The flu pandemic that came out in the city of Kansas City, USA in the spring season of 1918, named as the Spanish Flu, did not only affect First World War, but it also caused the death of millions of people. Nearly 500 million people were infected, and the number of people who died due to the pandemic in the world was approximately 50 million and the general death rate was between 2.5 and 5 per thousand. The so-called Spanish Flu killed more people (60 million) in a particular length of time than any disease other than the Black Death. The biggest characteristic of the Spanish Flu is that it is the pandemic that is known best in history that affected and killed healthy young people rather than the elderly, children, and the weak. The measures taken to prevent the spread of the Spanish Flu hit many sectors, mainly the food and beverage sectors. Some foods and beverages such as whiskey and onions played an important role in the treatment of the disease at that period.
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Influenza is an upper respiratory tract infection that is caused by viruses. Even though flu and cold reveal the same symptoms, they are in fact two different diseases. Common cold is a mild illness that can be described as harmless as caused by the virus. Flu is a more serious infection. Influenza is seen in the body with symptoms such as high fever, insomnia, and pharyngitis (sore throat). It can give rise to complications such as influenza, pneumonia, and bronchitis (Hudson, 1983). In microbiological respect, there are 3 different influenza viruses, namely Influenza A, B and C. Observation of these flu viruses became possible only after year 1930 because until that date, electron microscope which was required to see microscopic living things did not exist, yet. Influenza A virus was detected as a result of microbiological studies conducted by Mill Hill, C. H. Andrews, Patrick Laidlow and Wilson Smith at the National Institute of Medical Research in London in year 1933 (Talbert, 2001). Modern analysis of the Spanish flu virus from 1918 revealed an unusually virulent and deadly influenza A virus strain of the subtype H1N1. This virus had an extremely high death rate because it provoked a cytokine storm that ravaged young adults with strong immune systems. However, there is a question regarding this because the samples were all from second wave sufferers when the virus returned in an even more virulent manner. This second wave could be the source of the H5N1 subtype (Taubenberger & Morens, 2006). When examining deaths caused by epidemics, it is necessary to constantly consider the multiple causality approach. Regardless of the type of flu, the chronically ill, the elderly, and young children are more susceptible to the flu virus. Malnutrition and hygienic conditions can also affect the number of deaths. The structure of the virus that caused the Spanish flu is close to the classic swine flu. H1N1 flu has caused deaths not only in humans but also in pigs (Taubenberger, et. al., 2000).
The 1918 pandemic point of origin is particularly confusing because it spread in three waves that occurred simultaneously over the period of one year (1918-1919). These waves were in Europe (Germany, Scandinavia, Britain, Poland, Romania), Asia, and North America. The best described of these was the first wave of the 1918 pandemic that began in the United States in March, although it did not attract much attention at the time. Low mortality rates of the disease in the beginning and the fact that flu was not a notifiable disease could be shown as the reasons for this approach (Özdemir, 2021). US military camps were the breeding ground for the influenza in early 1918 and first came to wide attention Haskell County in Kansas. Afterwards it spread into Canada and Alaska where whole towns were devastated. At the same time, the countries of India, Indonesia, Samoa, Japan, Ethiopia, and South Africa were hit. The name of the flu originated in Spain, which was neutral in World War I and openly published news of the disease. As a result, the flu was wrongly labeled “The Spanish Flu” (Tsoucalas, et al., 2016). In fact, Spain, which remained neutral in the First World War, did not apply censorship while the governments in other countries applied censorship to hide the epidemic from the public. In the warring states, this epidemic was censored in the press as much as possible in order not to demoralize the people and not to be seen as weak by the enemy.
Second wave of the epidemic started in August 1918, and it spread to France, Sierra Leone and the United States at the same time. Mortality rates were approximately 0.5% of the population in the United States (about 600,000 deaths), up to about 5% in India, and up to 20% in some Pacific islands such as Fiji or Western Samoa (Allen, 2006). Spanish flu, which was considered as a mysterious disease at that time as a result of the blue color of the skin of many Spanish flu victims, was defined as the “purple death” in United States (USA). Purple death, which continued with a more deadly second wave in the late summer and autumn of 1918, continued with the third wave in year 1919. It was stated that the deaths in the USA in a short time from the Spanish flu were “more than the sum of the deaths in the First World War, the Second World War, the Korean War and the Vietnam War” (Lina, 2008).