The 1918 FLU PANDEMIC (January 1918 – December 1920) was an
unusually deadly influenza pandemic , the first of the two pandemics
H1N1 influenza virus . It infected 500 million people
around the world, including remote Pacific islands and the Arctic,
and resulted in the deaths of 50 to 100 million (three to five percent
of the world's population ), making it one of the deadliest natural
disasters in human history. Disease had already greatly limited
life expectancy in the early 20th century. A considerable spike
occurred at the time of the pandemic, specifically the year 1918. Life
expectancy in the United States alone dropped by about 12 years.
Most influenza outbreaks disproportionately kill juvenile, elderly,
or already weakened patients; in contrast, the 1918 pandemic
predominantly killed previously healthy young adults.
There are several possible explanations for the high mortality rate
of the 1918 influenza pandemic. Some research suggests that the
specific variant of the virus had an unusually aggressive nature. One
group of researchers recovered the original virus from the bodies of
frozen victims, and found that transfection in animals caused a rapid
progressive respiratory failure and death through a cytokine storm
(overreaction of the body's immune system ). It was then postulated
that the strong immune reactions of young adults ravaged the body,
whereas the weaker immune systems of children and middle-aged adults
resulted in fewer deaths among those groups.
More recent investigations, mainly based on original medical reports
from the period of the pandemic, found that the viral infection
itself was not more aggressive than any previous influenza, but that
the special circumstances (malnourishment, overcrowded medical camps
and hospitals, poor hygiene) promoted bacterial superinfection that
killed most of the victims typically after a somewhat prolonged death
Historical and epidemiological data are inadequate to identify the
pandemic's geographic origin. It was implicated in the outbreak of
encephalitis lethargica in the 1920s.
To maintain morale, wartime censors minimized early reports of
illness and mortality in Germany, the United Kingdom, France, and the
United States. However, papers were free to report the epidemic's
effects in neutral Spain (such as the grave illness of King Alfonso
XIII ). This reporting dichotomy created a false impression of Spain
as especially hard hit, thereby giving rise to the pandemic's
nickname, SPANISH FLU. In Spain, a different nickname was adopted,
the Naples Soldier (Soldado de Nápoles), which came from a musical
operetta (zarzuela) titled La canción del olvido (The Song of
Forgetting), which premiered in Madrid during the first epidemic wave.
Federico Romero , one of the librettists, quipped that the play's most
popular musical number, Naples Soldier, was as catchy as the flu.
* 1 History
* 1.1 Hypotheses about source
* 1.2 Spread
* 2 Mortality
* 2.1 Around the globe
* 2.2 Patterns of fatality
* 2.3 Deadly second wave
* 2.4 Devastated communities
* 2.5 Less-affected areas
* 2.7 End of the pandemic
* 3 Legacy
Spanish flu research
* 5 In popular culture
* 6 Gallery
* 7 References
* 7.1 Notes
* 7.2 Bibliography
* 7.3 Further reading
* 8 External links
HYPOTHESES ABOUT SOURCE
The site of the very first confirmed outbreak was at Camp Funston,
Fort Riley ,
Kansas , then a military training facility preparing
American troops for involvement in World War I. The first victim
diagnosed with the new strain of flu on Monday, March 11, 1918, was
mess cook Private Albert Gitchell. Historian Alfred W. Crosby
recorded that the flu originated in Kansas, and popular writer John
Barry echoed Crosby in describing Haskell County,
Kansas , as the
point of origin.
In contrast, investigative work in 1999 by a British team led by
John Oxford of St Bartholomew\'s Hospital and the Royal
London Hospital identified the major troop staging and hospital camp
Étaples , France, as being the center of the 1918 flu pandemic.
These researchers postulated that a significant precursor virus,
harbored in birds, mutated to pigs that were kept near the front.
Earlier hypotheses of the epidemic's origin have varied. Some
hypothesized the flu originated in East Asia. Dr. C. Hannoun,
leading expert of the 1918 flu for the
Institut Pasteur , asserted the
former virus was likely to have come from China, mutating in the
United States near
Boston and spreading to
Brest, France , Europe's
battlefields, Europe, and the world using Allied soldiers and sailors
as main spreaders. He considered several other hypotheses of origin,
such as Spain,
Kansas , and Brest, as being possible, but not likely.
Andrew Price-Smith published data from the
Austrian archives suggesting the influenza had earlier origins,
Austria in the spring of 1917.
