An Army doctor examines a flu victim at Camp Devens, Massachusetts, which was hard hit by the deadlier second wave of the Spanish Flu. Credit: U.S. Army
In America’s head-long rush to war in early 1918, few paid much attention to the growing number of soldiers reporting in sick with high fevers, body aches, and chills. It was, after all, flu season, and wartime expediency would not allow common influenza to slow down military training.
Within a year, however, that flu would become notorious as the ‘Spanish Flu,’ and the number of people it would kill would vastly surpass the number of soldiers and sailors who died in combat on all sides during all four years of World War I.
So-Called Spanish Flu Death Toll
From August 1914 to the signing of the armistice in November 1918, about 16 million military personnel and civilians were killed or died of diseases associated with combat. From the spring of 1918 to the spring of 1919, the Spanish Flu claimed the lives of at least 40 million people—far more, too, than were lost in the Black Plague. Some estimates of the number of persons who succumbed to the Spanish Flu reach as high as 100 million.
The Spanish Flu came in three waves, with infection rates rising and ebbing, then rising again. At its height in the fall of 1918, the Purple Death, as it was also known, could kill a person in mere hours. Unlike most influenza variants, this flu killed more than just the very young and the very old. It was also particularly harsh for victims 20 to 40 years old—the very population that was fighting at the front.
There was no cure, no vaccine, and little support that medicine could provide other than prayer.
Flu Epidemic: Where Did It Come From?
Even today, no one absolutely is sure where such a virulent avian H1N1 flu virus came from. Some researchers believe it may have started in China. Others theorize the virus had been around for years, with minor outbreaks occurring in France in 1916 and England in 1917.
Businesses just as theaters restricted their operations or were closed entirely in an attempt to stop the spread of the Spanish Flu. Credit: U.S. Public Health Service
What we do know is that in January and February 1918, flu swept through rural Haskell County, Kansas. Between late February and early March, three recruits from Haskell County reported for training at Fort Riley, Kansas. Many historians believe one or more of these recruits carried the virus. By the end of March, thousands of Fort Riley soldiers were ill. Soldiers transferring to other military camps carried the virus with them, and soon 24 of the nation’s 36 largest military installations were suffering large outbreaks of influenza.
Though highly contagious, at this point the flu was still relatively mild. Though the death rate from this flu was somewhat higher than the normal rate of 0.1%, it wasn’t high enough to cause alarm. Infected and uninfected soldiers were packed into cramp troop ships for the voyage to the French port of Brest. By the time the ships arrived, even more of the soldiers were infected. They, in turn, carried the virus into the trenches.
Once brought into the trenches, the virus quickly spread through the British, French, and German forces. In wartime, however, casualty rates, even for illness, are kept secret. Media censorship prevented journalists from reporting on the large numbers of soldiers coming down ill in both the training camps and trenches. The families of soldiers who died of the flu were simply notified that their love one “died on the field of honor.”
Whether on the battlefront or the home front, few people knew there was a flu epidemic. And no one realized how quickly it would become a global pandemic— or how deadly it would be.
Cotton masks were worn in public in a futile attempt to ward off the Spanish Flu. Credit: U.S. Public Health Service
The 1918 Flu Gets Its Name
By spring, the flu reached Spain, probably brought across the border by returning Spanish laborers who had been working in France. It arrived just as Spain was celebrating the Fiesta de San Isidro, a holiday celebrated by large gatherings of people that allowed the virus to easily propagate. Spain’s King Alfonso XIII and the country’s prime minister came down ill with it, as did many cabinet members.
Because Spain was neutral in the war, there was no press censorship, and the Spanish media reported freely on what the news service Agencia Fabra called a “strange form of disease of epidemic character.”
When the citizens of the belligerent countries finally became aware of the epidemics in their own nations, the flu had a new name. “Under the name of Spanish influenza, an epidemic is sweeping the North American Continent,” reported the Canadian Medical Association Journal. “It is said to have made its appearance first in Spain, hence Spanish influenza.”
The Second Wave Arrives
The flu subsided during the summer months of 1918, so much so that British military authorities declared the end to the Spanish Flu on August 10. But that was merely wishful thinking. The influenza virus was only in waiting; changing itself, mutating into a more efficient predator.
Today, scientists understand that viruses can become more virulent as they pass from one human to another, a process called “passage.” The 1960 Nobel recipient Dr. Macfarlane Burnet estimated the relatively mild virus seen in the first wave of Spanish Flu had gone through fifteen to twenty human passages, emerging in the fall of 1918 a much more lethal disease than before.
It would be this mutation that would give the Spanish Flu the nickname Purple Death.
Army recruits take their enlistment oath during WWI. Wartime training was responsible for spreading the Spanish flu. Credit: Library of Congress
Purple Death Hits Soldiers
As American soldiers continued to arrive in France in late August, French military authorities saw another eruption of influenza among their troops. So many sick French and American soldiers were hospitalized that the hospital had to turn away new victims.
