We’ve all been hearing a great deal this year about the Spanish flu epidemic of 1918-1920. At times it has seemed a good predictor of our current situation – notably with the ‘second wave’ - although this may be not so much a common pattern, as a case of seeking to fit our own experiences into a pre-cast mould. We all like to think that history provides examples that make unsettling events predictable, and a nice round centenary between past and recent events seems – however illogically – to enhance the sense that we are in known territory. And it is reassuring that in 1920, even with no vaccine, there was an ending to the story. The Spanish flu virus didn’t mutate into something even worse, nor did the disaster-movie scenario of shooting, looting and screeching tyres play out. Not, at any rate, in West Cornwall.

One interesting aspect of the 1918-1920 pandemic is the low impact it seems to have made locally.

A quarter of the UK population – about 10 million people - were infected, with a death toll of 228,000, about 2.3% of those recorded as contracting the virus or 0.6% of the population. Nationally, over 97% of those recorded as contracting ‘Spanish flu’ seem to have survived - a figure surprisingly close to the survival rate for Covid-19, given the major advances in medical understanding and the general health of the population over the past century.

In Cornwall there were 591 deaths attributed to the virus in 1918 (over 10% of the deaths recorded in Cornwall that year) and a further 242 in 1919 (nearer to 5% of the Cornish deaths). As the population of Cornwall at the time was about 320,000, this represents a death toll from ‘Spanish flu’ 1918-1919 amounting to about 0.25% of those living this side of the Tamar - below half the national average. This is similar to the comparison that gave Cornwall a starring role on the national news on November 26th 2020, when it was granted more freedoms under Covid-19 regulations than any other area in mainland Britain.

There is a limit to how deeply the 1918-1919 epidemic can be investigated without access to official records. But equally interesting, in its way, is how the epidemic was reported. Apart from rumour and personal knowledge, local newspapers were a major – perhaps still the main – source of news. This survey is based on relevant search results from the Cornishman in 1918-1919, with 1915 and 1922 providing an indication of the ‘normal’ background. It makes no pretence at being a statistical analysis – but reveals some interesting aspects of how the pandemic was represented and hence perceived.

The tables below give the number of results generated by searches for key words in the Cornishman and Western Morning News. Searches based on the scanning of print copies are not perfect – but a search for a ‘control’ word and a look at the visual quality of the pages suggest that the search facility within each title is similarly reliable in all the years under consideration. In 1918, some editions of both newspapers had slightly fewer pages.

Pneumonia search results

Of the 58 Cornishman search results for ‘pneumonia’ in 1918, six are from the first three months of the year compared to 40 in the last three months. However, this does not necessarily reflect the local onset of the epidemic, as most of the cases reported were servicemen or people living abroad. Only seven of the 58 search results indicate influenza affecting civilians living in West Cornwall.

Similarly, there are 30 results from the first three months of 1919 and only nine in the last three months – although the epidemic was not yet over: one of these nine was a 33 year-old man who died in late December, after only a week of illness with pneumonia.

Influenza search results

The pattern for ‘influenza’ follows exactly the same trajectory. It is interesting that in both cases, the Cornishman returns more results than the Western Morning News in 1915, but fewer during the pandemic itself and especially in 1922. This might be for any number of reasons, for example because a resurgence of ‘ordinary’ influenza in 1922 was of less severity locally and hence less newsworthy, but editorial policy in one or both cases must be a front runner.

The apparently greater willingness of the Cornishman to use the term ‘influenza’ rather than ‘pneumonia’ is similarly interesting. Yet Herbert Thomas, editor of the Cornishman, declared himself opposed to use of the term ‘influenza’ in November 1918. Implying that it trivialised the epidemic, he referred to a death from ‘this bronchial plague – septic pneumonia, following what is foolishly called influenza.’ Perhaps his editorial influence was limited when it came to detail; perhaps he was averse to micro-managing his journalists.

Total search results

Although the epidemic is commonly known as ‘Spanish flu’ the term does not seem to have been used in the press at the time. The Cornishman search shows only eight instances from 1918 where the word ‘Spanish’ and ‘influenza’ or ‘flu’ occur in the same sentence. Of these, six are within advertisements, and two deaths in mining communities abroad are specified as resulting from ‘Spanish flu.’ The phrase is not used in connection with local outbreaks. In 1919, the search produces no examples at all in advertisements or death reports, but one mention of ‘Spanish flu’ having returned to Helston. The search results from Western Morning News (and from other local newspapers) give exactly the same impression: even in the Daily Mirror, which is rather less reticent in its use of the phrase, ‘Spanish flu’ mainly affects foreigners. Was this deliberate avoidance? Self-censorship or official instruction? Or had the phrase simply not caught on (as its disappearance from advertisements might suggest)?

