The Spanish Flu had arisen without warning and was especially virulent. It challenged established knowledge about the nature of such diseases, killing not the young and the old, but instead men and women who were in the prime of life. Not only did doctors struggle to treat it, but they were also at a loss about how to understand it. To their astonishment and dismay, they found useless all the familiar and reliable methods for remedying the disease.

Sometime during January and February, 1918, the first cases of influenza developed at Camp Funston in Kansas. By March, the disease had spread to Camp Oglethorpe in Georgia, and by May it appeared in Europe, American soldiers having carried it across the Atlantic. Contemporaries mistakenly identified it as the “Spanish Flu,” assuming that it had originated in Spain. In reality, the uncensored Spanish press was among the few permitted to disseminate news of the illness. Leaders of the Allied and Central Powers alike, by contrast, expunged information about the virus in their countries, and hastened to blame the Spanish, who became a convenient scapegoat.

The initial occurrence of disease raised little anxiety. It was comparatively mild, and killed no more than previous influenza outbreaks. But on the Western Front, a second wave of the pandemic appeared in Brest, located on the northwestern coast of France. Serving as the disembarkation point for troops arriving from the United States, Brest experienced the first cases of flu in late August. At about the same time, the flu broke out in Boston, the port from which many of the Americans had departed weeks earlier. Boston became the locus of the flu in the United States. From Boston, the flu traveled westward across the continent and by sea to the Caribbean and Central and South America. The flu moved into Russia, Asia, and India by October. The governments of Australia, New Zealand, and various Pacific Islands reported their first cases in November and December. No part of the world escaped.[1]

During June and July, 1918, the flu devastated the German army, helping to end the offensive that the Germans had launched in the spring, a desperate attempt to win the Great War before American troops arrived in force. General Erich Ludendorff, who directed the German war effort, informed the government that more than 2,000 soldiers in every division were ill. In his autobiography, Ludendorff clarified the extent of the problem and the impact it had on the ability of the German army to continue the fight:

Our army had suffered. Influenza was rampant, and the army group of Crown Prince Rupprecht [of Bavaria] was particularly afflicted. It was a grievous business having to listen every morning to the chiefs of staffs’ recital of the number of influenza cases, and their complaints about the weakness of their troops if the English attacked again.

Even after the number of influenza cases began to diminish, Ludendorff acknowledged that “it often left a greater weakness in its wake than the doctors realized.” Some units experienced an infection rate of eighty percent. In a story published on July 12, 1918, a reporter for The Times of London shared Ludendorff’s assessment, conjecturing that the flu had decimated the German ranks and rendered multiple units incapable of carrying out military operations:

The question of how far influenza is responsible for the present enemy inactivity is an interesting speculation, so long as we do not allow ourselves to attach too great importance to it. That it is extraordinarily widespread, we know, and we get frequent evidence of the disease in individual units in the front line. Thus, one company of the 61st Regiment is so prostrated that it had to be relieved. Two whole battalions of the 232nd Regiment were so reduced that they had to be withdrawn from the line; one company of the 68th Reserve Regiment shrank to a fighting strength of 42 men instead of the normal 120; one company of the 174th Regiment was similarly reduced to 17 men; the whole of the 187th Division had to be taken out of the line because it had ceased to be effective; another division, the 119th, could not be relieved because the relieving troops were incapable of coming in.[2]

Although the flu afflicted all of the belligerents, it struck the Germans with a singular force two months before it vexed the Allies. By the middle of July, 1918, approximately 1.75 million German soldiers had been debilitated by the flu, which, when combined with illness at home that depleted the workforce, undoubtedly contributed to German defeat.[3]

Not until August and September did the flu begin to exact a terrible toll on Allied forces. At the height of the Argonne Offensive against the Germans in October and November, 1918, the American Expeditionary Force suffered more deaths from flu than from battle. Of the four million Americans deployed, at least one million contracted the flu, prompting General John Pershing to make repeated and urgent appeals for increased medical support. On October 3, 1918, for example, Pershing cabled officials in Washington that: “Influenza exists in epidemic form among our troops in many localities in France accompanied by many serious cases of pneumonia. Request 1500 members of the Army Nurse Corps . . . be sent to France as an emergency requirement.”[4] The flu impeded American military operations. It limited the reinforcements and replacements available to Pershing. In addition, the need to attend sick men, to say nothing of the medical personnel who had themselves fallen ill, complicated and slowed the treatment of those who were suffering from battle wounds.

