The 1918 Spanish flu epidemic, which killed somewhere between 20 million and 50 million people, started just as World War I was winding down. Nobody cured it, or really successfully treated it. A fifth of the people in the world got the flu during the pandemic. Read the show notes here.
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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
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Continued Dorothy missed in his reply from house networks that can allow and welcomes the paragraph I'm Tracy Wilson and I'm Holly fry and colleagues. So we don't normally start now with corrections very first thing that I need to do that today. Ok,
So you remember our PIG war episode where we talked about
you know a war that almost happened because of a pig adieu.
Accidently said in that
he traveled via the Panama Canal to get out to that part of the world yeah
no, that was wrong, whimsy daisy hours. Yes, that was my source said via Panama and my dumb brain just filled in the part that says canal there. The canal did not exist, yet
Very sorry, please
emailing us about his ears. What I'm saying, if that's the way?
crime you commit, I think, we're pretty good the hands. I do
big business, maybe like that was maybe the second hugest most email generating error in the pot gas and I'm not even get a mention what the other it was because we haven't gotten a method
about it, and maybe six months at its from years before we came on the show, a sobering corrections about it when we started so yes
I'm so sorry that I oughta completed something that was not built yet in the world and I'll try to do it again.
and they were gonna talk about something completely different yeah. So
not long ago, at all, we are some facebook for people to tell
Some ideas of things that they want to talk about that were events in history, because we have lots of episodes
people and some people prefer events and for whatever reason, whatever I sit down to do the podcast. My brain turns up people,
a lot like has to you so weird. Even
I try to pick a subject that is not a people and is an event eventually.
Sort of as the the notes in the plot liner kind of playing out, as I'm doing my research it almost always as focusing on one particular person that was part of it. I dont know if that's just some sort of brain situation, that it wants to focus on one smaller peace or wet, but it happens is tricky to pick an event and not do that. For me,
conveniently the event that people asked for the absolute most was the wreck of the Batavia with it
point. We had already recorded and meditated. It was waiting to be published so that worked out really well delivered
quickly without beating secret, but for now we had a couple of other things that were maybe not quite as much as heavily
I stated that one but extremely frequently requested, and one of them is what we're going to talk about today, which
These so called spanish flu epidemic of nineteen, eighteen and nineteen nineteen, so somewhere between twenty million and fifty million people died of
blue during this epidemic, which started just as world where one was winding down so
a lot of her past episodes that are about diseases
really about the people who saved us from them. So, like our small,
episode is all about it:
gender and smallpox vaccine, and our tuberculosis episode is all about Selwyn Walks, man in our shops and the discovery of struck the mice in which was the first antibiotic that could treat it
fairer and the cleanest episode called Pollio. The dread disease is also largely about the vaccines that
nearly eradicated polio from the world, but the story of the flu pandemic of eighteen, nineteen, eighteen and nineteen nineteen is not. That has a lot more in common
with our episode about encephalitis lethargic, which also happened right about the same time. The flu epidemic is
Probably why disease that was as crazy and terrifying isn't as encephalitis. Without it it not a better known event
medical history, the fleet,
completely overshadowed it because it killed seventy people, but like
Hepatitis Lethargic, the pandemic flu came and it went nobody could
Nobody could curate of faith
the people in the world got the flu that during the pandemic and
usually, while the typical flu is hard.
Our elderly people in the very young. This time it was deadliest among twenty to forty year olds.
At age bracket, it was so lethal. Then, in the union
states, for example, the average life expectancy dropped by more than a decade just
as a result of how many people died from the blue, which is scary, I feel like. I should confess that I have this completely unfair
I fear that I will die of random flu
This is also why we are doing the episode now and not at the height of Lucy's, as were exiting flew Caesar.
I believe every time I get the flu my thought is. This is the one that's gonna take me down so
Finally, I will ever pay etiquette back swampy record, but now keep my fingers crossed.
So before we start, though, we should talk a little bit about what the world of medicine and what public health were like in nineteen
so in many parts of the world nation.
