The state of a nation’s health came to be seen as an index of its modernity or civilisation. As disease surveillance improved, and health problems in the colonies of Africa and Asia became more visible, they became an embarrassment to colonial powers. At the same time, the indigenous inhabitants of those colonies became resentful of their own condition and blamed the colonisers for failing to provide adequate healthcare. They looked longingly to Russia and its system of universal coverage. The capitalist west had to come up with its own solution, and often that solution was furnished by the Rockefeller Foundation.
The Rockefeller Foundation was the philanthropic offshoot of Standard Oil, and it had been set up in New York State in May 1913 by that company’s owner, John D. Rockefeller, his philanthropic advisor, Frederick Taylor Gates, and his son, John D. Rockefeller Jr. The foundation’s International Health Division, created six weeks later, would become one of the most important players in international public health between the wars, helping to fight disease, not only in many colonies and newly independent states, but also in western Europe. In 1922, for example, it signed a deal with the Spanish government that put in place the building blocks of a modern health system in that country. It was also influential in helping Wu overhaul medical education in China–notably through the Peking Union Medical College, which it financed.
Rockefeller wasn’t alone. The Pasteur Institute also spread its wings in those years, and in 1922 it set up an outpost in Tehran–the direct outcome of conversations between Émile Roux and the Persian delegates to the Paris peace conference, who had been traumatised by the devastation the Spanish flu had wrought in their country. In the immediate post-war period, when Europe was ravaged by epidemics–not only flu, but also typhus and TB–religious bodies organised humanitarian aid in affected areas, while the Save the Children Fund was set up in 1919 to provide relief for emaciated, disease-ridden Austrian and German children–victims of the war and the Allied blockade.
In the context of all this well-intentioned but relatively uncoordinated activity, a need was perceived for a new kind of international health organisation. The Paris-based International Office of Public Hygiene had been set up in 1907, with the blessing of twenty-three European states, but its function was mainly to collect and disseminate information regarding infectious disease, not to implement public health programmes. Something more proactive was now required, and in 1919, with the support of the Geneva-based International Committee of the Red Cross, an international bureau opened in Vienna with the express mission of fighting epidemics.
It was here, at the international level, that the two opposing forces shaping public health–socialisation and politicisation–now clashed. No sooner had the anti-epidemic bureau opened, than nations began squabbling over whether the defeated powers should be included in it, and anti-Semitic elements started lobbying for Jewish refugees to be quarantined in eastern European concentration camps. (The term ‘concentration camp’ wasn’t new even then, having been used twenty years earlier to describe camps the British built to accommodate Boer women and children during the Second Anglo-Boer War; intended as humane shelters, they were soon overrun by disease.) Questions were also raised over the German POWs who were still in Russia: if there were Bolshevik agitators among them, should they be allowed to return home?
Eglantyne Jebb, the British founder of Save the Children, stood out in this debate for her insistence on inclusiveness–even of Bolsheviks. And it wasn’t just the anti-epidemic bureau that was hijacked for political ends, or perceived to be. Rockefeller was suspected by some of practising neocolonialism under the guise of philanthropy. The foundation saw its mission as bringing American-style enlightenment to ‘the depressed and neglected races’, and it maintained close ties with businessmen and missionaries in the countries to which it delivered that enlightenment (its reputation would later be tarnished by its involvement in Nazi eugenics programmes).
In the early 1920s, the League of Nations established its own health organisation, and this–along with the anti-epidemic bureau, the older Pan American Health Organization and the Paris-based organisation–was the forerunner of today’s World Health Organization (WHO). When both the League of Nations and its health branch collapsed in 1939, at the outbreak of the Second World War, it sent a clear message to the architects of the future WHO: the new organisation should not depend for its survival on that of its parent body, the United Nations. When the WHO was inaugurated in 1946, therefore, it was as an independent institution. By then, eugenics had fallen from grace, and its constitution enshrined a thoroughly egalitarian approach to health. It stated, and still states, that ‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.’
