SYMHC Classics: The Flu Epidemic of 1918

This 2014 episode coverts he 1918 Spanish flu epidemic, which killed somewhere between 20 million and 50 million people. Nobody cured it, or really successfully treated it. A fifth of the people in the world got the flu during the pandemic.

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Episode Transcript

Speaker 1 (00:02):
Happy Saturday, everybody. Over the last few weeks, we have
understandably gotten several requests to talk about the nineteen eighteen
flu pandemic. That is a topic we covered back on
May twelve, and we are re airing it today. We
gotta make a couple of clarifications. In this episode. We
say that public health officials recommended that people wear masks

(00:24):
to protect them from contracting the disease, and that this
was completely ineffective. That is true, but we should note
that if a person is ill, the right mask worn't
correctly can help them from infecting other people. Also, from
time to time, folks who find this old episode in
the archived have written in to say that the pandemic
starting point was in Fort Riley, Kansas. That is one

(00:47):
of the potential starting points for this pandemic, but there
are other possibilities as well, which are discussed in the
episode Welcome to Stuff You Missed in History Class production
of My Heart Radio. Hello, and welcome to the podcast.

(01:10):
I'm Tracy V. Wilson and I'm Holly Fry and Holly
so we don't normally start out with corrections. Very first
thing that I need to do that today, Okay, So
you remember our our pig war episode where we talked about, uh,
you know, a war that almost happened because of a
pig I do. I accidentally said in that episode that

(01:31):
somebody traveled via the Panama Canal to get out to
that part of the world. Ye, so that was wrong.
It was a little whoopsie daisy. That was yes, that
was my source said via Panama, and my dumb brain
just filled in the part that says canal there. The
canal did not exist yet. I'm very sorry. Please stop

(01:53):
emailing us about here's what I'm saying. If that's the
worst crime you commit, I think we're in pretty good hands.
I know. I think this is maybe like that was
maybe the second hugest, most email generating error in the podcast.
And I'm not even going to mention what the other
wood was because we haven't gotten a message about it
and maybe six months, and it's from years before we

(02:14):
came on the show, like you're still getting corrections about
it when we started. So yes, I am so sorry
that I auto completed something that was not built yet
in the world. Uh. And I'll try not to do
that again. And today we're gonna talk about something completely different, Yes,
so just not long ago at all. We asked on
Facebook for people to tell us some ideas of things

(02:36):
that they wanted to talk about that were events in history,
because we have lots of episodes about people, and some
people prefer events, and for whatever reason, whatever I sit
down to do the podcast, my brain turns up people
a lot of because to you so weird. Even if
I try to pick a subject that is not a
people and is an event eventually sort of as the

(02:59):
notes and the plotline or kind of playing out as
I'm doing my research, it almost always had the focusing
on one particular person that was part of it. I
don't know if that's just some sort of brain situation
that it wants to focus on one smaller piece or what,
but it happens. It's tricky to pick an event and
not do that for me. Well, conveniently, the event that

(03:19):
people asked for the absolute most was the wreck of
the Batavia, which at that point we had already recorded
and edited and it was just waiting to be published.
So that worked out really well. We delivered so quickly
without meeting to you. I know. We had a couple
of other things that were maybe not quite as much
as heavily requested at that one, but extremely frequently requested.

(03:39):
And one of them is what we're going to talk
about today, which is the so called Spanish flu epidemic
of nineteen eighteen and nineteen nineteen. So somewhere between twenty
million and fifty million people died of the flu during
this epidemic, which started just as World War One was
winding down. So a lot of our past episodes that

(04:00):
are about diseases are really about the people who saved
us from them. So like our smallpox episode is all
about Edward Jenner and his smallpox vaccine, and our tuberculosis
episode is all about Salmon Watsman and Albert shots and
the discovery of streptomycin, which was the first antibiotic that
could treat it. Sarah and Deblina's episode called Polio the

