1918-1919 Influenza Pandemic

[Sparky53]

Here is a letter from my Gt Grandmother to my Gt Uncle Horace mentioning the death of a 29 year old friend 9 March 1919

http://i25.photobucket.com/albums/c90/Beed...08/9Mar19sm.jpg

Then probably a bit later Horace & his mother Fanny have the 'flu looks like his brother Syd has recovered:-

http://i25.photobucket.com/albums/c90/Beed.../fannyflusm.jpg

Jane

[ian turner]

BG - interesting to remind us of this.

The June/July outbreak seems to have been a less virulent 'prequel' to the main pandemic in the Autumn and Winter of 1918.

My maternal Gt Grandfather was a 1918 victim - a civilian (48 years old and with a wooden leg) but he was a janitor at a local technical college where troops were billeted (my guess as to where he picked it up). Left my Gt Grandmother a widow with three young daughters (including my maternal grandmother). Cannot begin to explain the impact on subsequent family history and my very existence!

Ian

[alliekiwi]

Yes, there were several waves of the pandemic. The first, milder version was at its height in June/July of 1918, then a severe wave in November 1918, followed by another outbreak in the spring of 1919.

A few months ago I read a medical journal which had an hypothesis about how/why those in their 20s-40s were more often struck down, and then saw something similar online. However, I can't lay my fingers on it at present. Will see if I can find it.

Allie

[squirrel]

One of my relatives was on the "dangerously ill" list twice.

Once in France in late 1917 after he had been seriously wounded and once in Ireland in early 1919 suffering from the 'flu while still recovering from his wounds.

[alliekiwi]

The hypothesis is that the young and fit died as a result of an over-active immune response caused by a 'cytokine storm'. Basically, cytokines are proteins released by damaged tissue that promote inflammation. While a degree of inflammation is a good thing to help limit viral replication and spread, young healthy people can produce an excessive amount of inflammation. This can do more harm than good - even be deadly. The lungs vital air spaces can fill up with inflammatory fluid, the lungs no longer provide adequate oxygen to the blood. Falling oxygen levels will stimulate rapid breathing and cause fatigue/drousiness, confusion, coma and death. It's called ARDS - acute respiratory distress syndrome.

The same process has been the cause of death in bird flu.

Allie

[ian turner]

I researched a chap on my (then) local memorial - he had emigrated to NZ just before the start of the war. He joined up on outbreak, served at Gallipoli where he was wounded. Thence to the Western Front where again wounded. Thereafter took an officers course and was commissioned as 2Lt. Sent home in 1918, left the army but took up a post again at Featherston Camp, only to succumb to the 'flu. (Quite a few at this camp went the same way). I often wonder whether his constitution, being war-weary, was a contributing factor in his demise?

Ian

[BottsGreys]

This is from the U.S. Department of Health and Human Services Website:

"The Legacy of the Pandemic

No one knows exactly how many people died during the 1918-1919 influenza pandemic. During the 1920s, researchers estimated that 21.5 million people died as a result of the 1918-1919 pandemic. More recent estimates have estimated global mortality from the 1918-1919 pandemic at anywhere between 30 and 50 million. An estimated 675,000 Americans were among the dead."

[truthergw]

Thanks for the hard figures. This illustrates my query very well. Just over half a million in USA. If we say the same in the diferent large countries of Europe, we are looking at say 4 million. The commonwealth no more than a million alltogether. I am hard pushed to get ten million. The vast majority must have been in India, China, Russia where such epidemics were endemic so to speak.

[Jim Clay]

Tom, Wikipedia gives some more 'hard' figures which, again, tend to confirm (as far as Wikipedia can be thought to ...) your thoughts:

"An estimated 7 million died in India, about 2.78% of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it[citation needed]. In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died. In Britain as many as 250,000 died; in France more than 400,000. In Canada approximately 50,000 died. Entire villages perished in Alaska and southern Africa. In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%."

According to the same Wiki article, current thinking suggests an even larger worldwide death toll of 50 - 100 million. (source cited: The Story of Influenza, in Knobler S, Mack A, Mahmoud A, Lemon S: The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005). Washington, D.C.: The National Academies Press, 60–61. )

Jim

[BottsGreys]

...The vast majority must have been in India, China, Russia where such epidemics were endemic so to speak.

