Today I’ve excerpted from the 1919 article “War’s Deadlier Rival, the Flu,” by Samuel Hopkins Adams. The article oddly begins on page 16 of Collier’s Weekly and is the fourth headline down on the cover. Please, please, please do not take the numbers or the science in this article as facts. The epidemic lasted until 1920, and there has been much subsequent scientific research into its origins and overall global devastation. I merely want to offer you a contemporary account of the epidemic, as well as some images.
Current with the world war, and culminating in a mortality far above it, runs another agency of death. The pandemic of influenza has been less sensational than the flaming scourge of war; but it has been vastly more destructive. Now that its second seasonal onset has passed in this country and presumably the great majority of those liable to it have been infected, it is possible to reckon up roughly the account for the United States.
Conservatively speaking, for every American killed by the Germans, ten were killed by the flu. The total of those dying in battle or afterward from wounds is under fifty thousand. Nearly five hundred thousand had died of the epidemic up to the 1st of January. (The Metropolitan Life Insurance Company, which has compiled the only detailed figures on a large scale, reckons, on the basis of its records, that the total influenza deaths for the nation up to January 1, 1919, were upward of 470,000.) Fifty thousand more is a very moderate estimate for this spring’s recurrence; twice that number is probably nearer the truth. Even reckoning the total human cost of the war, those dead from sickness and accident as well as from wounds, influenza’s mortality record is as six to one, compared to war’s.
Compared with other epidemics in America, the present visitation stands forth in still more startling relief. Though figures for the great grippe epidemic of 1889-90 (practically the same disease as the flu) are unreliable and fragmentary, it may be safely stated to have been less than half as deadly as the present onset. But parallel this flu with a pestilence of a more sensational character, the famous “yellow jack” of 1878 which centered in New Orleans and swept through the South spreading terror and paralyzing commerce. More people succumbed in a single week of flu in Philadelphia than died in the whole course of the 1878 pest in New Orleans; and the flu deaths of one week in New York and Philadelphia together exceeded the total yellow fever mortality of the entire nation in the “plague year.”
After the pandemic of thirty years ago, influenza, while it still existed here as it did the world over, sank to a low level and stayed there until 1914. In that year the deaths from influenza rise to two typical, seasonal “peaks,” one in the early winter, another in the spring. In 1915 these “peaks” are somewhat more marked. The following year shows a still higher rise, and in 1917 there appears so decided an increase that the absence of expert medical commentary upon it is surprising. The spring of 1918 brought with it a definite epidemic in our camps. It was of a mild type and, at the time, unrecognized. So far as is now known there was no epidemic elsewhere in the world.
What happened then?
A curious but perfectly logical process. The germ which had been gathering power quite slowly in a robust and well-fed population—witness the very gradual rise of the mortality figures—was transferred to a soil far more suitable to its development, the war-harried, undernourished, abnormal peoples of Europe. It gathered momentum and virulence together.
France, where it was first introduced, did not suffer very severely in the early stages; nor did Spain, whither it was immediately transmitted, manifesting itself in May, 1918, very widely, though in mild form, and withholding its real power until the following September when it ravaged the whole kingdom. Probably through the taking of prisoners the infection crossed the French border into Germany, and here found, in the ill-fed civilian population, the ideal condition for its increase. By July its ravages were so destructive that the German medical authorities, despite the demands exercised by the war upon the medical fraternity, were holding “influenza congresses” to devise means of defense, military plans having been seriously deranged by the epidemic. By August the flu had reached its serious stage in France and all Europe became swiftly and formidably involved. There followed the return to America.
The influenza germ … , a comparatively unimportant agent of disease and death, impotent, up to that time, to raise our mortality rates to a point where any notice was attracted, came back surcharged with deadly power. It had acquired a malignity unequaled in the former history of the disease.
Before the unparalleled swiftness of its spread, methods of prevention collapsed. It could not be stopped. It could not even be checked. In one short week, the scourge swept like a driven flame across eastern Massachusetts and down into Rhode Island and Connecticut. Before the second week was over most of New England was ablaze with it, the infection was raging through eastern New York, eastern Pennsylvania, and New Jersey, and there were far-spread, unaccountable, small plague spots in Alabama, Wisconsin, Illinois, Utah, Texas, and on the Pacific Coast. Within six weeks of the time when the epidemic nature of the disease was recognized, there was no State, there was hardly a county in the whole United States, unstricken. What could our public health system do against such an onset?
Washington newspapers carried display advertisements, calling for volunteer gravediggers, and a local sash and door factory was commandeered by the District authorities and set to turning out coffins at top speed. Three hundred dollars a week was offered in Albany for trained nurses, with no takers. In Alabama relief parties going out through the country found whole families dead in remote houses, so suddenly smitten that they had been unable to get help. This occurred also in the rural districts of western Pennsylvania, the worst stricken section of the country, where in the six weeks of the epidemic’s height 1 per cent of the population died of it, a figure unequaled in American mortality records. Starvation threatened in many cities owing to the crippling of local traffic and the helplessness of the sick; but here the local Red Cross organizations, happily keyed up to a war basis of efficiency, were able to save the situation by a system of central food supply and volunteer deliveries. In the opinion of the highest health authorities, the war emergency alone enabled the country to come through the flu emergency without far greater disaster; since we were organized physically to meet special conditions, and braced, mentally and psychologically, to endure the strain and resist the panic which might otherwise have beset us.
