The Influenza Pandemic of 1918
The Influenza Pneumonia Pandemic of 1918 killed 600,000 people in the United States and more than 25 million people worldwide.
It was called the "Spanish Influenza" because of a large outbreak of the disease that occurred in Spain in May and June of 1918. The influenza may, however, have originated in March 1918 among U.S. soldiers in Kansas; about 500 men there were infected, among whom 48 were listed as having died of "pneumonia". Those who survived the illness may have carried the disease to Europe, where in the summer and fall of 1918 over one and one-half million U.S. soldiers were sent to fight in World War One.
Whatever its origin, by September 1918 the influenza had spread to the civilian population of America. It first reached epidemic size in Boston, and then spread to New York, Philadelphia and beyond, following the railroad lines. 12,000 people died of the influenza in America in September 1918, and a further 195,000 died in October. In fact, the highest death rate in U.S. history occurred in the month of October 1918; the rate was 5 dead for every 100 of the population, or 5 percent.
In America, the City of Philadelphia had the most deaths: out of a population of almost 2 million, almost 13,000 people died in the influenza epidemic. Over 11,000 of those deaths occurred in October 1918.
In July 1918 Philadelphia's Bureau of Public Health had issued a bulletin about the "Spanish Influenza". But health officials had not listed influenza as a reportable disease, and this denial of the danger of what was happening had encouraged people to take foolish risks. So it was that on 28 September 1918 a "4th Liberty Loan Drive" parade in Philadelphia was attended by 200,000 people. Since influenza is a respiratory illness spread by breathing, within days of the parade 635 new cases of influenza were reported; and on 6 October, 289 people died. Then city officials had to recognize that an epidemic was occurring, and they ordered all public gathering places, including churches, schools and theaters, closed. Despite these precautions, by mid-October hundreds of thousands of people were infected, and by the third week of October 1918, over 4,500 were dead. Since a large proportion of the city's doctors and nurses were in Europe to support U.S. involvement in the war there, many people in Philadelphia may have died because they did not get proper medical attention. And yet, although in October open trucks (death carts) had been sent out to collect corpses from wooden boxes on front porches (and abandoned corpses from gutters), by early November life began to return to normal. The end of the epidemic was celebrated along with the European Armistice on 11 November 1918.
The influenza had affected all the armies in the European War. In some American units, the influenza killed 80 percent of the soldiers. But when the U.S. Army general in Europe said that he wanted more men, the President sent them, even though this meant jamming soldiers onto troop ships where they would breathe on one another and transmit the disease. In September 1918, a further 13 million men across the United States were crowded into schools, city halls and post offices, when they were called together to register for the draft.
In the midst of the epidemic the acting Surgeon General of the Army noted the unusual character of this epidemic: whereas influenza normally was a mild disease that killed only the very young and the very old, this influenza was most dangerous to people 21 to 29 years of age. This influenza took the strong and spared the weak.
At that time of the influenza pandemic of 1918 health officials were faced with a disease that is caused by something scientists did not know existed, namely a virus. And there were no scientific instruments at the time that could have discovered its existence.
Source: based on texts found at the Web site "American Experience - Influenza 1918" (pbs.org/wgbh/amex/influenza/), as it existed in March 1999.
Notes: In pneumonia the lungs fill with fluid, making breathing difficult or causing death by suffocation. (1) In September 2006 there were news reports of research suggesting that the 1918 influenza virus provoked an extreme response from the human immune system; the bodies of people whose immune systems were strongest destroyed themselves, while people with weaker immune systems survived. (2) According to news reports in late December 2008, the 1918 influenza virus infected 1/3 of the world's population of 500 million human beings and killed between 20 and 50 million worldwide, more than all the deaths of World War One.
"Influenza, an acute epidemic infectious and contagious disease, sometimes becoming pandemic. It is characterized by an inflammation of the mucous membrane of the respiratory tract.... Pandemics have ... been recorded as early as ... 1510. It has always been noted that an epidemic is composed of three distinct waves as the disease sweeps over the world ... separated by many months, the second wave generally being the most serious. Pandemics or worldwide occurrences of influenza have been recorded in 1781, 1832, 1847, 1889, and 1918. In each of this instances the disease became epidemic in a definite area....
"The incubation stage of the disease is short, from one to three days. The onset is sudden, especially in the epidemic type, and is marked in general by a true chill and a rise in temperature to 102 degrees F. or even to 104 degrees F.... Practically all patients have respiratory symptoms such as running at the nose, laryngitis, and bronchitis with expectoration. The patient seems dull and apathetic.... When a typical case is encountered, especially during an epidemic, the diagnosis is easily made.... Severe forms without complications present the same train of symptoms but to an exaggerated degree. The chill is more severe, the pain in the limbs worse, and the prostration extreme. The temperature may be as high as 105 degrees F. Cough is racking, pain in the chest agonizing, and there may be nausea and vomiting. The patient looks extremely ill.... In about 10 per cent of the cases of influenza the pneumonic type is present, the signs appearing on the third or fourth day.... With the appearance of pneumonia the patient becomes more toxic and cyanosis is present. Occasionally a severe and rapidly fatal pneumonia is observed in which the patient is in extremis within 24 hours and dies within another day. Such cases were frequent during the epidemic of 1918. In the pneumonic cases where actual pneumonia is present the mortality may be from 20 to 60 per cent."
Source: Encyclopedia Americana 1954, Vol. 15, p. 124.
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Last revised: 4 January 2009 : 2009-01-04 by Robert [Wesley] Angelo