Really standardized or regulated what was required for a person to call themselves a doctor, so people practice medicine with all kinds of different credentials or with no credentials and patent medicine
which really didn't have any medical value and were mostly alcohol and laudanum. Most of the time we're still pretty prevalent. There was a lot of stuff floating around. It was not legitimate for treating anything and, at this point, Alexander
Fleming had not yet discovered penicillin that was still a decade away and its uses
was even further out a man, so penicillin wouldn't have helped fight the flu, since influenza is a virus and penicillin kills bacteria, but it might have.
Some of the people who wound up with bacterial pneumonia after contracting the flu- and this is more just two-
sort of point out a milestone of where we were in medicine. When this flu epidemic was happening, that so
bite of some of these things that we think of as basics today, like
clearing people to be trained to call themselves, doctors and antibiotics, and things like that.
Things have really advanced a lot in the world of medicine over the past century before the epidemic started. Most parts of the industrialized world at this point had
understood and accepted the germ theory of disease. So at this point pretty much everyone was on the same page in most places that germ,
there's had also figured out exactly which germs caused a number of diseases, including tuberculosis, malaria and cholera
idea of a reportable disease or one so dangerous that all cases of it needed to be reported. The government authorities also existed but
though there had been another serious flu epidemic a couple of decades before influenza was
Billy reportable in most places until this particular epidemic had really gotten dire, and at that point it was too late for warning the government to do, but really it any good
There were, they already knew. There was a big problem by the time people were able to start saying: hey. There is a big problem, vaccine
also existed. There was a vaccine for smallpox. There is a vaccine
rabies. Other vaccines are also in the works and people really five as the as the epidemic got going. But a vaccine for the flu was just around the corner, as
talked about in the encephalitis. Lethargic episode, though figuring out how to make a vaccine for a disease. When you don't know what's causing the disease is really hard
Not only the doctors not know what was causing the flu, they also had it pinned on a complete
different germ. They thought it had a totally different cause than it really did have so at the start of the epidemic. The purported culprit for the
Whew was a bacterium, had been named Pfeiffer Speck Phyllis after its
cover who was a german scientists, name, Robert Friedrich Pfeiffer, and he made
him action between his back sellers and the flu, but he hadn't really prove this connection and is happen
make war on. It became abundantly clear.
Pfeiffer was wrong. The Bruxelles he discovered was not present, insect patience and deliberately exposing people to it. Didn't give them
for you. So, even though in international team was dedicated to trying to create a vaccine, none of their work proved effective and at first
they were after the wrong germ and then they didn't have a good starting point. So
all of this together combines to mean that when the flu turned really deadly and nineteen eighteen, there was not much that legitimate doctors could do for their patience besides to keep them in bed and keep them is spent.
hydrated uncomfortable as possible. The most
things that had any efficacy at all were about prevention, which basically involved keeping the sick people quarantined and trying to educate people about how to keep themselves for being exposed and
there's knew that the flu was spread by coughing and sneezing, so they
common sense advice about covering your nose in mouth and staying away from people who were coughing and sneezing. Oh, and also telling people not to sit on the ground, so don't spit on the ground. Fleets,
either there are debates over whether that's
a civil way to behave in general, but sick people.
the girl now no spitting on its growth and spreads illness, so
There are also a lot of public health campaigns that we're trying to get people who were sick to stay at home, which probably sounds kind of familiarity when there's a big blue outbreak today they
Specially we're trying to educate people who were sick, too,
to stay away from crowds and businesses got it on the deal to trying to warn people who are ill to go home.
a sign at one theatre in Chicago Red
flew in frequently complicated with pneumonia is prevalent at this time throughout America. This theatre is
Why operating with the Department of Health? You must do the same if you have a cold and our coughing and
thing, do not enter this theatre and then in all
capital letters, go
home and go to bed until you are well that's. It was wise, not all of the above
On prevention with sound, though many people,
like hell, recommended that people wear masks and some places
required that masks be one.
by law. But this was in fact not effective yeah.
Some kind of effective when there's,
Syria involved, but when it's a virus, the viruses are just small. Before we
get into how this disease
and where it was first reported- and that looks take a brief moment for a word from a sponsor this epoch.
