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Inside The Swift, Deadly History Of The Spanish Flu Pandemic
Scientist Johan Hultin traveled to Brevig Mission, Alaska, a town of a few hundred souls in the summer of 1997. He was searching for buried bodies, and Alaska's frozen ground was the perfect place to find them. Digging through the permafrost—with permission from the town's authorities—he eventually uncovered a woman who died almost 80 years previously and was in a state of excellent preservation. Hultin then extracted samples of the woman's lung before reinterring her. He intended to use this to decode the genetic sequence of the virus that had killed this Inuit woman along with 90 percent of the town's population.
Brevig Mission was just one place that was part of a global tragedy, one of the worst ever to befall humanity: the influenza pandemic of 1918-19. The outbreak of this influenza virus, also known as Spanish flu, spread with astonishing speed around the world, overwhelming India, and reaching Australia and the remote Pacific islands. In just 18 months at least a third of the world's population was infected. Estimates on the exact number of fatalities vary wildly, from 20 million to 50 million to 100 million deaths. If the upper end of that estimate is accurate, the 1918 pandemic killed more people than both World Wars put together. (Get the facts on influenza.)
The first official cases of the 1918 Spanish flu pandemic were recorded at the U.S. Army's Camp Funston, Kansas, where this emergency influenza ward held treated patients.
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War and pestilenceSeveral closely related viruses cause influenza, but one strain (type A) is linked to deadly epidemics. The 1918-19 pandemic was caused by an influenza A virus known as H1N1. Despite becoming known as the Spanish flu, the first recorded cases were in the United States in the final year of World War I. (Explore the memorials of World War I.)
A magnified view of the H1N1 virus responsible for the 1918 pandemic.
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By March 1918 the United States had been at war with Germany and the Central Powers for 11 months. During that time America's small, prewar army had grown into a vast fighting force that would eventually send more than two million men to Europe. (How the United States entered World War I.)
American forts experienced a massive expansion as the entire nation mobilized for war. One of these was Fort Riley, Kansas, where a new training facility, Camp Funston, was built to house some of the 50,000 men who would be inducted into the Army. It was here in early March that a feverish soldier reported to the infirmary. Within a few hours more than a hundred other soldiers had come down with a similar condition, and more would fall ill over the following weeks. In April more American troops arrived in Europe and brought the virus with them. The first wave of the pandemic had arrived. (What is the difference between an epidemic and a pandemic?)
Deadly speedThe Spanish flu strain killed its victims with a swiftness never seen before. In the United States stories abounded of people waking up sick and dying on their way to work. The symptoms were gruesome: Sufferers would develop a fever and become short of breath. Lack of oxygen meant their faces appeared tinged with blue. Hemorrhages filled the lungs with blood and caused catastrophic vomiting and nosebleeds, with victims drowning in their own fluids. Unlike so many strains of influenza before it, Spanish flu attacked not only the very young and the very old, but also healthy adults between the ages of 20 and 40.
Biologists at St. Bartholomew's Hospital in London are analyzing brain and lung tissue from victims of the 1918 pandemic as part of global efforts to understand the virus. Here, wax-mounted tissue samples sit on a list of children's names who fell victims to influenza in 1918.
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The principal factor in the virus's spread was, of course, the international conflict then in its last phase. Epidemiologists still dispute the exact origins of the virus, but there is some consensus it was the result of a genetic mutation that perhaps took place in China. But what is clear is that the new strain went global thanks to the massive and rapid movement of troops around the world.
The drama of the war also served to obscure the unusually high mortality rates of the new virus. At this early stage, the illness was not well understood and deaths were often attributed to pneumonia. Strict wartime censorship meant that the European and North American press were unable to report outbreaks. Only in neutral Spain could the press speak freely about what was happening, and it was from this media coverage that the disease took its nickname.
Deadly Contact
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Native Americans treat patients infected by European diseases in this 1591 engraving by Theodor de Bry.
GRANGER/ALBUMEpidemics are as old as civilization: Signs of smallpox appear on 12th-century B.C. Egyptian mummies. Increased contact led to the spread of disease. In the sixth century A.D. The Plague of Justinian moved along trade routes, killing 25 million people across Asia, Africa, Arabia, and Europe. Eight centuries later, the Black Death wiped out 60 percent of Europe's population. When Europeans settled in the Americas in the 16th and 17th centuries, they introduced smallpox, influenza, and measles to the native peoples, killing an estimated 90 percent of the population. Here, Native Americans treat patients infected by European diseases in a 1591 engraving by Theodor de Bry.
The second waveThe overcrowded trenches and encampments of the First World War became the perfect hosts for the disease. As troops moved, so the infection traveled with them. The wave that had first appeared in Kansas abated after a few weeks, but this was only a temporary reprieve. By September 1918 the epidemic was ready to enter its most lethal phase.
