DURING A
a few months in 1918, more people died of influenza than any other illness or plague in recorded history. World War I (1914-1918) claimed an estimated 16 million lives. The influenza epidemic of 1918 killed over 50 million people. Nearly one out of every three persons on the earth was infected. It is not an overstatement to say that it is the most devastating natural disaster in history (barely covered in many history courses).
The name “Influenza” comes from an epidemic in 1357 in Florence, Italy. Derived from the medieval Italian word for “influence” (influentia), the word “influenza” refers to the causes or influences of the disease. According to the Oxford English Dictionary, the causes were originally believed to be astrological. Eventually, however, unusually cold weather came to be considered the primary explanation for this pandemic and was called “Influenza di freddo” (“influenced by cold”). The term “Influenza” has since come to be used universally for this now-known viral illness.
In 1892, Dr. Richard Pfeiffer isolated an unknown bacterium from the sputum of his sickest influenza patients, believing this to be the cause. He called it “Pfeiffer’s bacillus” or “Haemophilus Influenza.” This well known bacteria is not the cause of Influenza, which is a viral illness; nevertheless, we still use this misnomer today.
In 1918, it was dubbed the “Spanish Flu” because its first reports came from the Iberian Peninsula (Spain). We now know this is not
where it started.
Both Allied and Axis news sources during World War I wanted to print only encouraging news and thus withheld knowledge
of influenza outbreaks. Spain, which was not involved in WWI, was free to report on the pandemic and became responsible for its first reports. This led Americans to believe the outbreak was brought to the U.S. by Europe-an immigrants (which was used politically). The calls for “social distancing” and isolation were taken lightly, particularly by businesses that would be hurt by such actions. Political leaders failed to understand the potential impact, and down-played the devastating “influence” this infection could have on a community. This insert is from the collection of the national WWI Museum and Memorial:
Though New York City was in the throes of the pandemic by early October, Health Commissioner Royal S. Copeland repeatedly downplayed the situation, seemingly to mitigate public alarm. When the city reported 999 new cases on Oct. 4, he claimed, even so, that there were “no alarming symptoms about the spread of influenza in New York.” When on Oct. 6 the city experienced 2,070 new cases, he announced, nevertheless, “I do not believe that the city is stricken.” Whether speaking out of ignorance or hubris, such guidance did little to protect the public. Copeland would wait into the next week to finally establish an Emergency Advisory Committee. In other communities, businesses proved restive under the public health restraints. In Globe, Ariz., Wichita, Kan., and Terra Haute, Ind., theater owners fought against closures in courts. Still other locales found citizens resistant to public health controls. In San Francisco and Seattle people chafed under rules requiring the wearing of masks in public spaces.
The reality is that it likely started in Kansas! On March 11, 1918, the first report of many people coming down with influenza came out of Haskell County. One of them was a soldier sent to Camp Funston near Fort Riley. Later that same month, 1,100 soldiers at Fort Riley were infected and 38 died.
Informed of this outbreak (and others), President Woodrow Wilson was advised by his chief physician not to send soldiers to France for fear of worsening outbreaks. Wilson went against his advice and sent thousands of soldiers.
Upon the transport ships, 200,000 soldiers became infected. These transport ships became known as “floating coffins” (like cruise ships). Wilson may be responsible for more U.S. lives lost from this single decision than any other decision made during WWI. 80% of U.S. military lives lost were from influenza!
Somewhat ironically, it was the presence of influenza in France that likely slowed the German forces from over-running France and winning WWI. Influenza may be the most “influential” factor in stopping Germany in WWI.
President Wilson contracted influenza on April 3, 1919, at the Treaty of Versailles (“Paris Peace Treaty” after WWI). Some historians believe his influenza affected his decision-making capacity in which he did not hold to the agreements he had originally made with Germany—and these political embarrassments fueled right-wing German nationalists (e.g., Hitler) for WWII.
We must be reminded that in 1918 we still had no idea what caused “influenza.” The only “treatments” were quarantine, limitations of public gatherings (“social distancing”) and personal hygiene (hand washing). If you were coughing in a movie theater, you were asked to leave. Many associated this plague with God’s punishment along with WWI.
In 1933-36, the influenza virus was discovered. It was not until 1940 that the first vaccine was used on military personnel.
In 1957, a new strain of influenza (H2N2) was dubbed “the Asian flu” and resulted in another pandemic with 1.1 million deaths globally. As a result of the “Asian flu,” annual influenza vaccines were recommended in the U.S. for pregnancy, chronic illness, and over 65 years of age. Several other pandemics have since occurred, including our recent influenza scares in the U.S. with “swine flu” (H1N1) in 2009 and “bird flu” (H7N9) in 2013—and now the novel coronavirus causing Severe Acute Respiratory Syndrome (SARS-CoV-2), which we call COVID-19.
Flu vaccination rates for the U.S. in 2018-19 were 46-81% for children and 33-56% for adults. In 2018, 80,000 people in the U.S. died from seasonal influenza (just the “regular flu”). 80% of the children that died were unvaccinated. We live our beliefs without knowing our history. Remember 1918. Remember 2020.
“Look at history, lose an eye. Neglect history and you go blind.” ~A Russian proverb quoted in The Brothers Karamazov
REFERENCES
1. Morens, D. M. & Taubenberger, J. K., “Influenza Cataclysm, 1918” in New Engl J Med, December 13, 2018; 379; 24: 2285.
Mark Mosley
has done emergency medicine at Wesley Medical Center in Wichita, Kansas for over 25 years. He is boarded in Internal Medicine and Pediatrics. He received his M.D. from the University of Oklahoma. He earned his Master’s in Public Health in nutrition from Tulane School of Public Health and Tropical Medicine. He is married to his wife Jane and has five children. He attends Saint George Orthodox Christian Cathedral.
