A History of the 1918 Spanish In_uenza Pandemic and its Impact on Iran

Introduction

the term in_uenza has an Italian origin meaning ‘in_uence’ which is derived from the Latin word “in_uential” meaning ‘in _ow’ or ‘_ow into’. The word in_uenza “arose during the 15th century where an epidemic of the disease was ascribed to the in- uence [in_uenza] of the stars”. In the past medical writings of Iran, the word “bad-e nazleh” was used to describe in_uenza. The Dutch physician, Dr. Johan Louis Shlimmer (1819 – 1881) who was the teacher of modern medicine at the Dar al-Fonun School, in his French-Persian medical dictionary published in 1874, wrote: “Nazleh-e wabai-e ghacebetorrieh” as the Persian equivalent of in_uenza. In_uenza or grippe (_u/grip) is an acute contagious viral respiratory disease of short duration that presents with fever, chills, perspiration, muscular pain, and cough.

Major In_uenza pandemics in the world

 Based on historical records, in each century, one to three in_uenza pandemics have occurred, but the history of in_uenza pandemics in the past 300 years is more informative. In the 18th century, two in_uenza pandemics took place in 1729 and 1781 – 1782. In the 19th century, a pandemic occurred from 1830 – 1833 and another between 1898 and 1900. In the 20th century, two in_uenza pandemics happened in 1918 – 1919 and 1957 – 1968.8 The 1918 in_uenza pandemic was known as the Spanish _u and the 1957 pandemic was named the Asian _u. In 1968, another pandemic took place which was known as the Hong Kong _u.

The Spanish _u outbreak in Iran

The 1918 Spanish _u epidemic in Iran occurred during Ahmad Shah Qajar’s reign (1909 – 1925). The World War I began in 1914 of which Iran declared neutrality. During the last year of the war, the in_uenza pandemic began and spread to Iran. At that time, the Russian troops were in Azarbaijan Province and Ghazvin. The English and Indian soldiers were in Bushehr and Bandar-e Lengeh Ports. The Indian soldiers had an in_uential role in the spread of in_uenza to the Persian Gulf region and indeed the outbreak reached Bushehr from India. In addition, the public health status in Iran was poor due to a great famine as well as a cholera outbreak and lack of proper medical facilities. Mohammad Ali Jamalzadeh, the contemporary writer (1892 – 1997) described this gloomy situation in Shiraz. He wrote: “at the end of WWI, three lethal killers entered Shiraz; they were famine, cholera and the Spanish _u. Many people died and corpses were seen everywhere in the city. The Bazar and shops were closed. There was no doctor, no nurse, and no drug.”

In_uenza spread to the entire country with the rural areas more affected than urban regions. Ashair tribes, particularly the healthy men died from in_uenza. The reported mortality rate in the nomadic Ghashghai tribe was as high as 30%. According to Percy Sykes (1916 – 1945), at that time, the city of Shiraz had a population of 50,000 of which 5,000 died from the Spanish _u. The mortality rate in Kermanshah was reported as 1%, but in the villages as many as 20% of the people were reported to have died, a _gure which seems exaggerated. In Tehran, during a three month period, 1% of the population died as a result of the Spanish _u. Dr. Dawdson reported the in_uenza epidemic in Kerman in 1918 which coincided with the famine and the cholera outbreak, but he did not mention the mortality rate.

Reference:

1. Chantrell G. Oxford Dictionary of Word Histories. Oxford, New York: Oxford University Press; 2004: 272.
2. Mogabgab WJ. In_uenza. In: Encyclopedia Americana. Vol.15. Danbury, Connecticut: Scholastic Library Publishing, Inc.; 2006: 159.
3. Schlimmer JL. Terminologie Medico-Pharmaceutique et Anthropologique francaise-Persane. Tehran, 1874, lithograph; reset, with a preface by I. Afshar, Tehran: Tehran University Press1970: 306.
4. Stedman’s Medical Dictionary. 25th ed. Baltimore: Williams and Wilkins; 1990: 782.
5. Treanor JJ. In_uenza virus. In: Mandell GL, Douglas RG, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 6th ed. USA: Elsevier, Churchill Livingstone; 2005: Vol. 2: 2060.
6. A History of the 1918 Spanish In_uenza Pandemic and its Impact on Iran, Mohammad Hossein Azizi MD•, Ghanbar Ali Raees Jalali MD, Farzaneh Azizi