History Repeating Itself? The Spanish Flu of 1918.

Catharine Arnold

In 1918 humanity face another influenza pandemic, this one more lethal, which hit populations emerging from the horrors of World War One.
Familiar looking masks
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January 2018 saw the publication of my book, Pandemic 1918, the Story of the Deadliest Influenza in Human History, an account of the Spanish flu pandemic which killed up to 100 million people worldwide in three successive waves between 1918 and 1920. When Pandemic 1918 appeared, I never imagined that it would be more than the social history of a forgotten tragedy, of interest to students of that period and the readers who have followed me through previous books about the dark side of London.

Fast forward to January 2020, and I was suddenly witnessing a new pandemic unfolding before my very eyes. The hairs stood up on the back of my neck as I watched the news from China, and then Italy, empty highways, and deserted piazzas. I have never seen such events first hand. I attempted to find precedents, from 9/11 to the strikes and power-cuts of my 1970s childhood, from the Cuban Missile Crisis, to Suez. But in terms a genuine existential threat you would have to go back to World War Two, out of living memory for most of us.

When Pandemic 1918 appeared, I had no idea that we were about to be engulfed by another pandemic, which has led to the deaths of 1,634,422 worldwide, or that Britain would have the highest death rate in Europe (65,520 at the time of writing). I had hoped that such a pandemic would never happen again. In September 2018, while recording the ‘Panoramadocumentary The Flu That Killed 50 Million, I resisted the director’s request to predict another pandemic, for fear of sounding sensationalist. Back then, I had every confidence that such a crisis could be averted. After all, the British and United States authorities had civil contingencies to deal with such an outbreak. The Home Office classified a flu pandemic as potentially more serious than a terrorist attack. The United States had protocols at the Center for Disease Control to respond to such an eventuality. Little did I know that by 2020, the NHS would be crippled by cuts in public spending, or that President Donald Trump would dismantle the US pandemic strategy.  So, the unthinkable happened, and from the belated British Lockdown of March 23, through the summer and into Lockdown 2.0, COVID-19 changed the world.

As I write, families are being urged to keep their holiday celebrations to the minimum and to indeed have a ‘Merry little Christmas’ during the five-day amnesty, with another national Lockdown seeming likely to follow directly afterwards. It will be months, possibly years before life returns to anything approaching normal.

As Lockdown descended during the spring of 2020, I felt like we were living in a Netflix sci-fi drama. A wave of interest in Spanish flu emerged, and Pandemic 1918 suddenly achieved a new and chilling relevance. I developed a new role: taking the long view, as if understanding what happened in 1918 might enable us to process this terrible year’s events and even predict the future. But while there are similarities between the two, there are also critical differences. Spanish flu, that ‘clever little virus’ as virologist Jeffery Taubenberger put it, was the particularly virulent form of influenza, H1N1, while COVID-19 is a coronavirus and closer to pneumonia in impact. These pandemics occurred in two distinctly different historical contexts: Spanish flu flourished in the deadly, unstable climate of World War One; COVID-19’s deadly progress owes its success to budget airlines. Spanish flu, uniquely, targeted the young and the healthy by triggering an auto-immune response; COVID-19 has proved most deadly to the elderly and those with existing co-morbidities. 2020 has seen the development of a vaccine in record time, which provides real hope for the future. In 1918, scientists struggled to develop a vaccine against flu.

Few of us have been untouched by the impact of COVID-19, on a broad spectrum from critical illness and bereavement to mild inconvenience. But, so far, COVID-19 cannot match Spanish flu for numbers. While the current global mortality figure for COVID-19 is 1,634,433, the final death toll for Spanish flu stands at 100 million, according to Professor John Oxford, the leading expert in the field. In Britain, 65,000 people have perished from COVID-19 to date. During the period 1918-20, Spanish flu killed 220,000 people in England and Wales. Tragically, the figures are closer in the United States. To date, 300,000 Americans have died of COVID-19; in the previous pandemic, the death toll was 500,000. Such is the state of affairs in the US that Pan American Health Organization (PAHO) Director Dr Carissa F Etienne was moved to say that the pandemic ‘is undoubtedly the most extraordinary public health event of our lifetimes’ and ‘stands out in both scale and impact. And it has put a spotlight on two of the longstanding challenges of our region: inequality and underinvestment in our health systems.’

