Influenza 1918: 'Greatest medical holocaust in history'


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Gravestones of victims of the 1918 flu pandemic are seen in Hope Cemetery in Barre, Vt. (AP file photo)

One hundred years ago. the influenza pandemic of 1918, also known as the Spanish flu, infected 500 million people worldwide.

It has been called the "greatest medical holocaust in history."

Conservative estimates at the time pegged the death toll at 21 to 50 million, while more modern estimates place the total number of dead at 50 to 100 million. Some argue that  casualties were deliberately under reported by wartime censors in the interest of public morale.

By comparison, the World Health Organization estimated 35 million people have died of AIDS in the past three decades.

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Influenza victims crowd into an emergency hospital near Fort Riley, Kansas. (AP photo/National Museum of Health)

Some researchers argued that the 1918 pandemic began in France  or China, but other studies indicate it originated in the United States.

Immunologist and Nobel laureate Macfarlane Burnet concluded the evidence was “strongly suggestive” that the disease started in the United States and spread to France with “the arrival of American troops.

For many years, it was believed the first confirmed outbreak in the U.S. took place at Camp Funston at Fort Riley in Kansas on March 11, 1918. However, other argue it occurred months earlier in Haskell County, Kansas

In the months that followed, more than 25 percent of the U.S. population became ill and approximately 675,000 Americans died.

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Seattle police don masks to protect themselves from influenza in 1918. (National Archives photograph)

Influenza struck the U.S. population in two waves -- first in the spring and again in the fall of 1918.

The second wave proved to be far deadlier than the first and caught many by surprise.

While most influenza outbreaks disproportionately kill the young and elderly, the 1918 pandemic predominantly killed previously healthy young adults, ages 20 to 40.

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Red Cross workers in Boston making anti-influenza masks in 1918.  (National Archives photograph)In 1918,

In 1918, treatment for influenza was limited to asprin and morphine to comfort a patient.

Further complicating matters was the fact that World War I had left parts of the U.S. with a shortage of physicians and medical workers.

Much effort was put into containing the spread of the flu with the production and usage of face masks and isolating patients from the general public.

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Tent city in Springfield photograph courtesy of Frances Gagnon

In Springfield, a "tent city" was established at Forest Park during the 1918 influenza outbrerak.

Set up by the city with assistance from the state militia, the tent city was used as a quarantine area to house persons suffering from the Spanish flu.

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Precautions taken in Seattle, Wash., during the Spanish Influenza epidemic would not permit anyone to ride on the street cars without wearing a mask. 260,000 of these were made by the Seattle Chapter of the Red Cross which consisted of 120 workers, in three days. (Library of Congress photograph)

Precautions against influenza impacted many aspects of everyday life.

Passengers were denied entry on street cars if they were not wearing a cloth face mask.

Some movie theaters closed their doors, while stores discontinued sales that would draw large crowds.  In some communities, libraries stopped lending out books to curb the spread of influenza.

Even funerals were curtailed in length to reduce the chances of exposure.

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An influenza remedy advertisement in the Springfield Daily Republican on November 1, 1918.

There was no Theraflu on the market in 1918 to reduce the symptoms caused by influenza.

Horlick's Malted Milk was one of the products advertised to help those suffering or recovering from influenza.

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Nurse taking patient's pulse inside the Influenza ward at Walter Reed Hospital, Washington, D.C., 1918.  (Library of Congress photograph)

By July 1918, U.S. Army medical bulletin reported from France, the “epidemic is about at an end," while a British medical journal claimed influenza “has completely disappeared.”

Unfortunately, the reports were wrong and a second wave hit in September with an outbreak in Boston, where troops had arrived from overseas.

Cases continued to be reported into 1919.

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St. Louis Red Cross Motor Corps on duty October 1918 Influenza epidemic. (Library of Congress photograph)

In 2014, researchers led by Michael Worobey reconstructed the origins of the 1918 pandemic in Proceedings of the National Academy of Sciences.

They concluded that the pandemic arose when an existing human H1 flu virus acquired genetic material from a bird flu virus. That new  flu virus was able to evade immune systems.

Worobey’s study suggests that the unusually large loss of life among previously healthy adults was due to the lack of prior immunity.

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Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C., during the influenza pandemic of 1918. (Library of Congress photograph)

By the summer of 1919, the influenza pandemic officially came to an end, as those that were infected either died from the illness or developed immunity.

Since 1918, there have been several other influenza pandemics, although none as deadly as the Spanish flu.

A 1957-1958 pandemic claimed 2 million people worldwide, including some 70,000 people in the U.S., while a 1968-1969 outbreak killed 1 million people, including some 34,000 Americans.

More than 12,000 Americans died during the “swine flu” pandemic of 2009-2010.

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