Influenza: A Century of Science and Public Health Response

Chapter 2: The Forgotten Pandemic Remembered

42 One of the small bright spots amid the horrors of warfare is its propensity to stimulate rapid medical advances. Commanders of the imperial armies locked in the ferocious combat of World War I sought to keep their soldiers fit to fight, taking steps that included inducting vast numbers of physicians, nurses, and volunteers to provide medical support for the troops. Of course, the related medical research and experts involved focused primarily on the horrific injuries soldiers sustained in battle or on the fields where the next crop of casualties were being trained. This focus on protecting a nation’s armed forces meant that little attention was paid to minor disease threats or to the afflictions of civilian populations. In the case of influenza, it is not clear that earlier detection would have served much good at this time. But influenza would soon demonstrate that it was no minor annoyance. The terrible Spanish flu pandemic killed more people in a shorter amount of time than had any other disease in history. Spanish flu is not Spanish at all.1 The combatant governments of World War I censored news about the spreading flu pandemic so as not to demoralize their citizens, but Spain remained neutral in the war and so had no reason to follow suit. Spanish newspapers remarked on the early summer influenza cases infecting many citizens—even the king—and so Spain was tagged as chapter 2 The Forgotten Pandemic Remembered • the forgotten pandemic rememBered 43 the origin of the pandemic.2 The true point of origin cannot be conclusively proven, but a compelling argument identifies the United States as the seedbed of the virus.3 When the United States entered World War I, it initiated a massive callup . The nation’s military infrastructure was woefully unprepared for this surge of personnel, and the new draftees were crowded into hastily constructed barracks that dotted the countryside. Camp Funston (now part of Fort Riley) in Kansas was one such camp.4 Fifty-six thousand men assembled there for basic training, primarily drawn from the Midwest. The barracks were drafty, and the quartermaster section had been unable to keep up with the demand for winter clothing. When not drilling or training, the men huddled around the camp stoves for warmth. In addition, for reasons clear only to higher command , soldiers were periodically shuttled from camp to camp around the nation . The situation—young men from diverse areas (countryside, town, and city) crowded together, under the stress of training, and connected to various regions through a steady stream of transfers—was perfect for incubating and spreading a new infection, especially a respiratory infection. On 4 March 1918 a cook reported to the Camp Funston infirmary complaining of symptoms typical of influenza. Over the next three weeks he was joined by eleven hundred of his fellow soldiers who were sick enough to require a stay in the infirmary. Many thousands of others received treatment or medicine on an outpatient basis and recuperated in their barracks. Soon other camps began to report outbreaks of influenza-like illnesses, and in short order the infection traveled with the recruits who were being shipped to France to join their compatriots in the American Expeditionary Forces (AEF). The illness quickly radiated out from the American base and circulated through soldiers and civilians alike on both sides of the trenches.5 The “three-day fever ” circulated throughout Europe in the late spring and early summer but attracted little attention. Great things were afoot as the German army spilled over the Allied trenches and drove toward Paris. The Allies tried desperately to slow the Germans as the AEF rushed to halt the German advance. Influenza was only a minor annoyance in this grand drama.6 Only retrospectively were there signs that this three-day fever was caused by no usual influenza strain. The virus was at times extremely infectious, especially in enclosed places such as ships and hospitals. And although the mortality rate was not high, some of those who succumbed to the infection died quite rapidly with unusual pneumonia features. The war’s insatiable demand for men and matériel ensured that the infection traveled back from the western front to the homelands and colonial possessions that fed the engines of destruction . Throughout the mid- to late summer of 1918 (June–August), the number 44 the forgotten pandemic rememBered of diagnosed cases of influenza declined in Europe...