Fighting Flu: Military Pathology and the 1918–1919 Pandemic

Bresalier, Michael

doi:10.1057/978-1-137-33954-6_4

Michael Bresalier⁴

Part of the book series: Medicine and Biomedical Sciences in Modern History ((MBSMH))

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Abstract

The 1918–1919 influenza pandemic was encountered in Britain by a militarised nation in which medicine had been mobilised and transformed by the war machine. British approaches to the pandemic were governed by a military logic, developed in the years before 1918, in which the pathological laboratory provided key solutions to understanding and managing infectious diseases. This logic dictated two interrelated pandemic strategies: the identification of the primary causative agent—the germ—of influenza and the rapid production of preventive vaccines. During the war, these strategies were key to the military management of infections; during the pandemic they acted as important reference points for the organisation of medical scientific approaches to influenza. Re-examining the relationship between the pandemic and the war, this chapter traces the decisive role played by a highly militarised form of medicine and wartime imperatives in the development of official knowledge and strategies against the pandemic. Despite the enormity of effort, scientific medicine and especially bacteriology, had limited impact on the course of the pandemic. While some historical assessments suggest that this signified a ‘failure’ of scientific medicine, this chapter shows that these challenges gave rise to new approaches to influenza and were translated into opportunities to transform scientific research organisation and practice in Britain.

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Notes

1.
Arthur Newsholme, ‘Discussion on Influenza’, Proceedings of the Royal Society of Medicine, 12 (1918–1919), 1.
2.
Edwin Oakes Jordan, Epidemic Influenza: A Survey (Chicago: American Medical Association, 1927); John S. Oxford, ‘Influenza A Pandemics of the 20th Century with Special Reference to 1918, Virology, Pathology, and Epidemiology’, Reviews in Medical Virology, 10 (2000), 119–133; Niall P.A.S. Johnson and J. Mueller, ‘Updating the Accounts: Global Mortality of the 1918–1920 “Spanish: Influenza Epidemic’, Bulletin of the History of Medicine, 76 (2002), 105–115.
3.
Original estimates by the Registrar-General put the number of deaths from influenza in London between October and December 1918 at close to 12,000. Registrar-General, Report on the Mortality from Influenza in England and Wales during the Epidemic of 1918–19, Supplement to the Eighty-First Annual Report of the Registrar-General (London: HMSO, 1920). William Hamer revised the figure to close to 16,000. William H. Hamer, Report on Influenza by the County Medical Officer of Health (London: County Hall, 1919), 20. Recent estimates support this figure. Johnson and Mueller, ‘Updating the Accounts’, 105–115; Christopher Langford, ‘The Age Pattern of Mortality in the 1918–19 Influenza Pandemic: An Attempted Explanation Based on Data for England and Wales’, Medical History, 46 (2002), 1–20.
4.
The first estimates by the Registrar General put the toll at 151,446; when Scotland was included the figure was rounded up to 198,000. Registrar-General, Report on the Mortality from Influenza in England and Wales during the Epidemic of 1918–19, 3. More recent estimates have put the figure closer to 220,000. See Johnson, Britain and the 1918 Influenza Epidemic; Niall Johnson ‘1918–1919 Influenza Pandemic Mortality in England and Wales’ [computer file]. Colchester, Essex: UK Data Archive [distributor], July 2001a. SN: 4350. http://www.data-archive.ac.uk/ (Accessed 10 January 2018).
5.
Karl G. Nicholson, Robert G. Webster and Alan J. Hay (Eds.), Textbook of influenza (Oxford, Blackwell, 1998), 11. A more recent estimate suggests the number could range between 50 and 100 million; see Johnson and Mueller ‘Updating the Accounts’, 15.
6.
Major Greenwood, ‘The epidemiology of influenza’, BMJ (23 November 1919), 563–566.
7.
Newsholme, ‘Discussion on Influenza’, 1; Arthur Newsholme, ‘Epidemic Catarrhs and Influenza’, Lancet (2 November 1918), 599.
8.
Mark Harrison, The Medical War: British Military Medicine in the First World War (Oxford: Oxford University Press, 2010), 1–15.
9.
Mark Osborne Humphries, ‘Paths of Infection: The First World War and the Origins of the 1918 Influenza Pandemic’, War in History, 21.1 (January 2014), 55–81; John S. Oxford et al., ‘World War I May Have Allowed the Emergence of “Spanish” Influenza’, The Lancet Infectious Diseases Journal, 2.2 (February 2002), 111–114; Robert J. Brown ‘The Great War and the Great Flu pandemic of 1918’, Wellcome History, 24, 5–7; John S. Oxford, 2001, ‘The So-called Great Spanish Influenza Pandemic of 1918 May Have Originated in France in 1916’, Philosophical Transactions of the Royal Society of London, B, 336 (2001), 1857–1859; Andrea Tanner ‘The Spanish Lady Comes to London: The Influenza Pandemic 1918–1919’, London Journal, 27 (2002), 51–76; Carol R. Byerly Fever of War: The Influenza Epidemic in the U.S. Army during World War I (New York: New York University Press, 2005).
