By the spring of 1918, the United States had been involved in World War I (1914–1918) for a year but was only just reaching full mobilization of its armed forces. Hundreds of thousands of troops had been conscripted and trained at military bases across the country and were now traveling by rail and ship, bound for the trenches of Europe. The timing for a pandemic of a new form of influenza could not have been worse. Thousands of troops were crammed into railcars or sleeping in bunks stacked to the ceiling of crowded ships’ holds, traveling together for days. Such conditions were ideal for the rapid spread of disease. When they reached their destination, these soldiers would begin spreading the virus to others.
What came to be known as the Spanish flu was first diagnosed at a Kansas military base. The date was March 11, 1918, and around breakfast time Private Albert Gitchell (died 1918), a cook from Fort Riley’s kitchens, turned up at the infirmary complaining of fever, headache, and a sore throat. His case is the first recorded one of a new strain of influenza that would soon sweep the world.
The virulence of this disease was immediately apparent to the doctors at Fort Riley; Corporal Lee W. Drake came to the infirmary almost right after Gitchell had been admitted, then another, then two more, then dozens. By day’s end, the camp’s hospital was filled with more than one hundred men, all with high fever, aches, sore throats, and coughs that brought up blood-tinged foam. Soon many of them would be dead, including Gitchell.
The illness sweeping through Fort Riley was unlike anything the doctors there had seen before. Some thought it shared similarities with grippe, or influenza, but there were significant differences. Whereas influenza typically afflicted the very young or the very old, this disease attacked young men in peak physical condition. Furthermore, there was the bloody sputum, along with the fact that victims’ skin took on a bluish tint, sometimes with purple blisters. These symptoms were unlike those of previous influenza cases. Gitchell had reported to the infirmary with what he thought was a bad cold, but it quickly became obvious that this disease was new and far more serious.
The flu virus in general is exceedingly efficient when it comes to infecting new hosts. This respiratory tract infection is spread through the air, a single cough releasing millions of viruses into the air to be inhaled by others. The new strain of virus did its work quickly, with an incubation period of one to three days. To make matters worse, most U.S. medical professionals had volunteered to go overseas to help in the war effort, leaving stateside hospitals understaffed. The combination of the flu’s virulence and the movement of troops created ideal conditions for the rapid spread of the disease. Approximately twelve hours after Gitchell was admitted to the infirmary in Kansas, cases were reported as far away as Queens, New York.
The spring pandemic was the first of three waves that spread across the globe over the course of 1918. Initially, the disease was largely confined to military personnel, but it spread quickly among civilians in some locations. Back at Fort Riley, more than five hundred men were sick by the end of the week after Gitchell fell ill. Troop ships arriving in Great Britain and France were now full of sick soldiers, and the disease began to spread abroad. The virus continued to mutate and became even more virulent, spreading faster and proving even deadlier. The second and most infamous wave of the epidemic started in August, with cases being reported simultaneously in France, the United States, and Sierra Leone.
Although the flu had been raging among enlisted men for five months, it had not been widely reported. The censored press in combatant nations could not report on the full scope of the disease. However, the second, more virulent outbreak quickly spread to civilian populations and neutral countries. Spain was the first neutral country so afflicted, and its press, unfettered by wartime censorship, reported freely on the outbreak. This was the first time that many civilians in other countries had heard of a flu outbreak, so the disease was incorrectly labeled Spanish flu.
The first cases of the second outbreak in North America were reported along the East Coast. Many Americans theorized that the disease had come from Europe. Lieutenant Colonel Phillip Doane, an army health inspector, even speculated that German agents, dropped off by submarines, had come ashore with vials of infectious flu germs. Meanwhile New York City’s health commissioner, Royal Copeland (1868–1938), was assuring citizens that the city was not in danger of an epidemic, and people should not be worried. When Copeland issued this statement on September 13, 1918, thousands had already been hospitalized across the Northeast, and dozens were dying every day.
The flu generated widespread fear and helplessness. The doctors of the day had witnessed a generation of medical triumphs, starting with Louis Pasteur (1822–1895) and his pasteurization process, which he developed in 1862. Vaccines and treatments had been developed for various once-dreaded epidemic diseases, and the study of disease, specifically microbiology, was making tremendous strides. The unprecedented new strain of influenza, particularly its targeting the young and healthy—a generation who had already sacrificed so much in the Great War—left many medical professionals shaken. The progress of the disease was also startling. A victim could go from perfect health in the morning to death by evening. The afflicted ran fevers as high as 105° F (40°C). They thrashed in bed, were delirious, and coughed up blood. Once the disease entered the civilian population, it spread quickly across class and racial boundaries.
Some infected individuals survived. Among those were actress Mary Pickford (1892–1979, the first true movie star in the United States), General John Pershing (1860–1948, commander of U.S. forces in Europe), and President Franklin D. Roosevelt (1882–1945). However, most did not.
By early October, Boston and Philadelphia were reporting nearly three hundred deaths per day. The flu reached San Francisco in late September, and hardly a city or town in between was unaffected. Cities such as Philadelphia and San Francisco that had at first refused to acknowledge the severity of the outbreak now closed schools, churches, and other public gathering places. San Francisco made it illegal to go out in public without a cotton gauze face mask.
In Philadelphia, a local doctor announced that he had developed an inoculation against the flu. Ten thousand doses were administered with uncertain effects. Surgeon General Rupert Blue (1868–1948) received money from Congress to hire emergency medical personnel. So many doctors and nurses were abroad, however, that Blue had to resort to hiring medical students and retirees, and even then the need was barely met. One San Francisco doctor reported seeing more than five hundred patients in a given day. Blue calculated that if the epidemic continued to spread along its mathematical progression, there would soon be no one left on Earth.
Then, just before the war ended on November 11, 1918, the flu began to abate. It would come back in one final wave in December, but although thousands more fell ill, far fewer of its victims died. The pandemic finally ended in 1920.
Mortality rates from the Spanish flu were huge but uneven by country. Approximately five hundred thousand deaths occurred in the United States. India lost seventeen million people, fully 5 percent of its population. Canada, by contrast, lost 50,000. Worldwide estimates range from twenty million to fifty million, or 3 percent of the world’s population.
In the 1990s and 2000s, epidemiologists were able to isolate and recreate preserved specimens of the Spanish flu virus. They found it shared similarities to modern forms of avian flu, including its ability to kill by sending the body’s immune system into overdrive, which may explain why the disease was deadlier among people with well-developed immune systems, specifically young, healthy adults. But despite nearly a century of medical advances, researchers remained unclear about many factors that conspired to make Spanish flu so deadly. They do know, however, that the 1918 flu evolved under the perfect conditions for an epidemic.