Spanish Flu Pandemic And Healthcare Development

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This investigation will be on the topic of the Spanish Influenza Pandemic of 1918. This virus spread across the Americas and Europe, leaving a path of destruction behind it. The question that will be investigated is: How did the Spanish Influenza Pandemic of 1918 aid in the development of healthcare methods and plans, and what were the outcomes? In order to answer this question, two main sources were used. The first of these two sources is a report completed completed by the Division of Sanitation that served as a directive. It came from Washington D.C, in the United States and was dated September 26, 1918.

This is a primary source, which makes it very useful in this investigation. The source includes a list of precautions which were to be taken during the time of the pandemic in order to help the public avoid infection. This source is very valuable because it is from the year the Spanish Influenza Pandemic was at its worse and it demonstrates the current preventative methods that were in use. However, this source is also limited to region because it is from the United States. This pandemic occurred in other regions of the Americas, including Canada and Mexico, and also affected people in Europe. Therefore, this source is limited only to provide information on the preventative measures undertaken by the United States. The second main source is titled “Lessons Learned from the 1918-1919 Influenza Pandemic in Minneapolis and St. Paul, Minnesota” and was written by Miles Ott AB, Shelly F. Shaw MPH, Richard N. Danila PhD MPH, and Ruth Lynfield MD. It was completed in November and December of 2007 and was published by the Association of Schools of Public Health. This source describes different systems created by two neighbouring United States cities in regards to the Spanish Influenza outbreak, sharing both their successes and failures. The source describes the medical resources, the response of the public, the infection control, and the communications that each city used, and analyzed which parts of each plan were the most successful. This source also proposed a plan for how cities could better handle future Influenza outbreaks. This source is limited because it only provides information about cities located in the United States. This source also may be limited because it was written in 2007,which is almost one hundred years after the pandemic took place, so it is not a primary source. Both this source and the first source provide specific insights into the preventative measures that were taken during the Spanish Influenza Pandemic of 1918, specifically in the United States, and they help in answering the question, “How has the Spanish Influenza Pandemic of 1918 aided in the development of beneficial healthcare methods and plans, and what were the outcomes?

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The Spanish Influenza was a virus which caused widespread panic during the 20th Century; the rapid spreading, lack of proper sanitation, and wartime conditions provided this virus with the perfect environment to spread, eventually leading to the deaths of about 20 to 40 million people. Although tragic, this pandemic led to developments in sanitation and other preventative measures. It allowed for the creation of city-wide outbreak plans, communication plans for educating the public, the discovery of new sanitation techniques, and eventually a vaccine for the influenza virus, and greatly helped in the development of future vaccines and sanitation plans. The Spanish Influenza pandemic in the United States occurred in three main stages: from 1918 to 1919, from 1957 to 1958, and from 1968 to 1969, but this paper will primarily focus on the first outbreak from 1918 to 1919, during World War One. Due to the war, a majority of people in the medical profession were stationed overseas, leaving the country with a limited supply of doctors and nurses. According to one source titled Lessons Learned from the 1918-1919 Influenza Pandemic in Minneapolis and St. Paul, Minnesota, “In St. Paul, a system was set up between St. John’s Hospital and other hospitals to insure an adequate number of nurses to care for influenza patients.” Although this was a good idea, it failed due to communication issues.

This problem, and the problem of protecting nurses and doctors working with influenza patients from becoming infected, caused a large deficit in the number of medical workers. The soldiers in the war were also largely affected by the pandemic. Soldiers stationed both overseas and in the United States were extremely prone to infection due to their close living quarters, which allowed the virus to flourish and infect entire camps. One soldier, Martin Aloysius Culhane,was stationed at Camp Forrest in Georgia and wrote letters during the Spanish Influenza outbreak of 1918. In one of his letters he wrote, “Since noon today our camp has been under quarantine to prevent an epidemic of Spanish Influenza. We have had no cases thus far but it is the intention of the medical officers to prevent any case of the disease from making an appearance. All the men who have even slight colds have been put into separate barracks…” Another letter Culhane wrote which was dated the same day read, “Well, the Spanish Influenza has made an appearance here and we are under strict orders no visits to Chattanooga, we are certainly the hard luck guys when it comes to this quarantine proposition.” These excerpts from Culhane’s letters help to demonstrate how quickly the soldiers were affected by the Spanish Influenza and the different techniques that were used to prevent infection, which mostly consisted of isolation of the sick. Another place that allowed the Spanish Influenza virus to flourish were larger cities such as New York City, Boston, and Philadelphia. New York City in 1918 was no stranger to disease, as they had recently had an outbreak of tuberculosis, which helped them become more prepared when the Spanish Influenza began to spread. Many measures were already in place, which helped in developing new and improved prevention strategies. One of these strategies included the mandated staggering of business hours to help avoid overcrowding in public spaces, the establishment of over one-hundred emergency health centers, and other mandatory and voluntary measures. These techniques helped New York City immensely and, according to one source, “New York City’s excess death rate per 1,000 was reportedly 4.7, compared with 6.5 in Boston and 7.3 in Philadelphia.” Another way New York City and other cities throughout the nation tried to protect people from the flu were with posters. These posters could be found hung up all around the cities and usually warned people to cover their mouths when coughing and discouraged people from sharing drinks. These sign served to educate the public about the virus and the way it spreads.

