Dan Snow's History Hit - Origins of the Spanish Flu

Episode Date: April 2, 2020

This episode features military historian Douglas Gill who has extensively researched the origins of the Spanish Influenza as it emerged in 1915 and 1916 in northern France. Douglas has worked alongside leading virologist, and previous guest on Dan's podcast, John Oxford, to track the initial cases of this particularly violent strain of influenza which would go on to kill millions of people across the globe. For ad free versions of our entire podcast archive and hundreds of hours of history documentaries, interviews and films, including our new in depth documentary about the bombing war featuring James Holland and other historians, please signup to www.HistoryHit.TV Use code 'pod1' at checkout for your first month free and the following month for just £/$1.

Hi everybody, welcome to Dan Snow's History Hit. I've got another podcast for you about global pandemics now. I apologise for this fairly predictably relevant barrage of virology history, but I do think it's pretty fascinating this time. We've had a great response to it and I hope you'll forgive me for putting more experts on talking about the history of pandemics, our response and what they tend to mean for societies after the crisis. after the crisis. This episode features Douglas Gill. You heard Professor John Oxford a few weeks ago. It's one of our most listened to ever podcasts on the 1918 influenza pandemic. He works alongside a military historian, Douglas Gill, who's gone back through the military records, the medical records in particular, in fact, of the doctors serving in uniform in 1916, 17, 18. He's tried to identify where so-called Spanish influenza broke out. He's pretty sure that he has found the first few patients, the autopsies that were carried out when doctors realised a particularly virulent strain of influenza, that that stage had huge lethality but low transmittability, if that's the right expression,

in a huge military hospital at a with troops drawn from all over the world to fight in the British Empire's effort during the First World War. In this podcast, I talk to Douglas Gill and ask him about his work trying to hunt down the first few patients of a global pandemic that would kill tens of millions of people. I hope everyone is enjoying the YouTube live streams, the History Hit Live on YouTube. It's great. It's been great doing it. We're getting good response from teachers and students all over the world. I hope they're of interest to other people as well.

If you head over to Timeline, Timeline is the YouTube's biggest history channel. If you head over to Timelineeline then you will find Dan Snow's History Hit Lives on there we're going to be doing three of those a week they go out at 4 o'clock UK time every Monday, Wednesday and Friday live, please tell us what historians and what subjects you would like us to have

on there, you can also go for some serious history hit TV channel, it's like Netflix for history you enter a code in this case pod1 you1, P-O-D-1, and you get a month for free. You get that second month for just one pound, euro, or dollar. So you get two months, which is going to take us. It'll take us through, well, hopefully, a good chunk of this isolation.

Two months for just one pound, euro, or dollar. So please go and check that out. Go to historyhit.tv and use the code pod1. In the meantime, everybody, here is Douglas Gill. Douglas, thank you very much for coming on the show. Tell me, you're one of the great experts on the influenza of 1918. This time, everyone was following press reports closely from Wuhan in China. How gradual was the onset? How secretive was the initial spread of the great pandemic of

the end of the First World War? 20 years ago, no one really had any idea of the pandemic, save that it sprang up suddenly in various military camps in the US and at various locations in possibly in England as well. And there still is a general inclination, particularly in the US, to believe that it began among the young doughboys recruited for the war and sitting in their barracks in Kansas. But that didn't strike virologists as being very sensible. They came to me for the simple reason that they trawled through medical journals running back to the beginning of the war looking for unusual and inexplicable outbreaks of respiratory disease.

Outbreaks which, as reported in the medical press, seemed to have no rhyme or reason and didn't fit into bronchitis or pneumonia or any of the traditional respiratory problems. A man called John Oxford came across a couple of articles in the Lancet which recorded outbreaks of very fatal, but not infectious, not particularly infectious, tragic matters, really, because they were afflicting young fit soldiers round about the age of, you know, 18 to sort of 44, in military camps, either in northern France, or in the south of England. Men went down suddenly and inexplicably and couldn't be brought back. They went down prostrate, exhausted in sort of locations.