And now, victims were dying in large numbers – 20 times higher than normal flu – and many only hours after first showing symptoms. It was not unusual for a victim to wake up feeling fine, then collapse a few hours later. By dinner they would be dead. In between, bloody fluid filled the lungs, preventing the exchange of CO2 for oxygen. Cyanosis turned the skin blue, then purple, and sometimes nearly black, as the victim literally drowned in their own bodily fluids.
As the French and American soldiers left Brest for the battlefields, they took with them the new, deadlier virus.
Warships spread the disease even further. When the HMS Mantua arrived in Freetown, Sierra Leone, that month, she carried 200 sailors sickened by the flu. They, in turn, infected the dock workers, who then spread it to every other ship that stopped in Freetown.
In the trenches, influenza was decimating both sides. An outbreak among German troops entrenched near Ypres, France, so weakened their fighting strength they could not hold out against an attack by Commonwealth troops. Flu outbreaks among the British 15th and 29 Divisions forced them to postpone operations.
The Flu Comes Full Circle
In September the virus came full circle, returning to the U.S. with a vengeance aboard troop ships and warships returning from France. Once again, wartime expediency help spread the disease.
On September 25, 3,108 soldiers boarded a troop train at Camp Grant, Illinois. By the time they reached their destination at Camp Hancock, Georgia, a 950 mile trek, 2,000 of the soldiers had to be hospitalized with the flu. Dozens died.
Death from pneumonia secondary to the Spanish Flu was so prevalent, it was ranked as the third leading cause of death in the U.S. after heart disease and cancer. Credit: U.S. Public Health Service
In a September 29 letter to a friend, army physician Dr. Roy Grist described the horrors the flu created at Camp Devens in Massachusetts. “It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up… An extra long barracks has been vacated for the use of the morgue. 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”
The day before Grist wrote that letter, Philadelphia held a patriotic parade featuring thousands of soldiers, sailors, Boy Scouts, and civic group members. Within three days, every hospital room in the city was filled with flu victims. As many as a quarter of the victims died every day, only to be replaced with new victims.
Similar results were seen in every large city in the nation. In an attempt to staunch the spread of the disease, public health officials ordered stores and theaters closed. Businesses shut down. Public coughing and hand shaking were outlawed. People wore cloth masks over their faces in a useless gesture to avoid the virus. Field hospitals like those normally seen on battlefields began popping up across the country to take in the overflow of flu patients from brick and mortar hospitals.
Desperate to avoid the growing plague, Gunnison, Colorado sealed itself off from the rest of the world. Armed guards prevented any outsider from entering the city limits. Gunnison was probably the only town in the U.S. to avoid the flu.
The military draft imposed to build up America’s small peacetime army was stopped because of the flu, and by October almost all military training was halted. The pipeline of fresh troops headed for the trenches of France began to dry up.
Historians estimate about 700,000 Americans died from the Spanish Flu—more than all the Americans killed in combat in WWI, WWII, the Korean War, and the Vietnam War together.
This patriotic parade held in Philadelphia, PA in September 1918 was responsible for infecting thousands of citizens with the Spanish Flu. Within days, every hospital in the city was overflowing with flu victims. Credit: Naval Historical Center
A Pandemic of Global Devastation
But America was not alone in its suffering. This second wave of influenza spread throughout Europe, Africa, and Asia. In Spain, which gave the pandemic its name, Catholic Masses held to pray for deliverance only helped spread the virus faster. Twelve hundred flu victims died daily in Barcelona alone; eventually more than 260,000 Spaniards would perish. Churches and funeral homes could not keep up with the dead.
When the killing stopped on the battlefields, the dying from influenza and secondary infections continued.
A week after the November 11 armistice, the number of flu-related deaths in England soared to 19,000; eventually some 200,000 would die in the United Kingdom. India lost 5 million to the flu. Between 30,000 and 50,000 Canadians died. Many more perished in Africa, Latin America, Asia, and the Middle East.
Then, by the end of November, it was gone.
The virus that arrived in the third wave in December was a mere shadow of its former self. The virus had undergone an antigenic shift, creating a less virulent mutation. The third wave swept over New York City and San Francisco, California. It lingered throughout much of 1919, causing outbreaks here and there, but never the devastation the second wave wrought.
Countries across the globe established improvised hospitals like this one to treat the overflow of Spanish Flu victims from established care centers. Credit: U.S. Public Health Service
Spanish Flu: Aftermath
Despite its devastation, the Spanish Flu was largely forgotten until recently. Deadly outbreaks of the severe acute respiratory syndrome (SARS) virus in 2003 and the Novel H1N1 “swine flu” virus in 2009, plus the ongoing threat of terrorist acts involving biological agents, have led scientists to re-examine the etiology of the Spanish Flu.
Dr. Jeffrey Taubenberger, a pathologist with the U.S. Armed Forces Institute, and Professor John Oxford, of London’s Queen Mary College, have isolated specimens of the 1918 flu virus from the bodies of persons who died nearly a hundred years ago. They hope to isolate genetic material from the virus samples to better under how a normally mild flu virus became so deadly.
“The more we can learn from this kind of investigation,” Professor Oxford told WelcomeScience in 2005, “the better chance we have of holding off new pandemics.”
A postal worker makes his rounds wearing a cotton mask in a futile attempt to avoid the Spanish Flu. Credit: National Archives
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