Spanish flu 198796 226137957 2008-07-17T00:04:15Z Xinoph 47982 /* Spanish flu research */ The '''1918 flu pandemic''' (commonly referred to as the '''Spanish flu''') was an [[influenza]] pandemic that was first found in the [[United States]], appeared in [[Sierra Leone]] and [[France]], and then spread to nearly every part of the world. It was caused by an unusually severe and deadly [[Influenza A virus]] [[Strain (biology)|strain]] of subtype [[H1N1]]. Many of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The Spanish flu lasted from March 1918 to June 1920,<ref>[http://www.pasteur.fr/infosci/conf/CRC/Grippe_CRC.ppt ''Institut Pasteur. La Grippe Espagnole de 1918'' (Powerpoint presentation in French)]</ref> spreading even to the [[Arctic]] and remote Pacific islands. It is estimated that anywhere from 20 to 100&nbsp;million people were killed worldwide, or the approximate equivalent of one third of the population of Europe,<ref>America: A Narrative History by Tindall, George Brown & Shi, David Emory 7th ed. copyright 2007 by W.W Norton & Company, Inc.</ref><ref>[http://virus.stanford.edu/uda/ The 1918 Influenza Pandemic<!-- Bot generated title -->]</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/11875246?dopt=Abstract www.ncbi.nlm.nih.gov. NCBI. PubMed. Johnson NP, Mueller J. ''Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic.'' (2002)]</ref> more than double the number killed in [[World War I]].<ref>{{cite book | last = Hakim | first = Joy | authorlink = | coauthors = | title = War, Peace, and all that Jazz | publisher = Oxford University Press | date = 1995 | location = New York | pages = 21–24 | url = | doi = | id = | isbn = }}</ref> This extraordinary toll resulted from the extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by [[cytokine storm]]s. The disease was first observed at [[Fort Riley, Kansas]], [[United States]], on [[March 4]], [[1918]],<ref>[http://www.avian-bird-flu.info/spanishfluepidemic1918.html Avian Bird Flu. ''1918 Flu (Spanish flu epidemic)'']</ref> and [[Queens]], [[New York]], on [[March 11]], [[1918]]. In August 1918, a more virulent strain appeared simultaneously in [[Brest, France]], in [[Freetown, Sierra Leone]], and in the U.S. at [[Boston, Massachusetts]]. The [[Allies of 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]].<ref>See: [[Talk:Spanish flu#Origin of the name "spanish flu"]] {{unverifiable|date=November 2007}} </ref> Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a [[cytokine storm]], which explains its unusually severe nature and the unusual age profile of its victims (the virus caused an overreaction of the body's immune system—the strong immune systems of young adults ravaged the body, while the weaker immune systems of children and middle-aged adults caused less morbidity and mortality). ==Mortality== [[Image:W curve.png|thumb|300px|right|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).<ref name = "Taubenberger">{{cite journal | last = Taubenberger | first = J | coauthors = Morens D | title = 1918 Influenza: the mother of all pandemics. | url = http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm | journal = Emerg Infect Dis | volume = 12 | issue = 1 | pages = 15–22 | year = 2006 | pmid = 16494711}}</ref>]] [[Image:Spanish flu death chart.png|thumb|180px|Chart of deaths in major cities]] The global [[mortality rate]] from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of the human population, with 20% or more of the world population suffering from the disease to some extent. Influenza may have killed as many as 25&nbsp;million in its first 25 weeks (in contrast, [[AIDS]] killed 25&nbsp;million in its first 25&nbsp;years). Older estimates say it killed 40–50&nbsp;million people<ref name=Patterson1>{{cite journal | last =Patterson | first = KD | coauthors = Pyle GF | title=The geography and mortality of the 1918 influenza pandemic. | journal= Bull Hist Med. | year=1991 | month=Spring | volume=65 | issue=1 | pages = 4–21 | pmid = 2021692}}</ref> while current estimates say 50&nbsp;million to 100&nbsp;million people worldwide were killed.