Good news of slow recovery sometimes came in from the diaspora. Nearer to home, there were very few stories of happy endings; but this was, and as we know still is, the nature of news and does not tell us anything about the survival rates. With no testing, we have little idea how many people contracted the disease and lived to tell the tale - and as in 2020, almost all of the media references either promote possible preventions and cures, or report fatalities. In 1915, influenza was already a common winter illness. In April, for example, 49 of the 75 pupils at Lelant School were said to be infected although it is not clear whether cases were verified, and Newlyn Infant School was closed. Other areas returned similar reports. In the Helston area, there had been ‘an increased number of deaths respiratory diseases mainly due to influenza.’ Occasionally workplaces had been affected, or adults are noted to have missed meetings or other events on account of the illness.

“Copy of old photo. Mens Ward, Penzance Infirmary 1914 ( West Cornwall Hospital),” Morrab Library Photographic Archive, accessed November 25, 2020, http://photoarchive.morrablibrary.org.uk/items/show/9897  by kind permission

News items (if the person affected was significant), inquest reports and death notices draw reader attention to some but not all local deaths. Those that appear - by no means a representative sample - are often attributed in 1915 to heart problems, ‘apoplexy’ or stroke, or rheumatism (which could have masked kidney or other internal problems). Although most of the deceased are stated or implied to be of ‘advanced age,’ a large minority are only in their 50s or 60s. These people are generally suggested to have been chronically ill – with phrases such as ‘indifferent’ or ‘failing’ health ‘for some time’ frequent. Sometimes there is a history of a ‘breakdown of health,’ often attributed to overwork. These people may have been suffering from undiagnosed cancer (some deaths were post-operative), diabetes or tuberculosis. Also known as phthisis or consumption, this disease was often passed off as ‘asthma’ or ‘bronchitis’ (as Robert Tressell, a sufferer himself, records in The Ragged Trousered Philanthropists). The deaths of babies were often ascribed to poor feeding, accidental suffocation or other alleged ‘neglect.’

There are also some unexplained deaths in 1915 that, had they occurred three years later, we might assign to ‘Spanish flu.’ A woman of 62, for example, woke up feeling unwell, asked her daughter for ‘water and mustard’ as she was breathless, and died before the doctor could arrive. An inquest revealed a history of respiratory and heart problems. A man of similar age - who had previously suffered a ‘breakdown in health’ but partially recovered - ‘complained of feeling unwell.’ The doctor felt there was no ‘imminent danger,’ but within days the victim was found unconscious, and he died shortly afterwards. One man aged 39 died while recovering from influenza, but had already been a ‘martyr to rheumatics.’ The deaths always seem to have involved what we would now call ‘underlying causes’ – then as now, people who considered themselves fit and healthy could reassure themselves that unexplained deaths had befallen other kinds of people – those with pre-existing conditions. Similar deaths three years later, during the 1918-1919 epidemic, would not have seemed extraordinary.

During 1918, with the ‘Spanish flu’ underway, there are more explicit references to influenza and pneumonia as causes of death. However, mention of influenza in particular is largely confined to victims who had contracted it outside the UK, mostly military personnel and former residents. This probably reflects the nature of the pandemic, which is thought to have spread to and within the UK as invalid soldiers returned home. The prevalence of pneumonia in regions of the diaspora such as South Africa and the USA probably reflects the pre-existing lung conditions widespread in these communities, and resultant from mining.

Press reports of unexplained local deaths are reluctant to name influenza, even when it was probably the cause. One victim had gone to visit his son, wounded at the Front, and was himself seized by ‘an illness’ which proved fatal. The victim ran a business and his death was described as a ‘great shock’ which suggests an absence of what are now termed underlying conditions. A farmer’s wife was ‘only ill for a few days’ before her ‘sudden and sad… death at so early an age.” One woman died of pneumonia only a week after the burial of her baby, which is also suggestive of the virus – but she was described euphemistically as having had ‘a short illness.’ It is difficult, in cases of this kind where there was no inquest, to differentiate tuberculosis from influenza, a fatal combination of the two diseases, or some other illness altogether. That is perhaps the intention.

Death notices give a slightly different and perhaps more honest picture, which may result from authorship, what is and is not considered newsworthy, or simply coincidence. For example in the death announcements for one winter week, a woman of 25 was said to have died ‘from influenza’ and a man of 50 ‘unexpectedly, from flu and double pneumonia.’ A further four deaths were from undisclosed courses, but only one of these seems to have been in old age.

