Tuberculosis Caused Most 1918 Flu Pandemic Deaths

by Heidi Stevenson

27 August 2009

With all the hyperbole about the new influenza epidemic and comparisons to the 1918 pandemic, one would think that influenza is the danger. The reality, though, is likely far different. A close study of that worldwide outbreak shows that the real culprit was probably pandemic tuberculosis. Influenza, while certainly not a disease to be taken lightly, can best be viewed as the straw that broke the camel's back.

Estimates of the number of deaths in the worldwide 1918 flu pandemic vary from 20 million to as high as 75 million. That's about 1.08% to 4.05% of the world's population (1.85 billion) then.

To document this article's claim that tuberculosis was the primary cause of the 1918 pandemic death rate, view this graph depicting the tuberculosis death rate in the United States from 1900 through 1960. The dotted red line shows an average rate of decline in the death rate from tuberculosis.

NOTE: The dotted line was placed in the most generous manner possible. On the inset, the blue line is drawn according to the point at which the decrease in the rate of death continues at the same pace as pre-1918, about the end of World War II.

As expected, there is a spike in 1918. Note, though, that the rate of death from tuberculosis from 1919 until 1930 is less than would have been expected. It seems entirely reasonable to suggest that the very large death rate attributed to influenza was more likely related to people previously infected with the tuberculosis bacterium.

For at least 12 years after the 1918 pandemic, the tuberculosis death rate was less than expected, which would tend to imply that many, if not most, of the deaths attributed to influenza actually succombed as a result of being weakened by tuberculosis. That is, they died earlier than would have been expected, but they were already infected with a mortal disease. However, there is little to suggest that the number of deaths from influenza would have been any higher than in any other epidemic if tuberculosis hadn't been so rampant.

Descriptions of death throes during the 1918 pandemic and autopsies performed do not suggest a typical influenza scenario. The three most prominent symptoms were hemorrhaging from the nose and mouth, extreme cyanosis, and rapidity of decline to death. These are symptoms of pneumonia, a condition that often results from tuberculosis, and organ failure.

A 1920 study of French victims included careful examinations of bodies and autopsies. These showed remarkable organ damage, including:

• Lung engorgement and blood from ruptured capillaries.
• Acute emphysema with hemorrhagic engorgement throughout the lungs.
• Bloodstained fluid throughout the respiratory tract.
• Right side heart cavities dilated in all cases & distended with dark blood.
• Liver engorged and degenerated.
• Adrenal glands brittle in 60% of cases.
• Kidneys engorged and abnormally pale, with fatty degeneration.
• Some cases of hemorrhage in abdominal muscles, sometimes with muscle fiber degeneration.

A single pathogenic organism was cultured from every patient's blood: a hemolytic streptococcus, which much better describes the disease processes that killed victims than influenza does. Indeed, it would seem appropriate for medical practitioners to rule such a bacterial infection out before pronouncing death by influenza. (Note that pneumonia is not a specific disease, but a description of a range of diseases that attack the lungs.)

One Massachussetts physician described the progress of the disease:

These men start with what appears to be an ordinary attack of La Grippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen.

This doctor clearly distinguished between flu-like symptoms at onset with the ultimate pneumonia-like ones that killed patients.

In common influenza epidemics, those at risk are very young children and the elderly, not people in the prime of life. During the 1918 pandemic, these two groups suffered approximately the same percentage of deaths that are typically seen. However, people in their middle years, usually the prime of life, were the primary people who suffered death.

Why the 1918 Epidemic Matters Now

According to Dr. Bill Sardi, many people in Mexico are infected with tuberculosis. Thus, the high death rate there, which at this point appears to parallel that of the 1918 pandemic, is likely a result of underlying ill health.

Tuberculosis is a disease associated with socio-economic implications. A study reported in the 1948 American Journal of Public Health, which looked at tuberculosis mortality rates in the United States, Germany, and England, confirms this. The death rate for unskilled labor was nearly triple that of those in the upper classes. The same difference held true in Germany, when incomes were compared. The 1931 tuberculosis mortality rates in the Cleveland area were even more dramatic, with the poorest dying at nearly 7 times the rate of the wealthiest. (This particular report divided incomes into smaller groupings, so that a smaller percentage of the wealthiest and a smaller percentage of the poorest could be compared. This is likely the reason for such a dramatically worse result, not a greater distinction between the wealthiest and poorest.)

Considering the fact that Mexico is, overall, a very poor nation with a known tuberculosis problem, it's reasonable to assume that tuberculosis is a likely factor in the recent deaths attributed to influenza.

The implication of all this is that our medical system is focusing its efforts in the wrong direction. Rather than looking primarily at the causes of illness, it's focused on treatment of symptoms with harsh drugs and prevention through vaccinations.

It has not been possible to predict which variety of the virus will become prevalent at any time, as is clearly noted in the current outbreak. Therefore, what variety of vaccine to use is unknown, and it's possible, too, that a completely new variation will develop. There are risks associated with vaccinations, including chronic disease, factors which tend not to be considered—or to be treated as far less significant than they prove to be—in determining their value.

Treatment with drugs entails another set of problems. They virtually always have significant negative effects, both short and long term, and they tend to cause drug-resistant mutations that are more virulent than the original ones.

Therefore, influenza vaccinations, with their inherent risks and limited ability to predict an upcoming outbreak, seem a rather vain approach to prevention. When underlying ill health is also factored in, it becomes fairly apparent that the best way to fight disease is by assuring that people can live in good pollution-free environments with good sanitation, adequate clean water, and adequate good quality food. Outbreaks of influenza would be able to cause only very limited harm, and diseases known to be rampant in overcrowded areas subject to poverty, such as tuberculosis, might largely fade away.

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