179: The Great Influenza Pt. 1 - So It Begins


In 1918, as war raged in Europe a new, more deadly foe joined the battle.



Hello everyone and welcome to Episode 179 of the History of the Great War podcast. We have spent many episodes discussing the war in 1918, but this week we take some time to discuss another event that would sweep over the world in 1918 and 1919, the great Influenza Pandemic. While it did not involve the battlefield, it would be partially caused and inflamed by the war and the actions of those countries that were fighting the war. The story of the influenza begins in the United States, and it would then travel over the Atlantic with American troops. Once it had jumped over the ocean it would begin to circle the entire globe, carried to all continents by troop transports and other ships. There would be multiple waves of the influenza that would cross back and forth over the face of the earth, with the first wave beginning in the spring of 1918. This would be the most mild form of influenza, and it would find its primary victims in the armies of thost that were fighting the war. The second wave would arrive in early autumn, and it would be far more deadly. This second wave would be the real killer, and the most impactful around the world as it moved from country to country in late 1918 and early 1919. The third wave would come later, but it would be a step down from the second wave in terms of mortality rate, although it would still kill thousands. It is very likely that these waves were all the same virus, just a mutated version of it, although it is possible that there were multiple different viruses that overlapped and interacted with one another. This episode we will start with just a bit of a refresher on what influenza is and how it is caught by humans. We will then follow the 1918 outbreak of influenza from its roots, which were probably at a US Army Camp in Kansas, to the Western Front, and then to the civilian populations all around the world. Next episode we will spend a bit more time looking at the pandemic around the world and then look a the total cost of the most deadly pandemic if human history.

Influenza is a virus that did not initially originate in humans, but instead in birds. The influenza that exists in birds looks nothing like what it does in humans though, and for it to jump species, and then to also be infectious to other humans requires it to mutate. These mutations come in different forms everytime the virus makes a jump, and sometimes they only happen because it goes through a different species first, pigs are a frequent vector for these mutations, and the move from pigs to humans is generally easier, and it arrives in a far more deadly state. These types of movements and mutations still happen today, and when it does drastic steps are sometimes taken to prevent the spread of the disease. For example in 1997 when a virus was found in humans in Hong Kong, 6 people would die and every single chicken in Hong Kong, all 1.2 million of them would be killed. In 2003 a similar incident would occur in Europe and 30 million poultry and pigs would be killed. In both these casses the virus was given a designation, H5N1 and H7N7 respectively, and this type of designation is still used today and will be familiar to anyone who frequently watches the news. It seems like there is a new flavor of the flu every year with an HN designation. For those who are wondering, like I was, what these numbers mean, according to the CDC these HN designations are ways to tell which flavor of Influenza is being discussed: “Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). There are 18 different hemagglutinin subtypes and 11 different neuraminidase subtypes. (H1 through H18 and N1 through N11 respectively.)” In all of these cases drastic steps are generally taken to prevent the spread of a deadly new type of flu, in many cases to prevent situations like what happened in 1918 from happening again. When people talk about flu, flue shots, risk of epidemics 1918 really is a worst case scenario of a disease that cannot be contained or even really treated. The flu in 1918 was different than most, it caused pneumonic complications, which is often what killed its victims, not just the flu itself. This pandemic would also occur in a world before flu vaccines were widely available, and so all that could be done was to try and help the victims with less technologically advanced treatments. Warm food, war blankets, fresh air, really just nursing, not technology, was the only thing that could be done in the vast majority of cases. There were attempts to make a vaccine though, and there were already vaccines for many different diseases, and anti-toxins and serums available for other ailments. These types of treatments were combined to make things like tetanus, dysentery, diptheria, and cholera all treatable. But creating a vaccine was a challenge, and it took time, and that was something that the scientists in 1918 did not have. It also took time to determine what the new sickness was, where it came from, how to treat it, and how it was changing. This would lead the medical community down several treatment paths, most of them dead ends, and the changes to the influenza over time would prevent any treatment from being broadly applicable. all of this is getting a bit ahead of the story though, we need to go back to the beginning where the pandemic began, which was probably in Kansas, in the middle of the United States.