From the battlefields of France, the disease spread rapidly around the world. On August 15, the flu arrived in Freetown, Sierra Leone, which was a British colony, brought by two hundred infected British sailors aboard the HMS Manuta. Mortality rates throughout Sierra Leone eventually approached three percent of the population. Departing Freetown, the Shango transported the virus to Accra on the Gold Coast (Ghana), and from thence to the Cape Coast. In the middle of September, the SS Bida, which had also called at Freetown, took the flu to Lagos, Nigeria, where it spread into the interior of Africa along the rail lines, rivers, roads, and bicycle paths. Finally, the Jaroslav and the Veronej, which, like the other vessels, had made port at Freetown, returned to Cape Town carrying 1,300 members of the South African Native Labour Contingent who had served in France. These men introduced the virus to southern and central Africa.

The flu had arisen without warning and was especially virulent. It challenged established knowledge about the nature of such diseases, killing not the young and the old, but instead men and women who were in the prime of life. Not only did doctors struggle to treat it, but they were also at a loss about how to understand it. To their astonishment and dismay, they found useless all the familiar and reliable methods for remedying the disease. Misunderstanding its etiology, doctors, in fact, applied measures that could not have been effective. They did not know until 1933 that viruses cause the flu, and so they administered vaccines against a bacillus, the presumed cause, an antidote that proved futile. Dr. E.E. Wood, a South African physician, registered his bewilderment and frustration in dealing with the flu, when he wrote that “one of the most distressing conditions in respect to the recent visit of epidemic influenza to South Africa was the extreme uncertainty which existed in medical minds as to the best method of dealing with the outbreak. We had a rough idea that care was necessary, that fresh air was an essential, but as to medical treatment our minds were fogged.” His colleague, Dr. R. Leigh, confirmed that his experience “of the treatment of influenza is mainly negative. The only things of undoubted value are care of patients, going to bed in good time, and not getting up until convalescence is assured. All treatment appears to fail in severe cases, especially when the lungs are affected. So far as I have observed, inoculation, preventive or for treatment, is of doubtful value.”[5] Meanwhile, popular remedies abounded. Advertisements extolled the benefits of liquor, tobacco, garlic, camphor, cinnamon, quinine, and sugar cubes soaked in kerosene, while proposed “home cures” included laudanum, tincture of belladonna, chlorate of potash, iodine, chloroform, ipecac, creosote, jiggery, which was concentrated cane sugar, betel-nut, and black pepper.[6]

Politicians around the world were equally baffled and inept. As a consequence, the political response to the pandemic was haphazard at best, and in some cases dangerously negligent. Officials took measures both sensible and misguided to hinder the transmission of the disease. They closed schools, gymnasiums, libraries, theaters, and any other place where persons were likely to congregate in large numbers. At the same time, they often refused to impose strict quarantines or to shut down churches and bars. Apparently, the only two sane responses to the pandemic were to pray or to drink. When out in public, men and women were enjoined to wear masks. These efforts notwithstanding, governments could neither contain nor manage the outbreak, which had defied all expectations.

Confronting the exigencies of war, German authorities refused to make public any information about the flu, and even denied its existence until information about it entered Germany through foreign press agencies. A government directive issued in January 1918, at the very beginning of the outbreak, forbade the publication, or even the public discussion, of the number of persons infected. When the more lethal second wave of the disease entered Germany in August and September, the German government, from national ministries to local municipalities, continued to deny the gravity of the situation.[7]

The influenza pandemic of 1918-1919 was more ruinous than any other natural disaster in history, save the plague that had engulfed Europe during the fourteenth century. It killed more persons than any event of the twentieth century except for the Second World War. “One of the great historic scourges of our time,” declared George Newman, the Chief Medical Officer of the British Ministry of Health, the infection was “a pestilence which affected the well-being of millions of men and women and destroyed more human lives in a few months than did the European war in five years.” A Japanese physician, Dr. Ijiro Gomibuchi, echoed Newman’s sentiments when he wrote simply: “There was no stopping it.”[8] By the fall of 1919, when the pandemic at last receded, the flu had killed at least thirty, and perhaps as many as one hundred, million persons.[9]

Past flu epidemics had produced mortality rates of approximately 0.1 percent. The pandemic of 1918-1919, on the contrary, killed 2.5 percent of those infected. Great Britain, France, and Germany each suffered on the order of 250,000 deaths. Four hundred fifty thousand subjects of the Russian Empire died. In Canada, the figure was 50,000. The United States lost 675,000. Native populations in North and South America, Australia, and New Zealand suffered disproportionate to their numbers; many lost 80 percent of their populations. White New Zealanders, for instance, had a mortality rate of 5.8 per 1000 persons. The indigenous Maori, by comparison, died at a rate of 40.6 per 1000.

