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The Plague Years:
The Great Influenza
(With a Sidebar on
Dr. Johan Hultin)
By Bob Frost
West magazine, 1998
(Sunday magazine of the San Jose Mercury News)


One of the most lethal viruses of history cut a swath through the San Francisco Bay Area 80 years ago, during the rainy autumn and winter of 1918-19, killing more than 5,000 people here. Nationwide, more than 650,000 people perished from the Great Influenza and its complications in 1918 and '19.

This article presents a digest of Great Influenza coverage in 1918 culled from the pages of the San Jose Mercury Herald, precursor to the Mercury News. First, some background.

*

Globally, the Great Influenza killed at least 20 million people.

(Update: A 2002 study says the global death toll may have been as high as 100 million, while a 2008 estimate puts the number at 50 million.)

The 1918-19 influenza was thought to have originated in Spain, and was often called the Spanish flu, but the first wave of the disease probably surfaced in the United States in March, 1918, when farm animals spread the bug to soldiers. No vaccine existed. No scientifically-proven remedy was available. For long months there was no respite from the mounting death toll.

Symptoms included high fever, chills, aches, coughing, and inflammation. Pneumonia settled on the lungs and caused them to fill with fluid. Extreme muscular weakness sometimes came on abruptly - in South Africa, the operator of a mine-shaft elevator became so weak so fast that he lost control of his levers, and the car plummeted into the abyss, killing 24 men.

The disease hit all age groups, but oddly, it was especially deadly to healthy young people, killing them in much larger numbers than most flu strains. Young men and women worldwide, including Floyd Stull of San Jose, in his 20s, became ill and died as their lungs filled, their air sacs were destroyed, and their breathing was choked off. Healthy children such as Lionel Perez of San Jose got desperately sick overnight, coughed up bloody, frothy fluid, turned bluish-purple, and gasped desperately for breath, while their distraught families could only mop their burning brows, pray, and watch them die. Meanwhile, medical personnel perished because of their service to patients, including local nurse Ada Hodgson and local physician Joseph Regli.

Today, the 1918-19 pandemic (i.e., an epidemic over a wide geographical area) seems to be mostly forgotten. It killed more Americans than died in the battles of both world wars combined, yet little has been written about it for the general reader. It scarcely rates a sentence in some history textbooks. Few artists have examined it. Few, if any, public statues or plaques have been erected to the victims. "American Experience" on PBS, an arbiter of what matters in our history, has never devoted an episode to it. The pandemic is portrayed in the short novel "Pale Horse, Pale Rider" by Katherine Anne Porter (1939) which Hollywood has never touched. It's an aspect of a little television movie called "1918" (1985). One of the few significant books about this enormous world crisis is "America's Forgotten Pandemic: The Influenza of 1918" by Alfred W. Crosby (1989).

(Update: Since publication of this article in 1998, two histories aimed at general readers have been published - "Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It" by journalist Gina Kolata [1999] and "The Great Influenza" by historian John M. Barry [2003]. A book for young readers was published in 2000, "Purple Death: The Mysterious Flu of 1918" by David Getz. "American Experience" on PBS aired "Influenza 1918" in 2005. The inventive novel "Wickett's Remedy" by Myla Goldberg was published in 2005, and the wonderful novel "Dreamers of the Day" by Mary Doria Russell was published in 2008.)

Scientists have sought for decades to understand the Great Influenza, hunching over microscopes and peering at slices of preserved human tissue. They've pondered why it killed so many people, and why it was so deadly to the young and healthy. And they've wondered how many people will die if this flu strain, or one of its offspring, lashes out at humankind in the age of jet travel. (See sidebar.)

(Update: As many as 62 million people could die globally if a version of the Spanish flu emerges unchecked today, according to an estimate published in 2006 in The Lancet.)

*

The big news in 1918 was the First World War, known then as the Great War. The Mercury Herald covered the conflict with gusto.

In those days, the newspaper ran a screaming banner headline across the top of page one every day; during the autumn of '18, this headline almost invariably focused on the war. Only once during these months did the big headline mention the flu, despite the stunning death toll here. That day was October 31, 1918; the story concerned a flu "cure" that was soon shown to be illusory.

