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Review
. 2014 Sep;8(5):538-46.
doi: 10.1111/irv.12267. Epub 2014 Jun 27.

Death from 1918 pandemic influenza during the First World War: a perspective from personal and anecdotal evidence

Peter C Wever  1 , Leo van Bergen
Affiliations
Review

Death from 1918 pandemic influenza during the First World War: a perspective from personal and anecdotal evidence

Peter C Wever et al. Influenza Other Respir Viruses. 2014 Sep.

Abstract

The Meuse-Argonne offensive, a decisive battle during the First World War, is the largest frontline commitment in American military history involving 1.2 million U.S. troops. With over 26,000 deaths among American soldiers, the offensive is considered "America's deadliest battle". The Meuse-Argonne offensive coincided with the highly fatal second wave of the influenza pandemic in 1918. In Europe and in U.S. Army training camps, 1918 pandemic influenza killed around 45,000 American soldiers making it questionable which battle should be regarded "America's deadliest". The origin of the influenza pandemic has been inextricably linked with the men who occupied the military camps and trenches during the First World War. The disease had a profound impact, both for the military apparatus and for the individual soldier. It struck all the armies and might have claimed toward 100 000 fatalities among soldiers overall during the conflict while rendering millions ineffective. Yet, it remains unclear whether 1918 pandemic influenza had an impact on the course of the First World War. Still, even until this day, virological and bacteriological analysis of preserved archived remains of soldiers that succumbed to 1918 pandemic influenza has important implications for preparedness for future pandemics. These aspects are reviewed here in a context of citations, images, and documents illustrating the tragic events of 1918.

Keywords: 1918 Pandemic influenza; First World War; Spanish influenza; mortality; risk factors; secondary bacterial pneumonia.

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Figures

Figure 1
Figure 1
Headstone of U.S. Army private John R. Adams, who is interred in the Meuse-Argonne American Cemetery (Plot G, Row 36, Grave 32) after succumbing to influenza and pneumonia at the age of 26 on November 3, 1918 during the Meuse-Argonne offensive (photograph by first author; courtesy of the American Battle Monuments Commission).
Figure 2
Figure 2
Emergency hospital at Camp Funston, a U.S. Army training camp in Kansas, where the first outbreak generally considered caused by 1918 pandemic influenza occurred (photographer unknown; courtesy of Otis Historical Archives, National Museum of Health and Medicine, Silver Spring, MD, USA).
Figure 3
Figure 3
First World War era stereocard view of the barracks at Camp Devens in Massachusetts, which was the first U.S. Army training camp hit by the deadly second wave of 1918 pandemic influenza with more than 14 000 cases and 757 deaths (collection of first author).
Figure 4
Figure 4
Chart illustrating the symptomatology of 1918 pandemic influenza. Sudden onset, prostration, high temperature, headache, and conjunctivitis were the five symptoms reported most often from 16 U.S. Army training camps in 1918 (Reeve Photograph Collection; courtesy of Otis Historical Archives, National Museum of Health and Medicine, Silver Spring, MD, USA).
Figure 5
Figure 5
Lung specimen obtained during autopsy of an unknown individual who died of influenza-related pneumonia (accession number 3041, Army Medical Museum). Peribronchiolar consolidations were observed in both lobes extending out from thickened interstitial tissue at about the middle of the upper lobe. Culture revealed Streptococcus hemolyticus, currently referred to as β-hemolytic streptococci (photo reprinted with permission from the U.S. Army Medical Department Center of History and Heritage, Research Collection).
Figure 6
Figure 6
Case-fatality per 100 persons ill with influenza and pneumonia per age group in 1918 (U.S. Public Health Service house-to-house surveys, 8 states) and 1928–1929 (U.S. Public Health Service surveys). The unique W-shaped curve illustrates the high case-fatality rate among infants, young adults, and elderly in 1918 (published in reference 35; publication in the public domain).
Figure 7
Figure 7
While “influenza produced no heroes”, heroes themselves were not immune to the disease. British Army officer George R.D. Moor, who was awarded the Victoria Cross, the Military Cross, and an additional Bar to the Military Cross, died from 1918 pandemic influenza on November 3, 1918 at the age of 22. He is depicted on a so-called cigarette card commemorating First World War Victoria Cross recipients issued by tobacco company Gallaher Ltd (collection of first author).
Figure 8
Figure 8
“Sterbebild” (death card) of German private August Brodschelm who died on November 8, 1918 at the age of 22 from “Grippe” (collection of first author).
See this image and copyright information in PMC

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