Spanish flu - history, causes and symptoms

Spanish flu - history, causes and symptoms

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The Spanish flu - a lesson in horror
The Spanish flu was the worst epidemic of the 20th century in Europe and a warning against considering the flu as harmless. Science accounts for 25 to 50 million deaths between 1918 and 1920. This roughly corresponds to the plague of 1348, which killed every third person in Europe.

“In 1337 (1918), a devastating epidemic occurred in the Najd that affected both the townspeople and the Bedouins. So many people died that only God alone could count them. " Abdallah al-Bassam

Most of all, people between the ages of 20 and 40 died. This is unusual because influenza usually rages particularly heavily in young children and the elderly. There is an indication of what to look for in flu prevention.

Spanish flu?

The term "Spanish flu" is because the first reports of the disease came from Spain. In May of the last year of the war, news went through Europe that eight million people fell ill with the still unknown disease.

The disease probably did not originate in Spain, but the active belligerents suppressed the reports of it. In Germany, reports of civilian victims of the epidemic came to the public in June, and the soldiers had long known about the epidemic, which they called "Blitzkartarrh" or "Flanders fever".

Names for the disease in different languages ​​show that it was rampant across borders: Americans spoke of "three-day-fever" and "purple death", English soldiers generally of "flu", French of "la grippe" and the Italians suspected sand flies as a transmitter.

Three waves of death

In the spring of 1918 the outbreak was fairly light. Foreign media reported that the majority of infected people recovered in Spain. The situation was quite different in autumn: in Prussia and Switzerland, every second citizen fell ill, and in 1919 the effects of the third wave were less severe but still significant.

How many people died in this second and third wave can never be determined exactly. The war had just ended, the Bolsheviks were in power in Russia, the civil war was raging and serious reports barely reached Europe.

The situation with the Americans was clear: they lost almost as many soldiers to you from flu as from the war. Far from Europe, in India, at least 16 million were believed to have died from it, probably due to the British Army Indian soldiers bringing them to the country.

Spanish flu was probably fatal in 2.5% of those infected - with other flu viruses this is only the case in a maximum of 0.1%.

Where did the "Spanish" flu come from?

The origin of the epidemic is still unclear. This is mainly due to the conditions of mass extinction in the First World War. Soldiers from all nations involved in the war died on the front every day, civilians starved and lost their lives to various diseases - from typhoid to tuberculosis. First, the flu sufferers in May 1918 received little attention, and secondly, it was not noticeable when people with fever died somewhere in the trenches.

Frank Macfarlane Burnet, a Nobel Prize in Medicine, saw the origin of the flu far from Spain - namely in the rural Coutnty Haskell in the southwestern United States in the state of Kansas.

A new form of the flu

There the doctor Loring Miner reported about a new form of the flu, which was often fatal. He even contacted the US Public Health Service without getting an answer. However, the magazine belonging to the service published its article in spring 1918.

At least three sufferers were in Camp Fuston of the US Army. The first infected person was a cook in the camp on March 4, three weeks later there were 1,100 sick and 38 dead - with 56,000 soldiers. Those affected found the appropriate name "knock-me-down-fever". On March 18, the first occupied soldiers fell ill in Georgia.

"Knock me down fever"

The American soldiers figuratively described that the flu was very intense. Strong fever, severe pain in the head and limbs set in relatively abruptly, increased rapidly and usually improved after a few days. The death of the affected soldiers in the United States did not start because of the flu itself, but because of a subsequent pneumonia.

Almost 90% of the soldiers fell ill in the camps and expanded in prisons and factories: 1,000 Ford workers in Detroit and 25% of the prisoners in San Quentin. Of these, "only" three died.

The flu spread quickly, but the death rate was so low that health officials didn't recognize it as a danger.

How did the flu spread?

So it should be correct to say "American flu". Medical historians assume that American soldiers brought them to France, where the first sufferers were already in April 1918. The epidemic arrived in Paris at the end of the month and in early April more than 10,000 people were infected by the virus.

