And welcome to another post in out Monthly Medicine series. First and foremost, apologies for the lateness of this update (it’s still August where I am writing from!) I have been busy readying myself for my final year and had this saved on my computer but neglected to actually publish it! This month, we’ve decided to talk about Spanish Influenza or ‘The Spanish Flu’, perhaps one of the most deadly flu epidemics in history. The term relates perhaps most prolifically to the epidemic that occurred across the globe in 1918, resulting a huge death toll and many more suffering under
‘Spanish Influenza’ was a deadly pandemic involving the H1N1 influenza virus that occurred between January 1918 and December 1920. The disease is estimated to have infected an estimated 500 million people worldwide and was responsible for the deaths of between 20 and 50 million people.  The Spanish Flu is believed to have originated in Asia, spreading to Europe, North America and numerous other parts of the globe, utilising a number of different channels to facilitate its fast movement throughout the world, not least the movement of soldiers and civilians.  The epidemic proved particularly deadly compared to other flu epidemics due to the tendency for this particular strain to trigger what is known as a cytokine storm, a cytokine cascade, or hypercytokinemia, essentially a body’s overreaction in the production of peptides, proteins or glycoproteins in response to a pathogen.  Effectively, this causes the body to attack itself in reaction to infection from the virus, and it is commonly believed that this was the cause of many of the fatalities during the epidemic. The morbidity patterns focused upon young, healthy people, a departure from the typical flu demographic of older or more unhealthy people, and the rapid disease progression, leading to multiple organ failure and death, was responsible for the speed with which it claimed its victims. 
The impact of the epidemic spanned the globe. In Spain, many people refused to go to their workplaces for fear of catching the disease.  In the United States, funerals were limited to a maximum duration of 15 minutes, stores were forbidden to hold sales, and public health authorities distributed gauze masks to be worn to stop the spread of infection.  Many Americans were restricted from getting on public transport, from attending functions and gatherings, if the proper public health precautions had not been met. Some towns and cities across the world could not be entered unless a signed certificate was carried, and the traveller could prove they were not infected. Many popular representations of the disease likened it to a soldier, most commonly the Naples Soldier, for its ability to kill at such an alarming and effective rate. In a world torn apart by four years of violence that spanned continents and brought citizen and soldier alike into the firing line, the impact of the Spanish Flu epidemic cannot be understated: it is, even to this day, one of the largest events in the history of modern medicine.
Well, I wanted to keep this post nice and short, as the Spanish Influenza epidemic of 1918-1920 was an incredibly large event, and to do it full justice would take a huge amount of writing (and it has, as many scholars have indeed written entire volumes dedicated to this single event). Thank you for reading, I hope you enjoyed reading this as much as I enjoyed writing this, and I look forward to seeing you here on this blog again soon!
That’s all for now,
- Figures can be found at http://www.history.com/topics/1918-flu-pandemic
- Further information on the nature of cytokine storms can be found here http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0045027
Fig. 1 – Historical photo of the 1918 Spanish influenza ward at Camp Funston, Kansas, showing the many patients ill with the flu, Date 1918, Original can be found at Army.mil http://www.army.mil/-images/2008/09/24/22729/army.mil-2008-09-25-103608.jpg, taken by a U.S. Army photographer, Image is in the public domain
Fig. 2 – American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918, Photo by Edward A. “Doc” Rogers. From the Joseph R. Knowland collection at the Oakland History Room, Oakland Public Library., Image is in the public domain–