Part of talk given by Professor Geoffrey Rice author of Black November: The 1918 influenza pandemic in New Zealand.
HOW DID CHRISTCHURCH COPE IN THE 1918 INFLUENZA PANDEMIC?
By Professor Geoffrey Rice, Historian, University of Canterbury. “ Outside the Square” Lecture, Christchurch Town Hall, 29 November 2005
...So I grew up as a young lecturer in a history department that took it for granted that we had a duty to share our knowledge and expertise with the community in which we lived. I’m happy to say that that tradition continues strongly to the present day. My first work on the 1918 flu was right here in Christchurch, a piece of local social medical history. I spent my vacations interviewing survivors in retirement homes, working through the death registers and the newspapers of the day. I was fascinated to find that people had died of the 1918 flu just around the corner from where I grew up in Waltham. I knew the houses where they had died; I had walked past them every day on my way to school. That made history come alive for me, and made it somehow very close and personal.
One thing that interested me about the 1918 flu was the huge impact it must have had on young families, because that 1918 flu was a bit of a freak among influenza pandemics. Influenza normally only kills the very young or the very old. But the so-called Spanish Flu of 1918 preferred young adults in the prime of life, aged between 25 and 45. We still don’t know exactly why it behaved this way. Now that we know its genetic structure, that H1N1 virus looks very ordinary. It was actually closer to swine flu than avian flu, but that’s another story. I wondered how many orphans it must have left behind? Because it was spare-time research, alongside my other duties teaching European history, Black November took nearly a decade to finish. My then head of department at one point tried to put me off it, saying I should get on with my European research. I’m now very glad I persisted with the flu when a lot else was happening in my life. What kept me going was the enormous interest that people showed whenever I said I was working on the 1918 flu. Clearly, for a lot of New Zealand families and individuals it was the most important thing that ever happened in their lives. It changed the direction of their lives and altered their life-chances. This was even more marked in Maori society; there the 1918 flu was like a sword-cut across the silken fabric of time. As Sir Tipene knows, Maori people used to date events according to whether it was before or after the 1918 flu, it was such important an event for them. I soon realised that this was History that really mattered to ordinary people, and not just to the academic historians. But now that I’ve started talking about the 1918 flu it’s high time to move onto the second part, and the main part of this lecture.
So, how did Christchurch cope with the 1918 influenza pandemic?
Plainly it would be impossible to give a comprehensive answer to this question in the next twenty minutes. That would require another book! And I have more than enough material sitting in file boxes in my office at the university to write another book, just on Christchurch in the 1918 flu, if anyone could be bothered to publish it. In the meantime, may I refer you to chapter 5 of Black November for a brief outline. Nor is there time in a lecture like this to explain the pattern of the worldwide pandemic in 1918. Again, I refer you to Black November . For this part of the talk I can only sketch what happened in Christchurch in the 1918 flu, and highlight what the city council did, as that seems most appropriate for this particular lecture series.
A lot of people here in Christchurch were talking about influenza during October 1918, but they were in the tail-end of the mild first wave of the pandemic. There was a serious flu outbreak among the boarders at Christ’s College in October with 127 boys ill, some with pneumonia, but there were no deaths. A dozen nurses at Christchurch Hospital came down with flu, and there was a lot of absenteeism at the Post Office and among tramway staff. There were letters in the newspapers from worried people, and others giving advice, such as castor oil, cold packs, quinine and aspirin. One letter that was copied by many other NZ newspapers was from ‘Old Medico’ in Christchurch, who recommended beer, in regular doses, to ward off the flu bug or to help you get over it. This was probably old Dr Lester in Latimer Square. During the 1918 flu he kept a barrel of beer at his back door and encouraged his patients to bring a jug and take some free. Very good for convalescents, as beer in those days was more like stout. (I’m a Guinness man, myself.)
A lot of people at the time, and since, believed that the severe second wave of the 1918 pandemic was brought to New Zealand by the passenger ship Niagara, which was bringing Prime Minister Massey and Sir Joseph Ward back from an imperial conference. I don’t have time to go into that debate here – but it really is a myth – read chapter eight of Black November. The infection is far likelier to have been brought back on the troopships in October, when hundreds of returned soldiers scattered the length and breadth of the country.
