Influenza patients
Scientist examines
sample of cultured
influenza viruses
Priya, Sindu,
Nikita, Faye,
& Trisiah.
A devastating flu- known as “Spanish influenza”
Raged in World War I in Europe
Epidemic started in trenches during May of 1918
Referred to as a global disaster
Other Names for the Spanish Influenza: Spanish Flu, La Grippe, and Spanish
Lady. The word influenza came from the Italian language meaning influence
of a poison or danger.
Trenches of WWI
Not the Spanish people
Vaccinations
Influenza A – H1N1
◦ Influenza virus derived from an unknown source
Doctors told the patients and the world that the influenza was caused by
a germ- viruses weren’t known during that time period
◦ They would blame germs and bacteria in case of death or any other
situation
Struck right after soldiers came back from world war 1 – overseas
In 1918 it was believed the cause of the influenza was the refusal of
getting the shot which prevented the disease.
◦ Everyone in the towns went down with the flu, including doctors and
nurses
The virus strain was caused by a cytokine storm
◦ Immune systems were agitated to the maximum, resulting in the
destruction of the human body
◦ Stronger the immune system, the more it was affected (young adults)
Many deaths were from a pneumonia
◦ Causes were of a secondary bacterial infection from the Spanish
influenza
Spring of 1918
Tens of thousands had fallen ill and died
First wave was like a “prelude” of the second and third wave
Extremely contagious
Completed faster than second and third wave
Started quietly as most people were unaware of this new,
mild virus
Fall of 1918-1919
Reappeared in full force from first wave
during the spring of 1918
Extremely contagious, deadly, and fatalmost vicious and severe out of all three
waves
Caused simultaneous outbreaks in the
Northern and Southern Hemispheres
Data suggests that people unfortunately
faced with the influenza in the second
wave could have been protected
compared if they were infected in the
third wave
More frequent complicated, severe, and
fatal cases in the second wave as well as
the third wave
Transportation was much slower during
the second wave
Started in Switzerland
Winter of 1918-1919
Less deadly than the second wave, but
more deadly than the first wave
Third wave did spread internationally,
however, did not get much attention as
the first two waves because the war was
over during this time and many wanted to
start their lives over again
Presence of the third wave had somewhat
lingered
After the new year, 1919, flu showed signs
of slowing down
The world started to get back to normal,
as in back to normal routines and
activities, such as re-opening the schools
There is no exact known place
where the influenza first
occurred but it was estimated
that the first cases happened
near the ending of World War I,
early spring of 1918.
Many thought that the influenza
was a result Germans using the
flu as a biological warfare tool.
There were claims that “Bayer
Aspirin” was filled with
“poisoned germs” however, this
claim was disproved. Additionally,
there were accusations of
German spies infiltrating the
Medical corps and spreading the
flu through shots.
German flag
during WWI
One of the main
theories of Origin
was that the influenza
came from Asia.
The outbreak of a
fatal pulmonary
disease could have
been the cause and
mutation of the virus.
Chinese and
Vietnamese labourers
working in the United
States spread was
another theory.
Map of Asia
Despite many origins, many historians and scientists firmly
believe that the first outbreak of the Spanish Influenza was in the
United States in the Military Camp Funston of Kansas.
The flu has known to originate from farm animals where the
virus has mutations as it transfers between humans and
domesticated animals.
In the closely populated State, this likely happened with many
people raising poultry, cattle and hogs.
Patients who were some of the most healthiest and strongest
people in the country suddenly fell ill and soon came down with
pneumonia and died.
With almost 60,000 men in the camp, within three weeks, more
than 11,000 were sick enough to require hospitalization. The
influenza spread to other military camps in the States, first
starting with camps in Georgia.
In France, the outbreak of Influenza occurred
in Brest, the largest port for the in which the
Americans used to arrive for the war in
Europe. Soon, the flu spread across Europe.
In the unsanitary conditions of the trenches,
soldiers began to fall ill. With what appeared
to be a cold at first soon turned deadly.
Again, in military bases, soldiers collapsed
because of very high fevers and died of
severe pneumonia; there was also severe
respiratory failure.
