Bird Flu… Swine Flu… 1918 Flu. Just what does this flu do to merit the massive attention that media and government are seizing upon? There is not allot written about the 1918 influenza because there was a media black-out due to global events. The following is a vivid written and photographic description of the 1918 influenza from the US Army perspective.
From the trenches….
Accessed Under Fair Use from Suburban Emergency Management Project
(now purged from the internet)
Biot #641: August 16, 2009
In the fog of the influenza pandemic of 1918, Dr. Victor C. Vaughan, head of communicable diseases for the U.S. Army training camps, cautioned shaken observers that a full accounting of the pandemic required time and further study. (1) Surgeon General M.W. Ireland and Lieutenant Colonel Joseph F. Siler, M.D., prepared and delivered that final accounting in their 600-page tome titled The Medical Department of the United States Army in the World War: Communicable and other Diseases (1928). (2-4) Major Milton W. Hall, M.D., prepared the 110-page chapter on the respiratory disease outbreaks.
Surgeon General Merritte Weber Ireland. Source: http://upload.wikimedia.org/wikipedia/en/e/e5/Merritte_Weber_Ireland.jpg; accessed August 2, 2009.
U.S. Army camp hospital administration building, World War I, where record keeping likely was performed. Source: http://history.amedd.army.mil/booksdocs/wwi/MilitaryHospitalsintheUS/chapter4figure15.jpg; accessed August 2, 2009.
This work on the influenza pandemic and other disease outbreaks among American soldiers between April 1, 1917 and December 31, 1919 is based on massive amounts of actual data analyzed and interpreted by clinicians, medical epidemiologists, and scientists for use by posterity (us). The book is the most detailed, comprehensive, complete, reliable, valid and useful description of the 1918 influenza pandemic available today, in this author’s opinion. Its scientific approach contrasts with the social historical approach common to many books available today on the 1918 influenza pandemic.
What did the physician authors of The Medical Department of the United States Army in the World War: Communicable and other Diseases learn from the medical data collected during the Great War? What can people living a century later (us) learn from their work?
1. Many Infectious Diseases Flourished before and during the Influenza Pandemic Era, 1917-1919, but Influenza and its Complications Dominated
During World War I in the U.S. Army camps, many diseases flourished. There are individual chapters in The Medical Department of the United States Army in the World War: Communicable and other Diseases on the typhoid and the paratyphoid fevers, inflammatory diseases of the respiratory tract, tuberculosis, cerebrospinal meningitis, anthrax, diphtheria, the venereal diseases, the diarrheal group of diseases, chickenpox, scarlet fever, measles, mumps, German measles, encephalitis lethargica, infectious jaundice, typhus fever, trench fever, Vincent’s disease, the malarial fevers, intestinal parasites, diseases of the skin, and neurocirculatory asthenia. Of these myriad diseases afflicting soldiers in the U.S. Army during World War I, the respiratory diseases dominated in quantity and severity. (4) Dr. Hall declared, “[T]he serious and fatal inflammations of the respiratory tract…formed by far the most important factor in the sickness and death records of the Army during the World War.” (5)
Receiving building at a base hospital in a U.S. Army camp, World War I. This is not the hospital ward itself. Instead it is where sick soldiers went for evaluation and triage. Source: http://history.amedd.army.mil/booksdocs/wwi/MilitaryHospitalsintheUS/chapter4figure16.jpg; accessed August 2, 2009.
Interior of one-story hospital ward, U.S. Army camp, World War I. Source: http://history.amedd.army.mil/booksdocs/wwi/MilitaryHospitalsintheUS/chapter4figure26.jpg; accessed August 2, 2009.
2. Morbidity and Mortality Data, Influenza and other Contagious Diseases, U.S. Army, Great War
The total mean strength of the U.S. Army (officers and enlisted men, henceforth, soldiers) from April 1, 1917, to December 31, 1919, was 4,128,479. (6-7) Of these 4,128,479 soldiers, 3,515,464 (85%) reported sick for admission. [!] (6) This number of sick soldiers is astounding.
The total number of soldiers admitted for respiratory diseases was 1,125,401, which calculates to 27% of all soldiers in the U.S. Army and 32% of U.S. soldiers reporting sick for admission. In other words, one out of three soldiers developed respiratory disease requiring sick admission at some time between 1917-1919 and one out of three soldiers reporting for sick admission carried a respiratory disease diagnosis. Note that the respiratory disease diagnoses in the respiratory disease category employed by Dr. Hall were limited to influenza, bronchitis, broncho-pneumonia and lobar pneumonia. Each of these disease entities affects the lower respiratory tract. Upper respiratory disease categories such as pharyngitis [sore throat], tonsillitis, and sinusitis were not included in Dr. Hall’s respiratory diseases category.
Of the 1,125,401 soldiers admitted for respiratory disease diagnoses, 791,907 carried the diagnosis of influenza, which calculates to 19% of all soldiers in the U.S. Army (1917-1919) and 23% of all soldiers who reported sick for admission (1917-1919). By contrast and by way of example, 67,026 (2%) soldiers reported sick for syphilis, 4,831 (0.1%) for cerebro-spinal meningitis, and 1,529 for typhoid fever (0.04%). (2)
Of the 791,907 soldiers diagnosed with influenza, 24,664 (3%) died. (8) There were so many deaths, logistical problems arose over managing the bodies, according to a congressional probe to which Secretary of War Newton Baker responded in three days of testimony in late January 25, 1918, available elsewhere. (9) The U.S. Congress was having difficulty obtaining information on U.S. Army camp operations because of censorship of the press by the Wilson administration, which did not want Germany to know, via U.S. media, of troubles affecting the raising of a U.S. army. Of the 791,907 soldiers diagnosed with influenza, 767,243 (97%) survived their illness.
Of all the deaths charged to influenza, 99.4% were recorded as due secondarily to pneumonia (66.1% broncho-pneumonia and 33.3% lobar pneumonia; the difference between the two types of pneumonias is not important here; rather the fact that the patients died a respiratory death is what is important).
The total number of deaths from all diseases during the war was 58,119. Of the 58,119 deaths due to all diseases, the respiratory diseases accounted for 46,992, or 80.85%. (8) In other words, four out of five soldiers who died of disease died of respiratory disease (as defined by Dr. Hall, see above).
3. Problems Defining a Case of Influenza during the Great War
At the beginning of 1918, most clinicians believed that the bacillus of Pfeiffer caused influenza. Dr. Richard Pfeiffer was an eminent German researcher and son-in-law of Dr. Robert Koch whose conclusions that bacteria caused influenza were based on work done late in the 1889-1892 cycle of the disease. However, noted Dr. Hall, “With the advent of the earlier recognizable waves of the 1918 outbreak it became evident that the bacillus of Pfeiffer was not uniformly present in the cases examined.” (10) Bacteriologists simply were not growing the Pfeiffer bacillus (today known as Haemophilis influenza) from sputum, blood, or other fluids of the gravely sick soldiers exhibiting signs of what was being called “influenza.” In fact, instead, bacteriologists were growing pneumococci and other “mouth” bacteria from sputum, which were under normal circumstances considered benign.
Pfeiffer’s bacillus (Haemophilus influenza) under the microscope. Source: http://pathmicro.med.sc.edu/Infectious%20Disease/Hinfluenzae1.jpg; accessed August 2, 2009. Continue reading