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Outbreaks of the flu occurred in nearly every inhabited part of the world, first in ports, then spreading from city to city along the main transportation routes. India is believed to have suffered at least 12,500,000 deaths during the pandemic, and the disease reached distant islands in the South Pacific, including New Zealand and Samoa. In the United States about 550,000 people died. Altogether an estimated 25,000,000 persons throughout the world perished, most during the brutal second and third waves. Other outbreaks of Spanish influenza occurred in the 1920s, but with declining virulence

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. In 1918 children would skip rope to the rhyme (Crawford):

The origins of this influenza variant is not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized. The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918). However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. Wilson had just given his 14 point address. There was virtually no response or acknowledgment to the epidemics in March and April in the military camps. It was unfortunate that no steps were taken to prepare for the usual recrudescence of the virulent influenza strain in the winter. The lack of action was later criticized when the epidemic could not be ignored in the winter of 1918 (BMJ, 1918). These first epidemics at training camps were a sign of what was coming in greater magnitude in the fall and winter of 1918 to the entire world.

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years.

"The 1918 has gone: a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked, the end at least for a time, of man's destruction of man; unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918).

riers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people (Brown).

With the military patients coming home from the war with battle wounds and mustard gas burns, hospital facilities and staff were taxed to the limit. This created a shortage of physicians, especially in the civilian sector as many had been lost for service with the military. Since the medical practitioners were away with the troops, only the medical students were left to care for the sick. Third and forth year classes were closed and the students assigned jobs as interns or nurses (Starr,1976). One article noted that "depletion has been carried to such an extent that the practitioners are brought very near the breaking point," (BMJ, 11/2/1918). The shortage was further confounded by the added loss of physicians to the epidemic. In the U.S., the Red Cross had to recruit more volunteers to contribute to the new cause at home of fighting the influenza epidemic. To respond with the fullest utilization of nurses, volunteers and medical supplies, the Red Cross created a National Committee on Influenza. It was involved in both military and civilian sectors to mobilize all forces to fight Spanish influenza (Crosby, 1989). In some areas of the US, the nursing shortage was so acute that the Red Cross had to ask local businesses to allow workers to have the day off if they volunteer in the hospitals at night (Deseret News). Emergency hospitals were created to take in the patients from the US and those arriving sick from overseas.

scientists mistakenly believed that influenza was caused by a bacteria. not a virus. Called Pfeiffer’s bacillus, this bacteria had been first identified as the cause of influenza

bacillus also failed to cause influenza.

Some four million men were mobilized in the U.S. Armed Forces. Training camps and stations were often overcrowded. Soldiers and sailors routinely were packed on to passenger trains and sent to training stations and bases around the nation

When influenza struck the United States in the fall of 1918, it almost universally appeared in military populations before hitting civilian communities. Medical officers attempted to contain the epidemic through a host of measures, including nasal-pharyngeal sprays for all troops, quarantine of new arrivals, and isolation of cases in camp hospitals or special emergency

As the influenza epidemic raged, scientists and physicians struggled to isolate the causative microbe and to develop an effective vaccine against it.

Quacks and naysayers, on the other hand, advocated a host of alternatives such as raw onions rubbed on the chest, creosote baths, and the consumption of large quantities of brown sugar. Some—including several city health officers—claimed that a clean heart, clean bowels, or warm feet were all that was needed to stave off influenza.

Health officers, mayors, and city councils ordered theaters, movie houses, dance halls, saloons, schools, churches, and other places of public gathering to close for the duration of the epidemic.

In the three decades after 1890, nearly 24 million immigrants arrived on the shores of the United States

Seattle saw a drastic drop-off in the number of marriage license applications during the epidemic (although, interestingly, the number of divorce filings increased).5

World War I did not just affect soldiers, sailors, and Marines. On the home front, civilians were expected to contribute to the war effort as well by self-rationing food, fabric, gasoline, and other goods, and by purchasing Liberty bonds.

people in close proximity to one another. In the East, where the deadly fall wave

American Red Cross, the Visiting Nurse Association, the Blue Circle Nurses, the Public Health Nurses, and others played a vital role during the influenza epidemic, providing nursing care to the ill, staffing emergency hospitals, organizing volunteers, coordinating relief efforts, assembling gauze face masks, and operating ambulances. Communities across the nation were overwhelmed by the

magnitude of the crisis,

Local courts, on the other hand, had more flexibility in how they met the crisis

The 1918 influenza pandemic took a horrible toll of death and destruction in the United States