When the severe second wave started in Auckland at the end of October, the Health Department was caught completely by surprise. They had no contingency plans, because nobody ever expected flu to be such a killer. It wasn’t even a notifiable disease back then. There were just twelve staff at the Health Department’s head office in Wellington, but most of the department’s senior officials were attached to the army, in the big camps at Trentham and Featherston. The chief health officer was overseas, and his deputy was so busy coping with the outbreak in Auckland that nobody thought about quarantining the South Island. Yet it would have been so easy; just stop the interisland ferries from sailing. So there was a serious lack of planning and leadership from the health department and the government right at the start of the 1918 flu.
Christchurch was lucky to have a capable and alert Medical Officer of Health in 1918. Dr Herbert Chesson did not wait for instructions from Wellington, but went to see the Mayor, Henry Holland, on 6 November and asked the city council to start a general clean-up, removing rubbish and spraying disinfectant on footpaths and city streets. Remember that in 1918 nobody knew much at all about viruses. People then believed flu was caused by bacteria or germs. Hence the Health Department’s only suggested preventative, a spray of two per cent zinc-sulphate solution, a sort of primitive oral disinfectant, to kill any lurking bugs in the mouth, nose and throat. Dr Chesson had just one of these sprayers, and sent it over to Lyttelton to treat all the passengers coming off the Maori before they caught the train through to Christchurch. He also went to see Inspector Dwyer, and asked the police to enforce the by-law against spitting in public places.
But he did all this on his own initiative. There were no official instructions from Wellington until the second week of November, because all the health officials were busy in Auckland. And when telegrams began to arrive they were marked ‘Confidential’ so Dr Chesson wasn’t sure if he could tell the mayor or the city council anyone else how bad things really were in Auckland. At least the Minister of Health had influenza gazetted a notifiable disease on 7 November, and Dr Chesson at once ordered all the schools in Canterbury to be closed and the children to stay at home. That was the start of the longest summer holiday New Zealand school kids have ever had! He also ordered the closure of all cinemas and theatres and places of entertainment, anywhere that people might congregate and spread infection. He also organised or improvised some more inhalation sprayers. The Railway Workshops at Addington made them. The first one was in an upstairs room at the MED in Manchester Street, and this was soon seen to be utterly hopeless, as people queued on the stairs, sneezing and coughing at each other. They moved it into a shed across the road, but by then the city council had helped set up a larger facility in the bike shed behind the Government Building in Worcester Street. There’s a photo of this facility in Black November , on page 117.
So Christchurch was lucky to have an alert and energetic medical officer taking these early steps. But Christchurch was also unlucky in the timing of its flu epidemic. The 1918 flu could not have chosen a better time to come to Christchurch, because the first week of November was Show Week, with the A & P show at Addington and the big NZ Cup race meetings at the Addington trotting grounds and out at Riccarton Racecourse. The Friday, of course, was People’s Day at the Show, and Canterbury’s provincial holiday. In those days, hundreds of punters came to Christchurch from the North Island and all over the South Island just for the races, but hundreds of farming families in Canterbury also took that week as their annual holiday, and came to town for the Show as well as the races. Hotels and guest houses were always full during Show Week. It was an ideal mixing bowl for spreading the new flu virus.
November 1918 was a very special time, too, because the end of the Great War was expected almost any day, and a rumour spread at the Show on Friday 8 November that an armistice had been signed. A crowd gathered around Derry’s Brass Band to celebrate, but as the afternoon wore on there was no official confirmation. Then the hot nor’west day suddenly changed to a cold wet southerly, and one old lady I interviewed said that as a young woman she had dressed up in all her finery for the races and was caught by the southerly change and got soaked to the skin while waiting for a tram on Lincoln Road. That was the start of the flu for her, and for hundreds of other people in Christchurch. Other eyewitnesses who had been at the races remembered seeing people collapsing and being carried off by St John Ambulance stretcher-bearers. One lady told me the women’s rest room looked like a wartime casualty clearing station, with bodies lying everywhere, even on the floor. This flu struck suddenly, and was ten times worse than ordinary flu. People just collapsed and went unconscious. Other survivors told me they just felt pole-axed, and had to go to bed and were too ill and delirious to get up for days on end.