A higher percentage of Africans than Europeans died. The mortality rate in Europe was between one and two percent. Throughout Africa, it was on average at least five percent. But South Asia experienced the worst loss of life. Although statistics are unreliable, at least six million and perhaps as many as fifteen million died in India alone. Death in Indonesia approached 1.5 million. The Chinese and the Japanese seem to have withstood the disease better than any other peoples. The death rate in Japan was 4.5 per 1000. Records do not exist to calculate the morality rate throughout China, but the available evidence suggests that it was much lower than in other parts of the world. At 1.3 deaths per 1000, Shanghai may have boasted the lowest percentage of mortality anywhere. The Chinese and Japanese were not more adept at treating the virus than others around the world. But relying on traditional herbal remedies, such as a compound of gingerroot, peony, and dried ephedrine, Chinese and Japanese doctors do seem to have enjoyed better success at reducing fevers and congestion, thereby enabling the body to heal itself and, in time, to recover on its own.[10]

Yet, everywhere most persons who contracted the flu survived. Approximately 800 of every 1000 infected exhibited only mild symptoms, if they had any symptoms at all. But of the remaining 200 persons, 80 percent, or 160, died.[11] The disease was highly communicable. Those infected were contagious for twenty-four hours before they began to exhibit symptoms, and remained so for between five and seven days afterward. Herbert French of the British Ministry of Health vividly described a scene that became the characteristic epidemiological sequence of events:

In the midst of perfect health in a circumscribed community, such as a barracks, or a school, the first case of influenza would occur, and then within the next few hours or days a large proportion—and occasionally every single individual of that community—would be stricken down with the same type of febrile illness, the rate of spread from one to another being remarkable. The patient would be seized rapidly, or almost suddenly, with a sense of such prostration as to be utterly unable to carry on with what he might be doing; from sheer lassitude he would be obliged to lie down where he was or crawl with difficulty back to bed.[12]

No one was prepared. Hospitals were quickly overwhelmed, and could not admit all who needed care. Doctors and nurses found it impossible to treat the unprecedented number of ill and dying patients. Undertakers failed to meet the demand for coffins or to perform timely and compassionate funeral services for the dead.

In addition, this strain of the flu produced a variety of symptoms unlike those of previous manifestations. Dr. William Collier of Oxford noted that some of his patients “spit up a quantity of frothy sputum tinged with bright blood.” Especially traumatic was “the dreaded blueness” of the face and skin that Collier identified as a sign of heliotrope cyanosis, a condition whereby patients drowned in the fluids that had collected in their lungs. According to the official report of the British Ministry of Health, the bluing of the skin and face meant almost certain death:

It was amongst cases of this type that the great mortality of the epidemic occurred. In going around a large ward, one could, without examining the patients at all beyond looking at their countenances, pick out those who were going to die with almost uniform certainty by reason of their colour alone.

Dr. Collier wondered whether “we are seeing a type of influenza different from anything we have seen before. . . . Are we dealing with a new organism or with the recognized organisms of influenza which have for some reason attained greater virulence?”[13] For, unlike its antecedents, which had preyed on the very young and the very old, this particular flu afflicted men and women who were, on average, between the ages of fifteen and forty-five.[14] In the United States, for example, the flu killed those in this age cohort at a rate more than twenty times greater than any previous incidence.

Men were more vulnerable than women, although pregnant women were particularly at risk of infection and death. The severity of the disease provoked an immune response that itself exacerbated its virulence and contributed to the higher mortality. Antibodies attacked the virus, but in so doing they also weakened the tissue of the lungs, exposing victims to pneumonia and other disorders of the respiratory system. Doctors at the time had no explanation. They did not understand why the healthiest individuals with the most robust immune systems were often the most likely to die.[15]

Figure 1: Influenza and Pneumonia Mortality by Age in the USA, 1911-1918

Deaths per 100,000 persons in each age group, United States, 1911–1918. Influenza- and pneumonia-specific death rates are plotted for the interpandemic years 1911–1917 (dashed line) and for the pandemic year 1918 (solid line) Source: Jeffery K. Taubenberger and David M. Morens, “1918 Influenza: The Mother of All Pandemics,” Emerging Infectious Diseases Centers for Disease Control and Prevention 12/1 (January 2006), 15-22.