As with many newspapers around the country, the Mercury Herald's coverage of the pandemic focused almost exclusively on raw statistics provided by health officials, accompanied by relentless optimism along the lines of "the corner has been turned" and "the disease is on the decline." The paper made little or no effort to provide perspective or background on the disease, such as a graph charting mortality rates, or a summary of the pandemic’s impact nationally and internationally. Not a single story was published about the human experience of suffering from the flu.

Here, then, our digest.

*

In early September of 1918, Santa Clara County has war fever.

The T. & D. Theatre in San Jose shows newsreels about the Great War to packed houses. On a city street, the German kaiser, Wilhelm II, is burned in effigy. People who fail to buy a full quota of Liberty war bonds are thought to be peculiar at best, traitorous at worst. At Camp Fremont in Menlo Park, a U.S. Army soldier named Charles Lombard is sentenced to 25 years hard labor at Alcatraz for kissing a picture of the kaiser and uttering seditious remarks.

The Santa Clara Valley (the future Silicon Valley) is home to about 100,000 people. (Population today is 2.3 million.) The region is largely agricultural, with ranches and orchards growing prunes, peaches, apricots, cherries, plums, and walnuts. A good salesman in downtown San Jose can earn $125 to $250 a month selling cars, office equipment, or agricultural implements. A real estate firm, Clayton & Co., is selling 80 acres east of Milpitas for $9,500, a parcel that Google, Apple, Intel, or Cisco might spend many millions for today.

As ever, people worry about their health and are uncertain how to improve it. The National Ice Cream Company offers advice in a Mercury Herald advertisement shortly before the flu outbreak. Readers should "take 10 deep breaths" to "get your blood to circulating as it should do." Then "eat all you want of National Ice Cream so that after your blood is rushing about right down to your finger-tips, it will stay there."

Dr. Kneass, a San Jose dentist, declares in an advertisement that "haziness, dizziness, a bad liver or a bad stomach are generally caused by bad teeth or not enough teeth." His cohort, Dr. R. C. Anderson, asserts that in "nine cases out of ten teeth are at the bottom of our aches and pains."

Tuesday, Sept. 24, 1918, San Jose Mercury Herald: "INFLUENZA RAGES IN CAMPS" is a headline on page one of today’s paper. (Meanwhile, higher up on the page, the banner headline focuses on the war.) The flu story describes how, in East Coast military posts, thousands of young men are very sick - at Camp Devens in Massachusetts about 8,000 soldiers have influenza; the hospital there was built for 2,000. Hidden deep in the story is a startling fact: lots of people are dying. Sixty-five died at Camp Devens the previous day; 63 civilians died in Boston one day that week. "Officials expressed confidence today," says the story, "that the height of the epidemic had passed." The Spanish flu apparently hasn’t reached San Jose yet, and there's just one case in San Francisco, reports the San Francisco Chronicle.

Wednesday, Sept. 25: The Mercury Herald editorializes about the pandemic: "The Spanish influenza, according to the dispatches, has reached the Pacific coast. This need not particularly alarm anyone....The Government is dealing successfully with it." The paper declares that rest and relaxation are "effective" against the disease.

Saturday, Oct. 5: "The rumor....that there were cases of Spanish influenza in (Santa Clara County was) positively contradicted last night by Dr. William Simpson, county health officer."

Wednesday, Oct. 9: "INFLUENZA REACHES COUNTY: One hundred and fifty-three cases of Spanish influenza broke out at (Camp Fremont on Tuesday)." Theaters, schools, and churches remain open.

Thursday, Oct. 10: "EPIDEMIC DANGER IN (CAMP) FREMONT IS PASSING." The camp has 184 flu cases.

Saturday Oct. 12: Camp Fremont now has 405 flu cases. The Mercury Herald urges its readership to wear gauze masks to check spread of the disease. There is no scientific evidence that this will actually work, and in fact, the masks may be counterproductive, inspiring a false sense of invulnerability, encouraging large groups of masked people to congregate, such as an assembly of dozens of students at the University of the Pacific, photographed wearing their masks at the height of the epidemic.

