The Ghost of Days Past- What have we learnt from Past Pandemics – Part 2, The Spanish Flu

Assistant Librarian, Sandi, continues her look into past pandemics…

My Great Uncle George Apps was a soldier in the 5th Middlesex Battalion in WW1 who survived the conflict only to die of Influenza, the “Spanish Flu”, in England on 25 February 1919. He is commemorated on the Commonwealth War Graves Memorial at the City of London and Tower Hamlets Cemetery. He left a wife, my GtAunt Hennietta and two small children.

The “Spanish” Flu is a misnomer, the flu did not originate in Spain.

It was called the Spanish Flu because the outbreak was during the First World War when Britain, France, Germany and America censured newspaper reports that might affect morale, while neutral Spain did not.

The only mention of the Spanish Flu was advertising Veno’s Cough Mixture as a “cure”, which appeared in every Local Newspaper across Britain, and misinformation that it was spread my mosquitoes.

One of Spain’s first casualties, was King Alfonso XIII who become gravely ill but did recover. This was reported along with news of the epidemic in headlines in Madid newspapers in May 1918.

It was an avian flu virus that mutated to infect humans and came in three or four waves from March 1918 until March  1920.

North Devon Journal 14th November 1918 page 7

Just as now when doubt has been cast that Wuhan market in China was the source of the 2020 Covid-19 outbreak, there is more than one theory as to when the first outbreak of the “Spanish Flu” occurred.

John Oxford a British virologist cites an outbreak in a British Army camp of 100,000 soldiers at Etaples in France. In the winter of 1917 several hundred soldiers collapsed with influenza like symptoms, of which 156 died. The camp was on the migratory flight path of birds.

The most common hypothesis, “Track and Trace” of “patient zero” is to Albert Gitchell, a fowl farmer from Kansas, America.

When Albert was conscripted into the US Army during WW1 he worked in the kitchens of Fort Riley troop camp of 56,000 soldiers. He reported sick March 1918, within three weeks 1100 soldiers were seriously ill and 38 died. The Camp Medical Officer wrote to Washington but his concern was ignored.

The first wave was not particularly deadly, a high fever, depilating weakness over three days with a death rate similar to seasonal flu mortality. Between July and September cases were waning but then there was a resurgence, a second wave, as the virus mutated into a virulent strain capable of killing healthy people within 24 hours of showing symptoms, with patients drowning as fluid filled their lungs depriving them of oxygen.

United Kingdom History of Government by Tara Finn https://history.blog.gov.uk/2018/09/13/the-flu-that-wasnt-spanish/

In September 1918 the second wave hit the US Army Camp, Boston Camp Devens. Blinkered Officialdom failed to recognise that this was a far more deadly strain and instead of quarantining the men continued to ship them out to the Western Front.

On the 29th September 1918 the Leviathan a large transport ship left New Jersey with 9,000 troops, 50% over capacitated, the confined conditions of the closely packed soldiers an ideal environment for the spread of disease, producing a “plague ship”. In the eight days the ship crossed the Atlantic hundreds of the soldiers died never reaching the Western Front.

Those that did were moved out to various locations on the Western Front taking the infection with them. When they and other soldiers succumbed to the infection they were taken to field hospital with the wounded. When the wounded were shipped home and soldiers returned on leave, the infection was spread to Britain.

The overriding importance of the war effort to the Military was echoed by the intransigence of civilian officials.

Sir Arthur Newsholme the Chief Medical Officer of the British Local Government Board chose to ignore reports that recommended a strict civilian lockdown to halt the spread of the highly contagious disease.

https://wellcomecollection.org/works/pwpg7as3

Sir Arthur Newsholme The Flu that wasn’t Spanish History of Government files

He believed that a civilian lockdown would have impeded the war effort by keeping home the munition factory workers, and encouraged the public to “Carry on”, suggesting that it was unpatriotic to be concerned with the flu rather than the war. He was not quite as blinded as the Brazilian President terming the Corona virus as a “little flu” but could the lessening to our present lockdown for the benefit of economic regeneration result in a second wave of infections and deaths?

Sir Arthur Newsholme’s decision resulted in thousands of unnecessary deaths.

