Sunday, May 17, 2020

Looking Back: The Spanish Flu, 1918

World War 1 officially ended on November 11, 1918. When peace was finally negotiated and the Armistice signed, celebrations filled the cities. More sombre Peace Day commemorations followed after the signing of the Treaty of Versailles formalised the end of hostilities.

Rumours of Germany's surrender spread on Friday 8 November 1918. In Sydney and suburbs cheering crowds filled the streets and many businesses closed to allow staff to participate. Eventually the crowds dispersed when there was no official recognition.

Crowds in Martin Place, Sydney on False Alarm Friday, November 8, 1918

On the evening of Monday 11 November 1918 official news was received in Australia that the Armistice had been signed. Church bells rang, trains and ferries sounded their horns and cheering crowds assembled in every neighbourhood. Huge crowds poured into the city and choked all major streets for several hours.

Armistice celebrations in Martin Place 11 November 1918

Some WW1 statistics:

Population (millions)
Total deaths
(incl civilian)
New Zealand
United Kingdom

The above figures include civilian deaths and deaths subsequently through malnutrition etc that were war-related.  Where a range of figures has been provided, I have used the upper figure.

Then the Spanish Flu hit.


Some facts and comments about the Spanish Flu. . .


The Spanish flu pandemic of 1918, the deadliest in history, infected an estimated 500 million people worldwide—about one-third of the planet’s population—and killed an estimated 20 million to 50 million victims, including some 675,000 Americans.


The 1918 flu was first observed in Europe, the United States and parts of Asia before swiftly spreading around the world. At the time, there were no effective drugs or vaccines to treat this killer flu strain. Citizens were ordered to wear masks, schools, theatres and businesses were shuttered and bodies piled up in makeshift morgues before the virus ended its global spread.


During the flu pandemic of 1918, the New York City health commissioner tried to slow the transmission of the flu by ordering businesses to open and close on staggered shifts to avoid overcrowding on the subways.


The first wave of the 1918 pandemic occurred in the spring and was generally mild. The sick, who experienced such typical flu symptoms as chills, fever and fatigue, usually recovered after several days, and the number of reported deaths was low.

However, a second, highly contagious wave of influenza appeared with a vengeance in the fall of that same year. Victims died within hours or days of developing symptoms, their skin turning blue and their lungs filling with fluid that caused them to suffocate. In just one year, 1918, the average life expectancy in America plummeted by a dozen years.


It’s unknown exactly where the particular strain of influenza that caused the pandemic came from; however, the 1918 flu was first observed in Europe, America and areas of Asia before spreading to almost every other part of the planet within a matter of months.


One unusual aspect of the 1918 flu was that it struck down many previously healthy, young people—a group normally resistant to this type of infectious illness—including a number of World War I servicemen.

In fact, more U.S. soldiers died from the 1918 flu than were killed in battle during the war. Forty percent of the U.S. Navy was hit with the flu, while 36 percent of the Army became ill, and troops moving around the world in crowded ships and trains helped to spread the killer virus.


Although the death toll attributed to the Spanish flu is often estimated at 20 million to 50 million victims worldwide, other estimates run as high as 100 million victims—around 3 percent of the world’s population. The exact numbers are impossible to know due to a lack of medical record-keeping in many places.


The Spanish Flu did not originate in Spain, though news coverage of it did. During World War I, Spain was a neutral country with a free media that covered the outbreak from the start, first reporting on it in Madrid in late May of 1918. Meanwhile, Allied countries and the Central Powers had wartime censors who covered up news of the flu to keep morale high. Because Spanish news sources were the only ones reporting on the flu, many believed it originated there (the Spanish, meanwhile, believed the virus came from France and called it the “French Flu.”)


When the 1918 flu hit, doctors and scientists were unsure what caused it or how to treat it. Unlike today, there were no effective vaccines or antivirals, drugs that treat the flu. The first licensed flu vaccine appeared in America in the 1940s. By the following decade, vaccine manufacturers could routinely produce vaccines that would help control and prevent future pandemics.

