Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History

Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History

by Catharine Arnold


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Before AIDS or Ebola, there was the Spanish Flu — Catharine Arnold's gripping narrative, Pandemic 1918, marks the 100th anniversary of an epidemic that altered world history.

In January 1918, as World War I raged on, a new and terrifying virus began to spread across the globe. In three successive waves, from 1918 to 1919, influenza killed more than 50 million people. German soldiers termed it Blitzkatarrh, British soldiers referred to it as Flanders Grippe, but world-wide, the pandemic gained the notorious title of “Spanish Flu”. Nowhere on earth escaped: the United States recorded 550,000 deaths (five times its total military fatalities in the war) while European deaths totaled over two million.

Amid the war, some governments suppressed news of the outbreak. Even as entire battalions were decimated, with both the Allies and the Germans suffering massive casualties, the details of many servicemen’s deaths were hidden to protect public morale. Meanwhile, civilian families were being struck down in their homes. The City of Philadelphia ran out of gravediggers and coffins, and mass burial trenches had to be excavated with steam shovels. Spanish flu conjured up the specter of the Black Death of 1348 and the great plague of 1665, while the medical profession, shattered after five terrible years of conflict, lacked the resources to contain and defeat this new enemy.

Through primary and archival sources, historian Catharine Arnold gives readers the first truly global account of the terrible epidemic.

Product Details

ISBN-13: 9781250139436
Publisher: St. Martin''s Publishing Group
Publication date: 08/28/2018
Pages: 368
Sales rank: 162,267
Product dimensions: 6.00(w) x 9.40(h) x 1.50(d)

About the Author

CATHARINE ARNOLD read English at Girton College, Cambridge and holds a further degree in psychology. A journalist, academic, and popular historian, her previous books include The Sexual History of London, Necropolis, and Bedlam.

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A Victim and a Survivor

As dawn broke over a military hospital in northern France, another young soldier was pronounced dead. Sadly, this was a common occurrence at 24 General Hospital, Étaples, the biggest field hospital in France. Hundreds of men had already died here, from disease or wounds. When Private Harry Underdown, a farmer's son from Kent, died on 21 February 1917, he appeared to be just one more statistic. Even the words on Harry's death certificate seemed commonplace. At twenty years old, Harry was the latest victim of 'widespread broncho-pneumonia', a complication following an attack of influenza, but he may also have been one of the first victims of the disease that would morph into the terrifying entity that was Spanish flu.

Harry's short life was tragic but unremarkable; yet another young man among the millions killed during the First World War. Born near Ashford, Kent, in 1897, Harry grew up on the family farm, named 'Hodge End'. When war was declared, Harry initially chose to stay on at Hodge End, later describing his occupation as that of a 'hay trusser'. But then, at the end of 1915, Harry changed his mind and decided to enlist. At just 5 feet 1½ inches tall, and 132 pounds in weight, Harry was passed fit for military service and joined the Army Reserve, under a scheme whereby he was 'required to serve one day with the Colours and the remainder of the period in the Army Reserve ... until such time as you may be called up by order of the Army Council'. So, although he now formed a part of the Army Reserve, Harry returned to his farm. In April 1916, Harry was called back to the army, and, as a private in the 12th Battalion, Queen's (Royal West Surrey) Regiment, he was sent for training at an army depot. But within four months he had fallen ill, and was hospitalized with tonsillitis. Harry appeared to recover, then came a relapse, and he was not finally 'discharged cured' until 5 August 1916.

Almost immediately, Harry was sent over to France. Within a few weeks, he became a casualty, after being buried in debris when a shell exploded nearby. Although not physically harmed, Harry was invalided home, suffering from shell shock, the Great War's euphemism for combat stress. At Bagthorpe Military Hospital in Nottingham, Harry was found to be 'very shaken', with 'loss of speech and memory'. 'Rest & bromides' formed the course of treatment prescribed.

Despite these misfortunes, Harry was determined to stay in the army. In November 1916, he left hospital and returned to his regiment. After being detained in England for a few weeks, Harry crossed back to France in February 1917. Within a fortnight he had been struck down by 'widespread bronchopneumonia', as it was named by Lieutenant J. A. B. Hammond of the Royal Army Medical Corps. Lieutenant Hammond observed Harry's condition with sympathy and intense professional interest; he had witnessed similar symptoms in previous patients at Étaples, none of whom had recovered.

