A letter from a physician at one U.S. Army camp to a colleague puts a more human face on those numbers:

These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen … and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white. It is only a matter of a few hours then until death comes…. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies…. We have been averaging about 100 deaths per day…. Pneumonia means in about all cases death…. We have lost an outrageous number of Nurses and Drs. It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce…. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows…. Good By old Pal, God be with you till we meet again (Grist, 1979).

That letter reflected a typical experience in American Army cantonments. The civilian experience was not much better.

In preparing for another pandemic, it is useful to examine events of 1918 for lessons, warnings, and areas for further inquiry.

The Virus Itself

The pandemic in 1918 was hardly the first influenza pandemic, nor was it the only lethal one. Throughout history, there have been influenza pandemics, some of which may have rivaled 1918’s lethality. A partial listing of particularly violent outbreaks likely to have been influenza include one in 1510 when a pandemic believed to come from Africa “attacked at once and raged all over Europe not missing a family and scarce a person” (Beveridge, 1977). In 1580, another pandemic started in Asia, then spread to Africa, Europe, and even America (despite the fact that it took 6 weeks to cross the ocean). It was so fierce “that in the space of six weeks it afflicted almost all the nations of Europe, of whom hardly the twentieth person was free of the disease” and some Spanish cities were “nearly entirely depopulated by the disease” (Beveridge, 1977). In 1688, influenza struck England, Ireland, and Virginia; in all these places “the people dyed … as in a plague” (Duffy, 1953). A mutated or new virus continued to plague Europe and America again in 1693 and Massachusetts in 1699. “The sickness extended to almost all families. Few or none escaped, and many dyed especially in Boston, and some dyed in a strange or unusual

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