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Percy Toplis



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BerichtGeplaatst: 25 Dec 2010 22:25    Onderwerp: Reageer met quote

Influenza Digital Archive: W.P.I.B. (Western Pennyslvania Institute for the Blind)

Given prevailing Progressive Era attitudes towards physcially challenged individuals, the the Western Pennyslvania Institute for the Blind (WPIB) was a naturally isolated facility. WPIB was not geographically isolated however, and existed (and still does) in the middle of a busy section of Pittsburgh. We identified the WPIB as a provisional escape community, but the amount of information on the institution during the 1918-1920 influenza epidemic is rather limited.

At a Glance
Type of Site: Small, co-ed school for blind children in Pittsburgh, PA.
Population: 179 students; faculty and staff also lived on-site.
Pop. Density: N/A
Geographical Considerations: WPIB was an enclave restricted to faculty, students, and known visitors. Visitors were prohibited during the second wave of the pandemic.
Influenza Cases: 12
Influenza Deaths: 0
First Reported Case: Late-November 1918.
NPI Implemented: After several children returned with influenza after Thanksgiving, the school closed for one month (including the Christmas holidays).

Case Study
The Western Pennsylvania Institution for the Blind (WPIB) was chartered in 1887. In 1894 the school moved to its permanent home in the Oakland section of Pittsburgh, a thriving commercial and residential district and the cultural and educational center of the city. In keeping with the school’s mission, WPIB offered academic as well as commercial and industrial training to its students. Now called the Western Pennsylvania School for Blind Children, this facility remains open today.

The cloistered nature of the institution itself, its relatively small size, and a swiftly enacted protective sequestration policy all contributed to WPIB’s escape of the influenza pandemic, even as the disease ravaged Pittsburgh. Early in the pandemic, school officials announced that visitors would not be allowed to enter the school nor students allowed to go home for weekends. As a result of being effectively shut off from the rest of the city, no cases of influenza appeared in the school during the period of protective sequestration.

Although there is no recorded documentation, we learned from our tour of the extant building and meeting with the facility’s current Executive Director, Dr. Janet Simon, that there were on-site living facilities for the headmaster and his family. In addition, there were living quarters for the faculty and staff members, many of whom, as was the custom of the day, were probably unmarried women and men. It seems likely that the majority of the faculty and staff were placed in protective sequestration along with the students. We did uncover evidence that in the summer of 1918 the school installed a cold storage and refrigeration plant, allowing for the storage of large quantities of food. This may have played an important role in the institution’s ability to seal itself off from the rest of Pittsburgh.

By late November, as the epidemic in the Pittsburgh appeared to abate, the protective sequestration of WPIB was lifted and students were allowed to travel home for the Thanksgiving holiday. Upon their return in early December, however, 12 cases of influenza were diagnosed among the WPIB students. As a result, officials immediately closed the school for one month and scheduled the re-opening for after the Christmas holiday. When students finally returned to school in early January 1919, the epidemic was almost over in the Pittsburgh area and no new cases appeared at WPIB. There were no influenza-related deaths at the school during the second wave of the pandemic.

Research Materials
The amount of primary source material relating to the Western Pennsylvania Institute for the Blind in the 1918-1920 influenza epidemic is minimal. Because it was located in the middle of a Pittsburgh neighborhood, we also conducted research into how that city coped with the epidemic. Digitized sources include:

Newspapers:
Pittsburgh Gazette Times
Pittsburgh Sun

Archival Material:
Western Pennsylvania Institute for the Blind Annual Reports

Lees verder: http://www.med.umich.edu/medschool/chm/influenza/wpib.htm
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BerichtGeplaatst: 30 Dec 2010 20:14    Onderwerp: Reageer met quote

USS Siboney



Boxing match on the ship's forecastle, while she was at sea in the Atlantic Ocean, transporting troops to or from France in 1918-1919. Spectators are wearing masks as a precaution against the spread of influenza.

http://www.history.navy.mil/photos/events/ev-1910s/ev-1918/influenz.htm
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BerichtGeplaatst: 30 Dec 2010 20:28    Onderwerp: Reageer met quote

The 1918 influenza epidemic in Mamre
J. M. KATZENELLENBOGEN

Summary
The 1918 influenza epidemic was a historic, health and demographic
landmark in South Africa. In Mamre the mortality rate
was 39/1000, which was similar to the rate in Cape Town.
The male/female ratio was 1,33, with males between the
ages of 20 and 40 years accounting for 60% of deaths.

http://archive.samj.org.za/1988%20VOL%20LXXIV%20Jul-Dec/Articles/10%20October/1.13%20THE%201918%20INFLUENZA%20EPIDEMIC%20IN%20MAMRE.%20J.M.%20Katzellenbogen.pdf
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BerichtGeplaatst: 01 Jan 2011 13:38    Onderwerp: Reageer met quote

Samoan influenza obituaries



The influenza pandemic took a terrible toll on Samoa’s population. Over a single week, prominent businessman and community figure O.F. Nelson had lost his mother, one of his two sisters, his only brother and a daughter-in-law. S.H. Meredith lost seven close relatives. Of the 24 members of the Fono a Faipule, only seven survived the pandemic.

James Ah Sue

James Ah Sue was the son of Samoan and Chinese parents. He was educated at the Marist brothers' School at Mulivai, where his contemporaries included O.F. Nelson and S.H. Meredith.

After leaving school, Ah Sue served his apprenticeship as a reporter with Samoanische Zeitung, an Apia-based weekly newspaper established by the German administration in 1901. Later he went to Suva where he gained experience with the Fiji Times.

When the Samoa Advance Party of the New Zealand Expeditionary Force captured German Samoa on 29 August 1914, Ah Sue was back in Apia and editor of Samoanische Zeitung. After its final issue was published on 2 January 1915, he became editor and owner of its English replacement, The Samoa Times.

Unusually, the 22 November 1918 issue of The Samoa Times did not appear. The following week, the newspaper reported 'with deep regret' the death of James Ah Sue. On 15 November, he had 'published the paper in good time. Having done so, however, he collapsed, grew steadily worse day by day, and died.'

Deceased was kindliness itself and generous to the point of fault, and in these dark days of tribulation, when the revenging hand of Death has seared so many hearts, the passing of James Ah Sue touches us closely with a sense of profound pity and sorrow.
- The Samoa Times, 7 December 1918, p. 3

James Ah Sue was survived by his wife and 10 children. He was 41 years old at the time of his death.

http://www.nzhistory.net.nz/media/photo/samoan-influenza-obituaries
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BerichtGeplaatst: 12 Jan 2011 13:08    Onderwerp: Reageer met quote

The Great Flu Crisis at Mare Island Navy Yard, and Vallejo, California
Capt. Thomas L. Snyder, MC, USNR (Ret.)

Mare Island Navy Yard, the oldest U.S. Navy base on the West Coast, was founded by CDR David Farragut in 1854. The Yard was located across the Napa River from Vallejo, CA.

From the founding of the Navy Yard, Vellejo was a "Navy town." The yard civilian work force largely populated the city. Yard workers dominated city political, economic, and social structure. A lively social life between Navy personnel and the civilians of the city flourished.1

The Spanish Influenza epidemic

Next to HIV-AIDS, the 1918-19 epidemic was the worst public health disaster of the 20th century. Estimates put American influenza deaths at 675,000, mortal to more Americans, by far, than all the wars fought in that century.2

Several phenomena new to the 20th century contributed to the rapid spread of the contagion:

- Masses of personnel were being moved in multiple directions around the world as the Great War was being fought.

- Large groups of coughing and sneezing people attended war bond rallies and parades.

- Movies encouraged people to gather in groups, all the while promoting the transmission of the virus.

- In a Navy town like Vallejo, several dance halls provided the opportunity for the spread of contagion.

A less virulent influenza epidemic in the spring of 1918 had but little impact on military or civilian personnel, thence on public health thinking.
Accordingly, when the much more virulent form attacked in the autumn, health officials did not take the occurrence very seriously, and were late to institute appropriate public health measures to slow the contagion.

Preparations on the Mare Island Navy Yard

On 23 September 1918, the senior medical officer at Mare Island received a letter from the Naval Training Center at Great Lakes, which reflected the Great Lakes experience: 20 percent of the yard's manpower complement would become infected, and of those afflicted, 10 percent would develop pneumonia.3 The Mare Island medical officer and his assistants quickly calculated that they should prepare to care for as many as 1,600 influenza victims and 160 pneumonia cases. They immediately began planning for two "emergency hospitals" to supplement the permanent 200-bed Navy hospital, which would care only for the most ill, those with pneumonia.4 Calls for additional corpsmen, nurses, and medical officers went out.

The Navy yard commandant published instructions on how to recognize the symptoms of disease and what to do if they occurred. Any person presenting with upper respiratory-like symptoms was to be hospitalized and quarantined.

Things were thus in readiness when the first case of influenza, a Navy corpsman returning from leave in Oklahoma, presented at sick call on 25 September 1918.

Conditions in Vallejo

The situation in the City of Vallejo was quite different. Not only had little or no advance planning occurred, but the solitary local hospital, a very small facility, was under quarantine because of a small pox outbreak there, and doctors were involved in a smallpox vaccination program.5
At the same time, just as the epidemic began to break out, the city was filled with patriotic fervor over the Fourth War Bond Drive, for which large groups of people frequently gathered.

Housing in the city, whose population had swelled by the influx of 8 to 10 thousand war workers, was crowded and inadequate. Some workers and their families were housed in quickly constructed shacks; others lived in tents thrown up in the backyards of established homes.6 Crowding and its attendant spread of contagion was inevitable.

Because there was nothing, early on, to differentiate this virulent strain of flue from the "ordinary influenza prevalent here at various times",7 no provision for quarantine was made.

The first civilian cases, two, occurred on 27 September, according to the yard medical officer report. The local press reported the outbreak on 4 October.

The Epidemic Runs Its Course at the Navy Yard

With the diagnosis of influenza in the community, Navy authorities quickly responded. Liberty in the city was canceled and functions involving large groups of personnel were prohibited. On 5 October the emergency hospitals were opened. The peak of the epidemic among service people in the yard was around 13-15 October, and it was virtually ended by 30 October. There were 1,536 (1,600 predicted) service personnel treated for influenza. An emergency hospital for civilian employees of the yard opened on Navy yard grounds on 3 November and closed 30 November. Two hundred eighty-seven civilians received care.8

The Epidemic in Vallejo

As the first few influenza cases appeared in town, physicians, with assistance from three Navy surgeons, were vaccinating all school children against the local smallpox epidemic. Local press reports indicate that the vaccination program was successful; after 4 October no new smallpox cases were reported.9

Attention could now be directed to fighting influenza. On 4 October, the Vallejo Evening Times headlined "Fumigation of Public Buildings in Next 48 Hours." The Navy medical officer decried this procedure as a futile gesture and complained in his report to BUMED that local authorities were ignoring advice from naval authorities to institute effective public health strategies. However, on 8 October, by City Council resolution, public authorities did close all public buildings. Church services, while not prohibited, were moved out of doors in order to reduce crowding. The press noted though, that no efforts had been taken to prevent the influx of contagion from outside the city.

In an editorial on 9 October, the Evening Times was reassuring. "There is no cause for alarm. As far as can be learned, no Spanish influenza is prevalent here and the steps taken [the closure of public buildings] have been taken merely as a preventative." The next day, however, the headlines reported 12 civilian cases. On 11 October, local Red Cross officials met to prepare for the coming onslaught by formation of an "influenza unit" involving physicians and nurses working in a local building which would be converted into a hospital, "should the need arise."

The need quickly arose as headlines, just 4 days later, declared "between 60 and 70 cases are being treated,"10 in their homes. It is probable that each civilian doctor made at least 60 house calls a day during this period. The 17 October Vallejo Evening Chronicle headlined that a 60-bed unit was to be opened, but noted that ". . . While medical officers of the [Navy] station think that a 60-bed hospital is a good thing to start with, they also state that if Vallejo hopes to care for her sick she should have at least 300 beds ready."

"City Emergency Hospital"

On 21 October, under the auspices of the Vallejo Red Cross, the Emergency Hospital was opened in an annex of the Y.M.C.A., "in an effort to concentrate the patients [according to the Navy special report] and thus relieve the wild running about of physicians, conserve nursing facilities, and provide hospital care for the sick." The Evening Times had a different take on the purpose of the facility, reporting that red Cross workers would look after those afflicted who had no homes and who were not eligible for care at the Navy hospital, that is, people who were not civilian employees of the yard. There are no records to indicate how many people were hospitalized there.

By 23 October, 350 cases of influenza were reported in town. The Vallejo Evening Chronicle reported that the Emergency Hospital was staffed by a single nurse, who had been on duty for 48 hours without relief. The President of the Vallejo Board of Health tried, without success, to obtain help in the civilian community.11 On the same day, about 1 month into the epidemic, the City Council directed the use of gauze face masks by all citizens. Non-compliers faced stiff fines.

October 24th found 20 patients hospitalized in City Emergency Hospital, many seriously ill with pneumonia. Still unable to properly staff the hospital with civilian workers, the Red Cross made an urgent appeal for help from the Navy Yard. Navy authorities quickly ordered six hospital corpsmen to assist at the facility. They found that it was "a deplorable place for patients. It was unheated, low ceilinged, poorly ventilated, poorly provided with nursing personnel, commissary, and toilet facilities."12 There was no effective administration, and the lead corpsman, a Hospital Apprentice 2d Class "stepped in and practically ran the hospital." Each private physician admitted, attended, and discharged his own patients independently, which troubled the Navy medical officer, who reported: "[s]uch lack of management and system gave rise to untold confusion and largely defeated the object of the hospital, namely to conserve the time and strength of the doctors and afford proper care of desperately sick patients."

The Evening Times reported that physicians were too busy to report accurate numbers of sick, "but indications are that several hundred are suffering."

The Crisis Worsens

By 26 October, Navy yard officials became acutely aware of the loss of a large number of civilian shipyard workers to illness. Navy doctors working in town reported they had discovered whole families ill, with no one to care for or feed them. They found unmarried Navy yard workers sick and unattended in rooming houses; at night, uninfected workers from the Navy yard would return to these same rooming houses, to share poorly ventilated quarters with the sick. In poorer areas of town, people were simply unable to obtain the services of doctors and had to fend for themselves.

The Evening Times reported that local physicians were overwhelmed by the number of calls they received, and noted that "one physician received 15 calls in 2 hours" in the evening.

Conditions were so serious by 30 October that three representatives, the local Red Cross Director, a local physicians (and Navy reservist), and a Trades and Labor Council leader, met with the City Council to "demand . . . that some steps be taken to alleviate conditions existing here at the present time . . .",13 and to "have the entire situation placed under the command of CAPT Harry George [the Navy Yard Commandant] to be handled by his medical forces."14 An editorial in the Evening Times concluded that "The summoning of the naval hospital unit should have been carried out several days ago, or as soon as the disease was well in hand at Mare Island and the physicians and their aides were at liberty . . . To answer the call of the people of the community."

"Saint Vincent's Navy Hospital"

The City Council acknowledged the inability of the city's resources to deal with the crisis, and requested the aid of the Commandant of the Navy Yard. At the same time, the local Dominican Order offered the use of a newly constructed school for another temporary hospital. The Commandant promptly authorized a 100-bed facility to be opened.15 The Navy provided 4 medical officers, 24 corpsmen, and 58 support personnel. Six Dominican sisters acted as nurses. This hospital opened on 2 November. Three days later it was caring for 71 patients.

The Epidemic Finally Wanes

No sooner was the new hospital opened than newspapers began to report a decline in the number of new cases of influenza in town. By the 6th of November the Evening Times editorialized that "reports of today on the influenza situation indicated that the epidemic at last is under control and on the decline." By 16 November the Emergency Hospital at the Y.M.C.A. annex was closed. The St. Vincent's unit still had 68 patients but was closed on 30 November. Its Navy staff and the Dominican sisters had cared for a total of 190 patients, including 80 women and 42 children.

A Brief Resurgence of Infection

In January 1919 the epidemic recurred. While few cases occurred at the Navy Yard, local resources were again quickly overwhelmed. Mare Island Navy Yard employees telegraphed the Secretary of the Navy on 10 January: "Vallejo Calif calls for help. Your Mare Island Navy Yard civilian men are dying. Wives and children lay stricken without help. Hospitals full, no nurses. Doctors working day and night. Please advise Commandant Harry George of Mare Island Navy Yard to quarantine Vallejo and take full charge. Live up to your good record and show us some action. Yours for service."16

In a City Council meeting on the 11th, the major of Vallejo stated "there is no provision in the budget for any emergency." However, the Dominicans again offered the use of their school, and on 13 January "St. Vincent Navy Hospital" was reopened. Face masks were again required, and theaters closed once more.

That same day the Commandant of the Yard reported to the Secretary of the Navy by telegram:

"Influenza in Vallejo serious and fast becoming epidemic. St. Vincent's Catholic Church has placed school building at disposal Commandant as temporary hospital. Large majority of residents are Officers and enlisted men Navy and civil employees Navy yard and their families, and immediate steps should be taken to afford them medical assistance. Request authority to maintain temporary Naval Hospital at St. Vincent's school and to expend necessary funds. Consider project most urgent to safe life and protect Navy personnel and civil employees."17

The Vallejo Evening Chronicle (January 13) editorialized that "[the Navy Yard Commandant] was quick, as he has been in all things, and at all times, to see the necessity for checking and controlling the new trouble." By 22 January the Evening Times headlined "NO NEW CASES REPORTED" and reckoned the quick demise of the epidemic was ". . . due to the systematic way in which the epidemic was handled . . ."18 Public places were re-opened on 25 January, and the St. Vincent's unit closed on 28 January. A total of 55 patients had been hospitalized.

Commentary

The Spanish influenza epidemic represented a public health emergency of the highest order.
Mare Island medical personnel properly prepared for the onslaught of expected influenza cases. They "got their Public Health right" in that all patients presenting with symptoms of influenza were promptly quarantined. Similarly, contacts with the community where infection was rife were curtailed early on. Civil health officials were not so well prepared. Nor were they open to suggestions from Navy medical personnel about how to organize their efforts. Because the U.S. is an "open society," however, local citizens successfully urged Navy intervention. Naval personnel performed magnificently, to the copious approbation of citizens and civic authorities alike.19

What of Today?

Our current concerns about possible terrorist-induced epidemic, or another SARS-like outbreak, throw the experience of Mare Island Navy Yard and Vallejo into high relief. A very contagious, virulent virus could produce so large a volume of illness so quickly as to overwhelm local medical capabilities.

In California there is "no specific authority" for public health officials to "deputize" or otherwise organize local medical personnel to respond to an emergency. While quarantine can be ordered with judicial approval, medical response to a public health emergency is [still] based on a "gentleperson's agreement" among the various parties.20 Country health officials and local hospitals work together developing action plans to be instituted in the event of a large public contagion.

Clearly, there could be a large role for military medicine in some future contagion. This would call for civilian-military contingency planning for such an eventuality. Strategies for a public health response and for the management of large numbers of very sick people must be put in place now.

References
1 Lemmon, S. and Wichels, ED. Sidewheelers to Nuclear Power: A Pictorial Essay Covering 123 Years at the Mare Island Naval Shipyard. Annapolis, MD. Leeward Publications, 1977, Part II-People.
2 Armed Forces Institute of Pathology, The AFIP Letter. 1997; 155(2).
3 Neilson, JL. Influenza epidemic, Mare Island, Cal; special report on, from the medical Officer, Navy Yard, Mare Island, CA, to the (Navy) Bureau of Medicine and Surgery, February 28, 1919, page 4, paragraph 5.
4 Ibid, page 4, paragraph 4.
5 Vallejo Evening Times (VET), Wednesday October 2, 1918.
6 Neilson, page 3, paragraph 9.
7 VET, Friday October 4, 1918.
8 Neilson, page 19, paragraph 38.
9 Vallejo Evening Chronicle (VEC), Friday October 4, 1918.
10 The Vallejo Evening Times, in a page three article titled "Ways to Prevent Contraction of the Spanish Flu" emphasized: "THE SPECIAL PRECAUTIONS TO TAKE ARE: LOTS OF FRESH AIR, NUTRITIOUS DIET, AND AVOID THE EVILS OF OVERCROWDING."
11 VEC, Wednesday October 23, 1918.
12 Neilson, page 30, paragraph 57.
13 VET, Wednesday October 30, 1918.
14 Ibid.
15 VET headlines cried "NAVAL UNIT IS DETAILED TO HOSPITAL AT THE SCHOOL. Captain Harry George Answers Call of Health Officials to Protect Our People".
16 Telegram received Secretary of Navy 10 October 1919.
17 Telegram received at Navy Department 13 January 1919.
18 VET, Wednesday January 22, 1919.
19 Neilson, page 44, copy of letter from B.J. Klotz, M.D., President, Vallejo Board of Health.
20 Thomas Carron, MD, PhD, Medical Director, Solano County (California) Public Health Department, telephone conversation with author, 2 January 2003.


http://www.history.navy.mil/library/online/influenza_mareis.htm
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BerichtGeplaatst: 16 Jan 2011 21:45    Onderwerp: Reageer met quote

1919 - Spanish Flu|

In this program, a number of nurses and doctors recall the Spanish influenza epidemic which swept Australia in 1919. At least twenty million people died of the flu around the world, including twelve thousand Australians.

In the first half of that year, normal life in the country came to a standstill, as desperate governments tried to stem the spread of the disease.