At first, Hammond noted that Harry's symptoms seemed consistent with ordinary lobar pneumonia, 'with the sounds of crackling rales [popping sounds] clearly audible at the root of the patients' lungs'. What was different, however, was the amount of purulent pus Harry produced, together with a terrible breathlessness that made him visibly distressed, panicking and attempting to leap out of bed. There was worse to come; as Harry's condition deteriorated, his skin began to acquire a 'dusky heliotrope type of cyanosis of the face' due to lack of oxygen. Harry Underdown died soon afterwards.

Noting that this was the twentieth fatal case of 'widespread bronchial pneumonia' since the year began, Lieutenant Hammond and his colleagues became intrigued and concerned by this development, speculating that it was an unusual condition and might perhaps be war related. Lieutenant Hammond conducted a study of the condition with army pathologist Captain William Rolland and Dr T. H. G. Shore, the officer in charge of the Étaples mortuary and laboratory. Hammond's findings were eventually published in The Lancet in July 1917. The article came to the attention of Sir John Rose Bradford RAMC, consultant physician at Étaples. Bradford, a future president of the Royal College of Physicians, was 'an enthusiastic advocate of laboratory based research' and had been sent out to Étaples to do his part for the war effort. At first, Bradford had found himself frustrated by the lack of professionally interesting medical cases, freely admitting the fact in letters home to his wife. But the emergence of 'widespread bronchio-pneumonia' piqued his curiosity; the disease that killed Harry Underdown had eventually caused the death of 156 soldiers at Étaples during February and March 1917. Bradford recruited Hammond to conduct further research into the condition.

One aspect of the disease only became evident after death. During autopsy, in a case of lobar pneumonia, pathologists would expect to find damage to one of the lobes of a patient's lungs. However, in the case of these patients, there was widespread bronchitis. On being sliced open, the smaller bronchi oozed thick yellow pus and in some cases contained H. influenzae and other bacteria. Of the 156 soldiers who had been diagnosed with and died of purulent bronchitis in the winter of 1917, 45 per cent had purulent excretions blocking the smaller bronchi. As 'the disease assumed such proportions as to constitute almost a small epidemic' at Étaples, Hammond decided that these features constituted a 'distinctive clinical entity' and named the disease purulent bronchitis in a paper for the British Medical Journal published the following year.

The most disturbing aspect of the 'purulent bronchitis' outbreak of winter 1917 was its resistance to treatment. Doctors resorted to every conceivable type of approach, including oxygen therapy, steam inhalation, even blood-letting, but without effect.

While Hammond and his team were investigating the phenomenon of purulent bronchitis in Étaples, a similar outbreak occurred at an army barracks in Aldershot, England. RAMC Major Adolphe Abrahams, older brother of the Olympian champion Harold Abrahams, was in charge of the Connaught Hospital at Aldershot during 1916 and 1917, where a series of patients had presented with purulent bronchitis in the winter months. The symptoms which these patients presented were disturbingly similar to the ones witnessed at Étaples, including coughing up yellow pus and cyanosis, and the disease was resistant to every form of treatment and had a high fatality rate.

Abrahams and his colleagues conducted their research at Aldershot entirely independently from Bradford and Hammond, with the researchers only realizing that they were dealing with the same disease when both published papers in The Lancet in summer and autumn 1917. Abrahams came to the conclusion that the disease was more widespread than he had envisaged, and, more disturbingly, that it would continue to flourish during the winter months, increasing the need to develop a form of prophylaxis.

If, as Abrahams suggested, purulent bronchitis was more widespread than had been realized, the question arises as to how it was transmitted. Had Harry Underdown contracted purulent bronchitis earlier in his military career, becoming infected at Aldershot, or Bagthorpe? In his bid to stay in the army, and keep fighting despite his own poor health, had Harry inadvertently transmitted the prototype of the deadly disease across the Western Front? It is tempting to conclude that Harry Underwood, who lies buried at the military cemetery in Étaples, might have been the original 'Patient Zero', but in fact Harry's fate represented that of many like him who joined up and died, not in battle, but from the deadly disease that would become known as 'Spanish flu'. The origins of the disease itself and the virus that caused it proved to be far more complex.

Perhaps the answer lies in Étaples itself, a massive military base which is a strong contender for the birthplace of Spanish flu. A small town in the Pas-de-Calais, some fifteen miles south of Boulogne, Étaples Base embraced port facilities, railway yards, stores, hospitals, prisons, training areas and all the encumbrances of an army at war. In addition, there were infantry depots, training grounds, a firing range, cemetery, laundry and two post offices. As horses still played a significant role in combat, there were stables for the thousands of horses that needed veterinary attention during the conflict. For food, there were piggeries, ducks, geese and chickens. The coexistence of animals alongside humans had been a familiar feature of warfare for hundreds of years. Little did doctors suspect, during the First World War, that ducks operated as a 'reservoir' for bird flu viruses, littering the soil with faeces that were then snorted in by pigs grubbing for food, and that the pigs would subsequently incubate avian viruses and combine them with the human flu viruses acquired through contact with people. It would not be until the last decades of the twentieth century that virologists such as Professor John Oxford and Jeffery Taubenberger discovered that avian flu could leap the species barrier and mutate into an influenza virus capable of infecting and killing humans.