Other news snippets suggest that there was awareness of the ‘prevailing epidemic.’ In October 1918 schools were closed at St Ives after a teenager died and families were ‘plunged into mourning’ (the plural suggests other fatalities). Readers were advised that the physically fit would be ‘less liable to attack than those with poor physical fitness,’ wording which has moralistic overtones, and residents were urged to take ‘every reasonable precaution’ although no specific actions were advised.

photopol: GORDON BREWSTER & THE FLU

 
During the spring of 1919, reporting becomes more laconic: “several deaths have occurred this week from influenza and pneumonia,” and “influenza and pneumonia are still prevalent in the district.” Some reports of individual deaths still avoid mentioning what was probably influenza, alluding for example to a ‘slight indisposition’ which had developed into pneumonia. The death notices are less likely to suggest respiratory problems as a cause of demise, and although the age of the deceased is rarely mentioned, there is less suggestion of early death in the shape of, for example, surviving parents or words such as ‘sudden.’ Although 1919 returns more results than 1918 for the key search words, the tone is remarkably different. In Hayle according to the medical officer, influenza had ‘almost disappeared’ by January 1919 although sore throats were rife and diphtheria ‘rampant.’

The birth and death rates for 1918 in Redruth had shown no worsening from the previous year, despite the onset of the pandemic. Yet there had been 13 deaths from influenza – all with pneumonia as a complication - and 41 from other respiratory ailments. Looking back on the pandemic in the autumn of 1919, however, the medical officer reported the epidemic to be ‘the most severe that had visited the whole world within the memory of anyone living.’ The medical officer linked influenza to tuberculosis, implying that it, too, was spread via sputum. ‘The history of the severe cases at Redruth was the same as reported from every other district,’ he added. ‘The afflicted persons were seized with the disease suddenly and severely, very quickly causing the fear that they would not recover, being overwhelmed with the poison that rapidly produced the pneumonia and paralysed the brain and heart.’ This suggests that the epidemic had given rise to a range of symptoms, any of which might be considered the specific cause of death. Cornwall was less affected than ‘any other county.’

Influenza remained in the background, still claiming some lives (usually compounded with pneumonia) in 1922 – just as it had in 1915, before the pandemic began. Most of the local cases seem from the reporting to have once more involved what we now term ‘underlying conditions’ and most victims were aged 60 or over - although the deaths included a man in his 40s who had visited the doctor only hours previously with a ‘slight indisposition.’

In January 1922 the medical officer for West Penwith reported only two deaths from pneumonia in the past month, compared to 14 from heart disease. But this was followed by another local influenza epidemic, with schools closed and even billiard matches postponed in the Redruth area. This spread rapidly, but the disease seems to have been similar to the more ordinary influenza of 1915, and was downplayed as ‘not in itself of a dangerous character.’ The ‘two or three’ deaths reported were dismissed as the result of avoidable complications: most sufferers merely experienced something akin to a heavy cold and although most households were affected, some suffered ‘unknowingly’ and may have been what we would now call ‘asymptomatic.’ The medical officer of Redruth – while steering mercifully clear of slogans - also gave advice to which we have all become familiar: ‘it is well to avoid crowds, places of entertainment, and the like… don’t worry about it… if you have got it stay indoors… don’t go about ‘with the flu on you,’ it is not fair to yourself or to other people.’

Helston and St Just were also badly affected, although again with few deaths. In Camborne the 1922 epidemic was referred to – rather oddly – as ‘the most serious on record.’ This suggests either that breadth of spread, rather than morbidity, was considered the standard by which to judge an epidemic – or that the ‘Spanish flu’ of only three years previously was regarded as a different disease.

Advertising – including ‘advertorial’ material disguised as news - provides further indicators of the concerns and general mood of the public. In 1915, advertisers were already referring regularly to respiratory ailments during the winter months: using phrases like ‘pneumonia weather.’ Bovril (‘British to the backbone’ and often advertised in military language) could ‘put influenza out of action’ or ‘reinforce’ against its ‘offensive. The notion of ‘fighting’ (rather than evading, curing or suffering) disease was – as it still is - widespread.

By kind permission of the Cornish Studies Library, Kresen Kernow, Redruth

The soothing effect of ‘Peps’ tablets on the ‘farthest recesses of the lungs’ could fortify against not only ‘cold-germs’ but also the ominous threat of ‘more serious throat and chest trouble.’ A whole range of ‘perilous infection’ (including influenza) was ‘carried about by people you come into contact with’ and could be prevented by the ‘wonderful power’ of the product. Advertising for Nostroline developed this awareness of stranger danger: ‘smeared in your nostrils it strengthens your defence and repels invading germs. Guard yourself against infection in crowded assemblies, places of worship, meetings, theatres, picture houses, cars and trains.’ The list of risky settings offered to readers in 1915 is very similar to those which have been discouraged or disallowed in 2020, except that licensed premises are notably absent.

