Soldiers Struck Down

The Flu Hits the CEF in 1918

The 1918 influenza pandemic among soldiers of the Canadian Expeditionary Force (CEF)

Kandace Bogaert, with Steve Marti

The 1918 influenza pandemic was one of the worst demographic disasters of the 20^th century in terms of the speed of its spread and mortality rate.^[1]In general, the pandemic spread around the globe in three waves, with a mild “herald wave” occurring in the spring and summer of 1918, followed by the severe “fall wave,” and finally a recurrence in the winter of 1919.^[2]While it is known as the “1918 influenza pandemic,” many deaths were actually caused by secondary bacterial infections, like pneumonia.^[3] For this reason, cases and deaths from pneumonia and influenza (P&I) are often considered together. Researchers estimate that the fall wave of the pandemic alone resulted in the deaths of more than 50 million people world-wide.^[4]

The histories of World War I, and the 1918 influenza pandemic, are inextricably linked. In fact, the movement of soldiers and supplies around the globe, as well as the stressful and crowded living conditions in the trenches and army camps, are believed to be crucial factors behind the rapid spread and severity of the pandemic.^[5] To explore the inter-relationships between the war and the 1918 influenza pandemic, I ask: how did the 1918 influenza pandemic spread among soldiers in Canada? What biological and social factors made soldiers vulnerable, and how did these affect the spread of the pandemic among soldiers in Canada?

The Spread of the Flu in the CEF

Soldiers of the CEF represent an ideal population to study the 1918 influenza pandemic because their health had been closely monitored. Throughout the war, if a soldier fell ill, he was required to report to a medical officer immediately. Military hospitals also maintained detailed records of all soldiers admitted and discharged from hospital.^[6] For this reason, we have precise information on morbidity and mortality during the 1918 influenza pandemic among soldiers. No such data exists for the civilian population in Canada.

According to the Commonwealth War Graves Commission “Circumstances of Casualty” P&I mortality data,^[7]the first wave of the 1918 influenza pandemic among CEF soldiers began in March, with P&I deaths peaked in May (see Figure 1). The first wave of the pandemic emerged among soldiers in the Maritimes and then spread among soldiers in of the rest of Canada.^[8]

*Figure 1. Soldier deaths from P&I January – August, 1917 & 1918. Data from Rewegan et al.*

The deadly second wave of the pandemic appeared amongst soldiers in the United States in early September of 1918, and in Canada shortly thereafter (see Figure 2).

*Figure 2. P&I admission and mortality rates among soldiers during the Fall wave of the pandemic in Ontario. Data from K. Bogaert & Rewegan et al.*

The Polish Army Camp in Niagara-on-the-Lake was one of the first places where cases and deaths due to P&I occurred. Dr. J.L. Robinson, the camp medical officer, reported that the epidemic began on September,10, 1918.^[9] From there, the flu is believed to have spread west with soldiers mobilizing for the Siberian Expeditionary Force (SEF) and east with recruits destined for the Western Front.^[10]Little has been written about the third wave of the pandemic among soldiers in Canada (see Herring and Padiak for a discussion of soldiers overseas).

What were the bio-social conditions that made soldiers vulnerable to pandemic influenza, and influenced the way the disease spread in military camps? Influenza is a viral infection transmitted through respiratory droplets, for example, when an individual coughs or sneezes, or through direct contact.^[11] It is well known that influenza is able to spread quickly in crowded spaces, like schools, that are filled with susceptible individuals.^[12] In military camps across Canada, soldiers were sleeping in crowded tents and barracks see (Figures 3 & 4).

Figure 3. Photograph of the hospital ward at the RFC Armament School, in Hamilton, Ontario. This RFC hospital ward was undoubtedly similar to those at many smaller CEF training camps – it is easy to see how they could become overwhelmed with patients during the 1918 influenza pandemic. Canada. Dept. of National De-fence/Library and Archives Canada 1964-114 NPC. Copyright Expired.

They were eating, training and traveling across the country in large groups, creating conditions that were perfect for the spread of influenza. Recruits may also have been experiencing new physical and psychological stresses while training for military service, which may have depressed their immune systems and increased their vulnerability to P&I.^[13]

Figure 4. Photograph of the Cadets’ dormitory, RFC Armament School, Hamilton, Ontario. Again, it is easy to see how influenza would spread rapidly in these close confines at the RFC Armament School in Hamilton, which were likely similar to those found in may CEF training camps across Canada. Canada. Dept. of National Defence/Library and Archives Canada 1964- 114 NPC. Copyright Expired.

