INTRODUCTION
THE PURPLE DEATH
I had a little bird,
Its name was Enza,
I opened up the window,
And in flew Enza.
—Children’s jump rope song, 1918
IT WAS 1918 in the Alaskan outback, far from the muddy, bloody trenches of the Great War raging across Europe. The town of Brevig Mission, on the remote Seward Peninsula, was about as far as you could travel at the time and still be in American territory. (Alaska was not yet a state.) The people of Brevig Mission didn’t have to worry about the tanks, bombs, airplanes, and mustard gas that were wreaking havoc in France and Belgium. The dangers of a world war meant little in this small fishing village near the Arctic Circle.
Then the native villagers were hit by a strange malady. It began simply enough with coughs and sore throats, followed by extremely high fevers. The villagers complained of severe headaches, pain behind their eyes, and excruciating muscle aches. Keeping food down was impossible—men, women, and children were vomiting uncontrollably. Soon the people of Brevig Mission were coughing blood and choking on their own mucus.
Five days later, seventy-two of the village’s eighty inhabitants were dead. Rescuers who eventually reached the Lutheran mission there found little more than bones and corpses, which had been ripped apart by starving dogs. In one igloo, they discovered three children huddled together in the midst of their dead family. Living on oatmeal, they had miraculously survived several days in the unheated ice hut.
The dead were buried in a mass grave dug from the frozen earth, or permafrost.
Elsewhere in Alaska, in places that could be reached only by boat or mushers in dogsleds, other rescue teams found many more horrific scenes. In the small fishing outpost of Micknick, a Red Cross medical team found thirty-eight adults and twelve children dead. Across the Naknek River, the team reached another village with a seafood cannery. In the “barabaras”—traditional Aleutian sod houses that are partially underground—they found twenty-two of the twenty-four adults there had died; a twenty-third death followed the next day. Many of the victims had bluish skin, the reason some people called the mysterious sickness the Purple Death.
“Numerous villages were found but no sign of life about,” the Red Cross team reported, “except for packs of half-starved, semi-wild dogs.” The report continued, “It was impossible to estimate the number of dead as the starving dogs had dug their way into many huts and devoured the dead, a few bones and clothing left to tell the story.”
The Purple Death was actually part of a great wave of influenza, a lethal virus that swept across America and around the world starting in the spring of 1918. A second, even deadlier wave of influenza appeared in late summer and autumn of 1918, and a third wave continued into 1919. This highly contagious disease, later widely known as Spanish flu, killed an estimated 675,000 Americans in one year, according to historian and professor Alfred Crosby.
Consider this perspective: more Americans died from the flu in this short time than all the U.S. soldiers who died fighting in World War I, World War II, the Korean War, and the Vietnam War combined. Indeed, the Spanish flu killed as many Americans in about a year as did HIV/AIDS, the most notorious epidemic of modern times, in more than thirty years. According to the Centers for Disease Control and Prevention (CDC), the estimated number of deaths from diagnosed HIV infection classified as AIDS in the United States since the first reported death in 1981 through 2014 was 678,509—about the same number that died of Spanish flu from 1918 to 1919.
And America was not suffering alone. This was not an epidemic but a pandemic—a widespread outbreak of a killer disease—that eventually swept over the whole world. From the spring of 1918 and on through the winter of 1919–20, waves of influenza deluged the world like a global tsunami.
Rearing its head first in America, it has long been thought, Spanish flu spread its devastation across Europe and into Africa, India, New Zealand, and the Philippines. It knew no borders or boundaries. It struck kings, presidents, and generals, average soldiers and civilians, rich and poor alike. It killed Germans and Americans, Alaskans and Africans. Never before—or since—had an outbreak of the flu been so murderous.
For many years, the Spanish flu pandemic’s death toll was estimated at twenty to fifty million people around the world. That would make it the second most lethal pandemic in world history after the notorious Black Death, a series of catastrophic plagues that engulfed Europe, Asia, and the Islamic world in the 1300s. The Black Death killed an estimated seventy-five million people, with the real possibility that as many as two hundred million people died.
