Book: Pale Rider: The Spanish Flu of 1918 and How It Changed the World
Author: Laura Spinney
Publisher: Vintage (7 June 2018)
Language: English
Paperback: 352 pages
Item Weight: 303 g
Dimensions: 12.9 x 2.6 x 19.8 cm
Country of Origin: United Kingdom
Price: 492/-
A kind of déjà vu reading this book!! Each chapter, each paragraph, each sentence almost!!
Every soul on this planet knows that ‘Coronaviruses’ (CoV) are a huge family of viruses that cause illness ranging from the common cold to more severe diseases.
A novel coronavirus (nCoV) was identified on 7 January 2020 and was provisionally named “2019-nCoV”. It was afterward named the “COVID-19 virus”.
Today, notwithstanding regular health alarms about the nCoV, bird flu, SARS, HIV and Ebola, it is complicated to envisage a scenario in which something as common as influenza could cause extensive illness and death.
Although most of us will catch influenza more than a few times during our natural life, the influenza vaccination being only approximately 50 % effectual, the majority will survive with a minimum amount of medical attention.
What then was so unusual about Spanish flu and why did it have such an overwhelming brunt?
To gain some perception of these factors, we need to characterize the temperament of influenza and reflect on a brief history of the disease. In general terms, influenza is an intricate disease caused by an airborne virus which spreads between individuals in microscopic droplets, via coughing or sneezing.
Bringing people together in close contact aids the spread of the infection, predominantly in overcrowded communities such as schools, military camps and hospitals.
In numerous cases, schoolchildren are the first to catch the virus and then spread it to their families.
Although Spanish flu constituted the most deadly mutation of the flu virus, flu itself is nothing new. References to influenza as an affliction date back to classical times. We find Hippocrates witnessing a perceptible epidemic of influenza in Greece in 412 BC. Livy is seen recording a comparable outbreak in his History of Ancient Rome.
Spanish flu, however, was the greatest medical holocaust in history, killing more than the Black Death. In India, 17 million are estimated to have died, 13.88 million of these in British India.
In Africa, 2 % of the entire population was wiped out, 100,000 in Ghana alone. In Tanzania, an estimated 10 % of the population died, and the epidemic was followed by a famine which killed thousands more. In the United States, the figure was over half a million.
Given censorship, lack of precise records and erroneous death certificates, the total global mortality may be even higher. According to researchers, the figures from China, which were low by comparison with data from other parts of the world, have yet to be confirmed, while the circumstances of many servicemen’s deaths were concealed to safeguard morale.
But whatever the final tally, there is no doubt that the 1918 influenza outbreak was one of the deadliest natural disasters in human history.
The word ‘influenza’ dates from around 1500, when the Italians introduced the term for diseases that they attributed to the ‘influence’ of the stars. Another possible origin was the Italian phrase influenza di freddo, the influence of the cold.
By the 15th century, the illness was referred to in England as a ‘mure’ or ‘murre’; apparently it killed two monks at Canterbury Abbey, while an outbreak of the sudor Anglicus or ‘English sweate’ was recorded after the Battle of Bosworth in 1485.8 By 1562, Lord Randolph was writing from Edinburgh to Lord Cecil describing the symptoms experienced by Mary, Queen of Scots. Lord Randolph’s account will be familiar to anyone who has witnessed an outbreak of influenza.
By the 18th century ‘Age of Enlightenment’, a spirit of scientific enquiry enabled doctors and scientists to keep better records of epidemics and speculate as to the nature of the disease.
As doctors came to realize that influenza was spread via infection, rather than being caused by foul air and mists, recording major epidemics became a matter of note. One particularly virulent outbreak in 1743 originated in Italy, and as it spread across Europe the term influenza became generally used and was recorded in the Gentleman’s Magazine in May 1743.
In London the epidemic trebled the death rate in one week. Horace Walpole, describing its effects in a letter dated 25 March 1743, stated ‘not a family in London has scaped under five or six ill; many people have been forced to hire new labourers. Guernier, the apothecary, took two new apprentices, and yet could not drug all his patients.’
A generation later saw one of the worst influenza outbreaks in history commemorated by Edward Gray as ‘An Account of the Epidemic Catarrh’ in 1782 at the request of the Society for Promoting Medical Knowledge.