In 2014, historian Mark Humphries of Canada's Memorial University of
Newfoundland stated that newly unearthed records confirmed that one of
the side stories of the war, the mobilization of 96,000 Chinese
laborers to work behind the British and French lines on World War I's
western front, might have been the source of the pandemic. In the
report, Humphries found archival evidence that a respiratory illness
that struck northern China in November 1917 was identified a year
later by Chinese health officials as identical to the Spanish flu.
However, a report published in 2016 in the Journal of the Chinese
Medical Association found no evidence that the 1918 virus was imported
to Europe from Chinese and Southeast Asian soldiers and workers. In
fact, it found evidence that the virus had been circulating in the
European armies for months and potentially years before the 1918
When an infected person sneezes or coughs, more than half a million
virus particles can be spread to those close by. The close quarters
and massive troop movements of
World War I
World War I hastened the pandemic, and
probably both increased transmission and augmented mutation; the war
may also have increased the lethality of the virus. Some speculate the
soldiers' immune systems were weakened by malnourishment, as well as
the stresses of combat and chemical attacks, increasing their
A large factor in the worldwide occurrence of this flu was increased
travel. Modern transportation systems made it easier for soldiers,
sailors, and civilian travelers to spread the disease.
In the United States, the disease was first observed in Haskell
Kansas , in January 1918, prompting local doctor Loring Miner
to warn the U.S. Public Health Service's academic journal. On 4 March
1918, company cook Albert Gitchell reported sick at Fort Riley, Kansas
. By noon on 11 March 1918, over 100 soldiers were in the hospital.
Within days, 522 men at the camp had reported sick. By 11 March 1918,
the virus had reached
Queens , New York. Failure to take preventative
measures in March/April was later criticised.
In August 1918, a more virulent strain appeared simultaneously in
Brest , France; in Freetown, Sierra Leone ; and in the U.S. in Boston,
Massachusetts . The Spanish flu also spread through Ireland, carried
there by returning Irish soldiers. The Allies of
World War I
World War I came to
call it the Spanish flu, primarily because the pandemic received
greater press attention after it moved from France to Spain in
November 1918. Spain was not involved in the war and had not imposed
wartime censorship .
AROUND THE GLOBE
The difference between the influenza mortality age-distributions
of the 1918 epidemic and normal epidemics – deaths per 100,000
persons in each age group, United States, for the interpandemic years
1911–1917 (dashed line) and the pandemic year 1918 (solid line)
Three pandemic waves: weekly combined influenza and pneumonia
mortality, United Kingdom, 1918–1919
The global mortality rate from the 1918/1919 pandemic is not known,
but an estimated 10% to 20% of those who were infected died. With
about a third of the world population infected, this case-fatality
ratio means 3% to 6% of the entire global population died. Influenza
may have killed as many as 25 million people in its first 25 weeks.
Older estimates say it killed 40–50 million people, while current
estimates say 50–100 million people worldwide were killed.
This pandemic has been described as "the greatest medical holocaust
in history" and may have killed more people than the
Black Death . It
is said that this flu killed more people in 24 weeks than AIDS killed
in 24 years, and more in a year than the
Black Death killed in a
The disease killed in every corner of the globe. As many as 17
million died in
India , about 5% of the population. The death toll in
India\'s British-ruled districts alone was 13.88 million.
In Japan, of the 23 million people who were affected, 390,000 died.
Dutch East Indies
Dutch East Indies (now
Indonesia ), 1.5 million were assumed to
have died among 30 million inhabitants. In
Tahiti 13% of the
population died during only a month. Similarly, in
Samoa 22% of the
population of 38,000 died within two months.
In the U.S., about 28% of the population became infected, and 500,000
to 675,000 died. Native American tribes were particularly hard hit.
Four Corners area alone, 3,293 deaths were registered among
Native Americans. Entire village communities perished in
Alaska . In
Canada 50,000 died. In Brazil 300,000 died, including president
Rodrigues Alves . In Britain, as many as 250,000 died; in France,
more than 400,000. In West Africa an influenza epidemic killed at
least 100,000 people in
Ghana . Tafari Makonnen (the future Haile
Selassie , Emperor of Ethiopia) was one of the first Ethiopians who
contracted influenza but survived, although many of his family's
subjects did not; estimates for the fatalities in the capital city,
Addis Ababa , range from 5,000 to 10,000, or higher. In British
Somaliland one official estimated that 7% of the native population
This huge death toll was caused by an extremely high infection rate
of up to 50% and the extreme severity of the symptoms, suspected to be
caused by cytokine storms . Symptoms in 1918 were so unusual that
initially influenza was misdiagnosed as dengue , cholera , or typhoid
. One observer wrote, "One of the most striking of the complications
was hemorrhage from mucous membranes, especially from the nose,
stomach, and intestine.
