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What the Spanish Flu pandemic teaches us today

A lethal and global disease, a stricken British prime minister, dithering governments, innumerable dead – what really happened in 1918?

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In May 1918, almost four years into the First World War, the British and French armies on the Western Front were desperately fighting to keep the Germans from overrunning them before, they hoped, two million American troops would arrive and save civilisation from the threat posed by the Central Powers. As the Allies struggled, successfully, to keep the enemy out of the Champagne towns of Reims and Épernay, an existentialist threat even more serious than mechanised warfare was settling in on the continent of Europe: the Spanish Flu. 

It created such a talking point for the British public that the Spanish ambassador to London felt it prudent to make a statement about the disease. “The epidemic that has broken out in Spain,” he announced in late May, “is not of a serious character. The illness presents the symptoms of influenza with slight gastric disturbances.” 

His Excellency was wrong to understate the affliction, for two reasons. First, the virus was lethal. The numbers of millions it killed cannot be accurately computed; and it is believed a quarter of the world’s population was infected. Second, one cannot be sure where it started, but it was almost certainly not in Spain. Most historians agree on one of two schools of thought. The first is that it began in Kansas, in an enormous holding camp for doughboys who were about to come to Europe and help win the war, and who helpfully brought it across the Atlantic with them. The other is that it mutated in the great military hospital camp at Étaples on the French coast, which was overcrowded and filled with diseases of various types. It also contained large numbers of animals for provisioning purposes, and had a huge throughput of men, thousands a day going to the front, or to England. 

The Spanish were blamed because their press, unhampered by war, reported the virus’s spread more extensively than elsewhere. With the world’s attention drawn to the suffering of King Alfonso XIII, who nearly died from the flu, it seemed as though Spain was the centre of the outbreak. By 2 June, 700 had died in Spain in ten days; 100,000 people in Madrid alone were infected. With its customary omniscience, the Times announced that “the best preventives are fresh air, cleanliness and constant disinfection”. In the months that followed there were startling similarities between the present pandemic and its counterpart a century ago, but also substantial differences.

As King Alfonso recovered, “his” flu reached the British Isles. On 22 June it was reported that “an epidemic of influenza, said to be similar to that reported in Spain, has made its appearance in Birmingham”. Four days later there were 600 cases in two factories in Letchworth. A doctor told the local council that “a good precaution was to avoid picture palaces and other crowded places and to keep the mouth and nasal passages purified”. The disease spread rapidly. Towns in affected areas closed schools not to stop the spread of infection, but because so many teachers were ill. On 25 June, 40 workers at Cardiff’s Central Post Office were sent home. In Belfast the Workhouse Infirmary had to deal with 200 cases, 45 presenting in one day. There had been outbreaks in the north and west of Ireland in mid-June (at Athlone 150 hands in a factory suddenly absent). The necessary mass movement of people during wartime exacerbated the problem; but so too did undernourishment because of food shortages and low real incomes, and the exhaustion many civilians had from working long shifts for years in the interests of the war effort.

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By 1 July the flu was scything through London, notably in the East End textile trade. People working in enclosed, overcrowded premises with poor air quality – such as sweatshops – were especially vulnerable. Doses of ammoniated quinine proved of limited use, with around a quarter of the (mainly female) workforce of London’s textile workshops affected. The speed with which the flu came on – the fever, the renal pains, the exhaustion – was alarming. There were tales of City men reaching their offices in apparently perfect health at 10am – they worked gents’ hours in those days – and being taken home in an ambulance at noon. While those working indoors were heavily affected, those working outside were said to be “practically immune”. The Times, assured in its clinical judgement, insisted on 2 July that “the malady… is only dangerous to those of advanced age” and that “to go to bed at once is the safest course to pursue”. In fact, those afflicted had little choice but to go horizontal, so debilitating was it. 

In early July the Midlands was the worst-hit area, though it was reported that 70 per cent of men were absent from heavy industry in Newcastle. By 3 July doctors in Birmingham were said “to be at their wits’ end to know how to deal with the number of patients”. One arrived at his surgery to find 178 patients waiting to see him. In London, 1,700 people died of the flu between 15 June and 3 August. There was, of course, no NHS to protect; just a network of largely charitable institutions and grotesquely overworked doctors. The doctors were also mainly elderly; all those below the age of 55 had been called up to the army. 


