Then, the Army called them “atypical pneumonias.” Today we would call this atypical pneumonia Acute Respiratory Distress Syndrome (ARDS). The Army’s pneumonia board judged that “more than half” of all the deaths among soldiers came from this atypical pneumonia (Ireland, 1928).

One cannot extrapolate from this directly to the civilian population. Army figures represent a special case both in terms of demographics and environment, including overcrowded barracks.

Even so, the fact that ARDS likely caused more than half the deaths among young adults sends a warning. ARDS mortality rates today range from 40 to 60 percent, even with support in modern intensive care units (ICUs). In a pandemic, ICUs would be quickly overwhelmed, representing a major challenge for public health planners.

Treatment and Prevention in 1918

Physicians tried everything they knew, everything they had ever heard of, from the ancient art of bleeding patients, to administering oxygen, to developing new vaccines and sera (chiefly against what we now call Hemophilus influenzae—a name derived from the fact that it was originally considered the etiological agent—and several types of pneumococci). Only one therapeutic measure, transfusing blood from recovered patients to new victims, showed any hint of success.

George Whipple, later a Nobel laureate, studied numerous vaccines and sera and found them “without therapeutic benefit.” But of some vaccines he said, “The statistical evidence, so far as it goes, indicates a probability … [of] some prophylactic value.”2 Some bacterial vaccines may have prevented particular secondary pneumonias.

Meanwhile, the public used home remedies of every description. None showed any evidence of effect.

Some nonmedical interventions did succeed. Total isolation, cutting a community off from the outside world, did work if done early enough. Gunnison, Colorado, a town that was a rail center and was large enough to have a college, succeeded in isolating itself. So did Fairbanks, Alaska. American Samoa escaped without a single case, while a few miles away in Western Samoa, 22 percent of the entire population died.

More interestingly—and perhaps importantly—an Army study found that isolating both individual victims and entire commands that contained infected soldiers “failed when and where [these measures] were carelessly


JAMA 71(16):1317 current comment, Vaccines in influenza.

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