The first influenza epidemic of the 19th century appeared in Paris, and then Britain and Ireland in 1803, by which time some doctors were investigating the process of transmission by social contact and the possible benefits of isolation or quarantine. In 1831, a lethal strain of influenza swept across Europe, with pneumonia a common complication. This epidemic occurred in three waves, the second wave appearing in 1833 and the third in 1837.
The ultimate lethal wave claimed 3,000 lives in Dublin alone and was described by one London doctor as one of the ‘more direfurl scourges’.
In 1847–8, another influenza pandemic claimed an additional 5,000 lives in London over and above a normal influenza season and was compared to cholera. Over a period of six weeks it spread across Britain. Many died of pneumonia, bronchitis, asthma and similar ailments associated with influenza.
This book tells the tale of the Spanish flu in eight parts and an Afterword. The subsequesnt divisions are:
PART ONE: The Unwalled City
PART TWO: Anatomy of a Pandemic
PART THREE: Manhu, or What is it?
PART FOUR: The Survival Instinct
PART FIVE: Post Mortem
PART SIX: Science Redeemed
PART SEVEN: The Post-Flu World
PART EIGHT: Roscoe’s Legacy
AFTERWORD: On Memory
The narrative of the disease is embedded in a larger one – the one that tells how man and flu have cohabited, and co-evolved, for 12,000 years–so Part One, ‘The Unwalled City’, recounts that story up to 1918.
Parts Two to Six recount the crux of the development of the disease and form the heftiest section of the book.
Part Seven, ‘The Post-Flu World’, investigates the traces of the Spanish flu with which we live today. Since man and flu are still co-evolving,
Part Eight, ‘Roscoe’s Legacy’, looks forward to a future battle–the next flu pandemic–envisaging what new weapons we will carry into it, and what is likely to be our Achilles heel.
Together, these stories encompass a biography of the flu–a human story, that is, in which the fil conducteur is flu.
An afterword addresses the question of memory, asking why, when its brunt was so profound, we call it ‘forgotten’.
One would do well to bear in mind that in terms of national identity, there was nothing inherently Spanish about Spanish flu. At first, in the early months of 1918, the majority of doctors believed they were dealing with nothing more grave than a chiefly aggressive outburst of common or garden influenza.
But as the epidemic continued, and King Alfonso XIII of Spain fell victim along with many of his subjects, this powerful strain of influenza was discussed freely in the Spanish press. Debate of this nature was possible as Spain was a neutral country during the First World War.
Elsewhere, in Britain and the United States, censorship made such speculation impossible beyond the pages of medical journals such as ‘The Lancet’ and the ‘British Medical Journal’. Under ‘DORA’, or the Defence of the Realm Act, newspapers were not permitted to carry stories that might spread fear or dismay.
As the term ‘Spanish flu’ entered the language in June 1918, The Times of London took the opportunity to ridicule the disease as little more than a passing fad.
By the autumn of 1918, when the deadly second wave of Spanish flu was hitting populations worldwide, the implications of the disease proved impossible to ignore. Humanity was presented with staggering facts:
1) The United States recorded 550,000 deaths, five times its total military fatalities in the war,
2) European deaths totalled over two million
3) In England and Wales an estimated 200,000, 4.9 per 1,000 of the total population, perished from influenza and its complications, particularly pneumonia.
In 1918, mass troop movements spread Spanish flu among the military, while ‘bond drives’, aimed at persuading citizens to contribute to the war effort, and victory parades in the United States dispersed influenza among the civilian population. In Philadelphia, one such bond drive was to have devastating consequences and send the mortality rate soaring in the City of Brotherly Love. In Britain, Whitehall chiefs were reluctant to introduce quarantine restrictions on buses and trams for fear of damaging morale.
The end of the war did not bring an end to Spanish flu.
As the death rate soared, the joyful crowds gathered to welcome the Armistice in Albert Square, Manchester, unsuspectingly inviting the ‘Spanish Lady’ to join them, and the killer virus remained active well into 1919.
The most petrifying aspect of Spanish flu, in addition to its amazingly transmissible nature, was its horrendous symptoms. By comparison, in a conservative case of influenza, the victim incubates the virus for at least 24 hours and up to 4 or 5 days before the disease becomes obvious.
