Date March, 1918-1919

The influenza epidemic constituted a major medical disaster more severe than any witnessed since the fourteenth century. The outbreak spurred the discovery of influenza’s viral agent and a vaccine against the disease.

Locale Worldwide

Key Figures

• Christopher Howard Andrewes (1896-1988), British pathologist
• Thomas Francis, Jr . (1900-1969), American epidemiologist
• Patrick Playfair Laidlaw (1881-1940), British researcher
• Richard Edwin Shope (1901-1966), American animal pathologist and virologist
• Wilson Smith (1897-1965), British bacteriologist
• Charles Herbert Stuart-Harris (1909-1996), British virologist and influenza researcher

Summary of Event

The influenza (or grippe) pandemic of 1918-1919 was deadlier than any war in history. Its global fatalities were estimated at more than twenty million, but they may have been as high as forty million. All told, about a billion of the total world population of two billion at the time are thought to have been exposed to the virus. In addition, this epidemic spread faster and more widely than any previous epidemic. A noted American epidemiologist, Edwin Oakes Jordan, eventually computed the estimated breakdown of mortality by continents as follows: North and Central America, about 1 million; Latin America, about 300,000; Europe, about 2.2 million; Asia, about 15.8 million; Australia and Oceania, about 1 million; Africa, about 1.4 million. In the United States alone, some 550,000 died from influenza or its frequent pneumonic complications.

One peculiarity of the 1918 version of the flu was that it especially affected young adults between the ages of twenty and forty. Uncharacteristically, older citizens above sixty years, normally the most vulnerable, were now least so. Accordingly, it is on the basis of substantial increases in young adult deaths that pandemic pathways around the globe could be traced.

The United States was hit as early as March of 1918, as were France, Japan, China, and other countries. This initial wave of the attack was fairly mild and attracted little notice. Indeed, in recent times influenza had appeared identifiably in 1627, 1729, 1788, 1830, 1847, 1872, and 1889-1892 but it was known to have existed for centuries, and the disease had ravaged communities frequently but irregularly. In the early days, influenza epidemics had been attributed by astrologers to the influence (hence influenza) of the heavenly bodies. Only when the second, much more lethal, wave broke out in August-September, 1918, did the world witness an unprecedented flu epidemic.

The added virulence of this newer onslaught was subsequently explained as having been caused synergistically by a fairly mild flu virus acting in conjunction with an equally benign Pfeiffer bacillus. In combination, these two parasites produced a maverick killer that injured human lungs beyond their capacity to recover. During its peak in October-November, 1918, the influenza morbidity rate in the United States ranged from two hundred to four hundred per thousand; the mortality rate was about fifty, compared with the normal thirteen from all causes. Even though the pandemic visited all continents, this new strain of an old affliction was dubbed the “Spanish flu” because uncensored news of its devastation was coming out of that neutral country, Spain, during the world conflict.

Wartime conditions—individuals in their prime crowded in cities, in military camps, on vessels, in hospitals, and elsewhere and moving about in unprecedented numbers—contributed to the disease’s rapid spread. On the western front in Europe, major offensives, first by the Germans and then by the Allies, were blunted in the summer and fall of 1918, partly because of the large number of troops victimized by the flu. The ailment recognized no regions, races, or categories other than age. The epidemic seems, however, to have found easy victims among people worn down by the deprivations of war and/or poverty in countries such as India. Important world leaders were not spared; the flu’s victims included President Woodrow Wilson (who nearly died of influenza in April of 1919), Premier Georges Clemenceau of France, and Prime MinisterDavid Lloyd George of Great Britain.

At the time, the specific cause of this highly contagious respiratory infection was unknown. Its symptoms, since its identification as the “English sweat” in the sixteenth century, were, however, familiar: sudden fever, inflammation of the mucous membranes, coughing, headache, acute perspiration, occasional nosebleed, muscular discomfort, prostration. Even though an attempt was made in 1951 to exhume the well-preserved bodies of Eskimo victims known to have died of influenza in the pandemic and buried in Alaska’s permafrost, there was no trace of what was by then known conclusively to be the general cause of influenza: any of three distinct types of viruses, A, B, and C. These minute organisms mutate rapidly and resurface in several strains, or subtypes. Type A was identified in 1933 by Dr. Wilson Smith, Christopher Howard Andrewes, and Patrick Playfair Laidlaw as a filterable virus that was experimentally transmitted to animals and that the latter—not just hogs but also horses and birds among others—are suspected of harboring “underground” without causing outbreaks, except on occasion. One of these instances was in 1918-1919.

