Pale Rider: The Spanish Flu of 1918 and How It Changed the World Read online

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  Copyright © 2017 by Laura Spinney.

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  Originally published in hardcover and ebook by Jonathan Cape, an imprint of Vintage Publishing in May 2017

  First US Edition: September 2017

  Published by PublicAffairs™, an imprint of Perseus Books, LLC, a subsidiary of Hachette Book Group, Inc.

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  Map © Nigel Hawtin 2017

  Lines from ‘Sweeney Among the Nightingales’ from Collected Poems 1909–1962 by T. S. Eliot reproduced with permission from Faber and Faber Ltd.

  Typeset in India by Integra Software Services Pvt. Ltd, Pondicherry

  Library of Congress Control Number: 2017933356

  ISBNs: 978-1-61039-767-4 (hardcover); 978-1-61039-768-1 (ebook)

  E3-20170817-JV-PC

  Contents

  Cover

  Title Page

  Copyright

  Dedication

  Map

  INTRODUCTION: The Elephant in the Room

  PART ONE: The Unwalled City

  1. Coughs and sneezes

  2. The monads of Leibniz

  PART TWO: Anatomy of a Pandemic

  3. Ripples on a pond

  4. Like a thief in the night

  PART THREE: Manhu, or What is it?

  5. Disease eleven

  6. The doctors’ dilemma

  7. The wrath of God

  PART FOUR: The Survival Instinct

  8. Chalking doors with crosses

  9. The placebo effect

  10. Good Samaritans

  PART FIVE: Post Mortem

  11. The hunt for patient zero

  12. Counting the dead

  PART SIX: Science Redeemed

  13. Aenigmoplasma influenzae

  14. Beware the barnyard

  15. The human factor

  PART SEVEN: The Post-Flu World

  16. The green shoots of recovery

  17. Alternate histories

  18. Anti-science, science

  19. Healthcare for all

  20. War and peace

  21. Melancholy muse

  PART EIGHT: Roscoe’s Legacy

  AFTERWORD: On Memory

  Acknowledgements

  About the Author

  By the same Author

  Illustration Credits

  Notes

  Index

  For RSJF and the lost generations

  INTRODUCTION: The Elephant in the Room

  Japanese schoolgirls wearing protective masks during the pandemic, 1920

  The brevity of the influenza pandemic of 1918 posed great problems to doctors at the time… It has posed great problems to historians ever since.

  Terence Ranger, The Spanish Influenza Pandemic of 1918–19 (2003)1

  Kaiser Wilhelm of Germany abdicated on 9 November 1918 and in the streets of Paris there was jubilation. ‘À mort Guillaume!’ they shouted. ‘À bas Guillaume!’ Death to Wilhelm! Down with Wilhelm! Meanwhile, high above the city’s seventh arrondissement, the poet Guillaume Apollinaire lay on his deathbed. A leading light of the French avant-garde movement, the man who invented the term ‘surrealist’ and inspired such figures as Pablo Picasso and Marcel Duchamp, he had signed up to fight in 1914. Having survived a shrapnel wound to the head and the drilling of a hole into his skull, he died of Spanish flu at the age of thirty-eight, and was declared ‘mort pour la France’.

  His funeral was held four days later–two days after the armistice was signed. On leaving the Church of St Thomas Aquinas, the mourners set off eastwards towards Père Lachaise Cemetery. ‘But as it reached the corner of Saint-Germain,’ recalled Apollinaire’s friend and fellow poet, Blaise Cendrars, ‘the cortège was besieged by a crowd of noisy celebrants of the armistice, men and women with arms waving, singing, dancing, kissing, shouting deliriously the famous refrain of the end of the war: “No, you don’t have to go, Guillaume. No you don’t have to go…’” The famous refrain was directed with irony at the defeated kaiser, but it was filled with poignancy for the friends of Apollinaire.2

  The poet’s death serves as a metaphor for our collective forgetting of the greatest massacre of the twentieth century. The Spanish flu infected one in three people on earth, or 500 million human beings. Between the first case recorded on 4 March 1918, and the last sometime in March 1920, it killed 50–100 million people, or between 2.5 and 5 per cent of the global population–a range that reflects the uncertainty that still surrounds it. In terms of single events causing major loss of life, it surpassed the First World War (17 million dead), the Second World War (60 million dead) and possibly both put together. It was the greatest tidal wave of death since the Black Death, perhaps in the whole of human history.

  Yet what do we see when we unravel the scroll of the twentieth century? Two world wars, the rise and fall of communism, perhaps some of the more spectacular episodes of decolonisation. We do not see the most dramatic event of them all, though it’s right there before our eyes. When asked what was the biggest disaster of the twentieth century, almost nobody answers the Spanish flu. They’re surprised by the numbers that swirl around it. Some become thoughtful and, after a pause, recall a great-uncle who died of it, orphaned cousins lost to sight, a branch of the family that was rubbed out in 1918. There are very few cemeteries in the world that, assuming they are older than a century, don’t contain a cluster of graves from the autumn of 1918–when the second and worst wave of the pandemic struck–and people’s memories reflect that. But there is no cenotaph, no monument in London, Moscow or Washington DC. The Spanish flu is remembered personally, not collectively. Not as a historical disaster, but as millions of discrete, private tragedies.

