Influenza's impact on combat effectiveness both Allies and Germany

[John Gilinsky]

In part motivated by current events but more importantly the recognition that the influenza pandemic of 1918 to 1919 sprouted forth in the early spring of 1918 I am wondering if this spring 1918 epidemic seriously impaired the frontline combattant troops of the Allies or even if it played a major role in weakening the ultimate effectiveness of the German spring offensive of 1918. Does anyone have "sick" statistics or died from sickness for the Allied armies and/or the Germans for 1918 that tend to support or negate such a postulation?

John

Toronto

[davedobbin]

From an article I read recently, that outbreak of (Spanish?) influenza caused the immune system to go into overdrive, which caused overheating, damage to the organs and death in a very short space of time. Some of the irony was that bodies of the very old and the very young (whose immune systems were not so active or developed) were less likely to react in such an extreme way.

The ones who really suffered were the fit young adults - such as soldiers. The article indicated that the effect on the Germans was so bad that it was a contributory factor in ending WW1.

[John Gilinsky]

Any way to get a bibilographic citation to this article?

The irony of mother nature run amok actually significantly causing or largely contributing to ending the horrors of the war though admittedly supplanting it with other horrors is fascinating.

John

[Ron Clifton]

Hello John

See Casualties and Medical Statistics, edited by Major T J Mitchell and Miss G M Smith, one of the British Official History series for the medical services.

Page 167, referring to the BEF in France in 1919:

"There was little or no infectious disease until influenza broke out with startling suddennes, first in June and July and again in October, in a world-wide epidemic which no medical service could control, which laid low both friend and foe alike."

A representative sample of just over one million individual records was made the subject of detailed analysis as to cause of wounds or illness and eventual disposal of cases, and a table of the results appears on pages 304 to 306. These show that, within this sample which divided illnesses into 99 different groups, influenza was by far the commonest but only accounted for about 95,000 casualties, of which only just over 1,000 actually died. The next most common illnesses, with about 46,000 casualties each in the sample, were "pyrexia of uncertain origin" and "other diseases of the respiratory system", either of which could have included flu cases, but which only accounted for another 400 deaths between them. Some 69,000 cases of "diseases of the areolar tissue", which I don't think can be flu-related, accounted for around 80 deaths.

The implication is that the Germans' Spring offensives were not likely to have been much affected by flu, on either side, but it was undoubtedly a factor in sapping the strength of all combatants later in the year. Received wisdom is that the flu was brought to Europe by troops arriving from the USA, where in turn the majority of deaths were among the civilian population.

Personally, I think the war would have ended roughly when it did whether the flu had come or not, but it may well have been the case that the privations of the war, weakening the civilian poulation as well, may have contributed to the massive loss of life from flu.

Ron

Ron

[John Gilinsky]

Thanks Ron for your contribution. The medical statistics show fatalities but in fact the sickness and more importantly the sapping of logistical support for these sick combined with a difficult to measure contribution to already significant war weariness by having people known to you sicken and possibly die surely must have played an important factor as early as the German spring offensive of 1918 or March - April (extending of course into June 1918). The fluidity of the situation, dispersal and loss of some records and overshadowing by the war's "victorious" conclusion have I think hidden the impact of sickness and in particular influenza on the combat efficiency of all troops. Moreover, lack of proper sanitation and hygiene experienced by all troops in front line areas during rapid advances and withdrawals in conjunction with increased stress levels for all troops (whether advancing or retreating), poorer diets for the German troops perhaps all must have played a part in furthering influenza's deadly effectiveness which most people associate with October 1918 to early 1919.

Any have any accounts on either side of sickness amongst front line units or for that matter rear units during March - April 1918 in particular?

John

Toronto

[truthergw]

Current reports by BBC on the 1918 'Flu say that there was a mild outbreak in spring of that year with a very severe outbreak in autumn and winter, followed by waves over the following couple of years. This implies that the actual effect, if any, would have been towards the end of the war, in the 100 days and not, to any great extent in the spring offensive.