10.
The relationship between the militarisation of medicine and the pandemic has started to receive some attention. Carol Byerly has examined how the organisation of military medicine within the U.S. Army affected its approaches to the pandemic. See, Carol R. Byerly, Fever of War: The Influenza Epidemic in the U.S. Army during World War I (New York: New York University Press, 2005); Carol R. Byerly, ‘The U.S. Military and the Influenza Pandemic of 1918–19’, Public Health Reports, 125, Suppl. 3 (2010), 82–91. John Barry has elucidated the efforts (and failures) of laboratory pathologists enlisted in the American war machine to identify and control the influenza germ. See, John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (London: Penguin Books, 2004). My argument has benefitted most from Anne Rasmussen, who has argued that in France ‘the management of influenza took place within the military health organization’. Anne Rasmussen, ‘Prevent or Heal, Laissez-Faire or Coerce? The Public Health Politics of Influenza in France, 1918–1919’, in Tamara Giles-Vernick and Susan Craddock (Eds.), Influenza and Public Health: Learning from Past Pandemics (London: Earthscan, 2010), 73.
11.
Sandra M. Tomkins, ‘Britain and the Influenza Epidemic’, Ph.D. Thesis. Department of History, University of Cambridge (1989), 238.
12.
Tomkins ‘Britain and the Influenza Epidemic’, 239.
13.
Herbert French noted similarities in the gross pathology of the two conditions. Herbert French, ‘Influenza’, Guy’s Hospital Gazette, no. XXXIII (1919), 118–127.
14.
‘The Influenza Epidemic’, Lancet (2 November 1918), 595.
15.
‘The Spanish Influenza: a sufferers’ symptoms’, The Times (25 June 1918), 9; ‘The Mystery of Influenza’, Times (28 October 1918), 7. For metaphors of ‘seed’ and ‘soil’, see Worboys Spreading Germs, 283–285.
16.
‘The Etiology of Influenza’, BMJ (2 November 1918), 494.
17.
Influenza Committee of the Advisory Board to the D.G.A.M.S., ‘A Report on the Influenza Epidemic in the British Armies in France, 1918’ BMJ (9 November 1918), 505.
18.
Major Greenwood, ‘Discussion on Influenza’, Proceedings of the Royal Society of Medicine, 12 (1918), 23.
19.
Greenwood ‘Discussion on Influenza’, 23–24; Major Greenwood, Epidemics and Crowd Diseases: An Introduction to the Study of Epidemiology (London: Williams and Norgate, 1935).
20.
Newsholme ‘Discussion on Influenza’, 1.
21.
Olga Amsterdamska, ‘Standardizing Epidemics: Infection, Inheritance and Environment in Prewar Experimental Epidemiology’, in Jean-Paul Gaudillière and Ilana Löwy (Eds.), Heredity and Infection: Historical Essays on Disease Transmission in the Twentieth Century (London: Routledge, 2001), 135–180.
22.
Crosby, America’s Forgotten Pandemic, 217.
23.
Jay Winter, The Great War and the British People (London: Macmillan, 1985), 104; 114–117; 120–132.
24.
Thomas H.C. Stevenson, ‘The Incidence of Mortality Upon the Rich and Poor Districts of Paris and London’, Journal of the Royal Statistical Society (1921), 1–30.
25.
Catherine Rollet, ‘The ‘Other War’ II: Setbacks in Public Health’, in Capital Cities at War: Paris, London, and Berlin 1914–1919, Jay Winter and J-L. Robert (Cambridge: Cambridge University Press, 1997), 480, 482.
26.
Patrick Zylberman, ‘A Holocaust in a Holocaust: The Great War and the 1918 ‘Spanish’ Influenza Epidemic in France’, in Howard Phillips and David Killingray (Eds.), The Spanish Influenza Pandemic of 1918–19: New Perspectives (London: Routledge, 2003), 191.
27.
Ian D. Mills, ‘The 1918–1919 Influenza Pandemic—The Indian experience’, Indian Economic and Social History Review, 23.1 (1985), 35. For revised estimates of Indian mortality, see Johnson and Mueller, ‘Updating the Accounts’, 111–112.
28.
Mridula Ramanna, ‘Coping with the Influenza Pandemic: The Bombay Experience’, in The Spanish Influenza Pandemic of 1918–1919, 95.
29.