<ref name=Knobler>{{cite book | editor=Knobler S, Mack A, Mahmoud A, Lemon S | title = The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005) | chapter=1: The Story of Influenza | pages = 60–61 | chapterurl=http://darwin.nap.edu/books/0309095042/html/60.html | publisher=The National Academies Press | location=Washington, D.C.}}</ref> This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the [[Black Death]].<ref name=Potter>{{cite journal | last =Potter | first = CW| title=A History of Influenza | url= http://www.blackwell-synergy.com/doi/full/10.1046/j.1365-2672.2001.01492.x | journal= J Appl Microbiol. | year=2006 | month=Oct | volume=91 | issue= 4 | pages = 572–579 | pmid = 11576290 | doi =10.1046/j.1365-2672.2001.01492.x <!--Retrieved from URL by DOI bot-->}}</ref> An estimated 7&nbsp;million died in [[India]], about 2.78% of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it {{Fact|date=December 2007}}. In the [[United States|U.S.]], about 28% of the population suffered, and 500,000 to 675,000 died. In [[United Kingdom of Great Britain and Ireland|Britain]] as many as 250,000 died; in [[France]] more than 400,000. In Canada approximately 50,000 died. Entire villages perished in [[Alaska]] and [[southern Africa]]. In [[Australia]] an estimated 12,000&nbsp;people died and in the [[Fiji Islands]], 14% of the population died during only two weeks, and in [[Western Samoa]] 22%. 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.<ref name=Patterson1/> Indeed, 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 [[petechia|petechial hemorrhages]] in the skin also occurred."<ref name=Knobler/> The majority of deaths were from [[bacterial pneumonia]], a [[secondary infection]] caused by influenza, but the virus also killed people directly, causing massive [[bleeding|hemorrhages]] and [[edema]] in the lung.<ref name=Taubenberger>{{cite journal | last = Taubenberger | first = J | coauthors = Reid A, Janczewski T, Fanning T | title = Integrating historical, clinical and molecular genetic data in order to explain the origin and virulence of the 1918 Spanish influenza virus. | journal = Philos Trans R Soc Lond B Biol Sci | volume = 356 | issue = 1416 | pages = 1829–39 | year = 2001 | month=Dec 29 | pmid = 11779381 | url= http://www.journals.royalsoc.ac.uk/(3sud2455cjw1ut55yowx1d45)/app/home/contribution.asp?referrer=parent&backto=issue,3,22;journal,61,225;linkingpublicationresults,1:102022,1 | doi = 10.1098/rstb.2001.1020}}</ref> The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic [[mortality rate]] of 0.1%.<ref name=Taubenberger/><ref name=Knobler/> Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40&nbsp;years old.<ref>{{cite journal | last = Simonsen | first = L | coauthors = Clarke M, Schonberger L, Arden N, Cox N, Fukuda K | title = Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. | journal = J Infect Dis | volume = 178 | issue = 1 | pages = 53–60 | year = 1998 | month=Jul | pmid = 9652423}}</ref> This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70). ==History== While [[World War I]] did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic. Researchers speculate that the soldiers' immune systems were weakened by the stresses of combat and chemical attacks, increasing their susceptibility to the disease. A large factor of worldwide flu prevalence was increased travel. The modern transportation systems made it easier for soldiers, sailors, and travelers to spread the disease quickly and to communities worldwide. [[Image:1918 flu in Oakland.jpg|thumb|[[American Red Cross]] nurses tend to flu patients in temporary wards set up inside [[Oakland, California|Oakland]] Municipal Auditorium, 1918]] Two poems, dedicated to the Spanish flu, were popular in those days: <blockquote> ''I had a little bird,<br />'' ''Its name was Enza,<br />'' ''I opened the window,<br />'' ''And'' '''in-flew-enza.'''<br /> <small>-American Skipping Rhyme circa 1918</small> </blockquote> <blockquote> ''Obey the laws<br />'' ''And wear the gauze.