1918: A killer worse than a war

Figure 1 -- People infected with the Spanish Flu

In 1918 two wars were raging. One was was reported on daily in the newspapers, and most families new at least one person sent off to battle. The other was a surreptitious pest that didn't stop on the battlefield, traveling around the world, infesting anyone in the vicinity of its victim.

The surreptitious war was waged by a killer that was not seen by the naked eye. Scientists new about virus's, yet they had never seen one as the electron microscope hadn't been invented yet.  They had yet to learn about DNA and RNA, "the genetic material of viruses."  They didn't know the lungs were the ideal burrowing ground for the influenza virus due to an enzyme there that, once connected to a cell, allows the virus to "split one of its proteins during teh manufacturing of new virus particles."  (1, page 27-28)

Figure 2 -- Chart showing mortality from 1918 influenza
pandemic in the U.S. and Europe (published 2006)

So there were some wacky theories postulated as to what caused the Spanish flu.  One theory was that a so called Pfeiffer's bacillus caused it.  At Chelsea Naval Hospital north of Boston the Pfeiffer's bacillus was present in the throats of 80 percent Spanish Flu victims autopsies.  It was the accepted theory, even though other victims didn't have the bacillus.  (4, page 271)

The Pfeiffer bacillus was first discovered by the man who named it, Richard Friedrich Johannes Pfeiffer, in 1892.  It was a small rod-shaped bacteria that he found in the upper respiratory tract of patients infected with influenza.  With the germ theory being well known by this time, many didn't doubt the claims of Pfieffer. (Wikepedia, will find a reliable reference later)

Figure 8 -- Burying flu victims, North River, Labrador (1918)

We now know Pfieferr's bacillus as Haemophilus Influenzae.   Later studies confirmed it's a bacteria that it normally lives in humans without causing disease, although in the right circumstances is known to cause a variety of diseases, such as eppiglotitis.  (Wikepedia)

While the cause was being debated, the Spanish Flu continued to make it's way around the world, aided by the ignorance of the populace.  It was transferred from one person to another when it was exhaled, coughed or sneezed into the surrounding air, and inhaled by another person.  This surreptitious killer was a new and powerful strain of influenza.

Influenza was the last thing on anyone's mind, mainly because it was considered minor ailment, and it had been more than twenty years since the last pandemic.  The flu was considered a "minor inconvenience" compared with the smallpox or yellow fever.  It was so minor that the government didn't require new victims to be reported, and so there was no way of knowing a new pandemic was raging, until the bodies started to stack up. (3, page 5)

Figure 3 -- Men in an Alberta field wear masks during the Spanish flu,
Fall 1918, Canada.  Masks were made of gauze or cloth

It was called the Spanish flu because it was believed to have started in Spain. Although the truth is no one knows where it started.  In Spain it was called the "three day fever."  The rest of the world called it the Spanish flu, probably because Spain was a neutral state, and it was among the few European nations "that did not censor its news reports."  Yet before long the flu had spread to all of Europe, Asia, and the United States.  (1, page 10)

It hit hard.  While the flu normally kills 1.5 percent of its victims, mainly the very young and the very old with weakened immune systems, the Spanish flu was different: it killed men and women with fully developed immune systems:  people who we think of as being healthy and strong enough to fight off the virus; people strong enough to fight in a war

Figure 4 -- Patient's at Walter Reed Hospital are separated by sheets.  Nurses
wear cloth masks over mouth and nose (circa 1918 or 1919)

It was normal for the flu to spread fast through military barracks, prisons and schools.  But the Spanish flu was aided by a war, with thousands of troops huddled together in trenches.  These men traveled all over the world, carrying the virus with them.

Within 2-3 days of contact with the virus, they started showing the typical signs of flu: headache, fatigue, sore throat, aches and pains, dry cough, fever and chills.  Yet these typical signs progressed in some victims to chest discomfort, pneumonia, and then cyanosis of the fingers, toes and then face.

The pneumonia caused bleeding in the lungs, and the victims would cough up blood.  Their faces turned dark blue, and their toes black.  These were ominous signs that usually resulted in death from suffocation.  And unlike regular pneumonia, death from pneumonia caused by the Spanish flu was quick, sometimes in less than 48 hours. (3, page 8)

Perhaps it was the helpless feeling of watching these people suffocate that provided one of the reasons why many studies were performed during WWI on oxygen therapy, and oxygen equipment greatly improved.  By the 1920s oxygen was available in hospitals to treat diseases that caused hypoxemia, although to the victims of the Spanish Flu in 1918 this was of little help.