* * *

ANOTHER ELEMENT ADDED to this deadly petri dish was the presence of Chinese labourers, who were brought over to support the war effort. Recruited by the British in Northern China, their task was to ensure the smooth running of the Allied forces by ferrying munitions and food from the Channel ports to the camps. The presence of the animals, and the Chinese labourers, at Étaples was simply a familiar aspect of army life. At the time, the presence of the labourers was not regarded as a health issue, despite the Manchurian pneumonic 'plague' of 1910–11 which had killed between 43,000 and 60,000 people, the equivalent of the death toll during London's great plague of 1665. In hindsight, virologists such as Dr Kennedy Shortridge of Hong Kong University have identified China as 'the epicentre for influenza epidemics', due to the ingrained Chinese habit of living at close quarters with their animals, keeping vulnerable piglets in their homes, for instance. 'The ingredients are here – ducks, pigs, people, in close contact,' he said.

Conditions – ducks, pigs, people – were similar at Étaples, and were combined with the infectious diseases that beleaguer all military camps. Étaples consisted principally of a series of Infantry Base Depots (IBDs), gathered on the rising ground to the east of the railway that runs north–south beside the town. Drafts from England for numerous infantry divisions passed through the IBDs where, according to unit, they were regrouped, put through a period of training, and sent forward to the Front. Also in the depots were to be found men transferring to other theatres of the war or consigned to the category of 'Temporary Base' after hospital and convalescence. These included the interminable convoy of sick and injured Tommies and German prisoners of war from the Front nursed by a young Englishwoman, Vera Brittain, and her comrades in the Volunteer Aid Detachment or VAD at No. 24 General Hospital.

Étaples was a bleak spot at the best of times. Lady Olave Baden-Powell, wife of the founder of the Scouting movement and Chief Guide in 1918, volunteered in the YMCA huts at the base and dismissed Étaples as 'a dirty, loathsome, smelly little town'. While officers managed to escape from the base camp to the smart beach resort of Le Touquet, the troops encountered oppressive conditions, with no rest for the weary. At the 'Bull Ring', as the training grounds were called, soldiers barely discharged from hospital and men who had seen much service in the trenches were put through the same training as the latest drafts from England. A course in gas warfare and two weeks at the Bull Ring was the usual programme; two weeks of marching across the dunes, supervised by officers and NCOs (non-commissioned officers) of the 'blood on the bayonet' school. The NCOs in charge of the training, known as the 'canaries' on account of their yellow armbands, also had a reputation of not having served at the Front, which inevitably created a certain amount of tension and contempt. While conditions were poor, marching to and from the Bull Ring, and the training itself, took up the entire day. Although Étaples was a permanent base, the men were confined to tents and the main meal of the day consisted of two slices of bully beef, two biscuits and an onion. One officer remembered the training as 'demoralising beyond measure' while another man recalled that the Bull Ring was like 'passing through hell for two weeks'. One corporal encountered several men returning to the Front with wounds that were far from healed. 'When I asked why they had returned in that condition they invariably replied: "To get away from the Bull Ring."'

Conditions and morale deteriorated to such an extent that there was a mutiny at Étaples on Sunday, 9 September 1917. Vera Brittain recalled an atmosphere of rumour and secrecy, with female personnel locked up in their hospitals for their own safety, and concluded that the mutiny had been the result of harsh conditions.

The war poet Wilfred Owen, based at Étaples at the end of 1917, held an equally jaundiced view of the base, describing it in a letter home to his mother on New Year's Eve:

Last year, at this time, (it is just midnight, and now is the intolerable instant of the Change) last year I lay awake in a windy tent in the middle of a vast, dreadful encampment. It seemed neither France nor England, but a kind of paddock where the beasts are kept a few days before the shambles. I heard the revelling of the Scotch troops, who are now dead, and who knew they would be dead. I thought of this present night, and whether I should indeed – whether we should indeed – whether you would indeed – but I thought neither long nor deeply, for I am a master of elision. But chiefly I thought of the very strange look on all faces in that camp; an incomprehensible look, which a man will never see in England, though wars should be in England; nor can it be seen in any battle. But only in Étaples. It was not despair, or terror, it was more terrible than terror, for it was a blindfold look, and without expression, like a dead rabbit's.