The war also directly influenced the spread of influenza in Canada when military officials, like Lt. Col. Arthur LePan (Figure 5), at Camp Niagara, decided that curtailing recruitment would impede the war effort. As a result, the military continued to bring in new recruits and train them in military camps, despite evidence of the influenza pandemic.^[14]

Figure 5. Group photograph of the Canadian and French officers in the Polish Army camp at Niagara-on-the-Lake (1919). Lieutenant-Colonel Arthur LePan is in the front row, seventh from the left © IWM (Q 110394).

Soldiers were not the only young adults affected disproportionately by influenza. In fact, heightened P&I mortality rates among all young adults, remains one of the great remaining mysteries of the 1918 influenza pandemic. This trend was unusual, since typically it is the elderly and the very young who are most at risk of death from influenza.^[15]

It is estimated that the number of people in Canada who died during the 1918 influenza pandemic was almost equivalent to the number of Canadian casualties from the war.^[16]The war effort helped influence the spread of the pandemic across Canada during the first and second waves of the pandemic,^[17] and the unique social conditions created in military training camps helped a virulent respiratory virus to spread among soldiers across the country.

Acknowledgements

The author would like to thank Dr. Ann Herring, Alex Rewegan and Melissa Yan for sharing their published data on soldier mortality during the 1918 influenza pandemic in Canada (see Rewegan et al.), and Neil Orford for inviting us to be part of his exciting project commemorating the 1918 influenza pandemic.

ENDNOTES

[1] David Killingray and H. Phillips, The Spanish Influenza Pandemic of 1918-19: New Perspectives (New York: Routledge, 2003). Web. 6 July 2015.

[2] DR Donald R Olson et al., “Epidemiological Evidence of an Early Wave of the 1918 Influenza Pandemic in New York City” (Proceedings of the National Academy of Sciences of the United States of America 102.31, 2005), 11059–11063. Web. 6 July 2015. http://www.pnas.org/content/102/31/11059.short

[3] John F Brundage and G Dennis Shanks, “Deaths from Bacterial Pneumonia during 1918 – 19 Influenza Pandemic” (Emerging Infectious Diseases 14.8, 2008), 1193–1199. Web. 6 July 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

[4] JK Taubenberger and DM Morens, “Artemisa 1918 Influenza: The Mother of all pandemics,” (17.1, 2006), 69–79. Web.

[5] JS Oxford et al., “World War I May Have Allowed the Emergence of ‘Spanish’ influenza,” (Lancet Infectious Diseases 2.2, 2002), 111–114. Web.

[6] Mark Osborne Humphries, The Last Plague: Spanish Influenza and the Politics of Public Health in Canada (Toronto, University of Toronto Press, 2013). Web. 6 July 2015.

[7] Alex Rewegan et al, “The First Wave of the 1918 Influenza Pandemic among Soldiers of the Canadian Expeditionary Force” (American Journal of Human Biology 27.5, 2015), 638–645. Web. https://onlinelibrary.wiley.com/doi/abs/10.1002/ajhb.22713

[8] Rewegan et al, “The First Wave of the 1918 Influenza Pandemic among Soldiers of the Canadian Expeditionary Force.”

[9] Kandace Bogaert, Jane van Koeverden, and D Ann Herring, “Tracing ‘the Trail of Infected Armies’: Mobilizing for War, the Spread of the 1918 Influenza Pandemic, and the Case of the Polish Army Camp at Niagara-on-the-Lake, 1917-19,” (Lives in Transition: Longitudinal Analysis from Historical Sources, ed. Peter Baskerville and Kris Inwood, Kingston, McGill Queens University Press, 2015), 274–291. Print.

[10] Humphries, The Last Plague: Spanish Influenza and the Politics of Public Health in Canada.

