Short History Of... - The Spanish Flu

Episode Date: June 22, 2025

The influenza pandemic of 1918-20 infected about one-third of the world’s population at the time, killing at least 50 million people. Occurring during the First World War, what became known as the Spanish Flu spread rapidly as soldiers moved across continents. It overwhelmed hospitals, led to mass graves, and disrupted societies worldwide. But what made the disease so deadly? Was it really Spanish? And what lessons had been learned by the time Covid-19 emerged, a century later? This is a Short History Of The Spanish Flu. A Noiser Production. Written by Nicola Rayner. With thanks to Mark Honigsbaum, a medical historian, and author of The Pandemic Century: One Hundred Years of Panic, Hysteria, and Hubris.  Get every episode of Short History Of a week early with Noiser+. You’ll also get ad-free listening, bonus material, and early access to shows across the Noiser network. Click the Noiser+ banner to get started. Or, if you’re on Spotify or Android, go to noiser.com/subscriptions. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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around herself and trudges across the frozen ground. A pale light spills over the flat horizon of the Kansas plains as the sun rises, illuminating the sprawl of what is one of the largest army training camps in the country. Over 50,000 men are quartered here. Raw recruits, some barely out of boyhood, preparing for a war far away in Europe. The nurse passes clusters of them, hunched together in their great coats outside the low slung wooden buildings, hands cupped around morning cigarettes. She reaches the hospital at the edge of the camp, a loose huddle of long low wards quickly erected. Stamping the cold from her boots, she enters the admitting ward of Building 91, where the familiar tang of carbolic acid hits her immediately.

At the desk, the duty sergeant, who helps the medical staff with basic care, is attending to his first patient of the day. Company cook, Private Albert Gitschchel thinks he has a cold. But he's deathly pale, and his splitting headache, sore throat, and the pains in his neck and lower back seem to suggest something worse. When the thermometer is removed from the patient's mouth, the temperature reads over 103 degrees Fahrenheit.

The nurse dispatches him to the contagious ward and starts to record the case in the logbook. But she hasn't even written Gitschel's name before another soldier appears at the desk, a corporal. Between bouts of coughing into his sleeve, he describes the same fever, the same sore throat. The head nurse's heart sinks. Two cases, minutes apart, identical symptoms.

A coincidence, she hopes. It plays on her mind as she heads off to check if anyone else on the ward is experiencing anything similar. But now there's an urgent call from the duty sergeant. A third patient has arrived with the same complaints, with two more waiting to be seen. The nurse hurries over to the wall phone to call surgeon Schreiner, who arrives just minutes later on his motorcycle. A usually meticulous man, he has had no time to shave or even properly do up his collar, but within moments he is examining his first patient, followed swiftly by the others.

By noon, 107 men have been admitted to the hospital and they keep coming. Rushed off her feet, the head nurse has never seen anything like it, and it is about to get a lot worse. Soon the unexplained malady will have earned itself the name knock-me-down fever among the men. But today, we know it as the Spanish Flu, one of the deadliest pandemics in history. The influenza pandemic of 1918 to 1920 infected about one third of the world's population

at the time and killed at least 50 million. Occurring during the First World War, what became known as the Spanish Flu spread rapidly as soldiers moved across continents. But unlike typical influenza strains, it disproportionately affected young, healthy adults, with a high death rate for those aged between 20 and 40. The pandemic overwhelmed hospitals, led to mass graves, and disrupted societies worldwide. But what made it so deadly?

Was it even really Spanish? And what lessons had been learned by the time COVID-19 emerged a century later? I'm John Hopkins from the Noiza Network. This is a short history of the Spanish Flu. Spanish Flu. Though the first major outbreaks of the Spanish Flu took place in March 1918, the origins of the disease start a little earlier. In 1917, the First World War has been underway for three years. It's so far been a clash primarily between the allied powers that include Britain, France and Russia

and the central powers of Germany, Austria-Hungary and the Ottoman Empire. The mass movement of troops around the world and soldiers crowded together in close quarters combine to create perfect conditions for infectious disease. So it is that the first outbreaks of an unusual respiratory illness are reported in France and Britain as early as 1917. These initial occurrences are recorded by doctors as purulent bronchitis, rather than influenza. But researchers believe it is possible these could be among the first signs of the Spanish flu.

