America's Forgotten Pandemic : The Influenza of 1918
Author:
Genres: History, Medicine, Medical Books
Book Type: Paperback
Author:
Genres: History, Medicine, Medical Books
Book Type: Paperback
See, kids, this is why we need history.
It's also a devastating example of what happens when we fail to recall it, or learn from it. As said George Santayana, "Those who cannot remember the past are condemned to repeat it" ("The Life of Reason: The Phases of Human Progress" (1905-1906), Vol. I, Reason in Common Sense). A similarly famous sentiment, perhaps because it's so accurate, goes like: "People will not look forward to posterity, who never look backward to their ancestors" (Edmund Burke, "Revolution in France"). What follows here is perhaps the most prototypical example in the last century.
I'm going to let Professor Alfred Crosby (1931-2018), sometimes referred to as "The Father of Environmental History," one of my all-time favorite scholars, speak for himself, as he did in the preface to this edition. Thirty years after this book was first published, it's become prophesy fulfilled. He writes as follows:
"When I wrote this book at the beginning of the 70s, its subject matter, the 1918 pandemic, seemed more of academic than immediate interest. Insofar as I could see 15 years ago, neither influenza nor any other disease was among humanity's greatest immediate dangers. War was still running free, but the other traditional killers, symbolized by the Horsemen of the Apocalypse, were under a tight rein, at least in the advanced societies. For instance, a person died of infection only if very young, very old, weakened by alcoholism or physical injury, or extremely unlucky. The loss of a 20-year-old to communicable disease in the US seemed as likely as his being hit by a falling tree.... Tuberculosis and polio were only bad memories for citizens of the advanced societies, and smallpox was well on its way to extinction everywhere. The characteristic sin of the time vis-a-vis public health and medical science was hubris.
"Now hubris had given way to anxiety. Seekers after Lyme disease need only don shorts and sandals and scuff through a New England or New York meadow; and of course we all quail before the world-wide pandemic of AIDS. Scientists know amazingly more about molecular biology, pathogens and immunology than they did 15 or 20 years ago, but the bad guys, the pathogens, particularly the newly recognized ones, seem to the general public to have become nastier faster than scientists have become smarter. Whatever may be the truth of that, it is certainly true that unthinking confidence in our public health officials and medical scientists is in sharp decline. Anyone still swelling with hubris simply has not been paying attention....
"The last such experience took place in 1918, when influenza killed tens of millions, rolling across continents and oceans so swiftly that public health institutions were still preparing for the onslaught after it had passed. That pandemic baffled science and reduced the experts to recommending mass adoption of ineffective gauze masks, and even to inoculating thousands with vaccines that were no better (and with luck, no worse) than useless. If we want to know how we react to calamitous surges of disease, we should take a look at the 1918 flu. And if we went to avoid a reprise of that ordeal, we should reexamine it, because we still do not know why it was as bad as it was."
Prophetic indeed.
Crosby was a historian in some respects generations ahead of his time - he was a groundbreaking scholar who utilized a multi-disciplinary approach well before it became fashionable, and now, even essential. His primary areas of research focused on the cultural and biological changes which occurred in the wake of the (re)discovery of the New World. Synthesizing methods from history, geography and biology, as I strive to do also in my own research, Crosby was a true pioneer in the field of interdisciplinary history. According to a New York Times article, his fascination with environmental history stemmed from a near-obsession with Christopher Columbus in boyhood, a still-much-revered figure during his upbringing in the 1930s and 40s.
As a result, Crosby realized early on the biological consequences of New-World, Old-World contact. As a result, his research spawned an entire sub-field based on what is now termed The Colombian Exchange. In a 2011 interview, he stated regarding this novel approach intended to fill what was then a gaping hole in scholarship: âWe were thinking politically and ideologically, but very rarely were historians thinking ecologically, biologically.âAs an environmental historian who studies ancient agriculture and resource use, Crosby has been one of my inspirations since I began my academic journey decades ago, now, not least on account of his writing style, which speaks to a far broader audience than the academic specialists who are the usual focus of these fields.
"America's Forgotten Pandemic" is still a technical academic monograph, but it is highly accessible to a more-than-typical general audience, even if it's somewhat statistic-heavy, another of Crosby's hallmarks. He has also been called a "demographic historian," for that reason, as data are also his forte. That doesn't entail pages and pages of charts and graphs, however; they're used herein rather sparingly, as Crosby has a great talent for making reams of data accessible as a comprehensive and intelligible narrative, which is an enviable talent. This book proceeds both chronologically and geographically, looking at the various waves and phases of the pandemic, as well as the responses, or, rather and often, the lack thereof, in particularly hard-hit areas, such as Philadelphia, the most devastated city in the nation, Chicago, and other densely-populated urban centers.
