Review of 'The “Spanish Flu” Pandemic Of 1917-19 And Its Military Impact by Dr Jane and Michael Orr (October 2017)

The influenza virus is made up of strands of RNA surrounded by a sphere made up of two types of protein. Spanish flu, which is coded H1N1, was a particularly dangerous form of flu. The proteins have different purposes, one attaches the virus to a cell, the other releases the RNA. Spanish flu took an enormous toll on the armies in 1918. There are over 7,000 graves due to Spanish flu at Étaplesincluding a large number from the RAMC and the majority of the casualties taken by all sides in the final months of the Great War were due to Spanish flu (approx. between 50 and 100 million worldwide). How did this form of flu obtain its name? It was a Spanish newspaper which was the first to report this virulent form of flu, which it called French flu. In fact, the flu was raging in all the combatant countries but not one was prepared to report it as this would have been seen as a weakness. In the UK alone over 180,000 died in three weeks.

The deadliness of H1N1 was its effect on the bloodstream, any infection produces a rush of blood to the site infected, usual bodily control eventually reduces the blood flow when sufficient antibodies are involved. In the case of H1N1, this reduction does not take place and the patient dies from a cytokine storm, overreaction of the body’s immune system. Usually infants and the elderly die from influenza, Spanish flu killed fit young adults. In India 17 million (5% of the population) died, in the USA 675,000 (0.67%), in France 400,000 (1%) and in the UK 250,000 (0.6%).20% of those infected with Spanish flu died, opposed to the usual 0.1% mortality from the more usual forms of flu.

Survivors often suffered badly form ordinary infections later in their lives.

The influenza virus mutated as 1918 wore on, the first wave which had its major effect in June was not nearly as dangerous as the second wave (which produced a deadly form of pneumonia) which affected everyone again in October (there was a third wave in early 1919 but his was not as deadly as further mutation had produced a milder form). Anyone who had survived the first wave had immunity to the second wave.

The Medical Research Committee sent a virologist with mice and primates to France in September 1918 to investigate the flu. Post-mortem reports on baboons and rhesus monkeys revealed the damage to the lungs before death.

Military implications of the flu can be traced to Ludendorff’s explanation for poor performance of the German Army during the summer of 1918, he claimed flu was affecting the supply chain to his front-line troops who were suffering accordingly. 

The German Spring Offensive was launched before the effects of the first wave caused problems for all armies. In June, when the first wave had its greatest effect, supplying sufficient fit young soldiers for battle delayed the Allies’ counter offensive. When the second wave, which was deadlier, took effect in October, its effect on the Allies was minimal, it was the German army which could not respond to the continual offensives. The flu did produce logistical problems in late autumn but the war was coming to an end by this stage.

In Italy we can trace the effects of the flu during the two major offensives of 1918. When the Austrian attack took place on June 15, 23rd Division was recovering well from the first wave but 48th Division was suffering up to 50% casualties in some battalions – 1/5 Gloucester’s had less than 200 men in the line when the Austrians attacked. In fact, flu affected the staff work of the division, the GOC, Fanshawe, was the only fit member of his staff most days. He would leave the ‘least ill’ member of staff to mind HQ when he visited the front line each day. Unfortunately, it was the front manned by the Gloucester’s which suffered the greatest Austrian incursion. It took 24 hours and two battalions from the reserve to push the enemy back. This and the ammunition dump fire sealed Fanshawe’s fate. He was sent home after the offensive. When the second wave swept through the armies in October, the Austrian command could not cope with continual fighting and asked for an armistice in early November.

Report by Peter Palmer