Influenza 1918 Quotes

Shut your eyes,” said Miss Tanner. “Oh no,” said Miranda, “for then I see worse things…

So the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart.

The Spanish Influenza did not originate in Spain. In fact the first recorded case was in the United States, in Kansas, on March 9th, 1918. Beware the Ides of March. But because Spain was neutral in World War I, it did not sensor reports of the disease to the public. To tell the truth then, is to risk being remembered by its fiction. Countless countries laid blame to one another. What the US called the Spanish Influenza, Spain called the French Flu, or the Naples Soldier. What Germans dubbed the Russian Pest, the Russians called Chinese Flu.

Throughout the pandemic, the nation lacked a uniform policy about gathering places, and there was no central authority with the power to make and enforce rules that everyone had to obey. Each community acted on its own, doing as its elected officials thought best.12

When the next pandemic comes, as it surely will someday, perhaps we will be ready to meet it. If we are not, the outcome will be very, very, very dreadful.

The influenza pandemic of 1918 killed more people than the First World War—an estimated 3 to 6 per cent of the human race.

However, as bad as things were, the worst was yet to come, for germs would kill more people than bullets. By the time that last fever broke and the last quarantine sign came down, the world had lost 3-5% of its population.

Ebola is a zoonosis. So is bubonic plague. So was the so-called Spanish influenza of 1918–1919, which had its ultimate source in a wild aquatic bird and, after passing through some combination of domesticated animals (a duck in southern China, a sow in Iowa?) emerged to kill as many as 50 million people before receding into obscurity.

No other disease, no war, no natural disaster, no famine comes close to the great pandemic. In the space of eighteen months in 1918–1919, about 500 million people, one-third of the human race at the time, came down with influenza. The exact total of lives lost will never be known. An early estimate, made in 1920, claimed 21.5 million died worldwide. Since then, researchers have been continually raising the number as they find new information. Today, the best estimate of flu deaths in 1918–1919 is between 50 million and 100 million worldwide, and probably closer to the latter figure. 7

White Christians often explained the disaster in a time-honored way: it was God's punishment of humanity for its sings. To the seven deadly sins--anger, greed, lust, envy, pride, laziness, gluttony--they added an eighth sin: 'worshiping science.

overstate to make a point—warned, civilization could have disappeared within a few more weeks. So the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart.

In the United States, influenza death rates were so high that the average life span fell by twelve years, from fifty-one in 1917 to thirty-nine in 1918. If you were a “doughboy”—slang for an American soldier—you had a better chance of dying in bed from flu or flu-related complications than from enemy action.

Edward Jenner’s discovery of vaccination drew harsh criticism from the pulpit. Clergymen denounced the doctor for having put himself above God. Only the Almighty, they said, sends illness and only the Almighty cures it. Vaccination, critics charged, was “a diabolical operation,” and its inventor was “flying in the face of Providence

the disturbing possibility that the Spanish Lady might stage a return visit,

The 1918 epidemic came in two waves, a mild flu in the spring of 1918 followed by the killer flu in the fall.

Influenza had brought the all-conquering German army to its knees, while the Allies, stricken too, took advantage of their enemy’s weakness to regroup.

With influenza and many other diseases the order is reversed, high infectivity preceding symptoms by a matter of days. A perverse pattern: the danger, then the warning. That probably helped account for the scale of worldwide misery and death during the 1918–1919 influenza: high infectivity among cases before they experienced the most obvious and debilitating stages of illness.

Nowadays, the disease claims, on average, 36,000 Americans each year, out of a population of 320 million. Contrast this with another number: 35,092 Americans died in motor vehicle accidents in 2015.

For the influenza pandemic that erupted in 1918 was the first great collision between nature and modern science. It was the first great collision between a natural force and a society that included individuals who refused either to submit to that force or to simply call upon divine intervention to save themselves from it, individuals who instead were determined to confront this force directly, with a developing technology and with their minds.

Should we add the 40 to 50 million victims of the 1918 influenza pandemic to the 15 million who were killed in World War I, because the flu virus would not have evolved its virulence if the war hadn’t packed so many troops into trenches?

THE ACTUAL WORD ‘influenza’ dates from around 1500, when the Italians introduced the term for diseases that they attributed to the ‘influence’ of the stars. Another possible origin was the Italian phrase influenza di freddo, the influence of the cold.

Most parents thought they were being good parents. They learned from their parents or their grandparents, many of whom were severely traumatized and emotionally disconnected coming out of the devastation of a 1918 influenza pandemic and two world wars.

The CDC and three other research groups submitted a paper for publication in the journal Science detailing how they had reconstructed the 1918 H1N1 influenza virus, using virus genes that had been identified in lung samples of patients who died during the 1918 pandemic.

In many ways, it is hard for modern people living in First World countries to conceive of a pandemic sweeping around the world and killing millions of people, and it is even harder to believe that something as common as influenza could cause such widespread illness and death.

At least etymologically speaking, when we talk about influenza we are talking about the influences that shape the world everywhere at once. Today’s bird flu or swine flu viruses or the 1918 Spanish flu virus are not the real influenza — not the underlying influence — but only its symptom.

But as the program got going, the smallest details became issues, even the very name of the disease. Pig farmers complained to the Centers for Disease Control that the name “swine flu” might frighten people away from eating pork. They asked, to no avail, that the flu’s name be changed to “New Jersey

The new collectives that farming supported gave rise to new diseases–the so-called ‘crowd diseases’ such as measles, smallpox, tuberculosis and influenza. Humans had always been susceptible to infectious disease–leprosy and malaria were causing misery long before the farming revolution–but these were adapted to surviving in small, dispersed human populations. Among their tricks for doing so were not conferring total immunity on a recovered host, so that he or she could be infected again, and retreating to another host–a so-called ‘animal reservoir’–when humans were scarce. Both strategies helped ensure that they maintained a sufficiently large pool of susceptible hosts.

Flu pandemics are nothing new. Medical historians think the first one struck in 1510, infecting Asia, Africa, Europe, and the New World. Between the years 1700 and 1900, there were at least sixteen pandemics, some of them killing up to one million people. Yet these were tame compared to the 1918 calamity. It was by far the worst thing that has ever happened to humankind; not even the Black Death of the Middle Ages comes close in the number of lives it took. A 1994 report by the World Health Organization pulled no punches. The 1918 pandemic, it said, “killed more people in less time than any other disease before or since.” It was the “most deadly disease event in the history of humanity.

relationship with nature, modern humanity has generally been the aggressor, and a daring one at that, altering the flow of rivers, building upon geological faults, and, today, even engineering the genes of existing species. Nature has generally been languid in its response, although contentious once aroused and occasionally displaying a flair for violence. By 1918 humankind was fully modern, and fully scientific, but too busy fighting itself to aggress against nature. Nature, however, chooses its own moments. It chose this moment to aggress against man, and it did not do so prodding languidly. For the first time, modern humanity, a humanity practicing the modern scientific method, would confront nature in its fullest rage.

In the earlier tradition from which Mrs. Post wrote, the act of dying had not yet been professionalized. It did not typically involve hospitals. Women died in childbirth. Children died of fevers. Cancer was untreatable. At the time she undertook her book of etiquette, there would have been few American households untouched by the influenza pandemic of 1918. Death was up close, at home.

One way in which grief gets hidden is that death now occurs largely offstage. In the earlier tradition from which Mrs. Post wrote, the act of dying had not yet been professionalized. It did not typically involve hospitals. Women died in childbirth. Children died of fevers. Cancer was untreatable. At the time she undertook her book of etiquette, there would have been few American households untouched by the influenza pandemic of 1918. Death was up close, at home.

