A History of the Great Influenza Pandemics: Death, Panic and Hysteria, 1830-1920 9780755618613, 9781350160088

Citation preview

For NAOMI and FRANK

‘Influenza is the very Proteus of diseases, a malady which assumes so many different forms that it seems to be not one, but all diseases epitome’ — Sir Morell Mackenzie, Fortnightly Review, 1891.

LIST OF ILLUSTRATIONS

Chapter 2 1. Front cover of Le Grelot 2. ‘The Sneezing Duet’ 3. ‘The Prevailing Epidemic’ 4. Questionnaire circulated by George Buchanan 5. Weekly death rate from influenza in Sheffield, 1890 and 1891 6. Deaths from influenza in the three epidemics in London 7. ‘Gradual Transformation Scene—Flight of the Demon Influenza at the Approach of Spring’ 8. ‘Influenza at the “Zoo”’ 9. ‘More Influenza—John Bull Attacked by Wild Microbes’ 10. ‘The Influenza Fiend; Or, the Old Man and the Sneeze’ Chapter 3 1. ‘He came into the hall to greet me’ 2. Artist’s impression of Frank Taylor Chapter 4 1. ‘The Man Who Did Not Believe in Influenza’ 2. ‘The London Police and the Influenza Fiend’ 3. ‘Influenza Testimonials’

List of Illustrations

Chapter 5 1. Graphic double memorial issue 2. ‘The Plague of 1892’ 3. Carbolic Smoke Ball, Graphic 4. Carbolic Smoke Ball, Pall Mall Gazette 5. ‘Influenza: The Enemy at Home’, Penny Illustrated Paper 6. ‘Influenza: The Enemy at Home’, Hearth and Home

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ABBREVIATIONS

American Expeditionary Force (AEF) British Medical Journal (BMJ) Case fatality rate (CFR) Centers for Disease Control (CDC) Central nervous system (CNS) Chief Medical Officer (CMO) General paralysis of the insane (GPI) General Registry Office (GRO) Global Outbreak Alert and Response Network (GOARN) Global Public Health Intelligence Network (GPHIN) Ladies National Association (LNA) Local Government Board (LGB) Medical Officer of Health (MOH) Medical Officers of Health (MOsH) Medical Research Committee (MRC) Royal Society of Medicine (RSM) World Health Organization (WHO)

INTRODUCTION `

THE SPHINX OF EPIDEMIC DISEASES'

Flu is not a word calculated to strike terror into the human heart. Flu is too familiar for that, too ordinary. Most of us will have suffered a bout of influenza at one time or another and most of us will have survived to tell the tale, but precisely because flu is so commonplace it is not a tale that many of us would care to relate.1 As Virginia Woolf observed in 1925 while recovering from one of her recurrent bouts of flu-like illnesses, such a narrative would be exceedingly dull: The public would say that a novel devoted to influenza lacked plot; they would complain that there was no love in it . . . English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache.2 No doubt Susan Sontag would have concurred. The diseases we regard as metaphorical, she argues, are those that tend to scar the body or for which treatment is ineffectual. ‘First, the subjects of deepest dread (corruption, decay, anomie, weakness) are identified with the disease,’ she writes. ‘Then, in the name of the disease (that is, using it as a metaphor), that horror is imposed on other things.’3 But influenza is not metaphorical in this sense. It does not usually leave visible marks on the face or body, nor does it reduce its victims to a shocking or pitiable stake in the manner of smallpox or cholera. The

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result, observes Sontag, is that influenza ‘never arouse[d] the deepest dread’.4 She might have added that although the 1918– 19 ‘Spanish’ influenza pandemic is considered one of the most deadly disease events in the history of humanity, it does not seem to have inspired significant works of poetry or literature or left many traces in public memory either—hence its historiographical characterisation as the ‘forgotten pandemic’.5 This book argues that the reason influenza tends to perplex historians and cultural commentators is that it is a protean infection that is forever changing its medical identity. The most common symptoms of influenza are a dry cough accompanied by chills, a severe headache, fatigue, coryza (acute rhinitis) and muscular pain, especially in the back and legs. Yet while the symptoms of seasonal flus tend to be banal, pandemic strains can be terrifying, triggering fatal pneumonias and a condition known as heliotrope cyanosis in which sufferers’ faces turn a disturbing purple-black colour as their lungs fill with choking fluids.6 Pandemic forms of flu can also cause diarrhoea, nausea and vomiting, and because the chills frequently alternate with fevers and sweats, in the tropics the symptoms are sometimes confused with dengue fever and malaria. Moreover, even mild attacks of flu have the ability to provoke disturbing nervous symptoms, ranging from fatigue to depression and psychosis. This diverse symptomatology gives influenza considerable metaphorical flexibility. As the leading Victorian throat expert Sir Morell Mackenzie remarked in 1891: ‘Influenza is the very Proteus of diseases, a malady which assumes so many different forms that it seems to be not one, but all diseases epitome.’7 Moreover, while influenza is not ordinarily considered a frightening disease, I will argue that its protean symptomatology lends itself readily to metaphorical production. Like Janus, the Roman God who presided over doorways and new beginnings, influenza has two opposing faces. One is associated with immense mortality and suffering, hence the frequent comparisons between the Spanish flu and the Black Death.8 The second is that, during interpandemic periods influenza is more usually regarded as an inconvenience than as a mortal threat to life, hence its commonplace dismissal as a ‘trivial’ or ‘fashionable’ ailment

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on a par with the common cold.9 These opposing identities of influenza, I will argue, greatly complicate biopolitical discourses, destabilising medical efforts to manage people’s expectations about the health risks of the pandemic form of the disease, and combining a diagnosis of flu with potential moral judgement.10 Since the early 1970s, there has been a steady growth in interest in the 1918– 19 pandemic.11 If anything, this fascination with what one writer has termed ‘the greatest disease holocaust in history’12 has intensified in recent years, with the publication of 11 books in the last decade alone.13 However, although historians have scrutinised the 1918 – 19 pandemic, this scholarship has not usually extended to the 1889 – 93 pandemic of ‘Russian’ influenza—so-called because the first reported outbreaks occurred in St Petersburg in the autumn of 1889—or to the marked recrudescences of influenza in the closing years of Queen Victoria’s reign.14 Nor, for the most part, have medical historians shown much interest in the flu epidemics of the 1830s and 1840s. This book seeks to redress that balance by combining insights from the medical history of infectious diseases, the recent historiography of the emotions, and the sociology of material culture. Drawing on official medical investigations and reports, contemporary newspaper accounts, and the writings of prominent doctors and celebrity patients, I will argue that the ‘modern’ notion of influenza is a product of new scientific understandings of the disease that first emerged in the 1890s. By the mid-1890s these medical discourses increasingly focused on the respiratory, and nervous complications of influenza—discourses that, I will argue, were amplified by new telegraphic technologies and the competition between mass market Victorian newspapers, making the Russian flu a sensational topic and a barometer of wider fin-de-sie`cle social and cultural anxieties. These anxieties were partly a product of the aforesaid telegraphic technologies and partly of medical statistics, bacteriology and then theories of emotional pathology. They can best be understood by an examination of biopolitical discourses aimed at regulating the ‘dread’ of infectious diseases. Tracing these discourses through the interpandemic period, I show that while Britain was at

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peace, dread of influenza was a tool of biopolitics and biopower. By 1918 however, Britain was at war, resulting in the politicisation of dread and the stricter policing of negative emotions. The Spanish flu both drew on these discourses and undermined them, disrupting the propaganda effort and destabilising medical attempts to regulate civilian responses to the pandemic. Flu, I will argue, is a palimpsest that draws on the social, cultural and historiographical materials available to it. This is not to deny the biological materiality of flu, only to give intellectual priority to the forms of knowledge and social processes whereby flu, to paraphrase Jordanova, is ‘created’.15 In 1890 no one had experienced a pandemic of influenza for 42 years. As far as most British physicians were concerned, influenza was little more than a synonym for a bad cold or catarrh. Such catarrhs visited the British Isles every autumn and winter, sometimes in epidemic form, but unless they were complicated by bronchitis or pneumonia they were rarely lifethreatening. The Russian flu changed all that, sweeping across Europe and North America in three pandemic waves that left no doubt as to its morbidifying and killing power. In Britain alone, about 4 million people were sickened in the 1889– 90 wave, and some 27,000 died. Taking into account the subsequent 1891 and 1892 waves, it is estimated that some 110,000 Britons perished in the pandemic—a total that approaches the mortality from the better known Spanish flu.16 However, while by 1918 there was broad medical agreement that influenza was a contagious disease, spread, as most scientists thought at the time, by an infectious bacillus, in 1890 no one could agree whether influenza was one disease or several, much less whether it was due to a microbial life form or a miasmatic gas. The sudden eruption of the Russian flu therefore presented the Victorian medical profession and the media with considerable narrative opportunities. Like the shadowy figure of ‘Jack the Ripper’, whose murderous rampage on the streets of Whitechapel had struck fear into Londoners just two years earlier, influenza was a killer without an identity, a mysterious materia morbi that descended suddenly on cities, spreading panic, hysteria and death, before disappearing just as suddenly as it had appeared. As flu became an

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object of growing medical and scientific interest, however, this began to change and it was not long before flu was also being seen as a barometer of wider social pathologies connected to Victorian concerns about fatigue, degeneration and the technologising processes of modern life. Particularly during the early waves of the pandemic, hysteria and dread of the Russian flu was fuelled by alarming news reports of the spreading pan-European morbidity, as well as by the flu’s association with new global transportation technologies and the media focus on celebrity sufferers, such as the British Prime Minister and Foreign Secretary Lord Salisbury. By 1890, Victorians thought that better sanitation and advances in bacteriology had tamed the infectious disease scourges of the past. However, the speed with which the Russian flu was observed to spread via the railways from one European capital to another, and the wide social profile of its victims, undermined Victorians’ faith in medical progress. The result was that, come the bitterly cold winter of 1892 and the news that an ‘influenzal pneumonia’ had claimed the life of the Duke of Clarence, the son of the Prince of Wales and the second-in-line-to the throne, few Victorians doubted that influenza was a serious public health threat. In particular, doctors noted that the flu appeared to aggravate pre-existing lung conditions, frequently proving fatal to patients with bronchitis, asthma, and phthisis (pulmonary tuberculosis). As statistical calculations of the excess death rate due to these secondary respiratory complications became more commonplace, so, I will argue, the risks associated with influenza became more ‘visible’ to physicians and to the Victorian reading public. In everyday language, risk is a synonym for danger and peril, but risks do not simply exist ‘out there’ in nature, waiting to be discovered. Rather, they are a product of human knowledge systems and scientific discourse. This is nowhere more true than in the field of public health, where risk-avoiding discourses are invoked to persuade people to take note of health threats and adjust their behaviour accordingly. As Foucault has noted, in the modern liberal state that emerged in Europe in the eighteenth century, citizens increasingly found themselves at the centre of webs of knowledge whose object

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was the regulation of populations and, ultimately, of life itself. Typically, this ‘governmentality’ was achieved via either the collective pole of the politics of population or the individualising pole of discipline.17 As Rabinow and Rose have argued, in liberal societies individuals are not overly-regulated by oppressive strategies; rather, they are encouraged to adopt self-governing practices voluntarily as a quid pro quo for limiting the power of central administration.18 As I hope to show, such strategies proved particularly useful in the case of the Russian influenza—a pandemic that was not foreseen by medical science and that public health administrations were largely powerless to prevent or control. Instead, I will argue that in the 1890s patients for whom flu was deemed to be a risk were increasingly encouraged to become what the medical sociologist David Armstrong calls ‘agents of medicine; [and] their own self-practitioners’.19 As Alcabes has noted, discourses around epidemics commonly employ fear and ‘collective dread’ as a way of regulating behaviour and policing conduct.20 The questions I want to ask are how did these emotions first become attached to flu, and how did they evolve over time? Was the dread of flu a product primarily of epidemiology, bacteriology or of Victorian models of the mind? Moreover, how did newspapers and the editors of Victorian periodicals make sense of these medical and scientific constructions and translate them into popular idioms? What role did epidemiology and bacteriology play in making influenza more ‘visible’ to medical researchers and to public health officials, and how did these new ways of ‘knowing’ influenza affect biopolitical discourses that sought to regulate the health of populations? Furthermore, how did these constructions of influenza draw on wider cultural anxieties about fatigue, degeneration and urbanisation (and what did they reveal about the construction of gender roles and Victorian notions of identity and agency at the fin-de-sie`cle)? Finally, while the late Victorian and early Edwardian periods coincided with a long period of peace in mainland Europe, by 1914 Britain and the other major European powers were embroiled in the First World War—a war that saw the rapid militarisation of British

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society and the deployment of new mass propaganda techniques aimed at bolstering civilian morale. How did these political discourses affect the production and objectification of fear, dread and other negative emotions, such as anger and hatred of Germany? How did they interact with biopolitical discourses about other threats to the social body, and what effect did the 1918 – 19 pandemic have on these discourses? *** In Chapter 1 I show how, prior to the middle nineteenth century, influenza had no agreed nosology or fixed medical identity. Although probable epidemics of influenza had been identified in historical records stretching back to the twelfth century, such outbreaks were indistinguishable from the other epidemic ‘distempers’ and ‘fevers’ that periodically visited the British Isles.21 This only began to change in the 1830s, when a series of influenza epidemics began to alternate with epidemics of cholera and typhus, making influenza an object of increasing medical and epidemiological interest. However, the key turning point came with the 1847– 8 pandemic, the first to coincide with the General Registry Office’s (GRO) new system of registration. In particular, I argue that it was retrospective statistical analysis of the GRO’s annual mortality returns that made influenza ‘visible’ to sanitary reformers for the first time, by connecting the epidemic to fluctuations in the ‘excess’ death rate. At the same time, clinicians distinguished three distinct forms of the disease— respiratory, nervous, and gastric—underlining the association between influenza and other forms of ‘zymotic’ disease. However, at mid-century there was no network of cheap morning and evening newspapers to amplify these scientific discourses. The result was that, by and large, these insights remained the preserve of public health professionals and the readers of specialist medical journals. Chapter 2 shifts the focus to the Russian flu pandemic, and the recurrent waves of infection that swept the British Isles in 1889– 90, 1891 and 1892– 3. Arguing that the pandemic was the first to coincide with a mass Victorian newspaper market and distinctively ‘modern’ forms of communication, it shows how the rapid progress of

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the Russian flu via the European railway system, and the near instantaneous reporting of the outbreaks via the worldwide telegraphic network, made the flu sensational. In particular, I argue that ‘dread of the epidemic’, as The Lancet put it, was fuelled by newspaper correspondents’ ability to telegraph news of the flu’s depredations from European capitals well ahead of local British outbreaks. This popular fascination with the flu was matched by growing scientific scrutiny of the epidemic. In particular, this chapter focuses on the efforts by the medical department of the Local Government Board to map the epidemic and describe the flu’s clinical, epidemiological and bacteriological features. The chapter concludes by arguing that, while in the initial phases of the pandemic popular dread of the Russian flu was fuelled by sensational reports of the spreading morbidity, by 1891 closer clinical and epidemiological surveillance meant that this dread increasingly attached to the potentially fatal lung complications. At the same time, influenza was configured as a microbial infection associated with a specific bacillus. However, although epidemiology and bacteriology transformed flu into what George Buchanan, the Medical Officer of the LGB, called an ‘eminently infectious complaint’, it never became an object of state-sponsored medical interventions or coercive hygienic regimes. In Chapter 3 I go on to explore the dread of flu further, showing how such constructions drew on late nineteenth century medical and cultural discourses of ‘nervous’ illness. In particular, I show how the symptoms of neuralgia, insomnia, depression and psychosis that frequently followed attacks of the Russian flu drew on contemporary medical theories of nervous dysfunction and notions of fatigue and entropy. Male patients in particular were thought to present a heightened risk of the ‘psychoses of influenza’ because of the way that their occupations exposed them to ‘overwork’ and ‘overworry’. As in the initial phase of the Russian pandemic, the association between influenza and nervousness was amplified by the Victorian news media—in particular, by sensational newspaper reports of suicides and homicides linked to prior attacks of flu. However, I argue that the model influenza most closely resembled in this period was

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neurasthenia, and that, in the same way that a diagnosis of neurasthenia offered an acceptable medical diagnosis for a wide spectrum of psychiatric and psychosomatic disorders, so in the 1890s a diagnosis of influenzal psychosis became similarly fashionable. Chapter 4 focuses on the Prime Minister Lord Rosebery’s six-week battle with post-influenzal insomnia in the early spring of 1895, and shows how the nervous responses to influenza could also be construed as a form of hypochondria and hysteria. Arguing that the nervous ‘sequels’ of influenza disrupted Victorian notions of identity and agency, I show how popular interest in Rosebery’s illness was heightened by the fact that his insomnia came at a critical juncture in his premiership, paralysing his government and prompting speculation about the survival of the Gladstonian wing of the Liberal Party. A further factor was that of societal rumours implicating Rosebery in a homosexual liaison with Francis Douglas, the Marquess of Queensberry’s eldest son and the brother of Alfred Douglas, Oscar Wilde’s lover, and the fact that Rosebery’s illness coincided with Wilde’s criminal trial for libel. However, although Rosebery’s illness drew on social anxieties about the ‘divided’ bourgeois male subject, the nervous sequels of influenza were never stigmatised. On the contrary, newspaper reports of Rosebery’s breakdown tended to draw on his celebrity as a political aristocrat and millionaire race-horse owner, engendering broad public sympathy for his illness and prompting the multiplication of stories about other ‘celebrity sufferers’. Chapter 5 examines the connection between influenza, celebrity and sensation in relation to the sudden death of the Duke of Clarence from post-influenzal pneumonia in the winter of 1892. Contrasting the newspaper reports of Clarence’s illness with the private accounts of his attending physicians, I show how the Prince of Wales sought to manage the public response to his son’s illness by issuing a series of misleading medical bulletins. The result was that the gravity of Clarence’s illness was deliberately kept from the Victorian public until the last possible moment. Once the news was out, however, it radiated rapidly across the nation and Empire via the electric telegraph, creating a chain of ‘sensation’ that multiplied the public

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expressions of grief, and transformed Clarence’s funeral into a public ‘spectacle’—one in which Victorians were invited to share in the royal family’s suffering. Next, I examine the notorious case of Carlill v Carbolic Smoke Ball Company, showing how the Victorian patent medicine industry sought to exploit consumer dread of influenza to market ‘cure-alls’ to a gullible public. In an era when conventional medicine was powerless to prevent influenza, and the ‘microbe’ could strike down the wealthiest and highest-born individuals in the land, I argue that Elizabeth Carlill’s purchase of the smoke ball was first and foremost an act of faith in the magical powers of consumption. The chapter also examines the use of metaphor and symbolism in adverts for Bovril and other popular flu remedies in the later 1890s. Tracing these productions through the turn of the century and up to 1914, I argue that, whereas in peacetime Bovril’s advertisements freely exploited consumer anxieties about influenza and the dread of infectious diseases, by the time of the Boer War Bovril could no longer resort to such promotional strategies. Instead, as dread began to be seen as an emotion that could undermine morale on the home front, Bovril increasingly employed nationalistic rhetoric that extolled the virtues of stoicism and physical and mental forbearance, while invoking military metaphors and medical notions of ‘resistance’ to ‘attack’. Chapter 6 traces these metaphors through World War I and up to 1920. Rather than seeing the Spanish flu as being ‘overshadowed’ by the war, as some social historians have done, I review the historiography of the pandemic in order to examine the ways in which the Spanish flu did, and did not, draw on military metaphors and wartime propaganda. Juxtaposing the memoirs of the pacifist and cultural historian Caroline Playne with the nationalistic rhetoric of the Northcliffe press (principally The Times and the Daily Mail), I argue that whereas in peacetime dread had posed little threat to the social order, in 1914 – 18 it became an important instrument of social and political control. In an effort to unite Britons against a common enemy and stifle domestic dissent, the government, with the voluntary cooperation of newspaper proprietors, deliberately fostered dread and hatred of Germany. At the same time, British propaganda

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efforts aimed to create unity on the home front by emphasising civilian resilience and ‘staying power’. At first, the advent of Spanish flu had little impact on these discourses. This was because, unlike in 1890, press censorship meant that the first wave of influenza was not sensationalised by the media; nor did it become an object of statesponsored epidemiological investigation. Instead, newspaper editors and the Chief Medical Officer seem to have gone out of their way to ignore the epidemic. However, as the death toll from the Spanish flu increased, and it became necessary to persuade patients to regulate their behaviour to avoid the worst ravages of the disease, doctors and public health officials revived earlier risk discourses. The result was that the dread of respiratory and other complications of influenza once again became an object of biopower. Chapter 7 examines the way that the Spanish flu tends to destabilise psychoanalytic notions of traumatic memory and historical methodologies in which notions of social amnesia and trauma are routinely deployed to reveal subjective ‘truths’ about the past. Focusing on Virginia Woolf’s lifelong battle with mental and physical illness, which included repeated bouts of flu, I argue that in both her life and work Woolf exemplifies the challenge that illness presents to narration and to notions of historical memory. Woolf’s biographers have retrospectively deployed psychoanalytic readings to claim that her symptoms reflected her association of illness with repressed memories of childhood sexual abuse. These readings, I argue, parallel social historians’ retrospective readings of the 1918– 19 pandemic as a ‘collective trauma’ whose memory has somehow been ‘forgotten’ or erased from modern memory. Such readings take the notion of traumatic memory as given. But what if the Spanish flu was not nearly as traumatic or tragic as historians have assumed? This is the methodological challenge represented by Woolf’s encounter with flu. Indeed, far from regarding her recurrent bouts of flu as traumatic, Woolf appears to have drawn literary and aesthetic inspiration from them. I also show how in her writings on illness Woolf specifically grapples with influenza’s resistance to narration—hence her observation that ‘the public would say that a novel devoted to influenza lacked plot’.

