1918: A Study in How Disease Can Shape Public Policy
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I suppose the first I read of the Great Influenza was in the first few pages of the Charles Portis masterpiece True Grit. The book’s heroine, Mattie Ross, tells readers about Yarnell Poindexter, whom Mattie’s papa left at the farm to look after her mama and the family while he went to Fort Smith. Mattie and Yarnell “exchanged letters every Christmas until he passed away in the flu epidemic of 1918.”
Most people hadn’t heard a thing about the 1918 pandemic until 2020’s version of, if not the same thing, something similar.
But two new books in recent years offer some much-needed context. One is Laura Spinney’s 2018 book Pale Rider: The Spanish Flu of 1918 and How It Changed the World. The other is John Barry’s 2005 book The Great Influenza: The Story of the Deadliest Plague in History.
One thing that quickly becomes apparent from reading these books is that the numbers from the 1918 flu are startling.
Spinney writes, “The Spanish flu infected one in three people on earth, or 500 million human beings.” That’s an astounding number; however, as we are finding out, precise pandemic information is hard to come by.
The 1918–20 pandemic killed between 35 million and 100 million people worldwide and 675,000 in the United States. The current version has claimed over four hundred thousand souls worldwide. “Most of the death” in 1918, writes Ms. Spinney, “occurred in the thirteen weeks between mid-September and mid-December.” By the way, that thirteen-week period was the second wave.
The misnamed “war to end all wars,” World War I, was ending with 22 million deaths as its direct result. In Spinney’s view, the pandemic “influenced the course of the First World War,” and “ushered in universal healthcare.” Is it possible that the 2019–20 pandemic will push America to adopt the same?
Some of Today’s Reactions Recall 1918
If so, this wouldn’t be the only effect of the current pandemic that mirrors events past.
If you thought that President Trump’s touting of hydroxychloroquine was unusual (the drug is primarily prescribed for malaria), for example, Spanish flu sufferers in 1918 were overdosing on quinine, which although effective against malaria, displayed “no evidence that it worked for flu,” Spinney writes, “yet was prescribed in large doses.”
Many accounts have the influenza beginning in southwest Kansas, but the idea of the disease as the fault of foreigners nonetheless gained traction. Spain, for instance, had nothing to do with germinating the pandemic, but with the country not involved in World War I, the Spanish press freely reported on the outbreak, hence the name.
Indeed, American locals did plenty to spread the disease. In October 1918, the death rate in New York City was just short of four times the normal. Despite cases peaking in that month, President Woodrow Wilson led a Columbus Day parade down Fifth Avenue. Italians bore the brunt of the xenophobia, blamed not just for spreading the flu and polio, but “blamed for crime, alcoholism, communism and host of other social ills,” Spinney writes. Meanwhile, “TB became known as the ‘Jewish disease’ or the ‘tailors disease.’” The real problem was the overcrowding of tenements.
In his book The Great Influenza: The Story of the Deadliest Plague in History, historian John Barry tells of the Philadelphia Liberty Loan parade, which one observer said catapulted that city’s civilian population into an outbreak “assuming the type found in naval stations and cantonments.” Three days after the parade, the pandemic killed 117 people in a single day, Barry writes. “That number would double, triple, quadruple, quintuple, sextuple.” Barry provides the grisly facts. “Soon the daily death toll from influenza alone would exceed the city’s average weekly death toll from all cases—all illnesses, all accidents, all criminal acts combined.”
Philadelphia became the hottest of the hot spots, with a death rate of 7.92 times the normal in October 1918.
From a worldwide perspective, the 1918 influenza “killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty-four weeks than AIDS has killed in twenty-four years,” Barry writes.
Barry’s pandemic story highlights the career and power struggles between William Henry Welch (Skull and Cross Bones fraternity member), William Osler, William Crawford Gorgas, the Flexner brothers (Simon and Abraham), Victor Vaughn, the Rockefeller Institute, and the Carnegie Foundation.
The Flu, Woodrow Wilson, and the Treaty of Versailles
During the post–World War I peace talks in Paris, unlike his counterparts, Woodrow Wilson negotiated by himself, without aid of any kind. Everyone in his circle back home was ill, and the president suddenly fell ill at the conference. So suddenly that there was speculation that he had been poisoned.
Prior to his illness, Wilson had been prepared to walk out of the talks. Although he remained in Paris, for days he was too ill to participate. Finally he insisted that the talks continue in his bedroom. Others in Paris, including Herbert Hoover, Colonel Starling, and Chief Usher Irwin Hoover commented on the decline of Wilson’s mental acuity. Most bizarre was the president’s idea that his house was filled with French spies. By the afternoon Wilson couldn't remember what had happened in the morning. Lloyd George commented at the time of Wilson’s “nervous and spiritual breakdown in the middle of the conference.”
Ultimately Wilson, who had initially insisted on a “peace without victory,” capitulated to the French, Brits, and Italians. The treaty was harsh, and Wilson said, “If I were a German, I think I should never sign it.”
Most historians attribute Wilson’s health to a small stroke, but it’s more likely that he contracted the influenza. The result of Wilson’s failing health—harshness toward Germany—”helped create the economic hardship, nationalistic reaction, and political chaos that fostered the rise of Adolf Hitler,” Barry writes.
If pandemic histories provide any instruction, it’s likely contained in Welch’s frustrating prediction, made in 1920: “I think that this epidemic is likely to pass away and we are no more familiar with the control of the disease than we were in the epidemic of 1889. It is humiliating, but true.” Vaughn echoed Welch’s view, saying, “Never again allow me to say that medical science is on the verge of conquering disease.”
But that was a hundred years ago. Surely the medical community has figured pandemics out by now?
Don’t bet on it.