Complicating matters was the fact that World War I had left a shortage of physicians and other health workers. And of the available medical personnel, many came down with the flu themselves.

Additionally, hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students.

Officials in some communities imposed quarantines, ordered citizens to wear masks and shut down public places, including schools, churches and theatres. People were advised to avoid shaking hands and to stay indoors, libraries put a halt on lending books and regulations were passed banning spitting.


With no cure for the flu, many doctors prescribed medication that they felt would alleviate symptoms… including aspirin, which had been trademarked by Bayer in 1899—a patent that expired in 1917, meaning new companies were able to produce the drug during the Spanish Flu epidemic.

Medical professionals advised patients to take up to 30 grams per day, a dose now known to be toxic. For comparison’s sake, the medical consensus today is that doses above four grams are unsafe. Symptoms of aspirin poisoning include hyperventilation and pulmonary oedema, or the buildup of fluid in the lungs.  It is now believed that many of the October deaths were actually caused or hastened by aspirin poisoning.


The flu took a heavy human toll, wiping out entire families and leaving countless widows and orphans in its wake. Funeral parlours were overwhelmed and bodies piled up. Many people had to dig graves for their own family members.


The flu was also detrimental to the economy. In the United States, businesses were forced to shut down because so many employees were sick. Basic services such as mail delivery and garbage collection were hindered due to flu-stricken workers.

In some places there weren’t enough farm workers to harvest crops. Even state and local health departments closed for business, hampering efforts to chronicle the spread of the 1918 flu and provide the public with answers about it.


A devastating second wave of the Spanish Flu hit American shores in the summer of 1918, as returning soldiers infected with the disease spread it to the general population—especially in densely-crowded cities. Without a vaccine or approved treatment plan, it fell to local mayors and healthy officials to improvise plans to safeguard the safety of their citizens. With pressure to appear patriotic at wartime and with a censored media downplaying the disease’s spread, many made tragic decisions.

Philadelphia’s response was too little, too late. Dr. Wilmer Krusen, director of Public Health and Charities for the city, insisted mounting fatalities were not the “Spanish flu,” but rather just the normal flu. So on September 28, the city went forward with a Liberty Loan parade attended by tens of thousands of Philadelphians, spreading the disease like wildfire. In just 10 days, over 1,000 Philadelphians were dead, with another 200,000 sick. Only then did the city close saloons and theatres. By March 1919, over 15,000 citizens of Philadelphia had lost their lives.

St. Louis, Missouri, was different: Schools and movie theatres closed and public gatherings were banned. Consequently, the peak mortality rate in St. Louis was just one-eighth of Philadelphia’s death rate during the peak of the pandemic.

Citizens in San Francisco were fined $5—a significant sum at the time—if they were caught in public without masks and charged with disturbing the peace.


By the summer of 1919, the flu pandemic came to an end, as those that were infected either died or developed immunity.


The following extracts, photographs and comments are from an article by Paul Daley in the Guardian on 14 March 2020:

 How Spanish flu nearly ripped apart Australia's fledgling federation 



Australia emerged from WW1 hard hit.  A relatively new country, it had become a federation on January 1, 1901 when the then 6 British colonies—New South Wales, Victoria, Queensland, South Australia, Western Australia and Tasmania—united to form the Commonwealth of Australia. It lost the cream of its young men and women in WW1 at a time when such people had been particularly needed.

According to Daley:

The federation, its disparate state and territory elements supposedly forged into a nation in the hellfire of Gallipoli in 1915 and all of the horror that followed in the subsequent years of the great war, would, it seemed, confidently repel what was, by the time it hit Australia in early 1919, a global pandemic.  
But the reality was quite different. Some 40% of the fledgling nation’s population (predominantly men aged between 25 and 40 – a similar demographic to that which contributed most to this commonwealth’s world war one fatality lists) would contract the flu that ultimately killed 13,000 Australians and 50 million people worldwide. And by mid-late 1919 – by which time the Australian papers were filled with articles about the hundreds of people who were dying weekly – the federation, still working on the myth that nationhood stemmed from a foreign war, was buckling in the face of contagion.