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In Chapter 8 I conclude with some reflections on the 2009 swine flu pandemic, an infectious disease ‘scare’ that prompted scientists and public health officials to draw parallels with the 1918 pandemic. In fact, the rapid diffusion of information about the outbreaks in Mexico and the sensationalisation of the story in the media were more reminiscent of 1890 than 1918 and resulted in similarly panicked responses. These responses were not only the fault of the media, however, but can also be traced to new scientific conceptions of influenza as a rapidly mutating viral infection and to historical epidemiology. In particular, I argue that the historiographical focus on the ‘lessons’ of the 1918– 19 pandemic distorted the pandemic planning process, driving assumptions about the periodic recurrence of potentially ‘apocalyptic’ pandemics—hence the predictions in 2005 and 2009 that the emergence of bird flu and swine flu, respectively, could herald a catastrophic event on the scale of 1918. The result is a ‘new hysteria’ driven not so much by outmoded theories of flu’s affinity for the nervous system as by historical epidemiology and modern scientific knowledge about the virus. By examining the long nineteenth century history of influenza, my aim is to bring a broader historical perspective to the scholarship of the 1918 pandemic and provide a corrective to such nervosity. At the same time, I hope to show how influenza has an unusual ability to destabilise scientific knowledge, whether that knowledge aims at elucidating the aetiology of flu, the operation of memory, or history writing itself. Writing in 1901, an editorial in Outlook described influenza as ‘the sphinx of epidemic diseases’.22 That metaphor lies at the heart of my study.

CHAPTER 1 PRE-MODERN INFLUENZA

In the autumn of 1732 a violent distemper swept across Germany and Holland, arriving in the British Isles in late December. In London, where the epidemic raged for the first three weeks of January, the mortality was higher than at any time since the plague of 1588.1 By early February the distemper had reached Devon and Cornwall, and towards the middle of the month it arrived in Plymouth, prompting the physician and surgeon John Huxham to describe it as ‘the most completely epidemic disease of any I can remember’: Not a house was free from it. The beggar’s hut, and the nobleman’s palace were alike subject to its attacks; scarce a person escaping either in town or country: old and young, strong and infirm, shared the same fate.2 As a keen student of epidemics, Huxham made a careful note of the symptoms, observing that although they resembled those ‘arising from what is called catching cold’ [italics in original], the distemper had proven far more dangerous, being accompanied by fever, chills, and a ‘violent cough’. It was not uncommon for people to complain of a ‘racking’ headache and ‘flying pains’ in the back and lungs, he noted. Patients were also given to profuse sweating and there was a ‘universal complaint of want of rest, and a great giddiness’. Almost no one escaped the epidemic, but for all the morbidity Huxham

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observed that the distemper had proved ‘fatal to few’, the chief casualties being infants and elderly consumptives.3 Another observer, the Scottish mathematician John Arbuthnot, was similarly impressed by the ‘remarkable’ symptoms, noting that in addition to the coughs and neuralgia described by Huxham the disease had produced ‘a debility and dejection of appetite and spirits, much more than in proportion to its strength or duration’.4 What was this epidemic disease described by Huxham and Arbuthnot, and was it the same as the disease we call influenza today? The short answer is we do not know. At the time Huxham and Arbuthnot were writing there were no such things as viral assays or polymerase chain reaction tests, and although Huxham recommended bleeding at the beginning of the fever he did not think to preserve blood samples for future serological testing. Even a century later, medical science was little better able to distinguish one epidemic distemper from another, let alone divine the aetiology of such epidemics. Nevertheless, writing in 1852, Theophilus Thompson, a luminary of the Sydenham Society and an expert on phthisis (pulmonary tuberculosis), felt sufficiently confident of his ability to retrospectively ‘read’ Huxham and Arbuthnot’s accounts of the 1732– 3 epidemic that he included their reports in his Annals of Influenza, a comprehensive chronology of flu epidemics stretching back to 1510.5 While acknowledging that the signs, symptoms and epidemiology of influenza could vary widely from one epidemic to another, Thompson argued that there was ‘a grandeur in [influenza’s] constancy and immutability superior to the influence of national habits’: The changes in our national system of diet during the period which this volume embraces, have been calculated to effect remarkable modifications in the condition of the people in reference to disease, yet, as respects Influenza, they are not proved to have exerted any manifest influence.’6 The result was that although accounts of influenza were, in Thompson’s words, ‘not readily accessible . . . being sometimes . . . concealed in volumes devoted chiefly to other topics’—and

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notwithstanding the fact that medical records frequently abounded in ‘fallacious and imperfect observations’—he had been able to ‘present the picture of Influenza exactly as . . . delineated by the original observers’.7 Like many historical epidemiologists before and since, Thompson did not regard his ignorance of influenza’s aetiology and pathogenesis as a methodological impediment. Whether influenza was a contagious disease like smallpox, a zymotic disease like typhus, or a telluric disease connected to volcanic eruptions and the diffusion of gases and particles into the upper atmosphere, still its symptomatology was sufficiently distinctive, and its clinical forms sufficiently alike in different times and places, for him to feel more than justified in making retrospective diagnoses. ‘The disease . . . exhibits in the well-ordered mansions of modern days, phenomena similar to those which it presented in the time when rushes strewed the ground,’ Thompson opined.8 By keeping an open mind, and not dismissing the accounts left by sixteenth and seventeenth century observers as the products of ‘prejudice’ or ‘error’, Thompson concluded that it should be possible for historical epidemiologists to use the ‘reflected light’ of the past to illuminate the present, for ‘old and new facts when collated, by the harmony which they exhibit, become mutually illustrative, and acquire a value previously unknown’.9 Today we would say that the Annals falls squarely into the category of Whiggish history, for underlying Thompson’s effort to use the past to illuminate the present is the assumption that influenza in his time could be ‘known’ in a way that it could not in the past. In fact, as sociologists of science point out, the notion of the existence of ‘scientific facts’ independent of social processes is highly problematic. Science, like other forms of knowledge production, is subject to continual paradigm shifts.10 Even allowing for the ontological possibility that there may be such a thing as influenza with essential and unchanging biological qualities and attributes, neither influenza nor any other disease can stand outside of the epistemological and social frameworks that produce it. The present, in other words, is no more ‘knowable’ than the past.11

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Rather than seeing influenza as a biological entity that transcends time and place, this book takes a different approach. I argue that, like other diseases with shifting nosologies, influenza is best seen as a product of medico-scientific discourses and cultural narratives. The central contention is that, prior to the advent of Victorian state medicine and the application of sophisticated statistical methodologies to the elucidation of epidemic diseases, influenza had no fixed identity. Like hypochondria, influenza in the pre-modern period was a palimpsest: a constellation of symptoms and signs in search of a plausible diagnosis. With no agreed nosology, influenza was indistinguishable from the distempers, colds and catarrhs that were a familiar feature of the damp, fog-bound British winters. ‘Did you ever have an obstinate cold, a six or seven weeks’ unintermitting chill and suspension of hope, fear, conscience, and every thing?’ asked the English essayist and poet Charles Lamb, writing to his friend, the Quaker poet Bernard Barton, in the winter of 1824. ‘This has been for many weeks my lot, and my excuse—my fingers drag heavily over this paper, and to my thinking it is three and twenty furlongs from here to the end of this demi-sheet.’12 Like Huxham and Arbuthnot’s descriptions of the 1732– 3 epidemic—or John Donne’s famous ‘no man is an island’ peroration on illness in 1623—Lamb’s description seems to ‘speak’ across time, giving present-day readers the illusion of being able to directly access his past illness experience.13 Perhaps that explains why medical historians, re-reading Lamb’s letter in the wake of the 1918 –19 influenza pandemic, were confident in ascribing his symptoms to influenza and including his letter in a review of ‘early perceptions’ of the disease.14 In fact, although Lamb’s account refers to his ‘suspension of vitality’, ‘an occasional convulsional cough, and a permanent phlegmatic pain in the chest’—symptoms strongly suggestive of influenza—he makes no reference to flu.15 Moreover, while there were well-documented influenza epidemics in 1803, 1831, 1833 and 1837, 1823 – 4 does not appear to have been an epidemic year in England.16 That is not to say that Lamb was not suffering from influenza, just that in the absence of his referencing the term we can have no way of knowing.

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Naming Flu So how did influenza get named, and how did it become more visible to English medical practitioners? The term almost certainly derives from the Italian for ‘influence’. From around the sixteenth century, it had been common for Italian writers to blame outbreaks of epidemic catarrhs on volcanic eruptions and the passage of comets and meteors through the night sky—hence the Italian phrase ‘influenza coeli’, meaning ‘influence of the heavens or stars’.17 However, influenza also went by the French names ‘grippe’, from the French verb ‘agripper’, meaning ‘to grasp or to seize’, and, less commonly, ‘coqueluche’, from the French term for a monk’s hood (because those so afflicted wrapped themselves in a hood to contain their shivering).18 In 1510 a likely pandemic of influenza, described as a ‘gasping oppression’, was observed to spread along the trade routes from Asia to Africa, Italy and France. Characterised by cough, fever and constriction of the heart and lungs, the disease had a very high attack rate, sickening the eight-year-old future Pope Gregory XIII and a number of French bishops, prelates and university professors.19 According to Beveridge, similar probable ‘pandemic’ outbreaks occurred in 1580, 1732– 3 and 1781 – 2.20 The result was that by the end of the eighteenth century flu was recognised as a distinct disease whose key epidemiologic feature was its explosive spread and high attack rate, coupled by its appearance at unpredictable intervals or times of year. Ironically, the first person to use the term in professional English was Huxham in his Essays on Fevers of 1750, in which he referred to ‘the catarrhal Fever, which spread through all Europe under the Name of Influenza in the Spring [of 1743]’.21 However, as Margaret DeLacy points out, influenza went under so many different names in the eighteenth century that it was extremely difficult for clinicians to compare notes or develop a consistent nosology. In addition, patients with mild symptoms rarely consulted doctors, while parish registers often attributed deaths provoked by an initial attack of flu to better recognised secondary conditions, such as pneumonia. This gradually began to change with the advent of collective investigations drawing on what DeLacy calls ‘networks of

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correspondence’ to pool multiple medical perspectives on epidemics.22 Such investigations were greatly abetted by new forms of communciation, such as medical journals, the provincial press and the postal service. The result was that by the early 1800s such networks were increasingly able to alert country doctors to the appearance of flu in their districts and share knowledge prospectively. However, while in 1782 the Royal College of Physicians had adopted influenza as the official nomenclature, English medical writers tended to be wary of the Latinate term, preferring ‘simple catarrhal fever’ to describe mild, seasonal attacks of influenza, and ‘epidemic catarrhal fever’ to describe epidemic outbreaks of the disease.23 Nevertheless, like their Italian counterparts they tended to connect these epidemic catarrhs and distempers to celestial phenomena and to atmospheric and meteorological changes. Thus, describing a ‘malignant epidemic catarrh’ that had raged all over Europe in the autumn of 1578, Dr Thomas Short makes frequent references to the earthquakes, comets and the ‘cold, dry North wind’ that had preceded the six-week epidemic.24 Similarly, writing about an epidemic of coughs accompanied by fever and pains in the head and limbs in the autumn of 1675, Sydenham describes how the epidemic was preceded by an unusual period of warm mild weather, followed by ‘sudden cold and moisture’, a confluence of meteorological conditions that he took to be an indication that the ‘constitution of both the present time, and the whole of the previous autumn, [had] exerted itself to the utmost in the production of this epidemic fever’.25 As we shall see, Sydenham’s notion of an ‘epidemic constitution’ was to exert considerable influence over Thompson and other English epidemiologists well into the twentieth century.26

Influenza and Statistics It was not this occult branch of epidemiology that persuaded Thompson and other Victorian sanitary reformers of the importance of infuenza epidemics so much as its utilitarian cousin, statistics. Statistics had long been employed in the insurance and annuity business, but it was only in the 1830s and 1840s that such methods

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began to be employed in a systematic manner to measure variations in population health and longevity as part of a deliberate effort by sanitarians to divine regular laws governing the rate of sickness and the occurrence of epidemics. One of the most powerful tools of all in the sanitarian’s kit was the notion of the ‘excess death rate’. Calculated by subtracting the number of deaths observed during an epidemic from the average observed over non-epidemic seasons, excess mortality became a way of impressing on physicians, who may have been reluctant or unwilling to take influenza seriously, the importance of keeping a careful note of the occurrence of the disease. At the forefront of these efforts was William Farr. Appointed chief statistician to the General Registry Office (GRO) in 1839, Farr transformed statistics into one of the most powerful demographic and epidemiological tools available to the Victorian medical profession. The problem, as Farr saw it, was that many English practitioners had a tendency to ‘see nothing but a local disease’.27 The result was that they were often unaware of the devastating effect influenza could have at the level of populations. Farr’s principal innovation was to use national registration and census data to construct life tables measuring variations in the mortality between so-called ‘healthy’ districts and districts where the crude mortality rate was above the national average. Just as a barometer measured atmospheric pressure and a thermometer measured temperature, so Farr argued these life tables were a ‘biometer’, a way of measuring the vitality of any given population group. Besides his use of census and registration data to produce life tables and calculate crude death rates, Farr also designed a statistical nosology, or classification of diseases, for tabulating reported deaths, enabling the GRO to calculate annualised mortality rates for a range of zymotic diseases. This nosology revolutionised the classification of zymotic diseases, enabling Farr to measure the mortality from a range of epidemic, endemic and contagious diseases—a method that Farr popularised as the zymotic disease mortality rate.28 As Eyler has observed, Farr’s innovations helped make the life table the ‘most trusted’ measure of health and vitality. The result was

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that by the 1840s the Registrar General’s quarterly returns, ranking the largest towns by prevailing annual crude mortality rates, had become a regular feature in newspapers, as familiar to readers as the daily weather and stock market reports.29 As Hardy points out, these statistical insights were by no means confined to influenza but became increasingly significant in the later decades of the nineteenth century as the threat from cholera, typhus and smallpox receded, and respiratory diseases began to replace infectious diseases as the major cause of morbidity and mortality.30 More importantly, they also inaugurated what Hacking has called an ‘avalanche of printed numbers’, a process that converted Victorians from ‘non-numeracy to numeracy’ and gave birth to ‘a morbid and fearful fascination for numbers’.31 One of the first people to apply retrospective statistical techniques to the problem of influenza epidemics was Robert Graves (1797– 1853), the chief physician at the Meath Hospital in Dublin. Observing how influenza ‘overshadows the whole country in a space of a few weeks,’ Graves compared burials at the Prospect Cemetery at Glasnevin in the suburbs of Dublin in December and March of 1835– 6 with the same period during the epidemic of 1836 – 7. Finding that the epidemic had been responsible for three times as many deaths in Glasnevin in 1837, Graves then extrapolated the figures to neighbouring churchyards to produce a figure of 4,000 excess deaths for the Dublin area—a figure that, he noted, exceeded deaths from cholera in Dublin the same year. Graves concluded that while influenza was ‘not by any means so severe or so rapidly fatal a disease as cholera . . . the mortality which it has produced is greater, as it affects almost every person in society’. The result, Graves concluded, was that while cholera tended to be associated with a much higher case fatality rate, ‘the mortality of society at large is much greater in influenza’.32 Moreover, influenza frequently proved ‘very fatal’ to people with underlying health conditions, such as bronchitis, asthma and tuberculosis.33 Graves’ careful observations of the symptoms in both typical and atypical cases also led him to posit that influenza was a nervous disease. Epidemics of influenza accompanied by depression and other

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nervous symptoms had been noted as far back as 1732, when Arbuthnot observed that during the epidemic that year there had been ‘a great run of hysterical, hyponchondriacal, and nervous distempers,’ adding that in some cases these had been ‘so high . . . as to produce a fatality or madness’.34 In the epidemic of 1775, Dr George Baker had been similarly struck by the ‘uncommon languor, restlessness, and anxiety’ that accompanied attacks of influenza, while in its report on the 1782 epidemic the Royal College of Physicians noted that the ‘languor, debility and dejection of spirits [was] . . . far beyond what might have been expected from the degree of all the other symptoms’.35 As far as I can ascertain, however, Graves was the first to argue that the symptoms of dysponea (breathlessness) and bronchial congestion were due to a specific ‘poison’ acting on the nervous system. As we shall see, this claim would become increasingly important in the middle to late 1890s, as Britain suffered successive waves of ‘Russian’ influenza. The problem for Farr was that most English physicians lacked Graves’s familiarity with the epidemic form of the disease. Worse, they had no sense of the impact of epidemics at the level of populations. This failing was brought home by the 1847– 8 epidemic. The flu, which raged from November to January, killed in excess of 5,000 people in London—more than had perished in the 1832 cholera epidemic—but because of the difficulty of distinguishing influenza from other forms of respiratory disease, physicians recorded only 1,157 deaths from influenza, ascribing the rest to more familiar ailments such as asthma, bronchitis and pneumonia.36 In Farr’s view, such parochialism was detrimental to the cause of sanitary reform as it made influenza invisible to both the medical profession and the general public, engendering complacency about cleaning up the filth from which influenza and other forms of ‘zymotic’ disease were thought to emanate. Noting how epidemics of influenza appeared to precede or follow epidemics of typhus and cholera, Farr pointed out that the mortality in the final quarter of 1847 was higher than in any year since the commencement of the new system of registration.37 Although the epidemic had proved most fatal to the elderly, he noted that ‘influenza [had] attacked those labouring under

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all sorts of diseases, as well as the healthy’.38 The Times concurred. Arguing that had the symptoms of influenza been ‘more shocking and strange’ then the epidemic would have had a greater impact on the public imagination, a leading editorial opined: In this climate of chills and catarrhs we account a cold the natural death of an Englishman, and view an increased mortality under this head only as an extraordinary number of fashionable departures . . . Nothing has imparted so much terror to the influenza as the hint that it preceded the cholera— a much less destructive . . . visitation.39 The comparison with cholera is revealing. Compared to cholera or plague, influenza is not a particularly terrifying disease. In most cases, illness lasts from between three to five days, the typical symptoms being a sore throat accompanied by chills, headaches, fatigue and rheumatic pains. The result is that although an attack of influenza can be extremely debilitating, it is usually considered more of a medical inconvenience than a mortal threat to life. By contrast, cholera, if left untreated, kills 40 to 50 per cent of its victims, and it kills in a manner that is truly pitiable to behold, reducing its victims to a comatose, apathetic state, with sunken eyes and blue-grey, almost blackened, skin. Within hours of the cholera vibrio entering the intestine, there is violent vomiting and diarrhoea accompanied by agonising muscle cramps. Death comes rapidly, usually in three or four days, sometimes in a matter of a few hours, with the victim expiring in a puddle of foul-smelling rice stools.40 Farr’s solution was to impart some of this terror to influenza by using the weekly mortality returns to tease out the variations in mortality within different age ranges and population groups. In so doing, Farr invented the methodology of ‘excess’ respiratory and total mortality that has been used to identify and quantify influenza epidemics ever since.41 In Farr’s view there was nothing inevitable about the deteriorating health of town-bred populations. Just as the laissez-faire system and Victorian technological innovation had spurred a huge growth in the nation’s wealth, so, he hoped, the

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application of vital statistics to the problem of health would lead to similar progressive improvements in the life chances of urban populations and so ‘banish panic’.42 In Farr’s opinion, writers who focused on the health of rural districts at the expense of town-bred populations were in danger of missing the point. ‘There is reason to believe that the aggregation of mankind in towns is not inevitably disastrous,’ he argued [italics inserted].43 However, while such knowledge could be useful in the case of waterborne diseases such as cholera, which were a particular problem in urban areas lacking efficient systems for dealing with human waste, it counted for little in the case of epidemic diseases such as influenza that lay outside the scope of sanitary science. Instead, I will argue, Farr’s statisticallyminded discourses destabilised biopolitical discourses by reinforcing dread of the epidemic form of influenza without offering an obvious public health solution. In the 1890s, during the repeated waves of Russian influenza, these discourses would be widely broadcast. The difference in the 1840s was that there was no network of cheap morning and evening newspapers to sensationalise the epidemic, and no way of rapidly communicating news about outbreaks occurring in other European capitals. Instead, the risks associated with the epidemic form of the disease were largely privileged knowledge confined to statisticians and specialist medical publications. The exception was when an epidemic of influenza preceded or followed an outbreak of cholera, leading to speculation that the phenomena might be connected—hence The Times’s observation in 1848.44

‘Epidemic Constitutions’ The notion that influenza and cholera were linked was rooted in zyme theory and centuries-old Hippocratic ideas about airs, waters and places. Victorian health officials and sanitary campaigners did not generally talk about infectious diseases. Instead, they tended to lump both contagious and non-contagious diseases together under the heading of zymoses. These were diseases that were thought to be due to ‘zymes’ or ferments released by external rot, and that under the right environmental conditions could invade animal bodies and

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release chemicals, thereby initiating disease processes much as a spark ignites a flame.45 At one extreme were the non-contagious diseases such as malaria, cholera and typhus, in which it was thought that the ferments arose spontaneously from rotting organic matter and were transmitted either through ground water or miasmas arising from poisonous effluvia. At the other extreme were the highly contagious diseases, such as smallpox, in which the zyme was conceived of as a ‘poison’ or ‘virus’ that was thought to have been nurtured in another animal body and that was communicated by direct contamination. However, it is important to realise that there was nothing exclusive about these categories: zymotic diseases were neither wholly contagious nor wholly non-contagious but could vary in virulence and infectivity depending on the season, the prevailing meteorological conditions, and the inherited predispositions and constitutions of different individuals.46 Moreover, while the contagious particles could take the form of ‘viruses’ they could also take the form of tiny particles or ‘fomites’ that could attach to dust and other objects, such as parcels, letters, bedding and linen. As an exemplar of a miasmatic disease, influenza was generally presumed to travel aerially, with infection occurring when individuals inhaled the fomites from the surrounding atmosphere. The appeal of this aetiology was that it seemed to offer an explanation for the rapid diffusion of influenza without any apparent interconnecting chain of human contacts. At the same time, by appealing to Sydenham’s notion of an ‘epidemic constitution’, English epidemiologists raised in the Hippocratic tradition could explain the increased incidence of other forms of zymotic disease at times when influenza was epidemic. Thus, writing a few years after Graves, Thompson also observed how influenza appeared to elevate a population’s death rate by increasing the mortality from other diseases. ‘The importance of the subject cannot be estimated simply by the number of deaths recorded as directly attributable to the disease,’ he declared, as during influenza epidemics, ‘mortality is usually increased, often to a very remarkable degree.’ Influenza, he continued, appeared to ‘exert a power to modify any pre-existing disease with which it may combine

