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Wednesday, February 6, 2019

THE 1918 FLU Pandemic by Sarah J. McNeal

Since we’re in the middle of flu season I thought I would write about the worst flu pandemic in the history of the world.

U. S. Camp Hospital

The 1918 Flu or Spanish flu epidemic following World War I killed more people than World War I, between 20-40 million people worldwide. No subsequent flu breakout has killed that many people. The flu pandemic was caused by a subtype of Influenza A known as H1N1. In the book, “The Great Influenza” written by John Barry he states, “Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century.” I was completely shocked to learn that factoid. It makes me wonder how human beings have managed to survive on planet Earth this long. Look out extraterrestrial aliens; you might not want to come to Earth after all.

Walter Reed Hospital, Washington, D.C.

The 1918 influenza pandemic (January 1918 – December 1920; colloquially known as Spanish flu) was an unusually deadly influenza pandemic, the first of the two pandemics involving the H1N1 influenza virus. It infected 500 million people around the world, including people on remote Pacific islands and in the Arctic, and resulted in the deaths of 50 to 100 million (three to five percent of the world's population), making it one of the deadliest natural disasters in human history.

Mass Burial of Flu Victims North River in Labrador, Newfoundland

Most viral infections affect the very young, the elderly, and the already weakened population more than young, healthy adults, but the Spanish Flu seemed determined to kill the people who are usually less likely die from flu.
One group of researchers recovered the virus from the bodies of frozen victims, and trans-infected animals with it, causing a rapidly progressive respiratory failure and death through a cytokine storm (overreaction of the body's immune system). It was thought that the strong immune reactions of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults resulted in fewer deaths among those groups. The most vulnerable of all were pregnant women. If the mother survived, often times the baby died.
In 2007, analysis of medical journals from the period of the pandemic found that the viral infection itself was not actually more aggressive than any previous influenza, but that the special circumstances of the epidemic, probably due to the war, (malnourished, overcrowded medical camps and hospitals, and poor hygiene) promoted bacterial super-infection that killed most of the victims, typically after a somewhat prolonged death bed. 

So, why is it called The Spanish Flu?

The major troop staging and hospital camp in Etaples, France, was identified as being at the center of the Spanish flu by research published in 1999 by a British team, led by virologist John Oxford. In late 1917, military pathologists reported the onset of a new disease with high mortality that they later recognized as the flu. The overcrowded camp and hospital — which treated thousands of victims of chemical attacks and other casualties of war — was an ideal site for the spreading of a respiratory virus; 100,000 soldiers were in transit every day. It also was home to a live piggery, and poultry were regularly brought in for food supplies from surrounding villages. Oxford and his team postulated that a significant precursor virus, harbored in birds, mutated so it could migrate to pigs that were kept near the front. I guess this is why we gasp when we hear there has been another outbreak of Avian Flu.

Aspirin poisoning

Oh, here is another interesting factoid: the people who died from the flu were helped along by aspirin poisoning. The Surgeon General of the United States Army recommended high doses of aspirin of 8 to 31 grams of aspirin a day as treatment.
These levels produced hyperventilation in 33% of patients, as well as lung edema in 3% of patients convinced Karen Starko with infectious diseases that many early deaths showed "wet," sometimes hemorrhagic lungs, whereas late deaths showed bacterial pneumonia. She suggests that the wave of aspirin poisonings was due to a "perfect storm" of events: Bayer's patent on aspirin expired, so many companies rushed in to make a profit and greatly increased the supply; this coincided with the Spanish flu; and the symptoms of aspirin poisoning were not known at the time.

To get all this in perspective there are 1000 mg in 1 gm. There are 325 mg in each adult aspirin. The normal recommended dose is 2 aspirin every 4 hours with a maximum of 6 doses which would total 4,200 mg a day. So the recommended dose of 8 gm on the low end would be almost twice the maximum dose a person should take and 31 gm on the high end would be over 7 times the maximum recommended dose a person should take. It’s a wonder everyone didn’t bleed to death.  

