Pneumonia and Influenza - 1918

Red Cross Motor Corps on Duty St. Louis, Missouri, Circa October 1918.

Red Cross Motor Corps on Duty St. Louis, Missouri, Circa October 1918. Photograph Courtesy of the American Red Cross. National Archives and Records Administration RG 65-WW-269B-3. NARA ID # 45499293. GGA Image ID # 1508d4b79b

By Dr. M. C. Ruehl, M.D., Deering Works

Spanish Influenza is now present in all parts of the United States.

It is not ordinary "Grippe," but a serious disease and should be treated as such.

It is the most contagious disease prevalent at this time.

It is caused by germs carried in the mouth, throat, and nose.

It is spread through secretions of the mouth and nose, droplets of which are sprinkled about when an infected (not necessarily sick) person, coughs, sneezes or "spits."

These germs may be carried to the mouth by your hands.

DANGER: Pneumonia very frequently follows influenza and causes the great number of deaths. Call a physician early.

IF YOU HATE Pains in head, back, muscles, and joints; Sneezing or coughing; Fever and an "all in feeling;" consult your family physician at once.

From a Special Bulletin to Employees by the International Harvester Company.

Diphtheria, smallpox, and yellow fever at one time were considered the most dreaded of diseases, but with the administration of antitoxin in diphtheria, vaccination in smallpox and the destruction of the mosquito in yellow fever, the mortality has been brought down to almost nil, while the death rate of pneumonia is about 60 per cent.

In order to understand the reason of the high mortality, it is necessary to have some conception as to the nature of the disease. Pneumonia is an infection of a part of one lung, a whole lung, or both lungs.

It is self-limited in its course and is caused by specific bacteria. The bacteria can be found in the noses and throats of healthy individuals in 30 percent of cases and gain entrance to the lung through the respiratory tract.

Certain conditions favor the transmission and growth of the bacteria in the lungs, namely cold weather, especially when damp, general run down condition of the body, over-work and alcoholism, while unsanitary habits such as expectorating promiscuously are the most important direct means of transmitting the disease.

It might be well to mention here another type of pneumonia which follows a so-called cold or more properly speaking bronchitis. It usually occurs in children and the aged, but it can occur at any age and is commonly called Croupous-Capillary, Lobular, or Bronchopneumonia. It is this type which is causing so many deaths at the present time, of those who have become infected with the "Spanish Influenza" germs.

In comparing the two diseases it can plainly be seen that there is a great contrast between the two types.

In the first type there is usually an abrupt onset while in the capillary type the onset comes on slowly. In the first type only a limited portion of a lung becomes affected, the remaining portion remains normal, it runs its course in a week or ten days and then ends suddenly, while the latter type progresses steadily unless death intervenes, and it is often fatal in a few days especially when following "influenza".

As "Spanish Influenza" is not uncommonly complicated by pneumonia it might be well to give a brief description of a few of its characteristic manifestations. It usually begins suddenly, with the usual symptoms of "catching cold," such as sneezing, running of the nose and eyes—harsh dry cough—pains in the back, back of neck, legs or headache.

All of these may be present at the beginning or only one of them, the individual feeling normal otherwise, but when the temperature is taken it will be found to range between 100 and 104, accompanied by a rather high pulse rate and increased respirations.

Later on as the disease progresses all of the symptoms appear, the cough becomes almost constant and unless treatment is instituted early pneumonia usually results from the rapidly progressive bronchitis, but even in early and the most favorable cases the cough is most persistent, resisting treatment and prolonging the period of convalescence.

A few facts to bear in mind regarding "Spanish Influenza" are as follows:
It is a serious condition and during the present epidemic should any symptoms of a cold or the grippe present itself call your family physician at once. Early treatment hastens recovery, delay favors complications and endangers the chances of recovery.

Remember that it is one of the most contagious diseases and the most favorable means of transmitting it are coughing and sneezing, in which small droplets float through the air and in this manner gain entrance to the respiratory tract. Keep away from one infected even if he is your best friend.

The complications are few but all are many times more serious than influenza itself, the most common being the croupous type of pneumonia which is not infrequent in its occurrence and to which can be credited the high mortality rate.

Regarding treatment of these acute respiratory conditions—the most important and surest cure is a "home cure" that is "don't get them". There is absolutely no drug or patent medicine that will prevent*these diseases but a few simple hygienic measures and thoughtfulness on the part of each and every individual will greatly decrease them.

Consider that they are diseases of the respiratory tract, that they are of bacterial origin, that they gain entrance to the respiratory tract through the nose and mouth and are spread in the same manner.

It then stands to reason that in keeping the nose and mouth clean, the prevention of spitting on sidewalks or in public places, care in sneezing and coughing by holding the handkerchief over the nose and mouth, and the isolation from friends and family of those already infected, will certainly have a most important bearing upon the limiting of these diseases.

Other measures which are almost as important are careful regulation of habits, abstinence from alcohol which always has a tendency to lower the vitality and is in close relation with the high mortality rate.

Warm, comfortable clothing should be worn, as changing from a warm to a cold atmosphere is a common predisposing factor. Avoid unnecessary exposure to draft and cold. Carefully regulate your diet and keep the bowels open.

Do not try patent medicines before calling your physician. Call him at once as a few hours' delay in conditions which are as rapid in their course as pneumonia and influenza, may mean the life of those affected. Call your doctor, don't wait.

The slogan, "He who hesitates is lost" certainly applies well to this terrible epidemic.

The object in presenting this article is not to give the impression that pneumonia and influenza cannot be cured, but it is to impress upon everyone the importance of sanitary and other measures in the prevention of the disease, and thus lower the number of such cases.

Don't wait until you get pneumonia or influenza. Keep from getting it by applying a few simple rules of hygiene.


  • Don't spit on the floor or sidewalk.
  • Don't remain at work when sick.
  • Don't visit sick people.
  • Don't attend indoor meetings or remain in crowds.
  • Don't worry.


  • Cover your face when you cough or sneeze.
  • Keep your bowels active.
  • Get plenty of sleep.
  • Keep windows open, especially at night.
  • Wash your hands and face often, especially before eating.
  • Call a physician early.

Dr. M. C. Ruehl, M.D., "Pneumonia and Influenza," in The Harvester World, Chicago: International Harvester Companies Vol. 9, No. 10, October 1918, pp. 12-13.

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