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    This article originally appeared in the October 2009 issue of Louisville Magazine.

    By Tom Stephens and Jack Welch
    Photos courtesy of Dr. Charles Oberst

    Having survived a major windstorm, ice storm and a world-class Hash Hood in the past year, we Louisvillians might think we've seen — and can take — anything. But we never saw the effects of the flu of 1918.

    It is the story of a pandemic of biblical proportions, fueled by a perfect storm of the military concentrations and movements of World War I, medical ignorance of viruses, and weak and delayed governmental response to the quickly spreading disease. In the space of a little more than a year, according to the U.S. Department of Health and Human Services, an estimated 20 to 30 percent of the world's population of 1.5 billion people contracted what was thought then to he a bacterial sickness, resulting in at least 50 million deaths; during the most virulent stage, fall-winter of 1918, as many as 25 million people died over the course of 25 weeks, including more than 600,000 in the U.S. (The normal annual seasonal-flu roll here is 36,000.) The nation's average life span fell by 12 years that year.

    It was February 1918 when a mild but particularly contagious flu swept through vacationers in the little Spanish tourist town of San Sebastian, according to New York Times medical writer Gina Kolata in her book Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. Spain, neutral in the "Great War" then raging over the rest of Europe, was a refuge that year not only for those with time and money to spare, but for others anxious to temporarily escape the hostilities.

    The initial cases of the disease weren't much more than an inconvenience, bringing about three days of fever and aches and pains about 48 hours after exposure. This flu was unusual, however, in that it seemed to hit young and healthy adults with more regularity than children and the elderly — similar to the current "swine flu" pandemic,* (see footnote) which has had more young-adult victims than those over 60 — while yearly seasonal flus kill mostly seniors.

    As the tourists returned to their homes throughout Europe, Kolata writes, they brought this new flu with them, and by Match it had made its way to the first group of American soldiers to land on the Continent en route to the battlefront. By the time it appeared in the United States later that same month — regardless of its true origin, which is still in dispute — this new strain of influenza had become known as the Spanish flu.

    Spread human to human by virus-carrying respiratory droplets inhaled from close-quarters coughing and sneezing, as welt as by touching contaminated surfaces and then the mouth, nose or eyes, the disease traveled with the tightly grouped military, both to Europe and back to the U.S., where men unknowingly infected fellow soldiers at military camps and hospitals across the nation before and after their own symptoms appeared.

    As fast as that first wave of flu arrived, however, the illness seemed to vanish, and the memory of it quickly faded amid war headlines. But instead of leaving altogether, this flu — soon to mutate into a devastatingly virulent form of Type A influenza in port cities around the world — lay dormant like a time bomb.

    The bomb went off on Aug. 28 among thousands of U.S. sailors and soldiers docked in Boston awaiting transport to Europe, and in short order the decidedly more aggressive strain of the virus had appeared in France, Africa and coastal Asia. Within two weeks in Boston it had broken through to the civilian population. The second phase of the flu had begun.

    Doctors divided this second wave of the epidemic, which would radiate south and west, and arrive in Louisville at the end of September, into three forms. The first, afflicting about 20 percent of the victims, affected them much like the spring version, and they usually recovered within a week. The remainder succumbed to a disease that attacked the lungs in one of two ways. The first posed as a normal flu for the first three days. After that time, however, pneumonia-inducing bacteria flooded their lungs with fluid until they died or slowly recovered. The third, less prevalent version, however, was a death sentence. These victims sometimes only exhibited symptoms for a few hours before their lungs filled and high fevers sent them into unconsciousness and death.

    Attending physicians reeled at the sight of strong, healthy soldiers in their 20s shattered in a matter of a few days or even hours, with fevers soaring above 103 degrees, their ears and lips turning blue as they gasped for air. Modern pathologists attribute these fast-progressing viral attacks to a what's called a cytokine storm: overreaction by the body's immune system to a foreign invader. Young adults, with their stronger immune systems, suffered quick and devastating inflammatory damage from within.

    According to the Centers for Disease Control and Prevention (CDC), the Spanish flu entered Kentucky in late September 1918 when a group of Texas soldiers on their way to Camp Zachary Taylor — a massive artillery training complex built on 2,700 acres surrounding what is now the city of Audubon Park — hopped off a train in Bowling Green and walked around the town. On Sept. 25, Brig. Gen. Fred T. Austin, Camp Taylor's commandant, confirmed the post's first cases of very sick soldiers to the Courier-Journal. Within days the sick would include soldiers from little towns across the state, and the frantic families of stricken soldiers flocked to Louisville to visit their loved ones. They tramped in and out of the hospital, then returned home with the virus latent in their lungs, unknowingly seeding the sickness all across Kentucky, where 14,000-16,000 would eventually die from the flu.

    It's important to understand that harsh contagions were nothing new at a time when tuberculosis, measles, strep, influenza and pneumonia all paid frequent visits, so nobody saw the early stages of this flu pandemic as something to panic about — although it wouldn't be long before panic set in. There was no discernible path of the disease. With 19 nations at war and millions of soldiers and refugees on the move either toward or away from various battlefronts, the unrecognized virus seemed to pop up everywhere at once.

    On Sept, 28 at Camp Taylor, where up to 64,000 soldiers and support personnel were stationed] occupying row after row of closely spaced beds in dozens of barracks, a medical worker named Hiram Schumacher wrote to his family that because more than 1.000 soldiers had required hospitalization in just the last few days, the camp would be under quarantine for 30 days and his whole detachment of 900-plus men had moved from their barracks to tents so the sick could be isolated under one roof. Eventually, according to local Spanish flu researcher Dr. Charles Oberst, 11 of the camp's 70 soldiers' barracks were converted to sick wards.

