Disease, illness and death in Shakespeare Cliff (4)

Hello and welcome to the last of my blog posts concerning disease, illness and death as featured in my novel Shakespeare Cliff. Writing historical fiction involves a lot of research, during which I have uncovered information which informs the writing but isn’t necessarily included in the story. The purpose of this blog is to share some of the interesting facts I’ve come upon.
 
The subject of this blog is the so-called Spanish flu, an enlightening topic for these Covid 19 times.

Women wearing masks in 1918 (Getty images)

The Spanish flu does not figure at all largely in the novel. It is mentioned only once by Jane Marsh’s mother, Sarah, when she reports to Jane in March 1919 that she has found her a job with the butcher, Mr Coulter.
 
February was a miserable month of moping or searching for work, the loss of Jane’s income evident in the quality of the family meals. The atmosphere at home was gloom-laden with grief for Pa; outside was grey and wet. But in mid-March, when daffodils were blooming, Ma came back from her shopping and said: “I’ve found you a job, sweetheart.”
Jane looked up from her book. “Really? Where?”
“With Mr Coulter, the butcher. Do you remember his wife died of the Spanish flu last year? As you know, she helped in the shop, while he did the butchering, and….. Well, he’s employed a young lad to run errands and deliveries and sweep up and so on, but Mr Coulter says he needs someone else to serve in the shop, a more mature person, preferably a woman.”

The job has serious consequences for Jane but you will have to read the novel to discover what those are.

A Daily mirror cartoonist captures the confusion over public health messages (Getty images)

 
​​The Spanish flu was the most serious pandemic of modern times. Only the so-called Black Death caused by the bubonic plague during the fourteenth century caused a higher estimated death toll. But whereas the bubonic plague was caused by a bacterium, the Spanish flu was caused by an influenza virus of the H1N1 type originating in birds.
 
Spanish flu ravaged the world during 1918 and 1919, overlapping with ‘The Great War’ as WW1 was known at the time. The flu produced more fatalities than the war, causing upwards of 25 million deaths worldwide. It is impossible to arrive at a definitive number due to the lack of accurate record-keeping in many countries in that era, and some estimates put the death toll at more than 50 million. Whatever the exact figure, it far exceeds the current number of deaths due to Covid19.

The name Spanish flu is misleading as the disease did not originate in Spain. News of it was first broadcast from Spain. ‘All those countries that were combatants in World War I were not willing to mention that their troops might be decimated by an emerging pandemic and so were not talking about it. Spain was actually a non-combatant and because of that, they were ones that did not refuse to admit having cases and then got the moniker of Spanish flu' 1

Camp Funston hospital, Kansas

​It is still not known for certain where the virus originated. At first it was thought to have started in the filthy, disease-ridden trenches in France, and its spread related to the movement of troops, especially those returning home at the end of the war.
 
A recent reconstruction and analysis of the virus in strict security and safety conditions in a laboratory in the US shows that, although avian in origin, it had adapted to living in pigs before jumping the species barrier into humans. One early contender for the place of origin was the pig farms of Kansas, USA. Pig farmers, drafted for WW1, carried the virus to Camp Funston, Fort Riley, where forty-eight soldiers died from the disease in March 1918 at the very start of the pandemic. The troops at Camp Funston were crowded into barracks of two hundred and fifty men each. From there they travelled by train and ship to France, spreading the virus as they went.

The latest research, however, suggests that, like Covid19, the Spanish flu virus originated in China. ‘Historian Christopher Langford has shown that China suffered a lower mortality rate from the disease than other nations did, suggesting some immunity was at large in the population because of earlier exposure to the virus.’2 A respiratory disease similar to Spanish flu had struck northern China in 1917, and 96,000 Chinese labourers were mobilised to work behind the British and French lines on the Western Front during WW1. They may well have been the source of the pandemic.

