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One hundred years ago at the end of the First World War the Spanish flu spread across the globe. It was first recorded in an army camp (supplying war torn France) in Kansas USA March 1918. Only neutral Spain had proper records and hence it was called the Spanish flu. It came in three waves, months apart and killed more than 20 million people far more than had died in the war, infecting more than 100 million and spreading to all corners of the globe. Some said the flu was started by germ warfare.
Influenza in the arts
My grandparents must have been in their early twenties or late teens but it was never spoken of, there are no memorials to the victims and no one person is celebrated for bravery or cure, by statue or portrait.
Unlike the war, this flu was little recorded in the arts or literature . Many artists such as Egon Schiele died of the infection a few days after completing a portrait of his dying pregnant wife and himself, in their late twenties. (Image :wellcomecollection.org)
Munch portrayed himself sick recovering from the flu (image :wellcome collection.org)
The major paintings of the time recorded the horrors of the war. Perhaps an image by John Singer Sargeant “gassed” (see Wikipedia ) in which a line of masked soldiers (whose symptoms would have been remarkably similar to the flu) may have referred to the influenza. He himself contracted the flu in Northern France where he painted a watercolour of the hospital tent, red blankets over the contagious, brown over the convalescing. ( jssgallery.org)
In literature the writer, K.A. Porter penned the novel “Pale horse, Pale rider” ( in reference to the riders of the apocalypse) which was a story based on her battle with flu in which she lay with a temperature of 105. F for nine days in a hall way (being treated with injected strychnine), only to revive to find her partner (who had cared for her ) had succumbed to the virus. Virginia Wolff briefly mentioned the flu in her novel Mrs Darroway.
Why did such a disaster not permeate art and literature? Is war a more noble but unnatural thing leading to the remembrance of deaths? Is flu a personal thing shared amongst families rather than nations and politicians?
Is this why it has taken second place in our memories and our efforts? Could we be not be even more organised for these potential epidemics?
The social aspects of influenza and government response
Prevention and control of the spread of viruses have advanced, but the basis of social prevention now, in 1918 and even at the time of the 1664 plague remain very similar.
These infections often begin in animals ( viruses) or are carried by animals ( the plague).Viral mutations lead after many years and cross contact with humans to infections. Mutations change the surface of the virus such that the human immune system does not recognise the invader till too late.
The plague of 1664 was a bacterial infection, the 1918 flu, an influenza virus (as the present Covid 19).
To prevent viral influenzas there needs to be awareness of where these mutations can occur in the world. Close contact between domestic animals and wild animals (due to destruction of their habitat ) is likely to be one source. It is said there may be hundreds of thousands of viruses with a potential to infect humans, so surveillance is not easy although some areas of the world are more prone so reports from these of the animal to human interactions and of sick animals is important.
Both the 1918 epidemic and the 1664 plague followed wars ( the restoration in 1660) when people were tired and malnourished. The authorities were slow to track the infections and to put measures in place to prevent the spread. In the plague of 1664, two French soldiers died in London, there was panic( as this was not the first time plague had struck) but then a lull of false security as things seemed to settle. Authorities, out of fear moved slowly despite (initially )the obvious edging up of death figures.
Having infected but a few, the infections spread quickly and needed a rapid response. Modern times sees the movement of people far across the globe, possibly carrying infection, 1918 saw mass movements of troops with much of the flu breaking out in military bases. The plague was on the back of renewed prosperity with increased merchant trade entering London. Both the plague and 1918 flu hit most age groups.
The plague had a pneumonic version making it similar to the symptoms of viral flu.
In plague times, in 1918 and now the authorities reacted with advise on closure of all places where social gatherings would take place. In 1664 there was no police force or army of note to ensure these rules, no newspapers to pre-warn populations and news travelled relatively slowly. In 1918 at the end of the war there was reduced international cooperation , viruses were unheard of and countries gave the illness different diagnoses from the plague in Europe to typhus in Russia, leading to a disjointed spread of news. There was also a need for news reports to switch focus as the end of the war was paramount in people’s and politicians’s minds and often celebrated in large groups who denied the contagion (as in Philadelphia where a war effort parade attracted 200,000 of which 4500 spectators caught and died of flu)However, public gatherings were prevented and businesses closed haphazardly ( for fear of social unrest)across the globe.
In plague times the poor, living in overcrowded London were the first to be struck and like now the more well to do fled from London to the country, taking their infections with them. Passes were needed to travel and an attempt made to barr roads to prevent spread. London was empty, transport disappeared and passers by kept their distances. Social isolation was enforced in 1664; if a member of the household was sick...for 28 days a watcher would be put outside the locked door to ensure the occupants (family and servants), obeyed the isolation, he would get them provisions. Many not wanting to catch the illness from their relatives escaped towards the open roads and the country, leaving the sick to die alone but taking their prodromal illnesses (the period of developing infection before symptoms) with them.The wise in London, laid in provisions for many months and self isolated closing themselves in before any member of the household became ill, so preventing infection.
