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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.