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The Spanish flu raged 100 years ago. It remains a mystery to this day

In 1918 a deadly fever spreads across the globe. More people die than in both world wars combined.

When the Spanish monarch Alfonso XIII. and part of his cabinet are shaken by fever, one of the most devastating epidemics in human memory is given its name. At the end of May 1918, the Reuters news agency cabled all over the world: “A strange form of disease with an epidemic character has appeared in Madrid. The epidemic is mild and no deaths have been reported so far. " Soon everyone is talking about the Spanish flu - and it quickly becomes apparent that the disease is anything but harmless. In the following months between 20 and 50 million people die of the highly contagious influenza, some historians estimate the number of victims even at up to 100 million. Half a billion people, i.e. a third of the world's population at that time, are said to have been infected. They are ciphers of a horror that has long been treated as a footnote in history, as a mere appendix to the mass slaughter of the First World War, which was then drawing to a close.

Complaints about "lightning catarrh"

The Spanish flu did not originate in the Iberian Peninsula, but in all likelihood in the American Midwest. At Camp Funston, Kansas, where soldiers are being trained to work in the European trenches, an Army chef named Albert Gitchell reports to the infirmary on the morning of March 4, 1918. Furious headache and body aches, high fever and sore throat plague him. By noon, 100 more cases with the same symptoms are registered; after three weeks, over 1000, 38 recruits die. Gitchell later went down in medical history as "patient zero"; but at that time nobody suspected what was to come.

American soldiers are shipped to France by the thousands in March and April. With them the influenza also reaches the western front, where the armies of the Entente and the Central Powers have dug themselves meters deep. The Germans then complain about "lightning catarrh", the British about "Flemish fever", the American GI about a mysterious "knock-me-down fever". The rampant flu fills the hospitals, entire units are incapacitated for days, the offensives stall. The German General Erich Ludendorff later recalls: "The flu spread everywhere." The press censorship in the warring states, however, ensures that no disturbing news reaches the public.

Initially, the disease is no different from the usual seasonal flu. The writer Ernst Jünger reported by field post: "I take long sunbaths to prevent myself and have turned so tanned that no aviator will discover me." The frontline fighter, who knows his way around garnet hail and gas mist, takes the influenza calmly: "There is absolutely nothing terrible about it, unless it is spread."

Indeed, the flu, which is transmitted as a droplet and contact infection, races unstoppably across the globe in May and June: to neutral Spain, for example, where it is openly reported for the first time due to the lack of censorship; but also to Great Britain, Eastern Europe, Africa, America, Asia or Australia. In the Vatican, people soon fevered like in Havana, Mumbai or Philadelphia. Two modern achievements - the steamship and the railroad - as well as the gigantic shifts of troops and materials are responsible for this. Despite the horrendous number of infections, there are initially relatively few fatalities.

But when the flu-like spook seems to be over in summer, something happens that is still puzzling today: The pathogen returns in a murderously mutated form, and not until the following winter, but almost seamlessly. By the end of August, influenza was raging again on both sides of the Atlantic - in Boston on the American east coast, in Freetown in West Africa and in Brest in France. The great dying begins.

Dark blue corpses

After the same initial symptoms as in spring, this time the disease takes a dramatic course much more often. Mahogany-colored spots form on the cheeks of infected people, then the redness spreads all over the face. The patients spit blood, their bodies turn violet and dark blue, "until one could hardly distinguish colored people from white ones," as an American military doctor writes. Experts call this effect, which results from a lack of oxygen, "heliotropic cyanosis". The sick end up suffocating miserably and often with clear consciousness. During the autopsy of the corpses, the doctors found swollen lungs full of leaked blood. Most deaths are the result of bacterial pneumonia. Medical historians today assume that the virus weakened the organism to such an extent that the body could no longer defend itself against additional microbial attacks. The result: a so-called superinfection.

The writer Stefan Zweig wrote in his diary in Zurich in October 1918: “A world epidemic against which the plague in Florence or similar chronicle stories are child's play. It eats away 20,000 to 40,000 people every day. " And on the Indonesian island of Java it is apodictically: «Sick in the morning, dead in the evening; Sick in the evening, dead in the morning, ”as locals still tell scientists decades later. In fact, so many people die in such a short time during the second wave that there are shortages in coffin production in Europe and the USA; The deceased accumulate in the morgues, and many are finally buried in anonymous mass graves.

Because of the aggressive course of the disease, the discolored corpses and the censorship policy of the authorities, horror stories and conspiracy theories circulate among contemporaries. A return of the "black death", the plague, is speculated. Bigots believe in God's punishment. In Constantinople, a doctor said it was "a catastrophe that is not called the plague, but is actually much more dangerous and deadly." The flu is caused by toxic fumes rising from the piles of corpses on the battlefields in Flanders or Champagne, others claim. The Germans are even suspected of using insidious biological weapons or of poisoning aspirin tablets from the pharmaceutical manufacturer Bayer in order to win the world war. But they too die by the thousands.

Aspirin, quinine, heroin!

