DiseaseMedical

The 100th anniversary of the Spanish flu: what happened to humans and what has changed?

World War II ended in the atomic bomb, World War I ended in the flu virus.

Between 1918 and 1920, at the end of the First World War and two years after the war, a pandemic called “Spanish flu” swept across the Americas, Europe, Asia and even Eskimos, capturing The lives of 50 to 100 million people in the world reached 5% of the world population at that time. The number of people it knocked down far exceeded the number of war casualties.

Even more mysterious and frightening is that the disease likes to attack young people, and in a few short days, those strong bodies will fall painfully. Later, some researchers think that the flu may bring war on the population Reducing one of the reasons for the early end of World War I.

American hospital during the pandemic

Just as its arrival is unknown, its disappearance is not due to the valor of human beings. The flu in Spain is a “plague” that has been said by many people in history. From time to time people are reminded of the catastrophic consequences of the plague, and thinking is not without merit.

As the famous American journalist “The Great Influenza: Epic of the Deadliest Plague in History” published by the American historian John M. Barry in 2004 said: The 1918 pandemic was not a simple one about destruction, death and despair Is not just a story of how one society is struggling with the disasters that nature imposes on human society. It is also a story about science and exploration, a story about how people should change their way of thinking, one about how people should think calmly and then make a bold choice and act in an environment of total disarray rather than unnecessarily long hours Argue the story.

The end of December 2017, high-intensity seasonal flu broke out throughout the country. In the 52nd week, the number of flu cases in Beijing increased by 81.44% within one week and the number of flu cases in the country exceeded 120,000. In Beijing, Shanghai, Zhejiang and Tianjin, emergency departments of major hospitals in China were full, and the number of people infected with 0-4 and 25-59 infections increased dramatically. In the first week of 2018, 9,000 flu cases were reported in Beijing, 19 times more than last year.

In the United States, the worst flu in a decade also claimed the lives of 63 children in February, with 4.5 million people in the United Kingdom reporting the symptoms in January. In 2018, it became the worst winter in the world since the outbreak of the 1968 influenza in Hong Kong.

Vaccination failure, pediatric halt, out-of-stock “cure”, the school became a flu-hit areas, a series of epidemics and forewarning, isolation, emergency alert … … 100 years later, in the face of a sudden epidemic, human There seems to be no difference between panic and helplessness.

There is no reason why as the spring of 2018 approached, the number of cases of influenza that had entered an absolute peak began to decline and returned to its conventional level by the end of February. The flu virus, like every eruption in the past 100 years, goes away again.

At this moment, we have reviewed the pandemic that we had 100 years ago. It is exactly what we want to see and what we can change before the disease.

twenty four

War, a huge petri dish

“Spanish flu” does not originate in Spain.

In fact, it came to Europe only two months after the outbreak. Here the flu came to Italy from France and soon spread to Britain, Germany, Denmark and Spain.

That was the war that started in 1918 in the Balkans, which lasted for four years. Every newspaper in the warring states during the wartime reported on the army and the government with great reports – except for the neutral country of Spain. Here, the maximum warning and coverage of the flu pandemic that afflicted 800 million people, including King Alfonso XIII, was obtained.

In this way, the news war control gave the flu a name. This is only the smallest of the effects of the war on the Spanish flu.

In January 1918, the United States joined the war as a full-fledged country for just one year. For this full-fledged war, the U.S. military increased from tens of thousands before the war to millions in just three months. Hundreds of thousands of soldiers live in temporary shelters – they come from completely different states and regions, with radically different disease susceptibilities – many years after public health experts rate them, millions of young people gather at barracks Extreme tension and frequent contact with mixed populations mean an increase in the geometric progression of the epidemic.

In addition to the massive population and pathogenic aggression, the war also provided the best justification for population migration, together with the extreme war environment and harsh medical conditions, as the best breeding ground for the deadly infectious disease of 1918.

In February 1918, the flu came

By the end of February 1918, several young men were recruited from Haskell County, Kansas, where the “flu” epidemic was spreading. They arrived at the Foster Barracks on 2 March. Two days later, the Force Hospital began receiving the first batch of influenza soldiers and, within three weeks, 1,100 seriously ill patients from Foster Hospital were admitted to hospital. On 18 March, as many as 10% of the fledgling outbreaks occurred in the large cities of 30 neighboring military bases in the country, as 10% of the soldiers in Forrester’s camp in Frisian, Georgia, whose forces were mobilized with Foston.

