Dan Snow's History Hit - History's Deadliest Influenza Pandemic

Episode Date: July 1, 2020

Germans soldiers called it Blitzkatarrh, British soldiers called it Flanders Grippe, but the 1918 pandemic was most commonly known as 'Spanish Flu'. Catherine Arnold is the author of 'Pandemic 1918', and she joined me on the pod to discuss this terrible disease. A disease where victims suffered haemorrhages from the lungs and nose, skin turning blue from lack of oxygen and choking to death from 'air hunger' as the lungs filled with blood and pus. As Catherine explains, communities across the world battled with the infection in different ways, sometimes confronted with whole swathes of disobedient citizens. Yet again, it seems looking into the past provides valuable guidance for our actions today. Subscribe to History Hit and you'll get access to hundreds of history documentaries, as well as every single episode of this podcast from the beginning (400 extra episodes). We're running live podcasts on Zoom, we've got weekly quizzes where you can win prizes, and exclusive subscriber only articles. It's the ultimate history package. Just go to historyhit.tv to subscribe. Use code 'pod1' at checkout for your first month free and the following month for just £/€/$1.

Hello everyone, welcome to Down Snow's History. We're talking pandemic again, we're talking the 1918 pandemic, so-called Spanish flu. We have another great writer-historian on the podcast this time, Catherine Arnold. She wrote a big book all about 1918. We interviewed her for the documentary that we're producing. Well, we have produced on History Hit TV. Please go and check it out on the history of pandemics what these great catastrophes in the past how they've changed our societies with some thoughts some pointers some things to stimulate our conversation about where we want to go from here on in so this is Catherine Arnold that we featured clips of Catherine on that documentary but this is the full interview I did for this podcast you can watch that documentary on history hit tv you simply go to history hit.tv it's like the netflix for history you use the code pod1 pod1 and then you get a month for free check it all out watch the documentary watch all the documentaries on there hundreds documentaries and then you get

first month after that for just one pound euro or dollar so it's pretty sweet deal so please go and check that out and in the meantime everybody here's Catherine Arnold enjoy. Catherine thank you very much for coming on the show we all told ourselves we're due another pandemic but did you expect it? No I didn't it came as quite a surprise to me but that's because while I was writing it I was looking at the existing sanctions to cope the instructions for a pandemic. And back in 2015, 2016, it looked as if on both sides of the Atlantic, at least, we were equipped to deal with it. It was a top priority at the Home Office. It took priority even over a terrorist event, because as we can see, when there's a a pandemic the country grinds to a halt. This is not a political statement but I later found out that due to the restrictions in the National

Health Service by the time the pandemic actually came along in March of this year it didn't seem as if the health service had the resources to cope with a possibly annihilating pandemic which would have put it under unbearable strain. Meanwhile, across the pond, I had always hoped that what I'd been told was that the Centre for Disease Control in Atlantic Georgia had plans to deal with pandemic flu. There was also a pandemic flu programme at the White House. What I didn't know as I was working on this book and editing it and promoting it was that these pandemic schemes were stepped back by the president. He decided that they were unnecessary. And so instead of being able to put the White House on a war footing as soon as the pandemic struck, just as we were, the US authorities were floundering and trying to find a way through it, as indeed we still are.

So let's go back to 1918. On this podcast, we've looked into some of the new theories, how it might have begun in a tapler in the huge camps on the Western Front and then spread to America. Either way, when is the first time it appears on the radar, not just of specialist healthcare professionals, but of politicians, of civil servants? When does it really become a serious problem? Well, I think it really emerged as a serious problem in June of 1918. You can picture the scene in London, despite the fact they'd been at war for four years. London was quite a bright and vibrant place. There were still parties. there was still the ghost of a social scene. Women were still desperately trying to pair their daughters up with the available men who were still left. But just occasionally you get a little mention in the Illustrated London News, for instance, about the flu being a bit bad

this summer. Or a rather mocking aside in the London Times saying, oh yes, we've heard about this so-called Spanish flu coming over from Spain and now I suppose everybody fashionable wants to get it, but of course as soon as we have a bit of cold weather and a bit of rain, it'll just be gone. But that very same month, deaths began to occur and by the end of July, around 800 people had died of the so-called Spanish flu in London.

