189. Spanish Flu. Part 1

The 1918-1919 Spanish Flu pandemic is estimated to have killed 50 + million worldwide. In Australia, estimates have about 40% of the population affected to some degree by the virus and between 12,000 -15,000 deaths. In Europe at the time, it was determined that there were 3 waves, with the first in March 1918, the second more fatal wave from September to November 1918 and the third wave in early 1919.

In Australia, the disease was not officially identified until early January 1919 and the initial outbreak was also followed by an equivalent series of waves over the next 12 -18 months. Worldwide, the disease was particularly virulent and, unlike previous historical pandemics, on this occasion the young and fit were particularly susceptible. Death from Pneumonia was a common outcome and, in fact, in Australia the disease was referred to as ‘ Pneumonic Influenza’. The movement of large numbers of soldiers on transport ships played a critical role in the spread of the disease, particularly the movement of US troops to and from Europe over 1918-1919. However, there is still much about the pandemic which remains unknown, including its origin and the reasons for its particular virulence.

This initial post looks at the period through the second half of 1918 as the nature and extent of the threat facing Australia became apparent. A subsequent post next year will cover the actual impact and responses.

The perceived threat posed by the influenza pandemic on Australia was inextricably tied up with views of Australia’s ‘natural’ protection which were themselves tied to its geographical isolation. Admittedly, during the War, many had argued vehemently that Australia was not protected by its isolation. There was the famous 1918 enlistment poster by Lindsay (below) of defenceless Australians being shot by German soldiers against the tank stand in the back yard. The threat of German invasion was proclaimed as real and Australia could not simply rely on its unique geography. Similarly, the fear of an unpopulated and defenceless North was widely seen as an ongoing threat to both national integrity and the White Australia policy. However, there was also the common-sense conviction that Australia was greatly protected by its isolation. Certainly, in the case of the flu pandemic, both the medical authorities and the general population were initially reassured by the relative isolation. Also, Australia, again because of its relative isolation, had time to prepare for the flu should it breach the natural defence of geography.

The flu itself was hardly unknown at the time. Moreover even then, before the pandemic, it could and did kill, most commonly from either pneumonia or heart complications. For example, the Gippsland Standard and Alberton Shire Representative reported on 4/11/14 a severe flu outbreak at Womerah:

Severe forms of influenza have been responsible for confining many residents to their beds for a few days. The most serious case was that of Mrs. E. Stokes, who is being attended by Nurse Cocking [ Alice E Cocking enlisted in the AAMC in July 1915] of the Bush Nursing staff. On Wednesday evening it was thought that the patient was suffering from pneumonia, and the services of Dr. Rutter were quickly requesistioned. Anxiety was relieved when the doctor assured the nurse that it was only a severe attack of influenza.

Similarly, on 23/6/15 the paper reported the death of a 52 yo, highly respected local who had died from … heart failure following on an attack of influenza.

Word that there was a far more virulent form of influenza in Europe seems to have started to appear in the Australian press around June 1918. From late June, there were reports, admittedly very limited, that spoke of ’Spanish Influenza’. For example, Under the headlines Spanish Influenza in London and Hospitals Overcrowded, The Age (26/6/18) described how … Spanish Influenza is spreading in London. It noted that it was ‘extremely contagious’. Similarly, on 2/7/18 The Argus reported:

Influenza is spreading rapidly through the English towns, half the employees in some factories and business places being incapacitated by it. There are thousands of cases in London.

However, it then added, presumably at the direction of the censor:

The attack generally, however, is not serious, and only a few cases are fatal.

And it also noted – again, presumably, to level the perceived playing field – that the disease was …  also prevalent throughout Germany. In fact, at the time, there were several stories specifically detailing the extent of the epidemic in Germany.

In a short time, the level of fatalities associated with the flu became an issue. The Argus on 4/7/18 again noted how quickly the flu outbreak was spreading in England. Schools were now being closed and the number of children affected was very significant. Reporting on the situation in the Midlands, the paper noted:

Four thousand children at Dudley (in the heart of the “black country”) are affected and there have been some deaths.

