Scientific research and understanding often follow pandemics; viruses were identified in 1933, more than 10 years after what is now commonly referred to as the Spanish Flu. In the face of uncertainty and partial knowledge, government decisions and popular perceptions just over a hundred years ago were shaped by cultural and political preoccupations, prejudices and already existing priorities. Scientists estimate that between 1917 and 1920 a quarter of the world’s population were infected by the Spanish Flu; between 50 and 100 million of them died.
In the West Midlands, the first cases appeared in April 1918. Britain was war-weary, from nearly four years of conflict; there was little hope of an end to the stalemate on the Western Front and the Germans were poised to retake Passchendaele. Those on the home front were struggling to cope with the death and disruption caused by men fighting in foreign fields, alongside Zeppelins and aeroplanes bombing Britain. Housewives battled to feed their families as food shortages led to price rises, food queues and finally the introduction of rationing in 1918. At a national and local level winning the war was prioritised, concern about the influenza focused on how it compromised war production or the health of soldiers required for battle. Many in the Army Medical Corps considered that they had more pressing medical issues than flu, which was often seen in derisory terms as a mild complaint, compared to sepsis, gangrene, lice and enteric fevers. During this initial wave of the pandemic, which abated by late July, newspapers, doctors, propaganda and politicians conveyed the message that ordinary people should either ignore it, smile through the threat of illness, or take care of themselves. The Birmingham Mail reassured its readers that ‘fortunately the disease is not of a virulent type, carrying with it any actual danger’. Mortality figures suggest otherwise.
By early autumn 1918, a more lethal strain of the flu had arrived, lasting until the end of December. In November, as the guns of battle fell silent, Dr Masbyn Read, the Medical Officer of Health in Worcester, reassured the local population that although there had been 41 deaths from influenza in the city the previous week the ‘disease is past its worst’. The local press, however, noted that the disease was still widespread in Evesham and Stourport. Over 1,500 cases were reported in Kidderminster, which was considered to be particularly badly hit. Many workers were absent from the carpet and spinning mills in the town. There was a shortage of comics in Worcester, purchased to keep sick children amused when confined to bed. Despite demands made for theatres and cinemas to be closed or more tightly regulated, they were used to give the public information about preventing the spread of the disease, including the infamous film Dr Wise and a Foolish Patient. Schools were closed in some areas for 2 or 3 weeks, occasionally longer, despite anxiety that children running around the streets unsupervised would spread the disease.
Despite the Armistice, the war was not officially over until the Versailles peace treaty was signed on 28 June 1919, with the result that Germany continued to be blockaded and the British government was slow to release the doctors and nurses in the armed forces that were needed to combat the disease and care for the sick. Many doctors and medical students had volunteered for the forces and in early 1918 the government had raised the call up age for doctors to 55. Although elderly doctors were encouraged to return to practice, the number of doctors able to minister to patients in the West Midlands was heavily depleted. Doctors were run off their feet as were undertakers and vicars. Long queues were seen at chemist shops, people consumed lethal doses of aspirin. Charlatans made spurious claims and significant profits for patent products such as Dr William’s Pill for Pale People. Consumers were requested not to hoard Bovril, thought to prevent or at least aid recovery from the flu. The failure to release undertakers and grave diggers from the forces in late November 1918, or to make stocks of whisky (considered a cure) freely available, were widely criticized. A government with one priority – in this case winning the war – could not quickly change course and marshal resources to deal with another. Nevertheless, by late November, as the general election campaign got underway, soldiers in Britain were deployed to help dig graves and whisky could be obtained with a letter of recommendation from a doctor.
In European history and memory, the devastating consequences of the pandemic have often been either eclipsed by or entwined with the death and injury caused by the First World War. In all continents the flu was responsible for many more deaths than war and it was particularly devastating in India. In Britain approximately 850,000 were killed in armed combat whilst 240,000 died from the virus, although diagnosis was not always reliable. A unique feature of this pandemic was that it disproportionately affected younger adults; the peak age of death was 28. Thus, for many ordinary people like Mr and Mrs Slade Nash of Martley, Worcestershire, influenza was yet another element of the misery and sorrow that warfare inflicted upon their lives. They had already lost two sons in the war when their daughter Margaret died from influenza in October 1918.
