By John Andrew Prime

World War I killed an estimated fewer than 20 million people, but the Spanish Flu - so-called because war-neutral Spain didn't censor news of the illness - might have killed as many as 100 million people from 1918 to 1920, according to History.com. The website notes, “In fact, more U.S. soldiers died from the 1918 flu than were killed in battle during the war. Forty percent of the U.S. Navy was hit with the flu, while 36 percent of the Army became ill, and troops moving around the world in crowded ships and trains helped to spread the killer virus.”

Author John Barry, whose best-seller The Great Influenza (Penguin, 2004) retold the story of the pandemic, relayed the horror at the 1918 Pandemic Flu Symposium in May, sponsored by the Centers for Disease Control and Prevention at Emory University, Atlanta.

“ 'These men start with what appears to be an ordinary attack of la grippe or influenza,' ” Barry read aloud from a letter written by a military doctor at the time. “ 'When brought to the hospital, they very rapidly develop the most vicious type of pneumonia that has ever been seen. Two hours after admission, they have the mahogany spots over the cheekbones, and a few hours later, you see the cyanosis extending from the ears and spreading all over the face, until it is hard to distinguish the [black] men from the white. It's only a matter of a few hours, then, until death comes.

“ 'It's horrible. One can stand to see one, two, or 20 men die, but we've been averaging about 100 deaths per day. Pneumonia means, in about all cases, death. We've lost an outrageous number of nurses and doctors. It takes special trains to carry away the dead. Beats any sight they had in France after a battle.' ”

The Army's role

Like other less-lethal pandemics, the great outbreak of 1918 occurred in several waves. In his book, Barry says the flu originated in Haskell County, Kan., incubating in the overcrowded training camps established to build up the Army, then shipped overseas with soldiers to the war fronts. There, the virus made men in the trenches ill. It killed, mutated, receded, sickened, and killed again. It took no sides.

“People knew pretty easily that this was not ordinary influenza by another name,” Barry told symposium participants. “To quote one person in Washington who lived through it, 'It kept people apart. You couldn't play with your playmates, your classmates, your neighbors. The fear was so great, people were afraid to leave their homes. You had no school life, no church life, nothing. It destroyed all family and community life. People were afraid to kiss one another, afraid to eat with one another. Constantly afraid. You were quarantined ... from fear.' ”

The Navy's role

“The Spanish Influenza Epidemic taxed the resources of the transport medical departments to the utmost,” wrote Vice Adm. Albert Gleaves, commander of Navy convoy operations in the Atlantic, 1917-19. “Although every effort was made to eliminate sick troops at the gangway, it was inevitable that large numbers of incipient cases were taken on board, and naturally the crowded berthing spaces favored contagion. ... During this scourge in transports and cruisers there was a total of 789 deaths, and necessity required that many of the Khaki and the Blue be buried at sea.”

On Armored Cruiser No. 4, USS Pittsburgh
(CA-4), at Rio de Janeiro, Brazil, Rear Adm. William B. Caperton reported “on the 21st of October 16 bodies were taken from the Pittsburgh and landed for burial in the Sao Francisco Xavier Cemetery. ... Eight hundred bodies in all states of decomposition, and lying about in the cemetery, were awaiting burial. Thousands of buzzards swarmed overhead.”

In a 1986 interview, Navy nurse Josie Mabel Brown, who survived a March 1919 bout with the flu, said, “The morgues were packed almost to the ceiling with bodies stacked one on top of another.”

The public health service role

While the Army and the Navy are most prominently associated with the 1918-20 pandemic, another arm of the nation's uniformed services also played a role in the battle against the disease: the Public Health Service (USPHS). Despite in-fighting among scientists and administrators, it had a commanding role in coordinating responses to the disease.

“During the war, the USPHS played an important role in safeguarding the nation's health,” states the U.S. Naval History and Heritage Command's publication A Forgotten Enemy: PHS's Fight Against the 1918 Influenza Pandemic. The service, which dates from 1798 under President John Adams, was primarily responsible for protecting the health of military and national service personnel at military camps stateside and at industrial sites, as well as fighting venereal disease. That changed when the mortality of the flu manifested.

“In a single week in October, 4,500 died in Philadelphia, and 3,200 died in Chicago,” the report states. USPHS “reacted to the growing public health crisis by embarking on a four-part strategy. First, and foremost, state and municipal public health departments were urged to report weekly if not daily on their local conditions. Second, six million pamphlets warning people of the Spanish Influenza, the Three Day Fever, and The Flu were produced and circulated through local health departments. Third, an influenza director appointed to each state coordinated local disbursement of funds.”

USPHS established soup kitchens as well as emergency hospitals and clinics, but it also ventured into an offensive against the virus. It stepped up to help develop a vaccine and enlisted incarcerated soldiers in Boston and San Francisco who volunteered to be exposed to patients with flu-like symptoms. None of the more than 100 men involved fell ill, and they received full pardons for their part in the battle against the disease.

When the ferocity of the pandemic began to wane in November and December, USPHS sent statisticians and inspectors to 10 major population centers to tabulate morbidity and mortality. They were the first to correlate the H1N1 virus's unique targeting of the 20- to 40-year age group: Unlike other flus that mainly kill the very young and the elderly, the 1918 flu went after the strongest and healthiest members of society, including expectant mothers - something modern epidemiologists still cannot explain.

John Andrew Prime is a writer in Shreveport, La. His last feature for Military Officer was “Preserving Their Valor,” July 2018.

This story first appeared in Military Officer, October 2018.