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So back to exactly what happened when this disease made its debut the first reports of blue and this pandemic came in May of nineteen eighteen in Europe and the first
it's where among soldiers, so large numbers of otherwise healthy young troops, which is becoming really ill with fully like. Sometimes so they were getting coughing and sneezing embody aches. Most of them were
covering within a few days, and apart from the fact that this was disrupt
a war, it was now
a really big deal, but then a disease jumped from the military to
civilians in Europe and from there it spread to most
rest of the world over the course of just a couple of months,
It was still a relatively mild disease. Much like the seasonal flu. Most of us have had at one time or another in our lives. It wasn't pleasant, but it was also
Faded away later in the summer, but then in August
mutated and became really a lot more serious. This terrifying strain of the flu was reported in Boston Massachusetts in the United States and
town, Sierra Leone,
in breast france- and these are all port cities, though it's possible that the disease had spread between three of them on ships. When this time.
Along with the typical flew symptoms of coughing and sneezing, in a sore throat and body aches, the disease
very high feverish between two hundred and two and hundred and five degrees, Fahrenheit patients felt exam.
The earlier eyes became bloodshot, and some even here,
severe, knows bleeds or gastro intestinal problems even there.
Finally, with a lot worse from the fluid, it had spread earlier and sprang alot of people still recovered by pretty substantial portion of peoples.
But the devastating pneumonia, which was caused by one of a number of bacteria, was a secondary infection that was like a complication of this flu, their lungs Phil,
with fluid and started. Hemorrhaging and death often came alarmingly fast, with people going from sitting upright and talking to being dead within hours. Cities are the stories that make me paranoid
This is what I read an article when I was working on this about that. Episode of the about the flu pandemic that, within the down Abbe TV, show yeah so spoiled.
Or forgotten Abbe
similarly makes them,
when the household really really sick and it
one there's one particular character who goes from being she's.
If she's, how she has the flu she goes from. I'm sick with the flew to I'm dead end an episode which is not uncommon for tv, but also was really how it worked.
So in doctors performed autopsies on these patients who had died, they found it there
this, in their spleen through just grotesquely swollen so
description from a doctor who was stationed at Fort Evans outside Boston from that September. Here's
how to say this epidemic started about four weeks ago.
has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. The
spend start with what appears to be an ordinary attack of lagree by or influenza and when brought to the House so Revision Ross, but often brought to the house
a very rapidly develop the most viscous type of pneumonia. That has
Few hours after admission, they have the mahogany spots over the cheek bones and a few hours later, you can begin to see the sciences extending from their ears and spreading all over them
es until it is hard to distinguish the colored men from the white. It is over
a matter of a few hours. Then until death comes, and it is simply a struggle for air until they suffocate it is horrible. One can stand to see.
One two or twenty men die, but you see these poor devils dropping like flies sort of gets on your nerves,
We have been averaging about one hundred deaths per day and had and still keeping it up
There is no doubt in my mind: there is a new mixed infection here, but what I dont know and from the port city,
where this really started sort of blossoming outward the disease spread really rapidly over the next couple of months
it spread all over the world and then it too
faded out. Although another mild wave of flu went on
Around early nineteen nineteen, it's hard to pinpoint exactly how many people died during the pandemic.
Medical records from era were already kind of sketchy. Even before you, through a devastating pandemic into the mix, to make things even more chaotic doctors.
Misdiagnosed milder forms of the fleet with common coals, and sometimes they diagnosed, is much more serious version as another disease entirely like cholera
he's also moved so quickly that public health agencies could not accurately track what was happening so
decade after the pandemic, the estimated global deaths always twenty million people, but modern researcher.
You ve gone back and tried to reconstruct things, have marked the number as much higher between thirty million
Fifty million people died worldwide.