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so as to increase, in the population of an affected district, the liability to contract other diseases; and also to lessen the ability to resist any degree of fatal tendency which such concurrent diseases may possess’.47 Influenza was also ‘the most extensively diffused’ of epidemic diseases, as well as ‘the least liable to essential modification, either by appreciable atmospheric changes, or by hygiene conditions under the control of man’: It is not like Smallpox, communicable by inoculation; and, however, its fatality may be influenced by defective drainage, it is not like Typhus, traceable to this neglect of its cause. Unlike Cholera, it outstrips in its course, the speed of human intercourse. It does not, like the Plague, desert for ages a country which it has once afflicted, nor is it accustomed, like the Sweating-Sickness, in any marked manner to limit its attack to particular nations, or races of mankind. There is a grandeur in its constancy and immutability superior to the influence of national habits.48 Like Farr, Thompson also noted how influenza epidemics frequently preceded or succeeded cholera, writing that ‘nothing in the history of the succession of the epidemics is of more impressive interest than the intercurrency of influenza and cholera’.49 In 1846, Farr had argued that the epidemic constitution had favoured cholera, but in the summer of 1847 epidemics of typhus and influenza had set in, elevating mortality to the highest level since the commencement of the new system of registration. In all, the annual mortality returns recorded 215,000 deaths in 1847—35,000 more than for the corrected average of 1839 –45. Breaking the figures down further, Farr noted that most of the deaths had been concentrated in the final quarter of 1847, the period when influenza had been epidemic. In the six weeks from the outbreak of the epidemic on 27 November to its culmination in early January 1848, Farr calculated that some 11,339 Londoners had perished—the equivalent of ‘more than 5,000 souls over and above the mortality of the season’. This ‘excess’ was due largely to deaths from associated

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respiratory diseases, such as pneumonia, bronchitis and asthma. At the same time, Farr noted, the epidemic had elevated deaths from ‘hooping-cough’ [sic], measles and typhus. Yet although this suggested that influenza had attacked persons labouring under ‘other zymotic diseases’, doctors had returned influenza as the cause of death in just 1,157 cases—hence his and Graham’s criticism of English practitioners’ tendency to see only ‘local disease’.50 In all, Farr estimated that some 500,000 Londoners—or a quarter of the capital’s population—had been attacked. Not only that, but his analysis suggested that the epidemic had proved between two to four times more fatal in the ‘insalubrious’ districts of London, such as St George’s in the East End, than in healthy districts, such as Lewisham and Eltham.51 In Farr’s opinion, there could be no better demonstration of the need for sanitary reform. Whatever the origins of the epidemic, he argued in his quarterly return for the winter of 1847– 8, it was clear that ‘closeness, filth, and stench’ were the real dangers. Or, as The Times put it in a leader that quoted approvingly from key passages of Farr’s quarterly report: ‘Heaven speeds the arrow. Man envenoms the barb.’52 The Times was not the only paper to echo Farr’s words. The Daily News, London’s leading Liberal paper that had been launched just two years earlier as a rival to The Times, also published a lengthy article on the Registrar General’s report, while Gentleman’s Magazine ran a summary of the report on its ‘Domestic Occurrences’ pages.53 However, for all that The Times had reported in early December that the epidemic had disrupted schools and the police force and brought public institutions to a ‘stand-still’, by and large its coverage was patchy.54 Similarly, in the Daily News references to the epidemic tended to be buried in the paper’s political columns or tagged on to roundups of foreign news.55 Certainly, there was little sense that the epidemic was a major public health issue, much less a pan-European phenomenon. Although Paris and Madrid had been attacked at around the same time as London, reports about the French and Spanish epidemics only began to appear in the English press in late January, and then mainly in reference to the illnesses of prominent convalescents, such as the Spanish general and politician Baldomero

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Espartero.56 In part, this may have reflected the fact that Europe’s railway system was fragmented and by no means extensive, meaning that there was no clear pattern of east–west spread as would be the case in 1889– 90 when, as we shall see in Chapter 2, the flu was observed to spread rapidly along railways and roads from St Petersburg to Berlin, Vienna and other European capitals. Instead, the epidemic appears to have travelled south from its point of origin in Russia to Turkey and Constantinople, before entering the southern Mediterranean in the summer. The result was that while Moscow was attacked as early as February 1847, Malta and Nice were not attacked until the following October, and Berlin, Copenhagen and London not until late November.57 Another important factor was the absence of a network of foreign correspondents to telegraph news of the outbreaks to London and report on the sickness of prominent foreign convalescents. Only The Times had the resources to maintain such a network, boasting correspondents in New York, Paris, Madrid, Lisbon, Brussels, Hamburg and The Hague.58 However, cables were expensive and tended to be reserved for important diplomatic dispatches and news that might be expected to impact on British commercial and imperial interests. Moreover, until 1851 there was no underwater cable linking Calais and Dover. Instead, for information about foreign developments the London dailies relied on the mails that arrived by sea at Southampton and other Channel ports. This began to change in 1851 with the opening by Reuters of a London office to transmit financial and commercial information between London, Brussels and Berlin via the new underwater Channel cable. In 1848, however, news from Paris and other European capitals could still take anywhere from five to 10 days to reach London.59 A further factor keeping influenza ‘local’ was that diagnosing true cases of influenza was extremely difficult. Instead, physicians tended to rely on experience and, from around 1850, the stethoscope to track the movement of the infection from the larynx and through the bronchi into the lungs. The problem was that flu had no clear pathognomic marker. Moreover, the symptoms were extremely variable, ranging from fevers sometimes accompanied by chills,

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resembling malaria, to a high temperature and extreme weakness accompanied by peculiar gastric symptoms, resembling typhus, to a sore throat and cough, resembling catarrh. Little wonder then that for most laymen, and a good many medical men, there was little distinction to be made between influenza and the common cold. ‘Printing offices, Manufactories, Tailor shops and such like are struck silent, every second man lying sniftering in his respective place of abode,’ complained Thomas Carlyle, writing to his sister at the height of the 1837 epidemic. Influenza, he concluded, was nothing more than ‘a dirty, feverish kind of cold’.60

Ordering Flu Before influenza could become an object of wider sanitary and public concern, the clinical forms of the disease first had to be ordered. This was the task that Thomas Peacock, a physician at the Royal Free Hospital in London, set himself. Like Farr, Peacock had been struck by the way that the symptoms of influenza had at one moment resembled typhus and at another bronchitis and pneumonia. At the Royal Free Hospital, Peacock had been able to observe this protean symptomatology at close hand, and in 1848 he published a definitive account of his experiences. In essence, Peacock argued, influenza took three distinct forms: ‘simple catarrhal fever’, ‘catarrhal fever with pulmonary complications’, and ‘catarrhal fever with abdominal complications’.61 In the first form, the attack was sudden and generally followed exposure to damp or cold. The most notable symptoms were a sore throat and headache, accompanied by fatigue and punctuated by chills and hot flushes. The majority of patients recovered in three to five days, but in more extreme cases the illness could extend as long as seven to ten days. Peacock also observed how the attacks left patients physically and mentally ‘much reduced’, so that even after the symptoms had passed away and patients appeared to be on the road to recovery ‘there was a great tendency to relapse’.62 In the second pulmonary form of the disease, patients exhibited much the same symptoms. However, in a little over half the cases the

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symptoms were aggravated by acute bronchitis. As the illness progressed, these patients experienced great difficulty in breathing, and their pulses were extremely elevated. In some cases, patients’ complexions became flushed and livid, and their lips turned purple. Their expressions were ‘extremely anxious’ and they later expectorated large amounts of greenish-yellow sputum. According to Peacock, about half these cases had ended in death, and on postmortem the lungs showed considerable ‘consolidation’.63 In addition to the bronchial cases, Peacock also identified a smaller number of pneumonic cases. However, these were of ‘a very different character from that which pneumonia ordinarily presented, being attended by an unusual depression of strength . . . and more or less general bronchial inflammation’. Although such cases presented ‘a most threatening character’, only one in seven had proved fatal. Finally, there was the third abdominal form, marked by gastric and rheumatic symptoms. The course of the infection in such cases resembled an ‘enteric disorder’, with patients complaining of nausea, vomiting and diarrhoea, often accompanied by high fever and pains in the head, back and loins.64 Out of 79 patients admitted to the Royal Free during the epidemic, more than half had exhibited catarrhal and pulmonary symptoms, leading Peacock to conclude that this was the typical form of the disease. However, Peacock acknowledged that for all his diagnostic experience, flu’s symptomatology was so diverse he could never be sure what form the protean infection would take: The disease, in fact, passed by such insensible gradations from one typical form to another, that there were repeatedly under my care, in the wards of the hospital, cases presenting in turn every separate feature, from those in which the lungs were chiefly affected, to those wearing all the characteristic symptoms of fever, with gastro-enteric and hepatic disorder. Even when going over his notes in preparation for his book on the epidemic, Peacock explained that he had ‘repeatedly hesitated as to the class of affection to which they should severally be referred’.65

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If Peacock struggled to distinguish influenza’s various clinical forms, he was at an even greater loss to account for its pathology and aetiology. The only explanation for the wide array of symptoms, he conjectured, was ‘the influence on the nervous system of some powerfully-depressing agent’ or a ‘poison’ acting through the blood, but in what precisely this ‘morbific influence’ consisted Peacock could not say.66 Next, Peacock turned to accounts of previous epidemics to see if he could divine any pattern corresponding to the season or the weather. He could not. Although influenza usually coincided with the autumn and winter, epidemics had also occurred in spring and early summer, and had been preceded by both warm, damp conditions and by extreme frosts and cold. Epidemics, he noted, had also broken out simultaneously in places with very different atmospheric and meteorological conditions. Nor could he say whether or not influenza was ordinarily contagious, though he noted that in wards that had not been used for holding influenza patients no nurses had contracted the disease.67 *** Peacock’s account, adapted for Quain’s Dictionary of Medicine, would remain the standard classification until 1894, when it was revised by Dawson Williams.68 Though Peacock could offer no explanation for influenza’s transmission, like Farr he was convinced of the value of sanitary intervention, arguing that ‘defective drainage, overcrowding, impure air, deficient clothing, and insufficient or unsuitable food, powerfully conduce to the prevalence and fatality of the epidemic’.69 However, although his insights had the potential to transform English medical perceptions of influenza, Peacock’s book ran to only one edition and was soon overshadowed by a far more pressing medical concern—the return of cholera in the autumn of 1848. Like the 1847– 8 influenza epidemic, the cholera epidemic of 1848 and 1849 was the first to be subjected by Farr to detailed statistical analysis. Through close study of the London mortality returns, Farr was able to demonstrate that there was an inverse relationship between cholera mortality and the mean elevation of the

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district above the high water mark of the Thames—an observation that would eventually lead to the abandonment of the miasmatic theory of cholera transmission and pave the way for the virtual eradication of the disease from England by 1866.70 As in previous epidemics, Farr noted, cholera had proved most devastating in the summer months, killing 4,251 people in London in August 1849 and a further 6,644 people in September. In all, the epidemic had killed some 53,000 people in England and Wales in 1849.71 These were figures that far surpassed the mortality from influenza in 1847– 8, even taking into account ‘excess’ deaths from respiratory disease. When one considers the mortality burden represented by other forms of infectious disease in the 1850s and 1860s, coupled with the fact that, with the exception of small influenza outbreaks in 1855 and 1858, the period between 1848 and 1889 was relatively free of flu, it is little wonder that influenza ceased to be a topic of medical interest in these years.72 In 1891, however, the excess mortality from influenza would surpass the mortality from the 1849 cholera epidemic.73 Moreover, in the 1890s these statistical insights would be widely broadcast by mass market newspapers eager to bring Victorian readers the latest news about the epidemic, transforming influenza into a topic for sensation and dread.

CHAPTER 2 `

AN EPIDEMIC STARTED BY TELEGRAPH': NEWS, SENSATION AND SCIENCE

In the autumn of 1890 Winston Churchill wrote a curious poem about flu.1 Then a 15-year-old pupil at Harrow, Churchill’s precocious verse was inspired by Europe’s recent experience of the ‘Russian’ influenza, so-called because the epidemic had first broken out in St Petersburg in the autumn of 1889. To this impressionable young schoolboy and future British Prime Minister, the influenza was a ‘vile, insatiate scourge’, a disease that was no respecter of nationality or class. Tracing the Russian flu’s ‘noiseless tread’ from China and over ‘bleak Siberia’s plains’ to Russia, Alsace and ‘forlorn Lorraine’, Churchill wrote: The rich, the poor, the high, the low Alike the various symptoms know Alike before it droop.2 Churchill’s poem, written in the interval between the first and second waves of the Russian influenza pandemic, reflected his fascination with the Russian flu, and its unusual grip on the Victorian imagination.3 Unlike the 1847 –8 pandemic, the Russian flu was extensively documented and seen to spread rapidly between European

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capitals via international rail, road and shipping connections in a westward progression that was the subject of wide commentary in the daily and periodical press. This commentary was fuelled by the growth of the worldwide telegraphic network and the competition between the editors of the London dailies and regional papers to be ‘first’ with the news. Thanks to telegraphic bulletins filed the previous evening by Reuters correspondents in St Petersburg and other influenza-ed European capitals, Victorians were able to track the Russian flu in real time—something that had not been possible during the 1847–8 epidemic. As papers like the Daily News and Standard vied to bring readers the latest installments from Moscow, Vienna, Berlin and Paris, the epidemic quickly took the form of a real-life melodrama. With the exception of The Times, the tone of many of these reports was alarmist, with mass market titles such as Lloyd’s Weekly Newspaper running lengthy articles under bold, triplebanked headlines, leading to the accusation in The Lancet that ‘dread of the epidemic’ had been ‘started by telegraph’.4 This unprecedented attention to the epidemic in print meant that Victorian newspaper readers were aware of the flu’s depredations long before it reached the British Isles. Indeed, this chapter argues that the rapid progress of the influenza across Europe via the railways and the near instantaneous reporting of the outbreaks via the worldwide telegraphic network made the Russian flu something of a ‘media sensation’. In this sense, the pandemic was peculiarly ‘modern’—an event intimately linked to modern transportation and global communications technologies. This association between the pandemic and modernising tendencies at the fin-de-sie`cle was exacerbated by the wide morbidity of the flu and the fact that the earliest casualties were precisely those considered most essential to the smooth functioning of Victorian society and economy, such as male heads of households, politicians, diplomats, post office workers, lawyers, and the employees of banks and insurance firms.5 In an economy unsettled by the long agricultural depression, and in a period marked by mounting anxiety about urbanisation and the pace of social change, this gave the influenza wide cultural valency.6 A further factor was the high mortality associated with the 1891 wave in northern towns such as

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Sheffield, and the deaths of prominent members of the British establishment, including, in May 1891, the Archbishop of York and, in January 1892, the Duke of Clarence, the eldest grandson of Queen Victoria and the second in line to the throne. In addition, as we shall see in Chapter 3, the flu was associated with peculiar nervous ‘sequels’ that prompted disturbing episodes of psychosis and suicide. Popular responses to epidemics, like the responses to other hazardous events, are determined both by their direct biological impacts and by the ‘risk signals’ that attach to the communication of information about the events. As Kasperson and others have argued, these signals are the result of the interaction of c omplex psychological, cultural, social, and institutional processes that can either attenuate the societal responses to the risk events or amplify them.7 Social amplification generally occurs through direct experience of the risk object—in the case of an outbreak of an infectious disease, illness or a death in the family—or through the receipt of messages about the risk object from other actors, such as scientists, the media and social networks. Social amplification of risk models hypothesise that the greater the volume of information about the risk object, the greater the likelihood that amplification will occur. Similarly, disputes about the risk object also tend to fuel amplification, as does the dramatisation of the risks and the symbolic connotation of the risk information. Critical to this process is the way that science and the media signal the likelihood of some dangerous event occurring in the future. Thus, Burns and Kasperson argue that the societal costs of a hazardous event are determined largely ‘by what the event signals or portends’.8 Sontag makes a similar point when she argues that the modern ability to project events into the future through the employment of more sophisticated scientific tools and technologies created ‘a vast new source of instructions about how to deal with the present’. Tracing this distinctive mental habit of ‘future mindedness’ to the fin-de-sie`cle, Sontag argues that the scientific estimation of risk makes ‘every process . . . a prospect, and invites a prediction bolstered by statistics’. One consequence is a gulf between ‘the epidemic we have and the pandemic we are promised (by current statistical extrapolations)’—what Sontag calls ‘the imminent, but

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not yet actual, and not really graspable, disaster’. The result is ‘a permanent modern scenario: apocalypse looms . . . and it doesn’t occur’.9 This chapter argues that in the 1890s risk signals about the Russian influenza were amplified in just such a manner. First, the volume of the newspaper coverage was unprecedented, ensuring that the epidemic was rarely out of the public consciousness. Second, competing theories as to the aetiology and transmission of the flu meant that the disease was the subject of fierce medical disputes throughout the critical years of the pandemic. Third, the speed of the attacks and the severity of the symptoms, coupled with the deaths of prominent members of the British establishment, provided a narrative replete with drama and symbolic portents. While influenza may not have been seen as a particular threat to individual bodies, in sickening such a wide cross-section of British society, including some of the most prominent figures at Westminster, the disease was perceived as a direct threat to the Victorian political and social body—hence Churchill’s reference to the rich and poor ‘drooping’ before the symptoms.10 Finally, as the epidemic progressed and influenza became the object of closer clinical and epidemiological surveillance, dread of the Russian flu was fuelled by its association with pneumonia and other forms of respiratory disease—diseases that by 1891, it was realised, could greatly elevate the excess death rate.

Reporting Flu Unlike the previous 1847– 8 pandemic, the Russian outbreak coincided with a ‘golden age’ for Victorian newspapers, making it one of the best-reported pandemics in history.11 The crucial factor had been the introduction of web rotary printing machines and the repeal of the Stamp Act in 1855, which by abolishing the tax on newsprint made possible the production of mass market newspapers selling for as little as half a penny. These developments were followed in 1870 by the passage of the Education Act, fuelling working-class literacy and greatly expanding the market for urban readers.12 The result was

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that whereas in 1860 London had nine morning and six evening dailies, by 1888 the capital boasted 13 morning and nine evenings. Nationwide the number of newspapers rose from 91 in 1872 to 159 in the 1890s.13 Not only that but, thanks to the new presses and lower production costs, newspapers were selling many more copies than before. Following the reduction in its cover price to one penny in 1868, for instance, the Daily News’s circulation reached 93,000 in 1890, making it the largest selling Liberal newspaper in the world. The Daily Chronicle, Daily Telegraph, and Standard posted similarly impressive gains, selling in excess of 200,000 copies each by the mid1880s. The most dramatic increases, however, came at the popular end of the market, with the Star achieving circulations as high as 300,000 in the wake of the death of the Ripper’s seventh victim, Mary Kelly, while by the end of the 1880s Lloyd’s Weekly News was regularly achieving sales of 900,000.14 This growth was even more dramatic in the provinces, where papers like the Yorkshire Telegraph, the Liverpool Echo and the Manchester Guardian combined local news with a mix of domestic and foreign articles. Whereas in the 1850s the citizens of Sheffield, Liverpool, and Manchester depended on the delivery of the morning editions of the London papers for the latest foreign and domestic intelligence, by the 1870s the Central News Agency and the Press Association were supplying ‘wire copy’ direct to the Provincial Newspaper Society, enabling regional titles to produce breakfast editions ahead of the arrival by train of the London dailies. Victorians could also choose from a wide variety of weekly and monthly magazines, ranging from serious periodicals such as the Spectator and the Review of Reviews to satirical publications such as Punch, Fun and Moonshine. While the wire agencies aimed to provide standardised copy that left little room for literary flourishes, newspapers that could afford the expense employed specialist correspondents and commentators to give their own opinions. At the same time, editors experimented with bolder layouts incorporating banner headlines running across unbroken columns, and triple-tiered headlines. All these techniques were employed during the Russian flu pandemic. In addition, during the early stages of the outbreak it was common for

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the dailies to publish telegrams from wire agencies and overseas correspondents across several columns. The effect was to abolish the sense of time and space, giving Victorian newspaper readers the impression that they were instantly privy to distant events. Taking advantage of London’s position at the centre of the worldwide telegraphic network, Reuters correspondents aimed to file reports from affected European capitals within 24 hours of an outbreak occurring, while The Times drew on its own network of correspondents to compete with the Reuters’ dispatches. Particular attention was paid to the illness of prominent convalescents and mass outbreaks in public spaces. By early December, for instance, The Times was reporting that the victims of the epidemic included several members of the Imperial Russian household, the British ambassador to St Petersburg Sir Robert Morier, and the paper’s ‘own correspondent’.15 By the second week in December, several newspapers were reporting that the epidemic had spread to Vienna, Berlin and Paris. Although the symptoms were said to be generally mild, the numbers affected in Vienna were ‘considerable’, while in Paris it was reported some 1,000 clerks and telegraphic operators at the Rue de Grenelle were ‘too ill to leave their beds’.16 Of particular interest was a mass outbreak at the Magasins du Louvre, a drapery warehouse in the heart of Paris that boasted its own cafeteria. According to a report by Paris’s Department of Health that was reproduced in several newspapers, the epidemic had broken out in the last week of November, and by 10 December something like half the warehouse’s 3,000 employees were sick.17 Despite concerns that the flu was being spread by contaminated water, presenting a risk to members of the public who dined in the cafeteria, a Paris health department spokesman assured the Standard that there was no need for special prophylactic measures and that the epidemic would disappear with the first sharp frost.18 His confidence was not shared by the general public, however, and as the epidemic spread to other parts of the city Parisians flocked to doctors and druggists to demand quinine and antipyrins, prompting Le Grelot, a French satirical weekly, to lampoon the booming market in influenza medications (Figure 2.1).19

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Figure 2.1 Front cover of Le Grelot, showing ‘La Ronde des Medecins et des Potards’—‘the dance of the doctors and the druggists’. Le Grelot 12, January 1890, p. 1. Reprinted with the permission of the Wellcome Library.