For propagandists, whatever promoted the Allied cause was true, whether factual or not. What counted was the noble end--victory--not the sordid means of achieving it. 'Truth and falsehood are arbitrary terms,' declared a CPI official. 'There is nothing in experience to tell us that one is always preferable to the other....There are lifeless truths and vital lies....The force of an idea lies in its inspirational value. It matters very little if it is true or false.

least 40 million people died as a result of the epidemic, the majority of them suffocated by a lethal accumulation of blood and other fluid in the lungs. Ironically, unlike most flu epidemics, but like the war that preceded and spread it, the influenza of 1918 disproportionately killed young adults. One in every hundred American males between the ages of 25 and 34 fell victim to the ‘Spanish Lady’. Strikingly, the global peak of mortality was in October and November 1918.

in a letter to the New York Times, Dr. Hans Neumann from the New Haven Department of Health noted that based on the projected scale of the immunizations, within two days of getting a flu shot, about 2,300 people would have a stroke and 7,000 would have a heart attack. “Why?” he asked. “Because that is the number statistically expected, flu shots or no flu shots.” Likewise, in the week following a flu vaccine, another 9,000 people would contract pneumonia, of whom 900 would die. These would certainly occur after a flu shot, but not as a consequence of it. “Yet,” wrote Neumann, “can one expect a person who received a flu shot at noon and who that same night had a stroke not to associate somehow the two in his mind?” Grandma got the flu vaccine in the morning, and she was dead in the afternoon. Although association does not equal causation, this thinking could lead to a public backlash against vaccinations that would threaten future programs.

In 1918 fear moved ahead of the virus like the bow wave before a ship. Fear drove the people, and the government and the press could not control it. They could not control it because every true report had been diluted with lies. And the more the officials and newspapers reassured, the more they said, There is no cause for alarm if proper precautions are taken, or Influenza is nothing more or less than old-fashioned grippe, the more people believed themselves cast adrift, adrift with no one to trust, adrift on an ocean of death.

Today, we share no fewer than 300 diseases with domesticated animals. For example, humans get 45 diseases from cattle, including tuberculosis; 46 from sheep and goats; 42 from pigs; 35 from horses, including the common cold; and 26 from poultry. Rats and mice carry 33 diseases to humans, including bubonic plague. Sixty-five diseases, including measles, originated in man’s best friend, the dog. We can still get parasitic worms from pet dogs and cats. That is why it is not a good idea to kiss a pet on the mouth or sleep with it in bed.4

Bells Screamed all off key, wrangling together as they collided in midair, horns and whistles mingled shrilly with cries of human distress; sulphur-colored light ex-ploded through the black windowpane and flashed away in darkness. Miranda waking from a dreamless sleep asked without expecting an answer, “What is happening?” for there was a bustle of voices and footsteps in the corridor, and a sharpness in the air; the far clamour went on, a furious exasperated shrieking like a mob in revolt. The light came on, and Miss Tanner said in a furry voice, “Hear that? They’re celebrating . It’s the Armistice. The war is over, my dear.” Her hands trembled. She rattled a spoon in a cup, stopped to listen, held the cup out to Miranda. From the ward for old bedridden women down the hall floated a ragged chorus of cracked voices singing, “My country, ’tis of thee…” Sweet land… oh terrible land of this bitter world where the sound of rejoicing was a clamour of pain, where ragged tuneless old women, sitting up waiting for their evening bowl of cocoa, were singing, “Sweet land of Liberty-” “Oh, say, can you see?” their hopeless voices were asking next, the hammer strokes of metal tongues drowning them out. “The war is over,” said Miss Tanner, her underlap held firmly, her eyes blurred. Miranda said, “Please open the window, please, I smell death in here.

the Spanish press doesn’t have the same censorship that the French, German, and British governments have imposed on their newspapers.” “Correct again, Lilly,” said Noble. “You can add American government censorship of the press, also. As far as I can see, in A.I. Office communications regarding The War, there is no Spanish press censorship at all. There was even wide press coverage in the last week of Spanish King Alphonse XIII and his family’s serious illnesses with the grippe.” “Both the Allies and the Central Powers don’t want to let on there has been any reduction in fighting capacity. So, very little appears in their respective newspapers. The Spanish, however, are free to report all the various details of the influenza epidemic. It would be simple wrong to conclude the epidemic is ‘Spanish’ in origin.

Early on it is clear that Addie has a rebellious streak, joining the library group and running away to Rockport Lodge. Is Addie right to disobey her parents? Where does she get her courage? 2. Addie’s mother refuses to see Celia’s death as anything but an accident, and Addie comments that “whenever I heard my mother’s version of what happened, I felt sick to my stomach.” Did Celia commit suicide? How might the guilt that Addie feels differ from the guilt her mother feels? 3. When Addie tries on pants for the first time, she feels emotionally as well as physically liberated, and confesses that she would like to go to college (page 108). How does the social significance of clothing and hairstyle differ for Addie, Gussie, and Filomena in the book? 4. Diamant fills her narrative with a number of historical events and figures, from the psychological effects of World War I and the pandemic outbreak of influenza in 1918 to child labor laws to the cultural impact of Betty Friedan. How do real-life people and events affect how we read Addie’s fictional story? 5. Gussie is one of the most forward-thinking characters in the novel; however, despite her law degree she has trouble finding a job as an attorney because “no one would hire a lady lawyer.” What other limitations do Addie and her friends face in the workforce? What limitations do women and minorities face today? 6. After distancing herself from Ernie when he suffers a nervous episode brought on by combat stress, Addie sees a community of war veterans come forward to assist him (page 155). What does the remorse that Addie later feels suggest about the challenges American soldiers face as they reintegrate into society? Do you think soldiers today face similar challenges? 7. Addie notices that the Rockport locals seem related to one another, and the cook Mrs. Morse confides in her sister that, although she is usually suspicious of immigrant boarders, “some of them are nicer than Americans.” How does tolerance of the immigrant population vary between city and town in the novel? For whom might Mrs. Morse reserve the term Americans? 8. Addie is initially drawn to Tessa Thorndike because she is a Boston Brahmin who isn’t afraid to poke fun at her own class on the women’s page of the newspaper. What strengths and weaknesses does Tessa’s character represent for educated women of the time? How does Addie’s description of Tessa bring her reliability into question? 9. Addie’s parents frequently admonish her for being ungrateful, but Addie feels she has earned her freedom to move into a boardinghouse when her parents move to Roxbury, in part because she contributed to the family income (page 185). How does the Baum family’s move to Roxbury show the ways Betty and Addie think differently from their parents about household roles? Why does their father take such offense at Herman Levine’s offer to house the family? 10. The last meaningful conversation between Addie and her mother turns out to be an apology her mother meant for Celia, and for a moment during her mother’s funeral Addie thinks, “She won’t be able to make me feel like there’s something wrong with me anymore.” Does Addie find any closure from her mother’s death? 11. Filomena draws a distinction between love and marriage when she spends time catching up with Addie before her wedding, but Addie disagrees with the assertion that “you only get one great love in a lifetime.” In what ways do the different romantic experiences of each woman inform the ideas each has about love? 12. Filomena and Addie share a deep friendship. Addie tells Ada that “sometimes friends grow apart. . . . But sometimes, it doesn’t matter how far apart you live or how little you talk—it’s still there.” What qualities do you think friends must share in order to have that kind of connection? Discuss your relationship with a best friend. Enhance

Today, such studies are illegal. Medical scientists cannot offer inducements like pardons to persuade prisoners to take part in their studies. Although they can award small cash payments to research subjects, they are forbidden from giving anyone so much money or such tempting favors that their compensations might constitute what ethicists term an inappropriate inducement, an irresistible temptation to join the study. Now, more than eighty years after the 1918 flu, people enter studies for several reasons—to get free medical care, to get an experimental drug that, they hope, might cure them of a disease like cancer or AIDS, or to help further scientific knowledge. In theory at least, study participants are supposed to be true volunteers, taking part in research of their own free will. But in 1918, such ethical arguments were rarely considered. Instead, the justification for a risky study with human beings was that it was better to subject a few to a great danger in order to save the many. Prisoners were thought to be the ideal study subjects. They could offer up their bodies for science and, if they survived, their pardons could be justified because they gave something back to society. The Navy inmates were perfect for another reason. Thirty-nine of them had never had influenza, as far as anyone knew. So they might be uniquely susceptible to the disease. If the doctors wanted to deliberately transmit the 1918 flu, what better subjects? Was influenza really so easily transmitted? the doctors asked. Why did some people get it and others not? Why did it kill the young and healthy? Could the wartime disruptions and movements of troops explain the spread of the flu? If it was as contagious as it seemed, how was it being spread? What kind of microorganism was causing the illness? The normal way to try to answer such questions would be to study the spread of the disease in animals. Give the disease to a few cages of laboratory rats, or perhaps to some white rabbits. Isolate whatever was causing the illness. Show how it spread and test ways to protect animals—and people—against the disease. But influenza, it seemed, was a uniquely human disease. No animal was known to be susceptible to it. Medical researchers felt they had no choice but to study influenza in people. Either the Navy doctors were uncommonly persuasive or the enticement of a pardon was overwhelmingly compelling. For whatever reason, the sixty-two men agreed to be subjects in the medical experiment. And so the study began. First the sailors were transferred to a quarantine station on Gallops Island in Boston Harbor. Then the Navy doctors did their best to give the men the flu. Influenza is a respiratory disease—it is spread from person to person, presumably carried on droplets of mucus sprayed in the air when sick people cough or sneeze, or carried on their hands and spread when the sick touch the healthy. Whatever was causing the flu should be present in mucus taken from the ill. The experiments, then, were straightforward. The Navy doctors collected mucus from men who were desperately ill with the flu, gathering thick viscous secretions from their noses and throats. They sprayed mucus from flu patients into the noses and throats of some men, and dropped it into other men’s eyes. In one attempt, they swabbed mucus from the back of the nose of a man with the flu and then directly swabbed that mucus into the back of a volunteer’s nose.