The conditions to which the war itself had given rise enabled the virus to mutate into such a dangerous pandemic. In hospitals, camps, and trenches, thousands congregated, moving into and out of contact with one another. Although flu viruses regularly mutate, most do not survive long enough to reproduce. They kill off their hosts too quickly. But the war ensured the continual availability of new hosts to sustain and transmit the virus. As soldiers fell ill, others replaced them. Camps and trenches thus teemed with men who had been infected but who were not yet ill, living and fighting next to men who had not yet been exposed to the virus. Under these circumstances, new hosts for the disease were always available, ensuring its continued spread and its growing virulence.[16]

Contemporaries observed the intimate connections between the flu and the war. In Allied countries, citizens associated the flu with the Germans, both of which were equally to be feared and hated. The “Influenzal Hun” had attacked innocent, unsuspecting victims. An advertisement in the Illustrated London News cautioned readers that the flu had placed them “under the domination of enemies more ruthless and destructive even than the Hun.” The ad copy hailed the product being marketed, Kruschen Salts, as the “first line of defence” against the “Germ-Huns.” In April 1919, the British Medical Journal insisted that doctors who battled the flu were contesting with “mightier opponents than Ludendorff or Hindenburg, and must face a longer campaign than that of 1914-1918.”[17]

American writer Katherine Anne Porter described the mental and emotional confusion that the flu could engender. When Miranda, the protagonist of Porter’s short story “Pale Horse, Pale Rider,” contracts the flu and slips into a feverish delirium, she imagines that she has witnessed her physician killing a child. Tormented by hallucinations that recall the horrors of war, Miranda thinks that she sees Dr. Hildesheim coming across a field:

his face a skull beneath his German helmet, carrying a naked infant writhing on the point of his bayonet, and a huge stone pot marked Poison in Gothic letters. He stopped before the well that Miranda remembered in a pasture on her father’s farm . . . and into its pure depths he threw the child and the poison, and the violated water sank back soundlessly into the earth. Miranda, screaming, ran with her arms over her head; her voice echoed and came back to her like a wolf’s howl, Hildesheim is a Boche, a spy, a Hun, kill him, kill him before he kills you.[18]

The flu, as Porter’s story intimates, left many survivors traumatized, much like the victims of shell shock.

“Marked depression is common,” reported Sir Thomas Horder in The Lancet for December 1918, “emotional instability is often seen, and suicide is by no means rare.” Writing in The Lancet a few months later, in February 1919, Samuel West informed readers that “the depression which follows influenza is so constant that it ought to be regarded as part of the disease.” Meanwhile, Drs. David and Robert Thomson indicated that “all forms of hysteria have been observed after influenza, such as hysterical convulsions and the so-called hysteron-epileptic attacks. . . . Post-influenzal neurasthenia is very familiar, [and] post-influenzal psychoses . . . frequently observed and reported.”[19] The flu devastated civilians and soldiers alike, apparently leaving its victims physically, mentally, and emotionally debilitated even after they had recovered.

The most significant instance of mental incapacity resulting from the flu was that of President Woodrow Wilson. Like Wilson, the British Prime Minister David Lloyd-George and the French Premier Georges Clemenceau also became ill.[20] But Wilson’s condition was more severe, and his physical and mental impairment more pronounced. Wilson had traveled to Paris determined to forestall a punitive treaty that he feared would impoverish Germany and dishearten the German people. But the flu assailed him at a crucial moment in negotiations. He and Clemenceau had already quarreled bitterly about both the reparations to be imposed on Germany and the French desire to annex the Saar Basin. Relations among the Allied leaders had become so noxious that, on April 3, it appeared Wilson might withdraw from the proceedings and return to the United States.

That night, though, Wilson began to display acute symptoms of the flu. He developed a fever of 103°F, a cough that was so incessant that he struggled to breathe and to sleep, and chronic diarrhea. Already concerned that the acrimonious peace conference would put an undue strain on Wilson’s health, his physician, Admiral Cary Grayson, now feared that he might die. “In the early spring of 1919,” Dr. Grayson recalled, “came that ill-omened attack of influenza, the insidious effects of which he was not in good condition to resist.”[21] Wilson lay bed-ridden for the next five days, not only unable to work but also unable to think clearly.