A little later, The Age (23/7/18) reported that in the past fortnight there had been 5,500 deaths in England and Wales. However, the reporting remained inconsistent. For example, on 31/8/18 The Argus gave a contradictory account of the ’So-called Spanish Sickness’. It noted its prevalence in the UK – and, again, also in Germany – and quoted the London Daily Telegraph as stating that … In nearly every part of the Empire the epidemic continues to rage. Yet it also declared how fortunate it was that … the epidemic is taking a mild form.

Those back in Australia would also have been receiving word of family members who had been hospitalised with (Spanish) influenza. For example, in the Gippsland Standard and Alberton Shire Representative on 21/8/18 there was a reference to the family of Private A J Cummings receiving word that he had been admitted to hospital in Birmingham suffering from ‘Influenza, pleurisy and effusion.’ Alfred John Cummings was a carpenter from Yarram who had enlisted as a 25 yo in November 1915. After his hospitalisation with the flu he was repatriated to Australia and discharged as medically unfit.

McQueen (1976) has argued that between July 1918 and February 1919 … Australian troops in Britain suffered approximately a 10 per cent infection rate. He added that of this number 209 cases were fatal.

Against the picture of what was developing in Europe it was hardly surprising that any outbreak of (normal) flu in Australia took on a more sinister characteristic. In mid August 1918, The Age (17/8/18) reported on an outbreak of flu at the Broadmeadows Camp. It actually described it as ’Spanish influenza’:

A particularly severe type of influenza, believed to be a form of Spanish influenza, has broken out at the A.I.F. training camp at Broadmeadows. The epidemic first started about a week ago, and already over 150 recruits have been affected. The sickness has also made its appearance at the military camp at Laverton, although in a lesser degree. It is estimated that at the two camps the cases so far reported number at least 200. Patients have been arriving at the base hospital, St. Kilda road, at the rate of 30 and 40 a day. Some of them are very ill indeed. The sickness starts like an ordinary cold, and is followed by feverishness and severe pains in the head. In two or three cases the illness has developed into pneumonia, but so far there have been no deaths.

The same article accused the authorities of trying to … unduly minimise the extent of the epidemic at Broadmeadows.

The official response – The Argus 19/8/18 – from the Minister for Defence (Senator Pearce) was that the reporting was ‘very much exaggerated’ and that the outbreak at Broadmeadows … was simply the ordinary form of influenza and that no one was seriously ill. The Age (19/8/18) reported the same official line but continued to accuse the military authorities of ‘secrecy’ over the numbers of men at the camps who had been struck down by the sickness.

In the heightened awareness of of the time, there were ongoing reports of outbreaks of (normal) flu. For example, The Argus reported on 24/8/18 how the Melbourne Hospital had just set a record for admissions (400) as a result of ‘Winter influenza’.

In The Age on 7/10/18, there was a report that the flu was affecting the rate at which US troops were being sent to Europe. The rate had been 250,000 per month but this number was to be curtailed as there were 100,000 cases of influenza in ‘home camps’. The same report noted the very serious situation developing in South Africa:

The spread of Spanish influenza is assuming unprecedented proportions. Nothing like it has ever been known in South Africa. Every industry and public department is more or less seriously affected.

Towards the end of 1918, there was no doubt that those in Australia knew that the ‘Spanish Influenza’ was a major, international health crisis.

Also in October 1918, the authorities began issuing advice should the influenza pandemic reach Australia. They were still hopeful that Australia could escape the pandemic but should it arrive the best advice was ’strict isolation’. On 25/10/18 the Gippsland Standard and Alberton Shire Representative published recommendations issued by the officer in charge of the Quarantine Department:

“Most people know that influenza is spread from person to person with extraordinary rapidity, and the only way its progress through the community can be stayed is by the most rigid isolation on the part of not only the patient, but all who have contact with him from the time of attack. Such isolation includes confinement to bed, separation from children, and all others in the household, except one personal attendant, who should, of course, not come into contact with the rest of the household more than can possibly be avoided.”

