How the U.S. Dealt with the Spanish Flu of 1918
How the U.S. Dealt with the Spanish Flu of 1918

How the U.S. Dealt with the Spanish Flu of 1918

Larry Holzwarth - April 2, 2020

How the U.S. Dealt with the Spanish Flu of 1918
The announcement of the armistice was celebrated in major cities while the flu was still present. Influenza Encyclopedia

10. New York took contradicting measures to combat the numbers

The City of New York was hard hit by the second and third waves of the virus in 1918 and 1919. The city responded in ways which appeared confused and contradictory. Public schools were told to remain open, with the argument presented that school nurses rendered them safer for children than isolation at home. New York’s Health Commissioner, Royal Copeland, ran a concerted campaign to inform the citizens of the city of the dangers posed by the flu, and the behavior which minimized risk. The citizens of the nation’s mostly densely packed city were told to avoid crowds. Copeland convinced the business community to stagger shifts, reducing the congestion on the subways and commuter trains.

Workdays were staggered by industry, with retail outlets ordered to open at 8 AM, offices, at 8.30, and so on, with closing times similarly adjusted. Copeland did not order the closing of New York’s theaters and public spaces, though he did distribute leaflets warning against the dangers inherent with attendance. He used the Boy Scouts to distribute them, as well as cards warning of violations of the health code, recently enacted, making spitting on the streets a crime punishable by fine. Copeland’s actions were in line with those of federal officials and experts, who widely regarded the flu as no different than other years’, until the immensity of the second wave overwhelmed the public health systems across the country.

How the U.S. Dealt with the Spanish Flu of 1918
A Cincinnati barber prepares to shave a customer while wearing a mask. WCPO Cincinnati

11. Cincinnati took early steps to control the spread of the flu

Health officials in Cincinnati took note of the rapid spread of the flu down the East Coast from Boston in late September, 1918, and initiated steps to protect the citizens of the city. On October 3 its Health Commissioner, William Peters, banned non-essential hospital visits. The city closed schools, theaters, parks, churches, and initiated a ban on public and private meetings. Sunday schools were closed despite the protests of the large Catholic community in the city. The city allowed one major industry to remain open. Saloons, taverns, and brewery taprooms remained open for business, though alcohol purchased was carry-out only. On premises consumption was banned.

By October 15 the city’s fatality rate from the flu skyrocketed. Peters contracted the flu, though he recovered. At least 1,700 Cincinnati citizens were not so lucky. Resentment against the city’s large German population festered, and acts of violence against German businesses and churches occurred. On Armistice Day Cincinnati reopened businesses and schools, and another sharp increase in cases struck the city’s children. The city banned children from stores, theaters, streetcars, and parks. The schools again closed, and remained so until just after Christmas, following a drop in new cases. By January, 1919, the worst was over in the city.

How the U.S. Dealt with the Spanish Flu of 1918
Boston was besieged by flu arriving on ships, and in the military camps near the city. WBUR

12. Camp Devens and Boston

On September 5, 1917, the US Army established Camp Devens, near Boston, to process and train American troops prior to their deployment to the Western Front in Europe. The site was selected due to its proximity to the Port of Boston. One year later the crowded camp was hit by the Spanish Flu, which arrived in Boston by ship. In September, 1918, about 15,000 soldiers at the camp contracted the virus. A doctor testified to the tragic end of many flu patients as “simply a struggle for air until they suffocate. It is horrible”. In Boston, Chelsea Naval Hospital found itself overwhelmed by sailors, who likely contracted the disease in receiving barracks and ships.

The flu which first appeared in the military facilities in August spread to the city itself in September, overwhelming the unprepared health care system. More than 1,000 Bostonians died of the flu in September alone. From the city it spread to other eastern ports, carried by ships and trains to Rhode Island, New York, Pennsylvania, New Jersey and Virginia. The city worked with the military to erect a tent hospital on Corey Hill. By the end of September public schools were ordered closed, and the city recruited teachers to serve as temporary nurses. Boston shut down businesses and places of entertainment on September 26. On October 2, 1918, the Massachusetts Department of Health made influenza a reportable disease, making the Commonwealth one of the first in the nation to do so.

