Dr. Patricia Marsh: Queen’s University, Belfast

Dr. Marsh will be giving a talk entitled “The Spanish Influenza Pandemic in Antrim and Down 1918-1919” at Bangor Library on Thursday 21st February 2019 at 7.30pm, and Lisburn Road Library on Wednesday 27th February 2019 at 6.30pm 6.30 to 7.30 p.m.

Towards the end of the First World War in June 1918, a fatal influenza epidemic not only hit troops in the western front but also the civilians throughout the world. Although the exact mortality figures are unknown, it was responsible for the deaths of more people than the First World War[1] and in 2002 the global death toll of the pandemic was estimated to be approximately 50 million.[2]  Although called the ‘Flanders’ grippe ‘by English soldiers’;  ‘Blitzkatarrh’ by the Germans; ‘the disease of the wind’ in Persia; the name it became commonly known as was the ‘Spanish Influenza.’[3]  So why Spanish influenza? The neutrality of Spain during the First World War meant that there was no newspaper censorship in that country and consequently reports about the disease were published not only in Spanish newspapers and also in the worldwide press. The Times reported 100,000 victims in Madrid of an unknown disease responsible for 700 deaths in 10 days, which had caused disruption to public services, offices and factories.  King Alfonso XIII of Spain and other leading politicians were among those afflicted.[4]  It was these reports that gave rise to the erroneous impression that influenza had originated in Spain, leading to the misnomer Spanish influenza.  However, the Spanish themselves called it the soldier of Naples.[5]

The disease, however, did not originate in Spain.  One theory is that the pandemic originated as early as the winter of 1916, on the Western Front at the British Army camp at Étaples. The outbreaks at Étaples were diagnosed at the time as purulent bronchitis but in retrospect they showed the same symptoms as the Spanish ‘flu.  Dr Herbert French, author of the 1920 Ministry of Health Report was strongly of the opinion that the fatal cases from purulent bronchitis were likely to be the same as those of the pandemic.[6]  It has also been suggested that the pandemic could have originated in China and that the movement of a very large number of workers from China to France during the First World War might have played a part in the pandemic’s development.[7] However the most popular theory was that influenza started in America. The earliest recorded outbreak of the disease was on 5 March 1918 among army recruits at Camp Funston, Fort Riley, Kansas. By the end of March it had spread to military training installations in several US mid-western and south eastern states and from here it travelled with the troops on the ships to the Western Front.[8] 

1918 influenza victims crowd an emergency hospital at Fort Riley, Kansas

The Flu in Ireland

Spanish influenza struck in three concurrent waves throughout the world and Ireland was no exception with three distinct waves of influenza, which occurred in June 1918, October 1918 and February 1919.[9]  Speaking in 1920, the Registrar-General for Ireland, Sir William Thompson was of the opinion that influenza in Ireland was the worst disease of an epidemic nature since the period of the Great Famine.[10]  The death toll in Ireland was approximately 23,000,[11] however this is a conservative estimate as not all influenza deaths in the country were registered and also some were registered incorrectly. The morbidity from the disease is more difficult to ascertain as no accurate records of incidences of influenza were kept during this period.  However, Ida Milne suggests that as many as 800,000 people could have been infected in Ireland.[12]  As many as 300,000 people could have been infected in the province of Ulster, where 7,582 people were recorded as dying from influenza.  However, the death toll could have been much higher.[13] 

The first recorded outbreak of Influenza in Ireland was on the United States Ship Dixie docked in Queenstown (now Cobh),[14] however this outbreak was confined to the ship as there were no reports of ‘flu in the town.  The first wave proper was reported to be principally in Belfast and other districts of the north of Ireland.[15]  First mention of influenza in the province appeared on 11 and 12 June 1918 in Belfast newspapers when a notice appeared regarding the re-opening, after influenza, of a department in James Mackie & Sons munitions factory situated in the Springfield Road.[16]  Influenza spread from Belfast across the north of Ireland probably via the rail network. Elsewhere in Ireland there were also sporadic outbreaks at towns such as Ballinasloe, Tipperary town and Athlone.  It is notable that these towns were situated near army bases as the general consensus was that ‘flu was brought to Ireland with troops returned home on leave or to convalesce from wounds and then spread via the rail network.[17] 

