It is estimated that between 25 and 40 million people died from the influenza outbreak that began in 1918, took about 7 days to sweep across America, and three months to sweep around the world. World War I, which had just ended, took 9 million lives; this epidemic would quadruple that.

The epidemic, known as a pandemic because it grew to worldwide proportions, is believed to have been born in early March 1918 when soldiers at Fort Riley, Kan., burned tons of manure. "A gale kicked up. A choking dust storm swept out over the land -- a stinging, stinking yellow haze. The sun went dead black in Kansas." Two days later the first soldiers reported feeling sick. 48 soldiers died at Fort Riley with a listed cause of pneumonia.

It spread faster than any disease in history, before or since, and killed more people in less time than all of the great plagues of history, doing so in the presence of relatively "modern" medical science. Some areas were harder hit than others: in Alaska, 60% of the Eskimo population was wiped out. Islands in the South Pacific where respiratory illness is uncommon and non-lethal lost 20% of their populations, primarily adults. In the United States, estimates place the death toll at 500'000 to more than 675'000. As a comparison, fewer than 300'000 Americans lost their lives serving in the armed forces during World War II. In comparison, the Black Death killed 40 million people in Europe - but it took 150 years to do it.

"As their lungs filled … the patients became short of breath and increasingly cyanotic. After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth. It was a dreadful business." --Isaac Starr, 3rd year medical student, University of Pennsylvania, 1918.

Fevers reached 105 degrees Fahrenheit (40.5 C); victims typically died of pneumonia, trying to gasp for air. Spread in the air by coughing just like the flu we get today, it was far more virulent - it killed people in a week, sometimes in a day or two. A cure was never found.

Another phenomenon of the Spanish flu held true in Danbury. Of the 89 deaths, at least 56 were people in the prime of life - teen-agers or adults. It's one of the great unanswered questions of the pandemic - why it seemed to kill healthy young adults more than the very young and old, who are the usual victims of influenza. Apparently this was a flu strain which had undergone a mutation to particular savageness. Flu viruses mutate constantly in what is known as "antigenic drift", usually in such minimal ways that last year's flu or vaccine offers some protection against this year's. But about every decade or two, such drift may be major, with a significant protein coat change so dramatic as to be regarded by the human body as an entirely new virus. Then it sweeps through the human population with a vengeance.

I have often been asked what is the likelihood of a pandemic like 1918 coming again. The answer is still unknown. What is known is that influenza pandemics occur with surprising regularity, every 20-30 years. The chance of a new pandemic emerging is 100%. The last one was in 1968, so the chance of a new pandemic occuring in the near future is pretty good. -- Dr. Jeffery Taubenberger, Armed Forces Institute of Pathology, Washington D.C.

Some analysis has been done on the sequence of 1918 influenza strains. It is thought that it was a H1N1 strain of influenza A, known also as "swine flu". It is thought that the virus was particularly virulent due to a mutant strain of the hemagglutinin (HA) surface protein it carried. For activation, HA must be cleaved by a host protease. The normal protease responsible is found in the respiratory tract of humans, or the digestive tract of avians. Some mutants of avian flu contain different sequences at the cleavage point, allowing them to be cut by a wide variety of proteases, allowing the virus to be activated anywhere in the body. It is not known for certain that this is responsible for the virulence of the 1918 strain.

The most popular speculation for why the "Spanish Flu" seemed to kill the most healthy individuals is that the immune response itself was responsible for the pneumonia that killed many. A stronger immune response, like that of an adult in their 20s, would result in more rapid secretion of mucus in the lungs, causing the victim to essentially drown in it.

My great-grandfather, while serving in the US Army at the end of WWI, came down with a nasty case of the Spanish Flu. While there were no reliable cures in those days, his unit's doctor did come up with this:

Cure for the Spanish Flu

Ingredients:

Method:
  1. Go to bed and hang the hat on the bedpost.
  2. Drink the whiskey. Drink some more. Drink until there are two hats on the bedpost.
  3. Pass out.
  4. Upon waking up, repeat step 2.
  5. Repeat until fully recovered.

Naturally, I wondered how this could work. Wouldn't drinking that much just exacerbate the illness? Well, as CrazyIvan says, this strain of the flu killed its victims by provoking an excessive immune response in the lungs and thus causing severe pneumonia. In an twisted reversal of the usual death patterns of pandemic disease, this killed mainly the young and healthy.

Now, it was not common knowledge back in 1918, but today we know that ethanol is an immunosuppressant. The demon drink interferes with all of the human body's immune functions, but its effect on the alveolar macrophages is what made it such a potent cure.

Those little fellows are the human body's main line of defense against airborne pathogens like the Spanish flu, and it's their overreaction that killed most of the victims. With this response suppressed by truly staggering amounts of alcohol, the patient had a good chance to survive.

How did the doctor know this unorthodox cure would work? Well, it seems that he had had a patient who was, to put it kindly, a bit of a boozer. I'll call him Jones, since his real name hasn't survived these 84 years. The good doctor noticed that while the other men who had caught the flu died left and right, Jones and his bottles of hooch pulled through with only a mild cough. Since Jones's diet and exercise habits were the same one-size-fits-all government issue as the other soldiers', Doc guessed (correctly, as it happened) that Jones's abnormally heavy drinking must have been the secret of his survival.

With this idea formed, Doc needed only a test case to confirm his hypothesis. It just so happened that Great-Grandpa was the next man of the unit to come down with influenza, and the rest, as they say, is history. Thanks to his doctor's clever inductive reasoning, he survived to continue the lineage of which I am the latest generation.

So... remember, if the Spanish Flu ever resurfaces, whether by chance or by deliberate human action, a full liquor cabinet may be the difference between life with a bad hangover and drowning in your own phlegm.

Sources:
Alcohol and The immune system, by Andrew Greenfield and Colin Drummond, http://www.medicouncilalcol.demon.co.uk/articles_2001.htm#immune
Oral histories of the clan

Constructive criticism of facts and writing style is welcome.

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