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

by Laura Spinney

  Doctors labelled this chilling effect ‘heliotrope cyanosis’. Like so many Bordeaux wine merchants, they tried to describe the colour in as precise terms as possible, believing that slight changes in tint were informative about the patient’s prognosis. It was ‘an intense dusky, reddish-plum’ according to one doctor. As long as red was the dominant hue, there was room for optimism. But as soon as one ‘would need to mix some heliotrope, or lavender, or mauvey-blue with red’, the outlook was bleak indeed.2

  Blue darkened to black. The black first appeared at the extremities–the hands and feet, including the nails–stole up the limbs and eventually infused the abdomen and torso. As long as you were conscious, therefore, you watched death enter at your fingertips and fill you up. When Blaise Cendrars called at 202 Boulevard Saint-Germain on 8 November, the concierge informed him that Mr and Mrs Apollinaire were both sick. Cendrars recounts that he bounded up the stairs and hammered at the door. Someone let him in. ‘Apollinaire lay on his back,’ he recalled. ‘He was completely black.’3

  Apollinaire died the next day. Once the black had set in, death came within days or hours. The distress of the bereaved was compounded by the look of the cadaver: not just the blackened face and hands, but the horribly distended chest. ‘The body decomposed very quickly and the chest literally raised itself up, so that we had to push down my poor brother twice,’ wrote one survivor. ‘The coffin lid had to be shut at once.’4 Inside the chest, at autopsy, pathologists found red, swollen lungs that were congested with haemorrhaged blood, and whose surfaces were covered in a watery pink lather. The flu’s victims died by drowning, submerged in their own fluids.

  Pregnant women who caught the flu suffered miscarriages and premature births with shocking frequency. People bled spontaneously from the nose and mouth. The aptly named Leviathan–one of the largest ships in the world at the time–left Hoboken, New Jersey for France on 29 September 1918, with 9,000 military personnel and the ship’s crew aboard. The disease broke out as soon as it left harbour, and by the time it docked in Brest a week later, 2,000 men were sick and there had been around ninety fatalities on board. The scenes the ship’s passengers witnessed during the voyage were Dantesque. The spaces between the bunks in the troop compartments were so narrow that nurses tending the sick couldn’t avoid tracking blood between them. With the higher bunks unusable by the sick, semi-conscious men were laid out on the decks instead, which soon became slippery with blood and vomit. ‘The conditions during the night cannot be visualised by anyone who had not actually seen them,’ wrote one American soldier who made the crossing, and the ‘groans and cries of the terrified added to the confusion of the applicants clamouring for treatment’.5

  The whole constitution was affected. People said the Spanish flu had a smell, as of musty straw. ‘I never smelt anything like it before or since,’ recalled one nurse. ‘It was awful, because there was poison in this virus.’ Teeth fell out. Hair fell out. Some did not even show any signs before simply collapsing where they stood. Delirium was common. ‘They became very excited and agitated,’ wrote a doctor in Berlin. ‘It was necessary to tie them to their beds to prevent them hurting themselves as they threw themselves about.’ Another doctor in Paris observed that the delirium seemed to manifest itself, counter-intuitively, once the fever had broken. He described his patients’ anxiety-provoking sensation that the end of the world was nigh, and their episodes of violent weeping.6 There were reports of suicides–of patients leaping from hospital windows. Children died in tragic circumstances too, but while adults were described as ‘leaping’, children ‘fell’. Near Lugano, Switzerland, a lawyer named Laghi cut his own throat with a razor, while a clerk who worked in the City of London didn’t turn up for work one day. Instead, he took a train to Weymouth on the south coast of England and threw himself into the sea.7

  People reported dizziness, insomnia, loss of hearing or smell, blurred vision. Flu can cause inflammation of the optic nerve, and one well-documented effect of that is impaired colour vision. Many patients remarked, on regaining consciousness, how washed out and dull the world appeared to them–as if those cyanosed faces had drained all the colour from it. ‘Sitting in a long chair, near a window, it was in itself a melancholy wonder to see the colourless sunlight slanting on the snow, under a sky drained of its blue,’ wrote American survivor Katherine Anne Porter, in her autobiographical short story Pale Horse, Pale Rider.8