 So how did the Flu pandemic of 1918 end? 

After the lethal second wave struck in late 1918, new cases dropped abruptly to almost to nothing after the peak in the second wave. One explanation for the rapid decline of the lethality of the disease is that doctors got better at preventing and treating the pneumonia that developed after the victims had contracted the virus; but John Barry stated in his book that researchers have found no evidence to support this.

Electron Microscope View of Reconstructed N1H1 Spanish Flu

Another theory is that the 1918 virus mutated extremely rapidly to a less lethal strain. This is a common occurrence with influenza viruses: there is a tendency for pathogenic viruses to become less lethal with time, as the hosts of more dangerous strains tend to die out.

American Police in Seattle, Washington Wearing Mandatory Masks

Even with prevention methods like the flu vaccines each year it is difficult work to try to predict what strain of the virus will appear in a given year. Some people are dedicated to getting their flu shot every year. I have lost faith in flu shots and don’t take them, but I can tell you I am tenacious about washing my hands, wiping off the handles of grocery carts, and limiting my time in crowded public places during the flu season. I am also grateful for the appearance of antibiotics for treating pneumonia, too.

In my World War I novel , FOR LOVE OF BANJO, the heroine, Maggie, falls ill with the Spanish Flu.


Deceit stands between Banjo Wilding’s love for Maggie O’Leary and his search for the father he never knew.

FOR LOVE OF BANJO is the sequel novel to HARMONICA JOE’S RELUCTANT BRIDE. Banjo was the street wise teenager, raised by prostitutes that Joe and Lola took compassion on and Joe’s father, Ben, adopted. In this World War I era story Banjo searches for his biological father and attempts to prove he’s worthy of Maggie, the woman he loves.

Banjo Wilding wears a borrowed name and bears the scars and reputation of a lurid past. To earn the right to ask for Margaret O’Leary’s hand, he must find his father and make something of himself.
Margaret O’Leary has loved Banjo since she was ten years old but standing between her and Banjo is pride, Banjo’s mysterious father and the Great War.

