The heavy toll of an influenza epidemic

Emergency hospital during Influenza epidemic, Camp Funston, Kansas; Wikipedia commons

1918 saw a devastating influenza pandemic that killed anywhere from 50 million to hundreds of millions of people worldwide, and upwards of 675,000 in the US alone. One hundred years later,  we are experiencing another wave of flu that has already claimed the lives of several dozen patients. One aspect of the 1918 outbreak was the toll taken on health care workers who had to deal with the overwhelming need for their skills. It must have been a mentally and physically exhausting experience, one that sometimes led to even more mortality.

My great-grandmother was Susan Joanna Vosler (1863-1942) of Lawrence County, Pennsylvania. Her ancestors were English, Scotch Irish, and Palantine German immigrants that settled in western Pennsylvania. One of Susan Joanna’s brothers was physician David Claire Vosler (1870-1919). His death date of March 18, 1919 was significant.

David graduated from the University of Pittsburgh School of Medicine in 1894, and opened a practice in Ellwood City, PA. When the US entered World War I, he joined the army, and treated military personnel at the “General Hospital No. 9” set up in 1918 in a hotel in Lakewood, New Jersey. Captain Vosler treated men with a range of ailments, from battle wounds to diabetes, in addition to several hundred flu cases.

In the summer of 1918, the first World War in Europe was on the road to the November armistice. What was referred to at the time as the Spanish influenza was spreading from Europe to the US, fed by troop movements. Local newspapers in the US printed almost nothing about the coming epidemic, perhaps because of war time censorship that banned negative reporting. By August, flu deaths had already begun on the east coast. In September, after docking of a troop ship in Philadelphia, the first death was reported in that city. 600 people fell ill the very next day.

In October of 1918, authorities were scrambling to catch up with the mounting deaths in Pennsylvania, by closing down public gathering places like schools, churches, movie theaters, and sporting events. One city hard hit was Pittsburgh, only 40 miles from David Clare Vosler’s home of Ellwood City. One day after the movie theaters were shuttered, the first flu death was reported in Pittsburgh; only two weeks later, there were thousands of patients with flu symptoms. The details from the period are chilling – at least 4500 died in Pittsburgh city hospitals alone. It was estimated that 700 children were orphaned in western Pennsylvania. Hospitals set up tents on their lawns to handle the overflow. The overwhelming number of corpses presented a public health crisis, and coffin makers couldn’t keep up with demand.

The impact of the pandemic was particularly hard on health care workers. A large percentage of doctors were working on the war effort, so local hospitals were forced to call in retired physicians and even inexperienced medical students. Nurses and doctors were severely overworked and sometimes fell ill themselves, with less hope for proper medical attention than the patients they were treating.

By March of 1919, the pandemic had wound down. Dr. Vosler had finished his five months in the army, and was back to his peacetime medical practice in Ellwood City. According to a news article in the New Castle Herald, his wife Eva found him dead in his bed one night.

“Dr. Vosler was 48 years of age and had been a practicing physician here for the past 18 years. He had one of the largest practices of any physician in the county and during the influenza epidemic he overworked to such an extent that he had brought on a nervous breakdown culminating in his death.”

His death certificate lists the official cause of death as heart disease, but it seems likely that Dr. Vosler paid a heavy toll as a physician working to the point of exhaustion during the pandemic of 1918.


  1. US Army Medical Department, Office of Medical History, “General Hospital No. 9, Lakewood NJ“, 2013
  2. Us Army Medical Department, Office of Medical History, “Extracts from reports relative to influenza, pneumonia, and respiratory diseases“, 2013
  3. University of Pennsylvania Gazette – “Flu: It started with a cough in the summer of 1918“, 1998
  4. TribLive, Pittsburgh Tribune-Review,  “Pittsburgh decimated by 1918 flu pandemic“, 2005
  5. Pennsylvania Historical and Museum Commission, “1918 influenza epidemic records“, 2018
  6., American Experience, ” Influenza 1918 The flu in Philadelphia
  7. National Center for Biotechnology Information, “The treat of pandemic influenza: Are we ready?“, 2005
  8. The Washington Post, “The flu can kill tens of millions of people. In 1918, that’s exactly what it did.”, 2018

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