The following is an excerpt from the CQ Researcher Archives report on "Influenza Control", September 24, 1976. In the fall of 1976, the federal government sponsored a National Influenza Immunization Program that at the time was the most ambitious such effort in history. It was the first time a nation's government attempted to vaccinate virtually an entire population against a potential influenza epidemic.
Influenza apparently has plagued humankind throughout history, A flu-like epidemic swept through the Athenian army in 412 B.C., and Hippocrates described another epidemic in the same century that was probably influenza. The name influenza was coined by two Italian historians, Domenico and Pietro Buoninsegni, in 1580. They believed that fevers, sore throats, soreness and nausea were attributable to un influenza—an influence—of the stars. The word influenza was introduced to the English language in the mid-1700s.
For many years influenza was thought to be passed along by the winds. It was not until the late 19th century that this idea was dispelled. In 1892 Richard Pfeiffer identified the influenza bacillus, a tiny organism of varied forms that lives on certain substances in blood. For a time, this bacillus was thought to be the causative agent of influenza. But that notion was proved wrong during the period of intensive research and experimentation that followed the worst outbreak of influenza in world history, in 1918.
Devastating Influenza Pandemic of 1918–19
The great influenza pandemic that swept the world in 1918–19 may have been the most virulent outbreak of disease in history, at least in terms of the swiftness of its devastation. It killed more than 20 million persons around the world, including some 550,-000 in the United States—all within two years.  “Mathematically, had the epidemic continued its rate of acceleration, humanity would have been eradicated in a matter of months,” Joseph E. Persico wrote in American Heritage.  The pandemic killed about one out of every 100 people living in the world at that time. Influenza deaths outnumbered World War I fatalities by more than two to one.
The disease was known as the “Spanish flu” or the “Spanish lady” in the United States because, although waves of it swept many European countries during the final year of World War I, only in neutral, uncensored Spain did the newspapers report the full extent of the epidemic. No one knows for sure where the flu originated. Some scientists believe it may have started independently in Europe and Asia, or that Chinese workers carried it to Europe. Others say the best evidence points to the United States. At Ft. Riley, Kan., in March 1918, hundreds of soldiers came down with flu after a severe dust storm had whipped up clouds of dirt and smoke from burning piles of manure. Many of the soliders later sailed for France, and the French and British armies soon were hit by influenza outbreaks. Crowded military camps, unsanitary wartime conditions and constant troop movements contributed to the spread of the disease.
The German army was soon stricken, as were inhabitants of such faraway places as India, Japan, Chile, Greenland, Alaska and Africa. Among the world leaders who fell ill were British Prime Minister David Lloyd George, King George V, French Premier Georges Clemenceau, German Premier Prince Max of Baden, Kaiser Wilhelm II, Gen. John J. Pershing and Navy Assistant Secretary Franklin D. Roosevelt. Roosevelt nearly died, and Clemenceau lost a son to the flu. Densely populated cities naturally were centers of contagion, but people in remote farmhouses, lumber camps and sheepherders' cabins also were afflicted.
There were three “waves” of the pandemic in the United States: it appeared in the spring of 1918, peaked in the early fall, and reappeared in the spring of 1919. The disease completely disrupted everyday life throughout the nation. Doctors were virtually helpless in treating the illness, and were forced to fall back on the most rudimentary public-health measures. In Washington, D.C., schools, theaters and bars were closed, public gatherings were prohibited, and federal employees went on staggered work shifts. In Boston, the stock exchange was open only half a day, sports events were canceled, and “churchless” Sundays were declared. In New York City, huge signs warned that public coughing or sneezing without a handkerchief was unlawful and punishable by fines or jail sentences. San Francisco was one of many cities that required people to wear face masks in public. Around the country hospitals overflowed, health agencies ran short of supplies and personnel, and coffins became scarce.
Efforts to Develop a Vaccine Against Flu
The influenza struck abruptly, without warning. One minute a person would feel fine and the next minute he or she would be weak and helpless. Headache, chills, fever, sore throat, and leg or back pains were among the early symptoms. Severe coughing and gasping for breath followed, with accompanying symptoms of swollen ankles, bloody urine and eye-muscle paralysis in some people. The lungs filled with a dense fluid, and showed signs of hemorrhaging, abscessing and swelling; sometimes they collapsed. Since the capillaries could not carry oxygen to the bloodstream, the actual cause of death was asphyxiation. Some patients succumbed to pneumonia after being weakened by the flu. But those who did not die were usually up and around within a week. Strangely, the disease hit the young and strong harder than the old or weak.