But what is flu or influenza? Mark Honigsbaum is a medical historian and author of The Pandemic Century, 100 Years of Panic, Hysteria and Hubris. Obviously everyone's familiar with the common cold, which is caused by rhinoviruses, but also coronaviruses. Influenza is also a virus, and it circulates all year round from the northern hemisphere to the southern hemisphere and back again. Typically, influenza viruses only cause outbreaks in the autumn and winter. Why? Because people tend to congregate inside at that time of year.

And the cold damp weather also facilitates the spread of the aerosol. So influenza spreads as an aerosol and when you're in close quarters in unventilated rooms the chances of getting influenza increase. Aerosols in this context are tiny airborne particles that can carry the flu virus when an infected person breathes, talks, coughs, or sneezes. But some flu viruses are more dangerous than others. There are three types of influenza, categorized as types A, B, and C. Type B causes classic winter flu epidemics, but does not lead to global pandemics,

while type C rarely affects humans at all. Most dangerous are the type A viruses. They reside in wild waterfowl without affecting their health, but problems arise when the virus jumps via other hosts to humans. We know that in the case of the Spanish flu it appears to have emerged very rapidly from some unknown bird, probably a migratory bird of some sort, and it quickly adapted to humans at which point it acquired these very unusual mutations that allowed it to spread rapidly from person to person.

It's thought that the virus may have made the transition from birds to humans as early as 1917. Myself and other researchers, we've gone back and looked at the medical journals from the time, looking for accounts of unusual influenza-like outbreaks. And if you do that you discover that the British Medical Journal The Lancet recorded these outbreaks of something called Puralent Bronchitis, which occurred at a camp in southern England in Aldershot. But also there were reports from Etabla, this large British army camp in northern France. British Army camp in northern France. In Etapla, the early signs of the disease are marked by high fever and the production of blood-streaked sputum from the lungs. Sufferers also cough up a thick mucus, often a symptom of bronchitis.

Around half of them die from so-called lung block, a condition in which the lungs fill with fluid, blood or pus, essentially blocking them from functioning. The other key thing was that many of the men showed the symptoms known as cyanosis. So cyanosis is a condition that occurs when a patient becomes breathless because they can no longer transfer oxygen efficiently from the lungs to the blood. And what happens is that as your body struggles to get oxygen to the heart,

you begin to turn this bluish color at the extremities because it's the oxygen that turns the blood red. And as oxygen is leaked from the blood, typically these men develop these blue discolorations of the lips and ears, and as the condition became more extreme it went from a blue to sort of a purplish hue, and in the last stages, shortly before death, people would almost be like this mahogany color. So it was quite a frightening and a very sort of distinct symptom. Later, this cyanosis leads to another nickname for the Spanish flu,

the Blue Death. By February 1917, 156 soldiers in Etapola die from this outbreak. It's likely to be the Spanish flu. The researchers can't be entirely sure. A couple of months later, after German attacks on American naval vessels, the United States joins the Allies, declaring war on Germany. It is a critical time, not just in the conflict, but in what it means for the outbreak of the emerging flu. not just in the conflict, but in what it means for the outbreak of the emerging flu.

The United States begins rapidly mobilizing a vast land army. By early 1918, large training camps are appearing across the country to prepare troops for deployment. And military missions arrive from Europe to help train American soldiers in trench warfare. One major training site is in Fort Riley in Kansas. In January and February 1918, in nearby Haskell County, a local physician observes an unusually severe outbreak of influenza among his patients. Alarmed by its rapid spread and the severity of symptoms among the healthiest of its victims,

he reports it to the US Public Health Service. It's an unusual move for a country doctor, but his warning goes unheeded. Then, in March 1918, the disease erupts in Fort Riley. There was a section of the camp known as Camp Funston, and I think something like at its height there would have been 40,000 American soldiers being trained there. Many of these were sort of farm boys from Kansas. Young men had grown up on farms, out of cities, which meant they were healthy, they were outdoors sort of guys, but they probably hadn't been exposed to many of the bugs that you come into contact with in cities or if

you've been working in factories. So basically all these men were thrown together and then in March of 1918 suddenly there was an outbreak of a mysterious flu-like illness. Very quickly something like 1,200 men were placed on the sick list. And they very quickly overfilled the camp's small hospital. So they had to requisition a large hangar for the men. The flu quickly acquires the nickname of knock me down fever. This is very typical with influenza. You can feel perfectly okay one moment.

