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Why Did the Spanish Influenza of 1918 Become Known as the Forgotten Flu?
Erin Miller
003329-005
March 11, 2011
Word Count: 3,902
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Abstract
This essay investigates American society’s response to the Spanish Influenza of
1918 and what caused it to become known as the ‘Forgotten Flu’. Despite the tremendous
number of lives that the Spanish Influenza took worldwide, most doctors, writers, and the
American public in general neglected to record their experiences, contributing to a lack of
recognition by Americans today.
Through numerous different books about the disease, several primary sources, and
direct conversation with a leading historian, this essay presents a combination of four
main concepts that have led American society to christen the Spanish Influenza the
‘Forgotten Flu’. The first of these is the familiarity that Americans of 1918 had with large
epidemics, causing Americans to overlook the dramatic impact of the Spanish Influenza.
Recent medical advances contributed to the nickname, as scientists preferred to focus on
their successes rather than their failures. The timing of the epidemic, which occurred at
the same time as the United States’ participation in World War I, was another reason that
the Spanish Influenza was forgotten. Deaths from disease and deaths from war blended
together and citizens used the end of the war, roughly the same time the disease began to
die down, as an opportunity to put the horrors of 1918 behind them. The final concept
that attributed to the Spanish Influenza becoming known as the ‘Forgotten Flu’ was the
lack of physical evidence left by the disease, including the speed at which it came and
went, the absence of scars and lasting marks on survivors, and the lack of prominent
public figures affected by the disease to remember it by.
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Word Count: 268
Table of Contents
Abstract
2
Table of Contents
3
Introduction
4
Immediate Effects of the Spanish Influenza
5–8
Lack of Immediate Documentation
8 – 10
Society’s Familiarity with Epidemics
10 – 11
Medical Advances Versus Medical Failures
11 – 13
The Disease and World War I
13 – 15
Lack of Physical, Lasting Evidence
15 – 17
Conclusion
17 – 18
Bibliography
19 – 20
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Introduction
Imagine a disease unlike any other; a disease that turned the face and lungs blue
from bloody fits of coughing. Imagine that the disease preyed on the young and healthy
so quickly that a day after going to work, a man found himself lying in the hospital on his
deathbed. Then imagine that the disease infected more than 20% of the world and killed
more than 2.5% of its victims. 1 Imagine that the mortality rates of this disease were so
high that the lowest estimation of fatalities is 21 million.2 Now imagine that this was a
disease that the doctors couldn’t understand – or stop. In 1918, the world didn’t have to
imagine this scenario: it was reality.
Today, society recognizes this awful disease as the Spanish Influenza of 1918;
however, it is also referred to as the ‘Forgotten Flu’ because of the neglect that it receives
from American society. In the decades since the flu has passed, what caused society to
overlook such a deadly disease?
This paper is composed of three sections. First, a description of some of the
horrors caused by the Spanish Influenza is presented, demonstrating what should make
1
Kolata, Gina. Flu: The Story of the Great Influenza Pandemic of 1918 and the Search
for the Virus that Caused It. New York: Farrar, Straus, Giroux, 1999. 7. Print
2
Crosby, Alfred W., America’s Forgotten Pandemic: The Influenza of 1918. MA:
Cambridge University Press, 1989. 207. Print.
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this epidemic memorable to society. Following this are numerous examples showing a
lack of documentation and remembrance by American society, both from 1918 and
present day. The majority of this paper focuses on the reasons drawn from primary
resources as to why American society has largely forgotten the Spanish Influenza.
Immediate Effects of the Spanish Influenza
In 1918, World War I was not the only worldwide killer, nor was it the most
deadly. A disease, known as the Spanish Influenza of 1918, had been born. In March,
thousands of workers in Detroit and Kansas were sent home ill. That same month, the
15th U.S. Cavalry in Europe were stricken with the same illness. In April, German and
British soldiers were infected. The next month, French soldiers became sick as well. As
soldiers traveled, the disease traveled with them and by July, Switzerland, India, Russia,
China, and the Philippines were plagued too. As the disease spread throughout the world
during the summer of 1918, though, it disappeared from North America.3
The disease returned to the United States with a vengeance in fall of 1918. It
arrived in Boston, Massachusetts on August 28, brought by eight infected sailors
returning from Germany. The next day, 58 more sailors were ill. By the end of the week,
one hundred eleven sailors had contracted the flu, as well as one civilian. The first three
3
Crosby. Ibid. 17-29.