In 2020, governments responded swiftly as the threat emerged from China. A different story from 1918, when leaders preoccupied with the war wildly underestimated the dangers of Spanish flu. To put this into context, killer outbreaks were a regular occurrence, and the common consensus was ‘there’s nothing you can do for flu.’ There was no vaccine to stop the spread; no cure; the only treatments consisted of opiates and bed rest, alcohol, and herbal remedies. So Spanish flu rampaged across the globe, aided, and abetted by World War One’s industrial warfare.

It is impossible to overestimate the role of World War One in the Spanish flu pandemic. Troop ships became super spreaders, carrying the virus around the world. It had such a devastating impact on the German army that General Eric von Ludendorff was forced to abandon his plans for a spring offensive. Spanish flu may have hastened the end of the war as greater numbers of German soldiers succumbed, their immune systems already weakened by illness and malnutrition. Although 2020 has had its own complications, not least the devastating economic fall-out and an epidemic of mental health problems, at least we do not have to contend with a major war.

While the early months of 2020 have seen concerted efforts to contain COVID-19 and ‘stop the spread’, in 1918 Spanish flu appeared to be a secondary threat compared with the fear of a German victory. Everything and everybody had to be sacrificed to the war effort. British doctors were commissioned into the Royal Army Medical Corps (RAMC); women enlisted as nurses; the military commandeered hospitals. There were not enough doctors left to go round as Spanish flu hit Civvy Street, even if working people could have afforded their fees.

Today, social networking and mass media ensure that briefings and updates ping around the world in seconds. But in 1918, there was no coherent overall strategy to deal with the threat of Spanish flu. In Britain, public health responsibility rested with local government; in the United States, the response varied from city to city and state to state. The reluctance to take Spanish flu seriously also led to a delayed response. Indeed, when it first emerged, Spanish flu was treated as a bit of a joke. Named after an outbreak in Madrid which almost killed King Alfonso XIII, Spanish flu quickly became the target of satirists who labelled it a fashionable disease. A leader in The Times declared that the cause of the disease was ‘the dry, windy Spanish spring . . . A spell of wet weather or moist winds would probably check the progress of the epidemic.’ This was despite the rising mortality count from northern factories and collieries reported elsewhere in the same newspaper. The explanation for such an attitude was more complex; serious discussion of Spanish flu was censored by the authorities, on the grounds of national morale. Consider the difference between 1918 and 2020, when British Prime Ministers were struck down with the virus. Whitehall hesitated to inform the public that Lloyd George was in a critical condition when he contracted Spanish flu; when Boris Johnson caught COVID-19 in summer 2020, it was impossible to keep his condition private.

Back in London in 1918, where the ghost of a social season was in full swing, and an Allied victory seemed certain, Spanish flu appeared to be a minor threat. In a London where social distancing did not exist, theatres and music halls were a sea of navy and khaki, packed to the gills, with servicemen from Britain and the Commonwealth, out for a good time before they returned to the trenches. Spanish flu may have seemed like a joke; but then, over three weeks during July 1918, 700 civilian Londoners died of influenza and a further 475 from pneumonia, while a total of 10,000 influenza deaths had been recorded in Great Britain between June and July.

Scientists had attempted to flag up the dangers. When Walter Morley Fletcher, head of the Medical Research Committee, called for quarantine restrictions on public transport to stop the spread of flu, he was batted away by Sir Arthur Newsholme, Chief Medical Officer of the Local Government Board. Sir Arthur conceded that public transport constituted ‘prolific sources of infection’, but the war effort must come first. ‘The vast army of workers must not be impeded by regulations as to overcrowding of vehicles in their efforts to go to work and return home,’ he told Fletcher.

Fortunately, Fletcher was not alone in his determination to battle Spanish flu. When Dr James Niven, Chief Medical Officer of Health for Manchester, learnt that schoolchildren were dying at their desks like poisoned plants, he realised that he was dealing with a significant outbreak. Niven, who had experienced the Russian flu epidemic of the 1890s first hand, instructed the council to close the schools and issued 36,000 handbills informing people with symptoms to self-quarantine for a fortnight. His swift response saved lives. In the summer of 1918, 100,000 Mancunians became infected with flu, but only 330 died.

Emergency Hospital containing US soldiers

Over in the United States, Surgeon General Rupert Blue recognised the pandemic’s gravity but had no powers. He could only recommend quarantine and masks but could not enforce these measures. Some cities such as New York, San Francisco and Washington imposed quarantine and mask-wearing, while Philadelphia exhibited a confusing sense of priorities. Theatres and dance halls were shut, but citizens were actively encouraged to attend patriotic fundraising parades. On September 28, 1918, 250,000 people attended the Liberty Loan Drive. Just two days later, October 1,635 new cases were reported.