For the medical profession, the 1918–19 pandemic was a frustrating and sobering experience. That generation of physicians had developed the germ theory of disease and had found vaccines or other means of preventing typhoid fever, diphtheria, tetanus, meningitis, tuberculosis, malaria and yellow fever. But influenza was unaffected by known medications. No one knew what caused it, how it traveled or why it killed people. Various theories attributed the disease to chemical warfare gases, cosmic rays, coal dust, atmospheric stagnation, cats, dogs, fleas and dirty dishwater.
In September 1918, at the National Swine Breeders' show in Cedar Rapids, Iowa, a prophetic discovery was made—but few people realized it at the time. Many hogs at the show had been stricken by a debilitating disease, and Dr. J. S. Koen, a hog cholera inspector from the Bureau of Animal Husbandry, noted a similarity to human influenza. In his report to Washington, Koen called the sickness “hog flu,” but it was years before researchers found a connection between the human and animal illnesses.
The American virologist Richard E. Shope, who studied swine flu extensively, was the first to demonstrate, in 1931, that it was caused by a virus in conjunction with influenza bacteria. In 1933 influenza virus, type A, first was isolated by three British scientists, and in 1936 one of them, Patrick Laidlaw, suggested that swine flu was the cause of the 1918–19 pandemic. Shope supported Laidlaw's contention, and demonstrated that swine flu can survive in a latent form in hog worm parasites and can erupt suddenly for various reasons. During the 1930s, several scientists found that influenza viruses could be transmitted from humans to animals, and that animals infected with the virus developed an immunity to the disease. This discovery led to the development of flu vaccines.
In 1943, a U.S. Army commission on influenza conducted experiments with influenza virus vaccines grown on chick embryos in eggs. A test group of 6,250 vaccinated men experienced only one-fourth as much illness from type A influenza as a similar group of unvaccinated men. In 1945 the entire U.S. Army was vaccinated, and during a type B influenza epidemic that winter only 1 per cent of all the soldiers fell ill, compared to 10–13 per cent of the unvaccinated population.
Outbreaks of the Disease in Recent Years
The most severe influenza outbreak in recent years was the Asian flu of 1957–58. There were 45 million cases of Asian flu in the United States during the fall of 1957 alone, according to HEW estimates, and 70,000 persons died. From its point of origin in central China in February 1957, the Asian flu spread quickly to Hong Kong, Taiwan, Singapore and other nearby countries. By summer there were reports of influenza in Europe, the Middle East and the United States.
The West Coast was hit first in this country, followed by the South and then the East. In the fall the epidemic spread to the central and northern states, reaching its peak in late October. A second wave peaked in February 1958, but the number of cases was far fewer by then. Intensive efforts were made to prepare for the epidemic, through large-scale production of vaccines and nationwide cooperation of many agencies. A considerable amount of vaccine was available just before the fall outbreak and its usage is believed to have prevented much illness and death.
A decade later, there was a pandemic of the so-called Hong Kong flu, which started in that city in July 1968. It spread to the Far East, India and Australia by the early fall, and then to the United States. There were major outbreaks nationwide in the fall and winter of 1968–69, starting in Puerto Rico and Alaska in late September. California reported the first outbreak in the continental United States in late October, and large numbers of cases appeared in the eastern states in mid-November. By Christmas, the Hong Kong flu epidemic had touched all 50 states. The disease spread so swiftly that vaccination efforts were largely ineffectual. About 50 million cases were reported, 33,000 persons died, and the estimated cost to the nation was $3.8-billion in medical bills, sick leave and related costs.
 The Plague of Justinian, which began in 542 A.D., may have claimed 100 million lives, but it lasted for 50 years. The bubonic plague, or Black Death, of the 14th century, killed more than 60 million over a period of several years.
 “The Great Swine Flu Epidemic of 1918,” American Heritage, June 1976, p. 84.
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