The epidemic quickly spread to the other side of the earth. The day after the U.S. troops landed in Brest, Europe, the French Navy Command suddenly interrupted the attack. By the end of April, the epidemic went to Italy with French soldiers and then to British Army troops. In May, the outbreak of the Second Army in the UK deteriorated. One artillery brigade fell by 1/3 in 48 hours.

The first wave of influenza outbreak of the United States hospital

This is the first outbreak of the Spanish flu. The disease was spread to Spain, Greece, Germany and Denmark and arrived in Mumbai and Shanghai with a transport vessel in early June, but after 4 months, most of those infected recovered quickly and soldiers quickly returned to battle.

Everything is getting better, before the flu outbreak seems to be just an episode of the war. Until July 1918.

The spread of the pandemic worldwide

A serious flu broke out on a ship sailing to New York from France and had to temporarily stop in Halifax, Canada, due to an overwhelming number of sick sailors, awaiting seafarers regained their strength; a sudden outbreak in a small French military base , Took 5% of French recruits; and in July, a troop hospital was packed up with an outbreak of high-mortality influenza in a U.S.-backed contingent of Pike camp in Arkansas.

One by one, cases appeared one after another in the world. The second wave of epidemics was like the water in the pot to be boiled, finally bringing a fatal blow. Within a month, it has spread across all continents except Oceania.

Immediately more violent second wave

In Devon’s barracks in northern Boston, 345 people were diagnosed with pneumonia on 19 September alone, accounting for 19.5% of the entire barracks. In Philadelphia, there were streets full of white Silk cloth, stacked bodies are nowhere to be placed, and parents can only place their sons buried in macaroni’s boxes; Canada’s Labrador, frozen in the cold with sheets; Europe, Germany ordinary people The death rate of 27.3% in Africa, the Gambia, the flu erased the traces of most villages; 10% of Guam in Japan died of flu in Delhi, India, some of the train leaving the station when the car is still alive, Arrived when the body is full …

Blood everywhere – in a letter written to colleagues by the U.S. military chief Gerst, he described them as beginning to look like the common cold, but when they were taken to the hospital, their condition deteriorated rapidly to unheard-of malignancy Pneumonia, two hours after admission, their cheekbones appear reddish brown spots, a few hours later, the patient significantly cyanosis, they face bruising, can not distinguish between white or black. … El town opened a special train for the delivery of coffins in short supply. ”

In less than two months, the rate of death that climbed too fast has been boring. In the Michigan barracks, the dead were put into body bags without a complete break, and on the third day of the Philadelphia procession, 117 people were killed in the city, double the number on the fourth day. Sick people lying in bed with their bodies at home and people digging graves have got sick, they refuse to bury the bodies of these flu patients. Many of the dead were horrified with bleeding in their ears and nose.

October 1918 New York street

Infection in wartime hospitals

The second wave of influenza outbreak in Spain is the longest, the largest and the highest in the entire flu pandemic. In October 1918 alone, 200,000 Americans were killed by the flu, and the average life expectancy of Americans in 1918 was therefore 12 years less than usual.

The third wave of flu did not end until 1920

The spring of 1919, the war has ended more than two months. The third wave of influenza flu was welcomed by those lucky enough who survived the war and disease as they were no longer subject to censorship and this was the period when the flu was most widely reported. People pick up the pen in your hand and write the first word: fear.

Allegedly, the flu was a comeback of the ancient medieval “black death,” and a Sydney newspaper did not hesitate to use the “doomsday plague” to address the flu. When childhood survivors of flu experience writing memoirs as adults, “Black Death” has become their most direct memory.

Street masked soldiers

Warning sign about pandemic isolated

Fear did not allow volunteers to enter the families of those who were seriously ill. In the end, many patients even starved to death. Nurses did not even dare to answer the phone numbers of the solicitors, lest the disease would spread through cables. In the midst of having to go out, people wear masks and do not go too far to talk as far as possible. “It’s fear, not the disease itself – that smashes society.”