Monday, Oct. 14: Seven deaths so far in San Jose, according to the Mercury Herald. San Francisco reports 1,000 flu cases. "There is less danger in the Spanish Influenza," announces the Chronicle, "than in German peace propaganda."

Wednesday, Oct. 16: The Mercury Herald runs a big advertisement for Vick’s VapoRub on Page 5, in exactly the same typeface as news stories, with the tiny word "advertisement" tucked at the bottom. According to the ad, the influenza is "nothing new," it’s "simply the old grip, or la grippe." (This is false.) People in a "run-down condition" are the ones in danger. (This is false.) The best treatment is bed rest, laxatives, and nourishing food; liberal doses of Vick’s VapoRub will help to "throw off the grippe germs." (All of these ideas are more-or-less false, although bed rest is, indeed, essential, as if sufferers have any choice.)

Friday, Oct. 18: At Camp Fremont, 29 soldiers are dead from the disease. A camp officer declares that the peril has passed.

Saturday, Oct. 19: A bit of first-hand news finally emerges from Camp Fremont, with a shocking tone to it: "Describing the shortage of nurses at the base hospital, Camp Fremont, as not only alarming during the influenza epidemic, but reflecting what he terms the indifference of the American women to the sufferings of the men confined there, a soldier patient writes to Mrs. L. Richards of this city urging her to appeal to the women to volunteer as aides in the present emergency at the camp. He says that the situation is desperate, that the nurses are overworked and that though the military authorities are doing all they can, the patients cannot get the attention they require. In his letter he also declares that more than half of the regular army nurses are incapacitated from the work."

Sunday, Oct. 20: In San Jose, 75 new cases in the last 24 hours, and three deaths, including a six-year-old boy, Thomas Parlier. Pleas for nurses continue: "From the Santa Clara County Nurses’ Association last night came an appeal to the Mercury Herald that had in it a note almost of despair. Nurses, nurses, nurses must be had at once."

Monday, Oct. 21: In San Jose, 60 new cases, eight deaths.

Tuesday, Oct. 22: "INFLUENZA EPIDEMIC RAGES WITH UNEQUALED FURY THROUGHOUT CITY." But, states the Mercury Herald, “those who wear (masks) will be 99 percent safe.”

Wednesday, Oct. 23: Harts’ Department Store in San Jose offers ordinary flu masks for ten cents, and, for $1.95 to $3.95, chiffon veils with satin borders.

Thursday, Oct. 24: Eleven deaths are reported in the last 24 hours in San Jose, the highest daily toll in the city since the start of the pandemic.

Saturday, Oct. 26: Plans proceed for the Santa Cruz County Fair, where thousands will congregate: "There is much enthusiasm shown, for it will bring together farmers as well as nature lovers." In San Francisco, garbage goes uncollected, and other essential services are also breaking down, including police, firefighting, and phones.

Sunday, Oct. 27: In San Jose, 59 new cases, nine deaths. Dr. Woods Hutchinson calls masks "infallible."

Tuesday, Oct. 29: "In cases of this kind," announces the Mercury Herald in a scolding tone, "facts, and facts only, are what is to be dealt with and it is high time the public at large got out of the idea that the crest of the epidemic has passed, or that there is no particular danger." The paper does not mention its contribution to the public view of the danger.

Thursday, Oct. 31: A Mercury Herald ad for NR Tablets, a laxative: "Nothing you can do will so effectually protect you against the Influenza or Grippe epidemic as keeping your organs of digestion and elimination active and your system free from poisonous accumulations." (This is false.)

Meanwhile, bizarre flu treatments crop up around the world. In Nairobi, Kenya, Dr. Roland Burkitt wins the nickname "Kill or Cure" for his remedy: He puts patients between cold wet sheets and orders relays of servants to regularly soak the shivering souls with icewater. He apparently keeps no records on his success rate. In Tibet, healers keep up a 24-hour cacophony of drums and cymbals, believing that if sick people sleep, they will die. Again, no record on efficacy. A woman in Pennsylvania serves massive quantities of onions with every meal to her eight-member family. Everyone stays healthy. Meanwhile, doctors around the world note the phenomenon of "apparent death" among the flu’s victims – people who are alive but unconscious and cold to the touch, with no discernible respiration or pulse. It’s likely that some of these people are buried alive.

