We live in a time of marvelous medical achievements. We have identified and copied some of our genes that make important chemicals like insulin. That genetic information has been put into bacteria which now serve as factories to make human insulin. Plants and animals
continue to provide us with food, clothing, and shelter materials. But
now, some of these same plants and animals have been genetically
engineered to provide additional benefits. We even have genetically
engineered bananas and potatoes so that we can be vaccinated while eating them.
Viruses are now being used as carriers of genetic information. A
virus, once responsible for causing a type of cancer, has its cancer-
causing genes removed. In its place new genes, coded for producing an
essential protein known as an enzyme, is added. The virus then infects
human cells, transferring the essential genetic information to these cells
and enabling them to make the enzyme. Human gene therapy of this type
began in 1990 and continues to be used today. Dozens of different
types of diseases have been eradicated or brought under control in the
last 50 years.
In spite of these magnificent achievements, one disease continues
to kill at least 20,000 American citizens each year. Thousands more lose
valuable time away from work or school. Everyone who reads this book
will know of someone afflicted by this disease - perhaps themselves.
No one knows when or where this disease began. The famous Greek
physician, Hippocrates, documented an outbreak of a disease with symptoms that suggest influenza. This outbreak occurred around 412 B.C. in a region which is now part of Turkey. Two hundred years later, the historian Livy described a disease which struck the Roman army and might have been influenza. (http://www.msnbc.com/news/130842.asp?cp=1=1)
Recorded history is unclear as to when the next outbreak of influenza took place. Some evidence suggests that influenza was spread by the Crusaders. In the later Middle Ages the name "influenza" was first derived. It was thought that the disease was caused by catastrophic or "cosmic influences." Epidemics in Italy in 1357 and 1387 were described as being influenza. (Marks & Beatty)
The term EPIDEMIC refers to a dramatic numerical increase in the number of cases of a disease within a clearly defined area or region during a specified time period. The term PANDEMIC is sometimes defined as a world-wide epidemic.
During the 1500’s three major outbreaks occurred in Europe. The outbreak of 1580 probably qualified as a pandemic. The 1600’s were quiet in Europe but not in the colonies that would become the United States. The 1620’s found influenza in both Virginia and New England. The first recorded epidemic of influenza in North America occurred in 1647.
Subsequent epidemics occurred in New England and among the IroquoisIndians of Canada, in the latter half of the 1600’s. (Marks & Beatty) It has been suggested that influenza was present from South Carolina to New England during most of the 1700"s. In 1759, the father and mother of future president John Adams came down with influenza. His father died, but after a long period of recovery, his mother survived. This epidemic in Massachusetts was particularly devastating to the elderly. In 1790, President George Washington was struck with the flu. His own doctor predicted his death. Washington’s fever broke and he survived, in spite of his doctor's prediction. A few months later a number of Congressmen died from the flu. Thomas Jefferson and James Madison became extremely ill with the flu. Jefferson was said to have been distressed with terrible headaches for more than a month.
Fortunately for the newly formed nation, all of its leaders survived. (MCCullough, D.) The epidemic spread through New York, New England and Nova Scotia.
This epidemic in the United States was a small problem compared to the pandemic that swept through Europe in the early 1780’s. Records show that two thirds of the population of Rome, and three fourths of the population of Britain were afflicted. North America, Spanish America and the West Indies were also affected. (http://www.msnbc.com/news/130842.asp?cp=1=1)
As we move into the 19th century, we find that science and
technology have combined to find answers to some medical question thanks to work and observations made earlier. Anton von Leeuwenhoek
discovered microorganisms in the late 1600’s with his simple microscope-like device. Discovery of these previously unseen organisms led to speculation that diseases might be caused by these microscopic organisms. The 1700’s also saw the development and refinement of techniques that provided protection against some diseases by stimulating an individual’s immune system. These techniques, including vaccinations, were based on earlier observations made by the Romans and also the Chinese that individuals who recover from some diseases do not contract the same disease again.
