The Spanish Flu Pandemic,
also know as the Great Influenza Pandemic, the 1918 Flu Epidemic and La Grippe,
was possibly the most devastating epidemic in recorded human history - and a deadly strain of avian influenza.
A viral infection, it killed some 50 million to 100 million people worldwide in 1918 - 1919.
It was caused by the H1 N1 flu virus. 
Note: The current avian flu is H5 N1 - a very different strain.
The Spanish Flu killed more people in 25 weeks than;
• Black Death (Bubonic Plague) in 4 years 1347 - 1351
• The total Nº of people killed in the 5 years of WW1 1914 -18
• The total Nº of people killed from HIV AIDS in the last 25 years. 
The Allies of World War 1
frequently called it the Spanish Flu.
This was mainly because the pandemic received greater press coverage in Spain
than the rest of the world, because Spain
was not involved in the war and there was no wartime censorship and was the first to report the epidemic.
did have one the worst early outbreaks of the disease with some 8 million people infected in May 1918
and King Alfonso XIII of Spain
was one of the early victims
In Spain, they called it the "French Flu"
It was also known as "only the flu"
or "the grippe"
by public health officials seeking to prevent panic. The belligerents squashed news of the outbreak so the enemy will not find out about their weakness.
>>top of page
Early Records of Influenza
was the first to record an epidemic of flu-like infection in 412 BC
when it wiped out the Athenian
The first recorded European
epidemic was in 1173-1174
although the first generally agreed pandemic occurred in 1580
. Since then there have been 31 documented pandemics of cough, shivering, aching
pains and sweating; all symptoms suggestive of flu.
It is impossible to establish the early history of flu as it was so little understood until the mid 20th century.
Also, reparatory infections would have been secondary to other deadly infectious diseases such as plague, smallpox, typhus
There were two pandemics in the 19th century, 1847-48
The 20th century had 4 pandemics in; 1918, [H1N1] Spanish flu
; 1957 [H2N2] Asian flu (70,000 deaths)  1968 [H3N2] Hong Kong Flu (34,000 deaths)
; and 1977 [H5N1] 
>>top of page
Why was the 1918 Spanish Flu the deadliest?
All flu viruses are thought to have originated in birds.
Scientists also think that to cause human epidemics, the virus had to jump from birds to pigs, where the genetic changes occur to enable the strains to spread in mammals (humans).
Different influenza strains spread around the world annually. Every so often, a strain tough enough to kill millions emerges. Experts believe the world is overdue for another pandemic. Unravelling what made the 1918 Spanish flu
so vicious could help doctors' better react if a similar strain returns.
Asia's current bird flu, a strain known as H5N1
, clearly can jump from poultry to people. Most cases have been traced directly to contact with sick birds, although human-to-human transmission has not been ruled out in some instances.
New research by scientists using lung samples preserved from victims of the 1918 flu
llowed the reconstruction of the hemagglutinin protein
, present on the surface of the flu virus
which allows it to attach to and penetrate lung cells.Hemagglutinin
and bird flu viruses
interact with different cell receptors, which is why birds infecting people is rare.
However, the new studies show the structure of the hemagglutinin
from the 1918 flu
changed to make it capable of attaching to human cells. In doing so, it retained the features found in avian viruses
, not human or pig strains.
from the 1918 virus
is in a different family, called H1
, than the H5 bird flu
affecting the world today. Leading British investigator, Sir John Skehel
said "The two are quite different"
, meaning the research will not have an immediate impact on today's bird flu. 
>>top of page
The Most Deadly for the 20 to 40's
is usually a killer of the elderly and young children. However, the Spanish Flu was most deadly for people aged 20 to 40's.
This is thought to have occurred because the immune system of the young and elderly is weakened and cannot easily fight the virus. People aged 20 to 40 are in the prime of life
. Their bodies reacted, or in fact over-reacted
, to the unknown 1918 virus
, causing the lungs to fill with blood from burst blood vessels and in fact death was by drowning in one's own bodily fluids.
After-the-fact surveys of bloodstream antibodies suggest that 98% of Americans alive in 1918 and 1919 had been infected
The flu virus
had a profound virulence, with a mortality rate in the USA of 2.5%
compared to the previous flu epidemics which were less than 0.1% (25 times higher)
Different regions suffered different mortality rates
>>top of page
The First Recorded Case
The first true victim or the 1918 Spanish Flu
has been lost to history. Some experts believe the virus originated in China
- birthplace of many flu strains.