With mass movements of troops and supply
ships leaving war for their home countries,
the second wave of the deadly flu followed
and the virus spread through North America,
Europe, Brazil and the South Pacific.
Pneumonia lungsX-Ray B, healthy
lungs-X-Ray A
Due to a mutation in the virus, the second wave of the flu
was not only very contagious as the first wave, but
increasingly deadly as well. Few countries were spared.
Spain was the first country to notice and officially recognize
the flu in May 1918 when it killed nearly 8 million people.
(Hence, the Spanish Influenza)
Although the flu generally affects the elderly and young, the
Spanish Influenza unusually and mainly targeted young and
healthy men and women from the around the ages of 20 – 40
It killed ferociously in South Africa, Siberia, and Samoa
(humidity was a factor in spreading the disease) while, in
American cities, half the population became ill.
High fever-led to dangerous changes in the
victim’s mental state
Headache
Inflammation-choking pain, swelling, redness
Body or muscle ache
Delirium-crazy state, where victim is not
mentally able to control his or her self and
mind, happens because chemical or disease
(hence, Spanish Influenza) is disturbing the
neurons of the cerebral cortex
Diarrhea and vomiting-which led to
dehydration
Extreme fatigue
Foaming blood came from mouth and nose
and ear; nosebleeds
Some died within hours of the first symptom
Runny nose
Sore throat
Cough
◦ So severe that people would sprain
abdominal and chest muscles
◦ Produced blood-tinged sputum
Viral pneumonia-pneumonia started by a virus
Rapid breathing
Respiratory distress
Cyanosis
◦ Skin turns slightly blue from the lack of oxygen
Pulmonary haemorrhage- acute bleeding in the lungs, especially
in the upper respiratory tract, which resulted in deaths
Bacterial pneumonia-pneumonia started by bacteria
The H1N1 virus during the Spanish influenza pandemic had
characteristics of vital hemorrhagic fever viruses
Increased bleeding tendencies
Nosebleeds
Easy bruising
Bleeding from mouth and once again, in lungs
Intestinal bleeding
Petechial hemorrhage- A petechia is a small red or purple spot on
the body that is caused by a minor hemorrhage (broken capillary
blood vessels)
.....
Petechial
hemorrhage
Killed more people than WWI
By two years, the influenza transformed to a
common cold to a vast epidemic and a fifth of
the world’s population was infected
Flu prominent and more deadly for those aged 20 to 40
Unusual pattern because it mostly affected the elderly and youth
Approximately 675,000 Americans died because of this flu; this is
ten times as many as in the world war
US soldiers who died in Europe-most died from epidemic instead
of WWI
Journal of the American Medical Association final edition of 1918
notes describes 1918 as unfortunately a year in which developed a
most fatal infectious disease causing the death of hundreds of thousands
of human beings.” (12/28/1918)
Schools closed, illness also spread in family, deaths occurred
Influenza had profound impact on mortality/death rate (2.5
%) whereas other epidemics that broke out in the past were
mostly 0.1 % lower.
Mortality rate for those aged 15 to 34 was 20 x higher in
1918 compared to the previous years.
People struck with illness on the street, deaths were quite
rapid.
Influenza went international and most of humanity felt and
was impacted by the effects of it; trade routes and shipping
lines were affected, countries: North America, Europe, Asia,
Africa, Brazil, and the South Pacific
India: mortality rate extremely highabout 50 deaths per
1000 people.
Influenza did affect humanity internationally, but also affect
the war and the course of the war: entire fleets were ill
because of the influenza and frontline men were too sick to
fight and combat
Everyone affected: ¼ US affected, 1/5 world
affected-so many infected: lack of health
care workers and medical supplies, shortage
of coffins, morticians and gravediggers
Person infected would be dead within hours
of being infected by disease
Body sheds blood, lungs fill with liquid
Ways people were infected: high fevers,
shivers, coughs, muscle pain, sore throat,
tiredness, loss of strength ergo not able eat
or drink independently, difficulty in
breathing, death.
