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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.

"three-day fever,"

Victims recovered after a few days. When the disease surfaced again that fall, it was far more severe

could not identify this disease which was striking so fast and so viciously, eluding treatment and defying control

victims died within hours

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.

other two strains are the septicaemic plague, which infects the circulatory system in victims, and the pneumonic plague

the traders carried the bacterium yersinia pestis in the rats on board as well as in some of the sailors themselves. The Black Death had arrived in Europe.

Once the flea bites a human, infected blood from the rat is introduced to the healthy blood of the human, and the bacteria spreads. Death occurs in less than a week for humans. A high fever, aching limbs, and fatigue mark the early stages of infection. Eventually, the lymph nodes of the neck, groin, and armpit areas swell and turn black. Those black swellings on victims are what give the Black Death its name. The victim begins to vomit blood and in some instances suffer hysteria from fever and terror. Exposure to any body fluids means exposure to the bacterium, and thus spreading the disease is very easy through coughing victims. The victim dies shortly after the lymph nodes swell until bursting within the body.

As winter approached, colder temperatures killed fleas and caused rats to seek dormancy

disease was not gone, it was simply dormant for a few month

bubonic plague is actually the weakest strain of known plagues.

Black Death was solely caused by the bubonic strain of plague has been questioned

which infects the respiratory system

was the spread eastward to China

Black Death killed virtually all infected people raises doub

bubonic plague is not as fatal compared to the other two strains (which have mortality rates close to 100%)

the site of the first plague cases in Italy, Messina:

Soon the boils grew to the size of a walnut, then to that of a hen's egg or a goose's egg,

There was not nearly enough consecrated ground for each victim to have an individual plot, and so enormous trenches were dug into which layer upon layer of dead bodies were lain. The trench was topped off with a small layer of soil,

Pope Clement VI even consecrated the entire Rhone river so that corpses could be thrown into it for lack of earth.

people, and considered it to be a punishment from an angry God. Some peasants resorted to magic spells, charms, and talismans.

Some people burned incense or other herbs as they believed that they overpowering smell of the dead victims was the source of the disease.

Some people even tried to "drive the disease away" with sound from church bells and canon fire

Churchmen, and public officials considered the disease to be just that; a disease.

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

“The Black Death” Even before the “death ships” pulled into port at Messina, many Europeans had heard rumors about a “Great Pestilence” that was carving a deadly path across the trade routes of the Near and Far East. (Early in the 1340s, the disease had struck China, India, Persia, Syria and Egypt.) However, they were scarcely equipped for the horrible reality of the Black Death. “In men and women alike,” the Italian poet Giovanni Boccaccio wrote, “at the beginning of the malady, certain swellings, either on the groin or under the armpits…waxed to the bigness of a common apple, others to the size of an egg, some more and some less, and these the vulgar named plague-boils.” Blood and pus seeped out of these strange swellings, which were followed by a host of other unpleasant symptoms–fever, chills, vomiting, diarrhea, terrible aches and pains–and then, in short order, death. The Black Death was terrifyingly, indiscriminately contagious: “the mere touching of the clothes,” wrote Boccaccio, “appeared to itself to communicate the malady to the toucher.” The disease was also terrifyingly efficient. People who were perfectly healthy when they went to bed at night could be dead by morning. Did You Know? Many scholars think that the nursery rhyme “Ring around the Rosy” was written about the symptoms of the Black Death.

The Black Death arrived in Europe by sea in October 1347 when 12 Genoese trading ships docked at the Sicilian port of Messina after a long journey through the Black Sea. The people who gathered on the docks to greet the ships were met with a horrifying surprise: Most of the sailors aboard the ships were dead, and those who were still alive were gravely ill. They were overcome with fever, unable to keep food down and delirious from pain. Strangest of all, they were covered in mysterious black boils that oozed blood and pus and gave their illness its name: the “Black Death.” The Sicilian authorities hastily ordered the fleet of “death ships” out of the harbor, but it was too late: Over the next five years, the mysterious Black Death would kill more than 20 million people in Europe–almost one-third of the continent’s population.

Meanwhile, in a panic, healthy people did all they could to avoid the sick. Doctors refused to see patients; priests refused to administer last rites. Shopkeepers closed stores. Many people fled the cities for the countryside, but even there they could not escape the disease: It affected cows, sheep, goats, pigs and chickens as well as people. In fact, so many sheep died that one of the consequences of the Black Death was a European wool shortage. And many people, desperate to save themselves, even abandoned their sick and dying loved ones. “Thus doing,” Boccaccio wrote, “each thought to secure immunity for himself.”

Contents “The Black Death” Understanding the Black Death God’s Punishment? Facebook Twitter Google Print Cite Article Details: Black Death Author History.com Staff Website Name History.com Year Published 2010 Title Black Death URL http://www.history.com/topics/black-death Access Date April 16, 2014 Publisher A+E Networks Introduction The Black Death arrived in Europe by sea in October 1347 when 12 Genoese trading ships docked at the Sicilian port of Messina after a long journey thro

the Black Sea

Even before the “death ships” pulled into port at Messina, many Europeans had heard rumors about a “Great Pestilence” that was carving a deadly path across the trade routes of the Near and Far East.

The Black Death arrived in Europe by sea in October 1347 when 12 Genoese trading ships docked at the Sicilian port of Messina after a long journey through the Black Sea.

Strangest of all, they were covered in mysterious black boils that oozed blood and pus and gave their illness its name: the “Black Death.”

Blood and pus seeped out of these strange swellings, which were followed by a host of other unpleasant symptoms–fever, chills, vomiting, diarrhea, terrible aches and pains–and then, in short order, death.

“In men and women alike,” the Italian poet Giovanni Boccaccio wrote, “at the beginning of the malady, certain swellings, either on the groin or under the armpits…waxed to the bigness of a common apple, others to the size of an egg, some more and some less, and these the vulgar named plague-boils.”

The people who gathered on the docks to greet the ships were met with a horrifying surprise: Most of the sailors aboard the ships were dead, and those who were still alive were gravely ill.

Some people coped with the terror and uncertainty of the Black Death epidemic

Some upper-class men joined processions of flagellants that traveled from town to town and engaged in public displays of penance and punishment: They would beat themselves and one another with heavy leather straps studded with sharp pieces of metal while the townspeople looked on. For 33 1/2 days, the flagellants repeated this ritual three times a day. Then they would move on to the next town and begin the process over again

The Italian writer Boccaccio said victims often "ate lunch with their friends, and ate dinner with their ancestors in paradise."

The Europeans often ate stale or diseased meat because refrigeration had not yet been invented.

Europeans were susceptible to disease because many people lived in crowded surroundings in an era when personal hygiene was not considered important.

Cities began to build hospitals and enforce standards for sanitation.

The devastation of the plague led to advances in medicine.

People were advised to not bathe because open skin pores might let in the disease.

Some Europeans believed the plague was a sign from God. Groups known as flagellants tried to atone for the sins of the world by inflicting punishments upon themselves. The flagellants also had a tendency to persecute Jews and even clergymen who spoke out against them. Eccentric and unusual people were often charged with witchcraft and sorcery. Pope Clement VI condemned the flagellants, but they continued to reappear in times of plague.