Shortly before breakfast on Monday, 11 March 1918 the first recorded case of Spanish Flu
when Company cook Albert Gitchell
reported to the infirmary at Camp Funston, Fort Riley, Kansas.
He complained of a "bad cold". Immediately behind him came Corporal Lee W Drake
with a similar complaint.
By noon, Camp Surgeon Edward R Schreiner
had over 100 sick men on his hands, all apparently suffering the same symptoms. 
Within five weeks, 1,127 people would be infected and 46 would die.
was a sprawling establishment housing 26,000 men within its 20,000-acre boundaries. The winters were bone-chilling cold - the summers sweltering. Sandwiched between these two extremes were blinding dust storms. Within the camp were thousands of horses and mules that produced a stifling 9 tons of manure each month.
Disposal of the manure was by burning, often made more unpleasant by the driving wind. Like most army camps, it bred its own swine and poultry for consumption.
In April and May soldiers at Camps Hancock, Lewis
came down with the same ailment. Over 500 prisoners at San Quentin
, California also fell ill. Influenza spreading among men living in close quarters did not alarm public health officials at the time. Little data existed to indicate any sizable spread among the civilian population. Besides, the nation had bigger matters on its mind - it had a war to win!
In March 84,000 American 'Dough-boys'
set out for Europe
. They were followed by another 118,000 in April 1918. Little did they know they were carrying with them a virus more deadly than the rifles they carried.
While sailing the Atlantic, the 15th US Cavalry incurred 36 cases of influenza
, resulting in 6 deaths. By May, the killer flu had established itself on 2 continents and was spreading spectacularly.
>>top of page
The influenza of 1918
showed no bias in its approach to the combatants in World War I. Men from all sides sickened and died. Great Britain
reported 31,000 flu cases in June alone. By early summer, the flu had spread beyond the U.S.
and Western Europe
Numerous cases were reported in Russia, North & South Africa, South America
- which suffered one of the worst mortality rates with over 17 million dying after infected troop ships returned home.
The Pacific Ocean
provided no protection as influenza spread to parts of China, Japan (with one of the lowest mortality rates)
, the Philippines, Australia
and New Zealand.
By July, the Spanish Flu of 1918
had infected millions and tens of thousands had already died.
This first wave was but a prelude. During the autumn, it would mutate and reappear in full devastating force.
>>top of page
1918 Time line in the USA
: First reported case at Camp Funston, Kansas.
News of the war dominates headlines and after a few weeks, the flu epidemic abates and most Americans believe the worst is over.
April to June
: Thousands of infected American troops pass through the east coast exit ports and sail to the fighting in Europe
. When they land in France
, the virus spreads across the continent, infecting hundreds of thousands of civilians and combatants alike.
: Public health officials issue a bulletin about the so-called Spanish Influenza.
: The second wave of the virus mutates hits Europe
hard. Troop and supply ships spread the disease. Sailors stationed on board the Receiving Ship in Boston Harbour
begin reporting sick with flu-like symptoms on the 27th. By August 30th over 60 sailors were sick. Flu sufferers commonly described feeling as if they "had been beaten all over with a club." Within 2 weeks over 2,000 officers and men of the First Naval District had contracted influenza.
In the latter part of August 1918, somewhere in western France, the virus mutates and becomes highly toxic.
: Dr Victor Vaughn
acting Surgeon General of the Army
, proceeds to Camp Devens
. What Vaughn
sees changes his life forever: "I saw hundreds of young stalwart men in uniform coming into the wards of the hospital. Every bed was full, yet others crowded in. The faces wore a bluish cast; a cough brought up blood stained sputum. In the morning the dead bodies are stacked outside like cordwood."
On the day, Vaughn
arrived at Camp Devens
, 63 men died from influenza
, a former president of the American Medical Association
, stated, "This infection, like war, kills the young, vigorous, robust adults. The husky male either made a speedy and rather abrupt recovery or was likely to die."
He stated that the world was lucky the 'Spanish Lady'
hadn't claimed even more victims. He pointed out that doctors of the day "knew no more about flu than the 14th century Florentines had known about Black Death".
The Navy Radio School at Harvard University in Cambridge
reports the first cases of flu among 5,000 young men
studying radio communications.
On September 5
the Massachusetts Department of Health
alerts area newspapers that an epidemic is underway.
