There is no doubt that Niven’s approach saved many lives: 100,000 Mancunians contracted influenza during the spring and early summer, but only 322 died, ‘a relatively low mortality rate’,23 which may be taken as a testimony to Niven’s organizational skills. While Niven had responded admirably to this challenge, he realized that he was dealing with something different; there were two anomalies in this new outbreak. This form of influenza targeted the fittest and healthiest members of a workforce or community, instead of the very old, the very young and the vulnerable, as was traditional. The other anomaly was that the outbreak had arrived in the summer, and not in the traditional winter flu season.24 Niven could only hope that those people who had been infected and survived had developed immunity if the influenza was to return.
Down in London, morale was high. The public mood had been boosted by the latest developments in the war, with reports coming from the Western Front that the Allies had the upper hand. After four long years of food shortages, food rationing, Zeppelin raids and bereavement, the end was in sight. The Manchester Guardian reported that ‘The whole temperature of London has gone up in these two days of good news. Although there will be no flags or bells for some time yet the look on the faces of the people is like flags and bells.’25
At this exciting time, an unseasonal outbreak of influenza seemed unusual but of no great significance. The Illustrated London News observed in its science column that ‘luckily the complaint – which, as a matter of fact, now recurs annually, is this year of a type so mild as to show that the original virus is becoming attenuated by frequent transmission’.26 Meanwhile, The Times had adopted the new name for this curious manifestation. Under the headline ‘The Spanish Flu – a Sufferer’s Symptoms’ the paper declared that the cause of the disease was ‘the dry, windy Spanish spring … an unpleasant and unhealthy season at all times. A spell of wet weather or of moist winds would probably check the progress of the epidemic.’27 In the same article, the newspaper claimed, with a leaden attempt at humour, that ‘The man in the street, having been taught by that plagosus orbilius war to take a keener interest in foreign affairs, discussed the news of the epidemic which spread with such surprising rapidity through Spain a few weeks ago, and cheerfully anticipated its arrival here.’28
While Spanish flu rampaged across the rest of the country, Londoners basked in ‘the almost tropical heat’,29 and life was positively idyllic for some. Under the sub-heading ‘That Active Microbe’ the women’s editor of the Evening Standard commented light-heartedly that ‘A glance at the calendar shows that the hot weather we’ve been having, so far from killing the charity and matinee microbe, has stimulated it to a pitch of feverish activity, with the result that the philanthropic have a busy time ahead of them for the next few weeks.’30
In the same article, readers were presented with breathless accounts of what the most glamorous chorus girls were wearing in their West End shows. Gaiety Girl Ruby Miller dazzled in Going Up in ‘an aluminium grey frock of satin beaute with pannier draperies at the sides and slit up in front to show a ribbon-trimmed petticoat’31 and ‘an evening gown of cyclamen mauve georgette with … harem hem and cummerbund of silver tissue’.32 Marie Lohr, meanwhile, appeared at the Globe in ‘her white cloth frock with its slender lines of jade green embroidery and wide folded belt, caught at one side with three large green and white buttons, and the long straight, green-lined rap of white cloth, with its black velvet collar and array of pearl buttons worn over it’.33
Despite the war, the Manchester Guardian newspaper detected ‘the ghost’ of a London social Season in the West End, alongside the ‘extraordinary greenness of the grass and leafiness of the trees’.34 West End shopkeepers were carrying on as normal: ‘Painting and pointing’ had been carried out in Grosvenor Street and other areas of Mayfair, and ‘Regent Street, despite its lack of paint, looks gay with its summer fashions’.35
While weekending in country houses had declined, with so many men away fighting, and at a time when ‘hardly anyone is entertaining except in small restaurant parties’,36 St James’s Park had returned to its origins as a stylish pleasure garden, in ‘a sort of revival of the eighteenth century ways’.37 The big art shows were continuing as usual, while the Summer Exhibition at the Royal Academy attracted a ‘large attendance, especially from convalescent soldiers’.38 Even the summer dances, those traditional fixtures of the Season, had seen a small revival, as high society mothers did their best to marry off their daughters to the rapidly diminishing pool of eligible men.
