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

Isolated cases of the "Spanish Flu" occurred in early January 1918, but the first major waveof 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 1918–1920influenza 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  /www.cdc.gov/flu/pandemic-resources/reconstruction-1918-virus.html#discovering">tissue samples from Brevig Mission's influenza victims  ebabled 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 /www.census.gov/history/pdf/leopoldkahn1910.pdf">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 /www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet">$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.     
An influenza ward at Camp Funston, KS, in 1918, is reminiscent of the temporary COVID-19 hospitals established in the United States in 2020 and 2021.  The U.S. Army training camp atFort Riley, KS, was just a few hundred miles east of Haskell County, KS, where doctors may have identified the first "Spanish Flu" cases in January 1918.The influenza virus spread rapidly among soldiers living on U.S. bases and fighting overseas in World War I.  Infected soldiers easily transmitted the virus to the civilian population.  Between1918 and 1920, waves of influenza killed 675,000 Americans and 50 to 100 million people worldwide.Photo courtesy of the U.S. Army.
        Did you know?   U.S. Census Bureau alumni, surgeon, and hygienist  John Shaw Billings  conducted pioneering  vital statistics  research during the 1880 and 1890 Censuses.    During that time, he encouraged former Census Bureau employee and inventor  Herman Hollerith  to pursue his idea for the  mechanical tabulation  of data.    Billings later developed  Johns Hopkins University's  medical curriculum, founded the  National Library of Medicine , designed the New York City Public Library's main building, and created the library's cataloging system.        View larger image  Mortality Statistics   The U.S. Census Bureau collected mortality data during the 1850, 1860, 1870 and 1880 Censuses.When census takers collected population data, they also asked if any family members died in the year prior to the census.  If "yes," they recorded the deceased person's name, age, sex, race, marital status, occupation, parents' place of birth, length of U.S. residency, month of death, disease or cause of death, place where disease was contracted, and attending physician's name.The 1850 data showed that "zymotic" diseases like diphtheria and typhus killed 323,023 in 1850.  By 1860, the majority of reported deaths were from "consumption" (49,082), pneumonia (27,094), and scarlet fever (26,402).The number of statistical tables grew in 1870 to include data arranged by age, sex and race, and special tabulations for the foreign-born, Chinese, and Indian populations. In 1880, mortality data filled two volumes.  Tables for the nation, states, and 50 principal cities presented data for the White and "Colored" populations, plus  detailed cause of death and age data for the Chinese, IndianIrish, and German populations.Data on the cause of death ranged from common diseases like consumption (90,270) and diphtheria (38,143) to rarer maladies like leprosy (16), parasitic infection (25), and lead poisoning (30).Photo courtesy of the National Archives and Records Administration.                                          View larger image    This Month in Census History   On  March 1, 1790 , President George Washington signed the  1790 Census Act  into law.    The new nation's first census was taken as of the first Monday in August (August 2), 1790.    Approximately 650 U.S. marshals and their assistants used hand-printed schedules on which they collected the  name of the head of each family  and the number of people in each household by age, sex, and race in the 13 states, the districts of Kentucky, Maine, and Vermont, and the Southwest Territory.    Upon completing the census, marshals sent the data they collected about the  3,929,214  people living in the United States to Secretary of State  Thomas Jefferson .    These data showed that the state of Virginia had the largest total population with  747,610 , including  292,627 slaves  (more than 39 percent of its total population).  The state of Pennsylvania followed with 434,373 inhabitants, including 3,737 slaves.    Just  five cities  in the United States had populations exceeding 10,000 people: New York City, NY (33,131); Philadelphia, PA (28,522); Boston, MA (18,320), Charleston, SC (16,359); and Baltimore, MD (13,503).    Photo courtesy of the U.S. Department of Education.                                      **Visit *https://www.census.gov/history* every month for the latest Census History Home Page!**                                [an error occurred while processing this directive]  This symbol  indicates a link to a non-government web site.  Our linking to these sites does not constitute an endorsement of any products, services or the information found on them. Once you link to another site you are subject to the policies of the new site.           CONNECT WITH US**********- Information Quality
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