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deaths were reported on September 8, the same day the first cases of the flu arrived thirty
miles west of Boston, in Fort Devens, Massachusetts.4
The influenza spread rapidly until Fort Devens faced a nightmare scenario. The
camp filled ten thousand men past its capacity and the hospital, built for two thousand,
housed eight thousand sick and dying soldiers. The sick men spoke of headaches and
chills. Doctors observed that as the disease progressed, the soldiers’ fevers rose and
delirium set in as they drifted in and out of consciousness. Their feet turned black; their
faces turned blue; they coughed blood.5 Some men endured several torturous days before
death took them; others died after only several hours. One doctor at Fort Devens reported
an average of one hundred deaths a day, nonstop work hours from 5:30 a.m. to 9:30 p.m,
and a shortage of coffins.6
The Spanish Flue spread rapidly throughout the United States. By October 3, the
flu had reached Seattle, Washington, where 700 cases and one death were reported. 851
people died in New York in a single day. 7 At Camp Sherman, Ohio, 13,161 men
contracted the flu between September 27 and October 13, and 1,101 died. Nearly eleven
thousand men died of influenza in Philadelphia. 8
The disease hit its peak in October 1918, but lingered until spring 1919. The
disease infected an estimated 1/3 of the world’s population (500 million people). While
4
Kolata. Ibid. 12-13.
5
Kolata. Ibid. 16.
6
Kolata. Ibid. 14.
7
"1918 Spanish Flu Timeline." Twoop Timelines. Twoop, 2005-2006. Web. 13 Jan. 2010.
8
Kolata. IBID., 22.
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the seasonal flu kills less than 0.1% of its victims, the Influenza of 1918 killed 2.5%.9
The life expectancy of 1918 was 39 years, the lowest it was during the 20th century and
12 years shorter than it had been in 1917.10 According to the Center for Disease Control,
when the influenza vanished, roughly one year after it first appeared, it took between 20
million and 100 million lives with it.11
Most scientists and historians estimate that roughly 50 million people were killed
worldwide, but fatality numbers are imprecise. There are several reasons for this.
Initially, doctors did not record cases of the Spanish Influenza, believing it to be just the
common annual flu. As the disease progressed, Influenza victims filled hospitals so
rapidly that doctors had little time in between treating cases to record them. For example,
only twenty percent of doctors in New Orleans reported cases of the Spanish Influenza to
the Louisiana Board of Health in the fall of 1918. In addition, the immune systems of
Spanish Influenza victims were weakened, making victims more susceptible to other
sicknesses such as the common flu and pneumonia. Because both of these disease are
fatal each year as well, doctors were unsure of how many deaths from the common
annual flu and pneumonia were caused by weakened immune systems from the Spanish
Influenza and how many of them would have occurred anyway. It can be assumed,
9
Taubenberger, Jeffery K., and David M. Morens. "1918 Influenza: The Mother of All
Pandemics." Www.cdc.gov. CDC, 20 Dec. 2005. Web. 2 Jan. 2010.
10
11
United States of America. Center for Disease Control and Prevention. National Center
of Health Statistics. United States Life Tables, 1997. By Robert N. Anderson. Vol.
47. Www.cdc.com. Center for Disease Control and Prevention, 13 Dec. 1999.
Web. 31 Oct. 2010. <http://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_28.pdf>.
Taubenberger. Ibid.
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though, that many deaths from the common flu and pneumonia in the fall of 1918 were
caused by the Spanish Influenza because in the fall of 1918, Americans died of the flu
and pneumonia at a rate of 4.8 per every thousand cases while in 1916 and 1917, that rate
had been 1.7 per thousand cases. 12
However, even the low end of this estimate, fifty million deaths, is more than the
total of deaths in World Wars I and II combined. In the United States alone, 28% of
Americans contracted the disease.13 By comparing deaths from the common flu and
pneumonia between the fall of 1918 and the spring of 1919 to those in 1915, Alfred
Crosby estimates that roughly 550,000 American citizens died from the Spanish Influenza
and complications it caused.14 If a similar fraction of American people were felled by
such a plague today, 1.5 million Americans would die; this is more than the number of
fatalities from heart disease, cancers, strokes, chronic pulmonary disease, AIDS, and
Alzheimer’s Disease in a single year combined.15 Despite the tremendous effects of the
Spanish Influenza, today American historians today have dubbed it the ‘Forgotten Flu’.