You might even have gone to work in the morning and then suddenly in the middle of the day you're overwhelmed with fatigue and you suddenly realize actually you're pretty sick and you can't go on. This was an extreme version of that. But you know it wasn't all that serious. Most of the men recovered within three to five days. Some of the men, however, go on to develop pneumonias, which are severe lung infections.

Within a few months, there have been 75 deaths in the camp. Meanwhile, the camp feeds a constant stream of men to other American bases and onwards to Europe. The disease is on the move. The disembarkation point for American troops is Brest, a port city in northwestern France. From there, the virus moves swiftly to the western front, affecting both Allied and German forces. It spreads across France, Italy and Britain. By June, thousands of Allied soldiers are in hospital.

For some, the outbreaks of this new flu, which are becoming progressively more severe, are the source of deepening concern. But for others, the flu is dismissed as unserious. It's regarded as a trifling complaint when compared with other diseases suffered by soldiers, such as the deadly typhus and septicemia. The poet Wilfred Owen writes to his mother in June from a British army camp in Scarborough telling her that, Quite one third of the battalion and about thirty officers are smitten with the Spanish flu.

But in what way is it Spanish? It's really an accident of not so much history, but of the way that the outbreak was reported at the time and the censorship that applied on the Allied, but also the German side. You had correspondents on both sides, but the British correspondents were very strictly controlled by the government and their dispatchers were censored. In fact, most of the reporters, because they were very patriotic, would censor or downplay any sort of news

that might be seen to be undermining morale on the home front, but also which could give encouragement to the Germans and the Italians on the other side. The exception was in Spain because Spain was not a party to the war, it was neutral in World War I. And what happened was in April of 1918 and into May, the first outbreak of influenza, what we now retrospectively think of as the spring wave, broke out across the Iberian peninsula. And one of the first casualties was the then king of Spain, Alfonso XIII. So of course, all the Reuters correspondents in Madrid and also the Times and all the other big papers, this was a big story, the news wasn't suppressed,

and they talked about this strange new illness that's spreading in Spain that is claiming, you know, royal victors. So it immediately acquired the nomenclature of the Spanish influenza. But of course it's not just Spain that's suffering in Western Europe. And cases are soon reported in Central and Eastern Europe too. The same spring sees the end of Russia's participation in the First World War. After years of military defeats, economic collapse and political unrest at home, continuing the war has become impossible for Russia. After it signs a peace treaty with the Central Powers, Germany releases its Russian prisoners,

who bring the Spanish flu back to their country. Around the same time, outbreaks appear in North Africa, India and parts of Southeast Asia, probably carried by colonial troops and merchant vessels. Japan begins to report cases in late May and by June the flu has reached China. Australia meanwhile enforces strict maritime quarantines, keeping the flu out, at least initially. Back in France, between June 1st and August 1st, 1918, more than 200,000 Allied soldiers are hit so hard by the flu that they can't report for duty.

But then, suddenly, the British command declares the epidemic is over. A medical journal concurs later that month. These optimistic proclamations, however, are both premature and fundamentally misguided. And the world is utterly unprepared for the devastation to come in the deadly second wave. It's difficult to pinpoint precisely where and how the second wave of the Spanish Flu begins. But the mutated virus that emerges in the latter half of August 1918 is both highly contagious and more virulent than its predecessor. On the same day that the British Army declares the epidemic over,

so many French sailors are hospitalized with the influenza at breast that the naval hospital there is forced to close. And the death rate begins to soar. Traveling from Brest in overcrowded troop ships, soldiers bring the virus to Africa. In Freetown, Sierra Leone, they stop to refuel with coal for their journeys onwards towards South Africa and Asia and as the soldiers disembark and move among the population, so does the virus. The pandemic now spreads through West Africa

along the coast, rivers and railways to more remote communities. It is estimated that within a few weeks, the flu kills 3% of the population in Sierra Leone. And it is likely that the real figure could be more than double that. In Boston, Massachusetts, the second wave quickly escalates after arriving with sailors at the city's port.

