Doctor's Review: Medicine on the Move

October 30, 2014
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The so-called "Spanish" flu

Did a cook from a US military training base cause the great flu pandemic of 1918?

'Tis the season for pandemic paranoia. Just when you thought you'd forgotten what SARS stands for, dire warnings of an avian-generated flu outbreak are spreading faster than the disease itself. If the epidemiologists in question are correct, the planet may soon be ravaged by a devastating plague.

The flu strain in question, the innocuous-sounding H5N1, has already killed some 65 people in Asia, to say nothing of the millions of chicken, geese and ducks who've met their makers as a result. To make matters worse, dead birds have started popping up in Europe as well. Some World Health Organization estimates put the potential number of deaths from anywhere between two to seven million, should a pandemic occur, with the possibility of a virulent outbreak leading to more than 100 million deaths. Of course, fearsome media coverage of worst-case scenarios and predictions of vaccine shortages are helping to fuel concerns. But perhaps we can take some comfort in the fact that, whatever transpires this flu season, we've come a long way since the mother of all flu years: 1918.

When the so-called Spanish flu hit in the spring of that year, things were already looking a little suspicious. Normally, the flu season lasts from October to March and those who succumb to it are predominantly young children, the weak and the elderly. This flu, however, reared its ugly head months later than usual and proved to be most lethal to otherwise healthy adults, aged 20 to 40. Within 18 months, the killer virus vanished almost as suddenly as it had appeared. But before it ran its course, more than 50,000 Canadians and 675,000 Americans had succumbed to it. More dramatic still, it quickly circled the globe in multiple deadly waves, killing between 40 and 50 million people, perhaps more.

But where did it begin and how? The most common name for the killer virus, the Spanish flu, implied, of course, that it originated in Spain. Perhaps this was because there were serious outbreaks in both Madrid and Seville that infected eight million people in May of 1918 alone, even almost taking out the king himself, Alfonso XIII. But, more likely, Spain had this fatal flu named in its honour because of the freedom enjoyed by the Spanish press at the time. Because of its neutral position in World War I, Spain was not subject to wartime censorship, which in turn meant that the press could freely and passionately report on the extent of local outbreaks. This widespread coverage mistakenly gave the world the impression that the flu was more prevalent there than anywhere else.

The real geographical culprit, however, was not Spain, where the virus in question was actually most often referred to as the "French Flu." And, unlike the other serious but less deadly influenza pandemics that followed -- the Asian flu of 1957 and the Hong Kong flu of 1968 -- the site of the very first confirmed outbreak was not China, but the good old U. S. of A. The first known victim was an American soldier who also happened to be responsible for food preparation at his army training camp and may have unintentionally spread the sickness Typhoid-Mary style.

PATIENT ZERO
Camp Funston was situated within Fort Riley, Kansas, a military training facility housing 26,000 or so doughboys-to-be, the young men packed into barracks on 8100 cold and remote hectares. Soldiers dreaded the frigid winters and the gruelling hot summers as much as the severe dust storms in between. Still, their ultimate destination was far less pleasant; the Great War had been waging in the muddy trenches and foxholes of Europe for four long years. Right before spring, however, hell hit a little closer to home.

On Monday, March 11, 1918, mess cook Private Albert Gitchell awoke feeling achy and hot, his throat burning terribly. It would prove to be more than just your average case of the Mondays. Gitchell suited up and dragged himself down to the infirmary where the medic on duty realized this was no ploy to get out of serving up hard bread and bad coffee. With a fever over 103°F, Gitchell had chills as well as aches and pains just about everywhere.

 

As a precaution, Gitchell was ordered to the tent reserved for soldiers with potentially contagious conditions. But nothing could change the fact that Gitchell had been serving up meals to soldiers until the previous evening. A few hours after the cook was admitted, Corporal Lee Drake came in with almost identical symptoms. Then, Sergeant Adolph Hurby showed up. He too had frighteningly similar complaints. One by one, men with fevers of 104°F, blue faces and horrendous coughs made their way to the infirmary. By midday, Camp Funston had 107 cases of the flu, a total of 522 reported within the first week alone, and a staggering 1127 by the time April rolled around. In the end, 46 of those afflicted at Fort Riley died.

Though the situation was unusual, both the government and the military were distracted by the war effort. Officials called it a pneumonia outbreak and chalked it up to the strange combination of conditions in Fort Riley that week. Not only had the camp been shrouded in a vicious prairie dust storm, soldiers had been breathing in something even more noxious: putrid black ash created by tons of burning manure courtesy of the camp's thousands of horses and mules. In retrospect, the fact that countless swine and poultry were also living in close proximity to the soldiers may be a more likely place to lay blame since pigs can be susceptible to avian influenza viruses -- those strains responsible for most serious forms of flu -- which can then mutate and be transmitted to humans.

CATCH THE WAVE
As Camp Funston neared recovery from the outbreak, crowds of coughing American soldiers, many barely over this mysterious flu, were shipped off to Europe to live in even more cramped quarters. And, unfortunately, they brought the Spanish flu with them, spreading it first to France, England, Germany and then Spain. It followed not only the movements of the troops, but also travelled rapidly along shipping and trade routes throughout the world. By the end of the pandemic, only one major region on the entire planet had not reported an outbreak: an isolated island called Marajo, located in Brazil's Amazon River delta.

In September 1918, a second wave of the epidemic hit North America and this time it could not be ignored. It had mutated since its Fort Riley appearance and was now deadlier than ever. First, soldiers began dying at military bases around Boston, whose bustling port was working hard to manage all the much-needed war shipments. New shipments of soldiers brought the mutated form of the virus back to Europe, where more soldiers on both sides were felled by the flu than by enemy fire. It's no wonder. Crowded and unsanitary living conditions, damp trenches, and weakened immune systems proved the perfect breeding ground for the killer flu. At home, things were just as bad for civilians. By October, the domestic death toll reached staggering heights: some 200,000 Americans died in that month alone, with millions more infected. With the end of the war in November came a third wave of disease for the US and Canada as victory parades and massive parties spread yet another round of the fearsome flu.

CONSPIRACY THEORIES
Unfortunately, not much was known or understood at the time about the nature or spread of the epidemic. Governments imposed curfews, suggested masks be worn and banned public gatherings, but all bets were off when it came to celebrating V-Day. Allied countries suggested that the Germans and their new biological weapons -- namely, mustard gas -- were to blame, or perhaps it was just the damp winter weather of Europe. At one point, members of the American government even suggested that the popular new "wonder-drug," Aspirin, and its German drug-company manufacturer, Bayer, were to blame in some sort of smallpox-infected-blanket-type scheme. Of course they were way off, since Aspirin was one of the things that actually helped flu sufferers find relief!

In his own way, Albert Gitchell and others like him contributed to the war effort, though to which side is debatable. The flu he had was so devastating that few would disagree it was a significant factor contributing to the end of World War I. Weary governments and troop shortages on both sides made it pretty hard to fight the good fight.

To be fair to poor Albert Gitchell, there is another current school of thought, which actually links the 1918 Spanish flu to an earlier outbreak that winter in the Canton Province of China, one which possibly remained unknown and unreported because of its remote location and inadequate record keeping. The theory suggests that Chinese workers then brought the virus to France, where they were digging trenches for the French Army. Whatever its cause or origins, the frightening flu of 1918 was a bird of a different feather. So this fall, as you try to curb your patients' panic and we all take the wait-and-see approach with regards to avian flu H5N1, it couldn't hurt to have a back-up plan...

Anyone got tickets to Marajo?

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