The Spanish Flu

It’s May 1920, and the Spanish Flu pandemic is coming to an end after devastating the world for the past two years. US Army Private Josh Lee wrote a poem about his experience in the Great War

“It stalked into camp when the day was damp And chilly and cold. It crept by the guards And murdered my pards With a hand that was clammy and bony and bold; And its breath was icy and mouldy and dank, And it killed so speedy And gloatingly greedy That it took away men from each company rank.” (Wever and Bergen)

Lee gave his poem a simple title: The Flu.

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Intro

Hi, I'm Jesse Alexander and welcome to the Great War, where we are once again shooting in our lockdown studio in my living room. By May 1920, the Spanish Flu pandemic which had struck the world in 1918 was finally coming to an end, and infections and deaths had dropped far below the peaks of the earlier waves in 1918 and 1919. Something like a quarter of the world’s population – about 500 million people had caught the flu, and around 50 million died. That’s around 10 million more than those who died as a direct or indirect result of the Great War – and the flu had only lasted half as long as the war did.

Now before we get into the details, a word about the name of the pandemic. The Spanish Flu was not Spanish. Spain was neutral in the war, so the Spanish media reported on it before the censored media in the warring countries did. The disease had many names, like La Grippe or the Naples Soldier, but often names that reflected political rivalries. Some British called it the Hun flu, and in South Africa some whites called it the black man’s disease, and some blacks called it the white man’s disease. A rose by any other name, as they say.

Ok, so in this episode we are going to take a look at the epidemic that ended one hundred years ago, and how it affected the world back then. Disclaimer: this information is about the flu of 1918-1920, is not necessarily relevant to the current pandemic!

The Flu

Let’s start with a little medical summary. The pandemic lasted about two years, but it didn’t hit everywhere at the same time. It hit in different places in waves lasting about 4 weeks at a time, and it was during the peaks of these waves that the vast majority of deaths would occur.

The first wave is commonly dated around summer 1918 in the northern hemisphere. It was relatively mild and it would be the second wave of later that year which would be the deadliest. This would be followed by a third wave in early 1919 and a fourth, smaller wave in early 1920.

The Spanish Flu was quite different from previous flu epidemics. Usually, babies and the elderly were most at risk, but this time, the most at risk group was men aged 17-35 – normally a fit and healthy part of the population. About 2.5% of these men died. Why was this the case? Well, we think that this was because the strength of young men’s immune systems actually worked against them, and reacted so strongly to the virus that inflammation got out of control and led to pneumonia or organ failure – which may sound familiar if you read the news lately. But doctors at the time did not understand this. Not only was the flu lethal, it was fast. Symptoms could come on suddenly, and many victims died within days.

There is still a debate about where the flu came from. The most commonly accepted theory is that it originated in military camps, either in the US or in France – especially those close to animal livestock or migratory bird populations. Camp Funston in Kansas and a British camp in northern France are the most likely possibilities. Others think it came from China, or Indochina. Chinese flu deaths in 1918 were low, leading some to believe that there may have been earlier outbreaks there which gave immunity to some. Chinese labourers and Indochinese French colonial soldiers might have then brought it to the US and Europe.

But again, this was not understood at the time, and some suspected it was a German biological weapon. Others suggested it might have come from trench warfare and poison gas, or was caused by quote, “the smoke and fumes of war”.

Regardless of the cause, the flu spread farther and faster because of the war. In the crowded camps, trenches, and troopships was where it claim many of its victims.

The Flu and European Allies

In spring 1918, some British officers and medical staff thought the flu was just another illness like the ones soldiers had been suffering from throughout the war, like dysentery, typhus, or trench fever. But the rise in infections could not be ignored by early summer 1918. British captain and war poet Siegfried Sassoon described the impact:

“The influenza epidemic defied all operation orders of the Divisional staff, and during the latter part of June more than half the men in our brigade were too ill to leave their billets.” (Wever)

The British army would report 313,000 cases of the flu, with most deaths occurring in late summer of 1918. Captain Geoffrey Keynes of the Royal Army Medical Corps recalled his frustration:

“There were rows of corpses, absolutely rows of them, hundreds of them, dying from something quite different. It was a ghastly sight, to see them lying there dead of something I didn't have the treatment for.” (MacDonald)

The Germans were also affected, and recorded 700,000 cases in the army during the war. German General Erich Ludendorff worried about the impact on the fighting ability of the army:

“Influenza was rampant […]. It was a grievous business having to listen every morning to the chiefs of staffs' recital of the number of influenza cases, and their complaints about the weakness of their troops if the English attacked again.” (Wever)

Now, all armies were affected, but most affected was the American army, which ended up losing more troops to influenza than to enemy action.

Impact on US forces

The flu struck American forces in spring 1918,  just as they were beginning train and send large numbers of men to fight in Europe. More and more training camps in the US reported outbreaks, including Camp Upton, a major embarkation port for troops heading to France. In May, an even deadlier wave hit 14 of the 32 major camps in the US, and the virus by now was also spreading among the civilian population.

