History

Excerpts on the Influenza and Pneumonia Pandemic of 1918

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INFLUENZA-PNEUMONIA EPIDEMIC IN THE FALL OF1918

(All statistics In the following discussion are taken from current weekly health reports)

The health of troops was excellent up to the latter part of September, when the epidemic of influenza-pneumonia appeared in our eastern camps.. At the beginning of the period covered by this report (July 1, 1918),the annual death rate for disease as above by current weekly health reports was 3.1 per 1,000. The death rate remained remarkably low during the summer and early fall, the highest rate between July 1 and September 21 being 3.1 for the week ending July 5, 1918. The lowest rate was 2.1 for the week ending July 26. .The latter part of September, with the appearance of the influenza-pneumonia epidemic, mortality rates immediately soared, All previous records for mortality from disease among the troops in camps were shattered. The rise and subsequent fall in annual death rates, from week to week, is well shown on the following page.

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September 18	2.3
September 21	4.4
September 27	32.4
October 4	81.8
October 11	206.4
October 18	190.1
October 25	92.7
November 1	43.2
November 8	33
November 15	19.7
November 22	13.7
November 29	13.2

And so forth.

It will be seen that the peak, as regards deaths, was reached on October 11. The epidemic had spread rapidly from camp to camp due to the continued interchange of personnel from infected to non-infected camps, and vice versa. This transfer of personnel from camp to camp during the continuance of the epidemic was inadvisable and dangerous, which fact was strongly pointed out to the War Department at the time with proper recommendations from this office, but, on the ground of military necessity, troop movements were continued under slight restrictions.

One result of the free intercommunication of military personnel was that practically all military camps in the United States were at the height of the epidemic almost simultaneously. While the peak, as far as concerns the death rate, was reached for the week ending October 11, the height of the epidemic, with reference to new cases reported, was attained sometime earlier.

The influenza-pneumonia epidemic was a world-wide calamity. The number of deaths caused by the disease throughout the world in 1918 is variously estimated. It is certain that deaths were numbered in the millions, one estimate stating that 6,000,000 fatalities occurred within the period of the last six months of 1918. No plague of history approaches this experience of 1918 in the number of lives lost within a short period of time. In comparing the incidence of the disease and its mortality in Army camps in the United States with the incidence and mortality in civil communities, it is probable that the case incidence, in proportion to population, and also the death rate, will be shown to be considerably higher than in adjoining civil communities. It is easily explained why this should be.

1. Soldiers in camps were in the most susceptible age groups-20 to 40. It has been tile common observation throughout the present epidemic in civil communities that it is a disease affecting chiefly young and middle-aged men and women, and that infants, children, and the aged have been relatively immune from attack. If accurate statistics were available as to the relative incidence of the disease and death rate for men of military age in civil life, it is believed that the mortality statistics of the Army would compare more favorably with those of adjacent civil communities.

2. The greater density of population in camps, as compared with civil communities, is another adverse factor so far as the Army showing is concerned.

3. Housing conditions: In camps troops are housed in large numbers in a single room, which increases the liability to contact and droplet infection from the sick to the well. In civil life, on the contrary, the majority of men have individual sleeping rooms, and the liability to contact and droplet infection is relatively small. The military practice of eating in large groups, and the methods employed for washing mess kits, may also have been factors favoring the spread of the disease in the camps.

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From the standpoint of prevention, it may be said that very little has been accomplished in Army camps or in civil life. In camps where all known measures for the prevention of the spread of respiratory diseases were enforced, the incidence of disease apparently was as great as in other camps where less rigid preventive measures were enforced. Where certain preventive measures were applied early, it was possible to retard the progress of the epidemic and cause it to be spread over a longer period of time, but it has not been shown that such measures have accomplished reduction in the absolute number of cases occurring in one command as compared with another. In general it may be said that all susceptible human material in an individual camp suffered from an attack of the disease during the continuance of the epidemic. The percentage of susceptibles, as shown by records from various camps in the United States, apparently varied from 25 to 40 percent of the command.

The Medical Department met this emergency most efficiently. The heavy responsibilities and burdens placed upon camp surgeons during the height of the epidemic in our large camps can not be appreciated unless one has lived through the epidemic in the camp itself. Medical officers, nurses, and enlisted men of the Medical Department deserve the greatest credit, for their self-sacrificing devotion to duty, day after day, without proper opportunity for rest or relaxation. The proportion of medical officers, nurses, and attendants who contracted the disease and lost their lives is extremely high as compared with all other classes of camp personnel.

Full credit, too, must be given commanding officers, subordinate line officers, and enlisted men of the line; many of whom were detailed for duty with the Medical Department during the height of the emergency. Without exception, commanding generals gave the fullest support and assistance to camp surgeons, without which it would have been impossible to have successfully handled the difficult problems present in every camp at this time.

The first case of influenza of the present epidemic reported among troops in the United States appeared September 7 at Camp Devens. The disease was not at once recognized, the fulminating character of the infection suggesting cerebrospinal meningitis. Cases appeared on September 8 and the following days, the number rapidly increasing day by day. The height of the epidemic was reached on September 20,13 days after the appearance of the first recognized case. By the 30th of September this one camp had reported about 10,000 cases of influenza, nearly 2,000 cases of pneumonia, and 500 deaths from a command of approximately 45,000 men. This brief description of the course of the epidemic at Camp Devens may fairly be applied to all other Army camps which were subsequently infected. The disease extended rapidly, other camps being attacked in the following order and on the dates indicated:

Camps	Date of onset.
Upton	Sept. 13
Lee	Sept. 17
Dix	Sept. 18
Jackson	Sept. 18
Hoboken	Sept. 19
Syracuse	Sept. 19
Gordon	Sept. 19
Humphreys	Sept. 20
Logan	Sept. 20
Funston	Sept. 20
Meade	Sept. 20
Grant	Sept. 22
Taylor	Sept. 22
Sevier	Sept. 23
Lewis	Sept. 23
Sherman	Sept. 23
Newport News	Sept. 23
Pike	Sept. 24
Beauregard	Sept. 25