History

U.S. Census Bureau History: The 1918 Influenza Pandemic

Isolated cases of the "Spanish Flu" occurred in early January 1918, but the first major wave
of the virus began in March 1918. In scenes reminiscent of the recent COVID-19 pandemic,
people going out into public wore a masks to protect against the deadly virus.

Researchers estimate that as many as 100 million people died during the 1918–1920
influenza pandemic, including 675,000 people in the United States.

Photo courtesy of the National Archives and Records Administration.

Doctors documented the "first" case of the H1N1 influenza pandemic on March 4, 1918, in a U.S. Army cook stationed at Camp Funston, Fort Riley, KS, named Albert Gitchell. Nicknamed the "Spanish Flu," cases of "severe influenza" were observed in Kansas as early as January 1918. Many scientists and researchers suspect that these Kansas infections were the first of an influenza pandemic that afflicted 500 million and killed as many as 100 million between 1918 and 1920 worldwide. The 1918 influenza pandemic was one of the greatest pandemics in human history with scenes of mask-clad adults and children, social distancing, and overwhelmed hospitals reminiscent of the more recent COVID-19 pandemic.

As World War I-weary Americans welcomed the arrival of the New Year in 1918, a "flu-like" virus was rapidly infecting, spreading, and killing previously healthy people in rural Haskell County, KS. Dr. Loring Miner, a Haskell County physician and coroner who visited some of these desperately ill patients noted that their health deteriorated more rapidly than he had seen during previous influenza outbreaks. From his analysis of samples collected in the first months of 1918, he reported to the U.S. Public Health Service that a novel and severe strain of influenza appeared to be rapidly spreading in the communities he served.

The Public Health Service published Loring's findings in an April 5, 1918, Health Alert—"On March 30, 1918, the occurrence of 18 cases of influenza of severe type, from which 3 deaths resulted, was reported at Haskell, Kans." However, by the time that warning was published, the virus had already migrated out of Haskell County, KS. The region's inhabitants—especially young men enlisting for service in World War I—carried the virus between nearby Camp Funston (near Manhattan, KS) and their families when returning home on leave. On March 4, 1918, military doctors formally identified the new influenza virus in U.S. Army cook Albert Gitchell. Within a week, hundreds of soldiers who worked, trained, and bunked alongside Gitchell at Camp Funston were sick. Within a matter of weeks, more than 1,000 soldiers at Camp Funston were ill and the virus was reported at the majority of Army training camps throughout the United States.

The highly contagious influenza virus spread through the United States with soldiers moving from the Midwest to the East Coast of the United States. These soldiers infected each other and neighboring civilian populations at railroad hubs, embarkation ports, and debarkation ports in Europe. By the end of April 1918, influenza was spreading rapidly through the frontline trenches along Europe's Western Front. North Africa, India, and Japan reported widespread influenza infections in May; China in June; and Australia by July 1918. Luckily for those infected during this "first wave" of the new influenza virus, mortality rates were similar to previous influenza outbreaks. In the United States, approximately 75,000 influenza-related deaths were reported during the first half of 1918 compared to approximately 63,000 deaths from influenza in 1915.

During the first wave of the influenza pandemic, the sick and elderly were most at risk. By the time the second influenza wave began in August 1918, the virus had mutated to become much more deadly—rapidly killing the young, middle-aged, and old with many previously healthy people succumbing to respiratory failure within hours of becoming ill. At Camp Devens between Worcester and Boston, MA, more than 14,000 soldiers were sick and 757 died in September 1918. Between September and December 1918, nearly 300,000 Americans died of influenza compared to about 26,000 during the same period in 1915. In October 1918 alone—the deadliest month of the pandemic in the United States—an estimated 195,000 people died. The severity of the second wave forced public health officials to enforce quarantines of infected people and ordered residents to wear masks in public to slow the spread of the disease.

A third wave of the pandemic hit Australia and parts of Europe particularly hard during the first half of 1919, but despite outbreaks in American cities like Los Angeles, CA, Memphis, TN, and St. Louis, MO, the mortality rate from the virus fell dramatically. A fourth deadly wave of the influenza pandemic rapidly swept through New York City, NY, Chicago, IL, and the U.S. territory of Hawaii in early 1920. Particularly hard hit were Alaska Native populations in rural Alaskan villages, including Nenana, AK, which had avoided the first waves of the pandemic only to report a nearly 100 percent infection rate and loss of nearly 10 percent of its population to the virus' fourth wave in early 1920.

