Fever of War: The Influenza Epidemic in the U.S. Army during World War I (review)

The influenza pandemic of 1918–19 was the worst single demographic disaster of the twentieth century. The death toll was somewhere between thirty and one hundred million people, more than the total deaths attributed directly and indirectly to the Great War. In the United States 675,000 people died—undoubtedly a conservative estimate that fails to take account of the harsh shadow cast by the virus. The flu came in three waves, the most lethal of which was the second, in the fall of 1918. The virus spread rapidly, and all the achievements of modern medicine and public health could not stem its malevolent progress or heal the infected. Influenza was a known killer but usually of the weak, the young, and the elderly; the 1918–19 outbreak additionally and universally killed preponderantly more men aged twenty to forty years, the very cohort that might be thought best able to resist the infection. In the last ten years a number of both scholarly and popular books on the pandemic have appeared, but the outbreak has also been ignored by many historians surveying the last century. Epidemiologists continue to warn that a further pandemic will occur—hence the serious attention continually given to avian flu in southeast Asia.¹

Conventional scholarship argues that the pandemic originated in a military camp in Kansas in March 1918, and that troopships helped to spread the infection across the Atlantic to Europe. However, recent research indicates that flulike symptoms were present in the densely crowded British military camp at Étaples, France, during the winter of 1916. Carol Byerly's careful study focuses on the role of the U.S. Army during the pandemic, with greater detail than is provided in earlier studies. Using a wide range of official sources, private papers and diaries, and contemporary periodicals, she analyzes the influenza pandemic within the context of the preparation for war, military mobilization, the expansion of the medical department, and the transport by troopship of the American Expeditionary Forces to camps in France from which they were sent into action in the trenches of the Western Front. The high morbidity and mortality from flu, Byerly argues, drastically hindered the 35th Division in the Meuse-Argonne campaign of September–November 1918, although senior military men and the subsequent congressional inquiry downplayed or effectively ignored the impact of the disease. At all stages influenza hit the Army hard. In earlier wars, for example the Philippines campaign, more soldiers died from disease than as a result of enemy action. The United States, in its short involvement in the First World War, exceptionally among the belligerent powers again lost more men through disease, largely as a result of influenza: one in four soldiers suffered from flu, and more than 50 percent of all wartime deaths were from its consequences.

In the penultimate chapter of this excellent book Byerly addresses the question of why the pandemic was largely ignored by the authors of the multivolume official history, The Medical Department in the World War. Her persuasive analysis is that they leaned on racialist theories to explain the incidence of disease rather than on material factors such as housing and clothing. "Using race as a primary analytical tool," she argues, "camouflaged other relevant factors and obscured a more accurate understanding of how army policies and practices could promote death and disease in the ranks" (p. 167). Medical professionals were also anxious not to promote their failure to control influenza, which sat ill with ideas of progress and medicine's triumphalist record in conquering disease. Fever of War adds an important dimension to knowledge of the influenza pandemic of 1918–19.