(04:23):
Dread Disease is also largely about the vaccines that have
nearly eradicated polio from the world, but the story of
the flu pandemic of eighteen and nineteen nineteen is not
that has a lot more in common with our episode
about encephalitis lethargica, which also happened right about the same
time the flu epidemic is probably why a disease that

(04:46):
was as crazy and terrifying as as encephalitis lethargic is
not a better known event in medical history. Uh. The
flu just completely overshadowed it because it killed so many people.
But like encephalita lethargica, the pandemic flu came and it went.
Nobody could treat it, nobody could cure it. A fifth
of the people in the world got the flu that

(05:10):
during the pandemic, and UH. Usually, while the typical flu
is hardest on elderly people and the very young, this
time it was deadliest among twenty year olds, and in
that age bracket. It was so lethal that in the
United States, for example, the average life expectancy dropped by
more than a decade just as a result of how

(05:31):
many people died from the flu, which is scary. I
feel like I should confess that I have this completely
unfounded fear that I will die of a random flu.
This is also why we are doing the episode now
and not at the height of flu season, as we're
exiting flu season. I mean, every time I get the flu,
my thought is this is the one that's gonna take

(05:54):
me down. So UM, hopefully I won't have any panic
attacks while we record. Yeah, I will keep my fingers.
So before we start, though, we should talk a little
bit about what the world of medicine and what public
health were like in nineteen eighteen. So in many parts
of the world, nations hadn't really standardized or regulated what

(06:15):
was required for a person to call themselves a doctor,
so people practiced medicine with all kinds of different credentials
or with no credentials, and patent medicines which really didn't
have any medical value. And we're mostly alcohol and ladana
most of the time, we're still pretty prevalent. There was
a lot of stuff floating around that was just not
legitimate for treating anything. And at this point, Alexander Fleming

(06:37):
had not yet discovered penicillin. That was still a decade away,
and its use as a drug was even further out
than that. So penicillin wouldn't have helped fight the flu,
since influenza is a virus and penicillin kills bacteria, but
it might have helped some of the people who wound
up with bacterial pneumonia after contracting the flu. And this

(06:58):
is more just to sort of point out a milestone
of where we were in medicine when this flu epidemic
was happening. Yeah, So, in spite of some of these
things that we think of as basics today, like requiring
people to be trained to call themselves doctors and antibiotics
and things like that, things had really advanced a lot
in the world of medicine over the past century. Before

(07:20):
the epidemics started. Most parts of the industrialized world at
this point had understood and accepted the germ theory of disease.
So at this point pretty much everyone was on the
same page in most places, uh that germs caused disease,
and doctors had also figured out exactly which germs caused
a number of diseases, including tuberculosis, malaria, and cholera. The

(07:44):
idea of a reportable disease are one so dangerous that
all cases of it needed to be reported to government
authorities also existed. But even though there had been another
serious flu epidemic a couple of decades before, influenza wasn't
really really portable in most places until this particular epidemic
had really gotten dire, and at that point it was

(08:06):
too late for warning the government to do really any good. Yeah,
what they already knew there was a big problem. By
the time people were able to start saying, hey, there's
a big problem, vaccines also existed. There was a vaccine
for smallpox, there was a vaccine for rabies. Other vaccines
were also in the works, and people really thought as

(08:27):
the as the epidemic got going that a vaccine for
the flu was just around the corner. As we talked
about in the Encephalitis lethargica episode, though, figuring out how
to make a vaccine for a disease when you don't
know what's causing the disease is really hard, and not
only did doctors not know what was causing the flu,
they also had it panned on a completely different germ.