Bleeding from the ears and petechial
hemorrhages in the skin also occurred". The majority of deaths were
from bacterial pneumonia , a common secondary infection associated
with influenza, but the virus also killed people directly, by causing
massive hemorrhages and edema in the lung.
The unusually severe disease killed up to 20% of those infected, as
opposed to the usual flu epidemic mortality rate of 0.1%.
PATTERNS OF FATALITY
An unusual feature of this pandemic was that it mostly killed young
adults. In 1918–1919, 99% of pandemic influenza deaths in the US
occurred in people under 65, and nearly half in young adults 20 to 40
years old. In 1920 the mortality rate among people under 65 had
decreased six-fold to half the mortality rate of people over 65, but
still 92% of deaths occurred in people under 65. This is noteworthy,
since influenza is normally most deadly to weak individuals, such as
infants (under age two), the very old (over age 70), and the
immunocompromised . In 1918, older adults may have had partial
protection caused by exposure to the
1889–1890 flu pandemic
1889–1890 flu pandemic , known
as the Russian flu. According to historian John M. Barry, the most
vulnerable of all – "those most likely, of the most likely", to die
– were pregnant women. He reported that in thirteen studies of
hospitalized women in the pandemic, the death rate ranged from 23% to
71%. Of the pregnant women who survived childbirth, over one-quarter
(26%) lost the child.
Another oddity was that the outbreak was widespread in the summer and
autumn (in the
Northern Hemisphere ); influenza is usually worse in
Modern analysis has shown the virus to be particularly deadly because
it triggers a cytokine storm , which ravages the stronger immune
system of young adults.
In fast-progressing cases, mortality was primarily from pneumonia ,
by virus-induced pulmonary consolidation . Slower-progressing cases
featured secondary bacterial pneumonias, and there may have been
neural involvement that led to mental disorders in some cases. Some
deaths resulted from malnourishment.
A study – conducted by He et al. – used a mechanistic modelling
approach to study the three waves of the 1918 influenza pandemic. They
tried to study the factors that underlie variability in temporal
patterns, and the patterns of mortality and morbidity. Their analysis
suggests that temporal variations in transmission rate provide the
best explanation and the variation in transmission required to
generate these three waves is within biologically plausible values.
Another study by He et al. used a simple epidemic model, to
incorporate three factors including: school opening and closing,
temperature changes over the course of the outbreak, and human
behavioral changes in response to the outbreak to infer the cause of
the three waves of the 1918 influenza pandemic. Their modelling
results showed that all three factors are important but human
behavioral responses showed the largest effects.
DEADLY SECOND WAVE
American Expeditionary Force
American Expeditionary Force victims of the flu pandemic at U.S.
Army Camp Hospital no. 45 in
Aix-les-Bains , France, in 1918
The second wave of the 1918 pandemic was much deadlier than the
first. The first wave had resembled typical flu epidemics; those most
at risk were the sick and elderly, while younger, healthier people
recovered easily. But in August, when the second wave began in France,
Sierra Leone and the United States, the virus had mutated to a much
This increased severity has been attributed to the circumstances of
the First World War. In civilian life, natural selection favours a
mild strain. Those who get very ill stay home, and those mildly ill
continue with their lives, preferentially spreading the mild strain.
In the trenches, natural selection was reversed. Soldiers with a mild
strain stayed where they were, while the severely ill were sent on
crowded trains to crowded field hospitals, spreading the deadlier
virus. The second wave began and the flu quickly spread around the
world again. Consequently, during modern pandemics health officials
pay attention when the virus reaches places with social upheaval
(looking for deadlier strains of the virus).
The fact that most of those who recovered from first-wave infections
were now immune showed that it must have been the same strain of flu.
This was most dramatically illustrated in
Copenhagen , which escaped
with a combined mortality rate of just 0.29% (0.02% in the first wave
and 0.27% in the second wave) because of exposure to the less-lethal
first wave. On the rest of the population it was far more deadly now;
the most vulnerable people were those like the soldiers in the
trenches – young previously healthy adults.
