In early March 1918*, the first cases in the U.S. of what would later be called the Spanish flu were reported at a Fort Riley, Kansas, Army hospital.
The first Army private with symptoms had a fever, headache and sore throat. By noon, the hospital had more than 100 cases; within a week, there were 500. In that initial outbreak, 48 soldiers would die.
The source of the illness: unknown.
The Centers for Disease Control has estimated that “about 500 million people or one-third of the world’s population became infected with this virus.” Estimated deaths worldwide: at least 50 million. It was the worst epidemic in American history with US deaths estimated at 675,000.
World War I was still raging, and many of those soldiers in Kansas would ship out to Europe. But influenza was also spreading like wildfire there. According to Gina Kolata, writing in Flu, influenza was also part of the 15th U.S. Calvary traveling to Europe in March .
Unaligned Spain did not censor news reports like most of Europe. Historians hypothesize that this is why the illness was dubbed the Spanish flu.
The flu returned to America at the end of the summer of 1918. In early September, Dr. Victor Vaughan, acting Surgeon General of the Army, went to Camp Devens near Boston where 63 people would die the day he visited:
I saw hundreds of young stalwart men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood.
World War I would end on 11 November 1918.
The pandemic would last through Spring 1919. It would kill more people than combat had.
More than 25% of the U.S. population became infected. There were no vaccines, although some pretended to administer them by (unsuccessfully) injecting patients with a mixture of blood and mucus from flu victims .
About 1-in-5 who got sick had a mild illness and recovered “without incident.” Of the other 4-in-5, some died quickly after their lungs filled with fluid and others would develop pneumonia that would lead to death or a long convalescence .
Even before Covid-19, Seattle was a city that took pandemics seriously, even though historians and newspapers of the era did not. “Medical scientists are amazed by the great silence,” Kolata writes. “The flu blended into the general nightmare of World War I.”
The Readers Guide to Periodical Literature, 1919-1921, has 47 column inches dedicated to Prohibition; nine inches to baseball; and only eight to the flu pandemic that shortened average life expectancy in the United States by 12 years . Covid-19 has shortened US life expectancy by more than two years.
Johns Hopkins University was dedicated in 1876 and modeled after German universities. Hopkins was needed desperately: the US lagged Europe in the study of science and medicine. By the time WWI began, however, the US had caught up .
It may be hard for us to comprehend today, but at the beginning of the 20th century, the germ theory of disease was novel. It would be the 1940s before we developed antibiotics (which are useless against a virus, of course). However, the 1918 influenza pandemic “made a mockery” out of the technological optimism on display with the germ theory of disease .
The medical consensus is that the virus did not originate in Spain. In 1999, one researcher argued that the virus originated in China. In 2004, that the origin was the United States. A conclusive origin remains elusive.
 Kolata, Gina. Flu. (Farrar, Straus and Giroux, 1999)
 Barry, John. The Great Influenza: The Story of the Deadliest Pandemic in History. (Penguin Books, 2005)