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By Jack Davies on

The centenary of the Spanish flu

In 1918, as the First World War ended and peace celebrations began, a new enemy emerged - the Spanish flu.

In 1918, as the First World War ended and peace celebrations began, a new enemy emerged.

That year saw the beginning of one of the deadliest pandemics in our world’s history. Spanish flu spread to every corner of the world and, unlike many other diseases, it killed young, healthy adults aged between 20 and 40 years old, instead of groups considered to be more vulnerable, such as children and the elderly.

Estimates put the death toll at 3 to 5 per cent of the world’s population, amounting to 50 to 100 million people.

But what was the so-called Spanish flu?

Box of Kaputine medicine, England, 1930-1950
Box of Kaputine medicine, England, 1930-1950

The symptoms were gruesome, and they developed quickly. Patients had the normal flu-like symptoms: sore throats, headaches, fatigue, shivering, fevers, and body aches. But they also developed deep brown spots on their cheeks, they coughed up blood or bled from their ears, and their faces turned blue as a build-up of bloody fluid stopped the circulation of oxygenated blood. Many patients drowned, unable to breathe through the bloody froth that filled their lungs.

Most Spanish flu related deaths were caused by pneumonia, a secondary infection that overwhelmed patients’ weakened immune systems.

While many people think that the disease came from Spain, Spanish flu is a misnomer, and historians still debate where it originated. So why do we call it the Spanish flu?

Box of Fennings' Little Healers, England, 1940-1970
Box of Fennings’ Little Healers, England, 1940-1970

In short, it’s because of the First World War. More specifically, it was because of the need to control the spread of information through censorship. Most countries involved in the war censored their domestic press to prevent information from helping the enemy.

Though reports from battlefields or numbers of wounded or dead were the obvious targets of the censor, it extended far beyond that. In Britain it covered anything likely to cause ‘dissatisfaction’ in the population: including the spread of disease.

It was only Spain, a neutral country in the First World War, that published accurate information on the influenza pandemic, creating the false impression that Spain was more heavily affected. Thus, the disease was dubbed ‘the Spanish flu’.

The disease was caused by the H1N1 strain of the influenza virus. Though the 1918 virus was once considered a ‘superbug’, this theory has since been discredited.  Now we know that the 1918 strain was very similar to other strains of influenza, a model of which we have in our collection.

Model of a influenza virus, Canberra, Australia, 1994
Model of a influenza virus, Canberra, Australia, 1994

So, if Spanish flu was not a superbug, how did it kill so many people?

The First World War created the perfect environment for disease to spread; mass migration of populations, overcrowding in hospitals, barracks, and prisoner of war camps, and weakened immune systems due to malnourishment all allowed the virus to spread quickly. Soldiers from all corners of the globe fought in battles that spanned the entire world, spreading the germs they picked up along the way. Those who survived the war went home in 1918, taking the influenza virus with them to their friends and family.

As quickly as it appeared, the Spanish flu epidemic died out. It was suggested that its spread was controlled by quarantining patients, but it is more likely that this strain of influenza changed to become less severe.

Though this sounds unusual, it is not that uncommon. Many strains of influenza become weaker as time goes on because stronger strains kill their hosts too quickly, limiting the time the virus has to spread and infect others.

There were very few treatment options for patients with Spanish flu in 1918. Most medicines were aimed at making the patient as comfortable as possible by reducing fevers and alleviating pain. The Science Museum Group Collection holds examples of influenza treatment methods from the twentieth century, such as ‘Fennings’ Little Healers’ and ‘Kaputine’ medicine both pictured above.

Two cartons of 30 mg Tamiflu (Oseltamivir)
Cartons of 30 mg Tamiflu (Oseltamivir)

Now, we would probably prescribe antiviral medicine like Tamiflu, which was distributed during the swine flu pandemic of 2009. This object was donated to the museum by one of our medical curators, whose child was thought to have contracted the disease.

As well as commemorating the centenary of the First World War over the last four years, it is also important that we recognise the longer-term impacts of the conflict. The Spanish flu pandemic was one of the biggest threats that the world has ever faced. In one year, it killed more people than four years of the Black Death.

But this is much more than just an episode of medical history, it is a stark reminder of the long-term consequences of war, and the dangers that viral infections pose.

Influenza still exists, and the virus continues to mutate and change. Experts believe that it is not a case of if, but rather, when a new influenza pandemic will spread throughout the world.