Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It

by Gina Kolata

The 1918 flu epidemic puts every other epidemic of this century to shame. It was a plague so deadly that if a similar virus were to strike today, it would kill more people in a single year than heart disease, cancers, strokes, chronic pulmonary disease, AIDS, and Alzheimer’s disease combined. The epidemic affected the course of history and was a terrifying presence at the end of World War I, killing more Americans in a single year than died in battle in World War I, World War II, the Korean War, and the Vietnam War.

When I grew older and understood the overuse of antibiotics, I would disparage my father’s doctor, arguing that he was irrational.

The 1918 influenza epidemic is one of history’s great conundrums, obliterated from the consciousness of historians, who traditionally ignore science and technology but not, for the most part, plagues.

It is a story that begged to be told, both for the sheer drama of the tale and for its implications. The resolution of the mystery could help scientists save humanity if that terrible virus or another one like it stalks the earth again.

This is a detective story. Here was a mass murderer that was around 80 years ago and who’s never been brought to justice. And what we’re trying to do is find the murderer. —Jeffery Taubenberger, molecular pathologist

But influenza never makes the list of deadly plagues. It seems so innocuous. It comes around every winter and everyone gets it sooner or later.

Influenza” is an Italian word that, one hypothesis has it, was coined by the disease’s Italian victims in the middle of the eighteenth century. Influenza di freddo means “influence of the cold.”

How many became ill? More than 25 percent of the U.S. population.

How many died worldwide? Estimates range from 20 million to more than 100 million, but the true number can never be known.

So many died, in fact, that the average life span in the United States fell by twelve years in 1918. If such a plague came today, killing a similar fraction of the U.S. population, 1.5 million Americans would die, which is more than the number felled in a single year by heart disease, cancers, strokes, chronic pulmonary disease, AIDS, and Alzheimer’s disease combined.

But for one of the first towns to be hit by the flu, the disease was not easily dismissed—not because it was so deadly but because it was so infectious.

“They started calling it the ‘three-day fever’ here, but couldn’t camouflage it with a name when it runs its course in a week or more. It hits suddenly and one’s temperature nearly chases the mercury thru the top of the M.D.’s thermometer, face gets red, every bone in the body aches and the head splits wide open. This continues for three or four days and then disappears after considerable perspiration, but the ‘hangover’ clings for a week or two.”

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.

Soldiers trying to fight in World War I were laid up by the flu in such numbers that some commanders complained that the disease was hindering their ability to fight.

The flu, he added, contributed to the failure of his July offensive, a battle plan that nearly won the war for Germany.

as summer arrived, even the countries that were hardest hit had a reprieve. The flu seemed to vanish without a trace.

But a few months later the flu was back with a vengeance.

The second wave of the flu arrived in the United States in Boston, appearing among a group of sailors who docked at the Commonwealth Pier in August. The sailors were simply in transit, part of the vast movement of troops in a war that transformed daily life.

“Camp Devens is near Boston, and has about 50,000 men, or did before this epidemic broke loose.” The flu epidemic hit the camp four weeks earlier, he added, “and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. All assemblages of soldiers are taboo.” The disease starts out looking like an ordinary sort of influenza, Roy explained. But when the soldiers are brought to the hospital at the Army base, they “rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones and a few hours later you can begin to see the Cyanosis extending from the ears and spreading all over the face, until it is hard to distinguish the colored man from the white. It is only a matter of a few hours then until death comes and it is simply a struggle for air until they suffocate. It is horrible. One can stand to see one, two, or twenty men die, but to see these poor devils dropping like flies gets on your nerves. We have been averaging about 100 deaths a day, and still keeping it up.”

It became a problem just to dispose of the dead. “It takes Special trains to carry away the dead,” Roy remarked. “For several days there were not coffins and the bodies piled up something fierce and we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. 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 soldiers all dressed and laid out in double rows. We have no relief here, you get up in the morning at 5:30 and work steady until about 9:30 P.M., sleep, then go at it again.”