That sort of leaves us to wonder why this particular flu was so incredibly bad. We know the war often takes a job,
share of the blame for the spread of the flu pandemic and it's definitely true,
flew followed the troops and that it spread like wildfire among soldiers in close quarters.
and that soldiers returning home from the war brought the disease with them. That
held injuries and other illnesses also made it,
harder for soldiers to fight off the flu, so camps for the
or were basically like, flew incubators. It's also definitely
the war meant that a lot of the medical personnel who were trained at the time had been tasks
with the military, and so they were not available to help the civilian population, as the epidemic started, to spread coming
these in more rural areas, ass, their various government organizations to please send out
and nurses to help them. But often the few who were part of the war effort fell victim to the flu them
elves while they were travelling to their patience, but
it really. It wasn't just about the soldiers or the effects of the war, even if the epidemic had happened,
in peacetime. Hospitals just wouldn't have been able to handle the influx of so many patients temporarily
hospitals had to be built in churches, in schools and community centres, and some hospitals even expanded their capacity by housing. Their patients intense on hospital grounds,
and the way of life in the late nineteenth also played a big role in the spread of the disease. Cars were not in widespread use at this point.
Any larger citys around the world had developed extensive public transportation systems, so
was bringing sickened healthy people into contact with each other on street cars on trolleys Anna subways in several parts of the world. People are also
traveling really extensively by train, so
roll in the spread of the disease. Cars were not in widespread use. At this point, the many larger
and these long trips in close quarters, similarly fuelled the spread of the disease
the most popular leisure activities in nineteen, eighteen and nineteen nineteen also drew big crowds, so movie theatres had become affordable, they were extremely popular and they were
very widespread. They were everywhere and that made them a hotbed of infection. There were also dance halls and amusement parks and in many places, governments research.
their activities or shut them down entirely to try to keep people from gathering some towns.
Cancel school and cancel church services and universities
bending their operations in an effort to just sort of stop. This spread
going on everywhere. People gathered
that is also shut down or restricted their public transportation systems that were, at this point so popular and
rivers, either with their cities, authority or acting on their own, would refuse to carry passengers who work wearing masks or who they suspected to be ill, and although all of these factors have been about industry
People in rural and developing areas were not spared in the least
in the United States, the Eskimo population was disproportionately hit with the flu
in rural and developing areas, people were left with no medical care in there
little reliable information about what was actually going on or what they could possibly do about. It.
the war which took so much of the blame for spreading the disease wound up ultimately killing sixteen million people
but that number with just dwarfed by the total death toll from the flu. So before we talk about the aftermath of this devastation, let's say
other brief moment and have a word from a sponsor this episode of stuff you miss than history classes, brought to you by the travel store. I have wanted to go to Alaska from a really long time, and now I'm going to get too and I am so excited Holly is coming to, and so can you we will be on the July tenth sailing from Seattle, Washington, on celebrity crews. Lines will be going to several beautiful ports in Alaska, including Skagway. Catch can and Juno will also be in Victoria British Columbia, and we are also planning a couple of events on board where Holly and I will be where you can meet up with us.
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and conditions apply. So to get back to the aftermath of this. This flu
On top of the astounding loss of life, the flu panel
it had a lot of economic and social impacts, so many people were sick that public and municipal Services
we shut down because there was nobody left to do, the work garbage was piling up in the streets in cities were seen attention. Workers were particularly hard hit.
Telegraph systems failed when there were not enough operators that we're healthy enough to come into work. Canada-
me of stories about the black death and how so many people would die that there was no one left to bury them yeah.
Small businesses went bankrupt because their proprietors became too sick to work or they died, and then insurance companies also went bankrupt because their incoming claims skyrocketed if trains were found to have sick people aboard stations along a routes, would actually forbid them
stopping, so even the ones that we're working were subject to some. You know limiting.
Then, that trickled down with its own effects of people not being able to get together
it's a girl, the
it was also often really
genuinely panicked and governments took steps to try to maintain com, including trying to filter or suppressed information about the pandemic. So the talent
I was one of the primary modes of communication at this point. The telephone had been invented, but it was still extremely expensive, not at all prevalent in places
very affluent or places that were also a lot of people rely completely.
the telegraph to communicate with people over long distances, telegram
ran on a network of human operators who were privy to everything that was being transmitted because they were the ones that we are sending out the codes so
knighted states, for example, the public health service gave all of its officers code books to use,
They were sending information about the pandemic. So the tell the telegraph operators
be able to figure out what was being said and go spread alarm among other people.
