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

by Laura Spinney

  It probably also worked in the Italians’ favour that the military had been badly affected (the US Army lost more men to flu than to combat, partly due to those deadly transports), and that many of the soldiers who died were of foreign birth. Some Italians had gone to Europe to fight even before America had entered the war, while an estimated 300,000 men of Italian origin joined the US Army.

  Public funerals were banned in New York City during the pandemic, only spouses being allowed to accompany the coffin, but the authorities seem to have turned a blind eye on 27 October, when the funeral of Corporal Cesare Carella took place at the Church of Our Lady of Pompeii in Greenwich Village. Corporal Carella had survived the war only to die of Spanish flu, and large crowds gathered to watch his coffin pass on its way to the church. It was draped in the Italian flag, on which rested a bouquet of flowers and the distinctive wide-brimmed hat decorated with black capercaillie feathers that Carella had worn as a member of the Bersaglieri, a light-infantry unit of the Italian Army. American and Italian flags hung lowered from the windows along the route taken by the cortège, and the priest who addressed the packed church spoke, according to Il Progresso, ‘as only an Italian priest can, who has faith and la patria in his heart’. Afterwards, the congregation accompanied the coffin all the way to Calvary Cemetery in Queens. There, unfortunately, there was a backlog of coffins waiting to be buried–Copeland discovered 200 of them when he visited two days later. The day after the health commissioner’s visit, the mayor of New York, John Hylan, ordered seventy-five men to go to Calvary and clear the backlog.

  Copeland may even have unwittingly pushed the Italians a step closer to assimilation. In September, a couple of days after making the flu a reportable disease–but before officially acknowledging the epidemic–he made hospitalisation compulsory for all flu patients living in shared accommodation. This included, of course, the crowded tenements. The reaction of the hospital-averse Italians is not recorded, except for one intriguing item in Il Progresso. The community, it reported on 25 September, had at last roused itself from its ‘paralysing lethargy’, and donated enthusiastically to a fund for a new Italian hospital in Brooklyn.

  In fact, the sporadic cases of nativist prejudice that did occur in New York that autumn were directed mainly at those of German origin. In general, Il Progresso was punctilious about scotching wild rumours concerning the flu–including one that nurses and doctors found guilty of spreading flu germs among soldiers had been shot at dawn–but it couldn’t resist passing on one story about a man who had allegedly given books to children outside a school on Long Island, telling them to scratch the pages to reveal images of President Wilson and other famous figures. His suspicions aroused, the headmaster had rounded the books up, noticed ‘Made in Germany’ printed on the back, and sent them off to be tested for flu germs (the results were awaited).

  The flu also brought the Italians a new and powerful champion in Copeland. He now lent his support to reforms that Stella and other immigrant spokespeople had been advocating for years, declaring war on slum landlords and campaigning for better public housing. He argued that medical examinations of immigrants should take place before departure from the home country, to avoid exclusion on arrival, and lamented the waste of good farmers who were forced to scrape a living as ‘poor city peddlers’ in America. A year after the epidemic, the New York State legislature granted him $50,000 (around $900,000 in today’s money) for a major study on the ‘suppression and control of influenza and other diseases of the respiratory tract’, and he went on to make sweeping changes to the city’s public health structure, as part of which lectures were thenceforth organised in stores and factories in Italian and Yiddish.20

  The city’s first public housing project was initiated in 1934, on the Lower East Side. The mayor at the time was Fiorello La Guardia, the son of Italian immigrants and a former translator at the immigration depot on Ellis Island, whose first wife had died of TB aged twenty-six. ‘Tear down the old, build up the new,’ was how La Guardia presented the project at its unveiling in 1936. ‘Down with rotten antiquated rat holes. Down with hovels, down with disease, down with firetraps, let in the sun, let in the sky, a new day is dawning.’