To a large degree, the extent of the devastation that the flu caused on American cities depended on how they reacted to it. Those that took prompt action and made good choices had more limited devastation than others.

Investigators today believe that in the United States the 1918–19 epidemic caused an excess death toll of about 675,000 people.

NATURE CHOSE to rage in 1918, and it chose the form of the influenza virus in which to do

Perhaps, in some innocent encounter in China between a child and a bird, a new killer flu is on its way. Or perhaps, even now, a young man or a young woman has become infected with two different strains of flu viruses. They are mixing together in the person’s lungs, their genes reassorting. Emerging from that witches’ brew is a new virus, a chimera, that, like the 1918 flu virus, is perfectly suited for destruction. Perhaps, as we grow almost smug about influenza, that most quotidian of infections, a new plague is now gathering deadly force. Except this time we stand armed with a better understanding of the past to better survive the next pandemic.

The natural reservoir of influenza is generally considered to be birds, especially waterbirds. The big giveaway that a certain species plays the role of reservoir for a certain pathogen is that it doesn’t get sick from it.

I have dwelt at length on famines because they offer such an outstanding example of British colonial malfeasance. One could have cited epidemic disease as well, which constantly laid Indians low under British rule while the authorities stood helplessly by. To take just the first four years of the twentieth century, as Durant did: 272,000 died of plague in 1901, 500,000 in 1902, 800,000 in 1903, and 1 million in 1904 the death toll rising every year. During the Spanish Influenza epidemic of 1918, 125 million cases of ‘flu were recorded (more than a third of the population), and India’s fatality rate was higher than any Western country’s: 12.5 million people died. As the American statesman (and three-time Democratic presidential candidate) William Jennings Bryan pointed out, many Britons were referring to the deaths caused by plague as ‘a providential remedy for overpopulation’. It was ironic, said Bryan, that British rule was sought to be justified on the grounds that ‘it keeps the people from killing each other, and the plague praised because it removes those whom the Government has saved from slaughter!’.

Pig farmers complained to the Centers for Disease Control that the name “swine flu” might frighten people away from eating pork. They asked, to no avail, that the flu’s name be changed to “New Jersey flu.

knows exactly how serious this threat could be. Nevertheless, we cannot afford to take a chance with the health of our nation.” With that preamble, Ford announced that he was asking Congress to appropriate $135 million “for the production of sufficient vaccine to inoculate every man, woman, and child in the United States,” for a disease that no one could even prove to exist.

air cannot flow out of the room, only in. There they are bathed in blue ultraviolet light, which kills viruses. After that, they tug on

So the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best.

A Journal of the Plague Year

Capps’s article appeared in the August 10, 1918, issue of JAMA.

Today’s world population is 6.3 billion. To give a sense of the impact in today’s world of the 1918 pandemic, one has to adjust for population. If one uses the lowest estimate of deaths—the 21 million figure—that means a comparable figure today would be 73 million dead. The higher estimates translate into between 175 and 350 million dead.

If it is hot enough to barbecue,” a patient of mine once told me as I sutured the knife wounds on his chest, “it’s hot enough to stab someone.

in 2004, the National Intelligence Council, a research organization in the U.S. intelligence community, had published a report titled Mapping the Global Future, which presented scenarios for the year 2020. One of the scenarios imagined was a pandemic in 2020. It was eerily prophetic, even as to the year: It is only a matter of time before a new pandemic appears, such as the 1918–1919 influenza virus that killed an estimated twenty million worldwide. Such a pandemic in megacities of the developing world . . . would be devastating and could spread rapidly throughout the world.

ARDS by no means accounts for all the influenza deaths in 1918 and 1919, or even for a majority of them. It explains only those who died in a few days, and it explains why so many young healthy people died. Although influenza almost certainly killed some people in ways that had little to do with the lungs—for example, someone whose already weak heart could not stand the additional strain of fighting the disease—the overwhelming majority of non-ARDS deaths came from bacterial pneumonias. The destruction of the epithelial cells eliminated the sweeping action that clears so much of the respiratory tract of bacteria, and the virus damaged or exhausted other parts of the immune system as well. That gave the normal bacterial flora of the mouth unimpeded entry into the lungs. Recent research also suggests that the neuraminidase on the influenza virus makes it easier for some bacteria to attach to lung tissue, creating a lethal synergy between the virus and these bacteria. And in the lungs, the bacteria began to grow.

Some of those who died from influenza and pneumonia would have died if no epidemic had occurred. Pneumonia was after all the leading cause of death. So the key figure is actually the “excess death” toll. Investigators today believe that in the United States the 1918–19 epidemic caused an excess death toll of about 675,000 people. The nation then had a population between 105 and 110 million, while it was approaching 300 million in 2006. So a comparable figure today would be approximately 1,750,000 deaths.

In 1918 especially, this question of balance played a crucial role in the war between virus and immune system, and between life and death. The virus was often so efficient at invading the lungs that the immune system had to mount a massive response to it. What was killing young adults a few days after the first symptom was not the virus. The killer was the massive immune response itself.

In 1918 pathologists did see at autopsy the normal devastation of the lungs caused by the usual lobar and bronchopneumonias. But the lungs from those who died quickly during the pandemic, the lungs that so confused even Welch, those lungs were different. Said one pathologist, “Physical signs were confusing. Typical consolidation was seldom found.” And another: “The old classification by distribution of the lesions was inappropriate.” And another: “Essentially toxic damage to alveolar walls and exudation of blood and fluid. Very little evidence of bacterial action could be found in some of these cases.

Influenza robbed countless youngsters of normal childhoods. For them, attending school had been a regular part of life. The pandemic, however, forced local authorities to decide whether to keep public schools open.

For young survivors of the pandemic, life would never be the same. Like shell shocked soldiers, they bore emotional scars. These children had similar experiences and shared similar feelings of anxiety, of terror, of despair.

Australia had escaped. It had escaped because of a stringent quarantine of incoming ships. Some ships arrived there with attack rates as high as 43 percent and fatality rates among all passengers as high as 7 percent. But the quarantine kept the virus out, kept the continent safe, until late December 1918 when, with influenza having receded around the world, a troopship carrying ninety ill soldiers arrived. Although they too were quarantined, the disease penetrated—apparently through medical personnel treating troops. By then the strain had lost much of its lethality. In Australia the death rates from influenza were far less than in any other Westernized nation on earth, barely one-third that of the United States, not even one-quarter that of Italy. But it was lethal enough.

Statistics also confirmed what every physician, indeed every person, already knew. In the civilian population as well, young adults had died at extraordinary, and frightening, rates. The elderly, normally the group most susceptible to influenza, not only survived attacks of the disease but were attacked far less often. This resistance of the elderly was a worldwide phenomenon. The most likely explanation is that an earlier pandemic (later analysis of antibodies proved it was not the 1889–90 one), so mild as to not attract attention, resembled the 1918 virus closely enough that it provided protection.