    On Tuesday, Oct. 1, the Associated Press reported that more than 14,000 new cases had been reported in U.S. Army camps during the previous 24 hours, up from 3,600 new cases the day before. The next day, 18,000 new cases were reported. At that points the disease had spread to 43 states and was epidemic in New England, tidewater Virginia and South Carolina.


    At one point during the month of October 1918, 108 Louisvillians and Camp Taylor soldiers died from the Spanish flu in a single day.

    The following day, even as it reported five deaths and 932 new cases to the Army, Camp Taylor hosted a naturalization ceremony for 400 foreign-born troops. Later in the day, Brig. Gen. Austin issued an order prohibiting soldiers from gathering in Louisville's public places, including theaters, dance halls, stores and hotel lobbies. Saloons, apparently, were exempt. Provost guards were to be stationed around the city to enforce the order, and streetcars carrying troops to and from the camp were to operate with their windows down. Austin also requested 50 nurses from the American Red Cross to cope with the onslaught of cases, now numbering 7,000.

    October 1918 was by far the crudest month, here and elsewhere. A subsequent Camp Taylor Base Hospital report noted that Septembers death total was 28. Novembers was 67 and December's 60. Jumping off the page was Octobers toll: 857 dead. Despite camp officials continuing to assess that a decline in new cases signaled that the epidemic had been broken, daily death rolls at the camp grew — from 23 on Oct. 4 to 40 on Oct. 5, 50 on Oct. 8, 48 on Oct. 9 and 60 on Oct. 10.

    In Louisville proper, people also began dying in great numbers during October. A Centers for Disease Control chart shows Louisville deaths spiking by 300 percent in a weeks time in mid-October, to about 180, followed by another 180 the next week. At one point, 48 Louisvillians died from the flu in a single day. (Estimates of total Spanish flu deaths among Louisville's 230,000 population range from 500 to 1,200. Records kept by the Red Cross were lost in the 1937 Flood.) Then, as the month was ending, fatal flu cases in the city dropped by 65 percent.

    A huge reason for the plunge, the CDC concluded, was Camp Taylor's social-restrictions order, along with the newly instituted Kentucky Board of Health's Oct. 6 quarantine on public gatherings. Keeping people at a distance from one another was the key. Louisville's schools, churches, theaters and "other places of amusement and assembly" — even funeral parlors and the courts — were ordered closed until further notice. In his first published comment on the epidemic, Louisville Mayor George W. Smith said he wholeheartedly agreed with the state order and vowed it would be "rigidly enforced" in the city, adding that he had been in "constant" communication with city and federal health officials and had been "assured that the disease was under control." Some church services were held outdoors, in front of the church, because outside air was considered to be a curative of sorts.

    All over the country cities instituted quarantine and anti-assemblage measures in October as the generally westward-spreading disease peaked. In the nations capital, President Woodrow Wilson issued an order staggering the reporting times or federal workers to prevent the crowding of streetcars. Washington schools also were closed, and Liberty Loan war bond drive parades were prohibited.

    Streetcars carrying troops to and from the camp were to operate with their windows down.

    The Courier-Journal printed a list of preventative measures, which included avoiding crowds, breathing through the nose and not the mouth, choosing and chewing food well, drinking a glass or two of water upon waking up, wearing loose instead of tight clothing, and keeping windows open, while also delivering this curiously dark-humored admonition: "Smother your coughs and sneezes — others do not want the germs which you would throw away."

    With so little public activity taking place, businesses also closed or drastically curtailed their hours, and parties, weddings and funerals were postponed or canceled. Campaigning for the November elections virtually ceased. So as the death rate peaked in mid-October, the infection rare was headed down. Late in October life slowly returned to normal for survivors. The Board of Health lifted its public-gatherings ban on Nov. 10. The following day was the World War I's Armistice Day and joyous crowds filled the streets. That led to another November-December outbreak, but on a much smaller scale.

    In the end, the final tally was shocking. Camp Taylor alone, with its concentrated population and steady How of incoming and outgoing soldiers, reported 11,000 cases of the flu and 1,500 deaths. And, all told, Kentucky lost six times more civilians in 1918 to the flu than service members in the last year of the War to End All Wars.

     


    *The current "swine flu" pandemic, identified as such last June by the World Health Organization (WHO), is caused by what scientists call the "novel H1N1 virus," a genetically modified descendant of the 1918 H1N1 virus whose transmission rate is high but whose severity rare has been moderate. (The H and N refer to hemagglutin and neuraminidase proteins in the virus.) The fact that this flu strain is rooted in 1918's isn't particularly panic-worthy — all influenza A pandemics since 1918, says Centers for Disease Control and Prevention pathologist Jeffery Tauhenberger, have been Spanish flu descendants.

    They include flu pandemics in 1957 (Asian flu) and 1968 (Hong Kong flu). People who contracted and survived those flus — which killed 70,000 and 34,000, respectively, in the U.S. while annual seasonal flus average 36,000 deaths — are likely to have at least some immunity to the new swine flu. Without immunizations according to the WHO, as many as two billion of the world's 6.8 billion people could become infected. The CDC estimates chat 12-24 percent of Americans might come down with this flu without immunizations.

    By J. W.

     

    This article originally appeared in the October 2009 issue of Louisville Magazine.

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