  THE ILLNESS OF WINDS

  Ahmad Qavam al-Saltaneh arrived in Mashed in January 1918, having made the ten-day journey across the desert from Tehran, probably in a horse-drawn diligence. I imagine him pausing on the Mount of Salutation–the place where pilgrims caught their first glimpse of the martyr’s tomb–and gazing down on the golden dome glittering in the sunlight. He knew that a Herculean task lay ahead of him: the government had sent him to take charge of a city on the brink of anarchy.

  Mashed at that time was the only city in Persia’s vast north-eastern province of Khorasan. A sacred site for Shi’ite Muslims, it received the equivalent of its 70,000 inhabitants each year in pilgrims from all over the Shi’ite world. They came to pray at the shrine of Imam Reza, the eighth of twelve sacred imams considered by Shi’ites to be the spiritual heirs of the prophet Muhammad. But it was also a centre of the saffron and turquoise industries, known, too, for its beautiful carpets, and an important stop on the trade route from British India to the west, and from Persia to Russia.

  The government, 900 kilometres away in Tehran, had little or no authority in Mashed, but Mashed was not immune from the political and economic crisis that had engulfed the rest of the country. For more than half a century, Persia had been a battleground for imperialist interests–the backdrop to the so-called ‘Great Game’, in which the British and Russians struggled for control of the huge area between the Caspian and Arabian Seas–and by 1918 its government was weak and almost bankrupt. Persia was, by then, a de facto protectorate.

  A little over a decade earlier, in 1907, the British and Russians had signed a convention carving the country up into three zones–a northern Russian zone, a southern British zone, and a neutral zone in between–and this uneasy truce had held until war broke out in 1914. Persia declared itself neutral at the outset, but it didn’t make much difference: it became a theatre of war by proxy. The British and Russians found themselves fighting on the same side against the Ottomans–who were threatening the country from the north-west–and their German allies. For the British, Persia was an essential buffer protecting the jewel in the crown, India, from their enemies, so when the tsarist Imperial Army collapsed in the wake of the Russian revolutions, and a power vacuum opened up in the northern zone, it worried them greatly. As soon as the Russians signed the Treaty of Brest-Litovsk, the British moved to occupy the whole of the east of the country. Mashed, which had always been a valuable listening post for them, became in the spring of 1918 an even more valuable military base.

  By 1918, however, Mashed was not a comfortable place to be. It was a city under siege, controlled in all but name by tribes in the surrounding mountains who, long in the habit of robbing pilgrims as they approached the shrine on mule or horseback, were now brazenly sending raiding parties into Mashed itself. Pilgrims continued to converge on it, only now their numbers were being swollen by White Russian soldiers, many of whom had been wounded in fighting with the Bolsheviks further north. And there was famine. Two successive harvests had failed due to lack of rain, and the hunger had been exacerbated by the occupying armies’ requisitioning of grain to feed their troops.21

  Qavam set about restoring security to the city. He had a reputation as a deft negotiator, but he wasn’t afraid to use force, if necessary, to get things done. He had some of the tribal chiefs arrested and placed in chains while they awaited punishment under sharia law. Public executions soon became a regular feature of Mashedi life. Some of the tribes were left in peace at the request of the British, who needed them for their troop levy, while with others he negotiated. ‘The Governor General has satisfactorily settled the outstanding difficulty with the Hazara Chief Saiyid Haidar,’ reported the British Consul General, Colonel Grey, a few months after Qavam’s arrival. He had apparently persuaded Haidar to surre
nder 200 rifles in exchange for dropping all charges against him.22

  The supply situation was harder to resolve. By the spring of 1918, the American minister to Persia, John Lawrence Caldwell, was reporting that Persians were eating grass and dead (rather than slaughtered) animals, even human flesh. The price of bread had quadrupled since 1916, though wages had not risen, and meat was no longer to be had in Mashed. The shrine was taking in abandoned babies, and people were lying down in the streets. Some sought sanctuary or bast in telegraph offices, an ancient custom in times of trouble, though their choice of refuge may have been inspired by a more recent belief that the wire would carry their pleas directly to the shah’s palace in Tehran.