Een ABC-podcast... http://www.abc.net.au/rn/verbatim/stories/2008/2074757.htm
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BerichtGeplaatst: 19 Jan 2011 20:35    Onderwerp: Reageer met quote

Severe Winter of 1917-1918: Factor in 1918 Flu Pandemic

Meteorologist Preston C. Day (1859-1931) wrote in December 1918, “The severity of the weather experienced during December and January of the winter of 1917-1918 over the greater part of the United States east of the Rocky Mountains, and also over much of Canada and Alaska during the early part of the period, was so unusual as to the length of time the low temperatures persisted, the great area involved, and the degree of cold maintained, that some discussion of the contributing factors, and comparison with similar occurrences of previous years, seems desirable.” (1-2)

Climatologist Charles F. Brooks (1891-1958) wrote in June 1918, “Even though summer is upon us, it is not difficult to recall that last winter in the United States east of the Rockies was remarkably cold and snowy. The first killing frosts of autumn came early, and nipped crops which had started late and grown slowly in the cold spring and early summer. The South had a real winter, much to the detriment of fruit and truck crops which were caught by frost.”

Brooks continued, “By far the most intense winter conditions occurred in the regions from the Ozarks to New England, where low temperatures brought snow with passing cyclones, and the snow cover in turn cooled the air excessively whenever the sky was clear…In the eastern United States it was not surprising that autumn months which in many regions were the coldest on record, should be followed by a December and a January that defied the memories of the oldest inhabitants. For example, in Ohio, a 64-year record fails to show a colder December, and in New England, January seems to have been the coldest month at least since 1836, if an Amherst record may be considered as representative.” (3-4)

I.Three Theories

The extremely cold winter of 1917-1918 preceded the three deadly waves of pandemic influenza in 1918. Influenza and all other human disease occur in a context, an environment, which must be conducive to a disease-causing germ’s ability to enter and thrive in the human body. Classical germ theory states that an outbreak of infectious disease occurs because the germ itself has changed, becoming more virulent. For example, current theory on the origination of the influenza pandemic of 1918 suggests the causative virus became more virulent via drift or reassortment, while the environment more or less remained constant. Classical environmental medicine theory by contrast states that what is going on in the environment is as important as the nature of the disease-causing germ. Disease outbreaks occur even when the causative germ remains essentially unchanged, because the environment has changed, permitting the germ to, well, germinate. A third theory is that germs and environments change together. For example, a cold winter may cause humans and hogs to cohabitate indoors where they aerosolize and inhale one another’s influenza germs, which exchange DNA to create a new subtype of influenza A to which both species are newly susceptible.



Graph showing three pandemic waves: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919

The purpose of this article is to document the reality of the unusually severe winter of 1917-1918 in the United States and its association in time with the subsequent emergence of pandemic influenza in 1918. The gravity of the winter of 1917-1918 needs further study as a factor in the emergence of the deadly pandemic influenza strain in 1918. Did humans and their livestock cohabitate in enclosed spaces on farms in Haskell County, Kansas, during the brutal winter of 1917-1918? Haskell is the place that some people believe the 1918 pandemic strain originated. (5-10) Was this cohabitation against the elements the opportunity for reassortment of genetic material between pig and human flu strains that produced the novel influenza virus of the pandemic of 1918? Did a new influenza virus to which immunity was lacking in most young adults arrive to the United States via icy winds that blew southward from the Arctic for two months?

II.Federal Censorship of the Press during the Winter of 1917-1918

Information in the print press about the influenza and other disease epidemics during the winter of 1917-1918 is limited because of the control of the release of information by federal authorities in the Wilson administration. The paucity of information makes reconstruction of disease events more challenging for medical historians. Meteorologists fared better because the information they developed and distributed was essential to military and civilian authorities.

The rationale of limiting what was published was to minimize the Central Powers (Germany and her allies) ability to know about any difficulties the United States was experiencing during its military and national war goods’ ramp up to fight Germany. The United States was wholly unprepared as the war came nearer and nearer to our shores. Much haste was involved in creating a conscripted army, because the U.S. entered the war so late, on April 6, 1917, compared with her closest allies, Great Britain and France (August 1914).

III.Weather Preceding December 1917

Prior to December 1917, says Dr. Preston Day, September was a cold month over much of the eastern half of the United States. October 1917 was also a cold month in all portions of the United States from the Rocky Mountains eastward. “In fact, it partook largely of the characteristics of a winter month in the great central valleys. Freezing weather occurred throughout nearly all portions of the country; the earliest frosts of record were reported from points in the Southwest; and unusually heavy snows occurred near the end of the month in the Lake region and northern Appalachian districts.” (1)

IV.Weather of December 1917

November 1917, however, was warmer than usual. However, “with the closing days of November there was a rapid fall in pressure over interior Alaska and the British Northwest, which quickly overspread the United States.” Then high pressure and intense cold entered the Arctic portions of Alaska and pushed their way southward into the United States, where the month of December 1917 was one of the coldest of record over a large area east of the Rocky Mountains.

On December 7, 1917, the strong high-pressure area moved southeastward in the wake of a heavy snowstorm, bringing during the following few days the coldest weather of the season to date into the Gulf and south Atlantic States. By December 12, 1917, cold temperatures of -20 degrees Fahrenheit to -30 degrees Fahrenheit advanced rapidly into the central valleys and as far south as Iowa and Nebraska. December 13th and 14th, 1917, heavy snow with high winds prevailed form the Lake region to New England, followed by marked cold within the succeeding few days, the temperature falling to nearly -30 degrees Fahrenheit in portions of New England. (1)

In the latter half of December 1917 (28th and 29th), high pressure again entered the northern portions of the United States between the Great Lakes and the Rocky Mountains, with barometer readings, reduced to sea level, above 31 inches, about 1 inch above the normal. At this time, temperatures ranged from -62 degrees F., on the Arctic Circle in Alaska, to -30 degrees F., or lower, in portions of Iowa and Nebraska, and to freezing on the south Texas coast. The cold wave extended to the eastern portions of the United States and Canada during the following few days, the temperature falling below -40 degrees F., in the heavily snow-covered northern portions of New York and New England, and to freezing in the central portions of the Florida Peninsula. This was one of the severest cold waves of record over the northern portion of the country from the Great Lakes eastward, particularly in New England.

Day notes three causes of the extremely cold weather of December 1917 in the United States east of the Rockies (the weather west of the Rockies was abnormally warm). First, the flow of air was unobstructed “from the intensely cold far Northwest into nearly all portions of the United States…In the Great Plans the winds were northerly from 40 to 70 percent of the time, and as far south as San Antonio, Texas, they were from a northerly point 60 percent of the time.” (1)

Second, the unusually extensive and deep snow cover over a large part of the eastern United States during most of the month presented a snow surface that favored rapid cooling of the air at night and by preventing appreciable heating by day, kept the northerly winds cold. Also, on account of the large amount of heat required to melt the snow, the infrequent southerly winds could not maintain their high temperatures.” (1)

Third, there was no departure from the normal amount of solar output of heat. “[I]n fact, at the most northerly station at which such observations were made, Madison, Wisconsin, there was an apparent slight excess of heat received from the sun as compared with the normal. This, however, is accounted for, in part at least, by the unusual dryness of the atmosphere, which favored increased transmission of the solar energy through it,” explains Day.

V.Effects of December 1917 Weather on Society: Food and Coal Scarcity, Soldiers Suffer

The heavy snow covering during much of the early part of December 1917 caused havoc with farming operations, particularly east of the Mississippi River. “Plowing was abruptly halted, and the husking of corn proceeded so slowly that at the close of the month a large part of the crop was still in the fields.” The United States had entered the Great War in April 1917, and any decrease in food production was a problem. “While the heavy snow-covering afforded ample protection to winter wheat over most districts during the colder period of the month, much damage from the severe cold was experience by the truck crops of the South,” notes Day. (1)

“Heavy snow and extreme cold in the principal coal-mining districts of the east interfered seriously with the production, transportation, and distribution of fuel. At the close of the month much suffering from the severe cold was being experienced, and many important industries were either partially or wholly suspending operations from lack of coal. Heavy ice had formed on most of the important northern rivers, and in the Ohio the conditions were reported as the worst in its history, gorges forming which held for many weeks.” An ice gorge is a mass obstructing a narrow passage.”

The unusual cold in December 1917 caused suffering among soldiers in the U.S. Army cantonments, even in those (the majority) that were located in the South to take advantage of the usually warmer weather there. For example, On December 20, 1917, soldiers at Camp Wadsworth in Spartanburg, South Carolina, complained they “could not obtain equipment to protect them against cold.” In addition to a lack of hot water for showers and food that was sometimes only lukewarm, the soldiers lived in tents, instead of comfortable wooden barracks, heated by a small, wood-burning stove. A New York Times article from December 20, 1917, reads, “Each tent holds a squad of eight men and a corporal. The canvas conical [teepees] are heated by a small circular stove, burning wood. During the [ten-day] cold snap, water left in the tents at taps was ice at reveille. Three days ago, the entire camp water supply froze, and the men were forced to go outside the reservation and draw bucketfuls from farm wells.” The article continues,

The men assert that most of the wood goes into the incinerator fire or the fires in the company kitchens, which eat up five cords a day and burn all night—cooking the oatmeal for morning. Contending that they are unable to get enough wood any other way, the soldiers sometimes steal the kitchen supply or raid a more fortunate company. Recently an order went out threatening wood stealers with punishment in the guard house; but the men say they must keep warm and the wood still disappears. (11)

Coal in New York City was becoming so scarce in the last decade of December 1917, Federal Fuel Administrator Harry A. Garfield gave sweeping powers to the president of the Chase National Bank and the Fuel Administrator for New York State to deal with distribution of coal. “The authority to handle any emergency without first communicating with Washington was given” by Garfield. (11) Coal was not moving quickly enough into the city because of the ice and severe cold. “The largest number of deaths [56] from pneumonia in twenty-four hours in New York in the last five years occurred between December 17 and December 22, 1917, noted Dr. Charles Bolduan of the Health Department.” He attributed this increase to “weather conditions, dampness and slush, and added that in many instances it resulted through carelessness on the part of those who would not take care of themselves after taking cold.” (12)

VI.Weather of January 1918

The weather got worse in January 1918. At the beginning of the month, snow cover extended over a wide area as far southwards as Tennessee and the Carolinas. An unusually low pressure over the southern districts of the United States caused a pronounced flow of cold air from the north into the central and southern portions of the country. On January 6th to 8th, a snowstorm further increased the depth of the snow cover. The coldest air of the season then moved down from the north. Snow was unusually deep east of the Mississippi River. January 11th and 12th witnessed very strong, cold, north to southwest winds prevailing over the middle portions of the United States, carrying the temperature to nearly -20 degrees F. as far south as Tennessee, and to 20 degrees F. or lower on the Gulf coast and in Northern Florida. In the Ohio Valley and adjoining regions, January 12 [1918] was probably the coldest and most disagreeable day experienced in a century, said Day.

Ohio Weather Bureau Chief W.H. Alexander summed up January 12, 1918, in this way:

It is scarcely possible to portray adequately the real penetrating character of the winds that blew with gale force all day, causing great suffering and even death to man and beast. It is true that at some stations the temperature has been lower on previous occasions than during this storm; at some the snowfall has been heavier on other occasions; and even higher winds velocities have been recorded, but rarely if ever has there been in this State a combination into which the principal weather elements entered with such force and persistency as during the cold wave of January 12, 1918. (1)

Unusually cold weather continued. Around January 20, 1918, a cold wave once again extended southward from the Arctic, bringing, in some districts, the severest weather of the winter. Cold air from the north moved swiftly into “the interior and Southern States, with little opportunity for heating, due to the expanse of the snow and ice covered areas over which it passed. Temperatures fell to -20 degrees F. in Nebraska and to freezing in southern Texas.” The period from about January 7 to 23, 1918 inclusive--17 days--temperatures in the east-central portions of the United States were almost continuously below normal.

VII.Effects of January 1917 Weather on Society: Food and Coal Scarcity, Soldiers Suffer

Day wrote, “At the beginning of the month the ground was snow covered north of a line extending from South Carolina to the northern Rocky Mountain region. Frequent extensive storms sweeping well to the southward in their movements across the country added to the depth and surface extent of the snow, and by the middle of the month [January 1918] the greater part of the country was covered” with snow. “The depths had reached unusual proportions in the Ohio and middle Mississippi Valleys and thence northward over the Lakes region and northeastward to New England. At points in these regions some of the heaviest snowfalls and severest drifting ever known occurred; and the great transportation lines were often badly crippled and at times completely paralyzed. Wagon roads were blocked for long periods, the distribution of food and fuel was greatly delayed and much actually suffering was experienced, particularly on account of the intense cold and the general scarcity of fuel.” (1)

Day continued,

Severe cold, deep snow, and the attendant disorganization of nearly all industrial activities persisted with only slight variations until the end of the month, except that during the last week some melting of the snow cover occurred over the southern drainage area of the Ohio and thence to northern Texas.

Much additional ice formed on the rivers and lakes during the month, and in some of the important producing sections the gathering of the crop was delayed because the thickness was too great to permit the use of the special implements employed in the work. On the Ohio and middle Mississippi Rivers the amount of ice at points was the greatest ever known. Gorges that formed in the Ohio early in December, 1917, held in some places throughout the month [of January 1918], and when they finally broke up late in January, or early in February, caused much damage to river interests. It is estimated that one-half the tonnage on the lower Ohio and portions of the middle Mississippi was destroyed by the heavy ice. At Cairo, Illinois, it is reported that pedestrians crossed the Ohio River on the ice, an occurrence not previously related either in the known history or traditions of that place. At the mouth of the Chesapeake Bay, where ordinarily no interruptions occur to traffic, there were 15 days during the month on which it was impracticable on account of the ice barriers to operate car floats between Cape Charles and Norfolk…

Farm work of all kinds remained practically at a standstill, much corn still remained in the fields ungathered, and wheat not protected by a snow cover was badly damaged by the cold. In the Southern States, winter oats were killed or their growth greatly retarded, and in the great winter trucking districts only the hardier vegetables made appreciable growth, and some that survived the cold of December were further damaged during January. (1)

VIII.February 1918 Weather

“For the month as whole the temperature averaged well above the normal over the greater part of the country, particularly in the central valleys, where it was in marked contrast with that of the preceding two months. The heavy body of snow on the ground at the beginning of the month disappeared rapidly, and at the close only the northern districts were snowbound. The breaking up of the heavy ice in the rivers and the discharge of the excess of water resulting from the large accumulation of snow was accomplished with much less damage and loss by overflow than had been feared, although in the Ohio and some it its tributaries the formation of several extensive gorges caused considerable damage.” (1)

“The milder weather of February brought much relief to the mining and transportation interests and greatly relieved the suffering from cold due to a general scarcity of coal and other fuels. Much progress was made in farming operations usual to the winter season, which had been practically at a standstill since early in December.” (1)

IX.Weather Winter 1918-1919

The winter of 1918-1919 was as mild as the winter of 1917-1918 was severe. “The winter of 1917-18 and that of 1918-19 were two extremes,” noted meteorologist Robert DeC. Ward in March 1919. (13) “Coal that in 1917-18 came to the coal ports solidly frozen in the cars had to be steamed out, sometimes to freeze again before it could be dumped into barges, flowed out last winter [1918-1919] as freely as it does in June and there was no need of the elaborate steam sheds that had been added to the railroad equipment in anticipation of another hard winter and a continuation of the wartime demand,” noted another observer. (13)

X.Summary

The winter of 1917-1918 in the United States east of the Rocky Mountains was one of the coldest, windiest, iciest and snowiest on record, ever. The worst influenza pandemic in known history, caused by a novel strain, occurred in three waves immediately following this extraordinary winter. Environmental factors and germs are equal players in a disease outbreak.

Notes:
1.Preston C. Day: “The cold winter of 1917-1918.” Monthly Weather Review, December, 1918, pp. 570-580.
2.Dr. Preston Day’s obituary is available at http://docs.lib.noaa.gov/rescue/mwr/059/mwr-059-10...; accessed July 23, 2009.
3.Charles F. Brooks: “Notes on meteorology and climatology. The ‘Old-fashioned winter of 1917-1918.’” Science, June 7, 1918, Volume 47, pp. 565-567. Available at http://www.sciencemag.org/cgi/reprint/47/1223/565....; accessed July 23, 2009.
4.Dr. Brooks’ obituary is available at http://www.jstor.org/pss/2561518; accessed July 23, 2009.
5.Jeffery K. Taubenberger and David M. Morens: “1918 influenza: the mother of all pandemics.” Emerging Infectious Diseases, January 2006. Available at http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.ht...; accessed July 23, 2009.
6.“Influenza: Kansas—Haskell.” Public Health Reports, April 5, 1918, Volume 33, Number 14, p. 502. Available at http://www.pubmedcentral.nih.gov/picrender.fcgi?ar...; accessed July 23, 2009.
7.Public Health Reports was the predecessor of Morbidity and Mortality Weekly Reports (MMWR). The latter is published by the Centers for Disease Control and Prevention. The first Public Health Reports issue was published in 1878. For all issues, see http://www.pubmedcentral.nih.gov/tocrender.fcgi?jo...; accessed July 23, 2009.
8.John M. Barry: The Great Influenza. New York: Penguin, 2004, pp. 94-95.
9.John M. Barry: “The site of origin of the 1918 influenza pandemic and its public health implications.” Journal of Translational Medicine, 2004, Volume 2, Number 3. Available at http://www.translational-medicine.com/content/2/1/...; accessed July 23, 2009..
10.Janice Lee McClure (ed.): Haskell County, Kansas: A Historical Anthology; 100 Years beneath the Plow. Newton, Kansas: Mennonite Press, 1988, p. 295.
11.“Spartanburg men complain of cold; have warm clothing, they say, but tents are badly heated and hot baths are lacking.” New York Times, December 20, 1917.
12.“Sweeping powers given to fuel head; Dr. Garfield authorizes state administrator to close ‘luxury’ industries; priority in coal orders; domestic consumers to have first call—deaths from pneumonia increase.” New York Times, December 22, 1917.
13.Robert DeC. Ward: “Meteorological observations while traveling.” Monthly Weather Review, March 1919, Volume 47, Issue 3, pp. 170-171. Available at 701.http://docs.lib.noaa.gov/rescue/mwr/047/mwr-047-03...; accessed July 23, 2009.


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BerichtGeplaatst: 19 Jan 2011 21:28    Onderwerp: Reageer met quote

The site of origin of the 1918 influenza pandemic and its public health implications
John M Barry

The 1918–1919 influenza pandemic killed more people than any other outbreak of disease in human history. The lowest estimate of the death toll is 21 million, while recent scholarship estimates from 50 to 100 million dead. World population was then only 28% what is today, and most deaths occurred in a sixteen week period, from mid-September to mid-December of 1918.

It has never been clear, however, where this pandemic began. Since influenza is an endemic disease, not simply an epidemic one, it is impossible to answer this question with absolute certainty. Nonetheless, in seven years of work on a history of the pandemic, this author conducted an extensive survey of contemporary medical and lay literature searching for epidemiological evidence – the only evidence available. That review suggests that the most likely site of origin was Haskell County, Kansas, an isolated and sparsely populated county in the southwest corner of the state, in January 1918 [1]. If this hypothesis is correct, it has public policy implications.

But before presenting the evidence for Haskell County it is useful to review other hypotheses of the site of origin. Some medical historians and epidemiologists have theorized that the 1918 pandemic began in Asia, citing a lethal outbreak of pulmonary disease in China as the forerunner of the pandemic. Others have speculated the virus was spread by Chinese or Vietnamese laborers either crossing the United States or working in France.

More recently, British scientist J.S. Oxford has hypothesized that the 1918 pandemic originated in a British Army post in France, where a disease British physicians called "purulent bronchitis" erupted in 1916. Autopsy reports of soldiers killed by this outbreak – today we would classify the cause of death as ARDS – bear a striking resemblance to those killed by influenza in 1918 [2].

But these alternative hypotheses have problems. After the 1918–1919 pandemic, many investigators searched for the source of the disease. The American Medical Association sponsored what is generally considered the best of several comprehensive international studies of the pandemic conducted by Dr. Edwin Jordan, editor of The Journal of Infectious Disease. He spent years reviewing evidence from all over the world; the AMA published his work in 1927.

Since several influenza pandemics in preceding centuries were already well-known and had come from the orient, Jordan first considered Asia as the source. But he found no evidence. Influenza did surface in early 1918 in China, but the outbreaks were minor, did not spread, and contemporary Chinese scientists, trained by Rockefeller Institute for Medical Research (now Rockefeller University) investigators, stated they believed these outbreaks were endemic disease unrelated to the pandemic [3]. Jordan also looked at the lethal pulmonary disease cited by some historians as influenza, but this was diagnosed by contemporary scientists as pneumonic plague. By 1918 the plague bacillus could be easily and conclusively identified in the laboratory [3]. So after tracing all known outbreaks of respiratory disease in China, Jordan concluded that none of them "could be reasonably regarded as the true forerunner" of the pandemic [3].