So, what was the Influenza Pandemic of 1918-1919? It's a forgotten pandemic no more, as it's been frequently referenced during the modern COVID-19 pandemic of the last three years. I often wonder what Crosby would have said about our present predicament, had he lived to see it. The 1918 pandemic was caused by an unusually deadly influenza virus, now identified as an H1N1 influenza A variant (rather than a coronavirus variant), which first appeared in the US in what appears to be March, 1918, in Kansas, with additional cases identified in France, Germany and the UK by April. Two years later, nearly a third of the global population, or half a billion people, had been infected.
It has been described as the deadliest pandemic in human history, at least in terms of numbers, if not percentages. That dubious distinction probably belongs to The Black Death, an outbreak of bubonic plague in the fourteenth century, which may have killed a third or more of the world's human population. As even in the modern day, death reporting during the Great Pandemic of 1918 was spotty and uncertain, however: even with modern technology, one of the primary criticisms of the current death toll has been that doctors are often less than accurate about who has died FROM COVID-19, or WITH it. The same was true a century ago, to an even greater extent, which the book admirably describes; as such, death estimates remain unknown, and controversial, but typically range from 17 to as high as 50 million; some wildly exaggerated estimates claim that the eventual death toll topped 100 million. In reality, the figure probably lies somewhere around 20 million, more than the entire death toll caused by WWI.
In essence, the Great Influenza epidemic was the result of a perfect storm of unfortunate factors, mostly as a result of the Great War. Propaganda czars on both sides concealed evidence of the deadly outbreak, other than in neutral Spain, whose reporters were free to publish accurate reports - hence the name, Spanish Influenza, although it certainly didn't start there, nor was it the epicenter. This strain had a particularly high mortality for young adults, rather than what is normally seen, that is, among the very young and very old. As in the present day, this virus triggered a cytokine storm, which devastated the immune systems of even young, healthy adults. Responsible for the appalling death toll were, again, a perfect storm of factors: wartime mobility and particularly overcrowding, malnourishment, poor hygiene and a lack of modern medicine, especially antibiotics, which is likely what kept the modern-day pandemic from being much worse. Modern drugs and ventilators are largely what has kept the death toll from being much higher.
As in the present day, however, once the virus became entrenched in the population, there was almost nothing to stop the spread. All efforts, including, again, the useless masking, closing of public places and businesses, and efforts at quarantining entire swaths of the population did absolutely nothing to stop it. What else hasn't changed? The ignorance and arrogance of impotent doktor-gods, was manifest for all to see: they devastatingly underestimated the danger of the disease, and, worse, their ability to contain it. "On the same day that flu was made reportable, the news broke that ... the director of the laboratories of the Phipps Institute of Philadelphia, had indicated the cause of Spanish influenza: Pfeiffer's bacillus [wrong]. This, the "Inquirer" stated, has 'armed the medical profession with absolute knowledge on which to base its campaign against this disease.'"
Even worse, others made proclamations in the vein of "with such confidence among medical men, why shouldn't the rest of the community go about what it considered the most pressing business of the day?" including a kickoff wartime parade which drew some 200,000 people into the Streets of Philadelphia - with lethal consequences. The case was similar in Chicago, where health officers dramatically underplayed the seriousness of the disease, with one even stating that "There is no special reason I know of to fear an outbreak of disease in our city," Chicago, because "we have the Spanish Influenza situation well in hand now," even before, as Crosby notes, the situation had really even developed. Philadelphia became the hardest-hit city in the nation, with Chicago and other major metropoleis not far behind. As in our present day, Philadelphia and other major cities shortly thereafter closed all schools, churches and other public gathering places - too little, too late.
The moral of the story is really in the preface. I wish that public health officials had read this book prior to the present pandemic, but not surprised that most probably hadn't. It was thought that something like this just couldn't happen in the present day, because modern medicine, including its reliance on an early warning monitoring-tracking system, had advanced to the degree that something like the pandemic a century ago just wasn't possible - see by way of example the gratefully short-lived and limited Ebola outbreak, which for the first time in history reached the United States... but we were wrong.
Diseases are, simply put, smarter than us, and some are more genius than others. I know it's kind of an old-fashioned notion that we can "learn lessons" from history... but, as in this case, we can't afford not to. Acknowledging what had failed in the past may have had a positive impact in the present. But, now, as then: too little, too late. Maybe we'll be better prepared, with less hubris, for the next go-round... because there will, without fail, be one.