(08:50):
They thought it had a totally different cause than it
really did have. So at the start of the epidemic,
the purported culprit for the flu was a bacterium that
had been named Fifer's basilius after its discoverer, who was
a German scientist named Robert Friedrich Pfeiffer, and he made
the connection between his Baxillus and the flu, but he
hadn't really proved this connection, and as the epidemic war on,

(09:13):
it became abundantly clear that Phifer was wrong. The baxillus
he discovered was not present in sick patients, and deliberately
exposing people to it didn't give them the flu. So
even though an international team was dedicated to trying to
create a vaccine, none of their work proved effective, and
at first they were after the wrong germ, and then

(09:34):
they didn't have a good starting point. So all of
this together combines to mean that when the flu turned
really deadly in nineteen eighteen, there was not much that
legitimate doctors could do for their patients besides to keep
them in bed and keep them as fed and hydrated
and comfortable as possible. The most most of the things
that had any efficacy at all were about prevention, which

(09:56):
basically involved keeping the sick people quarantined and trying to
educate people about how to keep themselves from being exposed.
And doctors knew that the flu was spread by coughing
and sneezing, so they gave the common sense advice about
covering your nose and mouth and staying away from people
who were coughing and sneezing. Oh and also telling people
not to spit on the ground, so don't spit on

(10:18):
the ground, please. You know, their debates over whether that's
a civil way to behave in general. But uh, sick
people don't spread no spitting. It's gross and it spreads illness.
So there were also a lot of public health campaigns
that were trying to get people who were sick to

(10:38):
stay at home, which probably sounds kind of familiar to
when there's a big flu outbreak today. Uh. They especially,
we're trying to educate people who were sick to get
them to stay away from crowds. And businesses got in
on the deal to trying to warn people who were
ill to go home. So a sign at one theater
in Chicago read, influenza frequently complicated with pneumonia is prevalent

(11:04):
at this time throughout America. This theater is cooperating with
the Department of Health. You must do the same. If
you have a cold and are coughing and sneezing, do
not enter this theater. And then in all capital letters,
go home and go to bed until you are well.
That seems wise. Not all of the advice on prevention

(11:25):
was sound, though. Many people in public health recommended that
people wear masks, and some places even required that masks
be worn by law, but this was in fact not effective. Yeah,
masks are kind of effective when there's bacteria involved, but
when it's a virus, the viruses are just too small.

(11:46):
Before we get into how this disease spread and where
it was first reported and all that, let's take a
brief moment for a word from a sponsor, So back
to exactly what happened when this disease made its debut.

(12:09):
The first reports of flu in this pandemic came in
May of nineteen eighteen in Europe, and the first reports
were amongst soldiers, so large numbers of otherwise healthy young
troops were just becoming really ill with flu like symptoms.
So they were getting coughing and sneezing and body aches.
Most of them were recovering within a few days, and
apart from the fact that this was disrupting a war,

(12:31):
it was not a really big deal. But then the
disease jumped from the military to civilians in Europe, and
from there it spread to most of the rest of
the world over the course of just a couple of months.
It was still a relatively mild disease, much like the
seasonal flu. Most of us have had at one time
or another in our lives. It wasn't pleasant, but it
was also not especially alarming. This disease faded away later

(12:55):
in the summer, but then in August it mutated and
became really a lot more serious. This terrifying strain of
the flu was reported in Boston, Massachusetts, in the United States,
in Freetown, Sierra Leone, and then Breast, France. And these
were all ports cities, so it's possible that the disease
had spread between three of them on ships, and this time,

(13:17):
along with the typical flu symptoms of coughing and sneezing
and a sore throat and body aches, the disease caused
very high fevers between a hundred and two and a
hundred five degrees Fahrenheim. Patients felt exhausted and their eyes
became bloodshot, and some even had severe nosebleeds or gastro
intestinal problems. Even though this flu was a lot worse

(13:39):
from the flu that had spread earlier in the spring,
a lot of people still recovered, but a pretty substantial
portion of people developed a devastating pneumonia, which was caused
by one of a number of bacteria. It was a
secondary infection that was like a complication of this flu.
Their lungs filled up with fluid and started hemorrhaging, and
death often came alarmingly fast, with people going from sitting