Having recognized the relationship between military logistics and the spread of the influenza, US Army Physician and Surgeon General Crawford Gorgas saw the link between military logistics and the spread of the disease, and asked the authorities to stop troop movements from infected camps, like Camp Devens. But Army Chief of Staff Peyton C. March refused.

The army was preparing a major offensive in France and needed more men. This decision effectively turned troop transports into what historian John Barry has called quote “death ships.” Colonel Gibson of the 57^th Vermont regiment, wrote of conditions aboard his troopship:

“The ship was packed... [C]onditions were such that the influenza could breed and multiply with extraordinary swiftness... The number of sick increased rapidly, Washington was apprised of the situation, but the call for men for the Allied armies was so great that we must go on at any cost... Doctors and nurses were stricken. The conditions during the night cannot be visualised by anyone who had not actually seen them... [G]roans and cries of the terrified added to the confusion of the applicants clamoring for treatment and altogether a true inferno reigned supreme.” (Barry 304)

Overall 26 percent of all US service personnel were infected, and 75,000 died.

Now the flu would continue to spread after the armistice of November 1918, and have an impact on the Peace Conference in Paris.

Paris Peace Conference

The flu peaked in Paris in fall 1918, but by January 1919 deaths were on the rise again, possibly because of the arrival of the international delegations. It’s likely that both British Prime Minister Lloyd George and French Premier Georges Clemenceau both had the flu in early 1919. But again, it hit the Americans the hardest. Even before the US delegation arrived in Paris, numerous staffers contracted the flu, and advisor Colonel Edward House nearly died. After he had recovered, he wrote:

“I have had influenza 10 days and have been exceedingly miserable... So many have died since this epidemic has scourged the world. Many of my staff have died and poor Willard Straight among them.” (Barry 381)

Some historians have even connected the higher rate of illness and death in the American delegation to the perceived lesser performance during proceedings:

“Technical deficiencies within the American Peace Commission existed throughout the entire conference. For instance, the French and British, even on the minor committees, always seemed to have a plan ready, beautifully typed, and in multiple copies, while the Americans rarely did. The Americans, therefore, even when the ideas on which current discussion was based were theirs, often found themselves discussing those ideas as interpreted by minds hostile to the spirit of those ideas.” (Crosby 177)

Whatever the cause, President Wilson began to feel he was being consistently undermined and outmanoeuvred by the Anglo-French delegations, and his situation got even more complicated when he got the flu as well.

Wilson and the Flu

On April 3^rd, 1919, Wilson suddenly fell ill with severe flu-like symptoms. His own doctor at first suspected an assassination attempt. Like the British had done with Lloyd George, the American government downplayed its severity, suggesting he had a cold, but his doctor sent a confidential telegram to Wilson's chief of staff:

“The President was taken violently sick last Thursday. He had a fever of over 103 and profuse diarrhea. . . . [It was] the beginning of an attack of influenza. That night was one of the worst through which I have ever passed. I was able to control the spasms of coughing but his condition looked very serious.” (Barry 383/384)

For several days Wilson did not attend meetings, but sent House instead, and he then held meetings in his bedroom. His illness came at the same time as a crisis at the conference, and he told his wife his illness might prevent him from getting a peace deal through.

He also started to behave oddly – his staff said that he changed, and became less open-minded, paranoid about French spies, and obsessed over minor details. To Chief Usher Irwin Hoover, this wasn't the Wilson he knew:

“Coming from the President, whom we all knew so well, these were very funny things, and we could but surmise that something queer was happening in his mind. One thing was certain: he was never the same after this little spell of sickness.” (Hoover 98)

Of course we can’t say exactly to what extent the flu may have affected Wilson’s decision to make concessions to the French and British for a harsher treaty, but some historians have argued that it weakened him at a critical moment, and may have even contributed to the health problems that would cripple him later on.

But it wasn’t just Wilson. The flu was so widespread that many famous people were infected, like Franklin Roosevelt, Franz Kafka, Kaiser Wilhelm, and even Walt Disney.

They survived, but South African politician Louis Botha, British diplomat Mark Sykes, and Donald Trump’s grandfather Frederick, all died of the flu. French poet Guillaume Apollinaire also died, and last words are said to have been:

Of course, however, the vast majority of casualties would be everyday civilians from across the globe.

Impact on civilian life

The Spanish Flu eventually arrive reached all inhabited continents, though Australia was least affected. Numbers have to be estimated, but Asia, and in particular India, was worst hit with 26 to 36 million deaths. About 2.4 million died in Africa, and 2.3 million in Europe. Russia, Spain and Italy were worst hit. In North and South America, about 1.5 million died, with the US accounting for 675,00 of that number. In Oceania, only about 85,000 died, but some smaller islands like Western Samoa 1/3 of the population succumbed.

The protective measures put in place by the authorities were different all around the world – from strict national lockdowns to pretty much none. The best information we have is for Europe and North America, where methods generally copied those used for other diseases like cholera and yellow fever. In the UK, work shifts were staggered to reduce crowding on public transport, pubs stayed open and the government was eager to promote 'business as usual' until at least the war was over.