  Perhaps that has something to do with its shape. The First World War dragged on for four long years, but despite its name, the bulk of the action was concentrated in European and Middle Eastern theatres. The rest of the world felt the hot wind sucking it into that vortex but remained outside it, and in some places the war seemed very far away indeed. The war had a geographical focus, in other words, and a narrative that unfolded in time. The Spanish flu, in contrast, engulfed the entire globe in the blink of an eye. Most of the death occurred in the thirteen weeks between mid-September and mid-December 1918. It was broad in space and shallow in time, compared to a narrow, deep war.

  The African historian Terence Ranger pointed out in the early 2000s that such a condensed event requires a different storytelling approach. A linear narrative won’t do; what’s needed is something closer to the way that women in southern Africa discuss an important event in the life of their community. ‘They describe it and then circle around it,’ Ranger wrote, ‘constantly
returning to it, widening it out and bringing into it past memories and future anticipations.’3 The Jewish text, the Talmud, is organised in a similar way. On each page, a column of ancient text is surrounded by commentaries, then by commentaries on the commentaries, in ever-increasing circles, until the central idea has been woven through space and time, into the fabric of communal memory. (There may be another reason why Ranger proposed a feminised history of the Spanish flu: it was generally women who nursed the ill. They were the ones who registered the sights and sounds of the sickroom, who laid out the dead and took in the orphans. They were the link between the personal and the collective.)

  At the root of every pandemic is an encounter between a disease-causing microorganism and a human being. But that encounter, along with the events that lead up to it and the events that ensue from it, is shaped by numerous other events taking place at the same time–as well as by the weather, the price of bread, and ideas about germs, white men and jinns. The pandemic in its turn affects the price of bread, ideas about germs, white men and jinns–and sometimes even the weather. It is a social phenomenon as much as it is a biological one; it cannot be separated from its historical, geographical and cultural context. The way African mothers and grandmothers recount an event gives weight to that contextual richness, even if the event it impinges on lasts no longer than a historical heartbeat. This book sets out to do the same.

  The time is right. In the decades immediately after the pandemic, the only people who studied it–besides actuaries employed by insurance companies–were epidemiologists, virologists and medical historians. Since the late 1990s, however, Spanish-flu historiography has exploded, and this recent burst of attention has been noticeable by its multidisciplinary nature. Now economists, sociologists and psychologists are interested in it too, along with ‘mainstream’ historians. Each has trained their gaze on a different aspect, and between them they have transformed our understanding of it. All too often, though, their conclusions are buried in specialist journals, so this book attempts to bring them together; to weave all the different strands into a more coherent picture of the beast, in all its multifaceted glory–or horror.

  The information that is available today is not only more academically diverse, it is also more geographically diverse–capturing the global reach of the disaster. Most accounts of the Spanish flu to date have focused on Europe or North America. They had to, because for a long time it was only in those places that data had been collected systematically. In 1998, when Spanish-flu experts from around the world met in Cape Town to mark its eightieth anniversary, they acknowledged that almost nothing was known about what happened in large swathes of the globe–South America, the Middle East, Russia, South East Asia and inland China. But Europe- and North America-centred accounts distort the picture for two reasons. First, those continents reported the lowest death rates, on average, so their experiences were atypical. And second, by 1918 they were both heavily implicated in a war that would devastate Europe. War was undoubtedly the main event on that continent: France lost six times more souls to the war than to the flu, while in Germany the multiple was four, in Britain three and in Italy two. But on every other continent–with the possible exception of Antarctica, which both disasters left pristine–more died of flu than war. At the time of writing–nearly twenty years on from the Cape Town summit, and as we approach the centenary of the catastrophe–it is possible to begin to reconstruct what happened in those other parts of the world.

  This book takes a different approach to telling the flu. It moves in on it–from prehistory to 1918, from the planet to the human, from the virus to the idea and back again. At the heart of it is the story of how the Spanish flu emerged, swept the planet and receded, leaving humanity transformed. But that story pauses, at times, to look at what set communities apart in their experiences of it, as well as what brought them together. In 1918, the Italian-Americans of New York, the Yupik of Alaska and the residents of the Persian shrine city of Mashed had almost nothing in common except the virus, and in each place cultural and other factors moulded their encounter with it. A series of portraits therefore tracks the disaster as it unfolded in societies located at different points on the globe, highlighting the profoundly social nature of a pandemic.

