1918 was a harrowing and exciting time to be a nurse in America. Despite the massive casualties and suffering, many nurses saw the Spanish Flu as one of the most positive experiences of their lives, allowing them to reach new heights professionally, personally, and within society as a whole.
Thanks to the Great War, when the Spanish Flu reached American shores, there was a major shortage of trained nurses across the country. Due to this, the government forced to ask for volunteers. This ad from the Chicago Tribune is one example of many that could be found in newspapers everywhere:
While this ad doesn’t appeal directly to women, the audience is assumed to be women during this time period. During the Progressive Era, just as the many decades before, women were seen as having innate “feminine traits of purity and domesticity,” which made them “ideal” for activities like nursing, given their “natural” abilities to care for others, cook, offer emotional support and so on.1 As a result, much like caring for children, nursing seemed another task at which any woman would excel, regardless of training or temperament. So when the government put out the call, any and all women were encouraged to sign up.
Women who took up nursing in 1918, however, found a great deal more to the job than a way to exercise “feminine traits.” Many nurses found pride and purpose in their work, often more than they had in their entire lives. For mid-to-upper class privileged white women who were often cut off from the harsher realities of the world, their nursing experience was especially transformative. One nurse saw it as “the most immediately satisfactory experience” of her life, feeling “a certain tremendous exhilaration” and pride in her work that she had never felt before.2 Even providing basic practical care to patients—such as washing out wounds and changing bedding—was enough to give them a strong sense of accomplishment and pride. Many felt that “their ministrations had contributed in a meaningful way to their patient’s well-being” whether their patient lived through the flu or not.3 They saw themselves — as did the general public and the medical establishment — as uniquely vital to the process of medicine, for while the doctor “plants the seed of health,” it is the nurse who “makes it grow.”4
Nursing, then, was a way for women to feel capable, independent and important in a way that society had not allowed them to do on such a scale before. Women were actively encouraged to see themselves this way, too, thanks to ads like this one, which showed women as capable and strong while also displaying “feminine” traits:
This is part of the ad’s text:
“Women are mending men! Over black, shell-torn roads women are driving ambulances. Women stretcher bearers carry the precious burdens from the battlefields. Great hospitals, staffed by skillful and merciful women, receive them. Women surgeons, women nurses, women orderlies minister to them…From last to first, from first to last, women are at work. No task is too heavy for their slim fingers. They are salvaging the backwash of the war. Are you asking, ‘what can I do?’ There is work for every one of us. No woman but must feel: Here is my woman’s work. We have given the men for this war. We can save our men from its breaking!” 5
Women were also encouraged to enter the nursing field as a part of the general war effort. In newspapers and daily life, the public often compared nurses and doctors to men on the front lines. The Spanish Flu was seen as an “enemy” that needed to be “fought.” The flu was “the civilian’s equivalent of the soldier’s fight”, with doctors and nurses at the helm.6 This partial article from the Waukegan’s Daily Sun, entitled “What a Nurse Can do for U.S.,” encapsulates a lot of this warlike imagery, while also bolstering traditional views of women as natural caretakers who would doubtless feel “fulfilled” in engaging in such work:
Nursing was advertise as a way for women to obtain career advancement as well. This period recruiting poster offers “unlimited opportunities” for those who take up the profession, encouraging them to go beyond their initial training with free graduate classes:
Yet while nursing opened many new doors to women, there were limits to how far those opportunities went. As Nancy Bristow points out in American Pandemic: the lost worlds of the 1918 influenza epidemic, the public “expected doctors to perform as men and nurses as women.”7 Thus, doctors—who were always assumed to be male, thanks to them edging out women doctors during the early 1900s—were praised for their skill and expertise, while nurses “did not require skill, only a woman’s dedication,” with many of them “commended for their quiet and self-sacrificing commitment to duty.”8 Even so, the widespread and devastating nature of the Spanish Flu emphasized how important nursing was during a public health crisis, and professional nurses seized on the opportunity to expand and legitimize their professional status, opening new training schools, creating widespread nursing standards, and forming professional organizations, seeking to turn nursing into a skilled, respected profession rather than something which simply required “dedication.”