US Surgeon General Rupert Blue
dispatches advice to the press on
how to recognise the influenza symptoms. Blue
prescribed bed rest, good food, salts of quinine and aspirin for the sick.
Bayer Aspirin was just introduced to the US market at the time of the Spanish flu. But because Bayer was a German company, many Americans distrusted it and thought it was a form of germ warfare. Ironically, one of the fatal flu victims was Anton Dilger, in charge of German biological warfare in WW 1
>>top of page
Lt. Col. Philip Doane
, head of the Health & Sanitation Section of the Emergency Fleet Corporation,
speaking in Washington DC
, fuels the rumour and speculation by blaming the Germans
for the deadly influenza that was striking Americans
. "It would be quite easy for one of those German agents to turn loose Spanish influenza germs in a theatre or some other place where large numbers of persons are assembled. The Germans have started epidemics in Europe and there is no reason why they should be particularly gentle with America."
Dr William Hassler
, Chief of San Francisco's Board of Health
, predicts Spanish flu
will not reach the city. On 24th September Edward Wagner
, a Chicagoan newly settled in San Francisco
falls ill with influenza
On 28th September
, 200,000 gather in Philadelphia
for a 4th Liberty Loan Drive
. Days after the parade, 635 new cases of influenza were reported
. Within days, the city was forced to admit that epidemic conditions exits. Churches, schools and theatres are ordered closed.
, the Health Commissioner of New York
announces, "The city is in no danger of an epidemic. No need for our people to worry."
registers 202 deaths
from Spanish flu
on 2nd October. The city cancels its Liberty Bond parades and sporting events. Churches were closed and the stock market was put on half-days.
On October 6th Philadelphia
posts the first of several gruesome records for the month: 289 influenza related deaths in a single day
Congress approves a special US$1 million fund
to enable the US Public Health Service
to recruit physicians and nurses to deal with the growing epidemic. US Surgeon General Rupert Blue
sets out to hire over 1,000 doctors and 700 nurses. Many medical professionals are already engaged in providing care to fighting soldiers. Blue
was forced to look for recruits in old-age homes and rehabilitation centres.
851 New Yorkers die from Spanish flu
in a single day. In Philadelphia
, the city's death rate for one single week is 700 times higher than normal
The crime rate in Chicago
drops by 43%. Authorities attribute the drop to the toll that influenza
was taking on the city's potential lawbreakers.
October 1918 turns out to be the deadliest month in the nation's history as 195,000 Americans fall victim to influenza. The total of Americans killed in its 25-week rampage would be 675,000 
: To mark the end of World War 1
, 30,000 San Franciscans
took to the streets to celebrate. There was much dancing and singing. Everyone wore a face mask.
Sirens wail on November 21, signalling to San Franciscans
that it is safe - and legal - to remove their protective face masks. At that point 2,122 were dead
: 5,000 new cases of influenza
were reported in San Francisco 
>>top of page
New Zealand Expeditionary Force:
As in the SARS
epidemic, (SARS is also causes by a virus)
some outbreaks of Spanish flu
can be traced to a single person. A transport carrying 1,150 troops from New Zealand
anchored off Freetown, Sierra Leone. Influenza
was raging on shore and on some British
warships nearby. Unwisely a conference of ship's captains was called on one of them.
The captain of the New Zealand Expeditionary Force transport
sat next to the captain of the warship
. The former did not suffer from influenza subsequently, although he felt rather 'off colour' for a few days following. There had been absolutely no contact between shore and the transport, although some provisions were delivered to the ship's side. Influenza
began when the ship was about four days out and increased quickly in violence until practically all of the soldiers were infected. 
In all, there were 900 serious cases and 83 deaths
Brevig Mission, Alaska
had a population of 84 in 1918. In November 1918, it lost 85% of its population to Spanish flu
leaving only 13 children and teenagers.
In February 1998, The Molecular Pathology Division of the US Armed Forces Institute of Pathology
recovered samples of the 1918 influenza
from a frozen corpse of an Inuit woman
buried almost eight decades in the permafrost at Brevig. This was one of four recovered samples containing viable genetic material of the 1918 virus.
This sample provided scientists a unique opportunity to study the virus and determine it was avian flu H1N1
in the Pacific Ocean were split between the United States
, which controlled the
eastern islands, and New Zealand
, which had seized the western islands from Germany
at the start of the World War. On 17th November 1918, the steamship Talune
, from New Zealand
, anchored at Apia
, the capital of Western Samoa
. It carried people ill with flu.
