The Hidden 1918 'Spanish Flu' Pandemic: How a Deadly Disease Altered History and the Lives of Millions

Pandemics reverberate for generations, altering society, medicine and history in ways never considered. The 1918 "Spanish Flu" epidemic changed the world and shows the frightening aftermath of a global disease.

The first casualty of war is truth.

And in 1918, as World War I raged, truth was in short supply, most singularly when it came to the "Spanish Flu" pandemic, which claimed the lives of 675,000 Americans and more than 50 million around the globe before it subsided.

There was nothing Spanish about the flu, nor was there widespread media coverage of the mysterious virus that felled the young and middle-aged in devastating numbers — wiping out families, troops and orphaning hundreds of thousands of children, many of whom were shipped to distant relatives or adopted by complete strangers with no oversight.

There was a war on, and global leaders wanted nothing to mar morale or efforts to raise money for battle. That included coverage by the press and issuing mass public health warnings.

The U.S. entered the fighting in April 1917, and a year later the first American cases are believed to have been identified in soldiers at a Kansas military installation. There is no consensus on where the first international cases were reported, according to the Centers for Disease Control and Prevention.

"The net result of all this was a tremendous amount of fear, particularly given the fact that there was fake news back then," historical author and Tulane University scholar John Barry told Inside Edition Digital.

"The lies were frankly coming directly from the government. Because we were at war, and because Woodrow Wilson's administration believed that anything negative would hurt the war effort."

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Medicine was crude and the electron microscope had not yet been invented, so treatment consisted of aspirin and bed rest and scientists were hard pressed to find a cure because they weren't able to actually see the influenza's molecular structure. 

"One doctor, desperate, wrote an article for the Journal of the American Medical Association that he tried injecting hydrogen peroxide into people's veins," said Barry, the author of "The Great Influenza: The Story of the Deadliest Pandemic in History."

The doctor rationalized patients were lacking oxygen. "Exactly half of his patients died, and he counted that as a success. That's how desperate things got."

That doctor's response was not unlike former President Donald Trump's ill-advised supposition that injecting cleaning solutions into people with coronavirus would help them. (One day later, Trump walked back his suggestion, saying he was being sarcastic.)

Influenza patients bled from their eyes, noses, ears and mouths. Some turned blue. It was the worst plague in modern history. Worldwide, an estimated 500 million people became infected, or about 30% of the global population. In the U.S., those numbers were 22 million infected people, or about 28% of the country's population.

There are similarities to be drawn from that epidemic to the current one, despite changes in medicine and technology. 

The lessons learned from one pandemic to another are hard-earned. In the 1918 pandemic, loved ones were too afraid to offer help. Parts of society broke down, with corpses stacked like cord wood and no one to bury the mounting dead — a gruesome reality repeated during the early days of COVID-19, when refrigerated trucks were packed with bodies outside hospitals and funeral homes.

Pandemics reverberate for generations, altering society, medicine and history in ways that few can foresee. The "Spanish Flu" influenza changed the world and showed the frightening aftermath of a global disease. Those who survived were loathe to talk about it. The devastation of World War I, with its nightmarish trench warfare and mustard gas, was bad enough.

The Voices of Those Who Lived Through the 1918 Pandemic 

In the late 2000s, the Alabama Department of Archives and History interviewed flu survivors as a way to teach future generations the lasting dangers of a pandemic. Influenza paralyzed the state's rural communities, where fear spread like a prairie fire, isolating the dying and the bedridden and leaving bewildered children to wonder what had happened in their ripped-apart worlds.

Edna Register Boone was born in 1907 and was 10 years old when the flu erupted in Houston County. 

"My family was the only family in the little town that did not contract the flu. Therefore, my parents became automatic nurses. They nursed every family in town," the 100-year-old woman told an interviewer in 2008.

Alabama Department of Archives and History

"It was my job as a 10-year-old to take food to people, to families, all of them stricken," Boone said. "Mama would put a gauze bandage around my face and she kept sterilized fruit jars on the stove at all times. She would fill the jars with soup or whatever there was, and I would take those jars to the home of an afflicted family, knock on the door and leave the food at the door for someone to come pick it up.

"It was not a pretty picture."

There was no medicine for the ill, and nothing to be done except to bury the dead, she said. "My father and Uncle Eli, who we called his manservant, dug a common grave and buried three people in it: a mother, a father and a young daughter.

"We had no sanitary conditions in the area at that time, so the people were buried in the clothes they died in and wrapped in the sheets, because there was no one to wash the bed linens for them," she said. 

She remembered being overwhelmed by the sickness and dying around her, and breaking down in sobs because every family save hers was sick in their tiny community of about 200 households. In hindsight, she realized she was depressed as a child, and she had lived in a constant state of panic that someone in her family would fall ill.

"I came home one day, I don’t know where I had been ... and mama was stretched out on a pallet in front of the fireplace. Oh, I panicked," she recalled.

She called out "mama, mama, are you sick?” Her exhausted mother replied, “no, child. I’m just so tired' ...  I knew that if I got into that bed I might not ever get up.”

Those memories fill her with dread. "Children need to learn about what could happen," she warned. "Be aware. Be aware."

Garfield Johnson was just 5 when the pandemic struck down his father, putting him into a coma for three days.

"He was more or less not able to move," the 93-year-old Coffee County resident said. "He had a very serious ... case of it. But there were no doctors then," he said in 2007.

Alabama Department of Archives and History

"My dad had influenza. He lost consciousness three days and nights and then lived," Johnson said. "Then a brother of mine, a younger brother, a baby, got it and lived, but (it) affected his brain."