In June 1918, James Niven Medical Officer for Health responsible for the health of Manchester, tracked the outbreak and wanted to close down the schools and Sunday schools to limit the spread of infection but his opinion was branded an over-reaction and rejected. He produced 30,000 leaflets listing precautions which he distributed to factories, works, the press and in houses and 500 large posters which were put up throughout the city. The BBC documentary “Flu that killed 50 million” quotes that “he is doing more than anyone in the country to actively fight this pandemic”.

https://wellcomecollection.org/works/p7z3ywun

The First World War commitment helped disperse the virus through the relentless mobilisation of the troops and the cramped and insanitary conditions of the trenches. On the home front, it was spread by returning troops via shipping and the railway.

2020 has social mobility, global air travel and cheap foreign holidays, densely concentrated urbanisation, mass transportation and a world population that has increased fourfold in the last century. Michael Osterholm, Director of the Centre for Infectious Disease Research & Policy University of Minnesota, believes that “ if flu killed 50 million in 1918, we could expect …more than 250 million casualties today”

An unusual feature of Spanish Flu was that it particularly afflicted young people between the ages of 20 to 30 years, a group more normally resistant, whereas with seasonal flu generally the very young and elderly suffer the greatest mortality.

Vaccines Today

Within hours of the first symptoms victim’s lips, ears and fingers turned blue from lack of oxygen as their lungs filled with fluid causing “drowning” or suffocation. The virus caused the body’s immune systems to over react producing an inflammatory response with large numbers of white blood cells releasing excessive Cytokines causing pneumonia, more harm than good. This is referred to as Cytokine Storm. The strong immune systems of the young men and women reacted the most violently compared to other age groups.

With Covid 19 we are seeing a different demographic, with fatalities mushrooming in the over 70’s age group.

With both Influenza outbreaks, Black, Asian and Minority Ethnic [BAME] people have a much higher rate of mortality. Soldiers of the Empire returning to their home countries after fighting for Britain took the virus with them. Australia was the exception in that it remained free of infection for much of that time because it sealed its borders and quarantined returning ships.

In 1918 there was little known about viruses. Bacteriological science had identified the microorganisms for the most feared communicable diseases but it was not until 1939 that microscopes could detect something as small as a virus. Testing did not exist. Penicillin and anti-biotics to help with pneumonia was not available until 1928. There were no vaccines until the 1940’s or anti-viral drugs. The National Health Service was set up in 1948 before then only the middle and upper classes could afford to pay for a doctor.

Dr Basil Hood of the St Marylebone hospital in London wrote a memoir of the events, which saw his hospital overwhelmed with patients lining the corridors and staff succumbing to the illness. He was one of the first to advocate that staff use masks to protect themselves. Back then too there was a shortage of PPE.

Dr Hood 1904 Wellcome collection https://wellcomecollection.org/works/yztjq5es

Some states in the US did not cancel parades. Tens of thousands flocked to the Liberty Loan Parade in Philadelphia in September 1918 within 10 days 1,000 were dead and 200,000 were sick.

The Armistice in November 1918 exacerbated the spread of the second wave of infection by the close proximity of the large groups of people celebrating the peace.

More people died of the Spanish Flu than were killed in both the First and the Second World Wars together. The death toll in Britain was 228,000, one third of the population.

North Devon Journal 24th July 1919 page 7 column A

One hundred years apart Philip and Samuel Kahn, twins born 5th December 1919 both die from two catastrophic pandemics. Samuel died of Spanish Flu a few weeks after his birth, Philip died 17th April 2020 in New York from Coronavirus. [Lost Cousins newsletter]

And after the Corona virus of 2020 is all over and we immerge into the “new normal”, will the Government improve wages and conditions for NHS workers? Somehow “A Land Fit for Heros” the catch phrase after WW1 comes to mind. It didn’t come about then and the economy went into the 1920’s Depression. Will this History come back to haunt us again?

…Sandi Vass, Assistant Librarian

References

The Flu that killed 50 million BBC documentary

The Spanish Flu Pandemic of 1918 by Ben Johnson Historic UK

What we can learn from the Spanish Flu by Stephen Dowling BBC Future

The Flu that wasn’t Spanish History of Government files

Spanish Flu: the killer that still haunts us 100 years on Mark Honigsbaum Medical Historian Lecturer at the University of London Guardian Newspaper

100 years after the Spanish Flu: Is the world ready for the next pandemic? Gary Finnegan

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