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Beautifully illustrated family history books with a difference by a frequent contributor to the UK family history press. I write for Family Tree Magazine UK; Discover Your Ancestors Online Periodical and Bookazine; Who Do You Think You Are? Magazine. The publishers of my family history books are Pen and Sword Books and The History Press. I tweet (and retweet) thought-provoking content designed to help you tweak your approach to (your family) history at @RuthaSymes . Do follow me.

Tuesday, 17 April 2012

Causes of Death: The Flu Epidemic of 1918 (Scotland)

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Did Your Scottish Ancestor Die of Swine Flu?


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 [This article first appeared in the now obsolete Discover My Past Scotland 2010]


Confined to Bed. Flu Sufferers were advised to stay at home and in bed. Sunlight Year Book, Lever Brothers, 1897 

The current swine flu pandemic is by no means the first time in recent history that a disease has threatened thousands of lives – and family histories -  at once. In 1918 -1919, a devastating flu virus swept across Europe, Asia and Africa. In Scotland, initial estimates put the death toll at 17, 575. When deaths from flu-related illnesses are taken into account, the figure might have been as high as 33,000 – devastating in a population of just 4.8 million. In Britain, as a whole, the numbers were a startling 228,000 according to some estimates and worldwide it is estimated that as many as 50 million people may have died.

‘Not only does this epidemic of influenza tower over all previously recorded epidemics of similar nature: it proved the most fatal epidemic disease of any form that has occurred in Scotland since death registration began.’

T.F. Dewar, ‘Influenza in Scotland,’ Edinburgh Medical Journal, 1919, 23:303-8


It is unclear whether the flu virus started in China, in America or elsewhere. But the  first bouts in Britain were  - perhaps surprisingly - in Scotland on Clydeside, brought probably by troops returning from the front line in France to the port of Glasgow in April 1918. There were also some cases in April among the Royal Navy Grand Fleet at Scapa Flow (Orkney) and Rosyth (Fife). Then in May 1918, the flu hit the civilian population of Glasgow. At first, there were few fatalities but as the year progressed, the disease became more virulent. By mid-October 1918, approximately 310 people were dying every week from flu in Glasgow. Undertakers were overwhelmed and coffins were in short supply.







Wilfred Wilkinson. British soldiers stationed in France were hard hit by the flu virus  - contracted possibly from American reinforcements and possibly from Chinese trench diggers. My own collection

An extra problem for the sufferers in Scottish cities was that many doctors were enlisted in military service. In part of Fife, for example, there were 5,731 people to one doctor and in one area of Glasgow that normally had 17 GPs, ten were on military duty and three were ill themselves resulting in only four doctors being available for 55,000 people. Many elderly doctors were brought out of retirement to respond to the challenge, but some of these also fell victim to the virus.

‘The Mother of All Pandemics’


The 1918-1919 flu outbreak was an unusually severe and deadly strain of avian flu. It is thought to have entered the swine population as well as the human population in 1918. Experts believe that today’s bird and swine flu viruses are closely related to this earlier strain. Indeed, it’s possible that today’s much discussed H1N1 strain may have originated on the Western Front itself.



Symptoms and Treatment


There is plenty of evidence on the internet at sites such as http://www.health24.com/medical/Condition_centres/777-792-811-1705,16646.asp and  http://www.archiveshub.ac.uk/jan06a.shtml  that can help you imagine how your ancestors might have experienced the flu. Sufferers reported headaches, earaches, nightmares, fever, coughing spells, intense pain in the eyes and limbs, and loss of weight. In many cases, the skin turned bluish purple as a result of cyanosis caused by de-oxygenated haemoglobin in the blood vessels. This caused the flu to be known colloquially as ‘the blue death.’ In the worst cases a liquid formed on the lining of the lungs and victims effectively drowned in their own blood. Sometimes people died within a day of contracting the disease.

With no such antiviral drugs as Tamiflu on the market, doctors could volunteer only what now seems pretty inadequate advice. Patients were requested to gargle night and morning with a solution of permanganate of potassium and common salt. A variety of other largely ineffective treatments were put forward including Oxo, quinine, Vick’s Vaporub, and a concoction of pine oil, lavender oil and eucalyptus oil. It was understood that the disease could be spread by contact between infected people. Scottish Medical officers recommended that sufferers stayed at home and got plenty of fresh air. Many schools were closed and it was recommended that people keep away from cinemas, theatres and other places at which many people congregated.


Death Certificates and what to look for


If you suspect that your ancestors’ deaths in 1918 or 1919 were caused by the flu virus, take a closer look at their death certificates. Consider exactly where they were living when they died. Starting in the ports, the flu followed rail and road networks inland. Overall, the highest proportion of deaths in Scotland were in Edinburgh, Coatbridge, Falkirk, Leith, Kirkcaldy and Glasgow followed by Dundee, Perth, Clydebank, Paisley, Aberdeen, Kilmarnock, Motherwell, Greenock, Hamilton and Ayr. The worst hit areas in the Autumn of 1918 were the urban areas of Hamilton, Motherwell, Kilmarnock, Aberdeen, Clydebank, Perth, Dundee, Kirkcaldy and Coatbridge. In the spring of 1919, the disease struck most lethally in Ayr, Greenock, Paisley, Glasgow, Leith, Falkirk and Edinburgh. Part of the reason that the flu spread so successfully was that British soldiers and civilians were physically vulnerable after four years of fighting. In general, people were anxious, physically exhausted and undernourished – all characteristics which encouraged and exacerbated the disease. There were also thousands of people in transit and more places in which overcrowding was an issue such as in munitions factories, and on public transport. If your ancestors lived in more remote towns and rural areas, they are less likely to have contracted the disease.

