‘I opened up the window and in flew Enza..: How Spanish ‘flu added to Great War heartache

1007_flu-3090440_166x138In Shell Shocked Britain: The First World War’s legacy for Britain’s mental health, I examine a number of different causes of the trauma experienced by British society as a whole during and after the conflict. I also acknowledge that we should not attribute 21st century responses to those who lived 100 years ago. However, there are some that are, surely, timeless and there are moments in history that shake the very foundations of everything we believe in. Without getting too cliché ridden, there is only so much an individual can take, and in Shell Shocked Britain I consider extending this to the nation as a whole.

So take yourself back to September 2001 and the shocking attacks on the Twin Towers in New York. After the horrors of that day, and the aftermath, do you remember how worried everyone was that an anthrax attack was imminent? That the postal service could become the means by which death was spread across the US, and Britain (I was refused some strong antibiotics for  cellulitis on the basis that they must be stockpiled for just such an eventuality)?  The fear of the ‘other’ became overwhelming, leading nations into war and beginning a chain of events we have yet to recover from. Would we, some wondered, ever feel safe again?

Imagine that after 9/11 an epidemic strikes, affecting the world in the winter of 2001; it is a disease so virulent that hundreds of thousands are dead within weeks, including many who survived the horrors in New York. It is the stuff of disaster movies. But when considering the aftermath of the Great War what is often overlooked is a similar, real, event; another equally devastating but natural disaster that was about to scythe down those that had survived the worst years of the fighting. Influenza.

A protein from the virus, recently identified in 2004

A protein from the virus, recently identified in 2004

When the virus was first noted the symptoms were benign, no worse than the common cold. Soldiers in the trenches complained of sore throats, headaches and lack of appetite. Highly infectious in the cramped, insanitary conditions, no-one seemed to suffer the symptoms beyond three or four days and military doctors were relatively unconcerned. Similar outbreaks had occurred in 1916 and 1917, when illness spread amongst gas-weakened troops and may have been caused by contact with wild and domesticated birds. However, the virus quickly mutated and, mistakenly reported as having originated in Spain, ‘Spanish’ influenza became a killer. By the end of 1919, between 50 million and 100 million deaths could be attributed to the virus worldwide.

The pattern of spread in Britain can be traced from May 1918 with the first cases in Glasgow, moving south to London by June. In July, 700 were reported dead from the virus in one week. Schools all over the country closed and church attendances fell drastically as people tried to avoid infection. Over the summer, the number of deaths declined, but by the autumn the disease had returned, this time causing the deaths of 17,000 in London alone. Cinemas, theatres and any public buildings where large numbers might congregate were closed down.

100 years ago, the public were ignorant of the ways in which infection was spread and even as the war drew to a close were inclined to believe the conspiracy theorists who blamed the Germans.

Spanish fluThere was no cure; like the common cold it simply had to run its course. Hospitals became overcrowded and unable to deal with the number patients admitted. In Aldershot those most desperate cases were left under shelter in the open air to ensure there was room on the wards for those more likely to recover. Many families stocked up on the suggested home remedies, such as quinine, and crowd control was necessary at dispensaries. The  population was advised to wear small surgical masks, ensure good hygiene and sleep in well-ventilated rooms, all sensible advice.

Whilst researching Shell Shocked Britain I came across other supposed ‘cures’ that caused practical problems for those resorting to them. In August 1918, Joseph Jackson, a 31-year-old soldier who had fought at Mons and returned home later with shell shock, had been recommended to drink beer for the influenza he had contracted. This resulted in a six-month prison sentence for kicking a policeman when he was arrested for drunkenness.

Contrary to the rather ‘romantic’ scenes depicted in Downton Abbey, when the lovely Lavinia succumbed, watching someone suffer could be shocking, especially if they were one of the 20 per cent of patients who developed septicaemia or pneumonia, for which there were no modern antibiotic treatments. Some developed a lavender tinge to their skin, the sign of ‘heliotrope cyanosis’. Its onset was alarmingly fast and signalled lack of oxygen and imminent death. A fit, young person could be well first thing in the morning and dead by tea-time. Whole families were affected, children orphaned and left in the care of grandparents as mothers and fathers died.

The families watched as the lungs and major organs of loved ones became filled with a thick jelly, which caused suffocation; bleeding from the ears and haemorrhage from the mucous membranes made it a terrible death. A feeling of intense depression came over those infected and, even patients who recovered were left with a lasting feeling of dejection and hopelessness. In the book I detail some of the reports I uncovered of suicides successful and unsuccessful – by those affected.

Communities large and small could be free of the infection one day and prostrate the next. Troop movements and conditions on the Front contributed to the spread, with the autumn outbreak coinciding with the Armistice Day celebrations. The circumstances required to spread infection were maximised as strangers kissed and hugged in the crowded streets. This time wealth and status was no protection and the age group hardest hit were those who were actively engaged in war work: 20 to 30-year-olds. It is still not clearly understood why this otherwise fit age group was most affected. It might have been because they benefited neither from exposure and possible immunity from previous ‘flu outbreaks or from the improved nutrition available to school children through free school meals. Whatever the reason, it increased the pressure on already fragile temperaments and the Hackney Gazette did little to assuage fears, printing an article in January 1919 stating that ‘this adds a new danger to life. One is never safe in this world.’

Famous names were lost to the virus. Sir Hubert Parry, composer and musician; economist Max Weber; William Leefe-Robinson VC, the first man in Britain to shoot down a Zeppelin airship. But Kaiser Wilhelm contracted flu and survived.

By early 1919 the numbers infected by the virus were gradually falling and the worst was over, although reported cases continued well into the summer of that year. Experts still dispute how many died from this strain of influenza across the world, but estimates range between 40 million to 100 million and around 230,000 of the victims were British. Other countries were hit even more cruelly; 4 per cent of India’s population died, and in some parts of the United States bodies were piled high in the streets until mass graves could be dug, as nearly 675,000 people lost their lives and 25 per cent of the population contracted the virus. It was tragedy on a monumental scale.

Surely, when assessing the impact of the trauma of the 1914-18 conflict, one has to imagine how we would respond now to such a nightmare, bearing in mind at the hint of ‘bird’ or ‘swine’ flu we are on major alert. It is remarkable to think that the consequences of an illness with a higher body count than the Black Death, remains a footnote to the Great War.

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