Jordan also considered Oxford's theory that the "purulent bronchitis" in British Army camps in 1916 and 1917 was the source. He rejected it for several reasons. The disease had flared up, true, but had not spread rapidly or widely outside the affected bases; instead, it seemed to disappear [3]. As we now know a mutation in an existing influenza virus can account for a virulent flare-up. In the summer of 2002, for example, an influenza epidemic erupted in parts of Madagascar with an extremely high mortality and morbidity; in some towns it sickened an outright majority – in one instance sixty-seven percent – of the population. But the virus causing this epidemic was an H3N2 virus that normally caused mild disease. In fact, the epidemic affected only thirteen of 111 health districts in Madagascar before fading away [4]. Something similar may have happened in the British base.

Jordan considered other possible origins of the pandemic in early 1918 in France and India. He concluded that it was highly unlikely that the pandemic began in any of them [3].

That left the United States. Jordan looked at a series of spring outbreaks there. The evidence seemed far stronger. One could see influenza jumping from Army camp to camp, then into cities, and traveling with troops to Europe. His conclusion: the United States was the site of origin.

A later equally comprehensive, multi-volume British study of the pandemic agreed with Jordan. It too found no evidence for the influenza's origin in the Orient, it too rejected the 1916 outbreak among British troops, and it too concluded, "The disease was probably carried from the United States to Europe [5]."

Australian Nobel laureate MacFarlane Burnet spent most of his scientific career working on influenza and studied the pandemic closely. He too concluded that the evidence was "strongly suggestive" that the disease started in the United States and spread with "the arrival of American troops in France [6]."

Before dismissing the conclusions of these contemporary investigators who lived through and studied the pandemic, one must remember how good many of them were. They were very good indeed.

The Rockefeller Institute, whose investigators were intimately involved in the problem, alone included extraordinary people. By 1912 its head Simon Flexner – his brother wrote the "Flexner report" that revolutionized American medical education – used immune serum to bring the mortality rate for meningococcal meningitis down from over 80% to 18%; by contrast, in the 1990s at Massachusetts General Hospital a study found a 25% mortality rate for bacterial meningitis. Peyton Rous won the Nobel Prize in 1966 for work he did at the institute in 1911; he was that far ahead of the scientific consensus. By 1918 Oswald Avery and others at Rockefeller Institute had already produced both an effective curative serum and a vaccine for the most common pneumococcal pneumonias. At least partly because of the pandemic, Avery would spend the rest of his career studying pneumonia. That work led directly to his discovery of the "transforming principle" – his discovery that DNA carries the genetic code.

The observations of investigators of this quality cannot be dismissed lightly. Jordan was of this quality.

More evidence against Oxford's hypothesis comes from Dr. Jeffrey Taubenberger, well-known for his work extracting samples of the 1918 virus from preserved tissue and sequencing its genome. He initially believed, based on statistical analysis of the rate of mutation of the virus that it existed for two or three years prior to the pandemic. But further work convinced him that the virus emerged only a few months prior to the pandemic (personal communication with the author from J Taubenberger, June 5th 2003).

So if the contemporary observers were correct, if American troops carried the virus to Europe, where in the United States did it begin?

Both contemporary epidemiological studies and lay histories of the pandemic have identified the first known outbreak of epidemic influenza as occurring at Camp Funston, now Ft. Riley, in Kansas. But there was one place where a previously unknown – and remarkable – epidemic of influenza occurred.

Haskell County, Kansas, lay three hundred miles to the west of Funston. There the smell of manure meant civilization. People raised grains, poultry, cattle, and hogs. Sod-houses were so common that even one of the county's few post offices was located in a dug-out sod home. In 1918 the population was just 1,720, spread over 578 square miles. But primitive and raw as life could be there, science had penetrated the county in the form of Dr. Loring Miner. Enamored of ancient Greece – he periodically reread the classics in Greek – he epitomized William Welch's comment that "the results [of medical education] were better than the system." His son was also a doctor, trained in fully scientific ways, serving in the Navy in Boston.

In late January and early February 1918 Miner was suddenly faced with an epidemic of influenza, but an influenza unlike any he had ever seen before. Soon dozens of his patients – the strongest, the healthiest, the most robust people in the county – were being struck down as suddenly as if they had been shot. Then one patient progressed to pneumonia. Then another. And they began to die. The local paper Santa Fe Monitor, apparently worried about hurting morale in wartime, initially said little about the deaths but on inside pages in February reported, "Mrs. Eva Van Alstine is sick with pneumonia. Her little son Roy is now able to get up... Ralph Lindeman is still quite sick... Goldie Wolgehagen is working at the Beeman store during her sister Eva's sickness... Homer Moody has been reported quite sick... Mertin, the young son of Ernest Elliot, is sick with pneumonia... Pete Hesser's children are recovering nicely... Ralph McConnell has been quite sick this week (Santa Fe Monitor, February 14th, 1918)."

The epidemic got worse. Then, as abruptly as it came, it disappeared. Men and women returned to work. Children returned to school. And the war regained its hold on people's thoughts.

The disease did not, however, slip from Miner's thoughts. Influenza was neither a reportable disease, nor a disease that any state or federal public health agency tracked. Yet Miner considered this incarnation of the disease so dangerous that he warned national public health officials about it. Public Health Reports (now Morbidity and Mortality Weekly Report), a weekly journal produced by the U.S. Public Health Service to alert health officials to outbreaks of communicable diseases throughout the world, published his warning. In the first six months of 1918, this would be the only reference in that journal to influenza anywhere in the world.

Historians and epidemiologists have previously ignored Haskell most likely because his report was not published until April and it referred to deaths on March 30, after influenza outbreaks elsewhere. In actuality, by then the county was free of influenza. Haskell County, Kansas, is the first recorded instance anywhere in the world of an outbreak of influenza so unusual that a physician warned public health officials. It remains the first recorded instance suggesting that a new virus was adapting, violently, to man.

If the virus did not originate in Haskell, there is no good explanation for how it arrived there. There were no other known outbreaks anywhere in the United States from which someone could have carried the disease to Haskell, and no suggestions of influenza outbreaks in either newspapers or reflected in vital statistics anywhere else in the region. And unlike the 1916 outbreak in France, one can trace with perfect definiteness the route of the virus from Haskell to the outside world.

All Army personnel from the county reported to Funston for training. Friends and family visited them at Funston. Soldiers came home on leave, then returned to Funston. The Monitor reported in late February, "Most everybody over the country is having lagrippe or pneumonia (Santa Fe Monitor, February 21st 1918)." It also noted, "Dean Nilson surprised his friends by arriving at home from Camp Funston on a five days furlough. Dean looks like soldier life agrees with him." He soon returned to the camp. Ernest Elliot left to visit his brother at Funston as his child fell ill. On February 28, John Bottom left for Funston. "We predict John will make an ideal soldier," said the paper (Santa Fe Monitor February 28th, 1918).

These men, and probably others unnamed by the paper, were exposed to influenza and would have arrived in Funston between February 26 and March 2. On March 4 the first soldier at the camp reported ill with influenza at sick call. The camp held an average of 56,222 troops. Within three weeks more than eleven hundred others were sick enough to require hospitalization, and thousands more – the precise number was not recorded – needed treatment at infirmaries scattered around the base.

Whether or not the Haskell virus did spread across the world, the timing of the Funston explosion strongly suggests that the influenza outbreak there did come from Haskell. Meanwhile Funston fed a constant stream of men to other American locations and to Europe, men whose business was killing. They would be more proficient at it than they knew.

Soldiers moved uninterrupted between Funston and the outside world, especially to other Army bases and France. On March 18, Camps Forrest and Greenleaf in Georgia saw their first cases of influenza and by the end of April twenty-four of the thirty-six main Army camps suffered an influenza epidemic [3]. Thirty of the fifty largest cities in the country also had an April spike in excess mortality from influenza and pneumonia [7]. Although this spring wave was generally mild – the killing second wave struck in the fall – there were still some disturbing findings. A subsequent Army study said, "At this time the fulminating pneumonia, with wet hemorrhagic lungs, fatal in from 24 to 48 hours, was first observed [8]." (Pathology reports suggest what we now call ARDS.) The first recorded autopsy in Chicago of an influenza victim was conducted in early April. The pathologist noted, "The lungs were full of hemorrhages." He found this unusual enough to ask the then-editor of The Journal of Infectious Diseases "to look over it as a new disease" [3].

By then, influenza was erupting in France, first at Brest, the single largest port of disembarkation for American troops. By then, as MacFarlane Burnet later said, "It is convenient to follow the story of influenza at this period mainly in regard to the army experiences in America and Europe [6]."

The fact that the 1918 pandemic likely began in the United States matters because it tells investigators where to look for a new virus. They must look everywhere.

In recent years the World Health Organization and local public health authorities have intervened several times when new influenza viruses have infected man. These interventions have prevented the viruses from adapting to man and igniting a new pandemic. But only 83 countries in the world – less than half – participate in WHO's surveillance system (WHO's flunet website http://rhone.b3e.jussieu.fr/flunet/www/docs.html webcite). While some monitoring occurs even in those countries not formally affiliated with WHO's surveillance system, it is hardly adequate. If the virus did cross into man in a sparsely populated region of Kansas, and not in a densely populated region of Asia, then such an animal-to-man cross-over can happen anywhere. And unless WHO gets more resources and political leaders move aggressively on the diplomatic front, then a new pandemic really is all too inevitable.

References
1.Barry JM:
The Great Influenza: the Epic Story of the Deadliest Plague in History First Edition New York: Viking 2004.
2.Oxford JS: The so-called Great Spanish Influenza Pandemic of 1918 may have originated in France in 1916.
Philos Trans R Soc Lond B Biol Sci 2001 , 356:1857-1859. PubMed Abstract | Publisher Full Text
3.Jordan E:
Epidemic influenza First Edition Chicago: AMA 1927.
4.Outbreak of influenza, Madagascar, July-August 2002
Euro Surveill 2002 , 7:172-174. PubMed Abstract | Publisher Full Text
5.Thomson D, Thomson R:
Influenza. Annals of the Pickett-Thomson Research Laboratory First Edition Baltimore: Williams and Wilkens 1934.
6.Burnet FM, Clark E:
Influenza: a survey of the last fifty years Melbourne.: Macmillan Co 1942.
7.Collins SD, Frost WH, Gover M, Sydenstricker E:
Mortality from influenza and pneumonia in the 50 largest cities of the United States First Edition Washington: U.S. Government Printing Office 1930.
8.Ireland MW:
Medical Department of the United States Army in the World War – Communicable diseases First Edition Washington: U.S. Government Printing Office 1928.


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BerichtGeplaatst: 20 Jan 2011 21:54    Onderwerp: Reageer met quote

THE 1918 SPANISH INFLUENZA, BERKELEY’S “QUINTA COLUMNA”
Rex W. Adams

Author’s note: The influenza epidemic of 1918 was a disaster of international proportions.
Indeed, as Fred van Hartesveldt notes, “[i]nfluenza undoubtedly killed more in one-fifth
the time than World War I’s soldiers managed with all their machine guns, poison gas, and
rapid-fire artillery.” The world-wide death toll of the epidemic has been estimated at somewhere
between 20 and 40 million. Spanish Influenza has even been held responsible for
crucial developments in the Great War. Dr. Woods Hutchinson, a local physician, argued
for a Berkeley audience that “it is due to this disease that the German offensive was held
up for two weeks last spring, giving our American boys a chance to do their fine work at
Chateau-Thierry.”

The epidemic came to the University of California in three waves, the first and most
serious in October and November of 1918. During this period almost a quarter of the
campus community contracted the disease. It resurfaced briefly in December and again in
January, causing Spring semester to be delayed by two weeks. Though the State Hygiene
Laboratory on the university campus developed a vaccine in late October by using blood
donated by Berkeley students, the serum was distributed first to the military camps and
secondly to students and by the time it was made generally available, the epidemic had
largely run its course.

Lees verder: http://cshe.berkeley.edu/publications/docs/chron1_excerpt_Adams.pdf
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BerichtGeplaatst: 25 Jan 2011 0:22    Onderwerp: Reageer met quote

Quantifying social distancing arising from pandemic influenza
Peter Caley, David J Philp and Kevin McCracken

Abstract: Local epidemic curves during the 1918–1919 influenza pandemic were often characterized by multiple epidemic waves. Identifying the underlying cause(s) of such waves may help manage future pandemics. We investigate the hypothesis that these waves were caused by people avoiding potentially infectious contacts—a behaviour termed ‘social distancing’. We estimate the effective disease reproduction number and from it infer the maximum degree of social distancing that occurred during the course of the multiple-wave epidemic in Sydney, Australia. We estimate that, on average across the city, people reduced their infectious contact rate by as much as 38%, and that this was sufficient to explain the multiple waves of this epidemic. The basic reproduction number, R0, was estimated to be in the range of 1.6–2.0 with a preferred estimate of 1.8, in line with other recent estimates for the 1918–1919 influenza pandemic. The data are also consistent with a high proportion (more than 90%) of the population being initially susceptible to clinical infection, and the proportion of infections that were asymptomatic (if this occurs) being no higher than approximately 9%. The observed clinical attack rate of 36.6% was substantially lower than the 59% expected based on the estimated value of R0, implying that approximately 22% of the population were spared from clinical infection. This reduction in the clinical attack rate translates to an estimated 260 per 100 000 lives having been saved, and suggests that social distancing interventions could play a major role in mitigating the public health impact of future influenza pandemics.

http://rsif.royalsocietypublishing.org/content/5/23/631.full
De PDF: http://rsif.royalsocietypublishing.org/content/5/23/631.full.pdf+html
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BerichtGeplaatst: 27 Jan 2011 20:39    Onderwerp: Reageer met quote

Teachers’ Resource Kit: Spanish Influenza

http://www.qstation.com.au/pdfs/education/40%20Days%20for%20Schools%20Teachers%20Kit%20Stage%204.pdf
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BerichtGeplaatst: 31 Jan 2011 22:09    Onderwerp: Reageer met quote

The forgotten flu: the often-overlooked 1918 pandemic offers important lessons for the next major outbreak.(IN RETROSPECT)
By Stephen M. Soreff & Patricia H. Bazemore, Behavioral Healthcare, Feb, 2008

In 1918, an outbreak of influenza swept over the earth, becoming the deadliest pandemic in history. Between 50 and 100 million people died, including 675,000 Americans. (1) One-third of the world's population and one-fourth of Americans were infected. (2)

In this article, we provide an overview of how the pandemic affected American society. We also examine the impact on psychiatric hospitals. As we prepare for the next flu pandemic, the lessons learned from the 1918 outbreak remain relevant and instructive.

A Global Catastrophe

Despite intensive investigations, much about the virus (H1N1) that caused the 1918 pandemic remains a puzzling mystery. (2) We do know that it first infected birds before transforming to infect swine and humans. (3) Although some evidence suggests that human infection began in Canton, China, most historians say the pandemic began in Kansas near an Army base in February 1918. (1,3)

Fort Riley was a huge Army training facility in Kansas that had nearly 60,000 soldiers. As Barry states in The Great Influenza: The Epic Story of the Deadliest Plague in History, "It is impossible to prove that someone from Haskell County, Kansas, carried the influenza virus to Camp Funston [which contained Fort Riley's infirmary]. But the circumstantial evidence is strong." (1) At Fort Riley thousands of military personnel developed the flu in the spring, summer, and fall of 1918. The first official influenza sick call at Camp Funston occurred on March 4, 1918, and within three weeks at least 1,000 soldiers required hospitalization for severe symptoms. (1)

[ILLUSTRATION OMITTED]

The virus spread east in the United States and on to Europe, Asia, the South Pacific, and Australia. By May 1918 influenza was epidemic in Spain. Spain, a neutral country during World War I, did not have press censorship. Thus, reports of the large numbers of influenza cases circulated widely, and the illness became known as the Spanish Flu or La Grippe. (1) Influenza advanced around the world in three waves: spring 1918, fall 1918, and winter 1919. (2)

The 1918 flu had three significant clinical features: rapid death, fatal secondary bacterial infection, and highest mortality among those 20 to 40 years old (People born before 1889 were thought to have some immunity from exposure to a prior epidemic (2)). More U.S. soldiers died from the flu than from combat. (4)

Reactions at Home

Denial. Many Americans denied the outbreak's seriousness, based on limited news coverage and the stance of local and federal authorities. For example, officials in Philadelphia downplayed the significance of early cases and, in fact, encouraged large public gatherings. (5) Yet if the public had known of the flu's dangers, more might have participated in quarantine efforts which, when complete, were surprisingly effective.

Hatchett et al compared the flu's peak mortality rates in different U.S. cities to demonstrate the proven effectiveness of nonphar-macologic interventions (NPIs). (5) Communities that used several such interventions (e.g., preventing public gatherings and closing schools) had a reduction in peak incidence of influenza cases by 50%, although the overall number of cases was reduced by only 20% (still an impressive figure). Philadelphia had one of the highest mortality rates of major U.S. cities, attributed to a failure to implement NPIs and to allowing a citywide parade on September 28, 1918, which 200,000 people attended.

Mistrust. Some saw influenza as a German weapon brought to the United States by U-boats. (1) Others blamed the outbreak on immigrants. For example, Denver residents singled out Italians. (1)

With denial of the pandemic becoming impossible as more people died, the public lost trust in local and federal authorities. As Barry says, "The terror among Americans about the 1918 influenza was a direct result not of the disease itself but the result of the way in which authorities and the media systematically destroyed trust." (6)

Panic. Many feared that influenza would not only disrupt life but also would cause the end of civilization. (1) Suicide rates in the United States increased during the pandemic. (7) In rural areas, such as in Kentucky, flu victims starved to death because their neighbors were afraid to bring them food. (6) In many U.S. cities, social gatherings (e.g., church services and public performances) were suspended and schools were closed. (8) Corpses remained uncollected in homes and on streets, and morgues overflowed with bodies. (1)

The Psychiatric Impact

When considering the psychiatric impact of the virus that caused the 1918 pandemic, one has to remember the state of psychiatric research at the time. With that consideration in mind, influenza infection was said to cause delirium, described succinctly by a French clinician (quoted by Barry) as follows: "The mental disturbances during Influenza sometimes took the form of acute delirium with agitation, violence, fear and erotic excitation." Less commonly, "The main symptom was of a depressive nature ... fear of persecution." (1) A U.S. Army report (quoted by Barry) noted, "Nervous symptoms appeared early, restlessness and delirium being marked." (1)

Some patients reportedly became self-destructive as a result of delirium. Starr, who was a medical student during the pandemic, described how "Mike a piano mover was poised on the window ledge ready to jump." Following Starr's intervention, "Mike, delirious had turned the bed over on top of himself and was moving up the ward on his back. He lasted only a few hours after that." (8)

After the pandemic, influenza was an area of interest for psychiatric researchers. In 1926, Menninger hypothesized that pregnant women who had influenza produced children who later developed schizophrenia. (9) Others speculated that the infection disturbed fetal development and led to lower birth weights, and that this was the mechanism through which influenza led to schizophrenia. (10) While these hypotheses have not been proven, the long-term effect of in utero infection remains an area of schizophrenia research interest. (11)

Effect on Psychiatric Hospitals

Public mental hospitals in the United States in 1918 were self-contained communities, (12) but this relative isolation did not spare them from the pandemic. Many hospitals remained open to admissions, providing a source of infection. The Worcester State Hospital (Massachusetts) 1918 annual report states:

In 1918, the hospital's population was 1,774, yielding a 0.11% death rate from influenza alone or a combined "excess" pneumonia and influenza death (CEPID) rate of 0.67%, which is similar to the CEPID death rate of 0.65% in cities employing several quarantine-type control measures. (5) This CEPID figure is based on the assumption that 10 of the 31 pneumonia cases reported in 1918 at Worcester State Hospital were "excess" (i.e., beyond what would have been expected in a typical year). Prior to the epidemic, about 21 patients died from pneumonia annually.

At Dorothea Dix Hospital in North Carolina, only 18 patients and 2 staff members died as a result of the flu, and only 317 patients had the flu. (14) At that time the hospital's patient population was approximately 1,900. (15) At the New Hampshire State Hospital, "During the fall of 1918 we took our brunt of the influenza epidemic, 243 cases developing within the hospital with 16 deaths." (16) During the flu outbreak, the hospital had an average census of 1,368 patients.

Although the three state hospitals we examined did not seem to be significantly affected by the pandemic, Torrey and Miller report that the pandemic had a large impact on patient populations: "The only event that slowed this inexorable ascent [of insanity] was the influenza pandemic of 1918, which temporarily decreased the prevalence of insanity by killing large numbers of patients in the asylums." (17)

Across the Atlantic, in Amsterdam the pandemic was at its height in October of 1918, and admissions to mental hospitals actually increased during that month (although not a statistically significant difference). There is no evidence of any attempt to deny admission to patients to achieve quarantine. (18)

Final Thoughts

The 1918 pandemic offers important lessons for the next influenza outbreak. As Barry points out, the government needs to be honest and open to achieve positive results. (6) It's important to note that in many instances quarantine did reduce morbidity and mortality.

Yet it's remarkable how little the pandemic of 1918 is noted or discussed today, particularly outside academic circles. If not for the current concern about the avian flu, one has to wonder if this historic event would have continued to be neglected. After all, the human ability to forget, deny, and avoid unpleasant topics and memories is extraordinary. Langer's An Encyclopedia of World History, published just 40 years after the pandemic, fails to note it and the 50 to 100 million people who died. (19) But there are still some who remember the pandemic firsthand: Dr. Bazemore's father, now 101 years old, recalls running errands for ill people in Massachusetts while a Boy Scout during the outbreak.

To contact the authors, e-mail soreffs15@aol.com.