How the U.S. Dealt with the Spanish Flu of 1918
A sign at the Philadelphia Naval Shipyard warns workers against spreading Spanish Flu. US Navy

13. The business community largely opposed shutdowns

Across the nation in 1918, Americans relied on bakers for their daily bread, butchers for meat, and grocers for their food needs. Home refrigeration was scarce and primitive. There existed relatively little entertainments within the home compared to a later day. Limited knowledge of how contagion spread dominated, with the widespread belief that the illness was carried through the air, rather than it also being spread by contact with surfaces. The belief led the business community to push for protection through wearing masks, themselves primitive and of little use. The business communities found allies in the general public, which did not want to stay at home.

In communities where saloons and taverns were closed, men went to them anyway, hidden in backrooms or simply behind closed and locked doors. Barbers continued to give haircuts and shaves, at a time when sterilizing razors and scissors between customers was unknown. Bakers and butchers continued to serve customers using unwashed hands. People huddled together on crowded conveyances, carrying the flu to previously uninfected areas. Nurses visited hundreds of sick per day, then stopped at businesses on their way home to pick up what they needed. In cities where a crackdown on businesses violating closure orders occurred, police forces found their ranks depleted by officers contracting the virus as they attempted to force compliance.

How the U.S. Dealt with the Spanish Flu of 1918
Newspapers throughout the country published recommendations to avoid contracting the flu. Salt Lake Tribune

14. Government response to the Spanish Flu was haphazard

In 1918 there existed no Centers for Disease Control; no National Institute of Health; no Department of Health and Human Services. The response to the spreading virus relied on state and local officials. In some cities, public health commissions were in the hands of doctors, while in others they were politically appointed sinecures. Few in the United States were prepared for the virulence of the Spanish flu. Flu was a common event in the United States, arriving in most of the country in the fall and declining the following spring. Some years presented outbreaks worse than others. In most states, flu was not a reportable illness, with doctors required to notify state authorities of diagnosed cases.

The Spanish Flu changed that for all time. State and federal health agencies tracked flu in the United States everr since, as a result of the three major waves of the Spanish Flu in 1918-19. The health agencies of the time had little in the way of fighting and tracking the virus as it spread, and at any rate it spread too rapidly, and killed too quickly, for the efforts to have much effect. The overwhelming national response was to isolate those with symptoms from the rest of the population, either in their homes or in hospitals and temporary wards. Newspapers often scorned the efforts of health officials and local governments, siding with the business community which described the scourge as just another form of the flu.

How the U.S. Dealt with the Spanish Flu of 1918
Patent medicines aimed at the flu appeared around the world, but did little to ease the crisis. Wikimedia

15. The Armistice exposed the crisis in Europe

Following the Armistice on November 11, 1918, censorship of newspapers did not immediately cease. It did ease however, and reporters who had written of the flu in Spain learned of its extent in France, Great Britain, and throughout the British Empire. Its extent in the German sides of the trenches exposed itself, from German prisoners and civilians. In the first and second waves the flu ravaged the troops on the front lines, in the support trenches, and throughout the logistics trails. Railroads and other supply systems, disrupted by absences caused by the flu could no longer support the German Army in the last few weeks of the war.

The widespread nature of the disease in Europe was reported in America, though few Americans paid much attention, too concerned with their own plight to worry about the recently defeated enemy. In Great Britain and Canada the disease spread faster than attempts to contain it could be established. Throughout the European continent, hunger and malnutrition made the survivors of the war more susceptible to the illness, and more likely to die from its symptoms. No person was immune. At the Versailles Conference, in addition to American President Woodrow Wilson, the British Prime Minister, David Lloyd George, contracted the flu. So did Georges Clemenceau of France, and Johannes Ball, who represented Germany.

