http://www.libpubmedia.co.uk/MedJ-Issues/Issue-5/Erkoreka.pdf
a good paper without difficulties
mutliple snip.. must be read
Origins of the Spanish Influenza pandemic (1918-1920) and its
relation to the First World War
Anton Erkoreka
Basque Museum of the History of Medicine, Faculty of Medicine (UPV/EHU), E-48940 Leioa (Bizkaia), Spain
*Correspondence to: Anton Erkoreka, Email: a.erkoreka@ehu.es, Fax: +34 946 013211
Received 14 August 2009, Revised 01 November 2009, Accepted 05 November 2009, Published online 30 November 2009
J Mol Genet Med (2009), 3(2), 190-194
The virus which was responsible for the first benign wave of the Spanish Influenza in the spring of 1918, and which was to become extremely virulent by the end of the summer of 1918, was inextricably associated with the soldiers who fought during the First World War. The millions of young men who occupied the military camps and trenches were the substrate on which the influenza virus developed and expanded. Many factors contributed to it, such as: the mixing on French soil of soldiers and workers from the five continents, the very poor quality of life of the soldiers, agglomeration, stress, fear, war gasses used for the first time in history in a massive and indiscriminate manner, life exposed to the elements, cold weather, humidity and contact with birds, pigs and other animals, both wild and domestic. Today, this combination of circumstances is not present and so it seems unlikely that new pandemics, such as those associated with the avian influenza or swine influenza, will emerge with the virulence which characterized the Spanish Influenza during the autumn of 1918.
snip
MATERIALS AND METHODS
We examined the reports of the medical doctors who
attended the French and American troops during the First
World War. These documents are conserved in the
Archives of the Health Services of the French Army
(Archives du Service de Santé des Armées: ASSA), located
in Val-de-Grâce (Paris). Other sources included medical
articles and books published during that period. A variety
of archives in France, Spain and Portugal were also
consulted to provide more complete information.
RESULTS AND DISCUSSION
The preceding pandemic of 1889-1890
The 1889-1890 pandemic influenza is the most important
antecedent and is particularly interesting due to its
similarities and differences with respect to the later Spanish
Influenza. It constitutes the link between the epidemics and
pandemics which occurred in the Modern Age and the
extremely virulent 1918 influenza. Between these
pandemics, during the last decade of the XIX century and the
first two decades of the XX century, multiple foci of
influenza were reported in many places throughout the
world. The doctors at that time attributed these foci to
residues of the 1889-1890 pandemic and considered the
influenza to be an endemic disease. At that time, seasonal
influenza had not yet been distinguished from pandemic
influenza and the underlying virus had not yet been
discovered.
big snip...
i) Nervous influenza: Very brusque beginning, intense
cephalalgia, intense pain in the eye orbits, joints and
muscles. By the end of one to four days, these symptoms
ceased and a strong dry cough appeared. This was
accompanied, on occasion, by scarlatiniform, rubeoliform
and skin rash on the anterior part of the arms, wrists and
chest. On occasion, urticaria was observed.
Étaples (1916-1917)
Oxford et al (2002, 2005) have suggested that the
beginnings of the pandemic occurred in the British
military base at Étaples, situated in the north of France
(Department of Pas-de-Calais). This military base, which
was quite important throughout the First World War, was
occupied by 100,000 soldiers within a space of 12 km2.
The base was situated near sea marshes with abundant
migratory birds. Nearby, there were many farms with pigs,
ducks and geese reserved as food for the soldiers, and
horses which were used as a means of transport.
The mixture of crowded soldiers, animals and 24 types of
war gasses, which were massively used at the war fronts –
many of which were mutagenic – might have been the
cause of the appearance of the first outbreak of the
epidemic between December 1916 and March 1917.
