Fan Benno-Caris isn't so sure the public can relax after two frantic weeks of worry about the swine flu, now said to be a relatively mild illness.

BEN TORRES/Special Contributor

Fan Benno-Caris, 91, holds a picture of her mother, Esther Hoffman, who fell ill with the Spanish flu but survived.

Caris, 91, was a newborn and living in Dublin, Texas, when the first Spanish influenza cases began showing up in March 1918. The world was at war and took little notice of a virus that seemed no more serious than the common cold.

The flu went dormant during the summer but came roaring to life in September, killing an estimated half a million people in the U.S. during the following six months.

FILE/The Associated Press

Victims of the 1918 Spanish influenza crowded into an emergency hospital at Fort Riley, Kan. The virus strain had been mild in the spring but turned deadly that fall, creating a pandemic that claimed millions of lives around the world. In Dallas and elsewhere, entire families were wiped out, and many children were orphaned.

Caris' mother got the flu. She didn't die but became deathly ill, unable to nurse her infant daughter.

"My father had to hire a wet nurse to take care of me," said Caris, who now lives in Addison. "It was portrayed to me through the years that my mother could have died. This was really the worst thing that ever happened in my family."

BEN TORRES/Special Contributor

Fan Benno-Caris recalls when Spanish influenza swept through Texas. 'After what I've been through, I'm going to be careful,' she says of the recent swine flu outbreak.

Stories about the Spanish flu epidemic handed down through Caris and others bear an eerie similarity to the present outbreak: The closing of schools, cancellations of mass gatherings, admonitions about hand washing and the debate over the effectiveness of wearing surgical-style masks.

Now, public health officials are worried about the possibility of the H1N1 swine flu virus rampaging through the U.S. when the traditional flu season begins next fall, just like the Spanish flu in 1918.

"I could easily have died back then when I was a baby," Caris said. "Now, here it is again."

Dallas was a city of 150,000 people in 1918. By late October, two months into the epidemic, newspaper reports estimated that 215 people had died in Dallas, and doctors had reported more than 6,000 cases.

The tragedy continued through December, but a reliable tally of how many ultimately died in Dallas has never been available.

By order of the mayor, churches were shut down. Pool halls were vacant. Playhouse Row on downtown Elm Street, usually glowing with bright lights, went dark. People stayed home.

Doctors and nurses, laboring at St. Paul Hospital, Parkland Hospital and Baptist Sanitarium, came down with the flu and died in disproportionate numbers. Oak Cliff seemed hardest hit, and no one knew why.

By the time the flu crisis subsided in the spring of 1919, entire families had been wiped out. An untold number of children were left orphaned. Coffin shortages had required some family members to be buried in the same grave.

"During October, November and December 1918, more people died than were born in the city in that period," said a history of the Dallas County Health Department written in 1941. "This had never happened before and has not happened since."

No one is predicting a pandemic this fall on the scale of 1918. Today, antibiotics and vaccines can prevent and treat secondary infections resulting from the flu. Ventilators and other medical interventions not available in 1918 can save lives.

Dr. John Carlo, medical director of Dallas County Health and Human Services, has studied the small body of literature about the 1918 flu in Dallas. He refers to it as "the forgotten pandemic."

"It was so bad," he said, "that people tried to forget about it as quickly as possible."

How do you run for political office and not shake hands?

Ask Caris, who is running for a City Council seat in Addison.

"I have not gone out in big public places," she said. "I've tried not to shake hands with anybody and tried not to go to restaurants and theaters. I think we just have to let this subside."

But for how long? Some public health officials are suggesting that we, as a society, may be entering an era of eternal vigilance.

The numbers of confirmed H1N1 cases are not impressive thus far: 642 confirmed cases nationwide and 88 cases in Texas and only two confirmed deaths, both in Texas.

Many people sense that the swine flu scare is subsiding. Public health officials aren't so sure.

Dr. Richard Besser, acting director of the federal Centers for Disease Control and Prevention, has spelled out the next steps involved in tracking the H1N1 virus during the next several months.

Flu season, which cranks up in the fall, begins soon in the Southern Hemisphere. American public health officials will be watching closely what happens in countries such as Brazil, Argentina and Peru.

"That will tell us a lot about whether the virus is changing, whether it's becoming more severe and what measures we might want to take in the fall," Besser said.

Some investigators have theorized that exposure to a less virulent strain of Spanish flu in the spring of 1918 later immunized those people against the killer flu that erupted in the fall.

"The issue about exposure now and whether it's protective – there has been work done looking back at previous pandemics. I think 1918 in particular," Dr. Besser said.

Dr. W.L. Seeger, 29, died of pneumonia on Oct. 11, 1918, after a weeklong bout with the flu. He was a graduate of Baylor Medical College and had served two years as an intern at Baptist Sanitarium.

Seeger was statistically representative of the average Spanish flu victim.

Health records for the years 1916-20 show that the bug took equal numbers of men and women. The records also show that Spanish flu did not target infants, children or the elderly, three groups usually considered most vulnerable to disease. Instead, the vast majority were seemingly strong, healthy adults 25 to 45.

A newspaper story reported that the flu caused the "loss of many bread winners." Indeed, the Spanish flu epidemic turned life insurance actuarial tables upside down. The companies were not prepared to pay large numbers of death benefits on people who were not supposed to die, statistically speaking.

On a human level, adolescents whose fathers perished in the epidemic often were forced to pick up the slack and go to work.

So far this spring, the H1N1 virus has chosen a different set of victims than the Spanish flu. An estimated 62 percent of people with confirmed cases of the virus are under 18, the CDC reported this week.

In 1918, no one understood why the Spanish flu took those who were supposed to be the strongest. Today, Besser said no one really knows why H1N1 has hit the young.

The statistics focusing on the young provide scant solace to Caris.

"After what I've been through, I'm going to keep being careful," she said.

Carlo, the Dallas County medical director, agreed. Some things haven't changed in the 90 years since 1918. He advises frequent hand washing, staying home when sick and vigilant cleaning of homes, schools and offices with antibacterial products.

"I hope we don't relax those things," he said.