To understand why, it is necessary to look back at how American society reacted during
and directly after the epidemic.
Lack of Immediate Documentation
In 1918, Americans were unable or unwilling to record their experiences. During
the fearful fall of 1918, many prominent doctors searched desperately to find a cure to the
12
Crosby. Ibid. 204-205.
13
Kolata. Ibid. 7.
14
Crosby. Ibid. 206.
15
Kolata. Ibid. 7.
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baffling disease. One of these doctors, Victor C. Vaughan, arrived at Fort Devens,
Massachusetts, when the epidemic began. He watched hundreds of young soldiers slowly
die of the influenza in the hospital and performed autopsies on the fluid-filled bodies of
victims. He once said, “These memories are ghastly ones which I would tear down and
destroy were I able to do so…They are part of my being and will perish only when I die
or lose my memory.”16
The investigation of the Spanish Influenza at Fort Devens was a large chapter in
Doctor Vaughan’s career, but not in his book. In A Doctor’s Memories, his 464-page
memoir, published eight years after his work with the disease, Vaughan wrote two
sentences regarding the Spanish Influenza. They said, “I am not going into the history of
the influenza epidemic. It encircled the globe, visited the remotest corners, taking toll of
the most robust, sparing neither soldier nor civilian, and flaunting its red flag in the face
of science.” And that was all.17
Doctor William Henry Welch’s biography also exemplifies the reluctance of
primary witnesses to document their experiences. The U.S. Surgeon General called
Doctor Welch to accompany Doctor Vaughan to Fort Devens to examine the flu victims.
William Henry Welch and the Heroic Age of American Medicine, his 539-page biography,
16
17
Kolata. Ibid. 16.
Vaughan, Victor C. "The World War." A Doctor's Memories. Indianapolis: BobbsMerrill Company, 1926. Www.vaughan.org. Web. 15 May 2010. <http://
www.vaughan.org/bios/vcv/vcvmem13.html>.
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contains three paragraphs about the Spanish Influenza, saying that it was one of “the most
destructive epidemics of military history”, before moving on to a different subject.18
While doctors were prominent witnesses to the Spanish Influenza, they were not
the only observers who could have documented the disease and its effects. Nearly every
person in the United States lost someone in late 1918 and early 1919 and anyone could
have recorded their experience. Strangely, though, not many did. Historian Alfred Crosby
discovered that the Reader’s Guide to Periodical Literature from 1919-1921 contained
thirteen inches citing baseball articles, twenty inches about Bolshevism, forty-seven
inches of articles on Prohibition, and a mere eight inches regarding the 1918 Influenza. 19
During my own The Spanish Influenza was not a major topic of discussion in
newspapers.20
Authors of the time disregarded the epidemic as well. F. Scott Fitzgerald’s
division was delayed from going to France for fear of the disease and never entered the
war, much to his frustration. His close friend, Father Sigourney Webster Frey, died of the
flu in January 1919 and Fitzgerald, who recorded important occurrences of his generation
through books such as The Great Gatsby and This Side of Paradise, wrote nothing of the
influenza.
Even authors writing specifically about the war neglected to mention the flu. John
Dos Passos recorded his own experiences from the war in his book, Three Soldiers. His
18
Kolata. Ibid. 51.
19
Crosby. Ibid. 351.
During my research, I searched through the November 1918, archives
of The New York Times. I found one article regarding the Spanish
Influenza.
20
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experiences include his time as a doughboy on a troopship in the Atlantic, where he
himself soon came down with the disease. In his book, he writes several pages regarding
an illness on the ship: spinal meningitis, not the Spanish Influenza. 21
Lack of documentation during and immediately following the Spanish Influenza
of 1918 caused the disease to be overlooked, then and today, and historians have begun
recognizing the Spanish Influenza of 1918 as the ‘Forgotten Flu’. What caused society in
1918 to disregard the Spanish Influenza? In addition to the lack of documentation, what
else causes Americans today to overlook the disease? It’s difficult to say with certainty
what causes people to not remember something. However, based on my work with
primary sources, I can present several possibilities.