Recently, medical researchers have come to believe that the death toll from the Spanish flu of 1918–19 was much greater than first thought. India alone lost 18.5 to 20 million people. According to revised estimates, scientists now suggest that the worldwide tally from the Spanish flu may have reached 100 million dead—a figure that would have been about one person in twenty alive in 1918, or around 5 percent of the world population. Many more people were sickened by the flu, with long-lasting effects.
We live in a world in which we fear the deadly things we can see. Bombs, guns, and terrorism are the most visible threats to life and peace. History books are filled with accounts of wars that have killed millions of people.
But throughout human history, the things we cannot see have actually been the most lethal. Diseases have been more deadly than war. While many schoolbooks and historians tend to focus on great battles and the military decisions of kings and generals, history’s greatest killers have been the tiniest foes—microscopic parasites, bacteria, and viruses that have wreaked havoc on civilization. Only in fairly modern times has science been able to see these minute killers, understand how they function, and learn how to fight them.
There is no better example of this fact than what took place in 1918, as the world suffered through the global conflict now called World War I. Known then as the Great War, and optimistically called “the war to end all wars,” World War I ultimately took the lives of an estimated fifteen to twenty million people—soldiers and civilians. The unprecedented carnage of twentieth-century mechanized warfare shocked the world.
“Children lost fathers, wives husbands, young women the chance of marriage,” writes historian Margaret MacMillan. “And Europe lost those who might have been its scientists, its poets and its leaders. And the children who might have been born to them. But the tally of deaths does not include those who were left with one leg, one arm or one eye, or those whose lungs had been scarred by poison gas or whose nerves never recovered.”
Coming amid these unthinkable wartime casualties, the Spanish flu dwarfed World War I’s staggering human toll. The Spanish flu’s murderous reign was more terrible than the bullets and bombs, and wartime conditions only made matters worse. Refugees crowding cities, malnutrition, and shortages of doctors, nurses, and effective medications all contributed to the pandemic’s rapid spread and high rates of death. But it was the movement of troops—with men crowded together in barracks, tents, and trenches and jammed onto railroad trains and ocean-going troop transports—that was most responsible for the spread of the Spanish flu.
The outbreak of the Spanish flu in the spring of 1918 coincided with the last months of fighting in World War I, which ended on November 11, 1918. Through documents and the voices of the people who experienced these twin catastrophes, this book tells the story of a devastating disease and the people it affected. It tells how entire armies, great cities, and small towns were overwhelmed by death. It is a tale of families broken and destroyed, of lives shattered. It is a tale of heroism by the medical professionals and volunteers who desperately attempted, yet largely failed, to contain the disaster. And it is a scientific mystery of a virus that eluded detection—a puzzle solved only recently.
* * *
GIVEN THESE HORRORS, it is somewhat surprising that the devastation caused by the Spanish flu has been hidden in history books. Many accounts of World War I detail army tactics and political maneuvers but barely mention the Spanish flu. Some overlook it entirely. “The flu was expunged from newspapers, magazines, textbooks,” science writer Gina Kolata states, a form of “collective amnesia.”
“The average college graduate born since 1918 literally knows more about the Black Death of the fourteenth century than the World War I pandemic,” writes historian Alfred Crosby. He suggests that when combined with the catastrophic losses of World War I, the period was so dreadful that people simply did not want to think or write about it. It fell into a black hole of history.
The origin of the pandemic’s name was itself an odd result of the war. This particularly deadly burst of “Spanish influenza” did not come from Spain. When the epidemic first struck, most of the warring countries restricted what newspapers could print. They didn’t want their enemies to know that they were weakened by the flu. And they hoped to keep morale high in their countries.
A neutral nation during the war, Spain did not censor its newspapers, which published reports of the epidemic. By the time Spanish authorities realized that the nation’s reputation was being damaged, it was too late. The name stuck.
Soon known in many places as Spanish flu—or the Spanish Lady—the disease went by many other names as each country tried to point a finger of blame. In Spain it had been christened the Naples Soldier, the name of a popular Spanish song of the day. Germans called it the Russian Pest. The Russians called it the Chinese flu. In Japan, it was wrestler’s fever. In South Africa, it was known as either the white man’s sickness or kaffersiekte, blacks’ disease. Soldiers fighting in the Great War called it the three-day fever—a highly inaccurate description—and when it first struck in the spring of 1918, German soldiers called it Flanders fever, after one of the war’s most notorious and deadly battlefields.
