A short history of the 1918 flu pandemic

Now that we know at first hand what a pandemic is, this might be a sensible time to learn more about the 1918 flu–that thing most of us know as the Spanish flu. 

Spain’s connection was minimal. The disease first got public recognition there and that’s about it. World War I was still being fought, and newspapers were still censored in Germany, Britain, France, and the US–and possibly in assorted other countries that don’t get a mention. They weren’t allowed to mention the flu. You couldn’t publish anything that might lower morale.

Epidemics, you might have noticed, do lower morale.

Spain, though, sat on the sidelines in World War I. It didn’t censor its papers–at least not for any mention of morale-lowering diseases, although I wouldn’t rule out the possibility of censorship on other issues. So Spain broke the story and its reward was that the world blamed it for the disease it had mentioned. 

Irrelevant photo: a peony

Recent epidemiological research hints that the virus might have been circulating for two years before reaching pandemic levels, and US troops could have been–well, I don’t know if calling them the source of the epidemic would be correct, but the first known cases were in Fort Riley, Kansas, and they didn’t stop the US from shipping soldiers to fight in Europe. So you could make an argument that the US was the source. 

Alternative theories, on the other hand, point to China, Britain, and France. 

 

Numbers

Although a lot of us learned to call the 1918 flu an epidemic, it was a full-blown international pandemic. (Hands up: How many of us even knew the word before last year?) The only part of the world that didn’t report an outbreak was Marajo, which I never heard of until I started researching this post. It’s an island in Brazil’s Amazon Delta. 

The pandemic ran from 1918 to 1919 and killed over 50 million people worldwide. Or possibly 100 million. No one was keeping count, so we’ll have to settle for guesswork. And to confuse the picture further, even if folks had been counting, the symptoms were easy to confuse with other diseases. 

An estimated 500 million people were infected–a third of the world’s population.

In Britain, 228,000 people died of the flu; 1918 was the first year on record in which deaths outnumbered births. And Britain got off more lightly than many countries.

By way of comparison, worldwide Covid deaths are currently just under 4 million, although that’s generally agreed to be an underestimate. Britain’s had 128,000 Covid deaths.. 

The flu pandemic killed between 10% and 20% of the people who became infected, and more people died of it in a single year than died of the Black Death between 1347 and 1351. I believe that’s in Britain. Or in England. Or somewhere. Who cares? It’s a sobering comparison.

It hit young adults particularly hard–people between 20 and 40, who you’d expect to have the most resistance–but it also hit children under 5 and people over 65. Most of us, though, will have heard about  the 20-to-40 age group because it’s unusual for a disease to zero in on them.

 

Spreading the flu

The flu spread both through the air on droplets–those things that people breathe, sneeze, coughe, or talk into the air. It also spread on surfaces. You’d touch a surface that had germs on it, give them a ride to your face, and have yourself a nice little bout of the flu. 

Soldiers returning home from northern France get a special mention in any discussion of how the virus spread. In France, they’d been coming down with la grippe, which consisted of sore throats, headaches, loss of appetite, and the cramped trenches it circulated merrily. But they tended to recover quickly. Doctors called it a three-day fever. 

From that, though, the disease evolved into something deadly. We’ll come back to that. In the meantime, let’s go back to those British soldiers returning home on cramped troop transports and trains. Following their path, the flu spread from railroad stations to city centers, from city centers to suburbs, and from suburbs to the countryside. 

 

The pandemic’s waves

The first wave of the pandemic hit in the spring of 1918 and was relatively mild. The second came in the winter and was the most deadly. In the past, when I’ve read that the second wave was worse than the first, I assumed that meant only that more people got sick. No such luck. The disease itself had changed. In the second wave, you could be fine at breakfast and dead by nighttime. 

Let’s go to Historic UK for the gory details: “Within hours of feeling the first symptoms of fatigue, fever and headache, some victims would rapidly develop pneumonia and start turning blue, signalling a shortage of oxygen. They would then struggle for air until they suffocated to death.”  

The third wave hit in the early spring of 1919, and was somewhere between the first and third in its virulence. Smaller, localized outbreaks went on into the mid ‘20s. But in August 1918, an observer could reasonably have thought that the disease had ended, and since the government still had a war to fight it kept its attention on that. 

For the most part, pubs stayed open. The Football League and FA Cup had been canceled because of the war, but men’s regional tennis competitions went ahead and so did women’s football, which in the absence of men’s games attracted big crowds.  