White nurses weren’t the only group to take initiative during this time, however. African American nurses received a particular boost during the epidemic as well. Many nurses “recognized an opening in the epidemic” as a “chance to prove their value to a nation too busy…to enforce racial restrictions.”9 Prior to the epidemic, African American nurses who tried to join the war effort were refused, with the Red Cross only accepting 30 of over 33,000 applicants who initially applied.10 Within their own communities, however, African American nurses were both well-received and highly respected as heroes, providing access to care that many people couldn’t receive at hospitals due to widespread racism. African American doctors were also seen as heroes within their communities, and they saw the same “opportunities for both service and advancement” as their nurse counterparts.11 Doctors were also not just integral to the health of their underserved communities, but were seen as community leaders as well, casting themselves in “the role of ‘race men’ fighting for the reputation of their people against the forces of prejudice,” which allowed them to find something positive in the face of the disease.12
The positive and uplifting experiences of white nurses during the epidemic, however, were in stark contrast to their white doctor counterparts. While this was partly due to differences in their roles—doctors were supposed to provide cures and healing while nurses provided comfort and aftercare—there were also gender norms at play. Being a doctor in 1918 was a largely male profession, as women had been steadily squeezed out of the system for years even after they’d earned the right to be there. And since doctors were mostly male, they brought a masculine idea of what it meant to practice medicine—and what it meant to fail.
While doctors were part of the “army” fighting influenza, it was generally acknowledged by both themselves and the public at large that they were unable to do much to stop or cure the Spanish flu. This was particularly galling a medical community who by 1918 saw themselves as having “conquered” many major diseases, or at least make them manageable through emphasizing sanitary conditions and educating the public about health practices. Many doctors had even “begun to imagine a world free of infectious disease, a world in which their labors could protect Americans, indeed citizens of the world, from plagues that had hounded earlier generations.”13
Their utter failure in the face of the Spanish Flu left many doctors despairing, angry and helpless. These negative feelings are palpable in their accounts of the disease. It was the Army doctors who often noted “bodies stacked like cordwood” in the tents in American military bases, or how men would “turn blue” and die choking on their own lungs within hours of contracting the disease. As men, doctors saw themselves as having to “do” something for the sick or take action in some way, but the nature of the flu offered no way to do that beyond palliative care, turning the flu into an “emasculating” experience for many — the exact opposite of that of their female nurse counterparts.14
This mix of emotions is echoed today in healthcare worker’s experience with Covid-19, especially during the surges at the beginning and the height of the pandemic. While the pandemic has clearly demonstrated the value of both doctors and nurses, both have reported feeling equally helpless in the face of the disease, which for much of its course could only be given palliative care. The experience has been demoralizing and brutal, and the emotional and physical costs are a real struggle that will affect these professionals for a lifetime.
Articles like this one from the journal Nursing is full of examples of today’s nurses struggling to deal with Covid-19 day in and day out. As one interviewee notes, “Nurses are never going to be the same again. Everything we learn in nursing school is about support and comfort; COVID-19 took that away. We are supposed to minimize…the time we spend with our patients. Families are not allowed to come to the hospital. The isolation is stark. Imagine dying surrounded by people gowned, gloved, masked, and holding a cell phone in a hazard bag. What could be more terrifying?”15
Like their modern counterparts, nurses and doctors in 1918 also felt the suffering and loss of their patients very deeply—however, they were much less likely to publicly admit these feelings, no matter how strongly they were affected by them. Nurses in particular were under particular stress, as they had to balance intense patient care with the constant risk to their own physical and emotional health, since their exposure was greater than doctors. Nursing an influenza patient was a grueling task, even if one only took into account the “practical work” of the job such as changing bedding, rather than the training and knowledge required to constantly monitor the patient’s condition, nor the emotional toll of seeing patients they’d worked so hard to save die in spite of it all. Take for example this part of a volunteer nurse’s letter to a friend describing the “practical” nursing they were asked to do as untrained volunteers and how it impacted them, even after only being present for ten days:
“…we worked from seven in the morning until seven at night, with only a short time for luncheon and dinner. Believe me, we were always glad when night came because we sure did get tired. We had the actual Practical nursing to do—just like the other nurses had…Our chief duties were to give medicines to the patients, take temperature, fix ice packs, feed them at ‘eating time,’ rub their back or chest with camphorated sweet oil, make egg-nogs, and a whole string of other things I can’t begin to name. I liked the work just fine, but it was too hard, not being used to it. Then when I was in the Officer’s barracks, four of the officers of whom I had charge, died. Two of them were married and called out for their wife nearly all the time. It was sure pitiful to see them die. I was right in the wards alone with them each time, and Oh! The first one that died sure unnerved me—I had to go to the nurses’ quarters to cry it out. The other three were not so bad…Orderlies carried the dead soldiers out on stretchers at the rate of two every three hours for the first two days [we] were there.”16
On top of all this work, nurses were expected to present and act—through propaganda as well as in real life—as “calming devices” for the populace, who looked to them for strength in the light of doctors’ terrifying failure to stop the disease, casting them as tireless “angels of mercy” willing to sacrifice their own wellbeing for the sake of everyone else.17 As a result, many nurses ended up with what today we would recognize as PTSD, with many being removed from active duty due to “the stress and strain of service,” stress which included nightmares, insomnia, depression, severe headaches, and other indications of psychological and emotional trauma.18
Just as with shellshock after WWI, these kinds of narratives were repressed and glossed over by the public’s eagerness to move past the Spanish Flu once it ended. Unfortunately, this kind of narrative removes space for and acknowledgement of grief and encourages people to “get over it” as fast as possible and get back to “normal.” This cultural preference for an optimistic narrative in the aftermath of tragedies—which Bristow points out is endemic throughout American culture—drowns out people’s legitimate grief and “seems to include a corollary, the expectation that everyone can and should heal from trauma and tragedy, the sooner the better,” even from significant personal trauma such as PTSD.19 This “neglects entirely the reality of their circumstances and can make their persistent pain appear ‘abnormal’ even ‘pathalogical,’…[with] little room for their own narratives of loss.”20
One hopes that when the Covid-19 pandemic finally ends in America and around the world, today’s healthcare professionals will be given the space and time to tell their stories, get help in processing their feelings, and will have their grief, pain, and sacrifice recognized in a meaningful way, so that we all may honor their sacrifice properly.
