Die, Die, My Spanish Darling

by TJ Jurith

The Spanish Flu was the most devastating pandemic our world has ever seen. Even though few medical records exist, historians believe that 20 – 100 million people were killed by this flu. Despite the number of deaths and the severity and geographic reach of this disease, it merits little attention in the history books. Today one of our greatest medical threats is AIDS. The Spanish Flu is exponential compared to AIDS casualties. The Spanish Flu of 1918-19 affected our world like no other disease in history. It changed the ways people sought medical help, the ways physicians treated illness, the role of medical researchers and how society, particularly medical and political leaders respond to pandemic diseases.

“Influenza is a unique respiratory viral disease infecting the whole respiratory tract-namely, the nose, sinuses, the throat, lungs, and even the middle ear. The disease spreads from person to person by airborne droplets produced when an infected individual coughs or sneezes. Acute symptoms of influenza, including fever, headache, shivering, muscle pain, cough, and pneumonia, are the result of the virus replicating in the respiratory tract, in which infected cells die and slough off. " 1

The Spanish Flu got its name from newspaper reports of that period. It was thought that the influenza infection was carried form Asia to Spain during World War I. During WWI Spain remained neutral and the government did not censor the press. Spanish papers were filled with reports of the disease, especially when King Alphonse XIII became seriously ill with the flu.

In facts the origins of the flu are not certain. Although it came in three waves during 1918-19, it is also unclear why it halted in 1919. The first wave was in the spring of 1918. It was known for comparable mild intensity of symptoms and somewhat low death toll. Also, Americans were distracted by their involvement in WWI. "The spring epidemic isn't even mentioned in the index of the 1918 volumes of The Journal of the American Medical Association." 2



The second wave of infections began in autumn, 1918. In contrast to the first wave, the symptoms in the second wave were intensely painful and deaths greatly increased. The third wave came in early 1919. It was considered to have less intense symptoms than the second wave but even higher numbers of people were infected. Medical researchers have explained that as each time the infections passed from person to person, it become stronger and more deadly. Cold weather also facilitated the spread of the flu, especially from coughing and sneezing.

The flu created horrible problems for the human race in 1918. While at the beginning the civilian populations were slower to realize the effects, the military experienced the disease quickly, with great impact. It had immediate and high numbers lethal outcomes. As infected soldiers moved from training sites, camps and battlefields, the infection moved with them. One great example of how fast soldiers got sick involved an army base in Camp Funston, Kansas. The cook became ill; thousands of soldiers were admitted to hospitals within a three-week period. This was happening in army bases all over the country.

At the same time, soldiers were also exposed to outbreaks of measles, especially due to the fact that it was bitterly cold during the winter months of 1918. However, the worst consequence of influenza was that so many soldiers easily contracted pneumonia.

"Pneumonia is "an inflammation of the lungs with consolidation. This definition omits mention of an infection, but in practice pneumonia is almost always caused by some kind of microorganism invading the lung, followed by an infusion of the body's infection fighting weapons. The resulting inflamed mix of cells, enzymes, cell debris, fluid, and the equivalent of scar tissue thickens and leads to the consolidation; then the lung, normally soft and spongy, becomes firm, solid, and inelastic. The disease kills usually when either the consolidation becomes so widespread that the lungs cannot transfer enough oxygen into the bloodstream, or the pathogen enters the bloodstream and carries the infection throughout the body."3

It was very common for soldiers to develop pneumonia after getting the flu or measles. "Pneumonia was one of the leading causes of death around the world, greater than tuberculosis, smallpox, cholera, cancer, heart disease or the plague.