According to Oxford et al, “in the outbreak from
December 1916 to March 1917, soldiers were admitted to
the base hospitals, suffering from acute respiratory
infection, high temperature, and cough at a time when
recognised influenza was present. Clinical examination
showed, in most cases, signs of bronchopneumonia, and
pathology history showed acute purulent bronchitis. This
outbreak was further clinically characterised by heliotrope
cyanosis described extensively in the ensuing 1918
outbreak, and very high mortality”. Hammond et al (1917)
described this forgotten epidemic of purulent bronchitis,
which Abrahams et al (1919) compared with the great
pandemic of the Spanish Influenza: “We emphasize our
view that in essential, the influenza pneumococcal
purulent bronchitis that we and others described in 1916
and 1917 is fundamentally the same condition as the
influenza pneumonia of this present 1918 pandemic”.
“Pneumonie des Annamites” (1916-1918)
The Great War obliged France to mobilize hundreds of
thousands of men. During the early years of the War,French colonies were scarcely involved, but as the War
began to bleed France, army units were organized in the
French colonies in Africa, Asia and Oceania. These units
were known as “indigenous” units in the terminology of
that era. Hundreds of thousands of troops were transported
to French soil to fight at the fronts and collaborate in the
rearguard.
Indochinese soldiers from the old Annam kingdom
(presently Vietnam, Laos and Cambodia) fought on French
soil between 1916 and 1918. Frémeaux (2006) has pointed
out that over 50,000 Indochinese soldiers had been sent to
France, half of whom were assigned to stage battalions
(bataillons d’etapes).
A report signed by the military doctor Cachie on 13 May
1918 (Cachie, 1918) describes the epidemic, which
began on the 30th April among the Indochinese soldiers.
The symptoms which he describes clearly indicate the
presence of a complex influenza:
snip
New York (February, 1918)
In the ASSA archives in Paris, we found another 1918
report by a medical doctor, Pic (Pic, 1918), in which he
indicates that the influenza epidemic “began in February,
in the USA, in the Sing-Sing Prison, in New York”. More
recently, other authors (e.g., Oslon et al, 2005) have found
additional evidence for this New York influenza epidemic.
Camp Funston (Kansas), (March, 1918)
Fragmentary information from this period refers to distinct
outbreaks of influenza in the USA and in other countries
during the period 1915-1916. Barry (2005) and others
mention an acute infectious outbreak among young
farmers in a locality of Kansas called Haskell County. This
occurred in February 1918 and, due to its clinical gravity,
was compared to the Spanish Influenza. Many of these
young farmers were called to arms and incorporated into
the Funston military camp.
snip et re snip
Villers-sur-Coudun (April, 1918)
Among the abundant documentation which is conserved
in the Paris ASSA archives, there is a “Note regarding
influenza in the army from April to 10th November of
1918” (Archives du Services de Santé des Armées, Paris,
Carton 814; also see Figure 1), in which it is affirmed
that the first cases of influenza appeared in the Third
Army (3º Armée) in Villers-sur-Coudun (Department of
Oise) and in the Fère-Briange training field from the 10th
to the 20th April (1918). Influenza broke out in the
American army which was based on French soil towards
the 15th April (1918), in the outskirts of Bordeaux.
snip
Madrid (May, 1918)
The first country in Western Europe in which the
pandemic was widespread among the general population
and caused significant mortality, was Spain. It justifies the
denomination “Spanish Influenza” used to refer to this
pandemic. The first reference in the Spanish press to an
epidemic outbreak in the spring of 1918 can be found in
the Madrid newspaper “El Sol”, which published its first
headline about the subject on 22 May 1918. The report
goes as follows: “it seems that many cases are appearing
among the soldiers of the Madrid garrison of a sickness
which has not yet been diagnosed by doctors. Among an
artillery regiment, 80 soldiers have been affected by this
disease. In other regiments, the number ascends to up to
50 similar cases. …/… Undoubtedly, there is little
difference between the disease observed in the prisons by
our reporters and that which has been affecting Madrid
for the last few days. …/… The symptoms associated with
the disease are headache, shivering, weakness, fever and
joint pains, and the condition sometimes presents itself at
thoracic or intestinal levels”.
