Pale Rider: The Spanish Flu of 1918 and How It Changed the World

by Laura Spinney

  Gitchell may not have been the first person to catch the ‘Spanish’ flu. Beginning in 1918, and continuing right up until the present day, people speculated about where the pandemic had actually started. We now know, however, that his case was among the first to be officially recorded, and so by consensus–for the sake of convenience–it is generally considered to mark the beginning of the pandemic. Five hundred million others would follow Albert, metaphorically speaking, to the infirmary.

  America had entered the First World War in April 1917, and that autumn, young men from mainly rural parts of the country began to converge on military camps to be recruited and trained for the American Expeditionary Forces (AEF)–the armed forces that General John ‘Black Jack’ Pershing would lead into Europe. Camp Funston was one such camp. It supplied soldiers both to other American camps and directly to France. By April 1918, the flu was epidemic in the American Midwest, on the cities of the eastern seaboard from which the soldiers embarked, and in the French ports where they disembarked. By the middle of April it had reached the trenches of the Western Front. The weather in western Europe was unseasonably hot that month, but German troops were soon complaining of Blitzkatarrh, something that no doubt preoccupied the German Second Army’s director of hygiene, Richard Pfeiffer–the man who had lent his name to Pfeiffer’s bacillus. From the front it quickly spread to the whole of France, and from there to Britain, Italy and Spain. Towards the end of May, the Spanish king, Alfonso XIII, fell sick in Madrid, along with his prime minister and members of his Cabinet.1

  Also in May, flu was reported in Breslau in Germany, now Wrocław in Poland (where Pfeiffer held the chair of hygiene in peacetime), and in the Russian port of Odessa, 1,300 kilometres to the east. After Russia’s new Bolshevik government had signed the Treaty of Brest-Litovsk with the Central Powers in March, taking it out of the war, the Germans began to release their Russian prisoners of war. Manpower was short in Germany, and they initially held back the able-bodied, but under the auspices of several Red Cross societies, they did release invalids at a rate of a few thousand a day, and it was probably these ‘veritable walking dead men’ who brought the flu to Russia.2

  It made landfall in North Africa in May, and it seems to have circled Africa to reach Bombay (Mumbai) before the month was out. From India it travelled east. At some point, however, it may have met itself coming back, because there are reports of it in South East Asia in April.3 Soon enough, it was in China. ‘Queer epidemic sweeps North China’, reported the New York Times on 1 June, and sipping their morning coffee, New Yorkers went on to learn that 20,000 cases had been recorded in the northern Chinese city of Tientsin (Tianjin) and ‘thousands’ more in Peking (Beijing). In the capital, ‘the banks and silk stores have been closed down for several days in large sections, the police being unable to attend to their duties’. It erupted in Japan at the end of May, and by July it was in Australia. Then it seemed to recede.

  This was the first wave of the pandemic, and it was relatively mild. Like seasonal flu, it caused disruption but no major panic. It did, however, create havoc in the European theatre of war, where it interfered significantly with military operations. Following the signing of Brest-Litovsk, as a result of which the Eastern Front ceased to exist, General Erich Ludendorff–architect of the German war effort–tried to pre-empt the arrival of American troops by launching an offensive on the one remaining major front, the Western Front. He saw this Kaiserschlacht, or Kaiser’s Battle, as Germany’s last chance of victory, and he had the newly liberated divisions from the east at his disposal. Despite initial successes, however, the offensive ultimately failed. Both sides were weakened by flu. As many as three-quarters of French troops fell sick that spring, and more than half the British force. Whole units were paralysed and makeshift military hospitals were bursting at their canvas seams. The situation at the front was dire. ‘We were lying in the open air with just a ground sheet and a high fever,’ recalled a British private, Donald Hodge, who survived. On the German side, 900,000 men were out of action.