When Wilson at last rose from his sick bed he was a changed man. The disease had enfeebled his body and stupefied his mind. His vitality ebbed, and he could neither focus nor concentrate. He manifested symptoms of depression: fatigue, apathy, and even delusion. He had, for example, convinced himself that all the French servants in the chateau where he was staying were spies for the French government. Nothing anyone said could disabuse him of the notion. His butler and valet, Irwin Hood “Ike” Hoover, concluded that “something queer was happening in his mind. . . . He was never the same after this little spell of illness.” Gilbert Close, Wilson’s personal secretary, reached the same conclusion. On April 7, 1919, Close wrote that “I never knew the President to be in such a difficult frame of mind. Even while lying in bed he manifested peculiarities.” Members of the American delegation attributed the rigors of the Treaty of Versailles to Wilson’s illness and his subsequent indifference about whether his Allied partners adopted the principles that he had articulated in the Fourteen Points. After he recuperated, Wilson no longer had the stamina, the attention, or the interest to oppose Lloyd-George and Clemenceau. He gave up, acquiescing in a settlement that he thought so myopic and unjust that, as he told an aide, “if I were a German, I think I should not sign it.”[22]

Regrettably, German officials had no choice. Confronted with the stark reality of an ongoing Allied blockade that was reducing the German people to starvation, they had to sign. The material scarcity and national humiliation to which the Treaty of Versailles subjected Germany encouraged hostility to liberal, democratic government, which contributed to the rise of Nazism and the ascent of Adolf Hitler to power. It goes too far to argue that the influenza pandemic of 1918-1919 was thus a proximate cause of the Second World War in Europe. But it is not too much to suggest that the pandemic helped to shape a peace agreement that made another conflict more, not less, likely to occur.

Yet, for more than sixty years, this monumental event, along with the extraordinary number of deaths that it produced and the worldwide trauma that it engendered, vanished from popular consciousness and public memory. Only the AIDS crisis of the 1980s revived scholarly attention in the influenza pandemic. Why? First, the history of the Great War eclipsed the pandemic. The Bolshevik Revolution, the collapse not only of the Russian, but also of the Austro-Hungarian, German, and Ottoman Empires, the Great Depression, the rise of fascism and National Socialism, the Second World War, the Cold War, and the liberation of European colonial possessions in India, Africa, and Asia all resulted more or less directly from the Great War. These events have rightly engaged the minds and imaginations of all who are intent to understand the contours of the twentieth century.

A more profound reason for this enduring historical amnesia may be that the suffering which accompanied the influenza pandemic was simply too dreadful to bear. Science failed. Medicine failed. Government failed. No expert and no leader could prevent, manage, treat, or cure what had until then been a recurring and ordinary illness, an unremarkable commonplace that had now turned pitiless and deadly. Forgetting was easier. Forgetting may have been necessary for those fortunate enough to survive, for men, women, and children who were too devastated and too frightened to admit that the institutions on which they had come to depend for their welfare had proven incompetent to end their misery or to save their lives.[23]

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Notes:

[1] See Howard Phillips and David Killingray, eds., The Spanish Influenza Pandemic of 1918-1919: New Perspectives (London, 2003), 6-10.

[2] Erich Ludendorff, Ludendorff’s Own Story: August 1914-November 1918 (New York, 1919), Vol. II, 277; “Awaiting the Enemy Attack,” The Times of London (July 12, 1918), 6. See also Michael B.A. Oldstone, Viruses, Plagues, and History (New York, 1998), 173.

[3] Niall Johnson, Britain and the 1918-19 Influenza Pandemic: A Dark Epilogue (London, 2006), 191, argues that the flu did not contribute significantly to German defeat since it affected all armies. Andrew Price-Smith, Contagion and Chaos: Disease, Ecology, and National Security in the Era of Globalization (Cambridge, MA, 2009), 68, disagrees.

[4] Carol R. Byerly, Fever of War: The Influenza Epidemic in the U.S. Army during World
War I (New York, 2005), 113. See also Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (Cambridge, U.K., 1989), 157.

[5] “Notes on the Influenza Epidemic,” South African Medical Record, (December 14, 1918), 363-65.

[6] See, for example, “Quinine and Cinnamon to the Rescue,” London Daily Express (June 22, 1918), 3; “Treatment of Influenza,” Indian Medical Gazette (February 1919), 68.

[7] See Wilfried Witte, “The Plague That Was Not Allowed to Happen: German Medicine and the Influenza Epidemic of 1918-19 in Baden,” in Phillips and Killingray, eds., The Spanish Influenza Pandemic, 49-51.

