THE FLU EPEDIMIC OF 1918-19

Bad as all the previous pestilences had been, the twentieth century bore witness to what is arguably the most virulent epidemic in recorded memory. As the U.S. entered the conflict, World War I had already claimed nine million lives in its four-year duration. But a far greater and more lethal killer was lurking in Camp Funston (now Fort Riley) in Kansas.

On the morning of March 11, 1918, Albert Mitchell, a company cook, reported to the infirmary complaining of a low-grade fever, sore throat, headache, and muscle aches—typical flu symptoms. He was sent to bed. By noon of that day, 107 soldiers exhibited similar symptoms and within two days, a total of 522 people were sick. Some were close to death with severe pneumonia. (Remember, there were no antibiotics in general use until the 1950s.) Camp Funston was the tip of the iceberg as other military bases reported similar figures almost immediately. Even shipboard sailors docked off the East Coast were affected. Within a week even isolated locales were hit; the island of Alcatraz reported cases. No state escaped infection. Neither was the disease held in check by the vast expanse of ocean; by April, French soldiers and civilians were infected. Within two weeks, it had spread to China and Japan. During May it was found in Africa and South America. By this time, it had eased its burden of illness and death on the Americas, but continued its onslaught elsewhere. This first wave, somewhat more than a minor annoyance, was more deadly than the typical flu, but far from what was to be seen.

During the autumn of 1918, likely after experiencing antigenic shift, the flu reappeared in the Americas. This time it seemed more virulent and continued to attack people in the 19-34 age group along with the usual population segments of children and the elderly. Fully 20% of the population was affected. Deaths from pneumonia were unusually high. At military camps bodies could not be autopsied fast enough that the dead were piled like so much cordwood in storerooms. The civilian population was also decimated. Medical personnel were unable to offer more than palliative care. Some medical authorities claimed the cause was "Pfeiffer's bacillus" and recommended wearing gauze masks to prevent its spread. Schools and public places were closed. Many cities mandated the wearing of masks and levied fines of $5 on those who failed to comply.

The disease's effect on military age men was so great that the American draft was suspended in October of 1918 due to the epidemic. As the Allies engaged Germany in a series of "final" offensives, the flu was a major player in the overall mortality rate and swung the outcome of some battles. Even General Pershing, the commander of the American Expeditionary Force (AEF, impolitely referred to as ass-end-first by the common foot soldier) was affected. So many soldiers died of it, that the flu had a significant influence on the cessation of hostilities. The AEF suffered 35,000 battle-related casualties and 9,000 deaths from flu. Of course, this means that many, many more soldiers had been unable to fight because of the disabling disease. Even the peace conference at Versailles was affected as all three major participants, President Woodrow Wilson of the United States, Prime Minister David Lloyd George of Great Britain, and Premier Georges Clemenceau of France, contracted the disease and this likely changed the outcome of the negotiations.

The disease was generally called the Spanish flu (for no good reason other than announcements of its effect first came from the relatively open country of Spain), although Germans called it the French flu and the French called it the German flu, etc. The old familiar xenophobia anyone?

About eighteen months after its first appearance, the disease disappeared. At its height, mortality rates were 15.8% in Philadelphia, 14.8% in Baltimore, and 10.9% in Washington D.C. Sixty percent of the Inuit population in Nome, Alaska fell victim to the flu. Although overall death rates were relatively low, the incidence rate was abnormally high at around 20% of the population. Almost everyone in this country knew of someone who had succumbed to the flu. Between 80% and 90% of the Western Samoan population (under the governance of New Zealand) was infected. The U.S. death toll was 650,000—low by worldwide standards; Russia lost 450,000; Italy 375,000; Britain 228,000; 500,000 in Mexico; 44,000 in Canada; unnumbered millions died in the Asian subcontinent. Estimates of the worldwide mortality for this epidemic range from 25 million to 50 million. The unusual feature of this epidemic was the age-mortality curve: flu usually kills young children and the elderly, but this version also took a large proportion of males between 19 and 34. Compared to the Plague of the Middle Ages with its eight to thirteen million dead globally per year, this may have been the most lethal recorded epidemic in human history.