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NZ 1918: When the flu came to town

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  • NZ 1918: When the flu came to town

    Hat tip Kiwibird

    When the flu came to town

    As fear over swine flu grows, the impact of the Spanish Flu years ago remains a graphic illustration of what happens when a pandemic hits. PHILIP MATTHEWS reports.

    Scenes from an epidemic. In Kaikoura, the funeral of a 38-year-old man is said to have been well attended; he died in Christchurch from influenza, leaving behind a wife and seven children.

    Photos: PRESS FILES


    The medicine depot in Christchurch’s Cathedral Square, from where the government’s influenza medicine was supplied. Essential supplies: Boy Scouts distribute food and medicine to patients at their homes in Christchurch in 1918. A South African soldier dies in a boarding house in Peterborough St; The Press reports that ‘‘it was not possible to get any medical assistance for him’’.

    A 26-year-old man dies in Merivale, and ‘‘considerable trouble was found in getting an undertaker to provide a coffin and attend to the body, which had got into a terrible state very rapidly’’.
    And from Auckland: ‘‘A sad case of a mother and father dying from the effects of influenza and leaving behind four children, two of whom are ill.’’

    Church services are being held in the open air. Visitors are not admitted to Christchurch Hospital unless sent for. The Medical Superintendent of the hospital, Dr Fox, breaks down ‘‘as a result of overwork’’.

    These stories are a small selection of those that ran in The Press on just one day: Monday, November 18, 1918. On that day, the newspaper’s editorial claimed that ‘‘the weekend was the most dismal Christchurch has ever experienced’’. Shops were shut, streets were deserted, trams weren’t running. The only activity in the otherwise abandoned centre of town was around the medicines depot in Cathedral Square ‘‘and this briskness was not cheerful but ominous’’.
    Over that weekend, 117 people were admitted to the city’s hospitals with influenza, and 33 died. The same death rates continued for several more days and then fell off. In all, 458 people died in Christchurch during the 1918 influenza epidemic, a death rate of 4.9 per 1000.
    Every day,

    The Press carried updates from the 27 districts the city had been dissected into for epidemic control purposes, plus Canterbury’s outlying towns.

    ‘‘Like most places, Rangiora is in the grip of influenza,’’ the newspaper reported on November 16. On November 19, an update from Sydenham: ‘‘In one block of six houses on Brougham St, there were 43 cases.’’
    Initially, the threat seemed remote.

    A headline on November 1: ‘‘Epidemic widespread in Auckland. Two more deaths.’’ Something from the international page on November 14: ‘‘Statistics published show that 50,000 deaths occurred through influenza in South Africa and Rhodesia. Seven thousand of the victims were white.’’

    To read the newspapers of November 1918 is to see the euphoria of the World War I armistice suddenly give way to this new and more immediate threat: the enemy within.

    A ‘‘well-known undertaker’’ says he has never seen death rates like these. Three of Christchurch Hospital’s five doctors are sick, and one has died.

    The Linwood cemetery fills up, and there are stacks of coffins waiting to be buried in Sydenham. The Karitane Hospital in Cashmere takes in babies whose mothers have fallen sick. But then the hospital’s nurses fall sick themselves, one after the other.

    University of Canterbury historian Geoffrey Rice read these and other first drafts of history when he first became interested in the 1918 epidemic. His interest ultimately resulted in his seminal study, Black November, which first appeared in 1988 and has since been reprinted.
    Back in the 1970s, he saw that a national disaster that took the lives of about 8600 New Zealanders in a couple of months, within a worldwide total of between 40 and 50 million, had been largely forgotten. Where were the memorials, the histories?

    Which was curious, given the impact. ‘‘My guess is that there was scarcely a family in the country that didn’t know somebody who was bereaved or afflicted by the flu,’’ Rice says.

    Including his own, as it turned out. When Rice first raised the subject more than three decades ago, he heard his father’s story.
    His father was nine in 1918, and living in Taumarunui. His family was one of the few not to be affected.

    The able-bodied were recruited for relief work, even the children. Rice’s dad’s job was to go from house to house lighting coal ranges and checking bedrooms for those who had died overnight.

    It was an alarming sight for a nineyear-old: the bodies turned very black very quickly, due to cyanosis. For this reason, the 1918 epidemic was colloquially known as ‘‘the black flu’’.