It's also a devastating example of what happens when we fail to recall it, or learn from it. As said George Santayana, "Those who cannot remember the past are condemned to repeat it" ("The Life of Reason: The Phases of Human Progress" (1905-1906), Vol. I, Reason in Common Sense). A similarly famous sentiment, perhaps because it's so accurate, goes like: "People will not look forward to posterity, who never look backward to their ancestors" (Edmund Burke, "Revolution in France"). What follows here is perhaps the most prototypical example in the last century.
I'm going to let Professor Alfred Crosby (1931-2018), sometimes referred to as "The Father of Environmental History," one of my all-time favorite scholars, speak for himself, as he did in the preface to this edition. Thirty years after this book was first published, it's become prophesy fulfilled. He writes as follows:
"When I wrote this book at the beginning of the 70s, its subject matter, the 1918 pandemic, seemed more of academic than immediate interest. Insofar as I could see 15 years ago, neither influenza nor any other disease was among humanity's greatest immediate dangers. War was still running free, but the other traditional killers, symbolized by the Horsemen of the Apocalypse, were under a tight rein, at least in the advanced societies. For instance, a person died of infection only if very young, very old, weakened by alcoholism or physical injury, or extremely unlucky. The loss of a 20-year-old to communicable disease in the US seemed as likely as his being hit by a falling tree.... Tuberculosis and polio were only bad memories for citizens of the advanced societies, and smallpox was well on its way to extinction everywhere. The characteristic sin of the time vis-a-vis public health and medical science was hubris.
"Now hubris had given way to anxiety. Seekers after Lyme disease need only don shorts and sandals and scuff through a New England or New York meadow; and of course we all quail before the world-wide pandemic of AIDS. Scientists know amazingly more about molecular biology, pathogens and immunology than they did 15 or 20 years ago, but the bad guys, the pathogens, particularly the newly recognized ones, seem to the general public to have become nastier faster than scientists have become smarter. Whatever may be the truth of that, it is certainly true that unthinking confidence in our public health officials and medical scientists is in sharp decline. Anyone still swelling with hubris simply has not been paying attention....
"The last such experience took place in 1918, when influenza killed tens of millions, rolling across continents and oceans so swiftly that public health institutions were still preparing for the onslaught after it had passed. That pandemic baffled science and reduced the experts to recommending mass adoption of ineffective gauze masks, and even to inoculating thousands with vaccines that were no better (and with luck, no worse) than useless. If we want to know how we react to calamitous surges of disease, we should take a look at the 1918 flu. And if we went to avoid a reprise of that ordeal, we should reexamine it, because we still do not know why it was as bad as it was."
Prophetic indeed.
Crosby was a historian in some respects generations ahead of his time - he was a groundbreaking scholar who utilized a multi-disciplinary approach well before it became fashionable, and now, even essential. His primary areas of research focused on the cultural and biological changes which occurred in the wake of the (re)discovery of the New World. Synthesizing methods from history, geography and biology, as I strive to do also in my own research, Crosby was a true pioneer in the field of interdisciplinary history. According to a New York Times article, his fascination with environmental history stemmed from a near-obsession with Christopher Columbus in boyhood, a still-much-revered figure during his upbringing in the 1930s and 40s.
As a result, Crosby realized early on the biological consequences of New-World, Old-World contact. As a result, his research spawned an entire sub-field based on what is now termed The Colombian Exchange. In a 2011 interview, he stated regarding this novel approach intended to fill what was then a gaping hole in scholarship: âWe were thinking politically and ideologically, but very rarely were historians thinking ecologically, biologically.âAs an environmental historian who studies ancient agriculture and resource use, Crosby has been one of my inspirations since I began my academic journey decades ago, now, not least on account of his writing style, which speaks to a far broader audience than the academic specialists who are the usual focus of these fields.
"America's Forgotten Pandemic" is still a technical academic monograph, but it is highly accessible to a more-than-typical general audience, even if it's somewhat statistic-heavy, another of Crosby's hallmarks. He has also been called a "demographic historian," for that reason, as data are also his forte. That doesn't entail pages and pages of charts and graphs, however; they're used herein rather sparingly, as Crosby has a great talent for making reams of data accessible as a comprehensive and intelligible narrative, which is an enviable talent. This book proceeds both chronologically and geographically, looking at the various waves and phases of the pandemic, as well as the responses, or, rather and often, the lack thereof, in particularly hard-hit areas, such as Philadelphia, the most devastated city in the nation, Chicago, and other densely-populated urban centers.
