The hard lessons of the Spanish Flu in Scotland and the terrors of a virus aided by silence

IT remains the worst ever health crisis to hit Scotland. At the very least, 22,000 Scots were killed by a virus that left people to turn dark blue and delirious in their final hours – yet no one spoke about it for decades.

Nurses care for victims of a Spanish influenza epidemic in a field hospital of canvas tents. One soldier, in his account of the pandemic, wondered whether a war-weary God had sent a plague to finish off mankind, such was his horror of the new devastation that surrounded him.
Nurses care for victims of a Spanish influenza epidemic in a field hospital of canvas tents. One soldier, in his account of the pandemic, wondered whether a war-weary God had sent a plague to finish off mankind, such was his horror of the new devastation that surrounded him.

When it feels as if the Covid-19 era will forever be part of our personal histories, with reams of hard data and daily briefings underwriting the rolling emergency, it seems remarkable that the impact of the Spanish Flu went without any serious discussion for almost 80 years.

But back in 1918, the nation was battle weary. Morale both on the battlefields of Europe and off hung by the thinnest of threads. As a nation tried to look forward from the conflict, the pandemic fell into a national blindspot.

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The reality was that the pandemic that cut through the population between May 1918 and April 1919 was an even greater global disaster in terms of death tolls than the war itself. A staggering 50 million people died worldwide.

A ward at the Fourth Scottish General Hospital in Glasgow where most soldiers coming into the country with Spanish Flu were treated. This ward was for US servicemen and was run by the American National Red Cross

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But with information on the pandemic censored by governments still engaged in the conflict, there was little collective awareness of the scale of the health emergency.

Indeed, it was reports coming out of neutral Spain, where King Alfonso XIII fell gravely ill, that gave rise to the nickname ‘Spanish flu’ although it almost certainly didn’t originate here.

Professor Anthony Butler, honorary reader in medical science at St Andrews University, said: “Nothing was written about the subject in Britain.

The Spanish Flu is believed to have been brought into the battlefields of Europe by servicemen from US or labourers from China who were deployed to dig trenches. It was spread around the world as the military demobbed towards the end of the conflict.

"It is astonishing that one of the most significant medical events in recent history that killed far more than World War One went so unmentioned.

"No one wrote a novel or an academic study, nobody took on board how devastating it was – far more devastating than the current pandemic. Yet, there is a silence.”

Glasgow is believed to have been the entry point of the pandemic to Britain, with de-mobbed soldiers then distributing the virus to their towns, cities and villages as they made their way home to families and friends. It was meant to be time of celebration –but the flu virus also joined the party.

In the week surrounding the Armistice, there were 306 deaths in Edinburgh alone.

The virus typically attacked the young, usually in the 20 to 40 age bracket, as the heightened immune response of the fit and well ultimately attacked the organs and shut down the body.

Those feeling unwell at breakfast could be dead by night. Doctors were in short supply given GPs were often still in the battlefield.

One part of Glasgow had just four doctors for 55,000 people as the pandemic struck. Ten of the area’s GPs were at war and three had fallen ill, according to research by Prof Butler.

Bodies stacked up nationwide given the lack of gravediggers. According to the Florence Nightingale Museum, a significant number of suicides and even murders were linked back to Spanish Flu – but still no one really talked about it. It appears there was little appetite to remember in what one American academic described as a “collective amnesia” of the pandemic.

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Spanish Flu – believed to have been transmitted to the continent either by Chinese labourers – there were 135,000 of them brought in to dig trenches – or by American servicemen.

It was the last brutal, fatal act of a time already defined by brutality and loss. Was it a God weary of war that decided to wipe out humanity with a a plague more fatal than man’s destructiveness? This was one soldier’s account of life in a camp struck by the flu, such was the despair and disbelief that a new type of horror could surround him.

The first serious take on Spanish Flu in Britain was written by medical historian Niall Johnson in 2006.Prof Butler added: “When you look at The Scotsman in November 1918, which was the peak of the pandemic in Scotland and when the influenza is raging around Europe, it’s all about fashion and motor cars. There is a story about a shortage of whisky. It is remarkable .

"World War One was so much worse than anyone had ever imagined. I believe it was felt that people could genuinely not take any more.”

As Covid-19 testimony and pictures of hospital wards and bereaved families continue to scare, the crude accounts from 1918 terrify.

One of the most distinctive symptoms of Spanish Flu was heliotrope cyanosis, a dark blue or purple flush that spread over the body, caused by a lack of oxygen as the victim’s lungs filled with fluid and pus.

If a patient began to show signs of cyanosis it often meant death was close. Many victims essentially drowned in their own bodily fluids.

Explosive nosebleeds were also a feature – although this was generally considered a sign that the fever had broken and the body was in repair mode.

The first reports of infection in Glasgow – and Britain – were printed in The Lancet in July 1918.

An influenza-type illness had presented in the first week of May with 420 cases in three factories and 16 in a boys industrial school.

Following that, 280 people fell sick in two industrial schools, a public school and a hosiery manufacturer in Lanarkshire.

Eight deaths and 186 infections were recorded at Smyllum Orphanage in Lanark as a result of the outbreak, according to a recent paper by Dr Graham Connelly, of Strathclyde University and historian Michael Lawrence.

Those who died were David Clabby, 15, Daniel Daisley, 11, James McBrian, 13, Patrick Gaffney, 13, Robert Woods, 13, John Donaghy, 12, and Francis McLuskie, nine.

The “constant communication” between different centres, such as a Glasgow home and a school in Lanarkshire, helped to spread the infection, The Lancet report said.

