Flu, 1918-1919

Flu, 1918—1919

"The year men cried..."

A Milwaukee nurse

The epidemic struck as the fighting of World War I neared its end, and flu displaced war as the sorrowful centerpiece of everyday life. About two billion people were living on earth in 1918, and as many as half of them fell ill with the flu.

In just over a year, from March 1918 through April 1919, it spread worldwide in several waves and killed an estimated 22 million people—almost three times the number killed in the "war to end all wars." Including the people who died of complications, the toll was probably as high as 30 million deaths. To quote an article in Science in 1919, "Never before had there been a catastrophe at once so sudden, so devastating, and so universal."

Over 500,000 Americans died of this pandemic, which began as a mild incident on the morning of March 11, 1918, when a mess cook with chills and fever reported for sick call at Fort Riley, Kansas. He complained that his head and muscles ached and his throat felt sore. By noon 107 men had been admitted to the hospital with influenza. The caseload grew to 522 by the end of the week, and within five weeks there were 1,127 cases and 46 deaths. Doctors were puzzled and disturbed because the flu was hitting not the very young, very old, or infirm but robust people in their 20s and 30s, those whose resistance to disease is normally high.

Historical pathology lists at least 94 epidemics of influenza between a.d. 1173 and 1875. Fifteen were pandemic, affecting a high percentage of the world population. Hippocrates first noted a probable epidemic in Athens in 412 b.c. Centuries later the Italians christened it influenza di freddo, which means simply "influence of the cold." Later the belief grew that some sudden shift in the atmosphere could mysteriously communicate the disease to entire areas.

Fort Riley had experienced a notable atmospheric change just before the outbreak. Gale—force winds had shrouded the camp with a noxious pall of prairie dust, aggravated by stifling smoke from burning horse manure. The United States was up to its elbows in plans for winning the war, so the military chiefs were willing to accept this simple, finite explanation.

The deaths at Fort Riley and other crowded training camps were attributed to complications from pneumonia. So the army continued training two million men and shipped them off to France. Often they were packed into airless freighter hulls that were floating test tubes for breeding virulent, improved mutations of a flu virus not yet identified. Doctors searching desperately for the offending microorganism would discover many years later that the only constant in the flu virus was change.

U.S. troops landing in France by the summer of 1918 brought plenty of flu with them. Within a short time, flu began to provide the war with some stiff competition in the killing fields and occasionally proved superior. General von Judendorff blamed the flu for halting Germany's victory drive in July.

The pandemic spread quickly to England and to Spain, where it killed eight million Spaniards. It became known, in recognition of its swift and deadly invasion there, as the Spanish flu and was nicknamed "Spanish Lady," even though it had originated in the United States. Within four months, flu encircled the world. By August 1918 the disease had changed to a far more vicious form. Once again it spread around the world, and this time vast numbers of people died primarily from subsequent pneumonia, for which there were neither drugs nor treatment.

In September, when the flu was at its most deadly, General John Pershing, commander of the U.S. expeditionary force, was calling for every available soldier for a massive assault. When the October draft call was canceled because of raging flu outbreaks in army camps and ports, Pershing was almost forced to call off the assault. Although the Meuse—Argonne offensive did founder for a while as 69,000 troops fell ill, Pershing won the battle—but at a heavy cost from disease and enemy action.

The navy was hit even harder; 5,000 were lost to the epidemic in a service only one—tenth the size of the army. The captain of the USS Pittsburgh, a cruiser on patrol in Rio de Janeiro's harbor, saw more than half of his men disabled, and he buried 58 of them. He turned for home, taking the Pittsburgh out of the war just as if the ship had been sunk by a torpedo.

The speed at which the Spanish Lady spread was uncanny. It was called the Blitz Katarrh (lightning flu) when it reached the ragged ranks of the kaiser's army. The disease then swept into Russia, China, and Japan, down to South Africa, and across to India, where 12 million people died. It then spread into South America.

Horror stories were common. One man in Rio de Janeiro asked another where the streetcar stopped, thanked him politely, and fell over dead. On a Cape Town tram, seven riders, including the conductor and driver, collapsed and died within a three—mile stretch. In the goldfields of Johannesburg, an engine operator was hoisting a steel cage full of miners to the surface from deep underground. As he reached for the brake lever, he died of the flu, and the cage kept going and banged against the lift's overhead frame. Torn loose by the impact, the cage fell back into the shaft, plunging 24 miners to immediate death. In the yearlong pandemic, no place in the world was safe. The natives of South Pacific islands, with no defensive immunity to the disease, were the most vulnerable of all; 20 percent of the population of Samoa died from influenza. Even in as unlikely a place as Nome, Alaska, 176 (59 percent) of the 300 Inuit there became victims of the deadly disease.