Dr Chesson later told the Epidemic Commission that the flu in Christchurch started during Show Week and really took off over that following weekend. The city’s hotels began to look like army hospitals, with extra beds in the corridors and staff run off their feet. The situation at the hospital was even worse, because so many of the nurses were coming down with the flu even as the number of new admissions was soaring.
Amazingly, when news of the official Armistice came through the wires on
11 November, the city went ahead with a parade and rally in the Square on 12 November. It was a bright hot sunny day, and hundreds of people streamed into the Square to celebrate the end of the war to end all wars. A procession of floats and decorated cars had been in preparation for several weeks, just for this moment, and went ahead as planned despite Dr Chesson’s protests. The crowds lingered in the Square long after the parade had ended, and people then drifted off to the pubs to celebrate. By nightfall some of the revellers were drunk and started letting off fireworks in the High Street triangle. People who were suffering from flu in the United Service Hotel complained and the police were called to quieten them. You can read about the riot that broke out in Hereford Street in my book.
At Christchurch Hospital flu admissions doubled in three days to reach 145 by 14 November, with half of the nurses down with flu. The situation was grim, but it was never the complete shambles that some critics later alleged. The hospital was lucky that Dr Fox, the medical superintendent, had caught the mild flu in October, and seemed immune to the severe second wave. Later in November he collapsed from overwork and exhaustion, but there was someone else to take his place. An army doctor, Colonel Wylie, had just arrived to set up a new orthopaedic ward for wounded soldiers, and he had wide experience of busy army hospitals in France ands England. He was also one of Nature’s organisers. He just took over at the hospital and juggled the rosters of severely limited nursing staff. Over half of Christchurch’s flu deaths were at the hospital, and nearly all of the death certificates have Dr Wylie’s signature. Dr Fox had decided against the policy of dispersal used in Wellington and many other towns, where schools and church halls were hastily set up as temporary or emergency flu hospitals. His view was that since the nurses were falling like ninepins it was better to keep all the serious cases in one place where someone would always be available to care for them, rather than scatter the nurses around the city where they might fall ill and leave nobody to take their places. The main hospital was swamped, and on 16 November the health department and city council commandeered the Royal Hotel nearby in Oxford Terrace as an overflow hospital. Over 100 less serious cases were moved there, but they still had nineteen deaths at the Royal.
By mid-November Christchurch was really in the grip of the flu. So many people took to their beds that shops and offices and factories either adopted reduced hours or closed completely. One man I interviewed said he stood in Colombo Street at the height of the flu and he could have fired a gun either way and would not have hit a soul. The streets were deserted and the whole city became like a ghost town.
Local government played a big role in dealing with the 1918 flu in New Zealand.
When Wellington’s medical officer came down with the flu, the Minister of Health took charge himself and on 12 November sent a circular telegram to all mayors and county council chairmen throughout the country, setting out a plan of action to cope with flu at the local level. This was two weeks, notice, after the onset of flu mortality in Auckland. Mayor Henry Holland called an outdoor public meeting in Christchurch on 14 November, outside the civic offices, attended by mayors of the adjacent boroughs such as Riccarton, Woolston and New Brighton. They quickly agreed to set up a central bureau in the Square under the control of Nurse Maude, founder of NZ’s district nursing movement. The rest of the city was divided into sections or blocks, based on the wartime fund-raising campaigns of the Red Cross. One of the key differences between then and now is that New Zealand was at war in 1918. The whole country was organised for the war effort. People had had it drummed into them that everyone had to be brave and do their bit for the war effort. Christchurch also had a very public-spirited elite in those days, and it was a small enough city, just over 90,000 people, for everyone to know their neighbours and where leading citizens all knew each other at least by sight. The city council initially set up 31 blocks, and the mayor put notices in the newspapers calling for local meetings of volunteers the next day. But there wasn’t enough notice given, and in a few blocks nobody turned up. Most blocks had enough volunteers to form the basis of a local committee, and since the schools had been closed a good many of the volunteers were school teachers, who were used to organising things and keeping individual records. Local committees were elected on the spot and started teams of volunteers going from street to street knocking on doors to see how many people had the flu and if there were any serious cases that needed to be taken to hospital. The block committees set up their headquarters in schools and church halls, or anywhere handy that had a telephone. From this depot they would ring through to the central bureau and call for an ambulance or motor car to collect the serious pneumonic cases from their locality.
