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1 Appendix to the book : Vinet F. (218) «La Grande Grippe : la pire épidémie du siècle. Histoire de la grippe espagnole». Editions Vendémiaire. Paris. 26 p. Vinet F. (218) "the Great Influenza. 1918: the worst epidemic of the century. History of the Spanish Flu". (in French) Editions Vendémiaire. Paris. 26 p. This file brings together new figures on the Spanish Influenza pandemic in that are not published in the book. The sources and complete bibliographic references refer to the General bibliography published in the book pages The figures below can be reused freely with the source citation: Vinet F. (218) "La Grande Grippe : la pire épidémie du siècle. Histoire de la grippe espagnole (the Great Flu. 1918: the worst epidemic of the century. History of the Spanish Influenza)» Editions Vendémiaire. Paris. Annexes ************* ********* *** * Date Evénement March 1918 Influenza epidemic in American military camps April 1918 First cases in France May-June 1918 First epidemic wave in Europe (many cases in Spain) August 1918 Increase in flu-related deaths. Outbreak of the second wave in Europe September-November 1918 Second epidemic wave 2-25 October 1918 Peak of the flu epidemic in France 9 November 1918 Death of Guillaume Apollinaire November 1918 Outbreak of the epidemic in the Pacific 2 December 1918 Death of Edmond Rostand February March 1919 Third epidemic wave May 1919 End of the pandemic in France August 1919 End of the pandemic on a global scale Figure A.1 : historical timeline of the flu pandemic

Figure A.2: the spread of the flu epidemic in the province of Almeria (Spain) (see book page 49). According to Ferret (1921), the flu epidemic has spread from Murcia province (Esat of Andalucia).

2 Figure A.2: the spread of the flu epidemic in the province of Almeria (Spain) (see book page 49). According to Ferret (1921), the flu epidemic has spread from Murcia province (Esat of Andalucia). The virus disseminated by the valleys and the railway network till Guadix which is a key point in the southern Spanish railway network. From there the flu went southward to Almeria. A slower transmission could have been done by the roads and paths, which run along the Mediterranean coast between Huercal and Tabernas then Lubrin. 2

nombre de décès The mortality in hospitals The flu epidemic at the Suburban hospital in Montpellier (today called Hôpital Saint-Eloi ) 9 8 7 6 5 4 3 2 Décès non grippe décès grippe F.

3 nombre de décès The mortality in hospitals The flu epidemic at the Suburban hospital in Montpellier (today called Hôpital Saint-Eloi ) Décès non grippe décès grippe F.Vinet d'après AD34 Figure A.3 : the number of deaths at the suburban hospital in Montpellier between Jan and May Death increased 3 per month in normal times to nearly 8 in October This increase is entirely due to the flu epidemic. Figure A.4 : distribution by age of the deceased from influenza and complications to the suburban hospital in Montpellier (n = 142) between august 1918 and May F. Vinet from AD34 2. (see book p. 95). 1 AD34. 3 HDT 1Q 313 registre matricule des malades civils (hommes et enfants males moins de 15 ans) en AD34. 3 HDT 1 Q 339 pour les femmes en AD34 registre des décès de l hôpital suburbain. 3 HDT 1Q HDT 1 Q 339. The gender distribution is not significant as many men are cared in military hospitals. 3

4 Figure A.5 : Chronogramm of the spanish flu related mortality at the Surburban hospital of Montpellier (France) (January 1918-May-1919) (each dot represents a death with the date in X and age in Y). This graphic shows the mortality due to lung pathologies (bronchopneumonia, pleurisy, influenza and complications) from January 1918 to June 1919 in the suburban Hospital of Montpellier (France). From January 1918 to July 1918, the first wave of flu causes very little of death. The deaths are related to chronic bronchitis or Pleurisy. Archives attest that deceased persons are relatively older and their hospital stays are often repeated and long (several weeks). From early August 1918 comes up the Spanish flu related excess mortality with many young adults. These deaths are particularly numerous in September- October but continued until April-May 1919 with a second wave focused on February (see book p. 95) 4