Excerpt in which Banjo attends Maggie who is stricken by the Spanish Flu:
Banjo hurried to Maggie’s side and took her hand then sat on the bed next to her while Joe listened to her heart and lungs with his stethoscope. She opened her eyes and peered at Banjo. “I’m so sorry, Banjo. Some homecoming. I’m so sorry.” She closed her eyes again and drifted away from him again. He didn’t know if she could hear him, but he spoke to her anyway. “Don’t concern yourself with that right now.
I’m here and I’m not going anywhere ever again. You can count on it.” He squeezed her hands. They felt so cold. Before she closed her eyes, he saw that they had gone glassy. Banjo noticed her flushed cheeks, felt her hot forehead… she had a fever. Why were her hands so cold? Alarm ricocheted through his body. He lifted his eyes to Joe who packed the last of his instruments into his bag having finished his examination. “What is it Joe? Is it bad?”
Joe raised his head, his expression solemn as he seemed to listen to Maggie’s raspy breathing and studied her face. “I’m afraid it’s very serious. She has influenza. We’re definitely going to have to put the hotel on quarantine. It’s extremely contagious.”
Banjo’s faith wavered. At last, he had come home. He had made it through a war, through gunshot wounds and every kind of desperation…only to find the one dearest to him had fallen to a disease that could take her away from him for good. Did God hold something against him that He visited hardship upon him at every turn? Banjo didn’t want to leave Maggie for a minute, because every second with her had become precious to him. He glanced across the bed at Joe. “What can I do? Can you make her well again?”
Joe peered at Banjo with haunted eyes. “I can’t promise you anything. I wasn’t able to save my brother years ago from pneumonia. This influenza may be worse. People are dying from it.” He reached over Maggie’s still form to clasp Banjo’s hand. “I want you to know that I’ll do everything I can to bring her through this.”
“Just tell me what to do and I’ll do it, Joe—except leave her. I won’t do that.” He couldn’t keep his hands from trembling. Joe must have noticed, because he squeezed his shoulder firmly as if to lend Banjo his own strength.
“We have to safeguard ourselves so we don’t fall ill. We won’t be any good to Maggie if we get sick. And we need to keep our family from contamination. They won’t be able to visit with her while she’s contagious. As long as we’re here with Maggie, we have to keep our faces covered with bandannas and wash our hands, coming and going. We’ll have to drop the bandanna in a laundry bag outside the door each time we leave to be washed in hot, soapy water. When we get ready to enter the room, we’ll need to put a clean bandanna over our mouth and nose each and every time. Understood?”
“I understand. I’ll do whatever you say.”
Joe stood up and walked around the bed toward the door. “We’ll do our best for her, brother. I’m going to give you a little private time with her and then I’ll come back and see if we can get some medicine and treatment started.”
“Thanks, Joe.” Before he left, Joe tied a bandanna around the lower half of Banjo’s face. “Don’t take this off until you leave the room. I’ll set up equipment outside the door. From now on, no one comes up those stairs except you, Teekonka, and me. The two of you have to follow my instructions to the letter. Our family and friends, including the hotel staff, can come to the hotel—but first floor only, so they have no contact with Maggie. Their only contact will be through us and that’s why we have to follow my procedure to secure their safety.”
After Banjo nodded agreement, Joe gave Banjo one last look of reassurance before he left the room. Once Banjo was alone with Maggie, he took off his glasses and laid them on the bedside table. He rubbed the bridge of his nose where the glasses had rested then leaned forward to gaze at Maggie. The distant rumble of talk from downstairs was barely audible. Birds chirped outside the window and the sun beamed through it in a column of light. Life around him moved cheerfully along in spite of the dark turn his life had suddenly taken.
He spoke to Maggie in a low voice just above her ear. “I didn’t make it back home just to see you lay down and die. But no matter what Maggie, you have our son to think of.” He leaned closer to her. His voice shook when he spoke again. “You know that I love you and I’m going to do whatever it takes to get you back.”
Maggie moaned. He thought she might open her eyes and speak to him, but she did neither. He couldn’t think of a time in his life when he’d been this scared. He couldn’t organize his thoughts enough to say a decent prayer. Please God, please don’t take Maggie from me. Please. These few words were all he could say, all he could ask.

Sarah J. McNeal
Diverse stories filled with heart


  1. Sarah, my granddad's younger sister Julie died of this, and it's amazing to me how, as sparsely populated the US was then compared to now, it killed people even out in the smaller towns and country in alarming numbers. Julie was 16 or 17, I think, and her best friend had died of the flu, and Julie was determined to go to the funeral--which she did, and then she came down with the flu herself. Mom told me that my great grandmother, Julie's mom, told my mom about how they had hung her head off the side of the bed and poured cold water over her scalp (I am guessing the purpose was to get the fever down). Anyhow, she did die, and her half-sister, Altie, lost her husband and 3 children within a week's time. She lost her mind over that and had to go into an asylum. This article of yours is so interesting. I never knew so much of this! It's amazing to me to think of how far-reaching this disease was even to the smaller outlying areas, and obviously it was all over the US because where my gr grandparents lived was a tiny little country community in Oklahoma.

    1. Cheryl, the flu even invaded the tiny town of Numidia, PA where my dad was born and raised. My Uncle Donald had come home from World War I and amazingly did not contract the flu, but others in the town did. I can only guess that the flu spread everywhere in part because of soldiers returning home who were infected with the virus even if they did not fall ill with it themselves.
      What a disaster for the families you mentioned in your comment. Poor Altie to have lost her husband and her children so quickly to the flu...her whole family wiped away in the blink of an eye. In her place I may have lost my mind, too.
      The most astounding fact I came across in this research was that the Spanish Flu killed more people than the Black Plague in the Middle Ages and did it in ONE year. My eyes almost dropped out of my head when I read that.
      I know how busy you are, Cheryl, so I really appreciate you taking the time to visit my blog today and to relate part of your family history for us. Thank You!

