Spanish Flu, Part 1: Symptomology and Contagion

Following the Flexner report, the next major event in the history of medicine was the Spanish Flu epidemic. This disease struck in the years 1918 through 1920, and, according to the US Centers for Disease Control, it killed about 50 million people worldwide, although estimates can be found from about a third of that to about double that. Number of deaths isn’t something we’ll be focusing on here though, so for our purposes it won’t matter what the number really is. Right now our focus is on the disease itself: First of all, what is it?

In their 2019 book, What Really Makes You Ill?, Dawn Lester and David Parker explored some of the peculiarities about the Spanish Flu, saying,

The influenza epidemic of the early 20th century that is generally regarded as the ‘1918 Flu’ is claimed to have been responsible for the loss of many millions of lives. In marked contrast with other outbreaks of ‘influenza’, seasonal or otherwise, [which attack small children and the elderly,] this epidemic had a far greater impact on a completely different demographic, as it mainly affected adults between the ages of 20 and 40. Furthermore, contemporary sources indicate that the symptoms of this epidemic bore very little resemblance to the usual symptoms of flu. An article entitled The Influenza Pandemic of 1918 on the Stanford University website relates some of the symptoms reported by physicians,

Others told stories of people on their way to work suddenly developing the flu and dying within hours. One physician writes that patients with seemingly ordinary influenza would rapidly ‘develop the most viscous type of pneumonia that has ever been seen’ and later when cyanosis appeared in the patients, ‘it is simply a struggle for air until they suffocate’. Another physician recalls that the influenza patients ‘died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth’. The physicians of the time were helpless against this powerful agent of influenza.

This was clearly no ordinary ‘influenza’.

For the reader’s reference, the word “cyanosis” in the above text that Lester and Parker quoted is a word that refers to the skin turning bluish-purple—in extreme cases, a very dark bluish-purple. So we should be suspicious that the Spanish Flu is probably just unrelated to what we normally think of when we hear the word “influenza” today. Many of the symptoms weren’t like those we today associate with the flu.

But let’s go over its symptoms. Like today’s influenza, Spanish Flu would cause pulmonary edema (which is a fancy way of saying that the lungs fill with fluid), but the similarity pretty much ends there. The disease would also cause patients to cough up blood, it would cause brain swelling and abnormal states of consciousness, and it caused kidney swelling and fatty liver. It also caused the previously translated condition called cyanosis, which, again, refers to the skin turning bluish-purple. Let’s go over some sources for these claims.

According to one 1919 report based on 200 autopsies by a consulting pathologist for the US Public Health Service named E.R. LeCount, the patients’ lungs “over-flowed.” Further, he said that “many are like the lungs of the drowned.” Moreover, the fluid that they were filled with was an “often thin and watery bloody exudate,” and that it would form a “blood-tinged froth” in the airways after death. He also commented on how the brains of victims were swollen. (As his report was based on autopsies, he didn’t have anything to say about the victims coughing or having abnormal states of consciousness; dead people obviously don’t cough or have abnormal states of consciousness, but these symptoms would be found together with pulmonary edema and brain swelling, respectively.) LeCount also wrote about the swollen kidneys and fatty liver, saying,

The kidneys are regularly the seat of cloudy swelling, and have tense capsules. If any gross alteration of the liver deserves mention as fairly constant, it is the presence of patches of yellow on the front surface due to superficial fatty change.

This description of patches of yellow on the front of the liver are what would today be diagnosed as fatty liver. The reader can look up pictures of fatty liver for himself.

There was also a letter dated 29 September 1918 sent from Camp Devens in Massachusetts from a physician on that base’s surgical ward. The author of the letter was only identified as Roy, and he was describing the situation at the base to a friend named Burt. Here’s a section of it:

These men start with what appears to be an attack of la grippe or influenza, and when brought to the hospital they very rapidly develop the most viscous type of pneumonia that has ever been seen. Two hours after admission they have the mahogany spots over the cheek bones, and a few hours later you can begin to see the cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up.

So when we talk about Spanish Flu, this is what we’re talking about: The lungs filling with fluid, coughing up blood, brain swelling, abnormal states of consciousness, “cloudy” kidney swelling, fatty liver, and cyanosis. There are other symptoms, but these are the one’s we’ll be focusing on. We’re not talking about the normal flu, but something very different¹.

Now that we know what we’re talking about, it makes sense to ask if this thing’s contagious; people certainly always believed that it was contagious. For example, in that letter from Camp Devens, Roy wrote, “This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. All assemblages of soldiers taboo.” He also wrote, “There is no doubt in my mind that there is a new mixed infection here, but what I don’t know.” This is interesting, because apparently he didn’t know what was causing the disease, but he was nevertheless certain that it was caused by some kind of “new mixed infection.” No reason was given for this certainty either. Moreover, no reason was given for the fact that assemblages were taboo, so presumably everyone thought this disease was contagious. But was this truly a contagious disease, or was this just a disease that everyone assumed to be contagious?

