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Spanish Flu in Italy: New Data, New Questions

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Spanish Flu in Italy: New Data, New Questions Le Infezioni in Medicina, n. 1, 97-106, 2018 THE INFECTIONS IN THE HISTORY OF MEDICINE 97 Spanish flu in Italy: new data, new questions Alessio Fornasin1, Marco Breschi2, Matteo Manfredini3 1Department of Economics and Statistics, University of Udine, Italy; 2Department of Economics and Business, University of Sassari, Italy; 3Department of Life Sciences, University of Parma, Italy SUMMARY This paper proposes a new estimate for the number of of deaths recognizes two distinct peaks, one in October victims of Spanish flu in Italy and highlights some aspects and one in November 1918. Between these two peaks, the of mortality closely linked to the First World War. The lowest number of deaths falls in the week of the armistice sources used are official death statistics and the Albo d’oro, between Italy and Austria-Hungary (signed 4 November a roll of honour of the Italians fallen in the First World 1918). This suggests links between Spanish flu and WWI War. The new estimate of deaths from the flu is 410,000 that cannot be merely explained in terms of movement of for 1918, which should be raised to 466,000 when the people and contagion. numbers are taken up to 1920. Deaths from Spanish flu among the military were about 70,000. The time sequence Keywords: Spanish Flu, Italy, WWI. n INTRODUCTION the global reach of the epidemic, in fact focuses on the flu in the city of Bologna [6]. Even more taly was one of the European countries most recent is a work by Alfani and Melegaro which Iseverely affected by the Spanish flu [1]. places the Spanish flu in the more general context Nevertheless, the influenza pandemic of 1918-19 of pandemics as a whole [7]. Military historians, in Italy has not been the subject of many studies. however, have tended to look at the influenza of The first to address the topic was Giorgio Mortara 1918 in relation to war [8-10]. Some authors believe in 1925 in a volume about Italian health in the that the Spanish flu was a direct consequence of Great War [2]. After Mortara’s important work, the war and that the conflict represented the real we have to wait more than thirty years to see a incubator of the virus [11]. Influenza, in fact, was new contribution on the subject, a volume by born in military camps, where men and animals Giovanni Cavina which traces the history of the (livestock and pets) were in close proximity. influenza epidemic in Italy. Only in recent years Most authors claim a close connection between the question of the health of Italians during the the flu and the conflict, though the conflict was not war come back into the spotlight. Of course, here, necessarily the primary cause. The relationship the Spanish flu played a central role [3, 4]. between influenza and war should perhaps instead The only monograph dedicated to the Spanish flu be sought in the rapidity of the virus’ transmission in Italy is a book by Eugenia Tognotti published and its global spread. These aspects would have in 2002 [5]. More recently, Sabbatani and Fiorino been determined by the crowded conditions in published an article which, while starting with the trenches and in hospitals and, of course, by the long-distance displacements of large masses of soldiers and workers [12-21]. Some scholars, Corresponding author however, either downplay the association of Alessio Fornasin the war with the pandemic, or at least do not E-mail: [email protected] consider it to be obvious [22, 23]. According to Jay 98 A. Fornasin, et al. Winter, one of the most important demographers official death statistics broken down by cause of writing on the Great War, the link does not exist death. The data are published by the National at all: “The pandemic was not connected to the Institute of Statistics (ISTAT) and are presented by war, its impact did not relate to consequences of age groups and by the month of occurrence. The the conflict, such as malnutrition, overcrowding second source, the most widely used here, is the or anxiety for the fate of their loved ones. It is Albo d’oro, a roll of honour of the Italian fallen in possible that troops movements accelerated the the war [30, 31]. As this source is rarely used, even spread of the infection, which however started by scholars of the Great War, we give below some out independent of war” [24]. background and a careful explanation of how we It is not clear whether the Spanish flu originated in used it. the United States, China or France. Consequently, The Albo d’oro was released in the 1920s to we are not sure about the routes taken by the commemorate all the soldiers who fell during the infection. But we know that it spread in several First World War. The 28 volumes that make up waves. The first, in the spring of 1918, appeared the entire work collect the names and some