Cold Open

It’s early March 1918 in Fort Riley, a U.S. Army training facility in Kansas.

Inside the mess hall, the company cook, Private Albert Gitchell, ladles beef stew onto a metal tray. His movements are mechanical, borne of countless repetitions, as he adds a second dollop of watery brown sludge onto the tray and slides it to a waiting soldier. Gitchell wipes sweat from his brow with the back of his hand. But just as he’s about to call out “next”, he feels a tickle in his throat.

The cough rises and soon he's hacking. Then, another man appears at the counter: the camp’s notoriously ill-tempered drill sergeant. Gitchell stifles his cough and lowers his gaze, careful to avoid provoking the ire of the grumpy sergeant. Gitchell ladles two scoops of stew onto his tray. But as he passes it back… the tray falls from his hand and crashes to the floor.

Gitchell stares at his trembling hand, confused. Then his vision blurs and there’s a burning sensation in his skull. He looks up at the drill sergeant, whose boots are now splattered with gravy.

The sergeant hisses, “What the hell’s wrong with you, Gitchell?” Gitchell tries to mumble an apology. But the sergeant just stares at him, his expression turning from one of rage to one of concern. The sergeant barks, “You look awful, Gitchell… go get some sleep.”

The next morning, on March 11th, Gitchell wakes inside his barracks wracked with a terrible cough, a splitting headache, and violent chills. Struggling to breathe, he staggers to the infirmary, where a nurse takes his temperature. He’s running a fever of 103°F.

The nurse ushers Gitchell into a special wing reserved for contagious diseases. As he sits on a cot, he struggles to breathe, his face turning blue. The nurse asks if he’s been in close contact with anybody else. Between short, rattling breaths, Gitchell tells her he’s the mess cook. He’s been in contact with everybody.

By noon, every bed in the infirmary will be occupied by men plagued with coughs, fevers, and bodily aches. By the end of the month, over 1,000 soldiers from Fort Riley will have contracted the mysterious illness.

The nurses don’t recognize the symptoms. They assume it’s a virulent form of pneumonia, perhaps aggravated by the noxious yellow ash cloud that hangs over the camp – a by-product of pig manure being burned nearby.

But it’s not pneumonia.

Private Albert Gitchell has become the first known victim of a new, highly contagious disease – result of a mutation of the influenza virus carried by swine. This disease will spread rapidly through America and then the world, bringing suffering and death to millions, starting with the first reported case discovered on a military base in Kansas, on March 11th, 1918.

Introduction

From Noiser and Airship, I’m Lindsay Graham and this is History Daily.

History is made every day. On this podcast—every day—we tell the true stories of the people and events that shaped our world.

Today is March 11th, “The First Reported Case of the Spanish Flu”.

Act One: The Spanish Lady

It’s May 1918, two months after the flu outbreak at Fort Riley.

A transport ship carrying American soldiers to Europe cuts through the Atlantic ocean. Inside the cabin, a soldier from the 89th Infantry Division rolls over in his bunk and faces the wall. The ship is cramped and uncomfortable and the rough ocean makes the young private seasick. He shivers and shuts his eyes.

WWI has been raging on the Western Front for four years, but Great Britain and her allies are about to gain a crucial advantage: America’s military might.

When German submarines began sinking US merchant ships in the Atlantic, President Woodrow Wilson decided to respond. He declared war on Germany, and by the following spring, 200,000 US soldiers were being shipped to the battlefields of western Europe.

Aware of the incoming American troops, Germany launched its Spring Offensive, a last-ditch effort to push back the Allied advance before the US divisions arrive and tip the balance of the war. But unbeknownst to both the Germans and the Allies, these transport ships from America are carrying a much deadlier weapon than mere artillery.

By the time the ship docks in France, the American private’s seasickness has turned into a nasty head cold. He spends the journey to the front line convulsed in coughing fits and wracked with shuddering chills – the same symptoms exhibited by the men at Fort Riley.

And when he arrives at the trenches of the frontline, he finds him infested by rats and lice. When it rains, men are forced to wade through knee-deep rivers of mud. The dreadful conditions weaken the soldiers’ immune systems, and before long, many of them start complaining of sore throats and raging fevers.

Red Cross medics can’t identify the cause of these symptoms, so they call the malady “Flanders grippe”, named after the area of Belgium in which they’re fighting. For the soldiers, the disease is just another grim reality of the war, right alongside the guns and poison gas.

But as the Allies approach victory on the Western Front, “Flanders grippe” will spread across Europe and beyond - becoming more deadly as it mutates - until the virus, which causes the disease sets off a global pandemic.

***

It’s June 1918, three months after the outbreak at Fort Riley.

