|Influenza Pandemic (1918)|
The influenza pandemic of 1918 was, in terms of loss of life, the most catastrophic illness to have ever afflicted the world's population. Nothing before or since has approached its effects in terms of the number of fatalities or in the speed with which it spread.
From the latter part of the 19th century until World War I (1914–18), many Europeans and Americans had taken comfort in the idea that technical, scientific, and medical progress had created a better world. The war shattered most of that illusion, but any comfort that might have been derived from advances in medical science were not to be found as millions died from the disease.
The influenza of 1918 was often referred to as the Spanish influenza. It struck Spain, where it was reported on in detail. Because Spain was neutral in the war, there was no press censorship, and so the reports gave many the impression that it had started there. Where it came from is still unknown.
Whatever its point of origin, the pandemic killed between 25 million and 100 million people. Even at the lower number, it was a catastrophe; total casualties resulting from World War I were 15 million. One estimate is that 500,000,000 people were infected, one-third of the world's population in 1918.
Fatality rates were generally more than 2.5 percent of those infected. In Asia and Africa any public health statistics were partial or nonexistent. All estimates have to be taken as approximate with a great variance on which numbers can be considered reliable.
One estimate, for example, puts the number of deaths in India at 17 million. In the United States estimates of influenza-related deaths range from 500,000 to 675,000. Britain's figures of dead were said to be 200,000 and France's twice that.
Earlier recorded pandemics of influenza had occurred in 1781, 1830–32, 1847, and 1889. These had crossed from east to west, from Asia to Europe and, to a lesser extent the Western Hemisphere. Although serious, they never approached the level of destruction of life found in 1918. The world was a far different place in 1918 than it was earlier, even far different from 1889.
The World War had caused large numbers of people to move from one country to another, from one continent to another. It is fairly certain that soldiers from Europe brought the influenza virus back to America on troop ships. That war-driven mobility caused the virus to move farther and more rapidly than had ever been the case.
Another factor was that the war had displaced large numbers of people who had to live with decreased food supplies, no sure housing, lack of medical care, and susceptibility to infections or sickness. Another factor was the soldiers themselves who were cramped in barracks that were not healthy and who, because of the stress of combat, were physically susceptible to infections.
The influenza usually struck very quickly. There are many accounts of people appearing to be perfectly healthy and suddenly, within hours, becoming completely debilitated. From that point they could die, often the next day. Those stricken would cough up blood.
The coughing was so severe that bodies that were autopsied showed serious tears of internal muscles due solely to severe coughing. Pneumonia combined with the influenza, and many essentially drowned because their lungs were filled with liquid they could not be rid of.
In many cases, a blue tinge would develop at the ears and spread to the rest of the face, darkening it. Doctors and nurses in the United States mentioned that it was often difficult to tell Caucasians from African Americans, as patients of both races would become so dramatically discolored. Doctors and nurses generally believed that the most serious cases, the ones who would die, were those that showed the discoloration.
The British army's medical department, as part of its record keeping during the pandemic and in order to educate doctors and nurses what to look for, commissioned artists to draw pictures of soldiers who had been stricken. These illustrations would show the coloration to look for. Even many years after the pandemic, these portraits of ill soldiers, many of them about to die, provide an excellent idea of what they were suffering.
The time that the pandemic began has generally been agreed to have been in the spring of 1918. This was the first wave. It was reported and treated in several U.S. Army camps in the Midwest, primarily in Kansas in March. Those soldiers eventually transferred to France, where it is believed they spread the disease.
In August sailors from Europe reached Boston and brought the infection to that city. From there it traveled almost immediately to an army post in central Massachusetts, Fort Devens, where it killed 100 soldiers a day.
Influenza traveled very rapidly down the East Coast, following the transportation corridor created by the railroads. Of the cities on the east coast of the United States, Philadelphia was the hardest hit. By October influenza was so serious there that 4,600 people died in one week. The second wave of the pandemic hit hardest through November 1918. Despite the efforts of doctors and nurses, there was very little that could be done.
One of the effects of the pandemic was that in many places in the world, especially the United States, the public health service was mobilized. In the end that intervention did not significantly halt or affect the spread of the disease.
It did, however, lead to the practice of mobilizing all resources and taking steps by the government to try to halt the disease. Bans and quarantines were put into place. In many communities citizens were forced to wear face masks, or they would not be allowed on trolleys or might even be fined or jailed. Reporting on the incidences of disease as well as the quality of reporting changed.
Influenza had never been reported as a health issue until 1918. Record keeping was more stringent and included tissue samples, some of which would be used over 70 years later to support research on the spread of influenza and reconstruct the genome of the 1918 virus.