other in a benign form; the second, in the autumn of information about the soldiers who died in war, the same year, was marked by very high levels including, crucially for present purposes, the age of mortality; while the third, after the war, in the at death. There are 529,025 names. spring of 1919, killed a much smaller number of The criteria for its compilation were set out by victims. Contrary to the influenza pandemics that Fulvio Zugaro, head of the Army’s Statistics preceded it and that would follow, where children Office and Chief scientific advisor of the operation and the elderly are usually struck down, the [32]. The Albo d’oro was to include deaths in any victims were typically adults, especially males, war-related context: killed or missing in action; between the ages of 20 and 40 [25-29]. Here is a disappeared in war camps; death from illness, clear connection with the war and, in fact, those accidental causes, suicides, etc. Substantial who fell sick and died were mostly soldiers resources were dedicated to the operation, using participating in the conflict. a multitude of channels that involved numerous We intend to contribute here to studies on the central and peripheral public authorities, including Spanish flu with particular reference to military the town council register offices (population casualties. We have focused on the second wave, registers and civil registers), the Statistics Office that struck Italy and caused by far the greatest of the Supreme Command; the Historical Office number of victims. The aim is apparently limited. of the Supreme Command; the Ministry of War; The study of the flu among soldiers allows us the Head Offices of Military Health; the Italian to re-interpret some more general aspects of the Red Cross, the Uffici notizie (News Offices), the pandemic in the country as a whole. In particular, Care and Honours Commission; and the General we intend to propose new estimates regarding the Pensions Office. number of victims that the pandemic produced In this paper, given the sheer size of the Albo in the country. We also highlight some aspects of d’oro, we used a sample consisting of all the dead mortality closely related to military operations, included in the pages of each of the 28 volumes of which shed new light on its links with the conflict the work, singled out according to the sequence and its mode of diffusion. 1, 51, 101, 151 ... Every page contains 30 records. To achieve these objectives, we have divided the The total number of pages extracted are 367 (on paper into three parts. In the first we present our average 61 pages for every year considered) or sources, in the second we provide a new estimate 11,010 individuals, which corresponds to roughly of the number of Spanish flu deaths in Italy, and in 2.1% of the total1. the third we propose a new reading of the timing Part of the information extracted from the Albo d’oro and the logic of its spread. is shown in Figure 1. The figure summarizes the monthly distribution of deaths by distinguishing Sources victims of the fighting, deaths from disease (but Two principal sources are employed in this work. The first, already used by many scholars to draw 1 The whole work is freely available online at http://www. some quantitative conclusions, consists of the cadutigrandeguerra.it/. In this paper, given the sheer size of the Albo d’oro, we used a sample consisting of all the dead included in the pages of each of the 28 volumes of the work, singled out according to the sequence 1, 51, 101, 151 ... Every page contains 30 records. The total number of pages extracted are 367 (on average 61 pages for every year considered) or 11,010 individuals, which corresponds to roughly 2.1% of the total1. Part of the information extracted from the Albo d’oro is shown in Figure 1. The figure summarizes the monthly distribution of deaths by distinguishing victims of the fighting, deaths from disease (but not in enemy hands) and imprisonment (for all the causes). The decision to divide the information into three categories, two related to the cause of death and Spanish flu in Italy 99 one to the context of death, is in line, as we shall see, with the purpose of this work. Figure 1 - Monthly distri- 35000 All bution of the war dead. Wound Total and selected caus- 30000 Illness es and contexts (May Prison 1915-October 1920). Albo d’oro sample [31]. 25000 20000 N. deathsN. 15000 10000 5000 0 July 1914 July 1915 July 1916 July 1917 July 1918 July 1919 May 1914 May 1915 May 1916 May 1917 May 1918 May 1919 March 1914 March 1915 March 1916 March 1917 March 1918 March 1919 January 1914 January 1915 January 1916 January 1917 January 1918 January 1919 November 1914 November 1915 November 1916 November 1917 November 1918 November 1919 September 1914 September 1915 September 1916 September 1917 September 1918 September 1919 Month and Year Figure 1 - Monthly distribution of the war dead.
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