(14:02):
upright and talking to being dead within hours. See these
are the stories that make me paranoid about the flu.
This is this is why I read an article when
I was working on this about that episode of the
about the flu pandemic that was in the Down n
Abbey TV show. Yeah, so spoiler alert for Down n Abbey.
It's similarly, uh, make some people in the household really

(14:24):
really sick, and it has one There's one particular character
who goes from being she's sick, She's has she has
the flu. She goes from I'm sick with the flu
two I'm dead end an episode which is not uncommon
for TV, but also was really how it worked. So
when doctors performed autopsies on these patients who had died,
they found that their lungs and their spleens were just

(14:46):
grotesquely swollen. So a description from a doctor who was
stationed at Fort Devan's outside Boston from that September, here's
what he had to say. This epidemic started about four
weeks ago and has developed so rapidly that the camp
is demoralized and all ordinary work is held up till
it has passed. These men start with what appears to

(15:09):
be an ordinary attack of la grippa or influenza, and
when brought to the hosp so abbreviation for hospital. When
brought to the hosp they very rapidly developed the most
viscus type of pneumonia that has ever been seen. Two
hours after admission they have the mahogany spots over the cheekbones,
and a few hours later you can begin to see

(15:30):
the cyanosis extending from their ears and spreading all over
the face, until it is hard to distinguish the colored
men from the white. It is only a matter of
a few hours then until death comes, and it is
simply a struggle for air until they suffocate. It is horrible.
One can stand to see one, two, or twenty men die,

(15:51):
but to see these poor devils dropping like flies sort
of gets on your nerves. We have been averaging about
one deaths per day and and still keeping it up.
There is no doubt in my mind that there is
a new mixed infection here. But what I don't know,
and from the port cities where this really started sort

(16:13):
of blossoming outward, the disease spread really rapidly over the
next couple of months. It's spread all over the world,
and then it too faded out, although another mild wave
of flu went on around early nine It's hard to
pinpoint exactly how many people died during the pandemic. Medical

(16:34):
records from the era were already kind of sketchy even
before you threw a devastating pandemic into the mix. To
make things even more chaotic, doctors often misdiagnosed milder forms
of the flu is common colds, and sometimes they diagnosed
this much more serious version as another disease entirely like cholera.
The disease also moved so quickly that public health agencies

(16:56):
could not accurately track what was happening. So in the
decade after the pandemic, the estimated global death toll was
twenty million people, but modern researchers who have gone back
and tried to reconstruct things have marked the number as
much higher, Between thirty million and fifty million people died worldwide,

(17:17):
So that sort of leaves us to wonder why this
particular flu was so incredibly bad. Uh. We know that
the war often takes a giant share of the blame
for the spread of the flu pandemic, And it's definitely
true that the flu followed the troops and that it
spread like wildfire amongst soldiers in close quarters, and the
soldiers returning home from the war brought the disease with them.

(17:38):
Battlefield injuries and other illnesses also made it harder for
soldiers to fight off the flu, so camps for the
war were basically like flu incubators. It's also definitely true
that the war meant that a lot of the medical
personnel who were trained at the time had been tasked
to help with the military, and so they were not
available to help the civilian population. As the epidemics started

(18:01):
to spread, communities in more rural areas asked their various
government organizations to please send doctors and nurses to help them,
but often the few who weren't part of the war
effort fell victim to the flu themselves while they were
traveling to their patients. But it really it wasn't just
about the soldiers or the effects of the war. Even

(18:22):
if the epidemic had happened during peacetime. Hospitals just wouldn't
have been able to handle the influx of so many patients.
Temporary hospitals had to be built in churches and schools
and community centers, and some hospitals even expanded their capacity
by housing their patients intents on hospital grounds. And the
way of life in the late nineteen teens also played

(18:44):
a big role in the spread of the disease. Cars
were not in widespread use at this point, and many
larger cities around the world had developed extensive public transportation systems,
so that was bringing sick and healthy people into contact
with each other on street cars, on trolleys, and on subways.
And several parts of the world people were also traveling
really extensively by train, so, for example, in the United States,