"Influenza causes pneumonia either directly, by a massive viral invasion of the lungs, or indirectly- and more commonly- by destroying certain parts of the body's defenses and allowing so called secondary invaders, bacteria, to infest the lungs virtually unopposed. There is also evidence that the influenza virus makes it easier for some bacteria to invade the lung not only by generally wiping out defense mechanisms but by specifically facilitating some bacteria's ability to attach to lung tissue,"4

Compared to Europe, America was relatively a new country. Other countries like France and Germany have had a long history of epidemics and researchers in the field of medicine. American doctors were seeing the devastating effects of the flu for the very first time. Their only experience with epidemics was from smallpox during the Civil War. U.S. doctors traveled to army bases all over the country. They immediately noticed the poor level of public health. They saw how crowded the army bases were, how closely soldiers lived together. . This definitely was not conducive for soldiers to stay healthy or get well. Although the disease struck young adults the hardest, people of all ages sickened and died. What is tragic is the fact that we were at war, and to make matters worse, our country had to deal with worldwide sickness at the same time.

"This influenza virus, this "mutant swarm", this "quasi species," had always held itself the potential to kill and it had killed. Now, all over the world, the virus had gone through roughly the same number of passages through humans. All over the world, the virus was adapting to humans, achieving maximum efficiency. And all over the world, the virus was turning lethal."5

The illness exploded all over the country. Great waves of immigration after the Civil War led to heavy concentrations of immigrants in cities along the east and west coasts. Cities were hit very hard, especially Philadelphia. It was one of America’s oldest and wealthiest cities in our country. It was home to many families that funded and managed the Red Cross and other national service organizations. One of the worst aspects of the flu affecting the cities was the disposing of bodies on the streets. Morgues were filled up. Gravediggers refused to bury bodies out of fear that they would get sick. The streets of Philadelphia stunk of dead bodies. Sporadically public officials would hire men to drive wagons around and wrap the dead in blankets and carry them to ditches to be buried. Similarly, in New York many people lived closely together. Tenement living was typical of immigrant living in New York City. It was easy to spread the flu in tenements with no porches and little ventilation. Families were forced to put dead bodies in closets and closed off rooms.

"Symptoms were terrifying. Blood poured from noses, ears, eye sockets; some victims lay in agony; delirium took others away while living."6

Multiple members of families were passing away very quickly. Hospitals were completely filled up. Nurses even stopped taking bribes from families with sick children. Lines to these hospitals were incredibly long. During the winter months of 1918, Federal, municipal, and state courts closed. Schools closed as well. In some states public health officials made it mandatory to wear masks.

It was difficult for political and medical leaders in other cities to care for the sick, and maintain some kind of order. In Baltimore, Maryland, schools, churches and stores were closed. In New York City, individuals who did not cover their mouths when they coughed were given either a fine or they were sent to jail. It was illegal in Prescott, Arizona to shake hands. In Middle America farmers stopped farming. The flu was destroying family and community life. People were afraid to go outside, to go to work or social meetings. Some small cities even banned public gatherings.

More people died from the flu than from the war. The impact was worldwide. It is estimated that 7 million people died in India. Some one million people died in West Africa. According to letters from a doctor, the country of Ghana became a ghost town, with villages disappearing, schools, markets and offices closed and empty. In Australia, officials prohibited traffic among coastal towns and blocked checkpoints through its states. 7

The National Public Health Service, The Red Cross, and hundreds of medical laboratories all over the world were all trying to find a successful treatment for influenza. While the United States lagged behind Europe in its research efforts, it had one institute determined to work with international medical specialists.

The Rockefeller Institute was founded and funded by the John D. Rockefeller family. The family patriarch had made a fortune in the oil production and distribution business. The Rockefeller Institute employed researchers from all over the world. . Influenza was the AIDS and Cancer of the 1920's; researchers started working on vaccines right away.

In early winter of 1918, the U.S. government established the Volunteer Medical Service. Its purpose was to locate and train young physicians to help fight influenza. The Public Health Service dispatched these doctors to areas without any medical facilities or health professionals. The government also tried to give people practical preventive advice. .