We are not completely certain that the pandemic began in Kansas, specifically at Camp Funston which was a United States army training camp in Haskell County, Kansas. What we do know is that in the last week of February a group of men travelled to the camp and at that camp the first documented cases of influenza were recorded in early March. At this point it probably looked a lot like many ohter sicknesses which were almost inevitable when the thousands of men were gathered together at army training camps all over the country, many of which were overcrowded. However, by the end of March things began to develop rapidly and it became clear that something different was happening. By the end of March 1,100 men at Funston had come down sick and 237 had died. This was a time, with so many men being trained for the army, that there was an almost constant stream of personnel moving between camps, and that is how the disease began to spread. By the middle of March there were already reported cases in Georgia, with 10 percent of two camps in that state reporting sick by the end of the month. Once it had started moving to other camps it was simply impossible to stop, and while it would move all over these army camps for the rest of the year, it also began its movement overseas.

With tens of thousands of American troops heading to Europe every month during 1918, the jump overseas was inevitable. It would first be reported in a French army base near Paris on April 10th. Around the same time it would also be reported in British camps. The first cases would be reported by Parisian civilian hospitals in late April. The disease would quickly pass to almost all the units on the Western Front and in civilian areas behind the front, again this was inevitable giving the thousands and thousands of people constantly moving around for military purposes. By May the French were becoming very concerned and ordered that all cases of the outbreak be directly communicated to a central authority. By that point it had also passed over to the Germany army, which had their first recorded cases in late April. The German soldiers called it “Flanders Fever” since it seemed to happen more frequently in units on the northern end of the German front. Ludendorff would write after the war that “It was a grievous business, having to listen every morning to the Chiefs of Staff’s recital of the number of influenza cases, and their complaints about the weakness of their troops.” Remember that this would be the point where the Germans were trying to launch their war winning offensives, which were already costly enough in men without considering the toll that the flu would take on the German Army’s ranks.While it was being passed around the armies in France the flu would also continue to make its way around the world. It would ppear in Portugal and then Greece, and by July it was all over the British Isles. By June it was wreaking havoc on the German homefront, where many were already weakened from malnutrition. By the end of May it was in Shanghaig where one observer would say “It swept over the whole country like a tidal wave.” It would jump over to Australia and New Zealand in August, and in Sydney 30% of the population would be sick. One country that I have not yet mentioned, purposefully, is Spain. Spain turns into a special case not because of the specifics of the epidemic in that country but instead the name that we now associate with the pandemic as a whole, Spanish flu. As far as modern scholarship can determine the pandemic was not at all Spanish in nature, nor did the Spanish play much of a role in spreading it around the world. However, Spain had one feature that many other countries in the war did not, and that was very little censorship of the press. In many countries that were actively participating in the war th press was heavily controlled and censored, but in Spain, a neutral, these controls did not exist. This meant that when reports of the flu began to newspapers, they were newspapers in Spain. This was the first public acknowledgement that the sickness was real and that it was widespread, and that it was deadly. The Spanish claimed that the disease came from the battlefields of Western rueope, but everywhere else just started calling it the Spanish flu, beliving that it had started in that country since that is where the first reports were from. I have tried to steer clear of calling it the Spanish flu since that is an incorrect name, and I will continue to try and steer clear of that but I may mess up a few times. I think it is generally confusing to use names like that and in general causes too much confusion.

The flu pandemic would spread all around the globe, but before it got there it would first spread all over the ships of the American navy. The Navy would, at its peak, have 40% of its personnel down with influenza during 1918, and while for much of this time the mortality rate would not be very high, the mortality rate would peak in September. During this time there would be over 4,000 deaths from flu or complications caused by the flu. This meant that almost twice as many sailors died from the flu as they did from German actions during the war. While it was bad for the sailors, in some ways it was worse for the troops being transported over to Europe. The ships turned into death traps for many troops, with the September and October time period being the worst. During some weeks the number of deaths among the transports were higher than what the American troops were suffering during the Meuse-Argonne offensive. Things were so bad that Wilson considered stopping all troops transports, and while it was close, this action was never taken. There was some concern that stoppin the transports would worry the US populace too much, and make it seem like there was a big problem, which there was, but officially it was not being treated like a big problem. There were many attempts to mitigate the effects of the flu on the ships, one change was simply to give the troops better equipment for the trip. As the weather began to turn after the summer of 1918 there were initially not enough cold weather gear for the troops being sent over the oceans, this was remedied in a hope that it would reduce the effects of the flu, but it did not greatly change the situation. Experiments were also conducted to see whether it would be better to reduce the number of men on each ship, but thsid did not seem to greatly change the rate of sickness. Attempts were made to weed out as many sick men as possible before they got on the boat, but due to the incubation time on the disease even this had limited utility. On board the ships there were also attempts by medical personnel to quartantine and treat the sick soldiers, but this was mostly unsuccessful. In total thousands of troops would die either on the journey over the Atlantic, in Halifax where many sick men were off loaded, or just a few days after they arrived in Europe.

