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Pale Rider: The Spanish Flu of 1918 by Laura Spinney

Those who cannot remember the past are condemned to repeat it.

I read (listened to the audiobook) this well-researched book on the 1918 Spanish Flu – Pale Rider: The Spanish Flu of 1918 and How it Changed the World by Laura Spinney published in 2017. Had it not been the 2020 pandemic, I doubt I would’ve picked this book but I am glad to have read the book. I learned a lot from this book. It was captivating!

Astonishing to learn on how the world we live and humans as a species have been shaped by infections for thousands of years. If we had thought COVID-19 had travelled fast and wide around the world thanks to cheap air-travel, think again, Spanish Flu was no way different. The book has excellent coverage on the pandemic’s impact around the world. Every alternate page I see huge similarities with the current pandemic and the wide differences in the very next page. Stupidity, arrogance and sorrow were there a century before too.

Even in 1918, measures like:

  1. Requiring the public to wear a mask,
  2. Keeping your doors/windows open for fresh air,
  3. Washing your hands,
  4. Closing of schools, places of worship & congregations,
  5. Quarantine of the arrivals from the sea,
  6. The importance of getting existing vaccines (for other diseases);

had been enforced to various degrees of success around the world. Even then, these measures were questioned, ridiculed & not uniformly followed. Politicians had questioned the validity of the measures. Migrants were blamed. Some had argued to let the disease run its course then try to slow it down. New York for example like a few countries today had their schools open (like Singapore in the early days of COVID) so that children can be monitored better there & fed better. Then and now it is not clear whether kids are a vector for infectious diseases. And when cases started reducing or after months of restrictions, the masses grew tired and went about to their normal way of life.

Unlike today, modern medicine didn’t have any special status or recognition in many parts of the world over the unconventional and traditional medicines (the author calls them irregulars), so the western medicine (regulars) doctors had to fight the pandemic and rumours. Scientific drug formulations didn’t exist, the double-blind & placebo clinical trials haven’t taken hold. These meant the regulars had no arsenals in their bags to help the sick in any meaningful way. As a result, they threw everything from their chemical cabinets at the disease including Arsenic, Aspirin, Mercury with the (honest) hope of curing and helping the sick.

Just like now with COVID-19, people were turning to homemade recipes (no disrespect to them), natural products and snake oils to protect themselves or get cured when infected. Cities were the main hubs of infections due to their overcrowded accommodations and poor sanitary conditions. People were desperate for a cure and tried witchcraft rituals, like the Jewish tradition of Black Weddings in cemeteries were tried in Europe and America, voodoo dolls were used in India to wade off the evil spirits which were believed to be causing the unseen pathogens. In most places around the world, the locals didn’t have any other medicinal practices available.

Just like in 2020, the origins of the 1918 Spanish Flu have not been definitely answered, there are three theories widely discussed:

  1. Camp Funston in Kansas, USA,
  2. The Precursor to the pandemic was from China in 1917 and travelled with the CLC labourers who worked for the British Army as coolies,
  3. UK troop staging and hospital camp in Étaples in France.

In the China of 1918, train coaches were converted as isolation wards, just like India did in the months of April, May in 2020.

The modern-day estimates on the number of people who died from Spanish Flu range from 50 million to 100 million, the difficulty due to lack of data coming from Russia and China, two populous countries, who didn’t maintain health records for the dead and causes. In the 1990s and 2000s, the 1918 virus was re-cultured from the lung specimens that were preserved in army health vaults or permafrost in Alaska, these have some shed light on what happened a century ago. The virus probably came from water birds to humans. Earlier horses and pigs were a reservoir of viruses that then jumped to humans, but in recent years it seems to be water birds. 

With the genetic data of Spanish flu, scientists have identified it as H1N1 flu. Combining this new information with the recordings/writings from military doctors treating patients in 1918 of the symptoms and how the illness worsened, scientists believe that the death of patients from Spanish flu came mostly from the cytokine storms where an overzealous immune system clogs the lungs. People who were exposed to earlier mutations (probably a weak) of earlier seasons’ flu infections have done well when the H1N1 mutation took hold in 1918. It is still not clear why was this or with certainty as we don’t have the genetic data of viruses prior to 1918 flu infections.

India suffered (an estimate of) 18 million deaths from Spanish Flu, across age groups, women were most affected due to poor nutrition and probably a predominant (the author says) vegetarian diet. This made wonder, how to reconcile:

  1. The popular claims made in COVID times, of Indian native foods, organic crops, spices, to be providing greater immunity. I am not denying that most packaged foods are junk & sugar-heavy, and there are a lot of merits on Ayurveda, Siddha and so on. But a century ago, packaged foods were not yet invented and definitely affordable for Indians, so they couldn’t have been eating it worsening the infection.
  2. In 1918s, Indians and Asians have lived a simpler life, less stressful, and were close to nature, did physical labour more than in 2020.

