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

by Laura Spinney

  Shansi’s marginal position and natural ramparts meant that Governor Yen had less to fear from avaricious neighbours than other warlords, and he was able to divert his energies into an ambitious programme of reform. In 1917, he banned pigtails, the smoking of opium and foot-binding (which in Shansi meant wrappings to the knee, so that a woman’s lower legs withered). Progressive societies were born–the Society for the Liberation of Feet, the Early Rising Society–and the local youth mobilised to enforce the new rules. Gangs of small girls chased transgressors through the streets shouting, ‘Bad man, won’t you be good!’ All of Yen’s reforms were unpopular, but the most unpopular of all were his attempts to control disease. Smallpox and TB were endemic to the region, while epidemics of plague, cholera and typhoid swept through as frequently as high winds in a hurricane belt. Despite their devastating impact, his efforts to quarantine the sick before an outbreak reached epidemic proportions were quietly circumvented. ‘Few people were willing to be so unfilial as to turn their backs on a sick or dying relative,’ wrote his biographer.5 Filial piety, or respect for one’s parents and elders, was a central pillar of the Confucian code.

  In his battle to overcome this resistance, Yen came to lean heavily on the American missionaries who were the only providers of western-style medicine in Shansi. Many missionaries had been slaughtered in the Boxer Rebellion of 1900–a violent uprising of the Chinese against western and Japanese influence (so-called because boxing was a ritual of the secret society that initiated it). Since then, however, a few brave souls had come to replace the victims. Yen admired them–men like Percy Watson, who ran the American hospital at Fenzhou (Fenyang), and Willoughby ‘Dr Will’ Hemingway, uncle of writer Ernest. At the first sign of a new epidemic, these men saddled up their mules and headed out to the often remote area where the first cases had been reported, to put into practice their modern ideas about hygiene, quarantine and cremation.

  This is what they did again in October 1918, when the Spanish flu came to Shansi, and Governor Yen put the provincial police force at their disposal. ‘Whole families were victims,’ Watson wrote later. ‘No family into which the disease entered, escaped with a mortality of less than 80 or 90 per cent, and the ones who escaped were mostly young children.’ He added that ‘it would be a conservative estimate to say, that there were not twenty Chinese in the entire province who did not believe that Chinese physicians could cure the disease’.6 He was exaggerating, perhaps, but it was a telling comment: the population of Shansi was around 11 million at the time. Local people responded in their time-honoured way: ‘They take the dragon god from the temple just north of our court, and with great noise, shouts and beating of drums, they go from home to home, hoping that the dragon through the noise can rid the city of these devils,’ reported one missionary.7

  Whether Watson’s efforts were more effective is hard to know, but within three weeks the Spanish flu had receded. A few months of calm ensued, then on 7 January 1919 Governor Yen telegraphed Watson again, from the provincial capital Taiyuan, and asked him to investigate a new outbreak of disease in the mountains north-west of the city. Fenzhou was a hundred kilometres to the south-west of Taiyuan. With a team of experienced plague fighters, Watson set out, this time for a village called Wangchiaping, five days’ trek from Fenzhou by pack mule. In this hill country, winters were cold. Villages were numerous but small, averaging three to four families each, and people worked the land to the tops of the mountains. When Watson arrived at the epicentre of the new outbreak, he discovered that it wasn’t new at all. The first death had occurred a month earlier, on 12 December, but it hadn’t been reported for more than three weeks. During that time, the disease had spread from Wangchiaping to nine other villages, carried either by relatives visiting the sick, or by those hired to bury the dead, or by a Chinese doctor who eventually succumbed to it himself.

  As the missionaries moved from house to house, they came across scissors placed in doorways, apparently to ward off demons, ‘or perchance to cut them in two’. In one of the nine affected villages, two orphaned children had been taken in by a couple who thought they had escaped the disease. ‘When the children got sick it was at first decided to put them out in a temple and let them die there,’ wrote Watson, ‘but the man and his wife finally said they could not bear to do it, so the children were wrapped up in some bedding and left at one end of the kang bed* until they died the next day.’