(19:07):
train travel peaked in nineteen twenty, just a year after
the epidemic, and these long trips in close quarters similarly,
UH fueled the spread of the disease. Some of the
most popular leisure activities in nineteen eighteen and nineteen nineteen
also drew big crowds. So movie theaters had become affordable,

(19:27):
they were extremely popular, and they were very widespread. They
were everywhere, and that made them a hotbed of infection. UH.
There were also dance halls and amusement parks, and in
many places governments restricted activities or shut them down entirely
to try to keep people from gathering. Some towns even
canceled school UH and canceled church services, and universities suspended

(19:50):
their operations in an effort to just sort of stop
this spread that was going on everywhere people gathered. Cities
also shut down or restricted their public transport Asian systems
that were at this point so popular, and drivers, either
with their city's authority or acting on their own, would
refuse to carry passengers who weren't wearing masks or who
they suspected to be ill. And although all of these

(20:12):
factors have been about industry, people in rural and developing
areas were not spared in the least in the United States,
the Eskimo population was disproportionately hit with the flu, and
in rural and developing areas, people were left with no
medical care and very little reliable information about what was
actually going on or what they could possibly do about it.

(20:35):
The lore, which took so much of the blame for
spreading the disease wound up ultimately killing sixty million people,
but that number was just dwarfed by the total death
toll from the flu. So before we talk about the
aftermath of of this devastation, let's take another brief moment
and have a word from a sponsor, so to to

(21:03):
get back to the aftermath of this this flu pandemic.
On top of the astounding loss of life, the flu
pandemic had a lot of economic and social impacts. So
many people were sick that public and municipal services completely
shut down because there was nobody left to do the work.
Garbage was piling up in the streets in cities were

(21:25):
sanitation workers were particularly hard hit. Telegraph systems failed when
there were not enough operators that were healthy enough to
come into work. Kind of reminds me of stories about
the Black Death and how so many people would die
that there was no one left to bury them. Yeah,
small businesses went bankrupt because their proprietors became too sick
to work or they died. And then insurance companies also

(21:47):
went bankrupt because their incoming claims skyrocketed. If trains were
found to have sick people aboard stations along the routes
would actually forbid them from stopping, so even the ones
that we're working were subject to some you know, limitation then,
and then that trickled down with its own effects of
people not being able to get to where they needed
to go. The public was also often really genuinely panicked,

(22:11):
and governments took steps to try to maintain calm, including
trying to filter or suppress information about the pandemic. So
the telegraph was one of the primary modes of communication
at this point. The telephone had been invented, but it
was still extremely expensive, not at all prevalent in places
that weren't very affluent or places that were rural, so

(22:31):
a lot of people were relying completely on the telegraph
to communicate with people over long distances. Telegraphs ran on
a network of human operators who were privy to everything
that was being transmitted because they were the ones that
were sending out the codes. So in the United States,
for example, the Public Health Service gave all of its
officers codebooks to use anytime they were sending information about

(22:53):
the pandemic. So the tele the telegraph operators wouldn't be
able to figure out what was being said and go
spread an alarm among other people, and once it was
all over, perhaps because it had been so terrifying, and
perhaps because it came on the heels of a war
that had stretched on for years, most people really just
seemed to want to forget that the whole thing had happened,

(23:15):
and so for a long time, research into its cause
and its progression were actually quite minimal. In October of
nineteen eighteen, so as the epidemic was still going on,
doctors began to correctly theorize that the flu was caused
by a virus and not a bacteria, But influenza A
virus wasn't isolated until many years later, in nineteen thirty three.

