How the Spanish Flu Pandemic Changed the World

Emergency hospital during influenza epidemic, Camp Funston, Kansas. Otis Historical Archives, National Museum of Health and Medicine. (Public Domain)

World War I wasn’t the deadliest event of the 1910s.

That designation belongs to what some have called “the forgotten pandemic,” a global outbreak of influenza in 1918 that not only outstripped World War I’s mortality rate, but might even be the single deadliest event in recent human history.

In his book “America’s Forgotten Pandemic: The Influenza of 1918,” Alfred W. Crosby writes, “The important and almost incomprehensible fact about Spanish influenza is that it killed millions upon millions of people in a year or less. Nothing else—no infection, no war, no famine—has ever killed so many in so short a period.” Estimates for the total death toll hover around an astounding 50 million globally between 1918–1922, and 675,000 in the United States alone. One third of the world’s population was infected.

The headline of The Sun newspaper (literally "Independent Journal") reads: "The Fever of the Three Days in Madrid there are 80,000 attacked. His Majesty the King, Sick. May 28, 1918. (Public Domain)

The First Round

Counterintuitively, the Spanish Flu of 1918 didn’t actually come from Spain. It received this name because Spain’s neutrality in World War I meant the Spanish press was freer to report on the unfolding of the pandemic more openly than the countries who were belligerents in the war and engaged in stricter censorship. Since Spain was the first country to report fully on the outbreak, most of the world erroneously saw it as the origin of the infection. (The Spanish, incidentally, called it “the French flu.”)

Whatever its precise origin, the flu boasted some unique—and deadly—characteristics. Its first incarnation in the spring of 1918 was fairly mild. People experienced standard symptoms of an ordinary flu, such as a fever, headache, and sore throat, but normally recovered after a few days. In retrospect, this was mere deception.

Sudden and Lethal

The real calamity came upon the world with a resurgence of the disease in August. This time, things were worse. Much worse. The flu itself was more severe and it brought other complications with it. According to Crosby, this strain of influenza had a particular propensity to bring about pneumonia. And it was really these pneumonic complications—not necessarily the flu itself—that were so lethal. According to “Pale Rider: The Spanish Flu of 1918 and How it Changed the World” by Laura Spinney, most of the deaths were actually due to bacterial pneumonia that resulted from the influenza, not influenza itself.

Front page of The Times (London), 25 June 1918: "The Spanish Influenza" (Public Domain)

The symptoms went something like this: the illness would seize you suddenly, and you would soon have trouble breathing. As Spinney relates, deep red spots would appear on your cheek and begin to spread—within a few hours, your whole face would have changed to a mahogany color. At this point, there was still hope. But if the color changed again, your fate was sealed. A bluish tint would mix with the red, and then darken to black—first in the hands and feet and nails, then spreading up the limbs into the abdomen and torso. Once the blackness came, death was hovering near you. As doctors discovered by conducting autopsies, the lungs of victims became swollen and congested with blood and a watery, pink froth. In the end, people died from drowning in their own fluids. Sometimes the whole process took only a few hours, other times a few days.

Another unusual aspect of the illness: it bizarrely targeted previously healthy young people, killing many people between the ages of 20 and 40, including, with a certain tragic irony, millions of World War I soldiers and sailors. In some places, so many people died that bodies couldn’t be properly stored or buried. Anna Van Dyke, an eyewitness, recalled in 1984 what happened in Philadelphia: “[M]y mother went and shaved the men and laid them out, thinking that they were going to be buried, you know. They wouldn’t bury ‘em. They had so many died that they keep putting them in garages. That garage on Richmond Street. Oh, my gosh, he had a couple of garages full of caskets.”

Such striking images of garages full of bodies must have chiseled themselves forever into the memories of the survivors—as, even now, they imprint themselves on our minds, too, far-removed as we are.

The Far-Ranging Effects

The effects of the pandemic were far-reaching, including in the biological, psychological, scientific, artistic, and social realms.

Poster with the slogan: "Coughs and sneezes spread diseases." (Public Domain)

From a biological point of view, the general population was healthier after the pandemic, as Spinney argues in “Pale Horse.” This was based on an increase in fertility rates and life expectancy around 1920. At the same time, babies who encountered the Spanish flu while in utero would grow up to be slightly shorter than others, and also less likely to succeed academically and more likely to end up in prison or suffer from heart disease. There was additionally an uptick in mental illness and depression, which may have been due to the war and the flu jointly.

Socially, the world had much to adjust to following the pandemic. Many families, of course, were broken due to the deaths. People had a chronic sense of what Spinney calls “alternate histories”—what might have been had their loved ones survived? Some people—widows, orphans, or people suffering from depression—fell through the cracks. If a father and husband died from the flu, his family might struggle to support themselves. Some received life insurance policies, and some were the beneficiaries of wills, including Donald Trump’s father and grandmother, who invested the money from the will in property, the beginnings of the Trump real estate empire. The Trumps were not the only ones to prosper. Though there was an initial decline in the American economy in 1918, after the pandemic, the economy bounced back and gave rise to the Roaring Twenties.

Nurses tend to flu patients in temporary wards set up inside the Oakland Municipal Auditorium, in  Oakland, Calif. (Public Domain)

The medical establishment suffered a shockwave after the pandemic because alternative doctors claimed a higher cure rate and many began turning to them over “regular” doctors. This led to the growth of “alternative medicine” in the 1920s and the greater widespread acceptance of the importance of hygiene, exercise, and diet. On the more conventional front, virology was thereafter established as a science and the first influenza vaccines were created.

Art always reflects something of the times, and it was no different in the aftermath of the flu. For instance, Ernest Hemingway’s fiction includes a description of the choking, drowning death of a victim of the flu in “A Natural History of the Dead,” and the specter of the flu hangs over his story “A Day’s Wait” (Hemingway had firsthand experience of the flu in Italy when he was recovering from war wounds in the American Red Cross Hospital in Milan).

Mass burial site of flu victims from 1918 in Auckland, New Zealand. (russellstreet-1918 Influenza Epidemic Site/CC BY-SA 2.0)

In another instance, Jaroslaw Iwaszkiewicz wrote a story called “The Maids of Wilko” in which the death of a girl due to the flu haunts her five living sisters. Sir Arthur Conan Doyle, the famous author of the Sherlock Holmes stories, lost his son to the Spanish flu and turned most of his focus to trying to communicate with the dead.

We might speculate that the Spanish flu contributed to those experiences of the early 20th century that helped launch literary and artistic Modernism, with its more pessimistic, disillusioned atmosphere, and restless search for new and experimental forms of expression.

With the conclusion of a global war and one of the deadliest pandemics in history, humanity had entered, for the most part, a sorrier world.

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