    Rice later interviewed a nun who sat at the bedside of a dying man in Christchurch. She saw a strong, healthy-looking man suddenly take a big gulp and turn ‘‘jet black, not blue or purple, but black like an African’’.
    That said, Christchurch’s death rate of 4.9 per 1000 was well below those recorded in Auckland and Wellington. Auckland’s rate was 7.6 per 1000, rising to 13.4 per 1000 in crowded inner-city suburbs like Grey Lynn and Newton. Wellington’s was 7.9 per 1000, with higher rates again in the central suburbs.

    And those are the Pakeha death rates: the Maori death rate in Auckland was a staggering 68.4 per 1000, and nationally 42.3 per 1000.
    Why did Christchurch and Dunedin (3.9 per 1000) get off relatively lightly? There was the obvious time lag in a pre-air travel era. The virus had to come in by boat, which it duly did: it is said that one of the great failings of the Health Department was not stopping the ferries that brought infected crowds from Wellington to Lyttelton for Cup and Show Week.

    A second factor was the lower population density of the southern cities. Christchurch nurse Sibylla Maude told the Epidemic Commission of 1919 that she saw few examples here of the overcrowding that was so common in the north.

    Are there are lessons from 1918 that might be useful to us in the swine flu age? Yes, Rice says. There is the basic information around personal hygiene and social distancing.

    Hygiene first. There was a lot of gargling going on in 1918, but Rice suspects that it did more harm than good. But a study in Japan during a flu outbreak two years ago found that those who made a point of brushing their teeth and their tongue a few times a day reduced the flu’s severity. It was compared with keeping a doorstep swept.
    As for social distancing, it was a cruel twist in 1918 that armistice celebrations brought people together only to infect them. But authorities were smart to close schools, pubs and churches.
    Then again, inhalation treatment reassembled the same crowds, most notoriously at the site of the first inhalation chamber, in Manchester St, where the sneezing and the coughing were jammed together into a stairwell, awaiting their doses.

    Those inhalation sprays involved a 2 per cent zinc sulphate solution. Did it actually do any good? Opinion was divided, even if someone in Christchurch had the brilliant idea of converting 14 city trams into mobile inhalation units.

    Rice says the plus side of inhalation treatment is that it may have done something for the hygiene of people’s nasal passages, but in some cases the mixture was too strong, which inflamed nasal tissue and made people more susceptible to influenza. It’s worth noting that such treatment is not recommended now.

    This time, the main tool is Tamiflu, and the Ministry of Health’s pandemic plan is to identify the threat, isolate it and stamp it out. But in a pandemic, hospitals and health services will be overwhelmed.
    Expect to be thrown back on your own resources, Rice says. Have food stocks handy, along with Tamiflu and Panadol for the headaches.
    ‘‘You also need to know something about the practical nursing of pneumonia and the control of fever,’’ he adds.

    The worry is that fevers make patients delirious. ‘‘The noise of the delirium at night was terrific,’’ a nurse from 1918 said in the 1967 radio documentary The Great Plague. She went on: ‘‘Once they got very delirious, we just couldn’t save them, and there was no way of bringing the temperatures down except by cold sponging. And that had to be done by somebody with experience, otherwise they would get an awful shock and chills as well.’’

    In Japan in 1918, they worked hard on keeping fever down and got a relatively low mortality rate as a result, Rice says. Japanese households had medicine chests of powdered remedies; supplies of ground-up peony root were found to clear sinuses and control fever.

    ‘‘Another lesson from 1918 is that when you’ve got a lot of people off sick, you’ve got a real problem feeding them.’’

    What will happen if there are shortages? In 1918, supplies arrived by ship, and Wellington nearly ran out of flour and coal, two essential commodities. Now, supermarkets rely on shelves being restocked from trucks that roll down the highway from Auckland. The possibility of truck drivers being sick, along with the checkout operators and shelf stockers, has been factored into the pandemic plan, which Rice calls ‘‘an astonishingly thorough piece of thinking ahead’’.

    Any further lessons from 1918? Just the last and most alarming one. Don’t be lulled into a false sense of security by reports that have relatively few people dying from swine flu.

    In 1918, there was a first wave, with high levels of infection but a lower mortality rate. It was the second wave that did the real damage: somehow, a ‘‘mild form’’ of the virus shifted gears and became unusually infectious and fast-breeding.

    ‘‘The worry about this one is that it’s out of the box,’’ Rice says.


    ‘‘It’s spreading internationally. My heart sank when I heard the World Health Organisation say that it’s gone beyond the containment stage.’’

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