Before the end of that year, a matter of less than two months, 7,542 died of influenza
and its complications in Western Samoa
, approximately 20% of the total population. 
Without orders from the government but based on what he learned from a radio news service, the Governor of American Samoa, Navy Cmdr. John M Poyer
, instituted a quarantine policy. When he head of the outbreak on Western Samoa
, he banned travel to or from the neighbouring islands,
which were about 60 kilometres apart. When the Governor of Western Samoa, Lt Col. Robert Logan
, sent a boat with mail to American Samoa
to be put on the itinerant mail boat docked there, Poyer
refused even to allow the bags to be transferred. Enraged, Logan temporarily stopped all radio communication with the American islands.
persuaded the island's natives to mount a shore patrol to prevent illegal landings. People who disembarked from ships sailing from the American
mainland were kept under house arrest for a specified period or examined daily. Aspects of the quarantine continued into 1920, a year after Poyer departed to the sound of a 17-gun salute.
There were no influenza deaths in American Samoa
>>top of page
Many cities states and countries enforced restrictions on public gatherings and travel to try to minimise the epidemic. In many places, theatres, dance halls, churches and other public gathering places
, were shut down for a year.
Quarantines were enforced with little success (except for American Samoa - see above, and Iceland).
Some communities placed armed guards at the borders and turned back or quarantined any travellers.
One US town even outlawed shaking hands (in hindsight a wise move).
Some communities closed all stores or required customers not to enter, but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied morticians or gravediggers.
Mass graves were dug by steam shovel and bodies buried without coffins in many places.
>>top of page
The following people died in the epidemic:
Guillaume Apollinaire, French surrealist poet
Felix Arndt, American composer
Randolph Bourne, American political thinker
Henry G Ginaca, American inventor
Myrtle Gonzalez, American actress
Joe Hall, Canadian ice hocky player
Phoebe Hurst, American educator
Hans E Lau, Danish astronomer
Harold Lockwood, American actor
King Watzke, New Orleans bandleader
Reggie Schwarz, South African cricketer
Yakov Sverdlov, Russian revolutionary
• Jacinta and Francisco Marto , 2 of the 3 visionaries at Fatima, Portugal 1917
William Walker, British diver
Anton Dilger, in charge of German biological warfare in WWI
>>top of page
US President Woodrow Wilson became sick with flu in early 1919 while negotiating the crucial Treaty of Versailles to end the World War [ 12]
The Spanish flu
was unusual in killing mostly many young and health adults, as opposed to more common influenzas that cause most mortality among newborn and the old and infirm.
People without symptoms could be struck suddenly and rendered too feeble to walk within hours. Many would die the next day.
Symptoms included a blue tint to the face and coughing up blood caused by sever obstruction the lungs. In further stages, the virus caused an uncontrollable haemorrhaging that filled the lungs. Patients would drown in their own body fluids.
Global mortality rate from the influenza was estimated at 2.5% - 5%. The disease spread across the world killing up to 50 million people in 25 weeks.
Some estimates put the total killed at over twice that number, possibly as high as 100 million
. An estimated 17 million died in India
alone, with a mortality rate of 5% of the population. In the Indian Army almost 22% of troops who caught it died
Some 200,000 were killed
and more than 400,000
. The death rate was especially high in indigenous people, where some entire villages in Alaska and southern Africa perished.
Fourteen percent of the population of Fiji Islands died in a period of only 2 weeks.
By July 1919 257,363 deaths in Japan
were attributed to influenza
, giving a mortality rate of only 0.425%, much lower than all other Asian countries for which data is available.
On 5th October 2005, researchers announced the genetic sequence of the 1918 flu strain had been reconstructed using tissue samples. The 2005 H5N1 bird flu strain spreading through Asia has some features of the 1918 strain but so far is not able to pass easily from human to human 
At some point in late 1919, on a day as lost to history as the one of its emergence, Spanish flu made a final human being ill - then mutated again and disappeared
This Digest article can be downloaded as a FREE e-book on Smashwords.
Available on iPad / iBooks, Kindle, Nook, Sony, & most e-reading apps including Stanza & Aldiko.
Just click the following link
>> download free e-book dMAC Digest Vol 4 No 2
>>top of page
Colds & Flu
Reviewed 18 October 2016