How the U.S. Dealt with the Spanish Flu of 1918
The belief that contagion was impeded in the open air led to outdoor barber shops and open windows in streetcars and trolleys. National Archives

16. Changes to American society

Prior to the outbreak of the Spanish Flu in the United States, urban decorative water fountains often served as drinking fountains, equipped with metal cups on chains. Those desirous of hydration shared the common cups. Following the Spanish flu, they vanished, never to be seen again in American cities. Ladles near wells and water pumps, once common, also faded from American life. American healthcare professionals were joined by their British and French counterparts informing their populations to avoid undue fatigue, and wear adequate clothing to prevent becoming chilled. The role of nutrition in preventing illness was not yet known. The impact of the flu on communities prone to chronic hunger was observed and reported in the United States and Europe.

Flu epidemics before and after 1918, into the 21st century, killed annually, though the victims who died were usually among the elderly, the very young, and those with pre-existing conditions. The Spanish flu claimed those among its victims, but it also killed a large number of healthy individuals between the ages of 20 and forty. More than half the American men who died in Europe during World War I were in that category, victims of the flu rather than German guns. Thousands more died in the mustering and training camps before being sent to Europe, and in the receiving ships and hospitals of the Navy and Coast Guard.

How the U.S. Dealt with the Spanish Flu of 1918
Nurses and nuns at work in San Francisco. San Francisco Chronicle

17. The American public erased the flu from its collective memory

After the Spanish Flu returned in late 1919, and in early 2020, it vanished. In the United States and across Europe, it became associated with the horrors of the Great War, and much like that horrid conflict, largely forgotten. Both were later surpassed by yet another horrid war, which erased the name Great War and designated it as World War I. The lessons of the outbreak of 1918-20 faded as well. The need for isolation of the sick was never part of the American psyche, whether the illness be flu or the common cold. Throughout the United States, the idea of missing work due to either became anathema. It simply wasn’t done.

Staying home when ill, and thus protecting the public from transmission of whatever illness one was suffering, was frowned upon by employers. Employees without the protection of medical time off, which became known as sick days, often could not afford to miss work, the financial penalties too stiff. One aspect of the Spanish flu which has proven difficult to study was the number of people who transmitted the virus without falling ill, or fell ill with comparatively mild symptoms. From the 1930s on, nostrums which eased the symptoms of flu and colds encouraged people to go on about their daily business while clearly still contagious, a habit ingrained in American life in the 21st century.

How the U.S. Dealt with the Spanish Flu of 1918
Gustav Klimt, painter of The Kiss, was one of many luminaries who died of the Spanish Flu. Wikimedia

18. The Spanish Flu killed among the rich and famous

One of the enduring names of the American automobile industry – Dodge – was the surname of two brothers who founded the company, John and Horace Dodge. Both died of complications from Spanish Flu. Rose Cleveland, sister of former American President Grover Cleveland, died of the flu on November 22, 1918. Austrian artist Gustav Klimt succumbed during the third wave in 1919. Walt Disney contracted the illness and survived, as did the King of Spain, Alphonse XIII. Franklin Delano Roosevelt contracted the flu while serving as Assistant Secretary of the Navy.

General John J. Pershing was stricken by the flu, though he too survived. Another survivor of the second wave was Amelia Earhart, who served as a nurse among Canadian troops suffering from the flu near Toronto. Earhart was sickened, developed pneumonia, and nearly died. After she recovered she required surgery for sinus problems caused by the flu, which recurred for the rest of her life, causing her considerable discomfort on many of her famous flights. Yet another who contracted the flu and survived was the German Kaiser, Wilhelm II, who abdicated his throne at the end of the First World War.

How the U.S. Dealt with the Spanish Flu of 1918
State and local governments led the fight against the flu, unimpeded by Washington. Wikimedia

19. The American government downplayed the flu

As the Spanish flu emerged in America, the federal government downplayed the danger. President Wilson and his administration stressed the need for Americans to support the war effort, especially during the first wave. Information regarding the dangers from the flu, already suppressed by wartime censorship, remained sketchy. State and local officials faced the rising numbers of ill and dying with little to no federal support. Even those already ill were urged to report to work, and those who chose to remain at home were belittled for their lack of patriotic duty. Woodrow Wilson, President of the United States, did not address the issue of the sickness ravaging the country. He simply said nothing.