That was when it was beginning to impinge on public consciousness. But before that, in the rest of the country, there'd been a slow and steady body count. Pandemic flu or epidemic flu had started to emerge in Glasgow in the shipyards. It had travelled south. It had hit the factories in Sheffield. It had hit the mines in Nottinghamshire. But it really came to prominence, as so many things do, once it began being observed in London. Let's just rehearse. Why do we call it Spanish flu? Right, well, it's a bit of a misnomer, really, and at the time, the Spanish themselves referred to it as the disease of the Naples soldier,

which was a show that was running in Madrid at the time. We call it Spanish flu because it was first discovered in Spain. What happened was that there was already a killer flu that was doing runs of the military camps and the civilians and it rolled through France and Italy and then across the Pyrenees and it showed up in Spain and it infected and almost killed the king of Spain Alfonso XIII along with members of his cabinet. Some members of Alfonso's cabinet actually died, mercifully he was spared. Now Spain was neutral which meant that this strange new disease could be openly debated in the press. Newspapers could say what is this strange fashionable disease something that seemed like a

bit of an affectation and now nearly killed our king and doctors could talk about it freely. Over in Britain under the Defence of the Realm Act or DORA. Anything that affected public morale was suppressed so only really the briefest mention of Spanish flu was permitted at that time but cut a long story short that's how it got its name. It wasn't particularly anything the Spanish did, it wasn't their fault. It could almost be a form of xenophobia, calling it Spanish flu. But different countries had different names for it. The Poles, when they got it, blamed it on communist Russia. It's obviously impossible to know, but during the various waves of Spanish flu that hit all the way into early 1920, I think, didn't it? How many people do we

think it killed? My verdict, along with the leader in the field, Professor John Oxford, is around about 100 million. It's a terrifying figure. And in some ways, I accept that it has to be a round number, because in certain parts of the world, it was very difficult to keep detailed records. You think of somewhere like sub-Saharan Africa, or India, where people were living at best a subsistence existence, then it's hard to determine whether every single one of those people had a properly filled out death certificate. However, due to the research Professor Oxford and people like him have been doing, it seems as if the figure that was arrived on a few years ago of 50 million is now much closer to the 100 million. And people talk about COVID-19 as falling very unequally. It's still a bit of a mystery. Is it just that it will eventually spread evenly across the world? Or are there some societies and some places where for some reason it's taking less effect? What can we

learn from 1918's great influenza? Were there places that were sort of almost mysteriously spared or will eventually it'll just get everywhere? Well to look at the first part of that question, coronavirus currently, it does seem to be affecting an unfair proportion of people who live in houses of multiple occupation, who live in straitened circumstances, are victims of poverty and poor housing. And also it seems to affect people from certain ethnic groups, which is quite extraordinary. No sufficient explanation has been found for that. With Spanish flu, the numbers of people who were affected were generally those from deprived backgrounds. For instance, in Philadelphia,

far more people died in, I hate to use the word ghettos, but it was the word that was used at the time, far more people died in the Italian, the Jewish and the Afro-American ghettos in Philadelphia and Chicago than died in the affluent suburbs. This is probably down to what I mentioned earlier, the poor housing and the bad conditions that they were forced to live in. Whether this is a predictor for what can happen with coronavirus is another matter. But certainly every step that's taken to use the resources of quarantine, social distancing that we have now can only be to the good. As to its spreading, one of the strange things about the Spanish flu, and something I'd like to go back to,

you mentioned the belief that it started at a tarpeler, or there's the other belief that it started in Kansas. The thinking now is that Spanish flu itself originated in China, and was brought west by Chinese labourers who were hired to help the Allied war effort. Even more remarkable echoes in covid yeah one of the reasons i mentioned china again was because spanish flu spread across the globe there was nowhere apart from antarctica that went uninfected but curiously enough in china which is unfortunately the mother of all pandemics where you might have expected it to be at its worst and where obviously Covid was at its worst when it started. The Chinese death rate was lower than one might have predicted, suggesting that they may already have been living with some

