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The American Influenza Pandemic of 1918


Christine MacPherson
HIST 1700
Professor Cassandra Clark
Salt Lake Community College

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The Influenza Epidemic of 1918 also referred to as the Spanish Flu affected
Americans in unprecedented ways, forcing the closure of schools, businesses, churches, and
other public gathering places.1 The effects were felt throughout the United States, largely due to
the influenza strains unusual mortality rate for adults aged 20-40. The pandemic reached far and
wide throughout the world as World War I came to a close, and estimates suggest that at least 50
million people died worldwide, about 675,000 of them Americans.2 Despite the high mortality of
the flu and its far-reaching effects, there was little impetus for social development at this time,
and the American social hierarchy of class and race remained relatively unchanged.
This can be observed by studying the lives of Americans during the course of the
pandemic, which came in four waves from 1918-1920.3 Letters and documents dated during this
cataclysmic event can give us a glimpse into the lives of early twentieth century Americans and
how it affected them. Throughout the sources used in this paper, there are three common points
that can be observed: a lack of adequate medical care, quarantines and cessation of everyday
activities (such as the shutting down of schools, churches, and other gathering places), and, if
observed closely, racial and social attitudes during this period can be gleaned from the sources as
well.
One document that can help us observe these societal outlooks is a letter written by Dr. DA
Richardson, a visiting doctor on Pueblo land. In this letter, Richardson described his time caring
1 Charles J. McGurren, M.D. State of North Dakota 1920 Report of the State Board of Health
for the BiennialPeriod Ending June 30, 1920. Report. Bismarck: Bismarck Tribune, 1920.
http://history.nd.gov/textbook/unit5_4_stats_intro.html

2 Noymer, Andrew, and Garenne, Michel. "The 1918 Influenza Epidemic's Effects on
SexDifferentials in Mortality in the United States." Population and Development Review Vol.
26, No.3, pp 565-81. http://www.jstor.org/stable/172321.

3 Ibid.

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for the sick Pueblo Indians, mainly in Isleta. Richardson wrote that the conditions at there were
deplorable and that the patients, in the case of Indians, [were] literally falling to the floor.4
Throughout the letter, Richardson continued to point out that he had been working with Indians,
as if it was a special circumstance and that Indians had specifications for care. For example,
Richardson wrote: The element of fear in all instances among Indians is productive of great
harm and should be removed by suggestion or actions as early as possible in the case of
Indians.5
Richardson described in great detail the average case of the Indian.6 Essentially, he stated that
a patient would fall sick; first with extreme weakness, then eventually with cough, fever, and
diarrhea. Richardsons most effective treatment according to him was a prescription of
drinking hot water, eating only broth, and lying strictly in bed. Richardson did not hesitate to
point out the cases in which his direction wasnt followed and it led to unnecessary demise. For
example, in his letter, Richardson references a pitiful case of an Indian woman who was
convalescent the day preceding her death but was placed in a closed room full of smoke, a wet
cloth was laid over her face by the old medicine man, and she relapsed and died in a few
hours7
However, a doctor working in a Massachusetts military camp wrote a similar letter outlining the
deaths of soldiers. His description of dying soldiers did not diverge significantly from
Richardsons, and it can be assumed that plenty of white men died in his camp. The doctor,
4 DA Richardson, MD, Letter from visiting doctor, December 20, 1918.
Letter.https://www.archives.gov/exhibits/influenza-epidemic/records/visitingdoctor-letter.pdf

