“I had a little bird/ It’s name was Enza/ I opened a window/ And in-flu-enza.” It was a bizarre rhyme repeated by children as a game all over the country in late 1918 and into 1919. In an apocalyptic time of warfare, terror, and famine, now came the pestilence. The Spanish Flu outbreak became the worst epidemic in history, with an estimated 50 million dead worldwide, including more than 500,000 Americans. Arkansas would not be spared this disease as thousands were infected.

Influenza has haunted humanity for centuries. The famed Greek physician Hippocrates observed it around 400 BC. By the early 1700s, Italian doctors were referring to it as “influenza di freddo,” or “influence of the cold” as they did not quite understand the causes of the flu (which can be contracted in warm weather as well). Symptoms of flu arrive sharply about four days after the initial infection. Symptoms include high fever, headache, muscle aches, and fatigue. Symptoms can be very mild in some cases. Sneezing is rare and coughs are more common with the flu, the opposite of the common cold. Flu patients can develop bronchitis and pneumonia.

Where the 1918-19 pandemic came from has been a subject of some contention, though many pathologists have concluded it originated in Asia. It came to be called the Spanish Flu when Spanish King Alfonso XIII contracted it in 1918, and absent any wartime censorship there, his condition was followed by newspapers everywhere. As World War I raged, soldiers in close-knit camps contracted the sickness and quickly spread it from one unit to another and then to their home countries as troops went home. Because of the incubation period, patients never knew they were infected until symptoms appeared several days later. And by then, they had infected many others.

The first American appearance was at Fort Riley, Kansas, in March 1918. Soldiers suddenly started showing up at the infirmary in large numbers, with more than 400 falling ill before midday. The first outbreak faded but came back that August.

The first Arkansas reports emerged in August at army training camps at Fort Smith and Camp Pike in North Little Rock. Within days, more than a thousand new cases began showing up each day at the Camp Pike infirmary, out of 52,000 troops. The camp was quickly sealed off, but it was too late to stop the spread. Scores died, all men in their physical prime. Within days, hundreds of cases were reported among civilians in Little Rock. The flu radiated outward from Ft. Smith and Camp Pike across the state, soon reaching into the most remote corners of Arkansas because of a highly mobile wartime population. Little Rock businesses saw sharp drops in business because of the outbreak, as much as a 70% drop, prompting many businesses, especially neighborhood grocery stores, into bankruptcy.

The Arkansas Board of Health, established only in 1913, attempted to direct public information for prevention and possible treatments for the flu. But in an age before television or radio, and when many rural Arkansans did not even have a phone or were illiterate, distribution of information was extremely difficult. Many patients died never having seen a doctor. Many flu deaths were not recorded for this reason or because overwhelmed country doctors neglected to fill out death certificates. The board declared a statewide quarantine in October which lasted nearly a month in Pulaski County and was slowly lifted in rural areas well into 1919. By the time the epidemic passed in spring 1919, more than 7,000 Arkansans died.

The first flu vaccine was approved for use in the United States in 1945. Tamiflu and zanamavir were developed in the early 1990s as effective treatments for flu patients. By the time the Spanish Flu reappeared in 2009, referred to as “swine flu” or type H1N1, mass vaccinations and effective public health campaigns prevented a repeat of the 1919 disaster.

Flu outbreaks occur each year, usually from September through April, typically peaking in February. More than two thousand different strains exist, and scientists attempt to adjust the annual flu shot to closely match the strains which seem to be the most prevalent.

The 2017-18 flu outbreak of type H3N2 has created a much more severe outbreak than in previous years but still far from the Spanish Flu outbreak. Hospitalizations and deaths are up sharply, but vaccinations are still available and still the best way to prevent infection. Information is widely available from the Centers for Disease Control (cdc.gov), the Arkansas Department of Health (healthy.arkansas.gov), and family doctors.

Though the flu is a serious disease, it is treatable and preventable. The majority of patients recover within a few days. Panic is always the true enemy in an epidemic. And with any illness, awareness and quick action mark the beginning of a cure.