[8] Quoted in British Ministry of Health, Report on the Pandemic of Influenza, 1918-19 (London, 1920-1921), iv; Dr. Ijiro Gomibuchi, Personal Account of the World Influenza Epidemic of 1918-1919. . . . (May 1919), trans. by Edwina Palmer and Geoffrey W. Rice in “A Japanese Physician’s Response to the Pandemic Influenza: Ijiro Gomibuchi and the `Spanish Flu’ in Yaita-Cho, 1918-1919,” The Bulletin of the History of Medicine 66 (1992), 569.

[9] Estimates of the number of deaths vary. Thirty million is the conservative figure. Some estimates suggest that as many as one hundred million persons died, but those figures remain impossible to verify. The scholarly consensus fixes the death toll at between fifty and sixty million. See Jeffery K. Taubenberger and David M. Morens, “1918 Influenza: The Mother of All Pandemics,” Emerging Infectious Diseases, Centers for Disease Control and Prevention 12/1 (January 2006), 15-22.

[10] Phillips and Killingray, eds., The Spanish Influenza Pandemic, 7-10; Geoffrey W. Rice, “Japan and New Zealand in the 1918 Influenza Pandemic: Comparative Perspectives on Official Responses and Crisis Management,” in Phillips and Killingray, eds., The Spanish Influenza Pandemic, 83; K.F. Cheng and P.C. Leung, “What Happened in China during the 1918 Influenza Pandemic?,” International Journal of Infectious Diseases 11/4 (July 2007), 360-64.

[11] Phillips and Killingray, eds., The Spanish Influenza Pandemic, 4-5 and Johnson, Britain and the 1918-19 Influenza Pandemic, 162.

[12] British Ministry of Health, Report on the Pandemic, 67.

[13] Ibid., 72. See also Dr. William Collier, “A New Type of Influenza,” The Lancet (October 26, 1918), 567, and Phillips and Killingray, eds., The Spanish Influenza Pandemic, 5.

[14] Those ages 5-14 also suffered from a high incidence of infection, but had lower mortality rates. See Taubenberger and Morens, “1918 Influenza: The Mother of All Pandemics,” 15-22

[15] See Jeffrey K. Taubenberger, “Genetic Charaterisation of the 1918 `Spanish’ Influenza Virus,” in Phillips and Killingray, eds., The Spanish Influenza Pandemic, 40, 41; Douglas Almond, “Is the 1918 Influenza Pandemic Over?: Long-Term Effects of In Utero Influenza Exposure in the Post-1940 U.S. Population,” Journal of Political Economy 114/4 (August 2006), 681; Price-Smith, Contagion and Chaos, 60-61.

[16] Byerly, Fever of War, 93-94.

[17] Charles Graves, Invasion By Virus. Can It Happen Again? (London, 1969), 32; Illustrated London News, (July 20, 1918), 83; British Medical Journal (April 5, 1919), 418.

[18] Katherine Anne Porter, “Pale Horse, Pale Rider,” in The Collected Stories of Katherine Anne Porter (New York, 1965), 309. Porter herself had gotten the flu while working as a journalist in Denver during the war.

[19] Sir Thomas Horder MD, “Some Observations on the More Severe Cases of Influenza Occurring during the Present Epidemic,” The Lancet (December 28, 1918), 872; Samuel West, The Lancet (February 1, 1919), 196; see also Graves, Invasion By Virus, 25-26; David Thomson and Robert Thomson, Influenza Annals of the Pickett-Thomson Research Laboratory, Monograph XIV, Part I (London, 1933), 789, 796.

[20] John Barry, The Great Influenza (New York, 2004), 383.

[21] Cary T. Grayson, Woodrow Wilson: An Intimate Memoir (New York, 1960), 85.

[22] Irwin Hood Hoover, Forty-Two Years in the White House (Boston, 1934), 99; for the other quotations in this paragraph, see Crosby, America’s Forgotten Pandemic, 189-95.

[23] Only in 1997 did a group of scientists under the direction of Jeffrey Taubenberger at last determine that the H1N1 virus had been responsible for the influenza pandemic of 1918-1919. They did so by performing DNA tests on the preserved lung tissue of Private Roscoe Vaughan, who had died of the flu at Camp Jackson, South Carolina on September 26, 1918.

The featured image is a plague panel, which was used during the epidemic of Augsburg between 1607 and 1636 to warn passersby that the house upon which it was hung was infected. The image is in the public domain and courtesy of Wikimedia Commons.

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