Flu to form
A hundred years ago this year Britainâ€™s High Street chemists were doing good business.Â In 1918 the end of the Great War was at last inÂ sight. Germany might not yet have lost the â€˜war to end warsâ€™, but at the outbreak of hostilities four years earlier it had already lost foreign investments, merchant shipsÂ and international patents.
Amongst the patentsÂ forfeited by Germany onÂ the declaration of war inÂ 1914 was that for Aspirin.Â And now aspirins, bereft ofÂ their initial capital letter, wereÂ pouring over the counters of Britainâ€™s chemistsâ€™ shops and being consumed in their millions by millions.
What had fuelled customer demand was not an epidemic of headaches but an outbreak of influenza or â€˜fluâ€™.
Today flu is seldom fatal. Yet the term â€˜seldom fatalâ€™ is very much a relative term. It is no consolation whatever to those who have lost loved ones â€“ and the absolute numbers can be huge.
Well within living memory flu outbreaks in Britain the 1950s, 60s and 70s each saw more than 30,000 â€˜excessâ€™ deaths.
The so-called Chinese, Hong Kong and Asian Flu outbreaks in 1957, 1968 and 1977 become the basis for the Department of Healthâ€™s â€˜Influenza Pandemic Contingency Planâ€™. The planâ€™s worst case scenario is that â€˜Around a quarter of the population could be affected, with over 50,000 deaths in the UK.â€™
Yet even 50,000 might be optimistic. Back in 2005 Dr Jeffrey Tauenberger of the US Armed Forces Institute of Pathology disinterred bodies from the permafrost in Alaska. Viral DNA taken from the lungs of a woman who had died 1918 confirmed that the cause of her death was avian flu.
Unhappily avian flu, more commonly referred to as â€˜bird fluâ€™, is amongst a multitude of diseases shared by humans and birds. Constantly mutating, avian flu can become lethal to both man and bird.
In 1918 a lethal strain of bird flu not only killed a few folk in Alaska but also tens of millions of others around the world. Almost a quarter of aÂ million people diedÂ in Britain in just three months. Doctors, nurses and pharmacists succumbed as easily as anyone else. Britainâ€™s coal-powered economy was itself sick, with train and tram drivers unavailable to maintain timetables, and essential coal production dropping alarmingly as miners too stayed in bed.
By the end of the year, Germany which had just suffered the ignominy of defeat in the first world war now lost an additional 400,000 of its population to the flu. In the US, as many as one million died. In Alaska, not yet the 49th State, some 60% of the Eskimo population of Nome perished.
In India, the jewel in Britainâ€™s imperial crown, five million citizens died during the outbreak.
Estimates of the global death toll range from 40m-150m. And only adding to the scale of the tragedy was that in 1918 the young and the fit died in far great numbers than the elderly.
Why were the young and healthy so disproportionately afflicted? And where had the disease come from?
The British and Americans thought the disease had originated in Spain, and as such they dubbed it the â€˜Spanish Fluâ€™ or â€˜Spanish Ladyâ€™. To the French it was simply La Grippe; whilst to the Germans it was merely Blitz Katarrh.
Following the Great War, the American epidemiologist Richard Shope believed that he had traced the original source of the outbreak not to Spain but to pig farms in Iowa.
As for the young rather than the elderly dropping in droves: it seems probable that that the â€˜Spanishâ€™ flu strain had only recently mutated from a far less virulent virus responsible for a flu pandemic in the late 1880s. Those who had survived that event 30 years previously may have been partly immune.
Meanwhile what of the local chemist? Business may have been good but were they doing their patients any good? In truth none of the remedies sold by chemists could stem the dreadful tide. And ironically one may have made things much worse.
In a 2009 paper published in the journal Clinical Infectious Diseases, Karen Starko proposed that aspirin had contributedÂ substantially to the death toll. Checking post mortem reports in the USA she noted a largeÂ â€˜death spikeâ€™ in October 1918 just after the Surgeon GeneralÂ of the United States Army, and the Journal of theÂ American Medical Association bothÂ recommended doses of up to 31g of aspirinÂ per day.Â Starko suggestsÂ that aspirin poisoning was the trueÂ cause of many supposed flu deaths inÂ the USA. And with the loss of the aspirin patent the German wonderdrug may well have caused similar havoc worldwide.
Happily this year, 2018, is unlikely to be a re-run of 1918. But the flu virus will always mutate. We can be certain that one year in the future the Spanish Lady is bound to return for an encore.
Prepare to advise parents and carers on appropriate management of their children’s eczema.