Even though the causes of many diseases were being discovered, the cause of influenza was still unknown. A virus was still thought of as a chemical poison or toxin, not a distinct structure. Much of this was about to change as we move into the mid to late 1800’s. (BSCS-NIH) At least one historian listed no fewer than 94 epidemics and at least 15 pandemics of influenza between 1173-1875. During the sixteenth century European
doctors began to describe symptoms of disease more precisely. This made it possible to be reasonably sure of when influenza was the culprit.
By the 1800’s all major trading routes and contacts had been established. Europe, Asia and North America maintained continuous, although slow, contact through their shipping trade. Late in 1829 (http://www.msnbc.com/news/130842.asp?cp=1=1) an epidemic of influenza started in Asia. By January of 1831 it had reached Indonesia. At the same time, during the winter of 1830-31, the disease appeared in Russia and began to spread westward. By November of 1831 it had reached the United States.
The Southern Hemisphere was not free of the disease either (Marks & Beatty). Following a visit to New Zealand in 1826 by a British ship, there was a serious outbreak of the disease. The native population was very susceptible since they had no previous contact with the disease. A more serious epidemic broke out at the end of 1838. It seemed that everyone in the northern part of the island was affected. The elderly and those in poor health died in large numbers. Both New Zealand and Australia reported a large number of cases of flu between 1852-1860.
In the summer of 1889 a worldwide epidemic (Pandemic) began in central Asia (http://www.msnbc.com/news/130842.asp?cp=1=1). Following a number of trade routes the disease spread north to Russia, east to China and west to Europe. England was invaded during the first
---world map projection showing named countries and proximity---
week of 1890. (Burnett & White) At its height in 1891 and 1892, more than 4000 people, mostly infants and the elderly, died in London. It became known as the Russian flu. It was the most devastating of all flu epidemics up to this point in recorded history. More than 250,000 people died in Europe and two to three times that number worldwide. Eventually the disease struck North America, parts of Africa and the major Pacific Rim countries. The coming century was to bring more death and destruction, but not just from disease. Influenza remained in England with peaks in 1895, 1900, and 1908. The final onslaught was part of the great pandemic of 1918-1919, killing more than 150,000.
Our knowledge of the nature of viruses expanded at the end of the 19th century. Two investigators were studying a skin disease known as foot-and-mouth disease. They discovered that the agent of the disease was smaller than bacteria. They found that the agent would pass through filters that would trap the smallest bacteria. The following year, in 1899, a Dutch microbiologist, Beijerinck, was trying to find the cause of tobacco mosaic disease which afflicts both tobacco and tomatoes. He proposed that the disease agent was a "filterable virus" and that it must invade cells in order to reproduce. He called this agent a "contagium vivum fluidum" or virus. Beijerinck later discovered that the filterable nature of this disease agent had been discovered seven years earlier. Beijerinck
---picture of Beijerinck in his laboratory---
recognized that he was dealing with a different form of life and predicted that other plant diseases might be caused by a similar agent. His insights became the building blocks for the field of virology. In 1900 Walter Reed discovered that yellow fever in humans was caused by a virus. An understanding of the viral basis of many diseases was becoming clear. However, it would be another 33 years before the flu virus was seen by an electron microscope.