"The Surgeon General’s Advice to avoid influenza was what you would expect; avoid needless crowding, smother your coughs and sneezes; your nose not your mouth was made to breathe through. Remember the three Cs, clean mouth, clean skin, and clean clothes, Food will win the war. Help by choosing and chewing your food well, Wash your hands before eating, Don’t let the waste products of digestion accumulate, avoid tight clothes, tight gloves. Seek to make nature your ally not your prisoner. When the air is pure, breathe all of it you can- breathe deeply."8

Doctors around the world were desperate and experimented with hundreds of ways to cure influenza. They recommended alcoholic drinks, which may have masked pain temporarily but did not stop the disease. Physicians addressed pain with everything from aspirin to heroin. They tried to cure coughing with codeine. Doctors prescribed everything from hydrogen peroxide to mercuric chloride intravenously. In France some doctors believed that arsenic prevented the flu. While these treatments sounded reckless, many people had no doctor to go to at all.

While the Public Health Service focused on treatment, scientists all over the world were experimenting and recommending several vaccines. The Army Medical School distributed two million doses of a vaccine in weeks to officers, enlisted men, and civilian employees of the Army.

"Physicians even injected people with typhoid vaccine, thinking- or simply hoping- it might somehow boost the immune system in general even though the specificity of the immune response was well understood. Some patients and physicians claimed the treatment worked. Others poured every known vaccine into patients on the same theory. Quinine worked on one disease, malaria. Many physicians gave it for influenza with no better reasoning than desperation." 9

After the third wave, in 1919, the flu researchers and investigators did not stop their work in the laboratories. They started to ask questions of how it originated. They used census takers to solicit information during the next census. Medical historians tried to determines a more detailed list of persons impacted and also, fatalities. The influenza epidemic became the cornerstone of the 20th century response to disease, both public health, treatments, medical research and political leadership in national emergencies.

Our world can learn a lot from what happened in 1918. The flu affected millions of people in our country and the world. It left thousands of children orphans. It destroyed communities, property and commerce and left a permanent dent in society. Some historians have written that the influenza pandemic crisis negatively effected the negotiations when President Wilson met with world leaders for a peace treaty at the end of the war. Historians also believed that because of the so-called “Spanish Flu,” Americans were not supportive of that treaty.

Some lessons were remembered in this last decade. In 2009, millions of Americans were exposed to swine flu. Our president issued an immediate state of emergency. Researchers had observed medical forecasts and developed vaccines. People had access to these vaccines. Infected persons were quarantined. Political leaders, governments and travel officials put safeguards in place and set up travel precautions and detections. Officials in offices and schools issued warnings for everyone to be extra careful.

The Spanish flu pandemic of 1918 was a significant milestone in our history. It changed the way people deal with medical problems, the way doctors deal with diseases, and the way our world deals with pandemics. A health pandemic is probably one of the worst issues humans will ever have to deal with. For the first time public official of the 20th century had to respond to a health pandemic for the first time. The Spanish flu killed more people than the war itself. It hit every continent except Antarctica and destroyed families and communities all over the world. It also caused doctors and researchers from different counties around the world to work together and share their research with one another. What's ironic was that this happened while multiple countries were at war with one another. The flu forced people to look beyond their own borders, it made international citizens out of people, to care for the sick, to get access to medical help and to keep society functioning. Although the flu killed millions of people it taught us that disease is a force of nature that can cross international borders and upset the balance of civilization.

1 Collier. L., and J. Oxford. 1996. Human Virology: A Text for Students of Medicine, Dentistry, and Microbiology. Oxford: Oxfor University Press.

2 Crosby, Alfred W., Americas Forgotten Pandemic the Influenza of 1918. Cambridge, UK. Cambridge University Press, 2003

3 Barry, John. The Great Influenza. New York, NY. The Penguin Group, 2004

4 Ibid

5 Getz, David. Purple Death: The Mysterious Flu of 1918. New York, NY. Henry Holt and Company,2000

6 Crosby, Alfred. Epidemics and Peace, 1918. Westport, Con. Greenwood Press, 1976

7 Winter, J and Bagget, B. The Great War and the Shaping of the 20th Century. New York, NY. Penguin Studio. 1996

8 Pettit, Dorthy. A Cruel Wind: Pandemic Flu in America 1918-1920. Muffesboro, TN. Timberlane Books, 2008

9 Kolata, Gina. Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused it. New York, NY. First Tombstone, 1999