How a deadly influenza virus infected a world still recovering from the Great War
On a crisp morning in spring 1918, dawn breaks over the small French town of Étaples. War wages on the Western Front. A young soldier lies in sweat-drenched linen, gasping for air between coughing fits as foaming bodily fluids stream from his nose and mouth. His face is ashen grey, mottled with deep red, and his body convulses in a futile attempt to clear his lungs. Unwittingly, he sprays half a million viruses into the cramped military hospital. His body is under biological siege and after a short, excruciating battle, he draws his last breaths, succumbing to a mystery disease that will soon claim the lives of up to 100 million people worldwide.
Scenes reminiscent of the Black Death would play out across Europe and the United States before spreading across the globe. The soldiers on the frontline of World War I were unaware of the invisible invader thriving deep in the rat-infested trenches that would cause the most devastating epidemic in modern history.
The first wave of Spanish flu broke out in
France in 1918, sweeping across Europe while a simultaneous outbreak cropped up in North America. It spread fast, thriving in the poor sanitation of the battlefront, travelling with the battalions. When the guns fell silent after Armistice Day, soldiers returned home to their loved ones, unwittingly carrying the deadly microbe even further afield.
A second wave of the pandemic spread across China, India, Japan and the rest of Asia before making a return appearance in the United States. There was still more to mourn as the final wave of this great plague hit from January to June 1919, focusing its strengths on the areas that had been hit by the first wave and rarely touching the places afflicted by the aggressive second wave.
The 1918 influenza strain was unlike any other. It attacked the healthiest and strongest through a fatal chain reaction that triggered an unfathomable immune response. This flu subverted the immune system and used its strength to destroy the healthy tissue of vital organs. Individuals with poorer immune systems were spared by this overreaction of the body, while everyone else was bombarded with an attack from the virus and immune response instead.
Influenza can leave sufferers bedridden for weeks as the fever, joint pain and lethargy foreshadow the nastier symptoms yet to come.
The virus’ incredible success to plague our species comes from its remarkable ability to reshuffle its genes into new patterns, so it can invade unrecognised by the human body, making it virtually unstoppable.
The flu becomes more dangerous when it infects animals, where it can mutate to include more deadly genes, and it is this survival mechanism that has caused large-scale pandemics throughout history, including the Asian flu of 1957 and the Hong Kong flu of 1986. These pandemics have mostly arisen from disease hot spots where animals and humans live in close proximity, and scientists have little doubt the Spanish flu began in the same way.
At the time of the outbreak, there was hysteria as people blamed mustard gas and the squalor of the trenches, while burgeoning suspicions were fostered against the German U-boats — had they deployed biological warfare? But as Spanish flu penetrated further into Europe, it became clear that it was a devastating disease, although there were few reports about it.
While the British Empire and Allied nations had been placed under wartime censorship, Spain’s neutrality allowed relatively free reporting, leading to the false understanding that it was hit first.
This led to the disease’s nickname, Spanish flu. Though there is some contention surrounding the outbreak’s origins, there is a consensus that it didn’t start in Spain. Instead, there are two likely sources — France and the United States.
The site of the first confirmed outbreak was at Camp Funston in Fort Riley, Kansas, a US Army camp that was preparing American troops for battle across the ocean in Europe. The first victim was Private Albert Gitchell, who was diagnosed on 11 March 1918, and within days, over 500 men at the camp had reported sick. This was considered the source of the outbreak for decades and it had been expected that when the US became involved in the war, they brought the killer virus back home from Europe. But this hypothesis changed when Dr John Oxford, a British expert on influenza, identified the French military base in Étaples as the pandemic’s source.
This overcrowded major troop staging and hospital camp on the Western Front provided the perfect breeding ground for a killer virus.
The soldiers alternated every few weeks between the festering trenches before retreating to the military camps to rest in close contact with chickens and ducks. In late 1917, military pathologists reported the onset of a new disease with high mortality — which would later be recognised as Spanish flu — among the 100,000 soldiers that who were frequently passing through the encampment. Additionally, Dr Oxford’s team revealed a part of the story that had been lost in the historical narrative of the Great War — even before America’s involvement, doctors and nurses from the US were enlisted and were free to visit home. It is this movement he attributes to the almost simultaneous outbreaks at Fort Riley and Étaples.
The conflict had seen soldiers drafted from every corner of the British Empire and as war waged in the trenches of the Western Front, they needed yet more manpower. Soldiers answered the call for arms from Australia, the Caribbean, Pakistan and beyond. The disease then swept through the world in a second deadlier wave, facilitated by the jubilant servicemen returning home. It destroyed families and bought entire civilisations to their knees. Funeral homes were overwhelmed and bodies were piling up outside. Mass graves were being dug and some corpses were thrown into the ocean. In Punjab, streets were littered with uncollected bodies and trains were stopped to be cleared of the dead and dying.
In desperation, some Subarctic communities allegedly had no other option than to line the tops of the roofs of their houses with the bodies of loved ones as they were unable to dig into the frozen ground and didn’t want wild animals to drag the carcasses into the wilderness. The Moravian Mission reported that in Okak, Labrador, where only about 50 people survived from a population of roughly 266, huskies feasting on the bodies of the dead attacked an orphan child, who had been left to fend for herself.
Many who managed to survive the virus perished from starvation or hypothermia instead, when they were too weak to get water or stoke their fires. The workforce became weak and businesses, including postal and garbage disposal services, shut down. Almost every nation had makeshift morgues with hundreds of corpses. Some cities marked their doorways to show that someone had died. In Toronto, they used a white sash for children, grey for the middle-aged and purple for senior citizens.
Hearses carrying bodies through the streets became familiar sights, and anxious citizens stuffed cotton with camphor or adorned themselves with moth ball necklaces. Others sipped violet-leaf tea or warm milk and ginger, or would fumigate their houses with hot coals and sulphur. The desperate attempts to ward off the virus were futile. By November 1918, the outbreak had reached the remote town of Brevig Mission, Alaska, killing every adult. It only spared a few children and teenagers.
With no established cause for the disease that was killing people overnight, and with medical professionals contending with only rudimentary scientific knowledge on the pathogen they were confronting, countries frantically fought back against the virus in any way they could. New Zealand purportedly began exterminating rodents, while towns in England poured disinfectant into the street gutters. The United States began fumigating areas with potent concoctions of coal, tar and formaldehyde, and newspapers printed warnings about breathing in fresh air and to avoid close contact with other people.
People began to communicate more by phone and post but even letters may have been baked in a hot oven before they were opened to kill the bacteria. Telephone installers took to dipping cheesecloth in formaldehyde to cover their nose and mouth. The Australian and American governments mandated masks to prevent the spread but they did nothing against the virus. There was little the world could do other than to wait for it to run its course.
The deadly strain of influenza disappeared as fast as it had started but survivors were not left without scars. Many of those who recovered also suffered physically crippling involuntary jerks, spasms and catatonia caused by brain inflammation. Scientists believe that the so-called ‘Spanish Lady’ had become a victim of her own success, leaving only the immune or dead in the wake of her destructive path.
With few new hosts to infect, the virus evolved again into a much less deadly strain — an ancestor of the flu we battle today. Many details of the greatest medical tragedy will be forever lost to history, misplaced in the shadow of the Great War, but we can only hope to prepare ourselves for the day pandemic influenza strikes again.
A poster offering public health tips in Washington, DC A London double-decker bus is sprayed with disinfectant
Japanese schoolgirls wear face masks in an attempt to stave off the influenza
The flu that killed nearly 100 million people across the world