The devastating effect of world's biggest ever flu outbreak

Two women wearing masks to prevent catching the Spanish flu
Two women wearing masks to prevent catching the Spanish flu Credit: Keystone/Hulton Archive

New research into the the world’s worst ever flu pandemic reveals the toll the illness wrought on ordinary people still suffering the devastating effects of the First World War.

The Spanish flu swept around the globe in 1918 and is estimated to have caused between 50 and 100 million deaths worldwide.

The pandemic - sometimes known as the forgotten epidemic as it was overshadowed by the First World War - was exacerbated by the movement of troops at the end of the war and the poor living conditions of many at the time.

Now, 100 years since the start of the pandemic medical reports, letters from the Imperial War Museum archives and testimonies of those who witnessed the outbreak first hand have revealed how it devastated whole families and communities.

Some 228,000 people across the UK were killed by the Spanish flu - so-called because newspapers in Spain were not constrained by the same wartime censorship as in the UK so were the first to report it.

The documents, whose contents will be broadcast in special programmes on BBC local radio as well as on a BBC2 documentary, show that in some parts of the UK almost one in four deaths in 1918 were due to the virus. 

In Leicester undertakers were unable to cope with the high number of funerals, a problem exacerbated by the fact that a number of employees were still away in the war.

Doctors and nurses described being “run off their legs”, businesses were affected and whole families struck down by the disease.

EH Snell, the medical officer for Coventry, wrote of the toll the outbreak took on people in the prime of their lives.

“Cases were distributed throughout the whole city, and the illness was most fatal among young adults. The figures relating to school attendance showed that this was greatly affected, but a large number of children were apparently being kept at home to lend help in stricken families,” Dr Snell wrote.

Women wearing masks in Australia
Women wearing masks in Australia Credit: BBC

In Birmingham, where nearly 400 people died from the flu in a single week at the end of November 1918, overcrowding in the city’s slums was blamed for the high death toll.

William Angus, medical officer for health in Leeds, records how the city’s children’s hospital treated only flu cases in the last three months of the year. And in Newcastle nearly a quarter of the population - 22 per cent - was struck down by the disease during 1918 and 1919.

In Manchester, the medical officer for health's call to ban the city's Armistice celebrations were ignored, leading to soaring death rates over the winter.  More than 3000 people died from the flu over the next few months. 

Hannah Mawdsley, a PhD researcher at Queen Mary, University of London and the Imperial War Museum, delved into the archive of letters, which showed the devastating nature of the disease. 

The flu had some alarming symptoms: some victims turned blue as fluid filled their lungs, starving their bodies of oxygen. This condition, known as heliotrope cyanosis, was a sign the disease was fatal and victims’ corpses would often turn black.

Other symptoms included explosive nosebleeds, said Ms Mawdsley.

“Delirium was another symptom and there were reports of a baker in Norfolk who killed his wife and children and then hung himself because of the depression and mental disturbance he was suffering,” she said.

“There was a lot of confusion because although there had been a serious outbreak of what was called Russian flu in 1889 there had never been anything to this extent. Some people thought it was the plague and it was called the blue or black death by some,” she added.

Some of the accounts of the time show people using strychnine and creosote as remedies. One mother recounted reviving her baby with a tot of brandy after finding him unresponsive, after reading about this cure in the Daily Mail newspaper.

A man spraying the top deck of a bus with an anti-flu preparation
A man spraying the top deck of a bus with an anti-flu preparation Credit: Davis/Hulton Archive

Modelling commissioned by the Bill and Melinda Gates Foundation shows that if the Spanish flu struck today it would kill 33 million people globally in the first six months, spreading rapidly around the world through international travel and trade links.

Ms Mawdsley said her research had uncovered interesting parallels with the present day

“In 1918 there was a flu vaccine but it was based on a best guess of what strain of flu it was. We still don’t have a universal flu vaccine and researchers have to work out what strain of flu is most likely to be circulating,” she said.

She said she hoped the BBC programmes would reveal the voices of ordinary people “as well as help us to understand that we as a society are still vulnerable to global pandemic threats today”, she said.

  • The Flu That Killed 50 Million will be aired on Tuesday 25th September, BBC Two at 9pm.

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