In the winter of 412 BC, many inhabitants of Perinthus, a port city in the Sea of Marmora, began to complain of sore throats, difficulty swallowing, paralysed legs and very poor night vision. The physician Hippocrates recorded all this, and we are left with the first record of the disease, which is probably influenza. While some of the symptoms, such as paralysed legs and poor night vision, are not typical of influenza, we should be aware that Hippocrates understood the epidemic differently from us. The Greeks understood epidemics as divine punishment for their bad behaviour. Doctors were priests, partly fortune-tellers, and their task was to appease the angry gods through prayers and sacrifices.
The Perinthus flu was not, of course, the world’s first influenza epidemic, but in the absence of records of previous ones, we can assume that it was first tackled in the ancient walled city of Uruk, in what is now Iraq. 5000 years ago, it was the largest city in the world, with a population of around 80,000. No one was immune, no one could help another and many died.
Influenza was inevitable even in ancient Rome, and Livy wrote in his History of Rome: “Death and funerals are a daily occurrence. The lamentation of the dead can be heard from all sides day and night.” In the 16th century, the Age of Discovery, influenza probably travelled with Christopher Columbus to the New World and wiped out the population of the Antilles. Later, Cortes, Pizzaro and de Soto followed Columbus on his expeditions to the Americas and diseases, especially influenza, reduced the American population to Stone Age levels.
The first pandemic flu, an epidemic that affects several countries or continents, started in Asia in 1580 and spread from there to Africa and Europe. In Europe, it spread from north to south, covering the whole continent in six months. In Rome, one in ten inhabitants died. In 1780, a wave of influenza swept through St Petersburg, sickening 30,000 inhabitants. At that time, influenza was already called influenza. The term was coined by an Italian in the 14th century, who attributed the disease to the influence of the stars.
But it was not until the 19th century, with the Industrial Revolution and the growing urban population, that influenza reached some of its greatest effects, with cities becoming hotspots for almost all diseases. The worst of these was the Russian flu, which broke out in 1889 in Bukhara, Uzbekistan. It was also the first to be measured, in the belief that statistics could help to eradicate the disease.
It claimed nearly a million lives in Uzbekistan and then spread around the world in three waves. In some places it has developed into a deadly pneumonia, affecting people in their prime. Doctors were alarmed to notice that those who survived the disease were becoming depressed and nervous. The Norwegian Edvard Munch was probably one of them, and some believe that his world-famous painting The Scream was painted after he had the flu, influenced by his dark thoughts.
The flu virus is a parasite, which means it can only survive inside another living organism or host. Since it cannot reproduce itself, it must attack the host cell and hijack its reproductive organism. The offspring must then leave the host and infect a new one. Of course, millions of people did not know this in 1918, but it was becoming clear to them that a new life-threatening disease must be named, because only when a disease has a name can it be discussed.
But at the outset, when the disease breaks out, many people who start to deal with it do not yet have a full picture of what is going on, which can lead to misinterpretations of its origin or its nature. For example, the name AIDS has wrongly stigmatised the homosexual community. Similarly, swine flu is not transmitted by pigs, but by humans. The Zika virus is named after the forest in Uganda where it was first isolated in 1947, even though it is a major threat in Latin America.
To avoid this inconvenience, the WHO has issued guidelines for naming new diseases, which should not be named after places, people, animals or food. Not all of these instructions existed in 1918, of course. When influenza arrived in Spain in May, most Spaniards believed that it had entered the country across its borders. They were right. It had been raging in America for two months and in France for at least a few weeks. The Spanish did not know this, because those countries censored news of the flu with the unknown name, which was affecting thousands, so as not to damage the morale of the war. French doctors simply called it disease number eleven.
Spain was neutral in World War I and the press was not censored in principle, so it reported extensively on the unknown disease, and this coverage was picked up by the foreign media. The Parisians, who had no idea of the devastation that the unknown influenza was causing in the corridors of Flanders, learned from the newspapers that it had sickened two thirds of the people of Madrid in just three days. The French, followed by the British and the Americans, began to refer to it as the Spanish influenza. The flu had a name, so the enemy had a face to fight.
It started in Kansas
On the morning of 4 March 1918, Albert Gitchell, the head cook in the mess hall of Camp Funston, a military recruit camp in Kansas, reported to the duty doctor complaining of a fever and a sore throat and head. By lunchtime there were a hundred such cases, and within a month so many that the doctor requisitioned a nearby hangar to house all the sick. Alberth Gitchell may not have been the first to contract the Spanish flu, but even today doctors argue about where the disease started. But this case was the first to be officially recorded, and five hundred million more followed.
America entered the war in April 1917, and by autumn thousands of young men from predominantly agricultural parts of the country flocked to train in the many military camps from which General John “Black Jack” Pershing took them to the battlefields of Europe. Camp Funston was just one of these, sending young men directly to France, as well as to other military camps.
By the end of April, the epidemic had spread from Camp Funston to the American Midwest, to East Coast cities where soldiers were leaving for Europe, and to French ports of debarkation. Soon after, it reached the defence tunnels on the Western Front. The weather in Europe was unusually hot during these months and German troops soon began to complain about the Blitzkatarr, much to the concern of the Assistant Army Chief of Hygiene, Richard Pfeiffer – the man after whom the Pfeiffer bacillus was named.
