Was the Spanish Influenza the First Global Pandemic in the Modern Era?

Spanish Influenza inflicted a terrible toll on a world wrecked by the First World War. Was it the first global pandemic of modern times?

Apr 7, 2024By Aaron Stoyack, BA History, Museum Studies Minor

spanish influenza first global pandemic modern


Spanish Influenza was a widespread pandemic from 1918 to 1919. The highly infectious and fatal virus took millions of lives across the globe. Its death toll was enhanced by modern transportation but mitigated by modern medicine. Also known as the Spanish Flu, responses to this outbreak drew on centuries of public health measures. Analyzing its impacts unearths an infectious question: Was Spanish Influenza the first “modern” or “global” pandemic?


Overview and Virology of Spanish Influenza

spanish influenza virus recreation 1918 flu micrograph
Electron micrograph of a recreated 1918 influenza virus, photographed by Cynthia Goldsmith, 2005. Source: Public Health Image Library, Centers for Disease Control and Prevention


Over the course of two years, Spanish Influenza infected roughly 500 million people, one-third of the global population. Death toll estimates vary from twenty-one to one hundred million, with modern scholarship proposing a total greater than fifty million. At the time, many people lived in densely populated, unclean environments, especially the militaries fighting the First World War. Doctors often accompanied the armies, creating shortages of medical professionals on the homefront.


Spanish Flu was caused by a type A form of the H1N1 virus. Influenza types A and B cause annual flu epidemics, but type A is the only variety to spur global contagions. Flu viruses undergo frequent mutations, which are slight enough that immunity from past infections will provide protection. But roughly every forty years, a significant change in the virus’s makeup ignites a pandemic. Major influenza outbreaks have occurred since at least 1500, perhaps much earlier.


Aquatic birds are carriers of influenza A viruses and may be the source of their presence in humans. Spanish Flu is theorized to have begun in birds before transmitting to mammals. This could have occurred through mutation or from pigs. Pig cells have receptors vulnerable to both bird and human flu viruses. Respiratory disease in American pig herds coincided with Spanish Influenza but could just as likely have been passed to pigs by humans.

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Where Did Spanish Influenza Come From?

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Spanish Flu advertisement for Minard’s Liniment, by Minard’s Liniment Co., ca. 1918. Source: Nova Scotia Museum, Halifax


Spain was neutral during World War I and did not have strict controls on its press as wartime nations did. These belligerent countries suppressed reports of the outbreak, not wishing to alert their adversaries to their losses. Spanish publications documented cases freely, so other countries called the disease Spanish Influenza, or Spanish Flu.


There are several theories on the origin point of Spanish Influenza. The speed of transmission pushed the limits of contemporary transit to the extent that some suggest the virus arose as early as 1916, spreading quietly and gradually. Outbreaks at two British Army camps in France in 1916 and 1917 exhibited comparable symptoms and rates of infection and death. Influenza outbreaks in China in early 1918 have also been proposed as the source.


The United States had one of the first recorded cases at Fort Riley, Kansas on March 11, 1918. Unlike suggestions of an earlier patient zero, transmission can be traced from this individual across the globe. The cramped nature of the military outpost caused the disease to spread rapidly. In a short time, additional cases struck military personnel on both coasts. Initially, the American public had little exposure to the virus, and the military largely ignored its spread, which was overshadowed by the war effort. Spanish Influenza fizzled out in the United States in May 1918, but by August, it returned after planting its roots virtually everywhere else.


Spanish Flu Spreads Around the World

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Map showing the worldwide transmission of Spanish Flu. Source: Institute for Public Health, Washington University in St. Louis


Spanish Influenza killed 100,000 soldiers, but whether it affected the outcome of the war is debatable. Naval blockades and unrestricted submarine warfare threatened and substantially reduced commercial shipping and oceanic travel during the conflict. The end of the war brought a hasty return of troops, often welcomed back to their homes with celebratory events.


Mechanized transportation and the growing interconnectedness of the world allowed the virus to traverse rapidly across great distances. The flu struck India and North Africa by May, China by June, and Australia by July. A second, more fatal wave of the virus began in August, transmitting to the rest of Africa, Central and South America, and Europe. In December, countries began to recover and loosen restrictions before a third wave hit, ending for most in May 1919 and dissipating almost completely in 1920.


The Victims and Symptoms of Infection

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Plate 2, The clinical features of the influenza pandemic of 1918-19 by Herbert French, 1920. Source: University of Missouri Special Collections and Archives, Columbia


With most flu viruses, young children and the elderly are the most susceptible, but Spanish Flu was also extremely dangerous to healthy adults. In a reversal of course from every other influenza virus, half of all fatalities were from those aged 20-40, and 99% of victims were less than sixty-five years old. The death rate of 2.5% far exceeded the 0.1% of most influenza viruses.


Symptoms included a high fever, fatigue, dry cough, aches, and chills. Red spots formed on the cheeks before a blue hue took over one’s face from lack of oxygen. The disease ravaged the patient’s respiratory tract within hours. In time, the lungs filled with fluid, in which victims drowned. It was not uncommon for victims to perish the same day symptoms appeared. Complications such as pneumonia often killed patients if the virus did not claim their lives first.


