The Invisible Enemy!

   

The spring of 1918 brought with it a steely resolve on the part of President Woodrow Wilson to bring the war to an end, either through negotiations or total victory in battle. This resolve sowed the seeds of increased involvement and more battle-related deaths and injuries. But a silent, invisible menace created a worldwide terror that, during the course of one year, killed more young people than were killed fighting in the war. That terror was the grippe, or the "Spanish flu.”

THE CHALLENGES OF INFLUENZA

The Spanish flu, or Influenza type A, is caused by a virus. Viruses aren't living organisms like germs, but are strands of RNA (ribonucleic acid), a substance that is composed of four separate chemicals. The only way viruses can live and reproduce is to attach to a living cell (known as a host), and use chemicals and enzymes in cells to reproduce. The virus becomes part of its host.

Because a virus is not a distinct organism, it can't be seen with a traditional microscope, and it can't be isolated and grown in a Petri dish like germs. Today, electron microscopes allow researchers to see viruses but in 1918, scientists did not have electron microscopes, and they did not have any way of discovering what they were dealing with.

A virus can change over time by "rearranging” its chemical composition. This is called "mutation.” Like a chef modifying a recipe to suit a customer's taste, a virus can become weaker, stronger or change so that it can move from one species of animal to another by changing its chemical "mix”. This makes it hard for organisms to create immunity to a virus. The body's immune system may be programmed to combat one form of a virus, but may not react to the "new recipe.”

Viruses become better at infecting their hosts through a process known as progression. The first animal infected with a viral strain may not get very sick. The virus then changes its chemical composition so that the next animal infected becomes sicker, or needs less exposure in order to get sick. After a number of progressions, humans or animals may only need to be exposed to a small amount of virus in order to get sick.

The flu virus is highly adaptable. Flu strains usually begin in populations of birds. They jump species and infect mammals. Hogs are very susceptible. Because hogs are domesticated and their bodies are similar to those of humans, the flu virus can jump from hogs to the human population.

Finally, flu itself is usually not deadly, but the damage that the virus does to human lungs makes it easy for disease-causing bacteria to enter and create another infection. The virus strips the protective cells from the surface of the throat and lungs, much like what happens when you skin your knee. This opens a door for other germs to come in. Strep throat and pneumonia are diseases that commonly occur after a person has had the flu.

PIECES OF THE PUZZLE

Flu virus spreads from person to person primarily through the air (coughing and sneezing). Using tools that an infected person has used and may have contaminated with saliva or nasal discharge can also spread it. Flu can even be transmitted by shaking hands. This means that for flu to spread, people need to be close to one another for long periods of time, and using the same tools. Several factors came together in 1918 like puzzle pieces that created these conditions in the United States, and helped spread the flu worldwide.

The initial wave of illness was identified in Haskell County, Kansas, an area of the country rich with agricultural production, including extensive hog and poultry operations.

Haskell County had several of its residents drafted and sent to Camp Funston (now knows as Fort Riley), an army base actively involved in training recruits for overseas service. Built to house 45000 soldiers, by spring Camp Funston was home to over 56000 men who were transferred after training to other bases both stateside and overseas. These men were packed into barracks closed tightly against the winter air, and shared linens and eating utensils in their common areas.

During this same time, factories in large cities such as Boston and Philadelphia were working overtime to produce goods essential to the war effort. The promise of steady jobs and good pay drew thousands of people from rural areas to the cities. There wasn't enough housing available for these newly arrived workers, so many factories offered employees a cot on-site. Employees double-bunked with coworkers in these facilities, one working while the other slept, sharing linens, washcloths and eating utensils. Apartment-dwellers did the same thing, one person sharing a one-room flat with another who worked a different shift.

The increases in population in cities created problems with basic cleanliness. Many apartments in Philadelphia, for instance, had no indoor plumbing and relied on outhouses. Laundry was done by hand in sinks or basins. Coal-fired furnaces spewed black, thick smoke and dust into the air, creating an irritant to lungs and sinuses unfamiliar to those from rural areas.

One final piece was a shortage of doctors and nurses in the United States. Medical personnel had been sent to war-torn Europe and Africa to help mend allied troops wounded in the war. US hospitals were either severely understaffed, staffed by older doctors who had not been trained in the latest scientific techniques or staffed by interns, who didn't have experience in treating disease.

THE PIECES COME TOGETHER

On March 4, 1918, the cook at Camp Funston reported to the camp's doctor with a fever, cough, and head and muscle aches. Within three weeks, over 1100 men fell ill with the flu, and of those, 237 developed pneumonia. Of those hospitalized, 37 men died from this initial wave of flu.

Although higher than expected, thirty seven deaths from the flu was not considered critical enough to stop soldiers from Camp Funston from being transferred to other bases in the United States and Europe. One destination for the soldiers trained at Camp Funston was Camp Devens, located thirty-five miles from Boston, Massachusetts.

Civilians coming from Boston made deliveries of food and other provisions to Camp Devens, and recruits were being deployed from the camp to bases in Europe, Georgia, Illinois and Louisiana, and to the shipyards in Philadelphia and Baltimore. In late August, two employees at Boston's Navy Radio School were hospitalized with severe flu; by the end of September, over 1,000 soldiers at Camp Devens were hospitalized and many others were sick, but not considered critical enough to hospitalize. Troop trains carried soldiers who had been exposed to the flu across the country, arriving with cars filled with feverish, coughing men. Many didn't survive the train ride. Autopsies revealed the men died from flu, combined with pneumonia.

City hospitals overflowed with soldiers and civilians alike. Retired nurses and doctors were called into service, and public health agencies recruited nurses to go house to house to help people too poor or too sick to get medical help. These well-intended efforts only served to spread the virus as nurses had to wash, feed and tend to sick families one after another.

The virus ultimately spread worldwide with two exceptions. After New Zealand received word of the flu pandemic, it closed all of its ports to incoming ships and created a nationwide quarantine. And an isolated tribe in New Guinea that rarely receives outside visitors was spared.

THE PANDEMIC ENDS

The flu virus ended quietly in 1920, after killing between 20 and 40 million people. Scientists believe the virus self-destructed, mutating from a lethal form into a mild form that was easily defeated in healthy people. Although many researchers have tried to isolate the exact strain that caused this pandemic, none have been successful. They can only assume it was an unusual mutation that occurred at a time when conditions for its transmission were perfect.

Could this kind of pandemic happen again? Luckily, technology and communication has improved greatly since World War I. Today, there are health agencies worldwide that track suspicious outbreaks of diseases and communicate with one another quickly over the Internet and by fax. Data and information on diseases are shared quickly, and tissue and blood samples can be flown overnight to testing laboratories. Even agricultural agencies, such as our USDA, make certain that hogs and poultry infected with swine and avian flu are destroyed before the virus mutates and infects humans. Medical technology allows physicians to diagnose viral infections such as the flu with blood tests, and we now have shots that help our bodies create immunity to the current flu strains that have been identified.

Secondly, there are public health laws today that prevent the kind of overcrowding in apartments that occurred during World War I. Communities have laws against too many people living in apartments and houses, and livestock such as hogs or chickens aren't allowed in cities.

Third, coal-fired furnaces are rare. Current heating technology uses electricity, propane or natural gas, and gives off less pollution. This makes it easier for people to breathe, and this makes them less susceptible to lung problems.

Finally, people in general are better educated about personal hygiene, and preventive measures such as hand washing, coughing and sneezing into a tissue and not going to school or work when sick are well known and widely practiced.

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