New York City only33 000 deaths
Pres. Wilson infected by flu in Paris
working out details of Versailles Treaty
Disease also placed additional strains
on society and the economy, however
this was visible due to WWI as well
Sharp decline in demand
◦ Public areas where most economic
activities took place such as stores
and restaurants were avoided
Shrinking of labour supply
◦ Many workers became ill, stayed home to
prevent getting sick or were obliged take
care of others who are sick
Short Term Effects
There was an increase in demand for medical
services
◦ hospitals and clinics were overwhelmed,
hence emergency buildings
◦ Surveillance of the flu was hard to monitor
◦ Care for other health problems was limited
◦ Medical personnel had a chance to be strained
as they were exposed to the flu very often
Large decrease in travel
◦ Travel to areas where the disease is common drastically decreased
◦ People more likely stayed at home to quarantine themselves at home
Dramatic decline in retail trade
◦ Decreased attendance at theatres, sporting events, museums and
other entertainment
Reduced gross domestic product and supply of labour
Supply chains were affected
◦ Restrained transportation systems
Interrupted global trade
Long Term Effects
Reduction in population and labour force
◦ Depends on mortality of the outbreak (e.g. if very old people were
most affected, the effects would be relatively small compared to high
mortality rates of young workers)
Increased ratio of capital to labor/decreased rate of return to capital
◦ Slower pace of capital accumulation and growth of the gross
domestic product for several years
Predicted lower incomes and socioeconomic status of children who
were born immediately after the pandemic
Faster per capita growth
◦ Return to previous trend growth from recession
Epidemic so dreadful that average life span in
US decreased by 10 years.
Pregnancy was affected because the around
mid twenties to 34 was the age where most women
expected babies and were pregnant.
Physician’s responses to their patients health conditions:
 patients that seemed to have the ordinary flu or
cold(influenza) would rapidly "develop the most viscous
type of pneumonia that has ever been seen" and later
when cyanosis(change in colour to blue on skin mostly
lips, tougue, fingernails and a sign the oxygen is
dangerously decreased in blood system) appeared in the
patients, "it is simply a struggle for air until they
suffocate," (Grist, 1979)
 influenza patients "died struggling to clear their airways of
a blood-tinged froth that sometimes gushed from their
nose and mouth," (Starr, 1976)
Children sang this song during the epidemic:
I had a little bird,
Its name was Enza.
I opened the window,
And in-flu-enza.
More soldiers killed than those that could
have been killed with the weapons on both
sides during WWI
Already shortage of physicians during war
because of for example, battle wounds and
mustard gas burns, but more shortage after
because of the epidemic
To fight the influenza, Red Cross created a
National Committee on Influenza and fully
used nurses, volunteers, medical supplies.
Committee was involved in both military
and civilian sectors to assemble all forces to
fight the epidemic.
In US-Red Cross was forced to recruit more
volunteers to help fight the epidemic
Emergency hospitals created to help patients from US and
those sick overseas
Those that luckily weren’t infected still faced public health
regulations to prevent spread of the epidemic.
Gauze masks distributed, no sales in stores, funerals limited
to 15 minutes.
Whoever ignored flu laws was fined by officers (i.e. misuse
of gauzes-poke holes in gauzes to smoke, let gauzes hang
loose around necks which women did and used these masks
as veils, etc.) resulted in 100 $ fine and 30 days in jail.
Emergency
hospitals
created
Proper way
to wear a
gauze mask
Political instability
◦ Government should already be prepared and well informed to handle
this flu pandemic
◦ Government would be expected to address and find a solution (ex.
Supplies for the poor, famine, shortages)
◦ Likely loss of trust in government
◦ Potential rise in fascism
◦ Global terrorism may be influenced
Disruption in vital government services
Government needed to help minimize economic impacts
◦ Ex. Encourage people, mostly the infected, to conduct business using
electronic communications at home or encourage people to shop online
to help retail trade
Effective surveillance and immediate identification of pandemic strain
Provide the opportunity to find a vaccine
Disruption to public safety
◦ Outbreaks/public panic
◦ Lawlessness
◦ Violence
Strains of the virus could have developed from animals
◦ Ecosystems would be disturbed
There may be human interference in the environment to find
a cure
Higher number of stillbirths and premature
deliveries during and shortly after the
pandemic
Health of babies was affected because of flu,
plus some mothers could not take care of
their babies in great quality because of the flu.
