February 12th, 2018

 

Although the end of World War I wasn’t formally marked until 1919 with the Treaty of Versailles, the brutal combat that took place was essentially over by November 1918. Casualties from this four-year “Great War” were unprecedented in human history — truly astounding: about 20 million died from direct conflict (9-11 million soldiers and 5-6 million civilians) and indirectly from disease; an additional 23 million people were wounded during this (first) “War to End All Wars.” (Almost 20,000 British military lives were lost — enough to fill a modern sports arena — on one day alone, July 1, 1916, the first day of the Battle of Somme.)

Maybe it hastened the war’s ending, and it certainly contributed to the death toll, but the 1918 influenza pandemic overwhelmed the war-weary world and created its own casualty count that dwarfed those from WWI. It was “the greatest medical holocaust in history,” says Ashley Halsey III:

Experts believe between 50 and 100 million people were killed. More than two-thirds of them died in a single 10-week period in the autumn of 1918.

Never have so many died so swiftly from a single disease. In the United States alone, it killed about 675,000 in about a year — the same number who have died of AIDS in nearly 40 years.

 

It is estimated that a third of the global population became infected with influenza A (H1N1) in 1918-19, and about 10-20% of those who were infected died. That means 3-6% of the entire world’s population died from flu during the pandemic! Halsey paints a vivid picture:

The flu brought life to a standstill, emptying city streets, closing churches, pool halls, saloons and theaters. Coffin makers couldn’t keep up with demand, so mass graves were dug to bury the dead. People cowered behind closed doors for fear they would be struck down.

In Philadelphia, news stories described priests driving carts through the streets, encouraging people to bring out the dead so that they might be buried.

In New York there were accounts of people feeling perfectly healthy when they boarded the subway in Coney Island and being taken off dead when they reached Columbus Circle.

 

No corner of the world was spared from the ravages of this extraordinary disease outbreak which killed tens of millions in a few short months — in India (17 million deaths), Indonesia (1.2 million), Japan (390,000), and Iran (perhaps more than 2 million), Canada (50,000), Britain (250,000), France (400,ooo) — and sickened hundreds of millions more. In the United States, 28% of the population was infected and 500,000-675,000 Americans died. Halsey again:

Entire families succumbed.

In Tyler County, West Virginia, John Linza, his wife and two of their sons died on the same day. Two other sons died just days before them. The last Linza, an infant, died the day after his parents.

In the southwestern tip of Virginia, J.W. Trent, his wife and two sons fell ill. They were preceded in death by all four of their young daughters — Hattie, Mary, Ellen and Ruby.

In 10 weeks, the flu killed 20,000 in New York City and produced 31,000 orphans.

 

Unlike previous and subsequent flu epidemics where the very young and the elderly typically have the highest death rates, this particular pandemic saw mostly healthy young adults 20-40 years of age perish from the disease. Pregnant women were extremely vulnerable to the virus, and in those lucky survivors, 26% lost their babies. In other words, people who had the healthiest and most robust immune systems (infants, the elderly, and people with chronic illnesses generally have weak immune systems) were the ones who suffered the worst, died the quickest, and lost the most among living generations while trying to fight off the unusually aggressive “Spanish Flu” (so named because it made Spain’s King Alfonso III profoundly ill):

The Spanish flu infected the upper respiratory tract and then dove deep into the lungs with viral or bacterial pneumonia. How did it kill so many young healthy adults? Their immune systems attacked the influenza invader with such force that it killed them.

One Army doctor, quoted by historian John M. Barry, author of the bestseller, “The Great Influenza,” described the scene at a base hospital in Massachusetts:

“When brought to the [hospital] they very rapidly develop the most vicious 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 blueness] extending from their ears and spreading all over the face. … It is only a matter of a few hours then until death comes. … It is horrible.”

 

Other reports were just as gruesome:

In 1918 there were no flu vaccinations, and it would not have mattered anyway. After the “touch of the flu” that proved deadly only here and there during the spring, the influenza apparently mutated into a killer.

By early autumn the public face of America and the Western world had a gauze mask on it. People wore them to church, the military marched in them, police posed for photos in them and doctors wore them to visit patients. In Seattle, anyone who tried to board street cars without a gauze mask was arrested.

The masks served little purpose. The fine spray of a sneeze creates a cloud of more than half a million virus particles, and the virus can live for hours on any hard surface where they settle.

Four women who gathered to play bridge in Albuquerque in November prudently wore six-ply cloth masks. Three of them were dead the next day.

The frightening spread of the disease led to official and self-imposed quarantines…

Many flu victims died in their homes of starvation, and not the disease, because they were too weak to seek food and no one dared bring it to them.

 

Scientists constantly monitor the global distribution and genetics of circulating influenza viruses which easily mutate and make the production of effective flu vaccines a moving target. In an extraordinary report prepared for the CDC in 2006 entitled “1918 Influenza: the Mother of All Pandemics,” the authors fear a future pandemic (there have been three influenza pandemics since 1918 — 1957, 1968, and 2009) could be even worse:

Even with modern antiviral and antibacterial drugs, vaccines, and prevention knowledge, the return of a pandemic virus equivalent in pathogenicity to the virus of 1918 would likely kill >100 million people worldwide. A pandemic virus with the (alleged) pathogenic potential of some recent H5N1 outbreaks could cause substantially more deaths.

 

2018 — 100 years later — and scientists are still watching and waiting.

 

(Google Images: “American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918.”)

 

 

One Response to 1918

  1. I remember the catchwords of that epidemic when it was elaborated upon in medical school: immunologic barrage (killing the young healthy adults), von Economo encephalitis (encephalitis lethargica), post-influenza parkinsonism. I wonder if the global depression in the spirit of humanity following the war and dramatized in the writings of Ernest Hemingway and other authors of the “Lost Generation” was triggered as much by the fatalistic outlook and shock from the influenza epidemic as it was from the mass military casualties from ground combat.
    It goes without saying that we cannot be doomed to relive this epoch of history.

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  • MEET THE EDITOR

    Ned Ketyer, M.D.

    Ned Ketyer, M.D.

    Dr. Ketyer has special interests in developmental pediatrics and preventative medicine, specifically how nutrition and the environment affect health. He earned his bachelor’s degree from the University of Vermont and his medical degree from Northwestern University Medical School. He completed his residency at Children’s Hospital of Pittsburgh.

    As one of the founding physicians of Pediatric Alliance, PC, Dr. Ketyer served as its president from 1997-2004. He has been practicing general pediatrics at Pediatric Alliance since 1990. Dr. Ketyer and his wife have three boys and live in Pittsburgh's South Hills. 



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