form of this particular virus before it burst upon the rest of the world and acquired some form of immunity. In the 19th century you get these Asiatic diseases like cholera that spread in the unsanitary European cities. What does the influenza of 1918 tell us about those societies? The world was pretty globalised, people were travelling. I mean, what spotlight does it shine on those societies? Well, at the time when Spanish flu hit, they were already developing vaccines for diseases such as cholera. And many of the people who worked on the original attempts to find a vaccine for Spanish flu had helped defeat yellow fever.

There was another big outbreak of flu in the 1890s, which was misknown as Russian flu. It was kind of a misnomer calling it Russian flu because it didn't come from Russia. But again, there was a kind of bigoted belief that Russian Jews had brought it over with them when they were fleeing Pogrom. They just happened to land in New York at the time when there was a big outbreak of flu. But I think most scientists, when Spanish flu first arrived, felt confident that they could actually tackle it, that having got on top of these other diseases and they thought of it as a bacterial disease because viruses were not so much understood in those days at first there was a lot of confidence that they would find a vaccine and indeed in September 1918 there was kind of

worldwide rejoicing because one particular scientist said he'd found a vaccine and you know there would soon be a cure and everybody would be fine. So much so that in Philadelphia, on the 28th of September, they decided to go ahead with a huge Liberty Loan March. This is kind of like a big thing to promote people to fundraise for the war effort and give money. money. So 28th of September, you've got 200,000 people walking through Philadelphia, a city which has only recently recovered from the first wave of Spanish flu. And not surprisingly, there's a new outbreak the following day. And within a week, 700 people have become infected. But this kind of confidence, this overconfidence came from the belief that, yeah, we'll get on top of this thing soon. We'll have a solution to it.

Whereas now, for instance, we're looking at coronavirus and it could be years, if ever, that a vaccine is found for that. In the news at the moment, we are all following certain areas. Sweden's got a different approach to Germany, Italy, and then within the USA, of course, different approaches from different states. Was that true back in 1918? And can you see a corresponding incidence of disease and mortality in those places? Yes, certainly can. I'd like to start with mentioning Surgeon General Rupert Blue. And he was a surgeon general in the United States of America.

And by September, he was viewing with horror what was happening in the States and trying as far as possible to put in measures which would protect people and would limit the spread, as we say here. But unfortunately, his word was not law. So he could only recommend that people wear masks, that people stay home, that people try to be as hygienic as possible. And you're quite right that different cities took action in different ways. So instead of having a cohesive strategy backed by the government as we do in the UK at the

moment, over in the States, action on Spanish flu is being decided on a state by state basis. So you've got New York, as you say, locking down pretty quickly. Washington and Seattle being very strict. In Seattle, you couldn't get on a tram without a mask, for instance. In San Francisco, at one point, slightly later, January 1919, the mayor issued an edict saying you couldn't go out in public without a mask. But other cities ignored this, for instance, St. Louis. So January 1919, there's a recurrence of flu in San Francisco, and Mayor Rolfe says, right, everybody has to wear masks in public, no exceptions. This is immediately met with protests by a group that call themselves the Anti-Mask League,

and they meet, whether in public or in private, it's not said, they meet and they decide that this is unconstitutional and un-libertarian. And so they campaign, first of all, just with a petition in a normal way that you campaign against your council. And the mayor comes back to them and says, well, yeah, if I lift the restriction and say you don't have to wear a mask in public anymore, you do know the death rate will go up. But the Anti-Mask League say we don't care about this. This is unconstitutional. We demand to be allowed to go out without masks on. So this situation kind of went on for a few weeks. And then mid-January, an improvised explosive device is delivered to the public health department it contains three pounds of shot an alarm clock and other things gunpowder and other substances that would not

be pleasant if it had detonated and you can hardly blame him the mayor gives up and he says okay have it your own way leave your masks off but don't be surprised if the death rate rises and indeed it did. And within a couple of weeks, 300 people were dead. Well, that's a remarkable story. Off the back of that, it strikes me that, yeah, that we need to think about this, the second peak, the second wave. I mean, these things, it doesn't just come in one go, does it?