It has been calculated that the 13 weeks between September and December 1918 constituted the most intense period, taking the greatest number of lives. At least 195,000 Americans died in October alone. In comparison, total American military casualties for the whole of World War I came in at just over 116,000. Once again, it was the crowded military encampments where the second wave initially gained a hold. In September an outbreak of 6,674 cases was reported at Camp Devens, a military base in Massachusetts.
As the crisis reached its zenith, the medical services began to be overwhelmed. Morticians and gravediggers struggled, and conducting individual funerals became impossible. Many of the dead ended up in mass graves. The end of 1918 brought a hiatus in the spread of the illness and January 1919 saw the beginning of the third and final phase. By then the disease was a much diminished force. The ferocity of the autumn and winter of the previous year was not repeated and mortality rates fell.
Although the final wave was much less lethal than its predecessors, it was still able to wreak considerable damage. Australia, which had quickly enacted quarantine restrictions, managed to escape the worst of the flu until the beginning of 1919, when the disease finally arrived and took the lives of several thousand Australians.
The Spanish flu did not strike in Australia until 1919. Quarantine camps like this one, in Wallangarra, Queensland, were set up to treat and contain the illness.
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The general trend of mortality, however, was downward. There were cases of deaths from influenza—possibly a different strain—as late as 1920, but by the summer of 1919 health care policies and the natural genetic mutation of the virus brought the epidemic to a close. Even so, its effects, for those left bereaved or suffering long-term health complications, were to last decades.
Lasting impactThe pandemic left almost no part of the world untouched. In Great Britain 228,000 people died. The United States lost as many as 675,000 people, Japan some 400,000. The south Pacific island of Western Samoa (modern-day Samoa) lost one-fifth of its population. Researchers estimate that in India alone, fatalities totaled between 12 and 17 million. Exact data in the number of deaths is elusive, but global mortality figures are estimated to have been between 10 and 20 percent of those who were infected.
In 1997 the samples taken by Johan Hultin from the woman found in the frozen mass grave in Brevig Mission added to scientists' knowledge as to how flu viruses mutate and spread. Drugs and improved public hygiene—in conjunction with international institutions such as the World Health Organization and national bodies such as the Centers for Disease Control and Prevention in the United States—put the international community in a much better position to meet the challenges of a new outbreak. However, scientists know a lethal mutation could occur at any time, and a century on from the mother of all pandemics, its effects on a crowded, interconnected world would be devastating.
From The Plague To Spanish Flu:
Malulani Hospital in Wailuku, which became Maui Memorial Medical Center, was established by St. Marianne in 1884.
The coronavirus is not the first deadly scourge to come ashore in Maui County to cause death and wreak havoc on daily life.
From the time Capt. James Cook arrived to the overthrow of the Hawaiian Kingdom, the Native Hawaiian population collapsed from nearly 1 million to 40,000. So serious was the threat of disease that in 1840, King Kamehameha III adopted a law punishing anyone who knowingly violated the quarantine law with hanging.
By 1850, the Kingdom had instituted a Board of Health that was given very broad powers to prevent the spread of disease as well as the power to provide relief to those affected by quarantines and sanitary cordons.
The Board of Health system of managing infectious disease continued when Hawaii became a territory. Its first big test was the bubonic or "Great Black" plague outbreak late in 1899. Bubonic plague was not well understood and the board had near absolute authority to contain and eliminate it in Hawaii.
The board focused its attention on Honolulu's crowded Chinatown, with controlled burning of buildings where deaths had occurred. Then, on Jan. 20, 1900, unexpected winds caused a controlled fire to jump and 38 acres of downtown Honolulu burned down over the following two weeks. Additional controlled burns, including the burning down of Kahului's own Chinatown, occurred as the plague appeared on Maui.
Isolation wards were set up at Malulani Hospital during the Spanish flu outbreak on Maui.
The bubonic plague quarantine was lifted in April 1900.
Maui suffered isolated child deaths from diphtheria until 1910 when Russian immigrants to Honolulu brought an outbreak to Hawaii. By the end of 1910, an outbreak in Makawao caused the territory to close schools and temporarily quarantine the entire Makawao district. Unlike the bubonic plague, a treatment for diphtheria was known and administered which, The Maui News reported, brought the death rate down from 60 percent of infected children to 10 percent. The quarantine ended, but diphtheria continued to persist with occasional outbreaks until the vaccine was available and widely administered.
Around the same time, the county set aside land and funding for a public health farm at Keokea to address the so-called "Great White Plague," or tuberculosis. The Farm, eventually named Kula Sanitarium, was to be used to isolate and treat tuberculosis patients. The Maui News reported in 1919 that "Kula San" had 100 residents with a wait list of 200 more. These histories of contagion should have readied Hawaii authorities to address a bigger threat.