References
1. Barry JM. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York: Viking; 2004.
2. Taubenberger JK, Morens DM. 1918 Influenza: the mother of all pandemics. Emerg Infect Dis 2006;12(1):15-22.
3. Kilbourne ED. Influenza pandemics of the 20th century. Emerg Infect Dis 2006;12(1):9-14.
4. Byerly CR. Fever of War: The Influenza Epidemic in the U.S. Army During World War I. New York: New York University Press; 2005.
5. Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A 2007;104(18):7582-7.
6. Barry JM. What the 1918 flu pandemic teaches us. Yesterday's lessons inform today's preparedness. MLO Med Lab Obs 2006;38(9):26,28. http://www.mlo-online.com/articles/0906/0906clinical_issues.pdf.
7. Wasserman IM. The impact of epidemic, war, prohibition and media on suicide: United States, 1910-1920. Suicide Life Threat Behav 1992;22(2):240-54.
8. Starr I. Influenza in 1918: recollections of the epidemic in Philadelphia. 1976. Ann Intern Med 2006;145(2):138-40.
9. Menninger KA. Influenza and schizophrenia: an analysis of post-influenzal "dementia precox," as of 1918, and five years later. Am J Psychiatry 1926;82:469-529.
10. Wright P, Takei N, Rifkin L, Murray RM. Maternal influenza, obstetric complications, and schizophrenia. Am J Psychiatry 1995;152(12):1714-20.
11. Susser E, Lin SP, Brown AS, et al. No relation between risk of schizophrenia and prenatal exposure to influenza in Holland. Am J Psychiatry 1994;151(6):922-4.
12. Soreff SM, Bazemore PH. When state hospitals were communities. Behavioral Health Management 2005;25(4):10-12.
13. Eighty-Sixth Annual Report of the Trustees of the Worcester State Hospital for the Year Ending November 30, 1918. Boston; 1919.
14. North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services. History of Dorothea Dix Hospital. www.dhhs.state.nc.us/mhddsas/DIX/history.html.
15. Marge Ororke, a historian for Dorothea Dix Hospital. Raleigh, North Carolina. Personal communication. December 2, 2006.
16. Report of the New Hampshire State Hospital to the Governor and Council for the Biennial Period Ending August 31, 1920. Concord, New Hampshire; 1920.
17. Torrey EF, Miller J. The Invisible Plague: The Rise of Mental Illness from 1750 to the Present. Piscataway, N.J.: Rutgers University Press; 2002.
18. van der Heide DH, Coutinho RA. No effect of the 1918 influenza pandemic on the incidence of acute compulsory psychiatric admissions in Amsterdam. Eur J Epidemiol 2006;21(3):249-50.
19. Langer WL. An Encyclopedia of World History. Boston: Houghton Mifflin; 1958.
BY STEPHEN M. SOREFF, MD, AND PATRICIA H. BAZEMORE, MD
IN THIS DEPARTMENT
we take a look at some of yesterday's treatment, reimbursement, and technology trends--and where they stand now.
ABOUT THE AUTHORS
Stephen M. Soreff, MD, is President of Education Initiatives in Nottingham, New Hampshire, and is on the faculty of Metropolitan College at Boston University, Fisher College, Worcester State College, and Southern New Hampshire University.
[ILLUSTRATION OMITTED]
Patricia H. Bazemore, MD, is an Associate Professor in the Departments of Psychiatry and Family Medicine and Community Health at the University of Massachusetts Medical School in Worcester. She also is a member of the medical staff at Worcester State Hospital.
[ILLUSTRATION OMITTED]


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BerichtGeplaatst: 01 Feb 2011 9:30    Onderwerp: Reageer met quote

Spanish Influenza



Filmpje(s)... http://wn.com/Spanish_influenza
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BerichtGeplaatst: 05 Feb 2011 1:26    Onderwerp: Reageer met quote

The Influenza Pandemic of 1918-1919 in the British Caribbean
By DAVID KILLINGRAY

SUMMARY. The influenza pandemic swept through the Caribbean during the period
October 1918 to March 1919 and resulted in c. 100000 deaths. This article focuses on
the British possessions and is based principally on official reports and the local press. It
looks at how the virus entered and spread through the region, the possible reasons for
variations in levels of morbidity and mortality between islands, popular responses to
the infection, and the mainly fruitless official attempts to arrest and deal with the
disease. Jamaica was the first island to be affected, and along with Belize and Guyana,
suffered most severely. A number of islands, particularly those in the eastern Caribbean,
appear to have escaped relatively lightly. Although all sections of the population
were vulnerable, the heaviest mortality rates were among the very poor, East Indian
immigrant labourers, and native Americans. There was also a high toll among males
aged 15-40. Altogether the death rate from influenza in the British Caribbean was
c.30000. In London influenza was added to the official list of British 'imperial diseases',
and although it was recognized that poverty provided the conditions for the spread of
disease, the resources in the Caribbean were barely used to improve standards of living
and nutrition.

The Society for the Social History of Medicine, http://shm.oxfordjournals.org/content/7/1/59.full.pdf
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BerichtGeplaatst: 10 Feb 2011 16:19    Onderwerp: Reageer met quote

Comets and Contagion: Evolution and Diseases From Space
Rhawn Joseph, Ph.D., and Chandra Wickramasinghe, Ph.D.
Journal of Cosmology, 2010, Vol 7, 1750-1770

Abstract: For much of history comets have been associated with death and disease. There is increasing evidence that life on Earth originated in comets and other stellar debris. If passing comets have continued to deposit viruses and microorganisms on this planet, this may explain why ancient astronomers and civilizations attributed the periodic outbreak of plague to these stellar objects. Moreover, the subsequent evolution and extinction of life may have been directly impacted by the continued arrival of bacteria, archae, viruses, and their genes from space. On this picture the evolution of higher plants and animals, including humans, would be impacted by the insertion of genes from space, as well as recurrent episodes of pandemic disease. Near-culling pandemics and extinction episodes have in fact been preceded by or followed by inserts of viral genes into survivors who have transmitted these viral elements to their progeny, thereby impacting future evolution. Although ancient fears and reverence of comets may be coincidental with the outbreaks of pandemics, they may also have a factual basis.

Keywords: Panspermia, life, interplanetary transfer, disease, death, plague, pandemic, 1918 flu, comets

http://journalofcosmology.com/Panspermia10.html
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BerichtGeplaatst: 25 Feb 2011 10:51    Onderwerp: Reageer met quote

The Great Pandemic: The United States in 1918-1919



The Influenza Pandemic occurred in three waves in the United States throughout 1918 and 1919. Learn more about the pandemic, along with the Nation’s health and the medical care system and how they were affected. Also, take a glance at some people who fought the Influenza in the United States.

Mooie site! http://1918.pandemicflu.gov/index.htm
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BerichtGeplaatst: 25 Mrt 2011 22:49    Onderwerp: Reageer met quote

NEWSPAPER HEADINGS POPULARLY ILLUSTRATED.

"INFLUENZA MICROBE DISCOVERED AT A LONDON HOSPITAL."



http://www.gutenberg.org/files/11284/11284-h/11284-h.htm
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BerichtGeplaatst: 31 Mrt 2011 21:50    Onderwerp: Reageer met quote

The Influenza Pandemic, 1918 — 1919
Nyree Morrison

In light of the current Swine Flu pandemic, it is interesting to look back at how an earlier influenza pandemic affected the University.

Lees verder op http://sydney.edu.au/senate/documents/History/Flu.pdf
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BerichtGeplaatst: 25 Sep 2011 21:21    Onderwerp: Reageer met quote

Het RIVM: Spaanse Griep
http://youtu.be/cqMzia-ioeM
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BerichtGeplaatst: 27 Okt 2013 8:33    Onderwerp: Reageer met quote

Letter from nurse to her friend at the Haskell Indian Nations University, Kansas, October 17, 1918. Bureau of Indian Affairs.

In this letter, a volunteer nurse assigned to various military bases, writes to friend about her experiences. Her initial reaction to death is a window into a personal experience, rather than an official report: "the first one [officer] that died sure unnerved me-I had to go to the nurses' quarters and cry it out."

http://www.archives.gov/exhibits/influenza-epidemic/records/volunteer-nurse-letter.pdf
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BerichtGeplaatst: 15 Jan 2014 22:32    Onderwerp: Reageer met quote

Spaanse griep onder Servische krijgsgevangenen in 1919

Op 16 januari 1919 schrijft het Rotterdamsch nieuwsblad over de repatriëring van Servische krijgsgevangenen die zijn vrijgelaten uit het Duitse kamp Friedrichsfeld. Ook wordt melding gemaakt van ziekte onder deze Serviërs in Dordrecht en dat er voor deze groep een hulpziekenhuis wordt ingericht in Rotterdam. Tenslotte meldt het bericht dat in Rotterdam op 13 januari een daar gestorven Serviër is begraven.



Het betreft de 36-jarige Miloš Simonović http://www.secanje.nl/nl/slachtoffers/simonovicmilos/

De Nieuwe Rotterdamsche Courant van 22 januari en het Algemeen Handelsblad van 23 januari schrijven over de situatie in Nijmegen, waar er al 19 Serviërs aan de griep zijn overleden.




In totaal zouden er in Nijmegen 21 Serviërs overlijden http://www.secanje.nl/nl/begraafplaatsen/nijmegen/

Ook in het kamp te (Nieuw) Milligen heerste de griep, aldus het Algemeen Handelsblad van 29 januari. Er waren toen al 20 Servische slachtoffers begraven op het kerkhof van Garderen.



In Nieuw Milligen overleden 30 Serviërs, waarvan er 29 werden begraven in Garderen http://www.secanje.nl/nl/begraafplaatsen/garderen/

Op 6 februari schrijft het Rotterdamsch nieuwsblad over het hulpziekenhuis voor Serviërs en Portugezen aan de Schoonderloostraat (in het gebouw van de St. Aloysiusvereeniging) in Rotterdam, dat is ingericht voor de behandeling van Servische slachtoffers van de Spaanse griep en het bezoek dat Milan Milojević, de Servische gezant, bracht.



Bij dat bezoek op 5 februari zijn ook foto’s gemaakt door de Rotterdamse fotograaf H.A. van Oudgaarden.


http://www.secanje.nl/nl/resultaten/rotterdam-1919/

In januari 1919 brak de Spaanse griep uit onder Servische krijgsgevangenen die via Nederland werden gerepatrieerd. Er was sprake van een epidemie. In totaal overleden in 1919 in 5 weken tijd op acht plaatsen in Nederland 87 Servische krijgsgevangenen aan de gevolgen van de Spaanse griep. Eerder waren in Nederland al 5 andere Servische ex-krijgsgevangenen overleden.

In 1938 werden de stoffelijke resten van 88 Serviërs opgegraven, om te worden bijgezet op de Servische militaire begraafplaats (mausoleum) in het Tsjechische Jindřichovice.

http://www.secanje.nl/nl/slachtoffers/
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Spaanse griep in Nederland 1919 onder (Servische) militairen.

- www.servische-krijgsgevangenen.nl
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BerichtGeplaatst: 02 Feb 2014 8:53    Onderwerp: Reageer met quote

Nogmaals het Rotterdamsch nieuwsblad van 16 januari, nu beter leesbaar:



Ook in het Rotterdamsch nieuwsblad, op 22 januari verplaatsing van Servische krijgsgevangenen en Servische en Duitse burgers:



Vanaf 22 januari wordt uitgebreid verslag gedaan vanuit Nijmegen: De Telegraaf en Het Volk van 22 januari, de Middelburgsche courant en De Telegraaf van 23 januari, het Algemeen Handelsblad, de Nieuwe Rotterdamsche Courant en De Telegraaf op 25 januari, De Gelderlander op 28 januari:

















Op 24 en 27 januari berichtten de Nieuwe Rotterdamsche Courant en Rotterdamsch nieuwsblad over de eerste slachtoffers in Dordrecht:





In Dordrecht overleden in totaal 15 Servische krijgsgevangenen: http://www.secanje.nl/nl/begraafplaatsen/dordrecht/

Over de situatie in Enschede en Hengelo, staat geschreven in het Rotterdamsch nieuwsblad van 29 januari en het Algemeen Handelsblad van 4 februari:





In Enschede overleden in deze periode 6 Serviërs, in Usselo 10, deze werden allen in Lonneker begraven, waar ook al een gevluchte Serviër lag die in 1918 was overleden: http://www.secanje.nl/nl/begraafplaatsen/lonneker/
In Hengelo stierven 3 Serviërs: http://www.secanje.nl/nl/begraafplaatsen/hengelo/
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BerichtGeplaatst: 02 Feb 2014 8:56    Onderwerp: Op het veld van Eer Reageer met quote

Op 30 januari 1919 bezweek in Nijmegen in het hospitaal van de Koloniale Reserve de Nederlandse soldaat-verpleger Sietze Hassing (Amsterdam, 12-09-1880 – Nijmegen, 30-01-1919), die besmet raakte terwijl hij zieke Servische krijgsgevangenen verzorgde. Hij liet een vrouw en 5 kinderen na, terwijl de 6e op komst was. In Nijmegen werd een comité opgericht dat geld inzamelde voor dit gezin, zo berichtten de Nieuwe Rotterdamsche Courant en De Tegegraaf van 6 februari en De Gelderlander van 8 februari:






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BerichtGeplaatst: 30 Apr 2014 16:34    Onderwerp: Reageer met quote

Mysterie van de Spaanse Griep opgelost
Nieuwe kijk op vijftig miljoen griepdoden
DOOR: BENNIE MOLS


Quote:

Hoe kon het gebeuren dat de wereldwijde griepepidemie in 1918 de meeste levens eiste onder mensen in de kracht van hun leven? Het lijkt erop dat de Russische Griep het immuunsysteem onvoldoende voorbereidde op de Spaanse Griep.
In de nadagen van de Eerste Wereldoorlog greep een heftig griepvirus wereldwijd snel om zich heen. Omdat Spaanse kranten er het eerste over berichtten, werd al snel gesproken over de ‘Spaanse Griep’. Patiënten kregen eerst last van koorts, hoestbuien, spierpijn en keelpijn. Binnen een paar dagen ontstonden ademhalingsmoeilijkheden. Dat was weer het gevolg van een longontsteking. Bij gebrek aan antibiotica stierven de meeste patiënten aan die longontsteking. Wereldwijd kwamen in 1918/1919 naar schatting vijftig miljoen mensen om het leven.

Waar een griepepidemie vrijwel altijd de meeste slachtoffers eist onder de meest kwetsbaren - jonge kinderen en senioren - was dit bij de Spaanse griep niet zo. Juist in de categorie van 18-29-jarigen, mensen met een gemiddeld sterk immuunsysteem, was de sterfte het hoogste. Rara, hoe kan dat? Dat is al decennialang het mysterie van de Spaanse Griep.

Verkeerde kindervirus
Onderzoekers van de Universiteit van Arizona denken nu dat ze het mysterie hebben opgelost. Juist de 18 tot 29-jarigen hadden de pech gehad om in hun kindertijd aan het ‘verkeerde’ griepvirus te zijn blootgesteld: een griepvirus dat te veel afweek van de Spaanse Griep om enige immuniteit op te bouwen. De Amerikaanse onderzoekers publiceerden hun analyse deze week in het tijdschrift PNAS.

De Spaanse Griep was van het type H1N1 (de H en de N staan voor twee typen eiwitten). Wie echter tussen 1889 en 1900 werd geboren had de grootste kans om in aanraking te komen met de zogeheten Russische Griep, een griepvirus van het type H3N8. Maar een immuunsysteem dat op jonge leeftijd getriggerd is door de Russische Griep bleek zich maar weinig raad te weten met de Spaanse Griep, zo blijkt uit een analyse van de Amerikaanse onderzoekers.

Degenen die in 1918 tien tot vijftien jaar waren, hadden juist het geluk dat zij op jonge leeftijd waren blootgesteld aan een H1-type virus, verwant aan het type H1N1. En de ouderen waren beschermd doordat zij in hun jeugd vaak al een H1N1-type virus onder de leden hadden gehad. Hun vroege blootstelling leverde hen nog decennialang extra bescherming.

Stukjes vogelgriep
Tot nu toe luidde de standaardhypothese ter verklaring van het mysterie van de Spaanse Griep dat het immuunsysteem van mensen in de kracht van hun leven overreageerde. En die overreactie zou dan zo sterk zijn dat de dood erop volgde.

Voor de oorsprong van het Spaanse Griepvirus bestonden tot nu toe twee hypothesen. Volgens de eerste zou een gemuteerd varkensvirus uit China in de VS terecht zijn gekomen. Volgens de tweede hypothese zou een vogelgriepvirus bij de mens zijn beland, waarna het muteerde en gemakkelijk van mens op mens kon overspringen.

Het nieuwe Amerikaanse onderzoek vindt voor geen van deze klassieke hypothesen aanwijzingen. Het gebruikte moleculaire klok-methoden om de oorsprong te reconstrueren van drie griepvirussen: de Spaanse Griep, een klassiek H1N1-virus en een H1N1-griepvirus dat dominant was in de jaren 1918-1957.

Volgens de nieuwste inzichten ligt de oorspong van de Spaanse Griep in een H1-type virus dat al tien tot vijftien jaar bij de mens rondspookte tot het kort voor 1918 stukjes genetisch materiaal van een vogelgriepvirus wist in te bouwen. Pas toen kon het vernietigend om zich heen slaan.

Michael Worobey et al, 'Genesis and pathogenesis of the 1918 pandemic H1N1 influenza A virus', in PNAS, 29 april 2014.

http://www.wetenschap24.nl/nieuws/artikelen/2014/April/Mysterie-van-de-Spaanse-Griep-opgelost.html

http://www.pnas.org/content/early/2014/04/24/1324197111.abstract

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BerichtGeplaatst: 30 Apr 2014 16:35    Onderwerp: Reageer met quote

Zie ook: http://www.forumeerstewereldoorlog.nl/viewtopic.php?t=7911&highlight=spaanse+griep
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BerichtGeplaatst: 12 Jun 2014 14:30    Onderwerp: Reageer met quote

Beetje idiote wetenschapper. Iets opwekken wat al bijna uitgestroven is.
Ooit gaat het mis met dit soort wetenschap. Doomscenario is bijvoorbeeld de film Outbreak (1995).


http://www.hln.be/hln/nl/961/Wetenschap/article/detail/1915792/2014/06/12/Levensgevaarlijke-Spaanse-griep-tot-leven-gewekt.dhtml

Amerikaanse wetenschappers hebben in een beveiligd laboratorium in de staat Wisconsin de zogenaamde 'Spaanse griep', het uitgestorven influenzavirus, opnieuw tot leven gewekt.

In 1918 eiste een wereldwijde epidemie van de Spaanse griep naar schatting 20 tot 100 miljoen levens, een aantal dat het totale dodental van de Eerste Wereldoorlog ruimschoots overtreft.

Wetenschapper Yoshihiro Kawaoka van de universiteit van Wisconsin heeft het virus nu opnieuw tot leven geroepen. Het virus, dat voor 97 procent identiek is aan het dodelijke griepvirus uit 1918, werd in het beveiligde laboratorium gecreëerd met behulp van 'omgekeerde genetica'. Daarvoor gebruikte hij vogelgriepvirussen uit wilde eenden, meldt het vakblad Cell Host and Microbe.

Critici bestempelen het onderzoek als krankzinnig en gevaarlijk. Mocht het virus een weg naar de buitenwereld vinden, dan zijn de gevolgen niet te overzien, melden zij
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BerichtGeplaatst: 06 Nov 2014 9:24    Onderwerp: Reageer met quote

Van Spaanse griep tot Mexicaanse griep
Door Eric Mecking

Mijn nieuwe e-book is uit, bijgewerkt tot op de dag van vandaag: De Spaanse griep van 1918 was de grootste catastrofe ooit. De Eerste Wereldoorlog had circa 15 miljoen mensen het leven gekost, de grieppandemie ongeveer 50 miljoen. Deze massamoordenaar doodde in 24 weken tweemaal zoveel mensen als het aids-virus in de afgelopen 24 jaar.

http://griep.blog.nl/h1n1
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Laatst aangepast door Percy Toplis op 21 Nov 2018 9:14, in totaal 1 keer bewerkt
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BerichtGeplaatst: 12 Okt 2017 10:22    Onderwerp: Reageer met quote

Influenza 1918: Disease, Death, and Struggle in Winnipeg

Door Esyllt W. Jones

The influenza pandemic of 1918-1919 killed as many as fifty million people worldwide and affected the vast majority of Canadians. Yet the pandemic, which came and left in one season, never to recur in any significant way, has remained difficult to interpret. What did it mean to live through and beyond this brief, terrible episode, and what were its long-term effects?

Influenza 1918 uses Winnipeg as a case study to show how disease articulated abd helped to re-define boundaries of social difference. Esyllt W. Jones examines the impact of the pandemic in this fragmented community, including its role in the eruption of the largest labour confrontation in Canadian history, the Winnipeg General Strike of 1919. Arguing that labour historians have largely ignored the impact of infectious disease upon the working class, Jones draws on a wide range of primary sources including mothers' allowance and orphanage case files in order to trace the pandemic's affect on the family, the public health infrastructure, and other social institutions. This study brings into focus the interrelationships between epidemic disease and working class, gender, labour, and ethnic history in Canada.

