Death from 1918 pandemic influenza during the First World War: a perspective from personal and anecdotal evidence

Abstract

The Meuse-Argonne offensive, a decisive battle during the First World War, is the largest frontline commitment in American military history involving 1·2 million U.S. troops. With over 26 000 deaths among American soldiers, the offensive is considered “America's deadliest battle”. The Meuse-Argonne offensive coincided with the highly fatal second wave of the influenza pandemic in 1918. In Europe and in U.S. Army training camps, 1918 pandemic influenza killed around 45 000 American soldiers making it questionable which battle should be regarded “America's deadliest”. The origin of the influenza pandemic has been inextricably linked with the men who occupied the military camps and trenches during the First World War. The disease had a profound impact, both for the military apparatus and for the individual soldier. It struck all the armies and might have claimed toward 100 000 fatalities among soldiers overall during the conflict while rendering millions ineffective. Yet, it remains unclear whether 1918 pandemic influenza had an impact on the course of the First World War. Still, even until this day, virological and bacteriological analysis of preserved archived remains of soldiers that succumbed to 1918 pandemic influenza has important implications for preparedness for future pandemics. These aspects are reviewed here in a context of citations, images, and documents illustrating the tragic events of 1918.

A year of terror and a century of reflection: perspectives on the great influenza pandemic of 1918–1919

“…From 1916 to 1918, the route of travel to Europe for the labourers included checkpoints in Singapore, Durban, Cape Town, North Africa, and Canada. Additional reports of the first wave of the virus in the spring of 1918 suggest that the pandemic originated with Chinese workers at Camp Funston, Kansas, where the workers began suffering from 2 to 3 day fevers, gastrointestinal symptoms, and general weakness [37,41]. Within 3 weeks 1100 soldiers had been hospitalized, and thousands more had received out-patient treatment [41].…”

“…Additional reports of the first wave of the virus in the spring of 1918 suggest that the pandemic originated with Chinese workers at Camp Funston, Kansas, where the workers began suffering from 2 to 3 day fevers, gastrointestinal symptoms, and general weakness [37,41]. Within 3 weeks 1100 soldiers had been hospitalized, and thousands more had received out-patient treatment [41]. The illness was able to spread to other military camps within the US, before traversing the Atlantic Ocean via soldiers supporting Allied operations in Europe.…”

“…The illness was able to spread to other military camps within the US, before traversing the Atlantic Ocean via soldiers supporting Allied operations in Europe. The US Army reported that from March-May 1918, 11.8% of US soldiers were hospitalized due to this unidentified respiratory illness [41]. While illness rates were high during this initial wave, mortality rates were largely similar to seasonal outbreaks of influenza.…”

“…Radusin reported that although the physiological symptoms were similar to influenza, the illness was too mild and short-lasting with minimal complications for it to be influenza [37]. Infections began to subside in many regions by the early summer [41]. The generally accepted lines of spread of the first and second waves of the 1918 virus are provided in Fig.…”

Evolution and Emergence of Pathogenic Viruses: Past, Present, and Future

“…The emerging pathogens are defined as novel etiological agents that have been recently introduced in a population. The "Spanish flu" responsible for tens of millions of casualties in the early twentieth century, was the most devastating natural calamity in human history [2] . The flu pandemic returned in 1957 as "Asian flu" and then in 1968 as "Hong Kong flu" that killed about three million people [2] .…”