Spanish Influenza Pandemic: 1918-19

The First World War claimed the lives of over 10 million military personnel and 7 million civilians.  However, a more devastating killer came in the form of an unseen virus, sweeping across the globe and claiming between 50 and 100 million lives between June 1918 and December 1920.  This pandemic is considered one of the deadliest natural disasters in human history.

Unlike many illnesses, the highest  mortality rate from the Spanish influenza was in the 20-40 year old age range.

Three waves

The influenza struck in three successive waves.  The first, in the spring and summer of 1918, was relatively mild with a very low death rate.  The deadliest wave hit in the fall of that year.  Soldiers on the front came down with the flu, and were packed into crowded train cars and shipped to crowded infirmaries, which only worked to spread the disease.  This second wave traveled quickly, causing epidemics in communities around the world.  A third wave and final wave occurred in the spring of 1919.

Why “Spanish?”

The pandemic was given the moniker “Spanish flu” because of the perceived notion that Spain was one of the hardest hit countries.  Newspapers in Spain reported openly on the effects of the flu in the country, as Spain’s neutrality in the war meant no censorship had been placed on the media.  The US, Great Britain, France, and Germany would not allow stories to be printed that would lower morale.  In addition, these nations did not want their enemies to read their death tolls from the flu.  As a result, Spain’s coverage of the flu gave the illusion that it suffered more than other countries.


The Spanish flu typically struck suddenly.  A high fever accompanied by body aches sent those afflicted to their beds.  They might also suffer from a headache, sore throat, cough, and sometimes a very bad nose bleed.

The illness was often unpredictable.  Some made a full recovery.  Others died within hours of taking ill.  Then there were some cases in which a patient seemed to have recovered, only to suffer a relapse which was often fatal.


Most treatments offered by practitioners at the time were largely ineffective against the virus.  Patent medicines, available at most local drug stores, were widely prescribed, including Vick’s Vapo-Rub.  While doing research for my novel The Education of Eve, I found that the local newspapers ran weekly ads toting the healing properties of this product against the Spanish flu.  Unfortunately these patent medicines did nothing to help.

Some fell back on home remedies.  Selena W. Saunders of North Carolina followed a trained nurse, offering her assistance.  She noted:

[The flu] struck suddenly, spent itself quickly in a burning three-day fever, often leaving its victim dead. The people lost faith in the remedies they had relied on all their lives, and they became frantic.

Practitioners became desperate, resorting to archaic treatments to help “balance the humors.”  Patients were sometimes wrapped in blankets so that they would sweat, and sometimes cupping was used as a way to bring out the excess blood.

Doctors worked around the clock to help those in their communities, often making house calls.  During the height of the epidemic in Winston-Salem, North Carolina, Dr. Wingate Johnson reported that his “days” usually lasted between 30-40 hours.  He would sleep for 4 hours, then call a nurse for more tongue depressors and medicine before going out for another “day” of visiting patients in their homes.

Public reaction

Communities struck by the Spanish flu would often panic.  Selena Saunders described the public reaction in North Carolina:

Some of them locked themselves in their house, and refused to open the door for anyone…. Merchants nailed bars across their doors, and served the customers one-at-a-time at the doorway. We found whole families stricken, with none able to help the others.

Gauze masks were recommended by physicians

Besides quarantining those who were ill, many communities also placed bans on public gatherings in hopes of preventing the spread of the flu.  In some cases even public funerals were banned for fear that mourners would transmit the disease.  Gauze masks were recommended when going out in public, as physicians knew that the spread of the illness came from coughing and sneezing.  Posters were created and distributed, reminding people to cover their mouths when coughing.

Dan Tonkel, who was a child growing up in North Carolina during the 1918 pandemic, remembered how scary that time was:

I felt like I was walking on eggshells. I was afraid to go out, to play with my playmates, my classmates, my neighbors. I was almost afraid to breathe. I remember I was actually afraid to breathe. People were afraid to talk to each other. It was like—don’t breathe in my face, don’t even look at me, because you might give me germs that will kill me…Farmers stopped farming, merchants stopped selling. The country more or less just shut down. Everyone was holding their breath, waiting for something to happen. So many people were dying, we could hardly count them. We never knew from one day to another who was going to be next on the death list.

In November the worst of the second wave was over, and the US Public Health Service sent out reports that the number of influenza cases were declining.  Public panic subsided, and quarantines were slowly lifted, gauze masks discarded.  Public events were once again held, just in time for everyone to gather and celebrate the end of the war.

If you live in the United States, you can learn more about how your state was impacted by the Spanish influenza by going to the US Department of Health and Human Services page about the pandemic.

Sources: World War I Casualties, 1918 Flu Pandemic, The Great Pandemic: The United States in 1918-1919



Filed under World War I

3 responses to “Spanish Influenza Pandemic: 1918-19

  1. Jenny

    Very interesting. I have to admit that I hadn’t heard of this outbreak until last night on Downton Abbey. How scary that time must have been. And I can only imagine what it was like for doctors and nurses working in such conditions and really having no cure for all these patients.

    • It’s interesting, while I was researching this one of the articles I read said that in the US they tried to downplay the flu as much as possible, in order to prevent widespread panic, and that may be one of the reasons why the pandemic isn’t very well known. Kind of interesting to compare it to the way the media covered the “swine flu” outbreak a few years ago.

  2. Pingback: Downton Abbey Season 2, ep. 6 recap | Diana Overbey

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