  2. This is a great overview. I never heard of the deaths due to aspirin! I remember in history classes in school hearing about the great wars, of course. But somewhere down the line I learned about the Spanish Flu and it's death toll and I was astounded that we didn't hear more about this earlier. It's reach is hard to fathom but I guess as you pointed out it was at a time when then world's population was weakened. Great excerpt too!

    1. Patti, I didn't know about the aspirin deaths until I did this recent research. If I had known about it when I wrote FOR LOVE OF BANJO, I would have found a way to include it the story.
      I do remember a young man who came into the ER with an unrelenting headache who unintentionally over-dosed on aspirin. He collapsed in triage and ended up in ICU because of the aspirin. But in the case of the 1918 Flu, it was actually ordered by a general as treatment with devastating results.
      Thank you for your kind words about the excerpt of FOR LOVE OF BANJO. And thank you so much for coming.

  3. Great post and great excerpt, Sarah. Thank you for sharing this information about this horrible pandemic.

    1. Thank you for your compliment, Robyn; and thank you so much for coming.

  4. I've heard about the flu epidemic, but this post brings it to life. Horrifying time. Sarah, I enjoyed reading your excerpt from For Love of Banjo.

    1. Laurean, I knew that there must be some significance to the H1N1 virus a few years back because there seemed to be a fuss about it, but after seeing the devastation the H1N1 virus brought back in 1918, I see why the medical society was so alarmed. Kinda scary.
      I'm happy you enjoyed the excerpts from FOR LOVE OF BANJO. I truly appreciate you dropping be my blog today.

  5. Great excerpt. Very compelling. The 1918 was a terrible disaster, certainly helped along by troop movements, and probably ha echoes as to how modern air travel could spread disease. It was notable how it hot the young worst of all.

    1. C.A. Yes, air travel does pose a problem in the spreading of disease, especially airborne viruses. We have to be more vigilant than ever to prevent disease from spreading. I imagine they could start with changes in the ventilation system.
      Thank you for your kind comment about my excerpt and
      thank you for coming over and commenting. I do appreciate it.

  6. Medical people and laymen volunteers during times of great illnesses, pandemics, epidemics, etc. are warriors (soldiers) in their own right. I admire people who put their lives on the line for others. These people are also soldiers.

    1. I agree, Kaye. They don't always get the recognition they should. There is nothing as passionate and dedicated as the heart of a volunteer. People get scared during a pandemic and hide in their homes afraid to come in contact with others. I remember the beginning of the HIV crisis and how afraid people were to even touch a person with HIV--but there is always those brave and compassionate few who set an example for others. Elizabeth Taylor was a champion for those stricken with HIV. I remember those 2 ministers during the Eboli breakout who came home and were hospitalized in an effort to save their lives. They both survived and pay it forward by giving blood to help develop a vaccine. It lifts my spirits to know there are people who are willing to sacrifice for others both human and nonhuman.

  7. Sarah,
    This is a very sobering reminder of how quickly disease can spread, especially in this age of air travel. Thanks for such an informative post and a heartfelt excerpt from Banjo.

    1. Kristy, it IS scary how easily disease can spread with rapid travel between countries and symptoms don't always show up before the disease is contagious. Yikes!

    2. Kristy, thank you for coming by and commenting.

  8. I just finished a thriller about the Spanish flu--modern people uncovering a cemetery full of people who died of Spanish flu. It was fascinating. I agree about the flu shot--it never fails that they announce halfway through that the shot didn't work on whatever strain erupts--so why bother?

    1. Ah, a thriller involving the 1918 flu, very interesting.
      I do agree about the flu shot and how it's just a roll of the dice whether they will be effective or not, M.S. Maybe it would be better if we did more to boost our own immune systems like good nutrition. I worked with a doctor who refused the flu shot because she felt it was better to increase the immune system's resistance to viruses.
      I really appreciate you coming to read my blog and commenting.

  9. So very fascinating. Thank you for digging through the facts and distilling them to something easly read. Doris

    1. I'm so glad you came, Doris. Thank you for your comment.