Kevin McCraken and Peter Curson, ‘Flu Down Under: A Demographic and Geographic Analysis of the 1919 Epidemic in Sydney, Australia’, in The Spanish Influenza Pandemic of 1918–19, 130–131.
30.
Esllyt Jones, Influenza 1918: Disease, Death and Struggle in Winnipeg (Toronto: University of Toronto Press, 2007); Mark Humphries, The Last Plague: Spanish Influenza and the Politics of Public Health in Canada (Toronto: University of Toronto Press, 2013).
31.
Mike Davis, The Monster at Our Door: The Global Threat of Avian Flu (London: New Press, 2005), 30.
32.
Burnet and Clark, Influenza: A Survey of the Last 50 Years, 98.
33.
Paul Ewald, Evolution of Infectious Disease (Oxford: Oxford University Press, 1994), 109–118.
34.
Jeffery Taubenberger, ‘The Origins and Virulence of the 1918 “Spanish” Influenza’, Proceedings of the American Philosophical Society, 150 (2006), 86–112.
35.
Byerly, Fever of War, 8.
36.
Andrea Tanner, ‘The Spanish Lady Comes to London: The Influenza Pandemic 1918–1919’, London Journal, 27 (2002), 54.
37.
See Roger Cooter, ‘Of War and Epidemics: Unnatural Couplings, Problematic Conceptions’, Social History of Medicine, 16 (2003), 283–302.
38.
An exception is Tomkins, ‘Britain and the Influenza Epidemic’, 238ff.
39.
Harrison, The Medical War, 1–15.
40.
Winter, The Great War, 186. According to Anne Hardy by 1918, the RAMC consisted of 13,000 officers and 154,000 other ranks. See, Anne Hardy, ‘Lives, Laboratories and the Translations of War: British Medical Scientists, 1914 and Beyond’, Social History of Medicine, 30.2 (2017), 348; see also, www.ams-museum.org.uk/museum/history/ramc-history (Accessed 15 January 2018).
41.
Ian R. Whitehead, ‘The British Medical Officer on the Western Front: The Training of Doctors for War’, in Roger Cooter, Mark Harrison and Steve Sturdy (Eds.), Medicine and Modern Warfare (Amsterdam: Rodopi, 1992), 163–184.
42.
Roger Cooter, ‘War and Modern Medicine’, in William F. Bynum and Roy Porter (Eds.), Companion Encyclopedia of the History of Medicine (London: Routledge, 1993), 1536–1573; Roy Cooter and Steve Sturdy, ‘Of War, Medicine and Modernity: Introduction’, in Roger Cooter, Mark Harrison and Steve Sturdy (Eds.), War, Medicine and Modernity (London: Sutton, 1998), 1–21; Mark Harrison, ‘Medicine and the Management of Modern Warfare’, History of Science, 34 (1996), 379–410.
43.
For a detailed description and analysis, see Harrison, The Medical War, 16–122.
44.
Christopher Lawrence, ‘Continuity in Crisis: Medicine, 1914–1945’, in The Western Medical Tradition: 1800 to 2000 (Cambridge: Cambridge University Press, 2006), 257; Ian Whitehead, Doctors in the Great War (London: Leo Cooper, 1999), 210.
45.
Roger Cooter, Surgery and Society in Peace and War: Orthopaedics and the Organisation of Modern Medicine, 1880–1948 (London: Macmillan, 1993), 111.
46.
Cay-Rüdiger Prüll, ‘Pathology at War 1914–1918: Germany and Britain in Comparison’, in Medicine and Modern Warfare, 131–162.
47.
William B. Leishman, ‘Organization of the Pathological Service’, in History of the Great War Based on Official Documents. Medical Services. Pathology, 1–31.
48.
Joan Austoker, ‘Walter Morley Fletcher and the Origins of a Basic Biomedical research policy’, in Joan Austoker and Linda Bryder (Eds.), Historical Perspectives on the Role of the MRC: Essays in the History of the MRC of the United Kingdom and its Predecessor, the Medical Research Committee, 1913–1953 (Oxford: Oxford University Press, 1989), 22–33; Robert E. Kohler, ‘Walter Fletcher, F.G. Hopkins, and the Dunn Institute of Biochemistry: A Case Study in the Patronage of Science’, Isis, 69 (1978), 331–355.
49.
Medical Research Committee, First Report of the Medical Research Committee, 1914–15 (London: HMSO, 1916), 1–2.
50.
Austoker, ‘Walter Morley Fletcher’, 23–24.
51.
Leishman had been one of ‘Wright’s Men’. See Michael Worboys, ‘Almroth Wright at Netley: Modern Medicine and the Military in Britain, 1892–1902’, in Medicine and Modern Warfare, 77–97.
52.
Prüll, ‘Pathology at War, 1914–1918’, 144.
53.
Leishman, ‘Organization of the Pathological Service’, 5–6.
