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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.

There is no specific treatment for those with yellow fever beyond good nursing and supportive care. The disease, however, is completely preventable. People can be rendered immune to the virus through vaccination, and outbreaks can be contained by eliminating or controlling mosquito populations. Thanks to such measures, the great yellow fever epidemics of the late 19th and early 20th centuries are no more. Nevertheless, the disease is still present in tropical Africa and South America, where access to vaccine is sometimes lacking

An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of

An infectious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of mosquitoes. Yellow fever is one of the great epidemic diseases of the tropical world, and in earlier centuries it was one of the great plagues of the New World. At one time the tropical and subtropical regions of the Americas were subjected to devastating epidemics, and serious outbreaks occurred not only as far north as Philadelphia, New York, and Boston but also as far away as Spain, France, England, and Italy.

tious disease, yellow fever infects humans, all species of monkeys, and certain other small mammals. The virus is transmitted from animals to humans and among humans by several species of

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.

first symptoms

nervous system collapsed, causing extreme pain and bizarre neurological disorders

inspiration for “Dance of Death” rituals

skin blackene

the skin blackened, giving rise to “The Black Death.

“pocket full of posies,” that people carried with them and held near their faces to ward off the horrid odor

uncharacteristically cremated—the “ashes, ashes,”—and finally, death would come, and we would “all fall down.”

Fleas feeding on infected rodents can transmit the disease to people as well

Once infected, people can infect others by coughing, sneezing, or close talking

The origin of “The Black Death” dates to an outbreak in China during the 1330s

Unlike smallpox, the plague is still a threat in some parts of the world. Yersinia pestis, the bacterium that causes bubonic plague, is transmitted through rat-tainted fleabites in densely populated cities and in countries with poor hygiene, or in the open country from infected wild rodents. The most common form of human plague is a swollen and painful lymph gland that forms buboes.

Plague vaccines have been used since the late nineteenth century, but their effectiveness is uncertain. Vaccination reduces the incidence and severity of disease resulting from the bite of infected fleas, but it isn't 100 percent effective. The plague vaccine is licensed for use in the United States and is available for adults at high risk—people who live in the western United States, people who will be in parts of the world where plague is still endemic, and people who are around rodents. Severe inflammatory reactions are common, and plague vaccine should not be given to anyone with a known hypersensitivity to beef protein, soya, casein, or phenol. Finally, the vaccination routine is complex and requires frequent boosters to maintain its effectiveness.

Pneumonic plague is more difficult to treat, and even with antibiotics, victims can die from it. Pneumonic plague occurs when the infectious bacteria infects the lungs. The first signs of illness in pneumonic plague are fever, headache, weakness, and a cough that produces blood or watery sputum. The pneumonia progresses over two to four days and, without early treatment, death ensues.

Bubonic Plague