Thought bird-flu, SARS was bad?
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Coming out of the East, the Black Death reached the shores of Italy in the spring of 1348 unleashing a rampage of death across Europe unprecedented in recorded history. By the time the epidemic played itself out three years later, anywhere between 25% and 50% of Europe's population had fallen victim to the pestilence.
The plague presented itself in three interrelated forms. The bubonic variant (the most common) derives its name from the swellings or buboes that appeared on a victim's neck, armpits or groin. These tumors could range in size from that of an egg to that of an apple. Although some survived
The Plague's Progress
the painful ordeal, the manifestation of these lesions usually signaled the victim had a life expectancy of up to a week. Infected fleas that attached themselves to rats and then to humans spread this bubonic type of the plague. A second variation - pneumonic plague - attacked the respiratory system and was spread by merely breathing the exhaled air of a victim. It was much more virulent than its bubonic cousin - life expectancy was measured in one or two days. Finally, the septicemic version of the disease attacked the blood system.
Having no defense and no understanding of the cause of the pestilence, the men, women and children caught in its onslaught were bewildered, panicked, and finally devastated.
The Signs of Impending Death
"The symptoms were not the same as in the East, where a gush of blood from the nose was the plain sign of inevitable death; but it began both in men and women with certain swellings in the groin or under the armpit. They grew to the size of a small apple or an egg, more or less, and were vulgarly called tumours. In a short space of time these tumours spread from the two parts named all over the body. Soon after this the symptoms changed and black or purple spots appeared on the arms or thighs or any other part of the body, sometimes a few large ones, sometimes many little ones. These spots were a certain sign of death, just as the original tumour had been and still remained.
Varying Reactions to Disaster
"...Such fear and fanciful notions took possession of the living that almost all of them adopted the same cruel policy, which was entirely to avoid the sick and everything belonging to them. By so doing, each one thought he would secure his own safety.
Some thought that moderate living and the avoidance of all superfluity would preserve them from the epidemic. They formed small communities, living entirely separate from everybody else. They shut themselves up in houses where there were no sick, eating the finest food and drinking the best wine very temperately, avoiding all excess, allowing no news or discussion of death and sickness, and passing the time in music and suchlike pleasures. Others thought just the opposite. They thought the sure cure for the plague was to drink and be merry, to go about singing and amusing themselves, satisfying every appetite they could, laughing and jesting at what happened. They put their words into practice, spent day and night going from tavern to tavern, drinking immoderately, or went into other people's houses, doing only those things which pleased them.
In this suffering and misery of our city, the authority of human and divine laws almost disappeared, for, like other men, the ministers and the executors of the laws were all dead or sick or shut up with their families, so that no duties were carried out. Every man was therefore able to do as he pleased.
Many others adopted a course of life midway between the two just described. They did not restrict their victuals so much as the former, nor allow themselves to be drunken and dissolute like the latter, but satisfied their appetites moderately. They did not shut themselves up, but went about, carrying flowers or scented herbs or perfumes in their hands, in the belief that it was an excellent thing to comfort the brain with such odours; for the whole air was infected with the smell of dead bodies, of sick persons and medicines.
Others again held a still more cruel opinion, which they thought would keep them safe. They said that the only medicine against the plague-stricken was to go right away from them. Men and women, convinced of this and caring about nothing but themselves, abandoned their own city, their own houses, their dwellings, their relatives, their property, and went abroad or at least to the country round Florence, as if God's wrath in punishing men's wickedness with this plague would not follow them but strike only those who remained within the walls of the city, or as if they thought nobody in the city would remain alive and that its last hour had come."
The Breakdown of Social Order
"One citizen avoided another, hardly any neighbour troubled about others, relatives never or hardly ever visited each other. Moreover, such terror was struck into the hearts of men and women by this calamity, that brother abandoned brother, and the uncle his nephew, and the sister her brother, and very often the wife her husband. What is even worse and nearly incredible is that fathers and mothers refused to see and tend their children, as if they had not been theirs.
Thus, a multitude of sick men and women were left without any care, except from the charity of friends (but these were few), or the greed, of servants, though not many of these could be had even for high wages, Moreover, most of them were coarse-minded men and women, who did little more than bring the sick what they asked for or watch over them when they were dying. And very often these servants lost their lives and their earnings. Since the sick were thus abandoned by neighbours, relatives and friends, while servants were scarce, a habit sprang up which had never been heard of before. Beautiful and noble women, when they fell sick, did not scruple to take a young or old man-servant, whoever he might be, and with no sort of shame, expose every part of their bodies to these men as if they had been women, for they were compelled by the necessity of their sickness to do so. This, perhaps, was a cause of looser morals in those women who survived."