In the US, local governments generally led the process, which resulted in differences between cities. In general, where measures were enacted they involved closing theatres, churches, schools and Vaudeville halls. Richmond VA even considered a ban on kissing,  There was some opposition to these restrictions, mostly from businesses, and in San Fransisco an “Anti-Mask League” was formed. In one incident there, a police officer shot 3 people for not wearing a mandatory mask. It seems that cities like Seattle and St Louis, which enacted lockdowns earlier, fared better than cities like Philadelphia, which didn’t.

US newspapers worked to keep people calm. In August 1918, the New York Times announced:

“... Eleven more cases of Spanish flu, or whatever is it, were reported at Quarantine yesterday... the board proclaimed that 'this was done as a precautionary measure and not because the board believed there was the slightest danger of an influenza epidemic breaking out in New York.” (Rosner 44)

Health agencies did distribute information on new rules for hygiene and behaviour, but this was not coordinated, and showed some misconceptions of the time. The 'Surgeon General’s Advice to Avoid Influenza' read:

“Avoid needless crowding. . . . Smother your coughs and sneezes. . . . Your nose not your mouth was made to breathe thru. . . . Remember the 3 Cs, clean mouth, clean skin, and clean clothes. . . . [H]elp by choosing and chewing your food well. . . . Wash your hands before eating. . . . Don’t let the waste products of digestion accumulate. . . . Avoid tight clothes, tight shoes, tight gloves . . When the air is pure breathe all of it you can—breathe deeply.” (Washington)

The emphasis on clean air was  a hangover from older models of fighting diseases like tuberculosis, which was thought to thrive in humid and closed environments. A major vector of transmission – the virus remaining on surfaces – appeared to be overlooked.

There were, of course, also rumours of miracle cures: Lifebouy soap, Oxo soup cubes, aspirin, opium, ammonia, eucalyptus, beef tea, and even smoking were touted as cures, mostly by companies selling those products. 

However, a lot of this apparent naivety was not because of a lack of scientific understanding, but generally in spite of it. Since the end of the 19^th century, medical science had advanced leaps and bounds – but it still found itself only on the periphery of the battle against the Spanish Flu.

Science and Treatment

Initially, doctors were confused by the deaths. Rufus Cole, a respiratory disease expert recalled an early autopsy carried out by famous pathologist, William Henry Welch:

“[Welch] turned away from the blue, swollen lungs with wet, foamy, shapeless surfaces [and] became excited and nervous, saying, ‘This must be some new kind of infection or plague.’ It was not surprising that the rest of us were disturbed, but it shocked me to find that the situation, momentarily at least, was too much even for Dr. Welch.” (Byerly)

Eventually, medical experts were able to understand the results of influenza, but not necessary the virus itself, since breakthroughs in virology would not arrive until the 1930s.

Treatment was another question, since antibiotics to treat pneumonia had not yet been invented. There were various experiments, including spraying the mouths and throats of healthy soldiers with a daily dose of dichloramine-T – a strong disinfectant. But this had no effect on the rate of infection.

Other preventative measures were explored such as daily inspections and temperature taking, patient isolation, face masks and other protective equipment, good ventilation, screening between beds, prohibition of indoor activities and experimental vaccines. There is still debate about the effectiveness of the measures put in place, with some arguing they did little to stop the spread and others convinced social distancing was proven effective. Either way, most medical care that could be provided was concerned with increasing a patient’s comfort and little else.

Staff shortages were another issue, since many doctors and nurses had been called to serve in military hospitals and casualty stations. This was especially an issue with nurses, as a Red Cross recruiter at a US army camp wrote:

“The work at National Headquarters has never been so difficult and is now overwhelming us... [We are searching] from one end of the United States to the other to rout out every possible nurse from her hiding place... There will be no nurses left in civil life if we keep on at this rate.” (Dock 969)

Eventually, medical students were used to fill gaps. The US Army Medical Department even lifted its prohibition on black nurses, but they had to wait until segregated accommodation had been built before they could work.

Ultimately, there would be no cure developed for the Spanish Flu. The introduction of quarantines and isolation may have reduced illnesses in some cases, but the lack of a cohesive and global approach meant their effect was limited. In reality, the flu often came, killed, and then burned itself out. Some towns and cities would have to experience this cycle three or four times before it finally subsided in 1920.

Conclusion

The Spanish Flu would become the deadliest pandemic in human history – killing more than the Medieval Black Death. Despite this, it has not been well remembered until very recent times. The pandemic was under reported, was experienced vastly differently in different areas, and was overshadowed by the Great War. And although the disease clearly had an impact on the war, most scholars agree it was not a decisive factor in how or when it ended.

The war, on the other hand, was decisive in spreading the flu and making it a global pandemic that ended 100 years ago.

About

We want to thank Mark Newton with his help for this episode. As usual, you can find all our sources for this episode in the video description. If you want to support our channel, you can support us on Patreon or buy our merchandise. I’m Jesse Alexander and this is The Great War 1920, a production of Real Time History and the only Youtube history channel whose viral content you want to catch.

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