Spanish influenza during the First World War
More than two million civilians and 30,000 troops perished in the Spanish flu pandemic of 1918-19. The disease was worldwide, spreading from west to east. In May 1918, the first large-scale European epidemic took place in Spain. The mortality rate was especially great between the ages of 25 and 40. One contemporary view is that wartime conditions facilitated its spread and enhanced its virulence.
Flu and the war effort
The Great War created perfect conditions for the flu to spread in Britain. British civilians and soldiers were physically and mentally overburdened and undernourished. Huge numbers of people were in transit, and there was overcrowding on public transport as well as in factories, offices, frontline trenches and hospitals.
On 5 November 1918, the director general of the Army Medical Services received a letter from the War Office noting its concern for dietary health: "With reference to the present epidemic of influenza...I am directed to...call the attention...to the importance of fats in the diets of patients... It is suggested that bacon should be issued with breakfast at least three times a week, and that dripping should be utilized as much as possible."
The ensuing pandemic hampered the war effort, causing up to 40 per cent absenteeism in many factories and mines and inflating frontline sick lists.
A call for volunteers
The strain on human resources also affected the voluntary services, leading British Red Cross chief county director Lord Chilston to request more volunteers be recruited and trained: "In view of the possibility of an epidemic of influenza, it is suggested that county directors should ascertain through the commandants of the detachments, which of their members would be prepared to assist the medical officers and district nursing associations. It is important that members volunteering for work in an influenza epidemic should be inoculated before-hand."
Inconsistent record-keeping in wartime, and the failure to officially recognise influenza, meant that the actual incidence was far higher than reported. The mortality rate was also higher as virulent flu often lead to fatal complications but was not identified as the cause of death. The disease was often confused with other conditions. In the initial phase, cases were often recorded as 'three-day fever' or given some other generic label.
With influenza-related mortality reaching its peak in the first week of November 1918, it is conceivable that the pandemic played some role in the decision to conclude the war with an armistice. The three waves of the disease materially impacted upon the conduct of the war effort and significantly complicated efforts to achieve a return to normalcy in early 1919.
In May 1918 the capacity of the British Red Cross stores department, which distributed medical supplies to hospitals, was really tested. American army units arrived in England for training and many of the men fell ill. Epidemics of influenza broke out on transport and in the camps and no provision had been made to receive the invalids. Emergency calls were coming in rapidly and the bulk of the demands were on the British Red Cross stores department.
The department met demands in supplying hospitals across the country, including London, Falmouth, Liverpool and Sheffield. At Aldershot the overcrowding was so great that the most hopeless cases were placed under shelter in the open air to make room on the wards for those more likely to recover. Goods were sent to these hospitals as often as ten times a month, in addition to consignments they were sending abroad.
During June all records were broken by the despatch of goods worth £178,428 to the Paris Commission and £8,753 to Italy, in addition to the £18,017 previously needed for the units in England, making a grand total of £205,198, representing some 12,000 people who were helped by the equipment.
British Red Cross' work overseas
France and Belgium
During the autumn and winter of 1918, every French and Belgian medical unit in military rest stations was filled with patients suffering from influenza. The Red Cross stores department received a telegram from the assistant director of medical services requesting that 400 beds be supplied to a large corps rest station in France.
Much extra work was thrown on the nursing department by the advance during the summer of 1918. October was one of the busiest times for hospitals in France, as not only were large convoys of seriously wounded arriving from the front, but there was also an extensive epidemic of influenza, which added largely to the work and anxiety of the nursing staff.
Joyce Sapwell was sent to France as a voluntary aid detachment (VAD) in 1915. She describes her life and work in make-shift hospitals, caring for the wounded of both sides, including her experience of the epidemic: "Then the terrible flu pneumonia epidemic broke out. About one-third of the staff were down with it, and the hospital was full. We had one hundred and eight deaths in eight weeks. I had not even one orderly to help. Several patients became delirious, and if they got out of bed they usually died. I had to go from one ward to the other all night long. This was a very hectic time, on the go all night."
