© Constance J. Moore
Colonel, ANC (Retired), ANCA Historian
As the possibility of a swine flu epidemic confronted the nation during the past few months, it brought to mind the Army Nurse Corps efforts during the flu pandemic in 1918. The Spanish Influenza, as it was called, was the greatest, most lethal disease the world has ever known. The epidemic challenged the military healthcare team to care for huge numbers of wounded soldiers during the World War, and somehow not be overwhelmed by patients infected with the hypervirulent strain of influenza. When patients became dramatically ill from a hemorrhagic pneumonitis that rapidly progressed to acute respiratory distress syndrome and death, what did the nurses do to care for the vast numbers of people?
In this pre-antibiotic era, nursing rather than medical therapeutics were the most important interventions for patients to recover from the influenza. Since there were only palliatives measures for the flu and the pneumonia, isolation practices, asepsis rules, and strict routines were the priority standards of care. A nurse reported, “Our chief duties were to give medicines to the patients, fix ice packs, feed them at [meal] time, rub their back or chest with camphorated sweet oil, [and] make egg-nogs.”
Unfortunately, many of the patients did not recover. The illness simply astounded nurses with its rapid onset, how rapidly it spread, and how quickly it killed those in the most robust health. One nurse remembered, “We didn’t have time to treat them. We didn’t take temperatures; we didn’t even have time to take blood pressures. There was a man lying on the bed dying and one was lying on the floor. Another man was on a stretcher waiting for the fellow on the bed to die. Orderlies carried the dead soldiers out on stretchers at the rate of two every three hours.”
A massive number of nurses were mobilized to deal with the patients. African American nurses, who regrettably were not allowed to serve as Army nurses in support of the war effort, were finally given appointments to serve in the Army at military bases1. Religious orders also sent nuns to help nurse the afflicted in cantonment hospitals. The Red Cross recruited a total of 15,000 women, many who only had taken the Red Cross Home Hygiene Course to assist with work. These care providers worked long hours to meet the needs of patients in military camps and installations throughout the United States.
By the time hostilities of World War I ended and the epidemic ran its course, Army nurses and other nursing personnel cared for a greater number of flu cases than any other diseases or impairments caused by the war. Without the diligent nursing care by Army nurses and their staffs a far greater number of soldiers would have succumbed to this virulent disease. The rapid spread of the influenza epidemic demonstrated the importance of maintaining a reserve component of nurses who were ready to be called upon in time of national emergency.
1 Although the pandemic demonstrated the resilience and dedication of African American nurses, they were not allowed to maintain their appointments as Army nurses in the post-war era. This restrictive rule was finally eliminated 20 years later during World War II.
Sources: Primary sources are: a letter dated Oct 17, 1918, from “Ms. Lutiant to Louise,” recovered on 25 May 2009, http://bobmccarty.com/2009/05/01/letter-reveals-much-about-1918-flu-pandemic; another source on the net 1918 Pandemic www.cdc.gov/ncidod/ eid/vol12no01/05-0979.htm.
Secondary sources include COL (R) Mary Sarnecky’s A History of the U.S. Army Nurse Corps, John Brundage’s and G. Dennis Shanks’ article Death from Bacterial Pneumonia during the 1918-19 Influenza Pandemic, published in the Emergency Infection Disease Journal August 2008, and Jennifer Casavant Telford’s dissertation, American Red Cross during World War I: Opportunities and Obstacles, completed in 2007 at the University of Virginia.