One of the interesting features of the earliest spread of the disease, which would have been in mid-summer 1918 was not how deadly it was, but instead how NOT deadly it was, especially when compared with later outbreaks. During the earliest outbreaks in Europe, which was roughly around June and July only a few men who caught the flu actually died, even though thousands would set sick. For example out of 600 American troops that were admitted to the hospital only 1 would die. For the Royal Navy 10,000 sailors would fall ill, but only 4 would die. In France 200,000 British soldiers would get sick, but only a few of them would die. This is very different than what would happen with later outbreaks, which is when most of the casualties would occur. In fact at the front the epidemic began to wane in July, and things seemed to be going back to the normal. This would prompt the British command to delcare that it was over on August 10th. But while the armies believed that the worst was behind them, on the civilian front the situation was just beginning to head up.

While there was optimism at the front in August that the worst was past, throughout September and until the end of the war the second wave of the epidemic would hit the armies like a tidal wave. It is sometimes hard to get exact numbers in these situations, especially for more mild cases like what was prevelant during the summer months. For men in the front lines it was often the case that only the most severe cases would be allowed to come off the line, especially during offensives which is what the Allies were launching September and October. This almost certainly depressed the number of front line troops that would report with the flu nad it meant that there were far more cases reported in troops that were stationed behind the front. In the French army there was a drastic difference in the two groups, with rear echelon troops having a sickness rate of up to 12 times higher than those at the front. The unfortunate truth is that those front line units probably had more men die than necessary from the disease. In many cases men would stick with their units, either because they did not want to be separated from them or due to patriotism, or a variety of other reasons. This meant that these men, while they endured at the front longer, would be hit hard by pneumonia in an environment that was ill prepared to help them.

While the disease was spreading at the front it was also spreading around on the homefront, and everywhere it would have its effects, even if they were frequently different from one area to another. In mid-July it would make its first visit to London, with many other cities around England reporting cases at roughly the same time. In mid August the flu would jump onto the African continent at Freetown, Sierra Leone. I’m going to focus on this city not because it exceptional but because it is a good example of how the pandemic spread around the world. In mid-August Freetown was a major coaling center for ships that were travelling form Europe to the far east. On the 15th of htat month a troop transport, the HMS Mantua, arrived with hundreds of sick troops on board, all suffering from influenza. The men who loaded the coal onto the ship then caught the flu while on board and they transported it back to their houses. Soon the groups of men who coaled the ships were decimated by the disease. Once it had spread around Freetown it then made a jump back from the civilians to the military, like on the transport HMS Chepstow Castle which was on its way from New Zealand to Europe. The ship would stop in Freetown for coal and over the next three weeks 900 of the 1150 men on board would come down with the flu, 38 would die. All over the world, anywhere that the war touched in any way, ports, river transports, roads, rails, they were all conduits for the disease to spread, and spread it did. Perhaps the quickness of the spread of the disease is the best example of how the war effected the entire world, the war touched everything, and so did this disease. While the disease was spreading around the world in August, something was becoming apparent. The disease had changed, and it was far more deadly this time. This second wave of the influenza would move around the world starting in ports much like Freetown, or Brest in France, or Boston in the United States, and from these ports it woudl spread around the globe. The second wave of the disease would be far more deadly to those who caught it, and it would be far more widespread among the civilian socities around the globe. Its movements and effects will be the topic for our next episode.