Societies, especially in the developed world, were thought to be on the verge of becoming invulnerable to new plagues. Unfortunately, this expectation has proved to be spectacularly misplaced. Well into the twenty-first century smallpox remains the only disease to have been successfully eradicated. Worldwide, infectious diseases remain leading causes of death and serious impediments to economic growth and political stability. Newly emerging diseases such as Ebola, Lassa fever, West Nile virus, avian flu, Zika, and dengue present new challenges, while familiar afflictions such as tuberculosis and malaria have reemerged, often in menacing drug-resistant forms. Public health authorities have particularly targeted the persisting threat of a devastating new pandemic of influenza such as the “Spanish lady” that swept the world with such ferocity in 1918 and 1919.

The 1918 influenza pandemic famously had a W-shaped curve. The very young and the very old were at increased risk, but there was also elevated risk in the middle of the age distribution, spiking in patients around twenty-five years old. Scientists have been studying this for decades but are still unsure why it happened.

journalist asked her about it. “What scares me most and what I think about most,” said Charity, “is our ability to respond to a new pathogen, maybe one we’ve never seen before, or an old pathogen, like influenza that’s just mutated. The H1N1 pandemic of 1918 was over 100 years ago now. The world is overdue for a pandemic like that, whether it’s influenza or something else. And in public health, we know that we have to be prepared for that.

What scares me most and what I think about most,” said Charity, “is our ability to respond to a new pathogen, maybe one we’ve never seen before, or an old pathogen, like influenza that’s just mutated. The H1N1 pandemic of 1918 was over 100 years ago now. The world is overdue for a pandemic like that, whether it’s influenza or something else. And in public health, we know that we have to be prepared for that.

The last big deadly human influenza epidemic in the world was in 1918. There were about twenty million dead worldwide, including five hundred thousand in the United States. Based on our present population, the equivalent number of dead now would be approximately one and a half million people. Could you imagine such a thing today? And the 1918 virus wasn’t particularly virulent, and of course, travel was much slower then and less frequent. Today, the highways and skyways can spread an infectious virus around the world in days.

With them heredity, diatheses, the vicissitudes of weather and other meteorological conditions, elements of decomposition, impure atmosphere, gluttony, insufficient and unwholesome food, inebriety and other environments, potent factors in the formation of disease, are entirely overlooked. Having their gaze fixed upon the one ignis fatuus, they become oblivious to all things else in heaven, earth or sea.79

In more recent history, we learn from other viruses, including Measles, Ebola, Rabies, Herpes, how important it is to respond immediately to prevent the spread of infection. I was shocked when I learned more about the influenza pandemic, otherwise known as the Spanish Flu of 1918–1919. It began in the US, swiftly traveled across the world, and killed more people than any disease before or since.

Fauci trotted out his reliable old chestnut that the new version of bird flu could be as lethal as the 1918 Spanish flu epidemic that killed 50–100 million people.51 Dr. Fauci had reason to know that this weary bogeyman was a canard. In 2008, he coauthored a study for the Journal of Infectious Disease confessing that virtually all of the “influenza” casualties in 1918 did not actually die from flu but from bacterial pneumonia and bronchial meningitis, which are, today, easily treated with antibiotics unavailable in 1918.52 The Spanish flu that government virologists have invoked to terrorize generations of Americans with vaccine compliance is, after all, a paper tiger.

Dr. Fauci had reason to know that this weary bogeyman was a canard. In 2008, he coauthored a study for the Journal of Infectious Disease confessing that virtually all of the “influenza” casualties in 1918 did not actually die from flu but from bacterial pneumonia and bronchial meningitis, which are, today, easily treated with antibiotics unavailable in 1918.52 The Spanish flu that government virologists have invoked to terrorize generations of Americans with vaccine compliance is, after all, a paper tiger.

The National Institutes of Health in Maryland keeps samples of the 1918 flu virus in a freezer at an undisclosed location. It’s not easy to get anywhere near that locked freezer, let alone inside it. First, you have to get onto the campus of the NIH, which requires identification, a reason to be admitted, and a PhD, preferably in one of the life sciences. Once you get through and find the building, a guard has to buzz you in via an airlocked entrance with double doors. Inside, you will pass through a metal detector and then be firmly guided toward a locker, where your cell phone, thumb drive, computer, pager, and camera must be deposited. Then, and only then, will you be escorted farther into the building.

All this tinkering was creating superviruses that did not exist outside the lab and that might be more easily transmissible between different species, or more virulent, or more resistant to any influenza vaccine. Most researchers were insistent that these “gain of function” studies were needed to better understand how the flu virus might evolve, but the federal government saw things differently. These experiments were a security risk.

The 2009 “pandemic,” which was not really a pandemic at all, taught us that language is both a weapon and a handicap when waging a campaign against influenza.

Robert Graves, the poet and British Army officer, was in London, too, still shaky from the German metal he had received in his chest and thigh the year before. His mother-in-law contracted influenza, but deceived her physician in order to make the rounds of the latest London plays with her son, Tony, on leave from France. She died July 13: “her chief feeling was one of pleasure that Tony had got his leave prolonged on her account.” On the day she died, Grave’s friend and fellow poet, Sigfried Sassoon, who had been shot through the throat in 1917, was shot through the head while on patrol in No-Man’s-Land. He recovered. Tony was killed two months later.27 Yes, the war was much more engrossing than Spanish flu.

Spanish influenza had rounded the globe in four months following its appearance in the United States and fully earned a promotion from epidemic to pandemic. It had infected so many that, for all its mildness, it had doubtlessly killed tens of thousands already. In its next wave it would kill millions.

The characteristic of the influenza virus that makes it so dangerous and gives rise to epidemic after epidemic is its extreme mutability. It perpetually is changing the nature of its outer surface, which antibodies, the body’s most important defense system, must zero in on to be effective.

No other influenza before or since has had such a propensity for pneumonic complications. And pneumonia kills.

The case and death rates of communities which had “strict” closing orders were no better and often worse than elsewhere. However, public health officials had to do something, and closing up theatres, schools, pool halls, and even churches was the style in fall 1918.

In its first Spanish influenza pamphlet, issued in September, the USPHS recommended that those nursing flu patients wear gauze masks.37 Soon laymen decided that what was a sensible caution in the sickroom would be just as sensible in every situation. Gauze masks became a common sight in the streets and department stores of communities in the eastern United States. People could and did honestly believe that a few layers of gauze would keep out flu bugs, just as screens kept the flies off the front porch. The influenza virus itself is, of course, so infinitely tiny that it can pass through any cloth, no matter how tightly woven, but a mask can catch some of the motes of dust and droplettes of water on which the virus may be riding. However, to be even slightly effective during a flu epidemic masks must be worn at all times when people are together, at home and at work and in between, must be of a proper and probably uncomfortable thickness, must be tied firmly, and must be washed and dried at least once daily. Enforcement of such conditions is impossible and so the communities where masking was compulsory during the Spanish influenza pandemic almost always had health records the same as those of adjacent communities without masking.

The Great Influenza, a book by the historian John Barry about the 1918 flu pandemic.

Some spent years undermining Pfeiffer’s theory, and others—among them many of the most brilliant scientists of the era—took off after other alleged villains, spending untold thousands of man-hours in the crucially important but thankless task of proving themselves wrong.

Today, we know that viruses are submicroscopic entities twenty times smaller than a bacterium. They contain a core of genetic material covered by a protein capsule, and they reproduce exclusively within living cells.

The most useful definition we have is that an epidemic is a severe local outbreak, while a pandemic is a global outbreak that makes people very sick, and spreads rapidly from a point of origin.

Antigenic shift generated the deadly 1918 influenza virus and the swine flu outbreak of 2009.

We now think that the majority of deaths in the 1918 pandemic resulted from these secondary infections, not from the flu virus itself.

The third explanation for 1918’s lethality is that the flu virus triggered an overreactive immune response that turned the body against itself.

Today, influenza kills fewer than 0.1 percent of those who catch it. Nearly everyone recovers. In the 1918 pandemic most still recovered, but the death rate was twenty-five times greater. So many died in the U.S. that the average life expectancy in 1918 fell from fifty-one to thirty-nine years.

The history of the 1918 influenza pandemic is depressing reading. It’s like watching a horror movie that you have seen before. You know who the killer is, but you can’t jump in and save the victim.

