In the spring of 1918, doctors in Madrid, Spain began to note a particularly virulent influenza spreading among the population. Within a year, the Spanish flu became a world-wide pandemic that killed between 20 and 40 million people. It spread perhaps more easily because the Great War, as World War I was known at the time, disrupted sanitation and health systems. Troop movements also fostered the spread of the disease.
The Spanish flu was 20 to 25 times more likely to cause death than other forms of influenza. It had other singular characteristics: most victims were between 20 and 40 years of age (most diseases take a higher toll on the elderly and very young); it caused a terrible form of pneumonia that literally caused patients to suffocate to death; patients often came down with the disease and died in a few hours. In the US, 675,000 people died of the disease, and one-half of the US soldiers who died in Europe during the war, died of flu rather than war wounds.
Though North Dakota was a rural state with a small population, it, too, felt the effects of the Spanish flu. Sanitation in the cities was still primitive; some, including Fargo, dumped raw sewage into the Red River allowing diseases to spread to the next city downstream that drew water from the river. Local epidemics of diseases we no longer experience, such as diphtheria and scarlet fever, also contributed to the state’s death statistics. Antibiotics such as penicillin had not yet been discovered and anti-viral treatments were decades in the future.
Few small towns had hospitals, or more than one doctor. Private duty nurses assigned to care for patients in their own homes by physicians or the Red Cross provided the standard method of patient care. Hospitalization was available only in the larger cities. Though the death rate in North Dakota was lower than in some large cities, it was nevertheless a devastating illness on the northern plains as it was in other part of the world.
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