Fashionable London had changed dramatically in one respect, and that was the presence of the Americans. The entry of the United States into the war had caused this major transformation. While wartime arrivals in London were nothing new, the city having already witnessed ‘friendly invasions’39 of Belgian nuns, Brussels dandies and the Anzacs (Australian and New Zealand Army Corps) with their tall, lounging, sinewy figures and grim faces, the fourth year of the war was the year of the American, according to the Manchester Guardian.
‘The war year closes with the American in khaki and in blue almost in possession of London … In the last year many hundred thousands [sic] of Americans are actually passing through England to fight in France.’40 American servicemen swelled the audiences of London’s theatre district, where the seats were already dominated by young men in khaki and navy blue. Despite the war, London’s West End was still going strong in 1918, with ‘opera at Drury Lane and at the Shaftsbury, and a very good Gilbert and Sullivan production at the King’s Theatre, Hammersmith’.41
Pacifist Caroline Playne recalled that ‘during the summer of 1918 there was a great run on the theatres’.42 Desperate to distract themselves from the horrors of war, soldiers, sailors and civilians alike crowded into the theatres and music halls. Tragically, live entertainment proved to be the perfect breeding ground for Spanish flu.
‘In 1916 it seemed that there was no prospect of success in producing plays. In 1918 it was difficult to get seats at all even for the worst plays. Almost any production was a huge success. People were said to be fighting to fling their money into the box-office.’43 Leasing theatres involved the payment of a high premium, with high prices for seats and talk of raising them further.44 This came as no surprise given the shortage of other forms of entertainment.
‘It was the vast prosperity of almost every class and the closing of other opportunities for pleasure that caused the theatres to be thronged. The use of motor cars was restricted to trade and professional necessities. Skating rinks and beanfeasts were no more.’45
Drury Lane still presented a brilliant spectacle on some nights, with ‘jewels in the balcony and long strings of carriages waiting and even a footman or two’.46 Among the soldiers and sailors, a few stalwarts of the ancien régime were still in evidence, with ‘M. Nabokoff [sic] [father of the novelist Vladimir Nabokov] and a Russian diplomatic party’47 in one box watching Boris Godounov with its scenes of Russian revolution – an incident more dramatic than anything on the stage itself.48
It was against this backdrop that Mrs Mabel Pride, the mother-in-law of poet Robert Graves, decided to fight off her influenza symptoms and go to the theatre with her son Tony while he was home on leave. We do not know which show they attended, but there was plenty of entertainment on offer. The attractions of summer 1918, when Mabel accompanied her son to the theatre, included Charles Hawtrey and Gladys Cooper in The Naughty Wife at the Playhouse; George du Maurier, father of Daphne du Maurier, in Dear Brutus at Wyndham’s; while the notorious Canadian dancer Maud Allen starred at the London Pavilion. Maud had become the subject of wild allegations from a Tory MP, who had accused her of being the lesbian lover of Margo Asquith, wife of former Prime Minister Herbert Asquith, and a German spy. (It was debatable as to which of these allegations was regarded as the most shocking.) Those of a more serious disposition could go to see Ibsen’s The Master Builder at The Court, while anyone desperate for a little light relief could do worse than head for Chu Chin
Chow at His Majesty’s or Peg O’ My Heart at St James’s.49
Desperate to go out on the town with her son, Mabel visited her doctor, took quantities of aspirin to reduce her temperature, and went off to the theatre with Tony. It was to be Mabel’s last outing; her case of Spanish flu proved fatal, and she died two days later. Robert Graves later noted that ‘Her chief solace, as she lay dying, was that Tony had got his leave prolonged on her account.’50 Graves subsequently learned that Tony was killed in September.51
Mabel’s death was but one among many. Despite the confident mood, Spanish flu had spread across London and was making deadly inroads into the population. Many of the victims were young, affluent and healthy, with Chelsea and Westminster struck down as well as impoverished Bethnal Green.52 The writer Virginia Woolf noted on 2 July 1918 that ‘influenza, which rages all over the place, has come next door’53 the door in question being at Paradise Road, Richmond upon Thames. While Woolf’s neighbour died, Woolf, despite being a lifelong invalid, survived. Another writer, Lady Cynthia Asquith, recounted a dreadful encounter with the Spanish Lady.