By now, outbreaks were also occurring in London. The first intimation that the flu had reached the British capital came on 11 December, when the Standard reported that an influenza epidemic ‘similar to that which has appeared in Russia, but of a somewhat milder type’ had broken out in west London.20 Then, on 17 December, came reports that some 170 employees at a department

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store in Bayswater were ill. According to Dr Watson, a local physician, the symptoms came on rapidly and were very severe: chills and shivering accompanied by headache, prostration, and searing pains in the ball of the eye. Patients also complained of peculiar aches in their calf muscles, while many said they felt ‘as if they had been thrashed with sticks’.21 The first case to awaken wide national interest, however, was the illness of the Prime Minister and Foreign Secretary, Robert Cecil, third Marquis of Salisbury. Lord Salisbury had first started feeling unwell shortly after travelling up to his country seat at Hatfield to spend Christmas with his family. On 27 December, the Conservative leader had retired to his sickbed and both his personal physician and a Harley Street specialist had been summoned to his bedside. The Queen was also kept informed. However, the news was kept out of the public papers for several days, presumably for fear of triggering public alarm at a time of mounting diplomatic crisis in Southern Africa.22 When the first report appeared in The Times on 1 January, the details were scanty and the tone noticeably upbeat. ‘His lordship kept to his bed for two days,’ reported the paper’s Hatfield correspondent. Although the Prime Minister was still confined to his sickroom, ‘there is every reason to hope that no dangerous symptoms will now be developed. A slight improvement was observable this afternoon.’23 The Liberal press was somewhat franker in its assessment of the Prime Minister’s condition and less circumspect about sharing the details of his illness with the reading public. Noting that Lord Salisbury was the ‘most notable Englishman to be stricken so far,’ the Liverpool Mercury claimed that the Prime Minister’s illness had been ‘carefully concealed from the public as long as possible’. ‘Our present despatches represent the marquis is still an invalid requiring systematic treatment,’ it reported, before adding ‘the real gravity of his condition is only now leaking out.’24 Lord Salisbury was not the only prominent casualty. By the middle of January, Salisbury’s nephew Arthur Balfour, the Secretary of State for Ireland, was also laid up. A stern opponent of Home Rule, Balfour’s illness came as he was seeking to restore the rule of law to Ireland. The simultaneous illness of two such senior statesmen

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proved irresistible to the comic weekly Fun, which satirised the predicament of Balfour and Salisbury by portraying them sitting back-to-back holding handkerchiefs to their faces and with their feet immersed in tubs of hot water labelled, respectively, ‘Portugal’ and ‘Ireland’ (Figure 2.2).25 By now the press was publishing regular updates on the health of other prominent convalescents, including the President of the Board of Agriculture, Henry Chaplin, and Count Hatzveldt, the German Ambassador to Britain. Next came the news that hundreds of

Figure 2.2 The British Prime Minister Lord Salisbury (right) and his nephew, Arthur Balfour, the Secretary of State for Ireland, were two of the earliest casualties of the influenza. Fun, 15 January 1890, p. 24. Reprinted with the permission of the British Library.

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employees at the Central Telegraphic Office and the General Post Office in St Martin’s-Le-Grand—the centre of communications for the British Empire—were ill. ‘Scores of people’ had also been attacked at Queen’s Park, in North West London, while in South London the epidemic was affecting people from a wide range of occupations, including doctors, policemen, and omnibus and tramcar drivers.26 ‘From emperors to potboys, we have all ached in common,’ observed the Review of Reviews.27 The Liverpool Mercury concurred, arguing that the ubiquity of the epidemic and Lord Salisbury’s confinement demonstrated that ‘the sovereign is as liable to seizure as the costermonger’.28 It was the death of two soldiers at a central London barracks, however, that brought home the respiratory dangers of the flu. The victims—a Guardsman and a Highlander—had apparently contracted the flu while on furlough in London, later succumbing to pneumonia at the Guards Hospital in Rochester Row in Pimlico. Army medics subsequently traced the infection to the Wellington and Kensington barracks. Soon afterwards ‘severe’ outbreaks were reported at army garrisons in Windsor, Aldershot and Colchester, as well as on a navy guardship at Holyhead, sparking ‘apprehension’ at the War Office.29 The mood in the capital was summed up by the London correspondent of the Liverpool Mercury, who complained that fog had plunged London into ‘deep darkness’, while ‘those who retain their cheerfulness seem all to be struggling with the Russian influenza’. The correspondent concluded: The doctors are busy with it. It is more than suspected that the Prime Minister has got it. Certainly a number of Civil Service officials are prostrated by it, and the feeling abroad is that those who have not had it are either at the present moment attacked with it or will have it.30

The New ‘Sensation’ The Russian influenza can be categorised as a form of ‘sensation’ news. As such it was no different from any other sensational story, from

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murder and sexual scandal to a violent railway accident or the death of a royal, that could be expected to sell newspapers. Arguably the most astute practitioner of journalistic sensationalism in the late Victorian period was the crusading editor of the Pall Mall Gazette, W. T. Stead. In his famous 1885 expose´ of child prostitution on the streets of London, Stead had helped to create the New Journalism, a racier, more melodramatic style of news reporting that in the words of T. P. O’Connor, the editor of the Star and another practitioner of the art, aimed to strike readers ‘right between the eyes’.31 Stories about sexual misconduct and violent crime were the most likely to achieve this effect. Even better were stories of homicide or multiple homicides, especially if, like the Whitechapel murders in the autumn of 1888, the identity of the murderer was a mystery, giving the press a licence to indulge in lurid speculation. Although Matthew Arnold famously described the New Journalism as ‘feather-brained’, arguing that while full of novelty it had little interest in factual accuracy, it has been argued that few Victorian readers questioned the veracity or otherwise of such texts.32 On the contrary, unlike today, Victorians generally trusted to the accuracy of their favourite newspaper or periodical. This gave editors and specialist correspondents huge power to shape public opinion about crime, politics and unusual new phenomena, such as the emergence of a mysterious new disease from the East. One result of the unprecedented attention to the epidemic in print was to amplify public apprehension of the Russian influenza. As the Liverpool Mercury put it in early January, anticipating The Lancet’s editorial about ‘sensational telegrams’, news of the ‘much-dreaded influenza’ had induced ‘panic’ in Liverpool, while Dr Tatham, the MOH for Manchester, acknowledged that talk of an influenza epidemic had also induced ‘a state of great trepidation’ in Manchester.33 Although it was recognised that the press had amplified dread of the Russian flu, the telegraph was not the only source of fear. By early January, for instance, The Lancet’s letter columns were full of correspondence from doctors in hospital and private practice attesting to the suddenness of the attacks and other unusual features of the disease. At St George’s Hospital in central London, the medical registrar Dr Richard Sisley reported that one of

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his patients, a 22-year-old barmaid, had been seized with such a violent attack of shivering that she had spilled the drinks she had been in the midst of serving. She was admitted to St George’s on Christmas Day with a temperature of just over 100 degrees. A few days later, Sisley also fell ill, recording a temperature of 101.34 A doctor from Tottenham, North London, reported that in severe cases he had observed ‘marked cerebral disturbance, the patients expressing a fear that they were “going mad”’.35 Thomas Glover Lyon, assistant physician to Victoria Park Hospital, was similarly struck by the peculiar nervous ‘sequels’ of the flu, arguing that the epidemic ought to be known as ‘influenza nervosa’. Cases are reported, and I have met one, of the occurrence of globus hystericus. Fear of madness, with dread of doing something, such as jumping out of the window also occur.36 The public alarm was nowhere more apparent than at St Bartholomew’s, a voluntary hospital in the City of London, where Dr Samuel West, a specialist in respiratory disease, estimated that in the first six or seven weeks of 1890 ‘not far short of 8,000 cases of influenza were seen and treated’.37 The majority came in the second and third weeks of January, when nearly 6,000 patients were admitted, two-thirds suffering from flu. This was more than double the average seen in the same months of the preceding five years. On the heaviest days of the epidemic, West reported, there had been more than 1,000 patients—the majority of them men—‘clamouring for treatment’ in the casualty department. The rush was overwhelming, and utterly beyond the power of the staff to deal with, so that some of the house-surgeons and several of the dressers had to be called in to give their help. Even with all this extra force it was impossible to keep the work in hand, and the crowding was so great that many fainted.38 According to one junior house physician quoted by West, ordinarily few men reported to the casualty department ‘simply for a “cold”,

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their time, as a rule, being more valuable than the time of the women’. However, in the case of the Russian flu, male patients were so alarmed by the symptoms that they took themselves to hospital immediately. The patients could even name the hour at which they were attacked, saying, for instance, ‘I went to work all right this morning, but was suddenly taken ill at eleven o’clock, and had to leave off.’39 An analysis of the ward records suggests that the majority of patients were artisans and men employed in trades—an intake that no doubt reflected the demography of the area and the fact that St Bart’s was a voluntary hospital. Although The Lancet argued that this dread of flu had, in large part, been the result of the sensational news reporting, it accepted that the inundation of out-patient departments was ‘sufficient answer’ to the suggestion that the whole epidemic had been ‘started by telegraph’. ‘Fear exists,’ it added, ‘but it takes something more real than fear to keep away from their employment, workmen who are paid by piece work.’40 In The Lancet’s view, the problem was to find a balance between excessive fear and stoicism. Some sections of the public, it noted, were guilty of a ‘morbid dread’ of the flu and were ‘so fully alive to the prospects of the spread of this ailment that they have almost passed into a state of panic where, after all, no panic is warranted’. At the same time The Lancet lamented a ‘growing tendency among the better educated classes to regard the epidemic as something almost too trivial for serious consideration’. . . . This idea is often pushed to the extreme of thinking that it can be treated disdainfully by homely remedies, and by sufficient energy of self-control. But it is one thing to deny the reason for panic, and another to urge the recklessness of unconcern.41 This notion that dread could be both a positive and negative emotion was a recurring theme throughout the 1890s. To the extent that

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dread of influenza could persuade patients to regulate their behaviour and take precautions against infection, the emotion was encouraged by the medical profession, but to the extent that dread of flu could spill over into panic and hysteria, it was deprecated. The problem was that, because influenza presented as alternately threatening and benign, the line between what one might term ‘appropriate’ and ‘inappropriate’ dread was c ontinually shifting. Thus during pandemic periods, when influenza presented as a ‘new’ disease with alarming symptoms, it made sense to err on the side of caution, but once the pandemic form had been described and the health risks were understood dread became pathologically suspect, an emotion that could just as easily be read as sign of hypochondria or moral weakness as a rational response to a life-threatening infection.42 Because of the way that hysteria and hypochondria tended to be gendered feminine in this period, this made flu particularly problematic for male patients: those who exhibited symptoms of globus hystericus and similar nervous symptoms ran the risk of having their moral character impugned, while those who took the medical advice about the dangers of influenza to heart risked being mocked for excessive caution.43 A good example came in Punch’s ‘Answers to Correspondents’ column in early January. Sending up patients’ elaborate precautions against the disease, Punch warned: ‘If you sit all day in your great coat, muffled up to the eyes in a woollen comforter, and with your feet in constantly replenished mustard and hot water, as you propose, you will certainly be prepared, when it makes its appearance, to encounter the attack of the Russian Epidemic Influenza, that you so much dread’ (Figure 2.3).44 In a similar vein, Fun took aim at the proliferation of cures on the market, joking that with so many ‘infallible remedies’ available it was ‘a wonder Influenza had the “cheek” to show itself at all’.45 For all that satirical magazines mocked the public’s apprehension, however, the periodical and daily press appeared to regard popular responses as anything but hysterical. ‘Influenza,’ reported the Women’s Penny Paper in January, had ‘shorn’ the French capital of its ‘customary

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Figure 2.3 Mr Punch in front of a fire eating gruel: ‘It’s no joke being funny with the influenza.’ Engraving J. Leech, Punch magazine, circa 1891. Reprinted with the permission of the Wellcome Library.

splendour, and people are as panic-struck as when cholera was epidemic’. This is scarcely surprising, for the disease is making rapid ravages. On the last morning of the year there were no fewer than 450 funerals, an increase of over 100 on the preceding day . . . The great danger seems to be of incurring a relapse; those therefore, who are compelled to resume their avocations before they are completely cured, or who have constitutions enfeebled by age or debility, fall easy victims.46

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Mapping the Epidemic The press was not the only institution to make use of modern surveillance and reporting methods to track the epidemic. Mapping the flu was also a central preoccupation of the state. Unlike in 1848, when William Farr had used the blunt tool of retrospective statistical analysis, this could now be done in real time using the latest epidemiological methods. Leading these efforts was the Medical Department of the LGB. Created out of the Chadwickian Board of Health in 1858, the department had been incorporated into the LGB in 1871 when the board was given responsibility for administering England’s public health system. Working closely with the General Registry Office (GRO) and local sanitary authorities, the department’s main job was to produce and disseminate epidemiological information so as to inform preventive actions by Medical Officers of Health (MOsH). At the same time, the department was charged with monitoring the progress of epidemics and conducting ‘auxiliary scientific investigations’ into outbreaks of diseases such as typhoid, diphtheria, smallpox, scarlet fever and tuberculosis.47 Because of its close ties with animal pathology laboratories and leading London research hospitals, this put the Medical Department at the forefront of integrating the latest bacteriological techniques into epidemiology. However, while the department’s epidemiological work was informed by germ theory, it tended to be sceptical of laboratory-based medicine.48 Instead, it preferred to rely on the statistical methods pioneered by Farr combined with the close observation of outbreaks and, in the case of major epidemics, coordinated investigations entailing the exchange of information between the department and MOsH on the ground. In December 1889 the LGB’s Medical Officer, George Buchanan, asked his assistant, Henry Franklin Parsons, to conduct just such an investigation into the Russian flu.49 Parsons’ first step was to post a notice in the correspondence column of the British Medical Journal (BMJ) asking readers to forward information about outbreaks in their areas ‘presenting distinctive characters’ and asking whether the flu had been imported from ‘abroad . . . or in the case of institutions from

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Figure 2.4 Questionnaire circulated by George Buchanan, Medical Officer of Health of the Local Government Board. Parsons, Report on the Influenza, p. 1.

“outside”’.50 At the same time, Parsons c irculated detailed questionnaires to MOsH in each of Britain’s 1,777 sanitary districts seeking information as to aetiology of influenza, it’s ‘method of spread’, and its incubation period51 (Figure 2.4). In all, some 1,150 questionnaires were returned to the LGB. Parsons’ 1891 report into the epidemic, and his follow-up report in 1893, were models of case-tracking epidemiology, proving that far from the epidemics having erupted simultaneously in several locations, as miasma theory predicted, each wave of the pandemic had

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been preceded by scattered cases that had increased incrementally over a number of weeks. Not only that, but the spread had followed a clear urban hierarchy, with London and other major urban centres generally being attacked first, and smaller towns and rural areas following several days or weeks later. At a time when most people still subscribed to occult notions to explain influenza’s wide prevalence, Parsons’ reports transformed medical and scientific thinking about influenza. As George Buchanan put it in the introduction to the 1891 report, Parsons’ most significant finding was that influenza was ‘an eminently infectious c omplaint, communicable in the ordinary personal relations of individuals with one another’ that spread no faster than the most rapid forms of human communication.52 Second, Parsons would demonstrate that while the onset of the first wave had been sudden, with the deaths from influenza peaking on 18 January 1890, just three weeks into the six-week epidemic, thereafter the mortality had rapidly declined. He also observed that although the flu had elevated the death rate in London to 33 per 1,000 of population, the epidemic had been generally mild, sickening just a quarter of London’s population with an illness that in most cases ran its course in seven to ten days. By contrast, the onset of the second wave, in May to June 1891, had been more gradual and protracted, with an eight-week average duration in London, but ultimately had proved far more lethal. This pattern of gradual onset coupled with mortality in excess of the first wave was also a feature of the third wave in January –February 1892 (in total, 624 deaths were ascribed to influenza in London in 1890, 2,336 in 1891, and 2,264 in 1892).53 Third, the LGB’s investigations would show that the epidemic had been particularly fatal to patients with underlying lung conditions, escalating the death rate from respiratory diseases such as tuberculosis, bronchitis and pneumonia. In a period when respiratory diseases were beginning to account for a rising share of mortality, this would prove a highly significant finding—one that would underline flu’s threat to public health and increasingly make it an object of biopolitical discourse. The first challenge faced by Parsons and other experts in the LGB’s Medical Department was to establish where the flu had come from,

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and when and by what means it had arrived in Britain. Although the initial press reporting had focused on St Petersburg, other observers thought the seat of the epidemic had been Bokhara, an important Muslim trading post lying on the Silk Road from Afghanistan in what was then Tsarist-controlled Uzbekistan. In May 1889 a flu-like disease had sickened half Bokhara’s 80,000-strong population of Russians, Muslims and Jews. According to Johann Heyfelder, a German physician who had been resident in the city, the symptoms had included high temperature, profuse sweating, loss of appetite, malaise, nausea, and vomiting.54 Another popular theory was propagated by E. Symes Thompson, the Gresham Professor of Medicine and Consulting Physician to the Brompton Hospital for Consumption and Diseases of the Chest. In a series of lectures delivered at the height of the epidemic, Thompson argued that, far from originating in Russia, the flu had been due to the flooding of the Yellow River in China in the winter of 1888, and the burning heat the following summer that, he claimed, had acted on the malarious, refuse-saturated mud to send ‘countless of millions of organic spores’ high into the atmosphere.55 Once in the higher atmosphere, he posited, the poison could have been carried to Europe on the trade winds or by ‘other means . . . whether atmospheric, electrical or miasmatic’. Whichever had been the case, Thompson had little doubt that the abundance of ‘micro organisms’ was traceable to what he called the ‘general influence’.56 At first, Frank Clemow, a Scottish physician who had been based at the English hospital in Kronstadt near St Petersburg when the epidemic broke out, was similarly impressed by the rapid spread of the flu, pointing out that based on the initial case reports from Bokhara and Eastern Russia, the disease appeared to have travelled 3,000 miles in 17 days, much of it across ‘near impassable and sparsely populated steppe country’.57 To Clemow, this suggested that influenza was a miasmatic disease that, like cholera, could cross vast tracts of land and leap across international frontiers without regard to quarantines and other preventive measures. These parallels were reinforced when it was reported that in some parts of Russia the flu had been followed by outbreaks of cholera—a pattern that recalled

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the British experiences in 1831 and 1848 when cholera had also been preceded by influenza. However, Clemow recognised that miasma theory could not easily be reconciled with the observation that the flu had attacked people living near the railway while leaving houses some distance from the lines untouched. These anomalies were sufficiently worrying for Clemow to subsequently conduct a detailed retrospective epidemiological study using Russian Army records. These showed that the flu had almost certainly originated in the Kirghiz steppes in northern Kazakhstan, then a Tsarist possession, with the first cases occurring towards the end of September 1889 at Petropvalovsk, a town lying entirely within the steppe not far from the main postal route running from Moscow to Western Siberia. Soon after, Clemow noted, there had been an outbreak at Tcheliabinsk, a key terminus on the soon-to-be-extended Trans-Siberian Railway. From there, he argued, the flu had spread rapidly west and south and more slowly east towards Chinese territory, with outbreaks being reported in Tomsk and Tobolsk, in Western Siberia, in midOctober.58 By mid-November, the flu had reached St Petersburg, and by the end of the month outbreaks were being reported in Berlin, Vienna and Paris. Towards the middle of December, outbreaks were reported in Stockholm, Brussels and Madrid, and by the end of December the epidemic had reached the eastern seaboard of the United States.59 At first Parsons, like Clemow, was bewildered by the pattern of influenza’s spread. Reviewing the completed questionnaires, he noted that the consensus of opinion among medical officers was that influenza was ‘miasmatic and airborne’. A few considered the disease ‘infectious and contagious, but the great majority were of the opinion that it was not’.60 However, as Parsons studied the returns and mapped the progress of the flu he increasingly questioned miasma theory. In Britain, he noted, the first intimation of the epidemic had come in the autumn with outbreaks of ‘pink-eye’—a form of equine influenza—at stables in Cornwall and Staffordshire. In October 1889, some six weeks before the appearance of the first human cases, outbreaks had also been reported in London and Glasgow at stables containing studs for the railway and tramway companies. The onset

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of the symptoms was sudden, and closely resembled those of the subsequent human cases, with horses experiencing high fever and a rapid increase in pulse rate. However, though one medical expert was sufficiently alarmed to write to the BMJ warning that the outbreaks of pink-eye could be the forerunner of a human epidemic, the disease did not transmit easily to stable hands.61 According to Parsons, the first definite human cases occurred in the fortnight before Christmas. The initial focus of the epidemic was London. However, by the second week of January the flu had spread to South East England, the Midlands and the eastern counties, and by the end of January it had reached the western counties and Wales. In February influenza was epidemic in Cheshire, Lancashire and the North, after which the wave subsided. Of the large towns, Hull was attacked in December, supposedly as the result of the direct importation of the disease by Russian seaman from Riga; Portsmouth in the middle of December; and Birmingham, Liverpool, and Dover towards the end of December. However, in Manchester and Sheffield—towns without ports—influenza did not become epidemic until February, and in Derby it supposedly never attained epidemic proportions.62 Parsons’ careful review of the evidence left him in little doubt that influenza was contagious. At a discussion at the Society of Medical Officers of Health in April 1890, he argued that the speed of influenza’s spread had been ‘much exaggerated’. Noting that there was no part of England that could not be reached within 24 hours and that in many cases the first people to have been attacked were employees of the Post Office, he pointed out that the epidemic had coincided with Christmas—a period of ‘great traffic’.63 In his report, Parsons further developed the theme. Pointing out how the general progress of the epidemic had been from the South East to the North West, he argued that the diffusion pattern suggested Londoners holidaying over Christmas had introduced the disease to rural areas.64 The notion that the epidemic had erupted simultaneously in several locations, as miasma theory predicted, was further contradicted by the survey returns from MOsH and doctors showing that outbreaks had been preceded by scattered cases that had increased incrementally over several weeks.65 This pattern was particularly