The flu then spread to Italy, France and Spain, and by May King Alfonso XIII of Spain, his First Minister and almost the entire government had it. It was also reported in May from Breslau in Germany and Odessa in Russia. After the new Bolshevik government in Brest-Litovsk had signed an armistice agreement with Germany, the Germans began to release Russian prisoners from the camps and send them home. This is how the flu arrived in Russia. It then spread through Africa to India, first to Bombay, and then to China.
On 1 June, the New York Times reported 20,000 people sickened in the Chinese city of Tientsin and thousands sickened in Beijing, where banks and silk shops have been closed. At the end of May, influenza appeared in Japan and reached Australia in June. Then it seemed to be subsiding, especially in Europe.
But this was only the first wave of Spanish flu. It was relatively milder than a strong normal flu and did not yet cause panic. But it still had a profound effect on the war. Two-thirds of French soldiers and half of British soldiers fell ill. After the war, the diary of a fallen British soldier was found:
“At five in the morning we were to attack the enemy. Five minutes before that, our officer came to us on wobbly legs and said, ‘Let’s go and get the Swabians.’ Then he pulled out a pistol from the stream, put a whistle in his mouth to signal us to crawl out of the tunnels, but there was not a sound from the whistle. He tried again, but had no strength to whistle. He staggered, the sweat poured off his face, he was pale as a wall, he fell down on his feet. We just watched him, because half of our troops were in the same state. Five minutes later, an officer came out of the headquarters and shouted that we had to get a grip. But when he saw our officer lying on the ground, he shut up and left.”
On the British side, hundreds of thousands of soldiers were sick. “We are lying on the ground in high fever, covered only by a thin blanket,” wrote British soldier Donald Hodge. Kemal Mustafa (Atatürk), a Turkish officer visiting the German Kaiser, also contracted influenza in Vienna.
Just when everyone hoped the pandemic was over, the Spanish flu returned in August, but different, worse and deadlier. It broke out almost simultaneously in three points on the Atlantic; Freetown in Sierra Leone, the port of Brest in France and Boston in America. Although Switzerland was neutral in World War I and imposed strict sanitary measures on its borders, it still took in many wounded and sick prisoners of war by agreement and placed them in camps.
Carl Gustav Jung, a forty-three-year-old psychiatrist, was the commander of one of these camps. In the last months of the war, discipline eased and prisoners of war were allowed to receive visits from their relatives. The Spanish flu appeared in Jung’s camp in July and by early August there were reports of French soldiers dying after returning from the Swiss camps.
In early September, American soldiers returning from Europe helped spread influenza in America. On board the SS Leviathan, a transport ship that docked in New York, was a young Assistant Secretary of State for the Navy, Franklin Delano Roosevelt, who was so weakened by the flu that he had to be carried off the ship on a stretcher.
From Freetown in Sierra Leone, the Spanish flu spread inland by rail, reaching South Africa in September. Although the authorities imposed a strict quarantine on two ships docking in Capetown with 1 300 members of the South African contingent serving in France, they were unable to identify all the sick and discharged some home safe and sound, and from here the disease spread throughout East Africa. It reached the Horn of Africa in November and Haile Selassie I, Regent of Abyssinia, reported that 10,000 were already dead in Addis Ababa. ” I myself am very ill and it was God’s grace that saved me,” he remarked modestly.
In September, the Spanish flu has already swept across Europe. The tubercular Franz Kafka contracted it in Prague on 4 October and lay down to watch the collapse of the Austro-Hungarian Empire from his bed. “I was awakened by strange noises, the rattle of weapons and the shouting of commands. I got up, opened the window and saw military units closing off access to the city centre because the authorities feared a revolution.”
The Russian Civil War and the Siberian railway carried the flu to Persia, to the holy city of Mashed. But, unusually, the Spanish flu saved the life of a young Hungarian physicist, Leo Szilard, in the autumn. He fell ill during his military training in Kufstein and was sent home to Budapest. There, he spent a long time in a hospital that reminded him of a laundry. Wet sheets were spread out between the hospital beds, supposedly to ward off the disease. Here he received a letter from his captain, who wrote to him that almost the whole battalion had fallen at Vittorio Veneto. Szilard later emigrated to America and became one of the main physicists who developed the atomic bomb.
On 5 September in London, Sergei Diaghilev was preparing Cleopatra at the Coliseum Theatre. He was extremely afraid of the flu: “I wear nothing but a linen suit. They die around me like flies. It also wiped out the policeman, a burly man who was standing guard outside the theatre entrance.”
On 9 November, the German Emperor abdicated and crowds flocked to the streets, happy for the prospect of peace. It was the ideal moment for the spread of influenza. The poet Ezra Pound waded through the wet streets to observe the joy of the armistice and thought he had just caught a cold, but he had contracted the Spanish flu.