The explanations for Indian death count being high could be that the numbers could’ve even higher, had Indians been living a modern lifestyle, and were not having spices in their traditional foods. I think the reason of high deaths among Indians was due to the sheer volume of the population in the country, malnutrition was rampant due to an occupying power ruling over the natives, and a World War was not helping either.

Not attributed to any one country but the author quotes figures of children born to mothers who were pregnant in 1918, were on an average 1.5 cms shorter than their peers!

In the US, American insurance companies had paid over USD 100 million as claims for death victims’ families from Spanish Flu. One recipient of the insurance money was a widower of a German migrant, the family invested the money in buying properties and her grandson is none other than 45th President of USA Mr Donald Trump.

South Africa alone had over 500,000 children counted as orphans as a result of the pandemic adoption laws were passed by many countries around the world. Several states around the world where the death rates have been higher than others during the flu pandemic showed large growth in the 1920s.

The pandemic resulted in a backlash to modern science. The 28th October 1918 issue of “Times of London” newspaper wrote about the neglect and lack of foresight by science/scientific community and someone has to be held responsible. New York Times wrote that science has failed to guard us. The hubris of the medical community was punished all around the industrial nations. The irregulars (Traditional medicine doctors) everywhere called out that they had got better cure rates than the regulars (modern medicine) and their following from the public grow after the Spanish flu.

Royal S Copeland who headed the health care in the New York City during the pandemic was a surgeon and homoeopathic practitioner, in later decades during his term as a US senator, wrote as the primary author and sponsor of the Federal Food, Drug, and Cosmetic Act of 1938 which recognized homoeopathy. The trend against Smoking got reversed after the pandemic, it got promoted as a prophylactic against Spanish flu. Women took it up in a big way after 1919. Arthur Conan Doyle stopped writing fiction after he lost his son to Spanish flu.

Universal health care around the world started coming up, especially in Russia led by Vladimir Lenin. The state of native’s health in the occupied states of Africa and Asia became a source of embarrassment for the colonial powers of Europe. The capitalistic west has to come up with his answer to the Soviet’s universal health care, often the solution for it came from the Rockefeller Foundation. The foundation became a strong force in shaping the health care policies between the two world wars, in the colonies and in western countries like Spain. The Pasteur institute too set up its branch in Tehran. Rockefeller was suspected of practising neo-colonialism under the guise of philanthropy.

World War I & Peace

The German generals and a few historians believe that the central powers were infected with more damage by the Spanish flu than the allied forces due to the poor nutrition of German soldiers.

The third wave of the Spanish flu struck during the peace process in Paris. Delegates involved in the peace process were directly or indirectly were affected. Wellington Koo lost his wife to the Spanish flu. T. E. Lawrence was briefly absent to go to the death of his father.

The American President Woodrow Wilson got ill due to the flu and was because of his poor health, as a result, he couldn’t convince the allied powers from imposing harsh conditions on Germany; As a result, in an indirect way, his illness from the pandemic may have led to conditions leading to WWII.

In March 1919 Yakov Sverdlov, who wore a full black leather dress, and the right-hand man to Vladimir Lenin died after being infected by the Spanish Flu. His loss and subsequent declining health of Lenin may have led to Joseph Stalin coming to power a few years later.

Spanish King Alfonso XIII caught the infection, weakened, he negotiated a deal with his detractors. If he had died, the dictatorship in Spain would’ve come earlier.

Gandhi & the Spanish Flu

During the summer of 1918, Mahatma Gandhi was busy recruiting for the British to fight in the world war. He thought of this as a bargaining chip with the British to get at the least dominion status for India after the war. In the autumn of 1918, he was tired and got sick, he thought it to be common dysentery and wanted to starve the alien body by not eating anything. What he had actually caught was the gastric variety of the Spanish flu. This was three years after his return from South Africa. Gandhi had stopped drinking Cow’s Milk due to the way they were forced to lactate, but his doctors advised for his nutrition to take Goat’s milk at least, which he did and later repented on compromising on his principles to save his life.

In that year, Gandhi launched one of his first large protests in India – In Feb 1918 was the Textile mill workers in Ahmedabad went on strike urge by Gandhi after the plague allowance was withdrawn. The second was the Kheda Satyagraha from March to June 1918 to protest against the land tax. In a way, both the demands were met. These efforts and outreach to help the pandemic victims in a way increased the stature of Gandhi, making him be seen as the leader of the independence movement.

