“Soon after the war ended, there was a strange kind of flu,” recorded John Pears Jackson, who farmed near Keswick, and died in 2005, aged 98. “Many thousands of people, in England alone, died, including a lot of men and women in Cumberland, some of whom I knew. With none of the drugs and antibiotics we have today, doctors were powerless, and strong men and women were dead in the course of a few days… People drank whisky… and dosed themselves with all kinds of medicines. One farmer I knew swore he cured himself with paraffin oil.”
Margaret Pitt, then a pupil at Milton Mount College in Gravesend, recalled being offered something milder to drink: “The school was warned [of] the coming epidemic, so they tried to get us all home early before the Easter holidays. Telegrams were sent to our parents… Our trunks were packed and sent off. Then we all came down to the main hall ready for our journey, in coats, hats and gloves, and our hand luggage. The nurse and her assistant were there with thermometers to see if we were developing the virus. I think about half of us were sent back to bed, some were very upset as they were anxious to go home. I was one of those who had to go to bed. We were given plenty of drink… milk.”
The Flanders grippe
The British Medical Journal referred to the sickness – characterised by shivering, headache, sore throat and fever – as ‘Spanish flu’ because it was first recorded in Spain. Offended by the slander, Spaniards named the illness the ‘Naples soldier’. The German army called it ‘Blitzkatarrh’, and British troops referred to it as ‘Flanders grippe’ or the ‘Spanish lady’.
One recent study suggests it originated in China, and was transported by labourers heading for the western front. Other investigations concluded that its epicentre was a military camp – either in Kansas, or Étaples, northern France. Some claimed that mustard gas and battlefield fumes were responsible; others that it was a German biological weapon.
It’s estimated that somewhere between 25 and 100 million people died worldwide in what is, in absolute terms, the worst pandemic ever recorded. Only St Helena in the South Atlantic and a handful of South Pacific islands did not report an outbreak. Whereas, today, flu is especially dangerous for the very young and the elderly, in 1918 it mainly affected young adults. Those aged 75 and above had the lowest death rate of all.
Troops travelling home by boat and train at the end of the war took the flu into the cities, from where it spread to the countryside. The disease swept across Britain in three waves: mild in spring 1918; devastating in autumn 1918; and moderate in early 1919.
The port of Glasgow was the first place to record the flu, in May 1918, an unusual time of year for the sickness to appear. Young women, especially those working in factories, were worst affected. It reached London in June. By late August it seemed a spent force; but in October it returned with a vengeance, and reached every corner of the land.
The speed at which influenza struck defied efforts to deal with it. In July, a woman in Leicester stopped a doctor in the street, and while they were talking she collapsed and died. The brother of William Hall from Rosley, Cumbria, recorded in his diary: “We did not know he ailed anything until the morning of the day he died.”
The infection spread at an alarming rate. On 14 February 1919, poet Robert Graves returned from Limerick to his home in Hove, accompanied by “the Spanish Lady”. Within a couple of days, almost his entire household had contracted the flu.
Throughout Britain, a shortage of undertakers and grave diggers led to bodies lying unburied for days, and many funerals taking place at night.
Giving up kissing
Local authorities and the press did offer some useful advice. The Bexhill-on-Sea Observer advised readers to avoid crowds by catching a later train home, sitting outside the bus, and wearing an extra coat. In Brighton, publicans were urged to thoroughly wash the outside lips of drinking glasses in running water, while a pamphlet recommended people to “give up shaking hands for the present, and give up kissing for all time”.
A number of constructive measures were taken. In Rotherham, posters were displayed in prominent parts of the town, and health visitors and school nurses distributed leaflets from door to door, encouraging people to keep dirty handkerchiefs out of the reach of children. The Borough of Hackney recommended that victims stay isolated, go to bed the moment symptoms appeared, and gargle with potash and salt. In Keswick, Cumbria, the Medical Officer arranged for a free supply of “disinfectant mixture”. Every morning, formalin was sprinkled on the floor of Brighton’s public library and post office, and tramcars were fumigated in Doncaster.
