The great flu pandemic of 1918

There's a vague awareness this year that we're living in the 100th anniversary of the end of the Great War -- World War I -- or what I would call the introductory episode in the Wars of European Barbarism that afflicted all humanity in the first half of the 20th century.

But we're also living in the 100th anniversary of what came to be called the "Spanish" disease. In one devastating year, this world wide influenza pandemic killed at least 50 million people (and arguably 100 million), at very least nearly one third more than the estimated 37 million military and civilian casualties of the four year war. British science journalist Laura Spinney's Pale Rider: The Spanish Flu of 1918 and How It Changed the World is a fascinating account of this health catastrophe.

Because it came on so fast and swept onward so rapidly -- the acute phase causing the most infections and deaths usually lasted only about 3 months in any one location -- it is hard to give a general picture. Moreover the consequences of flu's arrival in any one place were radically different. In general, most developed locales has less deaths; perhaps half of one percent of the population died in the US and northern Europe. Meanwhile the flu took a ferocious toll in regions with less developed health facilities such as British India where 18 million are thought to have died. The highest known percentage toll in a subgroup was among Alaskan natives where in some villages 40 percent succumbed.

Spinney deals with the wide diffusion, differences in impact, and cultural and social variations in the responses by telling the story as a series of vignettes in widely separated locations. She has adopted a consciously unorthodox narrative technique:

The African historian Terence Ranger pointed out in the early 2000s that such a condensed event requires a different storytelling approach. A linear narrative won't do; what's needed is something closer to the way women in southern Africa discuss an important event in the life of their community. "They describe it and then circle around it," Ranger wrote, "constantly returning to it, widening it out and bringing into it past memories and future anticipations."

On the one hand, this serves her narrative well for this reader -- I found myself pulling out particular anecdotes and musing over them, glad for her inclusive survey. At the same time, I've not at all sure Spinney succeeded in painting a connected big picture. Perhaps an historian with such a diffuse subject can't. Each episodic anecdote could be its own historical narrative and probably has been or will be.

To demonstrate Spinney's technique, here are some fascinating, accessible, tidbits from her description of how the flu hit what she calls the "Imperial Metropolis," New York City.

New York in 1918 was many worlds within one world. It was therefore a thoroughly modern challenge that faced the city's health commissioner, Royal S. Copeland ... to elicit a collective response from a jumble of different communities who, while they overlapped in space, often had no common language and little shared identity. ...

Copeland was an eye surgeon and a homeopath ... he seemed a practical man who got things done, yet that summer and early autumn, he dragged his feet. [President Wilson insisted that troop shipments to the European war must not be interrupted.] ... By the time he officially acknowledge the epidemic, on October 4, infected troop ships .. had long been ploughing backwards and forwards across the Atlantic, distributing their deadly cargo. ...

Initially he intended to close all public schools, as had happened in the neighbouring states of Massachusetts and New Jersey. But the pioneering head of the health department's child hygiene division, Josephine Baker, persuaded him not to. She argued that the children would be easier to survey in school, and to treat should they show signs. They could be fed properly, which wasn't always the case at home, and used to transmit important public health information back to their families. ... [Copeland tried her approach] and in doing so he brought bitter recriminations down on his head, including from the Red Cross and former health commissioners. But he and Baker would be vindicated; the flu was practically absent from school age children that fall. ...

In Copeland's favour, however, New York was practiced the art of public health campaigns, having declared war on TB -- and particularly on the habit of spitting in public -- twenty years earlier. By the end of September, the city was papered in advice on how to prevent and treat influenza. But the advice was printed in English and it was only in the latter half of October, when the worst was already over, that boy scouts were sent scurrying through the tenements of Manhattan's Lower East Side to distribute pamphlets in other languages. ...

The main Italian-language daily newspaper in New York at that time was Il Progresso Italo-Americano. It sold close to 100,000 copies a day ... The writers of Il Progresso knew that their readers bound potato slices to their wrists to reduce fever, and kept their windows closed a night against evil spirits ... Il Progresso was one of the few to voice approval when Copeland announced his decision to keep the schools open. Italian families tended to keep their children close -- bringing them home for lunch, for example -- but as the paper pointed out that children liberated from the classroom often went unsupervised in the streets, while in school teachers watched over them and could spot the first signs. ...

[A] feared backlash against the Italians never came and no other immigrant group was blamed for the flu either. ...It probably worked in the Italians favor 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. ... The flu also brought the Italians a new and powerful champion in Copeland. He now lent his support to reforms ... declaring war on slum landlords and campaigning for better public housing ....

Spinney's account of the scientists' subsequent search for and recreation of the flu virus -- H1N1 -- is narrated in a more linear manner than the picture of the epidemic itself and quite fascinating. This is basic health science which we would all do well to have more awareness of. Her attempt to describe the economic and cultural aftermath of the great pandemic is more suggestive than conclusive; that field of investigation should be rich for other writers. The books title is derived from the apocalyptic Book of Revelation, as well as from one of the flu's literary offspring: Katharine Ann Porter's Pale Horse, Pale Rider.

Readers who liked Dr. Siddhartha Mukherjee's Emperor of All Maladies about our increasing understanding of cancer, and other medical histories, will like this book as well. It was good reading while I sat out a case of flu this winter.