The pandemic subsided in late 1920 as the virus may have mutated to a more benign form and the majority of the world's population built some immunity to the disease. Deaths from influenza in 1921 were comparable to pre-pandemic levels. In 1930, states reported 30,538 influenza deaths and 28,230 in 1935. Even though every single human influenza A infection since 1918 is directly related to the deadly "Spanish Flu," today's influenza strains have been mercifully less virulent. During the recent 2021–2022 "Flu Season," 9 million Americans were infected with influenza and 5,000 died. The low number of infections and mortality rate are partly a result of mitigation measures intended to prevent the spread of COVID-19, like masks, social distancing, and improved sanitation habits.

You can learn more about the 1918–1920 influenza pandemic using census data and records. For example:

• Even though the 1918 influenza pandemic is known as the "Spanish Flu," the first cases of the virus likely infected residents of Haskell County, KS. The sparsely inhabited county had a population of 993 in 1910 and 1,455 in 1920. Today, Haskell County, KS, is home to 3,780 people.
• Although the first "Spanish Flu" cases may have occurred in Haskell County, KS, the first confirmed cases of the 1918 influenza pandemic were identified at Camp Funston, Fort Riley, KS, among U.S. Army soldiers training to fight in World War I. Fort Riley is located in Geary and Riley Counties, KS. Between 1910 and 1920, the population of Geary County decreased from 1,335 to 1,023. Riley County's population grew from 15,783 in 1910 to 20,650 in 1920. Today, the two counties have populations of 36,739 and 71,959, respectively.
• Why was the 1918–1920 influenza pandemic called the "Spanish Flu" if the United States and other European countries likely had cases weeks or months before Spain? The first influenza cases in early 1918 occurred in countries fighting in World War I. The nations at war kept news of the illness out of newspapers, but reporters in neutral Spain freely wrote about that nation's first influenza cases. As a result, some of the earliest published newspaper accounts of the deadly virus came from Spain, thus [erroneously] earning the virus its "Spanish Flu" moniker.
• The U.S. Census Bureau collected mortality data during the 1850, 1860, 1870, and 1880 Censuses. In the 20th century, the Census Bureau began publishing annual mortality statistics in 1906 for states that sent the agency their death registration data for the year 1900. In 1900, "registration states" reported 539,939 deaths. Tuberculosis (55,504) and pneumonia (48,780) claimed the most lives, while 7,031 died of influenza. In 1918, annual mortality statistics reported that 477,467 people died from influenza and pneumonia—a record death rate of 583.2 deaths per 100,000 people. In 1915, deaths from influenza and pneumonia rose from 26,367 in September–December to 291,894 during the same months in 1918. In response to the deadly second influenza wave in late 1918, the Census Bureau compiled Special Tables of Mortality From Influenza and Pneumonia for hard-hit Indiana, Kansas, and Philadelphia, PA. In 1919, 189,326 died from influenza and pneumonia, corresponding to a death rate of 222.4 per 100,000 people. The influenza and pneumonia mortality rate fell to 208.3 deaths per 100,000 people in 1920. States reported 30,538 influenza deaths in 1930 and 28,230 deaths in 1935. More recently, an estimated 20,342 Americans died from influenza infections during the 2019–20 flu season.
• Poverty, crowded living conditions, and inadequate medical care resulted in American Indian and Alaska Native populations being especially hard hit by influenza between 1918 and 1920. In the Alaska Native village of Brevig Mission, 72 of 80 residents died from the virus over a 5-day period. [Decades later, the collection of tissue samples from Brevig Mission's influenza victims enabled researchers to sequence the Spanish Flu's DNA, reconstruct, and study why the 1918 virus was so deadly.] The Alaska Native village of Marshal, AK, lost 30 percent of its male and 10 percent of its female populations. Among American Indians, National Institutes for Health (NIH) studies suggest that some tribes lost 12 percent of their total population. At one point in 1918, the virus hospitalized nearly one-third of students at the Haskell Institute—an American Indian boarding school in Lawrence, KS—and 17 students died. The NIH estimates that total mortality among Navajo Indians was 12 percent, with 60 percent of deaths occurring in children under 15 years old.