A navy barracks there admits almost 60 men to its hospital in the first three days. And they start to die at an alarming rate. And the virus is still on the move. 35 miles northwest of Boston, Camp Devens was built to accommodate a maximum of 36,000 men. But on September the 6th, with preparations underway to send new divisions to France for what will be the final offensives of the First World War, it is packed with 45,000 soldiers. When the first cases begin to arrive at the camp hospital, these early patients are diagnosed with pneumonia. But one man is in so much pain that he screams when he is touched. So meningitis is suspected. Within a couple of weeks, more than 6,000 men are crowded into the 800-bed

facility with every corridor and corner crammed with cots for the sick and dying. The men, with a bluish cast to their faces, cough up blood, with crimson fluid also frothing from their nostrils and ears. Nurses and doctors begin to fall ill too, and the virus keeps traveling. Soon it's in New York City, and by the end of the month there are 800 cases of the flu a day. The city's Commissioner of Health takes the unusual step of ordering quarantines. Wealthy patients are permitted to remain in their homes, but those living in boarding houses or tenements are removed to hospitals,

where they are kept under strict observation. removed to hospitals where they are kept under strict observation. Yet worldwide, quarantines remain the exception rather than the rule. First of all, influenza wasn't even a disease that was notifiable. So because we'd had vast experience of diseases like plague and cholera that were seen as truly contagious diseases, and there were tests for them and we knew that you could isolate people. They were on a list of diseases that had to be notified to the medical authorities.

Influenza didn't feature on that list because influenza just comes and goes with the seasons. There was very little attempt to quarantine or stop it because people thought that didn't work with influenza. Main reason, of course, there was a World War going on, and that took the priority. You could hardly have quarantines when troops were passing back and forwards from northern France to the southern ports of the UK,

but also from across the Atlantic, from the United States to Europe. So there was no attempt to quarantine people. People were isolated. The main advice was, if you fall ill, you should isolate yourself at home. Try and keep warm, drink plenty of fluids and most important of all, don't return to work or use public transport until you're fully recovered. Introducing TurboTax Business, a brand new way to file your own T2 return, all while getting help from an expert who actually knows small businesses.

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Wartime conditions with the accompanying secrecy, censorship and embargoes disrupt scientific cooperation and hinder the sharing of medical breakthroughs. And the researchers are doing what they can. Their understanding of infectious disease is still rudimentary by modern standards. What you have to realize is in 1918, no one had actually seen a virus because viruses are very, very, very small, okay? And we didn't have electron microscopes in 1918, so it was impossible to visualize a microbe as small as a virus. However, doctors are familiar with bacteria

and have already identified the microbes responsible for diseases like tuberculosis, diphtheria, and cholera. What confuses the issue is that when people with Spanish flu die, autopsies often reveal lungs full of bacteria, such as streptococcus pneumoniae. Often the deaths aren't caused directly by the flu virus itself. Rather, the flu virus weakens the respiratory system and opens the door to pneumonia, which delivers the fatal blow. But it's believed these bacteria are the root cause of the illness, rather than one of its most dangerous complications.

By 1918, of course, we were able to make what they call bacterial vaccines against all sorts of diseases. And of course, people started to think, well, can we do something similar for influenza? So both in the UK, in a Tarpler and other places in England, but also in the United States, in Boston and New York, these other great centers of medical research, there was huge push to make vaccines. They did sort of trials. They succeeded in producing some rudimentary vaccines, but there's no evidence that they provided any real protection against influenza.

