Spanish Flu: How America Fought a Pandemic a Century Ago

Science and medicine have come a long way since the 1918 outbreak
Nurses carry a patient in St. Louis, Missouri, during the Spanish Flu pandemic in 1918.

En español | Before scientists identified the influenza virus in 1933, the medical community had far less knowledge of how the flu passed from person to person and how to treat those infected. In 1918, as the world was nearing the end of the first world war, what became known as the Spanish flu was spreading rapidly among the soldiers who lived in close quarters. Some erroneously attributed the deadly pandemic that ultimately claimed an estimated 50 million to 100 million lives around the globe to everything from volcanic eruptions to bad Russian oats, according to Jeremy Brown, author of Influenza: The 100-Year Hunt to Cure the Deadliest Disease in History.

Many countries censored news reports during World War I, especially information about the pandemic. Since Spain remained a neutral country, its press was free to report on the outbreak's relentless spread, leading to the name Spanish flu. Scientists are split over where the virus originated, with three possibilities being Kansas, France and China.

The Spanish flu killed about 675,000 people in the U.S. In September 2021, 18 months after the start of the coronavirus pandemic, American deaths attributed to COVID-19 hit 676,000, surpassing the toll of the influenza pandemic of 1918. Here are historical photos from the National Archives that show just how hard the Spanish flu hit America — and how Americans tried to avoid it, treat it and live with it.

munitions workers in washington dc line up for hot chocolate out
Parades and other large public gatherings were common, contributing to the spread of the flu. Here munitions workers in Washington, D.C., line up for hot chocolate.
National Archives
flu patients convalescing in a field house due to hospital overc
Convalescing soldiers were placed within arm's reach of each other in sick wards, separated by little more than a sheet, aiding the Spanish flu's spread. These patients were being housed at Eberts Field in Lonoke, Arkansas, because there was no room in the hospital.
National Archives
a group of soldiers gargle with salt water in this historical ph
Public health officials gathered in Chicago to address the epidemic, which at that point had already killed 400,000 people in three months. Experts agreed that whatever transmitted the disease could be found in mucus from the throat, nose and mouth. Gargling with salt water was recommended to military personnel as a preventive measure.
National Archives
influenza patient in a hospital bed flanked by military officer
Hospitals were crowded and offered limited treatment options. Antibiotics to treat secondary bacterial infections that often accompany the flu had yet to be discovered. At Fort Porter in New York, beds were reversed so patients wouldn't breath in each other's faces.
National Archives
historical photo of nurses making gauze bandage masks
Face masks made of gauze were widely used but offered little real protection. Nonetheless, these Red Cross workers in Boston assembled masks. “It is our duty to keep people from fear,” said Chicago's health commissioner. “Worry kills more people than the epidemic."
National Archives
a medical officer sprays disinfectant into the mouth of a soldie
As disease spread, medical officers (above, at Love Field in Dallas) sprayed the mouths and throats of 800 healthy men daily with a solution of dichloramine-T, a disinfectant. But when they compared their influenza rates with 800 untreated men, they were disappointed to find that “over a period of twenty days the incidence in the two groups was the same,” according to a public health report.
National Archives
flyer in a trolley car telling people to keep their windows open
It was thought that keeping windows open would deter the spread of the Spanish flu. This flyer in a trolley car in Cincinnati encouraged the practice, which was utilized nationwide.
National Archives
historical photo of court proceedings being held outdoors in san
Court officials in San Francisco held proceedings outside in hope that the open air would prevent infections.
National Archives
black and white photo of graves of one hundred american soldiers
It was a truly global epidemic; 100 American soldiers were buried in Devon, England, where they succumbed to the disease.
National Archives

Editor's note: This story was updated with the latest numbers on COVID-19.

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