• Studies of the 1918–1920 influenza pandemic suggest that the virus killed as many as 100 million people worldwide. Included among the estimated 675,000 American deaths were President Grover Cleveland's sister Rose Cleveland; Indianapolis 500 race car driver Johnny Aitken; pianist Felix Arndt; automobile manufacturing pioneers and brothers John and Horace Dodge; U.S. Marine Corps brigadier general Charles Doyen; Major League Baseball catcher Harry Glenn; Phoebe Elizabeth Apperson Hearst, mother of newspaper publisher William Randolph Hearst; U.S. Army brigadier general Lyman W.V. Kennon; and P.T. Barnum circus performer Leopold "Admiral Dot" Kahn.
• An estimated 500 million people worldwide were infected with and survived the influenza virus between 1918 and 1920. Included among the pandemic's American survivors are: Presidents Woodrow Wilson and Franklin D. Roosevelt; animator Walt Disney; General John J. Pershing; artist Georgia O'Keefe; Hollywood actresses Lillian Gish and Mary Pickford; aviation pioneer Amelia Earhart; jazz pianist Jelly Roll Morton; and author T.S. Eliot.
• Prior to the introduction of vaccinations, effective medical treatments, and improved hygiene in the 20th century, infectious disease was a leading cause of death in the United States. Millions died from disease, including President James Monroe (tuberculosis, 1831); President William Henry Harrison (typhoid fever, 1841); aviator Wilbur Wright (typhoid fever, 1912); political cartoonist Thomas Nast (yellow fever, 1902); writer Henry David Thoreau (tuberculosis, 1862); first lady Eleanor Roosevelt (tuberculosis, 1962); President Benjamin Harrison (pneumonia, 1901); President James Polk (cholera, 1849); two of President James Garfield's children, Eliza (diphtheria, 1863) and Edward (whooping cough, 1876); Confederate General Robert E. Lee (pneumonia, 1870); gangster Alphonso Capone (syphilis, pneumonia, 1947); Underground Railroad conductor Harriet Tubman (pneumonia, 1913); author Jack London (yellow fever/dysentery, 1916); and daughter of President Zachary Taylor and wife of future Confederate President Jefferson Davis, Sarah Knox Taylor Davis (malaria, 1835).
• Many once deadly diseases are far less serious or have even been eradicated thanks to the development of effective vaccines. In 1798, British physician Edward Jenner developed the first vaccine for smallpox—one of the deadliest scourges in human history. Naturally occurring smallpox was eradicated in the United States in 1949 and globally in 1980. In 1936, Dr. Max Theiler and colleagues developed a vaccine for yellow fever; production and nationwide distribution of a whooping cough vaccine developed by bacteriologist Grace Eldering began in 1940; and in 1955, the United States began distributing a polio vaccine developed by Jonas Salk. More recently, an effective vaccine to fight the COVID-19 virus began national distribution in December 2020. These vaccinations would not be possible without the dedicated microbiologists who study microorganisms like bacteria and viruses. According to the U.S. Bureau of Labor Statistics, 20,800 microbiologists earned a median salary of $79,260 in 2021.
• In 1929, total federal health spending amounted to more than $3.6 billion—$29.45 per person in the United States. Spending increased to approximately $48 million in 1940, and $2.5 billion following passage of the Social Security Act Amendments of 1965. In 2020, the national health expenditures were approximately $12,530 per person, totalling $4.1 trillion annually.
• Although the 1918–1920 Spanish Flu and COVID-19 pandemics were more than a century apart, the first line of defense against both viruses was a face covering or surgical mask. The U.S. Census Bureau collects data about manufacturers of surgical masks and gloves, biohazard protective clothing, bandages and dressings, hospital beds, and other items needed by the doctors and nurses battling COVID-19 as part of the Surgical appliance and supplies manufacturing (NAICS 339113) sector. According to data collected by the Census Bureau's Annual Survey of Manufactures, Surgical appliances and supplies manufacturers employed 79,116 people and had sales of more than $35.7 billion in 2020.
• Before he developed his incredibly successful polio vaccine, Dr. Jonas Salk developed an influenza vaccine for the U.S. Army in the early 1940s and the first publicly available vaccines were distributed in 1945. During the 2020–2021 flu season, the Centers for Disease Control reported that nearly 194 million doses of the influenza vaccine were distributed in the United States.
Learn more about the history of the U.S. Census Bureau's collection of mortality and vital statistics from Sanitation and Statistics: How Public Health Professionals Revolutionized the U.S. Census.