5,000 miles away from the Western Front, a ship carrying wounded Indian soldiers docks in the port of Bombay. In 1918, India is still part of the British Empire and these men belong to the colonial Indian Army. Most are infantry privates, known as sepoys, who were injured in the trenches of France before being sent home on this ship.

But in addition to their injuries, these sepoys are carrying an invisible threat – a deadly virus which they caught in the trenches and which will soon sweep across the country.

Within days of the ship’s arrival, the first cases of the mysterious virus are recorded in Bombay. It’s a densely populated city, and the virus quickly spreads. Here, it becomes known as “Bombay Fever” and it decimates the populace. By fall, nearly 800 people die from the disease every day.

And similar scenes are unfolding around the world.

In the bustling west African port city of Freetown, Sierra Leone, the contagion arrives on the merchant vessels carrying goods to and from the British front lines. Four percent of Freetown’s population are dead within three weeks.

Meanwhile, halfway across the world in Australia, returning troops complain of dry rasping coughs and persistent fevers. The virus goes on to infect around 40% of the Australian population and kills at least 12,000 people.

From Japan to Brazil to Finland, no corner of the globe remains uninfected. In the United Kingdom, the virus arrives via Glasgow’s shipyards and quickly spreads. Pamphlets and posters are distributed advising people to avoid shaking hands and to refrain from spitting.

In London, city buses are fumigated, and surgical face masks are distributed among factory and office workers. Local councils advise victims to self-isolate, and to gargle saltwater and potassium carbonate, if that doesn’t work, some suggest raw onions and whiskey. Even smoking cigarettes is encouraged to kill germs in the lungs.

But unsurprisingly, these remedies do nothing to stop people from dropping dead in the streets. By the end of the pandemic, 250,000 British people will have died. 

But with WWI still raging, press censorship restricts news stories about the public health emergency. The governments of Britain, France, and the United States know they’re on the verge of victory. They don’t want to weaken national morale at such a critical juncture.

So most of the initial reports about the virus emerge from one of the few European countries that remained neutral during the war: Spain. It’s how the disease gets its name: the Spanish Flu. In the summer of 1918, the virus kills an astonishing 8 million people in Spain in a single month. 

But then a second wave of the pandemic hits in the fall, and the symptoms intensify and the death tolls rise. Experts around the world begin to urge their governments to implement stricter precautions. But many public officials downplay the danger and dismiss public health warnings as needless fearmongering. In one city in the United States, this careless attitude will have devastating, and deadly consequences.

Act Two: Just the Common Cold

It’s September 28th, 1918, six months after the Spanish Flu first appeared.

The sun shines brightly over Philadelphia, where a large parade is underway. City officials organized this event to promote the government’s Liberty Loans initiative, a fundraising campaign designed to sell bonds and raise money for the war effort. Prior to the parade, Philadelphia’s public health director, Dr. Wilmer Krusen, expressed concern about a new virus sweeping the country.

After the initial outbreak at Fort Riley, Spanish Flu died down in the US. But by late September, cases are on the rise again as more and more soldiers return from the Western Front. Ten days ago, a British merchant ship docked in the Navy Yard here in Philadelphia. Days later, 600 sailors fell ill.

Dr. Krusen faced a tough decision: advise city officials to cancel the parade, or risk spreading the virus. But Dr. Krusen knows how important the parade is. It will boost morale and encourage the purchase of war-financing bonds. So he didn’t put up much of a fight. And this will prove a calamitous mistake.

Today, some 200,000 Philadelphians throng the sidewalks, waving and cheering, as marching bands and colorful floats parade down Broad Street. But in the midst of this jubilation, the contagion races through the crowds and across the city. In less than two weeks, more than 4,500 Philadelphians are killed by the virus. The city shuts down completely. Schools and public venues are closed. Volunteers dig mass graves. Church bells ring out in mourning. Philadelphia’s death toll is the highest in the country, with over 17,000 dead by the time the pandemic ends in 1919.

But no place in America is spared: Los Angeles, New York, Pittsburgh, Denver. All across the country, public health officials scramble to curb the spread of Spanish flu – frequently butting heads with people who want to downplay the severity of the virus. In the midst of this perilous moment, one public health official will emerge as the most strident voice of caution. But his decision to speak out will cost him.

***

It’s early October 1918, in Seattle, Washington.

A slight, bespectacled man waits patiently outside the Mayor’s office, his hands folded in his lap. Soon, a secretary pokes her head around the door and says, “Mayor Hanson is ready for you, Doctor.”

The man is Dr. Thomas Tuttle, the Public Health Commissioner for the state of Washington. Despite his owlish appearance and shy demeanor, Tuttle is a somewhat controversial figure. During the smallpox epidemic of the early 1900s, he drew criticism for recommending mandatory vaccinations. And he issued a sharp rebuke against those who refused to vaccinate – or, as Dr. Tuttle called them: “anti-vaccinationists.” 