For all its disadvantages, Étaples was the perfect spot for a military hospital. The base was close to the railway lines running south to Abbeville and the Somme, making it easy to bring the wounded in from the battlefield and send them back to the Front as soon as they were ready to fight again. Étaples was also close to Boulogne, offering a short hop across the Channel to England, an important consideration with German submarines patrolling the Channel.

Vera Brittain, who had abandoned her studies at Oxford University to volunteer as a nurse, first arrived at No. 24 General Hospital on 3 August 1916. Vera described Étaples poetically as lying 'between the sand hills and the sea', with 'vivid light' hanging over the marshes. The officers and men, with a blunter turn of phrase, referred to Étaples as 'the sandheap'.

The camp seemed more like a small town than a military base, extending as far as the eye could see, with row after row of tents for the doctors and huts for the nurses stretching across the fields on either side of the railway line. No. 24 General Hospital itself, which had enough beds for 22,000 patients, consisted of twelve long wooden huts covered with nasturtium plants and chintz curtains at the windows. But with the distant sound of gunfire, there was no escaping the purpose of the hospital and the constant atmosphere of tension. 'Everyone and everything' at Étaples was 'always on the move; friendships were temporary, appointments were temporary, life itself was the most temporary of all'.

No. 24 General Hospital at Étaples had been built to cope with the huge number of casualties from the Western Front, and the diseases that accompany war. Initially, these were the traditional wounds of warfare, although these grew increasingly worse as the war progressed due to innovations in weaponry, including high-explosive shells and machine guns. Vera's duties, when she first arrived, consisted of nursing prisoners of war housed in damp, overcrowded marquees, changing dressings and draining wounds in temperatures of 90° F. By September, as the weather remained unseasonably warm, the nursing staff developed a gastric bug, which they named 'Etaplitis'. With men packed so closely together, there was a real danger of dysentery and typhoid. The next problem was sepsis, and the danger that wounds sustained in the trenches would fester. The men also suffered from trench foot, a hitherto unknown condition in which the men's toes developed gangrene and dropped off, and trench fever, later discovered to have been transmitted by a louse, Pediculus humanus. There was also another new condition known as 'war nephritis', which presented with headache, fever and kidney damage, and the consequences of mustard gas, which led to chest infections, pneumonia and the dreaded 'pulmonary bronchitis' that had killed Harry Underdown and his comrades. Demoralized by war, their immune systems weakened, the convalescent troops were weak and vulnerable.


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Copyright © 2018 Catharine Arnold.
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Table of Contents


Introduction: An Ill Wind

A Victim and a Survivor

"Knock Me Down" Fever

The Killer Without a Name

The Invisible Enemy

One Deadly Summer

Know Thy Enemy

The Fangs of Death

Like Fighting With a Ghost

Eye of the Storm

A Winding Sheet and a Wooden Box

The Spanish Lady Goes to Washington

"You Can't Do Anything for Flu"

"Native Daughter Dies"

The Fatal Voyage

Ship of Death

"Like a Thief in the Night"

The Dying Fall

Armistice Day

Black November


"Viral Archaeology"

The Hong Kong Connection

Secrets of the Grave

Notes and References



Picture Credits


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Pandemic 1918: Eyewitness Accounts from the Greatest Medical Holocaust in Modern History 4.7 out of 5 based on 0 ratings. 3 reviews.
Anonymous More than 1 year ago
LilacDreams More than 1 year ago
Most interesting were the victims’ and families’ experiences with the influenza. The war made the pandemic possible with the worldwide movement of troops and ships bringing the flu to every port. Since fighting the war was paramount, nothing could interfere, certainly not quarantine or delay in sending troops to the battlefield. In so many cities, health officials believed they could handle an epidemic and belittled efforts to protect people. I’d heard of rumors that German U-boats had put the virus ashore in the US. I hadn’t known people believed the flu resulted from the use of poison gas in the war or from the scores of rotting corpses left to decompose on the battlefields. The book had a bit of a slow start for me with the story of the hospital at Étaples and what a bleak spot for training it was at the Bull Ring.
bookluvr35SL More than 1 year ago
This book covers the Spanish Flu epidemic that caused the loss of so many lives, and wreaked as much if not more havoc than the World War that was currently being fought. The author covers everything from "Patient Zero" to the end, and the book is filled with quotes, personal stories and pictures from that time. Although I had heard of the 1918 Spanish Flu, until I read this I didn't really grasp the depth of destruction it caused. This book was horrifying, yet compelling to read and learn more. Some of the stories made me laugh, others made me want to cry. If you are a history buff, or even if you aren't, I think you should read this book.