The most severe pandemic in recent history, killing some 50 million people worldwide, the Spanish influenza, may have emerged up to two years earlier than previously believed. And, according to a new and influential study, its early manifestation was ignored at the time as a ‘minor infection.’

It is believed that, if doctors had recognized that influenza was the cause of an illness which was killing soldiers in Etaples, France, and Aldershot, England, in 1916, scientists would then have had better grounds to embark on a two-year vaccination programme and some of the worst effects of the Spanish influenza could have been avoided. Such are the findings of a new paper, launched by Professor John S. Oxford, the UK’s top expert on influenza, and Douglas Gill, a military historian.

Published in Human Vaccines & Immunotherapeutics, the study uses modern day scientific technology and delves through literature published in The Lancet from the time, to not only track the origins of the virus, but to seek how we can use this information to learn from the past to prevent the spread of an influenza pandemic.

In their quest, Oxford and Gill trace the origins of the Spanish influenza as it emerged in 1915 and 1916 in the Etaples Administrative District in northern France. At the time, up to 30,000 soldiers were admitted each year to British army hospitals in France and England, suffering from typical influenza symptoms. In early 1917, however, a medical group in Etaples treated hundreds of patients infected with what they described as an «unusually fatal disease» presenting «complex» respiratory symptoms.

In Aldershot, in the south of England, three senior physicians were also tackling a problem whose hallmarks looked very much the same. In both instances, the disease was characterized by a ‘dusky’ cyanosis, a rapid progression from quite minor symptoms to death — with death in any case usually resulting from a superinfection involving staphylococcus, streptococcus, etc.

Both medical groups were encountering a case fatality in the order of 50%, and they were learning from colleagues in England and France (who were publishing in The Lancet in 1917) that the malady was occurring elsewhere.

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