  The most terrifying thing of all, however, was the way it arrived: silently, without warning. It is a characteristic of flu that the period of high infectivity precedes the onset of symptoms. For at least a day, and sometimes longer, a person may appear to be well though they are infected–and infectious. In 1918, if you heard a neighbour or a relation coughing, or saw them fall down in front of you, you knew there was a good chance that you were already sick yourself. To quote one health officer in Bombay, the Spanish flu arrived ‘like a thief in the night, its onset rapid, and insidious’.9

  LOVE IN THE TIME OF FLU

  When Pedro Nava arrived in Rio de Janeiro in August 1918, he was fifteen years old. He had come to live with his ‘uncle’ Antonio Ennes de Souza in the smart neighbourhood of Tijuca, in the north of the city. Ennes de Souza was actually a first cousin of Nava’s father, José, but José had died in 1911, leaving his family in straitened circumstances and forcing them to leave the city. When the time came for Nava to study seriously, his mother sent him back to Rio, into the care of Uncle Ennes de Souza.

  He was immediately entranced by his elegant and vivacious Rio relations, and by one visitor to the house in particular–a niece of ‘Aunt’ Eugenia named Nair Cardoso Sales Rodrigues. Describing the radiant Nair in his memoirs more than half a century later, he compared her to the Venus de Milo–with her ‘lustrous complexion, her red petal-like lips, her wonderful hair’–and recalled with perfect clarity the night they both heard about the epidemic known as espanhola.10

  It was late September, and as usual in the Ennes de Souza household, the papers were read aloud at the dinner table. They contained a report of 156 deaths on board the ship La Plata, which had sailed from Rio, heading for Europe, with a Brazilian medical mission aboard. The sickness had erupted two days out of Dakar on the west coast of Africa. But Africa was far away, and the boat was heading further still. What concern was it of theirs? Not reported that night–perhaps due to censorship, or perhaps because the press did not consider it sufficiently interesting–was the progress of a British mail ship, the Demerara, that had stopped in Dakar on its way out to Brazil. It had arrived in the northern Brazilian city of Recife on 16 September, with cases of flu on board, and was now heading south towards Rio.

  After dinner, Nava went to sit by an open window with his aunt, whose back he obligingly scratched. Nair sat with them, and as she contemplated the tropical night, he contemplated her. When the clock struck midnight, they closed the window and left the room, but Nair paused to ask if they should be worried about the ‘Spanish’ sickness. Years later, Nava recalled the scene: ‘We were standing, the three of us, in a corridor lined with Venetian mirrors in which our multiple reflections lost themselves in the infinity of two immense tunnels.’ Eugenia told her there was nothing to worry about, and they parted for the night.

  The Demerara entered Rio’s port in the first week of October, without encountering any resistance. It may not have been the first infected ship to reach the capital, but from at least the time of its arrival, the flu began to spread through the poorer bairros or neighbourhoods of the city. On 12 October, a Saturday, a ball was held at the Club dos Diàrios, a favourite haunt of Rio’s coffee barons and other powerbrokers. By the following week, many of the well-heeled guests had taken to their beds. So had the majority of Nava’s fellow students. When he turned up at college on Monday morning, only eleven of the forty-six students in his year were present. By the end of the day, the college had closed indefinitely. Nava, who was told to go straight home and not to dawdle in the streets, arrived at his uncle�
��s house, 16 Rua Major Ávila, to find that three members of the household had fallen ill since morning.

  The city was totally unprepared for the tidal wave of sickness that now overtook it. Doctors kept up punishing schedules and returned home only to find more patients waiting for them. ‘Agenor Porto told me that in order to have some rest, he had to lie hidden inside his landaulet [car] covered with canvas sacks.’ Food, especially milk and eggs, ran short. Cariocas–as inhabitants of Rio are called–panicked, and the newspapers reported the deteriorating situation in the city. ‘There was talk of attacks on bakeries, warehouses and bars by thieving mobs of ravenous, coughing convalescents… of chicken-stuffed jackfruits put aside for the privileged–the upper classes and those in government–being transported under guard before the eyes of a drooling population.’