In February 1919, the number of deaths from the flu in Paris was 2,676, compared to 1,517 in March. In fact, during the four months after the postwar Paris Peace Conference, the three giants of France, the United States and Britain participating in the conference have all been infected with the flu to varying degrees. It is even regarded as a stroke after President Wilson’s return to the United States One of the incentives.

The long third wave of flu lasts until the spring of 1920. At this time, the number of unconventional deaths in 1.8 billion people worldwide has exceeded 5%.

People are gradually convinced that the disease comes from the outside world

In 1918 when pathology and public health were still in their infancy, it was hard to get accurate judgment of the epidemic, even through public media messages.

At the time, the modern medical research in the United States was just beginning. Just decades before World War I, modern medicine was no different from two thousand years ago. Hippocrates, 460 BC, presented a medical approach to medical practice through observation. His “temperament and body fluid theory” was later refined by Gallon, a Roman physician, to conclude that “the disease is the result of an imbalance in the body, Need to adjust their balance, you can successfully treat the disease. ” It ruled Western medicine for nearly 1500 years, providing a powerful basis for “bleeding therapy”, “homeopathy” and the use of potent laxatives.

Paintings “Medieval medicine”, the picture center is Galen

But by the end of the nineteenth century medical education began to change in Europe, and medicine was gradually identified as a science that was experimentally explored rather than relied on logic and observation. Researchers began to examine medicine in a modern science-like way for 2000 The old thesis collapsed in just 300 years.

After the French Revolution, the French physician Bishu started to dissect the organs and used stethoscopes and thermometers. Dr. Louise and his colleagues conducted a comparative study of organs and healthy organs in the study of pathological anatomy and gradually formed a new concept of disease: disease Is a kind of intruding into the substantive part of the human body, it has its own characteristics, and the objective existence.

Numerical measurement systems such as thermometers and sphygmomanometers have also introduced mathematical logic into the medical field. In the 1840s, as an entirely new subject of epidemiology, the British physician John Snow made a detailed observation of the outbreak of cholera in Westminster, London, in his paper “The Study of Cholera Transmission Methods” He applied the statistics to the essay, suggesting that the spread of cholera did not originate from dirty air, but rather from serious water pollution.

At the same time, the statement that the disease originates outside the body has also been accepted by the microbiology community.

Robert Koch in the mirror found Bacillus anthracis and Mycobacterium tuberculosis

As a new achromatic lens became a standard feature for German doctors, microbiologists gradually found larger parasites under the microscope. After Virgins and Bernard Co-founded Cytopathology in 1849, human awareness of the disease was advanced To the cellular level. A large number of laboratories for exploration and research appeared in Europe. In 1840, the German microbiologist Henler published the article “On Poisoning and Infectious Diseases”, which laid the basic conditions for the etiological relationship between microorganisms and diseases. At this time, the etiology and emerging Microbiology finally solved the doubts that plagued medicine for twenty centuries, namely, “What exactly is contagion?”

But they still know nothing about the virus

But in 1918, the culprit – the virus – had not yet entered the researcher’s field of vision. It was not until more than 10 years later that the diagnosis of influenza caused by the virus was made public.

Today, as long as people with high school biology education know that viruses and bacteria are different, it is a life-form that does not require metabolism and has a copy-only function. At the heart of the virus is a segment of the gene that invades cells through various forms, modifies host genes and replicates them into thousands of new virus individuals. Different forms of influenza virus have different effects on the human body, of which Influenza A virus causes epidemic diseases in the region or the world.

H1N1 flu virus profile

Influenza virus mainly attacks the respiratory system. When the cells are invaded, the human immune system will respond quickly to it. The influenza virus bypasses the recognition of the immune system by means of “antigen drift” and “antigen drift” And bring popularity – many medical history researchers believe that several of the 15th and 16th centuries of the pandemic is actually a flu, after the beginning of modern human transport, the epidemic occurred in the 18th century, 6 occurred in the 19th century 4 times.

People who were obsessed with finding pathogens at the time did not know these. Pathologists represented by Parker, a New York City lab director and bacteriologist Lewis, have gradually attributed influenza to bacteria called Haemophilus influenzae, after anatomy and pathogen support.

