Syndemic
The worst of the 20th century influenza pandemics was the 1918 pandemic, where between 20-40 percent of the world’s population became ill between 40-100 million people died. More people died of the so-called Spanish flu (caused by the H1N1 viral strain) pandemic in the single year of 1918 than during all four-years of the Black Death. The pandemic had devastating effects as disease spread along trade and shipping routes and other corridors of human movement until it had circled the globe. InIndia, the mortality rate reached 50 per 1,000 population. Arriving during the closing phase of the World War I, the pandemic impacted mobilized national armies. Half of U.S. soldiers who died in the "Great War," for example, were victims of influenza. It is estimated that almost ¾ of a million Americans died during the pandemic. In part, the death toll during the pandemic was caused by viral pneumonia characterized by extensive bleeding in the lungs resulting in suffocation. Many victims died within 48 hours of the appearance of the first symptom. It was not uncommon for people who appeared to be quite healthy in the morning to have died by sunset. Among those who survived the first several days, however, many died of secondary bacterial pneumonia. It has been argued that countless numbers of those who expired quickly from the disease were co-infected with tuberculosis, which would explain the notable plummet in TB cases after 1918.
Gloucestershire Regiment in World War I
1st Battalion spent a week in the line near High Wood at the end of August, during which time it endured the most intense shelling it experienced in the whole war. After three days the trenches were practically obliterated, forcing the men into the shell holes in front of them, and by the time the battalion was relieved on 28 August it had lost 46 killed and 141 wounded. On 8 September the battalion joined the 2nd Welch and 9th Black Watch in an attack which carried the German second line in High Wood, but a lack of reinforcements forced them to withdraw. The attack cost 1st Battalion 3 officers (amongst them the commanding officer Lieutenant-Colonel Pagan), of whom 5 were killed, and 206 other ranks, of whom 84 were killed, leaving the battalion with just 4 officers and 96 other ranks fit for duty. The next day 10th Battalion suffered 122 casualties in a failed attack through the northwest corner of the wood.