The 1918 Influenza in Missouri: Centennial Remembrance of the Crisis.

david s. McKinsey, Md, MsMa member since 1987, and Joel p. McKinsey, Md, MsMa member since 2003, are with Metro Infectious Disease consultants, Kansas city, Mo. Maithe Enriquez, phd, aprN, is with the University of Missouri sinclair school of Nursing, columbia, Mo. Contact: David.mckinsey@hcamidwest.com In September 1918, war-weary Missourians were bracing for the coming storm: not another extreme weather event, but the lethal influenza epidemic steamrolling through the country’s eastern cities and military cantonments and bearing down on the Midwest. Tens of thousands of young people were dead; major cities were on the verge of collapse. Former Missourian Dr. Victor Vaughan, raised in rural Randolph County, headed the U.S. Army’s Division of Communicable Diseases. In October 1918, Dr. Vaughan concluded, “If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth within a few weeks”. This year marks the centennial anniversary of the 1918 Influenza pandemic. Although often overshadowed in our nation’s collective memory by World War I, in fact influenza took more lives in a shorter time period in 191819 than any other event in human history. Approximately 670,000 Americans succumbed to influenza in the U. S. , more than the cumulative combat death toll of our military forces in World Wars I and II, the Korean conflict and the Viet Nam War. Worldwide, 50-100 million died, 4 a figure vastly exceeding the mortality tolls of other pandemics in the 20 and 21 centuries (Figure 1). This article, the first in a series, will address the origins and spread of the 1918 influenza, its clinical and pathological manifestations, the impact of the pandemic on Missouri’s population, the responses of dedicated medical and nursing professionals in our state, and insights gained from new assessment of available epidemiologic data. The word influenza is rooted in the medieval Italian phrase influentia del freddo (influence of the cold), reflecting the centuries-old observation that annual epidemics occur in the winter months. Interspersed lethal pandemics emerge at unpredictable intervals a few times each century. In the early twentieth century, physicians had not yet identified the cause of this generally mild and self-limiting illness, commonly known as the “grippe. ” Although the germ theory of disease had been well-established for a few decades some physicians still attributed influenza to miasmas (noxious vapors) rather than infection. The field of virology was in its infancy and the possibility that influenza was a viral illness had not yet been considered seriously. No known treatment or prevention for influenza existed, nor would any become available until long after the 1918 pandemic (Figure 2.) In 1918 the country’s attention was focused squarely on World War I, which led to the mobilization of more than four million American military recruits and the construction of 30 hastily built cantonments throughout the country, each of which housed up to 50,000 soldiers in overcrowded barracks. Historians have concluded that the war effort was inextricably linked to the spread of the 1918 influenza in the United States and abroad. The extremely high risk for epidemics among soldiers had been well-known for centuries. During the war millions of young men, many of whom were immunologically naive to highly contagious infections, were dispersed around the country to military camps en route to battlefields in Europe, setting the stage for an explosive pandemic. Although the 1918 pandemic is widely known as the “Spanish Influenza,” a more appropriate name could be the “Kansas Flu. ” The federal Sedition Act of 1918 prohibited the use of “disloyal, profane, scurrilous, or abusive language” about the U. S. government, in a heavy-handed attempt to improve morale during the war. Accordingly, little was published in the U.S. about influenza. However, in neutral Spain the uncensored press reported freely about the influenza pandemic, leading to the enduring misperception that the disease had begun there. In fact most historians