Bakgrund: Spanska sjukan var en influensapandemi som spreds 1918–1920. Den orsakadeomkring 25–50 miljoner människors död. Sedan spanska sjukan har det förekommitytterligare tre influensapandemier med betydligt lägre dödlighet. Spanska sjukans betydandeomfattning och dynamik är fortfarande inte helt klarlagd. Kunskap om tidigare pandemier kan öka förståelsen och beredskapen inför kommande pandemier. Syfte: Syftet med studien var att förstå spanska sjukan 1918–1920 och dess omfattning. Metod: En hermeneutisk metod användes i form av texttolkning. Totalt inkluderades 20 textervarav 18 artiklar från PubMed och två bokkapitel. Urvalet av litteratur skedde utifrån relevansoch med mål att få en så bred bild av forskningsområdet som möjligt. Resultat: Utifrån vald litteratur identifierades nio teman som viktiga i förståelsen av spanskasjukan. Dessa var: 1. pandemins ursprung och början, 2. smittspridningens dynamik,3. mortalitet, 4. symtom och dödsorsak, 5. riskfaktor – ålder, 6. riskfaktor – socioekonomi,7. riskfaktor – abnormt klimat, missväxt och svält, 8. patogenen bakom pandemin samt9. samhällets insatser. Influensavirusets genetiska variabilitet och människans interaktion meddjur identifierades som nyckelfaktorer för pandemiers uppkomst. Slutsats: Spanska sjukans förlopp berodde på ett komplext samspel av både medicinska ochicke-medicinska faktorer. Lärdomen av spanska sjukan är att i förebyggande arbete inför ochvid insatser under kommande pandemier bör både medicinska faktorer som immunologi samticke-medicinska faktorer som beteende och demografi beaktas.

The swedish local history research on the spanish flu is relatively scarce. The research that is available today seems to be largely centered around accounts for morbidity and mortality as a result of the epidemic. This however, has also been an important part of the research, to provide a demographic depiction of the mortality. Another important element in the present study has also been to account for the authorities' actions during the epidemic, something that is largely lacking in research. In light of the prevailing Corona epidemic and the lack of local historical research on the course of the Spanish flu in Sweden, the present study has aimed to examine the course of the epidemic in the undersigned home municipality of Karlskoga, during the epidemic in 1918. With the use of the death and funeral books of the Karlskoga parish, old issues of the newspaper ”Karlskoga Tidning” and the Health Care Board's statistics and protocols, the undersigned has, through this case study, tried to provide a quantitative aswell as a qualitative depiction of the epidemic year. The study evince that at least 43 people died in the municipality, the majority of whom were men under 40 years old. It also turned out that the workers' areas in Bofors were home to 36% of those who died during the epidemic months, no other area in the municipality had such high mortality rate. The study also indicates that the authorities in Karlskoga considered the epidemic to be of great danger. Hence, they seemed to have used the available information channels at the time, as to prevent the spread of infection. In this research it is noteworthy that as of today, a hundred years later, similar approaches are used to limit the spread of infection.

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The aim of the following study is to depict the causes of death that were most common during a time period between 1880–1949 in the small villages Ivetofta, Ivö, Rinkaby and Vinslöv. The results will be presented in different time intervals of 10 years. Furthermore, the surge will analyse the variations over time and explain why causes of death may altern. In addition, it will also highlight specific aspects of the subject such as age, gender, birth, violent death, suicide and the Spanish flue. The results in the different areas will be compared to each other to illuminate similarities and differences. Moreover it will also be compared to national statistics to see if the different villages comply or oppose with the results. In order to improve the study, the conclusion will also be compared and connected to the two theories the demographic transition and The Epidemiologic Transition. They offer an explaination to the outcome and allow us to integrate this study in a greater context.   The results of this survey, show that the most common cause of death was that of age. Furthermore, there was a huge up-swing in heart diseases, brain diseases and cancer in the later time periods. At the beginning, most people that died were very young. This changed however and as time passed, more and more people began to decease at an older age and this complied with national statistics. There was a slight majority of women that passed away although almost all persons that occured in cases of violent death, were men and this category increased with time. Even though a lot of people died, a lot more were born and therefore the small societies had a positive birth ratio. There occured cases of the Spanish flue although it did not influence the vast statistics.

