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A Forgotten Enemy: PHS's Fight Against the 1918 Influenza Pandemic

In the midst of Would War I, many of America's newspapers were reporting that the Germans had spread a highly infectious and contagious disease through Bayer aspirin tablets. B. R. Hart, director of New York City's Food and Drug Inspection Station, called on the US Public Health Service Hygienic Laboratory to examine 200 tablets of aspirin imported from Germany to determine if they contained "organisms...responsible for the spread of Spanish Influenza." (Because Spain was not a belligerent in the war, reports of morbidity and mortality were not censored; the disease acquired this name due to the large number of cases reported from Spain.) The evidence failed to link the Germans to this form of biological warfare, and the rumors quickly dissipated.

Yet the hysteria over influenza was not entirely unwarranted. In late September 1918, with the war raging in Europe, localized outbreaks began to be reported on the East Coast. During the next four months, this common viral infection developed into a deadly global pandemic spreading to all parts of the United States and the world. All told, the 1918 pandemic claimed the lives of more than 550,000 Americans and more than 21 million lives world-wide, greatly superseding the 50,000 US and 4.9 million overall war-related fatalities.

During the war, the US Public Health Service (PHS) played an important role in safeguarding the nation's health. Surgeon General Rupert Blue, a North Carolina native who served in the post from 1912 to 1920, expanded many of PHS's responsibilities and duties as wartime demands required additional medical personnel and funding. PHS's responsibilities included safeguarding the health of personnel at military camps, improving the working conditions for industrial workers, and initiating a vigorous anti-venereal disease campaign at home and abroad. With society's and PHS's attention focused on wartime efforts, a small and seemingly innocuous biological foe managed to gain a foothold on the North American continent. PHS responded to the developing influenza pandemic, at least initially, in a routine and casual manner. Blue issued a series of precautions to safe-guard against the "flu" on September 13, declaring that "in most cases, a person taken with 'Spanish influenza' feels sick rather suddenly. He feels weak, has pains in his eyes, head, or back, abdomen, etc., and may be sore all over."' Although such warnings were typical for influenza, the 1918 strain proved to be something entirely different from expectations.

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