Some mothers could not
provide healthy milk to their
children because illness spread
Mother’s illness or death, of
course, affected the survival of
their child
^ inadequate care and nutrition
by mother
If mothers inhabited the flu during the first or second
trimester of pregnancy, there was an increase in prematurity
rates and therefore, neonatal mortality. (neonatal mortalitydeath rate during first 28 days of life)
Pregnant mothers were at higher risks of having miscarriages
between Sept 1918 to Jan 1919 (during the epidemic)
Babies born between Jan 1919 to April 1919 were at greater
risks of neonatal mortality during the epidemic
Influenza provoked premature births and disruptions during
pregnancy as well as interruptions during the mothers
maternity
Risks of miscarriage rose during
epidemic
Massive mortality rate
during October 1918 (second
wave) in Kansas because of
Spanish Influenza, which was
present during this time
period.
Due to the lack of knowledge
there was no particular medical
treatment
Home cures were created as to
how to cure the flu.
It included- wearing protective
gauze face masks, strange
remedies such as, eating fried
onions, wearing medicated bags,
sprinkling the streets with
formaldehyde, compressed
yeast, eating lemons and two of
the most popular- drinking
alcohol, and covering the body
with raw onions.
Fried Onions
Raw Onions
A small
amount of
brandy a day
Due to prohibition since 1915, alcohol was available only by
doctor’s prescription.
 Alcohol was considered an absolute necessity
 Before tending to influenza patients, the doctor at Rouleau,
Saskatchewan took a swig of brandy for medicinal purposes.
“He advised parents to give their children one teaspoon of
brandy in a cup of water each day, adults a mickey of brandy
a day to ward off the flu,” the Rouleau states.

Research
Jan.18th, 2007- Kobasa et al. reported of money being affected with
a disease, with symptoms of the 1918 pandemic and died from a
cytokine storm (overreaction of immune system). The studies
conducted on the monkeys explain why Spanish influenza affected
the young & healthy. It is due to their strong immune system which
would potentially have a stronger overreaction than of an elderly.
Sept. 16, 2008- The body of victim, Sir Mark Sykes was studied to
understand the genetic structure of the modern H5N1 bird flu.
Dec. 2008- Research conducted by Yoshihiro Kawaoka at the
University of Wisconsin, investigated the presence of genes- PA,
PB1, and PB2 and a nucleoprotein originated from the samples of
1918 flu to the capability to invade human organs such as lungs.
Studies done from the samples of the flu help medial scientists
produce drugs and vaccines that would help prevent the forth
coming viruses that our nations might be struck with.
Prevention
The science today has progressed immensely (with the help of
samples mentioned before) that drugs such as antiviral drugs
Rimantadine (Flumadine) & Oseltamivir (Tamiflu) have been
experimented and proved to be effective against such viruses.
These drugs and vaccinations provided protection against the
Spanish flu virus in the mice.
Flumadine 100
MG Tablet
Oseltamivir (Tamiflu)
Rimantadine HCL
100 MG Tablet
Re-emergence
The probability of the virus
returning from natural
source is remote
It is believed by the experts
that is it reemerges it would
be caused by an influenza
subtype, to which there are
rare or no preexisting
immunity in the human
population.
Because of the vaccines
provided today, the H1N1
component is taken care of,
thus the virus eliminates to
fit in the criteria of the new
pandemic strain.
Through profound research, one can see that the Spanish
Influenza was definitely not an “ordinary” epidemic. It was
deadly, vicious, aggressive, and contagious. However, it has
helped us in the present day for, for example, while
researching a recent flu - the swine flu. Although most
epidemics are all deathly and costly, they help the future
generations to use these events in history to create our
world a better, and safer, place to live in.
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