World War I killed upwards of fifteen millions, wreaked immeasurable physical, social, and psychic damage, and left most of the citizens of the belligerent powers with a deep conviction that war must in some way be prohibited.

When did the pandemic end? That is more difficult to say, for while flu pandemics often begin abruptly, they normally disappear only after several renewals of virulency and then a long tailing off. The pandemic of Spanish influenza subsided and sank below the level of general and even scientific perception in the United States and almost everywhere else in the world in spring 1919.

But the 1920 edition of the Spanish influenza virus was an attenuated variant of the original strain, and the human population was more resistent than in 1918 and 1919.

The pandemic of Spanish influenza is easier to measure if it is restricted to the years of 1918 and 1919 and its farewell performance of 1920 is excluded.

The pandemic of 1918–1919 was clearly one of influenza, except in two of its features. One, it killed more humans than any other disease in a period of similar duration in the history of the world. Two, it killed an unprecedentedly large proportion of the members of a group who, according to records before and since, should have survived it with no permanent injury. The year 1918 was an actuarial nightmare: the flu and pneumonia death rate of life insurance policy holders over 45 and 50, for whose deaths the insurance companies were at least partly prepared, did, of course, rise, but only slightly as compared to the rate of young adults, whose deaths in great numbers no insurance company anticipated.16

It seems that the returns of pandemic flu, every 30 or 40 years, are arbitrary. The return in 1918 happened to come in the midst of a world war, with all its crowds and migrations, and perhaps that coincidence created Spanish influenza. Perhaps, but can we be sure that crowds and migrations have much to do with increasing the virulency of flu? There is the annoying fact that two of the last three pandemics, those of 1889–1890 and 1957, appear to have originated not among the most cosmopolitan of the world—the citizens of New York or Panama City—but among the relatively isolated and static populations of the interior of Asia.24

most deadly disease event in the history of humanity.

if we use electrodes to study its oddly intelligent brain, we can replicate a pack of cloned genius dogs to do our bidding.” Everyone in the room smiled along with their leader. They followed his gaze to the TV monitor, now showing a photo of Wolfe with his arm around a young woman, and talking to a smiling black couple, while the dog sat at their feet. If any of those people happened to witness Jake Wolfe’s murder, they’d be killed too. He turned to Gisela and demanded, “Is the laboratory completion on schedule?” “Yes, it’s ready now, awaiting the scientists.” She tapped the remote and played a video. Attached to the mansion, in what appeared to be a five-car garage, a secret laboratory had been prepared for two epidemiologists Belken intended to kidnap. They would be forced to mutate the 1918 influenza pathogen into an even deadlier strain to be used as an aerosolized microbe weapon sprayed from ships or planes onto targeted cities. Their other task, equally important, would be to develop a new flu shot to immunize against the threat. There were murmurs of approval around the table. Belken nodded, hearing their flattering remarks. “Any report on our team kidnapping the targets?

even if things after the great influenza of 1918 never did go back to what people back then thought of as “normal,” they didn’t get worse . . . At least until a few years later, when World War II started.

The pandemic may have originated in the American military post at Fort Riley, Kansas, where a dust storm whipping about tons of incinerated manure had sent hundreds of coughing, stumbling doughboys diagnosed with influenza into the post hospital, where many died. Soon after, American troopships disembarked at Brest and Saint-Nazaire, and French poilus began to fall ill, then British soldiers. Then, as the malady rolled across France, German troops were stricken. The fatality rate was appalling. In the AEF, roughly one out of every three soldiers with influenza died, far worse odds than a man faced in battle.

The 1918–19 influenza virus strain, a pandemic which killed forty million people in Europe, Asia and America, was not confined to the war areas, though it struck them hardest.

Still, this particularly virulent and infectious strain of the flu virus is thought to have killed as many as 40 million people around the world between 1918 and 1919.

He estimates the number of deaths worldwide as 100 million, a larger number than the conventional estimate of 20 to 40 million. But, he said, 20 million people died in India alone, making it impossible for the 20 to 40 million figure to be correct.

Instead, the dean had said, “Take a look at the person sitting to your left and to your right. Chances are that person will not be there four years from now.” Every

least 40 million people died as a result of the epidemic, the majority of them suffocated by a lethal accumulation of blood and other fluid in the lungs. Ironically, unlike most flu epidemics, but like the war that preceded and spread it, the influenza of 1918 disproportionately killed young adults. One in every hundred American males between the ages of 25 and 34 fell victim to the ‘Spanish Lady’.

Two epidemics swept the world in 1918. One was Spanish influenza, the first recorded outbreak of which was at a Kansas army base in March 1918. As if to mock the efforts of men to kill one another, the virus spread rapidly across the United States and then crossed to Europe on the crowded American troopships.

Ironically, it was not the flu that actually killed people but the way in which it weakened them in ways that allowed pneumonia or meningitis could set in.

As the early outbreak at Fort Riley suggested, the primary breeding ground for the influenza consisted of army camps that were springing up all over America in the early days of 1918. America had entered World War I the previous October, and many young men were anxious to do their part and join the fight.  As a result, the camps soon became overcrowded with recruits and service veterans brought in from all over the country to train them.

the Indians who were our neighbors, they were only six miles away. So Dad and the city marshal rode up there one day to see how things were going at the Indian camps and they were horrified at what they saw. After an Indian died, his family and friends would sit around chanting him to the Happy Hunting Grounds and they’d spend all night there. And, by that time, they were all exposed, everybody had the flu. Ultimately, it killed about half the Indians.

Since that time there have been numerous epidemics of the disease. In 1889 and 1890 the disease was epidemic over practically the entire civilized world. Three years later there was another flare-up of the disease. Both times the epidemic spread widely over the United States. Although the recent epidemic is called ‘Spanish influenza,’ investigation has shown that it did not originate in Spain.  We now know that there was an undue prevalence of influenza in the United States for several years preceding the recent great pandemic. Because the disease occurred in mild form, and because the public mind was focused on the war, this increased prevalence of the disease escaped attention. Not until the epidemic appeared in severe form in Boston in September, 1918, did it excite any special interest.” - U.S. Public Health Service Report, prepared by Surgeon General Rupert Blue

They wondered if the end of The War had only set the stage for another future world catastrophe. Noble pondered if the dark “gifts” of influenza would continue for many decades to come.

I had a little bird, Its name was Enza. I opened the window, And in-flu-enza.

The small town of Gunnison, Colorado, lies at the bottom of the valley carved by the Gunnison River into the Rocky Mountains. It is now crossed by the Colorado stretch of U.S. Highway 50, but in 1918, the town was mainly supplied by train and two at best mediocre roads. When the 1918–19 influenza pandemic reached Colorado as an unwelcome stowaway on a train carrying servicemen from Montana to Boulder, the town of Gunnison took decisive action. As the November 1, 1918, edition of the Gunnison News-Champion documents, a Dr. Rockefeller from the nearby town of Crested Butte was "given entire charge of both towns and county to enforce a quarantine against all the world". He instituted a strict reverse quarantine regime that almost entirely isolated Gunnison from the rest of the world. Gunnison became one of the few communities that largely escaped the ravages of the influenza pandemic, at least in the beginning – in an instructive example of the limited human patience for the social, psychological and economic disruption of quarantine, adherence eventually waned and the front page of the Gunnison News-Champion's March 14, 1919, issue reports that the influenza pandemic got to Gunnison, too. Nevertheless, Gunnison had a very lucky escape – of a population of over 6,900 (including the county), there were only a few cases and a single death.

The 1918 influenza pandemic (also known as the Spanish Flu) was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. It’s estimated that about 500 million people—one-third of the world’s population—became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide, with about 675,000 occurring in the United States. This virus is still with us today, and is the reason for our annual flu shots.

The elderly, normally the group most susceptible to influenza, not only survived attacks of the disease but were attacked far less often. This resistance of the elderly was a worldwide phenomenon. The most likely explanation is that an earlier pandemic , so mild as to not attract attention, resembled the 1918 virus closely enough that it provided protection. (p. 408 paperback edition)

In 1918, the Spanish flu killed about 2.7 percent of the world's population. [60] The risk of an outbreak of influenza against which we do not have a vaccine remains a threat constant, which we should take extremely seriously. During the first months of 2009, thousands of people died from swine flu. For two weeks, it was a recurring topic on the news. However, unlike Ebola in 2014, the number of cases was not doubling, not even increasing in a linear fashion. Some researchers concluded that the flu was not as aggressive as the first warning signs had indicated. However, journalists continued to stoke fear for several weeks.

risk communication.” I don’t much care for the term. For if there is a single dominant lesson from 1918, it’s that governments need to tell the truth in a crisis. Risk communication implies managing the truth. You don’t manage the truth. You tell the truth.

