A review of PBS's “Influenza 1918” (American Experience)

“I had a little bird
Whose name was Enza,
I opened the door
and ‘in-flew-Enza.’ ”

– A popular ditty sung by children, at the time that the deadly epidemic was still going on

Two-thirds of a million Americans died from a deadly influenza strain called “Spanish flu” …

In the United States, more than two-thirds of a million Americans died in an influenza epidemic in 1918 – a particularly deadly strain of it that Americans call the “Spanish flu.” This is more American deaths than from all of the wars of the twentieth century combined. As a percentage of our population, we didn't lose as many people in World War One as many of the other nations did. For some other nations, World War One was actually more devastating than the flu epidemic. But the Spanish flu (not to be confused with common flu) was a worldwide epidemic, and killed comparable percentages of the population in many other nations. Nonetheless, this documentary focuses on the United States, as you might expect from a series calling itself “American Experience.” They show the full horrors of the Spanish flu epidemic, and bring them to life for a generation that have seldom heard of them.

Ironically, the hardest-hit group was actually young adults (including many soldiers) …

The film is less than an hour long, but is nonetheless quite good. The film has the brilliant narration of Linda Hunt, and uses real photographs and footage from the time. The epidemic actually lasted until late 1920, but this documentary focuses on the earliest portion of it. Their argument is that it started in Kansas with a group of American soldiers, but soon spread to many other parts of society (including civilians). Most diseases disproportionately affect the very young and the very old. But ironically, the group most affected by the Spanish flu was young adults, with the hardest-hit group being from ages 21 to 29. The disease was spread by breathing, which may have been why people were required to wear masks for a time. One man was actually shot for refusing to wear a mask. But the masks were actually useless against the disease (unknown to the people of that time), because the masks were porous, and the germs could easily get in despite them. People attempted to institute quarantines, but to no avail. They could not always avoid coming into contact with the disease, and sometimes got the disease anyway despite their best efforts.

Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston

Street car conductor refusing to allow passengers aboard who are not wearing masks – Seattle, 1918

The best medical science of the time was unable to stop it, or even to see it under a microscope …

At the time, there were autopsies of some of the influenza victims, which revealed that they had essentially drowned from having their own fluids enter their lungs. Even when they had died in dry hospital beds, they were still dying from a kind of drowning. It was also known that they coughed up bloody sputum, which helped to spread the disease. But the science of the time could not fight it, partly because the best microscopes in the world could not even see it – only the later electron microscopes would be able to see the viruses that caused it. It was known that this was a kind of “influenza,” but a much more deadly strain than people were used to encountering (as mentioned earlier). People today think of the disease as being similar to a cold – something that passes after a few days. But for the Spanish flu, a person who had been perfectly healthy in the morning could be dead that same day. It was incredibly contagious, and it was also very deadly.

An electron micrograph showing recreated 1918 influenza virions

People stole coffins (and got on waitlists for them), to avoid being buried in mass graves …

Coffins were in such high demand at this time that they were often stolen, and armed guards had to be posted around them to prevent this. People who went to the doctor for help were often told to get on the waiting lists for coffins, even while they were still alive. And doctors were not unwise to dispense this kind of advice. The alternative was to be buried in a mass grave, and there were an alarmingly high number of mass graves at this time. As with the Black Death of the Middle Ages, carts often carried some of the dead victims through the streets, and got their bodies to places where they could not spread the disease to the living. Contamination was a real problem at this time, and bodies were often left on front porches for someone to pick them up.

Red Cross workers remove a flu victim in St. Louis, Missouri (1918)

This was a worldwide epidemic, and the disease was ravaging both sides of the war …

America was a participant in World War One by that point, and was sending troops overseas to fight on the Western Front. It was actually known that sending reinforcements to Europe required them to be sent on crowded troop ships, where they were in close proximity to other men both above and below decks. But America was so desperate for a quicker victory that troops were still sent overseas anyway, despite the known certainty of spreading the disease that way. Other nations were also affected by the influenza epidemic, and the disease was ravaging both sides in the war. Some estimate that three to five percent of the world's population died in the epidemic (a worldwide pandemic). It is not as deadly as the Black Death of the fourteenth century, as it turns out, but it is definitely the deadliest epidemic of the twentieth century. As a percentage of the population, it was even more deadly than the later COVID-19 pandemic.

Victims of the Spanish flu at U.S. Army Camp Hospital in Aix-les-Bains, France 1918

Interviews with some of the survivors, and with experts in the science of disease …

This documentary thus interviews some of those who lived through it, most of whom were children at the time of the epidemic. Some recount the deaths of their childhood friends and family members, or how they contracted the disease themselves (but nonetheless survived). Some were told that they did not have long to live, and their parents were instructed to stop feeding them because of its perceived “uselessness.” But luckily, the interviewees actually survived anyway, and lived to tell the tale of it (when many others did not). This film was made in 1999, long before the COVID-19 pandemic. They also interview some epidemiologists who specialize in the science of the spread of disease. These people bring some scientific expertise to the documentary, and help you to understand why the disease was so contagious.

Drawing of a visiting nurse in St. Louis, Missouri, with medicine and babies (1918)

The disease eventually ended as quickly as it started, with survivors developing a sort of immunity …

There was no vaccination to protect against the disease, and those that were developed were protecting people from entirely different diseases (and thus had no effect upon the Spanish flu ). There were also many homemade remedies that the documentary comments on, none of which had any effect upon the disease. But in fairness to these remedies, the best medicines of the time could not help them, either; and all they could do was to avoid the company of others. But the disease seems eventually to have ended as quickly as it started, with the survivors developing a sort of immunity to it. The documentary ends its story at around the time of the Armistice of World War One, which was on the 11th of November 1918, as you may know. (As the saying goes, “the eleventh hour of the eleventh day of the eleventh month” – something not quoted in this documentary, but nonetheless useful in remembering this part of the history.) This may not have been a great place to end their story, because some have argued that the worst part of the epidemic for the United States was later than that. Nonetheless, this is where they end their story; and the story that they tell is nonetheless an interesting one.

American Red Cross nurses tend to flu patients – Oakland, 1918

Conclusion: This is a reasonably good introduction to the human story of what happened

This is a reasonably good introduction to the story of the epidemic (as experienced in America), and focuses on the human story of how it happened in this country. Commentary on the pathology of the disease is limited, since this is not really focused on the science involved here (although it does give some brief comments on this, as noted earlier). The interviews with the epidemiologists are done only to give some basic information about the disease, and not to comment upon more specific aspects of the scientific knowledge about it (which would be necessary to understand it from a medical perspective). Their focus is on something different, of course, and I am quite okay with their chosen focus. They make good use of real photographs and footage from the time (as mentioned earlier), and show headlines from the period's newspapers that report the grim casualty numbers. It is odd that this story is so forgotten today, because it killed more Americans than all of the wars of the twentieth century combined. And, of course, it became more topical when the COVID-19 pandemic hit. Thus, one hopes that this story will be more remembered; and that this film will be watched by a more general audience.

Footnote to this blog post:

The Centers for Disease Control website estimates that 50 million people died in the influenza epidemic worldwide. 675,000 of these deaths were in the United States. (see source) This represented half of a percent of the American population, as measured by the 1920 Census.

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