INFLUENZA PANDEMIC.

The influenza pandemic of 1918–1919 killed more people than did World War I itself. Estimates of pandemic influenza deaths vary between thirty and forty million. No one knows why the mutant virus that caused the disease appeared, and no one knows why it disappeared.

In March 1918 and October 1918, when the first two waves of the disease hit Europe and North America, discussions of the origins of the epidemic mirrored the stereotypes that war propaganda had made available everywhere. It was said that the German Bayer company—which invented aspirin—cleverly put the agent causing the flu in aspirin tablets, thereby destroying the Allies literally from within. If that hoary tale faded, others were quick to fill the vacuum of ignorance and fear. The flu was transported, it was said, by ship, probably from China, via the Iberian Peninsula—thus the name the "Plague of the Spanish Lady" or the "Spanish flu." Then it was shipped everywhere, once again the paranoid claimed, in German ships, which released clouds of suspicious materials. Or perhaps it was the U-boats that surfaced near Allied ports, sneaking ashore vials of influenza-soaked liquids, dumped into the water supply or released into the air in movie theaters or at rallies for war loans and in the United States for Liberty Bonds. So said Lieutenant Colonel Philip Doane, head of the Health and Sanitation Section of the America's Emergency Fleet Corporation in 1918. Wildly unlikely stories proliferated, by and large because no one had the slightest idea of the source of the infection or the vectors of its transmission.

It is certain, though, that the Germans and Austrians suffered just as badly as the Allies. Indeed, if there was any direct effect of the Spanish flu on the war it was to decelerate military activity on all fronts and in all armies in the late spring of 1918 and in the fall of 1918, when the first two waves of the epidemic hit. There was a third wave after the Armistice (11 November 1918), which may have been the most lethal of all.

What made this visitation so peculiar is that it hit with particular ferocity young adults in the prime of their lives. Like other viral infections that are relatively harmless in childhood, influenza was a killer to those previously healthy adults who contracted it. The elderly and the very young were also victims of the Spanish flu, but because they were hit year in and year out by ordinary strains of influenza, which killed them through its sequelae, bronchitis and pneumonia, there was nothing abnormal in the age groups ten years and under or sixty years and over falling to respiratory infections. What made the Spanish flu so frightening was that its morbidity (sickness) and mortality (death) rates were highest at ages twenty to forty, the age group of the bulk of the forces in uniform during the war.

The speed of this disease was astonishing. Active people would notice a headache, perhaps a burning sensation in their eyes, then the shivers, then cold that no number of blankets could relieve. Then came the fever, dreams, and at times delirium. The lucky ones would then begin to recover; the unlucky ones developed brownish or purple spots on their faces, and as their breathing became more labored, their feet would turn black. Death came quickly, but not painlessly, as the victims of the Spanish flu suffocated on the fluids released by the infection, fluids which took the form of a froth that completely filled their lungs and bronchial passages. The Spanish flu killed by drowning its victims in their own body chemistry. The French poet Guillaume Apollinaire died of the illness a mere week after contracting what seemed like an ordinary cold. His tongue and face, his friends said, had turned black.

The unprecedented character of the Spanish flu had important implications for the history of public health and medical care. First, it came at a time when the bulk of the combatant populations were not served by physicians. The pressure on states to provide medical care or clinical assistance during times of medical emergencies increased as a result of the pandemic. This linkage is direct in the British case, where there was no Ministry of Health before 1919. The idea of bringing together in one ministry those who would be able to help the population at times of medical emergency came directly out of the visitation of influenza.

The paradox of the Spanish flu was that just as it inflected the political and social support for extensions of provisions for public health, it under-cut the claim of the medical profession to offer effective antidotes to disease. This was a killer that came "like a thief in the night" in the words of Sir George Newman, chief medical officer of the British Board of Education. This infection defied virtually every kind of treatment. Quarantine was the only effective answer: the Australian state of South Australia simply closed the borders and let no one in or out. But aside from complete and universal isolation, there were no measures that made the slightest difference in the way the disease spread or in the lethality of its hold on its victims.

Bus conductors wore masks. Streets were sprayed with disinfectant. Schoolchildren were given special inspections, as were soldiers. Nothing worked. And when millions of people got the illness, there was absolutely nothing the medical profession could do to diminish the risks of death from the disease. It was beyond their comprehension and beyond their therapeutic power. Medicine was both more important and more impotent. For in the case of this disease, unlike AIDS, no one could tell people how to avoid it or what they needed to do not to get it. And no one could tell people what to do when they did contract it. It destroyed the pretensions of scientists and physicians to control natural phenomena. Here was one visitation that came and went as it pleased and how it pleased. Nothing like it happened during or after World War II.

See alsoAIDS; Public Health; World War I.

BIBLIOGRAPHY

Barry, John M. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York, 2004.

Burnet, F. M., and Ellen Clark. Influenza: A Survey of the Last 50 Years in the Light of Modern Work on the Virus of Epidemic Influenza. London, 1942.

Collier, Richard. The Plague of the Spanish Lady. New York, 1974.

Duncan, Kirsty. Hunting the 1918 Flu: One Scientist's Search for a Killer Virus. Toronto, 2003.

Kolata, Gina. Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. New York, 1999.

Phillips, Howard, and David Killingray, eds. The Spanish Influenza Pandemic of 1918–19: New Perspectives. New York, 2003.

Jay Winter