In 1918 How could soldiers self isolate? Troops continued to move.
Once the pandemic was recognised the government, as now, shut down shops, schools and trades, set up quarantine at ports and set up hospital isolation wards. People were advised to wash their hands, avoid crowds and keep their windows open. Masks were advised in some places. Many just bought in supplies and shut their doors to everyone.
During the plague, once the Lord Mayor had shut down the city, many went hungry without work. The authorities, collected in charitable donations for the poor, provided them with doctors to prevent them chasing fortune tellers and witches,and the Royal College of Physicians gave them medicines. However there were no regulations for food stores, starvation was a real possibility and country neighbours, initially not struck by the epidemic, delivered their produce and laid it outside plague boundaries. Many tradesmen were re-employed in jobs they could not refuse relating to plague care and surveillance,such as watchers, nurses (who confirmed the plague diagnosis), searchers (looking for new cases).
The medical and scientific aspects
The medical services in 1918 “were overwhelmed, with no ambulances, no staff,no palliative care, no medication,” with the carers falling ill and stretched to the limit with prolonged hours. How could services increase when they were at the brim with war casualties? Influenza was not a notifiable disease and so doctors did not initially alert the authorities so reinforcing the delay in planning.
In 1664 plague, the “pest house” was soon overwhelmed, doctors died and many sufferers just lay or died in the streets without any care or help.
A lot of research has followed the 1918 flu but our immediate management now is little different from then (or tried to be), in the 17th century.
We thankfully have a world health authority and public health systems.
Thankfully, in this flu episode countries have communicated and cooperated, the infection's existence was not denied and lead to a rapid and united response.
Thankfully governments put in stringent isolating and travel controls which were policed and thankfully the mass media spread the word and raised the “ante” to speed everyone’s response. Helping lesser equipped countries to provide more rapid and effective health care would in the future help prevent spread as would help to prevent poverty, overcrowding, wars and the destruction of wild animals’ environments.
Thankfully at least in the Western world there has been a united front in the production of new hospitals and the increase and protection of the medical services and staff needed to treat the growing numbers of sick This should happen all over the world and until cures are found surely should be a worldwide predetermined emergency preparation.
Prevention and cures
Research through The PREDICT and global virome projects to name two, are attempting to track the 700,000 zoonotic ( can jump species and to man )potential viruses around the world collecting blood from bats,primates, rodents and other animals to classify the viruses they carry.
Thankfully the bacterial plague is less likely to spread and responds to antibiotics although still present in parts of the world (appearing during the Vietnam war). The American society for microbiology however describes its increasing resistance to antibiotics.
We now have the options of a vaccine which primes our immune systems to recognise the new virus and so we more effectively mount a reaction if we come into contact with the real thing. But vaccines take many months to produce and are unlikely to be effective against the next mutation.
We have antiviral drugs ( the viral equivalent of antibiotic or antibacterials) but they are not as developed as the antibiotics.
Having been in medical practice for over thirty years and seen the rise in antibiotic resistance due to use of antibacterial medications against non bacterial infections (viruses have no response to antibiotics), it occurs to me that money could be spent on a test to ascertain the community cause of any respiratory illness , helping to differentiate between viral and bacterial.
Identifying the virus and having an electronic record of viral illnesses circulating in the population at any one time, reducing the use of antibiotics by targeting only bacterial infections allowing their use against illnesses such as the plague (should it return), and a ever updating map of viruses in communities would help everyone to adjust rapidly until effective preventions can be found.
Many die from the annual respiratory viruses, and hospitals are always under winter pressure as a consequence. The GP sees the rising numbers early on, their contribution to a viral forecast map would help the vulnerable stay in isolation until the risk lessened. Many diseases may be due to viruses “hiding” in our bodies or to the (auto)immune reactions they produce. The war against Viruses should be the next global battle and they, not outer space, should be the next frontier.
References:
Wellcome museum Spanish flu and art
wellcomecollection.org Spanish flu and the depiction of disease by Alison C Meler
Wikipedia en.m.wikepedia.org
A journal of the plague year by Daniel Defoe
Art forum.com
Artnet news ( http://news.artnet.com)
jssgallery.org
Book: Pale Horse, Pale Rider by Katherine Anne Porter
Pale horse pale rider “The forgotten apocalypse “ David Davis ( accessed via Jstor)
Book: Pale rider by Laura Spinney
Scientist.com predicting future zoonotic disease outbreaks. Ashley Yeager 31/5/18
American society of microbiology : aac.asm.org
Viruses and autoimmunity (journal : Viruses.2019 Aug) ncbi.nlm.nih.gov
© Barbara Milne 2020
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