The period from 1914 to 1919 was the deadliest six-year period in the history of mankind. You might think it was all because of trench warfare in World War I, but does anybody recall the Great Influenza Pandemic of 1918? After all, the pandemic caused at least twice as many deaths as the war, ranging from estimates of 25 million to as high as 100 million. It’s astounding how an event as large as this goes unrecognized by the world today. What’s equally astounding is how the majority of people aware that this happened are unaware of how it became so acute and widespread. How could an influenza virus that was active for only two years cause more deaths than AIDS, the Bubonic Plague, and World II? A case can be made the Great Influenza Pandemic would not have been as widespread if not for World War I. I think that the mobilization of troops around the world and the large numbers of weakened soldiers contributed to the spread of the virus.
In order to get a clearer picture of how the war contributed to the spread of influenza, an origin of the virus must first be recognized. The Great Influenza Pandemic is also known as “The Spanish Flu”, but it might be surprising to know that Spain was probably not the true origin of the disease. Because of Spain’s neutrality in the war, the Spanish media covered the pandemic extensively. Spain was also the first European nation to witness a major breakout in May of 1918. Soon afterwards, doctors and scientists began to doubt that the origin of the virus had been Spanish. Although no clear origin can be determined, many experts agree that the virus probably originated in China and was carried by birds east or west (Lovgren). What remains ambiguous is where these birds carrying the virus were headed. Two locations are most prominent: Spain and the United States. These two nations witnessed the first severe outbreaks of flu in 1918; both had initial mortalities starting in February of that year.
While the United States suffered a considerably lower number of casualties that spring, Spain witnessed the deaths of eight million people in May of 1918 alone. Arguing that the virus originated in Spain might make the most sense politically, seeing as how its closer proximity to the war may have served as a catalyst for the virus that had arrived from China.
In Paul Davies’ book Devil’s Flu, a case for the origin in Spain is outlined. “Given what the disease would come to be called, there was an outbreak of grippe at San Sebastian on the north coast of Spain in February” (52). San Sebastian was the well-known epicenter of the Spanish outbreak. Since influenza is an airborne virus, the contagious onset of it may have spread from San Sebastian to the European front. Even though Spain was neutral in the war, traffic flow and civilian interactions may have had a domino effect in getting the virus to the front.
The case for the virus originating in the United States is much more intriguing. It is one that relies solely on the distribution of troops to Europe. “Epidemiological evidence suggests that a new virus originated in Haskell County, Kansas, early in 1918” (Barry 92). Dr. Loring Miner, a Haskell County doctor, was the first to notice an unusual and extremely virulent form of influenza taking grip in his homeland. His worries were so great that he warned public health officials about it (Barry 94). The acute “eruption” of the disease came and went so swiftly that health officials and the public ignored it. By April, little remained of the outbreak in Haskell County. However, an unfortunate demand would soon grant a more promising way for it to spread: the demand for American soldiers to fight in Europe for World War I.
Men from Haskell County enlisted in the army were trained at Camp Funston, a major U.S. army base located in Fort Riley, Kansas, three hundred miles east of it. “There was a small but constant flow of traffic between the two places (Funston and Haskell County)” (Barry 70). While people were falling ill in Haskell County, soldiers were being transported to and from Camp Funston. Interactions between camps and the higher demand for soldiers created a network for the virus to spread itself. On March 18, camps Forrest and Green Leaf reported that 10% of their soldiers were sick with the flu. Soldiers from Camp Funston had been sent to these camps. By May, 24 of the 36 largest U.S. army posts were suffering from influenza outbreaks, and 30 out of every 50 camps were hit with high mortality rates of it (Barry 169).
But the death toll in the United States was not high enough to excite media attention. It was merely seen as a typical spring flu.
American soldiers from these camps were then transported overseas to camps in Europe- Camp Brest being the most notable. Brest was a British post that was located in France. The British had been sharing it with the French and American armies. Upon the arrival of American soldiers, Brest experienced the first unusual outbreak of flu in any combat in Europe that spring. It’s also known that the French army was subjected to a spike in influenza cases (Barry 170).