St John Ambulance had just two motor ambulances in Christchurch in 1918, so the city council requisitioned vans from drapery firms like Beaths and Ballantynes to collect stretcher cases. The Canterbury Automobile Association was one of the largest and most active in NZ in 1918, and no fewer than 264 members offered their cars, and themselves as drivers. The central bureau allotted half a dozen cars to each depot. At first it was all a bit chaotic, but the idea of the block system was to prevent overlapping and waste of time and effort. The doctors were each assigned to a block and asked to go to the houses where flu cases were found, and most of Christchurch’s doctors were happy to work within this system. By contrast, in Wellington, more than half the doctors came down with the flu and the rest refused to be confined to a single block, so there was a lot of overlapping and wasted effort there. Wellington finished up with the worst death rate of the main centres. But the doctors in Christchurch soon pointed out that some of the blocks were too small, so on 18 November there was a big meeting of block leaders and doctors, and they agreed to consolidate the map into just 15 blocks, half the original number. Part of the problem was that there weren’t quite enough volunteers to provide shifts for both day and night. (The photo on the back of my book shows the depot at the Methodist Church in Fitzgerald Avenue, the depot for the combined blocks 4 & 6.) The volunteers also had their own families to attend to. This is a useful lesson from 1918; the problem of volunteer fatigue.
Now I can see some of you nodding off and suffering from fatigue too!
So I’m going to pause here. In my lectures at the university I usually take a break at about this point to show slides illustrating what I’ve been talking about. I’m not going to do that tonight, as I don’t trust the technology. I’ve seen too many conference papers fall flat because the power-point won’t work The photos would all be black and white anyway, and they’re all in the book, so there’s another incentive to go and buy it!
To give you all a break, I want to ask a favour of you, a serious one. I want you all to turn and shake hands with the person next to you and say hullo. Both sides now. Yes, you powerful people too. Just say hullo. No, sir, she doesn’t want to know what you had for breakfast. Now are you all wondering, what’s this all about?
Well, the one big lesson I want you to take home from this lecture is that we should all get to know our neighbours, because if we do get hit by another big pandemic like that of 1918, it could be your neighbour who saves your life. I’ll come back to this point in the last part of the lecture. Well, that made you all take a break. And see, you didn’t even need a KitKat! Don’t forget to wash your hands later. Now let’s get on with the story.
How well did Christchurch do in terms of pandemic organisation? On the whole, I’d say, pretty well. At first it was trial and error, but by 18 November they had sorted themselves out and the system was working. But the key weakness was the central bureau in the Square. Nurse Maude was swamped with phone calls from people who wanted her to come and attend to their loved ones, right now! Here’s a lesson for a future health emergency: don’t focus too much responsibility on one key individual. Far better to have close-knit teams who all know what the job entails. Then if anyone collapses, there’s someone ready to take their place. In 1918 when Nurse Maude collapsed under the strain they moved the central bureau to the Red Cross shop beside the Post Office, and turned the Patriotic Bazaar into a medicine depot. This is one of the most often-reproduced photos of the 1918 flu in Christchurch. It’s on p.137 of my book. As well as bottles of the standard influenza remedy, with a doctor’s chit you could get small bottles of spirits, brandy or whisky, as stimulants for convalescents. Remember, the pubs had been shut since 15 November, much to the delight of the temperance movement, and the dismay of the regular drinkers. So the standard influenza remedy was very popular! And I wonder how many found their way to Dr Lester’s barrel of beer in Latimer Square?
