Living with Enza Also by Mark Honigsbaum The Fever TraiI: the Hunt for the eure for Malaria Valverde's Gold: in Search of the Last Great Inca Treasure Living with Enzo The Forgotten Story of Britain and the Great Flu Pandemie of 1918 Mark Honigsbaum Palgrave Macmillan © Mark Honigsbaum 2009 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Totten ham Court Road, london W1T 4LP. Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The author has asserted his right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988. First published 2009 by MACMILLAN Houndmills, Basingstoke, Hampshire RG21 6XS and 175 Fifth Avenue, New York, N.Y. 10010 Companies and representatives throughout the world ISBN 978-0-230-21774-4 ISBN 978-0-230-23921-0 (eBook) 00110.1007/978-0-230-23921-0 This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. A catalogue record for this book is available from the British Library. A catalog record for this book is available from the Library of Congress. 10 9 8 7 6 5 4 3 2 1 18 17 16 15 14 13 12 11 10 09 Transfcrcd to Digital Printing 2013. Fürmy father, Frank (antents list of figures viii acknowledgements ix prologue xii part I chapter 1 influenza: a primer 3 chapter 2 prelude : Etapies, winter 1916-1918 18 part 11 chapter 3 first wave, March-August 1918 35 chapter 4 second weve, September-December 1918 65 chapter 5 third wave, January-May 1919 107 part 111 . chapter 6 Vietnam, February 2005 153 chapter 7 Britain, Summer 2012 179 epilogue 199 biographical postscript 206 notes 212 selectedbibliography 224 index 228 vii li..+ "J Ji ... ________lULU.L.I..l\I'"""uCL[JOLeso«...- _ 1.1 Everyone has influenza 13 2.1 The piggery at Etapies 21 3.1 Sir Arthur Newsholme 58 4.1 A patient with advanced cyanosis 81 4.2 [arnes Niven 100 5.1 Major Greenwood 113 5.2 A mobile bacteriology laboratory 118 5.3 Mr Punch wrapped up in blankets in front of the fire, eating 143 gruel and suffering from influenza 6.1 Two women selling ducks at Hanoi wet market 159 E.1 George Newman 200 viii _____--"'ou..Jcknmrledg~e.LLmUlel.U.t.n.s'-------- I have been fascinated with the 'Spanish' inf luenza for many years but until I stumbled on Richard Collier's extraordinary eolleetion of letters at the Imperial War Museum I eould not see a way of doing justice to the British experienee of the pandemie. My first thanks then go to Richard Collier for having the means and wherewithal to eolleet the testimonies of British survivors before they were lost to history, and to the trustees of the Imperial War Museum for allowing me to quote from the letters freely. My seeond stroke of good fortune was in diseovering Will Francis at the literary ageney Greene and Heaton. lt was Will who encouraged me to see the testimonies in the Collier Colleetion not merely as first-hand aeeounts of a eatastrophic disease event but as a window onto a particular period of British history. In partieular, Will worked with me on early drafts of ehapter four, helping to eontextualize the material and to bring out the eonditions on the Home Front - eondi- tions which, I believe, go some way to explaining the stoicism of British survivors and why the experienee of the pandemie was so quiekly 'forqotten.' [ust as it was important to put the pandemie into a proper social eontext so it was essential to give readers some sort of scientific envelope with which to make sense of the theories about the origins of the 1918 virus and its unusual pathology. In particular, I am indebted to Professor Peter Openshaw at Imperial College, London, for taking the time to explain to me the various ways in whieh viruses and baeter ia trigger ix x acknowledgements infections of the respiratory tract and for helping me to under- stand the practical constraints on bacteriologists in 1918. This book could also not have been written without the help of Professor'lohn Oxford at Queen Mary's Medieal School, London. Oxford has been fascinated with the 1918 pandemic for far longer than I and in his pursuit of viral fragments from 1918 has built up an invaluable archive of offieial reports, letters and other historieal documents, many of whieh he kindly made available to me in the course of my research. He and his colleague, the military historian Douglas Glll, alsoshared with me the results of their investigations at Etapies - research whieh has done much to challenge the theory of a Kansas origin and to restore interest in the British and European history of the pandemie. . In addition, I also enjoyed many fruitful conversations with [ererny Farrar, the director of the Oxford University Clinieal Research Institute at the Hospital for Tropieal Diseases in Ho Chi Minh City. Farrar's insights into the epidemiology of bird flu provided me with a useful yardstiek against which to measure the debate over the origins of the 1918 virus and the supposed 'inevitably' of the emergence of a similarly lethai pathogen in the near future. All of the above also read key sections of the manuscript, drawing my attention to errors and correcting gaps in my understanding of the virology of influenza and the functioning of the human immune system. The science was not the only area filled with potential minefields. The voluminous military and social history of WW1 was similarly daunting, as was the regulatory context within whieh key publie health officials such as Arthur Newsholme and George Newman operated . For his insightful comments into the social, economie and politieal conditions on the Home Front in 1918 I am indebted to Nicky Howard; for their com- ments on the key medieal and health officials who feature in