The Australian authorities lifted the quarantine in early 1919, thinking the Spanish flu was over – but too soon. A third wave of influenza swept the country, killing 12,000 Australians. The third wave swept the world at a moment when the population had not yet recovered from the second. It peaked in New York at the end of January 1919 and then jumped to Paris, where peace talks were just beginning.
Only one wave of influenza reached Brazil – in autumn 1918 – but a second wave reached Chile just a year later, wreaking havoc in the Peruvian capital Lima. Iquitos, deep in the Amazon rainforest and accessible only by river or plane, faced only one wave of influenza due to its isolation, but it caused twice as many deaths as Lima due to poor medical care.
Japan experienced its last wave of deaths in late 1919 and early 1920. On 18 March 1920, a Japanese farmer wrote in his diary at his house 750 kilometres north of Tokyo: “Keishiro had a cold and a cough, so he went to pray in front of the statue of the saint, which stands south of the village of Kannonji, in the hope that he would recover.” From this it can be inferred that Keishiro was suffering from the Spanish flu. If this is true, he was one of the last victims of this flu, as the pandemic had already ended.
From reddish to blue
Most of those who contracted influenza in the spring of 1918 survived and suffered no consequences other than those of the usual flu. But when the Spanish flu returned in August, things became more complicated, as patients usually developed pneumonia as well – in fact, it was bacterial pneumonia that caused most of the deaths. Patients were breathing with difficulty, with mahogany-coloured spots appearing on their cheeks. If the reddish colour prevailed, there was still some hope, but when the bluish colour prevailed, there was no longer any reason for optimism.
Then the blue turned to black. It first appeared on the limbs of the arms and legs and spread to the abdomen and the whole torso.
When the French novelist and poet Blaise Cendras appeared outside the Apollinaire’s apartment on 8 November 1918, the housekeeper told him that they were both ill. He entered the apartment and saw Guillaume Apollinaire lying on the bed, his body completely black. The poet who first used the term Cubism in 1911 and is considered a forerunner of Surrealism died the following day.
As soon as the colour turned black, death occurred within hours. The body decomposed very quickly, and the chest expanded and rose so much that it had to be forced down to close the coffin. Autopsy usually showed red swollen lungs soaked with clotted blood, the edges of which were surrounded by a watery pink foam.
The Leviathan, carrying 9,000 soldiers and military personnel to France in September 1918, caught the Spanish flu as soon as it left Hoboken harbour. By the time it arrived in Brest, there were 2 000 patients on board and 90 had already died. Nurses on board said that the Spanish flu smelled like mouldy straw. They also reported people falling into delirium, losing teeth and hair, and experiencing visual disturbances. The scariest thing was that the disease came unheard and without warning.
But what did doctors know about flu even then? They knew that it was supposed to be accompanied by a cough, fever, sore throat and aches all over the body, and that these symptoms were caused by the Pfeiffer virus. However, this virus does not cause influenza, but it could be found in the human throat. Some doctors spoke of a type of cholera, others again of the unusual typhoid fever.
When people do not know the cause of an event, they become wary. This causes them to see things they would not otherwise have noticed, to remember prophecies they previously thought absurd. Medieval chronicles tell how, months before the Black Death arrived in Europe in 1430, swarms of locusts were seen, and lizards and snakes were said to be falling from the sky. These events were supposedly evidence of the corruption and rot in the atmosphere that would bring an even greater scourge; the bubonic plague.
This was in line with the medieval idea of miasma, or bad air, as the cause of illness. Some argued that the Spanish flu was caused by toxic fumes emanating from bodies buried on battlefields. Others spoke of biological weapons allegedly being tested by one of the belligerents. They wondered whether aspirin, produced by the German Bayer concern and sold in many countries, might not contain something extra.
The Chief of the Navy Sanitary Department, S. Doane, was convinced that German submarines sailing off the American coast were deliberately sending Spanish flu ashore. All these theories fell apart when it became clear that soldiers and civilians on both sides were dying from the Spanish flu. But other theories soon took their place. How was it possible to explain that this disease is so cruel that it affects young and old alike, and especially pregnant women? The average age of those who died was twenty-eight, which meant that it was undermining the foundations of families.
The Austrian painter Egon Schiele described this in his unfinished painting The Family. He painted himself, his wife Edith and their young son, a family that never existed because Edith died in October 1918, six months pregnant with their first child. Schiele died three days later while painting this picture. He was twenty-eight years old.
How could the coincidence by which the Spanish flu chose its victims be explained, and why did it almost completely devastate one village while barely scratching its neighbour? In 1918, no one could explain this lottery. One of the most flagrant cases occurred in South Africa. At that time, there were two large industrial centres in which gold was mined, as well as diamonds, the Rand and the Kimberley. The mines were controlled by the powerful De Beers company, which also built an extensive rail network to transport cheap black labour to its mines. Trains ran from Capetown and Durban, picking up young black men at intermediate stations during the two-day journey.
Alongside the mines, blacks were given sleeping quarters in overcrowded dormitories where coughing was common. The food was poor, the hygiene even worse, and there was no privacy.