They were brought back to the base hospital in France and there the pathologists, three of them at Etape in northern France, which was the largest concentration of hospitals in the British army of the day. They were puzzled and alarmed by these deaths. Accordingly, in January 1917, it was a very bitter winter, which may or may not be relevant, it was a very bitter winter, which may or may not be relevant, they saw these cases coming off the ambulance trains or falling sick in Itap itself. And they said to themselves, this is something we can't account for. This is not widespread through the armies,

but it is knocking men down in a fashion that we've not come across before. So they resolved to put onto the mortuary table every man who died of any disease, one by one. And so beginning on February the 1st and running right through to the middle of March, every man that died, and possibly one woman, they put on the mortuary table, opened them up, and looked for signs of this inexplicable respiratory problem. And they logged their results. So they ended up doing 156 consecutive post-mortems, and they were alarmed to find that in 45% of those cases, there were signs of this particular ailment. And it killed, obviously, mostly in the lungs,

from the medical notes, because, of course, the great thing about the army is that the medical notes are so profoundly detailed where they survive. And you've got the hour-by-hour temperatures and the patient's heart rate and pulse and breathing signs of improper breathing patterns. You've also got this telltale cyanosis, which is such a feature of the 1918 pandemic.

You've got that, and this is the first time that heliotropic cyanosis comes to the fore. It's a discoloration of the jaws and the ears. It's to do with the lack of oxygen, obviously, coming in the blood. But it had a particular cyanosis. It's a sort of scaly, purpley, reddy colour. And this heliotrope tinge to it was widely noted in the main wave of the pandemic in 1918. But it first surfaced at Ittab, or rather was first noted by diligent pathologists at Ittab

in February 1917. So that's the kind of area that's occupied me. And it seems to be the key to how the pandemic emerged. Is it possible to go back any further than February of 17? Even if it's just a hunch? I mean, people talk about this pandemic having come across from bats. Was it was it just the mass of humanity packed in here, immunosuppressed people? How do you think it began? Well, you have this extraordinary concentration at Etape of recruits, soldiers brought in from all parts of the world, Canada. It was all the infantry for the BEF, British Expeditionary Force, passed through the base camp at Etape. So you had there crammed onto those sort of undulating hills which run up eastward

from Itap, you had these very extensive network of wired-off, tented encampments. And you had, in February 1917, you had about 15, 18 base hospitals there. So with the influx of people from the West Indies, Canada, Australia, New Zealand, Portuguese, English, Scottish, Irish, the rest of it, there were also people from the United States there because there was a US hospital serving there. You had this intense concentration of young men under the greatest stress, packed far too many into each tent, and all knowing that within a week or two they'd be moved forward and trained for service at the front. So people say that these are the ideal conditions for the emergence of problems, and also you'll bear in mind that this is the route for one of the biggest bird

migratory paths in the world because the birds are coming from the southern climes landing in the song valley which is a vast estuary and then taking off again for siberia or or canton aviary and the like so you've got an endless different times the year you've got you've got millions and millions of wild geese traveling northwards over this area and if there is to be a pathogen which has an avian source then it's surely highly likely that there'll be a contamination from these wild ducks to the domestic fowl being sold in the towns around the tap and being bought, because there's pictures in the Imperial War Museum, of the quartermasters

buying lots of geese and the like in the markets. The British authorities, British medical authorities clearly were onto this. Was there a window to stop this? Did they have any chance of isolating it and defeating it? I would say that they were onto it and they weren't in the sense that it wasn't particularly contagious at that stage. The fatality rate was higher than it was during the main wave, because in the main wave, it was only, you know, two and a half, three percent. But in this particular time, those who got sick, a lot of them died, but not many got sick. And you can see the fact that they did post-mortems on 156 men, whose names we now know and whose details, you know, one can easily look up. You can see that for them it was very fatal.

But the authorities weren't worried about it becoming a kind of pandemic and reducing the utility of the British Army. These three pathologists wrote this paper for the Lancet. They did the work in February, March. By late March, they decided that the thing had disappeared. They then wrote the paper up. I suspect that it then went through the military censorship. Well, it has to. And they wouldn't have released it in the Lancet in July 1917

if they'd taken the view that this was something which was going to undermine the army. So I'm sure that the conclusion must have been by May, June, well, this was a isolated problem, interesting from the point of view of medical history and the profession, but of no great threat to the morale of the British Empire. And then is the next upsurge, if you like, is that the famous occurrences in military bases in Kansas? That didn't come until I think it was March 1918. Number 22 General Hospital was entirely staffed by Harvard professionals, physicians, surgeons, and nurses. So one of the 15, 12, 15 hospitals at Ittab running from 1950 onwards was this so-called Harvard unit. And they were not like British medical personnel who were conscripted or who'd signed for the duration of the war.