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apparent in so-called ‘institutional’ settings. In a typical example, Parsons demonstrated how at the General Post Office the greatest number of cases had occurred in the telegraphic department, where over 2,000 clerks worked side-by-side in long galleries. The incidence here had been ten to 20 times higher than among ancillary staff working in less crowded conditions.66 Household outbreaks provided further evidence of flu’s contagiousness. Male breadwinners and schoolchildren had usually been the first to contract the flu, Parsons noted, with their wives and younger children only falling ill later. Likewise, MOsH in counties to the south and north of London reported that the first cases could often be traced to businessmen who travelled regularly to and from the capital for work.67 Parsons’ report left little room for equivocation. Positing that flu was a living ‘germ’ communicated directly from person to person, he concluded that the epidemic had followed the ‘lines of human intercourse’, with cities and major urban centres being attacked before provincial towns and rural areas. Owing to its short incubation period, flu’s spread had been rapid and extensive, but it had never ‘travelled faster than human beings, parcels, or letters could travel’. Moreover, c ontrary to miasma theory, Parsons found that the epidemic had ‘prevailed independent of season, climate, and weather’, with outbreaks being reported simultaneously in the northern and southern hemispheres in opposite seasons. But perhaps his most significant finding was that while the initial cases had resembled ordinary ‘catarrh’—with several doctors denying the existence of an epidemic—later on the symptoms had become more severe, with many doctors recording ‘relapses and dangerous complications’.68 These complications had mainly affected the lungs, Parsons noted, with doctors recording mortality ‘in excess of the average’ for bronchitis, pneumonia and phthisis, as well as for diseases of the circulatory system. Indeed, while 303 deaths were ascribed to influenza in London during the first four weeks of 1890, Parsons showed that the excess over the corresponding period in the previous ten years was 2,258. ‘The explanation is probably that the later deaths ascribed to influenza were due for the most part to sequelae or complications occurring at a later stage,’ he noted, before concluding

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that ‘the mortality ascribed directly to influenza is . . . but a small part of that occasioned by the presence of the epidemic.’69 Finally, Peacock also noted that whereas during the 1847– 8 epidemic women had accounted for the majority of the deaths, in 1890– 1 doctors in civilian and military practice reported that men appeared to have suffered more than females.70 This observation was subsequently confirmed by the death returns, showing a clear excess of male (2,415) relative to female (2,108) deaths. This excess will be discussed in more detail in Chapter 4. For the moment, I merely wish to note that Parsons found it applied to every age group except the over 65s, and was particularly pronounced in the middle period of life (men aged 25– 65), an incidence that he concluded was probably connected with ‘the influence of the fatigue and exposure incidental to men’s vocations’.71

Second Wave While the dangers of the respiratory complications were of concern to Parsons and doctors like Samuel West in hospital practice, most physicians were sceptical of the threat, arguing that the case fatality rate of influenza could hardly stand comparison with truly dreaded diseases like cholera, smallpox and scarlet fever. Moreover, while it made sense to isolate smallpox and scarlet fever patients in fever hospitals, most physicians considered that the infectiousness of influenza had yet to be proven. In a lengthy article on ‘The Recent Influenza Epidemic’ accompanied by a detailed editorial, The Times concurred. Pointing out that there were many instances where doctors and nurses had failed to contract influenza from patients in their care, the paper argued that influenza was ‘not highly contagious’ and that its propagation most likely depended on ‘some vitiated condition of the air’. For all that ‘hypochondriacs and valetudinarians’ may have obsessed over their symptoms, The Times considered that influenza was a ‘troublesome rather than a fatal complaint’, one that had ‘produced an effect on the imagination altogether disproportionate to its actual destructiveness merely by the universality of its influence’.72 However, although the ‘direct mortality’ due to

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influenza had been ‘exceedingly slight’, The Times noted that the epidemic had elevated the death rate in London to 32.3 per 1,000 of population in the first week of January, while in Paris the death rate had peaked at 61.7 per 1,000. ‘There is no other disease except cholera which has so serious an effect on the death rate while it lasts,’ the paper concluded.73 That observation would be brought home by the second wave of the pandemic, and nowhere more so than in Sheffield and at the Palace of Westminster. Whereas the first wave of Russian flu had lasted just three weeks, the second wave had an average duration of eight weeks, with cases peaking in April –May 1891. The flu recurred first at Hull, breaking out in epidemic form in the first week of March 1891, with the town’s death rate peaking at 42.5 per 1,000 in the second week of April. Suspicion initially fell on Russian Jewish immigrants in transit from Hamburg to New York. However, it was subsequently discovered that the disease had not been prevalent in Russia or Hamburg until a later date, whereas influenza had never completely disappeared from low lying villages enclosed by hills or ravines in North Yorkshire. From the Humberside port town, the flu spread to East Yorkshire and the north of Lincolnshire, where it attacked villages and nearby market towns such as Driffield towards the middle of the month, before infecting Leeds and Sheffield in April.74 In contrast to London, where the onset of the first wave had been sudden, with deaths from influenza peaking on 18 January 1890, just three weeks into the epidemic, Sheffield’s experience of the first wave had been protracted and lingering, with deaths from influenza and pneumonia only finally subsiding in late June, some 20 weeks after the start of the epidemic. Overall, however, the impact of the 1890 wave in Sheffield had been mild. In all, the town recorded just 96 deaths from influenza, and although Sheffield’s MOH Harvey Littlejohn later concluded that a substantial proportion of the 1,575 excess deaths initially attributed to respiratory infections had really been due to epidemic influenza, in only two weeks of the winter 1890 outbreak did the number of deaths from influenza exceed ten. By contrast, during the second wave in the spring of 1891, influenza in Sheffield behaved like a classic infectious disease, the first deaths

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Figure 2.5 Graph showing the weekly death rate from influenza in Sheffield during the spring and early summer of 1890 and 1891. The rate peaked at 73.4 per 1,000 living in the week ending 2 May 1891—the highest ever recorded by the borough. Parsons, Further Report, p. 28.

occurring suddenly in the third week of April, before peaking at 111 just a fortnight later. Including deaths from associated pneumonia (76) and bronchitis (97), the mortality rate in the week ending 2 May 1891 was 73.4 per 1,000—the highest rate ever recorded by the borough (Figure 2.5).75 The sudden increase in the death rate shocked doctors and town hall officials, the more so as the influenza appeared to have been introduced by visitors from Driffield and other nearby market

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towns, suggesting that, contrary to the prevailing medical wisdom, influenza was intensely infectious. The spike in the death rate also sparked considerable alarm in the press. Although Sheffielders employed in the knife-grinding and cutlery trades had long been used to high levels of respiratory disease and phthisis (pulmonary tuberculosis), and, thanks to the privy midden system, dysentery and other water-born diseases were almost endemic to working class districts such as Brightside and the Crofts, a death rate in excess of 70 per 1,000 was, as the Yorkshire Telegraph put it, ‘staggering’. ‘Where is the epidemic going to end?’ the paper demanded. Sheffielders have so far accepted the epidemic with singular stolidity, and sensibly declined to encourage anything approaching scare, but with the death rate of 70.3 staring us in the face we are entitled . . . to demand from the custodians of health if something cannot be done to put an end to the ravages which it is making on our population.76 Even during the smallpox epidemic of 1887– 8 the weekly death rate in Sheffield had never risen higher than 30 per 1,000, and while the 1832 cholera epidemic had seen a far higher case fatality rate, for all the fear that cholera engendered, the 1832 epidemic was responsible for just 402 deaths over a five-month period, with the highest weekly death total being 92.77 By contrast, in the spring of 1891 the weekly death toll from influenza in Sheffield twice exceeded that of the 1832 cholera. Indeed, the second wave of Russian flu accounted for 399 deaths in 12 weeks in Sheffield, and if one includes the excess mortality due to pneumonia and bronchitis then the second wave of Russian flu was probably responsible for no fewer than 1,100 deaths in total.78 While the severe recrudesence of the flu in Sheffield had alarmed the Yorkshire newspapers, however, it was the resurgence of infections in the Palace of Westminster in May that once again made the Russian flu the focus of national concern. As in the winter of 1890, when the flu had incapacitated Salisbury and Balfour, press

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interest was guaranteed by the fact that the earliest victims included some of the most prominent political figures at Westminster. Moreover, as it became clear that, unlike in 1890 when the epidemic had lasted just three weeks, the new wave was more protracted, with infections being accompanied by sometimes mortal respiratory complications, public anxiety deepened.79 One of the first to succumb was the Duke of Richmond and Gordon, the Chairman of the Joint Committee on the Railway Rates Provision Order Bills, and his number two, Lord Houghton. The Conservative peers had been forced to retire while taking evidence in early May from representatives of the Manchester, Sheffield and Lincolnshire Railway who had travelled to Westminster to give evidence on the Railway Bill. The occurrence drew wide comment and did much to underline the infectious nature of the disease. Then, on 2 May, Lord Derby was also stricken with flu, followed by several MPs. By now the flu had spread from Sheffield to Liverpool. Several deaths had also been reported in Bradford, and in Leeds it was reported that several nurses had died at an infirmary.80 However, the event that did the most to engender public alarm was the sudden death of the Archbishop of York, Dr William Connor Magee. A graduate of Trinity College, Dublin, Dr Magee was an Irish prelate much admired in York and beyond for his impassioned defence of church orthodoxy and his championing of social causes, such as child life insurance. His sudden death in the early hours of 5 May 1891 was compounded by the facts that he had only been in office five months, and that the gravity of his illness had been deliberately kept from his parishioners. Just as in 1861 the unexpected death of Prince Albert from typhoid at the age of 42 had shocked the Victorian public, sparking widespread national mourning, so The Times reported the death of Dr Magee had ‘caused a most profound sensation, and the deepest grief was everywhere manifested’.81 Magee had apparently contracted influenza while chairing the Parliamentary Committee on Infantile Insurance two weeks earlier. Although he had retired to Lambeth Palace to convalesce, the flu had been succeeded by ‘bronchitis’ and, after several relapses, he’d fallen into a coma, dying of ‘heart failure’ soon after.82 Whether Magee contracted the disease

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in London or elsewhere is not known, but commentators at the time noted that before arriving in Westminster to chair the committee on child insurance he’d passed through Sheffield. The only other towns he had visited during his short period in office were Hull, which had been identified by Dr Bruce Low, one of the reporters appointed by Parsons to investigate the source of the epidemic, as the probable seat of the spring wave, and Driffield, where influenza had also been raging.83 Magee’s death gave the lie to those who considered influenza a trivial ailment on a par with catarrh or a severe cold. Henceforth, the respiratory complications had to be viewed as serious and potentially grave. But just as important was the way that the Archbishop’s death and the illness of other prominent people fuelled anxieties about overwork and the risks of foreshortening the convalescence period. ‘The lamented death of the Archbishop of York . . . had served to render [influenza] once more a topic of absorbing interest,’ commented The Times, before concluding that the public alarm was ‘much in excess of the actual danger,’ the principal perils being ‘inflammation of the lungs’ and ‘imprudent exposure or exertion’ before patients had fully recovered.84 For all that The Times counselled calm, however, it and other papers continued to stoke public anxieties by publishing regular updates on the progress of prominent convalescents. By the middle of May these included the Prince of Wales, the artist Edward Burne-Jones, and several leading supporters of Salisbury’s government. Then, on 12 May, it was reported that the Liberal leader of the opposition, William Gladstone, was laid up at his residence in Park Lane. In what may have been an attempt to allay public concern, Gladstone’s physician, Sir Andrew Clark, issued a statement maintaining that his patient merely had a ‘feverish cold’ and was making ‘favourable progress’. However, to judge by the large number of well-wishers who flocked to Park Lane to check on the popular Liberal leader, Clark’s reassurances were not believed.85 By 13 May some 77 MPs and Lords were ill with influenza, and there were substantial gaps on both the government and opposition benches.86 With the disease also affecting messengers and committee

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clerks, parliamentary business ground to a halt, prompting calls for the Whitsuntide holiday to be extended. Such an extension, it was argued, would not only allow members incapacitated by illness to recover their strength but would permit others to avoid the infection and provide an opportunity for the House to be thoroughly fumigated. In particular, MPs’ concerns were directed at what the Manchester Guardian described as the ‘unpleasant odours’ emanating from corridors and unventilated apartments. However, it was the risk of respiratory complications that elicited the greatest sympathy. ‘The feeling is stronger than ever that the Government ought to extend the Whitsuntide holiday, so as to give a chance to members of avoiding the epidemic,’ the paper reported. A good many members who are suffering from more or less serious chest complaints which might take a bad turn if they were complicated by an acute attack of influenza are naturally showing themselves reluctant to spend more time at Westminster than they can help, and even healthy men are looking anxiously forward to the holidays.87 A week later, the Manchester Guardian lent further support to the calls for an extension by running a lengthy article giving updates on the health of notable patients. By now these also included Lord George Hamilton, the First Lord of the Admiralty, who, owing to a relapse, was confined to his official residence, and Gladstone, who, it was now being admitted, had suffered a ‘very bad attack’.88 However, keen as House of Commons officials were to extend the recess to give them sufficient time to fumigate the chamber, concern about the health risks was tempered by business considerations and confusion over influenza’s aetiology. In the end, proceedings continued late into the night of Friday 16 May, meaning that most members were unable to leave Westminster for the country until the weekend, and because of the pressure of unfinished business many were forced to return when the House reconvened on Thursday 21 May. As both Monday and Tuesday had been public holidays when members of the public were allowed to visit the Palace of Westminster, that meant parliamentary

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engineers had only Wednesday in which to disinfect and ventilate the chamber. In a letter to The Times, Lyon Playfair, the former Deputy Speaker of the House, argued that this was clearly ‘insufficient’ and that a longer recess would have enabled engineers to thoroughly cleanse the woodwork and walls of members’ rooms.89 However, several commentators wondered whether there was any point in disinfecting the Commons so long as doctors remained at odds over influenza’s mode of transmission. Ventilation might well prove counterproductive, argued the Yorkshire Telegraph, as the ‘first breath of fresh air . . . may bring in forty thousand more microbes worse than the first’.90 In the event, concerns about the recess being too short proved unfounded. When the House reconvened on 21 May, the chief engineer, Mr Plunket, reported that officials had succeeded in fumigating all the lobbies and surrounding members’ rooms. There had also been time to scrub the floors with carbolic soap, clean carpets and cushions, and purify the libraries with a preparation of sulphur and camphor. All the while a ‘very powerful draught of air’ had been kept circulating throughout the House and its precincts, reported Mr Plunket, before concluding to loud cheers that the House was now ‘probably better ventilated and purified than any other house in London’.91 Nevertheless, many MPs took the medical advice about convalescence to heart, taking advantage of the recess to travel to Folkestone for the seaside air. Westminster reconvened on Thursday 21 May, but the knock-on effects on the social season were palpable, with only half the usual number of spectators turning up for the first meet of the Coaching Club in Hyde Park three days later. ‘London is at present depressed in its spirits,’ reported the Manchester Guardian. ‘Everybody has had, or has, or expects to have, the influenza.’92

Infectious Discourses Although the public continued to view influenza as a largely miasmatic illness, by now medical opinion was moving toward the contagionist position. Following the recrudescence of influenza at

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Hull, Parsons had sent his assistant, Dr Bruce Low, north to investigate. At first Low’s investigations c entred on Jewish immigrants who had passed through Hull from Hamburg en route to the United States, but Low discovered the port inspectors had found no cases of influenza on the ocean liner whereas influenza had been rife on a cattle ship, SS Hindoo, that had had sailed from New York on 5 March, arriving at Hull a week later. Whatever the original source of the outbreak, Low had little doubt that merchants from Hull had introduced the flu to Driffield and other Yorkshire market towns, spreading the infection by what he termed ‘personal contact’.93 Although Parsons’ report on the epidemic would not be published until July 1891, on 27 May the board’s president, Charles Ritchie, gave a strong indication of the direction in which the LGB’s thinking was moving, when in answer to a question in parliament he stated that the influenza ‘would have appeared to have been introduced from abroad’ and that its distribution ‘may for the most part be explained by regarding influenza as an infective disease having a short incubation period’.94 Ritchie’s response was not lost on the BMJ. Under an item headlined ‘Parliamentary Paralysis’ it declared that ‘we now have it on the highest authority of the LGB that this epidemic is of an infectious nature’ and that in all likelihood the disease had been introduced to the Palace of Westminster by the ‘Sheffield witnesses’.95 However, the decisive moment came the following week, when in another parliamentary exchange Ritchie used even stronger language. This time his answer came in response to a question about the 1889 Infectious Diseases Act, which gave sanitary authorities the power to control and contain infectious disease outbreaks by entering houses and supervising the disinfection of contaminated rooms and bedding. Although influenza was not designated an infectious disease under the terms of the Act, the legislation contained a provision permitting sanitary authorities to add new diseases to the notifiable list by the adoption of a suitable resolution.96 What the questioner, Morton, wished to know was whether any local authority had sought to apply the provision to flu and whether in the opinion of the board’s president influenza was a notifiable disease within the terms of the Act.

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Ritchie’s response was revealing. He replied that to his knowledge no local authority had passed an order extending notification to influenza. However, he had been advised that ‘influenza is an infectious disease and therefore within the terms of the Act’.97 This was a departure from the board’s previous position that flu was essentially a miasmatic disease that could, under certain conditions, also be transmitted from person to person, and was almost certainly a reflection of Parsons’ investigations. Whatever was the case, when Parsons’ report was finally published in July it left little room for further equivocation. As the LGB’s Medical Officer George Buchanan put it in the introduction: Probably no evidence has ever been put on record in such abundance . . . to show that in its epidemic form influenza is an eminently infectious complaint, communicable in the ordinary personal relations of individuals with one another. It appears to me that there can henceforth be no doubt about the fact.98 Although some members of the medical profession still clung to the view that influenza was a miasmatic disease, the report was generally well-received. Indeed, in a significant volte face, The Lancet, which like Clemow had previously argued that influenza should be considered both miasmatic and contagious, endorsed the board’s conclusions, stating that ‘there does appear to be an abundance of evidence to show that [the epidemic] travelled mainly along the lines of human intercourse . . . and that the disease travelled only just as fast as any humanly conveyed infection’.99 The Times, which had adopted a similarly equivocal position, also endorsed Parsons’ conclusions. In a lengthy review of the report, the paper stated that Parsons’ demonstration of influenza’s infectiousness was ‘well nigh absolute’ and that in future it would be ‘the part of prudence to give as wide a berth as possible to persons suffering from, or having recently passed through, the malady’.100 Only the Medical Press was unenthusiastic. Interestingly, this was not because it denied the infectiousness of influenza—on the contrary, early on in the pandemic it had voiced its support for the theory.101 Rather, the journal, which spoke for the

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vast body of medical practitioners, feared that evidence of influenza’s infectiousness would be used to impose further regulatory duties on an already overburdened medical profession and become a rod with which to beat practitioners. ‘The agitation is now on foot to add measles and influenza to the list of diseases which must be notified, and we see no reason to assume that syphilis and gonorrhea will not come next,’ the journal warned in June. We are thus rapidly approaching the Utopia of the notification compulsionists, when it shall be law that if a shopkeeper’s child catches a cold in its head, the doctor who is called to see it will go to gaol for omitting to report.102

‘A Horrid Bacillus, Which Threatens to Kill Us’ If the resurgence of the Russian influenza in London in the spring of 1891 had surprised medical experts, the return of influenza in the winter was to be expected. Indeed, anticipating just such a resurgence, in January 1892 at a meeting of the Society of Medical Officers of Health, the St George’s Medical Registrar Richard Sisley, who also doubled as a Harley Street flu expert, had renewed his calls for influenza to be made a notifiable disease, arguing that the official returns did not represent the true scale of the mortality and that once excess deaths from pneumonia, bronchitis, and diseases of the circulatory organs were taken into account as many as 27,000 people had perished in the 1890 epidemic wave alone.103 The spring 1891 wave had been even more dramatic, resulting in around 58,000 excess respiratory deaths. However, not even Sisley could have predicted that the third wave of infection would result in half this number of deaths again, or that one of the victims would be Queen Victoria’s grandson, the Duke of Clarence. Clarence’s illness and the public response to his death is discussed in more detail in Chapter 5. For the present, I simply wish to note that he died very suddenly of ‘influenzal pneumonia’ and that his death stunned the nation, prompting an outpouring of grief that eclipsed that which had followed the death of his grandfather, Prince

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Albert, 30 years earlier.104 More importantly, the elaborate pageantry of his funeral at Windsor Castle on 20 January and the extensive commentary surrounding his illness vividly brought home to the public what the BMJ called ‘the present power of influenza’.105 As statistical analysis of the weekly mortality returns demonstrated, this ‘power’ had by no means been exhausted by the winter of 1892. Indeed, in the week of Clarence’s death the GRO had recorded 506 deaths from influenza in England and Wales, a total that exceeded the maximum reached in the spring of 1891. At the same time, deaths from diseases of the respiratory organs, which had been 1,084 and 1,248 in the first two weeks of January, respectively, rose to 1,465 in the third week of January, or 868 above the seasonal average.106 As Dr F. A. Dixey demonstrated in a paper in the BMJ in August comparing the mortality returns for London during the three waves of the epidemic, the deaths from influenza in the third week of January 1892 had been the highest on record. Thus although the official returns for London had attributed 600 deaths to influenza in

Figure 2.6 F. A. Dixey’s tables showing deaths from influenza in London in 1890 –2 and excess due to respiratory diseases such as pneumonia and bronchitis. F. A. Dixey, ‘On the Influenza Epidemic of 1892 in London’, BMJ, 13 August 1892, pp. 353 –6.

