In our current day and age, we are no stranger to the word “pandemic.” Many of us are sick of hearing it and justifiably so. Yet, as the United States and the world continues to grapple with the ongoing COVID19 pandemic, many people look back to the last time this happened in human history: the 1918 Spanish flu pandemic.

It is logical to think that the 1918 pandemic originated in Spain, with the name and all, but that is not the case. While there is a reason that the disease was labeled as the “Spanish flu,” its origins lie elsewhere.

The start of the 1918 pandemic overlaps heavily with the end of the First World War. Therefore it is impossible to separate the two historical events from one another. As the disease was spreading, many countries who were actively fighting in World War I had censorship laws in place when it came to the media. Thus, in the United States, France, and Great Britain news that such a disease existed was suppressed. However, Spain had remained neutral in the ongoing conflict and thus, the Spanish press reported freely and extensively on the spread of the flu. The lack of reporting in the majority of Europe and in the United States coupled with the emerging reports of a mysterious, new disease being heavily concentrated in Spain resulted in the disease being erroneously labeled as the “Spanish flu.”

Following the 1918 pandemic, studies by both epidemiologists and historians strongly suggest that the origin of the pandemic was a lot closer to home for us Americans: the state of Kansas. But before we can get into why many scholars believe that to be the case, let us tell the story of the “Spanish flu” pandemic in the United States.

This famous photograph from the 1918 pandemic depicts an emergency hospital in Camp Funston, Kansas at the time of the outbreak there

The first confirmed cases of the 1918 pandemic were reported on the morning of March 4, 1918. Albert Gitchell, U.S. Army Private and mess cook, checked into the hospital at Camp Funston in Fort Riley, Kansas with flu or cold-like symptoms: sore throat, fever, and a headache. By the afternoon, around another hundred men reported feeling unwell with similar symptoms. A week following Private Gitchell falling ill, there are five times as many people who have contracted the disease. Just over a month later, more than a thousand soldiers had been infected and around 50 of them had died. By the time the pandemic had petered out in 1919, around 675,000 Americans would be dead from the disease — more Americans than died in the First World War.

Speaking of World War I, the conflict is integral to discussing the spread of influenza in 1918. In April 1917, just under a year before the outbreak at Fort Riley, the United States had declared war on Germany and entered the conflict. Shortly after the declaration of war had been made, thousands of American men were called upon to serve via draft and entered into training at military camps across the country. One of these camps was Camp Funston at Fort Riley. Camp Funston was the U.S. Army’s largest training facility with each barrack housing 250 men each. Soldiers had arrived at the camp from all across the Midwest and surrounding areas and 50,000 men lived at the camp in close quarters. Robert Smith, the supervisory curator at the Fort Riley Museum, notes that “recruits were being shifted from camp to camp by the thousands...it made for easy exposure.” In addition, the overcrowded military camps, which housed up to a million total recruits for the American war effort, created an environment where infection spread with deadly ease.

Men gargle salt water to prevent the spread of disease at Camp Dix, New Jersey in 1918

The disease soon tore across the United States and made its way to Europe alongside the American soldiers who were headed to fight in the war. Over 84,000 American soldiers were sent to the trenches in the month of March 1918 and 118,000 more soldiers followed them in April 1918. The disease soon spread across the trenches and to the German lines as well, hitting the German troops during the summer of 1918. Yet, the end of the war in late 1918 and the subsequent return of American soldiers led to a second and more deadly wave of the pandemic in the United States.

The second wave also began at a military camp, Camp Devens just outside of Boston, as the war was starting to conclude. By the end of September 1918, more than a quarter of the camp’s population had contracted the disease. Norman Roy Grist, a doctor at Camp Devens during the outbreak, described viewing the bodies of American soldiers who had died of the disease: “It beats any sight they ever had in France after a battle.” Working 16 hour days, Grist watched patients “very rapidly develop the most viscous type of pneumonia that has ever been seen.” The disease was well known for causing blue and purple skin in many patients as the virus caused a lack of oxygen in the blood. Some of the cases that Grist saw got so bad that he reported that it became “hard to distinguish the colored men from the white.”

Nurses assemble masks at Camp Devens in the fall of 1918

The month of October 1918 proved to be the deadliest in the United States as more than 195,000 Americans died that month of the disease — the most at any point during the 1918 pandemic. The war had caused serious staff shortages in civilian hospitals, as many healthcare workers had been deployed overseas or to military camps. Around half of all medical professionals under the age of 45 were enlisted to aid in the war effort. Furthermore, even though the war had been moving towards its conclusion over the following months, the official armistice would not occur until November 1918.

However, the impact of World War I on the 1918 pandemic did not end there, especially for the United States. As previously mentioned, the American government had enacted strict censorship laws due to the war. President Woodrow Wilson had created the Committee on Public Information, after being inspired by one of his advisors who wrote that: “truth and falsehood are arbitrary terms....The force of an idea lies in its inspirational value. It matters very little if it is true or false.”