A chart of deaths in major cities, showing a peak in the autumn
Even in areas where mortality was low, so many were incapacitated
that much of everyday life was hampered. Some communities closed all
stores or required customers to leave orders outside. There were
reports that the health-care workers could not tend the sick nor the
gravediggers bury the dead because they too were ill. Mass graves were
dug by steam shovel and bodies buried without coffins in many places.
Pacific island territories were particularly hard-hit. The
pandemic reached them from New Zealand, which was too slow to
implement measures to prevent ships carrying the flu from leaving its
ports. From New Zealand, the flu reached
Tonga (killing 8% of the
Nauru (16%) and
Fiji (5%, 9,000 people).
Worst affected was German
Samoa , today the independent state of
Samoa , which had been occupied by New Zealand in 1914. A crippling
90% of the population was infected; 30% of adult men, 22% of adult
women and 10% of children died. By contrast, the flu was kept away
Samoa when Governor
John Martin Poyer
John Martin Poyer imposed a
blockade. In New Zealand itself, 8,573 deaths were attributed to the
1918 pandemic influenza, resulting in a total population fatality rate
of 0.74%. In Ireland, the Spanish Flu accounted for 10% of the total
deaths in 1918 which can be seen as quite detrimental considering
World War 1 was still occurring.
In Japan, 257,363 deaths were attributed to influenza by July 1919,
giving an estimated 0.425% mortality rate, much lower than nearly all
other Asian countries for which data are available. The Japanese
government severely restricted maritime travel to and from the home
islands when the pandemic struck.
In the Pacific, American
Samoa and the French colony of New
Caledonia also succeeded in preventing even a single death from
influenza through effective quarantines . In Australia, nearly 12,000
By the end of the pandemic, the isolated island of
Marajó , in
Brazil's Amazon River Delta had not reported an outbreak.
In a 2009 paper published in the journal Clinical Infectious Diseases
, Karen Starko proposed that aspirin poisoning had contributed
substantially to the fatalities. She based this on the reported
symptoms in those dying from the flu, as reported in the post mortem
reports still available, and also the timing of the big "death spike"
in October 1918 which happened right after the Surgeon General of the
United States Army , and the Journal of the American Medical
Association both recommended very large doses of 8.0–31.2 g of
aspirin per day. Starko also suggests that the wave of aspirin
poisonings was due to a "perfect storm " of events:
Bayer 's patent on
aspirin expired, so that many companies rushed in to make a profit and
greatly increased the supply; this coincided with the flu pandemic;
and the symptoms of aspirin poisoning were not known at the time.
As an explanation for the universally high mortality rate, this
hypothesis was questioned in a letter to the journal published in
April 2010 by Andrew Noymer and Daisy Carreon of the University of
California, Irvine , and Niall Johnson of the Australian Commission on
Safety and Quality in Health Care . They questioned this universal
applicability given the high mortality rate in countries such as
India, where there was little or no access to aspirin at the time.
They concluded that "the salicylate poisoning hypothesis difficult
to sustain as the primary explanation for the unusual virulence of the
1918–1919 inﬂuenza pandemic".
But they overlooked that inexpensive aspirin had become available in
India and other places after October 1918, when the
expired. In responding, Starko pointed to anecdotal evidence of
aspirin over-prescription in
India and argued that even if aspirin
over-prescription had not contributed to the high Indian mortality
rate, it could still have been a major factor for other high rates in
areas where other exacerbating factors present in
India played less of
END OF THE PANDEMIC
After the lethal second wave struck in late 1918, new cases dropped
abruptly – almost to nothing after the peak in the second wave. In
Philadelphia, for example, 4,597 people died in the week ending 16
October, but by 11 November, influenza had almost disappeared from the
city. One explanation for the rapid decline of the lethality of the
disease is that doctors simply got better at preventing and treating
the pneumonia that developed after the victims had contracted the
virus, although John Barry stated in his book that researchers have
found no evidence to support this.
Another theory holds that the 1918 virus mutated extremely rapidly to
a less lethal strain. This is a common occurrence with influenza
viruses: there is a tendency for pathogenic viruses to become less
lethal with time, as the hosts of more dangerous strains tend to die
out (see also "Deadly Second Wave" , above).
List of 1918 flu pandemic cases American Red Cross
nurses tend to flu patients in temporary wards set up inside Oakland
Municipal Auditorium, 1918.
Andrew Price-Smith has made the argument that the virus
helped tip the balance of power in the later days of the war towards
the Allied cause. He provides data that the viral waves hit the
Central Powers before they hit the Allied powers, and that both
morbidity and mortality in Germany and
Austria were considerably
higher than in Britain and France.
