20 FEBRUARY, 1919: Coughs And Sneezes…

This has nothing to do with any particular anniversary, and I’ve got nothing particularly eye opening to say about it, but it really is time I talked about the flu.  The global influenza pandemic of 1918–19 is often referenced by popular history, but usually in the most general terms.  The estimated worldwide death toll of at least fifty million people, about one in ten of those infected, is bandied about anywhere you care to look, and the effects of the pandemic on developed civilian societies receive plenty of coverage.  As is the case concerning most major issues a century ago, the picture presented by our heritage history is far from complete, focusing on home populations and ignoring vast swathes of the planet, so some basic 101 on the subject seems to fit my brief.  Here we go.

The ‘Spanish Flu’ pandemic of 1918–19, which came in three waves, killed more people than any single outbreak of disease in human history to date, reducing the global population by between three and four percent.  Contrary to much popular thinking at the time, and to anyone on the Internet still peddling the idea, the arrival of the sickness had nothing to do with the four years of world warfare in progress when it arrived, though its rapid spread across the planet would not have been possible without the unprecedented crowding together of belligerent populations (in trenches, factories, mass protests, etc.) or the simultaneous surge in long-range transportation of humans.

Relatively minor outbreaks of a flu virus had taken place all over the world during 1915 and 1916.  It is now generally accepted that a mutated version of the same virus was responsible for outbreaks of what is seen (with hindsight) as a milder precursor of ‘Spanish Flu’ in military camps at Étaples in France and Aldershot in England between late 1916 and the following March.  Neither of the latter spread further, but a similar, much more infectious virus struck in the US state of Kansas a year later.  It quickly spread through military camps all over the country, crossed the Atlantic aboard ships and had become an epidemic across much of Europe by the early summer of 1918.

This first epidemic was no killer and most people recovered within a month, though it often left victims tired and lethargic for weeks afterwards.  It was also very big news, but in the midst of a global propaganda war the news was distinctly partial.  Highly disruptive wherever it struck, influenza’s effects on the fighting strength of belligerent armies were, for instance, concealed from public view at the time and have received little attention since – but modern historians generally agree that the sick condition of the German Army, which was struck by the disease after it passed through the Allied trenches, was an important contributor to the failure of its spring offensives on the Western Front.

Meanwhile a relative flood of news about disruption in neutral Spain, which had an uncensored press, was creating the false impression (promoted by the world’s press) that the virus was Spanish in origin.  And so the outbreak of early 1918 became ‘Spanish Flu’, for posterity and for millions at the time, but not for everyone.  The Spanish called it Italian, black South Africans called it ‘white man’s sickness’, white South Africans called it ‘black man’s disease’, Poles called it the Bolshevik disease, and dozens of other names, not all of them politically inspired, were used by contemporaries to describe a mysterious, apparently unstoppable affliction that was about to turn very nasty.

In Spain they called it the ‘Neapolitan Soldier’, and it killed.

According to modern medical orthodoxy, epidemic conditions produced rapid adaption in a virus that had mutated several times during the previous three years.  From August 1918, a new strain emerged that attacked the human lungs quickly and with potentially lethal ferocity, leaving many victims prey to bacterial pneumonia and proving particularly dangerous to vigorous young adults, whose strong immune systems over-reacted to cause viral pneumonia and respiratory crisis.

Arriving at a time of unprecedented human traffic as the Great War reached its climax, the new killer made its first appearances in three busy ports during late August.  It quickly hitchhiked around the world in the populations of ships and penetrated inland trade routes. From Boston it spread rapidly through the Americas, from Brest through Europe and from Freetown in Sierra Leone to western and southern Africa.  This second wave was by far the most destructive, infecting an estimated 500–600 million people during the autumn and winter of 1918 and responsible for the great majority of deaths. Just as the pandemic seemed to be abating, in early 1919, a third wave struck and a fresh mutation of the virus swept across the world, killing another 3–4 million people before it finally subsided in mid-summer.

The killer virus wasn’t understood in 1918, but people knew something about how to avoid it. US public medical advice, late 1918.

The pattern of influenza deaths was by no means regular, but was broadly explicable.  Generally speaking, Europe and North America suffered the least, while the worst hit areas were sub-Saharan Africa, Central America, southern and eastern Asia, and the islands of the Pacific – in other words the world’s poorest and least medically aware societies.  Death rates could also vary dramatically between regions or even localities in the same country.  These apparently inexplicable anomalies encouraged a wide spectrum of homespun superstitions surrounding the disease, everything from intervention for wartime sins by a divinity of choice to the idea that a source of death with ‘germ’ in its profile must be a German secret weapon.  There were, again with hindsight, more rational explanations.  The imposition and success, or otherwise, of quarantine regulations was often a local matter, as was the prevalence or otherwise of the crowds that spread the disease like lightning.  There is also evidence that those places most affected by the first wave of influenza had developed some degree of immunity to the second.

Most photographic records of the pandemic come from the United Sates – but this was a Maori hospital in New Zealand.

The disease killed more males than females, a difference attributed to social mores that encouraged men to keep on fighting or working when the most effective treatment was complete rest, but the flu also proved particularly dangerous to pregnant women, and controversy has bubbled ever since about whether to add unborn or stillborn babies to the overall death toll.  Some surviving children born to infected mothers are thought to have suffered developmental damage in the womb, and a large (though incalculable) number of adult survivors were left with permanently damaged respiratory systems.  Overall, the pandemic’s long-term physical effects on human society are difficult to quantify, not least because vast swathes of the infected world were bureaucratically challenged in 1919.

The psychological effects of such a massive global catastrophe on the heels of such a terrible war are equally impossible to pin down, but it does seem to fair to say that grief, fear, bitterness, pessimism and partying like there was no tomorrow were all significant influences on human history during following decades, and were all promoted by the pandemic experience of 1918–19.  On the positive side, the evident failure of contemporary medicine to understand or combat influenza prompted a frenzy of analysis and research in its aftermath.  Along with a transformation of first-world attitudes to disease prevention through quarantine and sanitation, a worldwide effort eventually produced decisive breakthroughs in the field of virology, enabling final identification of the virus responsible for the pandemic in 1933.

Apart from the usual reminders about first-world perspectives on relatively recent history, the enduring power of wartime propaganda and the links between the First World War and pretty much everything since, all I’ve been trying to do here is wrap some context around a well-known catastrophe.  Apologies if there’s nothing new on offer, but it always seems a good idea for us white folks from rich countries to season our unsalted heritage with a little context.

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