There are various theories about the flu's origins: some say it started in Spain, others say in Asia, and still others say in the United States. Recent pathological research has concluded the flu may have originated with swine and percolated for an undetermined number of years, perhaps even trading back and forth between pigs and people before growing strong enough to become virulent. 1 Some writers have determined there were two or three waves, but from 1916 to 1919 the epidemic ebbed and flowed for more than three years, finally becoming a pandemic. It gradually got worse in scope and severity, climaxing in the fall of 1918 before slowly subsiding in the winter.
The pandemic in the United States was a medical disaster of massive proportions. One authority suggests as much as one quarter of the population, 25 million, had the flu in 1918-19. 2 As many as 700,000 may have died; this was more than the total U.S. combat losses in both world wars, the Korean War, and the Vietnam War combined. 3
The flu struck the military services earlier and more severely than the civilian population. The Army may have had more than a quarter of its number down with the contagion at one time or another. Military camps in the United States became huge virtual hospitals, with entire barracks taken over as wards. Bases were so crippled that the Army's Chief of Staff urgently cabled General John Pershing in November 1918, "Influenza not only stopped all drafts calls in October but practically stopped all training." 4 The American Expeditionary Force in Europe was not hit quite so hard. The hospital admission rate in the war zone was approximately 64% that of the rate of soldiers in the states; 167 out of every thousand fell ill with the disease. Altogether, 12,423 U.S. soldiers in Europe died. 5
A much larger number died on the troop transports. "The worst place to have an epidemic, like a fire," writes one authority, "is in close quarters far from help, such as a ship on the high seas." 6 Troops literally were packed in the compartments of the transports, making it likely that if one person caught the disease, all in his immediate proximity soon would come down with it. In the last six months of the war, while the pandemic was spreading rapidly throughout the world, 1.5 million doughboys crossed the Atlantic to British and French ports. Transports often were crowded with the sick and the dead. One convoy commander radioed London that more than "1,300 cases of virulent pneumonia and influenza in convoy, 49 deaths." Admiral William S. Sims, Commander-in-Chief of the U.S. naval forces in Europe, threatened a quarantine, but it proved to be "politically impossible." 7
Though few in the crews of troop transports fell ill, this was not true of the Navy as a whole. The cruiser Minneapolis (C-13), while moored at the Philadelphia Navy Yard in January 1918, saw the first noticeable outbreak of flu. In a two-week period, 21 members of her crew came down with the disease. Within a month, the Bureau of Medicine and Surgery was receiving reports of numerous cases in ships and bases scattered along the Atlantic seaboard. 8
The epidemic soon spread to the naval forces deployed in the war zone. In March, a comparatively mild epidemic of influenza and pneumonia showed up among the naval personnel stationed at Brest and the U.S. naval air stations in Gujan and Fromentine. The disease spread quickly to the crews of escorts operating out of Brest. One of the surgeons at the U.S. naval hospital there wrote in early July that 30 members of a destroyer's crew became incapacitated with the illness. "We were thinking of taking them ashore," he wrote, "so as to fumigate the ship when came the call of a torpedoed ship. Every man slid into place, fever, headache, bone ache and all, and away she beat it to sea [to] pick up the survivors." 9
Influenza also spread among the U.S. sailors based in Great Britain. Even the London Headquarters staff of the U.S. naval force in European waters was affected. On 30 June, Commander T. A. Thomson, Admiral Sims's chief medical officer, reported that, "My entire office is out of commission with influenza, including myself." Nonetheless, he predicted optimistically to Surgeon General William Braisted at the end of July that there were only about 1,500 cases in the entire naval force, and that the epidemic was about over. 10 Commander Thomson tragically was mistaken; a far deadlier strain had been sweeping through Asia, and even as he wrote to the Surgeon General, British civilians were dying by the hundreds. 11
Washington officials were not especially alarmed over the flu in August. Medical officers still reported evidence of the disease at home and abroad, but the number of cases appeared to be decreasing. This changed toward the end of the month. Cables arrived from Brest with the news of a massive and deadly outbreak among French military personnel. Meanwhile, the Navy Department was notified of an eruption of the malady in Boston, which initially targeted the bluejackets crowded on a receiving ship moored at the city's Commonwealth Pier. On the last day of August, as the city focused on Babe Ruth pitching the Red Sox to the American League pennant, 106 sailors on the receiving ship came down with the flu. By the first week of September more than 2,000 officers and sailors in the Boston area were stricken. There were so many patients at Chelsea Naval Hospital that tents had to be erected on the lawn to handle the overflow. Before it was over, 26 sailors in the Boston area died from the disease. 12