5 DÉCÈS Nombre de décès Deaths in the Municipalities according to the civil status registers: a 25 few examples Figure A.6 : annual number of civilian deaths in Saint-Drezéry community from 1913 to 1922 (Hérault, population 6 inhabitants) décès civils décès militaires Figure A.7 : répartition mensuelle des décès à Saint-Drézéry en 1918 The average number of deaths in the Saint-Drezery community is per year in peaceful period. The year 1918 recorded 22 deaths i. e. more than double of the average. Deaths in 1918 are concentrated on the month of October with deaths, which focus on the period from 2th to 28 th i.e. more than one death per day. The civil registers do not give the cause of death but the age of the victims (8 out of are less than 35 years old) and the concentration on a few days leave no doubt about the influenza origin of this mortality. Excess loss of life amounts therefore to 12/15 deaths in 1918/1919 i.e. between 2 and 2.5% of the community population. 5

6 The Spanish Flu in the Community of Bousquet-d Orb (Herault, France) Figure A.8 : annual number of civilian deaths in the Bousquet-d Orb (34) 3 year Number of civilian deaths ? Figure A.9 : chronogramm of deaths in the Bousquet d Orb in Source : d après registres d état civil commune du Bousquet-d Orb, AD34 3 E 282/9. 6

7 Figure A. : Monthly excess mortalityin the community of Le Bousquet-d Orb (Herault, France) (average = ) F. Vinet according civil registry, AD34 3 E 282/ ans 2-39 ans 4-59 ans 6-79 ans 8-99 ans Figure A.11 : age distribution of deaths in the community of Bousquet d Orb from January to july F. Vinet according civil registry, AD34 3 E 282/ ans 2-39 ans 4-59 ans 6-79 ans 8-99 ans Figure A.12 : Age distribution of deaths in the community of Bousquet d Orb from August to December While the number of civilian deaths reaches an average of 4 per year in the town of the Orb Bousquet (2,1 inhabitants in 1911, 23 in 1921), there were 77 deaths in 1918 and still 55 in 1919 (Figure A.8). Excess civilian deaths rise up to 4 deaths in a population of about 2,2 people (1.8% of the population). When examining mortality in detail, we observe that between January and July 1918, the elderly predominate which reflects the 'normal' mortality. Between August and December 1918, deaths increase, and young adults and children become the majority. Even if the Spanish flu causes the great part of this excess of loss of life, local epidemics of measles or intestinal diseases could have worsen the toll. 4 Source : F. Vinet according civil registry Bousquet-d Orb, AD34 3 E 282/9 7

8 Mortality at national level (France) Figure A.13 : monthly evolution of civilian deaths in France ( ) 5 The evolution of the gross number of civilian deaths in France from 196 to 1928 is given at monthly time step, for all causes. The average curve on the same period (full line) is given for comparison. Deaths used to be more frequent in winter. The decrease in the number of deaths during the war is due to the reduction in the number of Department under French administration (75 departments). The monthly curve (grey histograms) highlights winter epidemics in 199, 1911 or The year 1911 was marked by a heat wave in August and September which resulted in many deaths of children affected by diarrhea. The Spanish flu had struck significantly from September 1918 to February 1919 especially in October 1918 which recorded 115,292 deaths against 53, usually. (See book p ) 5 H. Bunle, Le Mouvement naturel, op. cit., p

9 The mortality at global scale (see book p. 69-7) Figure A.15 : the evolution of the human toll of of the Spanish Flu pandemic Figure A.16 : mortality due to the Spanish Flu pandemic according Johnson & Müller, 22 (modified) continents Deaths due to Spanish flu ( ) % of each continent in the global toll Asia % population 6 (in million) 1 3 % of each continent in the world population Part of the population killed by the Great Flu 62.1% 34 America 154 3,7 % % 7.7 Africa 24 5,8 % % 18 Europe 264 6,6 % % 11 8 Oceania 85,2 % 8.5 %.6 Total calculated Total estimated % 186 % à A. Maddison, The World Economy: Historical Statistics, 23, Vol. 2, OECD, Paris appendix. Estimated population in 1918 for Asia and Americas, in 192 for other continents. Europe without Russia and some Eastern European countries had 261 millions of inhabitants. see millions of inhabitants for Ansart et al.,(29) «Mortality burden of the ». The population of Europe including Russia is estimated up to 488 millions by A. Maddison, (23) The World Economy. The toll of the Pandemic is not well known in Russia. 8 S. Ansart et al., «Mortality burden of the ». 9

nombre de veufs remariés The Great Flu and its consequences on demography Figure A.