The following extract is also from Paul Daley’s article:

. . . in late 1918, before Australian health authorities had experienced a single known case, the federal government had acquired the power to close interstate borders upon notification by state health officers of Spanish flu cases. The states effectively ceded control of borders and interstate traffic to the commonwealth.  
The first diagnosed case in New South Wales challenged the integrity of that agreement. He was a returned soldier who had come to Sydney from Melbourne. Victoria, despite medical evidence to the contrary, had not notified the commonwealth of the Spanish flu in its midst. It was only after NSW notified the commonwealth (its headquarters and federal parliament were based at the time in Melbourne) that Victoria itself made the formal notification. NSW, blaming Victoria for the transmission, responded unilaterally, shutting its border with Victoria and walking away from the agreement.  
Once transmitted to Australia the flu rapidly escaped a quarantine system whose efficacy relied on the honesty of ship medical officers to volunteer past or present cases on board, and the willingness of returned soldiers to self-report and voluntarily isolate themselves rather than seek “cures”.  
Quackery was rampant. The broader medical fraternity was divided on origins of the flu, methods and bases of diagnosis, and possible treatment.  
Then – as now with coronavirus – “foreigners”, even those who’d been in Australia for generations, were treated with utmost suspicion.  
Indeed, in Australia and throughout allied Europe and the US, the supposed genesis of the Spanish flu had its foundations firmly in fear and blame of the other, not least the old enemy.  
“This modern plague … has commonly been called Spanish influenza,” the Australasian of 29 March 1919 reported. “Yet it did not originate in Spain, nor was it exactly the grippe or influenza of other days. It appears that the Germans, in anticipation that the malady might be justly named German plague … broadcast a misleading name which they had craftily devised before the infection spread from Germany to other countries.”  
There was no evidence the pandemic began in Germany. Epidemiologists have since determined it was likely that servicemen from the US – who entered the war late – brought a milder flu strain to Europe. It then transmogrified into the Spanish flu (so named because the king of Spain was among the first to die of it).  
In Australia schools were closed, sporting events – if they proceeded – were unattended, and worshippers stayed away from church. As borders closed and the west coast was isolated from the east, and as coastal shipping all but ceased, the war-hit economy slowed. The poor and disadvantaged – especially Aboriginal communities who had always been hit disproportionately by European-introduced illness – were impacted the hardest. For example, at the Barambah government Aboriginal reserve in Queensland 590 Indigenous people contracted the illness and 90 of them died within three weeks.  
As Australian markets slump and the economy faces the prospect of recession, both in line with global trends, it would be illustrative to reflect on the economic impact of the Spanish flu on Australia’s post-world war one economy.  
But with the exception of McQueen and a few others, Australian historiography – while reflecting obsessively on the first world war which killed 62,000 Australians over four years – has not delved nearly as deeply into the economic impact on Australia of the pandemic that took 13,000 lives in about a year. It has all but ignored the fascinating story of how a seemingly robust new federation, supposedly forged in the blood and steel of overseas battle, almost crumbled in the face of a virulent threat on the home front.


Medical staff and workers in Surry Hills, Sydney, in April 1919. Schools and businesses were closed, hospitals overflowed and masks became compulsory in public.

Some 100 military tents were set up in 1919 on Adelaide’s Jubilee Oval to create a Spanish flu quarantine camp.

Workers wait to use the ‘inhalatorium’ at Kodak’s Melbourne factory in 1919. Steam carrying sulphate of zinc solution was sprayed on to their faces twice a day in an effort to ‘disinfect’ their throats and air passages.

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