Because influenza is a viral disease, it's not a bacterial disease. In 1918, the discovery of penicillin is still a decade away. So there is no widespread availability of antibiotics to treat the secondary infections. In October, New York is quarantining more than 2,000 people a day. Panic sets in. There are even cases of visiting nurses

being held captive in patients' homes. By now, the flu has arrived in San Francisco on the West Coast and is also raging in the South and Midwest. As the outbreak grips the city of Chicago, policemen and tram attendants begin to wear Gore's face masks. At the height of the pandemic in the United States, quite a few people adopted face masks. In the UK, though, very little. There's very little evidence that people use face masks, maybe in some large government

buildings such as the Post Office or the Telegraphic Office. It wasn't like today where everything is being reported all the time, and we were very used in COVID to being treated to daily addresses from the Chief Medical Officer and the Chief Scientific Officer. That did not happen in 1918. As a result, in some cities, the Spanish flu can spread undeterred. In Philadelphia, more than 200,000 people attend a so-called Liberty Loan Drive, a parade organized to promote the government bonds that help pay for troops. Within two weeks of the parade the city is recorded more than 2,600 deaths and the numbers continue to soar.

Philadelphia more or less has to shut down, with schools, churches, bars and theaters closed. Later, parades are cancelled, but the damage is done and the bodies begin to pile up in the morgues. When the flu hits Alaska, few Inuit families in the city of Nome escape infection. Over one eight-day period, 162 lives are lost. In some cases, whole families who are too sick to tend to the fire in their cabins freeze to death.

Meanwhile, in the UK, the second wave also hits urban centres like London, Glasgow, Manchester and Newcastle. By October, London is experiencing 1,500 deaths a week. Bodies are stacked one on top of another at morgues, many of them simply shrouded in cloth. Some newspapers report that London is running out of coffins, while gravediggers and undertakers struggle to keep up with the demand. In some cases, lorries transport the bodies in bulk to cemeteries,

and mass graves become the only option. From Europe, the second wave also sweeps through Russia and spreads throughout Asia. Following the Trans-Siberian Railway and the movement of soldiers and refugees, it reaches Iran, then moves into India, China, and Japan. And still, the Great War drags on. The impact of the flu on the final stages of the conflict

is still being debated. But while it doesn't directly end the war, it certainly weakens the belligerent nations. Germany and its allies are already worn out. Negotiations begin in earnest, with the Allies demanding the German Kaiser Wilhelm II should step down, and his country form a new democratic government. He abdicates on November the 9th, 1918. A couple of days later, a German delegation

signs the formal agreement for a ceasefire in a railway carriage in northern France. One of history's bloodiest conflicts is over. On the 11th of November, the signing of the Armistice, Armistice Day, everyone comes out onto the streets. Because this is the big news, the war is over. Hurrah! This awful period of people dying and restrictions and everything being very miserable and gloomy. Alas, we can look forward to better times. But as people gather in large crowds to celebrate across Europe and the US, they are unwittingly

providing the virus the exact conditions it needs to thrive. It is the evening of the 11th of November 1918. A young barmaid is coming to the end of her shift in a pub in London's East End. As she unties her apron and elbows her way out through the crowded establishment, one of her regulars, her cheeks ruddy from drink, pulls her in for an enthusiastic embrace. The punters are still singing and cheering as she leaves. Raising their glasses, they patter on the shoulder on her way out. The war is over.

Four years of death and suffering brought to a close. Out in the streets, church bells are still ringing in celebration. The barmaid waves cheerfully at a neighbor on the way to the bus stop. As she waits, a young soldier still in uniform staggers out to greet her. His eyes are glassy but kind. He pulls her close, twirling her in an improvised dance, both of them laughing right into each other's faces. When her bus arrives, she kisses her new friend on the cheek to say goodbye and hops aboard. The vehicle's progress is slow through the crowd-filled streets,

but the driver accepts the delay cheerfully, honking the horn as he goes. The barmaid chats to an older woman sitting next to her, who is looking forward to the return of her son from the front. Soon, the crowds are too dense for the bus to move, so the young woman jumps off, pushing briskly through the throng to meet her friends at their favorite dance hall.

