega M.D. – Episode #208

…the war will be killin’ two ways; if a bullet don’t get ya, the flu will…

During a day of work in early September at Florida A&M Hospital, an institution that he has helped to grow, from modest beginnings to respectability, A.O. attends a staff meeting concerning the sudden outbreak of influenza. Miss Virginia Hilyer supervises a stable of promising young doctors at this mostly black college facility and she is determined to get a handle on the cause of this spreading calamity, utilizing research labs to isolate what they think is an offending bacteria.

She says there is reason for alarm. Not only is this strain deadly, but it kills in a single day, taking down those considered the strongest, vital men and women in their 20’s. It has migrated out of the Orient, as do most flues, making a devastating stopover in Spain, leaving but a small percentage of its population untouched, before making port at Boston in late August. It seems that the increased coming and goings across the Big Pond, with the war as the cause, has provided the disease a virulent conduit… and it is spreading like a wildfire in the jack pine forests native to the Florida panhandle; tinder dry underbrush feeding sappy needles, fanned by Gulf breezes.

“We are seein’ our first cases already and I’m not takin’ any chances. We are closing off the top floor. It will serve as an isolation ward for the whole county. I lost my mother to the plague in 1914 and I won’t be repeating New Orleans’ arrogant mistakes!” Miss Jennie, as she is known, is also on staff as one of the top career nurses in the nation, dedicated to the care of others, even to the expense of her own personal life.

       No better example for a young physician than she; listen, attend, heal are her watchwords. And do not think that any of these qualities is lost on A.O. Campbell, who grew up watching the sternly skilled hands of Doc Ziggy work minor wonders, forever laced with compassion and kindness.

          Before the sun can reach its zenith and much to Campbell’s dismay, two of the first admissions to the isolation ward are familiar to him, one ill leading the other for care. His mother-in-law and his mentor look as though they’ve been to hell and back, sweating bullets on a cool-ish late summer day.

“I’ll be caring for them, Miss Jennie—my kinfolk and such—that’s if you don’t mind?”

There is gravity to the request. “You may have to stay with them until it’s over,” she informs him, as they are led to the electric elevator, too delirious to recognize A.O.

“I’ll have them good as new in a day or so,” he thinks.

“I don’t think you understand. Them means all of them, two or two thousand. Once you are exposed, we can’t have you infecting the rest of Leon County.”

He hesitates for a moment, staring the subtle hazards of epidemic straight in the eye. It is staring back at him.

  “Would you please go to my house and tell my Maggie that her mother and Ziggy are here and I’ll be caring for them… and anyone else who is struck down.” He has made up his mind. “Tell her not to go out of the house with the baby.”

“That is sound advice Doctor Campbell, somethin’ the whole world should do, but I have a feelin’ the war will be killin’ two ways; if a bullet don’t get ya, the flu will.


Alpha Omega M.D.

Self Portrait With Spanish Flu 1919 by Edvard Munch

Episode #208


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