Influenza 1918 concludes that social conflict is not an inevitable outcome of epidemics, but rather of inequality and public failure to fully engage all members of the community in the fight against disease.

https://books.google.nl/books?id=8YK06KZVCeoC&hl=nl&source=gbs_navlinks_s
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BerichtGeplaatst: 12 Okt 2017 10:24    Onderwerp: Reageer met quote

America's Forgotten Pandemic: The Influenza of 1918

Door Alfred W. Crosby

Between August 1918 and March 1919 the Spanish influenza spread worldwide, claiming over 25 million lives, more people than those perished in the fighting of the First World War. It proved fatal to at least a half-million Americans. Yet, the Spanish flu pandemic is largely forgotten today. In this vivid narrative, Alfred W. Crosby recounts the course of the pandemic during the panic-stricken months of 1918 and 1919, measures its impact on American society, and probes the curious loss of national memory of this cataclysmic event. In a new edition, with a new preface discussing the recent outbreaks of diseases, including the Asian flu and the SARS epidemic, America's Forgotten Pandemic remains both prescient and relevant. Alfred W. Crosby is a Professor Emeritus in American Studies, History and Geography at the University of Texas at Austin, where he taught for over 20 years. His previous books include Throwing Fire (Cambrige, 2002), the Measure of Reality (Cambridge, 1997) and Ecological Imperialism (cambridge, 1986). Ecological Imperialism was the winner of the 1986 Phi Beta Kappa book prize. The Measure of Reality was chosen by the Los Angeles Times as one of the 100 most important books of 1997.

https://books.google.nl/books?id=KYtAkAIHw24C&dq=12+october+1918&hl=nl&source=gbs_navlinks_s
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BerichtGeplaatst: 12 Okt 2017 12:11    Onderwerp: Reageer met quote

Ik ben vorige zondag voor de eerste keer met de Western Front Association naar Cambrai geweest en we zijn er op de Duits-Britse begraafplaats geweest en daar is een hele plot met allemaal soldaten van de Commonwealth die gestorven zijn begin 1919 ten gevolge van die rotte Spaanse griep.

Die moet er lelijk huis gehouden hebben zeg.
Hele mooie begraafplaats is het wel, alhoewel.....mooi is een begraafplaats moeilijk te noemen.

W zijn er ook naar een mooi museumpje geweest waar de eigenaar een schitterend 5-delig werk geschreven heeft over de Duitse veldartillerie, hét beste dat ik ooit al gezien heb over dit onderwerp.
Als gepensioneerd artillerist heb ik ze natuurlijk onmiddellijk aangeschaft waardoor ik iets later het gevoel had dat ik een portefeuille van uienleder had, ik begon namelijk spontaan te janken toen ik er in keek. Crying or Very sad
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BerichtGeplaatst: 07 Dec 2017 10:19    Onderwerp: Reageer met quote

Dear Canada: If I Die Before I Wake: The Flu Epidemic Diary of Fiona Macgregor. Toronto, Ontario, 1918

https://books.google.nl/books?id=ZN87BIW5eEwC&printsec=frontcover&hl=nl#v=onepage&q&f=false
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BerichtGeplaatst: 20 Dec 2017 9:36    Onderwerp: Reageer met quote

"Influenza Epidemic at Pueblos of Albuquerque Day School Section", December 20, 1918.

Interessante brief... https://www.archives.gov/exhibits/influenza-epidemic/records/visiting-doctor-letter.pdf
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BerichtGeplaatst: 14 Feb 2018 18:02    Onderwerp: Reageer met quote

Die Alliierten hielten die Grippe für deutsches Gift

Im Winter 1918 begann die „Spanische Grippe“ von den USA aus ihren tödlichen Siegeszug um die Welt. Bis zu 50 Millionen Menschen erlagen der Pandemie. Groteske Ursachen wurden diagnostiziert.

Die Meldung, die die britische Nachrichtenagentur Reuters im Mai 1918 verbreitete, klang harmlos: „Eine merkwürdige Krankheit mit epidemischem Charakter ist in Madrid aufgetreten. Die Epidemie ist von milder Natur, Todesfälle wurden bislang keine gemeldet.“ Im Gegensatz zu den Nachrichten von der Westfront, an der die Mittelmächte im Frühjahr 1918 die Entscheidung erzwingen wollten, klang das herzlich harmlos – und sollte sich sich als groteske Falschmeldung erweisen. Denn die Seuche raffte bald mehr Menschen dahin als der gesamte Erste Weltkrieg.

Die Pandemie, die von 1918 bis 1920 die Welt im Würgegriff hielt, ist als „Spanische Grippe“ in die Geschichte eingegangen. „Spanisch“, weil ihr Auftreten zunächst in Spanien bekannt wurde, wo auch König Alfons XIII. und mehrere Regierungsmitglieder an ihr erkrankten. Vor allem aber, weil das neutrale Spanien im Gegensatz zu den kriegführenden Mächten keine strenge Pressezensur unterhielt und daher offen über die „Gripe“, wie sie genannt wurde, berichtet werden konnte.

https://www.welt.de/geschichte/article173201060/Erster-Weltkrieg-Alliierte-hielten-die-Grippe-fuer-deutsches-Gift.html

En bekijk na het lezen ook even de commentaren, daar staan ook nog interessante dingen.
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BerichtGeplaatst: 19 Apr 2018 9:14    Onderwerp: Reageer met quote

The RAN and the 1918-19 Influenza Pandemic
by Dr David Stevens

Media reports surrounding the dangers of a new influenza pandemic often refer to the global outbreak of 'Spanish flu', which struck suddenly at the end of World War I. But none have yet recalled how the crisis brought about Australia's first overseas humanitarian assistance operation. Today, in the wake of tsunamis, earthquakes and cyclones we have grown used to the international relief efforts of our service personnel. However, 90 years ago it remained a novel expedition, but one that nontheless remained as fundamentally dependent upon maritime capabilities as many still are today.

Between April 1918 and May 1919 influenza, or its secondary complications, caused up to 50 million deaths, far more than had been killed in four years of war. Many died within the first few days of infection, and nearly half of these were young, healthy adults. The speed with which it spread has been described as 'Perhaps the most extraordinary feature of this extraordinary pandemic...',[1] for the easy transfer from shore to ship and ship to shore, meant that even communities isolated by sea were vulnerable. A rigorous maritime quarantine policy reduced the immediate impact in Australia, but by the end of 1919 the nation had still suffered more than 11,500 deaths.

The ships of the Royal Australian Navy (RAN), dispersed as they were around the world, were certainly not spared. The pandemic occurred in waves and the cruisers operating with the British Grand Fleet suffered several outbreaks in 1918, with up to 157 cases in a single ship. Outbreaks in the Mediterranean were even more severe with the cruiser HMAS Brisbane recording 183 cases between November and December 1918, of whom two died of pneumonia. In all, the RAN lost some 26 men to the disease. When the cramped mess decks and poorly ventilated living spaces of early 20th century warships are recalled, it is perhaps remarkable that the toll was not greater. The saving factor was largely the ready availability of professional medical treatment.[2]

Some of the most virulent outbreaks occurred in the islands of the South Pacific, where among the indigenous populations few escaped infection. The disease arrived on the regular cargo vessel SS Talune, which had sailed from Auckland on 30 October 1918, knowingly carrying sick passengers. Successively calling at ports in Fiji, Samoa, Tonga and Nauru, the steamer's visits were marked by the first cases of influenza appearing ashore a few days after her departure. With local authorities generally unprepared, the infection spread uncontrollably; a situation aggravated both by the shortage of suitable drugs and the fact that local health workers were among the first to fall. Hardest hit was the former German territory of Samoa, where inept New Zealand administration resulted in no attempts at patient isolation and the rejection of medical assistance offered from nearby American Samoa[3]. With the forced closure of government institutions and stores, few people being in a fit state to assist with the distribution of food and medicines, and a growing number of uninterred dead, the Samoan situation rapidly became critical. On 19 November the military governor in the capital of Apia telegraphed Wellington for help, but had his request turned down on the grounds that all doctors were needed in New Zealand. Australia offered the only alternative source of aid.

The Commonwealth Naval Board was already aware of the developing regional crisis. The sloop HMAS Fantome, stationed at Suva in Fiji for police duties, had reported her first cases of influenza on 11 November, and soon had more than half her ship's company incapacitated. More importantly in terms of an effective Australian response, of all government departments, only the RAN had suitable assets at immediate readiness. On 20 November the Board began gathering a joint relief expedition from among the available naval and military medical personnel, placing it under the command of Surgeon Temple Grey, RAN. The Commanding Officer of HMAS Encounter, Captain Hugh Thring, RAN, was then ordered to embark the expedition at Sydney and proceed at the earliest possible date to Samoa[4].

Even today the speed of Encounter's response must be admired. Her sailing orders were telegraphed from Melbourne on Friday 22 November, and throughout the next day and night the cruiser's ship's company worked tirelessly to get in relief stores. Without any information from Samoa as to specific requirements, Thring loaded almost 150 tons of cargo ranging from blankets and tents through to drugs and dry provisions, expecting that these would meet any emergency. The weekend created further difficulties as shops were shut and some items not in stock had to be purchased. Nevertheless, on Sunday forenoon the medical teams embarked, the last of the stores were in by 1550, and ten minutes later Encounter sailed from Sydney.

Encounter was not a modern ship, but she had led an active service life, most recently involving convoy escort and patrol duties in the Malay Archipelago and Australian waters. Just the previous month she had suffered 74 cases of influenza while operating out of Fremantle, and now, as a precaution against further infection, all members of her crew (over 450) were doubly inoculated. Encounter's normal passage speed was only 13 knots, but this had to be regulated by coal consumption and navigational requirements. Without modern navigational aids, it was sometimes necessary to arrive at certain points in daylight, while fuel replenishment, and hence range, relied on an efficient logistics system. A coaling stop in Suva would be necessary, but naval stocks there amounted to only 300 tons, so the Naval Board arranged for a rendezvous with a collier. This vessel could not, however, reach Fiji until at least 5 December.

Arriving in Suva on 30 November Encounter took on half the available coal and, 'almost more important', 39 tons of water[5]. With influenza still prevalent, Thring implemented a strict quarantine enforced by guards placed on the wharf. The ship's company completed all coaling, rather than the native labour normally employed. As no one could return from ashore Thring communicated by letter with Britain's resident High Commissioner for the Western Pacific, C.H. Rodwell. The news was not good. The Samoan epidemic showed no sign of abating, with deaths in Apia reaching 50 a day. Moreover, a message from Tonga indicated that conditions there were at least as bad while the facilities for coping with it were worse. On his own initiative, Thring extended Encounter's mission to include Tonga, but to avoid further delay, landed a nine-man team under the senior Army surgeon, Major Alexander, to take immediate passage in SY Ranadi. Unfortunately, the yacht broke down soon after sailing and was forced to return to Suva.

Sailing from Suva on the evening of 30 November, Thring called for 80 volunteers from his own ship's company should it prove necessary to provide greater assistance ashore. Despite the dangerous and unpleasant nature of the work, and the fact that any party landed would be left behind - missing their first peacetime Christmas at home -all the officers and most of the ratings volunteered. It would be difficult to find a more telling example of the Australian Navy's tradition of 'service before self'.

Encounter anchored off Apia on the morning of 3 December. The harbour was small for a ship of her size and, when combined with a considerable swell and strong winds, made unloading extremely hazardous. Although the ship rolled through more than 20 degrees, within six hours the landing party (6 surgeons, 18 medical orderlies and 3 naval sick berth ratings) and their stores were safely disembarked. Ashore Surgeon Grey and his teams immediately set to work, yet the scale of the disaster remained daunting, and for many of those afflicted help came too late. A Sydney newspaper reported that the Australians 'with their motor trucks are doing wonderful service day after day gathering up the dead, who are simply lifted out of their houses as they lie on their sleeping-mats. The mats are wrapped around them, and they are deposited in one great pit.'[6] Made worse by the deaths caused by exhaustion and starvation, the two-month epidemic eventually killed 25 per cent of the total Samoan population, and often more than half the male adults in individual communities. Economic and social collapse followed [7].

Meanwhile Encounter had proceeded direct to Tonga reaching the capital, Nuku'alofa, on 5 December. Here the British Consul advised that, although subsiding, the epidemic had struck down 95 per cent of the indigenous population and left 10 per cent dead. The situation in the outlying islands was just as bad. Thring attempted to get Fantome to bring out Major Alexander's party, which had been doing good work in Fiji, but the sloop had experienced a fresh outbreak of influenza and remained unfit to go to sea. Rodwell had no other craft available for the task.

Thring landed his last surgeon together with five orderlies and the remaining drugs and stores, but there was little more he could do. Yet even this small contribution was of great relief to the European and indigenous community. In thanking Thring for Encounter's 'timely aid', the Consul remarked: 'Though conditions had greatly improved before the party arrived there was still a good deal of work to be done of a nature that required professional skill and knowledge'. The party, he added, 'has been indefatigable... in efforts to eradicate the disease'. [8]

With Encounter running short of coal, Thring sailed for Suva on 7 December. Arriving two days later he received orders to return directly to Sydney. Encounter reached Sydney on 17 December and was immediately placed in quarantine. Only one member of her crew had shown any signs of illness during the voyage, and as testament to the effectiveness of the prophylactic and quarantine measures employed, none developed influenza.

Thus ended Australia's first overseas relief expedition. One which, although unusual for the times, foreshadowed the now regular employment of the RAN's assets to provide humanitarian assistance and demonstrate national interest in regional affairs. Indeed, in the context of the maritime doctrinal concepts of flexibility and adaptability, it should be noted that Thring's orders were not restricted to providing medical aid [9]. Preserving order in the Pacific was among the many subsidiary duties undertaken by the early RAN, and warnings of trouble brewing among the inhabitants of the Gilbert and Ellice Islands (now Kiribati and Tuvalu) had been received by the Naval Board in the weeks before the expedition. While in Suva, Thring took care to discuss with Rodwell how best a warship might support his authority. On this occasion no immediate assistance was necessary, but Encounter's mission might easily have been extended to provide presence elsewhere, and back this up with a large landing force if necessary. It remains a poignant reminder that by their nature, seaborne forces possess a variety of characteristics and attributes which are not necessarily present in other tools of government foreign policy.

References
1 A. Butler, Official History of the Medical Services 1914-18, Vol. III, Problems and Services, Australian War Memorial, Canberra, 1943, p. 191.
2 Butler, Problems and Services , pp. 394-5.
3 New Zealand formally apologised to Samoa in 2002
4 'Sailing Orders', HMAS Encounter/span> file, SPC-A.
5 'Report of Cruise to render assistance in the influenza outbreak', 14 December 1918, HMAS Encounter/span> file, SPC-A.
6 Sydney Daily Telegraph, cited in Dr Seini Kupu, Pacific Public Health Surveillance Network Influenza Guidelines , Secretariat of the Pacific Community, 2005, p. 37.
7 H.J Hiery, The Neglected War, University of Hawaii, 1995, pp. 172-5.
8 Letter, British Agent and Consul Tonga to Thring, 12 December 1918, HMAS Encounter file, SPC-A.
9 Royal Australian Navy, Australian Maritime Doctrine, Defence Publishing Service, Canberra, 2000, p. 50


http://www.navy.gov.au/history/feature-histories/ran-and-1918-19-influenza-pandemic
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BerichtGeplaatst: 22 Mei 2018 9:52    Onderwerp: Reageer met quote

The 1918 “Spanish Flu” in Spain
Antoni Trilla, Guillem Trilla, and Carolyn Daer
Hospital Clinic, Institut d’Investigacions Biomediques August Pi I Sunyer, University of Barcelona and Centre de Recerca en Salut Internacional
de Barcelona, Barcelona, Spain


The 1918–1919 influenza pandemic was the most devastating epidemic in modern history. Here, we review
epidemiological and historical data about the 1918–1919 influenza epidemic in Spain. On 22 May 1918, the
epidemic was a headline in Madrid’s ABC newspaper. The infectious disease most likely reached Spain from
France, perhaps as the result of the heavy railroad traffic of Spanish and Portuguese migrant workers to and
from France. The total numbers of persons who died of influenza in Spain were officially estimated to be
147,114 in 1918, 21,235 in 1919, and 17,825 in 1920. However, it is likely that 1260,000 Spaniards died of
influenza; 75% of these persons died during the second period of the epidemic, and 45% died during October
1918 alone. The Spanish population growth index was negative for 1918 (net loss, 83,121 persons). Although
a great deal of evidence indicates that the 1918 A(H1N1) influenza virus unlikely originated in and spread
from Spain, the 1918–1919 influenza pandemic will always be known as the Spanish flu.

Lees verder op https://watermark.silverchair.com/47-5-668.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAZkwggGVBgkqhkiG9w0BBwagggGGMIIBggIBADCCAXsGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMitOUCE2u-Cylv8XAAgEQgIIBTCyj7geeGt2lEoTvQrsdpT_yTMNf2C2LYbhiWPXvgOj9Wbx0l-rjCGKSSI2NTIV0enhbcB4wonNkziWegq0ey_j0JeVtJJ-noseyMODeoB2OZZ634b_pL4qs0Rdt2lv_NHB2_WlPs4DPG3MALlsS9sSNYGaak9tgmHzMV5xjbZQgFkGXGz95aXSPXzEbW6CYlls-cfJ93Ec1kZgLY1jqoUE5Uk8ZZHP5xPTkeRg3wq5RNDmvNNFtns6xBi_M5jIp-LmqhM7PBo6vkA8fTBAM5KFDngqqKoGvjcziG_ABHb0-cIOPZAvaBJMdx_uLdwZ59ANDEdJOmrDDql2DC3eVQhf5DFRGjUcq5_u1CGsDcy0xuLgJF8FUs7XiQoYtKyupiyOYV0gmyrNIKvb5SG3-MZ_8n9gxs_uMmKpZLBOb_2XbYbl8Uj7vEB9ank4s
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BerichtGeplaatst: 31 Mei 2018 10:36    Onderwerp: Reageer met quote

Daily Telegraph, May 31 1918

On page 4: The Spanish Ambassador says “the epidemic which has broken out in Spain is not of a serious character”.

Auw... https://www.telegraph.co.uk/news/ww1-archive/12215326/Daily-Telegraph-May-31-1918.html
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BerichtGeplaatst: 22 Jun 2018 7:59    Onderwerp: Reageer met quote

Century Ireland ... with all the news from 100 years ago.

Influenza epidemic reaches Ireland
Belfast, 1 July 1918 - The influenza epidemic first reported in Spain earlier this year has arrived in Ireland.

https://www.rte.ie/archives/2018/0620/971863-edition-129-century-ireland/
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Pegoud
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BerichtGeplaatst: 11 Jul 2018 11:29    Onderwerp: Reageer met quote

Spaanse griep dodelijker dan de Grote Oorlog: https://www.rd.nl/meer-rd/cultuur-geschiedenis/spaanse-griep-dodelijker-dan-de-grote-oorlog-1.1499815

Gr P
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BerichtGeplaatst: 02 Okt 2018 7:27    Onderwerp: Reageer met quote

Mass Mediated Disease: A Case Study Analysis of Three Flu Pandemics and Public Health Policy door Debra E. Blakely (2006)

Lijkt me interessant. De Spaanse Griep van 1918 ('Great Pandemic of 1918') wordt afgezet tegen de Asian Flu Pandemic van 1957 en tegen de Hong Kong Flu Pandemic van 1968.

https://books.google.nl/books?id=NTs2AAAAQBAJ&pg=PA59&lpg=PA59&dq=2+october+1918&source=bl&ots=lTC8GgO-1Q&sig=R7oWkF8cOjNhmDXawJ_WydQ0954&hl=nl&sa=X&ved=2ahUKEwjTvaDNjufdAhXJZ1AKHWPnDZA4ChDoATAAegQIBxAB#v=onepage&q=2%20october%201918&f=false
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Laatst aangepast door Percy Toplis op 02 Okt 2018 7:36, in totaal 1 keer bewerkt
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BerichtGeplaatst: 02 Okt 2018 7:36    Onderwerp: Reageer met quote

The Last Plague: Spanish Influenza and the Politics of Public Health in Canada, door Mark Osborne Humphries (2013)

https://books.google.nl/books?id=ic3bvvf9HpUC&pg=PT198&lpg=PT198&dq=2+october+1918&source=bl&ots=RAiNMUszOk&sig=xTNv64lcfJ_Db0vU_XYdqOrOw5U&hl=nl&sa=X&ved=2ahUKEwjTvaDNjufdAhXJZ1AKHWPnDZA4ChDoATAMegQIBBAB#v=onepage&q=2%20october%201918&f=false

Recensie:

The Spanish Influenza was the last of the great plagues, killing more than 50,000 people in Canada and felling perhaps five percent of the global population. The pandemic, which crossed the globe in three waves between January of 1918 and December of 1920, was distinguished not just by its virulence, but also by its unusually high mortality among young, otherwise healthy adults, a generation already depleted in the Canada by World War I. Despite its devastating global reach, the flu largely faded from popular consciousness and, until the 1990s, it garnered little attention from historians. This historical amnesia, Mark Humphries argues, stems in part from the intrinsically problematic nature of epidemics, which tend to defy and disrupt other historical forces and leave little room for human agency. The solution, he argues, is to treat disease as an historical actor in its own right, and he contends that the flu ought to be understood as an historical change agent that helped to transform the Canadian state.

