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
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