<br />'' ''Protect your jaws<br />'' ''From septic paws.'' </blockquote> ===Patterns of fatality=== The influenza [[Strain (biology)|strain]] was unusual in that this pandemic killed many young adults and otherwise healthy victims – typical influenzas kill mostly [[infant]]s (aged 0-2&nbsp;years), the elderly, and the [[immunocompromise]]d. Another oddity was that this influenza outbreak was widespread in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months. People without symptoms could be stricken suddenly and within hours be too weak to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable [[hemorrhage|hemorrhaging]] that filled the [[lungs]], and patients drowned in their body fluids ([[pneumonia]]). In others, the flu caused frequent loss of bowel control and the victim would die from losing critical intestinal lining and blood loss. In fast-progressing cases, mortality was primarily from [[pneumonia]], by virus-induced [[consolidation (medicine)|consolidation]]. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been [[neural]] involvement that led to [[mental disorders]] in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities. ===Devastated communities=== [[Image:165-WW-269B-11-trolley-l.jpg|thumb|right|Street car conductor in Seattle not allowing passengers aboard without a [[mask]] in 1918.]] While in most places less than one-third of the population was infected, only a small percentage of whom died, in a number of towns in several countries entire populations were wiped out. Even in areas where mortality was low, those incapacitated by the illness were often so numerous as to bring much of everyday life to a stop. Some communities closed all stores or required customers not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by [[steam shovel]] and bodies buried without coffins in many places. ===Unaffected locales=== 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. The only sizeable inhabited place with no documented outbreak of the flu in 1918&ndash;1919 was the island of [[Marajó]] at the mouth of the [[Amazon River]] in [[Brazil]]{{Fact|date=September 2007}} . In the Pacific, [[American Samoa]]<ref name=usnavyreport> [http://www.history.navy.mil/library/online/influenza_main.htm Influenza of 1918 (Spanish Flu) and the US Navy]</ref> and the French colony of [[New Caledonia]] <ref name=whoreport>{{cite journal | author=[[World Health Organization]] Writing Group | title=Nonpharmaceutical interventions for pandemic influenza, international measures. | journal=Centers for Disease Control and Prevention (CDC) Emerging Infectious Diseases (EID) Journal | year=2006 | pages=189 | volume=12 | issue=1 |url=http://www.cdc.gov/ncidod/EID/vol12no01/05-1370.htm }}</ref> also succeeded in preventing even a single death from influenza through effective [[quarantine]]s. In Australia, only 12,000 perished compared to higher rates in other countries. ===Government Response=== The Great Influenza was the source of much fear in citizens around the world. Further inflaming that fear was the fact that governments and health officials were downplaying the influenza. While the panic from WWI was dwindling, governments attempted to keep morale up by spreading lies and dismissing the influenza. On Sept. 11, 1918, Washington officials reported that the Spanish Influenza had arrived in the city. The following day, roughly thirteen million men across the country lined up to register for the war draft, providing the influenza with an efficient way to spread. However, the influenza had little impact upon institutions and organizations. While medical scientists did rapidly attempt to discover a cure or vaccine, there were virtually no changes in the government or corporations. Additionally, the political and military events were fairly unaffected due to the impartiality of the disease, affecting either side likewise. <ref>Graham, Rod. "Author Brings "The Great Influenza" to the School.." John Hopkins Bloomberg School of Public Health. 4 Mar 2005. John Hopkins Bloomberg School of Public Health. 6 Jun 2008 http://www.jhsph.edu/publichealthnews/articles/2005/great_influenza.html</ref> ===Cultural Impact=== In the [[United States]], despite the relatively high [[morbidity]] and [[mortality]] rates that resulted from the epidemic in 1918-1919, the Spanish flu remained a relatively obscure event until the rise in public awareness of [[bird flu]] and other pandemics in the 1990s and 2000s. This has led some historians to label the Spanish flu a “forgotten pandemic.” <ref>Crosby, Alfred. ''America's Forgotten Pandemic''. New York: Cambridge University Press, 2003.