The mighty fell along with the meek. Among victims who survived were Kaiser Wilhelm, King George V, King Alfonso XIII, German chancellor Prince Max of Baden, Assistant Secretary of the Navy Franklin D. Roosevelt, British prime minister David Lloyd George, Queen Alexandria of Denmark, and even Mary Pickford in Beverly Hills.

The early heavy toll among U.S. men in uniform was simply the disease's opportunistic response to their being confined in cramped quarters. Not until September 3 was a civilian case documented, in Boston. A week later three men dropped dead on the sidewalks of nearby Quincy. The first death in New York City was on September 15. Then, flu cases, fed by mass movements of uniformed personnel, began popping up all over the country—first by the hundreds and then by the thousands. The toll escalated to over 10,000 domestic deaths in September, and up to 90 recruits a day were dying in Camp Devens, Massachusetts, alone. In Philadelphia, one of the worst—hit cities, 13,000 died from the epidemic by the end of October.

In New York City, the death rate caused a shortage of coffins. The only solution was to carry the dead to common graves in a temporary coffin, from which they were removed and wrapped in a sheet for burial. The coffin was then reused to carry another body. In the last week of October 1918, 21,000 people died in the United States, the highest seven—day mortality toll in the country's history. And in the last four months of 1918, well over 300,000 died.

Americans flailed desperately against an unseen foe. Large gatherings were banned, and almost all public meeting places, including churches and saloons, were closed. In major cities, anyone caught sneezing, coughing, or spitting in public without a handkerchief paid a huge fine.

A worldwide preventive measure was the wearing of face masks. People fixed layers of gauze across their mouths and noses in the hope of preventing the transmission of infectious droplets. Since the virus passed easily through the gauze, the face masks did little good except to discourage contact. Even so, mask slackers were given a rough time, including occasional public beatings. At a West Coast naval base, guards were ordered to shoot to kill anyone attempting to enter or leave without official permission. Drinking fountains were sanitized hourly by blowtorch; phone booths were padlocked or the telephones were drenched in alcohol.

Since there were no medications to treat the flu, anxious people dreamed up their own preventions and cures. Among the prescribed treatments: drink Scotch, eat garlic, remove tonsils, inhale chloroform, sprinkle sulfur in shoes, wear vinegar packs on the stomach, tie slices of cucumber to the ankles, carry a potato in each pocket. In New Orleans, people bought voodoo charms and chanted, "Sour, sour, vinegar V, keep the sickness off of me." One mother covered her four—year— old daughter from head to toe in raw sliced onions. Several men slept with shotguns under the bed, believing the fine steel would draw out any fever present. One physician summed it all up: "It was polypharmacy run riot."

Real heroes of the relentless epidemic were those in the medical profession. Doctors pumped railroad handcars to reach isolated cases and made their rounds by horse, foot, and auto and even in the newfangled airplane. They not only treated entire families but also collected and handed out food and blankets, milked cows, cooked, built fires, heated water, and bathed and dressed the helpless. Doctors ate meals from the family stewpot when they stopped to eat, and fell asleep on the nearest couch. Sometimes they dozed upright in their buggies, warmed by heated bricks wrapped in newspapers as their horses were given free rein. They indeed stretched themselves to the breaking point, and many became victims.

For each person who died of the flu in the United States, an estimated 50 had come down with the disease. All that could really be done was to keep the patient quiet, warm, fed, and medicated against other life—threatening complications.

Fitfully, the long day's night began to fade. People who had survived the disease seemed to be immune from further episodes. Like a hurricane, the mysterious Spanish flu virus eventually blew itself out and seemed to vanish utterly from the planet. No outbreak of the flu before or since has equaled, in size or severity, the great scourge that gripped the world in 1918—19. Although more recent outbreaks—the Asian flu in 1957, the Hong Kong flu in 1968, the London flu in 1972, and swine flu in 1976—have caught our attention, they have been minor pandemics.

Scientists now know that all of this amazing misery stemmed from a virus so small that 2.5 million in a straight line would take up just about an inch in length. Research has established that influenza exists in three major strains, and vaccines can be created to combat all of them. The problem with flu is that each strain is quite unstable and mutates easily, creating a slight variation from earlier forms. This complicates the prevention process, for any new epidemic is almost sure to have originated with a virus changed enough to escape the antibodies still present in the human body from the previous year's vaccine.

The flu continues to live on, but annual vaccine injections keep the deadly type at bay. A stable, reliable vaccine is still an important work in progress. Each year delicate, elderly, and otherwise susceptible people are encouraged to prepare for the flu before the flu season arrives. For arrive it will.

From the book: 
Petrified Lightning