180: The Great Influenza Pt. 2 - Circling the Globe


The last few months of 1918 saw an influenza pandemic that circled the globe.



Hello everyone and welcome to History of the Great War Episode 180. Kathleen and Matt. Last episode we talked about the beginning of the influenza pandemic of 1918. This episode we will follow the pandemic to its end with discussions about how the virus evolved over time and how scientists and physicians all over the world tried to fight back against it. The second half of this episode will be spent looking at the effects of the influenza pandemic around the globe, and it would truly be a worldwide crisis. The scale of the problem in the civilian world was unprecedented, with many times more civilians being killed during the pandemic than deaths experienced by the military. One of the interesting effects of this podcast over the years has been people reaching out to me to tell me about how the war touched their families. This has also been try about the influenza pandemic, after the last episode I have had several people reach out to me about how their family was effected by the pandemic, often by a family member dying. Often these stories just prove te reach of the pandemic and how pervasive it was around the world. Unlike the war that had come before the destruction of the disease was not limited to the battlefields of Europe, or to those directly involved in the fighting, but instead it touched every area around the globe in its own deadly way.

In general when there is an epidemic there are certain groups in society that are more vulnerable than others, almost always at the top of the list are the very young and the very old. There are obvious reasons for this, these groups are just less physically able to fight off a sickness. However, with the influenza in 1918, and especially during the second and third waves of the panemic things were quite different. Instead of seeing the greatest rates of mortality on both ends of the age spectrum and a dip through the middle one of the highest peaks of mortality was in the middle, in healthy young people who should have been best positioned to survive it. At the time the reason for this phenomenon was not know, but later researchers would determine that many of those deaths among young people were due to something called Acute Respiratory Distress Syndrome, or ARDA. This condition was present not due to the severity of the influenza but instead due to the strength of the response from the victims immune system. During this response the victims lungs would become filled with fluid,which would then interact with pneumonia to permanently damage lung tissue, often resulting in death. This would not be the case for all fatal cases of the flu, but for many of the young people who died from the disease it is the likely cause. There were other very vulneral segments of society as well, and one that stands out was pregnant women.

While the influenza was sweeping the world in late 1918 and early 1919 for many countries there was still strong censorship of the press in place that had been implemented during the course of the war. As we discussed last week this caused many to believe that the pandemic began in Spain, but it had far more serious negative consequences when it came to how people viewed the pandemic and how they tried to prevent themselves from getting sick. The biggest problem was that for many people, seeing all of the sickness around them but then not seeing that situation reflected in the newspapers caused them to lose trust not just in those newspapers but also any official reports or recommendations. This distruct caused many to disregard information about how to reduce their risk of exposure, and how to help those who contracted it, because that information was surrounded by reports that did not conform in any way to what they were seeing around them. This was a mistake for which the governments of those countries should bear almost the entirety of the blame, it was a choice with drastic negative consequences that was made to hide the true problems from the citizens of their countries and to save face and prevent the need to fully admit how bad the situation was.

While the governments of the world were not necessarily handling the situation as well as they could have, doctors around the world were scrambling to try and figure out how to combat the influenza that was sweeping the globe. Across the world doctors in all countries were trying all kinds of treatments to try and make patients better. These can be broken down into two different approaches to treatment, therapeutic and active. Just focusing on the second category for a moment there were many different treatments that were attempted. There were some attempts at using quinine and its associated medicines, none of which were successful. One physician would give hydrogen peroxide intravenously while stating that “The anoxemia was often markedly benefited, and the toxemia appeared to be overcome in many cases.” Of the 25 patients that the treatment was applied to 12 would die. In Greece one doctor would use mustard plasters to create blisters on the patients skin, then he would drain those blisters, the liquid from them would then be mixed with morphine, strychine, and caffeine to then be reinjected into the patient the doctor would then record that “The effect was apparent at once, and in 36 to 48 or even 12 hours the temperature declined and improvement progressed.” An Italian doctor would inject mercuric chloride, another would use war milk enemas every 12 hours for every year of age of the patient. All of these tests were entirely experimental, and in many any result was considered a success, even though it was impossible to know if it changed the mortality rate to the vagaries of what the mortality rate of the epidemic was, since that was impossible to know. The examples I just mentioned, and countless other treatments around the world, were mostly just the medical community throwing everything at the wall to see what stuck. There was one thing that everybody knew would work if it could be developed, and that was a vaccine, but creating one was proving to be much more problematic than initially hoped.

