Just over 100 years ago, York was in the grip of a devastating viral pandemic that was even worse than Covid-19. So what can we learn from the Spanish flu, and the way this city dealt with it? CATHERINE OAKLEY of the Rowntree Society and STEPHEN LEWIS report

IN mid-June 1918, people across the UK began to fall sick. An article in a Yorkshire daily newspaper described the signs of their illness.

“Those people who have not yet been affected will be interested to learn that the first symptoms…are an attack of aches and pains all over the body, along with dizziness," the newspaper reported. "Then follow headache, pains in the back, and occasionally sickness, with a feeling of absolute helplessness."

The disease caused acute suffering. In the most severe cases, the infection led to an immune system response known as heliotrope cyanosis, in which the body turned black or blue as fluid leaked into the lungs and drowned the sufferer. There were also multiple incidences of delirium and psychological disturbances, leading to violence and self-harm.

As the illness spread throughout the population, it disrupted patterns of everyday life which had already been transformed by the turmoil of the First World War.

Northern England, with its industrial base and high urban population, was badly stricken. In some streets in Sunderland, every household was affected, and entire families laid up. In Newcastle, police, fire brigade and hospital staff were absent in significant numbers, and in Manchester, more than 200 tramway car drivers and guards went off sick.

In York, all elementary schools were closed in the first week of July and remained closed throughout the whole summer. Independence Day celebrations planned for American troops stationed in the city – including a baseball match, tea at the Assembly Rooms, and a parade – were all cancelled. Cinemas and other places of entertainment were designated as off-limits for soldiers, though they remained open for civilians.

Across the city, trained medical staff struggled to meet increased demand for their skills as they contended with an existing national shortage of doctors and nurses. In January of 1918, more than half of the country’s doctors had been on military duty. By the time the illness struck, nine York doctors reported that at one point that they had visited 6,000 cases between them. Edmund Smith, the city’s Medical Officer of Health, reported that 'the professional nursing staffs of the city and district were absolutely overwhelmed'.

This was the ‘Spanish flu’, so-called because Spain, which remained neutral during the First World War, did not censor news of the epidemic whereas participating nations did.

Historians and scientists disagree on the origins of the virus, which may have first emerged on a farm in Kansas, USA.

Whatever its origins, it spread across the globe, beginning its journey in early March 1918 and ending with the last recorded infection around March 1920.

Throughout this period, one in three people on the planet – 500 million – were infected, and between 50-100 million are estimated to have died, according to Laura Spinney in her book Pale Rider.

In the UK, a quarter of the British population contracted the virus and one estimate places the national death toll at 228,000. Mortality figures are, however, likely to be underestimates: many deaths will not have been recorded as influenza-related but as pneumonia, tuberculosis, bronchitis or even suicide, all of which were documented secondary complications.

The virus arrived in England and Wales in about mid June 1918, and by the end of July, it had diminished.

In mid October, however, it returned, and this 'second peak', far more deadly than the first, lasted until the end of the year, only to be followed by a third wave between February and May 1919.

Historian David Rubinstein in his book 'York in War and Peace, 1914-1945', gives a vivid account of the impact of this second wave of the virus on a city which had already been ravaged by the impact of four years of calamitous war - a war which was still only just, in that autumn of 1918, drawing to an end.

The second wave of the epidemic reached its height in mid autumn, Mr Rubinstein writes. "Schools were temporarily closed, and other places where children congregated were instructed to discourage them from attendance. These included church services, Sunday schools and, in the case of children under 14, cinemas."

On October 24, 1918, the Yorkshire Evening Press noted sombrely that there were 'scarcely any districts in the city without a large number of cases'. The situation was just as bad elsewhere. By early November, Mr Rubinstein writes, every house in the village of Claxton near York had been affected.

Newspapers tried to encourage their readers to take precautions but not to panic, Mr Rubinstein writes. "It was a panicky situation, however, particularly as medical staff found it impossible to cope."

Dr JC Lyth, secretary of the York Medical and Panel Committee, told the Yorkshire Evening Press that 'every doctor is working continuously from morning til night, almost without any cessation...There is grave danger of a serious breakdown in the medical services throughout the country'.

This second wave of the Spanish flu continued through to the end of the year. On November 23, the Yorkshire Evening Press reported the case of a young York army officer and his wife who both died, leaving two children without parents. By mid-December, the newspaper was saying it was estimated that there had been six million flu-deaths worldwide in just 12 weeks - and calculated that it was a killer five times more deadly than the First World War, with its twenty million deaths over four and a half years.

The late Hugh Murray calculated that 322 people in York died of the disease between October 5, 1918, and January 11, 1919.

In the nine days up to October 31, 1918, there were 110 burials in York Cemetery instead of the usual 30, David Rubinstein writes. "Soldiers had to be recruited to assist with digging graves."

So what can we learn today from the way that York dealt with the Spanish flu 100 years ago?

Three things stand out.

The first is the role played by the city's Health Committee and its Medical Officer of Health, Edmund Smith. This was a time before the NHS, when the role of local authorities in preventing and controlling outbreaks of disease was really important.

The effectiveness of responses across the country was very patchy. Manchester's Medical Officer James Niven is renowned for having saved many lives through preventative measures. One academic gives York as another positive example of a local authority response, citing the Health Committee's rigorous collection of data and a coordinated effort to provide medical attention and comfort to patients.

Secondly, when you are reading newspapers and other documents from the time, you get a strong sense of the work of carers in the city, and of communities that really pulled together. The hospitals were overwhelmed with patients, which put a lot of pressure on district nurses, who did home visits. They weren't able to stay long in each household, and in some houses, whole families were laid up at the same time. When the nurses left, neighbours would come in and take over, risking their own lives to save others.

And finally, you can see that the impact of the pandemic was related to many areas that were central to the philanthropic work of the Rowntree family in York - including poverty, housing, and the welfare of workers.

In 1918, the Spanish flu hit certain groups hard because of inequalities in society: women; those living in poverty and in overcrowded housing; and people from minority ethnic groups. The same is true for COVID-19 today.

In the years after 1918, the Rowntree family was involved in many projects of rebuilding society following the war and the pandemic. Rebuilding will be a task for us all, too, in the coming weeks, months and years, and the Rowntree emphasis on community, welfare and social justice can play an important role in planning for the future.

Dr Catherine Oakley is executive director of The Rowntree Society.

This article is an edited and extended version of a blog she originally wrote for The Rowntree Society, with the help of research from local archives and archivists. She is planning further blogs in the next few weeks looking at different aspects of the Spanish flu and the lessons we can learn from it. You can follow these on The Rowntree Society website at rowntreesociety.org.uk/ or on Twitter at @rowntreesoc