Tom:

I know from reports that things were particularly bad in Philadelphia and several other large U.S. cities. However, I agree with your view that conditions in underdeveloped countries, regions, etc, must then have been unfathomable. For example, I seem to recall that some Eskimo villages in Alaska (not yet a state) were particularly hard hit.

Chris

[linden]

One of the programmes I watched was about the US and I think it was Philadelphia they mentioned , where most of the city came out to some sort of parade or commemoration and the infection went wild . They talked to people who had been children at the time , going back to decimated classrooms , with their friends dead .

Another one was about exhuming victims in Alaska (and , maybe , Norway ) to see whether there was stll something to help current medical researchers .

The last one I remember is medical archives (I think in the US and the UK) where tissue samples still exist .

Didn't one of Ian Hislop's programmes talk about families where father came back from the war and only a couple of siblings survived the flu ; the pilot who was the first to shoot down a Zeppelin - he died from the flu .

[Pete1052]

Scientists Describe How 1918 Influenza Virus Sample Was Exhumed In Alaska

ScienceDaily (Jul. 4, 2007) — The effort to find preserved samples of the 1918 influenza virus has been a pursuit of both historical and medical importance. The 1918 influenza pandemic was the most devastating single disease outbreak in modern history, and examining the virus that caused it may help prepare for, and possibly prevent, future pandemics. When the complete sequence of the 1918 virus was published in 2005, it represented a watershed event for influenza researchers worldwide.

In an article in the journal Antiviral Therapy, scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, narrate the story of how scientists discovered samples of the 1918 strain in fixed autopsy tissues and in the body of a woman buried in the Alaskan permafrost. The article places this discovery in the context of decades of research into the cause of pandemic influenza, and the authors detail the strange convergence of events that allowed them to recover and sequence the virus in the first place. Its genetic material is so fragile that it should not have survived for days, let alone decades.

In a mass grave in a remote Inuit village near the town of Brevig Mission, a large Inuit woman lay buried under more than six feet of ice and dirt for more than 75 years. The permafrost plus the woman's ample fat stores kept the virus in her lungs so well preserved that when a team of scientists exhumed her body in the late 1990s, they could recover enough viral RNA to sequence the 1918 strain in its entirety. This remarkable good fortune enabled these scientists to open a window onto a past pandemic--and perhaps gain a foothold for preventing a future one.

Reference: "Discovery and characterization of the 1918 pandemic influenza virus in historical context," by J Taubenberger, J Hultin and D Morens. "Spotlight on Respiratory Viruses" issue of Antiviral Therapy 12:581--591 (2007). Article available at http://www.intmedpress.com.

[ericwebb]

I am currently researching a young subaltern who died of the 'flu' in October 1918, just 2 weeks before the Amistice, having fought right through the War - he joined up in August 1914, how unlucky can you get! He had been wounded on the Western Front and invalided home to Eastbourne to convalesce.

Here are two paragraphs from my write-up:

'From the summer of 1918 through the spring of 1919 a devastating pandemic of influenza swept the world, causing over 21 million deaths: more than the War itself. Over one billion people are thought to have become infected, out of a world population then of about two billion. On the Western Front and in the UK there was a prolonged, severe epidemic with major peaks in June - July and late October - early November 1918, and a smaller final peak the following February. Amongst cases admitted to military hospitals, 20% developed pneumonia, of whom about 40% died , ie. an overall mortality rate of about 8%: this amongst previously healthy young men, mostly unwounded. Through oxygen starvation and perhaps through other, more obscure pathogenic causes, the dying developed a distinctive bluish/purplish colouration, picturesquely described at the time as ‘heliotrope cyanosis’. Post mortem, their lungs were found to resemble those of poison gas cases. Effective fighting strength of the Allied armies was significantly weakened; fortunately, the Germans were equally severely affected. Taking the UK as a whole there were about 230,000 deaths. It was noted in Britain, Germany and elsewhere that mortality was especially great between the ages of 25 and 40.