By itself, Australia’s geographic isolation was increasingly seen as insufficient protection and the pandemic was moving closer. Its progress appeared inevitable and unstoppable. First South Africa and then New Zealand became the focus of attention. On 18/10/18 the Gippsland Standard and Alberton Shire Representative gave an account of the dire situation in South Africa:

It is officially stated that the deaths from the influenza epidemic in Cape Town and suburbs from 1st to 13th October number 5,000, of which 33 per cent. were Europeans. Signs of abatement are now evident locally, but the disease is spreading rapidly in country districts. The outbreak took on epidemic proportions in the first week of October. No similar development of influenza, so rapidly assuming virulent characteristics, with such a high mortality, had previously been known anywhere.

In late December 1918, with Australia still officially free of the influenza, the Gippsland Standard and Alberton Shire Representative described the crisis in New Zealand. It used war deaths to drive home the very high mortality level:

Seven hundred and sixty people died in 21 days in Auckland from Spanish Influenza. The total New Zealand losses in the war amounted to 12,000, while between 4000 and 5000 died in four weeks from influenza.

Then it rounded out the warning by pointing out that in the USA … this plague killed six times as many people as the war.

In late November 1918, there was a conference in Melbourne involving all the state health ministers to plan for an outbreak of the flu. At the meeting, a series of protocols for the notification of the disease and strategies for tackling it were agreed by all parties. The Commonwealth was given the critical lead responsibility. The Age (27/11/18) under the headlines The Influenza Peril and States and Commonwealth to Co-operate reported on the level of cooperation between the states and Commonwealth:

The conference of representatives from the various States, convened by the Commonwealth Government to consider methods of co-operation in regard to the influenza peril, met at Federal Parliament House [Melbourne] yesterday. … The fullest co-operation between the Commonwealth and the States … was assured in any steps that it might be necessary to take in combating any epidemic.

However, at this point – less than 20 years after Federation – there was no Commonwealth Department of Health and, as events were to show, Spanish Flu was going to test key principles underpinning the very ideal of federation. State borders were about to be re-imposed.

Not surprisingly, by the end of 1918 the level of anxiety in Australia was high. In fact, some were convinced in November and December that the flu – the Spanish Flu – had already taken hold. For example, on 15/11/18, an editorial in the Gippsland Standard and Alberton Shire Representative ran together the increasing number of deaths in New Zealand with reports of ‘further deaths’ in Sydney. Certainly, people realised that the most likely source of any outbreak would be returning soldiers, and, not surprisingly, some would have reasoned that this line of defence had already been breached. The same paper on 27/11/18 noted the need to maintain strict quarantine:

Several district soldiers were aboard the troopship that arrived in the Bay on Monday, but to guard against an outbreak of Spanish influenza, the boys are obliged to remain in quarantine for three days, until tomorrow.

Australia was more fortunate than most other nations at the time. It knew what it was facing and had had time to prepare. It was protected by its isolation and it knew the most likely source of entry for the disease. But in the end, ‘Spanish Flu’ or ‘Pneumonic Influenza’ did penetrate the country’s defences and while the death rate in the general population was not as severe as elsewhere – the death rate in Indigenous communities was very high – the level of infection certainly did reach epidemic proportions. The effects were bound to be both medical and psychological.

References

The Age

The Argus

Gippsland Standard and Alberton Shire Representative

McQueen, H 1976, “The ‘Spanish’ Influenza Pandemic in Australia, 1912-19”, in J Roe (ed.), Social Policy in Australia Some Perspectives 1901 -1975, Cassel Australia, Melbourne, pp. 131 147.

For a general background on the epidemic see the online resource Influenza pandemic from the National Museum of Australia’s Defining Moments in Australian History series.

 

 

Courtesy of Australian War Memorial

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