Pandemic! - The Great Influenza Epidemic of 1918 –1920

If you take a walk through any of the older cemeteries in Sydney, such as Rookwood or Gore Hill, you may notice what appears to be quite a number of gravestones marking people who died in 1919. In many cases this would be the direct result of one of the worst diseases ever to affect humanity, which swept the world in the closing stages of World War One and all through the following year – 1919.

In Australia alone nearly 12,000 people died, but on a global scale about 21 million were to lose their lives, which was more than had been killed in the War, and also many more than died of Bubonic Plague in Europe between 1347 and 1351.

This disease was a virulent strain of influenza known as "Spanish Flu" (thought to be the country of initial outbreak) or "La Grippe", and was a global disaster which has been cited as the most devastating epidemic in recorded world history.

It was thought to have been carried to Australia by soldiers returning from the War, and first appeared in Melbourne in January 1919. However the Australian authorities had been aware of the outbreaks across Europe in 1918, and had already put in place precautions which no doubt minimized its impact in Australia.

The NSW Government made the wearing of gauze face-masks compulsory in shops, hotels, churches, theatres and on public transport in the populous parts of the state. Those who had become infected were to be isolated and quarantine rules were tightened.
Many places where crowds might gather were closed – including schools,
libraries, churches, racecourses and many hotels.

In December 1918, representatives of the NSW Pharmaceutical Society and the Medical Association met and formulated a stock mixture and a solid inhalation for use should the disease spread into Sydney from those isolated at the North Head Quarantine Station.

Early in 1919 the Government further strengthened its public health measures. Libraries, reading rooms, theatres, music halls, auction rooms and billiard rooms were all closed, and indoor or outdoor church services within the County of Cumberland were prohibited. Space regulations limited the number of people able to gather in shops, hotels, tea rooms and restaurants. Shops were forbidden to hold crowd-attracting bargain or clearance sales. Travel on long-distance trains was restricted and quarantine regulations were further tightened. Troops returning from the war were quarantined at North Head and at the Sydney Cricket Ground, which became a “tent city” during this time.

Nevertheless the outbreak arrived in NSW in 1919, and peaked during that year, and eventually claimed 6387 lives in the state.
The epidemic created enormous public alarm and consternation, particularly in Sydney, with the whole urban lifestyle visibly affected, many less people out and about on the streets, and all wearing the eerie white gauze face masks.
In the street, children skipped rope to the rhyme:

I had a little bird,
Its name was Enza.
I opened the window,
And in-flu-enza.

The statistics were frightening: for each 100,000 people in the population, 319 were going to die. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to previous influenza epidemics, which were less than 0.1% – that is about 25 times more potent.

The morbidity pattern of the disease was also strange; most influenzas are particularly dangerous to the very young or the very old, but in this case more than half of the deaths were people between 20 and 39 years old, and more men than women died.

The onset of the disease was no less terrifying than the statistics it generated.
One doctor wrote “ that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it was simply a struggle for air until they suffocated." Another doctor recalled that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth."

The outbreak gradually wound down in the latter half of 1919, and although several smaller outbreaks were recorded in various parts of the world in later times, thankfully it never returned with similar force.

The origins of this influenza variant are not precisely known. It is thought to have originated in China in a rare genetic shift of the influenza virus. The recombination of its surface proteins created a virus novel to almost everyone and a loss of herd immunity. Recently the virus has been reconstructed from the tissue of a dead soldier and is now being genetically characterized.

Reference: Disasters, Events and Moments That Changed the World; Richard Whitaker
New Holland Publishers; ISBN 9781741105636