'Influenza had become endemic over preceding years, and commoner in winter than in summer, but with only a modest mortality rate and that largely amongst the elderly and infirm. Through the spring and early summer of 1918 the incidence of ’flu’ in the British army remained about as expected, until June when there was a sudden massive surge. It quickly became clear too that this was a much more serious disease than usual. The pandemic later became widely known as ‘Spanish ‘flu‘’ as the first European epidemic occurred in Spain, in May 1918, but the virulent pandemic strain had already been prevalent in America in 1917. Its true origin remains obscure. [As a medical student in the 1970’s I recall being shown, by Dr. Richard Hunter at the Friern Hospital in North London, elderly patients in long-term asylum care with chronic encephalitis lethargica, as a complication of infection in the 1918 - 1919 epidemic, but that is a different story.]'

My sources are 'The Plague of the Spanish Lady' by Richard Collier which provides a comprehensive overview of the Pandemic and the official British 'Medical History'.

Scary stuff! It could perfectly well happen again.

Eric

[BottsGreys]

I was today looking at a history of our local hospital and noted that it lost 43 patients to the influenza over a four month period during the pandemic. This was in a rural, farming county with probably less than 10,000 population total at that time.

Chris

[laughton]

I am not sure how many involved in this topic are scientific/medical but for those with an interest, I found the CYTOKINE STORM web site to be of interest. The more you read about this and see how it links to SARS and the Avian Bird Flu, the scarier the story becomes. On the aspect of the 1918 version they said:

1918-19, "Spanish flu," [Type A, subtype (H1N1)], caused the highest number of known influenza deaths: more than one-half million people died within the United States (nearly half of the deaths were young healthy adults aged 20-40), and between 50 and 100 million people may have died worldwide. Most deaths occurred within the first few days after infection, some deaths within hours of symptom onset, and other deaths occurred later as a result of complications. Influenza A (H1N1) viruses still circulate today after having been reintroduced in the 1970s. Although called the "Spanish Flu" because the first widely reported deaths were in Spain, it probably originated in China.

Be sure to take a look at the slide show from the New England Journal of Medicine here for details on the process:

http://www.cytokinestorm.com/cytokine_storm.html

It always shocks me to read that more people died of this pandemic than from the Great War. Was it the result of the intense interaction of all the forces in the trenches of France and Flanders? Did the gas attacks exasperate the spread of the disease? Were the allied troops "held up" in England before being shipped home to aid in the control of the spread of the disease? Where was the epicentre - a person, a platoon, a battalion?

So many questions, so few answers.

[alliekiwi]

The pandemic later became widely known as 'Spanish 'flu' as the first European epidemic occurred in Spain, in May 1918, but the virulent pandemic strain had already been prevalent in America in 1917.

Eric, I'm not sure that statement is quite correct. I thought it became known as Spanish flu because the Spanish King was reported to be ill with influenza in May of 1918. The Spanish newspapers did not have the same censorship that was prevalent elsewhere in Europe, so the flu that was spreading not just in Spain was assumed by journalists to be the same as what the king was poorly with, and having originated in Spain. I think it would be more correct to say that Spain had some of the first open-reporting of the flu, and thus became forever associated with it by name, however erroneously.

Richard, one thing about the spread of the influenza is that generally there is a Northern-Southern Hemisphere time lag of several months when it comes to 'bugs' showing up. However, in the 1918-19 pandemic, the peak date of deaths was a mere 3 days apart for England and Auckland, NZ.

Dr Geoffrey W. Rice, who is Associate Professor of History at the University of Canterbury (Christchurch, NZ) touches on gas warfare in the book I've mentioned previously in the thread. However, it is brief and he admits that the gas aspect has 'hitherto been largely ignored'.

Allie

[ericwebb]

Allie,

The error as to Spain - if error it be - is Richard Collier's, and with his book all-but a quarter century old now, research may well have moved on. I suppose that where any disease is first reported depends on how alert/scientifically clued-up the local medical authorities are.

What does seem well-attested is that - unusually for 'flu' - the disease moved west-east, which rather suggests that wherever it originated, American troop movements to Europe may have played a part. The coincidence of peak deaths in NZ and the UK may have been no more than that - a coincidence - although it confirms beyond doubt that the disease did not originate in either country. Before mass air travel, human to human transmission could only have been shipborne. There are some reports that the pandemic affected animals too, but not very convincing.

