Surviving Two Pandemics
“It’s for your own sake, Watson....It is infallibly deadly and horribly contagious....Keep your distance and all is well.”
— Sherlock Holmes in “The Adventure of the Dying Detective”
We three, that is to say Mr. Holmes, Dr. Watson and myself, managed to survive two global pandemics: The Russian flu waves of 1889 until early 1895 and the Spanish flu from 1918 through1920. These outbreaks proved to be the worst of the 19th and 20th centuries.
During the Russian flu waves we were in our mid to late thirties so our hardy constitutions and Dr. Watson’s up-to-date knowledge about recent germ theory and the importance of keeping things disinfected against germs no doubt contributed to our chances against this flu. However, Mr. Holmes was presumed dead in 1891 after battling Moriarty at Reichenbach Falls. His disappearance, we later learned, took him to remote areas of the globe where the reach of the pandemic was unlikely to occur.
We were in our sixties at the time of the Spanish flu. Curiously, it proved to be more lethal for people aged 20-40 and young children. Mr. Holmes’ relative isolation in Sussex kept him safe from infection. Dr. Watson kept abreast of all the learning garnered about the disease. He re-joined military service in WWI to assist the Royal Army Medical Corps. I kept myself to myself as much as possible, as Dr. Watson suggested, during this harrowing period
Unfortunately, Dr. Watson’s literary agent and his family were hard hit by both pandemics. His sister succumbed to the Russian flu and he contracted a bad case of the disease but survived. He sadly lost his son and brother to the Spanish flu.
In the following I describe what I know about how the Russian and Spanish influenza pandemics affected us here in the United Kingdom and what we may have learned for any future pandemics.
The Russian Flu
1889- Early 1895
Source: Alamy — Victorian hospitals were overwhelmed by the thousands of Russian flu victims
Also known as the “Asiatic flu”, the Russian flu took the lives of over 1 million people worldwide, and over 125,000 in the United Kingdom. The spread of the pandemic was extremely rapid. It began in St. Petersburg and spread to the United Kingdom a mere 6 weeks later. It is estimated that approximately one quarter of London’s population became infected with the disease. This pandemic had 4 distinct waves: October 1889 – December 1890, March – June 1891, November 1891 – June 1892 and finally the winter of 1893 – early 1895. Each successive wave proved to be more lethal than the previous one. Most of the deaths were linked to secondary respiratory infections particularly in middle-aged people. St. Bartholomew’s and the Royal Free hospitals estimated that at least one quarter of London’s population had been infected.
Source: Wikiwand — Map showing recorded dates of the influenza epidemic in 1889 and 1890.
Parsons, Henry Franklin (1891).
Scientists observed that unlike previous pandemics, the path of this flu tended to follow major roads, rivers and notably railway lines – many of which did not exist in an earlier pandemic in the 1840’s. It meant that the disease was spread by human contact rather than “miasmas” or winds or by other means. However, one of the best demonstrations of the influenza’s infection’s contagiousness came in the spring of 1891 when railway officials travelled from Sheffield to Westminster to give evidence before a parliamentary committee. Within days of their appearance, more than 70 MPs and lords contracted influenza including Liberal leader William Gladstone. The Russian flu pandemic is recognized as the first modern pandemic where the disease could move with ease due to innovations in the means of transportation. Furthermore, it was concluded that asymptomatic and mildly affected individuals should have been monitored more carefully and isolated. There was also a great need for more trained nursing staff.
The importance of self-isolation that convinced the wider Victorian public most profoundly was the death of Queen Victoria’s grandson, the Duke of Clarence or “Prince Eddy” as he was popularly known. He contracted the influenza during a shooting party and after a 5 day battle with pneumonia, he was pronounced dead at the age of 28.