Hospitals were overwhelmed, and it didn’t help that medical personnel had been vacuumed up by the war. Medical students were brought in to help fill the gaps. Doctors and nurses worked themselves to the point of exhaustion. 

Graveyards were also overwhelmed. Think of them as the kind of high-end restaurants where you need advance bookings. The draft meant the country had a shortage of grave diggers, of funeral workers, of coffin builders. Horses had been drafted as well, so even getting the dead picked up was a problem. In Sunderland at one point, 200 bodies were left unburied for over a week. 

When the war ended (November 11, 1918, in case anyone asks, at 11 a.m.), crowds turned out to celebrate, helping to spread the disease. There just might be a lesson hidden in there for us.

 

The expert advice

Sir Arthur Newsholme, the chief medical officer of the Local Government Board, wrote a memorandum in July 1918 advising people to stay home if they were sick and to avoid large gatherings. It wasn’t bad advice, and he promptly buried it. Britain had that war to fight.

Looking back on it in 1919, he said it could have saved many lives, but “there are national circumstances in which the major duty is to ‘carry on’, even when risk to health and life is involved.”

Keep smiling. Keep morale up. If you have to die, do it off stage.

The cabinet never discussed the epidemic. No lockdown was imposed, and I’m not sure the concept was available to be discussed. In 1917, it talked about forming a ministry of health to prevent disease and coordinate health care, but it did nothing about it until 1919, leaving localities to respond to the pandemic as well or badly as they could. 

In places, theaters, dance halls, movie theaters, and churches were closed for varying lengths of time, and in some places streets were sprayed with disinfectant. Some people wore masks. Some didn’t. Whatever happened, happened locally.

Public health messages ranged from the vaguely useful to the batty. Some factories relaxed no-smoking rules because cigarettes were known to prevent infection–or at least some people knew about it and probably thought the ones who didn’t were idiots or deliberately suppressing information.

But that’s just a guess.

In a Commons debate, M.P. Claude Lowther asked, “Is it a fact that a sure preventative against influenza is cocoa taken three times a day?”

The News of the World told people to “wash inside nose with soap and water each night and morning; force yourself to sneeze night and morning, then breathe deeply. Do not wear a muffler; take sharp walks regularly and walk home from work; eat plenty of porridge.”

Cleaning your teeth was also recommended. It might not keep you alive, but at least you’d die with clean teeth. Brandy and whisky were popular preventatives. So was ventilation, which would have actually helped, along with warm clothes. Worrying about your health, on the other hand, would make you more vulnerable. Besides, it could interfere with the war effort.

Predictably, in the absence of solid information, individuals were often blamed–for catching the disease; for spreading it; for taking risks that no sensible person would take, like passing up that third cup of cocoa.

People rushed to chemists to buy quinine, which was useful against malaria but roughly as helpful against the flu as turkey feathers. 

We can–and we might as well–laugh, but remember that there weren’t any antibiotics yet, which could have been useful against flu’s secondary infections. And there were no antivirals. The first vaccine for the flu wasn’t licensed until 1940. 

Many doctors prescribed what they had available: aspirin. Its patent had expired in 1917, so new companies moved in to produce it–I’d assume cheaply. Patients were told to take up to 30 grams a day, which is now considered a toxic dose. If you take anything above four grams these days, red lights start flashing and sirens go off. 

The symptoms of aspirin poisoning include hyperventilation and pulmonary edema, which is a buildup of fluid in the lungs. Some flu deaths may have been either caused or speeded up by aspirin poisoning.

To be fair, some of the recommended public health measures were useful, including ventilation, disinfection, limiting or banning large gatherings, quarantine, and isolation of patients, but they were applied unevenly. 

 

The pandemic’s legacy

Industrialized countries went into the pandemic with atomized health systems. Doctors worked for themselves or for charities or religious institutions. Public health policies–and this isn’t particularly about Britain–were colored by eugenics, a theory that, to simplify wildly and irresponsibly, managed to show that the people at the top of society were there because they were better genetic specimens and the people at the bottom were degenerate and a mess. So public health policy–or so the Smithsonian tells me–tended to be about protecting the elites from the diseases of the poor. 