As the 19th century ended and the 20th began, the United States was
actively pursuing a policy of expansion. Economically and politically, the United States was increasing its influence throughout the world. It became involved in the Spanish-American War and in the building of the Panama Canal. Presidents Theodore Roosevelt, William H. Taft and Woodrow Wilson were all involved in building trade relations with the European and Asian markets. In spite of this expansionist philosophy, the entrance of the U.S. into World War I was not inevitable and did not occur quickly. (Morison)
Slowly, and quietly it came to the sunny northern coast of Spain. Spain had remained neutral, and the war could be forgotten during the warm days. Tanned bodies of those in the prime of their lives strained with aches and pains. Sweat came not from the sun, but from high fevers. Older people and children seemed to be spared. In spite of all efforts by officials of the town, the word and the disease spread. Beautiful San Sebastian, Spain, a great tourist destination, was not a place to visit. The first wave of influenza had struck the shores of Spain. The great pandemic to follow would be known as the "Spanish Flu." The label was probably unfair since a random pattern of disease spread was occurring. While San Sebastian was infected in February, the 15th U.S. Calvary brought it with them to Europe in March. Two months later it seemed that all of Spain was affected. It was suggested that eight million people, including the King, were ill. Government offices were forced to close and vehicular traffic came to a standstill. The troops called it the "three-day fever" although the after-effects lasted at least a week. The "Spanish Flu" spread throughout Europe, Asia and the United States. Millions in all walks of life were affected, but relatively few died. Even when the numbers of those dying from the flu seemed high, they were overshadowed by what was happening in the war zones. The war effort was hindered on both sides as more and more troops were too ill to fight. For a while the flu appeared to be dormant in the United States.
Cartoons characters abound that can change from being quiet and mild-mannered to strong, often super human beings. Clark Kent often was described as the mild-mannered reporter who could change into Superman. Doctor David Banner was a quiet scientist who, when stressed, changed to the brutish Incredible Hulk. Remember also the radiation
plagued Peter Parker who becomes Spiderman. Like these cartoon changelings, the Spanish flu of the springtime became the deadly pandemic of the fall.
The flu had been spread to the European battlefields by the more than 1.5 million American soldiers who crossed the Atlantic to help fight the war. Some died at sea from the disease, while others carried the disease to the front lines and trenches. As the war came to a close, soldiers came home and brought a new form of the disease with them.
Throughout Europe the flu acquired a variety of names (Marks & Beatty). In Germany it was called Blitz Katarrh, in England and France, Flanders grippe, and in Japan it was wrestlers fever. The spring wave of flu was relatively mild in Spain, England, Japan and China. Other regions of the world had few, if any, cases. South America was missed completely.
In the United States, on March 11, 1918, the company cook at Camp Funston (part of Fort Riley), Kansas reported sick. Albert Gitchell
had a fever, sore throat, headache and muscular aches and pains. As his temperature was being taken a second soldier, Corporal Lee W. Drake reported to the same building. His temperature was 103 and his symptoms were nearly identical to Gitchell's. By noon, 107 cases had been admitted to the hospital. Within a week, 522 cases had been
emergency area at Camp Funston
reported in California, Florida, Virginia, Alabama, South Carolina and Georgia. Ships in East Coast harbors and prisoners in San Quentin were also affected. Fewer than 50 people died from this wave of flu in the U.S.
The second wave was particularly lethal. As the virus passed through multiple human hosts, it changed from a relatively mild form to something horrible. It reached China in July, Iran early in August, and France in mid August. When the second wave had ended, between 22-40 million people would be dead worldwide. The actual number will probably never be known. In the United States, 5-600,000 people died. The disease covered the globe in less than two months. How it traveled such great distances in such a short period of time is still unknown. This disease was so widespread that even Eskimo villages were completely wiped out.
Entrance to the United States probably occurred on August 28, 1918, just outside of Boston. It has been suggested (Marks & Beatty) that a sailor on a transport in Boston Harbor had symptoms of the flu. By August 30, over 60 sailors were reported ill. Flu sufferers described
feeling like they "had been beaten all over with a club." Some of the sailors on this ship were transferred to Michigan and Illinois and became the starting point for the spread of the disease into the midwest.
Camp Devans, the army base outside Boston, was a supply and exchange point for soldiers going to and coming back from the war. A case of the flu was diagnosed at Camp Devans on September 12th. By the end of October, more than 17,000 cases had been reported at Devans. Nearly 800 men in the prime of their lives died. It was said that "dead bodies were stacked in the morgue like cordwood." The disease moved down the east coast with death rates ranging from 6-15% of those affected. Crowded army camps saw as many as 24,000 soldiers die. By the third week of October the disease had reached the west coast and affected all of the major urban areas along the way.
