Spanish Flu

The history of the Spanish flu of 1918 is fascinating. The first curiosity is the name—it wasn’t Spanish at all. In a world where global communications were literally light years from where we are now, the name is thought to originate from censorship—or in this case, lack of it.

In a Europe locked down in a world war, Spain was one of the few neutral nations. As a consequence, the press freely discussed the influenza epidemic, in contrast to the warring parties—England, France, Germany, all refused to harm troop morale by revealing the truth. As Bismarck famously said, there are three occasions when men never tell the truth: before the election, during the war, and after the hunt.

Of course, Spain itself also dodged the bullet when syphilis arrived in Europe on the ships of Columbus—by the early XVIth century the disease had become the French Pox.

But both poxes have one thing in common—they originated in North America. In the case of syphilis, the origin will have been Guanahani, Cuba, or perhaps Hispaniola—the Castilian conquistadores weren’t fussy about where the rape and pillage took place.

The index case for Spanish Flu, on the other hand, can be traced to Haskell County, Kansas.

Canadian guidelines for Spanish flu and instructions on masks.

In early 1918, a country doctor called Loring Miner submitted a note about the Kansas outbreak to a US journal called Public Health Reports—this was the only mention of influenza published in that journal during the first six months of 1918.

Dr. Miner was well-respected in his community—a recurring comment was, “I’d rather have him drunk than someone else sober.”

Haskell County was a poor area where people lived in sod houses for want of other building materials, an area where hog farming was a way of life—and 1918 was an unusually bad year for swine flu. Haskell is still small—population in 2000 was 3,976—and one hundred years ago the mix of people, pigs, and poultry resembled parts of China today.

Birds carry many more flu viruses than humans, and although normally those viruses don’t ‘jump’, birds infect pigs and pigs infect us—if the virus mutates to propagate among humans, you have the recipe for a pandemic.

Given the type of community in the Haskell area, and the violence with which the ‘Spanish’ flu hit the population—young, strong people were suddenly struck down, pneumonia ensued, folks began to die—the key question for this isolated area of the Midwest is: if the disease didn’t originate there, then how the hell did it get there?

After much resistance, America entered the First World War on April 6th, 1917—President Woodrow Wilson had vehemently opposed the move, but when it finally happened, US recruits were stationed in cantonments throughout the country—one of these was Camp Funston, the 14th National Army Cantonment, located at Fort Riley, west of Topeka, Kansas.

The Haskell County outbreak was in January and February. All army recruits from Haskell reported to Camp Funston for training, interspersed with home visits. The next outbreak was in March at Fort Riley—eleven hundred soldiers were hospitalized and many more were ill. One of the patterns that quickly emerged was that this new flu attacked young men and women in a way that was not at all typical of previous influenza epidemics.

In contrast to the seasonal influenza strains of previous years, the Spanish Flu cut down those in the prime of life.

Soldiers moved among the various US cantonments—By March 18th, two camps in Georgia were infected, and by the end of April, two-thirds of American cantonments had suffered from the epidemic. From the United States, the soldiers took the disease to Brest, in northern France, which was the main disembarkation port for the troop ships.

The ‘Spanish’ flu had two stages—during the first, the hemorrhagic nature of the disease became clear—patients bled from the nose and ears, and autopsies showed lungs full of blood lesions. But it was the second stage, which hit in the fall, that was the real killer.

An excellent description of the pandemic to which the current crisis is often compared is provided in the award-winning book ‘The Great Influenza’ by John Barry.

In it, the reaction of the authorities in Philadelphia provides a sobering perspective on what we observe a century later (I condense and adapt Barry’s text below).

The Director of the Philadelphia Department of Public Health and Charities was Dr. Krusen, a political appointment by Mayor Thomas B. Smith. The flu epidemic swept through Philadelphia naval facilities, but Krusen did nothing. Or rather, he publicly denied that flu posed any threat to the city—there were no contingency plans, no stockpiled supplies, and no lists of emergency medical staff. He took a week to even schedule a meeting with physicians who alerted him to the drama surrounding him.

After hundreds of sailors were hospitalized, Paul Lewis, an eminent doctor from the University of Pennsylvania‘s Henry Phipps Institute called for a quarantine. Krusen refused, on the grounds it would harm wartime morale (think re-election).

He did however agree to start a campaign against coughing, spitting, or sneezing.

A public health poster on a Philadelphia streetcar during the 1918 pandemic.

A Philly newspaper called The Evening Bulletin (think Fox) ‘informed’ its readers that ‘influenza posed no danger, was as old as history, and was usually accompanied by a great miasma, foul air, and plagues of insects, none of which were occurring in Philadelphia’ (think magically goes away in April).

Krusen told reporters people weren’t dying from an epidemic, just ‘old-fashioned influenza or grip.’ The next day, fourteen sailors died—and one civilian. The following day, twenty died.

The Board of Health then made the disease notifiable, but endorsed Director Krusen’s view that it was not an epidemic. Their advice? ‘stay warm, keep the feet dry, and the bowels open.’

A week later, Philadelphia held a massive Liberty Loan parade to sell millions of dollars of war bonds. The day before the 28th September parade, two hundred more people—one hundred twenty-three of whom civilians—were admitted to hospital. Krusen refused to cancel the parade.

The parade stretched for two miles, hundreds of thousands attended, crushing together to see the show.

Two days after the parade—the incubation period for influenza—Krusen issued a statement. “The epidemic is now present in the civilian population and is assuming the type found in naval stations and cantonments.”

This is a short history lesson on how a pandemic turns into pandemonium.

The India Road, Atmos Fear, Clear Eyes, and Folk Tales For Future Dreamers. QR links for smartphones and tablets.

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