The second wave of the Spanish Flu in India came during September 1918 along with drought. Some American writers have recorded that people begged for water, stole water, bullocks leapt to well in search of water and died. In October 1918 the pandemic peaked with bodies floating on rivers. The Colonial masters couldn’t handle this health crisis. Public health was only available in cities and even there most doctors had gone to the war. The villagers had to fend themselves. The British Government asked for help and agencies linked to independence movements came forward. A pro-self-rule organisation called Gujarat Sabha set up relief council. In Surat freedom fighters Dayalji Desai, and the Kanbi brothers Kalyanji and Kunvarji Mehta followers of Bal Gangadhar Tilak, the leader of the first independence movement in India. These three people set up dispensaries. Kalyanji himself handled the disposal of corpses in many places. Home Rule league through volunteers gave medicines & vaccines to people. Their efforts were complemented by the Surat municipal commissioner who setup mobile dispensaries. The actual vaccine they distributed is not known, it was probably an Ayurvedic recipe. The student volunteers took these to backward areas, to Adivasis (scheduled tribe) villages which were mostly unreached before; initially, they were hesitant to get outside help, but Kalyanji’s patience won them over. After that period two vaccines were developed by the Government and a new vaccine was made widely available in December 1918 for free. The outreach by the Mehta’s is estimated to have reached over 10,000 people in Gujarat during the pandemic.

After the war, while Indians were looking forward to freedom, they instead got more repression with the passage of Rowlatt Act on 18 March 1919. Following this, on 13th April 1919, the Jallianwala Bagh massacre happened. Some historians’ belief the damage caused by the Spanish flu raised the tensions between the Indian people and their rulers more.

British Historian A J B Taylor believes that the Spanish Flu directly led to this incident by rising tensions in the country and it marked exactly the moment in which the Indians were alienated from British rule. Ten days after the massacre, an editorial appeared in the pro-independence “Young India” titled Public Health it reflected the mood: That a Government that allowed the six million to die of influenza-like rats, won’t mind if a few more die of bullets. In May, just before he gave up his knighthood in protest against the massacre, Rabindranath Tagore wrote to a friend that the British were guilty of the same kind of ignorance of the eternal wars which primitive people show when they hunt for some so-called witch to whom they ascribe their illness while carrying the disease germs in their own blood.

Literature and Art

Those who think about Spanish Flu often wonder why though it left a cluster of tombstones in every cemetery around the world, it didn’t wave a claim around the art world. Why? The art world doesn’t flow smoothly after the Spanish flu, there was

The last section of the book deals with the impact the Spanish flu left on the works of the famous artist and writers of the time. It traces the works of writers around the world including the famous Munshi Premchand and Nirala in India. The writer Suryakant Tripathi aka Nirala meaning the strange one had lost his wife and other members of his family to the Spanish flu when he was 22. He writes that he had seen the River Ganges swollen with dead bodies. He had said, “This was the strangest time of in myself, my family disappeared in a blink of an eye. For him, the universe was a cruel place with no room for sentiments“.

The 1995 film Outbreak talks about a fictional Ebola-like virus called Motoba that becomes airborne and ravages a US town. Virologists have said the scriptwriters of Outbreak could’ve gone further in their portrayal. Most experts consider another pandemic inevitable. Lessons learned from the Spanish Flu could help us in handling it better. Scientists are using Molecular clocks to track the mutation of viruses and then to identify the strains that are more transmissible. Today (2017) WHO and CDC in the USA take about a week before they can catch the signal of a pandemic, in a way to improve this response time, two American scientists have suggested in 2009 to use the Friendship Paradox – this is an idea that your friends have more friends than you – to identify those individuals who have more connections and then get them vaccinated earlier on to limit a pandemic.

How to persuade people to take vaccines and to follow mandatory health measure when announced? People have less tolerance to the restrictive measures, they are like to follow more when they are voluntary. From the lessons learnt from 1918, the CDC has recommended that the movement restrictions be made only when the proportion of sick crosses 1%. Many times when people don’t believe or follow the health recommendations the reasons go back to the past. For example in South Africa President Thabo Mbeki discredited the science behind HIV – the reasons could be traced from the Apartheid era act The Natives (Urban Areas) Act of 1923 passed to prevent the Natives from moving freely in predominantly White neighbourhoods, who believed the black people to be harbouring infections on their bodies, could in a way be borne out of the fear from the Spanish Flu a few years earlier.

There are over 80,000 books across 40 languages on World War I, but it has 400 books across 5 languages on Spanish Flu. Though these 400 books have grown exponentially in the last twenty years. Like the Yup’ik Eskimos of Bristol Bay in Alaska, many have chosen to forget the sorrows of Spanish Flu in order to health and look at the future, but meaning out of important events comes from distance. Spanish Flu has been called a forgotten pandemic, it may not be, in fact, our collective memory of it is a work in progress.

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