Nurse wearing a mask at water pump 1918
A nurse draws water from a pump during the height of the deadly flu epidemic of 1918.

In recent weeks, headlines about the new coronavirus have grown more alarming as it accelerates and spreads in ways not fully understood. From its epicenter in Wuhan, China, this rapidly moving epidemic has sickened tens of thousands of people, with a death toll that now exceeds 1,300.

The virus’s unchecked spread, the fear of contagion, and the increasingly strict measures to try to contain it, recall the influenza epidemic of a century ago. That, too, was a global health emergency, and it was nurses who provided the front-line response.

"Victims came on stretchers … their faces and nails as blue as huckleberries.”

Student nurse in New York City

During the 1918 pandemic, survival often boiled down to just one thing: skilled nursing care. There were no antiviral medications to inhibit its progression, no antibiotics to treat the complicating pneumonia that often followed. The care was basic:  nurses put patients to bed, covered them with blankets, and opened windows for fresh air. Following medical orders, or relying on their own nursing expertise and making do with what they had on hand, they administered ice packs and aspirin to reduce fever, Listerine gargles for sore throats, and mustard plasters and cough syrups to alleviate lung congestion. Nurses also dispensed Vick’s vapor rub, whiskey, and hot soup.

In some cases, nurses were the first and only ones giving this care. Lillian Wald, director of the Henry Street Settlement in New York City, recalled a situation in upper Harlem where the mother had flu, the father had lobar pneumonia, two children had measles, and one child was only four weeks old. The family “had been without care of any kind until the case was reported to the visiting nurse,” she said, adding “This is a situation duplicated in hundreds of homes.”

The timing could not have been worse. The Great War had created a severe civilian nursing shortage: 9,000 trained white nurses were sent overseas and thousands more were assigned to U.S. military camps. Intensifying the crisis was the fact that the nursing profession failed to fully enlist African American nurses.

Within days of the flu’s onset, civilian hospitals overflowed. One student nurse in New York City recalled: “Care was mainly supportive: we gave heart and respiratory stimulants, or sedation as the condition dictated … camphor in oil and caffeine by hypo [hypodermic injection] were in constant use, and we were forever balancing the advantages of forcing fluids against the disadvantages of edema, as kidneys or hearts became overtaxed and the lungs showed congestion … Victims came on stretchers … their faces and nails as blue as huckleberries.”

In Chicago, Commissioner of Health John Dill Robertson commanded “every victim … to go to his home and stay there.” Mandatory home quarantine only increased the demand for nurses. Making their rounds, nurses encountered entire households undone by the flu; feeding the family became a twin priority with caring for the sick. When parents died, it fell to the nurse to place the orphaned children.

Nurses collapsed from overwork. During the course of the epidemic, hundreds of nurses became ill themselves and many died. But in first-hand accounts, their hardships and exhaustion are often treated as a footnote.

In the segregated South, for instance, African American nurses worked without support from the local white community or help from the outside. Local Red Cross chapters set up separate emergency hospitals for African Americans and put out a special call for black nurses, but in rural areas where there was no hospital--and white nurses refused to care for blacks--the situation was dire. Nurse Bessie B. Hawse recounted her experience in Alabama: “As I entered the little country cabin I found the mother dead in bed. Three children buried the week before. The father and remainder of the family [were] running temperatures of 102-104. Some had influenza; others had pneumonia … I rolled up my sleeves and killed chickens and began to cook …  I milked the cow, gave medicine, and did everything I could to help…”

All told, the influenza pandemic of 1918 killed more than 50 million people worldwide; 675,000 in the United States alone. 

This Flashback Friday is brought to you by the BjoringCenter for Nursing Historical Inquiry, with special thanks to UVA professor emerita and AAHN president Arlene Keeling. This material is drawn from her book, A HISTORY OF PROFESSIONAL NURSING (Springer: 2018) and from her article “Alert to the Necessities of the Emergency: U.S. Nursing During the 1918 Influenza Pandemic,” in Public Health Reports, 2010 Supplement 3, Volume 125. All photos are courtesy of the National Library of Medicine.