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Discover Mid-America — April 2006

America’s Forgotten Pandemic: The Influenza of 1918 by Alfred W. Crosby (New York: Cambridge University Press, 2003), paperback, 352 pp., $22.99, 0521541751

Spread of flu during WWI has lessons for today

American public health officials predict avian flu, a deadly influenza virus sometimes transmitted from birds (its primary hosts) to humans, will arrive in the United States in the next year, or even earlier. This could be a reason to be alarmed, particularly if scientists do not create vaccines that work against the virus.

But avian flu should also make us take stock of the way our world works and how disease evolves to very human rhythms, behaviors and institutions.

The threat of disease should also produce in us humility. We think medical science has pushed back most of the frontiers of plague and pestilence. But Alfred Crosby reminds us in America’s Forgotten Pandemic, “We live in a world that has become in some ways a better place for nasty viruses and a worse place for us than it was in 1918.”

His account of the appearance, spread and subsequent disappearance of Spanish influenza during the closing days of World War One shows that the globalization of war made a familiar, ubiquitous disease into a worldwide killer.

Some 25 million people died as a result of the influenza that spread around the globe from August 1918 to sometime in 1920. It knocked down its victims in a matter of hours. But several days later, most people were back on their feet. Mortality was higher than with previous strains of the flu, but as American soldiers gathered in stateside military camps, on navy ships, and in the trenches of Europe, the disease seemed part of the regular cycle of a flu epidemic.

Crosby shows the flu virus is never the same virus as the one that struck before, and humans create it. In a highly dynamic and adaptive process, a new strain generally takes hold in domesticated animals, spreading through the crowded conditions of chicken coops and livestock yards, as well as the astoundingly similar pool of genes among selectively bred food animals. It evolves into new forms through literally hundreds of millions of mutations occurring in a single host. Mutations tailor the disease to the host, at the same time that some mutations find their way to new species.

Ramping up to war, the military had shoved thousands of soldiers into compact bases for training and conditioning. When Spanish flu first appeared in military training camps, it had already begun to adapt though genetic trial-and-error to the specific conditions of soldiers in those camps. One sick soldier could infect hundreds of others.

The illness overwhelmed the army’s health systems and moved aboard ships with troop mobilization. It made many in troop-ship holds deathly ill. The giant ship Leviathan left New Jersey with eleven thousand troops. During the voyage, so many became ill that the healthy could not care for them all, and they lay about the deck or crawled into any empty bunk they could find. By the time the ship reached Europe, two thousand soldiers were still sick with the disease. A hundred had died, and many tens more would die once the soldiers marched ashore.

The scene was repeated on hundreds of other troop carriers. Once ashore, it spread across enemy lines and settled populations, doing more human damage than all the bombs, bullets and deadly gas lobbed across and into the trenches.

Crosby shows that diseases move more than one way. Like the waves bouncing off the sides of a small pool, disease spreads back and forth with human commerce, mutating again and again, insuring its survival and propagation. Meanwhile, it can spread among rural and urban populations, changing in those environments, creating new strains to be transported around the world.

While diseases such as Spanish flu mobilize the body’s defenses so vigorously that the defenses actually kill the victim, many die from secondary bacterial infections. In Spanish flu, tracheal and bronchial swelling provided cover for various strains of pneumonia bacteria, which took hold in the weakened host and killed just as surely as the virus.

Only one thing in epidemiology is sure. Many diseases prompt immunities that the disease dodges by evolving further. During the 1918 pandemic, a soldier could become ill with one strain of virus and survive. He was immune to that strain but was likely to become ill with another strain of the same virus.

Modern, mobile war, then, spread disease. In much the same way, trade and travel has made the world a much more dangerous place even as it has interconnected societies. We cannot become xenophobic without becoming more hostile to one another. On the other hand, we cannot expect that disease will respect human boundaries.

So what is the lesson in Crosby’s text? War, peace and industrial progress obscured Spanish influenza in our collective memory. It did not change human institutions as much as it changed individual families. As such, we must understand that globalization means more than just increased commerce. Diseases like SARS, HIV and avian flu are our companions and will be for the foreseeable future unless we change our collective behavior. Diseases will mutate to those new conditions but they need not be as deadly if we are looking out for one another.

Patrick Dobson is a Kansas City-based writer and Ph.D. candidate in history. He can be contacted at

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