It’s worth noting that while the spring flu was dying in the United States, it was exploding in Europe. Alfred Crosby’s book America’s Forgotten Pandemic: The Influenza of 1918 (regarded as the most credible source on the subject), cites: “Oddly, just as the first wave of influenza was dying out in the U.S., it was beginning what was to be a much more spectacular sweep across Europe” (25). Crosby pinpoints Bordeaux as the first camp in which the virus was seen in Europe. American troops arrived there on April 15th, just after the March outbreak in the U.S. He didn’t ignore the coincidence and also thought the virus had American origins: “We must say that the new influenza appeared first in March and in the United States” (25). This is important because it suggests the virus may have died out if American troops hadn’t carried it to Europe. Frank Macfarlane Burnet, an American Nobel Prize laureate in medicine, also believed that the pandemic began in the United States. He further states that, “Its spread was intimately related to war conditions and especially the arrival of American troops in France” (Barry 99).
And what of the Spanish origin? Gina Kolata’s Pandemic of 1918 and The Search for the Virus that Caused It, and Paul Davies’ book, both seem to support that the virus was transmitted from Spain to the European front. Davies even claims that the outbreak in San Sebastian occurred a whole month before the one in Haskell County (52).
While one could argue that the European camps were only hit with influenza because of the outbreak of flu in San Sebastian, one could make an equally valid argument that the virus had been transmitted by the American army all the way to the battlefields of Europe. I don’t favor one position over the other, because it is irrelevant to the point. Either scenario suggests that World War I made the spread of the disease much greater than it would have been otherwise. If one were to decide that the American-born influenza was transferred all the way to Europe, they'd likely agree that the war itself was responsible for the pandemic. If one were to decide that the Spanish outbreak was responsible for it, they'd have to consider the numerous other ways in which the war turned a minor epidemic into a worldwide pandemic, which I’ll get to later.
The U.S. enlistment and training of soldiers and the transfer of soldiers brought back to America also mobilized the virus. Because French and British troops had been exhausted from years of fighting, a large number of American troops were needed on the European front. After America entered World War I, major crowds were necessary for the mobilization of troops. PBS.org illustrates this mobilization: “A further 13 million men across America were crowded into schools, city halls, and post offices when they were called together to register for the draft.” Other conglomerations of troops included the crowding of soldiers onto ships and trench warfare. Airborne viruses were given a good opportunity to mutate in the immune systems of crowded, cold, and seasick soldiers. Many men on these ships were feeling ill on the way to Europe. Then, after the soldiers landed there, the virus may have been “nurtured” by the unsanitary conditions of the war and the weak immune systems of wounded soldiers.
For example, large army bases along the French front housed hundreds of thousands of soldiers through the war years. One camp- Etaples in Northern France- held the perfect environment for the spread of influenza. “Undoubtedly, the conditions at this camp, with most soldiers housed in tents of temporary wooden barracks, were ideal for the spread of respiratory virus” (Oxford 112). These conditions would have easily accelerated any lethal strain of the virus.
The transfer of soldiers back to America from the war also assisted in the spread of the virus. “The war brought the virus back into the United States for the second wave of the epidemic. The war also enabled the virus to spread and diffuse” (Billings). As sick and injured soldiers were carried back to America by ship, the virus dwelled inside them. Anyone coming into close contact with the soldiers had a 30-40% chance of developing influenza. More than 25% of the United States population would eventually become infected. The Navy reported a 40% fatality rate and the Army an estimated 36% infection rate (Kolata 6). American servicemen were more likely to get infected, indicating the long rides home from the war most likely brought the flu to America.
Major ports and Army camps with the highest fatality rates were in Boston and Philadelphia. Philadelphia, having the largest shipyard in the United States at the time, suffered the most casualties from flu than any other American city (PBS). Once influenza broke out in the United States for a second time, there was no looking back. This was in September of 1918, and the coming months of autumn would be some of the deadliest in human history.
The scarcity of doctors and nurses was another one of the catalysts in aiding the pandemic. The war had attracted medical aid from all parts of the globe, not just the United States. With the number of doctors unavailable to treat influenza because of the war, the epidemic was able to reach pandemic levels as doctors struggled to prevent its rapid spread (Crosby 156).
There’s also the general principle that disease and war often go hand in hand. Every American war prior to World War I witnessed more deaths by disease than actual battle wounds (Emmeluth, Barry). Prior to the outbreak, there was a marked increase in influenza activity from the period of 1915 to 1918, not only in the United States but in Europe as well. An article titled "World War I May Have Allowed the Emergence of Spanish Influenza”, printed by Lancet Infectious Diseases 2, outlines the notable increase in flu fatalities as the war progressed. “The winter months of 1915 and 1916 showed increased influenza activity and higher recorded deaths for influenza and pneumonia in the U.K. and U.S.A. civilian population” (112).
