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The Social Impact of the Influenza Pandemic of 1918-19: with Special Reference to the East Midlands

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The Social Impact of the Influenza Pandemic of 1918-19: with Special Reference to the East Midlands The Social Impact of the Influenza Pandemic of 1918-19: with Special Reference to the East Midlands Joan Eileen Knight, MA Thesis Submitted to the University of Nottingham for the Degree of Doctor of Philosophy December 2014 Student ID: 2093506 ABSTRACT The purpose of this study was to explore the social impact of the 1918-1919 influenza pandemic, known as ‘Spanish influenza’, on the lives of the people of the East Midlands (defined as Leicestershire, Nottinghamshire and Derbyshire). A range of primary and secondary literature revealing the global impact of the event was examined, together with literature focusing on Britain and the East Midlands region to enable appropriate comparisons to be made and the East Midland’s experience to be contextualised. The event has been examined in six chapters. These consider theories relating to the origins and spread of the pandemic, together with morbidity and mortality levels in military and civilian populations, including patterns relating to age and gender, the susceptibility of particular communities and differences associated with socio-economic status and rurality. Provision of care for the sick in hospital and in the home and arrangements made for the burial of the dead have been discussed as have preventive and curative methods adopted by doctors, public health authorities and people themselves and the effects of the pandemic on everyday life, at work, at school and in leisure activities. The influenza pandemic is regarded as having struck in three waves, the first between March and August 1918, the second between September and December, 1918 and the third between January and May 1919. However, the onset and duration of these waves differed from place to place and many countries, particularly outside Europe, did not experience all three waves. Furthermore, not all places within the same country experienced the pandemic in the same way, some areas suffering severely while others suffered much less. This study, therefore, attempts to show how the East Midlands, an extensively urbanised and industrialised region in the centre of England, experienced the influenza pandemic and seek to explain this. Student ID: 2093506 Acknowledgements I would like to express my sincere thanks to Dr J. J. Frisby MB. BCh. FRCP. for her support regarding medical questions which arose during the course of this study and to Professor M. J. Taylor PhD. MRPharmS. for similar support with pharmaceutical questions. I would also like to thank Mr Christopher Pettitt, Mr Robert Povey and Mrs Sarah Wortley for their expert assistance in the production of graphs and tables and Mr Chris Baker, military historian, former chairman of the Western Front Association and owner of The Long, Long Trail website for providing me with information on East Midlands’ regiments. Finally I would like to thank my supervisor, Professor Beckett, for his endless patience and encouragement. Student ID: 2093506 CONTENTS Page List of Tables i List of Figures iii List of Abbreviations v Introduction ………………………………………………………………….…………… 1 Literature Review ………………………………………………………………………………. 20 Chapter 1 Soldiers, Sailors and Civilians………………………………. 38 Chapter 2 Morbidity and Mortality…………………………….…………… 67 Chapter 3 Rich or Poor; Town or Country…………………….………. 125 Chapter 4 Care of the Sick; Burial of the Dead…………….……… 157 Chapter 5 Prevention and Cure…………………………….……….……… 193 Chapter 6 Labour, Leisure and Learning………………………………. 243 Conclusion ………………………………………………………………………………. 282 Bibliography ………………………………………………………………………………. 286 Appendices ………………………………………………………………………………. 299 A. Regimental war diaries 300 Student ID: 2093506 LIST OF TABLES Page Table 1 Attacks of influenza in Leicester amongst the sample population 71 Table 2 Age incidence of influenza cases in six sample populations 73 Table 3 Incidence of influenza upon different age periods in the sample 74 population in Leicester Table 4 Mortality from influenza in the 82 county boroughs of England and 88 Wales 1918-19. Position in order of mortality for each wave and overall Table 5 Mortality from influenza in towns of over 20,000 population other 88 than county boroughs 1918-19. Position in order of mortality in each wave and overall Table 6 Weekly deaths and death rates for the county boroughs of 91 Nottingham, Leicester and Derby – June 1918 to May 1919 Table 7 Weekly deaths and death rates for towns exceeding 20,000 94 population and the remainder of counties for Nottinghamshire, Leicestershire and Derbyshire – June 1918 to May 1919 Table 8 Mortality peaks in the counties of Nottinghamshire, Leicestershire 95 and Derbyshire for each wave of the influenza pandemic 1918-19 Table 9 Admissions to hospitals and deaths from influenza and pneumonia 111 recorded for the British Army in the United Kingdom in September 1918 Table 10 Admissions to hospital and deaths from influenza and pneumonia 111 recorded for the British Army in France in September and October 