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It was a deadly October as the great influenza settled into Cincinnati and the surrounding region in 1918.
On a single day that month, Cincinnati General Hospital alone recorded 14 deaths attributed to "pneumonia following influenza" in an era when few people ever entered a hospital.
From Oct. 6 through Dec. 24, the hospital recorded at least one death every day - sometimes more than a dozen - attributed to the flu.
When the Spanish flu pandemic ended in the summer of 1919, the city's official death toll was 4,100, though it was likely higher. More than 600,000 people died in the United States.
Worldwide, the Spanish flu is believed to have killed as many as 50 million people, compared to 16 million in World War I, which was grinding to a halt as the flu began its lethal spread. Some sources put the pandemic's toll closer to 100 million.
It was the deadliest outbreak in modern history.
Today, a new pandemic has been declared as H1N1 flu circulates worldwide, following pandemics in 1957-58 and 1968-69.
Like the 1918 flu, waves of infections occurred in the spring and the fall, and cases have slowed since November.
But H1N1 hasn't shown itself to be as virulent as Spanish flu, or as infectious. The Centers for Disease Control and Prevention estimate 1 in 6 Americans have been infected by it. Worldwide, the death toll has been estimated at 10,000.
The second wave of H1N1 ended in November, and health-care professionals are enjoying the lull. But experts warn cases could pick up again. Historically, pandemic flu occurs in three waves.
"The pattern with this pandemic is the same as 1918, and that's one of the reasons for concern," said Steve Englender, director of public health preparedness for the Cincinnati Health Department. "If we follow 1918, there will be a third wave later this winter or spring."
Another concern for public health officials is the flu virus' ability to mutate, seemingly almost overnight. H1N1 flu has remained stable so far, but that could change.
"The incredibly good news compared to past pandemics is, although there have been issues with how rapidly it came out, vaccine is now widely available," Englender said.
Englender and other health experts are urging consumers to be vaccinated against H1N1. There's still time for the vaccine to take effect against a third wave, he said.
One of the national strategies to fight H1N1 has been to focus early vaccination efforts on school-aged children and teens - those most at risk to catch and spread the flu.
Officials had originally hoped school-based vaccination efforts would be complete before Thanksgiving, though delays in vaccine manufacture quashed those hopes.
Now Englender and his colleagues hope enough children and teens have been vaccinated to blunt a new wave of infections when students return to school in January.
This year, H1N1 has claimed at least 11 lives in the region, including two in Cincinnati, one in suburban Hamilton County, two in Butler County, four in Northern Kentucky and two in Southeastern Indiana.
In 1918, the first fatality in Cincinnati officially attributed to the flu was recorded on Oct. 1, according to records from the city's Board of Health.
Spring Grove Cemetery recorded its first burial attributed to Spanish flu on Oct. 3 when Forrest Hogsten, 23, of 624 Steiner Ave., was buried.
Few of the burial records mention influenza, said Phil Nuxhall, historian for the cemetery, though pneumonia was commonly listed in the last few months of 1918.
Across the river in Fort Thomas, 40 soldiers stationed at the military installation died of flu between Oct. 12 and Oct. 21. The highest toll came on Oct. 15 when 11 deaths were recorded, said Herman "Buck" Seibert, a Grant's Lick history buff who has widely researched Campbell County's history.
Seibert reviewed death certificates issued in 1918 in Campbell County and found that the county recorded 98 deaths attributed to influenza in October, as well as another 23 deaths attributed only to pneumonia.
Campbell County recorded its first flu death that year on Sept. 27, when a 27-year-old florist clerk from Newport died of pneumonia caused by "La Grippe," an old name the flu.
Normally in that era, Campbell County recorded about 700 deaths a year.
In 1918, it logged more than 1,000.
As the flu tore through the community, Seibert noted, deaths from accidents and violence seemed to disappear.
There was no vaccine in 1918, and no antibiotics to treat the pneumonia that often developed after influenza infection.
"People died in one of two ways. Some succumbed rapidly, probably directly due to the virus itself," Englender said. "They were fine in the morning. They were blue in the afternoon (from lack of oxygen as the infection attacked the lungs) and dead by evening. The other was individuals who got sick, were perhaps getting better, and developed a secondary bacterial pneumonia."
Recording fatality after fatality couldn't have been easy for doctors and nurses, Englender said.
"It was a very trying time," he said. "People were dying right and left."
The 1918 pandemic is still the benchmark public health officials use to gauge disaster, and how they'll respond to it.
In Cincinnati, as in other cities, schools, churches and theaters were ordered closed. Barbers and elevators were ordered to wear masks.
Downtown streets were sprayed with disinfectant, and an ordinance banning spitting was resurrected.
Records showed 80 men were arrested for violating the ordinance, originally enacted to prevent the spread of tuberculosis, and 73 paid a $1 fine.
The outbreak died down for the holidays, then picked up again in February and into March, though far fewer deaths were recorded in the final wave of sickness.
By 1919, medical officials with the U.S. Army were calling for a widespread public vaccination campaign against influenza, and Cincinnati's Board of Health voted to support the idea.
With H1N1, after an initial wave of panic, especially as promised vaccine failed to appear, Americans seem to have grown calmer.