Food was scarce in those times, he said, and larders ran very low. He remembered a cousin finally coming to stay with his family and going out to get some provisions. "It was awful out here, the way it was. Everybody was scared of it and they were scared to go help the folks that did have it. Afraid they’d get it and it was very contagious."

Even though he was just a little boy, Johnson was enlisted to help with the dead.

"I remember I helped build a lot of graves," he said. "I was told of whole, complete families that died with it and nobody to bury them, nobody to hire to bury them. It was an awful thing."

Johnson got sick, too, and remembered asking for something to take away the pain in his head. "It hurts awful bad," he told a visiting doctor. He rebounded after a day or two and never got the extremely high fever that sent his father into unconsciousness. "That fever would carry you away," he said.

"I don’t see how today, how my daddy lived to go three days and nights in a coma, but he did. He come back out of it."

There was neither rhyme nor reason to explain what was going on at the time. 

"Folks just stayed at home. They didn’t want to get it, you see. They stayed put, because if they didn’t have it, they didn’t want it, and you can’t blame them," Johnson recounted. "They were doing the best they could ... doing the best they know."

Agnes Gatlin was a young girl in Montgomery when influenza devastated her town and sent relatives to their beds with incapacitating fevers. 

"In our neighborhood there were a number of deaths," the 100-year-old woman said in 2007. "The families and the neighbors that could, would come in and help them, but they didn't have any outside people much to do that."  

Alabama Department of Archives and History

Gatlin's immediate family didn't contract the virus, but many of their relatives did. "They were deathly sick and bedridden and ... seemed to be everybody thinking they’d eventually die from it," she said.

Those who lived "took a long time to get over it."

She remembered not being able to travel, and never venturing from the family home. For food, people relied on what they had canned, and what grew in their gardens. When staples such as flour and sugar ran out, "they just had to wait," she said. 

"We didn’t have wheat, we had plenty of corn. We always had homemade meal and kept that on hand," she said. People did the best they could, using whatever homemade remedy they had on hand to treat the sick.

Asked what advice she had for those living in modern times, Gatlin replied, "I think people in this day and time need to take more consideration of diseases" and "be informed about them." Especially, she said, in how fast they can spread.

What the Pandemic Wrought

The Spanish Flu got its name through a strange confluence of war restrictions. The governments of warring countries did not want enemy nations to know their forces were being weakened by the fast-moving disease, nor did they want morale to deteriorate.

Spain was neutral during World War I and its newspapers were not censored. They published stories about the deadly influenza and so the "Spanish Flu" became a moniker that stuck. It was also called the "Purple Death" because sufferers sometimes turned a frightening shade of indigo from lack of oxygen in their bloodstreams. It was also called the "Chinese Flu" and the "Russian Pest."

In the U.S., children skipped rope to this rhyme: "I had a little bird, its name was Enza, I opened up the window and in flew Enza."

Masks were crude. They consisted of cheesecloth and gauze, said historian Kenneth Davis, which would be roughly akin to holding a piece of a screen window to one's face and hoping it would stop the bacteria.

There were no federal guidelines about anything. "There was no CDC. There was no National Institutes of Health. There was no Department of Health and Human Services," Davis said.

Society and families were collapsing. From major cities and rural areas came reports of people starving "because no one had the courage to bring them food, even other members of their own family," said author John Barry. 

Hundreds of thousands of children became orphans when their parents died from the horrid flu. 

Families were larger then, and siblings found themselves being separated and sent off to relatives or orphanages. Some would not see their brothers and sisters for decades, or ever again. Worse, some were put up for adoption and handed out like door prizes, with no one to oversee their welfare because social government agencies didn't exist at the time.

"They would put the kids who lost their parents on a train, and just go from depot to depot and anybody who wanted to adopt a kid would just show up," Barry said, "and walk away with them." 

"So, there was a whole generation of Spanish flu orphans."

The flu raged in three waves beginning in 1918, with the last ebbing around the summer of 1919. "The first phase, the least deadly, at least in the United States, went from March into the spring time," said Davis. "But then flu season returned in September, October. More troops on the move once again, and a real explosion. And that second wave was the most deadly" in America. 

The final wave stretched from the winter of 1919 until the summer months, when cases began declining.

The war ended Nov. 11, 1918. The survivors — soldiers, battlefield nurses and doctors — walked or limped back into day-to-day life, and more than anything, they wanted simply to move on.

In 1920, "Warren G. Harding campaigns for president on the idea of a return to normality, and that was a winning slogan," said Davis.  "He came in as (the) Republican president, and he said, 'We're going to return to normal.'''

One late sufferer of the virus was reportedly Woodrow Wilson, who was in Paris in 1920 to help negotiate the Treaty of Versailles. The French city was battling a high number of influenza cases at the time.

Wilson became seriously ill. He recovered, "but many people who knew him, including the White House valet who knew him for a long time, said he was never the same," Davis said. 

His judgment and reasoning may have been affected, not unlike coronavirus sufferers who complain of brain fog and debilitating mental setbacks.

"He did relent and concede some very, very important points," Davis said of Wilson's negotiations, including "much more punishing aspects of the retribution given to Germany in terms of the reparations that they would have to pay."

That, in turn, "certainly contributed to the rise of Hitler and the Nazis," the historian said.

In America, moving on from World War I included changes at every level of society.

Hemlines went up and social mores went down. Women got the vote in 1920, and many smoked openly in public, bobbed their hair and became "flappers." Businesses boomed, as did speakeasies, despite the new Prohibition against the production and distribution of alcohol.

"We tend not to think about history in terms of disease," Davis said. "This was an important part of history that we don't always teach or talk about."

People just wanted to forget. They wanted to get back to their lives.

"It was really something that was so terrible that nobody wanted to think or talk or write about it," Davis said.

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