This is a microorganism found in 1892 that is prevalent in the respiratory system of flu patients and is therefore considered by the Finder Dr. Phoebe as the causative agent of the flu. (Later studies have shown that it actually incurred bacterial pneumonia)

Haemophilus influenzae

Within two years of the flu, in dozens of laboratories in the United States and Europe, microbiologists began to isolate the bacteria in various ways from both the patient and the dead. Separation and cultivation process is very difficult, they can still find fault in the face of failure. Throughout October, antisera and influenza vaccines from Philadelphia, New York and Chicago were distributed nationwide, and millions of people were used by a massive vaccine, until Haemophilus influenzae has not yet been able to follow conventional bacteriology Principles are separated and nurtured.

Diseases and wars bring depression

The mystery of the flu has disappeared, and the impact it has had is much more than that.

Pandemic flu deaths in Europe and the United States in 1918 and 1919

Influenza sequelae and complications worldwide are documented. Heart disease and meningitis caused by the flu have dominated medical records for the next few years.

The bereavement pain brought by the war and the flu filled the literary works at that time. Later researchers believe that the depression of the will of the people and the nihilistic blend of betrayal and misery in the 1920s are now related to the flu. The bloody scenes on the fronts of World War I were restored by the flu around each and every one. The death of neighbors and loved ones, the failure of all kinds of epidemic prevention and treatment methods, all make people’s belief in science and religion fall into nothingness.

Three victims of the flu

In 1923, Dewey published an article in The New Republic, “It is questionable whether people are as widespread as they are today, and the concern with the cure and the savior is to prove the extent to which the world is seriously ill.”

During the invasion, many local governments were unable to dominate the overall situation, but the powerful social mobilization necessary for epidemic prevention and crisis management still enhanced people’s reliance on the central government.

The national public health system is shaping

There are also good aspects. As a result of this flu, humankind has begun to establish an international health cooperation program on a global scale. Epidemiological and medical statistics have become mainstream methodologies in public health research.

From Philadelphia to New Mexico, a completely new public health service was established, a large number of temporary hospitals were converted to permanent hospitals and the formal establishment of the modern medical system as part of the social fabric was fixed.

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Public health governance in the United States is inextricably linked to rapid urbanization in the late 19th century. Cross-regional travel with densely populated and susceptible populations, coupled with the rapid deterioration of urban sanitation, has created an excellent environment for the rapid spread of infectious diseases.

It was not until the late 1860s that Washington’s streets were full of residents’ dumping trash, rats and cockroaches even in the White House. Under such circumstances, the epidemic of the two epidemics in the late 18th and early 19th centuries has directly turned into an opportunity for early public health governance in the United States.

The first health commission in the United States was set up in New York in 1798 to control the plague after its pandemic of yellow fever. For the first time in 1804, the government set up a full-time health inspector in the densely populated city, under the leadership of the police station. Later, some major cities such as Boston and Philadelphia gradually established specialized health inspection systems. In addition to supervising sanitation, they are also responsible for quarantining and isolating infectious diseases. By the eve of the Civil War, many state health committees had established a special infectious disease registration and reporting system and started health promotion and vaccination against smallpox.

In 1878, as the industrial development and population increased, the sanitation situation in the United States deteriorated again. To this end, the Parliament passed a special “National Quarantine Law” to control infectious diseases. The quarantine law greatly strengthened the quarantine authority of the U.S. public health and naval hospital services, later the U.S. Public Health Bureau. When the Yellow Fever was once again erupted in New Orleans in 1905, the agency was empowered to regulate interstate transportation of sera, vaccines and other items.

By 1900, most of the health councils in the country had the function of strengthening legal supervision and prevention of infectious diseases. Between 1915 and 1920, these evolving health and epidemic prevention agencies were mixed and lacked standardization rules. Most of those mature public health programs deal with the federal government and the state government with great care. In small cities with a population of less than 25,000, the work of the health sector is often only premature for quarantine and chemical fumigation of sexually transmitted infections means.

Pandemic doctor and quarantine officer

At the beginning of the flu pandemic, the health minister in La Crosse, Wisconsin, pointed out the issue of standardization in the field of public health. After the flu, the public health agencies in the United States have been remarkably organized. People are also slowly realizing that public health matters require experts to answer their questions. Urban, rural and railway health systems began to unify standards for water, milk and wastewater treatment and the state government collected a uniform report of the disease.

