CAN WE STOP AN­OTHER PAN­DEMIC?

230,000 Bri­tons died from a flu bug that even­tu­ally killed 100 mil­lion asks if his­tory can teach us how to en­sure that it never hap­pens again

Daily Express - - NEWS - by John Triggs

ARMY COOK Al­bert Gitchell usu­ally got up be­fore dawn to pre­pare break­fast for the 56,000 troops based at Camp Funston in Haskell County, Kansas. The camp was a base for re­cruits through­out Mid­west­ern Amer­ica – sol­diers who would soon be sent to West­ern Europe to fight be­side their Al­lies from France and Bri­tain in the fi­nal year of the First World War.

But on the early morn­ing of March 4, 1918, Gitchell re­ported to the sick bay com­plain­ing of a fever, headache and sore throat. The duty med­i­cal of­fi­cer found he had a tem­per­a­ture of 40C and or­dered him to an iso­la­tion bed. But then the doc­tor no­ticed the two men wait­ing be­hind him; they too had fevers and sim­i­lar symp­toms – ones he recog­nised as the clas­sic signs of in­fluenza.

By lunchtime on that same day med­i­cal staff in the bar­racks re­ported 107 cases, by the end of the week they had 522 and by the end of the month 1,100 men had been in­ca­pac­i­tated with a se­vere form of flu that ren­dered many in­ca­pable of stand­ing up.

In most cases suf­fer­ers re­cov­ered within a few days but in some young and healthy men the symp­toms were more cruel – their cough­ing be­came vi­o­lent and un­stop­pable, they suf­fered pro­jec­tile nose­bleeds and their faces turned a fright­en­ing shade of blue: 48 of them died.

Within lit­tle more than a year the flu that had first been no­ticed in Al­bert Gitchell had spread to ev­ery cor­ner of the planet and killed some­where be­tween 50 mil­lion and 100 mil­lion peo­ple. In Bri­tain alone nearly 230,000 died from it, about as many as per­ished in the Pass­chen­daele bat­tle in 1917. And yet, while next month we will pause to re­mem­ber those who died on the bat­tle­fields dur­ing the Great War, the flu pan­demic that killed so many di­rectly af­ter it is al­most com­pletely for­got­ten.

“Though you will find mon­u­ments to the First World War there is no of­fi­cial mon­u­ment to this, the great­est dis­ease holo­caust that Bri­tain, or in­deed the world, has ever wit­nessed,” says Mark Honigs­baum, an au­thor spe­cial­is­ing in the sci­ence and his­tory of dis­ease and whose book trac­ing the story of the great flu pan­demic will be pub­lished next week.

One rea­son why the pan­demic seems to have been so for­got­ten by his­tory may be be­cause it was largely ig­nored by the press. News­pa­pers, be­lea­guered by sto­ries of losses on the bat­tle­field, were re­luc­tant to lower morale fur­ther at home with tales of a killer flu. In fact the only coun­try that did re­port the full scale of the dis­ease was Spain, which wasn’t in­volved in the war. The re­port­ing had the side ef­fect that many as­sumed the pan­demic had started there and the dis­ease be­came known as Span­ish flu.

Al­though Gitchell was the first recorded case of the in­fluenza, there’s some ev­i­dence that the dis­ease may have made the first cross­over from an­i­mals to man at the mil­i­tary base at Eta­ples, near Calais in North­ern France – an enor­mous and cramped area for Bri­tish sol­diers trav­el­ling to and from the front in which men and farm an­i­mals be­ing kept for sup­plies were of­ten in close con­tact.

Med­i­cal records from 1916 re­port sol­diers at Eta­ples suf­fer­ing from a dis­ease named pu­ru­lent bron­chi­tis. It had many of the symp­toms later iden­ti­fied as Span­ish flu, in­clud­ing masses of blood-streaked and yel­low­ish­green phlegm and a blueish colour in the cheeks that turned to dark pur­ple and spread through­out the face as the dis­ease wors­ened.

It was a symp­tom doc­tors know as he­liotrope cyanosis and be­came one of the most dis­tinc­tive signs of the 1918 pan­demic, caused by the lungs shut­ting down due to them over­fill­ing with blood and mu­cus.

“In 1918 there was lit­tle doc­tors could do ex­cept make pa­tients comfortabl­e and ask them to wait,” says Honigs­baum. “If the cyanosis dis­ap­peared and a healthy pink hue re­turned that meant pa­tients were usu­ally on their way to re­cov­ery. If, how­ever, the dis­coloura­tion dark­ened, that meant the prog­no­sis was bad.”

The world had suf­fered in­fluenza pan­demics be­fore, most notably in 1890 when Rus­sian flu swept across Europe, but no pre­vi­ous out­break had been as deadly as that in 1918. The flu came in waves, the first spread­ing with US troops, killing tens of thou­sands of sol­diers on all sides and in­ca­pac­i­tat­ing hun­dreds of thou­sands more.