On a single day that month, Cincinnati General Hospital alone recorded 14 deaths attributed to "pneumonia following influenza" in an era when few people ever entered a hospital.
From Oct. 6 through Dec. 24, the hospital recorded at least one death every day - sometimes more than a dozen - attributed to the flu.
When the Spanish flu pandemic ended in the summer of 1919, the city's official death toll was 4,100, though it was likely higher. More than 600,000 people died in the United States.
Worldwide, the Spanish flu is believed to have killed as many as 50 million people, compared to 16 million in World War I, which was grinding to a halt as the flu began its lethal spread. Some sources put the pandemic's toll closer to 100 million.
It was the deadliest outbreak in modern history.
Today, a new pandemic has been declared as H1N1 flu circulates worldwide, following pandemics in 1957-58 and 1968-69.
Like the 1918 flu, waves of infections occurred in the spring and the fall, and cases have slowed since November.
But H1N1 hasn't shown itself to be as virulent as Spanish flu, or as infectious. The Centers for Disease Control and Prevention estimate 1 in 6 Americans have been infected by it. Worldwide, the death toll has been estimated at 10,000.
The second wave of H1N1 ended in November, and health-care professionals are enjoying the lull. But experts warn cases could pick up again. Historically, pandemic flu occurs in three waves.
"The pattern with this pandemic is the same as 1918, and that's one of the reasons for concern," said Steve Englender, director of public health preparedness for the Cincinnati Health Department. "If we follow 1918, there will be a third wave later this winter or spring."
Another concern for public health officials is the flu virus' ability to mutate, seemingly almost overnight. H1N1 flu has remained stable so far, but that could change.
"The incredibly good news compared to past pandemics is, although there have been issues with how rapidly it came out, vaccine is now widely available," Englender said.
Englender and other health experts are urging consumers to be vaccinated against H1N1. There's still time for the vaccine to take effect against a third wave, he said.
One of the national strategies to fight H1N1 has been to focus early vaccination efforts on school-aged children and teens - those most at risk to catch and spread the flu.
Officials had originally hoped school-based vaccination efforts would be complete before Thanksgiving, though delays in vaccine manufacture quashed those hopes.
Now Englender and his colleagues hope enough children and teens have been vaccinated to blunt a new wave of infections when students return to school in January.
This year, H1N1 has claimed at least 11 lives in the region, including two in Cincinnati, one in suburban Hamilton County, two in Butler County, four in Northern Kentucky and two in Southeastern Indiana.
In 1918, the first fatality in Cincinnati officially attributed to the flu was recorded on Oct. 1, according to records from the city's Board of Health.
Spring Grove Cemetery recorded its first burial attributed to Spanish flu on Oct. 3 when Forrest Hogsten, 23, of 624 Steiner Ave., was buried.
Few of the burial records mention influenza, said Phil Nuxhall, historian for the cemetery, though pneumonia was commonly listed in the last few months of 1918.
Across the river in Fort Thomas, 40 soldiers stationed at the military installation died of flu between Oct. 12 and Oct. 21. The highest toll came on Oct. 15 when 11 deaths were recorded, said Herman "Buck" Seibert, a Grant's Lick history buff who has widely researched Campbell County's history.
Seibert reviewed death certificates issued in 1918 in Campbell County and found that the county recorded 98 deaths attributed to influenza in October, as well as another 23 deaths attributed only to pneumonia.
Campbell County recorded its first flu death that year on Sept. 27, when a 27-year-old florist clerk from Newport died of pneumonia caused by "La Grippe," an old name the flu.
Normally in that era, Campbell County recorded about 700 deaths a year.
In 1918, it logged more than 1,000.
As the flu tore through the community, Seibert noted, deaths from accidents and violence seemed to disappear.
There was no vaccine in 1918, and no antibiotics to treat the pneumonia that often developed after influenza infection.
"People died in one of two ways. Some succumbed rapidly, probably directly due to the virus itself," Englender said. "They were fine in the morning. They were blue in the afternoon (from lack of oxygen as the infection attacked the lungs) and dead by evening. The other was individuals who got sick, were perhaps getting better, and developed a secondary bacterial pneumonia."
Recording fatality after fatality couldn't have been easy for doctors and nurses, Englender said.
"It was a very trying time," he said. "People were dying right and left."
The 1918 pandemic is still the benchmark public health officials use to gauge disaster, and how they'll respond to it.
In Cincinnati, as in other cities, schools, churches and theaters were ordered closed. Barbers and elevators were ordered to wear masks.
Downtown streets were sprayed with disinfectant, and an ordinance banning spitting was resurrected.
Records showed 80 men were arrested for violating the ordinance, originally enacted to prevent the spread of tuberculosis, and 73 paid a $1 fine.
The outbreak died down for the holidays, then picked up again in February and into March, though far fewer deaths were recorded in the final wave of sickness.
By 1919, medical officials with the U.S. Army were calling for a widespread public vaccination campaign against influenza, and Cincinnati's Board of Health voted to support the idea.
With H1N1, after an initial wave of panic, especially as promised vaccine failed to appear, Americans seem to have grown calmer.
