Monday, 19 November 2018

When the guns fell silent: York and the 1918 flu

The signing of the Armistice in November 1918 was a bittersweet time for the people of York. Doubtless, many would have been looking forward to seeing their loved ones again after four years of conflict. Many would have been feeling the bite of the recently introduced rationing. Still more would have been feeling the Armistice all the more keenly when looking at the photographs of those they had loved and lost.

As the crowds mingled in York to mark the moment, any would have been feeling under the weather. Some may have been feeling the first signs of a cold-like virus, with a sore throat and high temperature. Others would have been at home in bed with a full blown fever, delirious, in pain with excruciating muscle cramps. Others would be in the final, terrible stages of influenza, developing a purple tinge to the skin, their breathing becoming ever more shallow, rapid and laboured as they effectively drowned in their own beds. 

The H1N1 virus - erroneously known as Spanish flu - was the final act of a war that had already claimed up to 19 million lives. The virus, most likely a mutation of a swine-borne flu, had manifested itself in military camps in the United States, and crossed the Atlantic with the massive moves of men as the US bolstered its efforts in France. The massing of men in hospitals and camps provided the ideal breeding ground, and the moves of so many men as the war drew to a close provided the ideal medium for transporting the virus all over the world. By the end of 1920, between 50-100 million people would have died from the disease and to to 500 million infected people infected worldwide. 

The reports of York’s Medical Officer of Health (MOH/Y/10) suggest that the 1918 flu hit York very much like anywhere else – in two distinct waves, the first in the summer (approximately 30th June - 27th July 1918), the next in late autumn, 'commencing just before the Armistice', though officially recorded as 12th October 1918-11th January 1919. It was this second wave that was to be the more deadly. 


MOH/Y/10: Medical Officer of Health report for York, 1919

The first signs that the city was taking the outbreak's return in October seriously came with the closing of 12 of the city's schools on the 22nd-23rd October, with a further 11 closed on the 24th-25th. 600 children had been reported as being ill up to the 25th October. On the 30th October, all of the city's schools were closed, at the very least until the 18th November.

By this point it was becoming apparent to the authorities that they were in the midst of a crisis. Unlike the summer wave, which had manifested as 'normal' flu, this iteration was much more virulent and deadly. Health visitors and school nurses were transferred to the job of supporting doctors in visiting cases at home. Here, the danger inherent in medical care was brought into sharp relief with the deaths of two home visitors from flu. 

The Medical Officer of Health 'engaged the services of disengaged midwives and other handy substitutes' to bolster the city's medical provision, with a panel formed to draw up guidance for home nursing. It was in vain. Nine of the city's doctors had reported visiting over 6000 cases between them. The MOH report notes that as a result of the flu outbreak, 'the professional nursing staffs of the city and district were absolutely overwhelmed.'

The city took further measures to try and slow the spread of the infection. It had already been noted that Armistice celebrations had provided the perfect conditions to spread the infection further, with a combination of packed tramcars and crowds jostling in the streets in scenes of spontaneous and civic celebrations. Cinemas were asked to close for an hour in the early evening to subject theatres to free ventilation and disinfectant spray. On the 18th November, the national Local Government Board recommended that all places of public entertainment should not be operate for more three consecutive hours and places should be thoroughly ventilated for a full 30 minutes between performances. By the 22nd November, this was extended to four hours.

By the end of November there were reports of multiple bodies in households, with delays in burying the dead. As a result, soldiers from local barracks had been deployed to aid the authorities in digging graves.

The Medical officer of Health, in typical fashion, reported the bare facts in his end of year report. There had been 1,318 deaths in York during 1918. Of these, 530 occurred between October and December, more than double the rate of the previous year. 226 deaths were attributed to influenza, with a further 166 being listed as being down to flu's common complication, pneumonia. It was noted that it was difficult to distinguish between the two, mainly as those who died in hospital were classed as dying of pneumonia as opposed to flu.

MOH/Y/10: Medical Officer of Health report for York, 1919

A defining feature of the 1918 flu was its mortality, disproportionately affecting those who would be classed as in their physical prime. This was reflected in York, with those aged 15-45 faring the worst. The poorest districts in the City were hit particularly hard - presumably due to their cramped living conditions – 89 deaths from influenza and 71 from pneumonia in Walmgate ward, 76 from flu and 59 from pneumonia in Micklegate ward. The outbreak had largely hit 'indoor workers' – those working in factories and offices, for instance. The nature of the workforce by the end of the war meant that the outbreak had hit women almost twice has hard as men.

The majority of people had died at home. Only 58 people had died in local hospitals – 26 in the Workhouse Infirmary, and 25 in the County Hospital. In addition to the city's own dead, 56 soldiers had died of flu at Fulford Barracks, in addition to 19 visitors to the city.

The records of the city's hospitals display, likewise, a struggle to cope with the sudden and extreme pressure they found themselves under. The Fever Hospital at Naburn was quickly emptied of cases to provide extra bed space, but even this was insufficient. York County Hospital reported 80 inpatients over the course of the outbreak, with a mortality rate of 50% for those admitted, 35% of those admitted dying within 48 hours of admission. In addition to patients admitted with flu or pneumonia, 7 patients already in the hospital contracted flu when 6 flu cases were admitted to a ward.

The House Committee minute book (YCH/1/1/3/10) records the situation. On the 12th November, 10 nurses, 2 maids and a porter were reported as being absent with flu. By this point, 16 staff had been infected. The meeting must have been a sombre one, as one nurse – Nurse Harrison – had died that morning. Accommodation was being arranged for those staff who were still recovering from flu but wished to work.


YCH/1/1/3/10, note stating that 10 nurses, 2 maids and 1 porter off duty with influenza, 12th November 1918

Patient records reveal that many of the nursing staff infected were treated in a hastily re-purposed Board Room. Treatments were rudimentary and were recorded as aspirin, brandy and, finally, morphine. Patients whose temperatures stayed below 100 degrees tended to survive; those who found their temperatures going higher than this rarely did.

The Committee 'desired to place on record their high appreciation of the zealous and devoted manner in which all the members of the staff are discharging their duties under the present exceptionally trying conditions’. This is something of an understatement. Later minutes from the hospital's Medical Board (YCH/1/1/6) stated that ‘the hospital was practically closed for two months’ due to shortage of staff, with only ‘extremely urgent’ cases admitted.

By the end of the year, the virus had passed. The 1918 strain of flu was virulent, but short lasting. It left behind in its wake yet more broken families, another swathe through a population in its prime. There is no memorial to the dead of the 1918 flu. Society, as a whole, has chosen to try and forget the deadly autumn and winter of 1918. Perhaps, as the evenings draw in and we look towards the end of the year and all the joys it brings, we should stop for a moment and remember the 400 of York’s community who lost their lives, and the many thousands more who found their lives changed forever - just as the guns stopped firing.

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