In the United States, Britain and other countries, despite the
relatively high morbidity and mortality rates that resulted from the
epidemic in 1918–1919, the Spanish flu began to fade from public
awareness over the decades until the arrival of news about bird flu
and other pandemics in the 1990s and 2000s. This has led some
historians to label the Spanish flu a "forgotten pandemic".
Various theories of why the Spanish flu was "forgotten" include the
rapid pace of the pandemic, which killed most of its victims in the
United States, for example, within a period of less than nine months,
resulting in limited media coverage. The general population was
familiar with patterns of pandemic disease in the late 19th and early
20th centuries: typhoid , yellow fever , diphtheria , and cholera all
occurred near the same time. These outbreaks probably lessened the
significance of the influenza pandemic for the public. In some areas,
the flu was not reported on, the only mention being that of
advertisements for medicines claiming to cure it.
In addition, the outbreak coincided with the deaths and media focus
on the First World War. Another explanation involves the age group
affected by the disease. The majority of fatalities, from both the war
and the epidemic, were among young adults. The deaths caused by the
flu may have been overlooked due to the large numbers of deaths of
young men in the war or as a result of injuries. When people read the
obituaries, they saw the war or postwar deaths and the deaths from the
influenza side by side. Particularly in Europe, where the war's toll
was extremely high, the flu may not have had a great, separate,
psychological impact, or may have seemed a mere extension of the war's
The duration of the pandemic and the war could have also played a
role. The disease would usually only affect a certain area for a month
before leaving, while the war, which most had initially expected to
end quickly, had lasted for four years by the time the pandemic
struck. This left little time for the disease to have a significant
impact on the economy.
Regarding global economic effects, many businesses in the
entertainment and service industries suffered losses in revenue, while
the health care industry reported profit gains.
Historian Nancy Bristow has argued that the pandemic, when combined
with the increasing number of women attending college, contributed to
the success of women in the field of nursing. This was due in part to
the failure of medical doctors, who were predominantly men, to contain
and prevent the illness. Nursing staff, who were predominantly women,
felt more inclined to celebrate the success of their patient care and
less inclined to identify the spread of the disease with their own
In Spain, sources from the period explicitly linked the Spanish flu
to the cultural figure of
Don Juan . The nickname for the flu, the
"Naples Soldier", was adopted from
Federico Romero and Guillermo
Fernández Shaw 's operetta, The Song of Forgetting (La canción del
olvido), the protagonist of which is a stock
Don Juan type. Davis has
argued the Spanish flu–
Don Juan connection served a cognitive
function, allowing Spaniards to make sense of their epidemic
experience by interpreting it through a familiar template, namely the
Don Juan story.
SPANISH FLU RESEARCH
Spanish flu research An electron micrograph
showing recreated 1918 influenza virions. Centers for Disease
Control and Prevention as Dr. Terrence Tumpey examines a reconstructed
version of the 1918 flu.
The origin of the Spanish flu pandemic, and the relationship between
the near-simultaneous outbreaks in humans and swine, have been
controversial. One hypothesis is that the virus strain originated at
Fort Riley ,
Kansas , in viruses in poultry and swine which the fort
bred for food; the soldiers were then sent from
Fort Riley around the
world, where they spread the disease. Similarities between a
reconstruction of the virus and avian viruses, combined with the human
pandemic preceding the first reports of influenza in swine, led
researchers to conclude the influenza virus jumped directly from birds
to humans, and swine caught the disease from humans.
Others have disagreed, and more recent research has suggested the
strain may have originated in a nonhuman, mammalian species. An
estimated date for its appearance in mammalian hosts has been put at
the period 1882–1913. This ancestor virus diverged about
1913–1915 into two clades (or biological groups), which gave rise to
the classical swine and human
H1N1 influenza lineages. The last common
ancestor of human strains dates to between February 1917 and April
1918. Because pigs are more readily infected with avian influenza
viruses than are humans, they were suggested as the original
recipients of the virus, passing the virus to humans sometime between
1913 and 1918.
An effort to recreate the 1918 flu strain (a subtype of avian strain
H1N1) was a collaboration among the Armed Forces Institute of
Pathology , the
USDA ARS Southeast Poultry Research Laboratory and
Mount Sinai School of Medicine in
New York City
New York City . The effort resulted
in the announcement (on 5 October 2005) that the group had
successfully determined the virus's genetic sequence, using historic
tissue samples recovered by pathologist
Johan Hultin from a female flu
victim buried in the Alaskan permafrost and samples preserved from
On 18 January 2007, Kobasa et al. (2007) reported that monkeys
Macaca fascicularis ) infected with the recreated flu strain
exhibited classic symptoms of the 1918 pandemic, and died from a
cytokine storm —an overreaction of the immune system . This may
explain why the 1918 flu had its surprising effect on younger,
healthier people, as a person with a stronger immune system would
potentially have a stronger overreaction.