Hemmed in: a sleeping area at the Naval Training Station, San Francisco, California, in 1918. Credit: Vintage Space / Alamy

The flu was badly affecting the war effort, with munitions factories and mines heavily hit. In the four weeks to 20 July coal production was down from over 19 million tons in the same period in 1917 to just under 16 million. In Manchester the tram network was largely disabled. Newspapers were filled with quack suggestions for precautions, such as eating porridge, forcing oneself to sneeze first thing in the morning and last thing at night, and to take brisk walks. Writing from the Garrick Club in London, a Mr Harry Furniss proclaimed that the only known cure was “to take snuff, which arrests and slays the insidious bacillus with great effect”. London’s Central Telegraph Office, a crucial communications hub, had 700 people off sick on one July day. Shortly before the summer holidays all the schools in Huddersfield were closed down. Death could come swiftly, and people were seen dropping from the disease in the streets. In some places undertakers ran out of coffins. So many people died in Ilford in Essex that the town ran out of undertakers. In Sunderland, it was reported that queues of funeral corteges had to be managed around the city’s cemeteries and churches.

There was then a lull, before in mid-September the disease rose again in a second wave, the first heavy incidence of cases being in the South Wales coalfield. A week later it was in Glasgow, and ravaged Dublin and Liverpool. Whitehall was badly affected: a quarter of the Ministry of Munitions’ staff were stricken. Around the capital firemen, police officers and nurses were felled in numbers far greater than in July. There were no national rounds of applause; but when nurses tending members of the armed forces died they were buried with full military honours.

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Personal protective equipment was not even a dream. Nor was what we have learned to call “lockdown”. There could not be such a thing. The German spring offensive had almost reached Paris and, if it had, the war would have been lost. Coal mines and the factories they powered had to keep going: the army had an almost insatiable desire for bullets, shells, vehicles, guns, cannons, uniforms and all other sorts of equipment. And, in any case, the huge movements of troops to and from the continent and around Britain would have made a lockdown pointless, even if the war effort could have stood it. The fact was the war was all-absorbing, and even a lethal pandemic had to take second place in political priorities.

On 12 September David Lloyd George, the Liberal prime minister of a coalition government containing mostly Conservatives – his own party regarded him as a traitor after his coup to remove Herbert Asquith in 1916, and most Liberal MPs refused to serve with him – opened what was effectively his election campaign with a speech at Manchester, where he received the Freedom of the City of his birth. He did not mention a poll but expressed hopes for the future, beginning with the certainty of victory – “the Germans have no America”. He promised better use of Britain’s “human material”, and stressed improved healthcare – perhaps his most celebrated remark was that “you cannot maintain an A1 empire with a C3 population”, and his claim that a doctor had told him an extra million men could have been under arms “if the health of the country had been properly looked after”. 

Lloyd George had planned a tour of northern cities but collapsed that evening with the flu. A bedroom was made for him in Manchester Town Hall, with the trams diverted to give him peace and quiet. One of the city’s leading specialists attended him; he recovered and returned to London, still enfeebled, on 21 September. He was in his makeshift hospital bed for a few days longer than Boris Johnson, who was admitted after developing Covid-19. Lloyd George was not able to resume his normal political activities for about another fortnight, but his life was never thought to be in danger.
The second wave quickly took hold, with outbreaks in Liverpool, Dublin and Middlesbrough by mid-October. The death-rate in Southampton rose from 14 to 44 per thousand; in Glasgow it rose from 12 to 41 per thousand. Half the deaths in Hornsey, north London in the four weeks to 21 October were from flu. Elementary schools in Brighton were closed for a month, and many other towns soon followed.

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It was not until 21 October, four months after reports of widespread infection across Britain, that Arthur Newsholme, principal medical officer to the Local Government Board, issued a memorandum on how best to counter the scourge. “It is particularly important that sick persons and old people should be protected against exposure to influenza,” he stressed. He told those who were ill to go to bed for three or four days as “control over the disease can be secured only by the active cooperation of each member of the community”. 

Newsholme urged victims to sneeze or cough into a handkerchief; and said that rooms where patients had been treated, and their bedding and clothing, should be cleaned and disinfected. He also advocated allowing the circulation indoors of as much fresh air as possible, avoiding overcrowded premises and keeping away from others if possible. In the cinemas the time between performances was greatly increased, to allow for a complete change of air inside the building. “Dirtiness” and “indiscriminate expectoration” were also deemed dangerous. He warned alcoholics that they were especially vulnerable. The sale of quinine, regarded as one of the few possible prophylactics, was to be regulated by the Army Council under the Defence of the Realm Act, as it was in short supply and causing public disquiet; this was no time for morale to crack.