Medical Treatments Were Largely Ineffective

iowa gymnasium temporary hospital 1918 spanish influenza
State Gymnasium serving as a temporary hospital for soldiers ill with the Spanish influenza, 1918. Source: Iowa State University Special Collections


Medicine in 1918 was closer to modern practices than to the pre-industrial era. Notions of health, sanitation, and disease prevention were relatively adequate. However, no viral test could detect the Spanish Flu, and there were no effective medicines to treat infection. Medical professionals used technology such as X-rays and basic diagnostic methods to identify infection.


Drug manufacturers attempted to create a vaccine but were far off from a successful product. The first step, isolating the virus, may have been completed by scientists in Japan and Tunisia, but they could not preserve the specimen. Blood transfusions from recovering patients showed promise in treating the illness and saw experimental administration in flu epidemics since, although their effectiveness is unclear.


Easing symptoms proved to be the most reliable and accessible means of treatment. Nurses, mostly women with little to no previous experience, provided active care in medical facilities and in the community. The nursing profession expanded during the First World War, and their continued service for the pandemic proved essential.


What Was Done to Stop the Flu?

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Policemen in Seattle wearing masks made by the Red Cross, during the influenza epidemic, December 1918. Source: National Archives


Governments mobilized to initiate measures aimed at mitigating the spread of the virus and its effects. Responses varied at the national, regional, and local levels. Municipalities prohibited public functions, sometimes even extending the bans to schools and churches. Law enforcement officers were empowered to fine people for spitting or to arrest people for sneezing or coughing outside.


Public health organizations issued guidance and dictated policy. War news and propaganda made citizens accustomed to reading informational posters and newspapers. The Red Cross campaigned for every person to wear a mask in public. Individuals donned face coverings of varying styles and efficacy to guard against airborne contagion, although many resisted recommendations and mandates.


Comparable Pandemics of Pre-Modern Times

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The plague of Florence in 1348, as described in Boccaccio’s Decameron by Luigi Sabatelli. Source: Wellcome Collection


The Plague of Justinian spread across trading routes as far as Western Europe, Britain, Africa, and Central Asia from 541 to 590. Estimates state it wiped out 40% of the Byzantine Empire’s population, or 25 to 100 million worldwide. Citizens of Constantinople ran out of room to bury bodies, so they placed the dead in guard towers, covering corpses in quicklime to hasten decay.


The Black Death, the most notorious historical pandemic, claimed 100 to 150 million lives. The plague originated in China in 1334, traveling along the Silk Road to reach Europe by 1347. By 1352, it spread to Russia and the Middle East. Those fearing the Bubonic Plague practiced self-quarantine and avoided public gatherings, as no treatments were effective against the contagion. The Black Death affected localities differently, sometimes sparing sparsely settled agrarian regions while killing fifty to sixty percent of a city’s population. Ports barred entry to ships, and militaries closed off roadways. Despite the high death tolls, the absence of contact with the Western Hemisphere bars them from being considered global pandemics.


Was it the First Modern Global Pandemic?

cholera model Vibrio Cholerae Spirillaceae bacteria
Model – Cholera, Vibrio Cholerae (Spirillaceae) photographed by Rodney Start. Source: Museums Victoria, Melbourne


An influenza pandemic in 1557 spread across Asia, turning west to Constantinople and Europe. Its presence may have been recorded in Central America, presumably ferried aboard Spanish ships. The flu ravaged the entirety of Spain almost simultaneously, making transmission plausible, but documentation of its presence in Spain’s colonies is lacking. Another outbreak in 1580 is more widely accepted to have spread across the entire known world. Slow transportation methods still hindered the transmission of these influenza contagions.


Cholera is a bacterial illness that inhabits the digestive system, contributing to an expulsion of fluids that causes dehydration and death. Seven distinct cholera pandemics have transpired since 1817. The disease spread first from India to neighboring regions, then to other continents and the Americas. As with the Black Death, official quarantines were imposed upon visitors from areas with known cholera infections.


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Love Field, Dallas, Texas. Preventative treatment against influenza, spraying the throat by US War Department, 1918. Source: National Archives


The seventh iteration continues today in the Pacific, Caribbean, Middle East, and Africa. Cholera receives comparatively less attention than other infectious diseases, although it continues to take 21,000 to 143,000 lives each year. The bacteria cannot be eliminated because they thrive in water sources, but illness can be prevented with access to clean water and sanitation. As the first outbreak to spread to every inhabited continent in recent history, it is fair to call cholera the first modern global pandemic.


Spanish Influenza’s Decline & Lasting Effects

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Cartoon in the Wichita Daily Eagle, October 11, 1918. Source: Newton Public Library


Worldwide populations that were still reeling from history’s deadliest war to that point were punished by history’s second deadliest pandemic. Most communities experienced the illness as a time of rapid death and panic, which mercifully ended within a short time. The Great War contributed to developments in transportation and mobilization, which spread the disease, as well as media and medicine, by which officials could attempt to contain and treat it.


Death rates dropped dramatically throughout the next decade as people gained immunity from past infections. The H1N1 family continued to circulate until 1957, when it was replaced by H2N2, reemerging in 1977 and continuing to the present. Spanish Influenza may not be the first global or the first modern pandemic, but it served as a period of coordinated action across society that continues to mold public health and pandemic response to this day.

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By Aaron StoyackBA History, Museum Studies MinorAaron is a historian, museum specialist, and writer. He graduated Summa Cum Laude from West Chester University with a BA in History. Aaron served on local commissions and presented at regional and national public history and education conferences. He enjoys researching and interpreting all aspects of history, from local to global scale.