Society’s Familiarity with Epidemics
Ron Lahti’s “Epidemic Timeline” shows that epidemics in the early twentieth
century weren’t uncommon. America was ravaged with epidemics throughout the 19th
century. Yellow fever epidemics struck the nation in 1803, 1854, 1867, 1883, 1886, and
1898. 22 In 1832, cholera, which had been destroying countries around the world,
attacked the United States, killing 7,000 people in New York City and New Orleans
alone.23 Smallpox was prevalent from 1860 to 1863. The polio epidemic in 1916 was the
most recent epidemic to hit the United States before the Spanish Influenza and resulted in
21
22
23
Crosby. Ibid. 315.
Lahti, Ron. "Epidemic Timeline." Bowerman Genealogy. 21 Nov. 2009. Web. 12 Feb.
2010. <http://hawkshome.net/misc_items/events/epidemic_timeline.htm>.
Lahti. Ibid.
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27,000 cases and 7,000 deaths.24 Also during these epidemics, typhoid fever, scarlet
fever, malaria, diphtheria, and typhus ravaged the American public as well.25 People tend
to fear the unknown and in 1918, sicknesses did not qualify as such. As Alfred Crosby
notes in his book Epidemic and Peace, many people affected by the Spanish Flu also
lived through the aforementioned epidemics as well. The familiarity with sickness and
disease-related deaths may have taken some of the fear out of the situation. In modern
day society, technological and medical advancements have made large, uncontrollable
epidemics rare and so when they do occur, people take notice. In 1918, however, these
types of outbreaks were out of the ordinary and this familiarity may have helped take
some of the fear out of the Spanish Influenza, leading people to not document it because
they didn’t see anything extraordinary about it.
Medical Advances Versus Medical Failures
Large epidemics provided scientists with opportunities to make great medical
advancements. The discovery and application of the germ theory of disease may have
factored into why the Spanish flu was forgotten. Developed by Louis Pasteur, using his
own scientific work along with that of Anton van Leeuwenhoek and Joseph Lister, the
germ theory of disease refuted the theory of spontaneous generation by saying that
diseases were caused by microorganisms.26 By 1879, scientists were using this theory to
indentify and cure different pathogens. The chart below displays the number of deaths in
24
Lahti. Ibid.
25
Lahti. Ibid.
26
Abedon, Stephen T. "Germ Theory of Disease." Lecture. Www.mansfield.ohiostate.edu. The Ohio State University Mansfield, 28 Mar. 1998. Web. 7 Mar. 2010.
<http://www.mansfield.ohio-state.edu/~sabedon/biol2007.htm>.
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New Haven, Connecticut, per 100,000 cases for several different diseases. It compares
the death rates in the years 1907-1911 to those of 1912-1916.
Diphtheria
1907-11
1912-16
18.4
17.0
Scarlet
Fever
7.5
4.6
Measles Whooping Typhoid
Cough
Fever
7.2
12.6
24.4
9.4
7.8
15.1
By 1918, although the rate of death of measles increased, diphtheria deaths were slowly
decreasing and scarlet fever, whooping cough, and typhoid fever were being treated and
rapidly becoming less fatal than they had been in previous years.27 In the years prior to
the Spanish Influenza, diseases that were typically regarded as deadly were gradually
becoming less so. Forward progress was being made in modern medicine.
As Carol Byerly writes in her book Fever of War, “The influenza epidemic
demonstrated that human intelligence and technology could not always predict and
control disease.” The Spanish Influenza, what appeared to be another everyday, treatable
disease, struck, and nothing could stop it. After the flu, many people, particularly doctors
and scientists, wanted to forget about it because the early twentieth century was an age of
scientific discovery and the Spanish Influenza, for which neither a cure nor a cause was
ever discovered, mocked all the medical advancements that had been made prior.
Scientists at this time chose to focus on their advancements in medicine, not their
failures. Because of this, state and territorial health officers did not include the Influenza
27
Winslow, A., James C. Greenway, and D. Greenberg. Health Survey of New Haven
Connecticut. Rep. no. 17. Yale UP, 1917. CONTROL OF COMMUNICABLE
DISEASES. 14 Dec. 1998. Web. 6 Dec. 2009.
