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The 1918 Influenza Pandemic in New Zealand
By Geoffrey W. Rice, Linda Bryder
Canterbury University PressCopyright © 2016 Geoffrey W. Rice
All rights reserved.
'Leg rope': Influenza before 1918
Influenza is unusual among major diseases known to humanity in that nearly all of us will experience it more than once in a lifetime, yet we do not expect to die from it. The initial symptoms of sneezing and a runny nose are similar to those of the common cold, which is caused by a different virus, but influenza is a potentially dangerous disease. Unlike a cold, a bad dose of flu can kill you. The very young and the very old have always been especially at risk of dying from influenza, while otherwise healthy adults can expect to recover even from a severe dose of flu within two or three weeks. We may feel totally washed out and depressed, but it isn't usually life-threatening. And you certainly know when you have the flu. You may try to treat it like a cold and 'soldier on', going to work and infecting your colleagues and people on the bus, but with influenza you just can't stay on your feet. The high fever is the classic symptom of flu, and its greatest danger, because of the secondary infections it can unleash, most often pneumonia. Recovering flu sufferers are likely to say 'it knocked me off my feet' or 'it knocked the stuffing out of me'.
The French term for influenza is la grippe, a disease that grips you tightly and immobilises you. In New Zealand during the 1890 influenza pandemic this term was Anglicised into 'grip' or 'leg rope', the latter being quite an appropriate description from a country where farmers are accustomed to tying an animal's back legs together to make it lie down.
Epidemics of influenza are distinctive for their sudden onset and rapid spread throughout the population. When this pattern is recorded by annalists and chroniclers in past centuries, and they also notice symptoms such as high fever, severe headache, coughing, vomiting and extreme prostration, we may be fairly sure that those poor people in the past had influenza. One of the earliest probable descriptions of the disease survives from 412 BC, by Hippocrates himself, the almost legendary Greek physician who has often been called the father of Western medicine. Roman historians such as Livy and medieval chroniclers such as Matthew Paris occasionally describe epidemics of 'fevers' which may or may not have been influenza, but it is a safe bet that influenza has been afflicting the human race for many thousands of years.
The word 'influenza' is Italian, and reflects the old medieval belief that some diseases were caused by the 'influence' of the stars or the heavens, just as mental illness was once thought to be caused by the moon (hence the old term 'lunatic'). Medieval Christians firmly believed that epidemics were sent by God to punish wicked humans for their sinfulness. Indeed, any unusual or unexplained event in the medieval centuries was routinely attributed to 'the will of God', but that did not stop thoughtful observers from wondering about diseases and how they were spread. Hippocrates believed that some diseases were caused by poisonous vapours, or 'miasmas' arising from swamps or rotting organic material.
This miasmatic theory of infectious disease was widely accepted for centuries, and persisted in some parts of Europe until the end of the nineteenth century. Other observers, however, believed that disease could be spread by contact with infected persons, clothing or bedding. During the Black Death of the fourteenth century, in which an estimated one third of Europe's population perished, several chroniclers were convinced that infection spread 'through the breath and the sight'.
This rival 'contagion' theory also had its supporters across the centuries, and is now recognised as a more correct description of how influenza is spread. When a flu sufferer coughs or sneezes, millions of invisible virions are sprayed into the air around them, and if that vapour is breathed in by someone else nearby, that person may come down with the flu. This is called droplet infection, and it explains why flu epidemics can spread so quickly from person to person. So the miasmatists and the contagionists were both right to some extent, but the vapour is produced by people rather than swamps or rotting vegetation. It took a long time for humans to realise that insects and animals also transmit disease. But why did some people catch the flu and not others? We now know that this has a lot to do with an individual's immune system and previous exposure to infection, but this riddle helps to explain the lasting popularity of the miasmatic model of infectious disease, because it was a convenient 'catch-all' explanation that blamed disease on the environment rather than other humans.
As far as we know, the term 'influenza' was first used in Italy in 1504, when an epidemic was blamed on an unusual alignment of the stars. A European pandemic of influenza in 1510 spread as far as England, but identifying the disease in the sixteenth century is complicated by the prevalence of 'the English Sweat' (sudor Anglicus), a peculiar disease that appeared in the mid-fifteenth century and disappeared in the early seventeenth. Though it closely resembled influenza, medical historians now think it was a separate viral infection, for it killed more quickly than flu and caused much greater mortality. As the name suggests, its chief symptoms were uncontrollable shivering and copious sweating. People at the time distinguished between the various fevers they experienced. Malaria (the name is Italian for 'bad air', a clear reflection of miasmatic theory) was known as 'ague' throughout the early modern period and was either tertian (shivering on the first and third days) or quartan (on the first and fourth days). But influenza was clearly different from other fevers because of the other symptoms involved, and its different epidemiology.