Humphries situates The Last Plague within a third wave of recent scholarship on the flu. He identifies in the first those waves, inspired by the AIDS epidemic, the attempt to document the disease's demographic impact and to assess responses in medical and epidemiological terms. The second wave localized the pandemic's impact through community-level case studies. These studies brought clarity to the ways in which social relations were disrupted or consolidated and communities fractured or united by the flu. But Humphries is critical of what he identifies to be the self-limiting nature of this body of work, arguing that in their attention to the local and particular, authors failed adequately to place the pandemic within a national or global narrative. This assessment is, perhaps, unduly harsh, but the author's claims to innovation are legitimate, and his book is at once a masterful synthesis of existing scholarship and one that and breaks new ground as a national history of the flu.

Humphries' predominant concern is to address the questions of how the state and individual Canadians understood epidemic disease and how the Spanish flu altered Canadians' relationship to, and expectations of, their government. Framing the pandemic as a national crisis, he argues that the flu, because it invalidated prevailing ideologies of public health governance, required a re-figuring of the role of the federal government in securing the health of citizens. More particularly, he argues that the nature of the epidemic, which could not be contained by traditional quarantine measures, compelled planners to understand disease not as a foreign threat that could be addressed by externally-oriented responses aimed at regulating immigrant bodies, but rather as an endemic threat that could only be met with positive measures to improve the health of the social body. The most concrete of these responses was the creation, in 1919, of a national Department of Health. This act affirmed a new covenant between Canada and its people at precisely the time when wartime idealism, progressivism, and the social gospel, as well as widespread popular support for an expanded central government, were at their zenith.

The book's temporal scope is much broader than its title would suggest. The author compiles a history of Canada's responses to epidemic disease that the spans a century, beginning with the cholera epidemics of 1930s and concluding with an assessment of the first two decades of the federal health department. He argues that over the long 19th century, the lesson that Canadian authorities had consistently taken from a succession of epidemics was that Canadians were an intrinsically healthy population living in a salubrious land. Disease was something that came from abroad, and the best hope of containing it was through negative measures like quarantine and immigrant inspection; positive public health measures were simply unwarranted. This anachronistic approach was entrenched in the British North America Act, which designated quarantine as a federal responsibility and charged the provinces with addressing endemic problems through the operation of asylums and poorhouses. This division stunted the development of uniform public health measures and, when the flu struck in 1918, Canada was caught unprepared. Whereas in Great Britain and the United States advances in sanitary science, bacteriology, and medicine had spurred the creation of robust public health bodies, the apparent success of Canada's quarantine measures, especially during the 1890 influenza outbreak, foreclosed such developments, and Canada remained a backwater.

The primitive state of Canada's public health apparatus left the government helpless in the face of the Spanish flu, and local measures to contain the epidemic were largely negated by the incompetence and impotence of the federal authorities. Extant regulations did not name influenza as a reportable disease and public health authorities asserted no jurisdiction over troop movements. Consequently, Canadian and American soldiers, predominantly white and Anglo-Saxon, crossed borders made more permeable by the exigencies of war and they were largely invisible to a system that was, by 1918, grounded more in rituals designed to discipline immigrant bodies than measures to identify and contain disease.

The manifest failure of government to address the crisis of the flu strongly influenced debates about postwar reconstruction as Canadians considered whether the government ought to relinquish the unprecedented powers it had gained in wartime, or whether it ought to turn these powers to the public good. While popular opinion favoured the latter, the Union government, formed to militarize Canadian society but elected on the basis of a fragile coalition with social reformers, opted to appease progressive voters rather than to seize the moment. The newly created Department of Health was far from being the far-reaching public health apparatus that many demanded. Nonetheless, Humphries chooses to count the department's successes, not its failures, and to emphasize change over continuity. He argues that the department oversaw a fundamental shift in public health policy from disease management to disease prevention, that new approaches to border screening reframed immigrants as potential citizens instead of potential threats, and that the development of innovative cost-shared programs marked the arrival of a new model whereby the federal government could work within the framework of the BNA Act to influence areas of provincial jurisdiction.

Well researched and argumentatively coherent, this is one of those rare books that will please readers of disparate interests. While Humphries is principally concerned with governance and public policy, readers interested in social or medical history will also find much for them in this book. One of the author's signal accomplishments is to integrate into his narrative clear and accessible explanations of the biology and pathology of the flu and a detailed account of contemporary understandings of the origins and spread of the epidemic. To his great credit, he does so without anachronism. He also breaks ground by bringing new sources to bear on old questions. By mining military records, he is able to offer a new and convincing assessment of how jurisdictional disputes between military and civilian authorities, combined with a singular focus on immigrants as the only plausible source of contagion, opened the doors to the rapid diffusion of the disease across Canada. And while his gaze remains substantially political, he does not neglect the social and the personal. Especially when concerned with reporting the flu's morbidity and mortality, he lends poignancy to his account by including carefully selected passages that give a sense of the psychic impact of this terrifying disease, and he reminds the reader that while the flu afflicted all social classes, its effects were not evenly distributed.

CHRIS DOOLEY - University of Winnipeg

https://www.thefreelibrary.com/Mark+Osborne+Humphries%2C+The+Last+Plague%3A+Spanish+Influenza+and+the...-a0370213621
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BerichtGeplaatst: 23 Okt 2018 14:30    Onderwerp: Reageer met quote

In mijn boek "Het elfde uur" is de Spaanse griep een van de "rode draden". Op mijn website heb ik een algemene uitleg gepubliceerd:
https://pieterserrien.be/hetelfdeuur/de-spaanse-griep/

Ik publiceerde ook het aangrijpende verhaal/getuigenis van de Vlaamse broeder-verpleger Hilarion Thans:
https://pieterserrien.be/2018/10/07/hilarion-thans-en-de-spaanse-griep/
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BerichtGeplaatst: 29 Okt 2018 12:33    Onderwerp: Reageer met quote

De huisarts en ‘de Spaansche griep’ 1918-1920
Door prof. dr. R.A. Melker
Gepubliceerd 10 december 2005


https://www.henw.org/artikelen/de-huisarts-en-de-spaansche-griep-1918-1920
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BerichtGeplaatst: 21 Nov 2018 9:12    Onderwerp: Reageer met quote

Sterfte aan influenza in November 1918
Muntendam, P.

https://www.ntvg.nl/sites/default/files/migrated/1919103540001a.pdf via https://www.ntvg.nl/artikelen/sterfte-aan-influenza-november-1918
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BerichtGeplaatst: 23 Nov 2018 8:52    Onderwerp: Reageer met quote

Stacking the Coffins: Influenza, War and Revolution in Ireland, 1918-19
By Ida Milne. Oxford University Press, 22 mei 2018 - 272 pagina's

The 1918-19 influenza pandemic disrupted Irish society and politics. Stilling cities and towns as it passed through, it closed schools, courts and libraries, quelled trade, crammed hospitals, and stretched medical doctors to their limit as they treated hundreds of patients each day. It became part of a major row between nationalists and the Government over interned anti-conscription campaigners. When one campaigner died days before the 1918 general election, Sinn fein swiftly incorporated his death into their campaign. Survivors interviewed by the author tell what it was like to suffer from this influenza; families of the bereaved speak of the change to their lives. Stacking the coffins is the first Irish history of the disease to include statistics to analyse which groups were most affected. It also draws on the memories of child sufferers telling their stories.

https://books.google.nl/books/about/Stacking_the_Coffins.html?id=SP9eDwAAQBAJ&redir_esc=y
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BerichtGeplaatst: 18 Feb 2019 9:39    Onderwerp: Reageer met quote

The 1918 Influenza Epidemic in New York City: A Review of the Public Health Response
Francesco Aimone, MPHa

SYNOPSIS - New York City approached the 1918 influenza epidemic by making use of its existing robust public health infrastructure. Health officials worked to prevent the spread of contagion by distancing healthy New Yorkers from those infected, increasing disease surveillance capacities, and mounting a large-scale health education campaign while regulating public spaces such as schools and theaters. Control measures, such as those used for spitting, were implemented through a spectrum of mandatory and voluntary measures. Most of New York City's public health responses to influenza were adapted from its previous campaigns against tuberculosis, suggesting that a city's existing public health infrastructure plays an important role in shaping its practices and policies during an epidemic.

Lees het gansche artikel op https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862336/
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BerichtGeplaatst: 18 Feb 2019 9:41    Onderwerp: Reageer met quote

Exeter and Plymouth Gazette - Saturday 09 November 1918

Influenza - It is good news that the influenza plague is generally losing its extreme virulence. The medical authorities tell that such a visitation has no sort of connection with the war, but recurs at odd and long intervals. Some off us will, nevertheless, continue to “hae our doots.” It seems fairly reasonable that we have a few million corpses under a few inches of earth, with all sorts of drainage complications, and the rough-and-ready improvised sanitary arrangements for armies numbering tens of millions of men, without paying some the general state of health. All soldiers that I know are convinced that the so-called influenza epidemic is directly due to the war conditions, and there will eventually prove be truth in the general theory. A more difficult question upon which expert opinion differs, is the possible effects of constantly, and for long periods, drenching whole areas of France and Belgium with powerful and enduring poison gas.

http://www.exetermemories.co.uk/em/_events/1918-this-week.php
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BerichtGeplaatst: 02 Apr 2019 8:58    Onderwerp: Reageer met quote

April 2: The Deadly Flu Pandemic of 1918-1919 Hits Connecticut

On this day in 1919, the medical paper “Complications of Influenza” was read to a desperately worried Hartford County Medical Society, who had been fighting a devastating global flu pandemic that had first reared its ugly head in Connecticut nearly twelve months before.

This particular strain of flu, commonly referred to as “Spanish influenza,” was unlike any ever seen before, ultimately killing over 600,000 Americans and up to 100 million people across the globe. Since Connecticut was home to a number of busy port cities and experienced heavy interstate commercial traffic, it was especially susceptible to an influx of people who carried the disease from overseas. Once the flu was confirmed in Connecticut in the spring of 1918, it spread at an alarming rate owing to the state’s higher-than-average population density. In October 1918, the flu was so widespread that several Connecticut cities closed schools and other public gathering places to try and prevent the disease from spreading. Factories throughout the state shuttered their doors for days at a time in order to prevent their entire workforce from becoming sick, and in Hartford, the Board of Aldermen voted to convert the Hartford Golf Club’s clubhouse into a temporary hospital where patients infected with the flu could recover in quarantine.

Unlike modern strains of the flu, the virus behind the global 1918 pandemic targeted healthy adults, not just children and the infirm. With no cure or vaccine available, the virus claimed the lives of over 8,500 Connecticut residents — and caused thousands more to virtually imprison themselves in their homes out of fear of catching the deadly disease. Thankfully — although the Hartford County Medical Society didn’t know it at the time — the global pandemic had already peaked and was winding down by the time they gathered to discuss “Complications of Influenza” in April 1919. The deadliest epidemic in Connecticut history was finally coming to a close.

https://todayincthistory.com/2019/04/02/april-2-the-flu-pandemic-of-1918-1919/
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BerichtGeplaatst: 09 Jul 2019 7:55    Onderwerp: Reageer met quote

Spaanse griep - De Spaanse griep van 1918: Amersfoort in rouw gedompeld?
Addy Schuurman - Historicus

Tussen alle aandacht die er de afgelopen tijd is geweest voor (het einde van) de Eerste Wereldoorlog, kon ook de Spaanse griep op enige belangstelling rekenen. De ene stelling over de epidemie, die de wereld in 1918 teisterde, leek nog spectaculairder dan de andere. ‘The greatest medical holocaust in history’. ‘Met 500 miljoen zieken en 50 tot 100 miljoen doden veroorzaakte de griep veel meer doden dan de strijd op de slagvelden.’

Het kan niet anders; de Spaanse griep moet ook in Amersfoort rond hebben gewaard. Hoe erg was het in onze stad? Ontwrichtte de ziekte het dagelijks leven? En wat deed het stadsbestuur?

Het virus komt in een gespreid bedje - De geboorteplaats van het betreffende griepvirus (voor medisch geschoolden: het virus werd aangeduid als H1N1) is nog altijd in nevelen gehuld; sommigen wijzen naar China, anderen naar de Verenigde Staten. Met Spanje had de griep niets van doen: de griepepidemie kreeg het etiket Spaans omdat Spaanse kranten als eersten uitgebreid over de ziekte schreven. Spanje was tijdens de Eerste Wereldoorlog neutraal; in de oorlogvoerende landen zorgde de censuur ervoor dat berichten over de griep uit de kranten bleven; meldingen van een dodelijke epidemie zouden immers de moraal en de oorlogsinspanning geen goed doen.

Feit is dat de ziekte in maart 1918 in New York opdook en spoedig daarna oversloeg naar Europa. In het Europa van de jaren 1914-1918 vond het een vruchtbare voedingsbodem. Het virus verspreidde zich razendsnel mede dankzij de voortdurende troepenbewegingen (het reisde met hele regimenten mee, maar ook met individuele verlofgangers) en dankzij de opeenhopingen van soldaten. In de lazaretten lagen honderden militairen dicht op elkaar gepakt, gewond en verzwakt; daar kon één ziektegeval zich makkelijk verspreiden. Maar ook de burgerbevolking was danig verzwakt door de vier jaren oorlog en de daaruit resulterende gebrekkige voedselvoorziening. De oorlog ter zee (duikboten en blokkades!) schaadde overal de aanvoer van voedsel. In de grote steden, zoals Parijs, Berlijn en Wenen, leed de bevolking honger en vormde daarmee perfecte infectiehaarden voor de griep.

Nederland getroffen - De epidemie werd waarschijnlijk naar Nederland gebracht door twee groepen: (geïnterneerde) militairen en grensarbeiders. Op 9 juli 1918 werd in de Amersfoortsche Courant voor het eerst melding gemaakt van een griepgeval in Nederland, een Engelsman in Schoten bij Haarlem. Enkele dagen later waarde de ziekte rond in een Engels interneringskamp in Groningen. Spoedig daarna volgden diverse militaire kampen en oefenterreinen, onder andere op de Veluwe (Oldenbroek, Millingen).

Er was echter nog een tweede bron; die werd gevormd door de Nederlandse grensarbeiders die in het Duitse Ruhrgebied werkten. In Duitsland had de epidemie in juli 1918 een enorme omvang bereikt. Mede dankzij de geallieerde voedselblokkades was de bevolking ernstig verzwakt; bij de fabrieken van Krupp in Essen waren half juli liefst 1600 arbeiders ziek. De vele Nederlandse arbeiders in het Ruhrgebied wachtten natuurlijk niet totdat zij ziek werden, maar trokken huiswaarts en met hen stak het griepvirus de grens over. Kort na 9 juli kwamen er dan ook vanuit de oostelijke grensregio’s meldingen van de Spaanse griep; in Emmerik, Elten en Losser deden zich tientallen ziektegevallen voor. Ook de mijnstreek in Zuid-Limburg werd zwaar getroffen met zelfs honderden besmettingen. De rest van Nederland volgde spoedig daarna.

Ondanks de vele honderden – zoniet duizenden – zieken, waren de gevolgen aanvankelijk beperkt. “Gevaar is er nergens bij”, zo meldde de Amersfoortsche Courant geruststellend. Er was “geen enkele echter met doodelijken afloop. Na 3 of 4 dagen zijn de patiënten meestal weer hersteld. De symptomen der ziekte zijn hooge koortsen, hoofdpijn, moeheid en pijn in den rug.” Natuurlijk, er stierven mensen aan de griep, maar in de eerste maanden waren dat vrijwel overal incidenten: in het ene dorp stierf er één zieke, in een ander twee of drie. Nergens tientallen, laat staan honderden tegelijkertijd. Toen later de rekening werd opgemaakt, telde men over de periode juli tot en met september 1918 precies 815 doden geteld, in heel Nederland.

De eerste griepgolf in Amersfoort - Amersfoort kreeg ook zijn deel. Rond 16 juli werd het Amersfoortse garnizoen getroffen; zes militairen waren ziek geworden. Vier dagen later werd in de krant al gesproken van zestig lijders, op zowel de Infanteriekazerne als de Cavaleriekazerne. Maar van paniek of zelfs ongerustheid was geen sprake. “De ziekte heeft een zeer goedaardig verloop.” Al na een week leek de epidemie over zijn hoogtepunt heen. De opkomst van een nieuwe lichting militairen rond 10 augustus zorgde later nog wel voor een nieuwe ziektegolf op de kazernes, maar doden vielen daar niet.

Ondertussen had de ziekte zich echter uitgebreid tot de stad. Zo waren op de ambachtsschool aan de Leusderweg (tegenover de Infanteriekazerne) 35 leerlingen besmet geraakt. De school werd gesloten en de leerlingen met vakantie gestuurd. Het was de laatste week van juli, de zomervakantie zou toch binnen enkele dagen beginnen. Tot half september 1918 ging de ziekte rond door de stad, maar de omvang van de epidemie is helaas niet bekend. Het aantal zieken werd niet geregistreerd. Af en toe dook er in de krant een berichtje op waaruit bleek dat de griepgolf nog steeds voortduurde. Zo werd begin augustus melding gemaakt van een gezin aan de Kruiskamp waar acht van de elf bewoners waren aangetast, terwijl een dag later het publiek om begrip werd gevraagd voor een vertraagde postbezorging, omdat een kwart van het personeel bij de posterijen ziek was geworden. En ten slotte kon een op 14 augustus gepland concert in Birkhoven niet doorgaan, omdat de musici ziek waren geworden.

Alles onder controle - Enerzijds moet het een raar idee zijn geweest: een griepepidemie in hartje zomer. Anderzijds, in een tijd waarin tal van besmettelijke ziekten voortdurend op de loer lagen (zoals mazelen, roodvonk, tyfus en tuberculose) zal de Amersfoortse bevolking ook niet heel erg opgekeken hebben van de epidemie. Ziektes hoorden bij het leven, ook nieuwe, onbekende ziektes. Van paniek was dan ook geen sprake. Het stadsbestuur schrapte op 16 juli (dus nog voordat het eerste griepgeval in de krant was verschenen) de lessen die militairen volgden op de lagere scholen in de stad, om te voorkomen dat de soldaten jongere kinderen besmetten. Dat was alles. Een oproep van Gedeputeerde Staten van de provincie Utrecht (op 24 juli) om ‘de noodige maatregelen te nemen tot het zooveel mogelijk tegengaan van den Spaanschen Griep’ werd ter kennisgeving aangenomen. ‘Maak het probleem niet groter dan het is’, ‘zaai geen overdreven ongerustheid’, dat was de houding van Burgemeester en Wethouders.

Ook in de stad was er weinig te merken van een toegenomen bezorgdheid. In de krant verschenen er goedbedoelde adviezen om zo veel mogelijk het huis te luchten en voorzichtig te zijn met huisstof. Een emmertje water of een vochtige doek gebruiken! “Stof verontreinigd en prikkelt oogen, neus en keel en kan in een tijd van besmettelijke ziekte dubbel nadeelig zijn.” En op kantoor werd aangeraden dikwijls de handen te wassen, ‘benevens al gorgelend den mond te spoelen’. Voor het overige ging het dagelijks leven gewoon zijn gangetje. De huisartsen hadden het druk, de apothekers deden goede zaken. En de post werd wat later bezorgd…

Half augustus was de ziekte alweer op z’n retour. Op de kazernes en in de stad kwamen er nog maar enkele gevallen per dag bij en op 20 september 1918 werd de laatste ziektehaard, het legerkamp Vlasakkers, ziektevrij verklaard. Het onderwijs aan militairen, dat op 16 juli was gestaakt, was toen al weer enkele weken hervat.

De fatale klap - Juist op het moment dat in Amersfoort de ziekte over zijn hoogtepunt heen was, verscheen een nieuwe variant van het griepvirus in Europa. Het kwam in het Franse Brest in augustus 1918 aan land. Vanaf half september waren de strijdende partijen in Europa weer in de ban van de griep en begin oktober bereikte de nieuwe golf ook Nederland. Er was een groot verschil met de eerste griepgolf; deze was veel kwaadaardiger en dodelijker. De griepverschijnselen gingen gepaard met een zware longontsteking. Vanuit Parijs kwam het bericht: “Men beschouwt de ziekte als een cholera-achtige epidemie. Het geheele economische leven in Frankrijk ondervindt de zeer ernstige gevolgen van de ziekte, terwijl de bevolking in hooge mate onder den indruk is.”

Ook Nederland ontkwam niet aan de nieuwe epidemie. De eerste berichten kwamen weer van de oostelijke grensregio’s, uit Oldenzaal en Almelo. Daar maakte de agressieve griepgolf honderden zieken. Binnen enkele dagen werd ook melding gemaakt van dodelijke slachtoffers. Overal in de zwaar getroffen plaatsen sloten burgemeesters de lagere scholen. In Almelo stierven in oktober 1918 137 mensen (ter vergelijking: 11 in oktober 1917) en werden niet alleen de scholen, maar zelfs alle publieke voorstellingen en bijeenkomsten verboden. Het mocht niet baten. Binnen een week kwamen uit het hele land berichten over ziekte- en sterfgevallen. Half oktober werd bijvoorbeeld melding gemaakt van tien doden in Spakenburg die ‘boven aarde stonden’ (opgebaard om te worden begraven).

De tweede griepgolf in Amersfoort - Ook in Amersfoort bleek de tweede golf direct van een heel ander kaliber dan de eerste. Op 14 oktober werd de openbare lagere school aan de Laan van Puntenburg gesloten. In verschillende klassen hadden leerlingen de Spaanse griep. Maar de grootste schok kwam weldra: ongeveer een week later overleden twee docenten: meester Prins van 40 jaar en meester Krom van 38.