The new epidemic reached the Atlantic Fleet and other shore installations in September. By the end of the month the Great Lakes Training Station near Chicago had nearly 10,000 down with the illness—so many that one sailor estimated half the barracks had been converted into temporary hospital wards. By the beginning of October, some 31,000 sailors, most of them on shore facilities in the states, had been stricken, and more than 1,100 had died. 13
In the war zone, the new and more deadly strain appeared first among the U.S. naval forces in French waters. Inevitably, Brest was battered by the disease. Flu already had ravaged French sailors and civilians in the district. To compound the situation, troopships from Norfolk, Boston, and other U.S. ports debarked thousands of doughboys weekly, many of whom brought the pestilence with them. A sailor on the President Grant (SP-3014) claimed years later that so many died on the transport that members of the crew, when not on watch, were required to prepare the deceased for burial. "I stood my watch in the radio room," he wrote, "and when off watch I turned to and helped sew up some of the dead soldiers till my fingers bled. We used a palm and needle rig to cross-stitch thru the canvas." 14 Marine Brigadier General Smedley Butler wrote his family after arriving at Brest: "We had a hell of a trip over, an epidemic of Spanish influenza breaking out among us…We had at one time fully 500 cases of influenza…I suppose it is one of the awful results of this devilish war…terribly hard to bear, this loss of your men when you can't help them." 15
During the three-month period from 15 September to 15 December, the patient load at the U.S. naval hospital in Brest averaged 800. In the end, more than 2,000 U.S. servicemen died in Brest from influenza. 16
The autumn Spanish Flu epidemic was widespread in Great Britain. In September, 14,000 died. The weekly death tolls mounted steadily, reaching their peak in the last week of October, when the total was 4,000. More than 18,000 died in London alone from September to December. Even the Prime Minister, David Lloyd George, came down with the flu in September. 17
Other than London, the cities hardest hit were the port cities, particularly Liverpool and Southampton. Luckily for the U.S. Navy, few of its personnel were in those cities. The ports that did have large numbers of sailors, however, were not so lucky. The southern Irish town of Queenstown, which had become the largest U.S. naval installation in the British Isles, saw a large number of cases. Throughout October, the number of new cases averaged 25 to 35 daily. When the new naval hospital at Whitepoint opened in late October, 150 patients were admitted immediately, all with the flu. 18
The sailors stationed on the battleships and other naval vessels concentrated near Berehaven in Bantry Bay in southwestern Ireland suffered the most from the epidemic. By the middle of October, a third of the Utah's (BB-31) and Oklahoma's (BB-37) crews were down with the disease. One of the Utah's officers recalled in his oral history that one Sunday in October he went hiking with several officers from the Oklahoma, including the ship's gunnery officer, and a few days later the gunnery officer was dead from the flu. 19 The Nevada (BB-36) experienced few cases until the second week in October, when the number began to escalate. As the ship's history recorded, "The end of the month found us riddled of the disease." A member of the ship's company wrote in his diary on 21 October, "a large percentage of the ship's crew is sick with Spanish Influenza." A few days later he remarked, "The general spirit is gloomy, everyone sees many of his shipmates groping around looking like hooded ghosts…One can tell by the expression on each face that they are battling to their utmost to keep going, for this is the surest way to down the discease [sic]." He also mentioned in his diary that the sick bay line was sometimes 50 or 60 feet long." Altogether, 11 of the Nevada's sailors died. 20
Personnel on the U.S. dreadnoughts attached to the British Grand Fleet, which suffered heavily from the flu, also were affected seriously. There were more than 600 cases on HMS Revenge. The battlecruiser HMS Princess Royal was so devastated that tugs were moored alongside to provide essential services. Some ships had to borrow personnel from sister ships to go on patrol. 21 In the U.S. squadron, according to one former officer, the Arkansas (BB-33) had "in excess of 1,200 cases" of the flu; this was in a total complement of about 1,500 men. "Everybody sick with the flu," a bluejacket on the Arkansas wrote dejectedly in his diary. Admiral Harry W. Hill, in h is oral history, recalled that, "On both the Texas (BB-35) and Wyoming (BB-32), we had more than half our [crews] incapacitated at one time or another. They were so numerous they couldn't be handled in sick bay, and had to be taken care of in special areas set up in various places in the ship." 22 Admiral John McCrea, who was on the New York (BB-34) at the time, said in his oral history that, "We had a hell of a time with it. We lost something around 14 or 15 people, including a couple of officers…There were 10 officers…whose rooms were forward of the wardroom. I was one of the 10…and I was the only one in that part of the ship [who] didn't have the flu."