Inside the smoke-filled room, bodies press against one another. The music, loud and chaotic, can barely be heard above the frenzy. After throwing her arms around her friends in greeting, she dances with partner after partner, young men still in their uniforms. They laugh, kiss and share drinks and cigarettes until the wee small hours. On the journey home, the barmaid is so tired that she can barely put one foot in front of the other. Her head aches, and there is a tickle at her throat. She complains to her friend, who puts it down to all the singing and shouting. But the soreness gets worse.

During the night, a cough develops and by morning her bedsheets are damp with sweat. The pounding in her skull won't stop. She sends a message with her brother to the pub to say she won't make it into work. Her mother lays a cold damp flannel over her forehead and frets about reports she's read of the deadly Spanish flu. By nightfall, the barmaid is struggling to breathe. Outside, the city still celebrates. Horns blare, music plays and people sing along. But she lies curled on her side,

her lungs filling slowly with something she can't cough out. The second wave of the 1918 flu pandemic proves far more deadly than the first and marks the peak of fatalities. Unusually for an influenza, it also strikes down healthy young adults between the ages of 20 and 40 who account for half of the total deaths. The scientists have puzzled over that maybe it had something to do with the immunology so that maybe people in their 70s and 80s had some protection against the virus because maybe they'd been exposed to a similar virus in previous pandemics. So if you were born before 1890 you would have been exposed to a virus that maybe had some crossover with the 1918 flu and therefore you had more protection than the average person. And then another theory is just as some people seem particularly susceptible to COVID today

and you know everyone will know this, there are people who get ill and recover and then there are other people who get ill and develop very severe symptoms or never recovered to develop long COVID. And could there be some autoimmune reason for that? You know, so maybe it was adults in the prime of life who had the most robust immune system that when they were exposed to a new virus that was very virulent that their body never seen before, maybe their immune system went into overdrive and flooded the lungs with fluids and that is what caused these symptoms of cyanosis that were so marked and reported on at the time. In the prime of life, some soldiers and nurses who've survived the war die from influenza

abroad before they can return home. Or they make it back to find the viruses decimated their families while they've been away. In many cases, what should have been a time of celebration and relief is ruined by this deadly disease. The third wave of the flu picks up in winter of 1918 and continues into 1919, spreading again through the United States and Europe. In Australia, the flu arrives for the first time in January after the war ends. The last severe wave was in the Northern Hemisphere winter, but it continued to cause outbreaks in Australia.

So Australia was an example of one place where strict maritime quarantines were imposed on troop ships returning from Europe with Australian soldiers and other people. But they managed to keep the influenza out for about six months. But in late 1990 to 1920 they had outbreaks and they had quite severe cases because people hadn't been exposed to it and therefore there was no immunity. New outbreaks appear in places previously untouched such as Madagascar. New Zealand records cases in May 1919 and Hong Kong and South Africa are both hit again in June.

The third wave surges through South America, and also proves deadly in Spain, Serbia, Mexico, and Great Britain. Though generally less severe than the second wave, it is still far more lethal than the first. But by 1920, the pandemic is beginning to fade out. There are smaller, less deadly flare-ups, though the final stages occur at different times in different parts of the world. An epidemiologist will tell you that at a certain point, enough people were infected and had acquired some immunity that it ceased to be a pandemic.

When we say, when did the pandemic end? What we're really talking about is when did it stop causing very severe disease and large numbers of deaths? The COVID-19 pandemic hasn't ended. Five years in, we're still living in the era of COVID-19. In the case of the 1918 Spanish Influenza, it never stopped circulating until 1957, when a new pandemic influenza virus emerged

and it displaced the ancestral Spanish flu virus. The ending, if it can be called that, comes with more of a whimper than a bang. But the numbers of fatalities make the Spanish flu one of the most deadly pandemics in history. In total, between 50 and 100 million people die worldwide. Only American Samoa, St. Helena and a handful of islands in the South Atlantic escape untouched. It causes more deaths in a year than the Black Death did in a century. More than a quarter of a million lives are lost in Britain, 400,000 in France and 675,000 in the United States. And across the Indian subcontinent, the death toll reaches an estimated 18.5 million.