When the pandemic died down and they had some space to think, the lesson many countries took from it was that healthcare had to be available to all, and free, although the moves in that direction weren’t universal or, at first, complete. Public health embraced the idea of not just treating disease but preventing it. Epidemiology–the study of diseases’ patterns, causes, and effects–came into its own, and epidemiology demands data, which governments, or some of them anyway, began to gather. One of the problems that article after article mentions about the flu pandemic is that it wasn’t a reportable disease, so doctors weren’t required to report cases to the government and wouldn’t have had a bureau to report them to if they’d been inclined that way. That meant no one knew the size or shape of the crisis.

In 1919, the forerunner of the World Health Organization was founded–an international bureau to fight pandemics.

29 thoughts on “A short history of the 1918 flu pandemic

    • Yes, but with more information to work with, they have less excuse. But I confess, I’m not in a particularly forgiving mood about this. They have done pretty well on vaccinations, but on other counts keep making the same mistakes over and over again. Now there’s talk of waiving restrictions on making UEFA happy by waiving restrictions, because we all know that important people don’t carry diseases. What is wrong with these people?

      Liked by 2 people

  1. The big lesson of the pandemic is that the best way deal with is with collective action – individualism is a disaster. You make a good point about public health policy being about protecting the elites from the diseases of the poor – I think that Victorian initatives (e.g. sewage systems, clean drinking water) only took place when it was evident that the rich could no longer keep themselves at arms’ length from the diseases of the poor. The cholera outbreak in London in 1854 or the Great Stink of 1858 when the stench from the Thames was overpowering, are both good examples of this.

    Liked by 2 people

    • It’s a point, I might as well admit, made in one of the articles I read. I don’t have enough information to have risked it on my own, but your examples are good ones. And I couldn’t agree more about the lesson of the pandemic. I wonder if we’re going to learn it.

      Liked by 2 people

  2. I’m not sure of the point of comparing the number of deaths during the Black Death with those during the Spanish flu pandemic. They’re both unknown numbers. The largest number I’ve come across for the latter is 200 million. Besides, it’s the percentage of people that died during the Black Death that’s huge, not the number of deaths themselves.

    Liked by 2 people

  3. What a fabulous shade of pink on that peony! Important stuff first :)

    Very interesting round up on “Spanish” flu – particularly how Spain got lumbered with the it. It took a while, but at least that’s one lesson learned – even if Grant Shapps didn’t read the memo that variants were now named after Greek letters before blabbing away to the press – so typically BoJo & Co. As for the rest, I fear that the first comment made here may become the line taken by the government while they frantically dodge any suggestions of an inquiry into their handling, while grabbing all the glory for the excellent work done by the NHS they’re working so hard to dismantle. Best I don’t get started on Dido…

    Liked by 1 person

    • Interesting to hear Shapps talking about the Nepal variant while the UK (pre-Greek letters) called the UK variant the Kent variant. Because, gee, it kind of sounded less like it was our collective fault.

      Et cetera. Let’s talk about flowers. Yes, I love the pink. Sadly, it isn’t scented, but with a pink like that you can get away with–or without–a lot of things.

      Liked by 1 person

  4. I have been a pandemic nerd since childhood. I read ‘The Roses of Eyam’ when I was about 9 and that set me off reading all of the books about plague that were in my library system. The 1918 flu is my second “favourite” historical pandemic after bubonic plague (with cholera in third place). As compelling as I have always found the history of pandemics and epidemiology more broadly, I really could have spent my life quite happily without gaining direct experience of living through a pandemic. While we have certainly made massive leaps forward with regard to medical science, I think the lesson from history is that we really have made paltry progress in terms of our societal response to public health crises.

    Liked by 3 people

    • That really is true, isn’t it? Although I do think that if governments had responded better and rallied people (the way I assume New Zealand, Taiwan, and a very few other places did) from the start, we might’ve had a response to be proud of. I think as a species we’re capable of better than this.

      Liked by 2 people

      • We are certainly capable of doing better. We have the means to have managed this situation better; there simply was not the will to do so. Public health should have been prioritized in all instances but instead there was far too much focus on secondary concerns, such as economic impact.

        Liked by 1 person

  5. Pingback: A short history of the 1918 flu pandemic — Notes from the U.K. – Historytalker

    • I can’t speak for all British people with any accuracy. The term didn’t catch on here, and most of the people we talk to hold Trump in contempt, but there is a strand of racism in Britain that’s gotten more vocal in the last few years, and I did read a few reports at the beginning of the pandemic of attacks on people who were assumed to be Chinese. I have no idea how common that was or whether it still continues–or, for that matter, whether anyone is tracking that kind of attack so that we could know how common it is.

      Liked by 1 person

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