Just in case things are moving too slowly for you. you might want to read this!
1918 REVISITED: LESSONS AND SUGGESTIONS FOR FURTHER INQUIRY
John M. Barry
Distinguished Visiting Scholar
Center for Bioenvironmental Research at Tulane and Xavier Universities
The 1918–1919 influenza pandemic killed more people in absolute numbers than any other disease outbreak in history. A contemporary estimate put the death toll at 21 million, a figure that persists in the media today, but understates the real number. Epidemiologists and scientists have revised that figure several times since then. Each and every revision has been upward. Frank Macfarlane Burnet, who won his Nobel Prize for immunology but who spent most of his life studying influenza, estimated the death toll as probably 50 million, and possibly as high as 100 million. A 2002 epidemiologic study also estimates the deaths at between 50 and 100 million (Johnson and Mueller, 2002).
The world population in 1918 was only 28 percent of today’s population. Adjusting for population, a comparable toll today would be 175 to 350 million...
...A letter from a physician at one U.S. Army camp to a colleague puts a more human face on those numbers:
These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen … and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white. It is only a matter of a few hours then until death comes…. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies…. We have been averaging about 100 deaths per day…. Pneumonia means in about all cases death…. We have lost an outrageous number of Nurses and Drs. It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce…. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows…. Good By old Pal, God be with you till we meet again (Grist, 1979).
That letter reflected a typical experience in American Army cantonments...
...But 1918 seems to have been particularly violent. It began mildly, with a spring wave. In fact, it was so mild that some physicians wonder if this disease actually was influenza. Typically, several Italian doctors argued in separate journal articles that this “febrile disease now widely prevalent in Italy [is] not influenza” (Policlinico, 1918). British doctors echoed that conclusion; a Lancet article in July 1918 argued that the spring epidemic was not influenza because the symptoms, though similar to influenza, were “of very short duration and so far absent of relapses or complications” (Little et al., 1918).
Within a few weeks of that Lancet article appearing, a second pandemic wave swept around the world. It also initially caused investigators to doubt that the disease was influenza—but this time because it was so virulent. It was followed by a third wave in 1919, and significant disease also struck in 1920. (Victims of the first wave enjoyed significant resistance to the second and third waves, offering compelling evidence that all were caused by the same virus. It is worth noting that the 1889–1890 pandemic also came in waves, but the third wave seemed to be the most lethal.)
The 1918 virus, especially in its second wave, was not only virulent and lethal, but extraordinarily violent. It created a range of symptoms rarely seen with the disease. After H5N1 first appeared in 1997, pathologists reported some findings “not previously described with influenza” (To et al., 2001). In fact, investigators in 1918 described every pathological change seen with H5N1 and more (Jordon, 1927:266–268).
Symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, “One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred” (Ireland, 1928:57). A German investigator recorded “hemorrhages occurring in different parts of the interior of the eye” with great frequency (Thomson and Thomson, 1934b). An American pathologist noted: “Fifty cases of subconjunctival hemorrhage were counted. Twelve had a true hemotypsis, bright red blood with no admixture of mucus…. Three cases had intestinal hemorrhage” (Ireland, 1928:13). The New York City Health Department’s chief pathologist said, “Cases with intense pain look and act like cases of dengue … hemorrhage from nose or bronchi … paresis or paralysis of either cerebral or spinal origin … impairment of motion may be severe or mild, permanent or temporary … physical and mental depression. Intense and protracted prostration led to hysteria, melancholia, and insanity with suicidal intent” (Jordon, 1927:265)...
...The case mortality rate varied widely. An overall figure is impossible to obtain, or even estimate reliably, because no solid information about total cases exists. In U.S. Army camps where reasonably reliable statistics were kept, case mortality often exceeded 5 percent, and in some circumstances exceeded 10 percent. In the British Army in India, case mortality for white troops was 9.6 percent, for Indian troops 21.9 percent.
In isolated human populations, the virus killed at even higher rates. In the Fiji islands, it killed 14 percent of the entire population in 16 days. In Labrador and Alaska, it killed at least one-third of the entire native population (Jordan, 1927; Rice, 1988)....
...But the viral pneumonias caused by the influenza pandemic were so violent that many investigators said the only lungs they had seen that resembled them were from victims of poison gas.
