really horrible
http://www.publichealthreports.org/archives/issueopen.cfm?articleID=2442
SYNOPSIS
The American military experience in World War I and the influenza pandemic
were closely intertwined. The war fostered influenza in the crowded conditions
of military camps in the United States and in the trenches of the Western Front
in Europe. The virus traveled with military personnel from camp to camp and
across the Atlantic, and at the height of the American military involvement
in the war, September through November 1918, influenza and pneumonia
sickened 20% to 40% of U.S. Army and Navy personnel. These high morbidity
rates interfered with induction and training schedules in the United States and
rendered hundreds of thousands of military personnel non-effective. During the
American Expeditionary Forces? campaign at Meuse-Argonne, the epidemic
diverted urgently needed resources from combat support to transporting and
caring for the sick and the dead. Influenza and pneumonia killed more American
soldiers and sailors during the war than did enemy weapons.
INFLUENZA IN THE CAMPS
Braisted pinpointed the arrival of the epidemic in the
United States to Tuesday, August 27, 1918, at Commonwealth
Pier in Boston ?. . . when three cases of
influenza were committed to the sick list.? The next day
produced eight cases, and on August 29, 58 cases were
reported, 15 so ill they were transferred to the U.S. Naval
Hospital in Chelsea.5 (p. 2427) Within 48 hours, three
medical officers who had seen the patients also fell ill.5
(p. 2473?4) Influenza reached civilians in Boston and
on September 8, arrived ?completely unheralded? at
the Army?s Camp Devens, outside of the city. Within 10
days, the base hospital and regimental infirmaries were
overwhelmed with thousands of sick trainees.16,17
Gorgas sent his best epidemiologists to Camp Devens
to investigate. His team included Victor C. Vaughan,
dean of the University of Michigan School of Medicine
and director of the Surgeon General?s Office of
Communicable Disease; William Henry Welch, famed
pathologist from Johns Hopkins; and Rufus Cole,
respiratory diseases expert from the Rockefeller Institute.
18 They found the medical situation ?grave,? and
recommended 16 measures to control the outbreak,
the most dramatic being a halt to transfers in or out
of Devens until the epidemic passed. Camp Devens
physicians performing autopsies described influenza
pathology as unique, characterized by ?the intense
congestion and hemorrhage? of the lungs.19 Cole and
Welch observed one such autopsy, and Cole noted that
Welch, ?turned away from the blue, swollen lungs with
wet, foamy, shapeless surfaces [and] became excited
and nervous, saying, ?This must be some new kind of
infection or plague.?? Added Cole, ?It was not surprising
that the rest of us were disturbed, but it shocked
me to find that the situation, momentarily at least, was
too much even for Dr. Welch.?20
and public health reports about 1918
http://www.publichealthreports.org/archives/issuecontents.cfm?Volume=125&Issue=9
<table align="center" border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td class="SectionHeader" style="padding-bottom:10px; padding-left:15px; padding-top:10px;" align="left" width="594">Article Title </td> <td class="SectionHeader" style="padding-bottom:10px; padding-top:10px;" align="center" width="186">Page Number</td> </tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Message from the Editor </td> <td class="text" align="center" valign="middle" width="186">1 </td> </tr> <tr> <td style="padding-left:15px; "> Laurence D. Reed </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Foreword: 1918 and 2009: A Tale of Two Pandemics </td> <td class="text" align="center" valign="middle" width="186">3 </td> </tr> <tr> <td style="padding-left:15px; "> Stephen C. Redd / Thomas R. Frieden / Anne Schuchat / Peter A. Briss </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Guest Editorial: The 1918-1919 Influenza Pandemic in the United States: Lessons Learned and Challenges Exposed </td> <td class="text" align="center" valign="middle" width="186">6 </td> </tr> <tr> <td style="padding-left:15px; "> Alexandra Minna Stern / Martin S. Cetron / Howard Markel </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Photo Essay: Influenza in 1918: An Epidemic in Images </td> <td class="text" align="center" valign="middle" width="186">9 </td> </tr> <tr> <td style="padding-left:15px; "> Julian A. Navarro </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Influenza: The Once and Future Pandemic </td> <td class="text" align="center" valign="middle" width="186">16 </td> </tr> <tr> <td style="padding-left:15px; "> Jeffery K. Taubenberger / David M. Morens </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The State of Science, Microbiology, and Vaccines Circa 1918 </td> <td class="text" align="center" valign="middle" width="186">27 </td> </tr> <tr> <td style="padding-left:15px; "> John M. Eyler </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Spanish Flu, or Whatever It Is?": The Paradox of Public Health in a Time of Crisis </td> <td class="text" align="center" valign="middle" width="186">38 </td> </tr> <tr> <td style="padding-left:15px; "> David Rosner </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Destroyer and Teacher": Managing the Masses During the 1918-1919 Influenza Pandemic </td> <td class="text" align="center" valign="middle" width="186">48 </td> </tr> <tr> <td style="padding-left:15px; "> Nancy Tomes </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Better Off in School": School Medical Inspection as a Public Health Strategy During the 1918-1919 Influenza Pandemic in the United States </td> <td class="text" align="center" valign="middle" width="186">63 </td> </tr> <tr> <td style="padding-left:15px; "> Alexandra Minna Stern / Mary Beth Reilly / Martin S. Cetron / Howard Markel </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response </td> <td class="text" align="center" valign="middle" width="186">71 </td> </tr> <tr> <td style="padding-left:15px; "> Francesco Aimone </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The U.S. Military and the Influenza Pandemic of 1918-1919 </td> <td class="text" align="center" valign="middle" width="186">82 </td> </tr> <tr> <td style="padding-left:15px; "> Carol R. Byerly </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The American Red Cross and Local Response to the 1918 Influenza Pandemic: A Four-City Case Study </td> <td class="text" align="center" valign="middle" width="186">92 </td> </tr> <tr> <td style="padding-left:15px; "> Marian Moser Jones </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Alert to the Necessities of the Emergency": U.S. Nursing During the 1918 Influenza Pandemic </td> <td class="text" align="center" valign="middle" width="186">105 </td> </tr> <tr> <td style="padding-left:15px; "> Arlene W. Keeling </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "There Wasn't a Lot of Comforts in Those Days": African Americans, Public Health, and the 1918 Influenza Epidemic </td> <td class="text" align="center" valign="middle" width="186">114 </td> </tr> <tr> <td style="padding-left:15px; "> Vanessa Northington Gamble </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Immigration, Ethnicity, and the Pandemic </td> <td class="text" align="center" valign="middle" width="186">123 </td> </tr> <tr> <td style="padding-left:15px; "> Alan M. Kraut </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "It's as Bad as Anything Can Be": Patients, Identity, and the Influenza Pandemic </td> <td class="text" align="center" valign="middle" width="186">134 </td> </tr> <tr> <td style="padding-left:15px; "> Nancy K. Bristow </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr></tbody></table>
http://www.publichealthreports.org/archives/issueopen.cfm?articleID=2442
SYNOPSIS
The American military experience in World War I and the influenza pandemic
were closely intertwined. The war fostered influenza in the crowded conditions
of military camps in the United States and in the trenches of the Western Front
in Europe. The virus traveled with military personnel from camp to camp and
across the Atlantic, and at the height of the American military involvement
in the war, September through November 1918, influenza and pneumonia
sickened 20% to 40% of U.S. Army and Navy personnel. These high morbidity
rates interfered with induction and training schedules in the United States and
rendered hundreds of thousands of military personnel non-effective. During the
American Expeditionary Forces? campaign at Meuse-Argonne, the epidemic
diverted urgently needed resources from combat support to transporting and
caring for the sick and the dead. Influenza and pneumonia killed more American
soldiers and sailors during the war than did enemy weapons.
INFLUENZA IN THE CAMPS
Braisted pinpointed the arrival of the epidemic in the
United States to Tuesday, August 27, 1918, at Commonwealth
Pier in Boston ?. . . when three cases of
influenza were committed to the sick list.? The next day
produced eight cases, and on August 29, 58 cases were
reported, 15 so ill they were transferred to the U.S. Naval
Hospital in Chelsea.5 (p. 2427) Within 48 hours, three
medical officers who had seen the patients also fell ill.5
(p. 2473?4) Influenza reached civilians in Boston and
on September 8, arrived ?completely unheralded? at
the Army?s Camp Devens, outside of the city. Within 10
days, the base hospital and regimental infirmaries were
overwhelmed with thousands of sick trainees.16,17
Gorgas sent his best epidemiologists to Camp Devens
to investigate. His team included Victor C. Vaughan,
dean of the University of Michigan School of Medicine
and director of the Surgeon General?s Office of
Communicable Disease; William Henry Welch, famed
pathologist from Johns Hopkins; and Rufus Cole,
respiratory diseases expert from the Rockefeller Institute.