Friday, Nov. 1, 1918: "A few more days of the mask," states the Mercury Herald, "and we shall probably be rid of the epidemic of influenza. There is no reason why everyone should not be happy and optimistic." A nice sentiment, but people in Santa Clara County continue to die. They will die at a steady rate all this month. They will die in December, and they will die in January, February, and March.

As spring arrives they are dying still, although by then, fatalities are sporadic. In April and May, children return to sidewalks and playgrounds. They chant a rhyme: "I had a little bird/And its name was Enza/I opened the window/And in-flew-Enza."

-The End-

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Flu Sidebar: Trying to
Conquer a Killer Virus

By Bob Frost, 1998

Dr. Johan V. Hultin, standing in the kitchen of his San Francisco home recently, speculated about the global death toll if the flu strain of 1918-19, or one of its direct descendants, strikes in coming years.

"One million dead?" he asked. "Fifty million? One hundred million?" He shook his head.

Hultin, 73, is a pathologist who has been interested in the 1918-19 flu for most of his adult life. He has taken bold action to ameliorate its possible return.

On this day in San Francisco, he peered at a freshly-peeled orange and assessed its dimensions. He carefully cut a precise quantity of fruit and popped it in his mouth. "I like to get an exact ratio of carbohydrate to protein," he said in his thick, cultured Swedish accent. "This is important for optimal health. It’s good, you know, to pay attention to these things." The ideal ratio, he said, is nine grams of carbs to seven grams of protein.

It’s possible, he continued, to achieve the proper ratio even in an emergency. You just need to be prepared. You need to stock some good food bars (also known as energy bars and meal-replacement bars), the sticky concoctions available in health-food stores and supermarkets. "Oh yes, a very good ratio," he said. "They'll keep you alive."

Hultin stores a dozen food bars in a suitcase that he stashes near his back door. Should a major disaster occur, he will load the case into his car and take off with his wife, Eileen, for the Sierra Nevada Mountains, where they have a cabin stocked with fresh water and several cupboards full of food bars. Here, they will quarantine themselves, listen to the radio, and wait.

Granted, he said, there’s only a slight chance they will ever have to do such a thing. But he likes to be prepared. He has read the mortality tables from the 1918-19 flu pandemic and he has done a lot of worrying. Out of his worry has come action; this action has led to information that might save millions of lives.

Hultin was born in Sweden in 1924 and enrolled in medical school there after the Second World War. At age 25 in 1949 he took a sabbatical from his Swedish education and came to the U.S. to study virology at the University of Iowa.

One day a professor told him that almost nothing was known about the virus that caused the Spanish influenza of 1918-19. Scientists had never encountered the actual living virus - a tiny parasite, 30 million of which could crowd onto the head of a pin. Until the 1930s, researchers didn’t even know that influenza viruses existed, and by that time, all the 1918-19 germs were apparently dead. True, scientists could study flesh samples from 1918-19 and glean shards of knowledge, but to really dig into the matter, they needed a living virus sample.

Hultin learned from the professor one possibility for finding such a sample.

"No scientist," said the professor to Hultin, "has ever traveled to the far north to find a body buried there."

Such bodies, he explained, would probably have remained frozen in the permafrost (i.e., permanent frost, ground so cold it never thaws). Perhaps, under such conditions, samples of the living virus would be preserved in victims' lungs in a dormant state. If the virus could be recovered, revived from dormancy, and studied, scientists could unlock its secrets and arm themselves with vaccines to fight it should another epidemic break out. (Or prepare to fight one of its descendants.)

"Ah!" thought Hultin. "I could go to Alaska!"

And so he did. In June, 1951, he found himself standing alone on a deserted burial ground in the Alaskan coastal village of Brevig Mission, near the Arctic Circle. According to death records studied by Hultin in Iowa, 72 of the town's 80 residents died in one week in 1918, solid evidence that the flu had struck with its full and awesome fury.