By October 1918, Spanish Flu cases are rising dramatically in Washington. And unlike Wilmer Krusen in Philadelphia, Dr. Tuttle is taking decisive action. That’s why he’s here to see Seattle’s mayor, Ole Hanson. In their meeting, Tuttle advises the Mayor to close churches and all public spaces; and to issue fines for spitting, and for not wearing face masks on streetcars.

Mayor Hanson knows the measures will be unpopular, but he listens to the doctor. He is persuaded by the science and puts preventive measures in place. Meanwhile, Dr. Tuttle takes his case to the press. In various publications, he reminds the people of Washington state that the virus will only be curbed “with the earnest, conscientious and intelligent help of every citizen of the State.” And for a while, Tuttles’s efforts pay off; Washington maintains a relatively low rate of infection.

But Dr. Tuttle’s measures are not universally popular. Many in the state ignore his advice. Blasé attitudes are fueled by the position taken by the United States Federal Health Service, which consistently reassures the public that “there is no cause for alarm.” In Chicago, the director of public health echoes these sentiments, stating that “worry kills more [people] than the disease.”

But this is far from the truth. And Dr. Tuttle knows it.

In December 1918, with cases on the rise, Tuttle travels to Chicago to attend the national conference of the American Public Health Association. There, he rails against the short-sightedness and intransigence of many of his peers and urges stricter enforcement of regulations.

Tuttle’s words of warning further alienate him from the powers that be in Washington. In early 1919, he is fired from his position as Health Commissioner, on the basis of his supposedly “hard-line views”. Suddenly, without occupation, he will move to Kansas, where he will take up a new role there on the State Board of Health.

Meanwhile, all around the world, doctors remain perplexed by the Spanish flu’s origins and struggle to produce a successful vaccine. But of its own accord, the virus will become less deadly as it evolves, until eventually, by 1921, fatality rates will return to pre-pandemic levels. But by this time, the virus has killed between 50 and 100 million people worldwide.

Despite his accomplishments, Dr. Tuttle will never understand the epidemiology of the Spanish Flu. In one report, he writes: “it is very probable we will meet our next epidemic with as little knowledge of the true nature of the disease as we had in the fall of 1918.”

Still, Dr. Tuttle’s hard work will not be in vain. His approach to public health guidelines will inform and inspire public policy over one hundred years later when the world finds itself in the grips of another deadly pandemic.

Act Three: Antecedents

It’s January 29th, 2020, 102 years since the outbreak of Spanish Flu.

A slight, bespectacled doctor stands behind a lectern at a medical conference in Arlington, Virginia. Projected on a screen behind him is the title of his lecture: Coronavirus Infection: More than Just a Common Cold.

The doctor is discussing the recent emergence in China of a novel strain of the coronavirus, SARS-CoV-2, and the respiratory disease the virus causes – COVID-19. The disease has not yet spread from China, but when it does, the world must be ready.

Doctor’s voice is solemn but measured. He has spent his career studying the preventative measures required to control global pandemics. He knows how difficult it can be to clearly communicate the urgency of caution to a disbelieving public.  

In 2009, he and a group of other medical researchers published a study entitled “A Historical Antecedent of Community Pandemic Flu Mitigation.” The report discussed the H1N1 strain of the influenza virus that killed 5% of the world’s population between 1918 and 1921 – better known as the Spanish Flu.

The report cited critical health guidelines including social distancing, the closure of schools and public spaces, and the use of face masks: all measures implemented by the Commissioner of Public Health in Washington at the time, Dr. Thomas Tuttle.

Now, as Dr. Anthony Fauci delivers his first public address on COVID-19, he thinks about those first measures recommended by Tuttle in 1918. And soon, Dr. Fauci and other public health advisors across the globe will set out to implement very similar measures to curb this newest pandemic.

The Spanish Flu was the deadliest natural disaster of the twentieth century. More people died from the virus than during the four years of WWI. And just like today, the true heroes were the nurses, doctors, and frontline workers who risked their lives for the good of community.

And thanks to the measures bravely implemented by the likes of Dr. Thomas Tuttle, today’s public officials are better equipped to handle public health emergencies, as they strive to learn from the mistakes made during the Spanish flu outbreak, which started on March 11th, 1918.

Outro

Next on History Daily. March 14th, 1964. In the first courtroom verdict to be televised in the US, Jack Ruby is found guilty of the murder of Lee Harvey Oswald, the assassin of President John F. Kennedy

From Noiser and Airship, this is History Daily, hosted, edited, and executive produced by me, Lindsay Graham.

Audio editing and sound design by Mollie Baack.

Music by Lindsay Graham.

This episode is written and researched by Joe Viner.

Executive Producers are Steven Walters for Airship, and Pascal Hughes for Noiser.