Dan Snow's History Hit - The Prime Minister Hospitalised: Lloyd George's Influenza

Episode Date: April 10, 2020

In September 1918 David Lloyd George, the charismatic wartime Prime Minister, visited the city of Manchester, attended a vast public gathering and then collapsed. He spent the next week and a half confined to the Manchester Town Hall in a hastily assembled private hospital ward. He needed assistance breathing. His valet said it was touch and go as to whether he would survive. He did pull through but a vast number of his fellow Brits did not. The country was in the grip of an influenza pandemic, known as Spanish Influenza. It is interesting that Lloyd George was in Manchester because it was under the care of one of the most remarkable public health officials in British history, James Niven. His rapid response the pandemic, his insistence on a public information campaign and closing of mass gatherings meant that Manchester suffered fewer deaths than other big cities like London. In this podcast I talk to Mark Honigsbaum who has written extensively about the Influenza and Niven. We talked about sick Prime Ministers and social distancing. Please check out Mark's podcast Going Viral for more on this and the historical resonances of the present crisis. 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.

Hello and welcome to Dan Snow's History Hit. The British Prime Minister is stricken as a pandemic sweeps across the land. He's a charismatic leader, but now he's confined to his bed. He needs help breathing. The nation around him waits for information as thousands of people themselves are struck down. I am of course referring to 1918, so-called Spanish Influenza, and David Lloyd George, confined to a hospital bed, prostrate with illness. His valet later said it was touch and go whether he would survive.

We've been talking a lot recently about pandemics, about Spanish influenza, the great influenza of 1918. People have been responding well to those podcasts, so I hope you'll tolerate another one. This is an interesting episode. This talks about Manchester during the great influenza. Not just the fact that David George got sick in Manchester in September 1918 but the remarkable work that a public health official, a man called James Niven, did in that city. He was the longest serving, effectively, chief medical officer of that city. He was responsible for a massive decline in lives lost due to his insistence on sanitary conditions, putting new sewers in, knocking down old and unsanitary buildings that weren't fit for human habitation. And I've managed to get the wonderful Mark Honigsbaum on the podcast. He's

a medical historian, he's a journalist. He's written some wonderful books like Living with Ends of the Forgotten Story of Britain and the Great Flu Pandemic of 1918. He's got a podcast out about COVID, as you will hear. It was great to catch up with him and some of the parallels, some of the way that history rhymes, if not repeats, are chilling. If you wish to go to History Hit TV, you can listen to all the back episodes of this podcast. You can also watch hundreds of hours of history documentaries. The perfect thing to do during this lockdown. Stay at home, stay safe, learn something, educate yourself, enjoy, entertain yourself. Perfect. You can get a history hit TV. If you use the code POD1, P-O-D-1, exclusive to podcast listeners, you get a month for free and you get one month for just one pound, euro or dollar. So if you head over there and do that

right away, it will sort you out before this long holiday weekend. Enjoy. Mark, thank you so much for coming on the podcast. Thank you for inviting me, Dan. We're here to talk about a sick Prime Minister on his back for days, knocked out with the flu during a pandemic that was causing huge harm to the country. We're talking, of course, about David Lloyd George, Prime Minister in 1918, September 1918. He went on a trip to Manchester, didn't he? And collapsed.

Yes. So, I mean, really extraordinary echo with what's going on now with Boris Johnson in hospital. So what happened in 1918 was in September of that year, Lloyd George was invited to Manchester to be given the keys to the city. And he arrived and it was pouring with rain. And he had to shake hands with lots of dignitaries in Albert Square. It went on for ages and he got soaked. And that evening it was reported that he'd caught a chill, which was a kind of euphemism for a cold or a flu. But it was no ordinary chill because basically he was so sick that he was unable to leave the town hall.

And as precaution, they installed him in a sickbed in the town hall in Albert Square. He was confined to that room for 11 days, an extraordinary amount of time. And we know he was very seriously ill because he was visited every day by his personal physician. And when he left the town hall, he was still so ill that he had to be given a respirator to aid his breathing. We presume it was the so-called Spanish flu, do we, which was ravaging the country at the time? Yeah, so we can't say for certain because there was no such thing as virological testing there. But based on the clinical symptoms and the fact

that we know the second really virulent wave of Spanish flu arrived in September and started spreading in the autumn of 1918. The Spanish flu was characterized by these very virulent pneumonias. And in some of the patients, they developed this condition called heliotrope cyanosis. So that was named after the blue color of heliotrope flowers. So what happened essentially is as the virus invaded deeper and deeper into the respiratory tract and the lungs, the lungs filled up with all the cell debris and these fluids that were triggered by the immune response. And essentially people started to suffocate and drown in their own fluids. And as a result, oxygen wasn't being

transferred into the blood. So the heart had to sort of grab oxygen from the red blood corpuscles. What that looked like was your face and your extremities would turn this sort of blue or this lavender colour. Yes, we had Douglas Gill on the podcast talking about the first autopsies carried out in a tapler a year or two earlier, the big army base there. And he mentioned that blue effect. It's quite spooky as well. Yes, very spooky. It's funny that it happened in Manchester, because actually Manchester is quite famous during Spanish influenza for its rather effective countermeasures. And can you tell me a bit about those and about the man who came up with them? One of the key figures in my book, Living with Enzo, which was published in 2008, is James Niven. Okay, so Niven was a very experienced medical officer of health.