Whatever name it went by, the reality of the Spanish flu was horrible. As it hurtled around the world in 1918, panic set in when some people dropped dead on the streets. Victims with high fevers, unbearable headaches, and severe coughing that brought up blood inundated hospitals. Stacks of decomposing bodies overwhelmed city morgues. There were shortages of coffins, and funeral parlors could not keep pace with the demands of grieving families.
Desperate but mystified doctors and public health officials tried anything. Many recommended wearing a gauze mask, similar to a surgical mask. In some places, these masks were even required by law. In San Francisco “mask slackers”—people not wearing masks—were subject to fines or jail.
Caused by a virus, the Spanish flu hit at a time when science did not fully understand what a virus was. Coined in 1892, the term “virus” refers to things much smaller than bacteria, which had been seen in early types of microscopes. Before 1930, microscopes were not yet powerful enough to reveal the viruses that cause the flu and other diseases, so these infinitesimal particles had never been seen. Many scientists of the day mistakenly believed that some type of bacteria caused influenza, commonly called the flu today.
The word “influenza” was first used in English in 1743 and is thought to come from an eighteenth-century Italian phrase influenza di freddo, which means “influence of the cold.” The Italian phrase may have come from the earlier Latin influentia coeli, or “heavenly influence,” a reference to the idea that illness and disease came from astrological influences—the stars in the sky.
In ancient Greece, the physician Hippocrates, considered the father of Western medicine, cataloged flu symptoms more than 2,400 years ago. He described headache, fever, body aches, and severe coughing, which typically appeared in early winter and ended by springtime—what is now commonly known as flu season. Over the centuries, influenza also went by such names as the grippe, catarrh, and the sweating sickness.
When the Spanish flu struck the world in 1918, accurate information was scarce, mass media was limited, and government officials sometimes deliberately withheld information, using censorship to avoid panic and maintain public morale.
This is the story of how the world tried to cope with a disaster whose global reach was unprecedented in modern times. It is a story of people desperately battling an illness that seemed like no other. It is the story of science’s distressed dash to find answers to a medical mystery.
It is also a story of how propaganda was used to shape public opinion. When the war broke out in 1914, newspaper accounts and government reports of atrocities made people fear other nations by calling them “barbaric.” When the flu hit in 1918, the public feared a disease they did not understand, and many were told that the enemy had spread the disease. Today, when propaganda and other types of “fake news” are filling the media and Internet, it is important to understand and recognize facts—about history, politics, religion, and disease.
The Spanish flu spread so quickly and so far because the world was going through a form of globalization—trade and travel on a widespread, international scale. In this case, that travel was brought about by war. During the Great War, people in very large numbers traversed the globe on ships and trains. Now people who might carry infectious diseases are also able to move around the world on jets and high-speed trains. In an era of global commerce, deadly diseases can be carried on large container ships that link the continents. The world has grown much smaller. Ignorance, poverty, conflict, natural disasters, and climate change still create the breeding grounds for terrible epidemics.
Since 1918, science has learned much about influenza and other serious illnesses. Once fatal on a wide scale, such mass killers as polio, malaria, and smallpox have largely been eradicated or brought under control. Of course, there are many things science does not yet understand or can’t fully explain. New threats emerge constantly, and such headline-making outbreaks as AIDS, Ebola, Zika, and new strains of flu can pose serious worldwide health dangers. But facing questions with sound reason and clear thinking usually produces much better decisions and results than blindly allowing unjustified fear and uninformed opinion to take over.
We can learn from the story of the Spanish flu. It is about how real people lived through one of the world’s greatest calamities, and how many of them responded with courage and self-sacrifice. It is about how the disease came to pass, and what we should all know about the dangers that still exist in our increasingly globalized world. Only by uncovering this piece of the past can we make use of its lessons today.
Copyright © 2018 by Kenneth C. Davis