Almost immediately after the epidemic began to spread around the United States military bases in spring 1918 scientists were at work on a vaccine. Vaccines were well known at this point in history and had already been used against several other ailments that had previously been very deadly. After a lot of work there was a vaccine created for the newest pandemic, and they were distributed in huge quantities, for example 2 million doses were given to the personnel of the United States military in early November. However, there was a problem, by that point the disease and mostly ran its course, meaning that the vaccine was already too late, and it only protected against a few types of pneumonia that the influenza was known to cause, it did not actually prevent the spred of the influenza itself. Since it came at around the same time that the pandemic was already winding down the vaccine was not as successful as hoped, and even if it had been 100% successful and if it would have come months earlier it probably would not have been able to be produced in large enough quantities to make an appreciable dent in the spread of the influenza.

By late November 1918 the second wave of the pandemic, which had begun just a few months earlier and had then proceeded to circle the globe was running out of steam. However right around the end of this trip it would mutate and begin the entire process anew with what is known as the third wave. This third wave did not mutate too much from the second wave and this meant that many people who had been sick from the second wave, and who had survived, had a pretty good chance of not getting sick again. This, along with other factors about how and where this third wave travelled meant that it was not as impactful. That is not to say that things were not bad, and it was still just as lethal to those who caught it as the second wave had been, but less people would become sick this time. In some places the third wave was actually worse, like in some areas of the United States and Australia. Another change in this wave was that press censorship began to wane as countries all over the world went from a war time stance to a peace time stance. This meant that many newspapers were once again writing whatever they wanted, and in many places this meant horror stories about the pandemic. One individual, who you may have heard of by the name of President Wilson, is now believed to have contracted this third wae of influenza. There is evidence that he would contract the disease in Paris and that it was a contributing factor for the stroke that he would eventually suffer, an event that would have ramifications for post-war America.

We have reached the point in the episode where we are going to sort of just take a trip around the world to talk about the spread of influenza around the globe, we will start in the United States nad then go from there. In the United States the government organization primirily responsible for handling the pandemic was the United States Health Service, but they were not ready to deal with such a huge problem. Like every other national health organization around the globe, or really any health organization not just nations, they would soon find themselves having to deal with a problem that it had never been properly prepared for. I am sure there had been discussions about what to do in case of a large pandemic, but such a huge spike in requirements of what needed to be done meant that resources were simply not available. On September 11th federal official did tell reporters that they feared that the Spanish fl had arrived in the United States. This would be the second wave of the pandemic, not the first wave that the Americans had originally sent to Europe, a fact that they for some reason never mentioned. While there was concern at the time of this announcements that the flu would move around the country it did not prevent he normal functionings of government, including a new wave of draft registrations that had to happen the next day where over 13 million men from all over the country would have to register for the next round of the draft. I known know about you, but when I am concerned about a possible epidemic the exact thing I want to happen is for 13 million people from all over the country to show up in public offices on a single day to fill out some paperwork. It would be about a month after the announcement on September 11th that the pandemic would reach its peak in the American military, and then at the beginning of November it started to ramp up in the public secotr. Cities all over the country had no idea what to do, and even if they did they would not have had the resources to do it.

Let’s take a look at just one of those American cities, Philadelphia. In Philadelphia hundreds of thousands of people would be sick from the pandemic and hospitals all over the city began to rapidly fill to capacity. One citizen would say that her neighbors went “to the closest hospital, the Pennsylvania Hospital at 5th and Lombard but when they got there there were lines and no doctors available and no medicine available. So they went home, those that were strong enough.” The hospitals had to adopt a policy of only accepting new patients who came with an explicit order from a doctor or from the police. One of the biggest problems for these hospitals was a lack of trained medical personnel. Many doctors nad nurses were away with the army, and of those that remained behind many had already been stricken down with the influenza. At Philadelphia General Hospial 43 percent of the staff required hospitalization. Even though the hospitals were bursting at the seams, and even though there were not enough doctors to treats those that were already admittd people still kept showing up, hoping to get in and receive treatment. When this was not possible they would just have to go home, a situation that would cause serious fear to fall over the city. All around people family members, friends, and neighbors were dying, often in pain, and there was nothing that anyond could do, and there was no hope of help from others, it was truly terrifying.