The Spanish flu reached the mines very early on, and because the company kept accurate data on its employees, it is known what was going on. The epidemic reached the Rand at first, but the vast majority of those who fell ill recovered and the mine management breathed a sigh of relief. It therefore watched calmly as the epidemic spread to Kimberley. But to their horror, it claimed as many as 2 500 lives there, representing a quarter of the workforce. No one could explain why there was such a difference in mortality between the two mines.
In 1918, when four years of bloody war had weakened the populations of almost every country, it was even easier to attribute the Spanish flu to God’s will. Evidence was sought and found to support this belief. The year before, in Fatima, Portugal, the visionary children Jacinta and Francisco Marto and their cousin Lucia Santos had claimed that the Virgin Mary had appeared to them on various occasions. Now, when the Marto siblings fell ill with the Spanish flu, they reported a new apparition. The Virgin Mary allegedly told them that she would come first for Francisco and later for Jacinta. Indeed, they died in that order and their graves became places of pilgrimage.
But if the Spanish flu was God’s punishment, what did humans do? Theories abound, from senseless wars to the degeneration of the lower classes and the exploitation of the native people. But for some, it was a punishment for something deeper; for people’s decision to stray from the right path. Such was the case in one Spanish city.
Zamora is a Spanish town on the Douro River in the north-western province of Castile-Leon. The deeply religious population is still known today for its processions of barefoot, hooded ghosts. When the inhabitants learned in 1914 that they were to receive a new bishop, they greeted him with the utmost solemnity. His name was Antonio Alvaro Ballano and he had already had a distinguished career as a thirty-eight-year-old. Before his appointment as bishop, he had been the head of the seminaries in Toledo.
In his first letter to the faithful, the new bishop attacked the dark forces that seek to reject God, and accused modern science of departing from God’s commandments. The letter was peppered with inappropriate allusions to Newton and his law of gravity and Ampere’s experiments with electricity. All of this showed that the once mighty Spanish empire had reached its nadir.
The Spanish-American War of 1898 stripped it of all its colonial possessions, from Cuba and Puerto Rico to the Philippines. Spain contributed nothing to the great scientific and musical achievements of the modern era, its society was still agricultural and living conditions in many of its cities were no better than in the Middle Ages.
The people of Madrid were also not used to machines and machinery, they had lifts in some places, but they were not used because they were always broken, and they had toilets with running water, but they were regularly clogged and dirty. The Spanish flu first appeared in the east of the country in the month of harvests, weddings, fiestas, bullfights and church festivities.
At that time, the army was just recruiting new recruits. Young men who had flocked to Zamora to take part in the regular artillery exercises around the town began to fall ill. At first they were billeted in an old medieval castle, but there was no room.
Fields have become short of workers, adding to the already existing food restrictions. The local newspaper Heraldo de Zamora dared to mention the filth in the city for the first time, pointing out that people were living with animals and only used soap when washing their clothes.
In the first wave of the epidemic, the provincial health inspector complained about bureaucratic procedures and lack of money, and the ignorance of people who were supposedly unaware that a sick person travelling was spreading the disease. One city doctor even wrote that the Spanish flu was the result of impure blood caused by sexual debauchery.
While the newspapers recommended that people should not gather and should stay at home, the church called for masses to pray for God’s grace. Local politicians ignored requests to fund temporary hospitals and ignored recommendations to introduce strict hygiene measures in cities.
On 30 September, Bishop Balleno defied the demands of the sanitary authorities and instituted night prayers in the churches for nine consecutive days, as the inhabitants of Zamora were said to be possessed by evil because of their sins and ingratitude. In the autumn, when the epidemic was at its height, fear turned to unrest. Milk, which had been recommended for a quicker recovery from the Spanish flu, became scarce and its price soared.
In October, the sanitary authorities were given greater powers to close establishments that did not comply with minimum sanitary conditions and to fine townspeople who did not keep their animals in pens. But the masses with the Pro tempore pestilentia prayer were still not over.
On 24 October, a great procession took place in the city and the cathedral was packed to capacity, so that the surrounding residents who had flocked to the city to take part in the procession were left at the doors of the packed cathedral. The townspeople were overcome with despondency as it seemed that the epidemic would never end. When the city authorities tried to prevent such a massive gathering, Bishop Balleno accused them of interfering in Church affairs.
In some other Spanish cities, the authorities have had funeral processions and the constant ringing of bells banned because it only frightens people. But not in Zamora. Here, bells were rung at every death and funeral processions wound through the city streets. Funeral coffins had long since run out and the dead were wrapped only in mortuary shrouds.
By mid-November, the worst was over and Bishop Balleno attributed it to God’s grace. But the epidemic returned in a milder form the following spring. The newspapers were unanimous in their belief that Zamora had suffered far more than any other Spanish city. The number of deaths in the city was never established, as the city authorities kept no such statistics.
Quarantine
Sanitary cordon, isolation, quarantine. These are ancient ways people have used to defend themselves against the spread of infectious diseases, and have been in use long before people understood the nature of infection. The sanitary cordon – a boundary around an infected area from which there is then no exit – was at the same time a brutal but effective way of containing infection.