[John Gilinsky]

This is the standard and accepted version of the early history at least during the last year of the war on the Western Front for the 1918 - 1919 influenza pandemic. However, I think someone (or perhaps a history of medicine grad student or prof) should take another look at just how the "mild" influenza impact was during the spring of 1918 on the military effectiveness of all the forces engaged on the Western Front. This would be a massive and very time consuming task but again with modern tech and the right time and money ( ) some very interesting results might ensue. How for example did AEF units medically relate to the British or French military units that they were placed with when it came to spreading influenza in the SPRING of 1918 (when there were plenty of US frontline soldiers in France)?

John

Toronto

[Pete1052]

If the Spanish influenza was a serious impediment to military operations in 1918 we would probably know about it now because it would have been commented upon at the time. Examination of the rates of sickness in the records of the armies for 1918 probably show increases but I doubt that the lines on the graphs suddenly turn vertical and go off the page.

Those wishing to do further research on the subject may want to consult The Medical Department of the U.S. Army in the World War, Volume 12, Pathology of the Acute Respiratory Diseases, and of Gas Gangrene Following War Wounds, 1929.

http://www.archive.org/details/WW1ArmyMedDeptHistV12

[John Gilinsky]

Contemporary front line war time diagnoses are to put it mildly not exactly undertaken in the best diagnostic circumstances: soldiers and men as we know generally in peacetime being loathe to admit to weaknesses including being sick; not wishing to leave your buddies in times of withdrawal, defeat or stress; misdiagnoses and mislabelled terms (this last being considerable). Consequently mild sicknesses including influenza like all other sicknesses would reasonably have been underreported. The graph lines therefore do NOT have to be that dramatic. Anecdotal but verifiable literature such as soldiers' diaries, letters and the like may furnish us with some more direct and personal evidence.

John

Toronto

[Pete1052]

According to America's Forgotten Pandemic: The Influenza of 1918 by Alfred W. Crosby, Cambridge University Press, 2003, the mortality statistics among the allied armies on the Western Front were as follows:

AEF, September, October, November 1918, 9,144 deaths from influenza and pneumonia

BEF, week ending 12 October to week ending 30 November 1918, 3,656 deaths from influenza

French Army, Zone of the Armies, September, October, November 1918, 10,158 deaths from influenza

The author cites the sources of his statistics and notes that until 5 October 1918 there was no such thing as a diagnosis of influenza in the BEF. He also points out that each army compiled its figures using its own criteria. Data from all three armies include military hospital admissions, which were often more than ten times higher than the death rates. American and French data are monthly and the British data are weekly. In the AEF and French army the worst month of 1918 for deaths was October, 5,092 American and 5,917 French. For the BEF the worst weeks were those ending 2 November (701) and 9 November (878).

[Tinhat47]

CNN has an excellent article today on their Web site about letters written by an American soldier to his brother and friend while he was sick with the Spanish influenza (he caught it twice and survived) in a Georgia military hospital in 1918. The article is written by the soldier's grandson, who works for CNN at the Pentagon in Washington, D.C.

http://www.cnn.com/2009/US/04/29/wwi.spani...ters/index.html

[Heid the Ba]

I have recently read the British 23rd Divisional History and it comments on the effects with the first cases being reported as the division moved through France en route to Italy. There was much debate as to the nature of the disease as it seemed like influenza but couldn't be as it attacked the healthy rather than the weak. The disease then spread from regiment to regiment and on to other divisions. The average effect was 3 or 4 days in bed (I don't recall reading of any fatalities) with it having burnt out/moved on from the 23rd by the time of the Austrian attacks. The 48th division was still in the worst of the epidemic and struggled in combat due to the numbers sick.

This is from memory, I'll dig out the refs. later.