  Watson wasn’t sure what the new disease was. He knew that the Wangchiaping district had been affected by the Spanish flu back in October, and he noted that the flu had been ‘moderately severe’ there, having been exacerbated by people crowding together on kangs to save on the kaoliang or millet stalks that constituted their only fuel. It was possible, however, that this new outbreak was a different disease: pneumonic plague. While all three varieties of plague are caused by the bacterium Yersinia pestis, they present differently. The bubonic form is characterised by telltale ‘buboes’, when lymph nodes swell painfully; the septicaemic form arises from an infection of the blood; while the pneumonic or lung form is accompanied by chills and bloody sputum. Pneumonic plague is the most lethal of the three, and it may also be the most contagious, since it can be transmitted by the air.

  The first death had occurred in Wangchiaping on 12 December, but Watson discovered that an elderly woman had died in another village in the same district on 28 November. This woman, he felt sure, had died of Spanish flu, because she had suffered profuse nosebleeds–a characteristic symptom of that disease, but not of pneumonic plague. In accordance with tradition, she had been left for ten days in an open coffin, in a courtyard, so that family members could pay their respects. ‘It was in this courtyard that the first patient who died at Wangchiaping had been getting the lumber he was hauling before his sickness,’ wrote Watson.

  He had uncovered a direct link between the autumn epidemic and the one that had broken out in December. It seemed likely, therefore, that he was dealing with a new wave of Spanish flu–or the tail end of the previous one–but he hesitated to make that diagnosis. The later outbreak, in Wangchiaping, was both highly contagious and highly lethal. Around 80 per cent of those exposed to a living patient caught it, and none of them recovered–a pattern more characteristic of plague than flu, and different from that of the previous outbreak. The only way to settle the matter was to perform an autopsy, but Watson considered it unwise to do so. Mutilation of a corpse had been strictly forbidden under the Qing, and was still insulting to conservative Chinese. He also wanted to keep local people on side, so that they would comply with his quarantine measures.

  He and his assistants did manage, cautiously, to obtain a few samples of sputum and lung tissue from victims using aspiration syringes. Emerging onto the hillside in plague suits, masks and goggles, Watson recalled, ‘I fear we did little to lessen the Chinese idea of demons and ghosts.’ Once they had got what they needed, a burial squad moved in, masked and gowned and armed with iron hooks with which to manipulate the cadavers. None of the doctor’s microscopic examinations revealed the plague bacterium, though the traces of oedema or swelling that he saw in the aspirated lung tissue reminded him very much of the ravages of Spanish flu.

  The ‘new’ epidemic was over by 25 January, two-thirds of the deaths having occurred before Watson arrived. Yen showed his gratitude by donating land to the American hospital in Fenzhou and decorating two Chinese members of its staff for their services in combating epidemics. His admiration for the missionaries was reciprocated. ‘In the broadness of his interests and the dash and vigour of his personality he reminds somewhat of Theodore Roosevelt,’ gushed one member of the Fenzhou mission.8 Other epidemics would sweep the province, and as time went on, Watson measured the impact of the governor’s modernisation efforts by his own practical yardstick: how many villages spontaneously organised their own quarantine at the first indication of an outbreak. Though he gave no details, he was clearly gratified by the results. By the 1930s, Shansi was regarded as a mode
l province, and Yen a model governor.

  * A kang is a large brick or clay heated platform used for sleeping on in northern Chinese houses.