Many permanent public health agencies are established and retained in the flu. For example, New Haven specifically for the Ministry of Health had a permanent transformation. They have reorganized school-level health screening companies and have dramatically increased the budget for child health services; a Massachusetts-based town no longer relies on the sanitation facilities around them and the temporary emergency hospital established in the flu has become a permanent establishment.

Influenza, universal health education has been popular. Education and publicity in the health sector is a national or even a worldwide improvement. In big cities such as New York and Los Angeles, the bus is tagged with spitting and death. People are starting to believe that bad health habits can really cause illness. Urban cleaning and personal cleaning have become the mainstream of social education.

Prevention and treatment of influenza posters

Because of the flu, the Department of Public Health gained new credibility and authority. Also in Massachusetts, many people directly support the Ministry of Health as the general manager and solve the social and medical problems in the state. People also demand that the federal government control public health on the grounds of flu. Some even propose that doctors and nurses should all be classified under the Central People’s Government. A Post Journal in the city of Rochester pointed out that it is necessary to classify the whole country like Britain and France 2-3 districts for medical supervision.

People have also learned a few lessons from the flu, such as the need to create a backup force for the Department of Health. After October 1918, a large number of health officials participating in quarantine and preaching fell one after another, and people began to realize many problems in the construction of the health system. On October 27, a bill establishing a reserve force for the Department of Health was passed by the National Assembly, although it did not make much sense at the time of the flu epidemic, but this normative procedure still plays a role in the ensuing public health emergencies .

Since then, similar attention to public health has re-emerged and until the official implementation of the Roosevelt New Deal Social Security Act in 1935.

In the history of public health in the United States, scholars do not always mention the flu. The post-World War II “New History” research trend, in turn, linked the history of public health to social change and personal life, the Spanish flu that killed nearly 100 million people is so hidden in innumerable cholera, yellow fever and plagues.

How to have the ability to eliminate a disease?

If the mutation and epidemic of the virus is just an accident, then when will the new round of epidemic come? What has our community prepared for this?

In the “post-Hispanic flu” years, these problems continue to plague people. In particular, the legacy of the Spanish flu has become even greater after the three massive flu attacks of the 20th century. How to get the attention of a decision-maker to a disease often depends not only on the number of victims and on the pressure of death but also on socio-political behavior, the cooperation of large corporations, research institutes and nonprofit organizations.

Take the “One dime Campaign” After the World War Two Greatly Preventing Poliomyelitis in the United States as an Example. In 1921, President Roosevelt became infected with the polio virus after a swim. Sitting in a wheelchair, he soon became the most intuitive advocate of the disease.

Roosevelt bad behavior

In the meantime, the post-war high fertility rate has also brought about an increase in the number of cases of poliomyelitis. In 1946, there were 25,000 reported cases nationwide and 58,000 in 1952.

Statistically, the probability of serious poliomyelitis is low, the probability of permanent paralysis is less, and the probability of lethality is negligible. However, the U.S. government quickly advocated the National Polio Foundation, which was established in 1938, and soon became a disease most concerned about by Americans. Just pick up a magazine, people will see the title: “For Parents: Poliomyelitis Tips,” “How can you help polio?”

Resistant to polio posters

Elvis also joined the “dime movement”

In 1934, American physician Charles Armstrong passed the polio virus to the monkeys and mice in the laboratory. In 1936, Maurice Brody, a research assistant at New York University, finally succeeded in using the spinal cord of the monkey as a viral growth environment to make a polio vaccine.

Next you need to test the effectiveness of this vaccine. In the vaccine testing phase, Brody began to use himself and a number of helpers as subjects, the test results are quite good. Thus, to demonstrate the effectiveness of the inactivated vaccine, the Foundation started a trial of the Salk vaccine, relying on a myriad of dedicated volunteers centered on protecting children and their parents – the largest public health trial in history .

Throughout 1954, millions of American parents were persuaded to get their children involved in the experiment, and 1.3 million children were injected with the vaccine under test.

Children / pictures after vaccination is completed by Chicago Tribune

The country is mobilized. The Foundation held a two-day workshop in 211 cities across the country. Doctors and nurses receive simple training in the clinical use of vaccines; school leaders and teachers learn how to record data, contact parents, and phone numbers to report on the vaccine are ringing in the vaccine research office at the University of Michigan. In the end, 95% of the 600,000 children received all three injections, attesting to the value of intensive national advocacy and community-based efforts.

