Lessons we can learn from the Spanish flu
AS the coronavirus threatens human health around the planet, we can look to the past to see the impact previous disease events caused society. The pandemic that most people compare it to is the 1918-1919 or ‘Spanish’ influenza pandemic which circled the globe in a little over a year, causing upwards of 50 million deaths, which is estimated to have infected between one fifth and half of the world’s population.
In Ireland, conservatively it killed 23,000 people, mostly clustered into three waves between June 1918 and April 1919. A broad rule of reckoning among international researchers of the disease is that 2.5pc of those who caught it died, which suggests about 800,000 sufferers on the island out of a population of four million.
This is a different disease, and we live in a different world, with much improved environments, medical expertise, and more educated citizens. But for a historian of disease, the social impacts are arrestingly similar.
It came in through the ports, most likely on passenger and merchant ships with Dublin, Belfast and coastal towns such as Howth, Dundalk and New Ross severely affected. While demobilisation of troops from World War 1 is often mentioned as a cause for the rapid spread in Ireland; this is unlikely as the bulk of demobilisation did not happen until the war was over.
As the flu passed through suburbs, towns and villages, entire communities went silent, as eyewitnesses reported. The area would shut down, with people either ill at home, or in one of the overwhelmed hospitals, where all available space was given over to flu patients. Poor Law Medical Dispensary doctors worked around the clock: Tommy Christian, then a five-year-old boy living in Ardclough in Kildare, told me that the doctor visited his sick family at three in the morning. Many doctors went off work ill themselves, and the health services struggled desperately to find replacements.
Schools were closed early as just like now children were considered to spread the disease, perhaps because we parents are in even closer contact with them. Cinemas begged the authorities to stay open, but they did not permit children in, and they were disinfected between showings.
Public buildings and court cases were postponed, concerts and all sport cancelled. The All Ireland hurling and football finals were eventually played in January and February 1919; Wexford’s football team played a Tipperary side weakened by the flu in the football final, making their four-in-a-row record all the easier.
Whole families would be sick with the disease — and there are many newspaper reports of several dying from one family. In Glasnevin and other cemeteries, bodies had to be queued for burial in the peak weeks of the pandemic. In the then South Dublin — now St James — coffined bodies were stacked 18-20 high, awaiting burial.
But most people recovered, even if with damaged health that affected the way they lived afterwards. Trinity College’s Prof RB McDowell caught it as a small boy in an upper middle-class family in Belfast; he remembered the family doctor telling his parents he was unlikely to last the night. He survived (and lived into his nineties), but the family nurse did not. Prof McDowell’s health suffered for a while after, and when it came to career choices, “the bar was out, and the army was out of the question”. So he went into academia.
People who worked with the public — and their families — were more likely to catch the disease, and so the death toll for those jobs was higher. Medical workers, police, postal workers, priests and clergy, teachers and journalists all suffered. And shop workers: shops struggled to stay open to provide a public service, and to stay in business, but they suffered from both the fall in trade as people stayed at home, and from depleted staff as their workers became ill.
James Delaney (28), a constable at Ladd Lane Dublin Metropolitan Police station, caught the flu in December 1918, and went back to work before he had completely recovered, as so many of the DMP were down ill. He died on the job, from pneumonia, a common secondary illness of influenza. His wife Margaret was forced to work, setting up a cake shop in Kimmage Cross Road. Their small children, Denis and Rebecca, died two years later from scarlet fever, a common killer at the time.
Death in poorer areas was high. In Dublin’s appalling tenement conditions, many working-class children died from the flu. Given the focus on handwashing in the coronavirus crisis, we can easily understand how a disease spread by coughs and sneezes would spread in buildings with poor handwashing facilities. The impact in 1918 also serves to underline the importance of handwashing today.
But children under five were also a vulnerable sector of society then: typically in the 1910s, 20pc of all deaths were of children under five. This is one reason why the pandemic’s impact on Irish society has not been recorded until the 21st Century, when I and two other historians, Dr Patricia Marsh and Dr Caitriona Foley, researched this individually for our doctoral theses.
We know how the 1918-19 flu pandemic ended. We rely on ourselves as responsible citizens to observe strict hygiene practices, as well as the medical professionals who are, like in 1918-19, working hard to mind us all.
We can, they tell us, help reduce the damage being done, and we have better washing facilities, communications, and housing than in 1918. Have we the sense to know we must keep the rules on handwashing, and stay as much as possible isolated in our homes, as many did in 1918-19 in order to survive?