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

by Laura Spinney

  The party returned later in the day to sprinkle the village with kerosene and set fire to it, shooting three more dogs the size of timber wolves. Once the fire had taken, they headed back downriver, and on 28 June the Unalga set a course for Unalaska. ‘All hands glad of it,’ wrote the cook, who would return twice more to the Bering Sea, though never again with Captain Dodge. Three days later, the Marblehead steamed south for San Francisco, bringing McGillycuddy’s Alaskan adventure to an end. For the next twenty years of his life, until his death at the age of ninety, he worked as the house doctor at the Claremont Hotel in Berkeley, California.

  The epidemic tailed off over July, by which time it was clear that the salmon run had failed again. Bristol Bay, the region of Alaska that was affected worst by the Spanish flu, had lost around 40 per cent of its population, and the Yupik who survived would recall that period as ‘Tuqunarpak’, which translates roughly as ‘big deadly era’. The Nushagak area seems to have been particularly hard hit. Some villages, Igyararmuit among them, had simply ceased to exist; others were so devastated that their remaining inhabitants abandoned them. During his 1912 expedition, French had counted nineteen villages along the Nushagak River, that varied in size from fifteen to 150 inhabitants (only three of them were marked on the map). Assuming an average of seventy inhabitants, that gives an estimated total population of 1,400. In 1920, Father Hotovitzky reported that, in Nushagak parish, ‘No more than 200 parishioners were left in all the villages.’24

  Apparently oblivious to the ugly rumours that had dogged him on his paschal peregrinations, Hotovitzky had prepared an audit of the Aleutian Deanery for His Eminence Alexander Nemolovsky, Archbishop of the Aleutian Islands and North America. Despite the benevolent intervention of martyr and healer St Pantaleon, he explained, the parishes for which he was responsible had been much reduced in 1919. ‘Those parishioners who survived saw out the year piously, by the Grace of God,’ he wrote, adding: ‘In Nushagak itself, the church was closed because there are no Orthodox left. During the epidemic, many objects were stolen from the church by the Americans.’25

  Close to 150 orphans were rescued from all points of the bay while the epidemic was raging. ‘They were freezing and shivering in cold huts, without fires or food, with little clothing or bedcovering–many of them crying, huddled about their dead,’ reported one APA superintendent.26 More were discovered after the epidemic had receded, and though the figures are unreliable, the eventual number of orphans that was brought to the hospital at Dillingham–a town of fewer than 200 inhabitants at the time–may have been closer to 300.27

  To begin with, the nurses’ principal dilemma was how to dress them. ‘Many had only clothing made from old flour sacks obtained from trading posts scattered through the vicinity,’ wrote Miller.28 French appealed for government funds to build an orphanage, and these were granted. It would be the doctor’s final gesture: in the months following the epidemic, he left Bristol Bay, never to return. Nearly half a century later, an anthropologist named James VanStone who made a study of the Yupik noted that, once grown, most of the flu orphans had tended to stay in and around Dillingham, rather than return to their places of origin. Today, all the indigenous residents of Dillingham claim to be descended from them.

  PART FIVE: Post Mortem

  British soldiers bathing in the sea at Étaples, 1917

  11

  The hunt for patient zero

  ‘We desire to present in this preliminary note a consideration of the similarity of the present epidemic to the epidemic of pneumonic plague which broke out in Harbin, China, in October, 1910, and spread rapidly and continuously throughout Northern China at that time; and to suggest that this epidemic may be the same disease modified by racial and topographic differences.’1

  So wrote James Joseph King, a captain in the US Army Medical Corps, on 12 October 1918. Even in 1918, medics doubted that Camp Funston–the military base in Kansas where cook Albert Gitchell fell ill on 4 March 1918–was the origin of the ‘Spanish’ flu. Alternative theories emerged while the pandemic was still raging, and initially they pointed to China. Where Captain King led, others followed. The quick pointing of fingers to the east was probably influenced–albeit often unconsciously–by contemporary western attitudes towards the peoples of East Asia, known collectively as the myth of the ‘Yellow Peril’. At its most extreme, this xenophobia manifested itself in accusations that Asians were to blame for falling birth rates in Europe, rising criminality, the kidnapping of women for the white slave trade and even vampires (who were supposed to have reached Transylvania from China via the Silk Road).2

  Captain King was undoubtedly sincere, but the possibility didn’t even occur to him that the pandemic might have been seeded in his own country. Americans were, naturally, only victims. ‘Since our soldiers and sailors have been returning from the battlefields of France,’ he wrote, ‘[the disease] has become very prevalent and serious in our camps and cities all over this country.’ However, the Chinese-origins theory has been revived in recent years, in the light of new historical evidence regarding the role that China played in the war. The Yellow Peril notwithstanding, it remains a possibility that the pandemic did start in the east, and to understand why we have to go back to an outbreak of disease in Manchuria in 1910–the very outbreak, indeed, that King referred to in his ‘preliminary note’.

