A Flu Like No Other - A Look Back At The 1918 Pandemic

By all accounts, the history of the 1918 flu pandemic is a horror story.

Several waves of the disease swept through the United States, Europe, and much of the world that year. Each wave was worse than the last, as the virus mutated. It exploded in the fall of 1918.

The symptoms were terrifying. People who seemed perfectly healthy in the morning were dead within a day. The infected struggled to breathe. They turned blue from the lack of oxygen. Many were too weak to move and died in their beds, sometimes not even seen by a doctor or nurse. Doctors and nurses died along with them.

The virus tore through so many cities and towns that many were closed to visitors or people trying to get home. Bodies piled up in homes and hospitals, because there was no one to move them, no one to bury them.

There were no vaccines, no antibiotics. Those who fell ill were at the virus' mercy. Most developed either viral or bacterial pneumonia. Their noses and ears bled. Sometimes blood spurted from their mouths.

The story of the pandemic is gruesomely detailed in John M. Barry's "The Great Influenza."

The influenza strain may have begun in Haskell County, Kansas in January and February of 1918. Some people, especially young adults, were getting sick. Barry talks about Loring Miner, a local physician who treated a number of patients.

He became concerned about the virulence and the severity with which people were falling ill. He diagnosed the disease as influenza. But it was an influenza he had never seen before.

"This was violent, rapid in its progress throughout the body, sometimes lethal," Barry wrote. "This influenza killed. Soon dozens of his patients - the strongest, the healthiest, the most robust people in the county - were being struck down as suddenly as if they had been shot."

But by March 1918, the virus seemed to have disappeared. It was a brief respite. The United States was embroiled in World War I. Military personnel were packed into trains and ships and sent elsewhere around the world.

Soldiers in the Kansas area were soon sent to Camp Funston, a military quarters with roughly 56,000 troops. Eleven hundred fell ill with influenza, but only 38 died. Some of the troop ended up in bases around the United States and in Europe. But the virus was only biding its time.

What happened at Camp Devens, northwest of Boston is a case in point. Although some men had sickened with influenza, at first no attempt was made to quarantine cases. The number of pneumonia cases began to rise alarmingly. And it was no ordinary pneumonia. Doctors and nurses could not keep up with the number of very sick patients.

The Camp Devens hospital had been designed to hold 1,200 patients. But when the cases began to multiply, the hospital had more than 6,000.

"Blood was everywhere, on linens, clothes, pouring out of some men's nostrils and even ears, while others coughed it up," Barry wrote. "Many of the soldiers, boys in their teens, men in their twenties, healthy, normal ruddy men - were turning blue. Their color would prove a deadly indicator."

Then came Philadelphia, which was already inundated with workers involved in the war effort. Housing was scarce. The political machine then in place and even newspapers downplayed the dangers, at first.

But at the height of the pandemic, every bed in each of the city's 31 hospitals was filled and people started to die. Eventually all schools, churches, theaters, saloons, federal, municipal and state courts were closed. And still the Philadelphia deaths continued.

There was no place to bury the bodies, no one to bury them and a shortage of coffins.

"In Philadelphia...fear came and stayed," Barry wrote. "Death could come from anyone, anytime. People moved away from others on the sidewalk, avoided conversation; if they did speak, they turned their faces away to avoid the other person's breathing. People became isolated, increasing the fear."

Doctors frantically worked to develop a vaccine against the deadly virus. But it was not enough for the many who were already ill.

On Oct. 10, 1918, 759 Philadelphians died, far above the weekly count of 485 a week. During the week of Oct. 16, 4,597 residents in the city died. Many volunteers who had offered to help those who were ill, or bury bodies, fled from the scene out of fear.

And what was happening in Philadelphia was happening all over in other cities and towns around the United States and in most of the world. Some towns banned visitors from stores. Visitors would shout their orders and store employees would heave the orders out into the street.

In Newark, New Jersey the epidemic was well underway when health officials began to realize how deadly it was, according to the Influenza Encyclopedia. More than 29,000 residents were infected and almost 2,200 died of the disease and its complications.

The state Department of Health ordered all businesses, churches and public gatherings closed. Mayor Charles P. Gillen was not happy. On Oct. 12, 1918, Gillen lifted the ban, despite the fact that the number of deaths hit a high the week before.

Gillen also issued an order to allow saloons to stay open to they could continue to sell liquor for "medicinal purposes, the Influenza Encyclopedia states.

Pandemics happen when a new and virulent influenza virus, unknown to the human immune system, infects a population, then spreads worldwide, according to an article Barry wrote in smithsonian.com.

"Ordinary seasonal influenza viruses normally bind only to cells in the upper respiratory tract—the nose and throat—which is why they transmit easily," he wrote. "The 1918 pandemic virus infected cells in the upper respiratory tract, transmitting easily, but also deep in the lungs, damaging tissue and often leading to viral as well as bacterial pneumonias.

The virus, brewing in many crowded U.S military installations, spread worldwide. In the United States the East and the South were the hardest hit, much harder than the West Coast. Only Australia seemed to have escaped, primarily due to a strict quarantine of incoming ships. By late November, the deadly second phase was coming to an end.

But the third, less deadly wave, would stretch out into 1919 and 1920. President Woodrow Wilson was one of its victims and was sick for weeks.

"Only in the next few years did it finally fade away in both the United States and the world," Barry wrote. "It did not disappear. It continued to attack but with far less virulence, partly because the virus mutated toward its mean... partly because people's immune systems adjusted. But it left a legacy."

No one will ever know exactly how many people perished in the pandemic.

Record keeping was spotty in many countries and many could not keep pace with the disease. The best estimates range from 50 million to 100 million. In the United States, 675,000 are estimated to have died.

Photos: Smithsonian.com, National Archives