Figure 5 -- Spanish Flu public notice from 1918

The Center for Disease Control (CDC) provides us with the following statistics regarding the Spanish Flu (2):

• A third of the worlds population (500 million persons) were infected
• Greater than 2.5 % of those infected died, as compared to the average flu virus killing 1.5%
• Total deaths are estimated anywhere from 50 million to 100 million

The most significant statistic is the last one there: over 50 million people died.  This made the Spanish Flu the worst pandemic in the history of the world.  Compare that with the following (1, page 7):

• 11.7 million died in the first 25 years of AIDS
• 9.2 million died in combat deaths in WWI
• 15.9 million died in combat deaths in WWII

Figure 6 -- Policemen wearing masks provided by the
American Red Cross in Seattle, 1918

Basically, the only remedy was to wait it out and hope you, or the ones you loved or were taking care of, survived.  A remedy tried was to inoculate "troops with vaccines made from body secretions taken from flu patients or from bacteria that they thought caused the disease.  They made them men spray their throats each day and gargle with antiseptics  or alcohol.  They hung sheets between beds, and at one camp they even hung sheets in the centers of thh tables at mess halls.  At Walter Reed Hospital, soldiers chewed tobacco each day, believing that it would ward off the flu."

While the origin of the Spanish Flu is unknown, some have developed conspiracy theories that postulate that the governments attempt to prevent the flu by giving such vaccinations were what caused the deadly strain in the first place.  We have heard stories of worse things being done by the Germans later, in the 1930s.  Yet such an attempt may have been performed in just about any country, including the United States.  Yet such conspiracies were never proven, and probably never will be.

Figure 7 -- A street car conductor iSeattle in 1918
refusing to allow passengers aboard
 who are not wearing masks

Another attempt to prevent the spread of the Spanish flu was to require people to wear masks made of gauze or cloth.  The problem with this is these masks often gave people the courage to go out into public places, and the virus was so resilient that it would make it's way right around the masks.  It was airborne, tiny enough, and wicked enough to do such a thing.

The Spanish flu went away as fast as it arrived, probably because it infected all the people who were vulnerable.  Eager to forget the dreadful events that just occurred, many newspapers refused to publish anything about the flu.  People were eager to put it behind them, and move on with their lives

Yet the Spanish flu had a major effect on society.  It interrupted society and economies all over the world, where people stayed home to care for their friends and relatives, and to keep themselves from getting the flu.

It also impacted the health care industry, whereas the government from then on required new epidemics of the flu to be reported.  Much of the way the influenza virus is kept in check today is based from researchers and scientists studying the outbreak of 1918.

Later, during the 1930s and 40s antibiotics and sulfa drugs were discovered to prevent and treat bacterial infections.  This made it so people who developed pneumonia as a complication of the flu could be treated and cured.  These medicines made the influenza bug less likely to be a killer.

Today we also have the ability to create an influenza vaccine and have it ready to give to people at high risk, if the strain can be isolated soon enough.  The problem that continues to plague scientists is there are many strains of the flu, and to inoculate against all of them wouldn't be cost effective.

Figure 9 -- "Demonstration at the Red Cross Emergency
Ambulance Station Washington, D.C.,during the
influenza pandemic of 1918."

So for this reason scientists must continue to be vigilant.  When new cases are reported, they are monitored.  Each year the "suspected" strain of influenza is readied in a vaccine and recommended for anyone at high risk, which generally are the very old, very young, and caregivers.  Although, as the Spanish Flu reminds us, sometimes those at risk aren't the typical victim.

Further reading:

1. Spanish flu creates the 'living room'

References:

1. Kolata, Gina, "Flu," 1999, New York, Farrar, Straus and Girouxx
2. Taubenberger, Jeffrey, David Morens, "1918 Influenza: the Mother of All Pandemics," Emerging Infections Diseases, Centers for Disease Control (CDC), http://wwwnc.cdc.gov/eid/article/12/1/05-0979_article.htm, accessed 11/26/12
3. Crosby, Alfred, "America's Forgotten Pandemic: The influenza of 1918," 2003, United Kingdom, Cambridge University Press
4. Wikepedia: all the photos for this post are from Wikepedia: The free online encyclopedia.