War and Pestilence:
How the First World War Coughed Earth to Death
December in Oregon: wet and cold schoolchildren trudge to their classes, shrugging raincoats closer to their skin. Teachers speak in front of rooms perpetually missing four students; they rotate illnesses every few days. After seventy-two hours of sniffling and moping, children return to fill the empty desks. At most, the seasonal, endemic influenza makes an unseemly mess of mucous and vomit: two pills of Advil PM per four hours will suffice. But as European streams flowed red in the year 1918, the world hacked and wheezed in recorded history’s most devastating pandemic.
From one perspective, the Spanish Influenza seems to not deserve this honor—or notoriety—when compared to the other great plagues. Smallpox, for instance, destroyed cultures across the Americas and had a frighteningly high mortality rate at 30 percent (Smallpox). In contrast, the grippe pandemic mustered a mere 2.5 percent mortality rate (Taubenberger). The Black Death of Middle Age Europe extinguished 200 million lives in the entirety of the 14th century (Decoding). But what yersinia pestis took a hundred years to accomplish, influenza came close to achieving in two years; between 1918 and 1919, up to 100 million people—one for every twenty then inhabiting the planet—perished from influenza and its complications (Gabel). With the aid of influenza, the War to End All Wars butchered many more young men than it could have otherwise. More importantly, the converse is true: the Spanish Influenza would have formed a minor smudge on the historical canvas if it had not been catalyzed and exacerbated by World War One.
Grippe typically contains all the perfect ingredients for destruction, save one—lethality. The disease infects across species; commonly, new strains of influenza transfer from pigs or birds to their keepers. Influenza does not require direct contact; it is a highly contagious airborne disease that primarily targets the respiratory system. Unlike plague or smallpox, a case of influenza rarely warrants a visit to the doctor’s office, for good reason: grippe usually kills less than .1 percent of those who contract the illness, and these victims are almost entirely infants and the elderly (Taubenberger). Even the Spanish Influenza of 1918 rarely was the sole culprit; most died from complications like pneumonia. Despite this, the disease’s swift transmission, due in large part to the First World War, circumnavigated the globe like a black-robed, scythe-wielding Ferdinand Magellan.
Although the pandemic would claim a larger death toll on the European continent, it likely began in the United States. Many epidemiologists agree that a minor outbreak in Haskell County, Kansas, probably triggered the disease’s spread, writes historian John Barry in his book The Great Influenza. The early 1918 local epidemic had little effect on the region, but did transfer to nearby U.S. Army Camp Funston. There, soldiers of the American Expeditionary Force, who would be the first Americans to fight and die in Europe, contracted the disease. Accordingly, the first European outbreaks of influenza centered in the cities where the American Expeditionary Force disembarked (Barry 98). Perhaps, without the war effort, the grippe would have exhausted itself in rural Kansas and no textbooks would mention the disease.
The war’s perpetual movement of troops circulated the disease well beyond its initial grounds with the American Expeditionary Force. In April, soldiers with the British Expeditionary Force lay in bed with fluid filling their lungs; by May, the influenza epidemic among French troops had grown to such proportions that the French army’s Service de Sante-Militaire issued an order that every new outbreak be reported by priority telegraph (Crosby 25). Germans likely contracted the disease directly over No Man’s Land and then spread the virus throughout regiments and, when on leave, the civilian population as well (Crosby 26). When the war ended in November of 1918, the rapid demobilization of armies sent infected soldiers away from the front. Soldiers returning home were often welcomed by parties and family gatherings, further augmenting the disease’s person-to-person transmission (Oxlbrd et al). In the United States, the effect of demobilization was especially noticeable because the localized, initial Kansas epidemic had long since died out. Most of the 1.5 million American soldiers traversing the Atlantic in the last half-year of the war, claims historian Alfred Crosby in his book America’s Forgotten Pandemic, were actually “passing from a land where there was no influenza pandemic to a continent where there was” (Crosby 31). After Armistice Day, these young men carried the virus from Argonne to every corner of the United States.