[11] DM Morens and AS Fauci, “The 1918 Influenza Pandemic: Insights for the 21st Century,” (Journal of Infectious Diseases 195.7, 2007), 1018–1028. Web. 6 Aug. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

[12] David J D Earn et al., “Effects of School Closure on Incidence of Pandemic Influenza in Alberta, Canada,” (Annals of internal medicine 156.3, 2012), 173–81. Web. 15 July 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

[13] RD Balicer et al., “Control of Streptococcus Pneumoniae Serotype 5 Epidemic of Severe Pneumonia among Young Army Recruits by Mass Antibiotic Treatment and Vaccination,” (Vaccine 28.34, 2010), 5591–5596. Web. 6 July 2015.

[14] Bogaert, van Koeverden, and Herring, “Tracing ‘the Trail of Infected Armies’: Mobilizing for War, the Spread of the 1918 Influenza Pandemic, and the Case of the Polish Army Camp at Niagara-on-the-Lake, 1917-19.”

[15] Alain Gagnon et al., “Age-Specific Mortality during the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality,” (PloS one 8.8, 2013), e69586. Web. 29 Aug. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

[16] E. Pettigrew, The Silent Enemy: Canada and the Deadly Flu of 1918, (Regina, Western Producer Prairie Books, 1983). Web. 21 July 2015.

[17] Humphries, The Last Plague: Spanish Influenza and the Politics of Public Health in Canada; Rewegan et al, “The First Wave of the 1918 Influenza Pandemic among Soldiers of the Canadian Expeditionary Force.”

REFERENCES

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Bogaert, Kandace, Jane van Koeverden, and D Ann Herring. “Tracing ‘the Trail of Infected Armies’: Mobilizing for War, the Spread of the 1918 Influenza Pandemic, and the Case of the Polish Army Camp at Niagara-on-the-Lake, 1917-19.” Lives in Transition: Longitudinal Analysis from Historical Sources. Ed. Peter Baskerville and Kris Inwood. Kingston: McGill Queens University Press, 2015. 274–291. Print.

Brundage, John F, and G Dennis Shanks. “Deaths from Bacterial Pneumonia during 1918 – 19 Influenza Pandemic.” Emerging Infectious Diseases 14.8 (2008): 1193–1199. Web. 6 July 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

Earn, David J D et al. “Effects of School Closure on Incidence of Pandemic Influenza in Alberta, Canada.” Annals of internal medicine 156.3 (2012): 173–81. Web. 15 July 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

Gagnon, Alain et al. “Age-Specific Mortality during the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality.” PloS one 8.8 (2013): e69586. Web. 29 Aug. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

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Humphries, Mark Osborne. The Last Plague: Spanish Influenza and the Politics of Public Health in Canada. Toronto: University of Toronto Press, 2013. Web. 6 July 2015.

Killingray, David, and H. Phillips. The Spanish Influenza Pandemic of 1918-19: New Perspectives. New York: Routledge, 2003. Web. 6 July 2015.

Morens, DM, and AS Fauci. “The 1918 Influenza Pandemic: Insights for the 21st Century.” Journal of Infectious Diseases 195.7 (2007): 1018–1028. Web. 6 Aug. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600384/

Olson, DR Donald R et al. “Epidemiological Evidence of an Early Wave of the 1918 Influenza Pandemic in New York City.” Proceedings of the National Academy of Sciences of the United States of America 102.31 (2005): 11059–11063. Web. 6 July 2015. http://www.pnas.org/content/102/31/11059.short

Oxford, JS et al. “World War I May Have Allowed the Emergence of ‘Spanish’ influenza.” Lancet Infectious Diseases 2.2 (2002): 111–114. Web.

Pettigrew, E. The Silent Enemy: Canada and the Deadly Flu of 1918. Regina: Western Producer Prairie Books, 1983. Web. 21 July 2015.

Rewegan, Alex et al. “The First Wave of the 1918 Influenza Pandemic among Soldiers of the Canadian Expeditionary Force.” American Journal of Human Biology 27.5 (2015): 638–645. Web. https://onlinelibrary.wiley.com/doi/abs/10.1002/ajhb.22713

Taubenberger, JK, and DM Morens. “Artemisa 1918 Influenza: The Mother of all pandemics.” 17.1 (2006): 69–79. Web.

Toman, Cynthia. Sister Soldiers of the Great War: The Nurses of the Canadian Army Medical Corps. Vancouver: UBC Press, 2016. Print.