The number of cases and deaths do not fully illustrate the horror of the pandemic; it is important to understand the virus itself, its symptoms, and the reason why it was such an effective killer. The disease often struck suddenly. A hospital administrator in Glasgow, Montana reported that this influenza was “the most peculiar disease [she had]…ever seen. Some persons hardly know they are sick until they’re dying.” John H. Walters, M.D., discusses the illness’s symptoms, which included fatigue, body aches and pain, cough, and fevers of up to 104°F. Most horrifying, though, was cyanosis, a bluish discoloration of the face and extremities caused by a lack of oxygen. Many historians and scientists describe cyanosis as a sure sign that death was imminent, especially when moist, productive coughing and hemorrhaging accompanied it.
Almost all pandemic scholars comment on its unique W-shaped mortality curve. In most influenza outbreaks, including seasonal influenza, mortality curves are U-shaped, with most deaths occurring among the very young and very old. The 1918-1919 influenza, however, struck down young, otherwise healthy adults most often. Ironically, researchers blame the very strong immune response of these individuals as the reason. John M. Barry and Tom Quinn provide excellent and understandable descriptions of a phenomenon termed “cytokine storm.” Strong immune systems mounted a response that released large quantities of immune proteins. The sheer volume of these proteins, though, damaged delicate lung tissue. Unable to function properly, lung cells broke down, and blood, fluids, and other wastes filled the lungs. Influenza and pneumonia victims literally drowned.
The cause of the pandemic of 1918-1919 was a mystery until 1997 when a team of scientists at the Armed Forces Institute of Pathology isolated its gene sequence in the tissues of victims frozen in Alaska’s permafrost. This groundbreaking discovery allowed subsequent research projects to determine that 1918-1919’s strain of influenza was H1N1 swine influenza, not the avian variation that many believed it had been. These findings allowed for the development of a vaccine that may help to prevent future pandemics caused by the 1918-1919 strain.
 Mullen and Nelson, “Montanans and the ‘Most Peculiar Disease,’” 59.
 John H. Walters, M.D., “Influenza 1918: The Contemporary Perspective,” Bulletin of the New York Academy of Medicine 54 no. 9 (October 1978): 855-64.
 John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History, rev. ed., New York: Penguin Books, 2009; Tom Quinn, Flu: A Social History of Influenza, London: New Holland Publishers, 2008.
 Jeffery K. Taubenberger, et. al., “Initial Genetic Characterization of the 1918 ‘Spanish’ Influenza Virus,” Science 275 no. 5307 (March 21, 1997): 1793-6.