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Epidemic in the 1919 annual conference agenda. 28 In addition, in his opening address at
the conference, Public Health Service (PHS) Surgeon General Rupert Blue focused on the
war, idealism, PHS war work, and an anti-malarial campaign, all successful topics, and
did not discuss the failure to find a cure for the Spanish Influenza.29
This has influenced historians today. In 1957, for example, one historian wrote,
“With the exception of its futile efforts to check the influenza epidemic, the record of
medicine in the war was so outstanding that it introduced a new era of warfare in which
the diseases that had once ravaged armies and civilians alike were kept under control.”30
The Disease and World War I
The Spanish Influenza occurred simultaneously with the United States’
involvement in World War I. By fall of 1918, the United States had been fighting in
Europe for more than a year. Americans were already very familiar with death from the
war and deaths from the disease may have just added on to the devastation that was their
lives.31
A short article published in the Topics of our Times section of November 5,
1918’s edition of The New York Times very accurately represents the American public’s
feelings regarding the Spanish Influenza. In the passage, “Showing the Courage of
28
Byerly, Carol R., Fever of War: The Influenza Epidemic in the U.S. Army during
World War I. New York: New York University Press, 2005. 187-190.
29
Bryerly, IBID. 187.
Dupree, A. Hunter. Science in the Federal Government: A History of
Policies and Activities to 1940. Cambridge, MA: Harvard University Press,
1957. 316.
30
31
Kolata. IBID., 53-54.
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Soldiers”, the anonymous author discusses the “peculiarity” of the public’s dismissal of
the flu.32
In the author’s words, Americans “accept this with a calmness that has remained
perfectly, even strangely, unbroken.” He continues on to say that Americans dealt with
the disease as if it were any other, taking necessary precautions and going about their
daily lives.
A popular rhyme that children skipped rope to developed during this time
accurately depicts the presence of the influenza in the daily lives of Americans:
I had a little bird
Its name was Enza
I opened the window,
And in-flu-enza.33
The fact that a disease that caused so much devastation could be put into a children’s
rhyme shows that citizens were familiar and comfortable with the disease; it wasn’t
something that they shied away from. It was commonplace; it was life.
The anonymous author of the New York Times article provides some insight as to
why Americans may have regarded the 1918 Influenza so lightly. This is because, as the
disease raged throughout 1918, America had joined the fight in World War I in Europe.
32
"Topics of the Times." Editorial. The New York Times 5 Nov. 1918. NYTimes.com.
New York Times. Web. 28 Mar. 2010. <http://query.nytimes.com/gst/
abstract.html?res=9B0CEFDC113BEE3ABC4D53DFB7678383609EDE>.
33
Carter, Laura S. "Cold Comfort." Dartmouth Medicine (2006): 36-57. Dartmouth
Medicine. Dartmouth University. Web. 26 Sept. 2010. <http://
dartmed.dartmouth.edu/winter06/pdf/cold_comfort.pdf>.
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The author of this article suggests that the ongoing war influenced the calm manner in
which Americans viewed the disease because citizens had “all learned to think more or
less constantly in terms other than those of individual interest and safety, and death itself
has become so familiar as to lose something of its grimness and more of its importance”.
Death was not uncommon in America in the fall of 1918; by the end of the war, which
was very near the time of the second wave of influenza and less than a week after this
article was published, more than 48,000 American soldiers had died. Deaths from war
and deaths from disease blurred together. October 1918, the month before this article was
published, was the most deadly month of the epidemic and one of the most deadly
months in American history, with 195,000 Americans succumbing to the disease.34
Soldiers in the war exemplified this tendency to mesh war deaths and disease
deaths together. In Camp Meade, Maryland, memorial services were held for soldiers
who died of the epidemic. After the names of soldiers were read, the Sergeant of the
man’s company would salute and declare, “Died on the field of honor, sir.”35 Soldiers
viewed deaths on the field the same as deaths from the Spanish Influenza, which may
have led civilians to adopt a similar attitude.
World War I and the Spanish Influenza occurred in America during roughly the
same time. As the War ended, Americans may have wanted to forget any and all bad
memories associated with it, including the Spanish Influenza.
34
"1918 Spanish Flu Timeline." Twoop Timelines. Twoop, 2005-2006. Web. 13 Jan.
2010.
35
Crosby, IBID., 321.