1. Bristow, Nancy K. 2017. American Pandemic: the lost worlds of the 1918 influenza epidemic. 59.←
2. Ibid. 132←
3. Ibid. 134←
5. “Display Ad 7 — no Title.” Chicago Daily Tribune (1872-1922), Oct 24, 1918. https://www-proquest-com.glenviewpl.idm.oclc.org/historical-newspapers/display-ad-7-no-title/docview/174467127/se-2?accountid=3688←
6. Bristow. 78←
7. Ibid. 139←
10. Ibid. 134←
13. Ibid. 35←
14. Ibid. 137←
15. Mancuso, Lisa BSN, RN, PCCN, CCRN, CLCP, LNCC Nursing during the COVID-19 pandemic, Nursing: January 2021 – Volume 51 – Issue 1 – p 42-44 website: https://journals.lww.com/nursing/Fulltext/2021/01000/Nursing_during_the_COVID_19_pandemic.11.aspx doi: 10.1097/01.NURSE.0000724360.49363.81←
16. Author Unknown. 1918, October 17. Letter from nurse to her friend at the Haskell Indian Nations University, Kansas, Bureau of Indian Affairs. Retrieved from National Archives at Kansas City: https://www.archives.gov/exhibits/influenza-epidemic/records/volunteer-nurse-letter.pdf←
17. Gordon O., et al. 2020. “Learning from the past? Spanish influenza and the lessons for Covid-19.” Nursing Times [online]; 116: 10, 27-31. Website: https://www.nursingtimes.net/clinical-archive/wellbeing-for-nurses/learning-from-the-past-spanish-influenza-and-the-lessons-for-covid-19-21-09-2020/←
19. Bristow. 195←
Photographic Citations, In Order of Appearance:
1. Nurses parade, Chicago. United States Illinois Chicago, 1918. [July] Photograph. https://www.loc.gov/item/2017679280/.
2.”Display Ad 6 — no Title.” Chicago Daily Tribune (1872-1922), Oct 16, 1918. https://www-proquest-com.glenviewpl.idm.oclc.org/historical-newspapers/display-ad-6-no-title/docview/174480146/se-2?accountid=3688
3.”Display Ad 7 — no Title.” Chicago Daily Tribune (1872-1922), Oct 24, 1918. https://www-proquest-com.glenviewpl.idm.oclc.org/historical-newspapers/display-ad-7-no-title/docview/174467127/se-2?accountid=3688)
4.Author unknown. “What a Nurse Can do for U.S.” The Daily Sun, Waukegan, Ill. August 16, 1918. 7.
5.Be a Trained Nurse. United States New York, 1917. [or 1918] Photograph. https://www.loc.gov/item/00650746/
7.Negro Red Cross Canteen, Meridian, Mississippi. This canteen unit, with the aid of the men in group, voluntarily undertook the establishement of a center for the wounded of their race in the storm of , and at Lincoln School, Meridian, not only nursed, but fed and clothed scores of the storm-victims. Their leader, Nettie Majors, is not included in the group as she answered the first call for Red Cross help and with a group of white workers from the Lauderdale County Chapter A.R.C. went to Philadelphia to give needed aid there. In addition to the splendid work at Lincoln Center, the members of this Red Cross Unit of negro women served in many capacities at the Matty Herse Charity Hospital in Meridian. United States Mississippi Meridian, 1920. Photograph. https://www.loc.gov/item/2017677027/
8.”Be a Nurse.” Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD): https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/historical-images.htm
9.Honigsbaum, Mark. “Nurses fell like ninepins’: death and bravery in the 1918 flu pandemic.” The Guardian. April 5th, 2020. https://www.theguardian.com/world/2020/apr/05/nurses-fell-like-ninepins-death-and-bravery-in-the-1918-flu-pandemic