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Administering aspirin during the Spanish flu pandemic

Whatever its origins, there is no doubt about the virulence of the disease. In the first wave, the symptoms were relatively mild like normal flu: headache, fatigue, sore throat, a dry cough and fever. Death rates were similar to seasonal flu. But then the virus mutated into a deadly strain capable of killing a young adult within twenty-four hours. You could be healthy at breakfast and dead by supper. ‘An unusual characteristic of this virus was the high death rate it caused among healthy adults 15 to 34 years of age.’3 

The symptoms caused by this second deadly wave of the disease were horrific. Within hours of feeling the first symptoms of fatigue, fever and headache, some victims would rapidly develop pneumonia and turn blue through shortage of oxygen. They would then struggle for air until they suffocated to death. ‘Struck with blistering fevers, nasal haemorrhaging and pneumonia, the patients would drown in their own fluid-filled lungs.’4

The rapid spread of the disease is not surprising. The war placed large numbers of men together in overcrowded and unsanitary conditions. Troop movements in 1918 and especially in 1919, when service personnel returned home after the armistice, carried the disease over the whole world. By the end of the pandemic, the only region not to have reported an outbreak was an isolated island in the Amazon River delta.

There was not much that could be done to stop the pandemic. The level of medical technology that we rely on today was unheard of in 1918. The influenza virus had not been identified and there were no diagnostic tests for flu. Vaccines did not exist, and there were no anti-viral drugs. Even antibiotics for treating associated bacterial infections, such as pneumonia, were not developed until the 1920s—penicillin was discovered in 1928.

With no mechanical ventilation or intensive care support of the type we rely on nowadays, treatments were limited. In November 1918, the British newspaper, The News of the World, advised its readers to: "wash inside nose with soap and water each night and morning; force yourself to sneeze night and morning, then breathe deeply. Do not wear a muffler; take sharp walks regularly and walk home from work; eat plenty of porridge." The benefits of fresh air were recognised, and in those climates that allowed it, indoor activities, such as court sessions, were relocated outdoors.

There is evidence to suggest that one of the treatments offered may have contributed to the number of deaths. Aspirin, the new wonder drug of the time, was commonly used to treat the illness and administered in doses considered unsafe today. Symptoms of aspirin overdose may have been difficult to distinguish from those of the flu.

As with Covid19 today, steps were taken to limit the spread of the disease. Public health notices advised against coughing, sneezing and spitting in public. In many communities, churches, schools, theatres, dancehalls and businesses were closed, and the wearing of masks was mandatory. In 1918, a health officer in San Francisco shot three people when one refused to wear a mandatory face mask.

In many countries, public gatherings were prohibited and victims quarantined in their homes. In Britain, most pubs stayed open, though restricted to wartime opening hours. Streets in some towns and cities were sprayed with disinfectant, and in some factories, no-smoking rules were relaxed, in the belief that cigarettes would help prevent infection.
​
There were several high-profile survivors of the Spanish flu: Mahatma Gandhi, Greta Garbo, Walt Disney, Edvard Munch, US President Woodrow Wilson, British Prime Minister David Lloyd George, and Kaiser Wilhelm II of Germany. One of the first high profile victims to die from the disease in the spring of 1918 was the King of Spain, Alfonso XIII.

Spraying a London bus with anti-flu preparation. (Photo by H.F.Davis, Getty images)

I had a little bird
its name was Enza
I opened the window,
And in-flu-enza.”
(1918 children’s playground rhyme)
  

Footnotes:
​
1 Dr Daniel Jernigan, 1918 Pandemic Partner Webinar — Commemorating 100 Years Since the 1918 Flu Pandemic, CDC. 
2 1918 Flu Pandemic That Killed 50 Million Originated in China, Historians Say, by Dan Vergano, National Geographic.
3 Readiness for Responding to a Severe Pandemic 100 Years After 1918, Barbara Jester et al. July 2018
4 Why the Second Wave of the 1918 Flu Pandemic Was So Deadly, Dave Roos, December 2020. History.com
Sources:
1.  How some cities ‘flattened the curve’ during the 1918 flu pandemic, by Nina Strochlic and Riley D. Champine, March 2020 National Geographic
2.  In 1918 pandemic, another possible killer: aspirin, by Nicholas Bakalar, October 2009, New York Times
3. Coronavirus: How they tried to curb Spanish flu pandemic in 1918, May 2020, BBC News
4. The Deadliest Flu: The complete story of the discovery and reconstruction of the 1918 pandemic virus, by Douglas Jordan with contributions from Dr Terrence Tumpey and Barbara Jester, CDC