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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 pestilence

Several 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 speed

The 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.

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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

Native Americans treat patients infected by European diseases in this 1591 engraving by Theodor de Bry.

GRANGER/ALBUM

Epidemics 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 wave

The 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.

The Spanish Influenza Pandemic Of 1918–1919

As noted in the introduction to this volume, the 1918–19 influenza pandemic started when Spain was very backward in public health matters and when the political crisis and adverse socioeconomic conditions made it difficult to answer the call for modernization from different medical sectors and health authorities. The Military Medical Service, having undergone a radical transformation during the reign of Isabel II (1833–68), was fighting to achieve scientific supremacy vis-à-vis an impoverished Civilian Public Health Service. But the Spanish army needed to reorganize and improve some of its infrastructure for this to occur. For instance, the hygienic conditions of the barracks and the food the soldiers were receiving were rather poor. As we shall see, these conditions would become prominent during the pandemic and, for some people, responsible for its existence and gravity.

As Charles Rosenberg has noted, an epidemic offers a cross-section of society, helping to highlight the existing and latent problems a given community has at the time of the outbreak. Moreover, an epidemic as a social phenomenon takes the form of a theatrical drama. In a limited time and space, different social groups are forced to modify their usual dynamic and to perform various activities to address the critical situation. This results in the mobilization of their members to perform propitiatory rituals, incorporating and reaffirming their fundamental social and cultural values.

Taking Rosenberg's approach as a starting point and using as my main sources military scientific journals and newspapers, as well as the general and popular press, this chapter explores the reactions of Spain's Military Medical Service to the 1918–19 influenza pandemic. In what follows I focus on the social impact of debates as well as on tensions and conflicts between different sectors of society. For this reason I assess whether the Military Medical Service defended scientific opinions that were more modern than those of the Sanidad Civil (Civilian Health Service) and whether there were any conflicts of interest between the measures they both took in response to the epidemic, especially as related to soldiers.

Spanish Flu Pandemic 1918 - Could It Happen Again?

A warehouse being used as a makeshift hospital for flu patients in 1918

It is 100 years since the influenza pandemic killed millions around the world, a death toll far worse than the bubonic plague. But what is the chance of something similar happening again? New strains of flu continue to emerge and experts warn that another pandemic could happen despite a century of advances in technology and healthcare.

During the 1918-19 outbreak, it was thought that Spanish flu was caused by bacteria rather than a virus. Viruses are now better understood, but scientists have also learned a great deal from studying the pandemic which struck a century ago.

A coloured transmission electron micrograph of A strain H5N1

They learned how very differently it could behave to our usual experience of seasonal flu. It hit proportionately more younger and healthier adults. Experts believe older people who were infected by Spanish flu may have previously encountered a similar strain, and therefore had a degree of immunity.

Dr Niall Johnson, who published a study of the 1918-19 pandemic says the medical profession a century ago was familiar with infectious disease, but not at this scale.

"Many of the medical memoirs mention the pandemic, and often say that it was not the presentation of the disease that was unusual but the sheer volume of cases - and how little they could offer people," he said.

Drawings from 1918 by John George Adami of (right) the trachea showing earliest stage of reaction in influenza and (left) the main bronchus of a set of lungs

Dr Jonathan D Quick is an expert on epidemics worldwide and is working to help nations prepare better.

"With some flu viruses - it was true in 1918 and in 2009 - one of things which happens is that the way that flu kills you is not the flu itself," he said. "It's what it does to your lungs, it sort of melts the linings and then you get a bacterial pneumonia... That will kill you.

"They didn't have antibiotics then, so they died faster. But the other thing that happens, particularly in young people when they have a good, active immune system is that your body overreacts. It ends up just filling your lungs with fluid. A lot of these deaths weren't from the bacterial complications, but from an explosion of the immune system."

Dr Johnson says the impact of new viruses today will vary, for several reasons. These include vaccines that may confer some immunity, anti-viral drugs, better hygiene and antimicrobials that deal with the infections such as pneumonia, that were major contributors to the death rate in the 1918-19.

"So, yes, I think we are better placed than in 1918 but the potential for a pandemic to be a global infection that sickens the majority of the world's population and kills a substantial number is still there."

Dr Quick believes such a scenario is not inevitable, if more is done to make the world safer and prepared.

"One of the most important things is to invest in the so-called universal flu vaccine," he says - one which works against all strains of the virus, by targeting the part of the virus which doesn't change.

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