In the 17th century, the inhabitants of the English village of Eyam locked themselves in such a sanitary cordon as soon as they heard that the village had the plague. By the time the epidemic was over, half the townspeople were dead, but the plague had not spread to neighbouring villages. In the following century, the Habsburgs made a sanitary cordon from the Danube down the Balkan peninsula to keep infected people from the Balkans out of their empire. Observation posts and checkpoints were set up, and armed peasants patrolled along the cordon, directing suspicious persons to quarantine stations set up along the cordon.
Another way of containing the disease was to isolate sufferers in their own homes. This can work, but it is expensive as it requires constant surveillance. It is more convenient to gather the sick in a predetermined place and keep them there until the infection has passed.
Quarantine was invented by the Venetians in the 15th century, when they forced ships coming from the Levant to anchor in a certain place for forty days before the crew could go ashore. In the days before trains and planes, people used ships to travel long distances. This is why diseases from distant places first appeared in ports. Lazarettos, or quarantine hospitals, were built there or on nearby islands, but they were more like prisons, both in their construction and in the way their inhabitants were treated.
In the 19th century, merchants realised that there was money to be made here, so they talked themselves into setting up restaurants, casinos and even brothels in the lazarettos. In the 20th century, however, the problem of containing disease became more complex, as not all passengers came only by boat.
The devastating plague of the Middle Ages gave birth to the idea of disease surveillance. In the beginning, reporting of the disease was very modest; diagnoses were vague and the number of cases approximate. Later, doctors began to collect data on where the sick person lived and when the first symptoms appeared. In the 20th century, reporting of infectious diseases became compulsory, and a doctor who failed to do so could find himself unlicensed in addition to being fined.
In 1907, the International Office of Hygiene was set up in Paris as a central point for collecting data on infectious diseases. But reporting was only compulsory for diseases that posed a high risk, such as smallpox, cholera and tuberculosis, but not for influenza. There was also no alarm system to warn of the possibility of diseases spreading to other countries.
There are isolated examples of timely notification, for example in Iceland, which at the time had only 100,000 inhabitants. Word of the Spanish flu spread rapidly here. The main road leading north was immediately closed, a guard was posted at the glacier leading to the east of the island and a quarantine was imposed on all ships landing.
In the summer of 1918, the Australian authorities learned that the Spanish flu was rampant in Europe, saw it spreading through Africa to Asia and promptly quarantined all ports in October. When crowds gathered in Sydney’s main square in November to celebrate the Armistice, they had nothing to fear. Although Australia was hit by a third wave of Spanish influenza in early 1919, the human cost was far less than if the virus had been allowed to spread across the country the previous autumn.
Influenza Impact on New York and Mashhad
It is interesting to see how influenza affected people in different cities, for example New York, Mashhad in Persia and Odessa in Russia at the time. In none of these three cities was the arrival of the Spanish flu initially reported. But this is where the similarities between the cities usually end. Thus, Mashhad had ten times as many deaths in percentage terms as New York.
New York was already home to 5.6 million people in 1918, and the city was growing by leaps and bounds, as it was the first point of entry for immigrants, mainly from Eastern Europe. Between 1890 and 1920, around 20 million immigrants landed here in search of a better life. At the same time, New York harbour was still the main departure point for thousands of American soldiers heading for the European theatre.
This was a major challenge for the city’s Health Commissioner, S. Copeland, when the second wave of Spanish flu hit the city in July. Copeland, who was an eye doctor and homeopath, was put in this challenging position in April. He was a practical man who liked to quote the Bible and get things right.
Port authorities increased surveillance of incoming ships in July, but when the heavily infected Norwegian ship Bergensfjord docked on 12 August and its 12 passengers were taken to hospital in Brooklyn, they were not isolated. This was not done until 7 September, when Spanish influenza with pneumonia had already spread through the city, but Copeland, fearing panic, was saying that everything was under control.
The Spanish flu was only officially recognised in the city on 4 October, after infected soldiers had already sailed to and from Europe several times on the Leviathan, spreading their deadly cargo. Copeland knew he was powerless when it came to troop transport, as President Woodrow Wilson followed the opinion of his generals and overruled the military doctors, demanding that troop transport to Europe continue.
After a long delay in allowing the public to be informed of the new wave of Spanish flu, Copeland was able to take three vital decisions on the basis of his new powers. He eased rush hour traffic by setting different opening times for factories, shops and cinemas. He deployed 150 urgent care centres across New York to coordinate care for the sick, and decided to keep schools open despite opposition from residents. He was convinced that students could be better supervised there than at home.
Public funerals were banned during the epidemic and only the closest relatives were allowed to attend funeral ceremonies. Copeland’s job was made all the easier because New Yorkers were already familiar with the various health campaigns. Twenty years earlier, the city had declared war on tuberculosis and the widespread spitting on the streets.
At the end of September, the city was already awash with posters on how to fight Spanish flu. But the notice was printed in English, and there were hundreds of thousands of people in the city who did not speak English. Of all the immigrant groups living in New York in 1918, the newest, the poorest and the fastest growing was Italian. And it was among the Italian immigrants that the Spanish flu took the greatest toll.
