Instituto de Historia de la Medicina y de la Ciencia "Lòpez Pinero"

The museum of the Instituto de Historia de la Medicina y de la Ciencia "Lòpez Pinero" in Valencia (Plaza Cisneros, 4) an interesting section dedicated to the so-called "Spanish flu" pandemic.

More information at the Institute's official website (in Spanish).


Etymology and First outbreak of the “Spanish Flu”

The hit the world between 1918 and 1920, just before the end of the Great War and for the following two years, aggravating what had already been a very difficult period in itself because of the First World War.

Contrary to what one might think, the "Spanish flu", a name now sadly known to us, did not originate in the Iberian Peninsula (although Spain was hit hard by disease, even Spain's king, Alfonso XIII, reportedly contracted the flu).

Since its beginning, the epidemic has been called the Spanish flu (or the “Spanish Lady”), probably because of the misinformation surrounding the news about the origin of the epidemic. It is usually accepted that, because Spain was a neutral country in World War I, freedom of the press in Spain was greater than that in the allied countries and in Germany.

The first public news of the epidemic appeared in Madrid. On 22 May 1918, the influenza epidemic was a headline in Madrid’s ABC newspaper. News stated that spread of a strange influenza-like illness, which was very mild, had been ongoing since the beginning of May.
The Spanish, meanwhile, believed the virus came from France and called it the “French Flu”.

The US and European press, likely for political reasons, did not acknowledge or transmit timely and accurate news about the high number of casualties among their military and civilian population that were attributable to the ongoing influenza epidemic.

Scientists are still not sure which country the contagion started from, some studies trace the first cases in France, Great Britain, China or the United States.
The most accepted hypothesis is that the virus began to spread from the latter, where the first official case was reported at Camp Funston in Fort Riley, Kansas, on March 11, 1918 (one of sixteen U.S. Army training camp established at the outbreak of WWI). Infected soldiers spread the disease to other military camps across the country, then brought it overseas. In fact, in March 1918, 84.000 American soldiers left for Europe crossing the Atlantic, and were followed by 118.000 others the following month.


Spread and Mortality of the Virus

The virus that caused the pandemic rapidly evolved within a few months. It went from a form of little contagious and little lethal (comparable to seasonal flu) to a very contagious and very lethal form that left no escape for its victims.
The first wave of the 1918 pandemic occurred in the spring and was generally mild. The sick, who experienced such typical flu symptoms as chills, fever and fatigue, usually recovered after several days, and the number of reported deaths was low.
However, a second, highly contagious wave of influenza appeared with a vengeance in the fall of that same year. Victims died within hours or days of developing symptoms, their skin turning blue and their lungs filling with fluid that caused them to suffocate.
Due to the lack of medical records in many countries in Europe at the time, there is no precise data on the deaths that the flu caused, nowadays the death toll attributed to the Spanish flu is often estimated at 20 million to 50 million victims worldwide. Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic.

The genetic sequence of the influenza A(H1N1) virus that caused the pandemic was discovered in 2005 through the joint efforts of the Armed Forces Institute of Pathology, the USDA ARS Southeast Poultry Research Laboratory, and the Mount Sinai School of Medicine in New York City.
In 2008, researchers announced they’d discovered what made the 1918 flu so deadly: a group of three genes enabled the virus to weaken a victim’s bronchial tubes and lungs and clear the way for bacterial pneumonia.


Drugs and strategies against Spanish flu

When the 1918 flu hit, doctors and scientists were unsure what caused it or how to treat it. Unlike today, there were no effective vaccines or antivirals, drugs that treat the flu.

Given the absence of effective anti-flu drugs, a very particular phenomenon developed at the time. Many doctors began prescribing their patients medications to alleviate symptoms, especially aspirin. Aspirin was produced and marketed for the first time in history by Bayer in 1899, but due to the fact that the patent expired in 1917, it allowed many laboratories worldwide to synthesize it in large quantities especially during the pandemic.
Medical professionals advised patients to take up to 30 grams per day, a dose now known to be toxic. Symptoms of aspirin poisoning included hyperventilation and pulmonary edema, or the buildup of fluid in the lungs, and it’s now believed that many of the October deaths were actually caused or hastened by aspirin poisoning.

Physicians and Public Health Officials suggested several measures to prevent influenza transmission. These measures included: cleaning and disinfecting the mouth and nostrils with hydrogen peroxide or a mixture of oil and menthol, avoiding meetings or gatherings in closed settings, avoiding direct contact with ill people, eating a healthy diet, walking often in fresh open air, ventilating homes, use of masks, and resting as needed; streets were cleaned with a mixture of water and sodium hypochlorite and even the goods sold were disinfected.

The small array of treatments prescribed included symptomatic therapy with salicilates and quinine and codeine for cough.


For persons who developed pneumonia, the therapeutic options were even fewer and included intramuscular or intravenous treatment with silver or platinum colloid solutions, digitalis, alcamphor oil, or adrenaline. Bleeding was often used.


Some experimental vaccines were also tried, notably those including mixtures of pneumococci, streptococci, and Pfeiffer bacillus (Haemophilus influenzae) with the aim of preventing respiratory complications brought by the flu.

  • Photos and main text by Cristiano Iaccarino (December 2019)
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