  Allied propagandists tried to turn the situation to their advantage. Leaflets were released over German positions informing them that if their own forces weren’t capable of relieving them, the British would. The leaflets fluttered down over German cities too. When the British journalist Richard Collier was soliciting eye-witness testimony of the pandemic in the early 1970s, he received a letter from a German man named Fritz Roth who remembered, as a schoolboy, picking one up in Cologne. The civilian population of Germany had been close to starvation since the ‘turnip winter’ of 1916–17–a failure of the potato crop that exacerbated underlying hardships caused by an Allied naval blockade. The wording of the pamphlet recalled by Roth translated approximately as ‘Say your Our Father nicely, because in two months’ time you will be ours; then you will get good meat and bacon, and then the flu will leave you alone.’

  The flu did leave them alone that summer, generally speaking, though it wasn’t completely absent from Europe. In late July, a Turkish Army officer named Mustafa Kemal was waylaid by it in Vienna on his way back to Constantinople (Istanbul). He had been inspecting German lines on the Western Front, and was unimpressed by what he had seen. Meeting his German ally, the kaiser, he told him bluntly that he expected the Central Powers to lose the war. (The Turkish officer recovered and went on to become the first leader of the Republic of Turkey, acquiring the surname Atatürk, or ‘Father of the Turks’.)

  In August the flu returned transformed. This was the second and most lethal wave of the pandemic, and again by consensus, it is described as having erupted in the second half of the month at three points around the Atlantic–Freetown in Sierra Leone, Boston in America, and Brest in France. It was as if it had been brewing in mid-ocean–perhaps in the Bermuda triangle–but it hadn’t, of course. A British naval vessel brought it to Freetown, a ship steaming from Europe probably brought it to Boston, while Brest received it either with the continuing influx of AEF troops, or from French recruits arriving in the city for naval training. In fact, many French people thought at the time that it had come into France from Switzerland. The Swiss, meanwhile, thought it had entered their country from neighbouring Germany and Austria, despite their best efforts to impose quarantine measures at the borders. Though Switzerland was neutral in the war, under an agreement with the warring nations it received a constant flow of sick and injured POWs, whom it accommodated in internment camps in the Alps.

  The forty-three-year-old psychoanalyst Carl Gustav Jung presided over such a camp, for interned British officers, in the picturesque mountain village of Château d’Œx. In the closing months of the war, camp discipline was relaxed, and the internees were permitted visitors. One of Jung’s biographers recounts the following, possibly apocryphal tale: one day, Jung was talking to the visiting wife of a British officer. During the course of the conversation she told him that snakes in her dreams always meant illness, and that she had dreamed about a huge sea serpent. When, later, the flu broke out in the camp, Jung considered it proof that dreams could be prophetic.4 The flu first appeared in Jung’s camp in July. By 2 August there were reports of flu deaths among French soldiers returning home from Swiss camps.5

  From Boston, Freetown and Brest the second wave spread outwards, helped on its way by troop movements. In early September, returning to New York from France on the troopship the SS Leviathan, Franklin Delano Roosevelt–a young assistant secretary of the navy at the time–developed symptoms and had to be carried ashore on a stretcher. Over the next two months, it spread from the north-eastern seaboard to the whole of North America, and thence through Central America to South America, which also received it from the sea (as did the Caribbean; Martinique was spared until the end of November, when it arrived, as so often, on a mailboat). South America, which had experienced no spring wave, reported its first cases after a British mail ship, the SS Demerara, docked at the northern Brazilian city of Recife on 16 September, with infection on board.

  From F
reetown, the flu spread along the coast of West Africa and inland via rivers and the colonial rail network. From railheads in the interior, infected individuals carried it by bicycle, canoe, camel and foot to the most remote communities. South Africa was wide open to disease, with its many ports and well-developed rail network, and the flu arrived in Cape Town in September, aboard two troopships that had called previously at Freetown. Between them, the Jaroslav and the Veronej were bringing home around 1,300 of the 21,000 members of the South African Native Labour Contingent who had served in France. Basic precautions were taken when the ships arrived, to isolate the infected, but not all the cases were identified, and some men were wrongly given the all-clear and allowed to board trains for home. From South Africa the flu spread rapidly through southern Africa up to the Zambezi River and beyond. The Horn of Africa received it in November, and Haile Selassie I, then regent of Abyssinia, reported that it killed 10,000 in the capital, Addis Ababa: ‘But I, after I had fallen gravely ill, was spared from death by God’s goodness.’6