It is often difficult to identify influenza epidemics in the past because of the incompleteness of symptoms recorded and the variety of names the disease was given before the Italian name was widely adopted. In England in the 1550s recurrent 'hot burning fevers' killed thousands of people, old and young alike, but whether or not this was influenza remains uncertain. When Mary Queen of Scots arrived at Edinburgh in 1562, both her court and the town were swept by an epidemic known simply as 'the Newe Acquayntance'. Though incomplete, the symptoms here suggest influenza:
It ys a plague in their heads that have yt, and a soreness in their stomaches, with a great coughe, that remayneth with some longer, with others shorter tyme ... the Queen kept her bed six days. There was no appearance of danger, nor manie that die of the disease, except some olde folks ...
Medical historians are inclined to think that the pandemic of 1580 was influenza, and that it may have been the first recorded global pandemic of flu, as it is mentioned in contemporary accounts from Asia, Africa, Europe and the Americas. Over 9,000 people died in Rome from this outbreak.
Europe's climate turned cold in the seventeenth century. Glaciers in the Swiss Alps advanced further down the valleys than anyone could remember, and some historians have dubbed this period 'Europe's Little Ice Age'. Not surprisingly, therefore, respiratory illnesses abounded. Though most people have heard of the Great Plague of London in 1665, few would know that in between plague outbreaks most deaths in this period were from 'fevers', most likely influenza and pneumonia. The diarist John Evelyn suffered 'an extreme cold' that was 'rife all over Europe, like a plague', in October 1675. This was almost certainly a flu pandemic, and another outbreak in 1693 was unusual because it killed strong healthy adults as well as the very young and the very old. Further flu outbreaks were noticed in 1729, 1733 and 1737, but with only moderate mortality. The Italian term 'influenza' was first used in England to describe an outbreak in 1743, when another famous diarist, Horace Walpole, complained of the worst 'cold and fever' he had ever experienced. The death rate in London trebled at the height of this epidemic.
By the eighteenth century influenza had become a fairly regular visitor to Europe, usually in the winter months. Mortality varied, and in some years was quite alarming, but influenza never killed on the same scale as the Great Plague of London in 1665, when nearly 70,000 plague burials represented almost a sixth of the city's pre-plague population. The worst flu pandemic of the eighteenth century occurred in 1781–82 and was reported in almost every country in the known world. In Rome two-thirds of the population were affected, and in Munich the estimate was three-quarters. As in 1693, the strong and robust were affected as much as the weak and elderly, suggesting a new type of virus to which most of the population had no immunity. This pandemic raged across Britain in the summer months, from June to August, and a second wave in 1782 carried off the Prime Minister, the Marquis of Rockingham, who had only held office for four months.
Influenza then disappeared from Britain for nearly twenty years, returning during the Napoleonic Wars in 1800–02, but this outbreak was mild, causing only minor mortality. Another pandemic in 1830–33 coincided with the major cholera epidemic in Britain, and the death rate in London quadrupled in just two weeks at the height of the flu, but the greatest influenza pandemic of the nineteenth century came in 1847, when 250,000 cases were reported in London and half the population of Paris came down with the flu. Though cholera has dominated the medical histories of this period, the 1847 influenza killed more people than the 1832 cholera outbreak. Influenza pandemics seemed to come round at regular twenty- to thirty-year intervals, but isolated places might escape altogether.
New Zealand was probably too isolated to have shared in any of these early modern pandemics, but as European visitors to the South Pacific increased in numbers at the end of the eighteenth century and in the early nineteenth, the likelihood of influenza epidemics also increased. Classical Maori society had been spared most of the world's nastiest diseases, including smallpox, measles, typhoid and influenza, and therefore had no inherent immunity to these diseases when they arrived on their shores with Europeans intent on harvesting seals and whales. Maori oral traditions mention a devastating sickness called 'rewharewha' that swept through New Zealand in about 1800, which may represent the first significant invasion of these islands by new disease. However, the description is too vague to allow accurate identification. Scholars suspect that it was either measles or influenza.
In December 1828 the medically trained missionary William Williams (later the first Bishop of Waiapu) had no doubt that he was witnessing an outbreak of influenza: 'the Northern part of the island was visited with influenza in its most virulent form. Every person seemed to be affected by it, both young and old, and many for a time were laid quite prostrate. Great numbers were carried off, particularly the aged and infirm, and persons who had been weakened by previous disease.' This epidemic spread as far as the Chatham Islands, and Gilbert Mair claimed that as many as forty deaths a day occurred there. The Reverend Richard Taylor, however, thought that 1844 was the first time influenza had appeared in New Zealand: 'so generally did it prevail that scarcely an individual escaped'. As he was writing some years later, he may have confused the severe epidemic of 1838 with a milder one that occurred in 1844.
The geologist and naturalist Ernst Dieffenbach visited New Zealand in the 1840s and noted 'a malignant catarrh of the bronchiae' widespread among Maori, which he assumed was influenza. (Catarrh is the profuse watery discharge from nose and throat caused by colds or flu; the classic 'runny nose'. This is the body's first defence against invading viruses, to catch them on the mucous membrane and flush them out with fluid.) Further outbreaks of influenza were reported in 1850–51 and 1852–53. These may have been delayed ripples from the great pandemic of 1847. Influenza was also said to be prevalent in Sydney, Auckland and the Waikato in 1860. Within half a century, therefore, influenza had become a familiar disease in New Zealand.