  Hunger invaded the house on Major Ávila. ‘I got to know that drab companion,’ Nava wrote. ‘After one day on thickened fish stock, another on beer, wine, spirits and the dregs of olive oil, I can still remember the dawn of the third day. No breakfast, nothing to eat or drink.’ Ennes de Souza, aged seventy-one, donned a wide-brimmed hat, took up a defensive stick and a wicker basket, and accompanied by his convalescent nephew Ernesto, ‘pale with an unkempt beard’, went out to see what he could procure for his famished family. ‘After many hours they came back. Ernesto was carrying a bag full of Marie biscuits, some bacon and a tin of caviar, his uncle ten tins of condensed milk.’ These precious stocks were strictly rationed by Aunt Eugenia, ‘as if the house on Major Ávila were Géricault’s raft after the shipwreck of the Medusa’.

  An unexpected visitor turned up at the house: Nava’s maternal grandfather. He was passing through, he said, from the neighbouring state of Minas Gerais–where the epidemic had barely got underway. He asked, of all things, to be shown the sights: Praia Vermelha, Sugarloaf Mountain. His grandson obliged, pausing in wonder at the sight of the Praça da República, the vast public space in the centre of the city, as empty as the moon. ‘I would see it like that once again, forty-six years later, on 1 April 1964, but that was during the revolution.’

  He recalled looking up at the sky and seeing a pumice-grey dome in which the sun appeared as a dirty yellow blot. ‘The sunlight was like sand in the eyes. It hurt. The air we breathed was dry.’ His intestines rumbled, his head ached. Falling asleep on the tram home, he had a nightmare that the staircase on which he was standing was falling away beneath him. He woke up shivering with a burning forehead. His grandfather delivered him home, where he gave himself up to the sickness. ‘I kept on rolling down those stairs… The days of hallucination, sweat and shit had begun.’

  At the time that Nava fell sick, Rio was the capital of a young republic. A military coup had brought the reign of Emperor Dom Pedro II to an end in 1889, and with the abolition of slavery the previous year, it had seen a massive influx of freed black and ‘mulatto’ slaves. The poorest moved into cortiços or slums in the city centre. The cortiços–the Portuguese word for ‘beehives’–often lacked running water, sewers and proper ventilation. Living conditions were better there than in the subúrbios, the shanty towns expanding on the outskirts of the city, but the cortiços were more visible. White, middle-class cariocas saw them as parasitising the city proper. Aluísio Azevedo conveyed the fear that they inspired in his novel O Cortiço:

  For two years the slum grew from day to day, gaining strength and devouring newcomers. And next door, Miranda grew more and more alarmed and appalled by that brutal and exuberant world, that implacable jungle growing beneath his windows with roots thicker and more treacherous than serpents, undermining everything, threatening to break through the soil in his yard and shake his house to its very foundations.

  When President Francisco de Paula Rodrigues Alves came to power in 1902, he launched an ambitious programme of urban renewal with the goal of turning Rio into a showcase of modern, republican civilisation. In his vision of the cidade maravilhosa, the marvellous city, there was no place for the cortiços, those nests of disease whose inhabitants, condemned by their biology, were ‘locked into a vicious cycle of malnutrition and infection’.11 They were razed and their inhabitants forced out. Six hundred homes were destroyed to make way for the magnificent Avenida Rio Branco, so that by the time the American travel writer Harriet Chalmers Adams described the city in 1920, she could write that ‘This portion of the city has been cooler ever since, as the breezes sweep through the wide avenue from waterfront to waterfront.’12 But the easy mixing of the different classes that had once characterised Rio, their coming together in the seeking of pleasure–especially when it came to music and dancing–had gone. Now there was no area of carioca life in which rich and poor were not divided by an impenetrable gulf.