Best remembered for her horror stories, Lady Cynthia at the age of thirty-one had already developed a literary career working alongside Peter Pan creator J. M. Barry and D. H. Lawrence, and her diaries contain entertaining and breathless accounts of life in wartime London. On this occasion, however, Lady Cynthia wondered if she was actually going to survive: ‘Just before luncheon precisely the same symptoms as yesterday came on, only much worse. My temperature went up to 102°, and all the afternoon and evening I felt as wretchedly, humiliatingly ill as I ever have in my life – bursting head, painful pulses, aching legs, sick, burning with cold shivers. I tossed and groaned.’54
While Lady Cynthia Asquith’s experience indicated the tendency of Spanish flu to attack the healthy and wealthy, the disease was also on the increase in other parts of London. American soldier Private Pressley, having survived the influenza outbreak at Camp Dix and lost his friend Cid on the voyage to France, was now in London. On 10 July, Pressley wrote to his girlfriend that ‘London, in common with the rest of the Eastern World, has had an epidemic of Spanish flu. It seems to cause a heavy fever, with a complete feeling of weariness, and usually only confines the patient to bed for a few days.’55
On the same day, over in Walthamstow, East London, Elsie Barnett wrote to her husband in Mesopotamia: ‘We have had a terrible doing from the Spanish Flu as they call it, but doctors are inclined to think it’s malaria brought about by soldiers. Am thankful to say I’ve kept clear so far and we are warned to wear camphor about us as people are dying with it in a few hours if they don’t lay up at once.’56
Young Margery Porter, from South London, also contracted Spanish flu that summer. She remembered:
I was an only child and I lived with my mother and father. When we all got the flu we couldn’t do anything else but go to bed, because we just couldn’t stand up. Your legs actually gave way, I can’t exaggerate that too much. Everybody at our end of the street had it. Next door but one lived my grandparents and my three aunts. They all had it, but my grandfather was the only one who died in our family. The rest of us recovered but it took a long time, because the flu took charge of your whole body. I don’t remember having a cold or sneezing. I just remember terrible pains in all my limbs, and I just didn’t want to eat anything. I think my bout of flu lasted about two weeks until I started going back to school again. I was so lucky. That was the worst illness I’ve ever had.57
By August 1918, the Spanish Lady had departed Britain as swiftly and mysteriously as she had appeared four months earlier. An American doctor, writing home from London on 20 August, noted that ‘the influenza epidemic described in recent letters has completely disappeared’.58 But the outbreak had left a dreadful legacy. Over three weeks during July 1918, 700 civilian Londoners had died of influenza and a further 475 from pneumonia,59 while a total of 10,000 influenza deaths had been recorded in Great Britain between June and July. By November 1918, this figure would exceed 70,000.60
CHAPTER SIX
KNOW THY ENEMY
HOWEVER PRESSING THE demands of the summer outbreak on the Home Front in Great Britain, Spanish flu was outranked by the war effort. The war dominated civilian life, half the country’s medical professionals were away on military service and hospitals were dedicated to military requirements.1 Medical science had little to offer in the way of prevention or cure, apart from the process of disinfection, notification and isolation as recommended by Dr Niven. There was little consensus on treatment apart from the traditional recourse to bed rest, opiates and folk remedies, while to make matters worse, significant individuals refused to take the threat of Spanish flu seriously.2
Sir Arthur Newsholme, Chief Medical Officer of the Local Government Board (LGB), pointed out that influenza travelled too rapidly to be stopped and could not be controlled: ‘I know of no public health measure which can resist the progress of pandemic influenza.’3 For this reason, Newsholme declined to issue an official LGB memorandum to civil authorities in the summer of 1918. Matters were not improved by the fact that, at this time, there was no actual Ministry of Health, which could have overseen a national prevention strategy or issued directives to prevent the spread of influenza. In 1918, public health was the responsibility of local ‘sanitary authorities’ and the local Medical Officers of Health who were appointed by city councils. Because influenza was not a notifiable disease, there was no legal requirement to put quarantine measures in place in the event of an epidemic. The LGB also maintained that nothing could be done to prevent outbreaks of influenza. Reflecting the government’s all-consuming preoccupation with the war, Newsholme claimed that the nation’s duty was to ‘carry on’ working, even suggesting that it was unpatriotic to worry about influenza when dealing with the threat to Britain’s survival. Another factor that explains why the authorities seemed to do nothing in the face of a deadly epidemic was that there was no general consensus as to the cause.