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Alarmingly – and in stark contrast to the information and advice shared by the government in 2020 and 2021 - there was no centralised public health campaign in 1918/19.

Sir Arthur Newsholme, the Medical Officer of the Local Government Board at Whitehall, the most senior health expert in government, decided not to publish a leaflet advising how to protect against flu.

The government was not talking about it. The people were not talking about it. The pandemic was on a green light – and the way was clear.

The major duty was to “carry on”, keep factories open and meet the relentless needs of warfare, Sir Arthur believed.

His actions have been criticised as ultimately costing lives – perhaps thousands – as infection rates started to soar.

It fell to local medical experts to bring in guidance and restrictions to protect the population with the messaging patchy as a result.

But there were heroes of the hour. The work of a Scot, James Niven, originally from Peterhead, is credited with saving hundreds of lives in Manchester where he served as the city’s Medical Officer for Health by introducing highly localised statistical models of infection and detailed public health messaging.

He wrote directly to the Manchester Guardian to warn readers not to be complacent should a sudden severe headache, pains in the back and limbs and fever set it. Discharge from nose and mouth should not be allowed to dry on handkerchiefs, he warned.

Anyone who caught the flu must “on no account join assemblages of people for at least 10 days after the attack and in severe cases they should stay off work for three weeks.”

Here, Dr Niven was building a public health response similar to the one unleashed across the four nations in 2020.

Dr Connelly said: "Some of the most basic public health messages - hand washing, social distancing, mask wearing - remain relevant.

"In fact, the modern science of public health really grew out of the 1918 pandemic."

Medical Officers for Health who had power to recommend closures of schools and public places in a bid to halt transmission, but it is understood that workplaces broadly stayed open.

Dr Connelly found that in Aberdeen, 5,000 children and 90 staff were absent from schools in October 1918 with primary schools shut for two weeks as a result.

By the end of that month, schools in Edinburgh were closed for three weeks.

Fatalities in the capital were mostly recorded in the 25 and 35 age group, with cases particularly high in the densely populated areas of Dalry, Gorgie and Canongate. As soldiers returned in November, the quiet mourning deepened.

A list of locally-approved cures and preventative measures started to build. In Edinburgh, an experiment was launched with a number of people put into a chamber, where steam was then blasted at high pressure.

In Wishaw in 1919, arrangements were being made for a special chamber where children would be taken to breath Formalin, a solution of formaldehyde and water.

A leaflet published by the local health committee was distributed through schools and public buildings.

"It was recommended that people sniffed up a salt solution twice daily, gargled with permanganate of potash, and soaked their handkerchiefs with eucalyptus, pine nuts or iodine,” Dr Connelly said.

In Montrose, there was talk of converting gas masks used in the trenches to facemaks to protect against the flu.

Dr Connelly, Honorary Senior Research Fellow at Strathclyde University with the Centre fo Excellence for Looked After Children in Scotland, said: “Awareness of the importance of public hygiene was different in 1918, and none of the accounts we have read mentions hand washing, or the use of alcohol gels.

“A century ago, great story was placed on the disinfection of public buildings and the virtues of fresh air through the use of open windows.”

Churches were disinfected between services in parts of Scotland with cinemas also targeted in local public health campaigns.

With cinema going rising in popularity during World War One, when footage from the Somme was screened and rising stars such as Charlie Chaplin and Mary Pickford started to captivate, concerns were raised that picture houses were the most dangerous breeding grounds for the deadly sickness.

Attempts were made to ban children from cinemas in Scotland as the epidemic spread with concerns they posed a greater threat to health than schools.

Military Police were also posted at cinema doors to stop soldiers attending the movies.

The impact of the 1918-1919 pandemic on cinemas in Scotland has been researched by Dr Trevor Griffiths, reader in economics and social history at Edinburgh University, who will share his findings at this month’s Hippodrome Silent Movie Festival, which will move online this year as a result of the Covid-19 pandemic.

Dr Griffiths said: “It was a varied approach. In Glasgow, it was felt that it was better to keep cinemas going as it was a healthier environment than people generally experienced but in Edinburgh it was quite different, where the Medical Officer appears to take against cinemas, where he expected them to be the main place where the disease is communicated.”

As a result, cinemas in the capital had to close for half an hour a day to allow for airing and disinfection.

It was herd immunity that ultimately brought the pandemic to an end, with the third and final wave of infection taking hold in Spring 1919.

The poor general health of the wartime population combined with overcrowded housing are believed to have driven the infection with such devastating effect, but the reality is, the virus still mystifies.

Tissues taken from the excavated body of an Inuit woman buried in Brevig Mission, Alaska, where 90 per cent of the population died from Spanish Flu, led scientists to sequence the full genome of the viral RNA in 2005.

But they still don’t know exactly why it caused the Spanish flu pandemic.

As the implications of Covid-19 infection start to emerge for some, with cases of ‘long Covid’ rising, the Spanish Flu had its own aftermath.

In the 1920s, a further 1,000 deaths from encephalitus lethargica were recorded in Scotland.

After attacking the brain, the disease leaves some victims in a statue-like condition, speechless and motionless. Some cases were still being reported in Scotland in the 1950s.

Dr Connelly said: “I don't think this was talked about. We need to keep this in mind and ensure that there is more openness and better support available for those living with the consequences of Covid-19. ”

As we feel a flicker of hope that the end of our own war with Covid-19 might be within touching distance, lest we forget the pandemic of 1918 and the lessons of a devastating impact of a virus aided by silence.

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