While its origin is not definitely known, a strong theory is that it had its centre at the major troop staging and hospital camp in Étaples in France. The overcrowded camp and hospital was an ideal site for the spreading of a respiratory virus. The hospital treated thousands of victims of chemical attacks, and other casualties of war, and 100,000 soldiers passed through the camp every day. It was also home to a piggery, and poultry was regularly brought in for food supplies from surrounding villages. It has therefore been postulated that a significant precursor virus, harbored in birds, mutated and then migrated to pigs kept near the front.
Infectious diseases already limited life expectancy in the early 20th century, but Spanish flu had a huge impact, with life expectancy in the United States dropping by about 12 years in 1918, the first year of the pandemic. The infection was unusual as it resulted in a higher than expected mortality rate for young adults rather than the very young, very old and very vulnerable.
Scientists offer several possible explanations for the high mortality rate of the 1918 influenza pandemic. Some analyses have shown the virus to be particularly deadly because it triggers a cytokine storm, which ravages the stronger immune system of young adults. In contrast, a 2007 analysis of medical journals from the period of the pandemic found that the viral infection was no more aggressive than previous influenza strains. Instead, malnourishment, overcrowded medical camps and hospitals, and poor hygiene promoted bacterial superinfection. This superinfection killed most of the victims, typically after a somewhat prolonged death bed.
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