Once it had arrived in Europe, the war atmosphere cultivated the virus as well as any laboratory Petri dish. Army camps, writes University of London microbiologist JS Oxlbrd, “were ideal for spread of a respiratory virus” because “most soldiers [were] housed in tents or temporary wooden barracks” (Oxlbrd et al). Many other problems with soldier life contributed to the disease’s spread, argues historian Jennifer Keene in her book World War I. Bad hygiene, overcrowding, physical exhaustion, front-line stress, and direct exposure to the elements all weakened a soldier’s immune system. An American medical officer noted that soldiers “were shifted from camp to camp by the thousands, taking with them such diseases as they were incubating, thus infecting all camps” (qtd in Keene 164). Poison gas, once dispersed, persisted in large enough amounts to irritate and weaken lung tissue long after the immediate threat had passed. The culmination of all these factors meant that millions of soldiers were nothing but a breeding ground for the influenza virus, which would mutate frequently as it moved from victim to victim. In this way, an initially benign disease evolved into the “particularly virulent form” which would later ravage civilians as well as soldiers (Oxlbrd et al). Over the summer of 1918, warmer weather helped keep the grippe at bay. But, Keene notes, “when the flu reappeared in the fall, the virus had become much more virulent and aggressive” (Keene 167).
Just as the war changed the nature of the virus, the virus might have altered the outcome of the war. In the spring and summer of 1918, Germany mounted an enormous, nearly-successful offensive designed to drive the British off of the mainland and defeat the French before American troops landed in Europe. But influenza hampered the German army’s ability to push forward; the battalions responsible for pressing the British back to the Channel were struck especially hard by the disease. Erich von Ludendorff, Germany’s highest general, blamed the offensive’s failure in part on the diminished strength of his armies due to the grippe (Crosby 27). On a more direct level, influenza drastically increased the death toll for soldiers at war. In 1918, the year that Americans brought grippe to Europe, respiratory disease slaughtered seven times as many soldiers as in 1917; Crosby writes that “for every American soldier who died in battle or as a result of wounds or gas in World War I, 1.02 died of disease”, and that the high mortality from diseases “was clearly due to Spanish influenza” (Crosby 206).
The medical community, even in the most advanced western European nations, was heinously unprepared for the pandemic’s onslaught. The germ theory of disease had only come to widespread acceptance in the late nineteenth century; older doctors had been trained beforehand and few had any understanding of how disease could spread. The use of statistical analysis to study disease was a tactic still in its infancy. Fred van Hartesveldt, professor of history at Fort Valley State University, writes that “clinical evidence was often simply ignored…many surgeons still operated in old coats or aprons, the fashion of wearing antiseptic cotton gloves, masks, and easily washable clothing having faded.” World War I allowed army medical officers to dramatically increase their understanding of disease transmission, but this information did not disseminate to the civilian medical community in time for the pandemic (van Hartesveldt).
Still, early twentieth century medicine far exceeded its precursor. Only rarely did physicians prescribe pointless and dangerous remedies, like bleeding and heavy chemical doses. Furthermore, the enormous success of earlier rudimentary smallpox vaccines raised similar hopes for the development of a similar treatment for influenza. Most medical researchers, unfortunately, mistook certain bacterial species that caused pneumonia as the disease’s cause; consequently, van Hartesveldt argues that “the vaccines could have done nothing to cure or prevent influenza,” although “they might have helped, if the patient was lucky enough to get exactly the strain” of secondary infection. Regardless, Dr. M.H. Gordon, then-researcher at the Central Laboratory for Cerebro Spinal Fever, commented that “the ‘blunderbluss’ vaccine can do no harm, [and] should increase resistance to these microorganisms which play an important part in the pulmonary complications of influenza to which the mortality is mainly due” (qtd in van Hartesveldt).