Mystery enshrouds various manifestations of the disease. Its greatest fatality was among those in the strongest years of life; between the ages of twenty and forty, when the human organism is supposed to exhibit the highest form of resistance. Why this should be so, science cannot tell. It was markedly more deadly to men than to women. For what reason? No reason which the experts can agree upon
What underlies this phenomenon? Something beyond present determination. The experience of the military camps shows, very broadly speaking, that, attacked by flu, the husky athlete died, the undervitalized indoor man recovered; the country boy succumbed, the city boy got well: just the reverse of what might be expected. The fact that very few people beyond the age of forty-five died suggested that this portion of the population had had the grippe in the great epidemic of 1889-90, and so were immunized. But if immunity is the explanation, why have deaths of children under fifteen, in the present epidemic, been so few, comparatively? Certainly they are not immunized by any former attack. Another phase of the mystery! The typical, and most formidable, phenomenon of the pestilence has been its “explosive” quality. In a great majority of the cities and smaller communities the infection, after entering, developed slowly for a brief period and then “exploded” into an appalling mortality for two or three weeks, when it swiftly subsided, an added feature being that the explosions were, generally speaking, nearly simultaneous over a great part of the country, taking place in mid-October and up through early November.
Susanna’s Note: World War I ended in November 1918.
Boston, at the height of the epidemic, showed a death rate about six times its normal; Philadelphia, ten times its normal; Baltimore, about eight and a half times its regular mortality, and Washington about the same. New Orleans, with a high regular death rate, multiplied that by more than six. Pittsburgh went to six times the standard rate. Albany rose to six times the normal, San Francisco to five times, New York to about the same, and Chicago to four times. But while this was typical, other cities exhibited no explosive phenomena whatever. Instead they showed a general level, markedly higher than the normal, but never shooting up to a decided “peak.” Herein was another peculiar feature. Why should New Orleans have blown its figures sky-high while Atlanta maintained a steady rate which hardly rose to one-quarter of the New Orleans high figure? What caused Chicago to explode, whereas the maximum at Grand Rapids never rose above double the normal rate, and Milwaukee kept her epidemic in hand almost as well? Why should Pittsburgh rise to six times its standard, and Columbus to only three times its normal? How explain the fact that Philadelphia’s high figure was two and a half times that of New York?
To one clue to the puzzle, thus far developed from any authoritative source, has been brought out by Dr. Raymond Pearl of the Johns Hopkins School of Hygiene and Public Health, working in collaboration with the United States Public Health Service. It is found that, almost invariably, the cities which showed the explosive flu rates have regularly an abnormal number of deaths from the common organic causes: that is, tuberculosis, heart disease, and kidney ailments.
Where the population is of weak organic constitution, the epidemic spreads and kills swiftly, as in Boston, Baltimore, Washington, Albany, New Orleans, and notably Philadelphia. Where the mortality from these standard causes is low the flu failed to make severe inroads, as in Birmingham, Grand Rapids, Columbus, Atlanta, and Milwaukee. It remains to be seen whether this showing, which appears quite definite and convincing in this country, is borne out by the reports (if they are ever forthcoming) from other parts of the world. General figures for the world epidemic are not yet available. Perhaps they never will be. The civilized world was too preoccupied with war to keep mortality records. In general, it is known that the destruction wrought by the pandemic varied in different countries only according as the people were strong or weak, for reasons of food supply, proper housing, and general condition, to resist it. One of the foremost of American hygienists, who has traveled in Europe studying conditions since the armistice, told me that in his opinion one year of flu and its sequelae killed more than four years of war in the combatant countries of Europe. Geographically there seems to have been no limit to the spread. Wherever ships touched, there the influenza was disseminated.
In British India five million victims died a heavier toll in few short weeks than the bubonic plague had taken in twenty years, all told. China reported a devastating onset shortly after. The South African’s went down before it as if it were cholera. It swept the European armies, both in camp and at the front. Even Switzerland’s well-fed, carefully housed troops developed it so generally that from 75 to 90 percent of the total fell ill. The contagion was shipped to Australia and New Zealand and thence was diffused throughout the South Sea Islands. In German Samoa between 80 and 90 percent of the populace was down at the same time and more than half the Government officials died. An infected steamship touched at Rio de Janeiro in October. Within a week there had developed from that one source between two and three hundred thousand cases. Within six weeks there were upward of 700,000 cases. The city was paralyzed. The whole medical, hospital, and burial machinery collapsed. Traffic stopped. There was no street-car service. Deliveries even of food were abandoned. A correspondent writes me that it was a common thing to see driverless cabs being drawn about the streets by starving horses in search of fodder! All South America was subsequently infected.
Barcelona, Spain, reported 1,200 deaths daily when the scourge was at its height. The medical expert of the London “Times” estimated that the twelve highest weeks of the pandemic represented a loss of 6,000,000 lives in all; but at the time of his reckoning many countries were still untouched or unreported. Not since the “black death” of the Middle Ages has there been anything to compare with the flu’s ravages.