When the Grand Fleet had to sortie once during the epidemic, several British warships did not have enough healthy men to get under way. All of the U.S. battleships, however, managed to join the fleet as it steamed out of the Firth of Forth. Fortunately, it was a false alarm; morale in the German High Seas Fleet had deteriorated to the point that it was unable to go to sea. Admiral McCrea recalled that if the German fleet had come out at that time, "the result could have been disastrous for the Grand Fleet…[The epidemic] was bad, bad , I can tell you." 23
Despite the large number of personnel in the squadron stricken with the flu, there were very few fatalities on the U.S. dreadnoughts—fewer than 30.
Of all the U.S. naval vessels affected by the epidemic, the one most savaged by it—the cruiser Pittsburgh (CAA)—was not in the war zone. While visiting Rio de Janeiro, her crew became so crippled by the disease that the ship could not sail. About 80% of her crew was affected, and 58 died, the most in any Navy ship. 24
Admiral Sims, the European naval force commander, became increasingly concerned about the severity of the fall outbreak of influenza. In early October he cabled the Navy Department that "there is no doubt that this [epidemic] is now a greater danger to people on ship-board than the Submarine is." He appealed to Chief of Naval Operations Admiral William S. Benson to send two hosp ital ships to European waters immediately. He also strongly urged Washington officials to reduce significantly the number of troops—up to 50%—per transport. "Many deaths," Admiral Sims wrote, "have occurred and many more expected. Immediate drastic measures should be adopted to avoid serious loss of life…[and] official public outcry and possible investigation by Congress." 25
By and large, it was left to individual commanding officers and medical personnel to handle the crisis. Unfortunately, there were few guidelines and even fewer effective medicines. Vaccines were virtually unknown in the days before antibiotics. Ingeneral, doctors relied on fresh air, bed rest, simplified diet, and quarantine. Quinine, aspirin, and whiskey were the most common drugs used to treat victims. Preventatives from coffee to throat and nose sprays were tried on most ships. One ship's surgeon, however, advised the Bureau of Medicine and Surgery that "the less medicine given by mouth," the better the chance of recovery. After the epidemic, the bureau concluded that quarantine was the most effective preventative. 26
The pandemic lingered on into 1919 before finally disappearing. The Navy, one authority claimed, kept more accurate records than did the U.S. Public Health Service concerning civilian cases. He concluded that at least 40% of the Navy's personnel had the flu. This may well have been a conservative estimate, since an undetermined number of ill sailors evidently did not report to sick bay. According to records, 5,027 Navy personnel died from influenza or complications. This was more than twice as many as those who died from enemy action. 27
The Navy was heavily affected by the pandemic. Crews were decimated, ships were delayed in sailing, and medical facilities were taxed, but as one surgeon wrote, "We can't stop this War on account of Spanish or any other kind of influenza." 28 Navy veterans of the Great War never forgot the pandemic. Inmemoirs and oral histories, they recalled the suffering and dying. "What do you recall thinking and experiencing at the time?" asked one historian. "Mostly flu," the sailor replied. "Men were dying every day." 29
Dr. Still is an adjunct researcher with the Marine Option Program at the University of Hawaii at Manoa. This article is part of a manuscript that will be published as a sequel to his American Sea Power in the Old World: The United States Navy in European and Near Eastern Waters, 1865-1917 (Westport, CT: Greenwood, 1980).
1 West Hawaii Today. 16 February 1999. See also Laurie Garrett, The Coming Plague (New York: Farrar, Straus and Giroux, 1994), pp. 156· 159. For the epidemic, see Richard Collier, The Plague of the Spanish Lady: The Influenza Pandemic of 191 8· 1919 (New York: Atheneum, 1974); A. A. Hoehling, The Great Epidemic (Boston: Little, Brown, 1961); Alfred W. Crosby, Epidemic and Peace, 1918 (Westport, CT: Greenwood Press, 1976); Trevor Wilson, The Myriad Faces of War: Britain and the Great War, 1914-1918 (New York: B. Blackwell, 1986); and Josie Mabel Brown, "The Influenza Epidemic of 1918," U.S. Navy Medicine, May-June 1995, pp. 11-19.
2 Crosby, Epidemic and Peace, p. 205.
3 Garrett, The Coming Plague, p. 157; Crosby, Epidemic and Peace, pp. 206-207.
4 Quoted in Edward M. Coffman, The War to End All Wars: The American Military Experience in World War I (New York: Oxford University Press, 1968), p. 82.