Before the pandemic, influenza was generally presented by advertisers as one of many ailments to be treated with respect. Veno’s cough mixture classes it with coughs and colds as ailments that should be cured lest they lead to ‘more serious dangers.’

During the pandemic, a change of tone in the advertising of cures confirms that influenza was causing concern. Some advertisers took the familiar course of exploiting fear and latent guilt to sell their products – ‘what are you doing to make sure that your home is kept free from epidemic disease.’

There was also emphasis on the aftermath of illness. Dr Williams’ Pink Pills could dispel the post-viral malaise which sounds suspiciously like what we now know as chronic fatigue syndrome: long-term depression, abdominal and back pain, and loss of energy and appetite. The same strategy was adopted to promote Dr Cassell’s tablets, ‘the universal home Remedy for Nervous Breakdown’ which could banish ‘lassitude,’ anxiety and insomnia.

By kind permission of the Cornish Studies Library, Kresen Kernow, Redruth

Some advertisements also seem to foreshadow measures that would be advised in 2020: Sanitas Disinfecting Fluid could be sprayed around the room, and those so inclined could gargle with it. Schools and workplaces were recognised as ‘germ exchanges,’ but daily application of Jeyes Fluid would soon sort that out. After the pandemic, fear of influenza continued to influence marketing, which suggests enduring fear. Benger’s Food – being already ‘partially digested’ - could nourish the invalid with ‘a digestive system weakened by the Influenza attack.’ Yet there are no advertisements for masks – nor, for that matter, any suggestions that people should be wearing them. Searches for ‘mask’ in 1918 and 1919 editions of both newspapers produce only two results related to anti-disease precautions. One of these concerns regulations in Australia, the other is small-print advice to those giving care or treatment to patients. Dozens of other uses of the word are either metaphorical (‘Ripping the Mask from the Kaiser’ and so forth), or occur in connection with outlawry, gas masks - or fancy dress parties, performances of ‘The Purple Mask’ and other entertainments.

In 1918, food was in short supply and subject to stringent wartime rationing. The Penzance Food Control Committee told those hoping for extra food for influenza sufferers that they would be unlucky. Only in the case of ‘serious complications’ such as pneumonia, could invalids be upgraded to ‘convalescent’ status. Panic buying and hoarding was simply impossible, although the manufacturers of Bovril made much of a ‘shortage’ in their marketing.

But why no other apparent public fear, or even any signs of great concern? Why no demands for lockdowns, no references to masks? As always, context provides the key. People were, to put it bluntly, accustomed to dealing with severe and untreatable illnesses, intractable infections and sudden deaths – as the reports from 1915 demonstrate. Another factor is the media environment of the time, compared to the febrile situation of the present day. WW1 had accustomed both editors and readers to prioritising national morale above truth. Overt government censorship may well have been involved – nobody seems quite sure - but it may not have been necessary. Where, anyway, does censorship end, and a paternalistic urge to maintain public morale begin? That, again, is something the UK government has found difficult to judge during the current pandemic.

By kind permission of the Cornish Studies Library, Kresen Kernow, Redruth

In 1918 men of power and influence (a ‘political elite’ if you wish) had full control of the few media outlets. In West Cornwall, the gatekeepers were a handful of men: the editors of the Cornishman (which by 1918 incorporated the Cornish Telegraph), West Briton, Royal Cornwall Gazette and Western Morning News. A detailed examination of their priorities, concerns, the commercial pressures under which they worked and the amount of licence they allowed to their columnists: what a splendid book that would be for somebody to write.

Linda Camidge


General references and further reading: With thanks to Jean Nankervis for supplying a wealth of references and background information including the statistics on infection rates in Cornwall.

Newspaper references and other details are from https://www.britishnewspaperarchive.co.uk which offers a good range of titles and editions from before 1950. These unfortunately do not yet include the West Briton, or the Royal Cornwall Gazette after 1912.

For anyone wanting in the future to look systematically at what was actually happening in terms of registered deaths and notifiable illnesses, there is a range of monthly official returns available at Kresen Kernow.


Also of interest, although with nothing specific to Cornwall:

https://blogs.lse.ac.uk/politicsandpolicy/public-memory-1918-flu

https://www.independent.co.uk/life-style/health-and-families/health-news/flu-how-britain-coped-1918-epidemic-5348535.html

https://www.bbc.co.uk/news/in-pictures-52564371

https://www.msn.com/en-gb/news/newsliverpool/social-distancing-in-liverpool-during-spanish-flu-pandemic-of-1918-and-how-restrictions-were-lifted/ar-BB13x0d0

https://www.livescience.com/spanish-flu.html

(all accessed 22/23 11 2020)