Christchurch also organised the inhalation system far better than any other New Zealand city. Someone noticed that the compressed air braking system on the trams could be hooked up to the zinc sulphate sprayers. The Tramways chairman John Barr took up the idea with enthusiasm, and had six trams converted on 12 November. The idea was to fill the car with vapour, so people entered at one end, walked through breathing the vapour, then off at the other end, without any need to queue up. The Tramways Board finally had 22 inhalation tramcars in use, stationed on the terminus loops out in the suburbs as well as in the central city. Some people went every day for their ‘preventive puff’ and swore that that was why they never caught the flu. Insofar as the inhalation treatment did any good, Christchurch had it down to a fine art.
The city council was in charge of these inhalation tramcars. Most of the staff were city council employees, and they organised the zinc sulphate supplies from Stevens and Co or Kempthorne Prossers. The whole system was controlled by the council’s chief sanitary inspector, Mr Nicol, who despite all the fumes he must have inhaled later came down with the flu himself. I’m glad to report that he made a good recovery, as did the great majority of the people who caught the flu in 1918.
As well as all the Red Cross and St John ambulance volunteers, the most visible helpers in Christchurch during the 1918 flu were the Boy Scouts. Like the Red Cross, that’s another notable NZ institution that was started in Canterbury. The Boy Scouts ran messages and helped with the door to door patrols.
The death toll in Christchurch peaked on 19 November with 48 deaths in that one day. The situation at the hospital was acute, with 43 bodies awaiting burial and the city’s undertakers already run off their feet. The city council then stepped in and provided trucks and drivers to clear the backlog and get the coffins out to the cemeteries at Linwood and Bromley.
After the peak of deaths on the 19th, the death toll dropped away sharply and was down to single figures by the start of December. The worst mortality had occupied just three weeks. The hospital had 722 admissions and 232 flu deaths. That’s a 32 per cent death rate. Considering that most of these were pretty far gone by the time they got to the hospital, that’s a creditable performance for those days before antibiotics, when you only had a 50/50 chance of surviving pneumonia. The doctors estimated that at least half the city caught the flu in November 1918, and had to take to their beds. The other half, who may have had immunity from the earlier mild wave of the pandemic, were kept busy nursing the sick in their homes.
The final death toll for Christchurch was 458. That gives a death rate of 4.9 per thousand, or just under half of one per cent. Wellington was nearly 8 per thousand, and Auckland 7.6 per thousand. Dunedin got off quite lightly, with only 3.9 per thousand. Christchurch’s death rate was well below the national average for the European population of 5.8 per thousand. Just to put this in perspective, the Napier Earthquake of 1931 killed 256 people. One of NZ’s worst disasters. Yet the 1918 flu killed nearly twice that number here in Christchurch in just a few weeks; in Auckland it killed four times the number who died in the Napier Earthquake. The total flu mortality for NZ was 8,500 – that’s nearly half the number of NZ soldiers killed in the four years of the First World War. We should pause for a moment and reflect on all those young lives lost, in the Great War and in the Great Flu. They were all someone’s beloved son or daughter, someone’s brother or sister, someone’s partner, someone’s Mum or Dad.
Once the initial medical emergency was over, of finding the worst pneumonic cases and getting them to hospital, there was a different sort of crisis facing the city. There were thousands of people recovering from the flu, who were still too weak to look after themselves. This is a phase that the current Pandemic Plan doesn’t say much about, but I was pleased to see the Ministry for Economic Development the other week starting to sketch possible scenarios for extensive social and economic disruption if the next pandemic turns out to be as bad as 1918. That was a nasty virus in 1918: survivors told me that it left them feeling as weak as a kitten for a long time afterwards. Some people had lost all their hair and fingernails from the high fevers, or had huge nosebleeds or vomited blood. They were the lucky ones who survived. But the survivors now had to be fed. Relief workers found many households with empty cupboards. In those days before any unemployment benefit, with the breadwinner off work, there were no wages coming in and no food being bought.
So the city council again took the lead and set up soup kitchens in various places; the Gas Company’s showrooms (where Rydges Hotel now stands), the Sydenham Manual Training Centre, and some of the boarding schools like St Margarets and Girls High. These kitchens were supplied by the butchers and greengrocers, and produced soup by the bucketful for the Boy Scouts to take to those households most urgently in need of help. The city council guaranteed payment to the suppliers, and later claimed the money back from central government. Dr McTurk and the Mayor may not want to hear this, but another lesson from 1918 is that pandemics are extremely expensive disasters. If we have another one, don’t expect your budget to balance for that year!
