Normally, the flu is regarded as a winter misery we endure. But the strain that circled the globe at the end of World War I proved one of the deadliest illnesses to strike humanity.
“The 1918 flu epidemic puts every other epidemic of this century to shame,” observed Gina Kolata in her book Flu. “It was a plague so deadly that if a similar virus were to strike today, it would kill more people in a single year than heart disease, cancers, strokes, chronic pulmonary disease, AIDS and Alzheimer’s disease combined.”
It killed more Americans in one year than the country lost in battle in its major 20th-century military conflicts.
Official estimates put the global death toll at 20 million, with over 500,000 of those fatalities recorded in the United States. Subsequent research suggests anywhere from 40 to 100 million died around the world. (Factors for this discrepancy include lack of mandatory record-keeping and revolutions in countries like Russia.)
In some American families, it was embarrassing to fall ill at a time when the public was urged to support the war effort. It was worse to be perceived as a slacker for skipping a local Liberty Bond rally than convalescing at home. This shame prevented some victims from reporting their illnesses until it was too late. Families kept quiet about who was stricken by the flu, creating holes for future generations to fill in. One way of finding out if your family was affected is to compare the 1910 and 1920 census records, as well as death certificates.
Here are a few facts about the flu epidemic of 1918:
No one can pinpoint where it originated: While no particular source has been verified, research suggests China as a strong possibility. The illness gained the nickname “Spanish Flu” due to an early outbreak in the Spanish resort of San Sebastián in February 1918. The name stuck partly due to neutral Spain’s unpopularity with everyone during the war.
The flu had many nicknames: Depending on where you were, the epidemic was known as “Flanders Grippe,” “Wrestler’s Fever,” “Naples Soldier,” “Blitz Katarrh,” “La Coquette,” “Bolshevik Fever,” and “Bombay Fever.”
The epidemic hit in three waves: The first, and mildest, wave hit during the late winter and spring of early 1918. Though it caused few fatalities, its effects were obvious. In Detroit, over 1,000 Ford Motor Company workers called in sick during March 1918, while one-quarter of the 2,000 prisoners in San Quentin fell ill. The second wave, which debuted in America courtesy of sailors docked in Boston in August 1918, was the killing strain. A third, whose strength fell in between, hit in early 1919.
Death could be swift. While some victims lingered for weeks before succumbing, others barely had time to contemplate their mortality. In an extreme case, a healthy-appearing woman boarded a New York subway train for her ride home. When the train arrived at her station 45 minutes later, she was dead.
Symptoms were out of a horror movie: In its most lethal form, the flu produced symptoms worthy of an FX makeup wizard. Following the usual flu symptoms, victims developed “heliotrope cyanosis,” where oxygen-deprivation turned lips and ears a purplish shade of blue. Their feet turned black. Bloody saliva was coughed up. Finally, the lungs filled up with fluid, effectively drowning the victim. “When a doctor does an autopsy,” Kolata noted, “he will observe your lungs lying heavy and sodden in your chest, engorged with a thin bloody liquid, useless, like slabs of liver.”
Youth worked against you: Young adults were among the demographics with the highest fatality rates. It has been suggested that being young, strong, and healthy provoked severe inflammatory responses, sending the body’s defense mechanisms into overdrive.
Life expectancy figures temporarily collapsed: While researching the epidemic, historian Alfred Crosby consulted world almanacs from the period. He noticed that the average life expectancy of an American was listed as 51 in 1917, then dropped dramatically to 39 in 1918 — a figure unseen since the beginning of Reconstruction.
World leaders were not immune: Among those hit by the flu epidemic were President Woodrow Wilson (who caught the flu while attending the Paris Peace Conference in 1919), Franklin Delano Roosevelt, King George V of England, King Alfonso XIII of Spain, and America’s movie sweetheart, Mary Pickford. The flu was fatal for Cyrano de Bergerac author Edmond Rostand and South African Prime Minister Louis Botha.
Medical services were overwhelmed: The United States was already suffering a doctor shortage due to the thousands who signed up for the war effort. Cities found themselves unprepared to provide adequate treatment and handle rapidly rising death counts. Philadelphia was one of the worst affected — bodies piled up at its lone morgue, which couldn’t cope with over 700 fatalities a day at the epidemic’s peak in October 1918. Many buildings were pressed into temporary medical use, including New York’s Sing Sing prison.