Population movements and wartime privations also played a key role in the devastating Serbian typhus/relapsing fever epidemics 1914 - 1915, following the intial, repulsed Austrian invasion, which may in turn [depending who you believe] explain Gallipoli.

Early in 1915 the Easterners originally wanted to send their force to Serbia, the standard explanation why they didn't is that the Greeks refused access via Salonica. Why then did the Allies not insist/cajole/bribe as they eventually did that October? Could be that - learning the country was riddled with Typhus - on second thoughts they preferred to steer clear. I have a contemporary account of an interview between Lord K and a returning doctor in which that explanation is suggested.

[i'm sure that in reality the decision was multi-factorial, but perhaps the typhus played a part?]

Good wishes,

Eric Webb

[Pete1052]

I think the term Spanish Flu is a lot older than its use in a book published 25 years ago. A scholarly article on a Stanford University website that attributes the term to large outbreaks in Spain is footnoted with a reference to the issue of the British Medical Journal dated October 19, 1918. I imagine the Spanish Flu term can be found in many articles and books that predate the 1980s.

The following letter by a U.S. Army physician is also from that website.

Camp Devens, Mass.

Surgical Ward No 16

29 September 1918

(Base Hospital)

My dear Burt-

It is more than likely that you would be interested in the news of this place, for there is a possibility that you will be assigned here for duty, so having a minute between rounds I will try to tell you a little about the situation here as I have seen it in the last week. As you know I have not seen much Pneumonia in the last few years in Detroit, so when I came here I was somewhat behind in the niceties of the Army way of intricate Diagnosis. Also to make it good, I have had for the last week an exacerbation of my old "Ear Rot" as Artie Ogle calls it, and could not use a Stethoscope at all, but had to get by on my ability to "spot" ' em thru my general knowledge of Pneumonias. I did well enough, and finally found an old Phonendoscope that I pieced together, and from then on was all right. You know the Army regulations require very close locations etc.

Camp Devens is near Boston, and has about 50,000 men, or did have before this epidemic broke loose. It also has the Base Hospital for the Div. of the N. East. This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. All assembleges of soldiers taboo.

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 viscous 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 extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I dont know. My total time is taken up hunting Rales, rales dry or moist, sibilant or crepitant or any other of the hundred things that one may find in the chest, they all mean but one thing here -Pneumonia-and that means in about all cases death.

The normal number of resident Drs. here is about 25 and that has been increased to over 250, all of whom (of course excepting me) have temporary orders-"Return to your proper Station on completion of work". Mine says "Permanent Duty", but I have been in the Army just long enough to learn that it doesnt always mean what it says. So I dont know what will happen to me at the end of this.

We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes Special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows. We have no relief here, you get up in the morning at 5.30 and work steady till about 9.30 P.M., sleep, then go at it again. Some of the men of course have been here all the time, and they are TIRED.

If this letter seems somewhat disconnected overlook it, for I have been called away from it a dozen times the last time just now by the Officer of the Day, who came in to tell me that they have not as yet found at any of the autopsies any case beyond the Red. Hepatitis. stage. It kills them before they get that far.

I dont wish you any hard luck Old Man but I do wish you were here for a while at least. Its more comfortable when one has a friend about. The men here are all good fellows, but I get so damned sick of Pneumonia that when I go to eat I want to find some fellow who will not "Talk Shop" but there aint none nohow. We eat it live it, sleep it, and dream it, to say nothing of breathing it 16 hours a day. I would be very grateful indeed if you would drop me a line or two once in a while, and I will promise you that if you ever get into a fix like this, I will do the same for you.

Each man here gets a ward with about 150 beds, (Mine has 168) and has an Asst. Chief to boss him, and you can imagine what the paper work alone is - fierce,-- and the Govt. demands all paper work be kept up in good shape. I have only four day nurses and five night nurses (female) a ward-master, and four orderlies. So you can see that we are busy. I write this in piecemeal fashion. It may be a long time before I can get another letter to you, but will try.