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1890, 2,200 in 1891, and 2,170 in 1892, Dixey calculated that once excess deaths from respiratory disease were taken into account the true totals due to the three years of the pandemic had been 2,800, 5,800 and 8,000 respectively107 (Figure 2.6). Parsons was similarly struck by the association with respiratory disease, arguing that a large part of the increase in mortality observed during the epidemic had been due a ‘low and insidious form of pneumonia’.108 Subsequent analysis of the GRO’s returns confirmed the phenomenon had not only been confined to London. Thus while the annual returns for England and Wales recorded 4,573 influenza deaths in 1890, 16,686 in 1891, and 15,737 in 1892, once excess deaths from respiratory diseases were included in the total the Registrar General calculated that the deaths due to the epidemic in 1890, 1891 and 1892 had been 27,074, 57,980 and 25,000 respectively, making the total death toll approximately 110,000.109 In addition, in the winter of 1893, a severe recrudescence of flu had resulted in a further 15,000 excess respiratory deaths, making the aggregate losses due to the pandemic in England and Wales for the years 1890– 3 as ‘not fewer than 125,000 lives’.110 In other words, for every three deaths attributed to influenza during the four years in which the Russian flu had raged, a further five people had died as a result of the complications of respiratory disease. If Clarence’s death and analysis of the mortality returns transformed perceptions of the respiratory dangers of influenza, however, it was bacteriology that enabled Victorians to visualise what this new threat might look like. Although most Britons still subscribed to miasma theory to explain influenza’s wide prevalence, by 1890 it was increasingly common to view influenza as a ‘microbe’ that could attach to inanimate objects, such as letters or parcels, or be conveyed aerially over long distances on particles of dust suspended in the atmosphere.111 The notion of microbial forms of life too small to be seen with the naked eye can be traced to the late seventeenth century and the development of the microscope by the Dutch draper Antonie van Leeuwenhoek.112 However, it was the elucidation of germ theory in the 1870s, and Pasteur and Koch’s groundbreaking isolation of the bacilli of anthrax, tuberculosis and cholera in the

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1880s, that made the public receptive to the idea that influenza might also be propagated by a microbe. The result was that no sooner had influenza broken out in Russia than researchers at various European institutions began the search for the presumed bacillus. The first to claim the prize was Dr Jolles, a former student of Koch’s in Vienna. On 22 January 1890, Jolles announced that he had discovered the ‘influenza microbe’ in Viennese tap water, and that it resembled a form of diplococcus (Streptococcus pneumoniae) commonly found in the lungs of pneumonia patients, the principal difference being that the influenza bacillus had ‘a dark-coloured curved head or hip’.113 Soon after, Professor Weicheselbaum reported finding a similar form of diplococcus in pus taken from the sinuses and middle ears of influenza convalescents.114 In a clarification to The Times in early February, however, Weicheselbaum equivocated, explaining that he and Jolles had actually found two different bacilli and that he was hesitant to assert that either was the true cause of influenza.115 Understandably, such statements made the British medical establishment wary. While the BMJ tended to be more supportive than The Lancet of bacteriological work, it warned its readers that all the microbial candidates advanced by laboratory researchers were already known agents of other diseases and that no one type of organism had been found to be common in all cases.116 Other medical observers used rather less diplomatic language. Arguing that influenza ‘escapes all bacteriological inquiry’, Sisley maintained that so impotent was bacteriology to recommend hygiene and prophylactic measures against influenza that ‘it would be the same to instruct the Police to protect London against the flies in the month of August’.117 Parsons was similarly sceptical. Reporting that examination of blood slides had failed to provide definitive proof of the presence of the influenza bacillus, he concluded that: A perusal of the conflicting statements of these different observers inclines one to think that the microbe (if there be one) which is the essential cause of epidemic Influenza has yet to be discovered, and that the forms which have been identified in the sputa and lungs of fatal cases are either accidentally present or

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connected with the occurrence of secondary affections for which the attack of Influenza had prepared the soil.118 Soon after those words appeared in print, however, Koch’s son-in-law, Richard Pfeiffer, advanced a new and seemingly far stronger candidate. In a paper in the Deutsche Medicinische Wochenschrift that was published in the BMJ on 16 January 1892, Pfeiffer astounded the scientific community by claiming that he had identified the bacilli that were the ‘exciting causes’ of influenza.119 Pfeiffer reported that in 31 patients with influenza he had found the bacilli present in sputum in every case. The bacilli were also present in ‘immense quantities’ in cases of uncomplicated influenza. However, because they were too small to be seen with the naked eye and did not stain easily, Pfeiffer speculated that other researchers had missed them or else confused them with the diplococci and streptococci that were also commonly found in sputum.120 Writing in the same issue of the BMJ, Shibashuro Kitasato, a Japanese associate of Koch famed for his discovery of the tetanus bacillus and later the plague bacillus, supported Pfeiffer’s claim. The ‘influenza bacillus’ was very difficult to cultivate, explained Kitasato, and even in an appropriate medium the bacilli appeared as ‘extremely small points like droplets of water’ that could only be seen with the aid of a lens. Given this, and the fact that the bacilli were often obscured by other more abundant bacteria commonly found in the nose and throat of influenza patients, Kitasato thought it likely that other investigators may have ‘overlooked them’.121 In Britain, the task of confirming Pfeiffer’s claims fell to the Viennese-trained histologist, Dr Edward Klein. Based at the Brown Institution in Wandsworth Road and St Bartholomew’s Hospital, Klein was the author of the leading British textbook on bacteriology. He also enjoyed a powerful patron in John Simon, the President of the LGB, and had already used his influence to introduce bacteriological methods into the study of diphtheria and typhoid.122 Shortly after the publication of Pfeiffer’s report, Klein had described how he had succeeded in isolating a bacillus very similar to the one seen by Pfeiffer and Kitasato.123 As a result, the LGB’s Medical Department agreed to fund an investigation by its Auxiliary

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Scientific Investigations Unit into the clinical, pathological and bacteriological aspects of the disease. Led by Klein, it would transform public health approaches to the disease. Assisted by the bacteriologist Dr F. W. Andrewes and others, Klein enrolled influenza patients at Kensington Infirmary and St Bartholomew’s Hospital, and set about isolating bacteria from their sputum and blood.124 Employing similar methods to the German researchers, Klein and Andrewes took bronchial samples from 20 influenza patients, sterilised the sputum in salt solution, then introduced it into agar.125 In every case, they were able to generate pure cultures of Pfeiffer’s bacillus. In addition, when they examined unwashed sputum on cover-glass plates stained with a methyl blue dye they reported finding a ‘great preponderance’ of Pfeiffer’s bacillus.126 Although the British researchers also reported finding ‘crowds’ of other bacteria in the cultures prepared from the sterilised sputum, they were able to ‘confirm the statements of Pfeiffer and Kitasato in all essential points’.127 Pfeiffer’s bacillus was ‘constantly present’ in the sputum of influenza patients, Klein argued, and in some cases the bacilli occurred in ‘great abundance’.128 The historiography of flu has tended to treat bacteriological claims about the aetiological role of Pfeiffer’s bacillus, or B. influenzae as it soon became known, as a tragic wrong turn in the otherwise triumphant progress of nineteenth century laboratory medicine.129 Starting from present-day scientific conceptions of flu as a viral disease, such accounts emphasise how, in c ontrast to other infectious diseases where identification of the causal microscopic agent in the laboratory transformed aetiology and treatment, flu researchers laboured under Pfeiffer’s misconception that flu was transmitted by a bacteria for nearly three decades.130 However, as Bresalier points out, this is to overlook the crucial role played by the bacillus at the time in mobilising scientific knowledge about flu and preventive strategies against the disease. Rather than dismissing the bacillus as ‘an erroneous object’, Bresalier argues that ‘we need to understand how it gained legitimacy as flu’s causative agent and how it was employed in the laboratory, and clinical and public health medicine’.131 In particular, Bresalier has shown how by working with the bacillus in clinical and

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laboratory settings Klein was able to lend legitimacy to Pfeiffer’s claims.132 Key to this process was the way that Klein correlated the bacterial and clinical pictures of the disease using exemplary cases, such as that of Walter Hall, an 18-year-old butcher’s assistant who had been admitted to Kensington Infirmary on 25 January 1892 having suffered a relapse from influenza. On 2 February Hall had been diagnosed with bronchitis and ‘muco-purulent expectoration’, prompting Klein to prepare cover-glass plates and cultures of his sputum. When he examined the preparations under a microscope, Klein reported finding an ‘almost pure culture of the specific bacillus’.133 Although as Hall’s condition improved Klein had found it progressively more difficult to isolate and identify Pfeiffer’s bacillus in the crowds of other bacteria on the agar plates, he argued that this did not negate the pathological connection between the bacillus and the disease. Rather, it suggested to Klein that as the disease abated and the patient got better so ‘the number of the bacilli also rapidly diminished’.134 Another key factor that persuaded Klein was the close association between the bacillus and lesions found in the respiratory tract. This was ably demonstrated by the case of Charles Joyce, a 70-year-old railway guard who had died on 3 February 1892 of the bronchial and pneumonic complications of flu. On post-mortem Klein had taken a section of Joyce’s diseased lung and examined the secretions for bacteria. ‘The cover glass specimens . . . contained the influenza bacilli in considerable masses,’ he reported. Although Klein also found other bacteria, notably streptococci, he argued that these were most likely the result of an old bronchial infection around which the new ‘pneumonic patch’ had formed.135 To make his findings more comprehensible to physicians, in an appendix to his report Klein helpfully included several pages of photographs showing the coverglass specimens containing the ‘colonies of influenza bacteria’ derived from the case subjects.136 Bresalier argues his pictures drove home the association between the bacillus and the clinical signs and symptoms in a manner that was far more persuasive than words alone: Klein’s report highlighted the apparent congruence between Pfeiffer’s bacillus and flu’s clinical and epidemiological identity

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. . . the bacillus met aetiological criteria that no other candidate had met: it was a new germ.137 Although Klein’s report may have assuaged Pfeiffer’s British sceptics, when it came to expressing a definitive opinion in favour of the bacillus’s pathognomic role, Klein hesitated. Instead, he conceded that while the ‘German authorities’ were ‘very probably right’ to argue that the bacillus was the causative agent of influenza, he could not exclude the possibility that it was also present in other diseases. ‘Perhaps we are as yet hardly safe in denying the presence of [Pfeiffer’s] bacillus elsewhere than in influenza,’ Klein concluded in his report to the board.138 There was also a further objection to Pfeiffer’s c ase, and that was that although he had succeeded in

Figure 2.7 ‘Gradual Transformation Scene – Flight of the Demon Influenza at the Approach of Spring.’ Punch, 25 January 1890, p. 38. Reprinted with the permission of the British Library.

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isolating the tiny Gram-negative bacillus from the sputum and lungs of sick patients and growing it in an artificial medium, when he inoculated monkeys with the bacillus none of them developed conclusive clinical symptoms of influenza, thereby failing Koch’s fourth postulate.139 Andrewes too had failed to reproduce the disease in experimental animals. In short, all that Pfeiffer and Klein had established was a correlation, not proof. Nevertheless, the bacillus was not associated with other respiratory diseases, and it had a definite identity when visualised through a microscope. The result was that by late 1893, Pfeiffer’s bacillus was being referred to as the ‘bacillus of influenza’.140 One of the consequences of Klein’s work with the bacillus was to give influenza a clear visual identity—one that leant itself readily to personification. This transformation in flu’s identity can be traced through the cartoons that appeared in Punch and the comic weeklies Fun and Moonshine during the key phases of the pandemic. In 1890, before the bacteriological basis of influenza was widely accepted,

Figure 2.8 Cartoon making fun of the effects of influenza on various animals at the zoo. The caption beneath the ‘Russian bear’ reads: ‘I gave it to them all.’ Moonshine, 18 January 1890, p. 36. Reprinted with the permission of the British Library.

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cartoonists had experimented with a wide range of visual metaphors. Thus in Punch influenza was portrayed as a demonic old man with wild hair and long fingernails who would be sent packing at the first breath of spring.141 By contrast, Moonshine focused on the supposed Russian origins of the flu, portraying it as a Russian bear who had infected other animals at London Zoo142 (Figures 2.7 and 2.8)

Figure 2.9 ‘More Influenza – John Bull Attacked by Wild Microbes,’ Fun, 5 February 1890, p. 56. The caption reads: “‘It has recently been discovered that the Influenza microbe strongly resembles parasitic bishops and other fearful and wonderful creatures of a parasitic nature.’ – Daily Paper.” Reprinted with the permission of the British Library.

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Only Fun’s cartoonists alluded to the supposed microbial origins of the disease, publishing a cartoon showing John Bull being pestered by ‘wild microbes’ (Figure 2.9). In the cartoon the microbe becomes a vehicle for political metaphors and takes the form of ‘parasitical’ bishops, striking workers, and city financiers whose financial demands are seen as a drain on honest John Bull’s vitality.143 Following Pfeiffer’s announcement, however, this threat is personified by the microbe itself. Hence in a cartoon that appeared in Fun on 27 January 1892 it is the bacillus itself that threatens to

Figure 2.10 ‘The Influenza Fiend; Or, The Old Man and the Sneeze’, Fun, 27 January 1892, p. 36. Reprinted with the permission of the British Library.

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choke the life out of John Bull and by extension the Victorian social body (Figure 2.10). To drive home the point, the bacillus is shown clutching a handkerchief and with its legs wrapped tightly around John Bull’s neck as doctors proffer ‘pills’ and other antidotes hover over his right shoulder.144 The personification of the microbial threat and the democratic nature of the epidemic is further underlined by an accompanying poem, entitled ‘The Influenza Fiend’, in which the flu is presented as ‘A horrid BacillusjWhich Threatens to Kill usjOur sisters and cousinsjAnd aunties, by dozens.’ The poem suggests that defeating the bacillus will not be easy, hence the closing lines: ‘And John Bull must fight toughly to shake off the squeezejOf this dangerous Grippe, this microbe of the sneeze.’145

Preventing Flu So far I have shown how in the early 1890s Victorian epidemiology and bacteriology constructed flu as an ‘eminently infectious disease’, mapping the ways in which the epidemic spread along the lines of human communication and commerce (railways, ships, postal delivery routes) and the hazardous objects to which the microbe could become attached (dust particles, letters, sputum). I have also argued that the sudden increase in the death rate during periods when the flu was epidemic shocked doctors and medical commentators, leading to demands that influenza be made a notifiable disease. However, unlike other leading nineteenth century infectious diseases, such as smallpox, cholera, tuberculosis and diphtheria, influenza never became an object of state medical regulation or coercive sanitary regimes. Instead public health officials relied on individuals to regulate their behaviour voluntarily by appealing to their sense of personal hygiene and civic duty. In other words, the ‘governance’ of flu was not to be achieved via the imposition of cordon sanitaires, compulsory vaccination measures, or the isolation of diseased individuals in fever hospitals and sanatoria, such as had been reserved for the victims of scarlet fever and tuberculosis. Rather, it was to be effected through what Foucault calls ‘technologies of the self’.146

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To see why this should have been the case one only has to consider the limited medicines and legal measures that were available to doctors and MOsH at the turn of the century. While the identification of the bacillus of diphtheria had, by the mid-1890s, led to the production of an antitoxin vaccine that could be applied both prophylactically and curatively, this was not the case with flu. Indeed, the first influenza serum vaccines only became available towards the end of World War I when the ‘Spanish’ influenza threatened to hospitalise Allied troops in northern France, prompting the War Office to co-ordinate the work of military and civilian bacteriologists. Even then, however, vaccines incorporating Pfeiffer’s bacillus produced mixed results and were of little prophylactic benefit.147 Between the 1890s and 1945, when penicillin and other antibiotics became widely available, effective treatments for the respiratory complications of flu were also in short supply. Moreover, while during the initial wave of flu there had been a rush on quinine by patients who believed the drug could interrupt the cycle of fever and chills, and while by the later phases of the epidemic Parsons was prepared to recommend quinine as a ‘prophylactic measure’, there was little evidence the drug was beneficial.148 Other popular remedies included mustard baths and sinapisms (plasters containing black mustard powder) for the relief of congestion; anodynes such as camphor and balsam; and morphine and opiates for the relief of pain and nausea. In addition, doctors might prescribe digitalis, a drug that strengthens heart contractions and slows the heart rate. However, these were salves at best and did little to stem the course of the infection. What about quarantines or the isolation of infectious patients? Such measures had proved effective against cholera and typhus in the earlier part of the century, so why not against flu? The issue was debated repeatedly throughout the key years of the pandemic, but on each occasion British medical authorities reached the same conclusion: namely, that while no one could doubt that flu was a contagious disease and a serious public health threat, it was simply too fast-moving and widely dispersed to contain. As Parsons pointed out in his second report, flu had an extremely short incubation period. Moreover, epidemics produced ‘numerous mild cases, the

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subjects of which . . . are capable of conveying infection’.149 The result was that flu could become ‘seeded’ in a community long before doctors could recognise the symptoms and alert the medical authorities that an epidemic was underway. On the other hand, to the extent that influenza was an infection transmitted by diseased sputum, the elucidation of the pathogenic role of the bacillus could, in theory, have led to the imposition of the same sort of hygiene measures that had proved effective against diphtheria and which were starting to prove effective against tuberculosis. Indeed, commenting on Klein’s findings, the assistant medical officer Richard Thorne argued that the sputa of influenza patients should be dealt with in exactly the same way as these diseases, especially during the acute stage when patients were most infectious.150 Thorne’s desire was shared by Sisley, who hoped the epidemic would spur the board to support calls for flu to be made a notifiable. The problem, as he explained in a paper to the Society of Medical Officers of Health on 20 January 1892, just six days after Clarence’s death, was that England’s sanitary laws were not fit for purpose.151 In theory the 1875 Public Health Act allowed sanitary authorities to levy fines of up to £5 on any individual suffering from a dangerous infectious disease who willfully exposed themselves in public, but it was by no means certain that the courts would uphold convictions against persons so fined, as it could be argued that under the 1889 Infectious Disease (Notification) Act flu was not considered a dangerous infectious disorder. Furthermore, under the terms of the 1889 Act it would take at least 12 days for a sanitary authority to pass an adoptive resolution to make influenza notifiable, Sisley explained. But if an authority were to wait for influenza to become widely prevalent before passing such a resolution then it would be too late to be of service. Adoption of preventive measures, such as the disinfection of bedding and the detention of patients using the 1890 Infectious Disease (Prevention) Act was similarly problematic, noted Sisley, requiring at least 14 days’ notice. Furthermore, the disinfection of houses would serve little practical purpose if infectious patients were free to go out in public without fear of being fined. But perhaps the most important consideration was the degree to which

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the public would be willing to tolerate such restrictions on their liberty, and whether ratepayers would be willing to bear the additional costs that early notification and the enforcement of preventive measures entailed. ‘Owing to the present state of knowledge or of ignorance which exists amongst the people of this country with regard to disease, it is advisable that sanitary authorities should not use any powers unreasonably, or without a fair chance of their being successful,’ Sisley explained. The old idea that an Englishman’s house is his castle, still exists . . . and all interference with what is considered personal liberty is strongly resented. Should inconvenience and expense be caused to the public without obvious and corresponding advantage, the people will begin to resent all sanitary interference, and in the present state of sanitary law and sanitary authorities, this would undoubtedly lead to much strife . . . and so the progress of sanitation would be checked.152 Sisley’s paper received support from a number of quarters, not least the Society of Medical Officers of Health, which quickly passed a resolution defining flu as a ‘dangerous infectious disease’ and calling for it to be added to the list of notifiable diseases.153 The BMJ was also broadly supportive, although it cautioned that notification should not be regarded as a universal ‘panacea’.154 Clarence’s death also seems to have concentrated minds at the LGB. During the initial wave of the pandemic the LGB had shied away from issuing any advice to the public, reasoning that without knowledge of how flu spread such advice would be pointless. However, Parsons’ and Klein’s elucidation of the pathogenesis of flu had shifted the onus towards prevention, and on 23 January 1892 Thorne issued a provisional memorandum setting out various ‘precautions against epidemic influenza’.155 These included early isolation of patients and ‘separation between sick and healthy’; the ‘disinfection of infected articles and rooms’; and the avoidance of public gatherings ‘since the propagation of influenza is known to be promoted by the assemblage of large numbers of persons in a

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confined atmosphere’. The memo also recommended ventilating public buildings when ‘influenza threatens or is present, with a view to secure that the air of the building be frequently changed’. However, although Thorne considered influenza an ‘eminently infectious complaint’, he explained that he had little confidence in the board’s ability to defend against further outbreaks, the reason being the same as those cited by Parsons in his report: namely, that influenza had too short an incubation period and was too widely dispersed. Even where identification and isolation of infected patients might be possible it was hardly advisable, given that many of those patients might be the ‘bread-winners of a community’.156 Instead, Thorne, like other medical commentators, stressed the importance of individuals regulating their own behaviour so as to avoid infection. In particular, individuals were urged to avoid ‘depressing conditions, such as exposure to cold or to fatigue, whether mental or physical’, as there was evidence that a person’s powers of resistance were ‘diminished by any conditions which depress the general bodily vigour’. For the same reason, Thorne recommended warm clothing, and the avoidance of ‘unwholesome food’ or ‘excessive use of alcoholic liquors’. Finally, he warned that because of the dangers of relapse and the risk of secondary pulmonary complications it was vital for patients to avoid exposure to cold or fatigue until they were sure they had made a full recovery. ‘Persons . . . who are attacked by this malady should not attempt to fight against it, but should at once seek rest, warmth, and medical treatment,’ he concluded.157 Thorne’s memo was broadly welcomed by the medical press. However, some commentators argued that it did not go far enough, and that, in the absence of compulsory notification, the most effective means of controlling influenza was through fear. One of the foremost advocates of this policy was Frank Clemow. Arguing that flu should be placed in the same category as scarlet fever and smallpox, he told The Times that it was ‘necessary that the danger of the disease to the individual and his immediate neighbours, should they contract it, be brought home to everyone’ . . . Over two years’

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suffering and a death toll of almost appalling magnitude are beginning to force the reality of the danger into men’s minds. The death of a young Prince near to the throne, under the most pathetic circumstances, has deeply impressed the minds of even the least impressionable. His death will not have been altogether in vain if the lesson be read aright.158 *** This chapter has argued that flu’s emergence as a scientific object in the 1890s was the result of both closer clinical and epidemiological surveillance and bacteriological investigation. The pandemic was also the subject of unprecedented media surveillance. In particular, during the initial phase of the pandemic, the near instantaneous reporting of the outbreaks via the worldwide telegraphic network and the competition between Victorian mass market newspapers made the Russian flu an object of ‘sensation’ and ‘dread’. At first this dread was fuelled by medical uncertainty about the aetiology of influenza and journalists’ ability to telegraph news of the flu’s depredations from European capitals well ahead of local British outbreaks. By the secondary and tertiary waves of the pandemic, however, the dread of flu was increasingly a function of the publicity surrounding the deaths of prominent convalescents, such as the Archbishop of York and the Duke of Clarence. At the same time the latest bacteriological insights into influenza’s pathogenesis resulted in the increasing personification of the microbial threat—hence the proliferation of images portraying the flu as a ‘fiend’. Perhaps the key factor, however, was the way that statistical observations about the ‘excess mortality’ from pneumonia, bronchitis and other respiratory diseases made the epidemic form of influenza an object of increasing public health concern. However, although new scientific insights drove home the epidemic threat, the impracticability of notification and other restrictive measures such as isolation of the sick, meant that influenza tended to escape coercive forms of sanitary regulation. Instead, medical discourses emphasised self-regulation, encouraging patients to police their own health behaviour so as to reduce the risk of relapse and avoid spreading flu

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to the wider community. This made biopolitical discourses double-edged. To the extent that dread of the epidemic form of the disease could persuade patients to regulate their behaviour and take precautions in their own interests, the emotion was considered socially and politically desirable, hence the medical press’s claim that the fear of Russian flu could have a ‘salutary effect’. However, to the extent that dread could spill over into panic and hysteria it was a source of concern, especially in a period when fear was framed as one of the ‘depressing influences’ that could make the body more susceptible to infection. The problem was that because of the way that influenza could change its form, alternating between a plaguelike disease during epidemic periods and a milder, c atarrh-like infection during interpandemic periods, the line between ‘appropriate’ and ‘inappropriate’ dread was continually shifting. Furthermore, as we shall see in coming chapters, in the most extreme cases, dread of influenza could be c onstrued as an idiosyncratic psychopathology, one that was thought to be destabilising to an individual’s mental health and sense of self.

