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The first recorded cases of virulent influenza in the United States occured in Boston. On August 27th, several sailors at the Commonwealth Pier reported sick with influenza. By the next day, there were eight new cases. On the third day, August 29th, there were 58 cases. These men were sent to the Chelsea Naval Hospital; from this hospital, the disease spread rapidly into the city of Boston and the rest of the state.

A military doctor and nurse wearing masks treat a sick patient who is lying in bed.

1918, in the second week of September 1918, influenza spread to Camp Devens outside of Boston, killing hundreds of men.

Within two weeks, over two thousand military officers and men stationed in the Boston area had influenza. By September 3rd, Boston City Hospital had admitted its first civilian influenza patient. On September 8th, the disease had reachedCamp Devens, a military camp near Boston which had 50,000 soldiers. As young adults were especially vulnerable to the 1918 influenza virus, the camp was quickly decimated by the disease.

In late September, a physician at Camp Devens provided a chilling description of the situation: "This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed....These men start with what appears to be an ordinary attack of La Grippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I don't know....The normal number of resident Drs. here is about 25 and that has been increased to over 250, all of whom (of course excepting me) have temporary orders – "Return to your proper Station on completion of work". Mine says "Permanent Duty", but I have been in the Army just long enough to learn that it doesn't always mean what it says...We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows. We have no relief here, you get up in the morning at 5.30 and work steady till about 9.30 P.M., sleep, then go at it again. Some of the men of course have been here all the time, and they are TIRED."

A black and white image of a woman in a dress and hat feeding numerous pigeons in Boston Common.  Several people appear in background.

c1915, Feeding pigeons in Boston Common. The city of Boston was the first in the country to be struck by the pandemic and also suffered the most losses. [Credit: The Library of Congress]

On September 26, the State Health Officer of Massachusetts requested immediate aid from the Surgeon General as the disease was spreading very rapidly over the entire state and he was unable to furnish doctors and nurses to the stricken communities. Orders were issued immediately to a number of commissioned officers to proceed to Massachusetts for duty in cooperation with the state authorities.

On September 27th, Massachusetts state authorities formally reported to the PHS that the disease had appeared in Massachusetts in August. On that date, the state health officer telegraphed the PHS, saying that "cases and deaths had been reported as follows: Everett, 698 cases, 7 deaths; Arlington, 160 cases, 1 death, Lynn 14 deaths; Middleboro, 100 cases, 1 death, Fall River, 102 cases, Lowell, 110 cases, Salem, 1,500 cases, 10 deaths; Provincetown, 415 cases, no deaths; Haverhill, 500 cases, no deaths; Natick, 78 cases, Chelsea, 1,193 cases, 13 deaths. The health officer further stated that Lynn, Quincy, Boston and Haverhill have large numbers of cases but the totals are not available. The disease has also been reported from Ayer, Gloucester, and other Massachusetts towns. In Boston, from September 16 to 23, inclusive, 333 deaths from influenza were registered." This report probably underestimated the actual number of deaths and cases.

By October 1st, state officials were reporting that "there were at least 75,000 cases in the State, exclusive of cases in the cantonments," the military camps where soldiers were stationed. During the week ending September 30th, 788 deaths from influenza and 196 deaths from pneumonia were registered in Boston; the actual number of deaths was likely much higher.

Despite these reports, the PHS remained oddly optimistic about the situation in Massachusetts, claiming that the disease had begun declining during the first week of October. This optimism probably stemmed from PHS officers' tendencies to accept the reports of state officials at face value. But even while adopting this optimistic view, the PHS was forced to acknowledge that the disease had now spread into the less densely populated western regions of the state. During the week ending October 7th, officials reported 1,023 deaths from influenza in Boston alone. Again, this figure probably underestimated the actual number of deaths.

By October 12th, the Massachusetts State Health Officer believed that the situation was improving in some areas. But even as he made these claims, the western part of the state was reporting more cases and more deaths.

In Boston, however, state officials were correct in assuming that the situation had begun to improve slightly. By late October, the city's death rate had probably dropped to fifty deaths from influenza per day. If true, this would have been a dramatic improvement as the PHS estimated that there had been at least 4,000 deaths from influenza between September 8th and October 25th alone.

During the pandemic, the PHS conducted several experiments in the Boston area in an attempt to isolate the exact cause of the disease. At the time, PHS researchers mistakenly believed that influenza was caused by Pfeiffer's bacillus (influenza is actually caused by a virus). Joseph Goldberger, one of the leading researchers in the PHS, led this research. Using 39 prisoners from a naval prison in Massachusetts, Goldberger attempted to induce influenza in the men. The experiment failed when none of the men contracted the disease. Because PHS officers remained stymied as to the causes of influenza, they were incapable of fighting or even containing it.

Looking back on the pandemic's impact in Framingham, a physician said, "The influenza epidemic of 1918-1919 manifested itself in Framingham in two distinct waves, culminating as measure by mortality in October and December 1918. There were probably between 1500 and 2000 cases of the disease in a population of approximately 17,000. Of these, about 1,100 were reported to the local health authorities." This type of under-reporting was common.

IAlthough influenza rates declined slightly in the late fall, the disease remained prevalent throughout the state into the spring. It was not until the summer of 1919 that influenza had begun to disappear from the state.

As ground-zero for the pandemic, Massachusett's became a focal point for post-pandemic studies. In the late 1920's, to PHS statisticians estimated that between September 1, 1918 and January 16, 1919, approximately 45,000 people died from influenza in Massachusetts alone. Horrific as these figures are, many historians believe that the number of influenza-related deaths in Massachusetts during this period was probably higher.

Population in 1920: 3.85 million. Boston, with a population of 748,060, was the state's largest city. Worcester was the state's second largest city with a population of 179,754.

Demographics: Most of the state's residents lived in urban areas.

First Official Report of Influenza:
The Public Health Service did not require states to report influenza before September 27th. Massachusetts first reported the presence of influenza on September 27th, but the disease was clearly present in the state much earlier.

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