Hektoen International

A Journal of Medical Humanities


Published in March, 2020


The recent coronavirus outbreak inevitably brings to mind the Spanish flu, the deadly influenza pandemic of a century ago. Here we republish seven articles about this devastating viral disease that spread to the four corners of the world, killing an estimated 50 million people, and leaving  behind bitter memories and fears that someday history may repeat itself.


Emerging infections: a perpetual challenge
Newly emerging diseases


Well-understood determinants of modern disease emergence, typically acting in concert, have been associated throughout recorded history with the emergence of major diseases. These determinants have been similar in their explosiveness, impact, and elicitation of public-health control responses. Whether the nature and pattern of these determinants are changing or will change in the future remains speculative. That most of the historical emerging diseases we examined were associated with unique patterns of common determinants suggests to us that an increasingly complex modern world will probably provide increasing opportunities for disease emergence. For centuries a fundamental challenge to the existence and well-being of societies—as reflected by scientific attention, as well as in art, religion, and culture—emerging infections remain among the principal challenges to human survival.


By David M Morens, Gregory K Folkers, and Anthony S Fauci



As humans fought one another throughout the centuries, they consistently shared a common foe: germs. Spurred by urban crowding, various epidemics swept continents, disrupted societies, ravaged civilizations, decimated armies, and took millions of lives. They also changed history. Hence, this essay will review three epidemics that over the span of a thousand years brought three mighty empires to their knees: 1) The Plague of Athens, that killed Pericles and ended the golden age of Athenian Democracy; 2) The Plague of Galen, that killed Marcus Aurelius and ended the golden age of Imperial Rome; and 3) The Plague of Justinian, that killed half of the population of Constantinople and left no soldiers to man the borders against the rising armies of Islam. For the last two “plagues” we have a fairly good…


By Salvatore Mangione




Seattle police during Spanish Influenza epidemic

A flu that brought nations to a standstill


The Spanish Flu disrupted the normal flow of life: towns and cities stopped functioning; desperate authorities enforced quarantine by gunpoint and imposed drastic restrictions on public gatherings. Police patrolled streets to ensure public safety in anticipation of mass panic. In the most extreme example, the US territory of American Samoa was successfully quarantined and had no influenza deaths, whereas its neighbor, Western Samoa, was decimated and 25% of its population succumbed to the raging pandemic.



By Jennifer Summers







Katherine Anne Porter


In the fall of 1918 Porter was a twenty-eight- year- old reporter for The Rocky Mountain News when she and a young army lieutenant both fell ill with the flu.  Her death seemed imminent; the newspaper had her obituary set in type.  Her fever was so severe that her hair turned white and fell out.  The first time she tried to sit up after her illness she fell and broke her arm; she developed phlebitis in one leg and was told she would never walk again.  Six months later her lungs were healthy, her arm and leg healed or were healing, and her hair had started growing back.  The lieutenant died.











The Influenza Pandemic of 1918 in Colorado. 
By Cristóbal S. Berry-Cabán READ ARTICLE





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