He was the longest serving medical officer of health in Manchester, actually. And he spotted very early on during the first wave of Spanish flu, which visited Britain in the summer of 1918, that this wasn't any ordinary flu. He first noticed this among school children in schools in Manchester, who would be okay one moment moment and then they would suddenly, you know, kind of drop or droop at their desks. And realised, based on his experience of previous flu pandemics, in particular the Russian influenza, which had occurred in 1890, that flu pandemics were different from seasonal flus in that they usually came in waves. So there'd be a first wave and then often a second and a third wave. And those following waves could be more virulent and

dangerous. So in the run up to September of 1918, he started laying all sorts of plans for, you know, putting up notices and warnings around Manchester, telling people, you know, not to crowd together, to isolate themselves at home if sick, all the sort of things that we're seeing today with COVID. And local authorities like Manchester to kind of to craft their response individually. Yes, essentially, that was the case. So I mean, 1918, we didn't have a unified centralised health system, there was no Ministry of Health that was established after the pandemic as a result of it. in fact. There was a local government board, which was the nearest thing to the chief medical officer today. And they certainly had the powers to advise or even instruct to a certain degree, but they chose not to do that.

And instead, they left it up to local medical officers of health, Niven to craft their own responses. How powerful was he? I mean, I've read about sort of arguments that he would have. You know, people didn't want to stop schools and Sunday schools and public events. I mean, did he have to fight a pretty tough institutional bureaucratic battle to get the changes he needed through? He had considerable power, so he was able independently to draft public notices. He had thousands of handbills printed that were distributed to homes and businesses across Manchester. He also put up posters warning people about the need for isolation

measures. But he also had to negotiate, for instance, with, so one of the battles he had was to try and close cinemas because during the war one of the principal refuges or or forms of entertainment was to go to the picture house where they showed films continuously and wanted the cinema theatres to do was to clean and disinfect between these showings and he he had this big battle. He said, we need to have, you need at least half an hour to disinfect properly. And eventually, after a lot of negotiations, they agreed to do that, but only for 15 minutes between each show. God, that's amazing that cinemas were unwilling to do that.

That implies that other parts of the country, someone with less force of character or length of tenure as a health official might not have got those changes through. I mean, did Manchester, was it notably different, the death rates to the rest of the country? Well, yeah. So, I mean, I think the best comparison is with London. So the situation in London, because London, you know, has many different councils and boroughs, each one had its own medical officer of health who reported to local council. And, you know, if you look across London, they all pursued different types of attacks.

So some recommended we need to close schools. Other boroughs kept schools open. In some of the worst affected boroughs, you know, there were panic runs on pharmacists and, you know, druggists. And what we do know is that as a result of the measures that Niven took in Manchester, the onset of the virulent second wave was very much delayed, but he couldn't stop it entirely. Eventually, it did arrive. And the problem was that although Niven was successful in stopping people congregating too much in October, in November, of course, November the 11th was Armistice Day, right? And there was nothing he could do to stop people pouring out of offices and businesses

to celebrate, you know, the declaration that the war was over. And within a matter of days, there were reports in the Manchester papers of an alarming increase in the mortality. And we know that something like 1,700 Mancunians perished in the second wave of the pandemic. 1,700 Mancunians perished in the second wave of the pandemic and at the peak in the final week of November the death rate exceeded the highest previous rate which had been seen during the 1849 cholera outbreak but in London it was much worse I mean the death rate in some boroughs was as high as 92 per thousand and we know that there were as many as 16,000 deaths in London in the period October and November of 1918. So nobody flattened the curve in London?

People didn't use that phrase. I mean, there were epidemiologists who realised, of course, that epidemics did peak, that there were this sort of spacing out. But it was impossible to do that. You asked me earlier, was there any centralised response? So there was this crucial debate that took place at the Royal Society of Medicine. It was, I think it was October 1918. And it was chaired by the then head of the local government board, Arthur Newsholm, again a very experienced public health former medical officer of health in Manchester. And Newsholm considered more stringent what we'd

call social distancing measures, right? So things like telling people to avoid travelling on trains and trams and to avoid public assemblies. But he decided that actually it would probably have little effect on stopping the spread of influenza because influenza was one of these diseases that by the time you realise it was in the country, it was probably everywhere already. He didn't subscribe, in other words, to these newfangled German bacteriological ideas. But the most important reason for him deciding that it was pointless issuing more stringent instructions was, as he put it, the needs of war demanded that we carry on, right? So we couldn't stop munitions factories turning out