(23:38):
Influenza A is what causes most epidemic strains of the
flu to other types. Influenza B and C weren't isolated
until nineteen forty and nineteen fifty, respectively, and the vaccine
didn't come around until nineteen forty four. And because the
flu mutates every year, the vaccine has to change every
year to keep up. This is why the vaccine provides

(23:59):
better action some years than others, because some years it's
just a better match to what's actually happening, and it
keeps up with the mutation right. Other, although less deadly
pandemics also followed in nineteen fifty seven and fifty eight,
and then again in nineteen sixty eight and sixty nine.
There was also the H one and one swine flu

(24:19):
pandemic in two thousand nine, and other flu seasons have
also had the potential to turn into pandemic flu, but
ultimately didn't. Scientists continue to study the nineteen eighteen nineteen
nineteen pandemic to try to figure out exactly what made
it so bad in the hopes of preventing another UH
similar situation in the future. They've done things like tried

(24:42):
to reverse engineer the genes of the nineteen eighteen version
of the flu and try to figure out what modern
drugs might be effective against something like that. In two
thousand five, researchers sequenced the genome of the flu virus.
They used samples from the body of an Inuit woman
who had been buried in a mass grave after the
flu killed nine of her village, and according to this research,

(25:05):
the flu came from an H one and one avian virus.
The sort of scientific verdict since then has flipped back
and forth a little about whether the pandemic flu came
from an avian or a swine origin, And then in
February of UH, an article published in the journal Nature
put the primary theory back to being an avian origin.

(25:28):
In January of historian Mark Humphreys published a paper in
the journal War in History theorizing a potential cause for
the pandemic. During World War One, ninety six thousand Chinese
workers were transported by rail to work on the Western Front.
He found medical records describing a respiratory virus that broke
out in southern China the year before, one that Chinese

(25:51):
officials later said was identical to the so called Spanish flu.
About three thousand of the workers were quarantined with flu
like symptom. Racist doctors called the sick workers lazy and
then sent them back to their camps. And at the
time of his papers publication, he was waiting on test
results from samples for confirmation. Yeah, this is one of

(26:12):
those things where, at least according to everything that I
was reading about it, UH, tests should confirm this theory.
But at this point a lot of people are like, yeah,
that makes a lot of sense. Um, So obviously that
means that this had nothing really to do with Spain.
We've left this for the end that the name Spanish
flu only came about because Spain's press was uncensored at

(26:36):
the time, so most of the earliest information that people
got about the illness came from Spain, where people weren't
restricting the information that was published about it. So it
really got its unfortunate uh association, just by the fact
that they were the most informative and they were really
there being the least obfuscating about what was happening. So, yeah,

(27:01):
this whole story is really alarming to me. I have,
or I had when I was young. I had a
living great grandfather who was born in nine and so
things didn't seem like they were in the distant past
to me until they had happened before he had been born.
So when I was little, the fact that this whole

(27:23):
thing had happened while he was alive, I was like,
this could happen again right now because that is in
the extremely recent past. And now as an adult, I
still think this could really happen again right now, But
it's not because of like the state of medical knowledge
is just because viruses can be terrifying. Yeah, like I said,
I have a completely irrational level of fear of the flu.

(27:48):
I don't know why. I don't know where that came from.
It's just it's irrational. Exercise caution, Wash'd say my level
of fear of it is irrational. Okay, that that maybe
maybe I could say this thing I won't overshare. But
last week I had a brief visit from food poisoning,
and I immediately my brain started whirling with that, Oh
my gosh, no, what if this is some really terrible

(28:10):
version of the flu and I will be patient zero.
It's irrational. Yeah, I think the thing that's made me
most afraid of illnesses like this is a game that
I've played on the iPad called Plague Incorporated, where basically
you try to make your plague kill everyone in the world,
and like, there's there are ways you can do it

(28:30):
where it just basically spreads silently among everyone and then
it turns completely deadly. And whenever I see that happen,
I'm like that that could happen. It could really happen.
I like how your entertainment choices are reinforcing your fears.
That's really good. Sometimes that's what happens. Yes, thank you

(28:51):
so much. For joining us today for this Saturday classic.
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(29:13):
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