Since 1880, around 4.5 million Italian emigrants have arrived in America, and most of them have stayed. They lived in Brooklyn, around the dockside warehouses, in the Lower East Side and in East Harlem. There, a veritable Italian ghetto emerged, known as Little Italy. Many of the peasants from southern Italy were not used to city life and they were very resistant to respiratory diseases.
Even before the Spanish flu epidemic broke out, many tuberculosis patients could be seen in these ghettos. Doctor Antonio Stella, who worked there, wrote: “Six months in overcrowded and unventilated rooms, where ten people lived and even slept in one room, transformed a flint-faced young man from Calabria, Sicily or Basilicata into a pale, youthful apparition who moved with gliding steps through the streets of New York.”
It was clear that immigrants were getting their diseases in America and not – as some mistakenly believed – bringing them with them from Europe. Most of these immigrants did not speak English. They were superstitious and distrusted the authorities, believed in witches and miraculous cures with the help of the Virgin Mary, regularly spat to the side if they met someone with the evil eye, and closed their windows at night to keep evil spirits out of their rooms. They viewed doctors with suspicion and believed that hospitals were places to die.
The largest Italian-language newspaper in New York was Il Progresso Italo-Americano, with 100,000 copies. The emigrants read it in groups, as many of them were illiterate. The one who read best read slowly aloud, while the others around him listened, and so they also heard the instructions on how to combat the Spanish flu. This newspaper was one of the few that supported the Mayor’s decision to keep schools open during the Spanish flu. “School hygiene and ventilation are much better than those in flats,” they wrote.
Copeland himself fell ill with Spanish flu at the end of October, but continued to work tirelessly. The epidemic ended on 5 November, and when asked by reporters how New York had had far fewer casualties than other American cities, he replied, “The city had a well-organised public health system thanks to a 20-year fight against tuberculosis.”
He then demanded that emigrants be medically examined in their home countries before leaving Europe. In 1934, when Fiorello La Guardia, the son of an Italian immigrant, was mayor, New York decided to build public housing for emigrants.
Ahmad Qavam al-Saltaneh arrived in Mashhad from Tehran in January 1918, after a gruelling ten-day journey across the desert. He knew he had a difficult task ahead of him. He had been sent by the government to deal with the anarchy that threatened to engulf the city.
Mashhad was at that time the only city in the north-eastern province of Khorasan, a holy city for Shiite Muslims with a population of 70,000, and which received just as many pilgrims every year. They came to pray at the tomb of Imam Reza, the eighth of the twelve holy Imams, the spiritual successors of the Prophet Muhammad. The city was also the centre of a thriving saffron and carpet industry and a stopover on the route from Persia to Russia.
When war broke out in 1914, Mashhad also became an important British military outpost, protecting access to the jewel of the British Empire – India. It was not a pleasant place to live, as thousands of White Russian soldiers also flocked to the town, many of them wounded in the fighting with the Bolsheviks in the north.
The city and its surroundings had experienced several bad harvests, famine was rampant and quarrels between different tribes were the order of the day. Qavam was supposed to restore order in the city, as he was known as a skilful negotiator who could use force if necessary to achieve his goals. Public executions thus became a regular feature of the city and several quarrelsome tribal leaders found themselves in prison.
Supplying the city has been more difficult to solve. The price of bread had quadrupled in two years, meat was almost unobtainable, typhoid fever had appeared, and the water was polluted. And then the Russian soldiers brought the Spanish flu. Apart from twelve beds in the medical ward of the British Consulate, there was no hospital in the town. There were two small medical stations, one at the tomb of Imam Reza, for pilgrims, and the other run by American missionaries, with the Reverend Lewis Esselstyn at their head.
In 1918, Mashhad was still a medieval town and many pilgrims came to die there. They were buried in mass graves, the bodies decomposing and polluting water sources. Mashhad got its water from the nearby mountains and it flowed through an open canal right down the town’s main street. Most residents were firmly convinced that it was clean if it flowed at 300 litres per second. So they washed their dishes in it, as well as bathing themselves and their donkeys.
The government in Tehran has made several attempts to sanitise the situation, at least for a time, but has always run out of money. As Mashhad was a holy city, the clergy had great influence, so when epidemics broke out, those who were infected were instructed not to leave the city, and those who were healthy were not allowed to enter. Otherwise, epidemics were considered a martyrdom for believers and a punishment for non-believers. As a rule, the sick inhabitants turned to herbalists for help.
Then Qavam came to the city, immediately took control of all the city’s institutions, and pacified the sleepy Sanitation Committee. The burial of the dead in the city was forbidden and graves had to be at least one metre deep and covered with a layer of clay. Qavam also asked the administrators of Imam Reza’s tomb to follow his instructions.
The worst was in September, when pilgrims carried the Spanish flu to Tehran and the rest of Persia. In Mashhad alone, a city with fewer than a hundred hospital beds, 40,000 people, almost two-thirds of the population, contracted Spanish flu. Local astrologers linked the end of the Spanish flu to the end of the British protectorate over Persia and the return of the Mahdi, the long-awaited twelfth Imam, who would cleanse the world of evil.