The children soon developed an allergic reaction, hundreds of whom died of accidents and infections. However, the results of the final test are encouraging. Studies show that the vaccine is effective in preventing paralytic poliomyelitis by 80% -90%.

A well-functioning system

Privately funded medical research also plays a role. In Europe, governments, universities and the rich are well-known for donating medical research. After diphtheria antitoxin was discovered in 1894, foreigners in America such as the rich and the private sector began to focus on the medical field.

In 1901, Rockefeller’s grandson died of a scarlet fever in Chicago. In the same year, the privately-funded Rockefeller Institute for Medical Research was established. The institute with 75 independent laboratories provided scientists with a perfect environment for collaboration. Since its inception, the Rockefeller Institute of Medicine has made medicine itself an independent field where scientists study infectious diseases and also lead researchers from the clinical world.

Six years after the birth of the institute, Simon Flechner, a scientist at the Institute, invented the serum therapy for bacterial meningitis, making himself and the institute famous.

More important than the fame is what the research institutes represent. Although none of the laboratories successfully identified the flu or isolated the so-called “Pf bacillus” in the flu, the concerted efforts of government, scientists and nonprofit organizations gave the later epidemic prevention a relatively well-functioning system.

Rockefeller Institute of Medicine

However, these agencies and behaviors devoted to public health services still often lead to dissatisfaction and doubt.

Just as Xiaotangshan Hospital, which set the world record for building speed records, in 2003, due to the rapid spread of the SARS epidemic, the Beijing municipal government urgently built a field infectious disease hospital with 508 wards and 1,000 beds in 8 days. It treated a total of 680 SARS patients in 51 days, most of whom were discharged. By 2010, the hospital, which is called Silent Hill in China, was announced to be demolished.

To what extent is the public’s awareness of the disease affected by a strong government? Does the system of public health care and health necessarily imply the transfer of individual rights? What factors can determine the ability of a society or country to fight the disease? Every large-scale epidemic will leave far-reaching topics for discussion.

The flu has triggered people’s thinking about methodologies

John M. Barry pointed out in “The Flu: Epic of the Deadliest Plague in History,” that the 1918 pandemic led people to think “two of the most important issues in science,” “What can I know?” And “I How do you know?

In his book, he wrote, “In fact, both science and religion have gone their separate ways in the first question of what can be learned. Religion – in a way that philosophy – thinks it can know Or at least deal with the “why” issue.

The question of “why” is too esoteric for science. Science considers itself to be able to study how things happen.

When science is not merely devoted to “what can I know”, but more importantly to changing its approach to research and to changing the answer to “How I Know”, the revolution in modern science, and especially in modern medicine, begins. ”

This is the methodological significance. In a narrow scientific field, the answer to “How do I know?” Determines whether one is confronted with scientific methods of operation – observation, logical deduction, or hands-on experimentation.

He also believes that the exploration of methods not only involves academic discussion, but also affects a society’s own management tools and even its social structure and its citizens’ way of life.

If a society believes itself to hold the truth and does not need to doubt its own beliefs, it will be easier for the community to stick to its rigid decrees and less likely to change. But if it leaves room for questioning the truth, it is more likely to become free and open.

“Pandemic: Epic of the Most Deadly Plague in History” cover

In the 1918 flu, people faced and accepted natural tyranny, facing the fear of death, while also suffering the harm caused by lies and ignorance. “It is impossible to estimate how many people died from the propaganda machine created by Wilson, There is also no direct sales how many young people because of the authority of the ‘flu’ guarantee in vain. We only know that in just four years the war killed 35 million people worldwide and the number of deaths due to communicable diseases surpassed the war.

Time went back to the Paris Peace Conference in the spring of 1919, and later the history of war and medical history even blamed the pandemic for the ultimately unsatisfactory peace talks. They would rather find evidence that the big three leading negotiators were caught in the confusion caused by the flu or could not explain why the peace talks originally planned for a permanent peace in the world became a breeding ground for the division of power and the retaliation for war.

In any case, World War I and the flu together imprinted “death” in people’s minds, which planted the seeds for the “evil” -battered war two decades later.

The pictures and images from the PBS documentary “American.Experience.Influenza.1918”