---Table of Death rates in US by Month---
The civilian population showed an infection rate of about 28%. Often people attending open air rallies for the Liberty Loan drives or
---Picture of Liberty Loan Parade---
watching parades of returning soldiers were surrounded by sneezers and coughers. In Philadelphia, 200,000 people gathered to support the war effort. Within a few days, influenza covered the city. Six hundred thirty five new cases of influenza were reported. The city closed theaters, schools and churches and passed laws preventing outdoor group meetings. People were required to wear gauze masks when in public. Unfortunately
the gauze was porous and would not stop the virus from escaping into the surroundings. Numbers were staggering in the big cities. 851 New Yorkers died in a twenty-four hour period. In Boston, the number was 202 dead in a day, while in Philadephia, 289 lay dead in a one day. October 1918 was the deadliest month in American history. Philadelphia, the City of Brotherly Love had lost nearly 13,000 of her citizens. A total of nearly 195,000 American citizens died from influenza related causes that October.
Young girls sang a song as they played and jumped rope:
I had a little bird
Its name was Enza.
I opened the window
The disease continued to circle the globe. It was estimated that more than 12,000,000 died in India. In some Pacific Islands, mortality figures reached 20% of the total population. Areas of the world that had not previously experienced respiratory diseases of this type had no built up immunity. They were extremely susceptible to the ravages of the disease. The more susceptible the population, the higher the mortality rate. The more densely packed the individuals, the higher the mortality. It was therefore not unusual for urban areas and overcrowded villages to see a large number of deaths. The disease began a slow retreat in November of 1918.
On November 11, 1918, 30,000 people in San Francisco celebrated the end of the war wearing masks. On November 21st the sirens sounded telling people in San Francisco that it was safe to remove their masks. Thanksgiving Day took on new meaning for some in the United States. In December, 5000 people in San Francisco came down with the flu. In San Diego, a general quarantine and the required use of gauze masks occurred that December. The citizens of San Diego had their own little tune.
Obey the laws
And wear the gauze.
Protect your jaws
From septic paws.
The mask law was not popular. Men cut holes in the mask to smoke cigars and cigarettes. Women draped the mask like a veil. Failure to obey the law could result in a hundred dollar fine and thirty days in jail. The law was rarely enforced. (http://www.sandiegohistory.org/stranger/flu.htm) During the time of the second wave of the flu epidemic in the U.S., "more people had died in America from the flu than in combat in all of the wars of this century."(Wark)
The post war years were relatively quiet from a flu standpoint. Regional epidemics continued to show up but there was no worldwide pandemic. Research on viruses continued to expand and become more sophisticated. By the 1930's researchers were looking for an animal host to test the disease. In 1932, the structure of a virus was seen with an electron microscope. Three English scientists used throat materials from patients, during the epidemic of 1932-1933 in England, to try to infect lab animals. The usual lab animals of rabbits, mice, and guinea pigs were not affected. Only ferrets showed the symptoms of influenza. By 1940 chick embryos had become the standard experimental animal (Burnett & White). In 1935 Stanley showed that viruses consisted of protein and nucleic acid and could be crystallized.
In 1956-1957 a new virus was isolated in Peking. Some suggested that it had started in Russia. In early April it reached Hong Kong after a visit to Singapore and Japan. This pending pandemic followed predictable air and water routes. By June and July the southern hemisphere was
----Picture of Route of Spread of Disease---
infected and by the last two weeks in October the disease had peaked in the northern hemisphere. At this peak twenty two million cases were reported. The pandemic became known as the "Asian Flu." More people were infected during this time period than during the pandemic of 1918-1919. However, the number of deaths was substantially fewer than in 1918. Some sources suggest that there were 70,000 deaths in the United States from the 1957 flu pandemic.