The second wave originated in Leinster. Howth on the east coast appeared to be the entry point and was reported to be there as early as 1 October 1918.[18]  From Howth it spread to Dublin and then throughout Ireland.  In Ulster influenza was first reported in the naval port of Larne on 9 October 1918.[19]  The disease did not reach Belfast until the end of October 1918.[20]  Influenza spread to most Ulster towns during this wave and this was the most virulent wave in the province.  County Donegal was badly affected during this outbreak, especially the Inishowen Union District, which had the highest death rate per thousand of population in Ulster.[21]

The third wave which started in February 1919, again originated in Leinster.  It was first reported on 5 February 1919 in the Celbridge district in Co Kildare.[22]  Initial reports of influenza in Ulster during this wave were in Holywood on 6 February 1919[23] and it was in Belfast by 18 February 1919.[24] Influenza visited most Ulster towns but in many such as Belfast, Lurgan, Larne, Newry and Dungannon this was a milder wave than those in 1918 and this may be because immunity was gained from previous waves. However, Dublin county and borough suffered severely during all three waves of the disease. County Donegal was again severely affected with a higher mortality during the third wave in 1919 than in both waves during 1918.  This was also the case with other counties in the west of the country such as Mayo, Sligo and Galway.

Age distribution

There was an unusual age distribution for this pandemic as it targeted young adults in particular.  Normally influenza kills the very young and the very old but Spanish influenza showed an unusual age distribution of deaths.  Although there was still high mortality for the very young and very old there was also a very high mortality for the age group between 15 and 44.[25] In England and Wales mortality was  concentrated among those aged 20 to 40 and especially those 25 to 35.[26]  It has been suggested that this peculiarity helped to produce Britain’s ‘lost generation’ caused by not only from the high mortality among young men killed due to the war but also from influenza on the home front.[27]

 In Ireland 55.5% of all influenza deaths in 1918 were of those aged between 15 and 45.[28]  In 1919 more than 58% of the total influenza mortality was between the ages of 20 and 65.[29]  Figure 1 is a graphical representation of the age-specific influenza death rates for Ireland comparing 1918 and 1919.  It shows that the age-specific death rates for Ireland followed the global trend of targeting young adults and that during 1918 it was those aged 25 to 35 who suffered the highest mortality of any age group.[30]  The Irish figures also show that infants under one year were also at particular risk during the pandemic.  This was hardly surprising as, even without epidemic disease, the urban areas of Ireland such as Dublin and Belfast suffered from one of the highest infant mortality rates in the United Kingdom due to infection and poor diet.[31]

Figure 1: Graph comparing the age-specific influenza death rates for Ireland for 1918 and 1919

Why was the pandemic so detrimental to 25 to 35 age-group? 

One theory was that elderly people had gained immunity to the 1918-19 pandemic due to previous exposure to the influenza epidemic of 1847-48 which may have been caused by a similar H1 virus.[32]  Another is that young adults were more likely to attempt to work through illness, thus maximizing their risk of succumbing to influenza.[33]  It has also been suggested that many of the age group 20-45 had been soldiers living in miserable conditions on the western front which would have lowered their immunity, but the same death rates were seen in young people in countries unaffected by the war.[34]  However, the answer may lie in a scientific study that took place in 2007, which suggested that the strong immune systems of young adults overreacted to the 1918 virus causing this particular age group to be at the most risk during the pandemic.[35]

Read Part 2: Spanish Influenza in Ulster

[1] Howard Phillips and David Killingray, ‘Introduction’ in Howard Phillips and David Killingray (eds.) Spanish influenza pandemic of 1918-1919: new perspectives (London, 2003), pp 3-4.

[2]Niall P.A.S. Johnson and Juergan Mueller, ‘Updating the Accounts: Global Mortality of the 1918 –1920 “Spanish” Influenza Pandemic’ Bulletin of History of Medicine. 76 (2002),, p. 115

[3] Pete Davies, Catching cold: 1918’s forgotten tragedy and the scientific hunt for the virus that caused it (London, 1999), p. 58.

[4]The Times, 3 June 1918.

[5] Davies, Catching cold,  p. 58.