  The president also set out to rid the city of infectious diseases, and in this he was aided by a doctor, Oswaldo Cruz, who in 1904, as head of the General Board of Public Health, had ordered a campaign of compulsory vaccination against smallpox. At the time, the vast majority of Brazilians had no grasp of germ theory. For many it was their first experience of state intervention in public health, hence something extraordinary, and poor cariocas rioted. The ‘Vaccine Revolt’, as it was called, was about more than one perceived violation, however. It was an expression of a broader class struggle over whom the city should serve–the Brazilian masses, or the European elite.13

  A decade later, vaccination had been accepted by most Brazilians, but Cruz’s unpopularity survived his death in 1917, and it was this legacy that shaped cariocas’ response to the new disease threat in 1918. On 12 October, the day that the flu spread through the elegant guests at the Club dos Diàrios, the satirical magazine Careta (Grimace) expressed a fear that the authorities would exaggerate the danger posed by this mere limpa-velhos–killer of old people–to justify imposing a ‘scientific dictatorship’ and violating people’s civil rights. The press portrayed the director of public health, Carlos Seidl, as a dithering bureaucrat, and politicians rubbished his talk of microbes travelling through the air, insisting instead that ‘dust from Dakar could come this far’. The epidemic was even nicknamed ‘Seidl’s evil’. By the end of October, when half a million cariocas–more than half the population–were sick, there were still those among Rio’s opinion-makers who doubted the disease was flu.14

  By then, so many corpses lay unburied in the city that people began to fear they posed a sanitary risk. ‘On my street,’ recalled one carioca, ‘you could see an ocean of corpses from the window. People would prop the feet of the dead up on the window ledges so that public assistance agencies would come to take them away. But the service was slow, and there came a time when the air grew filthy; the bodies began to swell and rot. Many began throwing corpses out on the streets.’15

  ‘The chief constable was on the verge of despair when Jamanta, the famous Carnival reveller, came up with a solution,’ wrote Nava. In daylight, Jamanta was José Luís Cordeiro, a journalist at the influential Correio de Manhã (Morning Post)–a newspaper that tended to take a disapproving stance when it came to Carnival. By night he was someone else, a prankster who ‘had learnt to drive trams just for fun, as would suit a bohemian night-owl type like himself’.

  As the Correio was apologising for its inability to meet its usual deadlines, due to sickness among its staff, Jamanta came into his own. ‘He asked his bosses for a luggage tramcar and two second-class tramcars and swept the city from north to south.’ With his grisly cargo he headed through the dark, empty streets for the São Francisco Xavier Cemetery in Cajú, in the north of Rio, where he unloaded his sinister caravan ‘resembling the Ghost Train or Dracula’s ship’, before turning round to make another tour, ‘even though the sun was already up’.

  The bell at the gate of the Cajú cemetery would not stop tolling, driving those who lived nearby almost mad. Gravediggers couldn’t dig fast enough; a thousand bodies awaited burial. To save time, they dug shallower graves. ‘Sometimes the ditch was so shallow that a foot would suddenly bloom on the eart
h,’ recalled the writer Nelson Rodrigues.16 Amateur gravediggers were hired at advantageous prices. ‘Then came the prisoners,’ wrote Nava: ‘Mayhem.’ The convicts were enlisted to clear the backlog. Talk of horrors spread: of fingers and earlobes severed for jewels; of the lifting of the skirts of young girls; of necrophilia; of people buried alive. In the hospitals, it was said, at the same hour every night, ‘midnight tea’ was served to those who were beyond help, to speed them on their way to the ‘holy house’–as coffin sellers euphemistically referred to the cemeteries.

  Were the rumours true, or were they some kind of collective hallucination, one city’s imagination let loose by fear? In the end, Nava concluded, it didn’t matter, because the impact was the same. Terror transformed the city, which took on a post-apocalyptic aspect. Footballers played to empty stadia. The Avenida Rio Branco was deserted, and all nightlife ceased. If you caught a glimpse of a human being in the streets, it was fleeting. They were always running, black silhouettes against a blood-red sky, their faces contorted in a Munch-like scream. ‘It just so happens that the memories of those who lived through those days are colourless,’ wrote Nava, who may have experienced that strange distortion of colour perception reported by other patients too. ‘No trace of early morning tints, shades of blue in the sky, twilight hues or moonlight silver. Everything appears covered in an ashen grey or a rotten red and brings back memories of rain and funeral rites, slime and catarrh.’