</ref> Indeed, one of the only major works of American literature written after 1918 that deals directly with the Spanish flu is [[Katherine Anne Porter]]’s ''[[Pale Horse, Pale Rider]]''. More recently (2006), author Thomas Mullen wrote a novel called ''[[The Last Town on Earth]]'', about the impact of the Spanish flu on a fictional mill town in Washington and author Myra Goldberg wrote a novel called ''[[Wickett's Remedy]]'' that is set in Boston during the pandemic. Several theories have been offered as to why the Spanish flu may have been “forgotten” by historians and the public over so many years, including the rapid pace of the pandemic (it killed most of its victims in the United States in a period of less than nine months), Americans' familiarity with pandemic disease in the late 19th and early 20th centuries, and the distraction of the [[First World War]].<ref>Crosby, ''America's Forgotten Pandemic'', pp. 320–322.</ref> Another explanation is shown when observing the age group affected by the disease. The majority of fatalities, in both World War One and by the Spanish Flu, were young adults. The deaths caused by the flu were overlooked due to the deaths from the war. When people would read the obituaries they would see the deaths from war and the deaths from the influenza side by side. Seeing the figures right next to each other lessened the impact the influenza had on individual people. <ref>Simonsen, L; Clarke M, Schonberger L, Arden N, Cox N, Fukuda K (Jul 1998). "Pandemic versus epidemic influenza mortality: a pattern of changing age distribution."</ref> The fact that the disease would usually only affect a certain area for a month before leaving, left little time for the disease to have a significant impact on the economy. During this time period pandemic out breaks were not uncommon, the terror of typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks lessened the impact the Influenza pandemic had on Americans. <ref>Morrisey, Carla R. "The Influenza Epidemic of 1918." Navy Medicine 77, no. 3 (May-June 1986): 11-17.</ref> ==Spanish flu research== {{main|Spanish flu research}} One theory is that the virus strain originated at [[Fort Riley]], [[Kansas]], by two [[genetics|genetic]] mechanisms – [[genetic drift]] and [[antigenic shift]] – in viruses in poultry and swine which the fort bred for local consumption, but evidence from a recent reconstruction of the virus suggests that it jumped directly from [[Bird flu| birds to humans]], without traveling through swine.<ref name=influenzareport>Sometimes a virus contains both avian adapted genes and human adapted genes. Both the [[H2N2]] and [[H3N2]] pandemic strains contained avian flu virus [[RNA]] segments. "While the pandemic human influenza viruses of 1957 (H2N2) and 1968 (H3N2) clearly arose through reassortment between human and avian viruses, the influenza virus causing the '[[Spanish flu]]' in 1918 appears to be entirely derived from an avian source (Belshe 2005)." (from [http://www.influenzareport.com/ir/ai.htm Chapter Two : Avian Influenza by Timm C. Harder and Ortrud Werner], an excellent free on-line Book called ''Influenza Report 2006'' which is a medical textbook that provides a comprehensive overview of epidemic and pandemic influenza.)</ref> On [[October 5]], [[2005]], researchers announced that the genetic sequence of the 1918 flu strain, a subtype of avian strain H1N1, had been reconstructed using historic tissue samples.<ref>{{cite journal |last=Taubenberger |first=Jeffery K. |coauthors=''et al.'' |year=2005 |title=Characterization of the 1918 influenza virus polymerase genes |journal=[[Nature (journal)|Nature]]|volume=437 |issue= |pages=889&ndash;893 |doi=10.1038/nature04230}}</ref> <ref>{{cite journal |last=Tumpey |first=Terrence M. |coauthors=''et al.'' |year=2005|title=Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus |journal=[[Science (journal)|Science]]|volume=310 |issue= |pages=77&ndash;80 |doi=10.1126/science.1119392|pmid=16210530}}</ref> On [[18 January]] [[2007]], Kobasa ''et al.'' reported that infected monkeys (''[[Macaca fascicularis]]'') exhibited classic symptoms of the 1918 pandemic and died from a [[cytokine storm]].