  These portraits shine a light into areas of the map that were previously dark, and give an indication of how the Spanish flu was experienced in parts of the world where 1918 was the year of the flu, not the year the war ended. They are not comprehensive, because millions of stories remain untold, so they come with caveats. It surely wasn’t only in Rio de Janeiro that a post-flu orgy produced a spike in births, or only in Odessa, Russia, that people performed archaic religious rituals to ward off the scourge. It wasn’t only Indians who temporarily transgressed strict social boundaries to help each other, or only in South Africa that people of one colour blamed those of another. A Catholic bishop may have frustrated efforts to contain the disease in Spain, but missionaries were often the only ones bringing relief to remote tracts of China. There is one overarching caveat: the narrator is, once again, European.

  The story of the Spanish flu is told in Parts Two to Six of the book. But that story is embedded in a larger one–the one that tells how man and flu have cohabited, and co-evolved, for 12,000 years–so Part One, ‘The Unwalled City’, recounts that story up to 1918, while Part Seven, ‘The Post-Flu World’, explores the traces of the Spanish flu with which we live today. Since man and flu are still co-evolving, Part Eight, ‘Roscoe’s Legacy’, looks forward to a future battle–the next flu pandemic–envisaging what new weapons we will carry into it, and what is likely to be our Achilles heel. Together, these stories comprise a biography of the flu–a human story, that is, in which the fil conducteur is flu. An afterword addresses the question of memory, asking why, when its impact was so profound, we call it ‘forgotten’.

  It is often said that the First World War killed Romanticism and faith in progress, but if science facilitated industrial-scale slaughter in the form of the war, it also failed to prevent it in the form of the Spanish flu. The flu resculpted human populations more radically than anything since the Black Death. It influenced the course of the First World War and, arguably, contributed to the Second. It pushed India closer to independence, South Africa closer to apartheid, and Switzerland to the brink of civil war. It ushered in universal healthcare and alternative medicine, our love of fresh air and our passion for sport, and it was probably responsible, at least in part, for the obsession of twentieth-century artists with all the myriad ways in which the human body can fail. ‘Arguably’ and ‘probably’ are indispensable qualifiers when discussing the Spanish flu, because in 1918 there was no way of diagnosing influenza, and hence no way of knowing for sure that that was what it was–any more than we can be certain that the bubonic plague (or one of its variants, pneumonic plague) caused the Black Death in the fourteenth century. What isn’t arguable is that the 1918 pandemic accelerated the pace of change in the first half of the twentieth century, and helped shape our modern world.

  If all of this is true, how come we still think of the Spanish flu as a footnote to the First World War? Have we really forgotten it? Terence Ranger thought we had, but if he were still alive today he might hesitate before repeating that claim. If so, then credit must go to a vast collaborative effort. The Spanish flu can no longer be told without the contributions of both historians and scientists, including social scientists. Science tells the tale up to the threshold of history, across the acres of prehistory that look empty but are, in fact, covered in an invisible scrawl–and that moulded events in 1918 just as much as what came later. History takes it up where the scrawl becomes legible, and science sheds some light back from the present. In another hundred years, science and history will themselves have been transformed. There might even be a science of history, in which theories about the past are tested against computerised banks of historical data.4 That kind of approach will likely revolutionise the way we understand com
plex phenomena such as pandemics, but it’s still in its infancy. There is one thing we can already say for sure, however: by the bicentenary of the 1918 pandemic, historians will have filled in more of the blanks, and the light shed by science will be brighter.

  PART ONE: The Unwalled City

  A crowded street scene in Bombay, circa 1920

  1

  Coughs and sneezes

  Sometime around the winter solstice of 412 BC, a cough wracked the people of Perinthus, a port city on the Sea of Marmara in what was then northern Greece. The Perinthians reported other symptoms too: sore throat, aches, difficulty swallowing, paralysis of the legs, an inability to see at night. A doctor called Hippocrates jotted them all down, and the ‘Cough of Perinthus’ became the first written description–probably–of influenza.

  Probably, because certain of those symptoms don’t seem to fit: impaired night vision, paralysis of the limbs. Their inclusion troubled historians of medicine, until they realised that Hippocrates defined an epidemic differently from us. Indeed, Hippocrates was the first to use the word epidemic (literally, ‘on the people’) in a medical sense. Before that, it had referred to anything that propagates in a country, from fog to rumour to civil war. Hippocrates applied it specifically to disease, and then he redefined disease.

  The ancient Greeks thought of disease as spiritual in origin, a punishment from the gods for any kind of misdemeanour. Doctors were part priests, part magicians, and it was their role to mollify the irascible divinities with prayer, spells and sacrifices. Hippocrates argued that the causes of disease were physical, and that they could be divined by observing a patient’s symptoms. He and his disciples introduced a system for classifying diseases, which is why he is often referred to as the father of western medicine: he was responsible for the notions of diagnosis and treatment that still underpin medicine today (he also left us with a code of medical ethics, the Hippocratic Oath, from which we have the promise made by newly qualified doctors to ‘do no harm’).