18 They found the medical situation ?grave,? and
recommended 16 measures to control the outbreak,
the most dramatic being a halt to transfers in or out
of Devens until the epidemic passed. Camp Devens
physicians performing autopsies described influenza
pathology as unique, characterized by ?the intense
congestion and hemorrhage? of the lungs.19 Cole and
Welch observed one such autopsy, and Cole noted that
Welch, ?turned away from the blue, swollen lungs with
wet, foamy, shapeless surfaces [and] became excited
and nervous, saying, ?This must be some new kind of
infection or plague.?? Added Cole, ?It was not surprising
that the rest of us were disturbed, but it shocked
me to find that the situation, momentarily at least, was
too much even for Dr. Welch.?20
and public health reports about 1918
http://www.publichealthreports.org/archives/issuecontents.cfm?Volume=125&Issue=9
<table align="center" border="0" cellpadding="0" cellspacing="0" width="100%"><tbody><tr><td class="SectionHeader" style="padding-bottom:10px; padding-left:15px; padding-top:10px;" align="left" width="594">Article Title </td> <td class="SectionHeader" style="padding-bottom:10px; padding-top:10px;" align="center" width="186">Page Number</td> </tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Message from the Editor </td> <td class="text" align="center" valign="middle" width="186">1 </td> </tr> <tr> <td style="padding-left:15px; "> Laurence D. Reed </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Foreword: 1918 and 2009: A Tale of Two Pandemics </td> <td class="text" align="center" valign="middle" width="186">3 </td> </tr> <tr> <td style="padding-left:15px; "> Stephen C. Redd / Thomas R. Frieden / Anne Schuchat / Peter A. Briss </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Guest Editorial: The 1918-1919 Influenza Pandemic in the United States: Lessons Learned and Challenges Exposed </td> <td class="text" align="center" valign="middle" width="186">6 </td> </tr> <tr> <td style="padding-left:15px; "> Alexandra Minna Stern / Martin S. Cetron / Howard Markel </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Photo Essay: Influenza in 1918: An Epidemic in Images </td> <td class="text" align="center" valign="middle" width="186">9 </td> </tr> <tr> <td style="padding-left:15px; "> Julian A. Navarro </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Influenza: The Once and Future Pandemic </td> <td class="text" align="center" valign="middle" width="186">16 </td> </tr> <tr> <td style="padding-left:15px; "> Jeffery K. Taubenberger / David M. Morens </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The State of Science, Microbiology, and Vaccines Circa 1918 </td> <td class="text" align="center" valign="middle" width="186">27 </td> </tr> <tr> <td style="padding-left:15px; "> John M. Eyler </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Spanish Flu, or Whatever It Is?": The Paradox of Public Health in a Time of Crisis </td> <td class="text" align="center" valign="middle" width="186">38 </td> </tr> <tr> <td style="padding-left:15px; "> David Rosner </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Destroyer and Teacher": Managing the Masses During the 1918-1919 Influenza Pandemic </td> <td class="text" align="center" valign="middle" width="186">48 </td> </tr> <tr> <td style="padding-left:15px; "> Nancy Tomes </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Better Off in School": School Medical Inspection as a Public Health Strategy During the 1918-1919 Influenza Pandemic in the United States </td> <td class="text" align="center" valign="middle" width="186">63 </td> </tr> <tr> <td style="padding-left:15px; "> Alexandra Minna Stern / Mary Beth Reilly / Martin S. Cetron / Howard Markel </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response </td> <td class="text" align="center" valign="middle" width="186">71 </td> </tr> <tr> <td style="padding-left:15px; "> Francesco Aimone </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The U.S. Military and the Influenza Pandemic of 1918-1919 </td> <td class="text" align="center" valign="middle" width="186">82 </td> </tr> <tr> <td style="padding-left:15px; "> Carol R. Byerly </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> The American Red Cross and Local Response to the 1918 Influenza Pandemic: A Four-City Case Study </td> <td class="text" align="center" valign="middle" width="186">92 </td> </tr> <tr> <td style="padding-left:15px; "> Marian Moser Jones </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "Alert to the Necessities of the Emergency": U.S. Nursing During the 1918 Influenza Pandemic </td> <td class="text" align="center" valign="middle" width="186">105 </td> </tr> <tr> <td style="padding-left:15px; "> Arlene W. Keeling </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "There Wasn't a Lot of Comforts in Those Days": African Americans, Public Health, and the 1918 Influenza Epidemic </td> <td class="text" align="center" valign="middle" width="186">114 </td> </tr> <tr> <td style="padding-left:15px; "> Vanessa Northington Gamble </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> Immigration, Ethnicity, and the Pandemic </td> <td class="text" align="center" valign="middle" width="186">123 </td> </tr> <tr> <td style="padding-left:15px; "> Alan M. Kraut </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr> <tr> <td class="text" style="padding-left:15px; " align="left" valign="middle"> "It's as Bad as Anything Can Be": Patients, Identity, and the Influenza Pandemic </td> <td class="text" align="center" valign="middle" width="186">134 </td> </tr> <tr> <td style="padding-left:15px; "> Nancy K. Bristow </td> <td class="text" align="center" width="186"> </td> </tr><tr><td colspan="2" height="15px;">
</td></tr></tbody></table>