Perhaps another clue to an 80 year old mystery: why the 1918 pandemic killed so quickly, and those who might have otherwise been expected to have the best chance to survive, as reported today in the Washington Post.

I wrote a short essay about the 1918 Pandemic, when I learned that my great-aunt had survived it as a teenager, and that her mother, my great-great grandmother had volunteered as a nurse, most probably in a special hospital set up in the town where they lived.

A Touch of the Flu

It was a seasonal thing, the spring flu that hit in that particular year— everyone caught it, and almost everyone got better— the usual aches and temperature, headaches and lassitude. It didn’t seem much different from what strikes us every year; translating into a couple of days curled up at home in bed under the quilts, drinking hot liquids, sleeping a fevered and restless sleep and when awake, feeling rather feeble and wretched. These days— as then— only a relative handful of elderly and chronically ill see the usual flu turn into pneumonia, deadly, swift and terminal. The only curious thing noted in early accounts from Spain, in the northern resort city of San Sebastian, was that everyone exposed to the spring flu seemed to come down with it.

San Sebastian was (and still is) a charming, compact little city, built around an almost perfectly circular harbor. A generous pedestrian promenade runs nearly the entire circumference, adorned with elaborate light standards and a low balustrade along the edge, broken by shallow stairs descending to the beach level. The shortest way to commute across the downtown is in fact to walk along the beach; my daughter and I noticed many primly business-suited professional men walking home in the afternoon, carrying a briefcase and their shoes and socks, with their pant-legs turned up towards their knees, sloshing through the shallow water. The business commuters strolled by ladies of a certain, old-fashioned age, wearing modest one-piece bathing suits, and serious night-at-the-opera jewelry; an elaborate choker or paurure, long bracelets set with many stones, and cocktail rings…

San Sebastian was a place to be seen, gambling in the casinos, strolling along the circular promenade, even in 1918 while the last tattered glories of Belle Époque Europe and all its old verities and optimistic assumptions were being smashed to microscopic fragments several hundred miles farther east. Spain was at peace, its’ newspapers uncensored, and although the city fathers of 1918 tried to downplay the spread of what otherwise seemed to be the usual three days of aches and fever— who wanted to come to a resort in the season, and spend ones’ holiday being sick— the spring flu struck across Europe. Government offices shut down, the British grand fleet couldn’t put out to sea in May because so many sailors were down sick, British and German ground offenses were put off, workers in vital war industries were unable to work… but then summer came, and the tide of illness— now termed the “Spanish flu” ebbed under the summer heat.

And then in August, the flu returned, crashing like a monstrous wave, nearly as communicable as it had been in the spring, but mutated during the interim— no one knows where by what means—into something deadly, something that killed large numbers of the young and otherwise healthy. It is estimated that in the United States alone, more than a quarter of the population caught the flu. Of those stricken, about twenty percent had a mild case and recovered without incident, but according to writer Gina Kolata, the rest became deathly ill. They died within days or even hours, delirious and gasping for air, their lungs filled with thin, bloody fluid.

Others, who seemed at first to have a manageable illness, would develop a deadly pneumonia, which if not fatal meant a protracted convalescence. And doctors and public health officials were all but helpless in the face of the deluge, a helplessness most particularly searing because the medical arts had just come off a seventy-year run of successes on all fronts. Miracles had seemingly been worked 2-a-penny: epidemic diseases like cholera, malaria, typhus had been banished or at least beaten back, anesthesia made complicated surgeries possible, antiseptics banished bacterial infection, childbirth made considerably less hazardous to the average Western woman, people no longer routinely died of appendicitis or a hundred other maladies that had kept human lives nasty, brutish and short. But the doctors were as helpless in 1918 as they had been a hundred years before; there was nothing they could do, as the strongest and fittest gasped out a last few agonizing breaths, their faces and extremities dark and congested from lack of oxygen. Hospitals filled up and up; as did the morgues and graveyards. Public health departments handed out gauze masks, and forbade spitting in public. Volunteers in places as far apart as Reading, England and El Paso, Texas set up temporary hospitals in schools and other public places.

I am fairly sure that my great-grandmother, Alice Page Hayes was one of those fearless and public-spirited women; according to her daughter, my adventurous Great-Aunt Nan (who did herself contract the flu), she had volunteered with the Red Cross and St. Johns’ Ambulance Service in Reading where she lived with her husband and daughter, all during the war. I have somewhere a tiny St. Johns’ Ambulance pin attesting to her service; of course, it was the done thing for middle and upper-class Englishwomen all during World War I. Alice Page Hayes, though, had an advantage over her peers, and that was that she had seriously trained as a nurse early in the 1880ies when it wasn’t quite the ladylike thing to do at all. Volunteer work made necessary by a war made it possible for her to continue with her calling, even though (as witness in her own copy of Mrs. Beatons’) nursing the sick was a particularly necessary part of ordinary household management, up until the day of inoculations and antibiotics. I am supposed to be like her, or so say a handful of family friends and connections acquainted with us both. Was she much like me? Managerial and confident, and just perhaps… one of those lucky people who never catch anything, or at very worst, a light case of whatever is going around?

One of the enduring puzzles of the 1918 pandemic was the mortality rate among the young and healthy, whereas the very young, the old and the chronically ill are the more usual victims. Some experts speculate that a previous flu in 1890 may have been just enough similar to the 1918 pandemic to afford immunity to those who had caught the earlier influenza variant… or that immunities acquired by those who were babies and small children at the time over-reacted with fatal results to the later epidemic. Nonetheless, I like to think of my great-grandmother, who had been exposed to and survived everything that the late 19th-century could throw at her, walking confidently into an emergency ward full of the desperately sick, knowing that she would do her best, that thanks to her work, some would live who otherwise would have died, that she would be OK…. and that she was one of the strong survivors.

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