[John Gilinsky]

I presume that the 23rd. Divisional History is referring to the spring of 1918 right? If not what exact time period are you referencing here?

Thanks for your post,

John

Toronto

[Heid the Ba]

Spring 1918; I'll check the dates when I get home tonight.

[centurion]

I was looking at the topic in relation to some other things a year or so ago. There are a number of factors to consider.

1. The initial outbreak was relatively mild - the big problems came with the later waves towards the end of 1918

2. The virus needs somewhat particular conditions in order to spread easily. These were to do with humidity and temperature plus air flow. Strangely the environment at the front was non optimal for the virus. The ideal condition for it to spread was a crowd in the open (or a very large interior space) so that the temperature was warm but not too hot, humidity wqas slightly up and there was a slow airflow rather than a breeze. When tracking the progress of the Britannia tank in the US I found that from about mid 1918 flu outbreaks followed its track with a delay of about a week or ten days. Similar figures show up for Victory rallies and the like. Flu was more likely to hit civilians in the rear than soldiers at the front.

[John Gilinsky]

Most of us are probably in agreement that the most deadliest effects of the 1918 - 1919 pandemic were on civilians: large overcrowded industrialized cities with minimal or non-existent medical attendance since medical attendance was already sapped to a bare minimum due to medical personnel serving the military. Poor diets weakening people's immune systems and overall health by 1918 in all countries must have also played a considerable part in both spreading and in the intensity of the epidemic. Would be interesting to see Medical Officer's of Health reports from England, France and Germany especially during the first 6 months of 1918 and compare these especially in the larger urban centers.

John

Toronto

[Pete1052]

The following from Crosby's America's Forgotten Pandemic is greater detail on the BEF's reported casualties from influenza in 1918. The source cited is MacPherson, Herringham, Elliott, Balfour, editors, History of the Great War Based on Official Documents. Medical Services. Diseases of War (London, His Majesty's Stationary Office, no date), Vol. 1, p. 175. The dates listed below are for "week ending."

12 Oct, 1,776 hospital admissions, no deaths reported

19 Oct, 3,080 admissions, 2 deaths

26 Oct, 9,280 admissions, 314 deaths

2 Nov, 13,203 admissions, 701 deaths

9 Nov, 11,877 admissions, 878 deaths

16 Nov, 7,389 admissions, 689 deaths

23 Nov, 8,008 admissions, 546 deaths

30 Nov, 8,206 admissions, 526 deaths

[jhill]

A couple of times I have tried to get a feel for the Influenza situation by browsing the War Diaries of the various Hospital and Medical Units on the Canadian Archives Site (because they are easily available!). Curiously, many diaries seem to ignore the Influenza issue entirely, and others mention it only in passing. The June outbreak is only mentioned in a few cases. Some Base Hospitals noted a spike in cases and an increased death rate for a week or two. The October outbreak was much more severe and is noted in the Diaries much more often. During 'flu months the number of deaths may have risen in some cases to 2.5 percent of admissions, where "normally" it may have been one percent or less. Influenza was still not the principal preoccupation of the Medical authorities, nor was it even the largest cause of "Sick".

In the British Armies the medical arrangments for sickness was quite mature by this time. Long before the arrival of the 'flu, medical officers were always on the lookout for contagious diseases and quarantine was routinely used. Sickness was always a drain on manpower, and steps were always being taken to minimize its impact.

One difference with Influenza, was that it affected the Hospitals themselves. Diaries tended to note, for example, that so-many of the Nursing Sisters had had a bout of 'flu that month.

Here are some numbers from the Diary of the Assistance Director of Medical Services of the 4th Canadian Division. They are the monthly numbers of sick evacuated to Casualty Clearing Centres. For some months the number of Influenza cases is noted.

My conclusion (on the basis of the bit of research I have done!) is that Influenza did not affect operations to any extent.

4th Canadian Division

Total Sick Evacuated to C.C.S.