20
War and peace
Erich Ludendorff, the general who led the German war effort, thought that the Spanish flu had stolen his victory. There has been plenty of ‘what if?’ speculation regarding the First World War. What if Herbert Asquith’s Liberal government had kept Britain out of it, as it so nearly did in 1914? What if America hadn’t stepped in three years later? What if Fritz Haber hadn’t discovered a way of manufacturing ammonia from nitrogen and hydrogen gases, allowing the Germans to continue making explosives despite the Allied naval blockade that prevented them from receiving shipments of saltpetre? Things happened the way they did because of a host of complex, interacting processes, and to try to pull one free of the mix risks misleading. Still, Ludendorff’s claim merits closer examination, if only because he’s not the only one to have made it. It has been repeated, in this century, by academics who study wars for a living.
When the Central Powers launched their spring offensive in late March 1918, they had the upper hand. The collapse of the Eastern Front had released large numbers of battle-hardened troops who were now retrained in such modern tactics as infiltration of enemy lines (these were the agile stormtroopers). Though food was scarce both at home and in the trenches, due to the blockade, the Germans felt they had reached a tipping point, and they were optimistic. Allied morale, on the other hand, was low. They were overstretched in terms of manpower and weary from years of failed offensives against the other side. The previous autumn, mutiny had broken out at Étaples, and been brutally put down.
The first phase of the offensive was successful, and by early April the Germans had pushed the Allies back more than sixty kilometres. On 9 April, they launched a second phase, Operation Georgette, and made further gains. In grim mood, the British commander-in-chief Sir Douglas Haig urged his men to ‘fight it out’ to the last. But then Georgette began to run out of steam, and it was called off at the end of April. On 27 May, a third phase began–Operation Blücher–but Blücher was faltering by early June. A successful French counter-attack halted the Kaiser’s Battle in July, and starting in August the Allies launched a series of offensives that pushed the Central Powers out of France and brought the war to an end.
By June, the Central Powers had outrun their supply lines, and they too were exhausted. But as this timeline shows, things started going wrong for them earlier–around the middle of April. It was then that the flu first appeared in the trenches. Both sides sustained heavy casualties from the disease, but Ernst Jünger, a German stormtrooper who had been sent with his company to defend a small wood twenty kilometres south of Arras (the British called it Rossignol Wood, the Germans Copse 125), felt that his side was hit harder. Several of his men reported sick each day, he recalled later, while a battalion that had been due to relieve them was almost ‘wiped out’. ‘But we learned that the sickness was also spreading among the enemy; even though we, with our poor rations, were more prone to it. Young men in particular sometimes died overnight. And all the time we were to be battle-ready, as there was a continuous cloud of black smoke hanging over Copse 125 at all times, as over a witches’ cauldron.’1
Most historians are reluctan
t to suggest that the flu determined the victor of the war, though they do agree that it accelerated the end of hostilities. Two have broken ranks, however, and suggested that the flu ‘punished’ the Central Powers more severely than the Allies, thereby biasing the outcome. Military historian David Zabecki agrees with Jünger’s claim that malnutrition in the German ranks exacerbated the flu among them,2 while political scientist Andrew Price-Smith argues that the lethal autumn wave may have been the last straw for the tottering Austro-Hungarian Empire.3 Ludendorff may have seen the writing on the wall, where Germany was concerned: towards the end of September, he suffered something resembling a nervous breakdown, and his staff called a psychiatrist.