Far more effective at reducing the pandemic’s destruction would have been comprehensive public health measures. Local governments could urge citizens to check the transmission of the disease by self-imposed isolation and vigilant hygiene. Simple measures such as a week’s rest to recover from moderate sickness would have cut the ability of the virus to spread. But wartime production had to continue, which meant that long recovery periods were discouraged, and workers sometimes returned to their posts before completely conquering the disease. Lower crowd concentration would likely have dramatically slowed the epidemic’s expansion. Unfortunately, van Hartesveldt explains, “in wartime conditions, reduced public transportation leading to jammed busses and trains…meant that some sacrifice of health was expected.” In today’s world, governments often halt epidemics by quarantining the victims. In 1918, however, “even if quarantine had been possible and potentially effective against flu,” Crosby writes, “a strict maritime quarantine on the ports of the United States was politically impossible, because it would have sharply reduced the flow of troops and supplies to the Western Front” (Crosby 31). The needs of generals, nations decided, superseded the lives of civilians.
Beyond merely complicating efforts to reduce the pandemic’s wrath, the First World War substantially increased European nations’ susceptibility to influenza. Throughout the war, the British blockade of the North Sea eliminated Germany’s imports. Consequently, toward the end of the war, rations of potatoes, the German staple, had fallen to 1.5 kilograms per week, per person; widespread malnutrition caused the German civilian population to be particularly weak in the face of the influenza pandemic (Crosby 27). Throughout Europe, the medical community had moved in droves to the battlefronts, where work and pay were more plentiful than at home. In Britain, more than 52 percent of the physician population had left the mainland for France, and some regions contained five thousand civilians to every doctor (van Hartesveldt). The supply of nurses and hospital beds was similarly reduced by the war effort. In London, a study conducted after the pandemic had subsided determined that over 62 percent of fatalities due to the grippe had never been attended to by any professional (van Hartesveldt).
History’s what-ifs abound. European nations prepared the perfect climate for pandemic nearly as well as if they had intended to do so. Armies nurtured and spread the virus across national borders. Although the epidemic would have strained the medical community without the war, military action practically eliminated any effective steps to limit deaths due to influenza. Food, supply, medical manpower shortages left the civilian population helpless against the grippe’s onslaught. Perhaps, if Archduke Ferdinand’s driver had chosen another road, the influenza pandemic would have never left Kansas. Regardless, it seems clear that without The Great War’s 8.5 million military deaths, a significant portion of the Spanish Influenza’s 100 million victims would have lived (WWI). Between the twin forces of war and pestilence, the world’s historical track shifted, Europe’s order realigned, and humanity suffered.
Works Cited
Barry, John. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York, New York: Penguin Group, 2004. Web.
Crosby, Alfred. America’s Forgotten Pandemic: The Influenza of 1918. Cambridge: Cambridge University Press, 2003. Web.
“De-coding the Black Death.” Health. BBC News. 3 Oct 2001. Web. 19 Jan 2011.
Gabel, Pearl. "Tales of the 1918 pandemic." Risk Management 55.12 (2008): 17. General OneFile. Web. 14 Jan. 2011.
Keene, Jennifer. World War I. Westport, Connecticut: Greenwood Press, 2006. Web.
Oxlbrd JS, Sefton A, Jackson R, Innes W, Daniels RS, Johnson NR. “World War 1 may have allowed the emergence of "Spanish" influenza.” Lancet Infect Dis. 2002;2:111-4.
“Smallpox Disease Overview.” Emergency Preparedness and Response. Centers for Disease Control and Prevention. 6 Feb 2007. Web. 19 Jan 2011.
Taubenberger, Jeffery K., and David M. Morens. "1918 influenza: the mother of all pandemics." Emerging Infectious Diseases 12.1 (2006). Centers for Disease Control and Prevention. Web. 17 Jan 2011.
van Hartesveldt, Fred R. "The doctors and the 'flu': the British medical profession's response to the influenza pandemic of 1918-19." International Social Science Review 85.1-2 (2010): 28+. General OneFile. Web. 14 Jan. 2011.
“WWI Casualties and Death Tables.” The Great War. PBS. 2004. Web. 21 Jan 2011.
Works Consulted
Byerly, Carol. Fever of War: The Influenza Epidemic in the US Army during World War I. New York, New York: New York University Press, 2005. Web.
"My Dear Mother." CMAJ: Canadian Medical Association Journal 176.4 (2007): 500. General OneFile. Web. 18 Jan. 2011.
Edited by Rafv Nin IV, 04 April 2011 - 03:19 AM.