In 1916, a particularly fatal illness had been affecting British and French troops on the Western Front. When the United States entered World War I in 1917, hundreds of young men from Maui volunteered or were conscripted into the U.S. Army to fight in Europe and would encounter the illness. Because Spain was neutral during the war and did not have press censorship, the outbreak of the disease was widely reported there, and this new illness became known as the Spanish flu.
By July 1918, Oahu military camps reported over 600 soldiers infected with the illness that was being described as similar to "la grippe" — an older French term for influenza.
Ephraim Ezera, a native of Ulupalakua and private in the Army, died at Schofield Barracks that July.
In mid-January 1919, the Spanish flu epidemic arrived in Maui. Over 300 schoolchildren in West Maui were out of school and the hospitals were overflowing with patients. The following week, hundreds of discharged soldiers returned from Europe via Honolulu, landing in Lahaina and Kahului. Hamakuapoko and Paia reported outbreaks.
The Board of Health closed movie theaters, churches or any public gatherings in closed buildings. The County Fair was canceled. The public was encouraged to ventilate closed rooms, to routinely wash hands with soap and to avoid hand-shaking.
Within a week, 1,500 new cases were reported. The county sheriff divided Wailuku up and systematically searched every house — discovering dozens of cases not previously reported. Lahaina and Hamakuapoko seemed to have reached a peak at that point while Hana, Makawao and Kula were just beginning to show signs of outbreak. A controversial decision was made to keep schools open as a way to detect spread of the disease and to better control it.
In mid-February, nearly 3,500 cases of infection and over 50 deaths had been reported. Puunene had become a hot spot while Hana and Keanae had contained the spread. School absences due to illness were reported at 50 percent and many school teachers were also sick. Half of the county police force was out sick. By the end of February, the number of cases stood at 4,500. The Board of Health lifted restrictions on theaters, churches and public gatherings.
In March, the number of infections had slowed and the peak for each outbreak area had passed. Some, however, were concerned about a recurrence, as was occurring in many other places.
The following January saw infections of the Spanish flu suddenly reappear in Wailuku. Plantations and the government immediately performed a systematic search of homes in the camps to identify the sick and implemented isolation wards at Malulani Hospital and established a field hospital at the Armory. Within two weeks, nearly 500 cases of infection and 15 deaths had been reported. But because of the quick action, in the weeks that followed, the number of infected did not significantly increase and by February's end, the field hospital was closed.
Oahu was not so lucky. The second wave hit Honolulu much harder. Filipino and Japanese sugar workers had joined together to strike for better wages and working conditions. Management responded by evicting over 12,000 workers from plantation housing, sending many workers and their families into the crowded tenements of Honolulu. Over 1,200 Spanish flu deaths in Hawaii were members of striking families.
In March, a resident physician of Ualapue, Molokai, reported that people were flocking to Molokai to escape from the flu or recover from it. He noted Molokai had 90 cases and lacked facilities to care for sick visitors. He also asked that even visitors, who were not ill, not come without ensuring they had a place to stay. By April, leeward Molokai's outbreak had peaked at over 250 cases.
In all, nearly 2,400 people died of Spanish flu in Hawaii between 1918 and 1920. The death rate impacted Native Hawaiians the hardest at 11 percent mortality, Filipinos at 6 percent mortality, Japanese at 4 percent mortality and Caucasians at under 3 percent.
Mortality was highest in children under 5 and people over 60 years old, and lowest for children 5 to 19.
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A History Of Global Epidemics
Influenza Order Quiz - A History of Global EpidemicsSpecialized History10 Questions FREE! Click here to Join FunTrivia. Thousands of games, quizzes, and lots more!Time3 mins
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1. (Roman era) Persian Plague (Persia) 2. (Byzantine age) Antonine plague (Roman Empire) 3. (Feudal Japan - Tenpyou era) Japanese smallpox epidemic (Japan) 4. (Medieval era) COVID-19 pandemic (worldwide) 5. (16th century) Black Death (Europe, Asia, North Africa) 6. (18th century) Third plague pandemic (worldwide) 7. (19th century) Cocoliztli epidemics (Mexico) 8. (World War I) Influenza A H2N2/Asian flu pandemic (worldwide) 9. (Mid-20th century) Spanish flu (worldwide) 10. (21st century) Plague of Justinian (North Africa, Europe, Western Asia)Most Recent Scores
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1. Antonine plague (Roman Empire) 2. Plague of Justinian (North Africa, Europe, Western Asia) 3. Japanese smallpox epidemic (Japan) 4. Black Death (Europe, Asia, North Africa) 5. Cocoliztli epidemics (Mexico) 6. Persian Plague (Persia) 7. Third plague pandemic (worldwide) 8. Spanish flu (worldwide) 9. Influenza A H2N2/Asian flu pandemic (worldwide) 10. COVID-19 pandemic (worldwide) Source: Author KankuretteThis quiz was reviewed by FunTrivia editor ponycargirl before going online.Any errors found in FunTrivia content are routinely corrected through our feedback system.
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