There are many other aspects of the city’s organisation to cope with the 1918 flu that I don’t have time to describe tonight, but perhaps one more deserves mention, to finish this main part of the lecture.
With the schools closed and so many children apparently immune to the flu, something had to be done for those who weren’t needed at home to care for their stricken parents. The architect Samuel Hurst Seager organised an open-air camp in Sydenham Park, with games and races and entertainments each day, and marquees where the kids could be given lunch. It worked on a ticket system, issued by the doctors or local relief committee. I recall interviewing one old chap whose father was a fireman at the Sydenham Fire Station, and he and his mates had a good racket going whereby they collected tickets from families that hadn’t used them and queued up for free soup and jellies and custard. That is until his mother got to hear about it, and gave him a smart clip over the ear, saying ‘that soup is for the needy, not the greedy!’ He never forgot that clip over the ear! The open-air childcare centre worked very well, until the tents were flattened by a hailstorm at the end of November. But by then the worst of the flu was obviously over, and people were returning to work and the city was beginning to come alive again.
That brings us to the final question: Could Christchurch do it again if we had another flu outbreak as bad as that of 1918?
When she was interviewed by the Epidemic Commission in 1919 Nurse Maude agreed with the commissioners’ suggestion that Christchurch had, and I quote, ‘risen to the occasion’. There was never any shortage of volunteers or cars, as there had been in Wellington. She thought there had been a bit of overlapping and wasted effort, but on the whole the relief organisation worked well, and she thought that from all the practical lessons learned in November 1918 the city would cope even better if the flu returned. Well, happily it didn’t return in 1919 or 1920 or thereafter. But I fear that many of those simple practical lessons of organisation have by now been well and truly forgotten in Christchurch, and that if we have another public health crisis like that of 1918 there will once again be a lot of trial and error while we learn the lessons all over again, and in a different context.
Such a lot has changed in New Zealand society since 1918 that we can’t be too complacent and assume that the city would once again rise to the occasion in the same way. The virus may behave differently. It may not be as lethal as the 1918 flu. But there’s a chance that it might be much worse. This H5N1 virus is a very nasty one. So far there have been over 120 human cases, and half of them have died. If the virus learns how to spread direct from human to human and kills at the same rate, we’d be looking at a repeat of the Black Death, when half the populations of Italy and England perished in the fourteenth century, and a third of the entire European population died. Let’s all hope it doesn’t come to that. But we just don’t know as yet. The WHO has another flu pandemic at ‘high risk’, the same as they had SARS in 2003, and they don’t do that lightly. The experts are very worried. The risk is there. At present it is still only a possibility, but it is hovering on the brink of becoming a probability.
But at least we have some big advantages over our predecessor citizens of Christchurch in 1918. We’ve had plenty of warning, and time to make preparations. As I said on the radio to Kim Hill a few weeks ago, it’s better to have some preparations and no pandemic, than to have a pandemic and no preparations. We also know exactly what we will be dealing with, a viral infection, and there are simple practical ways to reduce the risk. Frequent hand-washing, face-masks, use tissues not hankies, avoid kissing and crowds, keep your distance at work, and so on. There’s a lot of good advice available at your nearest medical centre. Go and get a leaflet tomorrow!
At least we now have a Pandemic plan, which they didn’t have back in 1918. The first version was released in 2002 and was known as IPAP or the Influenza Pandemic Plan. Then came the SARS scare of 2003, and the plan was revised to cover any sort of EID (Emerging Infectious Disease). Notice how the bureaucrats love acronymns! More on this in a moment. The plan has been revised and updated and is now the NHEP (National Health Emergency Plan). It runs to 54 pages and sets out a very comprehensive chain of command, identifying all the various levels and components of the NZ health system, as well as police and civil defence, and says who is responsible for what if a pandemic hits, and who should do what and how they should all keep in touch with each other. It is very impressive and a credit to the Ministry of Health planners, who have obviously tried to think of every possible contingency.
