Legacy of the 1918 influenza pandemic

In Stacking The Coffins - Influenza, War and Revolution in Ireland, 1918-19 (Manchester University Press), Dr Ida Milne, a historian of disease and European history lecturer at Carlow College, Ireland, tells the story of the 1918-1919 influenza pandemic which killed more than 50 million people and infected between one fifth and half of the world’s population. While Dr Milne’s book focuses on the effect of the pandemic in Ireland, she also gives an overview of the influenza outbreak globally. The outbreak of the pandemic came at the end of the First World War. Dr Milne, in the opening chapter of the book notes that the newspapers of the day flagged it as a “mysterious disease”, “a mysterious malady”. The pandemic disrupted the Paris Peace Conference, after delegations charged with negotiating a lasting peace, were affected by the mystery flu and in early spring 1918, doctors paid 125 house calls in one day to the American delegation. Dr Milne quotes a passage from Alfred Crosby’s American Forgotten Pandemic (1976) which states: “The most important and almost incomprehensible fact about the Spanish flu is that it killed millions of people in a year or less. Nothing less – no infection, no war, no famine – has ever killed so many in such a short period. And yet it has never inspired awe, not in 1918 and not since, not among the citizens of the United States”. The final global death toll was more than 50 million people but as Dr Milne notes death registration was rudimentary in many parts of the world so the final number of mortalities will never be known. This short article cannot do justice to Dr Milne’s book so I will focus briefly on Chapter 5 which deals with the doctor’s view of the disease. As Dr Milne notes, even today diagnosing influenza poses difficulties. The 1918 ailment could be a mild disease in some people with sore throat, fever and aches. In other cases, it could lead to death within a matter of hours. “A man could rise from bed, have his breakfast and leave for work. By lunchtime his wife could be informed that he had died,” says Dr Milne. Dr Milne also notes that some patients recovered from the influenza attack and resumed normal life but died from post-influenza pneumonia, heart attacks caused by the illness or other complications. The disease damaged the heart and lungs in some cases and could also cause various types of nerve, eye and ear disorders. The cranial nerves could also be affected leading to disturbed or temporary loss of smell. Ophthalmologists will also be interested to note that inflammation or atrophy of the nerves in the eye and ocular palsies occurred among some of those who were treated for the new strain of influenza. As Dr Milne concludes at the end of this excellent book, the 1918-1919 pandemic has legacies that still endure. This book is essential reading for ophthalmologists and other health professionals. * Colin Kerr is Executive Editor of EuroTimes. Update In February 2021, ESRS EuroTimes will devote a special issue to the aftermath of the COVID-19 pandemic, its affect on ophthalmologists and the health service and how medical professionals are being forced to adjust to new realities in their daily practices. This led me to revisit Dr Milne's book and, in particular, Chapter 9, Epilogue: the long aftermath.. The 1918-1919 pandemic, she notes, challenged and dented the confidence of the medical profession "whose scientific knowledge, skills and medicines proved less than up to the task of healing their patients when faced with such a difficult and protean disease". The pandemic also highlighted various problems within the health system through the extra pressure placed on hospital beds and financial difficulties caused by inadequate funding. Dr Milne also notes: "One cannot help feeling that the major impact of the influenza epidemic was not on politics, medicine, government structures, or public health administration, but on private lives. Individuals and families suffered from loss, altered economic circumstances and changed family structures..." Finally, she notes in the final paragraph of this fascinating history: "The 1918-1919 pandemic ....persuaded international health authorities of the need to set up the global influenza-monitoring system that exists today, which is run by the World Health Organization. It has left a physical imprint through the graves of the dead, the pages of cemetery records, and the thousands of news pages and new histories documenting its effects."

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