The first signs are headache, chills, dry cough, fever, weakness and loss of appetite. Generalized fatigue and, in some, bronchitis and pneumonia ensue. Recovery to full strength following influenza may take several weeks or longer.
What can confuse the matter is that although influenza is a distinct and recognizable clinical entity, many patients and some physicians tend to group most respiratory ailments under a blanket term of ‘flu’.
For most of us a case of flu means little more than a few days off work, paracetamol tablets and hot lemon drinks on the sofa.
But Spanish flu, by contrast, was far more belligerent and fast acting. Consider this:
#During the devastating second wave of the epidemic, which began in the summer of 1918, victims collapsed in the streets
#The victims would be seen haemorrhaging from lungs and nose.
#Their skin turned dark blue with the characteristic ‘heliotrope cyanosis’ caused by oxygen failure as their lungs filled with pus
#They gasped for breath from ‘air-hunger’, like landed fish. Those who died swiftly were the lucky ones.
Others suffered projectile vomiting and explosive diarrhoea, and died raving as their brains were starved of oxygen. Those who recovered were often left with a lifetime’s legacy of nervous conditions, heart problems, lethargy and depression.
Doctors and nurses worked heroically to care for the sick, often falling ill themselves.
Dr Basil Hood, medical superintendent of St Marylebone Infirmary, London London, left a devastating account of conditions at his hospital, which he described as ‘the most distressing occurrence of my professional life’.27 On the Western Front, nursing staff had to cope with an endless stream of corpses, dark blue and putrescent within hours of death,28 in addition to treating combat injuries.
Another disturbing feature of Spanish flu was the age of the casualties. Normally, it is the very young, the very old and patients with compromised immune systems who are most susceptible to dying of influenza.
But the majority of victims in the Spanish flu epidemic were healthy young men and women, wiped out in their prime. Pregnant women were particularly vulnerable, Spanish flu killing both them and new mothers and their babies. In Massachusetts, one midwife helped a young woman deliver her premature baby, only to have both die within hours.
Between spring 1918 and summer of 1919, the Spanish Lady continued her dance of death, attacking without warning, and seemingly at random.
As if in a disaster movie, there was no telling which members of the worldwide cast would live or die. Here are some interesting facts:
*Those who survived included Franklin D. Roosevelt, who arrived in New York after a near fatal voyage on the unlucky USS Leviathan;
*British Prime Minister David Lloyd George also almost lost his life to influenza, a death which would have caused dreadful loss of morale to the Allies;
*It was thought that Mohandas Gandhi wouldn’t survive, and Kaiser Wilhelm suffered alongside his subjects.
*The great American novelist John Steinbeck recovered, as did the author Mary McCarthy, film star Lillian Gish, and Groucho Marx and Walt Disney. The experience of Spanish flu appears to have had a significant psychological impact; writers in particular noted the changes.
*Thomas Wolfe, one of the greatest American novelists, left a spellbinding and compelling account of his brother’s death from Spanish flu in his most famous novel, Look Homeward, Angel.
Spanish flu presented the wartime medical profession with its greatest challenge: how to tame the epidemic through cure, control and containment. Given the huge impact of the disease on both sides, much of the research was conducted by the military. While the civil authorities dismissed influenza as a distraction when all thought should be of the war, military doctors in Britain and the United States began to look for a solution based on their existing research into other epidemic diseases such as typhoid and cholera; but their hands were tied.
They did not know accurately what they were dealing with. With the benefit of hindsight, we know that influenza is caused by a virus; but in 1918 scientists believed it was a bacterial disease, characterized by the presence of Pfeiffer’s bacillus.
Ultimately, the research conducted during these dark, terrifying times would lead to great scientific breakthroughs, such as the recognition that influenza can affect humans, birds and pigs, and the classification of the three subtypes of the influenza virus as type A (Smith, 1933), type B (Francis, 1936) and type C (Taylor, 1950).
But back in the autumn of 1918, as medical scientists struggled to develop a vaccine with their colleagues dropping dead around them, it must have seemed a desperate race against time.
Sort of déjà vu reading this book!! Every chapter, every paragraph, every sentence almost!!
Grab a copy if you choose. It’ll give you the creeps for sure.