This picture was painted on my memory cells at the division hospital, Camp Devens, in the fall of 1918, when the deadly influenza virus demonstrated the inferiority of human inventions in the destruction of human life.”

By that time, the flu had spread beyond Fort Devens, beyond Boston, beyond the military. The entire state of Massachusetts was staggering from the virus.

But it was impossible to divert doctors and nurses to Massachusetts since, by then, the flu was everywhere and everyone needed help. The disease was moving quickly throughout military bases and towns and cities across the nation. Hundreds of towns, cities, and military installations were hit.

Few public officials anticipated the disaster and almost no members of the public did. The outbreak, in fact, was preceded by soothing words from medical authorities with a sort of band-played-on bravado.

“Visiting nurses often walked into scenes resembling those of the plague years of the fourteenth century,” wrote historian Alfred W. Crosby. “They drew crowds of supplicants—or people shunned them for fear of the white gauze masks that they often wore.

By the first week of October, the flu had spread to every part of the globe except for a few remote islands and Australia.

“All the theaters and nearly all of the shops and restaurants are closed, and the streets have been full of funerals all day and ambulances all night.”

France, John McCrae, a Canadian doctor assigned to the Medical Corps, had written the most famous poem about World War I, “In Flanders Fields.” It is a paean to soldiers who died in battle: “In Flanders fields the poppies blow, between the crosses, row on row.” McCrae himself died in the war, but not in battle. He was felled by pneumonia in 1918—which leading virologists say almost certainly was caused by influenza.

The statement that influenza is uncomplicated is, I believe, erroneous,”

Public health departments gave out gauze masks for people to wear in public. A New York doctor and collector of historical photographs, Dr. Stanley B. Burns, has a photograph in his archive of a minor league baseball game being played during the epidemic. It is a surreal image: The pitcher, the batter, every player, and every member of the crowd are wearing gauze masks.

In Tucson, Arizona, the board of health issued a ruling that “no person shall appear in any street, park, or place where any business is transacted, or in any other public place within the city of Tucson, without wearing a mask consisting of at least four thicknesses of butter cloth or at least seven thicknesses of ordinary gauze, covering both the nose and the mouth.”

Anecdotes spread. There was the story of four women who played bridge together one night. The next day, three were dead from the flu. There were tales of people who set off for work and died of influenza hours later.

They even know why human influenza viruses infect only cells of the lungs—those are the only human cells with an enzyme that the virus needs to split one of its proteins during the manufacturing of new virus particles.

Captain Hegeforth cut off a slice of one of Private Vaughan’s sodden lungs for examination, impregnating the slice of lung with formaldehyde to preserve it, embedding it in a chunk of candle wax about the size of a thumbnail. Then he sent it to Washington, where it was stored in a small brown box on a shelf of a vast government warehouse.

Captain McBurney wrote. The doctor cut a small slice of James Downs’s lung, soaked it in formaldehyde, encased it in wax, and sent it to the same Washington warehouse that stored the scrap of Private Vaughan’s lung.

And there the lung specimens from Private Vaughan and Private Downs remained, for nearly eighty years, secreted among pathology tissue from millions of people who died of diseases both common and rare, in the Armed Forces Institute of Pathology’s archives. The archives had begun in the Civil War, created by an executive order by President Abraham Lincoln. Since then, military doctors had been sending in thousands of pathology specimens a year, with as many as 50,000 a year sent in more recently. The number of tissue samples stored in the warehouse had swelled to about 3 to 4 million. Several times in the past century, the warehouse specimens were moved as the ever-growing collection required more and more storage space. But the tiny paraffin cubes encasing lung cells from the autopsies of Roscoe Vaughan and James Downs remained in their boxes, of no interest to anyone until, at the end of the twentieth century, they were rediscovered by molecular biologists who thought it just might be possible to resurrect the flu virus from those ancient slices of lung.

Thucydides described scenes out of nightmares: “The bodies of dying men lay upon one another, and half-dead creatures reeled about the streets and gathered round all the fountains in their longing for water.” So many died that burial rituals went by the wayside and “they buried the bodies as best they could.”

