By Gordon Williams

1918 Influenza Epidemic
December 1918. Combating influenza in Seattle, Washington, at work in the Red Cross rooms in Seattle, Washington with influenza masks on faces.

Mention the American Red Cross and you think of aiding disaster victims, collecting blood and teaching first aid. Those are all functions the Red Cross performs, but in 1918 we were asked to do much, much more. The historic pictures from the National Archives that accompany this article tell a bit of the story.

On October 1, 1918, Rupert Blue, then the Surgeon General of the United States, telegraphed the American Red Cross headquarters in Washington, asking for help in getting the country through its worst medical disaster ever. That was the influenza epidemic that sickened 25 million Americans and killed nearly 700,000.

According to the U.S. Public Health Service’s Public Health Reports, the Red Cross was asked to “supply all the needed nursing personnel” and “furnish emergency supplies” when local authorities could not do so quickly enough. The Red Cross was asked to spend $575,000 financing this effort—over $10 million in 2018 dollars.

Help was needed because the sheer scope of the epidemic had swamped existing medical resources. It was wartime, and large numbers of doctors and nurses were on duty with the military—many of them overseas. The Red Cross, with its nationwide network of chapters and its tens of thousands of volunteers, seemed the logical place to turn to for help.

1918 Influenza Epidemic
December 1918. The 39th regiment on its way to France marched through the streets of Seattle, Washington. Everyone was provided with a mask made by the Seattle chapter of the American Red Cross.

And help the Red Cross did. The organization found and trained more than 18,000 nurses and volunteer health workers. It provided more than $2 million worth of hospital equipment and supplies, set up kitchens to feed the sick, and convalescent homes for those recovering. It transported people, bodies and supplies. It made the masks being worn in the National Archives photos. Finally, Red Cross volunteers distributed U.S. Public Health Service literature on the prevention and treatment of flu.

It wasn’t just the United States that was ravaged by influenza. The epidemic was a global event, sickening as much as one-third of the world’s population. Medical record-keeping was sketchy in many parts of the world, so there is no precise count of the death toll. The website says that estimates of the worldwide toll range from 20 million to 50 million. More American soldiers died from the flu than were killed in battle during World War 1.

By contrast, says that the swine flu epidemic that hit the 2009 and 2010 killed around 12,000 Americans.

Not until 2008, according to, did scientists discover what made the flu so deadly. A quirk of this strain of flu so weakened patients that they became unusually susceptible to bacterial pneumonia. The disease is highly contagious and there were no antibiotics in 1918 to counter it.

It was called the Spanish flu and it was so virulent that some victims were dead within a day of becoming ill. It didn’t originate in Spain, but did appear to hit that country especially hard. That may have only appeared to be the case. News from most European countries was blacked out by wartime censorship, while news flowed freely from neutral Spain.

No country in the world escaped the epidemic, and it struck down rich and poor alike. U.S. President Woodrow Wilson caught the flu in Paris early in 1919 while attending the peace talks that followed World War 1. It is not certain which U.S. city was the first to report a case of Spanish flu, but eventually it showed up in every corner of the country—from big urban centers to rural Alaska.

The full story of Spanish flu and Seattle is found in the Influenza Encyclopedia, published by the University of Michigan Center for the History of Medicine. It reports on how the epidemic played out in 50 U.S. cities—including Seattle.

1918 Influenza Epidemic
December 1918. Fighting Influenza with flu serum injections in Seattle, Washington.

The epidemic reached the Northwest region in September 1918, with some of the first cases showing up at what was then the Army’s Camp Lewis (now Joint Base Lewis-McChord). More cases turned up among naval training cadets at the University of Washington. Soon the outbreak became an epidemic. Hospitals were swamped. The top floor of the old King County Courthouse was turned into a hospital. So were churches that had kitchens that could be used to feed patients.

It appeared to peak in October, but a second wave hit in December. By February 1919, the epidemic in Seattle was essentially over. In the National Archives photos, Seattle residents are wearing the face masks that became mandatory for anyone venturing out in public. They had to be worn if you went shopping or rode a trolley car or generally mingled with other people. Those who went out without masks faced arrest. Red Cross volunteers made more than a quarter-million masks—nearly one for each of the 300,000 people who lived in Seattle at the time.

1918 Influenza Epidemic
December 1918. Precautions taken in Seattle, Washington during the Spanish Influenza Epidemic would not permit anyone to ride on the streetcar without wearing a mask. The Red Cross made 260,000 masks.

Actually, the Seattle Red Cross chapter was gearing up for epidemic relief even before the national headquarters asked for help. Frank Waterhouse, chairman of the Seattle Red Cross chapter, was in charge of a committee formed to coordinate local and federal flu relief efforts.

Despite an order that kept other groups from gathering, Red Cross workers were allowed to assemble to make relief supplies.

Besides masks, the Red Cross volunteers made pillow cases and an item called a pneumonia jacket. With no medicines available to heal the sick, treatment included keeping the patient warm. That is what pneumonia jackets were meant to do—and some even had rubber tubing inside, through which hot water flowed. A contemporary account says that every table at the chapter’s Seattle office was put to use by volunteers making things.

It is a full century since the Spanish flu epidemic. Since then, Red Cross workers have responded to thousands of disasters in every corner of the world. Yet from making face masks and pneumonia jackets to nursing patients back to health, the Red Cross response to the Spanish flu still may be our biggest, most complex and most challenging ever.

1918 Influenza Epidemic
Seattle, Washington. December 1918. Policemen in Seattle, Washington are shown wearing masks made by the Seattle chapter of the American National Red Cross during the influenza epidemic.

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