  China in 1910 was known as the sick man of Asia. It was sick in the real sense, having a gargantuan public health problem, and it was sick in the metaphorical sense, having bled land and autonomy to foreign powers since the middle of the previous century. The outbreak in the sensitive frontier region of Manchuria dissolved the tenuous distinction between the real and the metaphorical, and when news of it reached the mandarins in Peking, they recognised it for what it was–the first, distant death knell for the ruling Qing dynasty. Revolution was in the air, and the empire was weak. Russia and Japan had already run rail lines into mineral-rich Manchuria, and Japan had recently annexed Korea, so that it now shared a border on the mainland with its ancient foe. A plague that posed a threat not only to those nations, but also to Europe and America, which had their own interests in China, would provide them with the pretext to invade–with men in white coats leading the charge. The mandarins knew they had to bring the plague under control without foreign intervention. They had to put it in the hands of a doctor they could trust–one of their own. The man they chose was Wu Lien-teh (Wu Liande).

  The son of a Chinese goldsmith, Wu was born in Penang, a British colony in what is now Malaysia, in 1879 and graduated from Cambridge University in 1902–the first medical student of Chinese descent to do so. He went on to study with Mechnikov in Paris, and Koch’s student Carl Fränkel in Halle, Germany. In 1908, following his return back east, he took up a post training military doctors at the Imperial Army Medical College in Tientsin. This is where he was when, in November 1910, he received a telegram from the Ministry of Foreign Affairs, ordering him to go north and rein in the epidemic.

  When Wu arrived in the Manchurian city of Harbin, near the Russian border, he found conditions there unsatisfactory. ‘The local magistrate was a confirmed opium smoker, prided himself upon being an amateur physician and did not believe in germs or foreign medicines,’ he later recalled.3 There were no hospitals, only ‘filthy’ plague houses into which suspected cases were thrown. Many people had already fled in panic, and others were preparing to travel south to celebrate the Lunar New Year with their families. Wu suspended all non-essential train travel and turned schools, theatres and bathhouses into disinfection stations. Temples and deserted inns became plague hospitals, idle train wagons isolation wards. Seven hundred police and a thousand soldiers were put at his disposal, and he used them to enforce house-to-house searches and quarantine. The Manchus were less than cooperative. Terrified of quarantine, and justifiably–they had seen there was little chance of returning from it–they were also bound by the obligations of filial piety. They would often fail to report a case while th
e patient was alive, and sometimes try to hide the corpse when he or she was dead.

  Wu quickly suspected that he was dealing with pneumonic plague. His patients were reporting fever and chest pain. Soon they were coughing up blood and their skin had taken on a purplish hue. Nobody who fell sick survived, and death typically came within a few days. Merely suspecting plague was not enough, though. He knew that to identify the disease definitively he would have to isolate the plague bacterium, which meant performing an autopsy. In pre-revolutionary China, violating a corpse was a serious crime, one that could itself be punished by death, so it’s an indication of the seriousness the mandarins accorded the epidemic that they granted him an imperial dispensation to do just that. Having performed the autopsy on the body of a female Japanese innkeeper near Harbin, he analysed the bacteria cultivated from her lung tissue and found that she had indeed been infected with Yersinia pestis. Meanwhile, the bodies of plague victims were piling up outside the city. The temperature was minus twenty, the ground frozen solid; burial was out of the question. Wu obtained a second dispensation to cremate the corpses–another practice wholly contrary to Chinese custom–and the pyres burned for two days throughout the Lunar New Year at the end of January.

  The epidemic petered out in April, and Wu’s imperial masters were delighted. Though it had spread as far south as Hopei (Hebei) and neighbouring Shantung (Shandong) provinces, though it had claimed 60,000 lives, it had not breached Chinese borders. The threat of invasion had been averted. ‘The high rank of major of the Imperial Army with blue button was conferred upon me overnight,’ Wu boasted, ‘so as to enable me to receive imperial audience without unnecessary formalities.’4 The reprieve for the Qing was short-lived, however. The following October, the dynasty was overthrown and a Chinese republic was born. The diminutive, silver-tongued Wu (he stood five feet two, or one metre sixty, in his stockinged feet) found favour with the new regime, and in December 1917, he was called out to deal with another deadly epidemic of respiratory disease.

  This time, the outbreak had been reported in Shansi–Governor Yen’s fiefdom–and among Wu’s fellow plague-fighters was the missionary Percy Watson. Wu was about to discover that his ideas were no more popular in the countryside than they had been seven years earlier, least of all in conservative Shansi. When he tried to perform an autopsy without first asking permission from relatives of the deceased, an angry crowd surrounded the coach that served him for accommodation and set fire to it. It was this incident that persuaded Watson not to perform an autopsy in Wangchiaping one year later–the autopsy that might have enabled him to make a definitive diagnosis–‘because of the great trouble caused in Northern [Shansi] last year when Dr Wu Lien-teh got such a specimen’.

  Wu escaped and fled to Peking, taking with him the couple of tissue samples he had managed to obtain, and on 12 January 1918 he announced that he had found the plague bacterium in them. Other doctors who had been to the epicentre of the outbreak immediately contested his diagnosis, as did officials in Shansi. Though it certainly bore many of the hallmarks of that disease–bloody sputum, chest pains, fever–they deemed it milder than the epidemic of 1910. Strikingly, death was the exception rather than the rule. The officials insisted that it was merely a severe form of ‘winter sickness’–something more like influenza.