On 16 September 2008, the body of British politician and diplomat Sir
Mark Sykes was exhumed to study the
RNA of the flu virus in efforts to
understand the genetic structure of modern
H5N1 bird flu. Sykes had
been buried in 1919 in a lead coffin which scientists hoped had helped
preserve the virus. However, the coffin was found to be split because
of the weight of soil over it, and the cadaver was badly decomposed.
Nonetheless, samples of lung and brain tissue were taken through the
split, with the coffin remaining in situ in the grave during this
In December 2008, research by
Yoshihiro Kawaoka of the University of
Wisconsin linked the presence of three specific genes (termed PA, PB1,
and PB2) and a nucleoprotein derived from 1918 flu samples to the
ability of the flu virus to invade the lungs and cause pneumonia. The
combination triggered similar symptoms in animal testing.
In June 2010, a team at the
Mount Sinai School of Medicine reported
2009 flu pandemic vaccine
2009 flu pandemic vaccine provided some cross-protection against
1918 flu pandemic
1918 flu pandemic strain.
One of the few things known for certain about the influenza in 1918
and for some years after was that it was, out of the laboratory,
exclusively a disease of human beings.
In 2013, the AIR Worldwide Research and Modeling Group "characterized
the historic 1918 pandemic and estimated the effects of a similar
pandemic occurring today using the AIR
Pandemic Flu Model". In the
model, "a modern day "Spanish flu" event would result in additional
life insurance losses of between USD 15.3–27.8 billion in the United
States alone" with 188,000–337,000 deaths in the United States.
IN POPULAR CULTURE
The 1995 film
Outbreak , the 2011 film Contagion and the 2013 film
World War Z make reference to the pandemic.
The television show Resurrection uses the pandemic, in the episode
"Afflictions" that aired on November 2, 2014, as the explanation for
why many of the Returned were getting sick and disappearing.
In season four of British drama Upstairs, Downstairs , Hazel Bellamy
dies of Spanish flu in 1918, after her husband James Bellamy survives
injuries in the "Great War" (World War I). Her funeral takes place on
11 November, the day the war ends.
In season two of British drama
Downton Abbey , Lavinia Swire dies of
the Spanish flu in April 1919, after her fiancé Matthew Crawley
recovers from injuries and temporary paralysis from the Great War.
Twentieth-century fiction includes at least three novels with the flu
pandemic as a major theme: Katherine Anne Porter's Pale Horse, Pale
Rider , Thomas Mullen's
The Last Town on Earth , and Thomas Wolfe's
Look Homeward, Angel .
In the one-act play 1918 by
Horton Foote (part of his Orphans\' Home
Cycle (1979)), the presence and threat of the flu (and the tragedy it
ultimately causes) is a major element of the plot. The play was made
into a film of the same title , released in 1985, which was
subsequently edited for broadcast by
PBS as the last part of the
miniseries "The Story of A Marriage".
American Red Cross
American Red Cross nurses demonstrating treatment practices
during the influenza pandemic of 1918.
Albertan farmers wearing masks to protect themselves from the flu.
Policemen wearing masks provided by the
American Red Cross
American Red Cross in Seattle
A street car conductor in
Seattle in 1918 refusing to allow
passengers aboard who are not wearing masks
Red Cross workers remove a flu victim in
St. Louis , Missouri (1918)
Influenza ward at Walter Reed Hospital during the Spanish flu
pandemic of 1918–1919
Burying flu victims, North River, Canada (1918)
1919 Tokyo, Japan
Japanese poster in 1919
Demonstration at the Red Cross Emergency Ambulance Station in
Washington, D.C., during the influenza pandemic of 1918
Cavalry memorial on the hill Lueg, memory of the Bernese cavalrymen
victims of the 1918 flu pandemic;
Emmental , Bern ,
The Spanish flu as the Naples Soldier (Spain, 1918)
Spanish biologists and the flu microbe (Spain, 1918)
* ^ "La Grippe Espagnole de 1918" (in French).
Institut Pasteur .
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original-url status unknown (link )
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