The 'Spanish' Influenza Pandemic of 1918

World War I may have ended on November 11, 1918, but the wave of death sweeping the world did not. In 1918 an influenza pandemic, known, however erroneously, as the Spanish flu, spread around the world killing an estimated 50 million people, with most deaths occurring in the lethal second wave of late 1918. In absolute numbers, the Spanish flu is the deadliest pandemic in history.

Caused by a virulent strain of the H1N1 flu virus and aided in its global spread by the movement of troops, the ‘Spanish’ flu was also distinctive because it disproportionately affected young, otherwise healthy individuals. The average age of death was 28, roughly the same average age of death as that of soldiers. Both at home and abroad, nurses were on the front lines of the 1918 influenza pandemic; some paid the ultimate price with their lives.

It is estimated that around 55,000 people died of influenza and influenza-related illnesses in Canada. These deaths were concentrated, for the most part, over a few short weeks in the fall of 1918. Many think that the second wave of influenza came to Canada with injured soldiers returning home from war. In fact, after the Llandovery Castle disaster, Canada no longer transported injured soldiers back to Canada on hospital ships. Indeed, the second wave came to Canada via the United States, with sick soldiers stopping in Canadian port cities such as Halifax and Montreal. Thousands of soldiers were still leaving the United States and Canada to help win the war in Europe!  

In 1918, Canada also mobilized the Siberian Expeditionary Force, a force of about 4000 men who were sent to Russia to prevent Germany from gaining access to Russian oilfields. These men were drawn from bases all over Canada and shipped westward with great secrecy. They, of course, brought influenza with them wherever they stopped. City officials, unaware of the top-secret mobilization, were unprepared for the outbreaks that ensued. 

With outbreaks of illness all over Canada happening almost simultaneously, there was an increased need for nurses and doctors. The nation, however, had a shortage of nurses because so many were serving overseas. Hundreds of women with and without medical training therefore volunteered to serve on the home front as Volunteer Aid Detachment nurses, risking their lives to care for the ill and dying. These nurses helped by giving patients baths and medication, making sure they were hydrated and monitoring their vital signs, among other things.

There was no cure for influenza and antibiotics, which would have been able to treat the pneumonia that often accompanied it, had not been discovered yet. The most effective treatment and the best predictor for a positive patient outcome was support and care from a skilled nursing staff. 

That does not mean that scientists, doctors and others did not try to find a cure.  In fact, “cures” for influenza abounded, though they were at best ineffective and at worst, dangerous. There was very little regulation over the pharmaceutical industry in 1918 and numerous companies tried to turn the pandemic into a money-making opportunity, quickly marketing ‘preventive treatments’ and ‘cures.’ Most were benign, but some caused serious side effects if taken in large quantities.

Doctors also prescribed dangerously high doses of aspirin, and experimented with mercury, arsenic and strychnine (all of which are poisonous). 

Around the world, doctors and public health officials relied on non-pharmaceutical interventions to prevent the spread of illness. Frequent non-pharmaceutical measures included closing schools, theatres and places of worship, quarantining ports, setting up isolation wards and advising the public to avoid crowds, to keep their windows open and to wash their hands. Some places also recommended wearing a gauze mask.

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