They were volunteers, and they only signed for six months. So there was a backwards and forwards flow from Etap to the North American ports because at the end of six months these civilian Harvard people, their contracts had ended, they were free to go home and carry on with their civil practice in the USA. So this is a possible conduit of free movement backwards and forwards across the Atlantic which could conceivably have seeded the pathogen in the US, bearing in mind that the characteristics of the pathogen in 1917 were different to what they were in 1918. And indeed, in the two waves in 1918, they too had slightly different medical characteristics.

When does the world, when does medics wake up to the fact there is going to be a wave in 1918? when does medics wake up to the fact there is going to be a wave in 1918? I suspect when those people start dying in those US army camps. And how widespread was that initially? It became an important source of illness and death in those US camps from March 1918 onwards. And that surely has given fuel to the idea that it all began in the US. Two things about the pathogen is A, that Dr. William Rowland, one of the pathologists who did the work at ETARP in February 1917, brought back from ETARP tray loads of slides, old fashioned glass slides with tissue samples in them.

He brought them back and we have them still today. The pathogen was particularly fatal to those centering around the age of 29 and they were afflicted because of this notion of original antigenic sin. You build up immunities because of your exposure to pathogens, particularly, should we say, around the time you are born, you pick up immunities from your mother, and then if you're exposed to a particular influenza in your early years and you survive it, then you'll have a lifelong immunity to that. The difficulty was that the reason why the death rate was so low for elderly people during the 1918 pandemic and why it was so high for people aged 28, 29, 30, seems to be that the elderly folk, sort of 70 onwards,

had been exposed to some influenza which had crossed Europe in the mid part of the 19th century. And that was when they were born and therefore they had an inbuilt immunity to the H1N1 in 1918. But the people who were aged 28, 29, 30 in 1918 has been born around about the year 1890, 1889. And that was the year when the so-called Russian flu pandemic crossed Europe. Their mothers and they themselves as infants had been exposed to that Russian flu. And this original antigenic sin notion, it comes obviously from the theological notion of an original sin. They were born with a strong immunity against the Russian flu RNA, but they were born with a particular vulnerability

to what the H1N1 represented. So they were weakened in terms of their immune system by having been exposed to the Russian flu. Hence that unusual pattern which hasn't occurred in any other pandemic of young fit adults say the age between I don't know 25 and 35 being the first to die in the 1918 pandemic and of course that accounts for a lot of the mortality because they're the ones that are feeding their children and nursing they're the working adults who provide the income and the support to hold their families together. And when those mothers and fathers start dying in 1918, naturally, society is in a real crisis. Coming back to the military, today we've got the opposite

problem, it strikes me. Everybody knew everything about everything from the start. We were all looking at our graphs on Twitter and we were sort of terrified because of what was going on at Wuhan. Every single casualty was noted around the world. Back then, presumably, it was completely the opposite. Well, that's the exciting thing about the present pandemic, in my view, is that everyone can see the science from day one.

It's so clear. It's so lucid and transparent. Everyone can see how it's surface contamination, so lucid and transparent everyone can see that how it uh surface contamination you know social distancing you can you can see the thing and you can see the thing crossing the world so it's the first pandemic in which people are not rushing around with magic cures and rubbing themselves with garlic or or carrying you know sacred objects down the street in full you know regalia. But obviously in 1918, you might as well have been facing the Black Death in the Middle Ages, really, mightn't you?

Obviously, they knew it was respiratory, so they could see that protection might be afforded by masks and the like. They thought it was caused by Haemophilus influenzae, which a German microbiologist had discovered in 1892, but they were wrong. So when they were looking at the pathogens, they got the wrong one. And they had very few defences other than nursing. That's the only thing that got people through, nursing and luck.

Well, we got nursing and luck, we hope, this time, plus lots of other tools in the arsenal as well. So thank you, Doug Ziel. Thank you very much for coming on the podcast really appreciate that hi everyone it's me Dan Snow just a quick request it's so annoying and I hate it when other podcasts do this but now I'm doing it I hate myself please please go go onto iTunes wherever you get your podcasts and give us a five-star rating and a review. It really helps and basically boosts up the chart, which is good. And then more people listen, which is nice. So if you could do that, I'd be very grateful. I understand if you want to subscribe to my TV channel. I understand if you don't buy my calendar, but this is free. Come on, do me a favor. Thanks.