In 1918 the American Red Cross became a principal player in one of the largest and deadliest disease outbreaks in recorded history. In the fall of 1918 as World War I was drawing to a close, a deadly flu virus began infecting large numbers of people the world over and leaving millions of dead and dying in its wake. The total number of deaths attributed to the 1918 flu varies, from 540,000 dead in the United States to more than 675,000. A conservative estimate given by historians puts the world-wide death-toll at 21 million. Dubbed the "Spanish Flu" because during World War I neutral Spain had not censored its newspapers that reported the outbreak the strain was highly contagious and had a mortality rate of 2.5% compared to earlier flu viruses with rates around or less than 0.1%. The pandemic hit in two phases: the first phase began in the fall of 1918 and the second in the spring of 1919. By the time hostilities of World War I ended, more U.S. soldiers had died of the influenza virus than from combat-related injuries. more...
The Red Cross National Committee on Influenza
When it became apparent the influenza outbreak had reached the scale of a pandemic, the Red Cross national headquarters appointed a committee to coordinate its national response, which included:
W. Frank Persons-American Red Cross Director of Civilian Relief, Chairman
C.H. Blair-Assistant to Director General, Military Relief
Jane A. Delano, Director, American Red Cross Department of Nursing
Alfred E. Shipley, M.D.-Director, American Red Cross Medical Service
Frank C. Letts-Director, Department of Supplies
Taliaferro Clark, M.D.-Director of Bureau of Sanitary Service, Department of Military Relief
On October 1, 1918 the Surgeon General of the United States, Rupert Blue outlined a plan of action for the newly formed committee as follows:
Assume charge of supplying all the needed nursing personnel, and pay their salary and other expenses connected with the detail of such personnel for work during the present epidemic.
Furnish emergency supplies, when it is found that local authorities are unable to furnish such supplies with promptness required by existing circumstances.
Two days later, the Red Cross National Committee on Influenza drew up plans in collaboration with the United States Public Health Service for fighting the pandemic that included:
Supplying needed nursing personnel, and their salaries and other expenses
Furnishing emergency hospital supplies when local authorities were unable to
Allowing the U.S. Public Health Service to conduct all necessary dealings with state and local boards of health concerning the allocation of resources and personnel
Mobilizing all needed doctors through the U. S. Public Health Service
Distributing official statements issued by the U. S. Public Health Service concerning prevention and of treatment for this disease
Mobilizing Nursing Service
The Red Cross received its first urgent request for trained nurses from the U.S. Public Health Service for a quarantine station in Boston Harbor on September 14, 1918. As the influenza spread through the rest of the country the requests for trained medical help surpassed the supply. Part of the reason for the shortage was due to the fact that so many medical personnel had been recruited by the armed forces for duty overseas. In addition, the disease spread faster than any other outbreak experienced before.
Soon a national strategy for dealing with this medical crisis was coordinated between the Red Cross, U. S. Public Health Service and the armed forces, which included the U.S. Surgeon General making the Red Cross responsible for the recruiting of nursing personnel and the needed supplies. Red Cross national headquarters allotted $575,000 for the task and began recruiting nurses and others with medical training to assist in handling the alarming number of influenza cases.
From September 14 to November 7, 1918 the Red Cross recruited a total of 15,000 women, including regularly enrolled nurses, student nurses, practical nurses, nurse's aides and other women who had taken the Red Cross Home Hygiene course. Despite the high risks of infection and death, these women stepped forward to serve in military camps and hospitals, troop ships, civilian hospitals and the homes of infected civilians in cities, towns and rural areas across the United States. A total of 223 nurses and five dieticians are known to have died while providing humanitarian aid and service to flu victims.
By the spring of 1919 the Red Cross expended more than 2 million dollars for its services during the pandemic.
I am writing by fits and starts, as I can snatch a minute off to jot down our needs, hoping that the situation might be clear to you, and that you will be able to get us some supplies before we get snowed in for the winter. Our greatest need (next to fruit and malted milk) is feeding cups and drinking tubes, which we can't get at Winnemucca (the nearest town). We also need lots of gauze or cheese cloth and cotton for pneumonia jackets; also rubber sheeting, and quantities of old rags to be used and burned also gallons of formaldehyde if we are to stamp out the disease as everything is thrown on the ground, and will thaw out next spring and release all these germs again.
Red Cross influenza nurse-Denio, Oregon, 1918
Mobilizing Red Cross Chapters
Each Red Cross chapter was instructed to immediately organize its own committee on influenza, consisting where possible of the chapter chairman; a leading physician; a representative from the local Red Cross Nursing Service, the chairman of the chapter Committee on Nursing Activities; the chairman of the Home Service Section among others. Working with the local public health officer the chapter committee would make a survey of available nursing staff and hospital supplies in its area and mobilize them into makeshift influenza wards and the homes of the afflicted when the epidemic hit the community.
Relief for the Armed Forces
During World War I thousands of men were drafted and sent to temporary camps called "cantonments" before they were shipped overseas. At the cantonments conditions were often crowded and the medical facilities were rudimentary at best.
During the influenza pandemic of 1918, some of the highest infection and mortality rates could be found in these military camps where the close quarters proved a fertile breeding ground for the virus. In order to convert the men's barracks into temporary hospital wards the Red Cross stepped into the breach with badly needed supplies acquired through its Camp Service division. Bedding, masks, dishes, kitchen utensils, mops and brushes were purchased and turned over to the military. Hundreds of additional nurses were also recruited and supplied to the military for the emergency.
At Camp Dodge, Iowa there were 245 nurses on duty on October 10, 1918. Six days later the number of nurses had increased to 598. This mass deployment of nurses was repeated throughout the military during the crisis. An October 1918 Red Cross Bulletin, reported that "four out of every 1,000 troops under arms in this country died" of influenza.
I must lean heavily upon the Red Cross, and I am afraid the demands in this matter will tax your resources and endurance. Eventually the War Department will meet the requirements, but the emergency must be met by you.
Major Burch, base hospital commander-Camp Dodge, Iowa, 1918
Civilian Relief
Like the sailors and soldiers, civilians from all walks of life also succumbed to influenza in astonishing numbers. On November 2, 1918, the U.S. Public Health Service reported 115,000 deaths from influenza and pneumonia. The American Red Cross quickly supplied and staffed improvised influenza wards in any available community building: schools, armories, railroad stations and country clubs were all pressed into service for this unprecedented medical emergency. Canteens were also set up to feed people who could not receive food at home because of illness in the family. The newly formed Red Cross Motor Corps (established 1917) became indispensable, transporting nurses, doctors and patients and supplies to and from the influenza wards. The Motor Corps consisted almost entirely of women volunteers, most of whom used their own cars.
Conclusion
The speed and indiscriminate severity of the influenza pandemic of 1918 was unlike any viral outbreak the world had ever known. Both the healthy and the sick and wounded fell victim and there was no vaccine to combat it. Yet with limited resources and medical technology, the American Red Cross responded to the crisis in record time supplying not only nurses and health care professionals but a whole system of logistical support that saved many lives during the pandemic.
This article was compiled in part through reference material and collections found at the Hazel Braugh Records Center and Archives, the official repository of the American Red Cross national headquarters.
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