Of course, that depends on the pandemic. There have been different forms of pandemics. They're not all the same. What concerns me about the current situation is the plans to send children back to school. Although I realise it's necessary and desirable in some ways. I'm really concerned that this pandemic, we don't know about coronavirus, we don't really know how it behaves. There's nothing to guarantee that there won't be a second wave when they start lifting restrictions and that would be my fear. What happened in 1918 was there were three waves, so spring, summer, autumn

and then winter and towards the end of the summer, particularly in the US, it seemed that Spanish Flu had really burnt itself out and people were delighted to get back to normal. They could see that the war was coming to an end they could get their lives back and so Armistice Night was probably the most egregious example of avoiding everything they'd been told in the past and so not just my example from Manchester earlier on but all over the world in London people poured into Piccadilly Circus. People stood outside the gates of the palace and tapped the royal family. Everybody was out there. Lo and behold, a few days later, once again, the death rate went up.

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If that's true, what can we learn from the great influenza of 1918 in terms of quarantine, hand-washing, nursing? How can we mobilise history to help in the present? The thing is that the things we've learnt now about social distancing and lockdown, hygiene, quarantine, all of those, the things that we're actually living through at the moment, weren't put into action in the same way in 1918. Because basically, 1918, the whole emphasis was on winning the war. One civil servant turned around to a scientist who wanted to control the numbers of people who use public transport. And he said, you can't stop people going to work now that's not appropriate the war effort is what matters

so while there were attempts to quarantine people and recommendations about wearing masks and keeping clean they weren't implemented in the same really serious way that we've seen in this country, rather too late for my mind, but at least we did it, and in Spain and Italy, and of course in China itself, in Wuhan, where they went straight into the most serious form of lockdown ever. The big difference, if anything, the greatest difference between now and 1918, is that we're not engaged in global conflict. We're not engaged in what was called the Great War, as you know, because nobody had ever embarked on a war like it. We're not throwing everything at that and we're not sending troops around the world to turn the globe into a giant petri dish. That was the thing that spread Spanish flu the fastest.

It was the global troop movements. So today we're learning was the thing that spread Spanish flu the fastest. It was the global troop movements. So today we're learning from the method that they pioneered back in 1918, 1919. Was there variation? I mean, can you look at a city like Manchester and say, gosh, they got it right compared to London or Pittsburgh compared to somewhere else? I mean, we have in our hands, we can save lives by just changing the way we are. The Manchester example is a very good one, because what happened in Manchester was the chief medical officer of health, Dr. James Niven, had already experienced the Russian flu epidemics when he'd worked as a GP. And he started getting reports in Manchester that children were dying like plants at their desks. He knew something was terribly,

terribly wrong. So he told the council to close all the schools and they, good for them, did that straight away. Then Niven got 36,000 handbills in very simple plain English printed and circulated and they basically told Mancunians in 1918 to do what we're told to do today. If you feel sick, stay at home, wash your hands, observe quarantine measures. And in doing so, it's thought that Dr Niven saved thousands of lives. At that period in about June 1918, something like 100,000 Manx got infected with Spanish flu. Only 330 people died, which is an astonishingly low number. And it really shows what can be done if you've got somebody experienced and intelligent who takes control and says, yeah, this is how we deal with it. Unfortunately, six months later, when it came to the armistice, everybody, of course, wanted to gather to celebrate.

Everybody wanted to go into Albert Square on the 11th of November and celebrate the signing of the armistice. So Niven, knowing what he knew, turned around to the council and said, you have to ban armistice celebrations, because if all these people, if thousands of people come into Albert Square tonight to celebrate, the death rate will soar. And they ignored him. And just a few days later, the rate of infections rose. Another couple of thousand died. And the Manchester Evening News said it was the greatest disaster to ever befall the city. I mean, was there pressure, what we're seeing now, this argument about reopening?