His government, determined to maintain war production and the strength of the American economy, urged Americans to report to work. Across the country efforts to control the crisis by local authorities drew the disparagement of the federal government where it affected war production. The absence of national leadership gave rise to con men posing as medical experts, offering cures for the flu. One such huckster, Franklin Duane, who claimed to be a medical doctor, offered pills he called “Dr. Pierce’s Pleasant Pellets”. Along with the pills, Duane suggested a positive attitude offered protection against the flu. He was but one of many who profited from the tragedy, while the federal government did nothing to prevent the sale of placebos offered as “cures”.

How the U.S. Dealt with the Spanish Flu of 1918
A hospital admissions book listing patients for the last week of 1918. National Archives

20. The press downplayed the Spanish Flu

The most volatile period of the Spanish Flu, the second wave during the autumn of 1918, coincided with the peak of American combat involvement during the First World War. The press ignored the virus in favor of war coverage. On October 3, 1918 – a Thursday – 191 people died in Boston, according to the records of the Boston Globe. The total appeared on the newspaper’s front page the following morning, framed by two stories about the war, both of which featured much larger typeface, and both of which contained the inflammatory reference to the Germans popular at the time. They referred to them as “Huns”. The story about the casualties in Boston said that the nearly 200 persons had died of the “grippe”.

The Boston newspapers printed Friday, October 4, 1918, reported little regarding the crisis beyond the existence of the seasonal flu. The Boston Post reported, “Health authorities are encouraged that the increase is but a small one”, in reference to the number of deceased the preceding day. Instead, the several newspapers of the flu stricken city focused their attention on the Boston community’s failure to meet its goals in the sale of Liberty Bonds to support the war. Another story in the Boston Globe reported the governor of Massachusetts’ request to the federal government to cancel the ban on driving automobiles on Sunday (a wartime savings measure). In his plea, Governor Samuel McCall referenced the flu, and claimed driving in fresh air would help citizens, because “fresh air and sunshine will enable them to better fight the grippe”.

How the U.S. Dealt with the Spanish Flu of 1918
Most Americans ignored the spread of the flu until it appeared within their own communities. Green Bay Press Gazette

21. Average Americans didn’t know of the illness until it reached their community

The American people were less informed in 1918. Most of what they knew about world events and social situations came from the gossip of their neighbors and the content of their local newspapers. There was no 24-hour news cycle, no daily press conferences from national leaders, nor even local authorities. Philadelphia’s problems were of little concern to residents of Cleveland. The flu was a seasonal event, best handled locally by doctors and nurses. Locals had tried and true methods of combating it, which were used every flu season as they had been for generations.

When the flu struck it was a local event in the eyes of most Americans, not another step in a global battle. Its severity was stunning, and many communities experienced a backlash against the local authorities’ failure to contain it, but it they were short-lived. One of the most memorable factors of the Spanish Influenza is that it was almost completely forgotten. Newspapers reported it as it occurred and ignored it after it was over in their area. The global impact of the Spanish Flu all but vanished from the record. It became the forgotten disaster, unworthy of mention as just another bout of the flu which occurred during wartime. The 50 million losses became part of the casualties of the First World War.

How the U.S. Dealt with the Spanish Flu of 1918
The Creel Committee controlled the information given to the press and the people during World War I and the outbreak. National Archives

22. The US government made truth a victim

In 1917 the Wilson Administration created the Committee for Public Information. Its purpose was to monitor all information made available to the public regarding the conduct of the war, and the activities of the federal government. It was headed by George Creel, and became known as the Creel Committee. Creel believed that there existed little difference between telling the truth and outright lying to the public, as long as the desired ends were achieved. The Creel Committee decided what could and could not be reported to the American public about the war, both overseas and in the effort to support it at home. Under emergency measures rammed through Congress by the Wilson Administration, violating the strictures of the Creel Committee became sedition.

The federal government made little comment regarding the flu, leaving its control to the several states, which for the most part allowed municipal and county governments to lead the fight against the silent threat. Wilson’s government did encourage Americans to continue to work, to increase production, and to participate in Liberty Bond drives and rallies. The government also supported recruiting rallies. It was aware of the high rate of infection at military bases and aboard ships, and deliberately censored the reporting of such information in the communities which supported them. For the federal government, this catastrophe was treated simply as a rendition of the seasonal flu.