Significance

The countermeasures taken in that epidemic, most vigorously in cities such as San Francisco, were generally gauze masks, at times medicated, worn on the face, and even some makeshift attempts at vaccination. Nevertheless, such countermeasures did not seem to be effective. Indeed, it was not until the 1930’s that virology had advanced sufficiently to pinpoint the basic agent that had killed more in a year than World War I had done in four. Without a miracle drug or appropriate vaccine, rest, warmth, fresh air, and good nursing care were about the best that the medical profession could prescribe in 1918-1919, as immediate priorities at that time necessarily had to focus on symptoms and disease control rather than prevention.

Although individual survivors of the pandemic vividly recalled how the event affected them, surprisingly, this plague seems to have had little impact on the collective psyche. Mention of the epidemic by historians and writers describing the period has been generally casual, brief, or nonexistent. (Notable exceptions include authors Katherine Anne Porter, Thomas Wolfe, and Mary McCarthy, who were markedly affected by the event.) There may be at least two reasons for the lack of attention. First, influenza is usually an uncomplicated illness and a minor inconvenience. Second, because it recurs frequently, the ailment is only too familiar. In short, it lacks the drama of other killers, such as tuberculosis.

Several influenza epidemics have taken place since that of 1918-1919, going by different names, including “swine flu,” “Hong Kong flu,” and “Asian flu.” The reason is that most epidemics are caused by different strains of the Group A virus, and there are about a thousand of them. Samples of these are stored at the Influenza Center of the World Health Organization in London, but determining which particular subtype will hit in any particular flu season—essential to preparing an appropriate vaccination response in time—remained problematic. The variation of the virus is still not fully understood—though scientists have been able to piece together the 1918 virus’s genetic sequence—and the world may again witness the visitation of the “Spanish Lady.” In fact, in late 2005, researchers at the U.S. Centers for Disease Control and Prevention determined that the 1918-1919 epidemic was caused by genetic mutations that have a great deal in common with flu strains traditionally found mostly in birds, including the H5N1 strain from Southeast Asia, the strongest candidate for the next epidemic’s cause. Although this strain’s genes had much in common with the 1918 virus and H5N1 proved capable of transferring from animal to human, scientists were unsure whether it would mutate to a state that would allow it to transfer easily from human to human.

Bibliography

Barry, John M. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York: Penguin Books, 2005. Scientists and nonscientists will appreciate this fascinating account of the disease’s causes and effects. The author takes pains to show how the U.S. government’s casual treatment and lack of attention to the science behind the disease hastened its spread.

Beveridge, W. I. B. Influenza, the Last Great Plague: An Unfinished Story of Discovery. New York: Prodist, 1977. The author, a British veterinarian, speculates on the possible animal origins of the 1918 epidemic.

Collier, Richard. The Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919. New York: Atheneum, 1974. Based on the personal accounts of 1,708 survivors of the epidemic and thus highly anecdotal but nevertheless informative. Illustrated and with a good bibliography.

Crosby, Alfred W., Jr. America’s Forgotten Pandemic: The Influenza of 1918. 2d ed. New York: Cambridge University Press, 2003. This American medical writer puzzles over why the epidemic, despite its magnitude, was, generally speaking, neither traumatic nor memorable.

Jordan, Edwin O. Epidemic Influenza: A Survey. Chicago: American Medical Association, 1927. Although dated, still one of the most authoritative sources by an eminent American epidemiologist.

Kilbourne, Edwin D. Influenza. New York: Plenum, 1987. In chapter 1, “History of Influenza,” this medical doctor considers technical aspects of the 1918 pandemic.

Kolata, Gina. Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. Morongo Valley, Calif.: Sagebrush, 2001. A good popular history of the 1918 outbreak. Illustrated.

Osborn, June E., ed. Influenza in America 1918-1976. New York: Prodist, 1977. Includes an essay by Alfred W. Crosby, Jr., “The Pandemic of 1918,” that provides an excellent synopsis.

Pettigrew, Eileen. The Silent Enemy: Canada and the Deadly Flu of 1918. Saskatoon, Sask.: Western Producer Prairie Books, 1983. An account of how the epidemic killed more Canadians than World War I. Includes illustrations and a good bibliography.

Pyle, Gerald F. The Diffusion of Influenza: Patterns and Paradigms. Totowa, N.J.: Rowman & Littlefield, 1986. Chapter 3, “Calamity and Discovery: The Early Twentieth Century,” describes the epidemic of 1918 with considerable statistical information. Maps by the author-geographer graphically illustrate the spread of influenza.