Library Talk: The Flu Epidemic of 1918

Image: courtesy of the National Museum of Health and Medicine, Armed Forces Institute of Pathology, Washington, D.C., United States

To paraphrase a classic, a writer’s work is never done. That’s why this post, which should have appeared a month ago – closer the hundredth anniversary of the outbreak of the flu pandemic – is posted only now. But I was in the middle of doing final manuscript revisions for my second book (to be released in February 2019), so I have a good excuse.

In November 2018, I attended a talk at the Boston Public Library titled “Boston and the 1918 Flu Epidemic” by historian Lori Lyn Price as part of the library’s Family History Series. November is the month when the world commemorates the end of World War I, but the fall of 2018 also marks the centennial of another global watershed event. Most people have heard of the influenza outbreak that killed tens of millions of people worldwide, including up to 675,000 in the US, but how many know that it had started in the Boston area? I certainly did not.

There had been a limited flu outbreak in the spring of 1918 at Fort Riley, a military base in Kansas, but the epidemic did not get under way until the first cases started being reported in Boston in the late summer of that year.

Utilizing government records, media reports, and private letters and diaries, Price reconstructed the picture of an increasing virulence of the disease, the growing panic among the city’s population, and the state and local governments’ responses (often belated or inadequate) to the largest public health crisis they had ever encountered. Interestingly, the first reported cases of the flu were two sailors at a nearby naval station who fell ill on August 27.

Author: Navy Medicine from Washington, DC, USA

By the end of the first week, 100 new cases per day were reported among the sailors, and by September 11 the first civilian cases appeared. Within a week, hospitals were overflowing prompting the governor to call for the recruitment of anyone with medical training to help assist with caring for the sick. Stunningly, despite calls for municipalities to close public venues and cancel events, no such decision was taken in the crucial first weeks of the disease’s spread. On September 25 Boston Public Schools finally closed and the next day public venues shuttered, but churches remained open. By mid-October, some 3,500 people had died from the flu and its complications before the epidemic was declared over on October 20, and schools reopened the next day.

But that was not the end of the crisis. Cases (though fewer) continued to be reported in the city into December and beyond, and other cities, including New York and Philadelphia, had to deal with outbreaks of their own. Contributing to the spread of the disease were not only inadequate public health measures, government’s inexperience in dealing with disease outbreaks, but also the end of World War I with the military parades and celebrations that brought large numbers of people out into the streets.

Of course, as with any disaster, there was no shortage of conspiracy theories. One suggested that the disease originated from a German u-boat as a form of what today we would call bio-terrorism. Another claimed that Beyer, a (German) pharmaceutical company, had spread it through its aspirin product. None of it was true, and the fact remains that it was an organic viral contagion, albeit with some unique characteristics.

Transmission electron micrograph of Spanish flu virus (Centers for Disease Control)

These included a high mortality rate (2.5% or 25 times the usual mortality rate for the disease), high contagiousness, and the fact that younger and healthier people were very likely to die from it (normally, children and the elderly are the most at risk). In fact, half of all deaths were among those 20-40 years old. Symptoms were unusual as well, and included hemorrhage: coughing up blood and bleeding from ears and noses.

As today, there was no cure for the flu in 1918. Patients were advised to rest, take aspirin, spray their throats with an antiseptic, and avoid sneezers and coughers. But there was also a belief that sunshine and fresh air could help. According to Price, this may have contributed to a further spread of the disease by bringing people outside and in closer contact with others.

The 1918 flu also left survivors in worse shape that the disease does today. Many took months to recover and reported lingering muscle stiffness, weakness, malnutrition, insomnia, hearing and vision impairments, as well as mental health symptoms.

When all was said and done, between 50-100 million people had died and up to a third of the world’s population had been infected with the influenza virus, making it one of the deadliest natural disasters in all of history.


You can connect with Lori Lyn Price via

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