This letter will give you an idea of the monthly report which has to be in Monday. I have mine most ready now. My Boss was in just now and gave me a lot more work to do so I will have to close this.

Good By old Pal,

"God be with you till we meet again"

Keep the Bouells open.

(Sgd) Roy.

[truthergw]

Thanks for that one Pete. It was horrifying and fascinating in about equal measure. It brought home just how helpless the medical profession were in the face of general infection. The rapid onset of pneumonia was very noticeable. One thing was clear , this was very far from the dose of the 'flu which sends us to bed for a few days and needs a week off work to recover. Interesting that he thought it was a mixed infection. I can see why even as recently as last year, epidemiologists were trying to isolate a sample of the organism responsible.

[linden]

There are photographs of troops with geese and other birds , preparing them for the pot . A programme used this to connect the flu to SARS

Another suggested it originated in the States just as they were beginning to assemble troops for overseas

I tend to watch a lot of documentaries , and the flu has been well covered in the past 10 years

[BottsGreys]

Below is a typical victim of the pandemic. Private Robert L. Koch was born (1895) and raised in Tonawanda (Erie County), New York. While his parents, John and Augusta, were both also born in New York, his grandparents were all natives of Germany. His New York State statement of service card shows that he was inducted into the U.S. Army on May 26, 1918, at Lackawana, New York. He was with the 10th Training Battalion, 153rd Depot Brigade until June 19, 1918, when he was assigned to Co. H, 346th Infantry, 87th Division. He departed the U.S. for Europe on August 24, 1918. He died in France on October 26, 1918, of lobar pneumonia--one of 5,092 members of the AEF who died in the month of October 1918 due to the pandemic (Source: Medical Dept., U.S. Army, vol.6, p. 1106, as given in "America's Forgotten Pandemic: The Infuenza of 1918" p.159 by Alfred W. Crosby.) Koch's body must have been repatriated to the U.S. as he does not appear on the American Battle Monument Commission's site as being buried overseas.

Chris

[4thGordons]

There was an interesting snippet on a radio programme here last week.

The whole programme was about memory but towards the end (segment 3 on the linked page) there was a discussion with Guy Beiner who has looked at popular memory.

Towards the end of this he discusses the apparent "gap" in the memory regarding the Flu pandemic. I thought it might be of interest here - its in the last 5 or so minutes of the show.

LINK TO "TO THE BEST OF OUR KNOWLEDGE" Wisconsin Public Radio 06/07/08 you can fast forward to about minute 46 and you will get it.

the streaming audio is a small real media icon above the right hand book cover.

Chris

[barrowford29]

I read that as well. The virus turned the body's immune system in on itself, therefore the fitter the person-the stronger the immune system-the the more quicker (and more damaging) the virus was. A spin off from this was the "sleeping sickness" epidemic that followed this in the 20's and thirties. Scientists think it may have been a mutation of the original virus. They nicknamed it "the hydra" because the symptoms could present in many, many different ways and therefore the virus was known to have had a thousand different heads. My grandfather's first wife died from this or encephalitis lethargica as it is scientifically known - (watch the robin williams / de niro film awakenings)

I was rather surprised to see the diagnosis on her death certificate as we were told that she died in childbirth.

One woman fell asleep on the way to her wedding and never woke up again. Some people acted very strangely, violently and were locked up in institutions because they were thought to have gone mad. One guy even attacked the king. I'll bet you if you go to your local archive and look up sleeping sickness that you find some stories.

[59165]

I was thinking of starting a flu topic but,this fantastic thread you have all contributed to,willl suffice .

Wondering about the young & fit bit ,though.My reason for wanting to do a flu thread is that so many of 'my' blokes at Auberchicourt cemetery,up the road from us,died in the field hospital ,which was sited right next to where the cem is now.

Ok.Some dow but some died after the wars end because of flu.To be in the hospital in the 1st place means that they were already wounded.

Would this benefit or hinder their immune systems?

Hospitals were such a breeding/passing ground for flu,it seems.

Dave.

[squirrel]

Might some of them been admitted to hospital because they were suffering from 'flu not necessarily having been wounded.?