  In London, on 5 September, Sergei Diaghilev’s Ballets Russes gave a performance of Cleopatra at the Coliseum Theatre. The great dancer and choreographer Léonide Massine was terrified of catching the flu. ‘I wore nothing but a loincloth,’ he later recalled. ‘After my “death” I had to lie still for several minutes on the icy stage, while the cold penetrated to my bones… Nothing bad came of it, but the next day I learned that the policeman who always stood out front of the theatre, a great hulk of a man, had died of flu.’7

  By the end of September the flu had spread through most of Europe, triggering another lull in military operations. The tubercular Franz Kafka caught it in Prague on 14 October and, confined to his sickbed, witnessed the collapse of the Austro-Hungarian Empire from his window. ‘On the very first morning of Kafka’s influenza,’ wrote one of his biographers, ‘the family was awakened by unusual sounds, the clank of weapons, and shouted orders. When they opened the curtains, they saw something alarming: entire platoons were appearing from the dark side streets in full marching order and beginning systematically to cordon off Altstädter Ring.’8 The military had been mobilised to ward off the very real threat of revolution in the face of the disastrous supply situation and the movement, which was gathering strength, to declare an independent Czech state.

  The modern history of Poland finds a sorry echo in its experience of the Spanish flu. By 1918, the country had been entirely erased from the map by its more powerful neighbours–Germany, Austro-Hungary and Russia–who had divided it up between them. The modern territory of Poland received the second wave of flu from all three partitioning states, and the disease fronts met at the River Vistula in Warsaw–the geographic heart of the country as it would be reconstituted later that year.9 At the heart of Warsaw, Jan Steczkowski–the leader of the temporary government set up in the occupied Polish territories with the blessing of Germany and Austro-Hungary–fell ill.

  The autumn wave swept in a broad diagonal from south-west to north-east across Russia–suggesting that those returning POWs were still a source of infection–but the flu was probably introduced to the vast Russian territory at different points around its borders within a matter of days or weeks. The London Times reported that it was in Petrograd (St Petersburg) as early as August, along with typhus, smallpox, meningitis and a surge of ‘insanity’. The American historian Alfred Crosby noted that the AEF infected the White Sea port of Archangel, in the north, when it arrived there on 4 September to support anti-Bolshevik forces.10 And before September was out, the newly formed People’s Commissariat for Health in Moscow had received reports of it from all over the country.

  The Russian civil war, the Trans-Siberian railroad and the struggle between Britain and Russia for control of Persia–the so-called ‘Great Game’–all contributed to the flu’s spread across northern Asia. It entered hapless Persia via several routes, but perhaps the most efficient, in terms of dissemination, was the north-eastern one via the shrine city of Mashed. It arrived in India in September, and by October it was back in China. In the last few days of that month, a dose of it forced the Japanese prime minister, Hara Takashi, to cancel an audience with the emperor (he survived, only to be assassinated three years later).

  The epidemic was declared over in New York on 5 November, but it lingered on in war-torn Europe, drawn out by food and fuel shortages. As the weather turned cold, the French consul in Milan noted that housewives forced to queue for milk in freezing fog presented particularly easy pickings.11 On her release from an English prison, the Irish patriot and suffragette Maud Gonne returned to Dublin to reclaim her house from the poet W. B. Yeats, to whom she had lent it. Yeats’s heavily pregnant wife being ill with flu at the time, he turned Gonne away. The woman who had for so long been his muse, to whom he had addressed the lines ‘Tread softly because you tread on my dreams’, now bombarded him with hate mail, and Gonne’s daughter recalled a terrible confrontation between the two, ‘among the nurses and perambulators’ of St Stephen’s Green.12

  Strangely, the flu saved at least one life that autumn–that of a young Hungarian physicist named Leo Szilard. He fell sick while training with his regiment at Kufstein in Austria, and was granted leave to return home to Budapest. There he was wheeled into a hospital ward that ‘resembled a laundry’, with wet sheets draped between the beds.13 This humidity cure is unlikely to have contributed to his eventual recovery, but he was still in the hospital when he received a letter from his captain, informing him that the rest of his regiment had been killed at the Battle of Vittorio Veneto, on the Italian front. Szilard later moved to America and worked on the problem of nuclear fission. He would become known as one of the men behind the atom bomb.