Finally, in June, the flu broke out worldwide: in Germany, China, India and the Philippines.

The flu wave also affected the world war. The German troops probably lost their summer offensive in Champagne in July 1918 because the plague was rampant.

Denmark and Norway contracted the flu in July, Holland and Sweden in August, and reached Australia in September.

The disease was still considered harmless, but many people died in Louisville, Kentucky - and 40% of the dead were actually the most immune-deficient ages between 20 and 35.

Dying in America, Africa and Europe

The relatively mild wave in spring gave false security: In August, the crew of the British ship HMS Mantua spread the plague in Freetown, Sierra Leone. Two thirds of the locals fell ill and 3% died.

In Boston soldiers had been lying down since the end of August, and civilians from September. On September 23, 2,604 out of 35,000 soldiers were ill at Camp Stevens, and 63 died in a single day.

The catastrophic conditions in the military camps caused a rapid spread. In the hospitals there were dirty hospital beds in every room, the dead were piled up in the corridors. Elementary hygiene standards could not be met.

A quarantine for ships leaving the USA failed because the US Army did not allow any delay to bring soldiers to the front in Europe. The death rate among ship crews was even twice as high as on land. In September, at least 12,000 Americans had died of the flu.

India, Tanzania, Zambia, Mozambique, the Americas and the Pacific also mourned deaths in large numbers, and New Zealand also in November, when the victorious soldiers returned. 8,600 New Zealanders died, and one in five died in Samoa.

In Saudi Arabia, it is remembered as an apocalyptic event, as is the plague.

Natives most affected

Not only the indigenous people in New Zealand and Samoa, but also Inuit were the worst affected by the flu. In Cartwright in Labrador, 96 out of 100 Inuit fell ill, and 26 of them died, and 207 out of 266 died in the indigenous settlement of Ohak. Many survivors starved or froze to death.

Symptoms of the Spanish flu

The autumn flu had some symptoms that made it stand out from other flu diseases: It was extremely fast, the fever suddenly started and increased rapidly within a few hours, combined with chills and severe pain in the head and joints. The throat and throat were severely irritated, resulting in coughing fits. Some people bleed their noses.

Some patients died of bleeding pneumonia after a few hours, others developed conventional pneumonia after days. They also died often.

Blue skin

The skin turned bluish, very unusual for a flu. This was due to lack of oxygen.

Those who did not develop pneumonia did not usually die. However, they suffered from tiredness and severe fatigue for several weeks. Depression was also widespread.

The third wave was weaker overall, and there were further "aftershocks" in different parts of the world, which, however, settled in the seasonal course of the usual flu waves and were not to the same extent fatal.

Doctors grope in the dark

Typical of the “Spanish flu” was its rapid and violent course, the bloody pneumonia as a result and the high rate of deaths. That's why some doctors initially thought that it wasn't flu at all.

Some scientists saw a new form of pneumonia at work, and the bloody pneumonia spoke for it as well as the mass death. It was not until 1933 that flu viruses were isolated and recognized as the causative agent.

A biological weapon?

Conspiracy fantasies spread, which mostly suspected the opponents of the war that they had spread the plague. So Germans should have poisoned Spanish canned food and thus spread the flu. Americans believed that German agents contaminated fish, which the American soldiers would then eat.

Philipp Doane of the Health and Sanitation Section of the Emergency Fleet Corporation announced: "It would be very easy for German agents to release the pathogen in a theater or other place where many people are gathered. The Germans have started epidemics in Europe. There is no reason why they should be more careful with America. ”

Such theories were less daring than the fantasies of today's esoteric people, who believe that contrails from planes are chemtrails to poison people: mustard gas had killed countless numbers and the German army had used biological weapons.

She even wanted to use Pest virus against the British, and German agents launched anthrax attacks on horses, sheep and cattle, as well as animal feed in Romania, Spain, Argentina, the United States, Norway and Iraq.