The focus – if there was one – lay in minimising the risk of infection through contact. Hundreds of elementary schools were closed during the height of the epidemic. Cheltenham Boys’ School took the reverse step of locking staff and pupils inside the building. Election candidates in Sunderland abandoned house-to-house canvassing, and turned down requests to take voters to the polls.
Recognising the value of fresh air to stem the spread of influenza, cinemas were required to be ventilated in London for 30 minutes every three hours. Those in Wolverhampton were ordered to ban children, and remove all carpets. For three consecutive nights, a Walsall cinema showed a 15-minute public information film that featured Dr Wise and a foolish patient.
However, some of the advice was useless. One government official simply encouraged people to “clean [their] teeth regularly”, while the News of the World suggested readers “eat plenty of porridge”. Dr Robertson Dobie of Perthshire noted that hardly any of his flu patients worked at the local jam factory – where they lived in a sugary atmosphere all day – and prescribed jam and sweets. “In two months,” he predicted, influenza “will be a thing of the past.”
Often, recommendations proved difficult to put into practice. “Terribly overcrowded and insanitary conditions rendered any attempt to cope with the disease futile,” recognised a health report in Rotherham. Where up to seven people occupied one small bedroom, isolation, ventilation and cleanliness were impossible. Although the town had an isolation hospital, space was available only for the severest cases.
It was hard to “keep warm” and “eat good food”. “We might as well ask for the moon… the luxury of sitting in front of a roaring fire with all the windows open is not for rationed people”, rebuked the Bexhill-on-Sea Observer on 16 November 1918.
Too few copies of the public information film were available. Local authorities had to apply in writing to borrow it, and prove that flu was already rampant in their area.
The lack of internal plumbing made it hard for Brighton publicans to rinse glasses thoroughly, while dozens of people continued to squeeze into the town’s trams because there were no resources to build any more.
When action was taken, the reasoning behind it was sometimes questionable. Physiologist Sir Leonard Hill recommended the deep breathing of cool air and sleeping in the open. Several isolation hospitals apparently placed patients in “soaking wet beds and sprinkled them regularly with cold water to keep them completely sodden”, hoping it would stimulate their immune systems. Meanwhile, at the George Hotel, Nottingham, Sister Veitch offered flu victims electric shock treatment.
Many key ways in which the disease was spread were not addressed. Schools in London only closed if staff absenteeism made it impossible to keep them open. Secondary schools remained open throughout, as did churches, on the grounds that during a crisis people should turn to religion, not be excluded from it.
It was a case of business as usual in Britain’s factories, too. Those in the Black Country relaxed their no-smoking rules, believing that cigarette smoke would prevent infection.
Public parades and pageants were also allowed to go ahead. Armistice celebrations on 11 November meant tens of thousands taking to the streets.
The authorities’ reluctance to act, and confusion among doctors – who called influenza “the obscure disease” – left the door wide open for quack remedies such as Thompson’s Influenza Specific, which claimed to “act like magic”; and Dr Williams’ Pink Pills for Pale People. Eating raw onions – as did the inhabitants of Saffron Hill – was also believed to keep “the dreaded scourge at bay”. Baffled doctors in Manchester prescribed an age-old tonic: whisky.
Much talk, little do
Although recognised as contagious, the disease was not mentioned in parliament until late October 1918, and was not made ‘notifiable’ to the authorities until the third wave struck in early 1919. Even if it had been, there was no strategy for tackling it. Britain had no National Health Service until 1948, and there was only a patchwork of institutions to deal with health issues. The central board of health merely had power to give ‘advice’ to local authorities, and the Local Government Board kept a low profile, issuing the occasional memorandum.
Therefore, the British response was a decentralised and uncoordinated one. Every town had to rely on its own resources and existing facilities to cope with the outbreak. The result was the proverbial “much talk, but very little do”.
