The 1918 Flu Pandemic & the History of Hand-Washing

by Steven Dugan

It’s flu season again, and along with the usual media reports of symptoms to look out for, one hears many times, usually from your mother (or in my case, my wife), to “Wash your hands!” This year’s flu season is particularly noteworthy because it’s the centennial anniversary of the 1918 flu pandemic that killed between 50 and 100 million people, equaling 3-5% of the world’s population. Here in Southern California, the pandemic didn’t arrive until the fall of 1918, hitting full force from October through December. Understanding the potential for public harm, cities enacted laws to help curb the spread of the flu. The Los Angeles City Council, for example, banned the filming of crowd scenes in movies for a short time to lessen the risk of infection. Much to the chagrin of theater executives, theaters were also closed to limit exposure. These actions paid off, though, as some 70 deaths per 100,000 people per week were reported in the Los Angeles area from October through December, compared to double that number in San Francisco, a city that was less aggressive in their attempts to stop the spread of the disease. By early March 1919 the worst was over.

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This photo of Ascot Park in South Los Angeles was taken from a straightaway looking toward the large grandstand. The message on the front identifies a watermelon patch and the inscription on the back notes “camping under the grandstand during the flu epidemic of 1918.” Sleeping outdoors was an attempt to stop the spread of the disease. From the Homestead Museum Collection.

Epidemiologists cannot pinpoint one geographic origin of the devastating pandemic; but there are historic reports of flu outbreaks in China, Europe, and the United States in late 1917. Many factors contributed to the perfect storm of world-wide sickness and death. One was that troops fighting in World War I returned home infected and spread the virus to people at an incredibly fast rate. Additionally, modern researchers have theorized the high death rate among healthy people was probably due to a “cytokine storm,” during which one’s immune system releases an overload of antibodies to one part of the body to fight the infection, leaving the rest of the body vulnerable when exposed to new and highly contagious infections (like this strain of influenza). Malnutrition, overcrowdedness, and poor hygiene further contributed to the high death rate. So how did the easy practice of washing your hands become such a great germ fighter? And is your mom actually right?

Doctors of the nineteenth century had yet to understand how bacteria and viruses caused diseases. Most, if not all, relied on ancient theories that environmental factors, such as bad air or polluted water, caused sickness. In 1846, Hungarian doctor Ignaz Semmelweis was confident that bacteria and viruses played a part in causing diseases, but he had no proof. At the hospital where he worked, women were dying after childbirth at an alarming rate from a disease called Puerperal Fever, or Childbed Fever, a blood infection that could lead to sepsis—but no one knew why. Semmelweis tested many theories but none of them panned out. His observations showed that mothers who had their babies delivered by doctors had a mortality rate five times higher than mothers whose babies were delivered by midwives. Semmelweis also thought that this particular disease only affected women, since they were the ones dying. It wasn’t until a male pathologist died of Puerperal Fever that he started to piece together the cause. This pathologist had pricked his finger during the autopsy of a woman who had died after childbirth. When he became ill, his symptoms matched the woman exactly. With that, Semmelweis concluded that Puerperal Fever spread as a result of contamination, and that both women and men were susceptible.

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This photo of the 4th and 5th grade class at Hudson School in La Puente, CA, was taken about 1915. The woman at the left is teacher Bernice Lantz, and the young girl with the ‘X’ above her head is identified as Gracie Hoag. Gracie died at age 15 on January 1, 1919, during the pandemic. From the Homestead Museum Collection.

Semmelweis determined that because doctors were not sterilizing themselves after performing autopsies they were passing along the disease to new mothers, causing illness and death. He instructed all of his staff to wash their hands and instruments with soap and chlorinated water before deliveries. As a result, the death rate of the mothers dropped dramatically, from 20% to 2%. The medical community could not believe that hand-washing so dramatically slowed the spread of germs and lowered death rates. Most doctors were offended by his claim. How could men so revered be unclean? Others felt that Semmelweis was accusing them of intentionally infecting the mothers. Unfortunately, the good doctor was not tactful in arguing his case and was universally ridiculed. Semmelweis lived the rest of his life in relative obscurity, never getting the credit he deserved for his findings. Ironically, he died in a mental asylum from sepsis, the same type of infection he was trying to prevent.

Semmelweis’ practice of hand-washing and early conclusions on germ theory led the way for others to further expand on his findings. Frenchman Louis Pasteur’s work developed procedures for fighting germs with vaccination and pasteurization. Dr. Joseph Lister, an English surgeon, created sterile surgical practices to prevent post-operative infections, making surgery much safer. And finally, German physician Dr. Robert Koch discovered that specific microorganisms caused diseases like tuberculosis, cholera, and anthrax, building upon Pasteur’s earlier work on proving acquired immunity against diseases. Because of the work of these men, Semmelweis’ early conclusions were validated and he is now considered a pioneer of antiseptic policy.

So, whenever flu season comes around and your mom tells you to “Wash your hands,” she is right! It’s good for your health, and that of others, that you listen.

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