'No News but Flu': The Spanish Flu Pandemic, 1918 by Sheena Wilkinson

In real life I’m the world’s most squeamish person. Cough beside me on public transport and I guarantee we won’t be companions for long. But for some reason I can cope with almost anything on the page, which came in very handy when, several years ago, I decided to set a novel, The Greater Malady,  during the 1918/19 influenza pandemic.  

Why the fascination with the so-called Spanish Flu? It grew out of my long-held obsession with World War One, whose ending overlapped with the flu, perhaps one reason why this crisis – the single worst demographic disaster of the 20 century – has been comparatively overlooked. Again and again I consulted histories of the period, to find the pandemic passed over in a paragraph or two. Yet it killed at least 50 million people worldwide, and its after-effects were felt for years by many survivors. 

Despite the name, it didn’t start in Spain, nor was Spain affected more than anywhere else.  Theories disagree as to whether it began in China or India, or possibly in America, where it attacked thousands of soldiers in training camps. Germans called it ‘Tommy flu’ at first, and the English called it ‘German flu’. But Spain was neutral in World War One and therefore not bound by the same reporting restrictions as the fighting powers. When morale was already so low after four years of war, the last thing governments could afford was people panicking about infection.

And at first there seemed no need to panic. The flu came in three waves, and the first one, in spring 1918, seemed no worse than the usual seasonal flu.  But by the autumn, doctors were horrified and puzzled by this illness, described in The Lancet as ‘flu, but not as we know it.’ As well as the common symptoms of fever, cough, and severe aches, many people were stricken by
dysenteric and haemorrhagic symptoms, with many choking to death on their own blood as their lungs disintegrated. The characteristic marks of cyanosis turned the faces of oxygen-starved sufferers dark blue, which led to its being called the blue flu, or the black flu. It resembled and was sometimes referred to as ‘plague’, and it killed many more people than the Black Death, but it was ‘only’ flu nonetheless. It could strike so suddenly that many people got up feeling perfectly well, only to collapse and die by nightfall. 

It infected 1/3 of world’s population, about 500 million, with a death toll of 10-20% depending on conditions. Unlike most infections, it killed the young and fit disproportionately. The death toll of c.50 million is probably a conservative one, as people often died of after-effects, related complications etc. From about 1920 war memorials started to go up in towns and villages round the world, but there are no memorials to the flu dead. It’s hard to imagine the scale – but think of how difficult it would be for life to go on with one in three people ill. Life did go on, by and large, in a population hardened by years of war, but even so, there are widespread reports of coffins piled up in the streets, the dead lying unburied, and children starving to death because their parents were lying dead in their beds. On one day in October 1918, at the height of the second wave, sixty people dropped dead in the street in London alone. 

 Why was it so bad?  I’m not an epidemiologist or scientist, but people in 1918 were often living in close quarters, in filthy trenches, army camps, and at home in factories and overcrowded housing conditions.  There was a great deal of movement of troops and support personnel. Think of how often today we get sick after travelling. On the home front, there were food shortages, low morale, and crucially a severe shortage of doctors and nurses, 50% of medical personnel on military service. Nobody was equipped to deal with a pandemic on this scale. 

Why isn’t it better known? I’ve described it as a horror story but we choose to remember other horrors – indeed remembering horror is important in helping us not to repeat the mistakes of the past. But this was horrific in a different way from war, and maybe people were scared to remember it because they knew how powerless they were to prevent its happening again. The medical profession had made improvements in public health and infection control in the 19^th and early 20^th C, and the war led to great strides in wound treatment, mental health, brain surgery, cosmetic surgery etc. Powerlessness against flu doesn’t fit that narrative of medical progress and confidence, and it was accepted that there was very little doctors could actually do. Nursing -- and luck -- played the greatest role. 

Another narrative it doesn’t sit easily with is that of heroism, so important at the time. While death in battle could be seen – however grim the reality – as noble and sacrificial, death from a disease was simply bad luck. It’s also very hard to romanticize – the symptoms were so disgusting. And maybe, after over four years of the most terrible war, people simply couldn’t bear any more horror. 

We know now that, like most influenza pandemics, the 1918 flu lasted for about a year and then petered out, but those living through it had a great deal of uncertainty. What exactly was it? When would it end? Would they get it? Would they die? Was it in fact the end of the world? Was God punishing humanity for the devastation of the war? These are the questions people were almost afraid to ask at the time. They must have felt like they were living through a medieval plague, and who wants that to mess up the sense of 20^th century modernity?

Funnily enough – I didn’t think it funny at the time – The Greater Malady, which I spent two years writing, was never sold. Clearly the publishing world did not share my fascination with this pandemic. But when I wrote Star by Star, set at the end of World War One, I knew that the flu would be a central issue in the book, and all that disgusting, horrific research would come in very handy. And in my forthcoming novel, Hope against Hope, set in 1921, the heroine’s family has also been bereaved by flu, not because I was being lazy and repetitive but because, a hundred years ago, with one third of the world’s population affected, there can have been very few families immune.