<ref>{{ cite journal | last = Kobasa | first = Darwyn | coauthors = ''et al.'' | year = 2007 | month = | title = Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus | journal = Nature | volume = 445 | issue = | pages = 319&ndash;323 | doi = 10.1038/nature05495| quote = }}</ref> == Victims== [[Image:Sp-flu-alberta-field.jpg|thumb|250px|[[Alberta]]n farmers wearing masks to protect themselves from the flu.]] === Famous === * [[Guillaume Apollinaire]], French poet († [[November 9]], [[1918]]) * [[Felix Arndt]], American pianist († [[October 16]], [[1918]]) * [[George Freeth]], father of modern surfing and lifeguard († [[April 7]], [[1919]]) * [[Sophie Halberstadt-Freud]], daughter of Austrian psychoanalyst [[Sigmund Freud]], († 1920) * [[Harold Gilman]], British painter († [[February 12]], [[1919]]) * [[Henry G. Ginaca]], American engineer, inventor of the Ginaca machine († [[October 19]], [[1918]]) * [[Charles Tomlinson Griffes]], American composer († [[April 8]], [[1920]]) * [[Joe Hall]], [[Montreal Canadiens]] [[defenceman (ice hockey)|defenceman]], a member of the [[Hockey Hall of Fame]] († [[April 6]], [[1919]]). * [[Phoebe Hearst]], mother of [[William Randolph Hearst]], († [[April 13]], [[1919]]) * [[Jacinta and Francisco Marto|Francisco Marto]], ''[[Our Lady of Fatima|Fátima]] child'' († [[April 4]], [[1919]]) * [[Jacinta and Francisco Marto|Jacinta Marto]], ''[[Our Lady of Fatima|Fátima]] child'' († [[February 20]], [[1920]]) * [[Alan Arnett McLeod]], [[Victoria Cross]] winner, († [[6 November]], [[1918]]) * Sir [[Hubert Parry]], [[United Kingdom|British]] [[composer]], († [[October 7]], [[1918]]) * [[William Leefe Robinson]], [[Victoria Cross]] winner, († [[December 31]], [[1918]]) * [[Edmond Rostand]], French dramatist, best known for his play [[Cyrano de Bergerac (play)|Cyrano de Bergerac]], († [[December 2]], [[1918]]) * [[Egon Schiele]], Austrian painter († [[October 31]], [[1918]]). His wife Edith, who was six months pregnant, succumbed to the disease only three days before. * [[Yakov Sverdlov]], [[Bolshevik]] party leader and official of pre-[[USSR]] [[Russia]] († [[March 16]] [[1919]]) * [[Mark Sykes]], British politician and diplomat († [[February 16]], [[1919]]) * [[Max Weber]], German political economist and sociologist († [[June 14]], [[1920]]) * [[Prince Erik, Duke of Västmanland]] (''Erik Gustav Ludvig Albert Bernadotte''), Prince of Sweden, Duke of Västmanland († [[September 20]], [[1918]]) *[[Vera Kholodnaya]], The first star of Russian silent cinema († [[February 16]], [[1919]]) *[[Dark Cloud (actor)]], aka Elijah Tahamont, American Indian actor, in Los Angeles (1918). * Franz Karl Salvator (1893-1918), son of [[Archduchess Marie Valerie of Austria]] and Archduke Franz Salvator, grandson of Empress [[Elisabeth of Bavaria]] and Emperor [[Franz Joseph I of Austria]], died unmarried and childless. * Anaseini Takipō, Queen of [[Tonga]] from 1909, consort of King [[George Tupou II of Tonga]], survived by one daughter, († [[November 26]], [[1918]]) * [[Louis Botha]], first Prime Minister of the [[Union of South Africa]], († [[August 27]], [[1919]])<ref>{{cite book |title=Hunting the 1918 Flu: One Scientist's Search for a Killer Virus |last=Duncan |first=Kirsty |year=2003 |publisher=University of Toronto Press |isbn=0802087485 |pages=304 }}</ref> * Harry Elionsky, American champion long-distance swimmer<ref>{{cite book |title=Hunting the 1918 Flu: One Scientist's Search for a Killer Virus |last=Duncan |first=Kirsty |year=2003 |publisher=University of Toronto Press |isbn=0802087485 |pages=304 }}</ref> * "Admiral Dot" (1864-1918), circus performer under [[P. T. Barnum]]<ref>[http://www.pbs.org/wgbh/amex/influenza/sfeature/victims.html PBS. Influenza 1918. ''Victims'']</ref> * Irmy Cody Garlow, daughter of [[Buffalo Bill|Buffalo Bill Cody]]<ref>[http://www.pbs.org/wgbh/amex/influenza/sfeature/victims.html