There are many suggestions as to why the mortality was so much lower for this pandemic. The world was at peace, food and medical help were plentiful, and antibiotics were available to take care of secondary infections. Mortality of the Asian flu occurred mostly among older persons, usually from a secondary infection caused by the Staphylococcus aureus bacterium. On a worldwide basis, 10-35% of the population was affected but mortality was about 0.25%. (http://www.msnbc.com/news/130842.asp?cp=1=1)
In 1968-69, a new Hong Kong flu claimed 700,000 lives globally. About 34,000 died in the United States. In 1976 a new flu virus was identified in an Army recruit in Fort Dix, New Jersey. Known as a swine flu, it was feared that this flu was related to the flu of 1918-19. A massive program of influenza-immunization was undertaken. Happily for the rest of the world, the swine flu never left Fort Dix. However, the immunization program led to a number of cases of a type of paralysis among those who had been inoculated.
During the 1980's and 1990's, a number of individual cases of swine flu and flu of bird origin (avian) surfaced. These affected a very limited number of people, usually one or two. In 1997, another Hong Kong flu emerged. Eighteen people became ill and six died. This flu was unique because it moved directly from chickens to people. To stop the outbreak, more than a million chickens were gassed to death in Hong Kong. It has been suggested that although this procedure seems cruel, it was the smartest thing to do. It probably prevented a more widespread disaster from occurring. This action worked because this flu was not easily spread from person to person. It is now the 21st century. When and where will this deadly traveler arrive next?
As this chapter is being completed, it is April, 2002. Last year, a million chickens were slaughtered in Hong Kong. In spite of that destruction, a new strain of avian flu is currently spreading in Hong Kong. This strain has not yet been analyzed. Another strain of flu that affects only chickens and turkeys, but not humans, has been found in the United States.
References Cited and Consulted
ASM News, Volume 59, No.8, 1993, page 402
picture of Beijerinck and notes
Brock, Thomas "Milestone in Microbiology", Prentice-Hall, 1961.
BSCS, Videodiscovery, NIH Curriculum Supplement Series, National Institute of Allergy and Infectious Diseases "Emerging and Re-emerging Infectious Diseases" NIH Publication, October 1999.
Burnett, Sir MacFarlane & David O. White, "Natural History of Infectious Disease", 4th edition. Cambridge University Press, London. 1972.
Haimann, Barbara "Disease: Identification, Prevention, and Control" Mosby-YearBook Inc. 1994.
Kolata, Gina. "Flu...", Farrar, Straus & Giroux Publishers, 9/2000.
Madigan, M.T., Martinko, J.M., and J. Parker. "Brock Biology of Microorganisms", 8th edition, Prentice Hall, Upper Saddle River, New Jersey, 1997. page 943, Figure 23.17
Marks, Geoffrey and William K. Beatty "Epidemics", Charles Scribner's Sons, N.Y. 1976.
McCullough, David "John Adams", Simon & Schuster, New York, 2001.
McNeil, William H. "Plagues and Peoples", Doubleday, Garden City, N.Y. 1976.
Mims, Cedric A. "The Pathogenesis of Infectious Disease", Academic Press, N.Y. 1977.
Morison, Samuel Eliot "The Oxford History of the American People", Oxford University Press, New York, 1965.
Science, February 23, 1998 Volume 151, No, 7 The Hong Kong Incident, picture
Voyles, Bruce A. "The Biology of Viruses" Mosby-YearBook, Inc. 1993.
Wark, Lori "The Flu:The Hunt for a Killer in Disguise"
picture of Camp Funston
picture of makeshift emergency ward at Camp Funston
Influenza’s reach over time – time line of events
Martin, B.E. & J. Risser, The History of Influenza
table showing death rates
picture of man in a gauze mask
Richardson, Renee. The Brainerd Daily Dispatch (web posted 2/22/99)
1918 spanish flu epidemic struck with devastating quickness
San Diego pictures