Conditions were very bad in Central Europe by the autumn of 1918, though the true gravity of the situation didn’t become apparent to those beyond its borders until after the war had ended. Writer Stefan Zweig had a foretaste of it when, travelling back to his native Austria in the months following the armistice, his train was stopped at the Swiss border. There he was asked to leave the ‘spruce, clean’ Swiss carriages and step into the Austrian ones:
One had but to enter them to become aware beforehand of what had happened to the country. The guards who showed us our seats were haggard, starved and tatterdemalion; they crawled about with torn and shabby uniforms hanging loosely over their stooped shoulders. The leather straps for opening and closing windows had been cut off, for every piece of that material was precious. Predatory knives or bayonets had had their will of the seats, whole sections of the covering having been rudely removed by such as needed to have their shoes repaired and obtained their leather wherever it was to be had. Likewise the ashtrays were missing, stolen for the sake of their mite of nickel or copper.4
The British economist John Maynard Keynes issued a warning about the dire situation in the defeated countries in his book The Economic Consequences of the Peace (1919). ‘For months past the reports of the health conditions in the Central Empires have been of such a character that the imagination is dulled, and one seems almost guilty of sentimentality in quoting them,’ he wrote, before going on to quote a Viennese newspaper: ‘In the last years of the war, in Austria alone at least 35,000 people died of tuberculosis, in Vienna alone 12,000. Today we have to reckon with a number of at least 350,000 to 400,000 people who require treatment for tuberculosis… As the result of malnutrition a bloodless generation is growing up with undeveloped muscles, undeveloped joints, and undeveloped brain.’ We know that the tubercular were particularly vulnerable to the flu, and if it is true that Switzerland and France received the second wave of the pandemic from the east, as some sources suggest, then Austro-Hungary may have been exposed to it for longer than those countries, and sustained proportionally greater losses. It seems at least possible, therefore, that there is some merit to Ludendorff’s claim, and that the flu favoured the Allies.
What about the peace–did flu have a hand in that too? Some historians think so. The third wave struck Paris in the middle of the peace process, and delegates involved at every level of the difficult and protracted negotiations were affected by it, directly or indirectly. Wellington Koo of the Chinese delegation, who was fighting for the return of Shantung to China–and ultimately, to restore China’s dignity–lost his wife to it. T. E. Lawrence, Lawrence of Arabia–who was accompanying the Arab delegation led by Prince Faisal (later King Faisal I of Iraq)–absented himself briefly to go to England on hearing that his father was dying of the flu. Arriving two hours after Lawrence Snr’s death, he turned around and came straight back, not wanting to be away too long from discussions about the future of the predominantly Arab lands that had until recently belonged to the Ottoman Empire.5 David Lloyd George had recovered from his bout of the previous autumn, but the French prime minister, Georges Clemenceau, was racked with ‘colds’ throughout March and April. Clemenceau had survived an assassination attempt in February, and though these might have been sequelae of the bullet lodged behind his shoulder blade, they might also have been the Spanish flu.
Perhaps the most significant victim of the flu in Paris that spring, however, was the American president, Woodrow Wilson. He soldiered on, but observers noticed that this usually calm and deliberate man became, on occasion, forgetful, irascible and quick to judge (unfortunately his closest advisor, Edward House, also had a bad case). Wilson had an underlying neurological weakness and may have been suffering transient ischaemic attacks–mini strokes–for years.6 Some contemporary neurologists who have studied his case claim that the flu triggered further mini strokes that spring (others disagree, and retrospective diagnosis is a notoriously tricky affair). If so, did they affect the outcome of the negotiations?
Wilson was certainly a key player in those negotiations. Armed with his Fourteen Points, he fought an often lonely battle for a moderate peace and a League of Nations against his more vengeful European counterparts. But one of his recent biographers, John Milton Cooper Jr, doesn’t think his parlous state of health that spring did have a lasting impact. With the important exception of Shantung–which was conceded to Japan in exchange for a pledge to join the League, much to Chinese rage and Wilson’s chagrin–Cooper says that he essentially achieved all his aims in Paris. When it came to the reparations to be paid by the defeated nations, arguably the most damaging product of the peace process because of the humiliation and hardship it inflicted on Germany, the delegates agreed only on the principle, not on the actual amounts to be paid. Those were arranged later, by representatives of all the nations that had ratified the treaty–and as it turns out, the US was not among them.7
But if the experts can’t agree on Wilson’s neurological state in the spring of 1919, they do reach a degree of consensus when it comes to the massive stroke he suffered the following October. His earlier bout of flu certainly did contribute to that, they believe. That stroke left an indelible mark both on Wilson (leaving him paralysed down the left side) and on global politics, in Cooper’s view, because it rendered him unable to persuade the US government to ratify the Treaty of Versailles, or to join the League. Germany was forced to pay punitive reparations, stoking its people’s resentment–something that might not have happened had the US had a say in it. By turning Wilson into the greatest obstacle to his own goals, the Spanish flu may therefore have contributed, indirectly, to the Second World War.