etc...
a good paper without difficulties
mutliple snip.. must be read
Origins of the Spanish Influenza pandemic (1918-1920) and its
relation to the First World War
Anton Erkoreka
Basque Museum of the History of Medicine, Faculty of Medicine (UPV/EHU), E-48940 Leioa (Bizkaia), Spain
*Correspondence to: Anton Erkoreka, Email: a.erkoreka@ehu.es, Fax: +34 946 013211
Received 14 August 2009, Revised 01 November 2009, Accepted 05 November 2009, Published online 30 November 2009
J Mol Genet Med (2009), 3(2), 190-194
The virus which was responsible for the first benign wave of the Spanish Influenza in the spring of 1918, and which was to become extremely virulent by the end of the summer of 1918, was inextricably associated with the soldiers who fought during the First World War. The millions of young men who occupied the military camps and trenches were the substrate on which the influenza virus developed and expanded. Many factors contributed to it, such as: the mixing on French soil of soldiers and workers from the five continents, the very poor quality of life of the soldiers, agglomeration, stress, fear, war gasses used for the first time in history in a massive and indiscriminate manner, life exposed to the elements, cold weather, humidity and contact with birds, pigs and other animals, both wild and domestic. Today, this combination of circumstances is not present and so it seems unlikely that new pandemics, such as those associated with the avian influenza or swine influenza, will emerge with the virulence which characterized the Spanish Influenza during the autumn of 1918.
snip
MATERIALS AND METHODS
We examined the reports of the medical doctors who
attended the French and American troops during the First
World War. These documents are conserved in the
Archives of the Health Services of the French Army
(Archives du Service de Santé des Armées: ASSA), located
in Val-de-Grâce (Paris). Other sources included medical
articles and books published during that period. A variety
of archives in France, Spain and Portugal were also
consulted to provide more complete information.
RESULTS AND DISCUSSION
The preceding pandemic of 1889-1890
The 1889-1890 pandemic influenza is the most important
antecedent and is particularly interesting due to its
similarities and differences with respect to the later Spanish
Influenza. It constitutes the link between the epidemics and
pandemics which occurred in the Modern Age and the
extremely virulent 1918 influenza. Between these
pandemics, during the last decade of the XIX century and the
first two decades of the XX century, multiple foci of
influenza were reported in many places throughout the
world. The doctors at that time attributed these foci to
residues of the 1889-1890 pandemic and considered the
influenza to be an endemic disease. At that time, seasonal
influenza had not yet been distinguished from pandemic
influenza and the underlying virus had not yet been
discovered.
big snip...
i) Nervous influenza: Very brusque beginning, intense
cephalalgia, intense pain in the eye orbits, joints and
muscles. By the end of one to four days, these symptoms
ceased and a strong dry cough appeared. This was
accompanied, on occasion, by scarlatiniform, rubeoliform
and skin rash on the anterior part of the arms, wrists and
chest. On occasion, urticaria was observed.
Étaples (1916-1917)
Oxford et al (2002, 2005) have suggested that the
beginnings of the pandemic occurred in the British
military base at Étaples, situated in the north of France
(Department of Pas-de-Calais). This military base, which
was quite important throughout the First World War, was
occupied by 100,000 soldiers within a space of 12 km2.
The base was situated near sea marshes with abundant
migratory birds. Nearby, there were many farms with pigs,
ducks and geese reserved as food for the soldiers, and
horses which were used as a means of transport.
The mixture of crowded soldiers, animals and 24 types of
war gasses, which were massively used at the war fronts –
many of which were mutagenic – might have been the
cause of the appearance of the first outbreak of the
epidemic between December 1916 and March 1917.
