Epidemiological and Clinical Features of Spanish flu in the City of Ferrara and in Italy. Containment Rules and Health Measures Adopted in the Past to Fight the Pandemic

The “Spanish” flu has often been described as the “Greatest Medical Holocaust in History” and most vic- tims were young and healthy. In Italy, as elsewhere, this pandemic influenza struck in three successive and close waves with incredible speed in a very short time. The virus first arrived in a few Italian regions and gripped the country in an epidemic clamp. When the flu hit Ferrara, the health authorities began to claim that it was no more or less like the same disease that Ferrara had also experienced in the 19th century, al- though the population was not very willing to believe them. Moreover, the control measures were considered by all to be extremely mild, varying only the opening hours of cinemas and pharmacies and forbidding spit- ting on the ground; there was no disinfection of stores and streets and the dead were left at home for three days, unlike in larger cities. In 1918-19, Ferrara did much to contain the devastating effects of the war, es- pecially in terms of saving lives. The largest Red Cross unit in Italy, later called Ospedale Nuovo, was built. Moreover, since Ferrara was the first hospital evacua- tion zone, it was necessary to build other hospitals in the city’s schools in addition to the already existing ones, including the famous Ospedale Militare Neurologi- co di Villa Seminario, which was the first Italian neuro- logical hospital of the Great War for veterans of the front line, intended for the specialised treatment of nervous disorders and psychosis caused by the war or by bombs. We have extracted the cases of death from the Register of Deaths of the Municipality of Ferrara. During the pe- riod January 1918 - June 1919, in addition to the num- ber of deaths due to influenza, grippe or Spanish flu we also considered influenza-related complications affect- ing mortality and identified seven main groups of dis- eases by grouping them according to morbid forms and anatomical location. According to these criteria, 1,059 deaths were attributable to influenza or related causes during January-December 1918. This partly reflects the excess of deaths in the year 1918 of 1,279 over the aver- age for the years 1916-1919, and 1920. The largest num- ber of deaths was attributable to bronchopneumonia and pneumonia. However, an increase in mortality from other infectious diseases such as typhoid ileus, tuberculosis, malaria and smallpox was observed dur- ing the same period until January 2019, making up the shortfall in the total number of deaths recorded.