October was a holy month for Shia Muslims, commemorating the martyrdom of the third Imam Hussein. Processions of men stripped to the waist, flogged with chains and slashed their foreheads with knives, marched through the streets of the city until blood began to trickle down their white clothes. The American missionaries closed their modest hospital in December, as the workers were completely exhausted and without supplies.
A few years later, Qavam became the country’s first minister. He linked Mashhad and Tehran by road, opened mass graves, ordered bones to be loaded on carts and buried far outside the city in unmarked pits, and tombstones to be used to pave city streets.
Odessa
When the first wave of Spanish flu reached Russia in May 1918, it came almost unnoticed, except in Odessa. Odessa was different from other Russian cities. It was a warm, cosmopolitan and open city, and almost half of its half a million inhabitants were of Jewish origin. Of all Russian cities, Odessa was the most advanced in understanding and controlling infectious diseases.
As a port city, it was the place where silk and spices from the East arrived and then continued their journey by ship to Istanbul and beyond. In 1886, the first bacteriological station in Russia was set up here, producing a vaccine against rabies. The station was headed by Yakov Bardak, who subsequently conducted important research on anthrax, typhoid, cholera, malaria and tuberculosis.
Later, Bardak was removed as head of the bacteriology station because he was Jewish, as Jews were not allowed to occupy certain positions. Disappointed, he opened a successful ambush practice. In May, the Spanish flu reached its peak, but then the number of cases fell over the following months and Vera Kolodnaya, the undisputed diva of the Russian scene, arrived in town from Moscow. She came as part of a mass exodus of artists from Moscow and Petrograd, where political and economic chaos reigned. She was greeted by crowds of admirers who then saw her latest film, The Woman Who Invented Love, in August.
But cholera soon appeared in the town, brought by Austrian troop ships, and typhus was also smuggled in from the countryside. The town was thus placed in a kind of quarantine, paving the way for the Spanish flu, against which the town had no strategy, spending all its strength in fighting cholera and typhus. Cafés, restaurants and theatres were open and people sought oblivion in entertainment.
Dr Bardak did what he could. In a lecture to the City Doctors’ Association, he explained that individual efforts to fight Spanish flu do nothing until there is a comprehensive city programme to contain the epidemic. He then lectured in theatres, cinemas and synagogues, and even in the city market. He assured the audience that Spanish is not a new form of plague, but only a deadly type of flu that can be avoided just by ventilating your home and keeping it clean. In his view, Spanish flu was much worse than the Russian flu of 1890, as it was associated with nervous and respiratory problems.
Some refused to listen to him and on 1 October there was a black wedding in Odessa. The Jews called it a shvartze khasene. It was an old Jewish ritual to ward off death epidemics. The bride and groom had to be from the ranks of the most unfortunate and despised beggars. Thousands of people gathered in the Jewish main cemetery to watch the wedding, and then the procession proceeded to the city, where the newlyweds were given a reception and a gift.
Since Bardak announced on 8 October that the Spanish flu epidemic was over, the organisers of the Black Wedding could boast that it had been a success.
But the Spanish flu returned to the city in February 1819, and its most famous victim was Vera Kolodnaja, who was giving a charity concert at the time. The hall was freezing, the audience sat in fur coats and blew into their hands to keep warm, and she wore only an evening dress. She returned to the hotel on foot and fell ill the next day. None of the doctors could help her and she died of Spanish flu on the eighth day.
Two days later, a suffrage service was held in the Orthodox Church, which was also attended by many Jews. The funeral was held the next day at her open coffin and was attended by a huge crowd. She was buried temporarily in the crypt of the cathedral because they wanted to transport her to Moscow later.
But on the way there, the coffin and its remains are said to have disappeared. After her death, it was rumoured that she did not die of Spanish flu, but was poisoned with white lilies, her favourite flower, by a French diplomat who suspected she was spying for the Bolsheviks.
Yellow Danger
“I would like to draw your attention to the similarities between the current Spanish flu epidemic and the pneumonic plague epidemic that broke out in October 1910 in Harbin, China, and in northern China. I suspect that this is the same epidemic, but modified by racial and topographical differences.”
This was written in October 1918 by Joseph King, Captain of the US Medical Corps. Even before then, some doubted that Camp Funston was the initial focus of the Spanish flu and pointed the finger eastwards, mainly towards China, influenced by the general belief in the existence of the yellow peril. This xenophobia culminated in accusing Asians of being responsible for the decline in births in Europe, increased crime and the trafficking of white goods.
Captain King was undoubtedly sincere in his thinking and convinced that the beginning of the epidemic could not be traced back to America. Americans were only to be victims. “Since our soldiers and sailors have been returning from the battlefields of France, the Spanish flu has become the prevailing disease in our cities and country.”
But what was actually happening in China in 1910? China was then known as Asia’s hospital. It was sick in the true sense of the word, its population was suffering from severe health problems and its autonomy was in the hands of foreign powers. Revolution was in the air and the imperial central authority was weak. Russia and Japan had run railway lines into the ore-rich northern province of Manchuria, and Japan had recently annexed all of Korea.