Wilson also urged Congress to pass the Sedition Act of 1918 which made it illegal to “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the form of government of the United State...or to urge, incite, or advocate any curtailment of production in this country of any thing or things...necessary or essential to the prosecution of the war.” Violating the law could result in a prison sentence of up to 20 years. At the same time a government campaign urged citizens to report anyone that “spreads pessimistic stories...cries for peace, or belittles our effort to win the war” to the Justice Department. In short, the Wilson administration’s censorship and war on truth resulted in the American media vastly underreporting the disease’s spread. Additionally, many American healthcare officials falsely underestimated the deadly nature of the disease due to the fact that even though it spread rapidly -- it seemed to rarely kill those who were infected.

A typist dons a mask while at work in New York City in October 1918

While both of these circumstances sound familiar to the factors that allowed for the rapid spread of COVID19 in the United States during the year of 2020, it is also important to remember that medicine was barely modernized in 1918. Many doctors at the time still believed that disease was caused by “miasma” or the poisonous emissions and fumes that many physicians still believed caused disease. The wide acceptance of germ theory was still decades away in 1918, especially considering that microscopes of the time could not see the incredibly small viruses responsible for the flu and its variety of strains.

Looking back on the1918 pandemic through the lens of the limited medical knowledge at the time, it is difficult to ascertain where the disease originated. However, using the epidemiological evidence available as well as historical records, scholars have been able to narrow down where the outbreak started. Some scholars argue that it can be traced back to a 1916 respiratory disease outbreak at a British Army camp in France while others believe that outbreaks of the flu in 1917 China or Vietnam are actually responsible. Yet, the most convincing evidence suggests that the pandemic originated right here in the United States.

Tucked away in the southwest corner of Kansas, Haskell County in 1918 was a largely rural, farming community. In January 1918, the residents of this county began to fall ill from the flu. However, the disease was unlike any other form of influenza that local physician, Dr. Loring Miner, had seen. In fact, the illness alarmed the Kansas doctor so much that he wrote to to the U.S. Public Health Service alerting them of an “influenza of the severe type.” Dr. Miner’s report was corroborated by the local newspaper, The Santa Fe Monitor and confirmed that the community of Haskell County definitely experienced an influenza outbreak in early 1918.

All of the men who were drafted for the First World War from Haskell County reported to Fort Riley for their training. Furthermore, many of them traveled between the camp and their homes during furloughs granted in early 1918 meaning that these men could have easily picked up the disease in Haskell County and brought it back to Camp Funston. John M. Barry, writing for the The Journal of Translational Medicine, described Dr. Miner’s documentation of the disease in Haskell County as follows:

“It remains the first recorded instance suggesting that a new virus was adapting, violently, to man.”

There is a clearly established trail of the disease’s spread from Haskell County to Fort Riley to the outside world. The same cannot be said of the 1917 influenza outbreaks in China and Vietnam or of the 1916 disease seen in British Army camps. Furthermore, it is widely believed that the flu of 1918 had either aviary or swine origins. In other words, the disease first appeared in birds or pigs before moving to humans. Going back to Kansas: many of the farmers in Haskell County raised hogs and the county was in the migration path of around 17 different species of bird.

A street car conductor in Seattle, Washington not allowing passengers aboard without a mask, late 1918

While it is impossible to determine the origin point of the disease with complete certainty, it is also unlikely that the disease originated elsewhere and was thus brought into Haskell County. Not only was the county itself in a relatively isolated part of the state, but there were no other outbreaks of such a disease reported anywhere in the United States prior to Kansas in January 1918. Modern medical research also supports this theory as shown by the work of Dr. Jeffrey Taubenberger, who is best known for extracting samples of the 1918 virus from preserved tissue in order to sequence its genome. As a result of his research, Dr. Taubenberger believes that the disease behind the 1918 pandemic originated in the months before the outbreak officially reached the status of pandemic — meaning that it could not have been the British or Chinese outbreaks of 1916 and 1917 respectively.

Despite where the 1918 pandemic started, in just over a year it had become the deadliest outbreak of disease the world had ever seen. In total it killed anywhere between 50 to 100 million people around the world. To understand the full magnitude of this death toll, the 1918 pandemic killed more people in one year than AIDS had killed in the past four decades and more than the Black Plague killed in a century.

There are some disheartening parallels between the 1918 and 2020. However, today we have an entire century’s worth of modern medical knowledge by our side. We understand the nature of the germs that cause these diseases and are able to create vaccines to combat them — something that was impossible in 1918.

Ultimately, if the 1918 pandemic shows us anything, it is that history has a lot to teach us — especially with regards to how far we have come.

The First American Cases of the 1918 Pandemic