Spanish Flu - 50-60 million dead in 1918

The 1889–1890 Flu Pandemic was similar to the great Spanish Flu pandemic and might have prepared doctors and armies in WW1. It was first noted in different countries: China (1888); Athabasca in Canada (May 1889); Greenland (summer 1889), Tomsk in Siberia and Bukhara in Uzbek­istan (Oct 1889), St Peter­sburg in late Oct 1889, and expanded rapidly via railway across Europe. In Paris, the first cases were recorded on 17th Nov; in Berlin and Vienna on 30th Nov; in London in mid Dec, and in southern European countries in late Dec. The flu spread overseas to Boston and New York in Jan 1890. And then throughout North and South America, Africa, Asia and Oceania by mid 1890. The most tragic period was between Dec 1889 and Jan 1890; the majority of the million deaths were older than 50.

So how different was the Spanish Flu Epidemic of WW1? Even before the arrival of air travel, Spanish flu swept around the world in just 3 catastrophic months from Oct 1918 to Jan 1919 - and killed more people than WW1 had.

The 1918 flu came in two waves. The first wave was a benign bout that began in March 1918 in Spain. The epidemic was remarkable for the millions of victims struck down; high temp­er­atures; aching limbs; headaches and sore throats. Mostly the ill­ness quickly passed and few deaths occurred.

An early pandemic occurred in the British military base at Étaples (1916–1917) in North France. This military base, situated near sea mar­sh­es with migratory birds, was occupied by 100,000 soldiers within 12 sq ks.  Presumably the epidemic came from a mixture of very crowded sold­iers, ? infected birds and mutagenic war gas. Or perhaps the virus originated with pigs kept near the British troops at the camp, and then jumped species over to humans.

As France lost its own men in The Great War, hund­reds of thousands of troops in indigenous army units were organised in the French col­onies in Africa, Asia and Oceania. Of the 50,000+ Indo-Chinese sold­iers sent from the old Annam kingdom (now Vietnam-Laos-Cambodia) to France, half of them were assigned to active battalions, or as nurses and lorry drivers on the Front. But was there a connection with flu?

Medical records reported that an American flu epidemic began in Feb 1918, in Sing-Sing Prison in New York. Others mentioned an acute infect­ious outbreak among young farmers in Haskell County in Kansas. This too occurred in Feb 1918, especially once these young farmers en­listed and were incorporated into Kansas’ Funston military camp. The later link to the Spanish Flu in Europe might have been explain­ed in terms of the Chinese workers in Kansas i.e to the new c­om­­b­in­ation of viruses  of Chinese and Indochinese origin

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Camp Funston, Kansas, 1918

Photo credit: Kansas WW1

The Paris ASSA archives affirmed that the first cases of flu in France appeared in the Third Army in Villers-sur-Coudun and in the Fère-Briange training field in April 1918. At the same time, flu broke out in the American army which was based in the outskirts of Bordeaux. And there were flu cases reported in 1st and 2nd battalions of the British army in France, in the German army at the Western front, and in the Military Hospital of Cabour in Belgium. Without a vaccine or antibiotics, public health authorities watched as the pandemic raged. People best avoided in­f­­­ection via face masks and staying away from crowds.

But after a period of calm in mid 1918 the virus mutated, becoming extremely virulent. This more deadly second wave probably first start­ed in Spain. Thus the label “Spanish Flu”. Spain had been neut­ral in the Great War, but it permitted the pass­age of Portuguese troops, workers and merchandise towards Fran­ce. This important com­munic­at­ions hub between the Iberian Peninsula and Paris was in the Basque Count­ry, at the outlet of a marshy bird-filled river - a frontier region that could have been one of the places in which the virus mutated and became in­v­asive.

From Oct 1918 on, the flu mov­ed to the general population across Spain, eventually affecting Portugal, then French and Italian cities. Frightening mortal­ity quickly emerged. Fluid entered the lungs; faces turned blue; the cough brought up the blood-stained sputum and the feet turned black. The lucky victims quickly drowned in their own lungs. The unlucky victims developed bact­er­ial pneumonia as an agon­is­ing secondary infect­ion. In the morning, the dead bodies were stack­ed about the morgue. But between the speed of the flu outbreak and effective military cens­orship in WW1, families didn’t know what had happened to their loved ones.

The Allies had been boosted by hundreds of thousands of strapping young American recruits pouring into France aboard every trans-Atlantic troopship. How tragic it was that these fit young men who appeared most suscep­t­ible to the flu virus; in the crowded troop ships and training camps they fell ill and dropped dead. In October 1918, while 50,000 Americans died in battle, 70,000 of them were hospit­al­ised with flu, of whom 32% died. The Allied offensives almost ground to a halt because so many soldiers were sick. Had the Allies known it, the starving Germans were worse off.

Australian Red Cross Voluntary Aid Detachment members, 
working as flu doctors in Sydney, 1918. 
Photo credit: Australian War Memorial

The Great War, which had ravaged Europe for four years, was end­ing. But in the week in which The Armistice was signed, 11th Nov 1918, flu deaths in Europe reached their peak. British prime min­ister and US president, who met in Paris to design the Treaty of Versailles, both caught the flu and lived. But Sir Mark Sykes, whose Sykes-Picot Plan was to carve up the Middle East, died from flu.

I thought snow protected citizens against the flu, but the Spanish flu reached Sweden in June 1918, and a one-third of the population became infected. c34,500 persons died from flu during the pandemic or from acute pneumonia.

A milder third wave occurred in early 1919, while the fourth wave spread during early 1920. The majority of those who died were young, healthy adults aged 15-44 but mortality rates varied between countries. By the end of the epidemic, in less than 2 years, 50+ million people had died world­wide.

Summary
The Spanish Flu pand­emic was inext­ricably linked to the millions of young men in army barracks, military camps and trenches; this is where the Flu virus developed, became virulent and spread worldwide in Oct-Nov 1918. Soldiers and workers, from Europe, Asia, America, Africa and Oceania, mixed on French soil. The causal fact­ors were poor liv­ing conditions, stress, fear, war gases used indis­crim­inately, shocking winters, and contact with birds and pigs.

Thanks to the main references: "Origins of the Spanish Flu pandemic (1918–1920) and its relation to the WW1" by Anton Erkoreka and "When the World Sneezed" by Nigel Jones in History Today magazine, 5th May 2009.