As far as we know, for the next thirty years or so there were no serious outbreaks of influenza in New Zealand, but during that period remarkable things were happening in the worlds of public health and medical science back in Europe. Indeed, the whole nineteenth century saw astonishing changes in the understanding of epidemic diseases, surgery, hospitals, nursing and public health. This was the heritage with which New Zealanders faced the 1918 influenza pandemic, so it is worth taking a few pages to explain what happened and how these changes influenced people's responses in 1918.
Smallpox had been Europe's most-feared disease in the eighteenth century. It killed King Louis XV of France in 1774 and left its survivors disfigured and 'pocked' for life. Early in the century it was discovered that inoculation with a dab of pus from a human sufferer conferred immunity, but it also occasionally caused a full-blown attack of the disease, and about three deaths could be expected from every thousand inoculations. Edward Jenner (1749–1823) observed that milkmaids never caught smallpox, and deduced that the disease must be closely related to cowpox (variola vaccinae). In a famous treatise in 1798 Jenner urged vaccination rather than inoculation as a much safer preventive of smallpox. Though some members of the medical profession opposed it, Jennerian vaccination proved enormously popular and effective, and by the mid-nineteenth century smallpox had become a rare disease in Britain. Success with smallpox prompted renewed interest in other infectious diseases, and improved microscopes enabled researchers to examine yet smaller and smaller organisms in the early nineteenth century, leading to pioneering work on 'microbes' and cellular pathology. But the optimism of such researchers took a heavy blow in the 1830s when an epidemic of Indian cholera reached Europe and caused widespread misery and mortality. The unmistakeable symptoms of cholera included chills and nausea, uncontrollable diarrhoea causing dehydration with terrific pain and thirst, followed in half of all cases by a greyish pallor, purple lips, and death. The first major outbreak in England across 1831–33 killed over 22,000 people. There was no known cure or prevention. Cholera caused public panic and even riots; the 1832 Reform Act was partly a result of the cholera panic. But an equally important landmark was the creation of the Board of Health in 1831. This was Britain's first public health institution. Every major town and city set up a board of health to monitor the cholera epidemic, though most of their precautions were completely ineffectual. Almost nobody at the time guessed that the disease was being spread by contaminated water supplies.
Official fears of further riots and possible revolution by the 'lower orders' led the Poor Law Commissioners to ask Edwin Chadwick (1800–91; secretary to the notable reformer Jeremy Bentham) to investigate. His landmark Report on the Sanitary Condition of the Labouring Population (1842) warned that conditions in British cities such as Manchester, Birmingham and Liverpool were far worse than anyone had imagined. Thousands of migrant workers attracted by rapidly expanding factories were crammed into back-to-back rows of jerry-built tenements ('Coronation Streets') without toilets or bathrooms. Water would be taken from a single well or pump, often not far from a communal privy over a cesspit. Thanks to the establishment of the General Register Office in 1836 and the compulsory registration of births, deaths and marriages, Chadwick was able to base his report on detailed statistics from 533 towns and cities. He found that infant mortality in Manchester was three times the rate in Surrey, and that the average age of death for labourers and factory workers was only eighteen. Overcrowding, poor nutrition, polluted water and diseases such as typhoid and tuberculosis shortened most workers' lives by a decade or more. Chadwick pointed to contaminated water supplies as the obvious key, and estimated that the annual loss of life from 'filth diseases' was far greater than that from any recent major war.
The British upper classes were shocked by Chadwick's report. They feared for their own lives and those of their children from the spread of these 'filth diseases'. The result was Britain's first Public Health Act (1848), a landmark in the development of modern health systems. This act became a model for similar legislation in North America and Europe, and throughout the British Empire. In the 1850s most British cities put their water supplies into pipes, but the death toll from cholera remained high. The problem was that many town water supplies were drawn from rivers that were themselves polluted by untreated sewage. The solution was to filter and purify the water, and to remove sewage far away from any water intakes. Dr John Snow famously demonstrated the perils of infection from cesspits in 1854 when he traced a cholera outbreak to a single water pump in Golden Square, London. Once the pump had been dismantled, the death rate eased. It was discovered that the pump was being contaminated by a nearby cesspit.
Excerpted from Black November by Geoffrey W. Rice, Linda Bryder. Copyright © 2016 Geoffrey W. Rice. Excerpted by permission of Canterbury University Press.
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Table of Contents
Introduction to the first edition,
A few facts about influenza,
1. 'Leg rope': Influenza before 1918,
2. The Great War and the Great Flu,
3. Auckland's Armistice Epidemic,
4. Crisis in the Capital,
5. The Southern Cities,
6. Beyond the Cities: A typical country town,
7. 'Severest setback' for Maori?,
8. Origins and Diffusion: Was the Niagara to blame?,
9. Patterns of Death,
10. The Victims,
11. The Reckoning,
12. Influenza after 1918,
Influenza timeline since 1918,
Epidemic mortality in counties and towns,
Durations and peaks of the 1918 flu,