[6] J. S. Oxford, ‘The so-called Spanish influenza pandemic of 1918 may have originated in France in 1916’ Phil. Trans. Royal Society London 356 (2001), pp 1857-1859.

[7]Christopher Langford, ‘Did the 1918–19 influenza pandemic originate in China?’ Population and Development Review 31:3 (2005), p. 492.

[8] K. David Patterson, and Gerald F. Pyle, ‘The Geography and Mortality of the 1918 Influenza Pandemic’, Bulletin of History of Medicine  65 (1991), p. 5.

[9]Annual report of the Local Government Board for Ireland for year ended 31 March 1919, [Cmd 1432], H. C. 1920, xxi, 1, p. xxxvii.

[10] William J. Thompson, ‘Mortality from influenza in Ireland’ Dublin Journal of Medical Sciences 4th Series 1 (1920), p. 174

[11]Patricia Marsh, ‘The Effect of the 1918-19 Influenza Pandemic on Belfast’, ( M.A. thesis, Queens University Belfast, 2006), p.42

[12]IdaMilne, ‘Epidemic or Myth?: The 1918 Flu in Ireland’. (M.A. thesis, National University of Ireland, Maynooth, 2005), p. 35.

[13] Patricia Marsh, ‘The effect of the 1918-19 influenza pandemic on Ulster (PhD dissertation, Queen’s University Belfast, 2010), pp 42-57.

[14] United States Navy Department, Annual report of the Secretary of the Navy, Miscellaneous reports (Washington, Government Printing Office, 1919), pp. 2423-4.

[15]Annual report of the Local Government Board for Ireland for year ended 31 March 1919, p. xxxvii.

[16]Belfast Evening Telegraph, 11 June 1918; Belfast News-Letter, 12 June 1918.

[17] Marsh, ‘The effect of the 1918-19 influenza pandemic on Ulster, p, 67

[18]Irish Times, 1 Oct. 1918; Irish Independent, 1 Oct. 1918.

[19]Larne Board of Guardians Meeting, 9 Oct 1918 (P.R.O.N.I, Larne union minute book 1918, BG/17/A/132)

[20]Belfast News-Letter, 30 Oct. 1918.

[21] Fifty-fifth detailed annual report of the Registrar-General (Ireland), pp. v.

[22]Irish Independent, 5 Feb. 1919.

[23]Holywood Public Health Committee meeting, 6 Feb 1919 (P.R.O.N.I., Holywood Urban District Council minutes, LA/38/9AA/3)

[24]Belfast Board of Guardians meeting, 18 Feb. 1919 (P.R.O.N.I., Belfast Union minutes, BG/7/A/101).

[25]Andrew Noymer and Michel Garenne, ‘The 1918 influenza epidemic’s effects on sex differentials in mortality in the United States’, in Population and Development Review, 26:3 (2000), pp. 566-67.

[26] Herbert French, ‘The clinical features of the influenza epidemic 1918-19,’ pp. 90-1.

[27] Niall Johnson, Britain and the 1918-19 influenza pandemic: A dark epilogue, (London/New York, 2006), p. 84.

[28] Thompson, ‘Mortality from influenza in Ireland’, p. 183.

[29]Fifty-sixth detailed annual report of the Registrar-General (Ireland), p. xvi.

[30] Mortality figures calculated from Fifty-fifth detailed annual report of the Registrar-General (Ireland), p xvi and Fifty-sixth detailed annual report of the Registrar-General (Ireland), p. Xvii

[31] Ruth Barrington, Health, medicine and politics in Ireland 1900-1970 (Dublin, 1987), p. 75.

[32] Christopher Langford, ‘The age pattern of mortality in the 1918-19 influenza pandemic: An attempted explanation based on data for England and Wales’, in Medical History, 46 (2002), p. 15. Ann H. Reid, Jeffery K. Taubenberger, Thomas G. Fanning, ‘The 1918 Spanish influenza: Integrating history and biology’, in Microbes and Infection,3 (2001), p. 83.

[33] Johnson, Britain and the 1918-19 influenza Pandemic, p. 88.

[34]Reid, Taugenberger and Fanning, ‘The 1918 Spanish influenza’, p. 83.

[35] Kerri Smith, ‘Concern as revived 1918 flu virus kills monkeys’, in Nature, 445 (18 Jan. 2007), p. 23.