Whilst the First World War did not cause the pandemic, the mobility of people in wartime (shifting between countries or regions) helped to spread the Influenza. The Spanish Flu is now understood to have originated in Kansas in the USA, and was brought to Europe by soldiers sailing across the Atlantic to fight on the Western Front. As a neutral country Spain was not subject to the censorship other countries had experienced, and freely reported on the progress of the disease, particularly when King Alfonso XIII and members of his government became unwell, and people came to associate the disease with Spain. The Times noted on 18 December 1918 that once the disease had reached London it radiated out through Birmingham, Nottingham and other major centers via the rail networks. Public activities, schools, factories, churches, cinemas, theatres and public transport and Armistice Day celebrations all helped to spread the virus. Soldiers on the battlefronts, on leave, in training or prisoner of war camps, in hospitals, or when demobilised, were efficient carriers of influenza.
In the absence of any genuine scientific understanding of viruses and how the influenza actually spread, multiple different explanations and theories emerged, shaped by prevailing cultural prejudices, xenophobia and class prejudice. The Birmingham Daily Post pointed out in June 1918 ‘the man in the street … is sometimes inclined to believe it is really a form of pro-German influence’. The ‘unseen hand’ of the enemy was supposed to be spreading the illness. A quarter of a million Germans died from disease, nevertheless for some who were hyper-patriotic the link between germs and Germans was very close and a number of nicknames emerged for the virus that embodied this prejudice including ‘Flanders Grippe’, ‘Hun flu’, and the ‘Turco-Germanic bacterial criminal enterprise’. Soldiers writing from the front or visiting Britain on leave or to convalesce also conveyed rumours that the heart of this ‘German plague’ lay in the unburied corpses on the battlefields or the German’s use of poison gas.
The sense that the conditions of war, exhaustion, war weariness, and food shortages precepted the spread of the disease had more credibility, but was again laced with a touch of anti-German feeling. Thus, the Birmingham Daily Post argued in 25 June, ‘There can be no doubt whatever that it has been recurring in a very severe form in Germany, Austria, and the territories occupied by the Central Powers during the last two years.’ Those who were not convinced that the flu was the intentional work of the enemy powers often perceived it as an unintentional consequence of war and the arrival of groups of workers or troops from abroad. The French blamed the Spanish and in particular the Spanish workers who replaced French men who had joined the armed forces, whilst the Spanish singled out the Portuguese for culpability. The Germans apparently suggested that the flu had been imported by the 100,000 men who worked behind the lines, assisting the Allies in France, as part of the Chinese Labour Corps.
Other explanations for the Influenza included: the wartime propensity to dig up the land to grow more food, poor housing, and dirt. The Medical Officer of Health in Worcester long maintained that combatting this disease was a ‘purely a personal matter’ and that the spread was ‘due to the carelessness of individuals’. Newspapers warned against overcrowding, indiscriminate spitting and alcoholism and encouraged thorough cleaning of houses and whitewashing walls. Cultural assumptions and prejudices towards densely populated working-class areas of industrial cities was not however supported by evidence; influenza was a remarkably democratic illness. The Evesham Journal pointed out on 2 November that ‘All classes of the community are affected, and it appears to take an even more virulent form with the apparently hale and hearty.’ In the village of Badsey, where locals and 200 German prisoners of war worked on the land, the virus was rife.
This swirling mishmash of explanations, rumours, accusations and assumptions about the flu did have two positive longer-term influences. They added weight to arguments for the setting up of the Ministry of Health in 1918 and for slum clearances and the building of working-class housing in the inter-war years across the region from Birmingham to Tewkesbury.
The material in this blog is drawn from Maggie Andrews and Emma Edwards, Bovril, Whisky and a Shortage of Gravediggers: The Spanish Flu comes to the West Midlands (History West Midlands, 2019).