Some populations are hit harder than others. In New Zealand, the local Maori population die at seven times the rate of the descendants of British settlers. population die at seven times the rate of the descendants of British settlers. Its communities are often neglected by the European medics and left to fight the influenza with their own knowledge and herbal remedies. Similar differences in death rates are observed between indigenous and European descended people in Fiji and other South Pacific Islands. And all this points to the role that immunology must have played. So if you're living in a remote Pacific Island or a rural farming community far removed from the city you may not have been exposed to many influenza virus. That's the first thing because every time you're exposed to

influenza you get some immunity against the next influenza virus. against the next influenza virus. All in all, the Spanish flu's high death toll spurs a rethink in healthcare. In Britain, this leads to the founding of the Ministry of Health. It was very embarrassing for the medical profession because they'd shown to be essentially defenseless. There was no centralized Ministry of Health in the UK until 1919. You can trace back to the influenza pandemic the beginnings of a national system of not only medical surveillance, but eventually what we've come to think of as our national health service.

And that started with the formation of a Ministry of Health and saying, doctors and local authorities are required to tell us if they notice a large number of patients coming to their surgery with influenza. So we begin to see the beginnings of attempts of worldwide surveillance. Internationally, the League of Nations is established in 1920, an organization designed to promote global cooperation to prevent future wars. A precursor to the United Nations and the World Health Organization,

it helps to ensure that influenza will be monitored and studied more carefully in the years to come. It is autumn 1931, and the streets of North London are slick with rain. At Belsize Park tube station on the Northern Line, a train pulls into the platform. A young man in his early thirties steps off and navigates the stairs up to street level. The exit of the station opens onto a narrow bustling road where he frowns for a moment of the rain.

As an Australian, he's used to better weather. Frank McFarlane Burnett has dark, neatly combed hair and a thoughtful face. Most comfortable in his white lab coat, today he is dressed in a suit and tie. He wants to make a good impression at the National Institute for Medical Research, where he is headed to begin his fellowship. Briefcase in hand, he heads south along Haverstock Hill. Londoners pass him, their hats pulled low on their heads in defence against the rain. But Burnett has a spring to his step as he walks, in anticipation of the important work he is about to embark on in his new role. His mind returns, as it often does, to the experience of having Spanish flu as a 20-year-old student at the University of Melbourne more than a decade ago.

Though his was a mild case, it's something he's never forgotten. It inspired his lifelong fascination with influenza and the causes of the Spanish flu pandemic. Soon he arrives at the National Institute for Medical Research. He pushes open the modest iron gate and approaches the Victorian-style mansion with a steep pointed roof and small turrets at the corners. It more closely resembles a gentleman's residence than a scientific powerhouse. Burnett pauses for a moment, straightens his tie and enters the building.

After the initial introductions, he makes his way as swiftly as he can to the laboratory. Inside there is the usual smell of chemicals and antiseptic. Researchers are hunched over microscopes, carefully analyzing samples. A new colleague calls Burnett over to look at a slide, and he cheerfully gets to work. After all, there are important discoveries to be made. The arrival of the Australian scientist Frank McFarlane Burnett in London for his two-year fellowship at the National Institute for Medical Research coincides with a groundbreaking discovery. So after the war there was a concerted effort by medical researchers to try and isolate the pathogens so they went back and sort of did further studies but it wasn't until 1933 that some British researchers in Hampstead succeeded in showing that influenza was a virus and they did

this because one of the researchers, Dalil with with influenza and what they did is they took throat washings, removed all the bacteria and then introduced the fluid into a ferret, dropped it into the nose of a ferret. Long story short, the ferret fell ill with influenza-like symptoms and then the ferret sneezed in the face of another researcher who himself then fell ill with influenza. symptoms and then the ferret sneezed in the face of another researcher who himself then fell ill with influenza. Though scientists have confirmed the influenza is a virus they won't be able to actually see it with an electron microscope until the 1940s and while Burnett is not directly responsible for