Another way the government attempted to educate the public was through directives provided by the Division of Sanitation. These directives provided detailed lists of instructions to follow, including warnings to avoid crowds and suggestions to eat healthy, drink water, and get fresh air. One directive, which is being used as a primary sources for this paper, even provided people with a list of symptoms to be aware of. These symptoms included, “...chilliness, severe headaches, and “aching all over.” At times the disease begins with nausea, vomiting, and abdominal pain. Fever begins early.” This directive helped educate the public about what steps they should take to prevent infection or what to do in order to combat the virus. Preventative measures in New York City were very similar to preventative measures taken in other cities within the United States. One source illustrates the plans that were undertaken from cities such as St. Paul and Minneapolis, and how those two plans differed. Some doctors during the outbreak believed that the best option was to close public places, but others believed that isolating each case would be more effective. Doctors in St. Paul, Minnesota agreed with the aforementioned plan and decided to close the whole city on November 6, 1918. This closing order included schools, theatres, churches, and dance halls, and helped decrease the number of new influenza cases. However, because the closings were announced before being put into effect, people rushed to theatres and dance halls to enjoy one more night and created the overcrowding that the city meant to avoid. Streetcar regulations were also put into effect, including rules mandating that windows must be open to keep fresh air flowing and that the number of passengers in one car could not exceed 84. Other ways the public attempted to fight the spread of infection was through the use of gauze masks, the introduction of new sanitation laws that required dishes and cups in restaurants to be sterilized, and with the deployment of vaccination campaigns. Communication during this time of widespread infection was crucial, especially when it came to educating the public. According to one source, “postal workers, boy scouts, and teachers were enlisted to provide educational materials to the public and to teach health precautions.”

Teachers who had no jobs due to the closing of the schools helped by canvassing neighborhoods in search of people who needed medical attention, and even encouraged St. Paul to open a public kitchen, city health departments, and emergency hospitals. Communication was not always successful; the communication between doctors and city health departments, then to the newspapers left much room for possible falsification or errors. Also, the method of isolation that some cities used was not very success because people may have been afraid of seeking help due to fear of isolation. How has the Spanish Influenza Pandemic of 1918 aided in the development of beneficial healthcare methods and plans, and what were the outcomes? During the Spanish Influenza Outbreak of 1918 to 1919, different cities in the United States created plans and strategies that sometimes helped control the spread of the virus. Some of the techniques included directives and posters to inform the public, closing regulations that either mandated that open times be staggered or completely closing some theatres, schools, and dance halls, and streetcar regulations to prevent large crowds. These plans helped pave the way for improvements and helped federal and state governments create plans that would help more in a health crisis. One source said that, “of primary importance is developing a plan ahead of time that incorporates all levels of government health infrastructure and describes clear lines of responsibilities and roles. Plans for surge capacity and community containment must be discussed with stakeholders and consensus must be achieved,” and this realization allowed for the introduction of clear government plans that would be followed in the case of another outbreak. Another realization made by the source Lessons Learned from the 1918-1919 Influenza Pandemic in Minneapolis and St. Paul, Minnesota is that, “approaches and plans should be based on scientific data whenever possible, and include input from ethicists.” This led to an increased focus on scientific data and research, especially vaccine research. Better techniques were developed in labs, which increased experimentation. One source titled Influenza Vaccine History stated that, “with growing information on the virus, a governmental infrastructure was created both nationally and internationally for the monitoring of viral strains, production and testing of vaccines, and the release of recommendations concerning which population groups need to be vaccinated.” New guidelines were now created to help the research being done and to help research for future vaccines. The Spanish Influenza Pandemic of 1918 to 1919 was a tragic time in the United States, but the lessons learned during this time in terms of prevention, sanitation, and vaccine research helped make it easier to fight viral infections in the future.


To conduct research for this paper, it was necessary to take on the role of a historian. Historians must work very hard to find sources that are relevant to their topics and contain reliable information. One investigation I used is known as a heuristic investigation, which is the “identification of relevant sources.” This method is limited because it requires historians to define what is meant by a relevant source. Other challenges historians have to face are determining whether or not sources are reliable. One source has only a single-perspective, meaning there is always the possibility for a source to favor one side or exaggerate. There is always a dominant narrative in history, and other perspectives are usually avoided. History also usually only includes the highlights of the past, and historians must decide what the true story is. These highlights of the past are the events that we believe are the most relevant and necessary to learn, but the act of choosing which events can be difficult and can exclude parts of history that show mistakes and bad judgements. For this topic specifically, it was difficult to find primary sources that were relevant to the topic of preventative methods because most sources were written later on. However, by using the techniques of historians I was able to determine which sources were relevant and reliable.

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