Spanish Flu

In “Dark Treaty,” Louisa, one of Tom Munro’s love interests was a VAD (Voluntary Aid Detachment) nurse in 1918 at the St. John Ambulance Brigade hospital in Étaples, France. This was a Base Hospital receiving casualties from the Casualty Clearing Stations. At this time the so-called “Spanish Flu” was rife.

We have all become very familiar with the deadly effects and severe social disruption caused by the Coronavirus infection, but what was it like back in 1918? There have been many myths and rumours voiced about the “greatest pandemic in history” so hopefully the following facts will set the record straight.

  • The countries involved in WWI suppressed reports of the 1918 flu but neutral Spain did not. As a result, the first news of the disease emanated from Spain, hence Spanish Flu. The origin of the 1918 flu is debated to this day but is often suggested to be East Asia, Europe and even Kansas, USA.
  • In 1918, between 50 and 100 million people died world-wide – some 5% of the world’s population.
  • The flu mostly affected healthy young adults in 1918. Recent studies suggest that this was due to an over-reaction of the immune system to the virus, a so-called “cytokine storm.”
  • No specific anti-viral therapies were available during the 1918 flu. However, excessive doses of aspirin were prescribed (30 grams/day) and many deaths were eventually attributed to aspirin poisoning. Today, 4 grams/day is considered a maximum daily dose.
  • It is unlikely that the flu changed the course of the war as forces on both sides were equally affected. But the war profoundly influenced the course of the pandemic through troop concentrations and their movement across the globe.
  • It is now believed that a rapidly mutating virus evolves over time into less lethal strains. There was no immunisation against the 1918 flu so it is likely that after 18 months, the pandemic ended because people had been exposed to the virus and developed immunity and the strain became less life threatening.

Today, we know more about how to handle ill and dying patients and anti-biotics, not available in 1918, can be used to combat secondary infections. In addition, social distancing, hand washing, modern vaccinations and anti-viral drugs put us in a much better position to cope with this regular feature of human life.

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