ap central – education professionals – the college boardthis distinctive influenza epidemic...
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through electron microscopes, would that actually
have empowered them to halt the pandemic?
There was no cure for the disease then, or now.
Vaccines? Another generation would pass before
even partially effective vaccines against
influenza were developed. Even if all the
knowledge and technology to produce flu
vaccine had been at hand in 1918, would it have
been possible to produce it in sufficient quantity
and to distribute it across oceans and continents
in time to stop the swiftly spreading breath-
borne pandemic? Even today, when similar
questions are asked each time a new
strain of the virus appears, the answer falls short of
being a confident "yes.”
The influenza of the 1900s is still something of an
enigma, but the influenza that was sweeping around
the world at the time of the Armistice ending
World War I remains profoundly so. It killed tens
of millions, usually by opening the way for
secondary bacterial infections, such as those of
Pfeiffer's bacillus. Today, we presume that such
infections can be controlled with antibiotics. But a
significant fraction of those who died in the
pandemic of 1918-19 did not live long enough after
the onset of illness to contract a secondary
infection. They turned slate blue in a couple of days
and died of viral pneumonia. Even more disturbing
was the fact that the Spanish flu was especially
dangerous to young adults for reasons that have
been plausibly, but never definitely, explained.
Although influenza did not significantly affect
mortality in the United States until September
1918, its impact was so tremendous during the fall
and early winter of that year that it skewed the
distribution of age-specific deaths into
unprecedented proportions. Ever since the U.S.
Office of Vital Statistics started publishing
statistics on the age incidence of influenza deaths,
the distribution has been high at the extremes of
infancy and old age and very low in between. In
1918, however, age-specific death rates were high
for the very young, higher yet for 20-to-40-year-
olds, and lower
than normal for the elderly. The common
explanation is that this strain of influenza was so
new that it startled its victims' immune systems
into overreaction, and the more vigorous the
victim, the greater and deadlier the overreaction.
The defensive swelling of membranes and
increased secretion of fluids of the respiratory
system went to extremes in young adults, filling
their lungs with liquid until they drowned.
Overstimulation of the immune system is a
plausible theory, but we could subject it to
rigorous testing only if something like the 19 18
virus returned.
This distinctive influenza epidemic swept over
the world in three major waves during 1918 and
1919. We cannot be sure where and when the
initial wave in the spring of 1918 started, but the
earliest scientific and statistical evidence points
to the United States in March 1918. It attracted
very little attention because pneumonic
complications were rare and deaths even rarer.
Initially, the flu seemed no more than just another
respiratory disease of the kind that so often
circulates at that time of year. Only later did the
statisticians notice that an unusually large
proportion of the relatively few victims of the
spring of 1918 had been young adults.
THE FIRST WAVE
The first wave that spread across North America
in March and April temporarily disrupted the
operation of some military camps and a few
factories and then disappeared. However, as it
waned in North America, it rose to greater
heights in the Old World than had been
experienced at any time since the previous
influenza pandemics of 1889 and 1890.
According to the record (by no means as
complete in 1918 as today), the disease in Europe
first reached epidemic proportions in April in
France. It swept across Europe in the spring and
summer, attacking troops indiscriminately on
both sides and interfering with military
operations. (General Erich von Ludendorff
blamed the flu, among other factors, for the
4 The Spanish Flu and Its Legacy
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