Women: The Unsung Heroes of the 1918 Flu Pandemic

“With eager determination we entered the ranks.”

Pandemics—like the one we’re in the midst of now—can spur uncertainty, but they’re not unbeatable. Time and again our communities have shown solidarity and women in medicine have put themselves on the front lines in order to combat the spread of illness. We’re sharing the stories of some of these women to lift us all up.

The 1918 influenza pandemic, commonly known as the Spanish Flu, is estimated to have infected 500 million people, or one third of the world’s population. Killing around 20 percent of those who contracted it, the ultimate death toll was at least 50 million, with 675,000 occurring in the United States alone.

Despite the CDC referring to the outbreak—caused by an H1N1 virus of avian origin—as “the most severe pandemic in recent history,” the 1918 influenza pandemic wasn’t studied much. It wasn’t until Alfred Crosby’s America’s Forgotten Pandemic was published in 1976 that we had our first comprehensive account of the outbreak in the United States. 

Why did this pandemic barely leave a mark on our country’s historical and cultural record? According to one source, it could be due to the fact that most of the heroes of the epidemic were caregivers—nurses who “offered palliative care to alleviate symptoms as the sick suffered on.”

“Given America’s somewhat pathological focus on results-oriented medicine, and aversion to the acceptance of death, it’s little wonder that these women’s efforts went unhailed.”

Women shouldered the burden of caregiving during the pandemic because the virus disproportionately affected young men, which in combination with World War I, created a shortage of labor. In fact, demographic studies show that nearly 175,000 more men died than women in 1918.

What’s more, the doctors treating the outbreak—almost universally male at the time—were ready to move on from and forget the pandemic as quickly as possible. As Alfred Crosby explained, “All the physicians of 1918 were participants in the greatest failure of medical science in the twentieth century or, if absolute numbers of dead are the measure, of all time.”

Because this particular strain of flu infected and killed so many so fast, and there were no pharmaceutical interventions that could be used to treat it, the most common treatment for a flu patient was isolation, pain relief, bed rest, and plenty of warmth. As the CDC explains:

With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.

Given this treatment, as nurses, women became the primary caregivers of the pandemic. Taking charge of the day-to-day care, they risked infection while ventilating rooms, administering remedies the doctor had recommended, and ensuring patients were warm, nourished, and hydrated.

Even if ignored by the history books, the work these women did was crucial. By not documenting their participation and sharing their story, we’re short-changing the narrative of women in medicine. 

Not only did their role in this pandemic help shape the future for women in medicine, it provided female nurses of the time with a sense of professional fulfillment.

A Sense of Purpose

Whereas doctors tended to remember the epidemic with sadness, repulsion, and from a wholeheartedly negative place, the nurses who worked alongside them offered a different perspective. That’s because for these professional nurses who were already in high demand due to the war, the epidemic proved a time of great professional fulfillment.

One of these nurses was Mabel Chilson. As the epidemic raged in the Midwest, Mabel Chilson was one of many student nurses at Fort Des Moines who decided to help those in need. In The Spanish Influenza Pandemic of 1918-1919: New Perspectives, Nancy Bristow shares some passages Chilson wrote for her school yearbook: “We wondered, ‘were we helpless or could we fight?’ With eager determination we entered the ranks.”

Once at work, the nurses “soon became the happiest family, and when off duty we had jolly good times. The greatest comfort we possessed was the knowledge that each girl was doing her best and making good as a nurse.” As Bristow goes on to explain:

In the context of this ghastly disease and its epidemic incarnation, Nurse Chilson’s positive response to her experiences is noteworthy, made all the more so by the extent to which other nurses recorded similar reactions. Mabel Chilsons’s sense of satisfaction with nursing efforts during the epidemic was mirrored in the diaries, letters and more public published accounts of nurses throughout the United States. Though acknowledging the horror of the disease and the wretched state of its victims, nurses often recounted their experiences in the epidemic positively, emphasizing the opportunity it held for meaningful ministration.

In Bristow’s book American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic, we learn of more of these nurses, including Miss Condell, a nursing student in Boston, who said:

“We enjoyed the work and as it was considered a war measure to nurse the civilian population, we were very glad we were nurses and able to do ‘our bit’. The nursing experience was wonderful and we have learned many valuable lessons. The self control, the endurance, and the splendid willing spirit of all the nurses were marvelous.”

And another who recounted:

“All of us who had any part in helping in the epidemic must look back upon it as one of the most immediately satisfactory experiences of our lives, and this is true even though we were borne down with the knowledge that, do all we might, the pressing, tragic need for nursing was much greater than could possibly be met.”

Unlike their male counterparts who were unable to find a cure—or even a vaccine, female nurses succeeded at their job of administering care, and were rightfully proud of their work.


A Lasting Legacy

These women’s legacy extends beyond medicine. The shortage of male workers—at first due to war and then due to illness—opened access to the labor market for women, who began to take jobs outside the home in unprecedented numbers. In fact, the number of women in the workforce increased by 25% following the conclusion of the war, and by 1920, women made up 21% of all employed Americans.

Women began to move into industries that they were previously excluded from, demand equal pay, and advocate for their rights—including the right to vote. With more economic and social independence, they began to take on more leadership roles in the workplace, and eventually in the government.

And all this—this incredible domino effect—began thanks to female caregivers who offered to step up during a country’s time of need.

Pandemics PastThe Women in Medicine Legacy Foundation WIMLF