54.
Prüll, ‘Pathology at War 1914–1918’, 143.
55.
Prüll argues that this was a defining feature of British clinical pathology.
56.
For a comprehensive account of this system, see Harrison, The Medical War, 65–122.
57.
Leishman, ‘Organization of the Pathological Service’, 6.
58.
Prüll ‘Pathology at War 1914–1918’, 131–162.
59.
Leishman ‘Organization of the Pathological Service’, 29–30.
60.
Leishman, ‘Organization of the Pathological Service’, 23–24.
61.
Paul J. Weindling, ‘Between Bacteriology and Virology: The Development of Typhus Vaccines Between the First and Second World Wars’, History and Philosophy of the Life Sciences, 17 (1995), 81–90; Worboys, ‘Almroth Wright at Netley’. Anti-typhoid vaccine was also manufactured at the Lister Institute and Almorth Wright’s Inoculation Department of St. Mary’s Hospital.
62.
Leishman, ‘Organization of the Pathological Service’, 20.
63.
Leishman, ‘Organization of the Pathological Service’, 18.
64.
Joan Austoker and Linda Bryder, ‘The National Institute for Medical Research and Related Activities of the MRC’, in Perspectives on the Role of the MRC, 39.
65.
Austoker and Bryder, ‘The National Institute for Medical Research’, 39.
66.
For the MRC’s organisational activities, see: Medical Research Committee Annual Report of the Medical Research Committee, 1916–17 (London: HMSO, 1918); Medical Research Council, Report of the Medical Research Council for the Year 1918–1919 (London: HMSO, 1920); Walter Morley Fletcher, ‘The National Organisation of Medical Research in Peace after War’, in William E. Welch et al. (Eds.), Contributions to Medical and Biological Research, Dedicated to Sir William Osler (New York: Paul B. Hoeber, 1919), 461–470.
67.
Steve Sturdy, ‘War as Experiment: Physiology, Innovation and Administration in Britain, 1914–1918: The Case of Chemical Warfare’, in War, Medicine and Modernity, 65–84.
68.
Roger Cooter, ‘Keywords in the History of Medicine: “Teamwork”’, Lancet, 363.9416 (2004), 1245; Andrew Hull, ‘Teamwork, Clinical Research, and the Development of Scientific Medicines in Interwar Britain: The “Glasgow School” Revisited’, Bulletin of the History of Medicine, 81 (2007), 569–593; Sturdy and Cooter, ‘Science, Scientific Management, and the Transformation of Medicine in Britain’, 421–466; A. Landsbury Thomson, Half a Century of Medical Research. Origins and Policy of the Medical Research Council (UK), Vol. 1 (London: HMSO, 1973), 95–99.
69.
Medical Research Committee, Interim Report on the Work in Connection with the War at Present undertaken by the Medical Research Committee (London: HMSO, 1915), 3.
70.
Medical Research Committee, Interim Report, pp. 3–6; First Report of the Medical Research Committee, 31–48.
71.
Austoker and Bryder ‘The National Institute for Medical Research’, 53.
72.
For the relationship between the war and the professionalisation of pathology, see: William D. Foster, Pathology as Profession in Great Britain and the Early History of the Royal College of Pathologists (London: E&S Livingstone, 1965), 19–20; for the scale of pathological research, see Prüll, ‘Pathology at War 1914–1918’, 142–143.
73.
Medical Research Committee, Interim Report, 32.
74.
Harrison, Medical War, 292–295.
75.
Anne Hardy, ‘”Straight Back to Barbarism”: Antityphoid Inoculation and the Great War, 1914’, Bulletin for the History of Medicine, 74 (2000), 265–290.
76.
Leishman, ‘Organization’.
77.
French ‘Influenza’, 174.
78.
French ‘Influenza’, 174.
79.
John George Adami, ‘Influenza’, in History of the Great War Based on Official Documents. Medical Services. Pathology, 413–466.
80.
Adolphe Abrahams, Norman F. Hollows, John W.H. Eyre and Herbert French, ‘Purulent Bronchitis: Its Influenza and Pneumococcal Bacteriology’, Lancet (8 September 1917), 377–380; Aldolph Abrahams, ‘Epidemic at Aldershot: Discussion’, Transactions of Royal Society of Medicine, 12 (1917), 97; John Matthews, ‘Influenza or Epidemic Catarrh’, Lancet (2 April 1915), 727.
81.
J.A.B.Hammond, W. Rolland, & T.H.G. Shore, ‘Purulent Bronchitis: A Study of Cases Occurring Among the British Troops at a Base in France’, Lancet (14 July 1917), 41–46.
82.
Hammond, Rolland, and Shore, ‘Purulent Bronchitis’, 43.
83.
Adami ‘Influenza’, 417.
84.
