The effects of the contagion were historically downplayed by the medical community, who (like the Galenists of old) were acutely embarrassed by their impotence in the face of such an overwhelming epidemic. According to the medical historian Carol Byerly, "the tendency of medical officers, army commanders, and federal officials to downplay the role of the influenza epidemic in the Great War, and the impact of disease on military populations in general, has encouraged American complacency about the ability of medicine to control disease outbreaks during war."25 The German medical historian Wilfried Witte has noted that Prussian authorities went out of their way to downplay the severity of the pandemic during wartime, going so far as to repress the dissemination of data as best they could. Furthermore, existing data suggest that, while the majority of deaths were recorded in urban centers, there was significant debilitation and mortality in rural areas that likely went unrecorded because of a lack of medical personnel in those regions. Therefore, many of the mortality data from Central Europe are probably significantly lower than the actual mortality that occurred as a result of both repression and low levels of health-care capacity in rural regions.26 Johnson and Mueller concur with the assessment that available estimates vastly understate the impact of the contagion on mortality. They posit that "limitations of these data can include nonregistration, missing records, misdiagnosis, and nonmedical certification, and may also vary greatly between locations."27
The general dearth of investigation regarding the political and economic effects of the Spanish Flu are notable, and necessarily raise some questions. "The influenza epidemic's most important, if enigmatic, legacy," Byerly argues, "has been its reinforcement of the government's and the society's reluctance to acknowledge the deadly role disease often plays in war. As people have written war stories and official reports of wars, they have often effaced human suffering, reflecting the military's tendency to downplay the fact of injury as a product of war. This tendency is especially apparent with respect to the story of disease in war."28
Because death from disease was often regarded as ignoble, in the aftermath of the Great War military forces sought to diminish the perceived impact of the contagion, particularly since military medical officers had been utterly powerless in the face of such a pathogen. Byerly castigates the US government for its deliberate and widespread attempts to suppress evidence of mortality from disease during the conflict. She argues that the War Department's official record of the war "listed battle casualties only" and that "a 1919 Senate document on the cost of the war stated that 50,000 men were killed in battle. Although this report calculated various costs of the war . . . it failed to mention the war cost of 57,000 deaths from disease. It reduced the army death toll by more than half."29
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