  On 9 November, the kaiser abdicated. On the 11th, the armistice was signed and celebrations broke out across the world, creating close to ideal conditions for a crowd disease. Thousands poured into the streets of Lima, Peru, triggering an explosion of flu in the days that followed. An armistice ball organised by the Red Cross in Nairobi had a similar effect in Kenya, while in London, the poet Ezra Pound wandered through the rainy streets ‘to observe the effect of armistice on the populace’ and came down with what he thought, at first, was a cold.14

  By December 1918, most parts of the world were once again free of flu. Very few places on earth had been spared this murderous autumn wave, though there were examples: the continent of Antarctica; the tiny islands of St Helena in the South Atlantic Ocean and Marajó at the mouth of the Amazon River; the bigger island of Australia, a gleaming exception to the rule that humans could do little to protect themselves, since a strict maritime quarantine kept the flu out.

  The Australian authorities lifted the quarantine early in 1919–too soon, as it turned out, because it was then that the third wave struck. This wave was intermediate between the other two, in terms of virulence. More than 12,000 Australians died in the southern summer of 1918–19, after the virus finally gained a foothold there, but they weren’t alone in having let down their guard. The third wave arrived while communities all over the world were still reeling from the second. It peaked in New York in the last week of January, and by the time it reached Paris the peace negotiations were underway. Delegates from a number of countries fell ill–proof, if proof were needed, that the virus transcended geopolitical boundaries.

  Some have posited a fourth wave that struck northern countries in the winter of 1919–20, that may have claimed the lives of German political scientist Max Weber and, in Britain, Canadian physician William Osler–the man who coined the term ‘old man’s friend’ for pneumonia–but this is usually excluded from the pandemic proper. Most people consider that the third wave–and hence the pandemic–was over in the northern hemisphere by May 1919. The southern hemisphere, however, had many more months of misery to come, since its pandemic was staggered in time with respect to the north.

  Brazil experienced only one wave of flu–that of autumn 1918–but in Chile a second wave struck a whole year later,
while the most lethal wave to wash over the Peruvian capital was the third, in early 1920. The city of Iquitos lies deep in the Peruvian Amazon and, even today, can only be reached by river and air. Its isolation meant that it had only one brush with flu, late in 1918, but that same isolation, combined with poor access to healthcare, ensured that it was devastating. The death rate in Iquitos, at the time the centre of the Amazon rubber trade, was twice that recorded in Lima.15

  This final surge of death was mirrored on the other side of the Pacific, in Japan. The ‘Late Epidemic’, as the Japanese called it (to distinguish it from the ‘Early Epidemic’ of autumn 1918), began in late 1919 and ran into 1920. On 18 March 1920, a Japanese farmer in Sho¯nai, 500 kilometres north of Tokyo, made the following note in his diary: ‘Keishiro¯ caught a cold and is coughing, so he went to visit the divine image of the Stop-Coughing Priest south of Kannonji village, to pray he would get over his cough.’16 The entries either side of this one suggest that Keishiro¯, a member of the farmer’s family, was suffering from Spanish flu. If so, his must have been among the last cases, because by then, the pandemic was over.

  4

  Like a thief in the night

  The vast majority of those who caught the Spanish flu experienced nothing more than the symptoms of ordinary flu–sore throat, headache, fever. And as with ordinary flu, most of those who fell ill in the spring of 1918 recovered. There were rare cases in which the disease took a serious turn, and some of those unfortunates died, but though this was sad, it wasn’t unexpected. The same thing happened every winter.

  When the disease returned in August, however, there was no longer anything mundane about it. Now, what began as ordinary flu quickly graduated to something more sinister. The flu itself was worse, and it was also more likely to be complicated by pneumonia–in fact it was bacterial pneumonia that caused most deaths. Patients would soon be having trouble breathing. Two mahogany spots appeared over their cheekbones, and within a few hours that colour had flushed their faces from ear to ear–‘until it is hard’, wrote one US Army doctor, ‘to distinguish the colored men from the white’.1