The mask has become the iconic image of the current pandemic, symbolising continuing the battle against COVID-19. 1918 was no different, with masks being distributed by the Red Cross, indicating that the authorities were at least trying to do something. Citizens were enjoined to: ‘Obey the laws, And wear the gauze, Protect your jaws, From septic paws! While basic masks consisted of four layers of medical gauze held in place by tape, fashionable face coverings soon emerged, just as they have done this year, in luxury fabrics such as chiffon and silk. In Seattle, masks became mandatory on public transport. In Washington DC, Commissioner Louis Brownlow stated that public coughing and sneezing constituted a menace to the community, with offenders to be fined or even imprisoned. In San Francisco, Mayor Rolph issued a public mask order, with the warning that ‘whoever leaves his mask behind, dies.’

The majority of San Franciscans accepted this edict, with one couple of newlyweds even shyly informing their doctor that they had worn their masks and nothing else during their honeymoon.  But not everybody was happy to accept the new rule. An extreme example of the consequences of refusing to wear a mask appeared in The San Francisco Chronicle, October 28, 1918:


         ‘While scores of passers-by scurried for cover, H D Miller, a deputy health officer, shot and severely wounded James Wisser, a horseshoer following Wisser’s refusal to don a mask. According to the police, Miller shot in the air when Wisser first refused his request. Wisser closed in on him and in the succeeding affray was shot in the arm and the leg. Wisser was taken to the central emergency hospital, where he was placed under arrest for failure to comply with Miller’s order.’

James Wisser was not the only one. Enter the redoubtable figure of Mrs E Harrington, suffragette, first woman to vote in San Francisco, and to qualify for the Californian Bar.  Mrs Harrington, a downtown attorney, argued that Mayor Rolph’s mask ordinance was ‘absolutely unconstitutional’, and founded an organisation called the Anti-Mask League. According to US historian Brian Dolan, the League consisted of people who opposed masks from various perspectives: medical, economic, and libertarian. Dolan believes Mrs Harrington may have had a personal political agenda, as she was an ally of Mayor Rolph’s predecessor, Mayor Patrick Henry McCarthy. There was also a business angle, with department store owners worried that people would not want to undertake their Christmas shopping while wearing masks. In Dolan’s words, ‘it appears that the priorities of either side were not entirely about public safety’.

The Anti-Mask League held its first meeting at the Dreamland Skating Rink in December 1918. At first, the level of protest appeared civilised, as it was resolved to submit a petition calling for the mask order to be abandoned. But events took a darker side on December 18, when an IED composed of an alarm clock and 3lb of gunpowder was delivered to the public health offices with the message ‘compliments from John.’ Mercifully, the device did not detonate, but in January 1919 the mayor’s office relented, though warning protestors that without masks, the death rate would spiral. Within ten days of the mask order being revoked, there were 300 deaths from flu.

In 2020, anti-mask protests have taken place in Trafalgar Square, scenes which were repeated throughout the country. More disturbing versions occurred in the US, such as those in Michigan showing armed anti-lockdown, anti-mask protestors invading the capitol building and calling for the murder of Governor Gretchen Whitner.

As I write, anxieties surround the Christmas amnesty when social distancing restrictions will be lifted. November 11, 1918, saw celebrations of a different sort, with bacchanalian scenes of revelry breaking out after the signature of the Armistice agreement. As Manchester exploded in a spontaneous party, Dr James Niven warned the council that mass gatherings would result in further outbreaks. But the council, which had taken Niven’s advice in summer 1918, ignored him and thousands poured into Albert Square. By the end of that month, Niven had recorded 383 influenza deaths in one week. As the Manchester Evening News observed: ‘a real calamity had befallen the city’.  This perceived failure left an indelible impact on Niven. After the war, and following the death of his wife, Niven went into a decline. In 1925, he travelled to the Isle of Man, took an overdose of pills, and swam out to sea. His body was retrieved from the ocean two days later.

Catharine Arnold is the bestselling author of Pandemic 1918, The Story of the Deadliest Influenza in History, Necropolis: London and its Dead, and Underworld London: Crime and Punishment in the Capital City.

Aspects of History Issue Four is out now.