Mass Burials
"The plight of the lower and most of the middle classes was even more pitiful to behold. Most of them remained in their houses, either through poverty or in hopes of safety, and fell sick by thousands. Since they received no care and attention, almost all of them died. Many ended their lives in the streets both at night and during the day; and many others who died in their houses were only known to be dead because the neighbours smelled their decaying bodies. Dead bodies filled every corner. Most of them were treated in the same manner by the survivors, wbo were more
Citizens of Tournai bury plague victims. These are
fortunate to have coffins. Most victims
were interred in mass graves
concerned to get rid of their rotting bodies than moved by charity towards the dead. With the aid of porters, if they could get them, they carried the bodies out of the houses and laid them at the door; where every morning quantities of the dead might be seen. They then were laid on biers or, as these were often lacking, on tables.
Such was the multitude of corpses brought to the churches every day and almost every hour that there was not enough consecrated ground to give them burial, especially since they wanted to bury each person in the family grave, according to the old custom. Although the cemeteries were full they were forced to dig huge trenches, where they buried the bodies by hundreds. Here they stowed them away like bales in the hold of a ship and covered them with a little earth, until the whole trench was full."
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The influenza pandemic of 1918-1919 killed more people than the Great War, known today as World War I (WWI), at somewhere between 20 and 40 million people. It has been cited as the most devastating epidemic in recorded world history. More people died of influenza in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.
In the fall of 1918 the Great War in Europe was winding down and peace was on the horizon. The Americans had joined in the fight, bringing the Allies closer to victory against the Germans. Deep within the trenches these men lived through some of the most brutal conditions of life, which it seemed could not be any worse. Then, in pockets across the globe, something erupted that seemed as benign as the common cold. The influenza of that season, however, was far more than a cold. In the two years that this scourge ravaged the earth, a fifth of the world's population was infected. The flu was most deadly for people ages 20 to 40. This pattern of morbidity was unusual for influenza which is usually a killer of the elderly and young children. It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influenza during the pandemic, ten times as many as in the world war. Of the U.S. soldiers who died in Europe, half of them fell to the influenza virus and not to the enemy (Deseret News). An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby). 1918 would go down as unforgettable year of suffering and death and yet of peace.
The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza.
The influenza pandemic circled the globe. Most of humanity felt the effects of this strain of the influenza virus. It spread following the path of its human carriers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people (Brown). The Great War, with its mass movements of men in armies and aboard ships, probably aided in its rapid diffusion and attack. The origins of the deadly flu disease were unknown but widely speculated upon. Some of the allies thought of the epidemic as a biological warfare tool of the Germans. Many thought it was a result of the trench warfare, the use of mustard gases and the generated "smoke and fumes" of the war. A national campaign began using the ready rhetoric of war to fight the new enemy of microscopic proportions. A study attempted to reason why the disease had been so devastating in certain localized regions, looking at the climate, the weather and the racial composition of cities. They found humidity to be linked with more severe epidemics as it "fosters the dissemination of the bacteria."
The origins of this influenza variant is not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized. The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/191
where it allegedly killed 8 million in May (BMJ, 7/13/191. However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. Wilson had just given his 14 point address. There was virtually no response or acknowledgment to the epidemics in March and April in the military camps. It was unfortunate that no steps were taken to prepare for the usual recrudescence of the virulent influenza strain in the winter. The lack of action was later criticized when the epidemic could not be ignored in the winter of 1918 (BMJ, 191. These first epidemics at training camps were a sign of what was coming in greater magnitude in the fall and winter of 1918 to the entire world.
The war brought the virus back into the US for the second wave of the epidemic. It first arrived in Boston in September of 1918 through the port busy with war shipments of machinery and supplies. The war also enabled the virus to spread and diffuse. Men across the nation were mobilizing to join the military and the cause. As they came together, they brought the virus with them and to those they contacted. The virus killed almost 200,00 in October of 1918 alone. In November 11 of 1918 the end of the war enabled a resurgence. As people celebrated Armistice Day with parades and large partiess, a complete disaster from the public health standpoint, a rebirth of the epidemic occurred in some cities. The flu that winter was beyond imagination as millions were infected and thousands died. Just as the war had effected the course of influenza, influenza affected the war. Entire fleets were ill with the disease and men on the front were too sick to fight. The flu was devastating to both sides, killing more men than their own weapons could.
The pandemic affected everyone. With one-quarter of the US and one-fifth of the world infected with the influenza, it was impossible to escape from the illness. Even President Woodrow Wilson suffered from the flu in early 1919 while negotiating the crucial treaty of Versailles to end the World War (Tice). Those who were lucky enough to avoid infection had to deal with the public health ordinances to restrain the spread of the disease. The public health departments distributed gauze masks to be worn in public. Stores could not hold sales, funerals were limited to 15 minutes. Some towns required a signed certificate to enter and railroads would not accept passengers without them. Those who ignored the flu ordinances had to pay steep fines enforced by extra officers (Deseret News). Bodies pilled up as the massive deaths of the epidemic ensued. Besides the lack of health care workers and medical supplies, there was a shortage of coffins, morticians and gravediggers (Knox). The conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages. -
Notice that both infections were thought to have originated from the East?