According to Oxford et al, “in the outbreak from
December 1916 to March 1917, soldiers were admitted to
the base hospitals, suffering from acute respiratory
infection, high temperature, and cough at a time when
recognised influenza was present. Clinical examination
showed, in most cases, signs of bronchopneumonia, and
pathology history showed acute purulent bronchitis. This
outbreak was further clinically characterised by heliotrope
cyanosis described extensively in the ensuing 1918
outbreak, and very high mortality”. Hammond et al (1917)
described this forgotten epidemic of purulent bronchitis,
which Abrahams et al (1919) compared with the great
pandemic of the Spanish Influenza: “We emphasize our
view that in essential, the influenza pneumococcal
purulent bronchitis that we and others described in 1916
and 1917 is fundamentally the same condition as the
influenza pneumonia of this present 1918 pandemic”.
“Pneumonie des Annamites” (1916-1918)
The Great War obliged France to mobilize hundreds of
thousands of men. During the early years of the War,French colonies were scarcely involved, but as the War
began to bleed France, army units were organized in the
French colonies in Africa, Asia and Oceania. These units
were known as “indigenous” units in the terminology of
that era. Hundreds of thousands of troops were transported
to French soil to fight at the fronts and collaborate in the
rearguard.
Indochinese soldiers from the old Annam kingdom
(presently Vietnam, Laos and Cambodia) fought on French
soil between 1916 and 1918. Frémeaux (2006) has pointed
out that over 50,000 Indochinese soldiers had been sent to
France, half of whom were assigned to stage battalions
(bataillons d’etapes).
A report signed by the military doctor Cachie on 13 May
1918 (Cachie, 1918) describes the epidemic, which
began on the 30th April among the Indochinese soldiers.
The symptoms which he describes clearly indicate the
presence of a complex influenza:
snip
New York (February, 1918)
In the ASSA archives in Paris, we found another 1918
report by a medical doctor, Pic (Pic, 1918), in which he
indicates that the influenza epidemic “began in February,
in the USA, in the Sing-Sing Prison, in New York”. More
recently, other authors (e.g., Oslon et al, 2005) have found
additional evidence for this New York influenza epidemic.
Camp Funston (Kansas), (March, 1918)
Fragmentary information from this period refers to distinct
outbreaks of influenza in the USA and in other countries
during the period 1915-1916. Barry (2005) and others
mention an acute infectious outbreak among young
farmers in a locality of Kansas called Haskell County. This
occurred in February 1918 and, due to its clinical gravity,
was compared to the Spanish Influenza. Many of these
young farmers were called to arms and incorporated into
the Funston military camp.
snip et re snip
Villers-sur-Coudun (April, 1918)
Among the abundant documentation which is conserved
in the Paris ASSA archives, there is a “Note regarding
influenza in the army from April to 10th November of
1918” (Archives du Services de Santé des Armées, Paris,
Carton 814; also see Figure 1), in which it is affirmed
that the first cases of influenza appeared in the Third
Army (3º Armée) in Villers-sur-Coudun (Department of
Oise) and in the Fère-Briange training field from the 10th
to the 20th April (1918). Influenza broke out in the
American army which was based on French soil towards
the 15th April (1918), in the outskirts of Bordeaux.
snip
Madrid (May, 1918)
The first country in Western Europe in which the
pandemic was widespread among the general population
and caused significant mortality, was Spain. It justifies the
denomination “Spanish Influenza” used to refer to this
pandemic. The first reference in the Spanish press to an
epidemic outbreak in the spring of 1918 can be found in
the Madrid newspaper “El Sol”, which published its first
headline about the subject on 22 May 1918. The report
goes as follows: “it seems that many cases are appearing
among the soldiers of the Madrid garrison of a sickness
which has not yet been diagnosed by doctors. Among an
artillery regiment, 80 soldiers have been affected by this
disease. In other regiments, the number ascends to up to
50 similar cases. …/… Undoubtedly, there is little
difference between the disease observed in the prisons by
our reporters and that which has been affecting Madrid
for the last few days. …/… The symptoms associated with
the disease are headache, shivering, weakness, fever and
joint pains, and the condition sometimes presents itself at
thoracic or intestinal levels”.
etc...