Abrahams, Hollows, Eyre and French, ‘Purulent Bronchitis’, 377–380.
85.
Abrahams, Hollows, Eyre and French, ‘Purulent Bronchitis’, 379.
86.
Adami, ‘Influenza’, 419.
87.
Adami, ‘Influenza’, 423.
88.
Adami, ‘Influenza’, 420.
89.
A.B. Soltau, ‘Discussion on Influenza’, Proceedings of the Royal Society of Medicine, 12 (1918–1919), 27.
90.
Influenza Committee ‘The Influenza Epidemic in British Armies in France, 1918’, 505.
91.
Influenza Committee, ‘The Influenza Epidemic in British Armies in France, 1918’, 505; James McIntosh, Studies in the Aetiology of Epidemic Influenza, Medical Research Council Special Report Series, No. 63 (London: HMSO, 1922), 6–7.
92.
David Thomson and Robert Thomson, ‘Influenza (Part I)’, Annals of the Pickett-Thomson Research Laboratory (London: Bailliere, Tindall and Cox, 1933), 8.
93.
McIntosh, Studies in the Aetiology of Epidemic Influenza, 6–7.
94.
Tanner, ‘The Spanish Lady Comes to London’, 54.
95.
Tanner, ‘The Spanish Lady Comes to London’, 54.
96.
Aldophe Abrahams, Norman F. Hollows, and Herbert French, ‘A Further Investigation into Influenzo-Pneumococcal and Influenzo-Streptococcal Septicaemia: Epidemic Influenzal “Pneumonia” of Highly Fatal Type and its Relation to Purulent Bronchitis’, Lancet (4 January 1919), 1–11.
97.
Tanner, ‘The Spanish Lady Comes to London’, 54.
98.
John Burnford, ‘A Note on Epidemics’, BMJ (20 July, 1918), 50–51; S.W. Patterson, ‘The Pathology of Influenza in France’, Medical Journal of Australia, 1 (1920), 207–210.
99.
Soltau, ‘Discussion on Influenza’, 27. According to French, the First Army’s report of 18 June called the disease ‘three-days fever’. French, ‘Influenza’, 187.
100.
Crosby, America’s Forgotten Pandemic, 26.
101.
Newsholme, ‘Discussion on Influenza’, 13. For contemporary criticisms of Newsholme, see: John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885–1935 (Cambridge: Cambridge University Press, 1997), 270–73; Sandra M. Tomkins, ‘The Failure of Expertise: Public Health Policy in Britain during the 1918–19 Influenza Epidemic’, Social History of Medicine, 5 (1992), 440.
102.
‘Influenza’, Medical Supplement (1 October 1918), 353.
103.
For debates within German medicine and bacteriology, see Wilfried Witte, ‘The Plague That Was Not Allowed to Happen: German Medicine and the Influenza Pandemic of 1918–19 in Baden’ in Phillips and Killingray (Eds.), The Spanish Influenza Pandemic of 1918–19 (2003), 49–57.
104.
Edward B. Krumbhaar, ‘The Bacteriology of the Prevailing Epidemic’, Lancet (27 July 1918), 123.
105.
‘The Pandemic of Influenza, BMJ (27 July 1918), 91–92.
106.
‘The Prevailing Epidemic’, Lancet (13 July 1918), 51.
107.
Ludwik Rajchman, editor of the MRC’s Medical Supplement, used the term ‘Pfeiffer school’ to describe adherents to the orthodox notion that ‘true influenza epidemics’ were caused only by B. influenzae. ‘Influenza’, Medical Supplement, 1 October 1918, 354. Fildes and McIntosh used the term ‘anti-Pfeiffer school’ to describe critics of Pfeiffer’s bacillus. Paul Fildes and James McIntosh, ‘The Aetiology of Influenza’, British Journal of Experimental Pathology, II (1920), 159–174.
108.
See reviews by Fildes and McIntosh, ‘Aetiology of Influenza’, 159–174; McIntosh, Studies in the Aetiology of Epidemic Influenza.
109.
T.R. Little, C.J. Garofalo, and P.A. Williams, ‘Absence of the Bacillus Influenzae in the Exudate from the Upper Air-Passages in the Present Epidemic’, Lancet (13 July 1918), 34.
110.
Little, Garofalo, and Williams ‘Absence of the Bacillus Influenzae’, 34.
111.
C.P. Gladstone, C.J.G. Knight and Graham Wilson, ‘Paul Gordon Fildes, 1882–1971’, Biographical Memoirs of Fellows of the Royal Society, 19 (1973), 317–374.
112.
Paul Fildes and James McIntosh, ‘A New Apparatus for the Isolation and Cultivation of Anaerobic Micro-Organisms’, Lancet (8 April 1916), 768–770.
113.