CHAPTER 3 `

AN INEXPRESSIBLE DREAD': INFLUENZA, NERVOUSNESS AND PSYCHOSIS

Early on in the pandemic, doctors had noted how attacks of influenza were frequently accompanied by peculiar ‘cerebral disturbances’ and other worrying ‘nervous sequels’.1 These supposed nervous complications of flu ranged from neuralgia and neuritis to psychiatric conditions, such as neurasthenia, melancholia and depression. The most marked symptom, however, was a profound ‘nervous and mental prostration’.2 Such sequels were nothing new of course— Arbuthnot and Huxham had drawn attention to the nervous aftereffects of flu as early as the 1732 epidemic.3 However in the eighteenth century and for much of the nineteenth, these nervous sequelae (or sequels) were regarded as a curiosity rather than as a cardinal sign of the disease. By contrast, in the 1890s the nervous sequels became the defining feature of the Russian influenza, supplanting to a large extent the catarrhal symptoms. In particular, asylum attendants and neurologists remarked on the frequency of ‘psychoses after influenza’.4 These psychoses encompassed feelings of paranoia and persecution, not unlike the symptoms seen in cases of schizophrenia today, as well as hallucinations and various forms of disordered and delusional thinking. In the most extreme cases of all, they could also trigger suicidal thoughts and homicial urges. For

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some, such as Julius Althaus, a Harley Street neurologist who had studied under Jean-Martin Charcot in Paris, these ‘post-grippal psychoses’ were a ‘new feature’ of influenza epidemics.5 For others, the ‘psychical derangements’ were ‘as old as the influenza itself’.6 Whichever was the case, by the mid-1890s the Russian flu was being blamed for everything from the surging suicide rate to the general sense of malaise that marked the fin-de-sie`cle ebullition.7 Influenza, observed the Victorian throat specialist Sir Morell Mackenzie, had a propensity to ‘run up and down the nervous keyboard stirring up disorder and pain in different parts of the body with what almost seems malicious caprice’.8 T. S. Clouston (1840– 1915), the resident pathologist at the Morningside Asylum in Edinburgh and editor of the Journal of Mental Science, concurred. Noting that 1890 was the first year in which admissions to the Edinburgh asylum for depression had exceeded those for mania, Clouston observed that the Russian flu had ‘left the European world’s nerves and spirits in a far worse state than it found them, and that they scarcely yet have recovered their natural tone’.9 Similar post-influenzal psychoses were observed after the Spanish flu pandemic of 1918– 19, and although the diagnosis appears to have fallen out of favour in the 1930s there were also anecdotal reports of acute psychotic symptoms following the worldwide outbreaks of antigenically novel strains of influenza that occurred in 1957, 1968 and 2009.10 Thus, although today the Diagnostic and Statistical Manual of Mental Disorders (DSM) no longer recognises the ‘psychoses of influenza’ as a distinct nosographic category, for a period of at least 25 years, from 1891 to 1926, and perhaps longer, it was a fashionable diagnosis.11 This chapter argues that the psychoses are best viewed as part of a continuum of cultural and psychological responses to the Russian influenza that ranged from levity at one end of the spectrum—the commonplace dismissal of the flu as a trivial ailment—to an understandable dread of the life-threatening respiratory complications at the other.12 As we have seen, this dread of influenza was exacerbated by social and economic pressures—in particular the pressure on male breadwinners to compete in the Victorian marketplace and provide for their families. However, in the case of

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certain susceptible individuals it could also itself become a ‘nervous’ symptom of the disease, part of the peculiar psychopathology of influenza and its debilitating mental sequelae. Tracing this shift in influenza’s ‘nervous’ identity to the early 1890s, I argue that just as during the initial phase of the pandemic the Russian flu drew on the Victorian fascination with ‘sensation’, provoking sometimes hysterical responses that were deprecated by seasoned medical observers, so in the succeeding waves of the pandemic the flu drew on theories about the entropy of energy and electrical metaphors in which it was common to compare the nervous system to a galvanic battery that could become depleted or ‘run down’ through excessive wear and tear. The key to these nervous constructions of influenza was the way in which the psychoses could be precipitated by ‘overwork’ or ‘overworry’—key tropes of modernity and factors that were thought to lie behind other common forms of nervous exhaustion. Indeed, I will argue that the condition influenza most resembled in this period was neurasthenia, and that in the same way that neurasthenia can best be explained in terms of Victorian medical theories of nervous debility and male nervous dysfunction, so the psychoses of influenza should also be regarded as a construct of Victorian neurology—part of the so-called ‘Age of Nervousness’ associated with the writings of George Miller Beard and Charcot.13 Today the association between influenza and complications of the central nervous system (CNS) is well documented, even if the pathophysiology of such viral infections and their interaction with the nervous system is poorly understood. The latest research suggests that influenza A viruses can spread along cranial nerve pathways in mice and in the process express antigens with a strong affinity for the vagal and trigeminal ganglia regions of rodent brains.14 In humans it is thought that neurovirulent antigens may spark a chronic inflammatory process implicated in Parkinson’s disease.15 Other common CNS complications of influenza include manic psychosis, Reye’s syndrome, encephalopathy and encephalitis, and autoimmune conditions such as Guillain-Barre´ syndrome.16 Studies have found a positive correlation between seropositivity for influenza A and B and a history of mood disorders, and influenza B viruses are

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also significantly associated with a history of suicide attempts and psychosis.17 In addition, pre-natal exposure to influenza has been associated with an increased risk of schizophrenia in later adult life.18 Finally, exposure to influenza A viruses has been associated with encephalitis lethargica, the so-called ‘sleeping sickness’ that first appeared in Europe in 1917 almost coincident with the Spanish flu and which was endemic to Europe and North America until about 1929.19 In the 1890s, however, the psychoses of influenza were not so welldefined. Instead, they were regarded as a species of ‘nerve’ illness or neurosis resulting from organic changes to nerve function. These organic changes could be the result of a focal infection with a disease such as smallpox, syphilis or typhus; a sudden exogenous shock to the nervous system, such as was thought to occur in railway accidents; or ‘depressing influences’—a catch-all term which included both environmental conditions, such as cold weather, and certain emotional and psychological states.20 Whichever was the case, the resulting bodily and psychiatric symptoms were generally thought to have physical rather than psychological causes. However, in the absence of a specific lesion, these somatic processes could only be guessed at—hence Victorian doctors’ reliance on the functional language of nerves to make sense of the perplexing range of bodily and psychiatric symptoms. Interestingly, while Oppenheim and others have demonstrated how the pathologisation of overwork and overworrry in the neurasthenia diagnosis gave male patients an acceptable reason to seek medical advice, medical historians have paid scant attention to the way that the medicalisation of the nervous sequels of influenza may have performed a similar function.21 This is despite the growing medical consensus by the mid-1890s that influenza was an infectious disease. Moreover, although the nervous sequels of flu were seen to affect both sexes, men were thought to be at particular risk because of the way their economically- and socially-prescribed roles supposedly exposed them to excessive physical and mental strain. Thus, while female patients might be expected to take to heart medical warnings to convalesce after an attack of influenza, men—especially working-

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class men not in regular employment—might feel they had no choice but return to work before medically advisable.22 Although the nervous models of influenza closely mirrored neurasthenia, I will argue that what distinguished the psychoses of influenza in the 1890s was the recognition that they were often accompanied by serious psychiatric symptoms—symptoms that could find expression in Gothic feelings of ‘gloom’, ‘dejection’ and ‘dread’.23 Moreover, in the case of certain susceptible individuals, doctors recognised that this dread could itself became a ‘nervous’ symptom of the disease, part of the peculiar psychopathology of influenza and its debilitating nervous sequelae. Hence, the dread of influenza could be exacerbated by the lethargy and feelings of malaise that frequently followed primary attacks of influenza and, in some cases, might also become confused with the common nervous sequels of the disease. A further reason for dreading the psychoses of influenza was the way that the nervous complications of flu intersected with and mimicked more serious psychiatric disorders, such as general paralysis of the insane (GPI), a common cause of admission to asylums at the time. Indeed, in an era when insanity was thought to be traceable to hereditary ‘traits’, the notion that an attack of influenza could somehow ‘reveal’ hidden psychological faults in previously healthy individuals was particularly disturbing, hence the attraction of the psychoses as an ‘idiosyncractic’ diagnosis for what might otherwise be construed as evidence of an inherited neuropathy or family history of ‘madness’. The protean nature of influenza and the way that the somatopsychic aspects of the disease tended to blur the boundaries between organic processes and psychogenic states made the psychoses ideally suited to such fluid psycho-cultural constructions. By the 1930s, however, the increasing popularity of psychoanalysis and psychodynamic theories and more precise diagnostic categories meant that psychiatrists no longer had to resort to the functional language of nerves to explain psychogenic symptoms due to repressed emotional conflicts. The result was that, just as by the 1930s neurasthenia had ceased to be a useful diagnostic category, over time the psychoses of influenza also fell out of favour.24

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Nervous Discourses The English have have long been considered a nervous nation. Paeans to nervousness and dyspepsia fill the pages of Trollope, Austen and Dickens. As originally formulated by George Cheyne, the ‘English Malady’ was primarily a sign of civilisation and refinement—the price the English paid for their success as a mercantile nation.25 In common with other eighteenth century medical writers, Cheyne blamed this nervousness on a range of environmental, dietary and occupational factors. By the nineteenth century, however, it was increasingly common for Victorians to couch these discourses in the language of nerves. As Oppenheimer has argued, talk of ‘shattered nerves’ pervaded Victorian culture.26 These discourses were a sort of medical code. When Victorian nerve doctors spoke of ‘nervous collapse’ or ‘nervous exhaustion’ they did not necessarily mean that a patient had suffered a mental breakdown. Often such terminology denoted nothing more serious than fatigue or mild depression. However, the notion of nervous illness could also encompass ‘melancholia’, a far more serious psychiatric complaint, as well as various forms of mania and insanity. What linked these nervous and mental disorders is that they were all considered types of neurosis, a term originally coined by Cheyne’s contemporary, the Scottish physician and chemist William Cullen.27 For Cullen, neurosis denoted both organic disorders, i.e. ones in which a structural lesion had been identified such as GPI, and functional nervous disorders, i.e. ones where a lesion had yet to be identified but where, it was believed, one would be found at some point in the future (e.g. epilepsy, hysteria).28 Thus while all nervous disorders were by definition brain disorders, the functional neuroses permitted a degree of ‘definitional vagueness’.29 To the extent that psychosis simply meant a more severe form of neurosis, the psychoses—or as they were sometimes called the ‘psychoneuroses’—benefited from a similar lack of definitional clarity. In theory, ‘psychosis’ was a diagnosis that carried connotations of insanity, particularly where there was a history of madness in the family and psychiatrists suspected the presence of ‘predisposing’

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hereditary factors. However, as we shall see, such definitions were far from fixed. Moreover, in the case of the ‘psychoses of influenza’, many psychiatrists argued that the disturbances resulted from a prior focal infection with the influenza toxin, or else were an idiosyncratic reaction that could arise in patients with no prior history of mental illness. The result was that rather than nervous sequels being construed as a form of hysteria or anxiety, such symptoms came to be regarded as mere ‘sequelae’—perfectly normal after-effects of the flu. As a nosographic category, neurasthenia is notoriously vague and amorphous—what Gladstone’s physician Sir Andrew Clark once memorably described as ‘a mob of incoherent symptoms borrowed from the most diverse orders’.30 As Scrivener points out, in Beard’s original formulation neurasthenia was linked as much to dietary, climatological and hereditary factors as to civilised over-refinement. In this respect, he argues, it was scarcely different from Cheyne’s English malady.31 By 1879, however, Beard was arguing that the prime cause of the epidemic of nervousness was ‘modern civilization with all its accompaniments’.32 Underscoring the connection between nervousness and modernity, Beard listed these pressures as ‘steam power, the periodical press, the telegraph . . . the sciences, and the mental activity of women’.33 The inclusion of the electric telegraph in that list is particularly significant as it points to the way in which the Victorian obsession with nerves reflected what Morus calls the technologisation of the Victorian body, and the appeal by medical and cultural commentators to electrical metaphors to make sense of the human nervous system.34 The telegraph not only annihilated barriers of time and space, it also provided physiologists with a model for nervous dysfunction in the absence of visible lesions of the brain. Just as the central telegraph office acted as a controlling intelligence over the Victorian body politic, transmitting information by means of wires and electricity to the most distant reaches of the British Empire, so it was imagined the brain maintained a similar vigilance over the body through a network of nerves and electrical impulses. According to this model, hysteria, neurasthenia, and other forms of nervous

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dysfunction were simply the result of a breakdown or a failure of the brain’s vigilance caused by a draining away of this nervous energy.35 The second law of thermodynamics, discovered in 1847, taught that entropy was a fact of all closed physical systems, thus just as electrical energy could dissipate so could ‘nervous power’. Although natural philosophers tended to be dismissive of such correlations, physiologists found it a useful way of exploring the relationship between physical and nervous forces in relation to mental phenomena that were thought to have a physical substrate. Entropy, of course, was also an inescapable feature of the new Victorian machine culture, but while locomotives and printing presses could run indefinitely as long as they had a constant supply of energy and were well-maintained, the same could not be said of the human labour employed to operate machines. Sooner or later people would become fatigued and break down. This provided physiologists with another powerful metaphor for nervous dysfunction. As Rabinbach puts it, fatigue was ‘the most apparent and distinctive sign of the external limits of body and mind’, defining what he calls ‘both the limits of the working body and the point beyond which society could not transgress without jeopardizing its own future capacity for labor’.36 At the same time, fatigue could be construed as a social pathology and a ‘sign of weakness and absence of will’.37 The result was that any diagnosis of fatigue was charged with potential moral judgment. As we shall see, however, to the extent that both neurasthenia and the nervous sequels of influenza were thought to interfere with the automatic nervous processes that controlled the operation of will, individuals labouring under such functional impairments escaped criticism. As Beard explained in his 1880 treatise on nervousness in a section headed ‘morbid fears’: A healthy man fears; but when he is functionally diseased in his nervous system he is liable to fear all the more; to have the normal, necessary fear . . . descend into an abnormal pathological state, simply from a lack of force in the disordered nervous system.38

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‘An Inexpressible Dread’ Although psychoses had been observed during and after the 1833 and 1837 influenza epidemics, they had not been a prominent feature of the 1847 – 8 epidemic. The sudden appearance in 1890, therefore, of symptoms of hysteria and fatigue took many physicians by surprise.39 Frequently, this fatigue was the prelude to more disturbing neurological symptoms, such as insomnia, hypochondria, mania, melancholia and general paralysis. Moreover, in the most extreme cases, it was noted, the sequels could result in psychosis accompanied by suicidal thoughts and irrational homicidal urges. A good example of the wide cultural reach of these nervous discourses came in a short story that appeared in Strand Magazine in the summer of 1895.40 In the story a young doctor called Feveral calls unexpectedly at the house of a colleague at the height of the third wave of the Russian influenza (Figure 3.1). Feveral’s colleague, Halifax, is shocked by

Figure 3.1 ‘He came into the hall to greet me’. L.T. Mead and Clifford Halifax, M.D., ‘Stories from the Diary of a Doctor’, Strand Magazine 10 (July 1895): 80– 95, p. 80. Reprinted with the permission of the British Library.

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Feveral’s gaunt, sickly appearance and speculates that he must have suffered some sort of ‘nervous collapse’. The diagnosis is quickly confirmed by Feveral himself, who explains that in the winter of 1893 he lost his daughter to influenza and that he has also just suffered ‘a short, sharp attack’ of the disease. However, rather than take the medical advice to convalesce, Feveral says he has been run off his feet attending to patients, and fears he is losing his mind. ‘The influenza has left an extraordinary sequel behind,’ he explains. ‘I have an inexpressible dread over me. By no means in my power can I drive it away.’41 In the story, Feveral’s dread is linked to his fear that he is in no fit state to carry out his medical duties and may have administered poison to a patient by mistake.42 Interestingly, Halifax has no trouble accepting Feveral’s explanation and, rather than dismissing him as hysterical, tells him that his symptoms are perfectly normal. It is not because of any personal failing that he has been reduced to a state of despair but because of an exogenous shock to his nervous system—or what Halifax calls ‘a double shock’, namely ‘the death of his child, followed immediately by an attack of influenza’.43 Although the Strand story is fictional, the magazine claimed that, like other stories that appeared in the same series, it was ‘founded on fact’ and had been written ‘in collaboration with a medical man of large experience’.44 Certainly, Feveral’s dread of the nervous aftereffects of influenza would not have struck Strand’s readers or most medical men as unusual. Indeed, Dr Samuel West had noted the hysterical reaction of male patients who had been seized by influenza as early as the first wave of the pandemic. At first these men, the majority of whom were local artisans or employed in trades, had besieged the casualty department at St Bartholomew’s ‘clamouring for treatment’. However, once admitted to the ward the typical male patient could ‘hardly stand to have their lungs examined’ or else could be seen ‘huddled together, as if he cared nothing as to what became of him’.45 All at once all energy and vigour vanish; the patient feels for nothing and cares for nothing, is completely apathetic, listless,

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and gloomy, and may hardly have strength enough even to be irritable or sulky.46 During the initial phase of the pandemic The Lancet had carried similar reports, and by the spring of 1895 Victorian newspapers were full of stories of men and women who had similarly been driven to the brink of insanity and beyond by influenza.47 As in the Strand story, these tales frequently featured doctors and connected their psychotic behaviour to their anxieties around work and their failure to take on board medical advice about the importance of a lengthy convalescence. Although the explanations for such post-influenzal psychoses varied—with some doctors favouring organic models and others favouring psychodynamic explanations— few medics doubted the existence of a causal relationship. For instance, the well-known German physician Otto Leichtenstern (1845– 1900), who had observed 439 influenza patients at Cologne Municipal Hospital at the height of the pandemic, argued that ‘no other acute infectious disease is followed so frequently by acute and chronic psychoses’.48 His compatriot, Julius Althaus, who, though based at the Maida Vale Hospital for Nervous Diseases in London, was born and educated in Germany, was similarly convinced of a connection, declaring he had ‘no hesitation in stating that there are few disorders or diseases of the nervous system which are not liable to occur as consequences of grip’ [sic] [italics inserted]. According to Althaus, patients observed in both his public and private practice had exhibited ‘severe forms of neuralgia, loss of power, and a general break up of the nervous system’. In the most severe cases of all, he added, this loss of power could result in suicidal thoughts or the impulse to take the life of a close family member, such as a wife or child.49 The result was that by 1892 familiarity with the nervous form of the disease had resulted in a reclassification of influenza. According to Tuke’s Dictionary of Psychological Medicine the nervous sequels of influenza consisted of two types.50 The first coincided with the onset of fever or occurred shortly after the fever had abated, and included headache, insomnia, neuralgia and nervous exhaustion. However, these symptoms generally passed away, and it was the

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second type, what Tuke called the ‘psychoses after influenza’ that could occur anywhere from a few days to two to three weeks after the cessation of fever, that he considered more serious.51 The most common symptom of the psychoses was melancholia or depression, both mild and acute. Next in frequency came acute exhaustion, though this was rarely chronic, followed by mania. Finally, Tuke also recognised a further type of psychosis of a ‘peculiar character’ which simulated the symptoms of GPI and which had been observed among patients admitted to Bethlem Royal Hospital in 1890. Clouston, who contributed to many of the dictionary’s entries and who co-edited the Journal of Mental Science with Tuke, broadly concurred with this classificatory system. As we have seen, in 1890 Clouston had been struck by the association between the pandemic and what he called ‘lowered nervous action and vitality’.52 Clouston’s comments were based on his observation that the 1890 epidemic had boosted admissions for depression to the asylum at Morningside. Thus, in the previous five years there had been 847 cases of mania and 617 of melancholia at the Edinburgh asylum. However, in 1890 the proportions were very nearly even: 140 cases of melancholia and 134 of mania. Although Clouston could not be certain, he thought the increase in depression was probably the result of the epidemic, hence his observation that the Russian influenza had ‘left the European world’s nerves and spirits in a far worse state than it found them’.53 Clouston’s experience led him to emphasise the idiosyncractic relationship between influenza and psychosis. Such psychoses had long been recognised as sequelae of other common infectious diseases such as measles, typhoid fever, rheumatic fever, scarlet fever, erysipelas and malaria, and appeared to bear no relationship to patients’ prior psychiatric history. However, following Pfeiffer’s isolation of the supposed bacillus of influenza, by 1896 Clouston was arguing that ‘the microbe or poison of influenza destroyed the cortical energy to a much greater extent than any of the continued fevers’, hence his claim that mental disturbances after influenza ‘may arise from the direct influence of the disease on the brain cortex’ [italics in original] or from the disease’s ‘generally weakening and exhaustive effects’ on the nervous system.54