Upon arrival in the village, Hultin discussed his quest with local elders, explaining through a translator what he proposed to do. They agreed to let him dig up the old burial ground. Once they consented, Hultin called some friends in Iowa who had agreed to come north if the prospects were good.

Clouds of mosquitoes swarmed around the little group in the bleak, treeless tundra, with temperatures in the 40s and 50s. They got no help in digging from the local people, probably due to superstitions about the disturbance of spirits. (Why, then, did they let him dig? Did they believe that ghosts would only bother the actual diggers?) They thawed the ground by building fires on it, and after two days of heating and digging, they found the frozen body of a girl, perhaps 10 years old when she died. Her black hair was neatly braided and tied into pigtails with red yarn. Her skin was leathery but reasonably well preserved. There was no record of her name.

Hultin quickly took samples of her lung tissue and the group re-buried her. A shovel-full of dirt covered the red yarn and pigtails, and she vanished.

Back in Iowa City Hultin began slicing the girl's lung tissue into small sections, which he injected into eggs, hoping to culture the virus and revive it. He processed hundreds of eggs. He worked for six weeks. Nothing. Other researchers also tried. Nothing. The virus was dead. So much for the big idea, Hultin thought.

From the 1950s to the '90s Hultin built a successful pathology practice at a Los Gatos hospital. He married, raised a family, and pursued a formidable set of hobbies, including mountain climbing, sailing, home building, history, and wood carving.

He kept up with the medical journals and science magazines. In March, 1997, he read a most interesting article.

The piece was about Dr. Jeffery Taubenberger, 36, chief of the Division of Molecular Pathology at the Armed Forces Institute of Pathology in Washington, D.C. Taubenberger had created a new technique for extracting genetic information from "sub-optimal tissue" – tissue that had sustained damage to its genetic data due to bad preservation or use of formaldehyde.

Taubenberger sought new knowledge about the 1918-19 virus. He used his new technique on a tiny piece of formaldehyde-soaked tissue from a soldier who had died during the pandemic. The tissue sample had been preserved in the institute’s massive files. Taubenberger culled little bits of genetic information from the sample. But to develop a complete genetic blueprint of the 1918-19 virus, he and his team needed a lot more tissue from that era.

Hultin contacted Taubenberger with a question: "Would you be interested in a couple of lungs from a frozen flu victim?" The reply: "Yes!"

So, in the summer of 1997, Hultin, 72, retraced the steps he had taken in 1951. He again got permission from the elders of Brevig Mission (one of whom remembered him) and again dug in the graveyard (this time he found local helpers). He unearthed the well-preserved body of a middle-aged woman. Her name was not recorded. Hultin christened her "Lucy" after an important ancient skeleton discovered in Ethiopia in 1974 (which, in turn, was named for the Beatles song "Lucy in the Sky With Diamonds").

Hultin extracted Lucy’s lungs and packed them in preservative, erected crosses to honor the two unidentified souls who had been enlisted in his venture more than 40 years apart, and returned to San Francisco, where he packed four separate air freight packages with tissue and shipped them to Washington.

All four packets arrived safely. Taubenberger and his team excitedly opened the containers and commenced study of a key gene of the virus, the one that controlled formation of hemagglutinin, a protein on the viral surface that allowed the parasite to bind to lung tissue. Over the course of several months they decoded almost 2,000 chemical letters in the gene’s RNA sequence.

As of last June Taubenberger and his team had acquired significant genetic knowledge about the virus - enough to allow drug companies to create a vaccine should the virus return, or should one of its descendants emerge. "It would have been almost impossible to get a sufficient picture of the virus without the Hultin tissue," says Taubenberger.

(Update: A study published in 2008 says the 1918-19 flu was made particularly deadly by a group of three genes. Scientists say this knowledge might help in the development of new drugs.)

It is impossible to predict if the 1918-19 virus, or a descendant, will strike. Should it happen, the work of Hultin and Taubenberger may save lives. Still, scientists worry, because governments might need months to manufacture and distribute a vaccine, while the virus could spread widely in a matter of days. Furthermore, a new virus might be a baffling mutation. Johan Hultin, with a suitcase full of energy bars, is ready for the worst.

-The End-

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