Pandemic Then and Now

Lessons from the 1918 Influenza
Scan of a page with printed diagrams of microbe cultures under a microscope.

By Nancy Bristow


As American soldiers mobilized for war in the spring of 1918, a handful of army physicians began noticing a worrisome influenza moving among their soldiers. Often resulting in a deadly pneumonia, it struck down previously healthy young men, sometimes with surprising rapidity. Post-mortem exams revealed soggy lungs with evidence of hemorrhaging. Beyond these limited military observations, though, few in the United States noticed that the first wave of a deadly influenza pandemic was underway.

Black and white photograph of a medic tent with two soldiers standing guard outside. Inside the tent, a white-uniformed medic administers a throat spray to a third soldier.
"Preventive treatment against influenza, spraying the throat," Love Field, Dallas, Texas. c. 1918. Image courtesy of the National Archives.

Influenza was not yet a reportable disease, and the country was in the midst of war, rushing troops to Europe as the allies pushed back against the German’s spring offensive. When influenza appeared among troops on the Western front, belligerent nations tried to keep the story quiet, but by mid-summer, the European continent was awash in the disease. When Spain, a neutral country in a world at war, openly reported the impact of the disease there, observers quickly named the scourge the “Spanish flu,” and the moniker, inaccurate as it was, stuck. Though influenza raced around the world that summer, even hitting Puerto Rico, Cuba and Hawai’i, the first wave in the continental United States had passed.

Black and white photograph of rows of hospital beds with white sheets strung up between beds.
Influenza ward at Base Hospital No. 3 in Paris, France. Feb. 1919. Learn more in the Online Collections Database.

And then, on Aug. 27, influenza returned to American shores. Erupting in Boston in late August, the disease exploded almost simultaneously in Freetown, Sierra Leone and Brest, France. A second wave of the global influenza pandemic had arrived. Highly contagious, this new influenza reached from coast to coast in just a couple of months and infected roughly one in four Americans. This new incarnation was also unusually deadly, with a death rate twenty-five times that of the familiar seasonal flu. Though it generally passed through communities in a couple of months, a third wave of influenza followed later that winter and spring, throwing communities into renewed chaos.

In the end, some 675,000 Americans died—more than half a million more than would normally die yearly of the flu— and as many as 50 to 100 million people perished worldwide. Adding to the social and economic disruption, almost half of those who died were between the ages of 20 and 40, leaving shattered families in their wake.

Americans were shocked by the pandemic’s destruction. During the nineteenth century the bacteriological revolution had allowed scientists to identify the causal agent of several of the most costly infectious diseases, including for instance dysentery, malaria, scarlet fever, typhoid, bubonic plague, yellow fever and whooping cough, offering the potential for preventative vaccines, and perhaps even treatments. On the eve of the pandemic, scientists, physicians, and public health experts had begun to imagine a world free of infectious disease. As the New York City Health Department declared, “Public health is purchasable.” The pandemic would prove such a vision was premature.

As the epidemic took hold, public health experts hurried to offer advice to government officials and education to the public. The United States Public Health Service published six million copies of a pamphlet, “Spanish Influenza” “Three-Day Fever” “The Flu,” and the Red Cross put out its own pamphlet in eight languages. The public health infrastructure, though, was still in its infancy in the United States. Decisions about emergency measures were in the hands of state and local public health officials whose power and expertise varied widely. So also would their approaches to the crisis and their communities’ resulting experiences.

Black and white photograph of masked Red Cross orderlies carrying a stretcher with a prone person on it to an automobile with the Red Cross logo on it.
Red Cross Motor Corps during the Influenza epidemic, St. Louis, Mo. c. 1918. Image courtesy of the National Archives.

Communities with well-established public health systems moved quickly to implement an expansive range of protective measures. In Milwaukee, Wisc., for instance, the health commissioner immediately quarantined the nearby naval training station, initiated significant public education, commanded the reporting of all influenza cases, and called for isolation of the infected. As the pandemic worsened, he closed public spaces, and though some business owners and religious leaders pushed back, most community members proved generally supportive. Even when another wave of the pandemic required another round of closures, residents remained compliant. Milwaukee experienced one of the lowest mortality rates reported by a major city.

Black and white photograph of a regiment of soldiers marching down a city street. The soldiers are wearing white masks.
39th Regiment wearing masks while marching through the streets of Seattle, Wash. prior to deployment to France. c. 1918. Image courtesy of the National Archives.