How the U.S. Dealt with the Spanish Flu of 1918
Celebrating the Armistice in Reno, Nevada, meant donning protection against the flu. National Archives

23. The American economy recovered quickly

Because the shutdowns of businesses across the country were sporadic and staggered, the overall economy suffered little during the Spanish Flu, at least in the United States. The brief economic downturn which marked the beginning of the 1920s affected returning servicemen, but within a few months American industry produced consumer goods at previously unforeseen levels. About 875,000 Americans died from the Spanish Flu, more than 12 times the fatalities suffered by the American military during the World War. The average life expectancy for Americans dropped by about ten years. The economy barely faltered.

Prior to these events of 1918, America suffered numerous epidemics of dangerous diseases, including other bouts with influenza. Following this tragedy, other diseases continued to claim American lives annually, including tuberculosis, polio, cholera, yellow fever, scarlet fever, measles, malaria, and others. The Spanish Flu rapidly became part of the past, to the point it earned the sobriquet of the forgotten flu. The manner in which it appeared and swept the country remained hidden to the general public until recent events brought it back to the forefront of public attention. A century after this grim chapter in history, Americans again find themselves urged to self-isolate and avoid crowds. At the same time some Americans claim that we have never faced anything like the current situation before. They are wrong.

How the U.S. Dealt with the Spanish Flu of 1918
Red Cross litter bearers in Washington, DC, in 1918. National Archives

24. The lesson of the Spanish flu

The Spanish flu struck the United States as the nation was reaching its peak of mobilization during the First World War. Railroads teemed with relocating troops, harbors and ports were crowded with ships and sailors. Factories operated at full capacity. At the time flu was not known to be a virus, transmission by contact with contaminated surfaces had not been identified. In other words, it was a mysterious and previously unknown illness, which struck far more viciously than previously seen strands of seasonal flu. Americans at all levels were completely unprepared for its virulence, and watched with stunned helplessness as it killed seemingly at random.

Since these events, vaccines for flu and medicines to mitigate its symptoms appeared, both through prescriptions and over the counter compounds. Meanwhile, new strands of the flu continue to appear, as well as other viruses and illnesses which could easily reach these out of control proportions if the public is not informed of their existence and their propensity to spread. Medical knowledge advanced immensely in the century since the flu of 1918. That year and around the world into 1920, a respiratory illness caused by a novel virus claimed millions worldwide, while leaders suppressed knowledge of its existence. Some even opposed efforts to contain it out of financial and political concerns. Nothing more dramatically demonstrates the need to learn from history.

 

Where do we find this stuff? Here are our sources:

Aaron Kassraie, AARP. March 20, 2020. Online

“How U. S. Cities Tried to Halt the Spread of the 1918 Spanish Flu”. Dave Roos, History.com. March 11, 2020

Dr. Carol R. Byerly, Public Health Reports, National Institute of Health. 2010. Online

Article, US Centers for Disease Control. Online

Christopher Klein, History.com. October 5, 2018

“The Flu in San Francisco”. Article, The American Experience. PBS. Online

“2 cities handled this health crisis different. The results couldn’t have been more opposite”. Report, St. Louis. ClickOrlando Online

Dave Roos, History.com. March 3, 2020

Andrew Rettman, EU Observer. March 30, 2020

Mike Wallace, The New York Times. March 20, 2020

“Cincinnati, Ohio”. Article, Influenza Encyclopedia. Online

Jack Lepiarz, WBUR, Boston. March 11, 2020

Dr. Nancy Tomes, Public Health Reports, National Institutes of Health. Online

Paul Ratner, Big Think. March 7, 2020

Gary Finnegan, Vaccines Today. October 24, 2018

Martin Kettle, The Guardian. May 25, 2018

“Rampant Lies, Fake Cures and Not Enough Beds; What the Spanish Flu Debacle Can Teach Us About Coronavirus”. Joshua Zeitz, Politico. March 17, 2020

Walter Shapiro, New Republic. March 31, 2020

Gina Kolata. 1999

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