Un-remembered but Unforgettable: The ‘Spanish Flu’ Pandemic

In 1918, during the final months of the First World War, an influenza epidemic swept across the world. This strain of influenza was unusual, in that it was particularly deadly among 20–40 year olds, the age group typically least at risk from flu-related mortality. Many victims of the pandemic appear to have died from respiratory failure due to secondary bacterial infections, which medicine at the time lacked the antibiotics to treat. Wartime censorship and military objectives often obstructed the public health response, and troop movements helped to spread the disease. Worldwide, during the years 1918–19, the ‘Spanish Flu’ pandemic is estimated to have killed between 50 and 100 million people. Despite its massive impact on the world, the pandemic was largely written out of early 20th century history, possibly because of a wish to focus on the more heroic narrative of the war. The long-term repercussions of the ‘Spanish Flu’ lasted for generations, and have had both positive and negative impacts on societal resilience. This chapter discusses the pandemic, its impacts and effects, as well as its implications for modern public health practice. The word ‘influenza’ was first coined during an outbreak in Renaissance-era Italy, in which it was noted that the populace attributed the disease to the malevolent ‘influence’ of the stars.1 Today, influenza still retains some of the mercurial and enigmatic character lent to it by this early classification. In abbreviated lay parlance it is often used to describe a mild cold (“a touch of the ‘flu’”), or the perceived malingering and tendency to exaggerate trivial symptoms by men (“don’t mind him, he’s just got man-flu”). And yet, in its pandemic form it remains at the top of public health risk registers for most developed nations.2