NA FD1/530 Medical Research Committee, Influenza Research by Dr. Fildes.
114.
Paul Fildes, S.L. Baker, and W.R. Thompson, ‘Provisional Notes on the Pathology of the Present Epidemic’, Lancet (23 November 1918), 695–700.
115.
Fildes, Baker, and Thompson, ‘Provisional Notes’, 697.
116.
Fildes, Baker, and Thompson, ‘Provisional Notes’, 697.
117.
Paul Fildes, ‘James McIntosh 1882–1948’, Journal of Pathology and Bacteriology, 61 (1949), 285–299.
118.
James McIntosh, ‘The Incidence of Bacillis Influenzae (Pfeiffer) in the Present Influenza Epidemic’, Lancet (23 November 1918), 696.
119.
McIntosh, ‘The Incidence of Bacillis Influenza’, 696.
120.
Oscar H. Gotch and Harold E. Whittingham, ‘A Report on the “Influenza” Epidemic of 1918’, BMJ (27 July 1918), 82.
121.
‘Influenza, Medical Supplement (1 October 1918), 358.
122.
‘Influenza’, Medical Supplement (1 October 1918), 358.
123.
For the Inoculation Department’s vaccines, see Wei Chen, ‘The Laboratory as Business: Sir Almorth Wright’s Vaccine Programme and the Construction of Penicillin’, in Andrew Cunningham and Perry Williams (Eds.), The Laboratory Revolution in Medicine (Cambridge: Cambridge University Press, 1992), 245–292.
124.
John Matthews, ‘Influenza or Epidemic Catarrh’, Lancet (3 April 1915), 727.
125.
John Matthews, ‘On a Method for Preparing Medium for the Culture of Pfeiffer’s Influenza Bacillus’, Lancet (27 July 1918), 104.
126.
Matthews, ‘On a Method for Preparing Medium’, 104.
127.
Fildes and McIntosh, ‘The Aetiology of Influenza’, 159–174.
128.
McIntosh, ‘The Incidence of Bacillis Influenza’, 696.
129.
McIntosh, ‘The Incidence of Bacillis Influenza’, 696.
130.
Marta Alexandra Balinska, ‘Ludwik Rajchman: Pioneer of International Health’, International Health History Newsletter, 1 (1995), 8–9.
131.
‘Influenza’, Medical Supplement (1 October 1918), 359.
132.
‘Lessons of a Great Epidemic: the pathology of influenza’, Lancet (5 July 1919), 25.
133.
NA FD1/535 Influenza Committee: correspondence with Local Government Board and War Office. Richard Reece (War Office) to Fletcher, 3 November 1918; Fletcher to Reece, 6 November 1918; FD5/186 Memorandum on a scheme of inquiry concerning influenza.
134.
‘Bacteriology of the Influenza Pandemic’, BMJ (10 August 1918), 139–140.
135.
NA FD1/535 Influenza Committee: correspondence with Local Government Board and War Office.
136.
Medical Research Committee (1918b). ‘Memorandum’, Lancet (5 August 1918), 717; ‘Bacteriology of the Influenza Pandemic’, BMJ (10 August 1918), 139–140.
137.
NA FD1/533 MRC—General Scheme of Influenza Investigations, 11 November 1918.
138.
For the spread of the epidemic in Britain, see Niall P.A.S. Johnson, ‘Aspects of the Historical Geography of the 1918–19 Influenza Pandemic in Britain’, Ph.D. Thesis, Department of History, University of Cambridge (2001), 325–327; Niall Johnson, Britain and the 1918 Influenza Epidemic, 55–56.
139.
Abrahams, Hollows and French, ‘A Further Investigation into Influenzo-Pneumococcal and Influenzo-Streptococcal Septicaemia’, 1–11; Thomas S. Horder, ‘Some Observations on the More Severe Cases of Influenza Occurring During the Present Epidemic’, Lancet (28 December 1918), 871–873.
140.
Mark Harrison notes that ‘influenza was rife throughout Mesopotamia, and it was the main cause of admissions to hospital among British troops in the last months of the war and after armistice,’ Medical War, 284.
141.
William Hamer, Chief Medical Officer of the London County Council estimated the number of deaths between October and December 1918 to be close to sixteen thousand. Hamer, Report on Influenza, 20.
142.
Fildes, Baker and Thompson, ‘Provisional Notes’, 698.
143.
Fildes, Baker and Thompson, ‘Provisional Notes’, 697.
144.
Fildes, Baker and Thompson, ‘Provisional Notes’, 697.
145.
Abrahams, Hallows and French, ‘A Further Investigation into Influenzo-Pneumococcal and Influenzo-Streptococcal Septicaemia’, 1–11.
146.
NA FD1/534 MRC Influenza Committee (1918), 72.
147.