the experiment with the ferret he is inspired to continue in this line of research on his return to Australia. There he starts pioneering the technique for growing the virus in chicken egg embryos. Once injected into the fertilized chicken eggs, the virus multiplies, allowing the scientists to look at it more closely. It is an important step on the journey to creating a vaccine, and the method of using chick embryos is used to cultivate flu vaccines to this day. Bernat, who will be awarded the Nobel Prize for his work in 1960, also studies the variations in virulence of the virus,

and the epidemiology of the influenza, namely how it spreads, who gets it and why. He looks back at the Spanish flu and studies the patterns of mortality in 1918 and is convinced that it is the concentration of recruits from urban and rural districts in overcrowded barracks that holds the key to the pandemic's unusual characteristics. In short, he believes that the emergence of the Spanish flu was intimately connected to the war conditions in which it broke out. It may just be one of those sort of coincidences of history that this virus emerged right at the end of World War I. There's a second school of thought though, so it could be that the concentration of all

these men from all over the world somehow contributed both to the emergence of this virus or once the virus was up and spreading, basically accelerated the speed with which it spread and was able to mutate and go from being a mild sort of flu to a very different kind of flu, one which killed in a matter of hours or days and which the pathologists at the time compared to a plague. The general health of people during the First World War might also have contributed to the flu's spread. If you think of the urban conditions at the time, a lot of burning of coal, a lot of smog and particles in the air that could also have weakened the lungs or made you more susceptible.

And the other thing is people were under huge stress, right? Restricted diets, people in your family dying, women being sent to munitions factories. restricted diets, people in your family dying, women being sent to munitions factories. So people were working hard, the times were very stressful. Maybe all these things contributed to the virus. Since Burnett's discoveries, scientists have gained a much deeper understanding of how influenza viruses mutate and evolve, leading to the development of annual flu vaccines tailored to emerging strains. It's work that continues to save lives. If we compare it to COVID-19, the influenza had an attack rate of 65 out of 10,000 people

died. COVID is half that, 34 out of 10,000 Americans died from the COVID pandemic. We can come back to that because there's so many differences between 1918 and today that had COVID-19 emerged in 1918 when we didn't have any vaccines and we didn't have any antibiotics, maybe the mortality would have been similar to the Spanish flu. Claiming between two and a half and five times as many lives as the world war with which it overlapped,

the Spanish flu was one of the deadliest pandemics in human history. Many communities lost a generation of young adults, and in some remote regions the population never fully recovered. Today, technological and scientific breakthroughs, as well as more open communication between researchers, have improved public health beyond recognition in many parts of the world. Though the wartime conditions of secrecy, propaganda, and paranoia in which the disease emerged and flourished are largely gone, the digital age has exacerbated the threat of misinformation about infectious diseases, vaccines, and treatments. Even a century later, the Spanish flu is subject to wild claims, such as a recent, widely circulated

theory that it was caused by a meningitis vaccine, something experts and fact-checkers have discarded as impossible. But perhaps a greater challenge to learning from the legacy of the Spanish Flu and the pandemics that followed it is human nature, the impulse to forget the horrors of the past. Surely a virus that kills so many people, surely people would have remembered that and recorded and built memorials to it. No, none of that happened. It's virtually impossible to find a contemporary memorial to the dead of the Spanish flu.

But then the next question you have to ask yourself, well, how different is that really to what we see today with COVID-19? We've lived through the biggest pandemic in a century, and it's been endlessly reported on and broadcast. And we've all been put into lockdown, something that didn't happen in 1918. And we've had these fierce disputes on social media. But now five years later, I get the impression that nobody wants to talk or think about it.

Next time on Short History of will bring you a short history of Arthur Conan Doyle. The one thing that I really admire him for is this wish to know more, his curiosity. He was constantly campaigning for causes that he believed in. And that's one of those things that fascinates me about his life. You know, we say this all the time, he was so busy, you know, whether he's writing stories, adventure and playing sports, being a doctor, campaigning for justice. He squeezed every last drop out of his life. That's next time.