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Lack of Physical, Lasting Evidence
Alfred Crosby proposed another theory: that the lack of recognition for the
Spanish Influenza by society may have be influenced by the speed at which the disease
came and left and the lack of distinguishing marks remaining on survivors.36 The disease
arrived in early 1918 and was gone by 1919. Unlike diseases such as cancer and syphilis,
the Spanish Influenza did not linger. Those who died did so quickly. Unlike yellow fever,
the Spanish Influenza did not reappear numerous times over the next few years. After
spring 1919, it was gone. This rapid pace of the disease may have made it more easily
forgettable.
There are two physical ways for people to remember diseases by. The first of
these is the scars left on those who survived it. Smallpox and polio, for example, leave
survivors with permanent and obvious damage. The Spanish Influenza didn’t have this
effect. After victims died, they were buried and gone. The disease didn’t change
survivors’ appearances.
Other physical reminders of diseases are the famous individuals who either
contract the disease or die from it. President Franklin Roosevelt, for example, can easily
be associated with polio. Few influential people of 1917 or 1918 contracted the Spanish
Influenza. The daughter of General Edwards of the 26th Division of the AEF was killed,
but not the General. Two of the children of Senator Albert B. Fall were felled, but not the
Senator. The daughter of the President of the American Federation of Labor died, but not
36
Crosby. IBID., 321.
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the man himself.37 This is a result of the ages affected by the disease. While the fatality of
18
the traditional flu is U-shaped regarding ages, the very young and the very old are killed,
while those in between typically survive, The Spanish Influenza was unique because it
added a third curve between the ages of about 15 to roughly 45, forming a W-shape. A
graph from the CDC’s website, made by Jeffery Taubenberger and David Morens,
compares the death rate by age of the common flu from 1911-1917 and the Spanish
Influenza of 1918.
Young people died, not influential, middle-aged people. Because of the ages of those who
died, most powerful leaders and prominent figures in society survived the sickness,
leaving no face for the public to associate the disease with and remember the disease by.38
Conclusion
In one year, roughly the same disease felled approximately 50 million people
worldwide. The Spanish Influenza was one of the most horrific epidemics to strike not
37
Crosby, IBID., 322.
38
Taubenberger, IBID.
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just a country, but also the entire world. Historians often refer it to as the ‘Forgotten Flu’.
The reason why goes back to a lack of primary accounts from prominent doctors, authors,
and the general society of 1918. These people chose not to record the effects of the
disease for a variety of reasons. The disease arrived at a time when America and the rest
of the world were accustomed to epidemics. The familiarity of the large-scale diseases
made the Spanish Influenza nothing extraordinary; just another disease to face and move
on from. At the same time, numerous medical advancements had been made just before
the Spanish Influenza struck. The Spanish Influenza, however, was a disease that doctors
could not treat or cure in any way and doctors chose to focus on their scientific progress
in regards to other diseases rather than their failure with the Spanish Influenza. The
Spanish Influenza also occurred simultaneously with World War I. Death wasn’t
unfamiliar to Americans during 1918 and deaths from disease and deaths from the war
blended together. The disease died down just as the War was ending and Americans may
have taken these endings as opportunities to start over and forget about all the bad events
that happened in 1918. Historian Alfred Crosby also suggests that the rapid pace of the
Spanish Influenza may have led to the rapid forgetfulness of the public. Those who
survived it had no permanent physical damage to remember it by and, because of the Wshaped age groups of those most fatally affected, the public was left with no one of
significant importance to remember the disease by.
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Word Count: 3,634
Bibliography
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The Ohio State University Mansfield, 28 Mar. 1998. Web. 7 Mar. 2010. <http://
www.mansfield.ohio-state.edu/~sabedon/biol2007.htm>.
Byerly, Carol R., Fever of War: The Influenza Epidemic in the U.S. Army during World
War I. New York: New York University Press, 2005.
Crosby, Alfred W., America’s Forgotten Pandemic: The Influenza of 1918. MA:
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-Epidemic and Peace 1918. Westport, CT: Greenwood Press, 1976.
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Dupree, A. Hunter. Science in the Federal Government: A History of Policies and
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the Virus that Caused It. New York: Farrar, Straus, Giroux, 1999.
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2010. <http://hawkshome.net/misc_items/events/epidemic_timeline.htm>.
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DISEASES. 14 Dec. 1998. Web. 6 Dec. 2009.
21