When an epidemic broke out in Manchuria, Wu Lien-tehu, who had trained in the UK, France and Germany, was entrusted with her fate. When Wu arrived in the Manchurian city of Harbin, he was horrified. The governor was a sworn opium smoker, there were no hospitals, only filthy plague houses where the sick were carried to die. Many fled south in panic, others wanted to go south to celebrate the lunar year with their families.
Wu immediately abolished all unnecessary train travel and turned schools, theatres and closed baths into disinfection stations. Seven hundred policemen and 1000 soldiers searched houses and ordered isolation. Wu thought he was dealing with pneumonic plague. Patients had fever and chest pains, spat blood and their skin turned purple. No one who fell ill survived.
But it was not enough to suspect plague, the disease had to be identified by isolating the infectious bacteria, which meant autopsies on the deceased. In pre-revolutionary China, this was a crime punishable by death. However, given the circumstances and the gravity of the situation, Wu received approval for the autopsy from Beijing. He performed it on a deceased Japanese innkeeper who lived near Harbin, analysed the bacteria from her lungs and found that she was infected with Yersinia pestis.
Meanwhile, the bodies of the deceased were piling up outside the city. The temperature was minus 20 degrees Celsius and the ground was too cold to dig graves, so the bodies were burned. The heap of corpses burned for two whole days. The epidemic began to subside in April and Beijing breathed a sigh of relief. It claimed 6 000 victims but did not cross the border into Manchuria.
The following year, the Republic of China had already been proclaimed, and the epidemic broke out in Shansi province. When Wu tried to perform an autopsy here without permission from the authorities, he was surrounded by a riotous mob and narrowly escaped with his life. He fled to Beijing, but took some tissue samples with him. He found no plague bacteria in them.
Although the sufferers showed signs of the disease; spitting blood, chest pains and fever, the epidemic was milder than the one in Manchuria in 1910. Strangely, death was the exception rather than the rule. The authorities therefore claimed that it was just a more severe form of winter sickness, something similar to influenza.
If it was the Spanish flu, Wu had no real chance of proving it. Whatever the truth, the doubt about the disease that raged in Shanxi in 1917 has never been removed, and it is this doubt that is supposed to confirm that this was the first time the Spanish flu had appeared here. If that is the case, how did it spread from isolated Shanxi around the world?
The answer, according to the Yellow Peril theory, is to be found in the acronyms CLC, the Chinese Labour Corps. China was neutral in World War I and hoped to regain some of its lost territories after peace. Therefore, its contribution to the war effort of Great Britain and France was a certain number of Chinese workers, who were not supposed to take part in the fighting, but to dig gun trenches, repair tanks and collect cannon shell casings.
The CLC was a clandestine operation in which 135,000 workers were sent to France and Belgium and 200,000 went to Russia. These workers were carefully selected from the northern provinces, where people were taller, lighter-skinned and more accustomed to the cold. Europe did not treat them well as a lower race.
They arrived in Europe from the port of Tsingtao, where they were subjected to a rigorous medical examination. Those destined for France and Belgium then travelled via Canada or Cape Dobre nade. The journey took three weeks, and they were packed like sardines and locked in ships and cattle wagons.
As early as January 1918, many people in Tsingtao Port complained of sore throats and breathing difficulties. The guards in Canada who accompanied them also had the same problems. It could have been seasonal influenza, or it could have been something else, such as the Spanish flu.
But what if the Spanish flu did not start in China, nor in the tunnels of France, but at Camp Funston? At Camp Funston, recruits came in large numbers from Haskell County, Kansas. This was one of the poorest areas, where people lived in wooden houses and raised corn and pigs.
In January 1918, many of the farmers there complained of sore throats, some of them contracted pneumonia and died. The local doctor, Loring Miner, was frightened by the large number of sick people and wrote a report for the US Public Health Service and sent it to Washington.
The epidemic reached its peak in March and nobody would have cared if it had not been for the illness of recruit Albert Gitchell and then several other recruits at Camp Funston. The camp’s military doctor immediately informed his superiors. But it must have been 90 years before a journalist remembered these events and made the connection. Unbeknown to him, a young farmer, Gitchell, who came from Haskell County, had taken the disease to Funston Camp, from where it spread all over the world.
How many people have died from Spanish flu? The Russian flu took one million lives in 1890, so the Spanish flu must have taken many millions more. In 1920, the American bacteriologist Jordan estimated the number of deaths at 21.6 million. That was already more than all the dead in World War I.
Today, we know that these figures were underestimated, but they have persisted for 70 years. In 1991, the Americans raised the figure to 30 million, but warned that the figures for China were doubtful. In Russia, there were only 450 000 victims, which means that the Spanish flu only scalded Russia. However, some cities in Russia have been badly affected, most notably Odessa with 40 000 victims.
Rich countries like America and the UK lost around 0.5% of their population to the Spanish flu. In 1998, on the eightieth anniversary of the Spanish flu, the Americans released new figures on the death toll. The number was estimated at 50 million worldwide, with 30 million in Asia alone. In the annals of epidemics, the Spanish flu is therefore something unique and still something very mysterious. It would have occurred even if it had not been for the First World War, but that war made it highly contagious.