munitions. We couldn't, you know, halt the passage of soldiers back and forth to northern France and Belgium. Sounds eerily familiar, people talking about the needs of the economy and the needs of continuing, quote unquote, normal life. What is the end point? We're all talking about how we get out of this lockdown. What advice would Niven, if this isn't too strange over 100 years, what advice would he give us about a gradual lifting? I mean, what is the first thing we can do? And what are the things that we have to leave as long as possible, perhaps, you know, public gatherings, for example? I mean, the problem is that in 1918, we didn't have a vaccine. And there was no possibility

of developing one, because people didn't know that influenza was a virus. They actually thought it was an infection caused by a bacterium. So I think that Niven would have, you know, applied these stringent social distancing measures, but he would have realised sooner or later that, you know, the flu would have to run its course but I think he probably would have done some version of flattening the curve because he'd observed in 1890 that the Russian influenza had come in these waves and some of the secondary and follow-on waves could be as dangerous or more dangerous than the first one. So he would have basically he would have kept a really careful watch on the situation, relax the measures, you know, certainly he would have relaxed the measures, I think, after the second wave had passed, but he would have been

aware that it could have come back as it did, and indeed did come back in the winter of 1919. And then he would have reapplied isolation and, you know, social distancing. Did Niven get the recognition he deserved for the work that he did in Manchester? Well, he did among his peers. He was elected to all sorts of societies. I mean, he enjoyed a very long and distinguished career. And a lot of his writings were way ahead. I mean, he foresaw lots of things about influenza that have turned out to be true. And by the time he retired, he had a staff of 860. He was in charge of two sanatoriums. So he was very focused on the problem of tuberculosis and pioneered a lot of important treatments for that.

He had an isolation hospital. He was very concerned about maternity and child welfare. So he had 12 maternity and child welfare centres. And he was the first medical officer of health to propose the notification that, you know, that tuberculosis should become a notifiable disease, and pioneer citywide health visitor services. And as a result of that, I mean, Manchester, which had been considered, as they put it, a rather unsanitary town, its reputation for hygiene soared. So I think it was very important for the growth of Manchester as a major urban metropolis. But he had a sad end, didn't he? Yeah, I mean, well, rather tragically, Niven retired.

I forget exactly how old he was, but before he retired, his wife had died in 1912. His daughters had long since left home and he ended up living alone in lodgings. We don't know much about exactly what happened. All we know is that on the 28th of September 1925, he travelled to the Isle of Man, checked into a hotel. And two days later, his body washed up at Onchan Harbour. body washed up at Onchan Harbour. And at the subsequent inquest, the coroner concluded that Niven had committed suicide by taking poison and drowning after swimming out to sea. So a very sad end for someone who really devoted his life to saving other people's life. Do you think he felt he could have done more more during the pandemic or we just don't know? I don't know. I think he must have been frustrated that he saw a

lot of, you know, problems, that his advice really wasn't properly heeded. So yeah, he must have, I don't think he would have had regrets because clearly he did his best, but it must have been frustrating. And let's just quickly come back to David Lloyd George. He recovered. He rose from his bed. I mean, how close do we think he came to dying? That's hard to say. I mean, I think that there must have been a considerable risk. So in the same way that today, when Boris Johnson was initially hospitalised, Downing Street press office was very reluctant to give many details. They kept it all very vague. Exactly the same thing happened in 1918.

His physician issued these bulletins that were very upbeat, downplayed the diary that his personal valet kept that Lloyd George's condition was much more serious than was let on. And even after he returned to Downing Street, it was several weeks before he was actually really fit enough and had fully shaken off the virus. Well, that's fascinating stuff. Thank you very much for coming on the pod. Now tell everyone about your podcast. A couple of years ago, I made a podcast all about the history and science of the 1918 Spanish flu pandemic. The podcast was made to coincide with the centenary of that pandemic in 2018. And we're now making a second series all about the pandemic of COVID-19, which has so many fascinating and almost uncanny parallels with what happened 100 years ago. How do people find it?

So the podcast, I should say, my producer will shoot me for not saying that, is called Going Viral. And you can find it on Libsyn, iTunes and other good podcast providers. Just Google Going Viral, the mother of all pandemics. Great. Well, thank you very much indeed for coming on the podcast and talking. Lloyd George, Manchester and Niven. Fascinating stuff. Thank you so much for giving me this opportunity. I hope you enjoyed the podcast.

Just before you go, bit of a favour to ask. I totally understand if you don't want to become a subscriber or pay me any cash money. Makes sense. But if you could just do me a favour, it's for free. Go to iTunes

or wherever you get your podcast. If you give it a five-star rating and give it an absolutely glowing review, purge yourself, give it a glowing review, I'd really appreciate that. It's tough weather, that law of the jungle out there and uh i need all the fire support i can get so that will boost it up the charts it's so tiresome but if you could do it i'd be very very grateful thank you