Whilst many of these insights could and probably should have aided the public health response, the British health authority preferred to advocate only conservative preventative measures that had little impact to mitigate the disease’s progression. But the Russian flu was the first pandemic to be tracked in real time. Using case reports and questionnaires, epidemiologists mapped the spread of the flu and measured frequency of attacks in an effort to answer key questions about causation, transmission and interaction with other respiratory illnesses like pneumonia and bronchitis. It was also concluded that many patients exhibited milder symptoms such that they were able to move about freely and transmit the disease. Unfortunately, due to the short incubation period and more pressing military issues meant that the lessons learned from the Russian flu were not heeded in the 1918 Spanish flu pandemic, as we shall see.
The Russian flu also coincided with the “golden age” of Victorian newspapers. It was one of the best reported pandemics in modern history. It also sparked a mass hysteria in London, particularly among male patients. Dr. Samuel West, a specialist in respiratory diseases described how he had been astonished to arrive for his morning office hours to find more than 1,000 patients — mostly male – clamouring for treatment.
The Spanish Flu
January 1918-December 1920
Source: Wikipedia — Soldiers of the American Expeditionary Force victims of the 1918 flu to the US Army Camp Hospital
The allies of WWI came to call this outbreak of influenza “The Spanish flu” primarily because the pandemic received greater press attention after it moved from France to Spain in November, 1918. Spain was a neutral nation at that time and had not imposed the censorship constraints the allies did upon reporting of the pandemic. It emerged in early March, 1918 during WWI, though it is unclear where it first began.
The Spanish flu pandemic was an unusually deadly one. It infected 500 million people – about one third of the world’s population at the time – and killed approximately 50 million people. This was 3 times the number that were killed in The Great War, and it did this faster than any other illness in recorded history. Unlike most influenza viruses, the 1918 flu was most prevalent for people ages 20-30 and young children. The death toll in Great Britain was 228,000.
Source: Keystone/Hulton Archive — Two women wearing masks to prevent catching the Spanish flu
Source: National Museum of Health and Medicine —Chart showing mortality from the 1918 influenza pandemic in the US and Europe.
There were 3 waves of the Spanish flu. The first wave was generally mild, with cold-like symptoms. The second wave in August was considerably more severe. Some people died within hours of becoming ill, their skin turning blue and their lungs filled with fluids, causing them to suffocate. The properties that made it so devastating are not well understood. With no vaccine available or medicines available to treat secondary infections, such as pneumonia, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, disinfectants and limitations of public gatherings, which were applied unevenly.
Those who were fortunate enough to avoid infection had to comply with public health ordinances. Gauze masks were distributed to be worn in public. Stores could not hold sales, and funerals were limited to 15 minutes. Besides the lack of healthcare workers and medical supplies, there was a shortage of coffins, morticians and grave diggers. Sadly, the conditions in 1918 were not so far removed from the Black Death in the era of the bubonic plague of the Middle Ages. In fact more people died in the first year of the Spanish flu than in the 4 years of the Black Death. Rumours of enemy spies spreading the infections beyond the lines as a kind of biological weapon created a climate of suspicion and mistrust. This loss of social trust constrained economic growth for many decades.
The outbreak hit the UK first in Glasgow in May and reached London by June. Its peak was at the end of WWI. Returning from Northern France at the end of the war, the troops travelled by train. As they arrived at the railway stations, the flu spread from the stations to city centers, then to suburbs and out to the countryside. Troops also arrived home in ships as well with the same devastating effect.
Source: History of Nephrology — Doctor’s bag, circa 1910
Hospitals were overwhelmed, and doctors and nurses worked to the breaking point, although there was little they could do. Medical schools closed their third and fourth-year classes and the students helped in the wards.
In many towns theaters, dance halls, churches and other gathering places were shut. Streets were sprayed with chemicals, mail service was cancelled and fires went unattended. Armistice Day on 11 November set off the second wave of infection. Sadly, as people gathered to celebrate the end of the war, the virus swept through them. Parties and parades turned to disasters.