This is a splendid plan, and it should help us all to sleep peacefully in our beds at night, at least until the pandemic comes. I do have a few little niggles about it, and some big ones. The little niggles are to do with the use of acronyms. I remember pointing this out at a conference of the Influenza Immunisation Awareness Group in Wellington in 2003. One of the officials was referring to PPDs, and in my ignorance I put up my hand and asked, please sir, what is a PPD? He looked at me, pityingly, and said,’ a Personal Protection Device’. Well, to most of our students out at the university, the first thing that would suggest would be a condom. No, in this context, he meant a face-mask. They come under the general acronym of PPE (Personal Protection Equipment). Well that’s fine and dandy for officials in the know, but a pandemic is going to involve all of us, the ordinary citizens. I suggested that they should be calling them face-masks if that is what they meant. Far better to call a spade a spade.
My big niggle about the plan concerns the assumption that all the key people will be on deck to do what is expected of them. As historians well know, wars and revolutions almost never run according to plan, and pandemics are very like wars and revolutions. They are full of surprises that nobody expects. What went wrong in Wellington in 1918 was that most of the doctors and all the key health officials themselves came down with the flu, and for a week there was nobody in charge to organise anything. That was a fatal delay for hundreds of people, the flu raced out of control, and Wellington finished up with the worst main-centre death rate in 1918.
Now, of course, we have the advantage of the anti-virals, the plug-drugs discovered by some Australian scientists, almost by accident apparently, in someone’s lunch-hour, or so I’ve been told. There’s another interesting story! The Ministry of Health has persuaded the government to invest heavily in stockpiles of Tamiflu to protect those key officials and front-line staff such as doctors, nurses, ambulance drivers, police and civil defence. Let’s hope it works. But if it doesn’t, we will need back-up people, deputies in depth, who can step into the shoes of anyone who falls ill and who know what has to be done. Again I’d stress the need for team-work, and that means advance training and exercises, as I discovered when I was researching my book on St John Ambulance in Christchurch. Training is vital for effective teamwork. The more elaborate the plan and chain of command, the greater the risk that some bits of it may break down and stop working. This applies to any large organisation, of course, including our present city council, the regional council, Environment Canterbury, and (dare I say it) the University of Canterbury.
Another big advantage we have over 1918 is that we now have antibiotics to cope with the secondary infections (mainly pneumonia) that killed most of the victims in 1918. But there are problems here with the delivery mechanism. If Tamiflu works we should have enough doctors and nurses on deck to distribute antibiotics to those who need them. But will we have enough stocks? The Pandemic Plan is a bit vague on this point, and leaves it up to the District Health Boards to make sure they have enough stocks in their regions. But as my own GP warned me, some people are allergic to penicillin-based antibiotics, and he would not like to see them dished out en masse like Tamiflu. That could cause more harm than good. But I am pleased to report that Christchurch’s doctors are extremely well-organised, and have been thinking about this problem in advance. Pegasus Health has taken the lead and organised training seminars. Most if not all practices now have a designated pandemic controller, and the aim is to set up separate flu clinics so that these patients won’t cross-infect people with ordinary ailments. Let’s just hope that the secondary infections are bacterial pneumonias. Antibiotics won’t be of much use if the bird-flu causes viral pneumonia.
The medical response is therefore likely to be far more prompt and effective than it was in 1918. But as a historian I still have a strong hunch that a lot of things will break down if we have a really serious outbreak, and a lot of people fall ill all at once. My guess is that the front line, then as now, will be in our own homes and in our immediate neighbourhoods. So we need to stock up for an emergency, not just a Y2K hiccup, but seriously, as if for a flood or an earthquake. If we had to survive without access to supermarkets for two or three weeks, would we have enough to live on? We can’t assume the government will send in supplies by helicopter! And if there are thousands of people who survive the flu, as in 1918, but are still in bed for several weeks as helpless convalescents, who is going to feed them and look after them? That’s one important point the Pandemic Plan doesn’t really address, as Tony Ryall pointed out last week. This is where local government will have a vital role to play, vital because it could mean the saving of many lives. This is an eventuality we need to plan for now. It’s no good waiting until the pandemic bursts upon us.