1918 Table 11 Weekly influenza admissions to British Army hospitals in France – 112 May to August 1918 Table 12 Influenza in British military hospitals in France – October 1918 to 113 January 1919 Table 13 East Midlands’ soldiers who died in the Leicestershire Regiment 116 and the Nottinghamshire and Derbyshire Regiment – January 1917 to January 1919 Table 14 Analysis of number of deaths in the Leicestershire Regiment 1917 119 to 1919 i Student ID: 2093506 Table 15 Analysis of number of deaths in the Nottinghamshire and 120 Derbyshire Regiment 1917-1919 Table 16 Mortality rates in cities, towns and counties during the influenza 129 pandemic in New Zealand (European only) - October to December 1918 Table 17 Annual mortality per 1,000 living for administrative areas in 137 England and Wales during each wave of the influenza pandemic 1918-19 Table 18 Mortality from influenza in the remainder of counties 1818-19. 142 Positions in order of mortality in each wave and overall Table 19 Influenza remedies advertised in East Midlands’ newspapers 1918- 225 19 ii Student ID: 2093506 LIST OF FIGURES Page Figure 1 Diagram of the structure of an influenza viron 7 Figure 2 Map of the global spread of the influenza pandemic 1918-19 47 Figure 3 Map of the diffusion of influenza into Europe in the first wave of 48 the pandemic, spring 1918 Figure 4 Map of the worldwide diffusion of influenza in the first wave of the 49 pandemic, spring 1918 Figure 5 The spread of influenza in London and the county boroughs of 51 England and Wales – June 1918 to April 1919 Figure 6 Railways in the East Midlands in the nineteenth century 55 Figure 7 Map of the diffusion of influenza within and from Europe in the 58 second wave of the pandemic, autumn 1918 Figure 8 Map of the worldwide diffusion of influenza in the second wave of 59 the pandemic, autumn 1918 Figure 9 Age incidence of influenza cases in 6 sample populations 72 Figure 10 Weekly influenza mortality in England and Wales 1918-19 79 Figure 11 Monthly influenza deaths in Scotland, England and Wales 1918-19 80 Figure 12 Weekly influenza mortality for English county boroughs 1918-19 81 Figure 13 Weekly influenza mortality for English towns exceeding 20,000 82 population 1918-19 Figure 14 Influenza mortality in England and Wales for the week ending 9th 85 November 1918 Figure 15 Influenza pandemic mortality for England and Wales 1918-19 86 Figure 16 Influenza mortality in selected cities 1918-19 87 Figure 17 Weekly mortality in the county boroughs of Nottingham, Leicester 92 and Derby – June 1918 to May 1919 Figure 18 Weekly mortality in towns exceeding 20,000 population other than 93 county boroughs in Nottinghamshire, Leicestershire and Derbyshire Figure 19 Influenza and pneumonia mortality by age in the United States of 97 America 1911-1918 Figure 20 Age structure of influenza mortality in England and Wales 1916-20 99 iii Student ID: 2093506 Figure 21 Age structure of influenza mortality in Scotland 1918 99 Figure 22 Age distribution of standardised mortality from influenza, females 104 1847-1919 Figure 23 Influenza in the British Expeditionary Force – May 1918 to January 114 1919 Figure 24 Military deaths from disease in base hospital and casualty clearing 115 stations – January to December 1918 Figure 25 East Midlands’ soldiers who died in the Leicestershire Regiment 117 and the Nottinghamshire and Derbyshire Regiment – January 1917 to January 1919 Figure 26 Weekly influenza mortality for English administrative counties 136 excluding towns with populations exceeding 20,000 and county boroughs 1918-19 Figure 27 Urban and rural influenza mortality in England and Wales 1918-19 138 Figure 28 Weekly influenza mortality for administrative areas in the Midlands 139 1918-19 Figure 29 Weekly influenza mortality in the remainder of counties of 141 Leicestershire, Nottinghamshire and Derbyshire – June 1918 to May 1919 Figure 30 Advertisement for Oxo 229 Figure 31 Advertisement for Bovril 229 Figure 32 Advertisement for Jeyes’ Fluid 230 Figure 33 Advertisement for Lifebuoy Soap 231 Figure 34 Advertisement for Pinkobolic Soap 232 Figure 35 Advertisement for Formamint 233 Figure 36 Advertisement for cold and flu powders 236 Figure 37 Advertisement for Hart’s Influenza Mixture 237 iv Student ID: 2093506 List of Abbreviations AEF American Expeditionary Force BEF British Expeditionary Force IWM Imperial War Museum LGB Local Government Board MOH Medical Officer of Health MRC Medical Research Committee RAMC Royal Army Medical Corps RG Registrar-General TNA The National Archives USA United States of America VAD Voluntary Aid Detachment WWI World War I WWII World War II v Student ID: 2093506 INTRODUCTION The history of epidemic disease is a topic which has inspired many writers and researchers over the years. Bubonic plague, smallpox, cholera, typhoid and many other infections, their effects on society and the lives they claimed, have been the subject of numerous volumes in Britain and countries across Europe, America and elsewhere. However, one epidemic disease which, until relatively recently, had not received such attention, was influenza, a common enough infection which tends to appear annually without arousing undue concern.
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