IT was in this month 100 years ago that one of the greatest medical catastrophes to hit Scotland finally drew to a painful, exhausting close. Influenza had killed tens of thousands of people of all ages – though the majority were in the 20 to 40 age group – with only bubonic plague and cholera having previously taken more lives than the H1N1 virus did in just 10 or 11 months in 1918-1919.

The so-called “Spanish flu” pandemic finally came to a conclusion in Scotland in April, 1919, and unless I have missed something, I have not seen any national commemoration of the centenary of this utter disaster that was visited on many families across Scotland and which killed tens of millions of people around the world. There have been newspaper articles and television programmes, mostly asking if it can happen again, but there has been no national marking of the tragedy, and while the writer and historian Trevor Royle is one of a number of people who have suggested a monument to the dead, none has so far been built.

It is impossible to exaggerate the devastation, dread, fear, hysteria, and agony that the outbreak of influenza brought to Scotland in 1918-19. Remember, there was no National Health Service back then. Antibiotics were in their puny infancy and Sir Alexander Fleming was years away from discovering penicillin.

There was no immunisation against the deadly virus. If you got it, there was no genuine medical treatment. Basically you went to your bed and if you were lucky, you survived, and if not, you were days, sometimes only hours, from a very nasty death. Imagine that – no doctor could really do anything medical to help you and their efforts were concentrated on stopping the spread of the infection, there was no flu jab to stop you getting it, and you had to pay for any treatment that you got, even when, in many cases, it didn’t work.

Worse still, when influenza arrived in Scotland in May, 1918, many medical staff were working on the Western Front or those other theatres of the First World War which are often ignored by the history books. Their absence until November 1918 hampered the most important thing that medical people could so which was to contain the spread of the virus.

In many cases, death was swift and horrifying with victims suffering from cyanosis and turning blue before expiring. Many other victims saw the virus greatly exacerbate existing conditions such as asthma or respiratory illnesses so that people died after days of struggling for a breath. That is why in folk memory, if not official records, Spanish flu was so feared.

What is mystifying for any historian attempting to discover the truth of the outbreak is the sheer lack of information, especially newspaper coverage, of the events of 1918-19. That is because the UK Government used wartime restrictions to “lean” on compliant newspapers to underplay the outbreak’s damage, especially in the latter years of the war.

The press were encouraged to write about its effects elsewhere, and that is how the pandemic got its name – the illness of King Alfonso XIII of Spain could be reported as Spain was a neutral country and had no restrictions on the press, so that people thought it was a Spanish problem more than anywhere else.

For this account of the effects in Scotland, I have relied largely on a report by medical experts AR Butler and JL Hogg who wrote in their excellent briefing paper “Exploring Scotland’s influenza pandemic of 1918–19, lest we forget” for the Royal College of Physicians of Edinburgh (RCPE) a dozen years ago: “Scotland suffered a proportionate loss of life but it was little reported at the time and has been little studied by social historians since.

“The Great War had been such a traumatic experience that the authorities, and the general public, could take no more tragic news and the result was an uncanny silence. There is little information on the way in which people were affected by the pandemic.”

The two experts suggest why: “The death of a soldier, even an non-heroic death in a trench, was seen as a sacrifice made in defence of King, country and Christian values. It had an element of nobility about it. But what could be said of a young man or woman killed by an invisible virus?

“Such a death made poor newspaper copy. The nation was weary of fatalities and possibly newspaper editors were sensitive

to this. Presumably everyone

hoped the pandemic would disappear as mysteriously as it appeared and life could return to some sort of normality.”

That it was overwhelming in nature is beyond doubt. The RCPE itself reported to the Edinburgh Medical Journal in 1919: “Not only does this epidemic of influenza tower over all previously recorded epidemics of similar nature: it proved the most fatal epidemic disease of any form that has occurred in Scotland since death registration begun.”

To put the outbreak in Scotland into context, reports of the death toll here vary between 25,000 and 40,000, perhaps more. This was in proportion to the global fatalities. It is a fact that more people worldwide died from the virus than were killed in the First World War. Some fifty million are believed to have died of Spanish flu with some areas particularly badly hit – some remote Pacific islands lost 20% of their population.

The virus may have been brought to Europe by Chinese labourers imported to dig trenches in wart-torn Europe. They mingled with Allied troops so that theory is plausible. So, too, is the theory that the virus came to Europe from the US where the first outbreak was reported in Camp Funston in Kansas leading to the theory that US “doughboy” troops imported it with them.