So, what was the Influenza Pandemic of 1918-1919? It's a forgotten pandemic no more, as it's been frequently referenced during the modern COVID-19 pandemic of the last three years. I often wonder what Crosby would have said about our present predicament, had he lived to see it. The 1918 pandemic was caused by an unusually deadly influenza virus, now identified as an H1N1 influenza A variant (rather than a coronavirus variant), which first appeared in the US in what appears to be March, 1918, in Kansas, with additional cases identified in France, Germany and the UK by April. Two years later, nearly a third of the global population, or half a billion people, had been infected.
It has been described as the deadliest pandemic in human history, at least in terms of numbers, if not percentages. That dubious distinction probably belongs to The Black Death, an outbreak of bubonic plague in the fourteenth century, which may have killed a third or more of the world's human population. As even in the modern day, death reporting during the Great Pandemic of 1918 was spotty and uncertain, however: even with modern technology, one of the primary criticisms of the current death toll has been that doctors are often less than accurate about who has died FROM COVID-19, or WITH it. The same was true a century ago, to an even greater extent, which the book admirably describes; as such, death estimates remain unknown, and controversial, but typically range from 17 to as high as 50 million; some wildly exaggerated estimates claim that the eventual death toll topped 100 million. In reality, the figure probably lies somewhere around 20 million, more than the entire death toll caused by WWI.
In essence, the Great Influenza epidemic was the result of a perfect storm of unfortunate factors, mostly as a result of the Great War. Propaganda czars on both sides concealed evidence of the deadly outbreak, other than in neutral Spain, whose reporters were free to publish accurate reports - hence the name, Spanish Influenza, although it certainly didn't start there, nor was it the epicenter. This strain had a particularly high mortality for young adults, rather than what is normally seen, that is, among the very young and very old. As in the present day, this virus triggered a cytokine storm, which devastated the immune systems of even young, healthy adults. Responsible for the appalling death toll were, again, a perfect storm of factors: wartime mobility and particularly overcrowding, malnourishment, poor hygiene and a lack of modern medicine, especially antibiotics, which is likely what kept the modern-day pandemic from being much worse. Modern drugs and ventilators are largely what has kept the death toll from being much higher.
As in the present day, however, once the virus became entrenched in the population, there was almost nothing to stop the spread. All efforts, including, again, the useless masking, closing of public places and businesses, and efforts at quarantining entire swaths of the population did absolutely nothing to stop it. What else hasn't changed? The ignorance and arrogance of impotent doktor-gods, was manifest for all to see: they devastatingly underestimated the danger of the disease, and, worse, their ability to contain it. "On the same day that flu was made reportable, the news broke that ... the director of the laboratories of the Phipps Institute of Philadelphia, had indicated the cause of Spanish influenza: Pfeiffer's bacillus [wrong]. This, the "Inquirer" stated, has 'armed the medical profession with absolute knowledge on which to base its campaign against this disease.'"
Even worse, others made proclamations in the vein of "with such confidence among medical men, why shouldn't the rest of the community go about what it considered the most pressing business of the day?" including a kickoff wartime parade which drew some 200,000 people into the Streets of Philadelphia - with lethal consequences. The case was similar in Chicago, where health officers dramatically underplayed the seriousness of the disease, with one even stating that "There is no special reason I know of to fear an outbreak of disease in our city," Chicago, because "we have the Spanish Influenza situation well in hand now," even before, as Crosby notes, the situation had really even developed. Philadelphia became the hardest-hit city in the nation, with Chicago and other major metropoleis not far behind. As in our present day, Philadelphia and other major cities shortly thereafter closed all schools, churches and other public gathering places - too little, too late.
The moral of the story is really in the preface. I wish that public health officials had read this book prior to the present pandemic, but not surprised that most probably hadn't. It was thought that something like this just couldn't happen in the present day, because modern medicine, including its reliance on an early warning monitoring-tracking system, had advanced to the degree that something like the pandemic a century ago just wasn't possible - see by way of example the gratefully short-lived and limited Ebola outbreak, which for the first time in history reached the United States... but we were wrong.
Diseases are, simply put, smarter than us, and some are more genius than others. I know it's kind of an old-fashioned notion that we can "learn lessons" from history... but, as in this case, we can't afford not to. Acknowledging what had failed in the past may have had a positive impact in the present. But, now, as then: too little, too late. Maybe we'll be better prepared, with less hubris, for the next go-round... because there will, without fail, be one.
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