Then, in the fourth dreadful year of the war, as the American Expeditionary 
Forces (AEF) assumed fighting strength and prepared their first great 
offensive against the Germans, the flu struck. By the War Department's most 
conservative count, influenza sickened 26% of the Army—more than one 
million men—and killed almost 30,000 before they even got to France.*2* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B2>,*3* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B3> On both sides of 
the Atlantic, the Army lost a staggering 8,743,102 days to influenza among 
enlisted men in 1918.*4* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B4> (p. 1448) The 
Navy recorded 5,027 deaths and more than 106,000 hospital admissions for 
influenza and pneumonia out of 600,000 men, but given the large number of 
mild cases that were never recorded, Braisted put the sickness rate closer 
to 40%.*5* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B5>,*6* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B6> (p. 2458)

The Army and Navy medical services may have tamed typhoid and typhus, but 
more American soldiers, sailors, and Marines would succumb to influenza and 
pneumonia than would die on the industrialized battlefields of the Great 
War. The story of the influenza epidemic in the military is often lost in 
the historical narrative of the Great War, included merely as a coda to 
that four-year horror, coinciding with the final battles and the Armistice. 
But an examination of medical reports and War Department and Department of 
the Navy documents from the war reveals that the war and the epidemic were 
intertwined.*7* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B7> 
World War I and influenza collaborated: the war fostered disease by 
creating conditions in the trenches of France that some epidemiologists 
believe enabled the influenza virus to evolve into a killer of global 
proportions. In turn, disease shaped the war effort by rendering much of 
the Army and Navy non-effective and diverting resources, personnel, and 
scarce human attention and energy from the military campaign. The 
exigencies of war also thwarted many of the efforts such as crowd 
mitigation and quarantines to control the epidemic. The influenza epidemic 
in the U.S. military therefore provides a cautionary tale about the power 
of war to change the health environment and the power of disease to 
influence the conduct of war.

GOING TO WAR

The United States at first hung back from the killing in Europe, as many 
Americans believed it was not their fight. But under increasing pressure 
from Britain and France, and angered by German U-boat attacks that 
threatened American commerce and security, and the revelations in the 
Zimmermann Telegram that Germany was urging Mexico to attack the United 
States, President Wilson abandoned neutrality and in April 1917 asked 
Congress for a declaration of war.


The U.S. economy was already booming as farmers and manufacturers shipped 
foodstuffs and military supplies to the belligerent nations. Now the United 
States would also generate its own military force that would help overwhelm 
the enemy and bring about the armistice of November 11, 1918. Congress 
quickly established a draft, and more than 4,600 Selective Service draft 
boards screened 10 million men to find the strongest and most fit soldiers 
and sailors. The military grew from just 378,000 strong in April 1917 to 
more than 4.7 million by war's end, with an Army of 4.1 million and a Navy 
of 600,000. Seventy-two percent of enlisted forces were inducted, and the 
military population reflected the country's ethnically diverse and racially 
segregated society. An estimated 20% of Army draftees were foreign-born and 
the troops spoke at least 46 languages, some 5,700 were Mexican aliens, and 
12,500 were American Indians.*8* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B8> (p. 367-409) 
More than 400,000 African Americans served in the Army, some in two black 
combat divisions but most in labor battalions. 


The Navy employed only 5,300 black sailors, confining them to positions as 
cooks and stewards.*9* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B9>

War mobilization drew millions of civilians into military institutions and 
extended the military into all corners of the country. To train and supply 
these men, the Army and Navy expanded existing facilities and directed 
training activities at various civilian organizations. Military camps, 
arsenals, air fields, and supply depots sprouted up in every state. The 
Army began training recruits in the fall of 1917 at 32 large camps, each 
home to 25,000 to 55,000 troops. 


Soldiers also went to specialized camps for training in specific fields 
such as artillery training at Camp Knox, Kentucky, railway operations at 
Camp Benjamin Harrison in Indianapolis, military engineering at Camp 
Forrest, Georgia, and medical unit training at Camp Crane, Pennsylvania. 
The War Department also operated some 40 air fields for aviator training 
and 10 embarkation and debarkation camps.*8* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B8> (p. 677-–78) The 
Navy expanded its training capacity from 6,000 recruits to more than 
100,000 at stations on both coasts, the Gulf of Mexico, and Lake Michigan, 
and also had specialized training centers such as the Navy gas engine 
school and the aviation ignition school at Columbia University in New York. 
In addition to the training camps, in the summer of 1918 the War Department 
established the Student Army Training Corps (SATC), intended to augment the 
work of the Reserve Officers Training Corp (ROTC) and prevent war 
mobilization from emptying institutions of higher education. Under the 
program, more than 500 colleges and universities trained officer candidates 
and provided technical instruction in fields such as auto mechanics and 
radio operation. By the Armistice, about 158,000 young men had enrolled in 
SATC programs.*8* <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B8> 
(p. 556) This expansion of military institutions created a virtual network 
of young adults across which influenza could and would travel (*Figure 1* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/figure/F1/>).

....

As they conducted their analyses, military medical officers soon understood 
that the wave of influenza that had run through many U.S. training camps 
during the spring of 1918 constituted a first wave of the pandemic. 
Fourteen of the largest training camps had reported influenza outbreaks in 
March, April, or May, and some of the infected troops carried the virus 
with them aboard ships to France.*12* 
<https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/#B12> In the late 
spring and summer, influenza visited all of the armies of Europe, including 
the AEF, but because influenza was common in the military, and few patients 
became critically ill, medical officers were not alarmed. But by the late 
summer some saw the emergence of a new, lethal influenza.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/

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