We need to revive our neighbourhood watch groups, get to know our neighbours, and make sure we all have the names and phone numbers of the people who live close to us. My wife is an expert on Japanese language and literature, and she tells me that under the bakufu system in Tokogawa Japan every household had to know who their neighbours were, the ones on either side and the three opposite. This was part of the feudal system of policing and social control. If one householder committed a crime, the heads of all six households would be punished. That’s a bit drastic, eh! It would soon fill the prisons if we had it here. But it made sure you knew your neighbours and what they were up to! And it’s not a bad model for neighbourhood watch groups in a pandemic, so even if several households come down with flu there should be someone in that group to look after them. Now we have cell-phones and e-mail to keep in touch. Remember, if you start feeling feverish and dizzy, ring someone and tell them you’re crook before you pass out!
We’ll need stocks of face-masks to protect the volunteers who will go door-knocking to check how many have the flu, and to protect the volunteers who will have to look after households where everyone is in bed with the flu. Do we all know how to nurse a severe case of pneumonia at home? How to control the fever without chilling the patient? How to replace fluids, and keep their strength up? How to toilet people who are utterly helpless? If a lot of people fall ill at once, which is the usual pattern with pandemic influenza, the hospital will soon be swamped. You may ring for an ambulance but you will probably have to join a waiting list. We may all need training in home nursing, especially of pneumonia, and that is something I think the Ministry of Health ought to add to its pandemic plan. They could use the TV to show people what to do. It would make a useful change from watching the ads or the soaps!
In 1918 a lot of public-spirited volunteers got out and helped their neighbours regardless of the risk to themselves. Many of the old folk I interviewed about the flu told me they just put their trust in God and did what had to be done. I wonder how many people today in Christchurch would adopt that same brave selfless attitude? Far fewer, I suspect. In 1918 the Boy Scouts did marvellous work taking soup and medicine to stricken households. How many parents today would even let their kids out of the front door in a pandemic? In 1918 most people didn’t bother to lock their doors at night. They didn’t need to. People were much more trusting and law-abiding back then, and Christian values of honesty and charity were far more widely practised. How many people today would be more inclined to lock their doors and look after themselves, and watch what’s happening on TV? In the North Island I came across several examples of people who had locked their doors, refused access to the relief patrols, and were later found dead inside their homes. There has to be a happy medium between such extreme isolation and helping your neighbours. Confusingly, isolation is one of the things recommended by the health authorities, but that contradicts the basic principle of community survival, which is that we should help one another in times of need. New Zealand society has changed a great deal since 1918. We now live in a much more materialistic and individualistic society, the ‘me’ generation of affluence and instant gratification. Families are much smaller than they were in 1918, when even if both parents were sick in a family of six there would be an older child to look after the rest. Families today are smaller and more scattered. There are many more solo parents with young children. A lot more people live alone than was the case in 1918, and a lot more of our elderly are living in retirement homes, which are so vulnerable to the spread of viral infections.
So there are a lot of questions we can’t answer as yet, and a lot of doubts and fears as we try to anticipate and prepare for a major pandemic. I do hope it doesn’t happen, but if it does it will test us all to the max. It will sort out the brave from the cowards amongst us, it will sort out the kind from the selfish, it will sort out the doers from the talkers. As I remarked to Kerre Woodham on Newstalk ZB in Auckland at the weekend, there’s a hero deep inside all of us; in an emergency, I hope we’ll all be brave enough to find that hero inside and be brave enough to do what has to be done. I’d like to end on an optimistic note. Let’s hope this Bird-flu, if it comes, is no worse than 1918, because back then less than one per cent of the population died. Nearly everyone who got the flu got over it. We need to keep a sense of proportion and use our common sense. I’d like us all to be cheerful Charlies, and to stay positive. And always remember, however many die, life will go on for the survivors, as it did even in the Black Death and the Great Plague of London. Life is for living. Take each day as it comes, but make the most of every day. Thank you for listening so patiently.