The purpose of this thesis is to find out how a hundred and its public healthcare system managed the 1918 flu pandemic, with Näs hundred as a case study. Relevant information is found using archived copies of the provincial physician's sent letters, editions of the local newspaper, and death-and-funeral books. Such information includes mortality statistics, which measures were taken, which role the private sector had, and if there was any change within the public healthcare system. The study finds that the Spanish flu stood out from other illnesses and the general state of health. At its culmination in October, hundreds were sick and private workplaces were short of staff. The mortality rate seems to have been around 0.49% of the population, which is a reasonable rate in comparison to other case studies. When the epidemic was at its height, the authorities closed schools and prohibited events that attracted larger masses of people. This was announced through the local newspaper, alongside urges for the people to avoid crowding. Within the public healthcare system, there were no extensive changes, except an increase in workdays, a higher salary and a decrease in the number of nurses. There was a discussion on who should be allowed to be cared for in the epidemic hospital, as this hospital, according to routine, did not care for people with influenza or people from outside the central locality. There is no evidence on how this turned out, but some information seems to suggest that the hospital, or at least the epidemic nurse, did get to care for people with influenza. Nonetheless, it is clear that the public healthcare system could not manage the epidemic, and that the majority of people had to be treated in their homes by a relative or an ambulating nurse. When it comes to actions taken by the private sector, charity funding for the victims is the sole provable action. In contrast to other case studies, there is no evidence of private healthcare or charity organizations that would have cooperated with the public healthcare system. This charity, as well as those measures taken by the authorities, can be seen as consequences of a so-called institutional weakening, which itself would be a consequence of the epidemic outbreak. The outbreak showed that the public healthcare system could not handle an epidemic of this size, which in turn made established routines obsolete, showed that there were holes in the system and legitimized interventions made by the authorities. As a consequence, the aforementioned measures were taken to inhibit the spread of the epidemic and to care for the sick. / Syftet med denna uppsats är att undersöka hur ett härad och dess sjukvårdsorganisation klarade av 1918 års influensapandemi, med Näs härad som fallstudie. Relevant information hittades genom att granska provinsialläkarens konceptböcker, nummer av Säffle-Tidningen och död- och begravningsböcker från tiden. Sådan information inkluderar hur sjukan utmärkte sig som bidragande faktor till det allmänna hälsoläget, vilka åtgärder som vidtogs som reaktion av epidemin och ifall någon förändring i sjukvårdens organisation skedde till följd av spanska sjukan. Uppsatsen kommer fram till att spanska sjukan stod ut från övriga sjukdomar och det allmänna hälsoläget. Vid kulmen i oktober var hundratals insjuknade och arbetsplatser hade brist på personal. Dödstalet låg på runt 0,49% av befolkningen, vilket är ett rimligt tal i jämförelse med tidigare forskning. När epidemin var som mest utbredd stängde myndigheterna skolor, biografer och liknande tillställningar som drog till sig större folkmassor. Detta utannonserades i Säffle-Tidningen, samtidigt som de uppmanade folk att hålla distans till sjuka och undvika trängsel. Inom sjukvården kom inga större förändringar, utan främst utökade arbetstider, höjd lön och en minskning i antal sköterskor. En diskussion fanns dock kring vilka som skulle få vårdas i epidemisjukhuset, som enligt rutin inte tog emot folk sjuka av influensa eller folk utanför den centrala köpingen. Det går inte att belägga hur detta kom att se ut, men en del tyder på att epidemisjukhuset, eller åtminstone epidemisjuksköterskan, trotts allt kom att vårda folk sjuka i influensa. Oavsett är det klart att sjukvården inte hade beredskap nog att hantera sjukan, och att majoriteten av de sjuka fick vårdas i hemmet av anhörig eller kringvandrande sjuksköterska. Av vad man kan belägga med det givna källmaterialet är en välgörenhetsfond åt de utsatta det närmsta man kommer vad gäller reaktioner från privat sektor. Till skillnad från fallstudier i tidigare forskning finns inget bevis på att privat vård eller välgörenhetsorganisationer kom att samarbeta med sjukvården. Oavsett kan detta, samt de åtgärder och förändringar som vidtogs av myndigheterna, ses som ha kommit till följd av en institutionell försvagning, som i sig var en följd av det epidemiska utbrottet. Epidemin påvisade nämligen att sjukvården och samhället inte kunde hantera en så stor mängd sjuka, vilket gjorde att rutiner blev obsoleta, att hål i systemet uppenbarades, och interventioner kunde legitimeras av myndigheterna. Som följd vidtogs ovannämnda åtgärder för att försöka hämma epidemins spridning och vårda de sjuka.