  7

  The wrath of God

  ‘In Bangkok,’ wrote the British journalist, Richard Collier, ‘the British Embassy’s doctor, T. Heyward Heys, noted with dismay that almost all his prize roses had withered and died.’ Owls came mysteriously to Paranhos da Beira, Portugal–a mountain village that had never known owls before–and hooted and screeched on every windowsill, while a faith healer in Montreal predicted a time of pestilence after the sky darkened in daytime, but no storm followed.1

  Fear makes people vigilant. It impels them to notice things they might not otherwise have noticed; to pay attention to certain associations and ignore others; to remember prophecies they might previously have dismissed as absurd. Medieval chroniclers tell how, in the months before the Black Death arrived in Europe in the late 1340s, there were sightings of swarms of locusts, storms of hailstones ‘of marvellous size’, lizards and snakes raining from the sky. These frightening happenings testified to the corruption of the atmosphere that would soon bring an even greater evil in its wake: the plague.2 They fit with medieval man’s notion of miasma, or bad air, as the cause of disease. By 1918, germ theory had largely displaced miasma theory, but Galen’s concept still lurked in the dark recesses of the human mind, and now it enjoyed a revival.

  Some people claimed that the flu was caused by noxious vapours rising from the cadavers left behind on the killing fields. In Ireland, Kathleen Lynn, Sinn Féin’s director of public health, told that organisation’s council that the fever factory was ‘in full working order in Flanders’, and that ‘the poisonous matter from millions of unburied bodies is constantly rising up into the air, which is blown all over the world by the winds’.3 Others suspected human agency in the form of a secret programme of biowarfare conceived by one or other warring nation. This was less outlandish than it sounds. Biowarfare had a long and not very illustrious history. Possibly the first example of it occurred in the fourteenth century when, realising they had been infected with plague, Mongol forces laying siege to the Black Sea port of Kaffa (now Feodosia in Ukraine) hurled their dead over the city walls. Plague ripped through the city and the few who escaped fled west, taking it with them. Now, reaching for the aspirin packets manufactured by the German drug company Bayer, people in the Allied nations wondered if aspirin was all they contained. In Washington DC, meanwhile, newspapers reproduced comments made by Lieutenant Philip S. Doane, head of the health and sanitation section of the Emergency Fleet Corporation, in which he raised the spectre of German U-boats beaching in America and deliberately sowing the flu. ‘The Germans have started epidemics in Europe, and there is no reason why they should be particularly gentle with America,’ he was quoted as saying.4

  These theories shrivelled and died, like Dr Heys’ roses, as it became clear that soldiers on both sides of the front were dropping like flies. But other theories implicating an invisible hand took their place. How else could people explain the breathtaking cruelty of the disease? It became apparent very early on that, besides the elderly and the very young, it had a predilection for those in the prime of life–people in their twenties and thirties, especially men. Women seemed to be less susceptible, unless they had the misfortune to be pregnant, in which case, stripped of that invisible shield, they lost their babies and died in droves. The peak age of death in that middle group was twenty-eight, which meant that the disease was felling the pillars of families–including soldiers who had survived the war–and cutting the hearts out of communities. The Austrian artist Egon Schiele left a testament to that cruelty, in an unfinished painting he called The Family. It portrays him, his wife Edith and their infant son, a family that would never exist because Edith died in October 1918, when she was six months pregnant with their first child. Schiele died three days later, having painted The Family in the interim. He was twenty-eight years old.

  Another thing: how could you explain the randomness with which the disease selected its victims, if not as the work of a vengeful or vindictive force? Yes, the young and fit were in the firing line. But why was one village decimated, while a neighbouring one got away relatively unscathed? Why did one branch of a family survive, while a parallel one was snuffed out? In 1918 this apparent lottery was inexplicable, and it left people profoundly disturbed. Attempting to describe the feeling to Collier, a French doctor who was in the city of Lyons at the time, Ferréol Gavaudan, wrote that it was quite unlike the ‘gut pangs’ he had experienced at the front. This was ‘a more diffuse anxiety, the sensation of some indefinable horror which had taken hold of the inhabitants of that town’.5

  One of the most striking examples of this randomness took place in South Africa. The two great industrial centres in that country at the time were the gold mines of the Witwatersrand, or Rand, and the Kimberley diamond mines, dominated by the mighty De Beers Company. Between them these two economic powerhouses had driven the development of a railway system that had spread its black tentacles across southern Africa, keeping the ravenous maw supplied with cheap migrant labour. Trains set off from the port cities of Cape Town and Durban and penetrated deep into the rural interior, where they took their fill of African male youth before steaming a thousand kilometres north to disgorge their cargo into the mineral-rich heartlands.

