“Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever.”

- Sir William Osler ³

Emergency hospital during 1918 pandemic, Kansas

It started, harmlessly enough, with a cough drowned out by the raging world war. It was known as Spanish influenza only because censorship by the warring governments wouldn’t allow reports of the spreading illness for fear it would damage morale.⁴ However, Spain, being neutral, allowed its press to publicize what was happening. The first cable read, “A STRANGE FORM OF DISEASE OF EPIDEMIC CHARACTER HAS APPEARED IN MADRID.” Because of the censors, even as millions were dying around the globe, the world press was apt to report little about the pandemic beyond what the Spanish King Alfonzo’s temperature was that morning.⁵ In Spain they called it the French flu.⁶

“The year 1918 has gone,” the editors of the Journal of the American Medical Association wrote in the Christmas issue, “a year momentous as the termination of the most cruel war in the annals of the human race; a year which marked the end, at least for a time, of man’s destruction of man; unfortunately a year in which developed a most fatal infectious disease….”⁷ That most fatal disease killed about 10 times more Americans than did the war.⁸ In fact, according to the World Health Organization (WHO), “The 1918 influenza pandemic killed more people in less time than any other disease before or since,”⁹ the “most deadly disease event in the history of humanity….”¹⁰

The word “epidemic” comes from the Greek epi, meaning “upon,” and demos, meaning “people.” The word “pandemic” comes from the Greek word pandemos, meaning “upon all the people.”¹¹ Most outbreaks of disease are geographically confined, just like most disasters in general. Wars, famines, earthquakes, and acts of terror, for example, tend to be localized both in time and space. We look on in horror, but may not be affected ourselves. Pandemics are different. Pandemics are worldwide epidemics. They happen everywhere at once, coast to coast, and can drag on for more than a year.¹² “With Hurricane Katrina, people opened their homes, sent checks and people found safe havens,” writes a global economic strategist at a leading investment firm, but with a pandemic, “there is nowhere to turn, no safe place to evacuate.”¹³

The word “influenza” derives from the Italian influentia, meaning “influence,” reflecting a medieval belief that astrological forces were behind the annual flu season.¹⁴ In 1918, though, the Germans called it Blitzkatarrh.¹⁵ To the Siamese, it was Kai Wat Yai, The Great Cold Fever.¹⁶ In Hungary, it was The Black Whip. In Cuba and the Philippines, it was Trancazo, meaning “a blow from a heavy stick.” In the United States, it was the Spanish Lady, or, because of the way many died, the Purple Death.