Spitting prohibited

In Canada, the recommendation was to avoid crowds, wash your mouth and skin thoroughly, and clean clothes. Towels, cutlery and other items that other people had used should be avoided.

This advice, which makes sense from today's perspective, was accompanied by rather helpless information. So you shouldn't wear tight shoes, gloves and shirts, drink a glass of water in the morning and chew your food well.

In the United States, eucalyptus and figs were used as a cure, in New York it was prohibited to spit on the street.

In Europe, Spanish flu was considered a disease that would have spread during the war, such as typhus, but this was a misinterpretation: it was not only soldiers who were weakened by the circumstances that were affected, but particularly well-nourished people in the prime of their years.

What was the cause?

One of the curiosities of the Spanish flu was that 25 to 29 year olds were particularly affected and, in another circle, 20 to 40 year olds.

Evolutionary biologist Worobey researched this at the University of Arizona. In the "Proceedings of the National Academy of Sciences", the scientist from Tucson wrote: The course and the severity of a flu episode largely depend on the pathogens with which people as children have had contact. "

Flu pathogens change very quickly, and there are many variants.

Avian and human flu

Worobey and his team reconstructed how the H1N1 pathogen mutated at the time of the death waves and compared this with later H1N1 viruses and swine flu 200. Virus.

Older not prepared

Worobey concluded: The older and younger had come into contact with the H1 type, but not the young adults. Instead, they would have been infected with another flu virus, H3N8, as children.

If you have antibodies against the H 3 protein, you have no defense against H 1N1.

Not aggressiveness, but immune system

Decisive for the lethal course was therefore not a particular aggressiveness of the virus, but the lack of immune defense. According to Worobey, it also fits that many patients died of the following pneumonia.

And, as can be added, it also explains the high mortality rate among Inuit and Maoris: They had never come into contact with this variant of the flu virus.

Teaching for today

Young people died of flu waves of our time, especially old people on H7N9. Both were (partially) immunized against certain flu strains, but not against others. So it is about an immunity developed in the early days.

New vaccination strategies

Worobey's conclusion is that flu vaccination alone is not enough to avoid deaths. The vaccines should include which generation came into contact with which pathogen.

That is the decisive aspect of how devastating flu waves could spread. Worobey writes: "" Vaccination strategies that mimic the apparently powerful lifetime protection of early childhood contact could dramatically reduce mortality from both seasonal and new strains. "

A warning

The Spanish flu is not only a lesson in the development of vaccines, but also a warning. “Ordinary people” often get the flu right away with a flu infection that almost goes with it in autumn and winter and is unpleasant, but after a few days fever, headache and bed rest go away.

A deadly disease

However, flu variants are quickly fatal and no less dangerous than large epidemics such as typhoid or cholera.

The victims of the Spanish flu probably did not die because the war had exhausted them, the hygienic conditions were poor, they did not wash, etc., but because they had not developed immune bodies against a specific mutation of a flu virus.

That means: A new variant of a flu virus could affect us today just as much as our ancestors. Not only are new vaccines necessary, but also to protect yourself from the epidemic with these vaccines. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch


  • Maybaum, Thorsten: Spanish flu: a virus - millions killed, study medicine, 2018, aerzteblatt.de
  • Salfellner, Harald: The Spanish Flu: A History of the 1918 Pandemic, Vitalis, 2018
  • Stanford University: The Influenza Pandemic of 1918 (accessed: August 12, 2019), web.stanford.edu
  • Centers for Disease Control and Prevention: 1918 Pandemic (H1N1 virus) (accessed: August 12, 2019), cdc.gov
  • National Geographic: Inside the Swift, Deadly History of the Spanish Flu Pandemic (accessed: August 12, 2019), nationalgeographic.com

Video: Why Spanish Flu Killed Over 50 Million People - Deadliest Plague in Modern History (October 2022).