  The trains were spartan and became increasingly crowded as they stopped at each backwater on the two-day journey north (the Swazi word for train, mbombela, means ‘a lot of people in a small space’). But if conditions were bad en route, they were only a taste of what was to come. At the mine compounds, men were allocated to overcrowded dormitories that consisted of concrete bunks built into the walls. Washing facilities were inadequate, food was scarce, and there was no privacy. Poorly lit and badly ventilated, these dormitories resounded with the miners’ hacking coughs. Pneumonia was rife in Kimberley and on the Rand, because bacteria that caused it thrived in the cramped, humid underground spaces where the men worked. A lung that has been weakened by one infection is generally easier for another to invade. The two populations, in other words, were extremely vulnerable to a new respiratory disease–but on paper, at least, they were equally vulnerable.

  Both the gold and diamond mines were affected early in the epidemic in South Africa, and because the companies that owned them kept track of their employees for accounting and legal purposes, we know what happened there. The flu reached the Rand first, by about a week, and the miners immediately knew they were confronting something other than the pneumonia epidemics that periodically tore through them, because this disease did not discriminate between new hands and old-timers. The vast majority of those who fell ill recovered, however, and the authorities breathed a sigh of relief. They then turned to watch with relative sangfroid as it advanced towards Kimberley. Their sangfroid turned to horror as the death rate in Kimberley quickly climbed to a staggering thirty-five times that recorded on the Rand. More than 2,500 diamond miners–almost a quarter of Kimberley’s working population–died that autumn, and health officials could not explain why (they can now, as we’ll see later).

  In 1987, 43 per cent of Americans saw AIDS as divine punishment for immoral sexual behaviour.6 In 1918, when a more mystical, pre-Darwinian era was still in living memory, and four years of war had worn down people’s psychological defences, it was even easier for them to fall back on the belief that epidemics were acts of God. They looked for and found evidence to confirm them in that belief. A year earlier, the child visionaries of Fátima in Portugal, Jacinta and Francisco Marto and their cousin Lúcia Santos, had claimed that the Virgin Mary had appeared to them on numerous occasions. Now, as the Marto siblings languished with flu, they reported a new visitation. ‘Our Lady appeared to them and dissolved any possibility of a riddle with her simple statement that she would come for Francisco first and for Jacinta not long after that,’ wrote their biographer. ‘Their dry and fevered lips cracked under the
strain of their smiles.’ The children died, in the predetermined order, and their burial place became a site of Catholic pilgrimage.7

  But if the Spanish flu was a punishment from God, what crime were people being punished for? There was no shortage of theories: the senseless war, of course, but also–depending on your position in society–degeneracy in the underclasses or the exploitation of indigenous peoples by their colonial masters. For some, however, it was retribution for something much more profound: people’s decision to turn away, en masse, from the one true path. This was the case, for example, in one city in Spain.

  A SIGNIFICANT VICTORY

  The Spanish city of Zamora–known as la bien cercada, or well enclosed, due to its impressive fortifications–straddles the River Duero in the north-western region of Castile and León. Deeply religious, it is famous even today for its sombre processions of hooded, barefoot penitents in Holy Week. In 1914, when its citizens learned that they were about to receive a new bishop, the bells rang out for three days. The man himself arrived a few months later, stepping down from a specially chartered train to a railway station packed with well-wishers. Fireworks were let off, and a joyful crowd accompanied him to the cathedral where he took his oath of office. The church-sanctioned newspaper, El Correo de Zamora, promised obedience to the new bishop, and praised his eloquence and youth.