Doctors are puzzled. The progressive among them believe that the flu symptoms come from a bacillus named after its discoverer, the German bacteriologist Richard Pfeiffer - a fallacy that stems from the fact that this bacterium (Haemophilus influenzae) is found in many patients. But it doesn't trigger flu: the influenza virus that caused it, which at the time was not visible under the microscope because of its size, was not discovered until 1933.

Because medical professionals are in the dark when it comes to diagnostics, their remedies do not work either. All known therapies fail. There is still no flu shot, no antivirals, or antibiotics to treat bacterial infections. Doctors often resort to the “miracle drug” of the time, aspirin, which at least relieves pain and lowers fever; prescribe quinine, which has already proven itself in the fight against malaria; administer fortifying arsenic preparations, heroin and morphine or inject mercury. Bed rest, nasal showers and inhalations are part of the standard program. The consumption of hard liquor is also common. The British trust the effects of whiskey, while doctors in French-speaking Switzerland write against the misconception that “alcohol in high doses protects against influenza”.

In non-industrialized countries, people rely on traditional healing methods, in India on Ayurveda, in China on sweating and opium smoking in public baths. Bloodletting from premodern times is also being practiced again in times of need.

The authorities recognized the seriousness of the situation by the second wave of influenza at the latest. Alarm systems for flu cases are now being introduced, quarantines are being imposed at ports and train stations, and isolation wards are being set up in hospitals. The slogan is “social distancing”, so no more mass gatherings: schools, theaters, markets and churches are temporarily closed. The use of face masks and disinfectants is recommended or even required by law to reduce transmission rates. In the USA signs spread the warning “Spitting means death!”, In Switzerland “Grippsano”, a “telephone disinfector”, is advertised. Public life is flagging. But the measures taken can at best delay the further spread of the deadly disease, but not prevent it. Those who can do it like the later star architect Le Corbusier, who holed up in his Paris apartment, drinks cognac, smokes - and waits until the worst is over.

24,500 dead in Switzerland

When the guns finally rest in November after more than four years of war, the killer viruses find new breeding ground: Hundreds of thousands are in each other's arms at the victory celebrations, revolutionary gatherings take place in the losing states. Above all, however, millions of fighters return to their homeland - and spread the pathogen further. The virus penetrates into the remotest corners of the world and kills people. Only very few areas such as Antarctica, St. Helena in the South Atlantic or the island of Marajó at the mouth of the Amazon are spared because no ships with infected people dock there. In December the situation calmed down noticeably, but in the spring of 1919 a third wave of flu broke out over individual regions of the world. In this last phase, Alaska, for example, is particularly hard hit, where almost the entire population falls ill at one stroke. But the epidemic has not yet got rid of Europe either: During the Paris peace negotiations, for example, the American President Woodrow Wilson suffers such a violent attack of flu that his personal doctor initially assumes a poison attack.

To this day it is controversial how many millions of people fell victim to the Spanish flu. Most states did not have death records even in peacetime, let alone in an all-out war that pushed borders and created chaos. Somewhat reliable data still exist: Experts estimate 675,000 flu deaths for the USA, 350,000 for Germany, and 400,000 each for France and Japan. In Switzerland, which was unscathed by the war, the federal authorities recorded 744,000 cases of the 4 million inhabitants Influenza, around 24,500 people died. In remote areas such as Western Samoa or the Fiji Islands, death rates of 15 to 20 percent have been recorded. On the other hand, hardly any statistical information is available for densely populated areas such as India, China, Russia, the Orient and the African continent. It is only clear that they were hit hard by the Spanish flu, which is why the more recent projections by medical historians Niall Johnson and Jürgen Müller of 50 to 100 million deaths worldwide - more than the two world wars combined! - are entirely plausible.

Why the strong?

A hundred years after the terrible epidemic spread around the globe, other important questions have not been finally answered: Why did robust men and women between the ages of twenty and forty so often die of the Spanish flu and not mainly children and the sick, as with the usual seasonal flu and old ones? And how exactly are the deadly pandemic and the First World War related? The massive relocations of troops, the rigid press censorship and the poor health of large sections of the population have certainly promoted the spread of the flu. What influence the killer virus had on the course of the war is just as controversial among historians as the consequences of this deep demographic break have remained unexplored.

The fact that the Spanish flu has barely found its way into national cultures of remembrance can, however, be explained: On the one hand, the memory of the devastating disease was overlaid by the more powerful images of a four-year "total" and extremely momentous war. On the other hand, epidemics are generally unsuitable for heroic portrayals - especially not when politics and medicine are as perplexed as in those feverish months of 1918.

Literature on the subject:
Laura Spinney: 1918 - The world in fever. How the Spanish flu changed society. Hanser-Verlag, Munich 2018.
Harald Salfellner: The Spanish flu. A history of the 1918 pandemic. Vitalis Publishing House, Prague 2018.
Wilfried Witte: Belladonna and quarantine. The history of the Spanish flu. Klaus Wagenbach Publishing House, Berlin 2008.
Alfred W. Crosby: America's Forgotten Pandemic. The Influenza of 1918. Cambridge University Press, Cambridge 2003.