In 1918 the lies of officials and of the press never allowed the terror to condense into the concrete. The public could trust nothing and so they knew nothing. Society is, ultimately, based on trust; as trust broke down, people became alienated not only from those in authority, but from each other.

Epidemiological evidence suggests that a new influenza virus originated in Haskell County, Kansas, early in 1918. Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe. Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world. In its wake followed a keening sound that rose from the throats of mourners like the wind.

NO ONE WILL EVER KNOW with absolute certainty whether the 1918–19 influenza pandemic actually did originate in Haskell County, Kansas. There are other theories of origin, including France, Vietnam, and China. But Frank Macfarlane Burnet, a Nobel laureate who lived through the pandemic and spent most of his scientific career studying influenza, later concluded that the evidence was “strongly suggestive” that the 1918 influenza pandemic began in the United States, and that its spread was “intimately related to war conditions and especially the arrival of American troops in France.

The Purple Death was actually part of a great wave of influenza, a lethal virus that swept across America and around the world starting in the spring of 1918. A second, even deadlier wave of influenza appeared in late summer and autumn of 1918, and a third wave continued into 1919. This highly contagious disease, later widely known as Spanish flu, killed an estimated 675,000 Americans in one year, according to historian and professor Alfred Crosby. Consider this perspective: more Americans died from the flu in this short time than all the U.S. soldiers who died fighting in World War I, World War II, the Korean War, and the Vietnam War combined. Indeed, the Spanish flu killed as many Americans in about a year as did HIV/AIDS, the most notorious epidemic of modern times, in more than thirty years. According to the Centers for Disease Control and Prevention (CDC), the estimated number of deaths from diagnosed HIV infection classified as AIDS in the United States since the first reported death in 1981 through 2014 was 678,509—about the same number that died of Spanish flu from 1918 to 1919.

How lethal was it? It was twenty-five times more deadly than ordinary influenzas. This flu killed 2.5 percent of its victims. Normally, just one-tenth of 1 percent of people who get the flu die. And since a fifth of the world’s population got the flu that year, including 28 percent of Americans, the number of deaths was stunning.

But in the rest of the world, the illness came to be called the Spanish flu, to Spain’s consternation. After all, the other countries of Europe, as well as the United States and countries in Asia, were hit too in that spring of 1918. Maybe the name stuck because Spain, still unaligned, did not censor its news reports, unlike other European countries. And so Spain’s flu was no secret, unlike the flu elsewhere.

The victory over cholera was only a beginning. With the growing and profound knowledge that many diseases are caused by microscopic organisms and that the spread of disease can be prevented, the Western world was transformed. It took years for the change to be complete, but the result was a vigorous public health movement that emphasized simple but powerful measures like cleaning up water supplies and teaching people what now seem to be basic lessons of health and hygiene—keep flies away from food, wash your hands before handling food, give your babies milk, not beer, quarantine the sick. The results were dramatic. In large areas of the world, many of the killer diseases seemed tamed, or even vanquished, and deadly epidemics seemed to be relics of the past.

[T]he only epidemic disease that plagued the troops during the early years of World War I was syphilis.

Medical historians believe the sickness began in China in 1331. Along with a civil war, it halved the Chinese population. From there, the plague moved along trade routes of Asia and arrived in the Crimea fifteen years later, in 1346. Then it entered Europe, North Africa, and the Middle East. It disrupted society in ways eerily reminiscent of the Athens plague so long before. It emptied streets and public places like the flu epidemic that followed it. And its very name became emblematic of the horrors of epidemics. It was known as the Black Death. At the time the illness was as mysterious as the plague of Athens but now it is known that the Black Death bacteria, Yersinia pestis, were spread by fleas that lived on black rats. The rats, in turn, moved from port to port on ships, taking the illness with them. The fleas would bite people, infecting them with the bacteria. The plague would not have been so overwhelming if it could only spread through flea bites. It turned out that once the bacteria began infecting people, they found another way of spreading. They would infect the lungs and cause a pneumonia, whereupon sick people could infect the healthy simply by coughing or sneezing.

Giovanni Boccaccio wrote in his Decameron that people, afraid of contamination by the rotting corpses, would drag the dead outside their houses and leave them in front of their doors to be picked up, like so much garbage.

Epidemics are local and occur in one place every 1 - 3 years, while Pandemics occur worldwide and happen at irregular intervals of several decades.

Oliver Sacks’s The Awakening were victims of the 1918 influenza pandemic.)

Even though the casualties, both military and civilian, were massive during World War I, deaths from the epidemic of influenza virus in 1918–19 surpassed the war’s toll: Some 40 to 50 million people died of influenza in less than a year (3–7). This was over four times the number of fatalities during the four years of war. An estimated one-fifth of the world’s human population was infected, and 2 to 3 percent of those infected died.

By the dawn of the twentieth century, for the first time since cities had come into existence 5,000 years before, infectious diseases were staunched to such an extent that cities were able to remain stable, and even grow, without depending on a constant stream of migrants from the countryside. It was a remarkable change.

A pandemic would have a cascading effect. Always eager for a sensational story, the media - particularly television - would spread panic. The labor force - because of sickness, fear, or having to tend to sick family members would not report for work. Soon, the economy would come to a standstill as industries shut down, businesses closed, and unemployment soared. Growing shortages of vital goods, from food to fuel to medical supplies would bring chaos. Government would cease to function. Hospitals, mortuaries, and cemeteries would overflow as in 1918, only more so. Taken by surprise, drug companies would not have the time or healthy scientific personnel to develop a new generation of vaccines.

In 1918 and 1919 came the Great Influenza, the Spanish Flu.  The only global pandemic in modern times.  Fifty million to a hundred million dead.  How did Tibet fare this time, you ask?” McAlister’s face was stoic, immobile. Suddenly angry, Undertaker said, “No. You don’t ask, Dr. McAlister; you don’t ask because you already know.  Tibet was barely touched.  A few sick, no one reported dead.

Inhabitants of isolated or remote regions where there has been little or no contact with the outside world are often described as “epidemiologically naive.” What this means is that they have limited immunity to diseases like influenza and measles that are endemic in other parts of the world, and when exposed to them they often suffer high rates of death. One of the best-known examples comes from the pandemic of 1918, in which certain populations, notably indigenous Alaskans and Pacific Islanders, died at rates that were four, five, and in some cases even ten times those of other populations. The pandemic is thought to have killed between 3 and 6 percent of the global population; in Western Samoa, 20 percent of the population died. In the nineteenth-century Pacific, this scenario played itself out over and over.

But the flu was expunged from newspapers, magazines, textbooks, and society’s collective memory. Crosby calls the 1918 flu “America’s forgotten pandemic,” noting:

Since the body does a better job of fighting infection when it is a few degrees hotter, might reducing the fever lead to a worse outcome for the patient? A group from McMaster University in Canada looked at what happens in a large group of people when some of them—infected with, say, influenza—take medicine to reduce their fever. Once they feel better, patients with the flu get out of bed and start to socialize, spreading the virus. On a population level the effect is rather drastic. The McMaster group concluded that the practice of frequently treating fevers with medication enhances the transmission of influenza by at least 1 percent. I know that doesn’t sound like a lot, but remember that as many as 49,000 people die from the flu each year in the United States. If you plug the McMaster estimates into these flu numbers, almost 500 deaths per year in the U.S. (and perhaps many more elsewhere) could be prevented by avoiding fever medication during the treatment of influenza.

In medieval times, one-third of Europe’s population was decimated by the bubonic plague. Within a few centuries of Columbus’s arrival in the New World, 95 percent of the indigenous population of the Americas had been wiped out by smallpox, measles, influenza, and other germs brought in by European invaders and colonists. More people died in the 1918 Spanish flu epidemic than were killed in the trenches of World War I. Malaria, presently among the most deadly infectious agents on the planet, is arguably the greatest mass murderer of all time. Experts estimate the disease has killed half of all people who have roamed the planet since the Stone Age.