Unfortunately, Philadelphia was not an exception, and all over the world similar events were happening. Across the Pacific ocean both Japan and New Zealand would reach the peak of their epidemics in November. In New Zeland the officially recommended treatment was for the patient to inhale an atomised spray of 2% zinc sulphate, which was something like cold medicine. Many people believed, partially due to this recommended treatment, that the influenza was nothing more than a normal cold, and of course when people have a normal cold they still go to work, and this would just spread the influenza around those workplaces. In New Zealand the government forbit the newspapers from every printing anything even resembling mortality statistics, with the hope that this would reduce panic, but instead it just increased it. This is a mistake that many governments around the world would make both during the war and afer, the belief that if newspapers did not publish actual statistics that it would reduce the panic of the populace when in fact it often had the opposite effect. The publci imagination would inflate the true numbers many times, and with each increase fear and doubt would increase as well. The overall mortality rate in the country was 5.8 per thousand for European New Zealanders and 7 times higher for Maori New Zealanders. In Japan the officially recommended treatment was to wear gauze masks and in some town people were forbidden to go into public places without masks. The government also told people to gargle specific liquids, the efficacy of which was very doubtful but it gave people something to do that made them believe they were helping. The Japanese officials were also very strick at keeping sick people confined to their homes on bedrest. The mortality rate in the country would be 4.5 per 1000. The pandemic also swept through China, although records of its effects are harder to obtain. There was a lot of turmoil in the country both during the war nad immediately after which makes accurate medical records almost non-existent. One thing that we know actually helpd China when compared to other countries was htat overall mobility in the interior of the country was quite low, people just did not moved around very much, and this meant that while the cities and ports were hit hard by the pandemic it did not become pervasive in the interior of the country.

In Australia they attempted to quarantine the entire country, with an order in October for quarantine procedures to be enacted at all ports, but by that point it was already too late. Over a third of the total population of Sydney would be sick at one point or another but the mortality rate in the city would be quite low. One possible explanation for this was that the pandemic hit Australia quite early, during the summer, and not during the autumn when it was the most deadly. In Britain the deadliest period would be during the second wave, when over two-thirds of the fatalities would occur. The superintendent of one London hospital would say “Not only was there a great increase in cases, many critically ill with influenzal pneumonia but the staff also began to go down like ninepins.” In France they had similar problems, a huge shortage of civilian doctors because so many were away with the army, but in France it was far worse that in Britain or even in Germany. In France there was one doctor for up to 10,000 civilians, due to how many were with the army, whereas in most of Britain that numbers was closer to around 1 for ever 2,500 civilians. While this greatly reduced the number of people who could be treated in French hospitals the actual effect on civilian mortality is hard to determine since there were so few effective treatments. However, it did nothing to raise civilian morale, which was greatly hampered by how difficult it was to get treatment.

While the situation was very bad in many of the countries that we have discussed, in many ways the people in those countries had it good. In other areas of the world, especially in areas where immune systems were not as developed in certain ways the situation was far far worse. For example in the Africa country of Gambia only 8 percent of the European population would die, but in the interior entire villages of African natives would be killed. One British visitor would later write that “I found whole villages of 300 to 400 families completely wiped out, the houses having fallen in on the unburied dead, and the jungle having crept in within two months, obliterating whole settlements." In the Indian army Indian troops would suffere mortality rates three times that of British soldiers in the same units. In India itself there are stories of trains leaving one station and arriving days later at the other end full of dead and dying victims. It is possible that 20 million people died in India alone, but getting an exact number is impossible. The difficulty of determining accurate numbers make it almost impossible to determine how many people got sick and died from the pandemic. Even in more highly structured countries where for many things we have good records the records for the pandemic are spotty. For example in the United States only 24 states kept accurate records of those who fell ill. In many places like Africa there are not records at all, while in places like Russia, Eastern Europe, and China, all dealing with civil war or internal strife, records are very spotty. Due to the huge gaps in the historical record, the numbers for how many people died from the pandemic have changed greatly over the years. In 1927 one of the first major studies estimated the total dead at 21 million, and since that date the estimates have only increased. By 1940 the estimate was between 40 and 100 million. That number mostly sticks today, with the bottom end of that estimate generally being seen as too low, with around 50 million being the low estimate you will find these days. Even at the low end of that estimate though it is almost impossible to properly contextualize. Remember that the total deaths from the war were 20 million, and this could be as much as 5 times higher than that number. That is just staggering, especially since the pandemic could hit anybody anywhere at almost any time, it did not matter what you did, or where you lived, you could get sick and you could die, a truly terrifying thought.