Once it was all over, perhaps because it had been so terrifying and perhaps because it came on the heels of a war that had stretched on four years most people.
Just seem to want to forget that the whole thing had happened, and so for a long time, research into
cause in its progression were actually quite minimal in October. Have ninety
eighteen. So as the epidemic is still going on. Doctors began to correctly theorize that, before
was caused by a virus and not a bacteria but influence
the virus, was isolated and so many years later in nineteen thirty three influenza is what
this is most epidemic strains of the flu too
types, influenza, b and c weren't isolated until nineteen, forty and nineteen fifty respectively and the vaccine
come around until nineteen, forty four, and because the flu me
it's every year. The vaccine has to change every year to keep up. This is why the vaccine provides better protection,
years than others, because some years, it's just a better match to what's actually happening, and it keeps up with the mutation
right other, although with deadly pandemics also followed and nineteen fifty seven and fifty eight
again in nineteen, sixty eight and sixty nine,
there was also the eighty one and one swine flu pandemic in two thousand and nine and twenty ten other.
You of also have the potential to turn into pandemic flu. But ultimately, didn't scientists contain
To study the nineteen eighteen nineteen nineteen pandemic to try to figure out exam,
We, what made it so bad in the hopes of,
adding another similar situation in the future. They ve done things like tried to run
engineer the genes of the nineteen eighteen version of the flu and try to figure out what modern drugs might be effective against something like that in Sudan
in five researchers sequence, the genome of the flu virus. They use sample
from the body of an annual woman who had been buried in a mass grave after the flu killed. Ninety percent of her village and according
This research, the flu, came from an h one and one avian virus, the sort of scientific verdict since then has slipped back and forth a little
about whether the Pandemic flu came from an avian or a swine origin, and then, in February of twenty fourteen
article published in the journal nature, but the primary theory back soon
avian origin pin
January of twenty fourteen historian, Mark Humphreys, published
for in the Journal war in history, theorizing potential cause for the pandemic
during the war one. Ninety six thousand chinese workers were transported by rail to work on the western front. He found medical records
scrubbing respiratory virus that broke out in southern China the year before, one that China.
officials later said, was identical to the so called spanish flu about three thousand of the workers were quarantined with flew like symptoms
since doctors called the sick workers, lazy and then sent them back to their camps and at the time of his papers publication, he was waiting on test results from samples for compromise
Yes is one of those things where, at least according to everything- and I was reading about it- tests should can-
this theory. But at this point a lot of people are like yeah. That makes a lot of sense so
Obviously that means that this had nothing really to do with Spain. We left this for the end
but the name spanish flu only came about because Spain's pray
was uncensored at the time, so most of the earliest information that people got about the illness came from Spain, where people were
restricting the information that was published about it. So I really got it unfortunate association just by the fact that they were them
informative, whom he always going, our being there
the least obvious skating about what was happening so yeah,
This whole story is really alarming to me. I have, or I have
The least obvious skating about what was happening so yeah
nineteen hundred, and so big
didn't seem like they were in the distant past to me until they had happened before he had been born
so when I was little of the fact that this whole thing has happened
while he was alive. I was like this
happen again right now, because,
then it's extremely recent past and
How is that adult? I still think this could really happen again right now, but it's not because of like the state of medical knowledge is just because viruses can be terrifying year. Legacy
I still think this could really happen again right now, but it's not because of like the state of medical knowledge is just because
just because viruses can be terrifying. Yeah, like I said I I have it,
wash rightly, my level of fear of it is irrational, ok,
bad. Maybe maybe I do those things I won't overseer, but last week I had a brief visit from food poisoning
I immediately my brain started. Whirling with the oh, my gosh know what, if this is some really terrible version of the flu and I
patient zero its irrational. I think
it made me most afraid of illnesses like this is a game that I've played on the Ipad called plague incorporated, were basically you try to make your playing, kill everyone in the world
like there's. There are ways we can do it where it is basically spreads signed.