So some cities lifted restrictions too early, I take it? the city. I mean was there pressure what we're seeing now this argument about reopening so some cities lifted restrictions too early I take it? Today we're under pressure to reopen for economic reasons you know people obviously want to keep their jobs the country doesn't want to see itself going into a vast depression I can sympathise with that. As I've said earlier the main emphasis in 1918 was the war effort so we've got a scenario where there's Walter Fletcher, who's a top Cambridge medic, and he's put in charge of what then became the Medical Research Council. It was then called the Medical Research Committee. And Fletcher's job was to help find a vaccine and just find a way of getting on top of flu. His directives came not

so much from the government as from the army, because obviously they were horrified by the loss of troops, the men who were being killed by flu. So at one point, Fletcher realises that many, many people are dying because they're contracting flu on public transport. So he goes to Sir Arthur Newsholme, who's a top civil servant, and says, isn't there a way we could control the numbers travelling on public transport? Because I think what's happening is people travelling on public transport are spreading flu around the entire country. But Sir Arthur ignored him. And in a speech later that year, he said he conceded that public transport constituted prolific sources of infection, but he maintained that given the importance of the war effort, the vast army of workers must not be impeded by regulations as to overcrowding of vehicles

in their efforts to go to work and to return home. So that's a good example of the government overriding scientific advice. Fascinating. So, I mean, we really should think about these influenza casualties as tied up with the atrocious loss of lives in the First World War because it's all one great joined-up scheme in the minds of these officials in the UK and I'm sure elsewhere. I think that's a very good way of seeing it. I think the reason it was forgotten about for so long and it didn't really surface in history as a big subject of research until fairly recently, it was kind of tagged on

to the end of the First World War as just another horrific example of all the terrible things that happened in those four years. And of course, the symptoms are so unpleasant. And witnessing your loved ones or knowing your loved ones had died in those really ghastly circumstances would also preclude people wanting to mention it. There's also the fact that in those days, if your son's killed in a firefight or, you know, invading an enemy trench or something, then it's a tragedy, but it's a good way to go you know pro patria mori but to know that your son has died not by being shelled or an exchange of fire but to know that your son has died vomiting and worse and turning blue and coughing himself to death in a hospital bed it's not heroic it's something people prefer to forget can i pick you up on talking about sons

dying because that's something so fascinating about Spanish influenza, the great influenza, is the age groups affected because again like today it's very uneven isn't it? Coronavirus, although it's not a flu it's more of a pneumonia, it does attack the kind of people that traditionally flu attacks. So the constituency that coronavirus goes for is older people and people with pre-existing morbidities, you know, people who maybe already have cancer or diabetes or obesity, of course, is a big one. So far, the number of younger people dying is lower. However, with Spanish flu, it's completely different because what it did was attack people as a form of autoimmune disease, rather like HIV, AIDS. And sadly, the younger and the fitter and the healthier you were,

the more likely you were to become a victim. Because as Spanish flu attacks you, your body puts up this huge effort to combat it. So it's like you're fighting yourself. And young men were at most risk as casualties but also so were young women and pregnant women which is doubly sad. Again, looking for lessons from the past do you see any patterns about how communities reacted?

Was it sort of xenophobic and aggressive or was it altruistic? Like the way my parents live in a suburb of London and they're being bombarded by shepherd's pie and cake and friendship from all their neighbours they didn't really know very well before. Is this something that you see back 100 years ago? There are mixed messages. In Chicago and Philadelphia, I've come across examples of people from different faith groups, for instance, joining together to help each other.

