The year 1918 proved to be a trying time for people overseas and at home. Still in the midst of World War I, populations were then introduced to another adversary: the “Spanish Flu.” While great medical strides had been made to prevent other deadly diseases, such as smallpox, by the time of the global outbreak of influenza in 1918, the flu virus, or H1N1, had yet to be identified.

The 1918 flu resembled a more severe cold. The symptoms included fever, pains in the head and other body parts, and fatigue. While some patients recovered, others developed more severe and deadly conditions, like pneumonia or meningitis. Perhaps the greatest threat of the 1918 flu was the contagious nature of the virus with approximately one third of the world’s population infected and an estimated 50-100 million global fatalities.

During a virtual “science café” held by the National Museum of Health and Medicine (NMHM) last month, NMHM’s Historical Collections Manager Alan Hawk discussed the rapid spread of the 1918 influenza pandemic in a case study on Montgomery County, Maryland.

In 1918, Montgomery County was transitioning from a rural farming community into a suburban area. The county had recently improved its transportation systems connecting railroads and trolley lines to Washington, D.C. for those commuting to work in the city. Less than a month after the first influenza fatality in Washington, D.C., there was an estimated 1,200 cases of influenza in Montgomery County; most cases were within five miles of the railroad or trolley lines.

As we know today, the influenza virus is easily transmitted between those in close proximity to each other, up to about six feet, making the crowded trolleys and trains a prime place for spreading the flu in 1918. This was particularly damaging to the U.S. military, as traveling military personnel often shared cramped quarters in barracks, trains, and trenches.

The devastating impact of the flu in Montgomery County and the surrounding areas drove public health officials to require the adornment of gauze masks in public, and locals to cancel events with large gatherings of people.

While a vaccine wouldn’t be developed for a few more decades, military laboratories and civilian scientists worked tirelessly in 1918 to discover the agent that caused the flu. Autopsies were performed and samples of lung tissue were forwarded to the Army Medical Museum (now NMHM) for further study and preservation. 

Along with the tissue specimens, the museum collected archival and historical materials – for example, photographs showing influenza wards like Camp Funston, Kansas, a possible ground zero for the virus in America, and medical equipment – to illustrate the devastating impact of the 1918 pandemic and the military’s medical response. 

These materials aid today’s researchers in parsing history and understanding the nature of the 1918 flu in comparison to current strains or other viruses. A virtual exhibit shows how DOD scientists used a sample of lung tissue to recreate the genetic sequence of the 1918 virus, and a new teacher’s guide compares the 1918 influenza to COVID-19. Perhaps future studies can help us identify key characteristics of the 1918 influenza pandemic and why it was so deadly.

For those interested in accessing the collections for research, visit the museum’s website.