In many other American communities, though, the public health response was significantly less robust. Though by late September Boston was suffering mightily, many other major cities carried on business as usual. In Philadelphia, political corruption helped to produce a leadership vacuum. When the Fourth Liberty Loan commenced, the city hosted a massive parade on Sept. 28. Three days later the city faced 625 new cases of influenza in a single day. Though the city now moved quickly to forestall the disease, it was already too late. Philadelphia would suffer one of the highest death rates in the country. Though theirs is often cited as the most egregious failure in the face of the pandemic, many other communities also moved too slowly to respond to the crisis. City after city hosted Liberty Bond kickoffs. Mayors, and even some health providers and public health officials, spoke reassuringly to their citizens.

Black and white photograph of a group of men lined up with their heads back gargling salt water. They are standing in front of a shed-like structure in a field.
"Men gargling with salt and water after a day working in the War Garden at Camp Dix. This is a preventive measure against the epidemic of influenza which has spread to army camps." Sept. 1918. Image courtesy of the National Archives.
Scan of a newspaper advertisement. Image: 3 circles with printed images of microbes in them. Headline: The Influenza Epidemic. The Kruschen Habit is your first line of defence.
A 1918 ad for Kruschen Salts touting their supposed health benefits against Influenza, from the collection of the National WWI Museum and Memorial. Click image to enlarge.

Though New York City was in the throes of the pandemic by early October, Health Commissioner Royal S. Copeland repeatedly downplayed the situation, seemingly to mitigate public alarm. When the city reported 999 new cases on Oct. 4, he claimed, even so, that there were “no alarming symptoms about the spread of influenza in New York.” When on Oct. 6 the city experienced 2,070 new cases, he announced, nevertheless, “I do not believe that the city is stricken.” Whether speaking out of ignorance or hubris, such guidance did little to protect the public. Copeland would wait into the next week to finally establish an Emergency Advisory Committee. In other communities, businesses proved restive under the pubic health restraints. In Globe, Ariz., Wichita, Kan. and Terra Haute, Ind., theatre owners fought against closures in the courts. Still other locales found citizens resistant to public health controls. In San Francisco and Seattle people chafed under rules requiring the wearing of masks in public spaces.

Black and white photograph of a row of hospital beds on a long open porch with sheets strung up between each bed. In the foreground, a female nurse attends to a patient in a bed.
Nurse in Influenza ward at Walter Reed Hospital, Washington, D.C. Nov. 1918. Image courtesy of Library of Congress.

As we look back from 2020, in the midst of the Coronavirus pandemic, we might take valuable lessons from this earlier experience. The comparison is not exact, and in many ways our circumstances are quite different. While air travel has facilitated the rapid worldwide spread of the virus, other technologies are helping us against COVID-19. Scientists have identified the virus and are continuing to study its symptoms and its spread. Though testing has been slow to get underway, we have the capacity to check people for the virus, and have medical interventions such as ventilators and antibiotics for treating the critically ill and managing secondary infections. Labs across the globe are working on developing a preventive vaccine.

And we know that the public health practices too often tried haltingly and inadequately in 1918, can have an enormous effect in our struggles against this disease. Research on the influenza pandemic confirms that social distancing and quarantining, if implemented early, comprehensively, and for the duration, will lower death rates and save lives. Slowing the pace of spread will give communities more time to prepare, and ease the pressure on our health system the flood of victims would produce.

This earlier experience also makes clear how important it is that our political leadership and public health experts speak honestly and directly to us, providing accurate information and sound guidance. This is no time for false hope or empty reassurances. It is a time for honesty and openness. Finally, the experiences of the 1918 pandemic suggest that the vast majority of us will step up to do the right thing once we know the truth. In those actions we might find solace, indeed hope, much greater than that which false encouragements can provide. If we act as we must to manage this crisis, if each of us moves to protect the health of others and to care for the most vulnerable among us, we will find much to buoy our spirits.

Learn More

View Nancy Bristow’s 2019 presentation “Forgetting Catastrophe: Influenza and the War in 1919” at the National WWI Museum and Memorial. Watch on YouTube

And for teachers and students: go further in-depth with the history of the Influenza pandemic with this video and accompanying enrichment questions.


Nancy K. Bristow is a professor of history at the University of Puget Sound where she also serves on the leadership team of the Race and Pedagogy Institute. She is the author of American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic.