During the supposed first wave of pandemic influenza that appeared in the United States during the spring of 1918, initial mortality in military training facilities hovered around 10 per thousand. Such mortality eventually declined to mere 2.3 per thousand by mid September of 1918.32 However, the most virulent strain arrived soon after that point, and on October 11, 1918, mortality soared to 206 per thousand.33 The morbidity and mortality associated with the pandemic had profoundly deleterious consequences for the operational capacity of many US military units. In September 1918, US Brigadier General Charles Richard commented to his peers: "Epidemic influenza . . . has become a very serious menace and threatens not only to retard the military program, but to exact a heavy toll in human life. . . ."34 In the US experience, pandemic influenza induced absenteeism, loss of morale, and logistical chaos throughout the military infrastructure. The historian James Seidule argues that influenza had a significant negative effect on the morale of US forces and undermined their logistical cohesion during the conflict: "The flu sapped the strength and the morale of everyone in the AEF [and it] combined with malnutrition, inadequate clothing, and lack of sleep to create thousands of soldiers who suffered from combat exhaustion. . . . The result was an ineffective army with low morale."35 Crosby describes the effects of the contagion on the US 57th Pioneer Infantry during their march to the naval vessels that would ferry them to France: "Some men stayed where they had sprawled. Others, almost as sick, struggled to their feet to keep up with their platoons, even throwing away equipment to avoid falling behind. No one was ever able to determine how much equipment or how many men the 57th lost on that march."36
The rise of influenza had other pernicious effects on the war-fighting capacity of US forces, including logistical problems and the quarantine of US training camps. Eventually the virus resulted in suspension of the draft: "On September 26, with Pershing calling for reinforcements, with the AEF (American Expeditionary Force) pushing forward into the Argonne . . . the Provost Marshal General of the United States Army canceled an October draft call for 142,000 men. Practically all the camps to which they had been ordered were quarantined. The call up of 78,000 additional men in October had to be postponed. . . ."37 Crosby notes that the strains of the pandemic forced a 10 percent reduction in troop shipments to France. Furthermore, on October 11, 1918, "the War Department ordered a reduction in the intensity of training at all army camps. At the end of the month, the Chief of Staff in Washington wired General Pershing that the flu had stopped nearly all draft calls and practically all training in October."38
The pandemic thereby undermined the American Expeditionary Force's prosecution of the Meuse-Argonne Offensive, which began on September 26 and concluded on November 11, 1918. "When Pershing needed 90,000 replacement troops for his Meuse-Argonne campaign," Byerly argues, [US Army Chief of Staff] March could provide him with only 45,000 because of the epidemic."39 Indeed, during the Meuse-Argonne offensive, the estimated US morbidity from influenza was 68,760, as compared to 69,832 soldiers wounded by bullets and 18,864 who succumbed to gas.40 The comparative mortality statistics of the US 88 th division are also illustrative regarding the effects of the pandemic. "The total of all combat losses for the 88 th—killed, wounded, missing, and captured—was 90. The total of its flu cases during the fall wave was 6,845 [or] approximately one-third of the division. One thousand and forty five contracted pneumonia, and 444 died."41
Alexander Stark, chief surgeon of the First Army, concluded that "influenza so clogged the medical services and the evacuation system, and rendered 'ineffective' so many men in the armies that it threatened to disrupt the war."42 "By the War Department's own account," according to Byerly, "flu sickened 26 percent of the army—more than one million men—and accounted for 82 percent of total deaths from disease."43
Given the malign synergy between the influenza virus and secondary sources of infection, one must include much of the subsequent mortality from infections (after October 1918) within the aggregate assessment of pandemic-induced mortality. Comprehensive assessments of mortality by the US War Department showed that the contagion actually killed more American troops than deaths from injuries sustained in combat. Specifically, while 50,280 American soldiers were killed in action, 57,460 died from pandemic influenza.44 The US War Department eventually estimated that the pandemic resulted in the loss of 8,743,102 person-days to influenza among enlisted personnel in 1918 alone.45 The US Navy was particularly affected by the destructive capacity of the pathogen: "All in all, the US Navy lost 4,136 of its officers and men to the flu and pneumonia in the last third of 1918. Despite the efforts of Germany's undersea fleet, almost twice as many Americans soldiers died in the pandemic than as the result of enemy action in 1918."46 US Naval statistics compiled during the course of the contagion indicate that circa 40 percent of naval personnel succumbed to the flu during 1918. Meanwhile, 361 per 1,000 US soldiers were admitted to hospital in 1918 for complications arising from influenza infection. "In total over 621,000 [US] soldiers caught the flu in 1918, upwards of one-sixth of the total number of American soldiers in World War I."47 Furthermore, assessments of morbidity provide an indication of the aggregate impact of influenza on military effectiveness. The records of the Surgeon General of the US Army indicate that, of the 1 million men of the AEF who were hospitalized, circa 775,000 were hospitalized because of illness (influenza), while the remaining 225,000 were hospitalized for wounds incurred on the battlefield.48 Additional data indicate that 26 percent of the personnel in Army units were similarly debilitated by the pathogen.49
In the final analysis, US War Department records indicate that morbidity associated with the conflict saw 227,000 hospitalized for wounds incurred in battle, while over 340,000 were hospitalized for influenza.50 According to War Department records, the Army Surgeon General noted that debilitation and death from influenza had resulted in the loss of 9,055,659 days of manpower, with the result that almost two full divisions were out of action for the entire year 1918.51
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