This is something that we wouldn't appreciate these days when we're all more ecumenical. But in America at that time, different faith groups were often almost at each other's throats. But under the threat of flu, you'd get something like a Jewish doctor taking over the running of a Roman Catholic hospital, or Catholic nurses helping look after Protestants. In South Africa, where of course there was a colour bar and there were great tensions between the native Africans, the Cape Coloured people, which is kind of a specific category, and the white settlers, many of them found they had to cooperate and work together

in the face of this appalling visitation, as they called it, the long pest. What's sad about that is that blacks and whites work together in the face of this appalling visitation, as they called it, the long pest. What's sad about that is that blacks and whites work together for the duration in some cases, but as soon as the threat has passed, you come across references to sort of middle-aged white women saying, huh, what's the matter with my maid? You know, she's been off all this time, not prepared to give their black maids time to recover from Spanish flu. I mean, there's a very sad example from, I think, Philadelphia, where somebody's saying people became selfish. It was a dog-eat-dog atmosphere with bad reactions among the neighbours. And there were cases of coffins being stolen.

As today, you see all sides of the human spectrum, good and bad. Xenophobia seems to be omnipresent when it comes to epidemics and pandemics, whether it's the Russian flu, so-called, or the rise in hate crimes towards Asians and British Asians in the UK at the moment. Do you see that back then during the Great Influenza? Yes, unfortunately. At one point in Eastern Europe, where anti-Semitism unfortunately has existed for a long time, there were examples of Polish and Russian people blaming the Jews. That was kind of pretty much standard, unfortunately, at that time. aspirin in the United States was actually poisoned by the Germans and contained Spanish flu because the Germans were trying to use it to kill the Americans. It was the kind of thing now that

you sort of see on the internet late at night. There's absolutely no validity for it. You know, there's no explanation. It was just a crazy example of bigotry. Everyone at the moment is trying to get historians to become futurologists. I'm very cautious about that, so I won't press you. But what do you think the legacy was? And are there any clues as to what the effects of this pandemic might be? Depression as in economic depression, they suffered from nervous diseases, heart diseases, and of course the famous encephalitis lethargica, or sleeping sickness, which inspired Oliver Sacks to write Awakenings. There is even a suspicion that some forms of schizophrenia may have originated in people who'd suffered from Spanish flu. So there are all kinds of reactions in that way. Long term, I think the legacy was to create

a pall of sadness because you've got a whole generation that not only lost sons, brothers, fathers, uncles in the war, but families who lost members to Spanish flu. And that adds to the kind of crushing feeling of sadness among many people who lived through that era. I mean, for instance, my father's parents, so my paternal grandparents were killed by Spanish flu. My father was considerably older than my mother, hence there's an age gap. And he would never talk about it. He was orphaned. And I think that reaction was common. I think

Spanish flu created millions of orphans and it also left a huge gap not just economically but culturally. So while the number of men who died meant that there were no longer sons and brothers to take over farms and work in the professions, work in every aspect of human life, including the arts. That left a huge gap. What about politically? The UK establishes a Ministry of Health afterwards. I mean, is there a silver lining to this? Does it force a serious approach to public health on a national, perhaps even international level? Well, I can give you one example. The doctor I was mentioning earlier, Walter Fletcher, he survived.

He didn't die in the Spanish flu epidemic, although many doctors did. And he committed the rest of his life to setting up what were called the Mill Hill Laboratories in North London. And these started to do research into the causes of flu. And that was his life's work and of course in 1938 eventually we have the first flu vaccine so yes in medical terms it certainly forced people to focus on research into flu and other forms of epidemic disease the other people to gain from it were nurses, because at last their profession became a serious and respected profession. Because with flu, when I say you can do nothing for flu, that was the standard phrase around then, you can't do anything for flu. But nurses could do

a lot, because although there was no vaccine and no cure, they were invaluable in that they could clean people down, they could comfort them, they could administer substances which at least would make people feel comfortable. And in the US in particular, nursing took a great step forward because for the first time, Afro-American women and women of colour were allowed to become nurses. Before 1918, they weren't. So that's a significant breakthrough. Yeah, well, it would be fascinating to know how the world changes as a result of this pandemic. Your book is called? Pandemic 1918. Thank you very much indeed. Hi everyone, it's me, Dan Snow.

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