Those who began to feel ill would despair and that despair itself “into which they instantly fell took away their power of resistance, and left them a much easier prey to the disorder.”

It was normal—expected, in fact—for the healthy to aid the sick. Those who tried, however, could catch the disease themselves. Athenians had to decide: Should they nurse their friends and relatives and risk becoming ill, “dying like sheep”? Or should they turn coldly away and attempt to save themselves? The answer, for the frightened Athenians, was obvious. People began holing up in their homes, afraid to visit friends, relatives, or neighbors. The sick began to perish from neglect.

The order of a civil society quickly disintegrated. The epidemics, Thucydides relates, brought forth a wild recklessness, a “lawless extravagance which owed its origins to the plague.” “Men now coolly ventured on what they had formerly done in a corner,” he said. Athenians could not forget the sight of rich men dying suddenly and those who had had nothing seizing the rich men’s property. What was the use of saving or living frugally, many asked, when death could come at any moment and the poor could descend...

Traditional notions of honor were abandoned, and, instead, “it was settled that present enjoyment, and all that contributed to it, was both honorable and useful.” Lawlessness took hold. “Fear of gods or law of man there was not to restrain them,” Thucydides wrote. Why worship gods, many asked, when “they judged it to be just the same whether they worshipped them or not, as they saw all alik...

The city was never the same after that plague. In fact, Thucydides implied that the plague was a reason why Athens failed in its plans to def...

Until the twentieth century, infectious diseases were so common and so untreatable that it was difficult for populations even to maintain their numbers in the face of epidemics. There were lulls, but each lull seemed to be followed by the fury of another terrifying infectious disease.

The worst were plagues that changed the course of history and spelled doom for societies. They even changed human evolution. Survivors of plagues were the genetically lucky ones who had inherited a resistance to the disease-causing organisms. Even in the most extreme plagues, there are resistant people who either do not become infected, no matter how many times they are exposed to the sickness, or who get only a mild disease and recover. When everyone else is dying, the resistant people will be the ones who remain to propagate. Their genes will begin to predominate. And those who were genetically susceptible to the devastating illnesses would lose out in the great Darwinian struggle.

The Black Death came at a time when Europe had been relatively free of disease for three centuries and when its population, tamped down for hundreds of years by illnesses, had tripled. Europeans had grown prosperous and optimistic. Then they were struck with a catastrophe. In the few short years from 1347 to 1351 the sickness killed at least a third of the European population.

The scene in Florence resembled Katherine Anne Porter’s account of Denver during the 1918 flu. Between 45 and 75 percent of the inhabitants of the Italian city were killed by the Black Death and the streets were bereft of crowds. Only carts and wagons rattled down the roads, scooping up bodies of the dead.

But, Boccaccio added, people quickly hardened their hearts to the dead. “There were no tears of mourners to honor the dead,” he wrote. “In fact, no more respect was accorded to dead people than would nowadays be accorded to dead goats.”

People were changed by the epidemic. Boccaccio told of two extremes. One group of terrified citizens hid out from society, locking themselves inside of homes where no one had gotten sick. There, they “settled down to a peaceable existence, consuming modest quantities of delicate foods and precious wines and avoiding all excesses. They refrained from speaking to outsiders, refused to receive news of the dead or the sick, and entertained themselves with music and whatever other amusements they were able to devise.” At the other extreme were those who fled to lives of wild abandon. They “maintained that an infallible way of warding off this appalling evil was to drink heavily, enjoy life to the full, go round singing and merrymaking, and gratify all of one’s cravings whenever the opportunity offered, and shrug the whole thing off as one enormous joke.”

No one was left to enforce laws of society or religion, Boccaccio wrote. For “all respect for the laws of God and man had virtually broken down and been extinguished in our city.”

Like the city residents, those who lived in small towns and on farms “behaved as if each day was to be their last,” and “tried in every way to squander the assets in their possession.”