How the Horrific 1918 Flu Spread Across America

How the Horrific 1918 Flu Spread Across America The toll of history’s worst epidemic surpasses all the military deaths in World War I and World War II combined. And it may have begun in the United States An emergency hospital at Camp Funston, Kansas, 1918. “Of the 12 men who slept in my squad room, 7 were ill at one time,” a soldier recalled. (New Contributed Photographs Collection / otis historical Archives / National Museum of Health and Medicine) By John M. Barry Smithsonian Magazine November 2017 Haskell County, Kansas, lies in the southwest corner of the state, near Oklahoma and Colorado. In 1918 sod houses were still common, barely distinguishable from the treeless, dry prairie they were dug out of. It had been cattle country—a now bankrupt ranch once handled 30,000 head—but Haskell farmers also raised hogs, which is one possible clue to the origin of the crisis that would terrorize the world that year. Another clue is that the county sits on a major migratory flyway for 17 bird species, including sand hill cranes and mallards. Scientists today understand that bird influenza viruses, like human influenza viruses, can also infect hogs, and when a bird virus and a human virus infect the same pig cell, their different genes can be shuffled and exchanged like playing cards, resulting in a new, perhaps especially lethal, virus. We cannot say for certain that that happened in 1918 in Haskell County, but we do know that an influenza outbreak struck in January, an outbreak so severe that, although influenza was not then a “reportable” disease, a local physician named Loring Miner—a large and imposing man, gruff, a player in local politics, who became a doctor before the acceptance of the germ theory of disease but whose intellectual curiosity had kept him abreast of scientific developments—went to the trouble of alerting the U.S. Public Health Service. The report itself no longer exists, but it stands as the first recorded notice anywhere in the world of unusual influenza activity that year. The local newspaper, the Santa Fe Monitor , confirms that something odd was happening around that time: “Mrs. Eva Van Alstine is sick with pneumonia...Ralph Lindeman is still quite sick...Homer Moody has been reported quite sick...Pete Hesser’s three children have pneumonia ...Mrs J.S. Cox is very weak yet...Ralph Mc-Connell has been quite sick this week...Mertin, the young son of Ernest Elliot, is sick with pneumonia,...Most everybody over the country is having lagrippe or pneumonia.” Several Haskell men who had been exposed to influenza went to Camp Funston, in central Kansas. Days later, on March 4, the first soldier known to have influenza reported ill. The huge Army base was training men for combat in World War I, and within two weeks 1,100 soldiers were admitted to the hospital, with thousands more sick in barracks. Thirty-eight died. Then, infected soldiers likely carried influenza from Funston to other Army camps in the States—24 of 36 large camps had outbreaks—sickening tens of thousands, before carrying the disease overseas. Meanwhile, the disease spread into U.S. civilian communities. The influenza virus mutates rapidly, changing enough that the human immune system has difficulty recognizing and attacking it even from one season to the next. A pandemic occurs when an entirely new and virulent influenza virus, which the immune system has not previously seen, enters the population and spreads worldwide. Ordinary seasonal influenza viruses normally bind only to cells in the upper respiratory tract—the nose and throat—which is why they transmit easily. The 1918 pandemic virus infected cells in the upper respiratory tract, transmitting easily, but also deep in the lungs, damaging tissue and often leading to viral as well as bacterial pneumonias. Although some researchers argue that the 1918 pandemic began elsewhere, in France in 1916 or China and Vietnam in 1917, many other studies indicate a U.S. origin. The Australian immunologist and Nobel laureate Macfarlane Burnet, who spent most of his career studying influenza, concluded the evidence was “strongly suggestive” that the disease started in the United States and spread to France with “the arrival of American troops.” Camp Funston had long been considered as the site where the pandemic started until my historical research, published in 2004, pointed to an earlier outbreak in Haskell County. Wherever it began, the pandemic lasted just 15 months but was the deadliest disease outbreak in human history, killing between 50 million and 100 million people worldwide, according to the most widely cited analysis. An exact global number is unlikely ever to be determined, given the lack of suitable records in much of the world at that time. But it’s clear the pandemic killed more people in a year than AIDS has killed in 40 years, more than the bubonic plague killed in a