The outbreak of swine flu that has health authorities concerned about the possibility of its worldwide spread reminds some people of the last flu pandemic.

Ninety-one years ago, in 1918, an outbreak of a strain of influenza known as Spanish flu rapidly spread around the world.

The death toll in Clatsop County exceeded 150 in a four-month period.

In 1997, Liisa Penner, the Clatsop County Historical Society archivist and editor of its quarterly magazine Cumtux, spent several months poring through newspaper articles and death records from that moment in history. She documented her findings in an article in the Winter 1997 edition of the publication.

Unlike other outbreaks of diseases, the 1918 flu strain’s victims seemed to come from the healthiest population of men, mostly in their 20s and 30s.

There is no way of knowing exactly how many people died from the disease, but at least 20 million deaths occurred worldwide as a result of the outbreak. Half a million Americans died, 2,000 in Oregon.

October seemed to be the height of the outbreak in the county. Penner pulled out photocopies of ads from the Oct. 2, 1918 issue of the Morning Astorian.

An ad for “anti-influenza spray” and one for Horlick’s Malted Milk claimed to offer respite from the flu. A local chiropractor claimed he could cure the flu in his ad. But no cure was really known. Penner wrote in her article that a form of aspirin was the most common treatment. She added that some doctors injected people who hadn’t caught the flu with a vaccine cultured from victims who had died of the flu, but the treatment was ineffective.

“The Sisters of St. Mary’s Hospital asks that no visits be made to their hospital during this epidemic of influenza in Astoria. Exceptions will be made in extreme and urgent cases,” read one ad.

Penner’s eyes light up as she reads through her files, sparking memories. She smiles almost with the pride of someone speaking of a heroic descendant as she points to a photo of Doctor Nellie Smith Vernon, an Astoria City health officer who acted as the health officer for the entire county during the outbreak. Vernon is credited with limiting the death toll in the county.

“The only thing they really could do was isolate people who were sick,” Penner explains.

She said health workers wanted to use a vacant building to isolate some of their patients, but the building’s owner refused to let them.

Sitting amidst the museum’s archives, Penner indicated through the window that the brick building across the way was once the hospital. Stone stairs descending from its parking lot once led into part of the hospital.

Penner wrote that health workers understood the conditions that promoted spread of the disease – people living in close quarters in unsanitary conditions, like the soldiers who were just returning from World War I as it was reaching its conclusion.

In August 1918, cases of the flu turned up on the East Coast in Boston. By late September it was found at Camp Lewis, in Washington state.

The Northwest’s abundance of spruce was needed for the production of airplanes for the war. Vast, crowded camps were formed, bursting with manpower to get the backbreaking work done.

On Sept. 26, the Morning Astorian warned of the need to clean up the “filthy conditions” in camps where soldiers were gathered. The next day it reported that there hadn’t been a case of Spanish flu found in Oregon as yet.

But it was on its way, and people could see it coming in the news reports.

Penner said it had been the same way when there was a cholera outbreak in the 1830s.

“I was reading the old newspapers from the 1830s,” Penner said. “They could see the cholera coming closer and closer and closer.”

The Spanish flu virus arrived on the North Coast late in the last days of September, when trains brought 1,650 men from Camp Lewis to Fort Stevens. One hundred twenty men were reported ill with the disease on Oct. 2. And men began to die.

More than 150 deaths as a result of the flu were recorded over the next four months, more than half in October.

“It spread really quickly. When you had a lot of people together in those camps…” Penner said before her voice trailed off.

“It was an incredibly dramatic time in the history of the county – so many families had members who died.”

In 1918, 12 rules were provided to control the disease. Among them was to avoid needless crowding, “influenza is a crowd disease,” the rule said. Wash your hands before eating, one rule advised. Also, smother your coughs and sneezes. And, “Remember the three ‘C’s – a clean mouth, clean skin and clean clothes.”

“I remember the statement in one of the articles I read – ‘It’s not a matter of if it comes back, but when,'” Penner said.

The lessons of the past have world health organizations on alert. They want to avoid the tragedies that occurred nearly 100 years ago. There have been multiple confirmed cases so far and one death in the United States.

Health officials say there are three important ways to make sure the flu doesn’t spread. The first is to wash hands often. The second is to cover your mouth when you cough, preferably with a tissue. The third is to see your doctor if you are sick, but try not to expose others.

An interactive timeline showing the history of the current outbreak, where cases have been confirmed in the U.S. and including a video of precautions being taken in Mexico has been posted.

By The Associated Press

Key developments on swine flu outbreaks, according to Centers for Disease Control and Prevention, World Health Organization, and government officials:

-Deaths: 159 in Mexico, seven confirmed as swine flu and rest suspected. One confirmed in U.S., a 23-month-old boy from Mexico who died in Texas.

-Sickened: 2,498 suspected and 19 confirmed in Mexico. Confirmed elsewhere: 91 in U.S.; 13 in Canada; 14 in New Zealand; five in Britain; three in Germany; four in Spain; two in Israel; and one in Austria.

-Confirmed U.S. cases by state: 51 in New York, 14 in California, 16 in Texas, two in Kansas, two in Massachusetts, two in Michigan, and one each in Indiana, Ohio, Arizona and Nevada, according to CDC and states.

-U.S. Food and Drug Administration issues emergency guidance allowing certain antiviral drugs to be used in broader range of population if needed. Public health emergency declared and roughly 12 million doses of Tamiflu from federal stockpile to be delivered to states.

-Cuba bans flights to and from Mexico; Argentina suspends flights from Mexico; U.S., European Union, other countries discourage nonessential travel there. Arriving travelers questioned at Mexico’s U.S. border and world airports. Cruise lines avoid Mexico ports.

-Mexico suspends all schools until May 6. In U.S., some schools closed in Illinois, New York City, Texas, California, South Carolina, Connecticut, Minnesota and Ohio; President Barack Obama says more closings may be necessary.

-Mexico City hands out surgical masks, closes public venues and cancels public events. President assumed new powers to isolate infected people. World Bank loaning Mexico more than $200 million.

-Egypt begins slaughtering nation’s roughly 300,000 pigs as precaution.

-World Health Organization alert at Phase 4 of 6, meaning disease spreads easily but isn’t pandemic.