Away from the peace process, the flu shaped other important political events. In March 1919, Yakov Sverdlov, chairman of the All-Russian Central Executive Committee, caught the disease and died within a week. A small, imperious man with a serious voice, who liked to dress from head to toe in black leather, he had been Lenin’s right-hand man since the latter was shot and badly injured in an assassination attempt the previous August. Leon Trotsky reported that Lenin phoned him at the war commissariat with the news of Sverdlov’s death: ‘“He’s gone. He’s gone. He’s gone.” For a while each of us held the receiver in our hands and each could feel the silence at the other end. Then we hung up. There was nothing more to say.’8 Sverdlov was buried on Red Square in the Bolsheviks’ first major state funeral. Sverdlov replacements came and went–all of them lacking his formidable energy, all of them unequal to the enormous task of building a communist state from scratch–until in 1922, Joseph Stalin stepped into the role.
Two months before he fell ill in May 1918, the Spanish king, Alfonso XIII, narrowly avoided a coup. Having risen from his sickbed, he managed to cobble together a new coalition government by pleading with opposing factions to come to the table, and threatening to abdicate if they didn’t. It was his last-ditch attempt to save the turno pacífico, the compromise that had brought to an end the turmoil of the nineteenth century by ensuring that liberals and conservatives took turns to rule in governments chosen by him. Some have argued that had the king not recovered, or had his convalescence taken much longer, Spain would have become a dictatorship a few years earlier than it did. As it was, a coup led by General Miguel Primo de Rivera in 1923 ushered in a period of dictato
rship for which Spaniards had arguably shown their appetite in their calls for a sanitary dictatorship in 1918. They were desperate for a strong hand at the helm, someone to steer them out of their backwater and back into the main European current.9
The autumn of 1918 saw a wave of workers’ strikes and anti-imperialist protests across the world. The disgruntlement had been smouldering since before the Russian revolutions of 1917, but the flu fanned the flames by exacerbating what was already a dire supply situation, and by highlighting inequality. It hurled a lightning bolt across the globe, illuminating the injustice of colonialism and sometimes of capitalism too. The eugenically minded who had noticed how badly the underclasses had suffered tended to blame their inferior stock. But the underclasses had also noticed the disparities, and they interpreted them as proof of their own exploitation at the hands of the better-off. In the French colony of Senegal, for example, it did not go unremarked that colonial doctors had prescribed champagne for Europeans, and wine for natives.10 Revolution broke out in Germany in November 1918, in the midst of the autumn wave, and even well-ordered Switzerland narrowly avoided civil war, after left-wing groups blamed the high number of flu deaths in the army on the government and military command.
Western Samoa experienced one of the highest flu-related mortality rates in the world, losing more than one in five of its population after the infected New Zealand steamer the Talune arrived at its capital Apia in November 1918. The catastrophe exacerbated indigenous resentment against the islands’ New Zealand administration, and the 1920s saw a revival of the Mau–a non-violent protest movement that had been mobilised against the islands’ previous occupiers, the Germans (New Zealand seized the islands from Germany at the outbreak of the war). In 1929, during a peaceful demonstration in Apia, police tried to arrest the Mau’s leader, High Chief Tupua Tamasese Lealofi. A struggle ensued and they fired into the crowd, killing Tamasese and ten others. The Mau’s popularity only grew after that, and following a number of failed attempts, Western Samoa (now Samoa) finally obtained its independence in 1962. Neighbouring American Samoa remains a US territory.
Pale Rider: The Spanish Flu of 1918 and How It Changed the World Page 24
