The 1918-1919 influenza pandemic in the United States: lessons learned and challenges exposed.

Few have described the influenza pandemic of 1918–1919 better than Dr. Victor Clarence Vaughan, the portly dean of the University of Michigan Medical School and advisor to the U.S. Surgeon General during World War I. In early September 1918, upon surveying the destruction wrought not from bullets but rather from microbes at a military camp outside of Boston, Vaughan bemoaned that influenza had “. . . encircled the world, visited the remotest corners, taking toll of the most robust, sparing neither soldier nor civilian, and flaunting its red flag in the face of science.”1 Striding between the crowded, makeshift hospital wards and the overflowing morgue, Vaughan anxiously recorded that bodies were being stacked about “like cordwood.” Vaughan’s macabre image of the alarming and accelerating loss of thousands of young soldiers in the prime of their lives foreshadowed the overwhelming sickness and death that would engulf the globe in the fall of 1918, as the deadliest wave of this contagious calamity took its harrowing toll. After the pandemic subsided in the winter of 1920, at least 50 million people had died worldwide, including approximately 550,000 in the United States. It reached its height during the final months of “the war to end all wars,” which mobilized tens of millions of young men to the European theater of battle. Moreover, it appeared at a time when public health had made tremendous advances thanks to a combination of sanitarian campaigns and bacteriological science, but several decades before the viral etiology of influenza had been determined. When influenza appeared in the United States in 1918, Americans responded to the incursion of disease with measures used since Antiquity, such as quarantines and social distancing. During the pandemic’s zenith, many cities shut down essential services. Public health professionals on the home front, including many volunteer nurses, deployed their limited medical armamentarium as they tirelessly tended to the ill and attempted to contain the spread of disease. Across the nation, hundreds of thousands of personal tragedies unfolded and irrevocably changed the lives of those who survived. Children were orphaned, a disproportionate number of young adults died, and for a brief period fear, suspicion, and panic prevailed. Yet even in this trying context, the historical record reveals that many Americans responded courageously during the crisis. Historians and journalists have long been interested in this dramatic chapter in American life and have produced an impressive body of books, articles, and multimedia on this topic. The memory of the 1918 pandemic has also left a lasting mark on public health policy, planning, and practice. Indeed, for each influenza pandemic that followed in its wake—in 1957, 1968, and most recently in 2009, as well as during the swine flu scare of 1976—the events of 1918 have served both as a reference point and as a severe if not “worst-case” scenario. Even with a growing literature on the historical, epidemiological, and public health aspects of the 1918 influenza pandemic in the United States, significant DIGITAL ARCHIVE