Hoe wrang het ook klinkt, het was nog maar een voorproefje. Eind oktober verschenen berichten in de krant die spraken van een sterke uitbreiding van de ziekte èn van verschillende dodelijke slachtoffers. De ziekte heerste onder de burgerij in de stad maar ook onder de militairen van het garnizoen . Tachtig zieke soldaten werden in het Militair Hospitaal aan de Hogeweg opgenomen. En ook “bij de burgerij neemt deze ziekte hand over hand toe.” Zeker tot half november was de omgeving in de greep van de ziekte. In Hoogland bijvoorbeeld stonden er op één dag negen lijken ‘boven aarde’.

Vanaf half november begon de epidemie te minderen. Vanuit het garnizoen werd gemeld dat de ziekte onder de militairen geweken was: er lagen nog wel zieken met griep in het Militair Hospitaal, maar er kwamen geen nieuwe gevallen meer bij. En ook onder de burgerij liep na half november het aantal zieken sterk terug. Zoals ook elders in Nederland. Het hoogtepunt van de Spaanse griep in Amersfoort duurde dus minder dan een maand, van eind oktober tot half november 1918.

Omvang van de epidemie in Amersfoort - De Spaanse griep zou in Nederland ongeveer 60.000 slachtoffers hebben gemaakt. Op het eerste gezicht een indrukwekkend aantal, maar met een sterftecijfer van 9 ‰ is de epidemie in Nederland aanzienlijk minder dodelijk geweest dan in veel andere landen.

Ook in Amersfoort zorgde de Spaanse griep niet voor een enorme uitschieter. Volgens de Amersfoortse Gezondheids-Commissie verliep de ziekte in juli ‘vrij gunstig’, maar in oktober was ‘het aantal ernstige patiënten belangrijk grooter’. Hoeveel zieken er waren? Het is onbekend, maar het moet een aanzienlijk aantal geweest zijn. Uit Hilversum (met ruim 36.000 inwoners iets groter dan Amersfoort, dat toen 29.000 telde) kwam een melding van 5000 à 6000 zieken. In Amersfoort is alleen bekend dat op de HBS 50 % van de leerlingen ziek was geweest. Op basis van deze uiterst summiere gegevens mag echter wel geconcludeerd worden dat de stad een groot aantal zieken telde, mogelijk enkele duizenden.

In vergelijking met het aantal zieken is vermoedelijk het aantal sterfgevallen gering. Dat mag geconcludeerd worden op basis van de sterftecijfers in de stad voor 1918 (in vergelijking met 1917) en op basis van de officiële cijfers over de Spaanse griep, die helaas slechts over een gedeelte van het betreffende tijdvak (juni-oktober) bekend zijn. In de officiële cijfers maakte men onderscheid tussen de sterfte aan de Spaanse griep en de sterfte aan de Spaanse griep in combinatie met andere longziekten. Van juli tot september werden daarvan in Amersfoort 3 respectievelijk 27 sterfgevallen geregistreerd. In de maand oktober ging het om 19 respectievelijk 38 doden. Al deze cijfers opgeteld leverde dus 30+57=87 doden op. Nogmaals, de sterfte in november en mogelijk december was onbekend.

Met behulp van de totale sterftecijfers (die naast de Spaanse griep ook de sterfte als gevolg van ouderdom, zuigelingen- en kinderziektes en dergelijke omvatten) heb ik getracht de officiële cijfers aan te vullen, ook voor de maanden november en december. Hierbij trad echter een complicatie op: de gebruikte cijferreeksen zijn niet gelijkaardig en leveren dus ook verschillende uitkomsten op. Het belangrijkste verschil zit ‘m in de mensen die officieel niet in Amersfoort woonden, maar wel in Amersfoort gestorven zijn. Concreet: de militairen op de kazernes en mogelijk de Belgische vluchtelingen die in kampen in de omgeving van Amersfoort woonden, zijn in de ene statistiek wel en in de andere niet meegenomen. Dat leverde een verschil op van ongeveer 100 doden (612 versus 516), waar dus rekening mee moet worden gehouden. De cijfers in de grafieken 1 en 3 zijn inclusief deze niet-ingezetenen, de grafiek 2 is gemaakt op basis van sterftecijfers exclusief de niet-ingezeten.

In grafiek 1 staat de absolute sterfte in Amersfoort in 1917 en 1918 per maand afgebeeld. Daaruit is duidelijk af te lezen dat met name in augustus, oktober, november en december 1918 de sterfte in Amersfoort in vergelijking met dezelfde maanden in 1917 uitzonderlijk hoog was. De krantenberichten die aangaven dat de Spaanse griep in die tijd in de stad heerste, worden dus hiermee bevestigd. Het absolute verschil tussen deze maanden in 1917 en 1918 bedroeg respectievelijk 23 (augustus), 53 (oktober), 116 (november) en 35 doden (december). Te samen 227 doden. Voor de maanden augustus en oktober liggen de uitkomsten bovendien redelijk in lijn met de officiële cijfers, die hierboven staan vermeld. Bovendien kunnen we uit de cijfers afleiden dat de sterfte in november nog aanzienlijk hoger was dan in oktober en de epidemie mogelijk ook nog een staartje had tot in december.

Een andere methode om de sterfte aan Spaanse griep te schatten is door de sterfte anno 1918 af te zetten tegen de sterfteontwikkeling op de lange termijn. In de grafiek 2 is duidelijk te zien, dat zich in 1918 een sterftepiekje voordeed (in vergelijking met de jaren 1914-1917 en 1919-1920) van ongeveer 5 ‰. Dat staat gelijk aan ongeveer 150 mensenlevens. Gevoegd bij de 87 reeds bekende doden levert dat dus een (eveneens plausibel) aantal van ongeveer 65 doden voor november en december op.

Al met al kan op basis van beide grafieken het aantal doden als gevolg van de Spaanse griep in Amersfoort geschat worden op zo’n 150-225 (oftewel 5-7½ ‰ van de bevolking), afhankelijk van het feit of je de sterfte onder de niet-ingezetenen al dan niet meetelt. Sowieso bleef echter het aantal slachtoffers in Amersfoort ruim onder het landelijk gemiddelde.

Ook is uit de grafiek 2 eenvoudig af te leiden, dat historisch gezien de Spaanse griep in Amersfoort voor een weinig spectaculair piekje zorgde. Nog geen twintig jaar daarvoor, rond de eeuwwisseling, was de ‘normale’ sterfte (schommelend rond 20 ‰) hoger dan de sterftepiek in 1918 (17 ‰). Om maar te zwijgen van de jaren 1880 en 1890, toen mazelen, roodvonk en tyfus regelmatig voor sterftegolven zorgden die ver boven de sterftecijfers van 1918 uitpiekten. En wat te denken van de cholera-epidemieën die in de negentiende eeuw de stad enkele malen troffen? Tijdens de epidemie van 1866 stierven in Amersfoort 186 mensen ofwel 14 ‰ van de bevolking. Dat is dus twee à drie keer zo hoog als de Spaanse griep.

Een van de redenen waarom de Spaanse griep zo’n grote indruk maakte, was het feit dat vooral jonge mensen in de kracht van hun leven het loodje legden. Dat was ook in Amersfoort te zien. De plaatselijke schoolarts schreef op 18 october aan B. en W. dat ‘de epidemie in vele gevallen een ernstig karakter aanneemt, terwijl vooral ook bij kinderen dergelijke gevallen voorkomen en dikwijls het eerst in het gezin optreden.’ Een voorbarige conclusie van de schoolarts – de epidemie woedde immers pas korte tijd in de stad – die achteraf gezien ook niet helemaal juist was. De Gezondheids-Commissie keek later terug en oordeelde: “De ernstige complicatie van longontsteking kwam, zooals ook elders, vooral voor bij patiënten van 20-40 jaren en had dikwijls een doodelijk gevolg.” De sterftecijfers van 1918 in vergelijking met die van 1917 (grafiek 3) bevestigden dit beeld.

Het optreden van het stadsbestuur - Duizenden zieken, mogelijk enkele honderden doden. Wie het archief van het stadsbestuur induikt, wordt altijd weer verrast hoe weinig indruk een dergelijke epidemie leek te maken bij het stadsbestuur. In het college van Burgemeester en Wethouder ging alles z’n gewone gang. Dat was het geval tijdens de cholera-epidemieën in de negentiende eeuw, dat was het geval bij de Spaanse griep in 1918 en ook tijdens de AIDS-epidemie in de jaren tachtig en negentig van de twintigste eeuw. Een goed geoliede machine die zich niet door de waan van de dag liet leiden, dat is de indruk die je krijgt van het functioneren van Burgemeester en Wethouders anno 1918. ‘Business as usual’ was het motto. De Spaanse griep? Dat was ‘gewoon’ af en toe een agendapunt in een lange rij onderwerpen die B. en W. afhandelden, tussen de bouwplannen en wegverbeteringen of de vergunningaanvragen voor collectes of circus Carré. Ook het gemeentepersoneel kwam ter sprake: in het najaar meldden zich opvallend veel mensen ziek, maar het begrip Spaanse griep viel zelden. De ziekmeldingen werden ter kennisgeving aangenomen, tijdelijk personeel werd aangesteld en er werden besluiten genomen over het al dan niet doorbetalen van (tijdelijk) personeel in geval van ziekte. Af en toe was er een bericht van overlijden van een ambtenaar of gemeentelijke werkman. Hoe zulke berichten werden ontvangen? Het is helaas niet vastgelegd in de archieven. Een diepe zucht van burgemeester Van Randwijck? Een momentje stilte?

Naar buiten toe bleef het gemeentebestuur rustig en probeerde men de indruk te wekken dat alles onder controle was. De gemeentelijke Gezondheids-Commissie drong er op 24 october bij B. en W. op aan, “de ingezetenen te wijzen op het gevaar dat zij loopen besmet te worden, indien zij plaatsen bezoeken waar vele menschen zich te samen bevinden, b.v. bioscopen, toneelvoorstellingen, vergaderingen enz.” B. en W. wezen het verzoek af “omdat het door hen niet wenschelijk wordt geacht, de menschen meer dan noodig, ongerust te maken.”

Niet over één nacht ijs - Deden Burgemeester en Wethouders dan helemaal niets? Nee, zeker niet. In verband met de Spaanse griep kwam één onderwerp regelmatig ter tafel: de sluiting van de lagere scholen. Het stadsbestuur was verantwoordelijk voor het reilen en zeilen op de openbare lagere scholen en die werden nauwlettend in de gaten gehouden. Besmettelijke ziekten waren een voortdurende bron van zorgen voor de schoolopziener (de inspecteur), voor de gemeentelijke schoolarts en voor de gemeentelijke Gezondheids-Commissie. Een complicerende factor was hierbij, dat de gemeente weinig zeggenschap had over de bijzondere scholen. Alleen de Gezondheids-Commissie was bevoegd om klassen of scholen te sluiten, maar dan moest er echt sprake zijn van een noodsituatie. Voor het overige kon de gemeente niets anders doen dan verzoeken en adviseren.

Alle toezichthouders trokken regelmatig bij B. en W. aan de bel. Het college maakte echter eigen afwegingen; soms ging men direct accoord met een voorstel van bijvoorbeeld de schoolarts, soms werden zijn aanmaningen voor kennisgeving aangenomen en terzijde gelegd. Zo adviseerde de schoolarts begin oktober de bijzondere scholen om hun lessen te staken in verband met de Spaanse griep. Aan dit advies werd al op 11 oktober gehoor gegeven. Maar toen eenzelfde advies – om alle openbare scholen te sluiten – precies een week later naar de gemeente ging, legden B. en W. dit advies aanvankelijk naast zich neer. ‘De epidemie was nog niet dringend; bovendien liepen de leerlingen ook risico buiten de school, dus waarom zo’n drastische maatregel?’ Aldus B. en W.

Deze weigering had dus het merkwaardige gevolg dat de bijzondere scholen – op aandringen van een gemeente-ambtenaar – dicht waren, terwijl op de openbare scholen gewoon les werd gegeven. Dat was reden voor sommige bijzondere scholen om aan te kondigen dat zij na hun herfstvakantie (die voor hen op zaterdag 26 oktober zou eindigen) weer open zouden gaan.

Maar ondertussen waren B. en W. overstag gegaan. Na een verzoek van de afdeling Amersfoort van de Maatschappij tot bevordering der Geneeskunde om de openbare scholen alsnog te sluiten, stemde het college daarmee in: met ingang van donderdag 24 oktober werden de leerlingen van de openbare lagere scholen naar huis gestuurden. De herftsvakantie voor de openbare scholen stond voor de deur en werd hiermee een paar dagen vervroegd. Bovendien ging er enkele dagen later een brief naar de bijzondere scholen die na hun herfstvakantie weer open wilden gaan, met het advies om voorlopig de deuren dicht te houden. Zo leverde een op het eerste gezicht eenvoudige maatregel als de sluiting van de lagere scholen, nog heel wat gedoe op.

Ook het wederom openen van de (openbare) scholen in de tweede week van november ging niet bepaald van een leien dakje. De schoolarts kwam desgevraagd met een weinig eenduidig advies. Hij had begin november geïnformeerd bij de Amersfoortse huisartsen en die waren verdeeld: sommigen waren voor het voortzetten van de sluiting, anderen pleitten juist voor hernieuwde opening. De epidemie was weliswaar nog lang niet uitgewoed, maar enkele huisartsen waren van mening dat de leerlingen buiten school ook risico liepen; ja, dat het zelfs beter was hen overdag te isoleren in een goed verwarmd gebouw dan hen buiten aan allerlei schadelijke invloeden bloot te stellen. Want inmiddels was wel duidelijk geworden dat niet de leerlingen het meeste gevaar liepen ziek te worden, maar juist volwassen personen.

Gezien de verdeeldheid onder de artsen, kozen B. en W. voor een ‘polder-oplossing’: met ingang van 11 november gingen de scholen weer open, maar als de ouders de leerlingen thuis hielden, werd dat niet als ongeoorloofd verzuim gezien. De ouders mochten de eerste week zelf kiezen. Maar vanaf 18 november zouden de lessen weer ‘op gewone wijze’ van start gaan.

Na dit besluit kwamen bij B. en W. enkele boze brieven binnen. De Gezondheids-Commissie vond de opening voorbarig omdat de epidemie in Amersfoort nog lang niet voorbij was en het gevaar van besmetting te groot. Ook de afdeling Amersfoort van de Bond van Nederlandsche Onderwijzers schreef een brief op hoge poten naar het stadhuis. De eerste week bleef zo’n 40-60 % van de leerlingen thuis, een duidelijk signaal dat de ouders het nog niet vertrouwden en voor de vakorganisatie reden om zijn zorgen uit te spreken. Met zo’n lage opkomst liep de grote groep thuisblijvers een leerachterstand op of zaten de leerlingen die wel naar school gingen voor spek en bonen in de klas. Bovendien liepen de docenten gevaar om via de leerlingen besmet te worden. Kortom, geen wenselijke situatie. De gemeente liet zich echter niet overtuigen. De sluiting van de scholen had lang genoeg geduurd.

Het maatschappelijk leven ontwricht? - In de Amersfoortse kranten uit 1918 verschenen regelmatig artikeltjes over de gevolgen van de Spaanse griep elders in het land. In Amsterdam werden trams uit de dienstregeling gehaald, kampte de gasfabriek met ernstig personeelstekort en raakte het telegraafverkeer ernstig ontregeld. In Den Haag regende het ziekmeldingen in de Tweede Kamer. Op het platteland werd geklaagd over een ernstig gebrek aan artsen: door de oorlogsschaarste was nauwelijks aan benzine te komen en dus moesten artsen uit de stad dikwijls met de fiets of zelfs lopend naar hun patiënten in de omliggende dorpen. Ook in Amersfoort hadden de huisartsen het bijzonder druk: zij drongen er bij de bevolking op aan zich al ’s ochtends vroeg te melden. Spreekuren later op de dag werden geschrapt, omdat zij overdag liever huisbezoeken aflegden.

De ziekte had dus grote gevolgen voor het dagelijks leven. Honderden, zoniet duizenden mensen lagen ziek op bed. Desondanks, als je de kranten moet geloven, ging alles in Amersfoort zijn normale gang. Er waren geen berichten over sluiting van bedrijven, zoals in Amsterdam. Lezingen, vergaderingen, zelfs de voorstellingen van circus Carré; alles ging zo veel mogelijk gewoon door. HVC speelde zijn wedstrijdjes met invallers, die de zieke spelers van het eerste elftal vervingen. Slechts af en toe werd een voorstelling afgelast vanwege ziekte van de musici of toneelspelers.

Hoe we deze ‘rust’ moeten interpreteren? De houding van de krantenredacties heeft hierbij zeker een rol gespeeld. De redacties wilden geen paniek zaaien en waren terughoudend in hun berichtgeving over de Spaanse griep. Zo werd de dood van de beide meesters van de school aan de Puntenburgerlaan in drie lokale kranten gemeld, waarvan twee de doodsoorzaak in het midden lieten. Bovendien mag men eraan twijfelen in hoeverre de krantenredacties zelf actief op zoek gingen naar lokale informatie. Nergens werd ooit de suggestie gewekt dat een lokale journalist of krantenmaker met een huisarts of de schoolarts had gesproken. Het nieuws werd keurig uit binnen- en buitenlandse bladen overgenomen (‘de schaar werd meer gehanteerd dan de pen’), maar wat er buiten op straat of achter de gevels in de slaapkamers gebeurde, dat bleef vaak verborgen.

We moeten er naar gissen. Met duizenden zieken moet de economische schade aanzienlijk zijn geweest. En de emotionele schade? Denk alleen al aan de vele familieleden, die naast het ziekbed van een geliefde in spanning op herstel wachtten of zich naar de kerk spoedden om daar Gods genade af te smeken.

Besluit - Na november 1918 nam de Spaanse griep zienderogen af. Nadien dood de ziekte nog wel af en toe op en maakte ook enkele slachtoffers. Zo was er in de maanden februari tot april 1920 nog een kleine opleving: in het Militair Hospitaal aan de Hogeweg stierven in zes weken tijd nog 17 soldaten aan de Spaanse griep.

BRONNEN - De Amersfoortse kranten uit 1918 (Amersfoortsch Dagblad De Eemlander, Amersfoortsche Courant, De Eembode), Archief van het stadsbestuur 1811-1945, te raadplegen op Archief Eemland. Hier is afgezien van een uitgebreid notenapparaat. Wie de tekst inclusief notenapparaat wil ontvangen, stuurt een berichtje naar de auteur: addyschuurman@hotmail.com

Ga voor de grafieken naar https://www.destadsbron.nl/nl/Spaanse_griep
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BerichtGeplaatst: 16 Jul 2019 11:30    Onderwerp: Reageer met quote

De Spaanse griep leek eerst zo mild
Wim Köhler - 23 maart 2018

Pandemie. Een eeuw geleden had de dodelijkste ramp ooit plaats: alleen al in Nederland stierven ruim 40.000 mensen aan de Spaanse griep. Een terugblik op hoe het begon.

‘De ziekte welke Spanje teistert, schijnt een soort influenza te zijn, die blijkbaar een goedaardig verloop heeft. Gevallen met doodelijken afloop werden tot nu toe niet gemeld.” Zo werd de Spaanse griep op 30 mei 1918 door De Telegraaf bij de Nederlandse lezers geïntroduceerd.

Een jaar later waren er 50 miljoen mensen gestorven aan dat nieuwe influenzavirus. Of 20, of misschien wel 100 miljoen mensen. Het is niet precies bekend. Er waren in 1918 weinig landen met een betrouwbare sterfteregistratie. Nooit eerder in de geschiedenis van de mensheid vielen er zoveel doden door één enkele ramp.

De Spaanse griep was tot eind mei onbekend in Nederland. Andere Nederlandse kranten schreven er een paar dagen eerder voor het eerst over. De koning van Spanje was immers ziek. Ook de minister-president en andere ministers hielden het bed. Eenderde van de Spaanse bevolking was „aangetast”, maar nogmaals: „De ziekte wordt niet als ernstig beschouwd.”

Wie de opwinding over de Mexicaanse griep van 2009 heeft meegemaakt – de eerste detectie van het virus, de ongerustheid over een dreigende pandemie, de vaccinontwikkeling, de opslag van medicijnen, de vaccinatiecampagnes, de sisser waarmee het afliep – kijkt verbaasd terug naar een eeuw eerder.

Terug naar 1918. Artsen wisten dat influenza een besmettelijke ziekte was. Iedere winter was er de jaarlijkse griep – een influenza-epidemie zoals nu nog heerst in Nederland.

Maar de ziekteverwekker van influenza was onbekend. Diverse keren werd ten onrechte een bacterie als de boosdoener aangewezen. Het Twentsch Dagblad Tubantia schreef op 18 juli 1918: „Aan den assistent van de Boedapester kliniek voor ooglijders, Dr. Nostlingen, is het gelukt, de bacil van de Spaansche griep te ontdekken. Dit is de zoogenaamde Pfeiferbacil, die de epidemische oogontsteking, bekend onder den naam conjunctivitus, veroorzaakt, welke een gelijksoortig verloop heeft als de Spaansche griep. Een bacteriologisch onderzoek bevestigde de juistheid van deze hypothese.”