5 Ibid.
6 Ibid.
7 Ibid.

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Roy, described his patients as they became extremely weak and began to cough. Eventually,
the soldiers faces would be covered with pockmarks, until it is hard to distinguish the coloured
men from the white.8
It almost appears as if Richardson was downplaying the effect the pandemic was having
on the population he treated, while Roy described very devastating effects. However, it is
possible that the close quarters and the mortality rates age demographic made it especially
dangerous for soldiers living in US army camps. One can stand it to see one, two or twenty men
die, Roy wrote, but to see these poor devils dropping like flies sort of gets on your nerves. We
have been averaging about 100 deaths per day, and still keeping it up.9
Richardsons document is also one of few that did not mention the desperate conditions for
medical care. Conversely, Roy described his long work days from 5:30am to 9pm and wrote that
there were ten times as many doctors and nurses as was usual (250 as compared to 25), yet they
were still stretched thin.10 We have lost an outrageous number of nurses and doctors, and the
little town of Ayer is a sight. It takes special trains to carry away the dead.11
Other camps did not fare so well, either. Another letter from an Indian nurse, Lutiant LaVoye,
outlined her experiences in Washington, DC, to her quarantined friend in Haskell, Kansas. At the
time of the letter, LaVoye had volunteered for about a total of two weeks ten days at a camp
and four days at a hospital. LaVoye wrote, As many as ninety people die here every day with
8 Roy. A Letter from Camp Devens, MA. September 29, 1918. Letter.
American
Experience.http://www.pbs.org/wgbh/americanexperience/features/pr
imary-resources/influenza-letter/
9Ibid.

10 Ibid.
11 Ibid.

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the Flu. Soldiers too, are dying by the dozens.12 Luckily, she did not contract the flu, despite
being among some of the very wors[t] cases.13 She also mentioned the twelve-hour work days
that were required by all nurses in her camp. For nurses and doctors who treated the patients of
influenza, there was little relief and an excess of death.
LaVoyes unique perspective broadens our limited view of some of the racial and societal
issues of the early 1900s. As a young Indian woman, LaVoye wrote, they are certainly hard
up for nurses even me can volunteer as a nurse in a camp or in Washington.14 This suggests
that prior to the epidemic, the same doctors would have been hesitant to hire a young Indian
woman as a nurse. LaVoye went on to write that, although the epidemic was not necessarily a
good thing, it was nice for her to be guaranteed some work.15
Later in the letter, LaVoye described her run-in with a gentleman soldier whom she
hoped to meet up with again in the future. All the girls have soldiers here Indian girls also
The boys are particularly crazy about the Indian girls. They tell us that the Indian girls are not so
easy as the white girls, so I guess maybe thats their reason. This is a very interesting social
commentary, especially during the early twentieth century. During this time period, American
Indian culture was generally looked down upon and many native youth were being sent to

12 LaVoye, Lutiant. Letter from nurse to her friend at Haskell Indian Nations
University. Letter. October 17,
1918.https://www.archives.gov/exhibits/influenzaepidemic/records/volunteer-nurse-letter.pdf
13 LaVoye, Lutiant. Letter from nurse to her friend at Haskell Indian Nations
University. Letter. October 17,
1918.https://www.archives.gov/exhibits/influenzaepidemic/records/volunteer-nurse-letter.pdf
14 Ibid.
15 Ibid.

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boarding schools (like Haskell, where LaVoye had once attended), where there was a great deal
of controversy regarding the treatment of Native American culture and its children.
Elsewhere in the United States, the epidemic was equally devastating. Newspaper headlines were
full of the various cases of influenza raging through the nation.16 Other cities and counties, like
Haskell, were quarantined and many ceased business and transportation. A document issued by
the Division of Sanitation encouraged citizens to avoid railroads and to seek medical help if they
experienced symptoms of the flu.17
In a1920 North Dakota state report by the Board of Health, it was stated that some
counties found it was necessary to close schools, churches, public gathering places, theatres,
etc.18 The report also referred, once again, to a general lack of medical care. In Burleigh County,
the shortage of medical staff forced those who were sick to travel far for medical care, causing a
high mortality rate. It was also believed that many records of death, injury, and sickness, had
been understated or were incomplete due to the shortage.19
It is possible that the lack of medical care was caused by a number of sick nurses and doctors,
who could have contracted it while treating sick patients. A 1918 San Francisco newspaper stated
16 Various authors. The Post Standard. October 4, 1918.
Newspaper.http://quod.lib.umich.edu/cgi/t/text/idx/f/flu/0140flu.0011.
410/1/--influenza-cases-at-hospitals?
rgn=subject;view=image;q1=hospitalization
17 Division of Sanitation, Directive from Washington, DC, regarding treatment and
procedures,September 26, 1918. Government document.
http://www.archives.gov/exhibits/influenza-epidemic/records-list.html
18 Charles J. McGurren, M.D. State of North Dakota 1920 Report of the State Board of
Health forthe Biennial
Period Ending June 30, 1920. Report. Bismarck: Bismarck
Tribune, 1920.http://history.nd.gov/textbook/unit5_4_stats_intro.html
19 Ibid.