Lee among everyone admit it turns completely deadly, and whenever I see that
when I look back back, it happened, they could really happen. I like how you
Entertainment choices are reinforcing your fear. Such really good sometimes happens. Yes, do you have listener veil? I do have one her male. This was their mail is run. Sarah and she says I led the podcast an have written before when you two were doing pop stuff,
really enjoyed your episode on binding and couldn't help, but wonder if other cultures might be our western custom of circumcision. In the same light, I know it has
the religious meeting for many people, but the tip
thirdly that in a hospital, doesn't follow jewish guidelines for circumcision. Babies. Of course, remember. The procedure
will heal better than adults choosing to undergo the operation to fit it, but it is still a cosmetic procedure but can't really be reversed and its given with
Consent of the child
I know some men wish they were circumcised and feel they didn't get a say in the matter and in recent years many people have advocated against it. I pray
We haven't made up my mind about it, but there are strong arguments on both sides. Maybe if I
children. I will have to make a decision, if so hard for me to think that I might permanently change boys body just because it is a cultural norm. I should point out that
I dont believe circumcision is in any way as life altering as the active foot binding, but that it is something for our society to consider and then she sent some show ideas so.
I think this was like one of the most
emails about circumcision that we got after the for binding absurd. It's a topic, people feel very
passionately about, and we got a lot of emails about it. We owe alive,
some of them- were extremely screaming at us. So
here is why I can't I'm not sure if it was your because there is not really a modern equivalent of this in the west, but I think we both premature, felt that and feel that we are doing
So here is why I did not put sir.
Vision into the same category as but finding so both of them are there
armed or where are or were performed on children without their consent. They
Not medically critical
There are some arguments about medical benefits of circumcision. Bet. It's like not something that it's an elective procedure that ticket
but it yeah and they do change a person's body, but something
It is not in
in culture, the way that binding is like it was
pretty much the thing to do with baby boys for many years, but that
not mean that baby boys who were not circumcised, were in L a
to be married ear rings,
meaning. We talked about it, the episode, if a family.
Chosen not to bind the feet of their daughter. They were sort of condemning, heard too
ready LE rough life like she would basically odd
ethically beyond one of the lowest wrongs of society. Right
also a lot of really contradictory research about exactly what effect that circles
does or does not have on. For example, a man's sexual help. There are prey
and cons in the things literate like medical benefits, like it
It appears that being circumcised lowers the risk of HIV Transit transmission like there
humans on both sides of that.
Binding, on the other hand, has zero medical value at all whatsoever and is crippling
So are we talked about it? Let episode that they they found that women that had had their feet
later on in the year in their older years, had a higher instance of osteoporosis than we rain. That did not yet, and I think it's possible-
but a hundred years from now or five hundred years from now, or something like that, it's entirely
of all the culture will look back on circumcision and make them
the equation that, yes, it was just as bad as as but finding but like we're. Not at that point in culture or history.
Like. There are some parallels, but I cannot
I'll say that they are equivalent well, and the other thing that counts.
Is that, unlike footmen
whether or not a man is circumcised is not immediately obvious to passers by in the street right where
women that were caught in that that middle ground that we talked about after for binding, had been outlawed and fallen out a favour, but still had their feet bound. People were taunting them in some times, assaulting them in the streets, because they could obviously see that they were part of the
older tradition. That was now not in favour where you get. That would not be the case if circumcision suddenly were completely eradicated as a practice,
when the head sort of legacy circumcision are not gonna get taunted industry, because people will not know that
so in my mind, for something to be equivalent to two
binding it would have to be simultaneously crippling perfect
and on children without their consent and so
oh ingrained in a culture that that removing it from that culture would have all kinds of other ramifications. So a lot of
other suggestions that people wrote into us about things that there were like well
that women wearing high you'll soon that can perform their body like that is about making a choice themselves.
and you know, if you dont we're Hideel shoes that doesn't mean you're gonna, be socially outcast for the rest of your life. So it s a
all of those things at the same time. For me to say: ok, yet that would be a modern equivalent.
yeah, I was saying: there's not a modern cool. It's not diminish the discussion that people are having about issues like circumcision, but it just doesn't meet the same criteria right
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