“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. Texas 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.

More than 4,500 people died in Philadelphia in one week that autumn, with another 3,000 perishing in Chicago. Many people died within twelve hours of the first symptoms appearing. Some communities passed laws prohibiting spitting on the sidewalk in response to the epidemic as well as imposing strict curfews and shutting down schools and churches.

In September, hundreds of cases suddenly appeared at Camp Logan, just outside Houston. By October, Dallas leaders were working with army officials to quarantine troops at Camp Bowie outside Fort Worth. More than a thousand cases had been reported in Dallas, with Parkland Hospital overflowing with flu patients. The Buckner Orphans’ Home in Dallas reported 200 cases. Cities worked quickly to try to contain the epidemic with a variety of quarantines.

El Paso reported 131 deaths in one week in October. Camp MacArthur, near Waco, was hit hard, with more than 900 cases. More than 200 soldiers died. Nearly 500 civilians died in Waco itself. Schools, churches, and theaters closed across the state.

Local doctors and county health boards attempted to educate the public as quickly as possible about flu prevention and possible treatments. San Antonio ultimately reported more than 12,300 cases with nearly 900 deaths though there were likely tens of thousands of other cases that went unreported. More than 800 died in Dallas. Estimates put the death toll at more than 20,000 in Texas, including 1,800 troops.

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 Texas Department of State Health Services (http://dshs.texas.gov/flu/), 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.

Ken Bridges is a Texas native, writer and history professor. He can be reached at drkenbridges@gmail.com