PBS. Influenza 1918. ''Victims'']</ref> * [[Harold Lockwood]], silent film star, († [[October 19]], [[1918]])<ref>[http://www.pbs.org/wgbh/amex/influenza/sfeature/victims.html PBS. Influenza 1918. ''Victims'']</ref> === Fictional === * Hazel Forrest Bellamy, a fictional character in the television series "[[Upstairs, Downstairs]]" (played by Meg Wynn Owen) († [[1918]]) * William Krichinsky, a fictional character in the film "Avalon", directed by Barry Levinson *Fanny and Jemma Macgregor in If I Die Before I Wake by [[Jean Little]] * Elizabeth Masen and Edward Anthony Masen Sr., fictional characters in the Twilight series by [[Stephenie Meyer]]. († [[1918]]) ==References== {{Reflist|2}} ==Further reading== {{refbegin|2}} *{{cite book|last=Barry|first=John M.|title=The Great Influenza: The Epic Story of the Greatest Plague in History|publisher=Viking Penguin|year=2004|isbn=0-670-89473-7|series=}} *{{cite journal|last=Beiner|first=Guy|year=2006|title=Out in the Cold and Back: New-Found Interest in the Great Flu|journal=Cultural and Social History|issn=|volume=3|issue=4|pages=496–505}} *{{cite book|last=Collier|first=Richard|title=The Plague of the Spanish Lady - The Influenza Pandemic of 1918-19|publisher=Atheneum|location=USA|year=1974|isbn=0-8371-8376-6|series=}} *{{cite book|last=Crosby|first=Alfred W.|title=America's Forgotten Pandemic: The Influenza of 1918|publisher=Cambridge University Press|location=Cambridge|year=1990|isbn=0689105924 |series=}}. A popular history. *{{cite book|last=Crosby|first=Alfred W.|title=Epidemic and Peace, 1918|publisher=Greenwood Press|location=Westport, Ct|year=1976|isbn=0-8371-8376-6|series=}} *{{cite book|last=Johnson|first=Niall|title=Britain and the 1918-19 Influenza Pandemic: A Dark Epilogue|publisher=Routledge|location=London and New York|year=2006|isbn=0-415-36560-0|series=}} *{{cite journal|last=Johnson|first=Niall|year=2003|title=Measuring a pandemic: Mortality, demography and geography|journal=Popolazione e Storia|pages=31–52}} *{{cite journal|last=Johnson|first=Niall|year=2003|title=Scottish ’flu – The Scottish mortality experience of the “Spanish flu|journal=Scottish Historical Review|volume=83|issue=2|pages=216–226}} *{{cite journal|last=Johnson|first=Niall|coauthors=Juergen Mueller|year=2002|title=Updating the accounts: global mortality of the 1918–1920 ‘Spanish’ influenza pandemic|journal=Bulletin of the History of Medicine|volume=76|pages=105–15|doi=10.1353/bhm.2002.0022}} *{{cite book|last=Kolata|first=Gina|title=Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It|publisher=Farrar, Straus and Giroux|location=New York|year=1999|isbn=0-374-15706-5|series=}} *{{cite book|last=Little|first=Jean|authorlink=Jean Little|title=If I Die Before I Wake: The Flu Epidemic Diary of Fiona Macgregor, Toronto, Ontario, 1918|publisher=Scholastic Canada|location=Markham, Ont.|year=2007|isbn=9780439988377|series=[[Dear Canada]]}} *{{cite journal|last=Noymer|first=Andrew|coauthors=Michel Garenne|year=2000|title=The 1918 Influenza Epidemic's Effects on Sex Differentials in Mortality in the United States|journal=Population and Development Review|issn=0098-7921|volume=26|issue=3|pages=565–581|doi=10.1111/j.1728-4457.2000.00565.x}} *{{cite journal |author=Oxford JS, Sefton A, Jackson R, Innes W, Daniels RS, Johnson NP |title=World War I may have allowed the emergence of "Spanish" influenza |journal=The Lancet infectious diseases |volume=2 |issue=2 |pages=111–4 |year=2002 |pmid=11901642 |doi=10.1016/S1473-3099(02)00185-8}} *{{cite journal |author=Oxford JS, Sefton A, Jackson R, Johnson NP, Daniels RS |title=Who's that lady? |journal=Nat. Med. |volume=5 |issue=12 |pages=1351–2 |year=1999 |pmid=10581070 |doi=10.1038/70913}} *{{cite book|last=Phillips|first=Howard|coauthors=David Killingray (eds)|title=The Spanish Flu Pandemic of 1918: New Perspectives|publisher=Routledge|location=London and New York|year=2003}} *{{cite journal|last=Rice|first=Geoffrey W.|coauthors=Edwina Palmer|year=1993|title=Pandemic Influenza in Japan, 1918-1919: Mortality Patterns and Official Responses|journal=Journal of Japanese Studies|issn=0095-6848|volume=19|issue=2|pages=389–420|doi=10.2307/132645}} *{{cite book|last=Rice|first=Geoffrey W.