The United States, England, and Germany all reported that 1915 had their largest influenza outbreaks since the dawn of the century. Similar outbreaks broke out later in France in 1917 (Davies 51). Even though the United States wasn’t in the war at the time, the increase of influenza activity around the world seemed to strangely coincide with the start of the war. World War I had had more deaths than any other war in the history of mankind. Since casualties from disease often surpass casualties from battle, it’s safe to say that a war on that large of a scale should precipitate one of the largest disease outbreaks in history.
The cold winters of 1917 and 1918 assisted the war in increasing disease in Europe and the United States. Europe suffered one of its worst winters on record in 1917, and a year later the United States suffered from its coldest winter on record. The winter before the Great Influenza Pandemic was also the coldest on record at Camp Funston, the base that relayed soldiers from Kansas to Europe. The severe cold made soldiers insist on gaining comfort by huddling against each other, sharing an air of mixed breath and germs- the perfect agent for an influenza outbreak (Barry 96). The climate of winter, combined with poor sanitary conditions in the war, caused a greater spread of the disease.
Finally, the greatest reason for blaming the outbreak on World War I can be revealed by considering trench warfare. The trenches provided a perfect environment for weakening the immune system. Crosby points out that conditions in the trenches allowed, “Poor diet, poverty, and sharp decline in sanitation” (156). Disease is often characterized by having originated in swamp-like conditions. The environment of the trenches matched a good description for a swamp: muddy, murky, dirty.
Patrick Ewald and Stanford’s department both consider the repercussions that trench warfare had on the soldiers’ immune systems. They outline that stress in combat, such as exposure to mustard gas, may have weakened the soldiers’ immune systems. But this is unproven and only theoretical. These factors, along with the overall unsanitary and swampy conditions of the trenches, increased vulnerability to the flu and accelerated its spread (Ewald 107).
Besides all the direct ways in which the war helped the spread influenza, there are more obscure ways that weren’t accounted for in any of my references. This last argument is an inference I came across after reading a passage in Paul Davies’ book. The passage reads: “Spanish flu happened at the climax of the most appalling war yet seen in history. At any other time, it would have been everywhere and acknowledged, instantly and in horror, as a global disaster” (87). My inference is that the publicity over the war distracted the public from focusing on the rising threat of influenza. This in turn lessened awareness of the flu, making people unable to realize that influenza was a great threat to their lives. Had this publicity been met, I believe more people would have been wearing masks to prevent infection. More money would have gone into taking preventative measures against influenza and not into supplying armies with ammunition. Newspapers would have made it the top headline instead of making it peripheral. To go along with the mobilizations, the conditions in the trenches, and the limited number of doctors available: all these details make a great case for the war causing the spread of influenza.
Despite all the evidence supporting the war’s spread of disease, some believe it didn’t have much to do with it. Crosby writes how researchers argue about the correlation between those who died in the war and those who died from the virus. He asserts that since the research is sketchy, no claim can be made. It’s also known that “neither France nor Germany suffered more (influenza) casualties than Sweden, Switzerland, or New Zealand” (216). Thus, influenza death rates in close proximity to the trenches were actually lower than those farther away.
Crosby also states that an argument can be made using the fact that World II had greater amounts of soldiers with greater amounts of unsanitary army camps. World War II never caused an extreme amount of disease fatalities, at least not as many as World War I did (217).
However even with these claims, there’s still irrefutable evidence that World War I contributed to the spread of influenza in 1918. These counter arguments are unsound in that they only argue against World War I being responsible for the virus, but not as a contributor. Besides, there’s no telling how many soldiers would have died in the trenches from influenza if they hadn’t been killed by enemy fire in the first place. That may have skewed the mortality rates for influenza being greater in countries farther away from the trenches.
In conclusion, the Spanish flu erupted at the climax of one of the largest wars in history. It’s a shame that more people aren't aware of what happened in 1918; it’s almost as if the war blanked out the entire event from history. We must remember events like these, especially when other pandemics threaten us, like the current one in South Asia. Perhaps researchers a hundred years from now will hypothesize that the tsunami in Indonesia was responsible for the current outbreak of bird flu. It’s very unlikely, but I believe history is meant to help us learn from our mistakes, regardless of how many times we repeat them. Otherwise, the six-year period from 1914 to 1919 may become only the second deadliest period in the history of mankind.
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