Professor Barry Doyle discusses how the Library’s online public health resource, London’s Pulse, enabled him to do new research into the influenza epidemic of 1918, and shares his findings with us.
With the centenary of the First World War and the growing concern over the Ebola Virus making news headlines, public and academic interest has been turned to the worldwide Influenza pandemic of 1918-20. Commonly called Spanish Flu, the outbreak is estimated to have killed upwards of 50 million people across the globe, affecting all regions and social groups.
Historians have paid limited attention to the strategies adopted by the authorities to track, contain or treat the disease in England. This is surprising as England had one of the most developed health care systems in the world yet it did little or nothing to contain the spread of the infection or treat those infected.
Researching why England’s sophisticated medical services failed to halt the spread of the disease offers a number of challenges. There is much accessible material on the national debates but the job of managing the epidemic fell on local public health team led by the Medical Officer of Health (MOH) – and their story has traditionally been more difficult to access. My own study of the MOH reports in provincial municipalities showed very different policies in respect to the containment and treatment of the disease, raising questions about policy and practice in other parts of England.
Yet accessing a significant number of MOH reports would prove time consuming and expensive – or it would have before the Wellcome Library released London’s Pulse: Medical Officer of Health Reports, 1848-1972 making it is possible to compare responses to the crisis in over twenty of the capital’s local authorities.
Searching London’s Pulse for coverage of the influenza pandemic proved straight forward. You can search by key terms, borough or time period as well as browsing the complete set of reports for an individual borough. A general search brings up a list of hits divided by borough and year. Clicking on a hit in the list opens a facsimile of the page in the original report supported by a transcription of the content below. There is a facility to zoom in and out (similar to that in iphoto) though this takes a while to master.
What do the reports tell us about municipal responses to the flu pandemic? As expected, boroughs acted very differently. Coverage in a selection of reports for 1918 ranged from a bald statement of influenza deaths to detailed reports tabulating the demographics of the visitation, describing the preventive actions taken and musing on the predisposing and exciting causes of the outbreak.Harrow’s part time MOH was most interested in the opportunities the disease offered him as a pathologist while Hackney’s chief medic satisfied himself with a reproduction of a poster placarded round the borough:
As the disease spread so quickly, medical officers could not tackle the outbreak in the usual way – notification, isolation in a hospital, disinfection and medical inspection of contacts – instead leaving it “to the individual to apply such measures to him or herself…what may be termed personal or individual preventive measures”.
The role of the public health authorities was to be educational and to monitor the only central regulations imposed – those relating to the ventilation of places of public entertainment (mainly cinemas). No attempt was made to close schools or workplaces or operate isolation or quarantine approaches.
Advice included gargling morning and evening with a mixture of permanganate of potash, salt and water which could additionally be ‘snuffed up the nostrils two or three times a day’!
Some municipal medics sought to explain the onset and pattern of the disease. Unlike many respiratory infections, Spanish Flu proved most fatal amongst those aged 15-35. Children and the elderly did get it, but invariably they did not die. In the case of the elderly the MOH of Bermondsey felt it was because “when they are attacked they give in promptly and go to bed” while young adults “tried to ‘shake it off’ the result being they contracted pneumonia with, in many cases, a fatal result.”
The gender distribution was also interesting. Generally more women than men died, with Hampstead’s MOH feeling that, given the wartime gender imbalance, women may have been proportionately less affected. But others suggested they were more vulnerable as they undertook most of the domestic nursing exposing them directly and frequently to infection.
In seeking to explain why the epidemic was so widespread and serious none blamed the war directly but it was seen as important in causing food shortages and high prices, leading to undernourishment and exacerbating overcrowding, which allowed the disease to spread rapidly.
London’s Pulse allows us to tap a wealth of information and opinion on the capital’s health across more than a century. As this case study shows it also allows us to see how and why local medical systems dealt with specific crises and long term concerns and compare them in time and space. In this case it reveals an emerging individual preventive health strategy which was transforming the role of the MOH but may have proved inadequate in the face of a health crisis of this scale.
Author: Barry Doyle is Professor of Health History at the University of Huddersfield.