The forgotten flu

Nurse at isolation facility.

The great pandemic of 1918 – known as the Spanish flu – is thought to have infected 20-25% of the world’s population. About three percent of those died, somewhere between 50 and 100 million people.  In the US, the number of deaths lowered life expectancy statistics by 12 years.

The first case in the United States appeared on March 4, 1918, at an army base in Kansas.  A second case showed up in New York on March 11.  By August, a new and more deadly strain had appeared simultaneously in France, Sierra Leone and Boston.  It was thought that the milder variety had increased in virulence by being passed among soldiers in the trenches of WWI.

The deadlier strain killed fast, sometimes within hours of the first symptoms appearing, and it struck the young and healthy most of all, those between 20 and 40.  Those with healthy immune systems fought the disease so vigorously that a cytokine storm – an attack on the body by its own immune system – was created.  Children and older people, with weaker immune systems, actually had a better chance of survival.

Trolley conductor in Seattle refuses to allow the man without a mask to board.

It spread quickly, as far north as the Arctic, even to remote Pacific islands.  In Tahiti, 14% of the population died in two months and in Samoa, in the same amount of time. 20% of the population died.

It was called Spanish flu because of the war. Press censorship was so stringent in Allied countries, that very little information was printed.  But in Spain, which was neutral and where news was not censored, so much information was forthcoming that the public began to associate the disease with that country.

Then it stopped. Philadelphia, for instance. reported 4,597 deaths in the week ending October 16 – by November 11 there were almost no cases.  The theory is that the strain weakened, but no one now can be sure.

What we do know is that until very recently, coincident with bird flu and other epidemics, the pandemic of 1918 was known as ‘the forgotten flu.’  Erasing it from the collective memory began almost immediately and there are theories about that too – chiefly that the devastating losses from the war seemed more important.  And, in a world that still experienced epidemics of measles, typhoid, scarlet  fever, diphtheria, and cholera, this was just one more cross to bear.

In fact, it swept through the U.S. in about nine months and then it was gone.  It would be years before researchers realized what it had wrought worldwide.

A shot in the arm

Microorganisms growing on agar plate

The Black Death – bubonic plague – which killed one-quarter of the population of Europe in the 14th century, faded away, but never quite died out.  It returned in the middle of the 19th century in the Third Pandemic, which began in China, spread to India and killed 12 million people in those countries before it began to decline.

In 1894, Dr. Shibasaburo Kitasato was called on to tackle the problem of plague.

Kitasato had already made history as the first person to grow tetanus bacillus in a pure culture.  He was studying with Dr. Robert Koch in Berlin and soon he and Emil von Behring had developed a serum therapy for tetanus.  They did pioneering work in the field of antitoxins and passive immunity, but it was von Behring who was awarded the first Nobel prize for medicine in 1901.

Dr. Shibasaburo Kitasato

Kitasato had returned to Japan in 1891 to found the Institute of Infectious Diseases in Tokyo where he continued to work on such scourges as dysentery and tuberculosis.  In 1894, the government asked him to go to Hong Kong to help with an epidemic of bubonic plague.  Working in a makeshift hut, he succeeded  – on this date reportedly – in isolating the infectious agent in the plague.

Next door, Alexandre Yersin of the Pasteur Institute was also working on the problem.  Their results were almost simultaneous, but it was Yersin that got the credit and the bacterium is named for him.

Four years after his work on the plague, Kitasato and one of his students were able to isolate the bacteria that causes dysentery.  In his lifetime, he made substantial, sometimes seminal contributions to the eradication or amelioration of major causes of human misery with his work on tetanus, tuberculosis, plague, dysentery and anthrax.  His work on antitoxins helped speed the creation of effective vaccines.

Kitasato, who never received a Nobel or had a bacillus named for him, was one of the pioneers of microbiology  – he just happened to live out of the mainstream of European medical circles and at a time when information traveled slowly if at all.  Nonetheless, he should be right there in the pantheon that includes Pasteur, Wasserman, Ehrlich and others.

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This was the date on which the British destroyed the Library of Congress, setting fire to more than 3,000 books.  Such a nasty little war, the War of 1812 – the British really were just plain malicious, burning the White House and all the town halls they could find.  Still smarting from the Revolution, I guess.