A severe form of influenza attacked the Italian region of Bassano in the spring of 1918 where an English unit was working. The outbreak kept ambulances at work day and night and the numbers carried during the epidemic were very high. Turin Hospital, which had been made available to the British forces from 1917, was at the disposal of the British Red Cross and had all its available accommodation occupied during the prolonged outbreak.
During a particularly serious influenza epidemic in Rome, the British Red Cross nurses treated not only the war wounded but also British civilians suffering from the flu. 'Invalid foods' - foods believed to be best for ill people - were impossible to procure in Italy and were provided by several Red Cross National Societies.
In November 1918, there was a serious outbreak of influenza among Swiss soldiers and temporary hospitals were opened. The British Red Cross assisted as far as possible, giving 1,338 items, including towels and clothing which were very much appreciated. Heavy demands were made on the Red Cross to cope when influenza attacked several camps in turn with many fatal cases.
In January 1917 the British Red Cross opened 'The Gray Hut' in the village of Chateau d'Oex as a canteen, recreation and educational centre for the officers. When the influenza epidemic attacked Chateau d'Oex with great severity in June 1918, the existing Swiss hospitals were scarcely adequate to cope with the spread of the condition. The British Red Cross supplied milk puddings and nourishing light diets to the sick men and a regular system organised by which meals were fetched twice a day by orderlies from The Gray Hut. The Red Cross believed this good food saved the lives of a number of the men.
Red Cross volunteers sacrifice all
When the flu first struck, the British Red Cross' primary role, as dictated by the Royal Charter of 1908, was to aid the sick and wounded in time of war. It was not until 1919 that the Supplemental Charter added the objectives of "the improvement of health, the prevention of disease and the mitigation of suffering throughout the world".
However, British Red Cross nurses played an important role in caring for those affected by the influenza epidemic. Women were not only the mainstays of the industrial workforce during the war but also made incredible sacrifices as nurses, the often forgotten medical heroes of the time. The increasing number of obituaries of members of voluntary aid detachments (VADs) that appeared in the Red Cross Journal who had died of "pneumonia following influenza" highlights the tremendous sacrifice many volunteer nurses made to help others suffering from the flu.
"Miss Elger died on February 10th from pneumonia following influenza...For two and a half years she was a devoted and conscientious worker at Clayton Court Hospital, where her loss is felt most keenly by all who knew her. Clayton Court, it will be remembered, was most generously placed at the disposal of the Red Cross Society by Mr and Mrs Elger early in the war. After doing so much to help their country, it seems hard that they should have to bear this further personal sacrifice. " Obituary in the Red Cross Journal, 1918
In the Red Cross Journal of 15 May 1919, the Surrey county director wrote an obituary about a VAD named Miss Long, describing how she "nursed through the war at the Esher Red Cross Hospital, where she never missed a day, and was the most devoted worker; this is in addition to domestic work at her home. On demobilisation, she went to nurse village families during the influenza epidemic, contracted the disease, and died on Easter Day. It is on such foundations that the British Red Cross is built".
A number of VADs who had belonged to detachments since their early beginnings, and those who had been amongst the first members, lost their lives, often working right up to the time of their deaths.
Although VAD nurses were most affected within the Red Cross, other members also lost their lives, such as Mr E.A. Alley, who "was the assistant honorary secretary of East Lancashire... He was especially concerned with the work of the men's detachments, in the unloading of ambulance trains coming into Manchester, provision of staff for military hospitals, and the recruiting of orderlies for abroad. He was also the chairman of the foodstuffs board, which was largely responsible for the provisioning of the hospitals in the Branch."
Miss Crump was another volunteer who "died of pneumonia following influenza in November, the art mistress who gave her services in the Cornwall Auxiliary Hospitals during her holidays".
The volunteers' obituaries highlight their dedication during the extreme conditions of the war and epidemic, including Miss Sollars, who died from pneumonia following influenza. She had belonged to Worcester/52 since 1911 and worked at Powick Red Cross Hospital since its opening. Her commandant wrote: "Her work which was untiring and devoted in its character was much appreciated by patients and staff and I have lost a keen supporter."
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