The Bubonic Plague has been considered the ultimate killer among diseases. Epidemics in the 6th, 14th, and 17th centuries combined to kill an estimated 137 million people worldwide.

The mention of the name today sends shivers down the spines of many and there is little doubt that it is a terrible and deadly disease.

The death rate was 90% for those exposed to the bacterium. It was transmitted by the fleas from infected Old English black rats. The symptoms were clear: swollen lymph nodes (buboes, hence the name), high fever, and delirium. In the worst case, the lungs became infected and the pneumonic form was spread from person to person by coughing, sneezing, or simply talking. From the time of infection to death was less than one week.

The plague is considered to be the worst epidemic of all time, but it wasn't (not that we are downplaying the severity of the plague). At its worst, the bubonic plague killed 2 million victims a year. This is certainly a bad situation, but there is one that is worse. The pandemic (an epidemic that is spread worldwide) that killed at least 25 million people in one year (maybe 40 million before running it's course). A disease that is largely forgotten. A disease that occurred in the 20th century! You may be thinking AID's, Syphilis, or the dreaded Ebola.

All are wrong.

It was the influenza of 1918-1919, right after World War I (the war killed 9 million men in 4 years) This was no minor disease -- everyone on the planet was at risk. And it started in the United States.

In one year, nearly twenty million cases were reported in the United States, accounting for almost one million deaths. The cause is still unknown, but is believed to have been a mutated swine virus.

It all started on the morning of March 11, 1918 at Camp Funston, Kansas. A company cook named Albert Mitchell reported sick with typical flu-like symptoms -- low-grade fever, mild sore throat, slight headache, and muscle aches. Bed rest was recommended. By noon, 107 soldiers were sick. Within two days Camp Funston had 629 cases and many of them were gravely ill with severe pneumonia. Then reports started coming in from other military bases around the country. Thousands of sailors docked off the East Coast were sick. Within a week the disease was hitting such isolated places as Alcatraz.

Whatever the cause, it was clearly airborne. Within seven days, every state in the Union had been infected. Then it spread across the Atlantic. By April, French troops and civilians were infected. By mid-April, the disease had spread to China and Japan. By May, the virus had spread throughout Africa and South America.

The actual killer was the pneumonia that accompanied the infection. In Philadelphia, 158 out of every 1000 people died. 148 out of 1000 in Baltimore. 109 out of 1000 in Washington, D. C.

The good news (if there was any) was that the disease peaked within two to three weeks after showing up in a given city. It left as quickly as it arrived. The United States death toll was a total of 850,000 people, making it an area of the world that was least devastated by this virus.

In Nome, Alaska sixty percent of the Eskimo population was wiped out. 80-90% of the Samoan population was infected, many of the survivors dying from starvation (they lacked the energy to feed themselves). Luxury ocean liners from Europe would arrive in New York with 7% less passengers than they embarked with. The confined area of the ship was especially conducive to the spread of the disease.

In the end, 25 million people had died. Some estimates put the number as high as 37 million. Eighteen months after the disease appeared, the flu bug vanished and has never shown up again.

So what happened? Until recently, no one was really sure. In March of 1997, the news broke that researchers at the Armed Forces Institute of Pathology in Washington, D. C. had isolated genetic material from the virus. This was no easy task. The living virus is no longer around. It turns out that while conducting autopsies in 1918, Army doctors had preserved some specimens in formaldehyde. One of these jars contained the lungs of a 21 year old soldier that died on September 26, 1918. The researchers spent nearly two years extracting just seven percent of the genetic code, but the evidence gathered has provided a great wealth of information.

It appears that the virus passed from birds to pigs and then to humans. These are the deadliest of all viruses. The viruses tend to remain stable in the birds, but occasionally they infect pigs. Of course, the pig immune system kicks into action and the virus is forced to mutate to survive. Both the Asian flu (1957) and the Hong Kong flu (1968), which were not as deadly, mutated from pig viruses.

The scary part is that it could happen again -- and we're not prepared.

Mundus Novus Historia®

Update -- September, 2001

The Charlotte Observer -- Medical Mystery

An Australian research team believes it's found a clue to one of medicine's biggest mysteries -- why the Spanish flu virus of 1918 was so deadly.

Scientists at Australian National University in Canberra say a crucial gene in the 1918 virus arose from the recombination of genes in two pre-existing influenza viruses.

The resulting hybrid was different enough to catch most people's immune systems unprepared, which allowed it to spread rapidly.

"What we've in essence found is that a fairly significant change occurred immediately before the pandemic," said Mark Gibbs, a biologist at the university.

The quest isn't simply academic. Virologists and public health officials would like to be able to identify dangerous strains of influenza among the many variants emerging every year.

The explanation, which appears today in a paper in Science written by Gibbs and two colleagues, was greeted skeptically by other scientists.

Robert Webster, an influenza researcher who wrote a commentary in Science, called the proposal "definitely a stretch."

The Australian researchers used data from the partially reconstructed viral genes from three 1918 victims to make their argument.

The Spanish flu killed at least 20 million, and possibly as many as 40 million people in 1918 and 1919. What caused the virus to infect and kill so many people has puzzled virologists.

Influenza virus contains eight separate pieces of genetic "segments." There are numerous variations of each segment. Those variations account for the huge number of distinct flu viruses infecting people, chickens, geese, ducks, pigs, horses and other animals.

Two gene segments are especially important because they carry the directions for making the proteins hemagglutinin (HA) and neuraminidase (NA) that sit on the outside of the virus.

A global pandemic occurs when a virus appears carrying a new HA or NA gene, with the old one swapped out. This is called reassortment. Gibbs says the 1918 bug wasn't a reassortment, but something rarer: A new HA gene was formed by the cutting and splicing of two pre-existing HA genes -- called recombination.

Recombination has only been seen a few times in influenza virus, and some experts contend it's actually never been proved.