Flu Pandemic of 1918

aka La Grippe, Influenza A

(Source) When you think of the great killer plagues of history, a few names come to mind -- bubonic plague, tuberculosis, smallpox... You probably don't immediately think of the cold and flu season. But you should.

In 1918 and 1919, the Spanish Flu pandemic killed more people than Hitler, nuclear weapons and all the terrorists of history combined. (A pandemic is an epidemic that breaks out on a global scale.) Spanish influenza was a more severe version of your typical flu, with the usual sore throat, headaches and fever.

However, in many patients, the disease quickly progressed to something much worse than the sniffles. Extreme chills and fatigue were often accompanied by fluid in the lungs. One doctor treating the infected described a grim scene: "The faces wear a bluish cast; a cough brings up the blood-stained sputum. In the morning, the dead bodies are stacked about the morgue like cordwood."

If the flu passed the stage of being a minor inconvenience, the patient was usually doomed. There is no cure for the influenza virus, even today. All doctors could do was try to make the patients comfortable, which was a good trick since their lungs filled with fluid and they were wracked with unbearable coughing. The "bluish cast" of victims' faces eventually turned brown or purple and their feet turned black. The lucky ones simply drowned in their own lungs. The unlucky ones developed bacterial pneumonia as an agonizing secondary infection. Since antibiotics hadn't been invented yet, this too was essentially untreatable.

 The pandemic came and went like a flash. Between the speed of the outbreak and military censorship of the news during World War I, hardly anyone in the United States knew that a quarter of the nation's population -- and a billion people worldwide -- had been infected with the deadly disease. More than half a million died in the U.S. alone; worldwide, the estimates ran as high as 50 million.

There were minor outbreaks around the world throughout 1918, but the real fun didn't start until winter, when the disease broke out in force in Europe, then spread over large segments of the population in America, Europe and Africa. Media censorship kept the story out of the headlines in most countries. Spain foolishly allowed its newspapers to report on the news and paid the price -- the pandemic would be known forever as "Spanish Flu."

 The deadly variant of influenza -- technically designated A/H1N1, or simply Influenza A -- had cropped up from time to time in history, but the 20th century was an era of global transportation unlike any before it. Automobiles, steamboats and even early air transportation made it easy for infected people to carry the ultra-contagious airborne virus into densely populated cities and commercial ports.

Military personnel provided one important vector for the virus, especially in the U.S., where returning World War I soldiers were among the hardest hit. Half of all U.S. military casualties in Europe died from influenza, not in combat.

Because of the media blackout, it's difficult to be sure where the first significant outbreak took place. In March 1918, several hundred soldiers fell ill at Fort Riley, Kansas. Fewer that 50 died, but the company -- numbering in the tens of thousands -- was deployed to Europe, and apparently they took the flu along with them.

The soldiers, presumably healthier than the average schmoe, were able to survive the illness better than the people to whom they transmitted it. The flu was particularly deadly for people aged 20 to 40 -- a variation on the usual pattern, which is usually lethal only for the very young and the very old. No one knows exactly why young people in the prime of their life were so susceptible to the disease, but you can't argue with a massive pile of corpses.

And the pile was historic in its proportions. The exact number is unknown, in part due to the fact that many cases of flu were misdiagnosed as pneumonia. In Europe, influenza raced through the population, then expanded into Africa, India and the Middle East with similar speed. Millions of Spaniards were infected, and unknown millions more around the Continent.

Then the U.S. Army brought the virus back to the states, where it afflicted millions more. More than 200,000 Americans died in one month. Because of the war and the pandemic combined, the medical establishment was stretched to its absolute limit, resulting in even more deaths.

U.S. authorities responded by shutting down public places where the flu might spread, including churches, bars, theaters and schools. Survivors were often reduced to skeletal shadows. Corpses were everywhere. In Philadelphia, they were piled three deep in the streets at times, where they rotted in the open air, provoking a secondary wave of illnesses. In Alaska, many were buried in mass graves under the tundra. In France, bulldozers were used to excavate massive ditches where the dead were unceremoniously thrown. In Ireland, orderlies dug pits behind hospitals to hold the remains of their former patients.

By the end of the second wave, from late summer to early winter 1918, worldwide casualties reached the tens of millions. A third wave in the spring of 1919 concluded the pandemic, for a final minimum estimated death toll between 20 and 30 million people. Most historians believe that the total was closer to 50 million dead --- all in the course of a single year, and medical researchers have recently upped the top range of that estimate to 100 million.

 Even with the low end estimates, the Spanish Flu was the most lethal documented pandemic in history -- far worse than the more notorious Black Death that ravaged Europe in the Middle Ages.

No one knows exactly where the killer strain originated. At the time, conspiracy theories were common. Many Americans thought the disease was a German plot, spread through Bayer aspirin. Later, some would suggest that flu vaccinations had actually caused the disease. None of these contentions ever came to more than rank speculation.

Many flu viruses originate in birds. Genetically, bird flus tend to be different from human diseases and are not directly transmittable to humans. However, pigs are susceptible to both human viruses and viruses carried by birds like chickens and ducks. When the virus jumps to a pig, it can mix up with human viruses and mutate while under attack from the pig's immune system. Occasionally, the result is a lethal virus capable of killing people.

Some theories say the "Spanish" flu started in Tibet and spread to Europe, where it was contracted by American troops and brought back to the States. During the 1990s, research suggested that the Spanish flu virus first mutated in American swine. Under this theory, it was contracted by U.S. troops, who carried the virus around the globe during their World War I adventures.

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