Medical Research Committee, Annual Report of the Medical Research Committee, 1917–18 (London: HMSO, 1919), 72–73.
148.
NA FD1/530 Medical Research Committee, Influenza Research by Dr. Fildes. Fletcher to Sir W… 12 November (1918).
149.
Medical Research Committee, Annual Report of the Medical Research Committee, 1917–18, 73.
150.
The phrase was attributed to Newsholme, but it reflected official opinion. Arthur S. Newsholme, ‘Epidemic Catarrhs and Influenza’, Lancet (2 November 1918), 599–603.
151.
French, ‘Influenza’, 176.
152.
NA FD1/535 Influenza Committee.
153.
For USA, see John Eyler, ‘The Fog of Research: Influenza Vaccine Trials During the 1918–19 Pandemic’, Journal of the History of Medicine and Allied Sciences, 64 (2009), 401–428; John Eyler, ‘The State of Science, Microbiology, and Vaccines Circa 1918’, Public Health Reports, Suppl. 3., 125 (2010), 27–36.
154.
John Matthews, ‘Influenza and Preventive Inoculation’, Lancet (2 November 1918), 602.
155.
Chen, ‘The Laboratory as Business’; Worboys, ‘Almroth Wright at Netley’.
156.
John W.H. Eyre and C.E. Lowe, ‘Prophylactic Vaccinations against Catarrhal Affections of the Respiratory Tract’, Lancet (12 October 1918), 484–487; W.H. Wynn, ‘The Use of Vaccines in Acute Influenza’, Lancet (28 December 1918), 874–876.
157.
John Eyler, has examined this problem in American efforts to manufacture influenza vaccines. Eyler, ‘The Fog of Research’, 401–428.
158.
Eyre and Lowe, ‘Prophylactic Vaccinations against Catarrhal Affections, 484–487.
159.
Eyre and Lowe, ‘Prophylactic Vaccinations against Catarrhal Affections, 487.
160.
Fildes, Baker, and Thompson, ‘Provisional Notes’, 700.
161.
Eyler, ‘The Fog of Research’, 404.
162.
Fildes, Baker, and Thompson, ‘Provisional Notes’, 700.
163.
Medical Research Committee, Studies of Influenza in Hospitals of the British Armies in France, 1918 (London: HMSO, 1919).
164.
‘Memorandum by the Royal College of Physicians’, BMJ (16 November 1918), 546.
165.
Johnson, Britain and the 1918–19 Influenza Pandemic, 98–140.
166.
Eyler, Sir Arthur Newsholme and State Medicine, 272–273.
167.
‘The utilisation of vaccine for the prevention and treatment of influenza,’ Lancet (26 October 1918), 565.
168.
‘Utilisation of vaccine’, 565.
169.
‘Utilisation of vaccine’, 565.
170.
‘Utilisation of vaccine’, 565.
171.
‘Utilisation of vaccine’, 565.
172.
Medical Research Committee, Annual Report of the Medical Research Committee, 1918–19, 72.
173.
Thomas S. Horder, ‘Influenza and Preventive Inoculation’, Lancet (9 November 1918), 642.
174.
Matthews, ‘Influenza and Preventive Inoculation’, 602.
175.
W.H. Wynn, ‘The Use of Vaccines in Acute Influenza’, Lancet (28 December 1918), 874.
176.
Wynn, ‘Influenza and Preventive Inoculation’, 643.
177.
Matthews, ‘Influenza and Preventive Inoculation’, 602.
178.
Matthews, ‘Influenza and Preventive Inoculation’, 602.
179.
Matthews, ‘Influenza and Preventive Inoculation’, 602.
180.
Horder, ‘Influenza and Preventive Inoculation’, 642.
181.
Horder, ‘Influenza and Preventive Inoculation’, 642.
182.
NA FD1/533 MRC, Influenza General research in UK, 1918 ‘Circular sent to District Laboratories,’ 1 November 1918.
183.
See Fletcher’s correspondence with pathologists, NA FD1/534 Medical Research Committee.
184.
Leishman, ‘Organization’ 30; ‘The vaccines and serums supplied to the Royal Navy’, Lancet (25 January 1919), 545. One dose = 1c.cc.
185.
William B. Leishman, ‘The Results of Protective Inoculation Against Influenza in the Army at Home, 1918–1919’, Lancet (24 January 1920), 214–215.
186.
J.J. Heagerty, ‘Influenza and Vaccination’, Canadian Medical Association Journal, 9 (1919), 226–28; Patrick George Hodgson, ‘Flu, Society and the State: The political, social and economic implications of the 1918–1920 influenza pandemic in Queensland’, PhD Thesis, James Cook University (2017), 67–69. The official history of Commonwealth Serum Laboratories claims that the company produced 3 millions doses of the vaccine: ‘A History of CSL’ at www.toxinology.com/fusebox.cfm?staticaction=generic_static_files/avp-csl-01.html (accessed on 20 April 2018).