Nov-17 466

Dec-17 343

Jan-18 345

Feb-18 401

Mar-18 374

Apr-18 496

May-18 386

Jun-18 193

Jul-18 235

Aug-18 637

Sep-18 422

Oct-18 310 (262 Influenza in Divn)

Nov-18 590

Dec-18 600 (207 Influenza in Divn)

Jan-19 514 (120 Influenza in Divn)

Feb-19 601 (167 Influenza in Divn)

Mar-19 405 (28 Influenza in Divn)

Apr-19 269 (36 Influenza in Divn)

[RobertBr]

The War Diary of 281 Bde RFA first mentions flu as a problem on 28 June 1918, which implies it was not a particular problem in March.

Bob

[John Gilinsky]

Thanks everyone for your contributions. There is a fairly good breadth of military medical historical literature both serial and monographic on how sickness and disease relate to armed conflicts throughout history. However, part of the problem is the sheer scale including unreliability of medical statistics compiled during or shortly after an armed conflict due to a variety of factors.

John

Toronto

[Borden Battery]

Here is another website to consider. Borden Battery

The 1918 Influenza Pandemic

The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster. [CEF Study Group - August 2006]

http://virus.stanford.edu/uda/

In addition, here is a PhD thesis on the topic.

Johnson, N.P.A.S. ‘Aspects of the Historical Geography of the 1918-19 Influenza Pandemic in Britain’, PhD, Cambridge University, 2001

[phil andrade]

In relative terms. i.e., in comparison with the numbers who were killed in battle, the number of deaths from disease on the Western Front was remarkably small, and this was true for 1918 -even though that was the year of the 'flu.

The proportion for 1918 was somewhat higher than in previous years, indicating the impact of the disease. In France and Flanders, the British Official Medical History tells us that only four and a half per cent of all BEF fatalities 1914-1918 were from non battle causes, and this accounts for accidents and injuries as well as illnesses. The corresponding figure for 1918 alone is seven per cent, which indicates that there was a significant difference that year, although not to the extent that one might have imagined.

Many of the soldiers who died from the 'flu died at home, and are not included in the statistics above. While the British records indicate that, on the Western front itself, more than ninety five per cent of all fatalities were battle deaths, the overall figure for all fronts is eighty eight per cent, which is due in part to the numbers who died at home.

More than two million German troops were killed or died, of whom 166,000 (8.3%) were victims of disease. Probably half of that total of disease deaths occurred in the period of the flu pandemic - many of them after the fighting had ceased.

The US reported a very different proportion - deaths from disease outnumbering those from enemy action, but here again the preponderance of these died at home.

In terms of deaths, then, we can confidently assume that the impact of the 'flu was relatively trivial compared with the slaughter of combat : but this does not allow for the numbers who were incapacitated during the summer of 1918. I think I remember reading that German divisions on the Western Front were depleted by an average of well over one thousand each on account of the influenza during the period of June-July 1918, which is significant .

Phil.

[Heid the Ba]

23rd Div history p.247 - 8: Paraphrased - April 1918 in Italy. The 23rd was the first division in the British Army to suffer flu; first cases came after a unit stayed at a silkworm farm; started with 70th Brigade and moved from unit to unit; after 3 days casualties were recovering; nothing prevented the spread but there was no re-occurence; it went through the division unit by unit and then spread to 48th Division.

p262: "By ill-luck , influenza was at its worst in the 48th Division on the day the Austrians had chosen for their attack. The weakened garrison of the left sector had been forced from the front line, . . . "

[ian turner]

My grandfather's battalion war diary mentions a short/sharp outbreak of 'flu in June 1918 with most of those affected back in the line after a week or two's illness. Not a fatal outbreak at that point. It was the 7th Bn Seaforth (9th Scottish Div) at Meteren, France.

[stevem49]

The Battalion war diares for the 9th Sherwood Foresters only mentions one case of Flu in the whole of 1918.

stevem