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that eleven nurses had contracted influenza in the pursuit of their duties.20 This was likely the
case in many scenarios LaVoye had also mentioned in her letter that only a few of the Indian
nurses, including herself, had not contracted the flu while treating soldiers in the camp.21
Furthermore, as reported by the San Francisco newspaper, the nurses had undergone a voluntary
quarantine. Others with influenza symptoms were encouraged to do the same.
From a quick observation of each of these sources it is easy to come to the conclusion
that the United States was profoundly affected by the disastrous epidemic. The quarantines, death
count, and lack of medical care were indicative of a nation that found itself in a vulnerable and
unexpected situation. However, despite the tragedy, it does not appear as if this was a time of
significant social change. As can especially be seen in LaVoyes and Richardsons accounts,
American Indians (likely along with other minorities) were certainly still looked down upon; or
at least looked at as different or other. This was something that Richardson certainly implied in
his report of the typical Indian; and in the way in which LaVoye described the soldiers
exoticism of American Indian women.
In conclusion, the epidemic was certainly a significant event in American history.
Although the Spanish Flu was shocking in its unprecedented deaths, injuries, and quarantines,
Americas societal hierarchy was not significantly affected.

20 Author(s) unknown. Eleven Nurses have Influenza. San Francisco Examiner. October 9,
1918.Newspaper.
http://quod.lib.umich.edu/cgi/t/text/idx/f/flu/0010flu.0009.100/1/--elevennurses-have-influenza?rgn=subject;view=image;q1=quarantine

21 LaVoye, Lutiant. Letter from nurse to her friend at Haskell Indian Nations
University. Letter. October 17,
1918.https://www.archives.gov/exhibits/influenzaepidemic/records/volunteer-nurse-letter.pdf

Bibliography
Division of Sanitation, Directive from Washington, DC, regarding treatment and procedures,
September 26, 1918. Government document.
http://www.archives.gov/exhibits/influenza-epidemic/records-list.html
Lutiant LaVoye. Letter from nurse to her friend at Haskell Indian Nations University. Letter.
October 17, 1918. https://www.archives.gov/exhibits/influenzaepidemic/records/volunteer-nurse-letter.pdf
Charles J. McGurren, M.D. State of North Dakota 1920 Report of the State Board of Health for
the Biennial Period Ending June 30, 1920. Report. Bismarck: Bismarck Tribune, 1920.
http://history.nd.gov/textbook/unit5_4_stats_intro.html
Noymer, Andrew, and Garenne, Michel. "The 1918 Influenza Epidemic's Effects on Sex
Differentials in Mortality in the United States." In Population and Development
Review Vol. 26, No. 3, pp 565-81. http://www.jstor.org/stable/172321.
DA Richardson, MD, Letter from visiting doctor, December 20, 1918. Letter.
https://www.archives.gov/exhibits/influenza-epidemic/records/visiting-doctorletter.pdf
Roy. A Letter from Camp Devens, MA. September 29, 1918. Letter. American Experience.
http://www.pbs.org/wgbh/americanexperience/features/primaryresources/influenza-letter/

Uknown author(s). Eleven Nurses have Influenza. San Francisco Examiner. October 9, 1918.
Newspaper. http://quod.lib.umich.edu/cgi/t/text/idx/f/flu/0010flu.0009.100/1/--elevennurses-have-influenza?rgn=subject;view=image;q1=quarantine
Various unknown authors. The Post Standard. October 4, 1918. Newspaper.
http://quod.lib.umich.edu/cgi/t/text/idx/f/flu/0140flu.0011.410/1/--influenza-cases-athospitals?rgn=subject;view=image;q1=hospitalization