187.
For different vaccine preparations, see Harold E. Whittingham and C. Sims, ‘Some Observations on the Bacteriology and Pathology of Influenza’, Lancet (28 December 1918), 865–871; ‘Prophylatic Inoculation in Influenza’, Lancet (5 April 1919), 572–573.
188.
Wynn, ‘The Use of Vaccines in Acute Influenza’, 874–876.
189.
NA FD1/529 MRC, Influenza Research by Colonel Cummins with British Forces in France, ‘Prophylactic Anti-influenza Vaccination’, 21 December 1918.
190.
Leishman, ‘The Results of Protective Inoculation Against Influenza’, 214–215.
191.
These figures were reported in G. Dansey-Browning, ‘A Study of the Prevention of influenza’, JRAMC, 57 (1 September 1931), 188. Dansey-Browning the reported total number of “non-inoculated” observed as 43,520 and the number of inoculated observed as 15,624.
192.
Leishman, ‘The Results of Protective Inoculation Against Influenza’, 215.
193.
Adami, ‘Influenza’, 413–466.
194.
Herbert French, ‘The Clinical Features of the Influenza Epidemic of 1918–1919’, in Report on the Pandemic of Influenza, 1918–1919, 66–78.
195.
McIntosh, ‘Studies in the Aetiology of Epidemic Influenza’, 33.
196.
Fildes and McIntosh, ‘The Aetiology of Influenza’, 172.
197.
Fildes and McIntosh, ‘The Aetiology of Influenza’, 119.
198.
H.B. Maitland and Gordon Cameron, ‘The Aetiology of Epidemic Influenza: A Critical Review’, Canadian Medical Association Journal, 6 (1920), 492.
199.
W. D’este Emery, ‘Influenza and the Use of Vaccines’, Practitioner, LXXXIV (Ferbuary 1919), 73.
200.
NA FD1/530 Walter Fletcher to Paul Fildes, 22, 28 October 1918; NA FD1/533 MRC Influenza General Research, 1918, 1 November 1918.
201.
NA FD1/533, Walter Fletcher to Paul Fildes, 28 October 1918, 171.
202.
Hardy Anne Hardy, ‘“Straight Back to Barbarism”’, 278–279.
203.
Leishman, ‘Results of Protective Inoculation’, 367.
204.
For these criteria, see Eyler, ‘Fog of Research’, 24–26.
205.
Major Greenwood, ‘The Prophylaxsis of Influenza’, in Report on the Pandemic of Influenza, 1918–1919, 175.
206.
Greenwood, ‘The Prophylaxsis of Influenza’, 175–176.
207.
NA FD1/535 Walter Fletcher to Arthur Newsholme, 23 October 1918.
208.
NA/FD1/535 Walter Fletcher to Arthur Newsholme, 23 October 1918; Parke Davis & Co., ‘Influenza Prophylaxis Vaccines’, Lancet (4 October 1919), 616.
209.
NA FD1/530, MRC, Walter Fletcher to Paul Fildes, 22 October 1918;, NA FD1/535 Walter Fletcher to George Buchanan, 4 March 1919;, NA FD1/537 Schools Reports on Cases and Treatment of Influenza, 1919.
210.
NA FD1/535 Arthur Newsholme to Walter Fletcher, 3 January 1919.
211.
‘The Prevention of Influenza’, Lancet (3 January 1920), 41; ‘Preparations for an Influenza Epidemic’, Lancet (31 January 1920), 271.
212.
For example, William Hamer, ‘The Relationship Between Influenza, Cerebrospinal Fever, and Poliomyelitis’, Appendix to the Report of the County Medical Officer of Health and School Medical Officer for the Year 1918 (London: County Hall, 1919); William Hamer, ‘The Influenzal Constitution’, Proceedings of the Royal Society of Medicine, 20 (1927), 1349–1368.
213.
See, for example, Johnson, The Overshadowed Killer: Influenza in Britain in 1918–19,152–154; Tognotti, ‘Scientific Triumphalism and Learning from Facts’, 97–110.
214.
Chen, ‘The Laboratory as Business’, 253–259.
215.
Johnson and Mueller, ‘Updating the Accounts’, 113.
216.
Sturdy, ‘War as Experiment’, 82–83.

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Department of History, Heritage, and Classics, Swansea University, Swansea, UK
Michael Bresalier

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Bresalier, M. (2023). Fighting Flu: Military Pathology and the 1918–1919 Pandemic. In: Modern Flu. Medicine and Biomedical Sciences in Modern History. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-33954-6_4

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DOI: https://doi.org/10.1057/978-1-137-33954-6_4
Published: 01 August 2023
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