Fortunately, there are some studies on the contagious nature of the Spanish Flu. Some of these were the infamous Rosenau experiments, named for Milton Rosenau. Tom Cowan and Sally Fallon Morell, both of whom are associated with the Weston Price Foundation, described Rosenau saying that he “had built a successful career in public health by instilling a fear of germs, overseeing quarantines, and warning the public about the dangers of raw milk.” This will be important to keep in mind while learning the conclusions he drew from his experiments.

For his experiment, Rosenau took volunteers from the US Navy,

all of the most susceptible age, mostly between 18 and 25, only a few of them being around 30 years old; and all were in good physical condition. None of these volunteers, 100 all told in number, had “influenza;” that is, from the most careful histories that we could elicit, they gave no account of a febrile attack of any kind during the winter, except a few who were purposely selected, as having shown a typical attack of influenza, in order to test questions of immunity, and for the purpose of control.

The experiments involved attempting to get these hundred volunteers sick with influenza by any means possible. At the time, there was a bacterium known as Pfeiffer’s bacillus which was thought to cause the disease. Cultures of this bacterium were administered to the nostrils of the volunteers. When that failed to produce disease, bacterial cultures were sprayed into the eyes, nose, and throat of volunteers. When this too failed to produce disease, mucous secretions were taken from the mouth, nose, throat, and bronchi of patients sick with influenza, and the volunteers were made to gargle those mucous secretions, but still no one got sick. The experimenters upped the dose so that they were putting 6 cubic centimeters of mucus into each volunteer, but still no one got sick. They shoved cotton swabs up the noses of influenza patients and then shoved those same swabs up the noses of volunteers, but still, the disease couldn’t be transferred. They drew blood from influenza patients and injected it into the volunteers. When that failed to produce disease, they resorted to injecting filtered mucus directly into the volunteers². Because all of these methods failed to produce influenza, they resorted to trying to imitate “the natural way” that influenza spreads. Volunteers were made to shake hands with patients, bring their faces two inches apart so that they would be breathing each other’s breath, and they’d have a five minute conversation, followed by the patient exhaling as hard as he could onto the volunteer at the same that the volunteer was inhaling. No matter how many times this “natural” mode of transmission was tested, it always failed to produce sickness in the volunteers. They had patients coughing on the volunteers’ faces, but alas the disease would not contage. So here we have allegedly one of the most contagious diseases ever to grace our earth, and yet evidence of contagion could not be found.

Rosenau concluded his report with the following paragraph:

As a matter of fact, we entered the outbreak with a notion that we knew the cause of the disease, and were quite sure we knew how it was transmitted from person to person. Perhaps, if we have learned anything, it is that we are not quite sure what we know about the disease.

Rosenau was very reserved about his results. It was certainly his zealous faith in germ theory that kept him from coming to the obvious conclusion indicated by his experiments. If he admitted that this disease wasn’t contagious, then he’d have to reëvaluate whether this disease was caused by a germ. And if he admitted that he didn’t have any evidence that this disease was caused by a germ, then he would have to reëvaluate whether there actually was any evidence for his beloved quarantines and dairy pasteurization. Instead of acknowledging the obvious implication of his experiments, Rosenau instead stated: “I think we must be very careful not to draw any positive conclusions from negative results of this kind.” How convenient.

In alternative health circles, Rosenau’s experiments have become the most widely cited experiments proving the noncontagious nature of influenza (or at least Spanish influenza), but there were actually other similar experiments, all of which also failed to demonstrate contagion. For example, there was a similar series of experiments carried out by George McCoy and De Wayne Richey in San Francisco, who published about it in their 1918 paper Experiments Upon Volunteers to Determine the Cause and Mode of Spread of Influenza. They did a lot of the same things that Rosenau did, playing with bacterial cultures and the bodily fluids from people with influenza, squirting things up volunteers’ noses, dropping things into volunteers’ eyes, and injecting things beneath the skin. In all cases, Spanish Flu could not be induced. One of their test subjects got an inflamed throat and fever, but because they didn’t have a control group, they couldn’t actually know how many people would get a sore throat over the course of the experiment anyway independent of their interventions. Moreover, a sore throat is a far cry from coughing up blood and turning blue, so, whatever this person had, it very obviously wasn’t Spanish Flu. The reality, which might be shocking for most readers, is that all experimental evidence cuts against the hypothesis that the Spanish Flu was passed from person to person. It simply wasn’t contagious³.