William Park, Oswald Avery, and Paul Lewis each approached science in his own way. Park, a man who almost became a medical missionary, saw it as a means to a larger end; he saw it as a tool to relieve suffering. Disciplined and methodical, his interest lay chiefly in immediate results that he could apply to his purpose. His contributions, particularly those made with Anna Williams, were enormous; their improvement of diphtheria antitoxin alone doubtless saved hundreds of thousands of lives over the past century. But his purpose also limited him, narrowed him, and limited the kind of findings he and those under him would make. Avery was driven and obsessive. Part artist and part hunter, he had vision, patience, and persistence. His artist’s eye let him see a landscape from a new perspective and in exquisite detail, the hunter in him told him when something, no matter how seemingly trivial, was out of place, and he wondered. The wonder moved him to the sacrifice of all else. He had no choice but to sacrifice. It was his nature. Cutting a Gordian knot gave him no satisfaction. He wanted to unfold and understand mysteries, not cut through them. So he tugged at a thread and kept tugging, untangling it, following where it led, until he unraveled an entire fabric. Then others wove a new fabric for a different world. T. S. Eliot said any new work of art alters slightly the existing order. Avery accomplished that all right, and far more. Paul Lewis was a romantic, and a lover. He wanted. He wanted more and loved more passionately than Park or Avery. But as is true of many romantics, it was the idea of the thing as much or more than the thing itself that he loved. He loved science, and he loved the laboratory. But it did not yield to him. The deepest secrets of the laboratory showed themselves to Lewis when he was guided by others, when others opened a crack for him. But when he came alone to the laboratory, that crack closed. He could not find the right loose thread to tug at, the way to ask the question. To him the laboratory presented a stone face, unyielding to his pleadings. And whether his death was a suicide or a true accident, his failure to win what he loved killed him. One could consider Lewis, in a way meaningful only to him, the last victim of the 1918 pandemic.

States has far fewer hospital beds than a few decades ago. Indeed, during a routine influenza season, usage of respirators rises to nearly 100 percent; in a pandemic, most people who needed a mechanical respirator probably would not get one. (The strain influenza puts on health care was driven home to me in a personal way on my book tour. In Kansas City, a flare-up of ordinary seasonal influenza forced eight hospitals to close emergency rooms, yet this was only a tiny fraction of the pressure a pandemic would exert.) This and similar problems—such as if a particular secondary bacterial invader is resistant to antibiotics, or shortages of such seemingly trivial items as hypodermic needles or bags to hold IV fluids (a severe shortage of these bags is a major problem as I write this)—could easily moot many medical advances since 1918.

The cholera epidemic was a turning point marking the last time the disease would rage without simple precautions of public health.

Then the influenza epidemic arrived. Unlike the plague of Athens, unlike the Black Death, unlike even the cholera epidemic that felled William Sproat and the other cholera epidemics to come in that century, the flu epidemic had no chronicler.

The 1918 epidemic came in two waves, a mild flu in the spring of 1918 followed by the killer flu in the fall. And it seemed that the two flu strains were closely related. Infection with the first strain protected against the second

The dollar sign is exalted above the health sign,” said Hassler, referring to the influence of the merchants on the supervisors’ decision.73

Yet the story of the 1918 influenza virus is not simply one of havoc, death, and desolation, of a society fighting a war against nature superimposed on a war against another human society. It is also a story of science, of discovery, of how one thinks, and of how one changes the way one thinks, of how amidst near-utter chaos a few men sought the coolness of contemplation, the utter calm that precedes not philosophizing but grim, determined action.

Yet even that number understates the horror of the disease, a horror contained in other data. Normally influenza chiefly kills the elderly and infants, but in the 1918 pandemic roughly half of those who died were young men and women in the prime of their life, in their twenties and thirties. Harvey Cushing, then a brilliant young surgeon who would go on to great fame—and who himself fell desperately ill with influenza and never fully recovered from what was likely a complication—would call these victims “doubly dead in that they died so young.

killed enough to depress the average life expectancy in the United States by more than ten years. Some of those who died from influenza and pneumonia would have died if no epidemic had occurred. Pneumonia was after all the leading cause of death. So the key figure is actually the “excess death” toll. Investigators today believe that in the United States the 1918–19 epidemic caused an excess death toll of about 675,000 people. The nation then had a population between 105 and 110 million, while it was approaching 300 million in 2006. So a comparable figure today would be approximately 1,750,000 deaths.

Perhaps the strength of American society in 1918 was only the brief by-product of the war spirit. In the next year or so race riots, bombings, and a hysterical red scare would give proof that Americans were not always filled with mutual love and respect, but for that moment in fall 1918, when everyone in the nation had a fever and aching muscles or personally knew someone who had, Americans did by and large act as if they were all, if not brothers and sisters, at least cousins.

Nature chose to rage in 1918, and it chose the form of the influenza virus in which to do it. This meant that nature first crept upon the world in familiar, almost comic, form. It came in masquerade. Then it pulled down its mask and showed its fleshleass bone.

Before addressing those questions, we need to understand the commonalities of the few pandemics we have information about: 1889, 1918, 1957, 1968, and 2009. First, all five came in waves. (A few scientists argue that the difference in lethality between 1918’s first and second waves mean that these were caused by different viruses, but evidence showing otherwise seems overwhelming. For one thing, exposure to the first wave provided as high as 94 percent protection against the second wave, far better protection than the best modern vaccine affords, and that’s just one piece of the evidence that the same virus caused both waves.) In fact, some investigators now speculate that the 1918 virus circulated in humans for several years before mutations allowed it to spread easily. If true, this would of course explode the hypothesis that Haskell was the origin. The 1889 pandemic virus did follow this pattern, generating two and a half years of sporadic outbreaks around the world, including

Perhaps, in some innocent encounter in China between a child and a bird, a new killer flu is on its way. Or perhaps, even now, a young man or a young woman has become infected with two different strains of flu viruses. They are mixing together in the person’s lungs, their genes reassorting. Emerging from that witches’ brew is a new virus, a chimera, that, like the 1918 flu virus, is perfectly suited for destruction.

Even the influenza virus of 1918–1919, having killed up to 50 million people around the world, remained a ghostly cipher, unseen and unidentified at the time.

city did take a few precautions. On September 18, its health officials began a public campaign against coughing, spitting, and sneezing. Three days later, the city

In a way, these researchers had spent much of their lives preparing for the confrontation that occurred in 1918 not only in general but, for a few of them at least, quite specifically. In every war in American history so far, disease had killed more soldiers than combat. In many wars throughout history, war had spread disease. The leaders of American research had anticipated that a major epidemic of some kind would erupt during the Great War. They had prepared for it as much as it was possible to prepare. Then they waited for it to strike.

For if there is a single dominant lesson from 1918, it’s that governments need to tell the truth in a crisis. Risk communication implies managing the truth. You don’t manage the truth. You tell the truth.

But the 1918 virus, like all influenza viruses, like all viruses that form mutant swarms, mutated rapidly. There is a mathematical concept called “reversion to the mean”; this states simply that an extreme event is likely to be followed by a less extreme event. This is not a law, only a probability. The 1918 virus stood at an extreme; any mutations were more likely to make it less lethal than more lethal. In general, that is what happened. So just as it seemed that the virus would bring civilization to its knees, would do what the plagues of the Middle Ages had done, would remake the world, the virus mutated toward its mean, toward the behavior of most influenza viruses. As time went on, it became less lethal.

Epidemiological evidence suggests that a new influenza virus originated in Haskell County, Kansas, early in 1918. Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe. Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world.

But in late January and early February 1918, Miner had other concerns. One patient presented with what seemed common symptoms, although with unusual intensity—violent headache and body aches, high fever, nonproductive cough.

