The Great Influenza of 1918

Microbes have proven themselves to be masters of evolution that expertly exploit every opportunity created by the changing lifestyles of humanity through the ages. From the hunter-gatherers to farmers, and from rural homesteads to city dwellings, throughout human history, microbes have mutated and stayed with us, in the form of bubonic plague, influenza, smallpox, typhoid, polio and a wide range of other diseases.In late 1918, in the United States of America, rows upon rows of people could be seen lined up in hospital rooms, “bloody and dying in some new and awful way.” It was the flu. The blood came mostly from nosebleeds, some from coughing. The victims “writhed in agony or delirium” and experienced extreme head and body aches. Often, their skin darkened significantly. The illness was spreading explosively from the first, non-lethal waves thought to have originated in Kansas in January 1918, to the second and most deadly wave that hit in Boston, Philadelphia and elsewhere in the autumn of 1918 and again in 1919. Roughly 25 percent of the nation’s population (over 25 million people at the time) took ill, and between 500,000 and 675,000 perished. Morgues ran out of coffins, corpses were stacked up in spare rooms, in closets, on porches and ultimately on the street, until they could be collected for mass graves. Most textbooks state that about 20 million people died during the flu pandemic of 1918. On the contrary, experts today estimate that 20 million likely died in India alone and calculate the total number of victims to be between 50 and 100 million worldwide, or about three percent of the world population. If this is true, no disease in human history has caused as many fatalities, including the Black Death. Most diseases tend to be especially hard on the very young and the very old; the lethal second wave of the 1918 flu was most severe on young adults in the prime of life and the life expectancy in the United States in 1918 dropped by 10 to 12 years. Studies have shown that the viral infection itself was probably no more aggressive earlier iterations of influenza. Instead, the unfortunate circumstances of the times— namely, malnourishment, overcrowding in medical camps and hospitals, and poor hygiene—enabled the bacterial infection to spread like wildfire. On the battlefield, the close quarters and massive troop movements of World War I hastened the pandemic, and likely aided transmission and mutation. Soldiers' weakened immune systems due to the stresses of combat and chemical attacks increased their susceptibility.The symptoms were gruesome. Some victims turned blue because their lungs were no longer able to deliver sufficient oxygen to their bloodstream or coughed so violently that they ruptured abdominal muscles or cracked ribs. Frequently, patients became so sensitive to any contact that they screamed at the slightest touch or were unable to move their eyes without shooting pain. Sometimes air pockets formed under the skin, so that when a patient was moved, his or her body would make popping sounds. Death came quickly to the more fortunate victims, while others succumbed only after weeks of agony on their deathbeds. The influenza pandemic can be considered the first great clash between nature and modern science, as it was first instance in which modern humanity, utilizing the scientific method, confronted the absolute rage of nature. While the graduate studies physics, chemistry and engineering thrived in the late 19th and early 20th centuries, the United States had a dismal quality medical education compared to that of Europe: “In no area did the United States lag behind the rest of the world as much as in its study of the life sciences and medicine.” The flu pandemic altered the course of history. German Army chief of staff, Erich von Ludendorff, blamed the flu for the failure of his spring offensive, which precipitated an early end to World War I. During the negotiations at the Paris peace conference, Woodrow Wilson fell ill with a high temperature, and eyewitnesses reported that he was a different man when he returned to the bargaining table. Many people thought they were witnessing the end of civilization. The medical professionals on the front lines worked overtime, risking their lives against an unfathomable killer, and many doctors and nurses did succumb to the disease. Since there was no flu vaccine at the time, they hoped perhaps vaccines against other diseases could help. Doctors prescribed morphine, codeine, and heroin; other drugs including quinine, digitalis and opium were “routinely prescribed indiscriminately.” In a throwback to more primitive times, some physicians even suggested bleeding the sick or using leeches. None of these measures. Ultimately, the most effective method was the nursing care that kept patients hydrated, rested and warm. Because all the drugs and medicines failed, the desperate public rushed in with its own theories and prescriptions. Laws were passed in various cities making it illegal to shake hands or requiring citizens to wear gauze masks, despite the fact that the microscopic influenza virus could easily pass through the mask. In San Francisco, the police even raided hotels to arrest those without masks. Again, scapegoats abounded, such as Bayer, the German drug company that created aspirin. In Denver, the health commissioner declared that the city’s Italian immigrants were at fault. In Phoenix, a rumor spread that dogs were the carriers, so the police took to killing strays, and many pet owners went so far as to kill their canine companions. “Of the million or so microbes in existence, only 1,415 are known to cause disease in humans. Of course, they don't mean to harm us; our diseases are just side-effects of their life-cycles. But ever since Homo sapiens evolved, we have been locked in mortal combat with microbes, our deadly companions.” It is essential to look back at the cycles, causes and effects of viral outbreaks in history as we face the current global pandemic crisis.Bibliography Barry, John M. The great influenza: the story of the deadliest pandemic in history. New York: Penguin, 2009.Crawford, Dorothy H. Deadly companions: how microbes shaped our history. Oxford: Oxford University Press, 2009.