The lack of speed with which the government acted prompted the Times to fury in a leader on 23 October. Those of us used to the uncertainty of the present government’s response to Covid-19 – its dithering about lockdown, its failure to organise testing, its U-turn on herd immunity – will hear the echoes from more than a century ago. “It would have been better to lock the stable door before the escape of the horse,” the Times said. “The need for a Ministry of Health to protect the public in matters of this kind has never received a more forcible illustration.” The ineptitude and lack of leadership in 1918 indeed resulted in the creation of a ministry of health the following year. (Sadly, as we are seeing, even the existence of a ministry is no guarantee that such a pandemic will be countered effectively.) 

Although there was no lockdown, the ways in which people were being asked to change their behaviour was causing disquiet. But no one was prevented from going out, or from working: victory was close, and everyone had to play his or her part. 

On 28 October the government admitted the national mortality rate had risen enormously as a result of the epidemic. William Hayes Fisher, president of the Local Government Board, said matters were not yet so bad as in Paris or Vienna. Yet an estimated 4,000 people died in a week. The Medical Research Council spent an increasing amount of its resources on seeking to prevent the spread of the flu, but because of the work it was doing on the treatment of wounds, it could not devote the necessary effort to the epidemic.

Inflaming an already delicate situation, in late October 111 “political” prisoners in Belfast jail were afflicted: this was two years after the Easter Rising, and Sinn Féin was on the verge of seizing political control of Ireland. Worse still, given the shortage of men for the forces, was the report that at the RAF camp at Blandford in Dorset, where the average daily complement was 15,000 men, there had been 252 cases of flu in five weeks, 198 of which had required hospitalisation and 59 of which had resulted in death. The Local Government Board, operating on a skeleton staff of a medical officer, four assistant medical officers and 20 health inspectors for the whole of England and Wales, oversaw the production of posters, leaflets and press announcements to warn the public of the best ways of preventing infection: though the only certain way, as they admitted, was to lock oneself indoors and avoid contact with anyone else.

In July the flu reached Berlin, and started to kill an undernourished and exhausted population whose leaders were already suing for peace. The London that celebrated the Armistice on 11 November was still being ravaged by flu. Between 27 October and 2 November, 200 died from it in the capital alone. The disease burned itself out in Britain in early 1919. Altogether, an estimated 230,000 people died in Britain. 

The flu was exported from Europe around the world. Outposts of the British empire, notably India (where around 14 million people died) and west and southern Africa, were gravely affected. It ravaged a defeated central Europe, its peoples malnourished already after years of blockade and with its agriculture running at half-speed. Soldiers returning to the US and elsewhere took with them the new, more virulent strain that had started the second wave in Europe. The latest, albeit contested, estimates compute that 3 to 5 per cent of the then population of the world, or 60 to 100 million people, died of the flu.

In most parts of the world the pandemic came in two waves, in the spring and summer and then in the autumn (the highest number of deaths globally was in October), lasting into 1919. The pandemic ended abruptly, according to one theory, because the virus mutated into a less lethal strain.

It is hard to separate specific economic consequences of the flu from those of the war; across the world, economies kept functioning. The flooding of labour markets after the Armistice as soldiers returned home had a far more profound effect, as did the withdrawal of the government as a main customer once defence procurement shrank. The first put many newly emancipated women, whose contribution in Britain to winning the war cannot be overstated, out of work. 

But as demand contracted many men found themselves out of work too, with 1921-22 being a grave episode for Western economies, marked in Britain by the “Geddes Axe”, named after the minister forced to find enormous cuts in public spending to avoid the country going broke. It was an age when the current cultural determination to avoid risk, illness and death did not exist and for that reason, as much as for the war effort, there was no question of halting normal life. It was probably as well, for even if Britain had still won the war, the economic horrors of the years that followed, and the Great Depression of the early 1930s, would have come sooner, and have been unimaginably worse. If the global economy avoids such a passage now, we shall all be lucky.

Simon Heffer writes for the Daily and Sunday Telegraph. His most recent book is “Staring at God: Britain in the Great War” (Random House)

Simon Heffer is a journalist, author and political commentator, who has worked for long stretches at the Daily Telegraph and the Daily Mail. He has written biographies of Thomas Carlyle, Ralph Vaughan Williams and Enoch Powell, and reviews and writes on politics for the New Statesman

This article appears in the 08 May 2020 issue of the New Statesman, Remaking Britain