Your ancestor’s exact date of death may also be of particular interest. In Scotland, the flu virus came in three waves between April 1918 and March 1919. The first phase (from April to July 1918) was generally considered mild. Its chief victims were those under two years old, the elderly and the sick. The second phase of the disease in October and November of 1918, however, claimed a different sort of victim. This time many deaths occurred in the ranks of healthy young adults aged between 20 and 40. Indeed, nearly half of all the deaths from the flu affected those in this age group. This meant that many young children lost one or both parents. The third phase of the disease which struck in February-March 1919 was also vicious and produced a high death toll.

You should also take a closer look at the cause of death on your ancestor’s death certificate. Be careful: flu was often confused with other conditions, and in the initial pandemic phase, when it was still little understood, deaths were often attributed to 'PUO' (a pyrexia of unknown origin). Once identified, the disease became known as the ‘Spanish flu’ (partly because reporting of it was not subject to censorship in Spain, a fact which made it appear more virulent there than anywhere else). It was also known as La Gripe Española, or La Pesadilla and as 'three-day fever'. Remember also that many sufferers died from complications after the flu. Their deaths may have been attributed to ‘pneumonia,’ ‘pleurisy’ or ‘bronchitis.’

Look carefully too at the records relating to your soldier ancestors. They may not have died straightforwardly from gunshot wounds, but from the flu that prevented them from recovering from injury. One useful website detailing the deaths from flu of Scottish servicemen from Orkney is http://www.rbls-kirkwall.org.uk/memorials/ww1BCasualties/SpanishFlu.doc. Finally, it’s worth bearing in mind that many survivors of the flu virus were left severely depressed. A number of suicides and murders in Britain were put down to the after effects of the flu.                        

Other evidence


If you are looking for other information on your ancestors’ experience of flu in 1918-1919, you may be disappointed. Newspapers – both local and national were oddly quiet on the subject. Even The Scotsman barely mentions the disease. This silence may have been the result of a tacit agreement between government and press to ensure that public morale was not further depressed after all the bad news emanating from the Front Line.


The Scot who said ‘Spit Kills’

 

One of the most famous doctors to tackle the 1918-1919 virus was a Scot. Dr James Niven was born in Peterhead in 1851 and trained firstly at Aberdeen University. Niven was Chief Medical Officer of Manchester from 1894-1922 and was responsible for introducing a large number of public health measures designed to hold back the progress of the flu. It was Niven, for example, who coined the phrase ‘ Spit kills.’ He was also one of the first to suggest closing businesses and schools as a response to the disease. Niven, like many older people, had himself lived through the so-called Russian flu pandemic of 1889-1890, and had probably developed an immunity to later strains of the disease.

 


Dr James Niven Obituary. Dr James Niven – a Scot – who fought the virus on the streets of Manchester.  The Obituary of Dr James Niven 1851-1922, British Medical Journal, October 10th 1925.  2 (3380):673-674. Reproduced with permission from the BMJ Publishing Group.

 

 

  


The virulence of the flu pandemic had enormous consequences for the history of many ordinary Scottish families. Indeed, if one or more of your ancestors did die of the flu, you may find that your family tree changed shape and direction entirely in the space of less than two years between 1918 and 1920. Many people were widowed and may later have married again; family breadwinners disappeared; large numbers of young children died; thousands of youngsters lost one or both parents and were adopted by other family members; household groups split up and moved to other parts of the country, and in some cases, out of the country altogether. It’s worth bearing in mind that once the 1921 census becomes available, many of us will find momentous changes have taken place in our ancestors’ households since the previous census of 1911. And these may well have been due as much to the deadly flu virus of 1918-1919 as to the Great War itself.

Useful Websites


http://virus.stanford.edu/uda/ - general history of the 1918 flu pandemic

http://www.archiveshub.ac.uk/jan06a.shtml  Archives Hub collection of material on coughs and sneezes in history, especially the 1918 flu outbreak.

http://www.rbls-kirkwall.org.uk/memorials/ww1BCasualties/SpanishFlu.doc List of casualties of the Spanish flu among servicemen from Orkney 1918-1920

www.rcpe.ac.uk/journal/issue/journal_37_4/Butler.pdf Article by A.R. Butler and J.L. Hogg, ‘Exploring Scotland’s Influenza Pandemic of 1918-1919: Lest We Forget’


Useful Books


Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. Viking; 2004.

Brown R. The Great War and the Great Flu Pandemic of 1918. Wellcome, History 2003.

Honigsbaum, Mark, Living with Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918, Palgrave, 2008.

Kolata, Gina Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the virus That Caused It. San Val 2001.

Quinn, Tom, Flu: A Social History of Influenza, New Holland Publishers, 2008

Oxford, John S., Ranger, Terry, Killingray, David and Phillips, Howard eds, The Spanish Flu Pandemic of 1918: New Perspectives. Routledge: Studies in the Social History of Medicine, 2003.

Van Hartesveldt FR. The 1918-1919 Pandemic of Influenza: The Urban Impact in the Western World. Edwin Mellen Press: 1992.


Keywords: European ancestors, genealogy, family history, Scotland, Scottish, health, flu, ancestry

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