Then, the Army called them “atypical pneumonias.” Today we would call this atypical pneumonia Acute Respiratory Distress Syndrome (ARDS). The Army’s pneumonia board judged that “more than half” of all the deaths among soldiers came from this atypical pneumonia (Ireland, 1928).
One cannot extrapolate from this directly to the civilian population. Army figures represent a special case both in terms of demographics and environment, including overcrowded barracks.
Even so, the fact that ARDS likely caused more than half the deaths among young adults sends a warning. ARDS mortality rates today range from 40 to 60 percent, even with support in modern intensive care units (ICUs). In a pandemic, ICUs would be quickly overwhelmed, representing a major challenge for public health planners...
...Simultaneously, the government mounted a massive propaganda effort. An architect of that effort said, “Truth and falsehood are arbitrary terms…. There is nothing in experience to tell us that one is always preferable to the other…. The force of an idea lies in its inspirational value. It matters very little if it is true or false” (Vaughn, 1980).
The combination of rigid control and disregard for truth had dangerous consequences. Focusing on the shortest term, local officials almost universally told half-truths or outright lies to avoid damaging morale and the war effort. They were assisted—not challenged—by the press, which although not censored in a technical sense cooperated fully with the government’s propaganda machine.
Routinely, as influenza approached a city or town—one could watch it march from place to place—local officials initially told the public not to worry, that public health officials would prevent the disease from striking them. When influenza first appeared, officials routinely insisted at first it was only ordinary influenza, not the Spanish flu. As the epidemic exploded, officials almost daily assured the public that the worst was over.
This pattern repeated itself again and again. Chicago offers one example: Its public health commissioner said he’d do “nothing to interfere with the morale of the community…. It is our duty to keep the people from fear. Worry kills more people than the epidemic” (Robertson, 1918).
That idea—“Fear kills more than the disease”—became a mantra nationally and in city after city. As Literary Digest, one of the largest circulation periodicals in the country, advised, “Fear is our first enemy” (Van Hartesveldt, 1992).
In Philadelphia, when the public health commissioner closed all schools, houses of worship, theaters, and other public gathering places, one newspaper went so far as to say that this order was “not a public health measure” and reiterated that “there is no cause for panic or alarm.”
But as people heard these reassurances, they could see neighbors, friends, and spouses dying horrible deaths.
In Chicago, the Cook County Hospital mortality rate of all influenza admissions—not just those who developed pneumonia—was 39.8 percent (Keeton and Cusman, 1918). In Philadelphia, bodies remained uncollected in homes for days, until eventually open trucks and even horse-drawn carts were sent down city streets and people were told to bring out the dead. The bodies were stacked without coffins and buried in cemeteries in mass graves dug by steam shovels.
This horrific disconnect between reassurances and reality destroyed the credibility of those in authority. People felt they had no one to turn to, no one to rely on, no one to trust.
Ultimately society depends on trust. Without it, society began to come apart. Normally in 1918 America, when someone was ill, neighbors helped. That did not happen during the pandemic. Typically, the head of one city’s volunteer effort, frustrated after repeated pleas for help yielded nothing, turned bitter and contemptuous:
Hundreds of women who are content to sit back had delightful dreams of themselves in the roles of angels of mercy, had the unfathomable vanity to imagine that they were capable of great sacrifice. Nothing seems to rouse them now. They have been told that there are families in which every member is ill, in which the children are actually starving because there is no one to give them food. The death rate is so high and they still hold back.3
That attitude persisted outside of cities as well. In rural Kentucky, the Red Cross reported “people starving to death not from lack of food but because the well were panic stricken and would not go near the sick” (An Account of the Influenza Epidemic, 1919).
As the pressure from the virus continued, an internal Red Cross report concluded, “A fear and panic of the influenza, akin to the terror of the Middle Ages regarding the Black Plague, [has] been prevalent in many parts of the country” (The Mobilization of the American National Red Cross, 1920). Similarly, Victor Vaughan, a sober scientist not given to overstatement, worried, “If the epidemic continues its mathematical rate of acceleration, civilization could easily … disappear … from the face of the earth within a matter of a few more weeks” (Collier, 1974).
Of course, the disease generated fear independent of anything officials did or did not do, but the false reassurances given by the authorities and the media systematically destroyed trust. That magnified the fear and turned it into panic and terror.
It is worth noting that this terror, at least in paralyzing form, did not seem to materialize in the few places where authorities told the truth.
http://www.nap.edu/openbook.php?record_id=11150&page=58
__________________
