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

by Gina Kolata

When the plague came, on those chilly days of autumn, some said it was a terrible new weapon of war. The plague germs were inserted into aspirin made by the German drug company Bayer. Take an aspirin for a headache and the germs will creep through your body. Then your fate is sealed. No, the plague came in on a camouflaged German ship that had crept into Boston Harbor under cover of darkness and released the germs that seeded the city. Boston, after all, was where the plague started. There was an eyewitness, an old woman who said she saw a greasy-looking cloud that floated over the harbor and wafted over the docks. No, it was started by Germans who slipped into Boston Harbor on U-boats and then sneaked ashore, carrying vials of the plague germs with them. They let the germs loose in theaters and among crowds gathered for those interminable Liberty Bond rallies. Lieutenant Colonel Philip S. Doane, head of the Health Sanitation Section of the Emergency Fleet Corporation, said so, and he certainly was in a position to know. It was on page one of the Philadelphia Inquirer.

They called the plague of 1918 influenza, but it was like no influenza ever seen before.

When the illness was first observed, doctors were reluctant even to call it the flu. It seemed to be a new disease, they said. Some called it bronchopneumonia, others called it epidemic respiratory infection. Doctors suggested it might be cholera or typhus, or perhaps it was dengue fever or botulism. Still others said it was simply an unidentified pandemic disease. Those who used the term “influenza” insisted on enclosing it in quotation marks.

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. 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.

No one knows for sure where the 1918 flu came from or how it turned into such a killer strain. All that is known is that it began as an ordinary flu but then it changed. It infected people in the spring of 1918, sickening its victims for about three days with chills and fever, but rarely killing them. Then it disappeared, returning in the fall with the power of a juggernaut. In retrospect, medical experts talk of the two waves of the 1918 flu. The first was banal, and easily forgotten. No one mentioned plagues or germ warfare when the influenza epidemic first arrived. But when it came back, in the second wave, it had become something monstrous, bearing little resemblance to what is ordinarily thought of as the flu.

Overnight, Fort Devens became a scene out of hell. One doctor, assigned to work in the camp that September, wrote despairingly to a friend about an epidemic that was out of control. The doctor’s letter is dated September 29, 1918, signed with his first name, “Roy.” Nothing more is known about who he was or what became of him. His letter was discovered more than sixty years later, in a trunk in Detroit, and was published in the British Medical Journal in December 1979, having been sent in by a Scottish doctor, N. R. Grist of the University of Glasgow, who saw it as a cautionary tale. Roy wrote: “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 th...

But by October 1, the city was under siege. In one day, 635 cases of the flu were reported to public health officials. That, however, was an underestimate. Doctors had become so overwhelmed caring for the sick that most cases went unreported and the true numbers will never be known. On October 3, the city closed all schools, churches, theaters, pool halls, and other places of amusement in a frantic attempt to slow the spread of the disease.

In the week that ended on October 5, as many as 2,600 were reported to have died in Philadelphia of the flu or its complications. The next week, the flu death reports reached more than 4,500. Hundreds of thousands were ill.

Within a month after the flu arrived in Philadelphia, nearly 11,000 people died from the disease. On one fateful day, October 10, 1918, 759 Philadelphia flu victims died.

Army doctors tried every measure to stem the epidemic. They inoculated troops with vaccines made from body secretions taken from flu patients or from bacteria that they thought caused the disease.

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.

Doctors gave out elixirs and vaccinated people against the flu, but to no avail. Crosby wondered about those flu vaccines. What was in them when no one knew what was causing the flu? He interviewed a doctor who had helped produce flu vaccines in 1918. The doctor, Crosby said, told him that the vaccines were just a soup made of blood and mucus of flu patients that had been filtered to get rid of large cells and debris. When they injected it into people’s arms their arms became horribly sore. “So they thought it really worked.”

Those optimistic tales, told when the flu struck Philadelphia, that a bacterium that caused the flu had been isolated, turned out to be untrue. Yes, the bacterium was found. But no, it did not seem to lead to a treatment or a vaccine. The cause of the disease remained a mystery. In 1918, the widely proclaimed discovery of Pfeiffer’s bacillus turned out to be a false trail. The influenza virus was beyond anyone’s grasp.

Even today, with the exquisite advances of molecular biology and the pharmaceutical industry, viral diseases—and influenza in particular—are largely untreatable. It’s not that molecular biologists are ignorant about the inner workings of influenza viruses. They have known for decades that the simple influenza virus has only eight genes, each made of the material RNA, and that the viruses die in hours if left alone with no cells to infect. They know what the flu viruses look like—under an electron microscope, they are little balls or egg-shaped particles, although sometimes they form long filaments. They know how they are put together—flu virus particles are wrapped in a slippery fatty membrane, held in place by a protein scaffolding underneath. They know how the viruses burrow into a cell and burst out again by using hundreds of sharp protein shards that poke out of the virus’s membrane. 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. But what they do not know is how to make a medicine that is the equivalent of a penicillin for the flu. The best way to combat an influenza pandemic is with vaccines—if manufacturers have enough advance notice of a new flu strain to make enough vaccine to go around. Manufacturers could, if they understood what made the 1918 flu so deadly, stockpile vaccines sufficient to pro...