TH­IS­first wave killed 5,500 Bri­tish troops and hos­pi­talised 226,000 more. By July it reached Lon­don, where it killed 700 di­rectly and a fur­ther 475 from as­so­ci­ated pneu­mo­nia, but by Au­gust had dis­ap­peared al­most as swiftly as it had ar­rived. But the respite was brief and when the flu re­turned in Septem­ber it did so in a much dead­lier form.

This time when the dis­ease hit Lon­don it killed nearly 12,000 peo­ple in three months and rapidly spread through­out vir­tu­ally ev­ery ma­jor city in the UK. Mean­while, at the front dur­ing the fi­nal months of the war, al­most as many men were dy­ing from it as per­ished in bat­tle – 35,000 be­tween Septem­ber 1918 and April 1919.

Mean­while, so many peo­ple were in­ca­pac­i­tated that the coun­try al­most ground to a halt. Lon­don was es­pe­cially af­fected. At the height of the pan­demic 61 peo­ple col­lapsed in the streets in the space of 48 hours.

“By the fi­nal week of Oc­to­ber some 1,400 Metropoli­tan po­lice­men were ill and in many parts of the cap­i­tal so many fire­men were off sick that there were in­suf­fi­cient to man the pumps,” says Honigs­baum. “The am­bu­lance ser­vice was sim­i­larly short staffed and when some 1,000 tele­phone op­er­a­tors also fell ill, the Post­mas­ter Gen­eral is­sued an ap­peal ask­ing sub­scribers to limit their calls to the ex­change.”

Many schools were also closed to stop the dis­ease spread­ing among chil­dren and, as the num­ber of dead

spi­ralled, fu­neral par­lours ran out of wood to make coffins and be­gan ad­ver­tis­ing for vol­un­teers to help to bury the back­log of bodies.

Al­though many of the symp­toms were the same, the speed and man­ner with which the flu af­fected its vic­tims dif­fered greatly. Some would slip into delir­ium, oth­ers would be fully con­scious up to within half an hour of death while an un­for­tu­nate few would go into a coma days be­fore they died.

In sev­eral cases the dis­ease was so de­bil­i­tat­ing that vic­tims com­mit­ted sui­cide rather than suf­fer any longer.

Al­though the dis­ease spread through­out most of Bri­tain’s ma­jor cities, at first Manch­ester sur­vived rel­a­tively un­scathed. Iron­i­cally it was the end of the war that brought the most deaths to Manch­ester. WHEN

the Armistice was an­nounced on Novem­ber 11 fe­male mu­ni­tion work­ers rushed into the city’s Al­bert Square where they re­joiced with Bri­tish, US and Bel­gian sol­diers and the cel­e­bra­tions con­tin­ued for sev­eral days with mas­sive crowds cram­ming into the streets, trams and mu­sic halls. The flu spread like wild­fire. The pre­vi­ous week Manch­ester had recorded just eight deaths from the sec­ond wave of the in­fluenza but the week af­ter 383 peo­ple died and an­other 1,600 died in the fol­low­ing months.

Af­ter a brief respite in Jan­uary 1919, the pan­demic re­turned for a third and fi­nal wave in Fe­bru­ary, only pe­ter­ing out com­pletely in May. This third wave was not as dev­as­tat­ing but still ac­counted for a quar­ter of all fatal­i­ties from the pan­demic and it left the pop­u­la­tion of Bri­tain ex­hausted of death.

Per­haps it was this weari­ness that pre­vented many from talk­ing about it, or per­haps be­cause it was so uni­ver­sally suf­fered that many felt there was lit­tle left to say.

But to­day sci­en­tists and gov­ern­ments are looking at the 1918 flu pan­demic to learn how to pre­vent such a global catas­tro­phe from hap­pen­ing when an­other out­break re­turns. Bri­tain in 2008 may have bet­ter health­care than in 1918 but it also has al­most twice the pop­u­la­tion, and they travel more fre­quently, po­ten­tially spread­ing the dis­ease even faster.

We have to hope gov­ern­ments have learnt the lessons of 90 years ago be­cause as Pro­fes­sor Sir Liam Don­ald­son, Bri­tain’s Chief Med­i­cal Of­fi­cer, said in 2005: “We can’t make this pan­demic go away be­cause it’s a nat­u­ral phe­nom­e­non – it will come. But what we can do is limit its im­pact.”

To or­der Liv­ing With Enza, by Mark Honigs­baum, pub­lished by Macmil­lan at £16.99, call the Ex­press Book­shop on 0871 521 1301 (10p/min from BT land­lines) or on­line at www.ex­press­book­shop.com UK de­liv­ery is free.

CRI­SIS WARD: An emer­gency hos­pi­tal for troops in the 1918 flu out­break. Even mod­ern medicine won’t pre­vent an­other pan­demic

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