The British army, however, took a very different approach. After the influenza epidemics struck France in spring 1918, the Army Medical Service had gone into overdrive, determined to combat the disease with typical military logic and energy. Research was conducted by the Medical Research Committee in London (which would later become the Medical Research Council) and in the army pathology laboratories, which had already been set up in hospitals on the Western Front. The army committed time and manpower to investigating the causes of the influenza epidemic in an effort to create a vaccine, a form of inoculation that had become increasingly common following the pioneering work of Louis Pasteur in 1881. The scientific community maintained that something constructive could be done to halt the inexorable progress of the killer disease, despite the fact that its origins remained mysterious. Army medical teams had successfully combated other diseases such as cholera and dysentery in the past, and so this new strain of influenza should not present a lasting problem. Resources were deployed to combat the mystery illness, with overall control coming from the Medical Research Committee.
The MRC had been founded in 1913 as part of the provisions of the National Insurance Act of 1911. In July 1914, Sir Robert Morant, the senior civil servant tasked with setting up the committee, recruited Walter Morley Fletcher (1873–1933), a brilliant Cambridge physiologist, to act as Secretary to the Committee. Fletcher had graduated from Trinity College Cambridge with first-class honours in Natural Science in 1891, before undergoing clinical training at St Bartholomew’s Hospital and returning to Cambridge as a Senior Demonstrator at the Cambridge School of Physiology.4 Elected to a fellowship at Trinity College, Fletcher was an outstanding character even by Cambridge standards, possessing a vivid personality, spectacular physique, striking features, dynamic energy, quickness of thought, and an elegance in the spoken and written word, set off by an endearing stutter when he became excited.5 Warm and humane, Fletcher could also be masterful, principled and held an intense belief in the value of science in
the service of humanity.6
But Fletcher also wanted more than the familiar routine of academic life, requiring a bigger arena for his intellectual versatility and flair for management.7 This made Fletcher the perfect individual to steer the MRC through its first big challenge, the battle against influenza. When war broke out in August 1914, Fletcher had been appointed to the Army Pathological Committee working to combat sepsis, gas-gangrene and other ‘diseases of war’.
Fletcher’s ferocious work ethic proved injurious to his own health. In order to spend as little time away from his desk as possible, he lunched on a cup of coffee and a Welsh rarebit at the local ABC.8 (The ABC tearooms, run by ‘the Aerated Bread Company’, were a familiar feature of London life.) According to his wife, Maisie, when Fletcher eventually reached home in the evening, after a day of innumerable meetings at the War Office, RAMC (Royal Army Medical Corps), Home Office, Air Force and Royal Society, dealing with the problems presented to medicine by the war, he would immediately settle down to a mountain of paperwork.9
This punishing schedule had led to Fletcher’s own brush with death in February 1916, when he contracted double pneumonia, which was next door to a death sentence, according to Maisie.10 Fletcher endured ‘agonising pleurisy’ (inflammation of the layer covering the lungs), with the ancient remedy of leeches being applied to add to the torment, and later a major operation for empyema (lungs filled with pus), which he barely survived.11 Even then, Fletcher’s ready wit did not desert him. ‘He spoke his mind to his devoted, tireless doctors, when he saw the list of remedies and the medicine bottles that had been amassed in the weeks when he had been unaware of their doings. “That collection of stuff,” said this pioneer of the New Age of medicine, “is worthy of the physicians of Charles II.”’12
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