|title=Black November: the 1918 Influenza Pandemic in New Zealand|location=Canterbury University Press|year=2005|isbn=1-877257-35-4|series=}} *{{cite journal |author=Tumpey TM, García-Sastre A, Mikulasova A, ''et al'' |title=Existing antivirals are effective against influenza viruses with genes from the 1918 pandemic virus |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=99 |issue=21 |pages=13849–54 |year=2002 |pmid=12368467 |doi=10.1073/pnas.212519699 | url = http://www.pnas.org/cgi/content/full/99/21/13849}} *{{cite book| last = Hakim| first = Joy| title = War, Peace, and all that Jazz| publisher = Oxford University Press| date = 1995 | location = New York| pages = 21–24| id = | isbn = }}</ref> {{refend}} ==External links== {{commonscat|Spanish flu}} *[http://www.scribemedia.org/2006/11/22/avian-flu/ Video from Expert Panel Discussion on Avian Flu] *[http://www.nature.com/nature/focus/1918flu/index.html ''Nature'' "Web Focus" on 1918 flu, including new research] *[http://www.stanford.edu/group/virus/uda/ Influenza Pandemic on stanford.edu] *[[n:The Deadliest Fall|Article: The Deadliest Fall]] *[http://www.pbs.org/wgbh/amex/influenza/ Influenza 1918 in the United States on pbs.org] *[http://www.pbs.org/wnet/secrets/case_killerflu/index.html Secrets of the Dead: Killer Flu (PBS)] *[http://www.upenn.edu/gazette/1198/lynch.html Flu by Eileen A. Lynch. The devastating effect of the Spanish flu in the city of Philadelphia, PA, USA] *[http://www.ninthday.com/tauben.htm Dialog: An Interview with Dr. Jeffery Taubenberger on Reconstructing the Spanish Flu] *[http://www.archives.gov/exhibits/influenza-epidemic/ The Deadly Virus - The Influenza Epidemic of 1918], by the National Archives and Records Administration (see actual pictures and records of the time). *[http://www.nzhistory.net.nz/culture/1003 The 1918 Influenza Pandemic in New Zealand - includes recorded recollections of people who lived through it] *[http://www.nytimes.com/2005/10/06/health/06flu.html?ex=1286251200&en=3f9a510cfd4c3d45&ei=5090 Experts Unlock Clues to Spread of 1918 Flu Virus] - ''[[The New York Times]]'' *[http://www.pbs.org/wgbh/amex/influenza/sfeature/latest.html PBS - recovery of flu samples from Alaskan flu victims] *[http://www.medsci.org/v02p0087.htm An Avian Connection as a Catalyst to the 1918-1919 Influenza Pandemic] *[http://www.gi.alaska.edu/ScienceForum/ASF13/1386.html Alaska Science Forum - Permafrost Preserves Clues to Deadly 1918 Flu] *[http://www.vlib.us/medical/mja.htm Pathology of Influenza in France, 1920 Report] *[http://www.cosmosmagazine.com/node/694 "Deadly secret of 1918 flu virus unmasked"], ''Cosmos'' magazine, September 2006 *[http://ww3.startribune.com/blogs/oldnews/archives/43 Yesterday's News blog], 1918 newspaper account on impact of flu on Minneapolis *[http://news.bbc.co.uk/1/hi/health/6271833.stm "Lethal secrets of 1918 flu virus"] BBC News, January 2007 *[http://www.news.wisc.edu/13360.html "Study uncovers a lethal secret of 1918 influenza virus"] University of Wisconsin - Madison, [[January 17]], [[2007]] *[http://www.translational-medicine.com/content/2/1/3 "The site of origin of the 1918 influenza pandemic and its public health implications"] Journal of Translational Medicine, [[January 20]], [[2004]] {{Influenza}} [[Category:Aftermath of World War I]] [[Category:1918 disasters]] [[Category:Influenza pandemic]] [[ca:Grip espanyola]] [[cs:Španělská chřipka]] [[da:Den Spanske Syge]] [[de:Spanische Grippe]] [[es:Gripe española]] [[eo:Hispana gripo]] [[eu:Espainiako gripea]] [[fr:Grippe de 1918]] [[gl:Gripe de 1918]] [[ko:스페인 독감]] [[id:Flu Spanyol]] [[is:Spænska veikin]] [[it:Influenza spagnola]] [[he:השפעת הספרדית]] [[la:Morbus Hispanicus]] [[lt:Ispaniškasis gripas]] [[hu:Spanyolnátha]] [[ms:Selsema Sepanyol]] [[nl:Spaanse griep]] [[ja:スペインかぜ]] [[no:Spanskesyken]] [[nn:Spanskesjuka]] [[pl:Pandemia grypy w latach 1918-1919]] [[pt:Gripe espanhola]] [[ro:Gripa spaniolă]] [[ru:Испанский грипп]] [[simple:Spanish flu]] [[fi:Espanjantauti]] [[sv:Spanska sjukan]] [[tr:İspanyol gribi]] [[uk:Іспанський грип]] [[zh:西班牙型流行性感冒]]