  If it was influenza, one thing is certain: Wu would have had no way of demonstrating it. Still, he claimed to have seen the plague bacterium. Some have suggested that he exaggerated his confidence in his diagnosis to convince the authorities to put in place the containment measures he considered so vital, or more simply, because he had already convinced himself that he was dealing with plague. Whatever the truth, a doubt hangs over the nature of the disease that ravaged Shansi in the winter of 1917, and that doubt has fuelled speculation that it was in fact the first manifestation of the Spanish flu. If so, how did it travel from isolated Shansi to the rest of the world? According to the revived theory of an eastern origin, the Chinese Labour Corps (CLC) provides the key.5

  While the epidemic raged in Shansi, war raged on the other side of the world. China had declared itself neutral in 1914, its hands being tied by the fact that warring nations on both sides claimed concessions within its borders (it finally declared war on Germany in August 1917). Right from the start of the war, however, its leaders had tried to find a way of contributing without compromising that neutrality, in order to earn a place at the negotiating table when the inevitable peace process happened. They saw that process as their chance to claw back the territory the last Qing emperors had ceded to foreign powers. The plan they came up with, in cooperation with the British and French governments, was to create a body of labourers who would not take part in combat, but who would take on the heavy lifting behind the lines–digging trenches, mending tanks and assembling shells. This was the CLC, and beginning in 1916, in a largely secret operation, as many as 135,000 men were transported to France and Belgium under its auspices, while another 200,000 went to Russia.

  These men were carefully selected from northern Chinese populations who were considered taller, on average, and more suited to a cold climate than southerners. Most were peasant farmers from Shantung and Hopei provinces, though some came from as far away as Shansi. Hopei is sandwiched between Shansi and coastal Shantung, and all three provinces were affected by the ‘plague’ of the winter of 1917. The British often used missionaries to recruit them. American journalist and secret agent Josef Washington Hall was travelling in Shantung when he came across one ‘recruiting coolies by means of his marvellous oratory in the temple square’. The priest, famous in those parts, was known by his Chinese name, Pastor Fei. Hall recounted that Fei Mu-sa told the crowd:

  I have come to tell you of an opportunity to see the world. Those of you who are able-bodied shall sail across two seas to the land where men look the opposite way from you to see the sky, where there are buildings as large as a walled village, in cities as clean as a threshing floor. You shall work there only one-third of each twenty-four hours, and each receive the pay of three men, while your families will be paid their food money each month here at home. You will be safe from danger, for iron masters as large as three-beam houses will protect you. And when the great British king has won victory he will send you back to your homes with enough money to buy you each a new field, and a reputation which will make you esteemed of your neighbours and posterity. All this I swear by my honour. If it is not true, when you come back, look me up.6

  It wasn’t true, unfortunately–though history doesn’t relate if those whom the pastor swayed did look him up on their return. They would be mistreated as racially inferior ‘chinks’, exploited, and not always kept at a safe distance from the front line. From the spring of 1917 they were recruited mainly at Tsingtao (Qingdao) in British-occupied Shantung, where they were subjected to a medical inspection before being dispatched around the world. This inspection was quite rigorous, until the numbers of recruits grew very large and the system started to break down, but it was designed to weed out mainly diseases considered ‘Asian’–such as trachoma, that can cause blindness–not common-or-garden flu (for which, anyway, they had no test). Those labourers destined for France or Belgium went eastward via Canada or westward via the Cape of Good Hope. If they took the easterly route, they entered Canada at Victoria, British Columbia. The voyage took three weeks, they were packed like sardines into poorly ventilated holds, and conditions at the William Head Station on Vancouver Island where they were quarantined weren’t much better. Herded onto sealed trains that were protected by armed guards, they were then ferried across the country to Montreal or Halifax, from where they embarked on the final sea voyage to reach the killing fields of Europe. Those who went west entered France at Marseilles.

  Slivers of circumstantial evidence exist to support the Chinese-origin theory. The numbers of men at the Tsingtao depot swelled over the winter of 1917–18, and by January many of them were complaining of sore throats. Something like flu was in the
air when Pastor Fei was recruiting in Shantung. Although Hall doesn’t mention the exact date when he saw him, it was in the spring of 1918, and that night Hall woke with a chill. ‘The next morning,’ he wrote, ‘I had every symptom of the influenza or “small plague” as the Chinese call it, though it has killed a million or two of them.’ Thousands of CLC recruits left Tsingtao that spring, and there is some evidence of a spike of respiratory disease in the soldiers assigned to guard them on Vancouver Island. This might have been nothing more than seasonal flu, but either way, the soldiers mixed with the local civilian population and could have passed it on.

  There is nothing more than circumstantial evidence, however, because we don’t know what the disease was that erupted in Shansi in late 1917, and receded the following April, having claimed an estimated 16,000 lives. Wu Lien-teh came the closest to identifying it, but fairly or unfairly, a shadow hovers over his credibility, and since the tissue samples he risked his life to obtain no longer exist, as far as we know, it will hover there forever.