Other factors compounded the country’s difficulties. The epidemic could not have struck at a worse moment. The First World War had diverted a vast number of medical staff: some 52 per cent of doctors were at the front. Those not in military service – doctors over 50 years old and often lacking up-to-date training – were run off their feet. At Kingston-upon-Thames, one doctor reported: “From early morning till late at night I have done nothing but rush from one flu patient to another.” Having been called to 35 flu victims in one street, a Nottingham doctor simply told flu sufferers to pass his prescription on. At Bookham, Surrey, the only doctor was himself a victim.
The medical profession didn’t fully comprehend the severity of the disease. In the summer of 1918, the Royal College of Physicians announced that Spanish flu was no more threatening than the still well remembered ‘Russian flu’ of 1889–94. The British Medical Journal accepted that overcrowding on transport and in the workplace was necessary to help the war effort, and implied that the inconvenience of flu should be quietly borne.
Individual doctors tried to play down the severity of the disease to avoid spreading anxiety. In Egremont, Cumbria, where the death rate was appalling, the medical officer asked the rector to stop ringing the church bells every time there was a funeral because he wanted to “keep people cheerful”.
No cause for alarm?
The press did likewise. The Times suggested that the illness was probably a result of “the general weakness of nerve-power known as war-weariness”, and the Derby and Chesterfield Reporter, 12 July 1918, declared that it was “not really a matter for alarm”. The Manchester Guardian scorned protective measures: “Women are not going to wear ugly masks.” What’s more, masks would steam up people’s glasses, and be of “doubtful usefulness at mealtimes”. The Sussex Daily News joked that influenza was no more than “an ingenious attempt” to sabotage the forthcoming general election, while Hanningtons department store in Brighton declared that the best way of treating influenza was spending money at their sale.
Other countries, no less affected by the war, made more rigorous efforts than Britain to deal with the flu. In the United States, schools, churches and cinemas were closed, and public gatherings were banned. Health departments distributed masks, shops were not allowed to hold sales, and funerals were restricted to 15 minutes. It was forbidden to travel by train unless you carried signed certificates that you were clear, and overcrowding was reduced by introducing flexitime at work. Parts of Arizona outlawed handshaking, and in San Francisco drinking fountains were sterilised with blowtorches every hour. Meanwhile, Canada built an emergency hospital for flu victims in Vancouver.
In France, schools, theatres and churches were closed down, extra staff were recruited to clear rubbish tips, and spitting in the street became a criminal offence. Train passengers in Spain were “generously sprayed with foul-smelling disinfectant”.
Australia succeeded for a while in imposing a national quarantine. Passengers had to stay in isolation before being allowed to enter the country.
By the summer of 1919, when the flu pandemic subsided, 228,000 people had died in Britain. Letters to newspapers condemned the government’s slowness to demobilise doctors at the front, the authorities’ “timidity” to act, and “armchair complacency”. A correspondent in the Hackney Gazette of 8 November 1918 had complained: “Schemes for checking these terrible visitations need to be thought out and prepared beforehand,” while another observer had remarked in the Perthshire Advertiser, 26 October 1918: “We possess much more stringent laws in regard to the health of animals than to that of human beings.”
The crisis hastened the Local Government Board’s replacement by a new Ministry of Health. Meanwhile, scientists attempted to identify what had brought Spanish flu. Existing wisdom that the disease was caused by a bacterium was wrong.
Only in 1933, with the invention of the electron microscope, did a team at the National Institute for Medical Research in London demonstrate that an extremely infectious virus (H1N1 A) caused influenza, and that droplets shed by coughing and sneezing transmitted it from person to person.
Fifteen years earlier, the priorities of war, determination to play down the seriousness of the illness, and limited medical knowledge resulted in a state of inertia, and allowed Punch to quip that those citizens who “insisted on having influenza”, did so “at their own risk”.
Dr Robert Hume is a writer and former head of history at Clarendon House Grammar School, Ramsgate, Kent
Books: Pale Rider: The Spanish Flu of 1918 and How it Changed the World by Laura Spinney (Jonathan Cape, 2017); Britain and the 1918–19 Influenza Pandemic: A Dark Epilogue by Niall Johnson (Routledge, 2006)
Radio: BBC World Service’s Pandemic is due to air in January
This article was first published in the January 2018 edition of BBC History Magazine