The results were unequivocal. Both in London and in the United States, people who had survived the 1918 flu had antibodies that completely blocked Shope’s swine flu virus. People who were born after 1918 did not have those antibodies.

pandemics are lethal. Antigen shift guarantees that the new virus will infect huge numbers of people, but it does not guarantee that it will kill large numbers. The twentieth century saw three pandemics. The most recent new virus attacked in 1968, when the H3N2 “Hong Kong flu” spread worldwide with high morbidity but very low mortality—that is, it made many sick, but killed few. The “Asian flu,” an H2N2 virus, came in 1957; while nothing like 1918, this was still a violent pandemic. Then of course there

H1N1 virus of 1918, the virus that created its own killing fields.

Another Colorado town, Ouray, in the San Juan Mountains, went further. Ouray’s sheriff hired guards to enforce a “shotgun” quarantine against outsiders. No matter: influenza got in anyway, infecting 150 townspeople. St. Louis, Missouri, barred soldiers and sailors on leave from entering the city.15

Epidemiological evidence suggests that a new influenza virus originated in Haskell County, Kansas, early in 1918. Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe. Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world. In its wake followed a keening sound that rose from the throats of mourners like the wind. The evidence comes from Dr. Loring Miner.

Only on May 23, 1918, had Provost Marshal Enoch Crowder, who oversaw the draft, issued his “work or fight” order, stating that anyone not employed in an essential industry would be drafted—an order that caused major league baseball to shorten its season and sent many ballplayers scurrying for jobs that were “essential”—and promising that “all men within the enlarged age would be called within a year.

July the incidence of influenza in the AEF had reached its lowest point since early spring. Only 99 men died of flu and pneumonia that month, and the number was expected to be even lower

In 1918, the world population was 1.8 billion, and the pandemic probably killed 50 to 100 million people, with the lowest credible modern estimate at 35 million. Today the world population is 7.6 billion. A comparable death toll today would range from roughly 150 to 425 million.

problem as I write this)—could easily moot many medical advances since 1918. Disease impact would also ripple through the economy to disastrous effect. With everyone from air traffic controllers to truck drivers out sick, just-in-time inventory systems would crash, supply chains would collapse, for lack of some part production lines would shut down, while schools and day-care facilities might close for weeks, and an overburdened “last mile” would limit the ability of people to work from home.

Based on studies of what U.S. cities did in 1918, modelers have concluded that “layering” several interventions—most of them different kinds of “social distancing”—would at least stretch out the length of an influenza outbreak in a local community,

Based on studies of what U.S. cities did in 1918, modelers have concluded that “layering” several interventions—most of them different kinds of “social distancing”—would at least stretch out the length of an influenza outbreak in a local community, easing the strain on the health care system.

For if there is a single dominant lesson from 1918, it’s that governments need to tell the truth in a crisis.

In 1918 the lies of officials and of the press never allowed the terror to condense into the concrete. The public could trust nothing and so they knew nothing.

But as horrific as the disease itself was, public officials and the media helped create that terror—not by exaggerating the disease but by minimizing it, by trying to reassure. A specialty among public relations consultants has evolved in recent decades called “risk communication.” I don’t much care for the term. For if there is a single dominant lesson from 1918, it’s that governments need to tell the truth in a crisis. Risk communication implies managing the truth. You don’t manage the truth. You tell the truth.

In 1918 the lies of officials and of the press never allowed the terror to condense into the concrete. The public could trust nothing and so they knew nothing. Society is, ultimately, based on trust; as trust broke down, people became alienated not only from those in authority, but from each other. So a terror seeped into the society that prevented one woman from caring for her sister, that prevented volunteers from bringing food to families too ill to feed themselves and who starved to death because of it, that prevented trained nurses from responding to the most urgent calls for their services. The fear, not the disease, threatened to break the society apart. As Victor Vaughan—a careful man, a measured man, a man who did not overstate to make a point—warned, civilization could have disappeared within a few more weeks.

By 1918 humankind was fully modern, and fully scientific, but too busy fighting itself to aggress against nature. Nature, however, chooses its own moments. It chose this moment to aggress against man, and it did not do so prodding languidly. For the first time, modern humanity, a humanity practicing the modern scientific method, would confront nature in its fullest rage.

Epidemiological evidence suggests that a new influenza virus originated in Haskell County, Kansas, early in 1918. Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe. Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world. In its wake followed a keening sound that rose from the throats of mourners like the wind. The evidence comes from Dr. Loring Miner. •

In the summer of 1918 in the U.S., the Spanish influenza first touched someone in Philadelphia. Americans were hoping for an end to the war and the return of their surviving fathers and sons. Many of the nearly 2 million citizens of Philadelphia flocked to theaters to see vaudeville, plays, and big events and concerts, exchanging occasional coughs. Nobody had paid attention to the fact that 8 million Spaniards were sick and dying from a strange new disease named the “Spanish influenza” or that people in Boston had come down with the same thing. The alarm bells were silent.

Today such news would galvanize the Medical Corps, but in 1918 it attracted only a modicum of attention.

In addition to antigenic drift, there is a larger change that the flu virus can undergo, antigenic shift, and that’s how we get our flu pandemics. During this shift, viral proteins assume an entirely new structure, and the virus is said to be “novel.” These novel viruses—which most often arise when animal and human viruses share and swap their genes—are like entirely new criminals, not old ones in disguise. This makes them sneakier, more prolific, and perhaps more deadly. Antigenic shift generated the deadly 1918 influenza virus and the swine flu outbreak of 2009.

Hopkirk, like many physicians of his day, also prescribed quinine to treat the flu. “In quinine,” he wrote with great certainty, “we have a drug that not only controls fever-producing processes allied to fermentations, but also exerts a definite anti-toxic action on the specific virus of influenza itself.

Eissinger, president and “honor man” of Penn’s class of 1918, died. Dudley Perkins, a Swarthmore football hero, died. Nearly two-thirds of the dead were under forty. It was a common practice in 1918 for people to hang a piece of crepe on the door to mark a death in the house. There was crepe everywhere. “If it was a young person they’d put a white crepe at the door,” recalled Anna Milani. “If it was a middle-aged person, they’d put a black crepe, and if it was an elderly one, they put a gray crepe at the door signifying who died. We were children and we were excited to find out who died

Recall the Spanish influenza virus, the one that swept the world in 1918. They found the same virus in America in 1977, but nobody died then. The first time around it slaughtered between twenty to forty million people worldwide, and sixty years later, it was basically harmless.

Institutions are a strange mix of the mass and the individual. They abstract. They behave according to a set of rules that substitute both for individual judgments and for the emotional responses that occur whenever individuals interact. The act of creating an institution dehumanizes it, creates an arbitrary barrier between individuals. Yet institutions are human as well. They reflect the cumulative personalities of those within them, especially their leadership. They tend, unfortunately, to mirror less admirable human traits, developing and protecting self-interest and even ambition. Institutions almost never sacrifice. Since they live by rules, they lack spontaneity. They try to order chaos not in the way an artist or scientist does, through a defining vision that creates structure and discipline, but by closing off and isolating themselves from that which does not fit. They become bureaucratic. The best institutions avoid the worst aspects of bureaucracy in two ways. Some are not really institutions at all. They are simply a loose confederation of individuals, each of whom remains largely a free agent whose achievements are independent of the institution but who also shares and benefits from association with others. In these cases the institution simply provides an infrastructure that supports the individual, allowing him or her to flourish so that the whole often exceeds the sum of the parts. (The Rockefeller Institute was such an institution.) Other institutions avoid the worst elements of bureaucracy by concentrating on a clearly defined purpose. Their rules have little to do with such procedural issues as a chain of command; instead rules focus on how to achieve a particular result, in effect offering guidance based on experience. This kind of institution even at its best can still stultify creativity, but such institutions can execute, can do a routine thing efficiently. They resemble professionals trying to do their jobs and duty; they accomplish their tasks. In 1918 the institution of the federal government had more force than it had ever had—and in some ways more force than it has had since. But it was aiming all that force, all its vital energy, in another direction.

Helping other did wonders for volunteer's self-esteem. Why, if women showed such dedication and courage in this crisis, they could do anything - even vote in election!. Opponents argued that "the ladies" should not have the right to vote because they were too unstable, too emotional, too "fragile" to make important decisions without male guidance. Women's activities during the pandemic helped change minds. Thus, it was no accident that, in August 1920, most states approved the Nineteenth Amendment to the U.S. Constitutions, which granted women to right to vote." ~ Very, Very, Very Dreadful Albert Marrin