  The famine was at its worst in June. By then, the British were feeding several thousand people a day, out of a courtyard at the consulate compound, though some have argued that the British relief effort was paltry by comparison with the stocks they had requisitioned.23 Grey himself reported that during Ramadan, a well-known Mashedi preacher publicly criticised the British and threatened them with divine retribution. Typhus or typhoid or perhaps both were now raging in Mashed (there was diagnostic confusion over all the diseases present in the city at that time), and towards the end of June, cholera was reported further north, in the Russian city of Ashkhabad. Grey laid in supplies of serum from India and lamented the city’s dismal sanitary situation: ‘Nothing to be done regarding protection of the water supply.’ In July it became clear that the next harvest would not fail, and the famine relief effort was eased back, but the British were still sufficiently concerned about cholera that they tried to discourage large numbers of people from making the traditional pilgrimage from what is now Pakistan to Mashed after the end of Ramadan.24 They were still worrying about waterborne diseases when an airborne plague arrived in town–the Spanish flu.

  It probably came in with a Russian soldier returning from Transcaspia, now Turkmenistan, along a rough-hewn road that wound through the Kopet Dag mountains in the north-eastern corner of the country. Its arrival in the third week of August coincided with that of a cold gale, causing local people to describe it as a disease of evil winds. Within a fortnight Grey was reporting that it had attacked every home and place of business, and that the platoons the British had levied–which were gathered in the city–were badly affected. The woeful inadequacy of the city’s medical facilities now became apparent.

  Apart from the British consulate’s twelve-bed hospital and dispensary, there were two other conventional medical facilities for civilians in Mashed, both small in modern terms: one at the shrine, and one run by American missionaries. The shrine had had its own hospital since the nineteenth century (and some kind of medical facility long before that). It served mainly pilgrims, and occasionally miracles of healing were reported there. But by the time missionary doctor Rolla E. Hoffman arrived in Mashed in 1916, and visited it, he described it as ‘a place where men went only to die; hardly a pane of glass in the whole place, wooden bedsteads without sheets or pillow cases, a dirt floor, no stove’.25

  It might seem surprising that Presbyterian missionaries had dared enter such a holy Muslim site as Mashed, but years later another of them, William Miller, explained the impulse in startlingly simple terms: ‘Since Meshed [sic] was an important center of Islamic devotion, it seemed incumbant [sic] on Christians to raise there the banner of Christ.’26 The first to venture in, in 1894, was the Reverend Lewis Esselstyn. He caused a riot, and a kindly local smuggled him out again, but he was back in 1911, speaking Persian, and this time he managed to stay. When Hoffman joined him five years later, he quickly formed the opinion that it was only because of the medicine they provided that the Christians were tolerated there at all.

  Mashed was still medieval in 1918, but its mud walls were crumbling. It was a city of graveyards where pilgrims who came to die had been buried on top of each other for centuries, and where, from time to time, old graves simply gave out, dissolving into the water supply. This took the form of man-made channels called qanats, that brought the water into the city from the nearby mountains. The water flowed uncovered down the middle of the main street–a permanent throng of pilgrims, merchants, camels and mules–and in the absence of a separate and enclosed sewage system, was easily contaminated. Germ theory had made its mark in Persia by 1918, but only in the literate 5 per cent. When it came to water, most people were guided by a religious prescription according to which water was clean if it was flowing, and if its volume exceeded one korr (350 litres). They therefore washed their pots and pans, their donkeys and themselves, very close to the open qanats.

  The Tehran government had made repeated attempts to put in place a nationwide sanitary infrastructure, including a quarantine system for containing epidemics, but these had so far failed due to a lack of funds and because the British and Russians always managed to subvert them for their own political and commercial ends. For such an infrastructure to work, the country would have had to be united, and in 1918 it was far from that. Local attempts to improve hygiene in Mashed had also failed. When cholera broke out there in 1917, Qavam’s predecessor had set up a sanitary committee that recommended long-term reforms such as moving the cemeteries outside the city walls, and introducing the reporting of contagious diseases, but none of them had been implemented.27