WHAT is undeniable is that Glasgow and Lanarkshire saw the first cases in Britain in May, 1918. Most medical experts agree that the influenza virus was brought into the UK by returning troops from the Western Front and the points of entry were usually ports such as Glasgow, Liverpool, Portsmouth and Southampton.

The National:

The illness was named after King Alfonso XIII of Spain

Miraculously, the first 436 Scottish cases that centred on three factories and an industrial school saw 100% survival – the usual survival rate for the pandemic in Scotland was 90%. But a second outbreak a week later at two industrial schools in Lanarkshire saw eight deaths.

The first deaths in the community occurred at the Smyllum Park orphanage in Lanark, run by the Daughters of Charity of St Vincent de Paul – the same orphanage that has featured in the atrocious reports of ill-treatment of children which have been put before the ongoing child abuse inquiry in Edinburgh.

The first child victims were said to have died of acute enteritis, but medical officers later corrected the record to show that they died of flu.

The eight victims at the orphanage were aged between nine and 15. They were buried together in a mass grave in the grounds of St Mary’s Cemetery.

The first wave of the spread of the virus engulfed central Scotland from late May onwards. People collapsed, and sometimes died, in the streets. Others took to their beds, many suffering a long lingering death agony.

Schools closed early for the summer because of high rates of infection among both teachers and children. There were hundreds of deaths, but by the end of July the worst seemed to be over.

What appears to have happened over the summer and into the early autumn is that the H1N1 virus mutated and this second wave of the virus was particularly deadly.

The peak of the outbreak in Scotland occurred in October and November 1918, when up to 1000 cases per week were being reported. Such was the shortage of medical staff that many cases went unreported and untreated at all.

Butler and Hogg reported: “In one part of Fife, there were 5731 people to one doctor, and in one area of Glasgow, normally looked after by 17 GPs, ten were on military duty and three were ill. This meant there were only four doctors for a population of 55,000 people.

“Many elderly doctors were brought out of retirement to help with GP services during the war and the stress of the flu pandemic was just too much. In one district of Glasgow in the course of one week two elderly practitioners died on their rounds, one seated at the bedside of a patient, the other in the street.”

It was a one-sided battle and the flu was winning. All that could be done was to contain the virus and some factories lifted their bans on smoking as it was thought that tobacco could kill the germs most people blamed for the outbreak. At its peak, schools, cinemas, theatres were shut or had their opening hours curtailed. Public buildings were closed, and that included churches, as people tried to avoid infection.

Streets and buildings were sprayed with disinfectant. People were told to eat porridge, and wash their noses out. What made the pandemic particularly hateful was the fact that it attacked young adults most of all. It is thought that this was due to the nature of the human immune system’s reaction to the particularly virulent strain of influenza. In people between the ages of 20 and 40 the immune system reacts most strongly and that enabled the virus to kill and replace many more cells within the body while the relatively weaker immune systems of children and the elderly were able to survive the onslaught.

This also meant that young men who had survived the horrors of the Western Front came home safe only to catch the virus and pass away.

There was no cure. One senior doctor recommended an internal carbolic acid preparation only to be slapped down in public by the Pharmaceutical Society. The professions just did not know what to do, and the public resorted to “old wives’ tales” remedies – whisky sales soared, strangely enough.

As is so often the case, it was the local newspapers which chronicled the events most closely. For example, in its edition of November 8, 1918, the Linlithgowshire Gazette reported: “The number of deaths in the burgh and parish of Linlithgow from influenza, since 15th October when the first death was registered, number 55. In one home in Bridgend there have been four deaths – the father and three sons ... It is stated that the mortality in the burgh and parish from influenza has exceeded that from the cholera epidemic ... between 50 and 60 years ago.”

The outbreak in Scotland died down over Christmas and New Year, when people were encouraged to break off from the tradition of visiting friends and “first footing”, but the number of cases rose again in February and March of 1919.

Then it was gone just as suddenly as it came. One theory is that the virus mutated into a considerably less infectious and damaging strain, others think that doctors got better at treating the often fatal side effects of Spanish flu such as pneumonia.

Whatever happened, by the end of April 1919, the number of new cases drifted downwards so that the pandemic could safely be said to be over. The death total for the whole of the UK was put at 228,000 at least, the highest mortality rate since the great cholera outbreak of 1849.

I don’t want to be alarmist but the Spanish Flu pandemic of 1918-19 is still being studied by scientists today. That is because they fear another pandemic.