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The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. In 1918 children would skip rope to the rhyme (Crawford):

The origins of this influenza variant is not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized. The name of Spanish Flu came from the early affliction and large mortalities in Spain (BMJ,10/19/1918) where it allegedly killed 8 million in May (BMJ, 7/13/1918). However, a first wave of influenza appeared early in the spring of 1918 in Kansas and in military camps throughout the US. Few noticed the epidemic in the midst of the war. Wilson had just given his 14 point address. There was virtually no response or acknowledgment to the epidemics in March and April in the military camps. It was unfortunate that no steps were taken to prepare for the usual recrudescence of the virulent influenza strain in the winter. The lack of action was later criticized when the epidemic could not be ignored in the winter of 1918 (BMJ, 1918). These first epidemics at training camps were a sign of what was coming in greater magnitude in the fall and winter of 1918 to the entire world.

The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years.

"The 1918 has gone: a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked, the end at least for a time, of man's destruction of man; unfortunately a year in which developed a most fatal infectious disease causing the death of hundreds of thousands of human beings. Medical science for four and one-half years devoted itself to putting men on the firing line and keeping them there. Now it must turn with its whole might to combating the greatest enemy of all--infectious disease," (12/28/1918).

riers, along trade routes and shipping lines. Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific (Taubenberger). In India the mortality rate was extremely high at around 50 deaths from influenza per 1,000 people (Brown).

With the military patients coming home from the war with battle wounds and mustard gas burns, hospital facilities and staff were taxed to the limit. This created a shortage of physicians, especially in the civilian sector as many had been lost for service with the military. Since the medical practitioners were away with the troops, only the medical students were left to care for the sick. Third and forth year classes were closed and the students assigned jobs as interns or nurses (Starr,1976). One article noted that "depletion has been carried to such an extent that the practitioners are brought very near the breaking point," (BMJ, 11/2/1918). The shortage was further confounded by the added loss of physicians to the epidemic. In the U.S., the Red Cross had to recruit more volunteers to contribute to the new cause at home of fighting the influenza epidemic. To respond with the fullest utilization of nurses, volunteers and medical supplies, the Red Cross created a National Committee on Influenza. It was involved in both military and civilian sectors to mobilize all forces to fight Spanish influenza (Crosby, 1989). In some areas of the US, the nursing shortage was so acute that the Red Cross had to ask local businesses to allow workers to have the day off if they volunteer in the hospitals at night (Deseret News). Emergency hospitals were created to take in the patients from the US and those arriving sick from overseas.

DefinitionYellow fever is a disease carried by female mosquitoes. The species of mosquito that carry yellow fever are native to sub-Saharan Africa and South America, but can also be found in other areas. Although it may be rare in developed countries, yellow fever is endemic in impoverished areas where people cannot afford to get vaccinated.

Prevention Vaccination is the best way to prevent yellow fever. The yellow fever vaccine is recommended for people aged 9 months to 59 years who are traveling to or living in areas where the disease is present. Your doctor will help decide if the vaccine is right for you.

Typhoid Mary, for intentionally spreading the deadly illness

In turn-of-the-century New York City, typhoid was a growing problem. The Department of Health had a lot on its plate; in addition to typhoid, it was trying to quell out­breaks of smallpox, tuberculosis, diphtheria and whooping cough that were sweeping through the area [source: NOVA]. Luckily,

scientists had developed a sophisticated understanding of microbial diseases and how they spread -- even if everyone in the lay public didn't quite

rasp all of it yet.The Department of Health knew what caused typhoid, but dealin

g with the spread of the disease was another question altogether. It's a question that plagues us to this day. It's no longer considered humane to simply cast contagious disease victims out of society and into the wilderness to fend for themselves. What exactly to do with them remains controversial. Authorities must walk the line between keeping their societies safe from debilitating illness and infringing on the victims' personal rights. This controversy reached a fever pitch in early 20th-century New York when it came to one individual.It might surprise you to learn that this fervor revolved around someone who was actually immune to typhoid. Though it's uncommon, some people are naturally immune to the illness, meaning they can carry the parasite and never suffer from a single symptom. Nevertheless, these people can just as easily spread the disease to others. This was the case for one Mary Mallon, aka Typhoid Mary. She was in the wrong place at the wrong time as well as in the worst possible occupation for a carrier of typhoid: She was a cook.

Painful diarrhea, high fever, nasty red rashes and sleeplessness typically characterize the illness. Left untreated, typhoid can result in death.

called the Black Death because one of the symptoms produced a blackening of the skin around the swellings.

Key Dates relating to the event: This terrible plague started in Europe in 1328 and lasted until 1351 although there were outbreaks for the next sixty years

buboes were red at first, but later turned a dark purple, or black.

spread of the Black Death followed all of the Trade Routes to every country

Nearly one third of the population of died - about 200 million people in Europe The 1328 outbreak in China caused the population to drop from 125 million to 90 million in just fifty years7500 victims of the disease were dying every day

Bubonic plague, the disease's most common form, refers to telltale buboes—painfully swollen lymph nodes—that appear around the groin, armpit, or neck. Septicemic plague, which spreads in the bloodstream, comes either via fleas or from contact with plague-infected body matter. Pneumonic plague, the most infectious type, is an advanced stage of bubonic plague when the disease starts being passed directly, person to person, through airborne droplets coughed from the lungs. If left untreated, bubonic plague kills about 50 percent of those it infects. The other two forms are almost invariably fatal without antibiotics.Yersinia pestis is extraordinarily virulent, even when compared with closely related bacteria. This is because it's a mutant variety, handicapped both by not being able to survive outside the animals it infects and by an inability to penetrate and hide in its host's body cells. To compensate, Y. pestis needs strength in numbers and the ability to disable its victim's immune system. It does this by injecting toxins into defense cells such as macrophages that are tasked with detecting bacterial infections. Once these cells are knocked out, the bacteria can multiply unhindered.Victims are so overwhelmed that they're more or less poisoned to death as the bacilli gather in thick clots under the skin, where a passing flea might pick them up. Other grim side effects can include gangrene, erupting pus-filled glands, and lungs that literally dissolve.

Plague still exists in various parts of the world. In 2003, more than 2,100 human cases and 180 deaths were recorded, nearly all of them in Africa. The last reported serious outbreak was in 2006 in the Democratic Republic of the Congo in Central Africa, when at least 50 people died. The United States, China, India, Vietnam, and Mongolia are among the other countries that have confirmed human plague cases in recent years.Most people survive if they're given the correct antibiotics in time. Good sanitation and pest control help prevent plague outbreaks since they need crowded, dirty, rat-infested conditions to really get going.There are fears that plague bacteria possibly could be used for a bioterror attack if released in aerosol form.