Het maakte weinig uit. Of het nu een virus of bacterie was: de artsen stonden met lege handen. Medicijnen waren er niet. Antibiotica, die effectief bacteriën doden, kwamen pas in de Tweede Wereldoorlog.

Trainingskampen - Toch hadden de kranten aanvankelijk gelijk: de eerste golf van de Spaanse griep, van maart tot mei, verliep ogenschijnlijk mild. De miljoenen doden vielen vanaf de late zomer, toen de tweede golf van de Spaanse griep langsrolde. Was het gewoon de jaarlijkse wintergriep die lang aanhield?

Nee. Dat is deze eeuw glashelder geworden, door analyse van schaarse gedetailleerde ziekte- en sterfteregistraties. In Kopenhagen bijvoorbeeld. En in New York. En in de 39 militaire trainingskampen die in 1917 in de Verenigde Staten uit de grond werden gestampt om er snel duizenden recruten op te leiden voor de strijd in de Eerste Wereldoorlog.

In die kampen waren influenza-uitbraken, van december 1917 tot in februari 1918 en in maart-april 1918. Er waren zieken en, geleidelijk steeds meer, doden door een longontsteking. De gewone wintergriep „maskeerde de trage, gelijktijdige, opkomst van een ernstige-ziekte-veroorzakend pandemisch virus”, schreven de recrutenkamponderzoekers drie jaar geleden in een infectieziektetijdschrift. Het signaal dat er iets vreemds gebeurde met de griep was vijf maanden voor de meest dodelijke najaarsgolf al te zien. Maar de alarmklok is toen niet luid geluid.

In de militaire trainingskampen woonden vooral jonge mannen. Later bleek precies die leeftijdscategorie uitzonderlijk hard door de Spaanse griep te worden gepakt. Traditioneel is de griep gevaarlijk voor baby’s en 65-plussers. Die leeftijdsverschuiving is in het voorjaar van 1918 heel duidelijk in New York gezien. Daar heerste griep in januari 1918 en opnieuw van februari tot april. De zieken en de doden werden geregistreerd. Het zag eruit als een normale griepwinter. In een publicatie uit 2005 in PNAS staat hoe tijdens het sterftepiekje in januari de extra doden onder de 65-plussers vielen. Maar in februari en maart waren het vooral 15- tot 44-jarigen die aan de griep stierven. De winterse golf werd kennelijk toen al overgenomen door een ander influenzavirus.

Wat zou er met een tijdige waarschuwing zijn gebeurd? Het is moeilijk voorstelbaar dat al die tienduizenden jonge mannen níet naar Europa zouden zijn verscheept, om er in oktober en november, in de loopgraven, opnieuw dat griepvirus tegen te komen. Iets verder gemuteerd, iets ziekmakender.

De conclusie dat de Spaanse griep is ontstaan waar hij het eerst werd gezien is onterecht. Het is alleen duidelijk dat in steden of landen met een goede maandelijkse (of wekelijkse) ziekte- en sterfteregistratie dat nieuwe influenzavirus al in maart 1918 opgemerkt kon worden, met kennis van nu.

Waar het Spaanse-griepvirus als eerste mensen ziek maakte is nog steeds onbekend. Camp Funston, een van die Amerikaanse trainingskampen, is vaak genoemd. Er werkten Chinese arbeiders. Die zouden het virus mee hebben kunnen nemen uit Azië.

Ook het Britse militair kamp Étaples aan de Noord-Franse kust is genoemd als broedplaats: het kamp was overbevolkt en er werd veel eend en gans gegeten, ter plaatse geschoten. Alle influenzavirussen hebben watervogels als natuurlijke gastheer. Die Spaanse griep kan overal zijn ontstaan, maar Spanje is onwaarschijnlijk. Hoe komt die griep dan aan zijn naam?

Censuur - De perscensuur in de oorlogvoerende landen speelde een rol. De Amerikanen, de Fransen, de Engelsen, de Duitsers wilden geen griepnieuws in de kranten. Het zou de moraal ondermijnen als bekend werd dat meer jonge jongens aan de griep bezweken dan de heldendood stierven door gifgas en granaatscherven.

Terugkijkend zat de Nederlandse krant De Maasbode van 29 juni 1918 waarschijnlijk dicht bij de werkelijkheid: „De Parijsche berichtgever van de Daily Mail schrijft over de influenza-epidemie: Volgens mededeelingen van dokter Legraux, van het instituut Pasteur, stamt de ziekte van het front, waar zij is uitgebroken en wel over de geheele uitgestrektheid er van. Van Duinkerken tot aan de Vogezen. De epidemie bereikte Parijs in Mei, om zich van daar naar Spanje uit te breiden en vandaar weder naar Parijs terug te komen.”

Die eerste voorjaarsgolf van het virus ging aan het neutrale Nederland voorbij. Of de neutraliteit er iets mee te maken had is onbekend. Er reisden geen Nederlandse soldaten van en naar de loopgraven. Er was minder grensverkeer, hoewel er vluchtelingen arriveerden.

Begin juli schreven de Nederlandse kranten dat de Spaanse griep in Frankrijk, Engeland en Duitsland om zich heen greep en slachtoffers begon te maken. En toen, op 11 juli was hij in Nederland: „In het Engelsche interneeringskamp te Groningen is de Spaansche Griep uitgebroken. Er zijn ongeveer 100 gevallen. Men hoopt dat de patiënten binnen 2 dagen genezen zullen zijn. Te Losser zijn reeds 38 mensen door de Spaansche griep aangetast. Naar wij vernemen zijn ook hier ter stede enkele gevallen van Spaansche griep geconstateerd.” Zo haalde de Nieuwe Rotterdamsche Courant die dag de epidemie binnen, waar in het volgende halfjaar meer dan 40.000 Nederlanders aan zouden sterven. Eind juli gingen de berichten vooral over zieke mijnwerkers en grieperige gemobiliseerde militairen in hun kazernes. In Losser viel waarschijnlijk de eerste griepdode.

Daarna barst het drama in volle omvang los. Dagelijks zijn er berichtjes over schoolsluitingen, het afgelasten van bijeenkomsten, zieken en doden. Meestal kort. Het Algemeen Handelsblad van 10 december 1918: „In de gemeente Hemelumer Oldephaert (Fr) stierven op één dag in één gezin 4 kinderen aan de Spaansche griep.”

Uit de longen
Honderd jaar later is nog steeds onbekend waarom dat nieuwe virus voor ouderen niet heel gevaarlijk was, maar veel jongeren pakte. Het Spaanse-griepvirus is begin deze eeuw voor wetenschappelijk onderzoek weer tot leven gewekt. Vanaf 1999 werd het virus van de Spaanse griep gereconstrueerd uit fragmentjes van vaak maar 100 basen lengte. Die fragmenten kwamen uit de longen van twee overleden Amerikaanse militairen en van een mevrouw die in Alaska aan griep overleed en in de permafrostbodem was begraven. Een artikel op 7 oktober 2005 in Science bekroonde de reconstructie van het 1918 H1N1 influenzavirus. In goedbeveiligde laboratoria worden er experimenten mee gedaan.

Moet dat wel? Gaan terroristen en schurkenstaten er niet mee aan de haal? Voorafgaand aan publicatie in 2005 is dat afgewogen. De conclusie was dat het belang om te weten groter was dan de angst voor misbruik.

Wat heeft die kennis inmiddels opgeleverd? Zeven Amerikaanse influenzadeskundigen, onder aanvoering van Jeffery Taubenberger die voor de reconstructie van het 1918-virus tekende, hebben zichzelf beoordeeld in 2012 in een minireview in het tijdschrift mBio.

We weten nu dat het 1918-virus echt de moeder van alle pandemische virussen is. De pandemieën van na 1918 – de Aziëgriep van 1957, de Hongkonggriep van 1968 en de Mexicaanse griep van 2009 – zijn veroorzaakt door nieuwgevormde virussen die allemaal delen van het 1918-virus in zich dragen. Sinds 1918 leven we in één ‘pandemisch tijdperk’. Het 1918-virus is door een onbekend mechanisme uit een vogelvirus ontstaan en heeft zich in de eerste maanden of jaren waarin het mensen kon besmetten hoogstwaarschijnlijk verder aangepast tot een echt ‘mensengriepvirus’. Of beter gezegd: een zoogdierenvirus. Daar is nu veel over bekend.

„Het verleden is gebruikt om de toekomst beter te kunnen begrijpen”, schrijven de virologen. Maar toch, in hun conclusie moeten de virologen bescheiden zijn. Hoe „toekomstige pandemieën moeten worden voorkomen of verzacht” is nog onbekend.

Het Spaanse-griepvirus is vaak beschreven als extreem ziekmakend en dodelijk. De onderzoekers uit de groep van Taubenberger die in PNAS autopsies op longen van 68 aan Spaanse griep overleden jonge Amerikaanse militairen uitvoerden, gieten koud, nou ja, lauw water over die bewering. Ze houden het erop dat bijna al die soldaten aan bacteriële longontstekingen overleden: dezelfde manier waarop mensen tijdens andere grieppandemiën en tijdens de jaarlijkse griepepidemiën overlijden. Met misschien een uitzondering waarin een plotselinge hevige afweerreactie (een cytokinestorm) de patiënt doodt. Maar nu er antibiotica zijn waarmee verreweg de meeste bacteriële infecties te bestrijden zijn, lijkt de angst voor een nieuwe influenza-epidemie waarbij 2,5 procent van de wereldbevolking overlijdt – het zouden nu ruim 150 miljoen mensen zijn – onterecht.

https://www.nrc.nl/nieuws/2018/03/23/de-spaanse-griep-leek-eerst-zo-mild-a1596876

Bronnen, genoemd/gebruikt in het artikel:

Influenza Circulation in United States Army Training Camps Before and During the 1918 Influenza Pandemic: Clues to Early Detection of Pandemic Viral Emergence, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4506031/

Epidemiological evidence of an early wave of the 1918 influenza pandemic in New York City, https://www.pnas.org/content/102/31/11059.long

Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus, https://science.sciencemag.org/content/310/5745/77.long

Reconstruction of the 1918 Influenza Virus: Unexpected Rewards from the Past, https://mbio.asm.org/content/3/5/e00201-12.long

Autopsy series of 68 cases dying before and during the 1918 influenza pandemic peak, https://www.pnas.org/content/108/39/16416.long
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BerichtGeplaatst: 11 Sep 2019 10:33    Onderwerp: Reageer met quote

Spanish flu: the killer that still stalks us, 100 years on
Mark Honigsbaum

The pandemic wiped out up to 100 million lives, but scientists still struggle to explain what caused it. The answers could ensure that it never strikes again

One hundred years ago this month, just as the first world war was drawing to a fitful close, an influenza virus unlike any before or since swept across the British Isles, felling soldiers and civilians alike. One of the first casualties was the British prime minister and war leader, David Lloyd George.

On 11 September 1918, Lloyd George, riding high on news of recent Allied successes, arrived in Manchester to be presented with the keys to the city. Female munitions workers and soldiers home on furlough cheered his passage from Piccadilly train station to Albert Square. But later that evening, he developed a sore throat and fever and collapsed.

He spent the next 10 days confined to a sickbed in Manchester town hall, too ill to move and with a respirator to aid his breathing. Newspapers, including the Manchester Guardian, underplayed the severity of his condition for fear of presenting the Germans with a propaganda coup. But, according to his valet, it had been “touch and go”.

Lloyd George, then aged 55, survived, but others were not so lucky. In an era before antibiotics and vaccines, the “Spanish influenza” – so-called because neutral Spain was one of the few countries in 1918 where correspondents were free to report on the outbreak – claimed the lives of nearly 250,000 Britons. Cruelly for a nation that had seen the flower of British male youth mown down by German guns, the majority were adults aged 20 to 40. The mortality was the inverse of most flu seasons, when deaths fall most heavily on the elderly and the under-fives.

The global death toll was inconceivable: according to the most recent estimates, between 50 million and 100 million people worldwide perished in the three pandemic waves between the spring of 1918 and the winter of 1919. Adjusting for population growth, that is equivalent to between 200 million and 425 million today.

Unlike now, when reports of new bird flu outbreaks in south-east Asia are closely monitored by the World Health Organisation, there was no early warning system. Consequently, when it was reported in May 1918 that King Alfonso XIII was ill in Madrid, most people dismissed the Spanish flu as a joke. The main advice was to gargle with salt water and to isolate yourself until the fever had passed. However, these rules did not apply to munitions workers who were urged to “carry on” for the sake of the war effort.

As in other 20th-century epidemics and pandemics, such as HIV/Aids, Africans and Asians suffered proportionately more than Europeans and north Americans. Thus, while the average case mortality in the developed world was about 2%, in India, where 18.5 million perished, it was 6%, and in Egypt, where 138,000 died, it was 10%. In isolated regions with “virgin” populations with no immunity to flu, the impact was truly astonishing – in Western Samoa, for example, a quarter of the population was wiped out. By contrast, American Samoa recorded no casualties.

The severity of the pandemic and the peculiar death pattern puzzle scientists to this day. Few epidemiologists believe the pandemic began in Spain, pointing instead to pre-pandemic waves in Copenhagen and other northern European cities in the summer of 1918. Where the virus first leapt from birds to humans or some other mammal is even more perplexing, with some scientists favouring a Kansas point of origin and others northern France or China.

Earlier this year, in search of answers for a new podcast series, I travelled to Washington DC to interview one of the world’s leading experts on the 1918 pandemic. Jeffrey Taubenberger, a molecular pathologist at the National Institute of Allergy and Infectious Diseases, has been studying the Spanish flu virus for more than 30 years. In the late 1990s he succeeded in retrieving fragments of viral RNA from stored pathology specimens taken from American soldiers who had died of flu at US army camps in 1918 and an Inuit woman who been buried on a beach in Alaska, where the permafrost had preserved her lung tissue from decay.

Using modern molecular techniques, Taubenberger and his colleague, Anne Reid, amplified the fragments and, in 2005, published the virus’s genetic sequence. Their findings were a shock. Previously, epidemiologists had observed that flu pandemics were preceded or followed by outbreaks of influenza-like illnesses in dogs, cats, and horses. It was also known that from time to time flu viruses could infect pigs and, of course, humans, and that wild flu viruses circulated in migratory waterfowl. However, when Taubenberger analysed the genome of the Spanish flu, he found that most of its genes were derived from a bird flu virus. Indeed, Taubenberger considered the H1N1 virus so “avian-like’” he could not discount the possibility that it had transmitted directly from birds to humans shortly before 1918 – and perhaps as early as 1916.

Taubenberger’s discovery raised the terrifying possibility that, in the future, some other avian influenza virus – like the H5N1 bird flu then circulating in south-east Asia or the H7N9 flu currently causing sporadic human infections in China – might suddenly acquire the ability to trigger a similarly devastating pandemic. It also begged the question, why bring the Spanish flu back to life, and what if the virus escaped the laboratory and fell into the hands of terrorists?

To prevent that happening, Taubenberger and other scientists with access to the freezer containing the virus are screened by the FBI and must wear double-gloves, a respirator and a full body suit – like the ones worn by medical workers during the west African Ebola epidemic. They must also submit to an iris scan. “It’s really the equivalent to top secret clearance,” he says.

Continued experimentation is necessary for the development of vaccines and other medical interventions. In mice, the H1N1 Spanish flu is extremely virulent, generating 39,000 times more virus particles than a modern flu strain. By targeting the inflammatory response, Taubenberger has shown that mice can be protected. But scientists are a long way from finding a cure for flu, much less a universal vaccine against seasonal and future pandemic strains.

Frustratingly, it is still not known where and when the Spanish flu acquired its avian genes and first began spreading in humans. The genes map most closely to wild waterfowl from north America but, despite examining the Smithsonian Institute’s extensive bird collections, Taubenberger was unable to find viable autopsy remains from before 1918.

One theory is that the so-called “spillover” event occurred in early 1918, not far from an army camp in Kansas that supplied soldiers to the American Expeditionary Force. Certainly, there were explosive outbreaks of an influenza-like illness at Camp Funston, Fort Riley, in March 1918, followed by similar outbreaks along the eastern seaboard of the US and on the transatlantic troop carriers that ferried American troops to France. However, the earliest fragments of the pandemic virus obtained by Taubenberger date from May 1918, so there is no way of telling whether outbreaks prior to this were caused by the pandemic strain, as opposed to an ordinary seasonal influenza.

A rival theory, favoured by the British virologist John Oxford, is that the pandemic began at Étaples, a huge British military camp an hour south-west of Boulogne. With accommodation for up to 100,000 soldiers, Étaples lay on a migratory bird flyway close to the Somme estuary and had all the necessary conditions for a spillover event: wild waterfowl, plus chickens and pigs, living in close proximity to men packed into airless barracks. Étaples also had several hospitals where soldiers whose lungs had been compromised by mutagenic gases deployed on the battlefield were evacuated for treatment.

In the winter of 1917, several hundred British soldiers collapsed with influenza-like symptoms and medics at Étaples recorded 156 deaths. At the time, the epidemic was labelled “purulent bronchitis” because of the yellow pus that oozed from the larger airways of the lungs at autopsy (some medics thought it resembled the lung damage from phosgene gas).

Another prominent feature was cyanosis, a distinctive purple-blue discolouration of the lips, ears and cheeks, caused by the loss of oxygen to the heart. Cyanosis was also a hallmark of the pneumonias associated with the Spanish flu – an observation that persuaded doctors writing in the Lancet in 1919 that it and purulent bronchitis had been “fundamentally the same condition”.

Another puzzle is why, in some cases of pneumonia associated with the Spanish flu, the onset was rapid and the lung damage highly localised, while in others, the infection resembled an aggressive bronchopneumonia with extensive haemorrhaging and swelling throughout the lungs. These features have never been adequately explained, with some pathologists arguing that the virus triggered an unusual auto-immune response known as a cytokine storm and others that extensive lung damage is better explained by bacterial infections that followed the flu – a big danger in the days before antibiotics.

But perhaps the biggest unanswered question is why the Spanish flu proved so deadly to young adults. Here, present-day science has hypotheses but no good answers. One suggestion is that the elderly enjoyed greater immunity because, as children, they had been exposed to a pandemic virus with a similar genetic makeup to the H1N1 Spanish flu. Conversely, those aged 28 and over had an immunological blind spot because their first exposure had been to the 1890 “Russian flu”, an H3 virus with a completely different configuration of genes. Or it could be that the unusual mortality pattern seen in 1918 was the result of an as yet unidentified environmental exposure or stressor peculiar to young adults at the time.

Answering those questions is important because genes from the Spanish flu continue to circulate in human and pig populations to this day. Some of these genes are direct descendants of the 1918 virus; others have reassorted with other pandemic viruses, such as the 1968 Hong Kong flu and the hybrid H1N1 virus responsible for the 2009 swine flu pandemic. As Taubenberger puts it: “[The outbreak of] 1918 set up a very successful introduction of a bird-like virus in humans that has never gone away in 100 years. It really was the mother of all pandemics.’

The pandemic was especially hard on children, perhaps more than any other segment of the population. Take Ada Darwin, who was seven when the “Spanish Lady” called at the house in Manchester’s Moss Side she shared with her mother and five siblings.

“It was Sunday 17 November that I was put to bed,” Darwin recalled when I interviewed her at her home in Chester in 2005. “I remember this great big headache and telling my mother to ‘stop my sister Norah chattering, it’s making my head hurt’.”

The next to fall ill was Ada’s mother, Jane Berry, and her baby sister, Edith, followed by her younger brothers, Austin, two, and Noel, four. With the whole family stricken, Ada’s grandmother was summoned to their home. But by the time she arrived, Ada’s mother was covered in dark blue patches – an indication she had cyanosis – and the prognosis was hopeless. She died the next day – Wednesday 20 November – followed, three days later, by Noel. Jane Berry was just 34.

Then, on 25 November, Darwin learnt that her 38-year-old father, Frederick Berry, a member of the Royal Army Medical Corps, had also died, most likely after catching the flu at Salford military hospital, where he had stayed on after the Armistice to nurse wounded soldiers. He was buried with full military honours at Manchester Southern Cemetery on 29 November, along with Darwin’s mother and Noel. Aged 94, Darwin could still recall the triple funeral cortège as it passed her primary school.

“It’s like a film in my head,” she told me in 2005. “There were the black horses with the plumes made from ostrich feathers, then the gun carriage with my dad’s coffin covered with the union flag. My mother’s coffin was in a big glass hearse with Noel’s coffin under the driver’s seat. My grandma told us my mother had gone to Jesus, but I said, ‘Jesus has got plenty of people, I want my mummy’.”

Darwin was not the only child to be orphaned by the flu. In Cape Town, observed one eyewitness, the autumn wave “made orphans of between two to three thousand children”.

In London, meanwhile, it is estimated that 16,000 people perished between September and December 1918, the majority of them young men and women. The result was that 1919 would be the first year since records began that Britain’s death rate exceeded its birthrate.

Today, there are few people still alive to recall those dark days in November when, according to Manchester’s chief medical officer, James Niven, “it seemed as if it would not be possible to get coffins for the dead, or gravediggers to dig the graves”. All the more reason why, in the centenary year of the pandemic, it is worth recalling the experiences of Darwin and other survivors of the Spanish Lady.

Mark Honigsbaum is the author of Living With Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918. His podcast, Going Viral: The Mother of all Pandemics, is available at Libsyn and other podcast providers.
https://www.theguardian.com/world/2018/sep/09/spanish-flu-pandemic-centenary-first-world-war
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