  Because Mashed was a holy city, the shrine managers wielded great power–not only spiritually, but also financially, since the shrine owned large amounts of real estate. In 1918, Islamic thinking was still based on ninth-century teaching when it came to epidemics.28 It accommodated the concept of contagion, but only up to a point. The general rule was that those inside a plague-stricken area should not flee, while those outside it, who were still healthy, should keep away. But there was also a fatalistic element to the prescriptions: plague was a martyrdom for believers and an agonising punishment for infidels. When sick, the vast majority of Persians turned to hakims or herb doctors, who followed two apparently complementary systems of medicine: the Galenic, and one that held that the Quran offered the best protection against disease. They might put an illness down to a humoral imbalance and recommend a change in diet, in line with the first; or they might identify the cause of the illness to be the sting of a jinn, and recommend strapping a prayer to the arm, in line with the second.

  Esselstyn’s missionaries had been run off their feet helping the British consulate distribute food during the famine. Both Hoffman and Esselstyn–who sometimes served as Hoffman’s assistant, tucking his long red beard into his surgical gown–had caught typhus. Esselstyn died, and was buried in the Russian cemetery. Hoffman survived, only to come down with flu. It was at this point that Qavam made his first foray into public health. With the help of the British–and exploiting local fears of a Bolshevik invasion–he had by now taken control of most of the public institutions in the city, and revived the dormant sanitary committee. The committee in turn resurrected the recommendations it had made the previous year, during the cholera outbreak (it had barely had time to do anything else). They included a proposal that the burial of corpses inside the city be prohibited, at least for the duration of the epidemic, along with the bringing of corpses into Mashed from surrounding areas, and that a sanitary inspector oversee any burials that did take place inside the city walls.

  Qavam wrote to the shrine managers on 18 September, asking them to implement the recommendations.29 He was asking them to suspend centuries-old traditions, potentially even challenging sacred texts, and he must have anticipated the possibility of a rebuff, but his famous powers of persuasion saw him through. The shrine’s chief administrator wrote back the same day, stating that, while he had not appreciated certain words and expressions the committee had used, which he had found insulting to the dignity of the shrine, he would nevertheless accede to the governor’s request out of personal respect for him. He then wrote to his subordinates telling them what to do. Perhaps he had been impressed by the scale of the disaster himself, since he agreed that the committee’s i
nspector be allowed to oversee burials, and even that the shrine underwrite his salary. Graves, he ordered, should be at least one metre deep. After the corpse had been placed inside, it should be covered with a thick layer of earth and lime, ‘to eliminate the risk of noxious air rising from the corpse’. Anyone who failed to obey the new rules would be severely punished.

  It was a breakthrough, of sorts, though not one that was likely to rein in an illness of winds–and certainly not at that late stage. The epidemic ran its natural course in Mashed. The worst was over by 21 September, by which time Khorasan and neighbouring Sistan provinces were thoroughly infected, and the flu was travelling west to Tehran at the speed of a ‘prairie schooner’–the American nickname for a diligence. From Mashed, it rippled out with pilgrims, merchants and soldiers to the four corners of the country. By the end of September it was almost gone from the city, though it was still depleting outlying areas. At that point, life for Mashedis eased in one way and one way only: raids and attacks on pilgrims became rare. Qavam’s policy of zero tolerance towards bandits may have begun to bite, but the hiatus was probably also an ominous sign of the havoc the flu had wrought in the mountains.

  In a city with fewer than a hundred hospital beds, some 45,000 people, or two-thirds of the population, had come down with flu. An insight into the state of mind of the survivors–not only in Mashed, but in Persia as a whole–is provided by the words of the city’s chief astrologer, spoken at a public meeting towards the end of September. Astrologers were essentially mystics to whom Persians turned in times of crisis, and whose credibility was bolstered by the Islamic belief in predestiny. The chief astrologer relayed prophecies made a few days earlier by his counterpart in Tehran, to the effect that the British government would be annihilated the following year, 1920 would see the return to Persia of the current shah’s father, who had been deposed in 1909, and 1921 the return of the Mahdi, the long-awaited Twelfth Imam, who would rid the world of evil.