As described first in the case of the Russian flu, pandemics now spread much more quickly, despite our advances in medical science, because we move around the globe much more rapidly and easily than we did over 100 years ago.
It is indeed a miracle that Mr. Holmes, Dr. Watson, and I managed to survive both pandemics.
Note that with any type of flu, warm liquids are recommended.
Source: Wikipedia — Pablo Picasso, 1902-03, La Soupe (The Soup), oil on canvas, 38.5 x 46.0 cm, Art Gallery of Ontario, Toronto, Canada.
RECIPE
2-Day Chicken Soup
Ingredients
One 3 ½ - 4 lb. chicken cut into 8 pieces with giblets and neck
6 medium to large parsnips (3 whole and 3 roughly diced)
1 large whole onion
6 medium to large carrots (3 whole and 3 roughly diced)
bouquet of fresh dill and Italian parsley
8 celery stalks (4 whole and 4 roughly diced)
salt and pepper to taste
cold water to cover (or optional: water plus 1 large carton of regular or low sodium chicken broth for extra depth of taste.)
1 package of egg or yolk-free noodles (choose medium or large width)
Garnish: a bit of chopped fresh parsley.
Mode
Day 1
Place chicken, giblets and neck into a large stock pot.
Add 3 whole parsnips, 3 whole carrots, onion, 4 whole celery stalks, onion and bouquet of dill and parsley.
Reserve roughly chopped vegetables.
Add cold water (and chicken broth if desired). Bring to a boil and then simmer covered for 1 ½ hours.
Cool and remove vegetables, herbs and discard.
Remove chicken skin, bones, giblets and neck and discard.
Roughly dice chicken and return to pot. Refrigerate overnight.
Day 2
Skim off any remaining fat.
Add reserved diced vegetables. Simmer until vegetables are soft – about 20- 30 minutes.
Meanwhile cook noodles separately until al dente. Drain and add to finished soup.
Garnish: with chopped parsley. Season with salt and pepper to taste.
Recipe
Hot Toddy*
*Note: Dr. Watson was always partial to brandy as a restorative.
Ingredients
1 ½ ounces of brandy
1 Tbs. honey
½ ounce lemon juice (fresh wedge; to taste)
1 cup hot water
1 tea bag
Mode
Heat the water to boiling point and pour into a teapot.
Add a tea bag and let it steep for about 3 to 5 minutes (or according to the tea's recommended brewing time).
While brewing the tea, heat a mug or an Irish coffee glass by filling it with warm water.
Once the glass is warm, dump the water out and coat the bottom with honey.
Add the brandy, squeeze the juice from the lemon wedge into the glass, then fill with the brewed tea.
Stir well to incorporate the honey.
Here are some general guidelines approved by Florence Nightingale and recommended in “Mrs. Beeton’s Book of Household Management” when preparing food for invalids:
Source: Wellcome Collection — Florence Nightingale, An Angel of Mercy. Scutari hospital 1855.
Let all the kitchen utensils be delicately and scrupulously clean.
Never make a large quantity of one thing and it is desirable that variety be provided for them.
Always have something in readiness should the invalid desire sustenance. If obliged to wait too long, the patient loses his or her desire to eat.
In sending food to the invalid, let everything look as tempting as possible.
Have a clean tray cloth; let the spoons, tumblers, cups and saucers be very clean and bright. Gruel is more appetizing when served in a tumbler.
As milk is an important food for the sick, in warm weather let it be kept on ice. Many other delicacies may be preserved in this manner for a little time. If the invalid is allowed to eat vegetables, never send them undercooked or raw. Let a small quantity be cut into small pieces and temptingly arranged on the pieces.
Never leave food in a sickroom. If the patient cannot eat it, take it away and bring it back in an hour or two. Miss Nightingale says, “To leave the patient’s food by his side, from meal to meal, in hope he will eat it in the interval, is simply to prevent him from taking food at all.”