You can clearly see a low of birth in July-August 1919. This minimum is not related to the First World War as Portugal was not much engaged in the conflict.

158-159) 3 25 2 15 5 F. Vinet d'après données in H. Bunle, 1954 Figure A.

10 nombre de veufs remariés The Great Flu and its consequences on demography Figure A.17 : Spanish influenza and birth rates in Portugal from 1918 to 192 Full line: the curve of the births in Portugal expressed compared to the average of previous years. You can clearly see a low of birth in July-August This minimum is not related to the First World War as Portugal was not much engaged in the conflict. If we shift the curve nine months back (dot curve), we can deduce that conceptions have declined in the month of October and November 1918 at the heart of the epidemic. (see book p ) F. Vinet d'après données in H. Bunle, 1954 Figure A.18 : Second Marriage of male widowers in Spain after the Great Flu The consequences of the flu were also sensitive about weddings. In Spain, the number of widowers marriage increases strongly from 1919 as many young women died during the flu epidemic (see explanations book la Grande Grippe p. 161). The same trend exists but is less pronounced for female widowers. Source : H. Bunle, Le Mouvement naturel de la population dans le monde de 196 à 1936, Paris, Institut national d études démographiques, 1954, p

The scientific research on the Spanish influenza Pandemic Figure A.19 : scientific publications dealing with Spanish influenza according to the Web of Science.

11 The scientific research on the Spanish influenza Pandemic Figure A.19 : scientific publications dealing with Spanish influenza according to the Web of Science. Research made on the Web of Science from key words: "Spanish flu, influenza, pandemic, 1918" in the words of the title, keywords and abstract (F.Vinet & S.Deveze Univ Montpellier 3. Oct.217). Total : 1115 publications. (see explanations book p. 169) Location of the first authors laboratories for 1115 publications dealing with Spanish Flu (number of publications in circles). (F.Vinet & S.Deveze Univ Paul Valéry Montpellier 3. Oct.217). 11

12 Pays Figure A.21 : the human tolls of 1st World War and of The Spanish Influenza Military deaths due to 1st World War Civilian deaths due to 1st World War 9 Deaths due to Spanish influenza pandemic Germany 2,36, , 426,574 Russia 1,811 1,5,* 45, France 1, , 24, Austria-Hungria 1, 467, 12,458 UK 885,138 9, 231, Ottoman Empire 8, 4,2,*? Italia 651, 589,* 544,288 Serbia 275, 45,*? Roumania 25, 43,*? USA 116, ,-675, Bulgarie 87,5, 51,156 Indian British Empire 74,187 18,5, Canada 66,148 2, 5, Australia 61,928 14,528 Belgium 42,987 62,? Greece 26, 15,? New-Zeland 18,5 8,573 South african Union 9,463 3, Portugal 7,222 82,* 135,6 others 3,415 3,491 Global Toll 9,72,453 8,871,248 ± 5,, N.B. : in grey : countries where the number of war related deaths exceeds the Spanish Flu toll. 9 Civilian casualties pointed by a * are to be taken with caution because they can include Great Flu related deaths For deaths due to Spanish Influenza : Source : N. P. A. S. Johnson, J. Müller, «Updating the accounts : Global mortality of the Spanish Influenza pandemic», Bulletin of the History of Medicine, 22, 76 ; S. Ansart et al., «Mortality burden of the influenza pandemic in Europe», in Influenza and Other Respiratory Viruses, 3 (3),

CHAPTER I. CONTENTS.

199 CHAPTER I. CONTENTS. 200 201 202 THE INCIDENCE OF EPIDEMIC INFLUENZA DURING 1918-19 IN EUROPE AND IN THE WESTERN HEMISPHERE. BY R. BRUCE Low, C.B., M.D. INTRODUCTION. When it was first recognised that