century. The impact of the pandemic on the United States is sobering to contemplate: Some 670,000 Americans died. In 1918, medicine had barely become modern; some scientists still believed “miasma” accounted for influenza’s spread. With medicine’s advances since then, laypeople have become rather complacent about influenza. Today we worry about Ebola or Zika or MERS or other exotic pathogens, not a disease often confused with the common cold. This is a mistake. We are arguably as vulnerable—or more vulnerable—to another pandemic as we were in 1918. Today top public health experts routinely rank influenza as potentially the most dangerous “emerging” health threat we face. Earlier this year, upon leaving his post as head of the Centers for Disease Control and Prevention, Tom Frieden was asked what scared him the most, what kept him up at night. “The biggest concern is always for an influenza pandemic...[It] really is the worst-case scenario.” So the tragic events of 100 years ago have a surprising urgency— especially since the most crucial lessons to be learned from the disaster have yet to be absorbed. Initially the 1918 pandemic set off few alarms, chiefly because in most places it rarely killed, despite the enormous numbers of people infected. Doctors in the British Grand Fleet, for example, admitted 10,313 sailors to sick bay in May and June, but only 4 died. It had hit both warring armies in France in April, but troops dismissed it as “three-day fever.” The only attention it got came when it swept through Spain, and sickened the king; the press in Spain, which was not at war, wrote at length about the disease, unlike the censored press in warring countries, including the United States. Hence it became known as “Spanish flu.” By June influenza reached from Algeria to New Zealand. Still, a 1927 study concluded, “In many parts of the world the first wave either was so faint as to be hardly perceptible or was altogether lacking...and was everywhere of a mild form.” Some experts argued that it was too mild to be influenza. Yet there were warnings, ominous ones. Though few died in the spring, those who did were often healthy young adults—people whom influenza rarely kills. Here and there, local outbreaks were not so mild. At one French Army post of 1,018 soldiers, 688 were hospitalized and 49 died—5 percent of that population of young men, dead. And some deaths in the first wave were overlooked because they were misdiagnosed, often as meningitis. A puzzled Chicago pathologist observed lung tissue heavy with fluid and “full of hemorrhages” and asked another expert if it represented “a new disease.” A ravaged lung (at the National Museum of Health and Medicine) from a U.S. soldier killed by flu in 1918. (Cade Martin) By July it didn’t seem to matter. As a U.S. Army medical bulletin reported from France, the “epidemic is about at an end...and has been throughout of a benign type.” A British medical journal stated flatly that influenza “has completely disappeared.” In fact, it was more like a great tsunami that initially pulls water away from the shore—only to return in a towering, overwhelming surge. In August, the affliction resurfaced in Switzerland in a form so virulent that a U.S. Navy intelligence officer, in a report stamped “Secret and Confidential,” warned “that the disease now epidemic throughout Switzerland is what is commonly known as the black plague, although it is designated as Spanish sickness and grip.” The second wave had begun. The hospital at Camp Devens, an Army training base 35 miles from Boston that teemed with 45,000 soldiers, could accommodate 1,200 patients. On September 1, it held 84. On September 7, a soldier sent to the hospital delirious and screaming when touched was diagnosed with meningitis. The next day a dozen more men from his company were diagnosed with meningitis. But as more men fell ill, physicians changed the diagnosis to influenza. Suddenly, an Army report noted, “the influenza...occurred as an explosion.” At the outbreak’s peak, 1,543 soldiers reported ill with influenza in a single day. Now, with hospital facilities overwhelmed, with doctors and nurses sick, with too few cafeteria workers to feed patients and staff, the hospital ceased accepting patients, no matter how ill, leaving thousands more sick and dying in barracks. Roy Grist, a physician at the hospital, wrote a colleague, “These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis”—the term refers to a person turning blue from lack of oxygen—“extending from their ears and spreading all over the face....It is only a matter of a few hours then until death comes...It is horrible....We have been averaging about 100 deaths per day...For several days there were no coffins and the bodies piled up something fierce...” Devens, and the Boston area, was the first place in the Americas hit by the pandemic’s second wave.

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