5 Coffman, The War to End All Wars, p. 83; Crosby, Epidemic and Peace, p. 205.
6 Quoted in Crosby, Epidemic and Peace, p. 121.
7 Crosby, Epidemic and Peace, p. 31; Sims to Wilson, 8 October 1918, reel 10, ME-11, National Archives; Commanding Officer, USS North Carolina, to Sims, 4 October 191 8, reel 10, ME-11, National Archives.
8 Annual Report of Surgeon General (Washington, DC: Government Printing Office, 1919) , pp. 367·368; Richard E. Winslow, Do Your Job! An Illustrated Bicentennial History of the Portsmouth Naval Shipyard, 1800-2000 (Portsmouth, NH: Portsmouth Marine Society, 2000), p. 118.
9 Talley to wife, 8 July 1918, Talley letters, Naval Historical Center; Lawrence to Kate. 18 November 1918, Lawrence papers, Wisconsin Historical Society; Robert W. Meals, "The Air Station at Dunkirk," The Hospital Corps of the Navy, Supplement to the United States Navy Medical Bulletin, January 1920, pp. 12·13.
10 Thomson to Braisted, 26 July 191 8, file 2127046, Record Group 52, National Archives.
11 Wilson, The Myriad Faces of War, p. 650; John Williams, The Home Fronts: Britain, France and Germany, 1914-1918 (London: Constable, 1972), p. 258; Hoehling, The Great Epidemic, p. 21; Crosby, Epidemic and Peace, p. 30.
12 Annual Report of the Secretary of the Navy (Washington, DC: Government Printing Office, 1919), p. 2246; Debra Sanderson, "The Worst Disaster in Recorded History," Old Fanner's Almanac, 1993, p. 114; The Portsmouth Herald, 17 September and 1 October 1918.
13 Crosby, Epidemic and Peace, p. 48.
14 Alex Breth statement, World War I Research Project, American Military History Institute .
15 Anne Cipriano Venzon, ed., General Smedley Darlington Butler: The Letters of a Leatherneck, pp. 205-206.
16 Army and Navy Journal, vol. 56 (1918), p. 979.
17 Hoehling, The Great Epidemic, p. 187; Williams, The Home Fronts , pp. 258-259; Wilson, The Myriad Faces of War, pp. 650-651.
18 Destroyer Flotilla Queenstown, 12 March 1919, ZP subject file, Record Group 45, National Archives; Force Medical Officer to Sims, 1 November 1918, file 125135, Record Group 52, National Archives; Flotilla Surgeon's reports, 12 October 1918, file 131000, Record Group 52, National Archives; Force Medical Officer to Bureau of Medicine and Surgery, 26 October 1918, file 130212, Record Group 52, National Archives.
19 Oklahoma General Recall, vol. 4, no. 3, September 1977; Joe L. Todd, USS Oklahoma: Remembrance of a Great Lady, p. 20; Olaf M. Hustvedt Oral History, U.S. Naval Institute.
20 Rodgers to Sims, 26 October 1918, OB subject file, Record Group 45, National Archives; Guy Rickett's Diary and Memoir, Smithsonian Institution.
21 John McCrea Oral History, U.S. Naval Institute; Eric Wheler Bush, Bless Our Ship (London: Allen & Unwin, 1958), p. 82.
22 Harry Hill Oral History, U.S. Naval Institute; Straubat to Anderson, 1 December 1977, in World War I Research Project, American Military History Institute; Entry for 24 October 1918, Presspick Diary, author's copy; Memo for Surgeon General, 6 October 1918, file 130212, Record Group 52, National Archives.
23 Allan E. Smith, "The Sixth Battle Squadron, A Reminiscence," American Neptune, January 1980, p. 57; Bush, Bless Our Ship, p. 82.
24 Crosby, Epidemic and Peace, p. 122.
25 Sims to Navy Department, 5 and 18 October 1918, file 1302 12, Record Group 52, National Archives.
26 Files in Record Group 52 in the National Archives, especially file 130212, contain reports from virtually every ship and station medical officer concerning preventative measures. See also Stars and Stripes , 13 December 19 18; Alexander W. Moffar, Maverick Navy (Middletown, CT: Wesleyan University Press, 1976), pp. 122-123.
27 Annual Report of Surgeon General, p. 354; Coffman, The War to End All Wars, p. 84; Crosby, Epidemic and Peace, p. 206.
28 Quoted in Sanderson, "The Worst Disaster in Recorded History," p. 113.
29 Unidentified sailor's questionnaire, World War I Research Project, American Military History Institute.