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By contrast, other physicians emphasised the role of ‘disposition’ and hereditary factors. According to George Savage (1842– 1921), the superintendent of Bethlem Royal Hospital, who, like Clouston, had had ample opportunity to observe the effect of the epidemic on asylum admissions, the psychoses had been most common in persons ‘who from excess or injury have damaged their nervous systems’, where excess could include alcohol, and injury could include conditions such as GPI. Influenza, he argued, also appeared to attack the nervous system ‘in those who are already falling along the nervous lines, as well as those who by inheritance or acquisition are nervously unstable’.55 Thus, in patients prone to melancholia, influenza might, by aggravating pre-existing neuropathic tendencies, provoke fullblown depression. Similarly, an attack of influenza could trigger symptoms of GPI in patients who were showing signs of ‘nervous wear’.56 Finally, Savage appears to have believed that influenza could also precipitate psychosis in patients with a previous history of insanity influenza. However, he argued there was ‘no direct connection’ between the severity of an influenzal attack and such neurotic sequelae.57 Savage’s position was shared by Wilhelm Griesinger, the German neurologist and author of the standard late nineteenth century textbook on mental pathology, who argued that focal infection with influenza tended to act in ‘cooperation [with] psychical causes’ where such psychical causes could encompass ‘hereditary’ disposition, ‘acquired disposition’ or the ‘influence of moral causes’.58 ‘Influenza alone does not produce insanity’, Griesinger argued. Instead, he believed it should be regarded as a ‘predisposing cause [of] a reduction of nervous or bodily power; or . . . the last shock to upset an unstable system.’59 The difficulty with Griesinger and Savage’s position was that, while few asylum officers doubted there had been an increase in admissions for depression after 1890, in the case of other patients whose insanity pre-dated the pandemic, influenza appeared to have no affect on their psychiatric symptoms. Moreover, in the case of many newly admitted patients for whom the onset of disturbing psychiatric symptoms had followed soon after an attack of influenza,

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there was frequently no previous history of neurosis or psychosis. Thus in 39 cases of psychosis reported by Tuke, he found evidence of hereditary predisposition in just 21 cases, or a little over 60 per cent.60 The distinguished German psychiatrist Emil Kraepelin (1856– 1926), who based his remarks on a similarly careful observation of asylum cases, put the incidence even lower, arguing that ‘defective heredity’ was present only half the time.61 Another critic was Thomas Claye Shaw (1846– 1927), the medical superintendent at the London County Council Asylum in Banstead, Surrey, and a lecturer in psychological medicine at St Bartholomew’s Hospital. Banstead was one of the larger city asylums, and at the outbreak of the pandemic contained more than 2,000 patients, plus attendants. As superintendent, Shaw was in the perfect position to observe the effects of influenza both on the so-called insane portion of the asylum population and on the non-insane. His observations provided little support for Savage or Griesinger’s position. On the contrary, Shaw found that more staff and attendants had been attacked than patients.62 Moreover, among the insane patients who were attacked, influenza appeared to have had no ‘material’ effect on their nervous symptoms.63 While Shaw acknowledged that even in a closed institution obtaining reliable statistics was difficult, he concluded that there ‘did not appear to be very trustworthy evidence that a person in whose family insanity was strongly marked would be more liable on that account to the ‘“nervous” rather than to the “gastric” or “respiratory” type of influenza’.64 By the turn of the century, familiarity with the psychoses had led many British physicians to reach a similar conclusion, normalising the ‘psychosis of influenza’ as a diagnosis in which no blame could attach to the patient. Thus, writing in 1907 in a special edition of the Practitioner devoted to influenza, Clifford Allbutt, Regius Professor of Physic at Cambridge, said he had been struck by how often influenzal psychosis occurred in patients with no previous history of neurosis. I cannot admit that the neuropathic consequences of influenza generally require a neurotic stock on which to engraft themselves. On the contrary, severe and prolonged as in these

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cases they may be, I have been surprised again and again to see them appear in no slight severity, and only too protracted, in persons of well-balanced temper, steady health and good family history.65

Nervous Exhaustion and ‘Failure of Brain Power’ Perhaps the physician who did most to normalise the psychoses was Julius Althaus. Born in Lippe-Detmold, Germany, in 1833, Althaus graduated as a doctor of medicine at Berlin in 1855, before proceeding to Paris to study under Charcot. In the late 1850s he settled in London, where he worked with Robert Bentley Todd at King’s College Hospital on the therapeutic effects of electricity, and published a book entitled A Treatise on Medical Electricity.66 However, his best known works were the The Functions of the Brain (1880), in which Althaus likened the grey matter of the brain to a galvanic battery and the white matter to ‘telegraphic wires which conduct the current to any place where it may be required’, and On Failure of Brain Power (1882).67 In 1866, Althaus was instrumental in founding the Hospital for Epilepsy and Paralysis in Regent’s Park, later the Maida Vale Hospital for Nervous Diseases, serving there as senior physician until 1894, when he resigned to devote more time to his private psychiatric practice in Harley Street.68 In 1891 he began contributing regular articles and letters on the nervous sequelae of influenza to The Lancet, and in November 1891 he delivered a lengthy lecture on the subject to the Medical Society of London, followed in July 1892 by a lecture to the Psychological Section of the British Medical Association.69 That same year he also published a short book on influenza in which he set out his theories on the nervous sequels in detail.70 In the book, Althaus described the 1889– 91 epidemic as the ‘most interesting event’ of recent years and called for British physicians to adopt the European term ‘grip’ [sic] arguing that it was a more precise term than influenza, which merely meant ‘influence’.71 Criticising the popular belief that influenza was equivalent to the common cold, Althaus argued that the nervous sequels observed after influenza were far in excess of the post-febrile neuroses observed after

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other infectious diseases, such as diphtheria, typhoid, measles and smallpox. Throughout the pandemic, he reported, large numbers of patients had presented with symptoms of ‘neuralgia, loss of power, and a general break-up of the nervous system’. According to Althaus, these ‘post-grippal psychoses’ were a ‘new feature’ of influenza epidemics. No other infectious fever, ‘nor indeed all of them put together’, had produced so many nervous sequels.72 Althaus thought that the high incidence of such sequels had been partly due to the ubiquity of the infection—at one point, Althaus estimated, more than half the British population had been ill with influenza. However, the main factor had been the ‘remarkable’ virulence of the ‘grippal toxine’ [sic] and the way that it had combined with other diseases, such as syphilis, that may have been dormant in the nervous system for many years.73 According to the complex pathophysiology developed by Althaus, this toxin was ‘secreted’ by the hypothecated influenza bacillus, which in turn acted on the ‘vascular bulb’, the body’s principal heat-regulating mechanism—hence the fevers commonly observed in influenza. However, at the same time, Althaus argued that the toxin also irritated the bulb’s nerve nuclei, causing ‘congestion of the brain’ and nervous symptoms, ranging from headaches to insomnia and delirium.74 Even though Althaus gave primacy to the organic changes produced by the hypothecated influenza toxin, when it came to the fraught issue of the role of neurotic predisposition, he hedged his bets. In the case of some patients the secretion of the toxin was all that was required to spark the nervous sequels so that, as he put it, influenza was ‘the fons et origo mal altogether’ [italics in original]. However, in other cases these nervous afflictions, once triggered, could also be grafted onto preexisting neuroses or other nervous predispositions.75 Nevertheless, Althaus maintained that in more than a third of the cases he had studied there was no evidence whatsoever of prior neurosis.76 Indeed, as Althaus made clear in the second edition of his book, he believed that the psychoses of influenza could occur without any predisposing neuroses in the patient, but purely as a result of the action of the toxin on individual idiosyncrasies. Arguing that such idiosyncratic reactions were a well-known phenomenon, Althaus

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observed that there was ‘probably no disease, and certainly no infectious malady, in which the symptoms are so extremely variable as they are found to be in influenza’. I therefore contend that simply from the effects of idiosyncrasy, persons may be affected with mental disorder from the effects of grippo-toxine without there being any neurotic tendency, either in patients or their ancestors.77 Like other medics, Althaus recognised that in their mildest form the nervous sequels of influenza might amount to nothing more serious than headaches and neuralgia—symptoms that, if the patient obeyed the medical advice about a proper convalescence period, would soon pass away. However, in other cases resembling that of Feveral in the Strand short story, patients might exhibit symptoms of neurasthenia and depression accompanied by delusions and thoughts of gathering doom. According to Althaus, in such cases: The patient is incapacitated from attending to his ordinary occupations and falls into a gloomy habit of thought, in which dark forebodings of some impending disaster, the apprehension of an incurable disease, which is about to carry him off, or the delusion that he has committed some fearful crime, for which he is going to be imprisoned, tried and executed, play a leading part. He considers himself disgraced or financially ruined, contemplates suicide as the only escape from his imaginary troubles, and complains that his persecutors do not leave him in peace for a single instant.78 An interesting example came in May 1891, when a 26-year-old clerk presented at Althaus’ surgery suffering from what Althaus termed ‘delirium of inanition’.79 Before succumbing to influenza, the clerk’s father explained to Althaus, his son had never suffered a day’s illness in his life. However, after being attacked by influenza, his son had become so ‘anxious to resume his occupation’ that he had ignored his doctors’ orders to stay in bed, returning to the office after only a

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week’s convalescence. Once there, his colleagues noticed how he had ‘dawdled over his work [and] did not seem to know what he was about’. Gradually, the clerk’s behaviour had become increasingly disturbed—he accused colleagues of theft, became convinced he was going to be charged with perjury, and had great difficulty sleeping. Indeed, the night before arriving at Althaus’ surgery the clerk had risen from bed at 2am and had run to his office where he’d created a ‘great disturbance’. Althaus treated the clerk with morphine and prescribed a sedative at bedtime, as well as a nourishing diet that included four ounces of brandy every four hours. Three days later, he reported, the clerk was sufficiently improved to be removed to the country where he remained for three months, making steady progress before returning to work in September.80 The vast majority of patients, however, suffered from what Althaus termed ‘simple mental depression’, their symptoms ranging from ‘ordinary neurasthenia to the more severe forms of hypochondriasis, melancholia and depressive insanity’.81 As an example, Althaus cited the case of a 35-year-old housekeeper whose attack of influenza in March 1890 had left her ‘unable to attend to her occupation’ and complaining of insomnia, nightmares and loss of appetite. In another case, involving a young woman of 19, influenza had left the patient ‘sullen’ and ‘disinclined for work or conversation’.82 Then there were the cases in which infection with the ‘grippo-toxine’ could prompt suicidal thoughts and homicidal impulses.83 Thus, in February 1890 Althaus had treated a 33-yearold broker and married father of five who, on entering his surgery, had immediately burst into tears. According to Althaus, the man suffered from persistent insomnia and was in a ‘dreadful condition, as he constantly felt an almost irresistible impulse to kill his wife and children’.84 Althaus also cited the case of an 18-year-old girl who had become melancholic after an attack of influenza and had committed suicide by hanging herself.85 Overall, however, Althaus found that men were more prone to such psychoses than women, an analysis of 166 cases showing that men accounted for 96 or 57.8 per cent of the cases.86 Although, Althaus recognised, that neurasthenia and depression might be symptoms of the psychoses, he did not try to

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connect their pathophysiology. Nor was he particularly interested in the role of fatigue or psychological factors, such as anxiety and excessive mental strain. This may have been because Althaus was sceptical of Beard’s term, considering the neurasthenia diagnosis ‘vague’.87 In this respect, his position contrasted sharply with that of his colleague, Thomas Stretch Dowse. A graduate of Aberdeen, Dowse had become a Fellow of the Royal College of Physicians in Edinburgh in 1873, before settling in London in the 1880s where he worked alongside Althaus at the Hospital for Epilepsy and Paralysis in Regent’s Park. Dowse also served as physician-superintendent at the London Sick Asylum in Highgate, north London, so when the epidemic struck, he was in a similarly privileged position to observe the effects of influenza and develop his own theory of the psychoses. Like Althaus, Dowse had initially been sceptical of the neurasthenia diagnosis, regarding Beard’s term as ‘vague and unscientific’.88 By 1880, however, he had become an enthusiastic disciple, publishing a tract entitled On Neurasthenia, or Brain and Nerve Exhaustion, in which he followed Beard in attributing the increase in ‘so-called nervous diseases’ to ‘life at high pressure’.89 Like Beard, Dowse tended to regard neurasthenia as a fatigue state resulting from ‘excessive mental strain’. This strain could result from over-exertion in study or business or be due to ‘some perpetual anxiety’. In either case, the principal symptoms were insomnia, headaches, loss of appetite and ‘rapid fatigue upon exertion’.90 Indeed, Dowse appears to have placed a particular emphasis on fatigue, arguing that while in healthy individuals fatigue was the natural consequence of physical or mental exertion, in individuals whose nervous systems were impaired fatigue could overtax the system and increase nervous exhaustion. The worst advice in such cases was to allow patients to exert themselves before they were fully recovered, Dowse argued, as this would only exacerbate their symptoms.91 For Dowse, the fatigue that accompanied attacks of influenza mirrored the exhaustion seen in typical cases of neurasthenia, hence his decision in 1892 to reissue his book under the new title On Brain and Nerve Exhaustion (Neurasthenia) and on the Exhaustions of

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Influenza [Romans inserted].92 Like the Victorian throat specialist Morrel Mackenzie, Dowse regarded influenza as a capricious infection with a ‘wizard-like action’ on the nervous system. In a passage that drew on Spencerian notions of survival of the fittest and electrical metaphors, Dowse argued that influenza was ‘essentially a nervous fever’ with a special ability to seek out weaknesses in the human organism:93 Influenza . . . like other forms of energy, travels in the lines of least resistance, the least resistant being naturally the weakest, the strained, and the enervated . . . in other words, the toxine [sic] of influenza has the special faculty of picking out and exercising its presence for evil upon the weakest part of the individual coming under its influence, lest that be an overstrained brain and nervous system, a weakened state of the lungs or respiratory system, or a weak heart and circulatory system.94 In particular, Dowse drew attention to the marked ‘emotional depression’ that followed these nervous attacks, theorising that this depression was due to ‘some disorder of the highest nerve processes, owing to the low tension of the energy’.95 Come the 1894 edition, however, Dowse had revised his theory yet again. Replacing the phrase ‘exhaustions of influenza’ in the title with ‘the nervous sequelae of influenza’, Dowse argued that it was not so much that influenza ‘exhausted’ the nervous system as that it hindered its normal function. ‘The fire is choked out or starved out rather than burnt out’, he explained in an amended passage.96 Depression was still one of the most marked and dangerous symptoms, but it was the inability of the influenza invalid to restore nervous equilibrium and ‘will’ him or herself back to health that held the key to the condition. Drawing an analogy with the traumas observed after railway accidents, Dowse argued that the ‘dejection and despondency’ that he had observed after influenza attacks was ‘not altogether unlike the state produced by the shock of an accident’. In each case, he argued, the patient exhibited ‘defective will-power, sleeplessness, troublesome dreams, and a temperament capricious and explosive [italics in

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original]’.97 Lest anyone was under the impression that influenza was a trivial ailment, Dowse also emphasised the depths of existential despair to which victims of post-influenzal depression could sink. With its literary flourishes, his description could have been taken from the pages of a Victorian Gothic horror: I have seen men, within twenty-four hours of taking the influenza, sob like children for hours together as though their hearts would break . . . This sense of gloom and dejection is a conscious living entity, as sad as Hades, where joy and tranquility, and peace and love, are unknown . . .. Woeful indeed are this man’s woes . . .. The sacredness of life is seen only through a flimsy veil of conflicting emotions of doubt, of dread, and of determination to burst these bonds by one fell swoop of severance from the mortal to immortality.98 Like Althaus, Dowse recognised that this ‘gloom’, ‘dejection’ and ‘dread’ could also result in more extreme responses, such as suicide. However, Dowse considered such impulses uncommon, arguing that where they did occur they were the result of ‘continuous brain strain and stress’ that had likely pre-dated the infection.99 Dowse’s comparison with the traumas observed after railway accidents is significant as it points to the incipient psychology that informed his approach to neurosis. The notion of railway ‘shock’ dated back to the theories of John Eric Erichsen, a professor of surgery at University College Hospital in London. In 1866 Erichsen had given a series of lectures in which he argued that the jarring quality of the railway accident and the unique qualities of rail travel gave rise to a condition known as ‘railway spine’ and other psychiatric symptoms.100 For Erichsen, such symptoms resulted from the shock of the accidents and the disturbing scenes that frequently attended them. As both Schivelbusch and Caplan have argued, by drawing attention to these emotional and psychogenic factors in railway accidents, Erichsen laid the ground for the emergence of trauma theory and the future psychologisation of the neuroses.101 The result was that by 1883 Herbert Page, a consulting physician for the

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London and Western Railway Companies, was arguing that railway accidents could bring about a state of collapse ‘from fright and from fright only’, and by the 1890s it was increasingly common for juries to award compensation to victims of railway accidents on the basis of the mental trauma alone.102 What interests us here, however, is how Dowse, by appropriating this model of psychic ‘shock’, was able to incorporate psychogenic symptoms into his organic model of postinfluenzal neurosis. At the same time, Dowse conceived a patient’s nervous sthenicity, or the capacity for action, as a sort of residual energy. This energy was dependent on automatic processes that in overly fatigued individuals could become impaired or blocked. This is what Dowse meant by ‘defects of will-power’. Such defects were not the fault of the individual but due entirely to functional impairments to these automatic processes. Interestingly, in the 1894 edition of his book, Dowse argued that these defects of will were also ‘the most prominent, if not the most characteristic sign of neurasthenia’.103 This was why the key to the recovery of neurasthenics, as with influenza patients, lay in their getting ample rest and quiet. Railing against one’s symptoms and thinking that one could bring about an improvement through an act of will would merely exacerbate the fatigue and prove counterproductive. For Althaus, such failures of will—or as he put it, ‘loss of [nervous] power’—also held the key to the psychoses, hence his emphasis on the interaction of the influenza toxin with idiosyncrasies in the patient. By pathologising the psychoses in this way, therefore, both Dowse and Althaus removed the moral opprobrium that might otherwise have attached to the nervous sequels of influenza. The result was that, just as in the 1880s ‘railway spine’ and ‘railway shock’ had become acceptable medical terms for what otherwise might have been viewed as suspect psychosomatic disorders, so in the 1890s the psychoses of influenza attracted similar medical respect.

Suicide and Psychosis The medical respectability of the psychoses of influenza and the way that the diagnosis could be invoked to explain what otherwise might

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have been deemed aberrant or criminal behaviour can be seen in the numerous cases of post-influenzal suicide that came before coroners’ courts. One of the earliest examples occurred in February 1890, when it was reported that a 36-year-old married Kingston woman under treatment for influenza had attempted suicide by drinking laudanum. According to the testimony of her doctor, the neuralgia from influenza was so extreme that the ‘pains . . . in her head would render her temporarily out of her mind’. The magistrates concurred, remanding her to the Union asylum after concluding that she had ‘acted under the influence of her temporary derangement’.104 By the time that influenza revisited the British Isles in the spring of 1891, a verdict of suicide while of unsound mind or due to ‘temporary insanity’ as a result of a prior attack of influenza had become almost commonplace. Thus, on 15 April 1891, a Bootle coroner’s court returned verdicts of suicide whilst of unsound mind on both a former member of the 4th King’s Rifles and a railway porter. The soldier had shot himself in the chest with his rifle following an attack of influenza, while the railway porter had slashed his throat with a razor.105 A few months later, an East Essex coroner’s jury returned a similar verdict in an even more spectacular case involving a yachtsman and ‘gentleman of independent means’.106 The man, who had been suffering from influenza, had become ‘greatly depressed’ because his yacht had been deemed unseaworthy, and he had been unable to join his friends when they had set sail on the Colne. At first he had tried to stab himself with a pair of scissors. Then, when that failed, he had thrown himself from a railway bridge, landing on the guard’s brake of an oncoming train and smashing his skull. The jury returned a verdict of ‘suicide whilst temporarily insane’, commiserating that the deceased ‘had done his best under the circumstances’.107 Unfortunately, in the absence of virological and postmortem evidence, it is impossible to say whether and to what extent prior infection with influenza was a feature in these cases. Moreover, given the paucity of research into the neuropathophysiology of the influenza virus and its associated CNS effects, it is doubtful whether even with better virological and postmortem evidence it would be

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possible to reach a definitive conclusion. All that can be said with confidence is that the pandemic coincided with a marked increase in the suicide rate in many other European countries, as well as in the United States. This marked increase that coincided with the Russian influenza and the start of the fin-de-sie`cle period has been the subject of much scholarship. In her landmark study of suicide in Victorian and Edwardian England, for instance, Olive Anderson gives prominence to a diagram from Judicial Statistics published in 1895, showing a steady increase in suicides to about 1874, followed by a trough in 1889, and a further marked increase in around 1890 coinciding with the pandemic.108 The social historian F. B. Smith has also drawn attention to the sudden increase in suicides in the early 1890s, pointing out that about half the reported coroners’ findings of suicide in London, Norfolk and Dublin between 1890 and 1894 give influenza as a primary cause.109 To illustrate his argument, Smith cites seven cases drawn largely from the Norfolk News.110 According to Smith, coroners’ verdicts of suicide in England and Wales, of which 60 per cent were male, increased by 25 per cent between 1889 and 1893. The increase in 1889– 90 was the sharpest in 50 years, and in 1893—a year in which the Registrar General recorded 15,000 excess deaths from influenza and associated respiratory diseases—the suicide rate peaked at 85 per 1 million, ‘the highest on record’.111 A similar phenomenon was noted in Paris, where the suicide rate rose 23 per cent in 1889– 90.112 The French army and navy also suffered an increase in suicides in 1892 – 3, and in the same period suicides rose by about 12 per cent in Ireland.113 American physicians also noted how recovering influenza patients were ‘plagued with thoughts of suicide’, while in New York and Philadelphia the papers carried lurid reports of homicides and suicides following attacks of influenza.114 Both Smith and Anderson link the increase in suicides to the shift in fin-de-sie`cle aesthetic attitudes that occurred around the same time. In 1891 Ibsen had extolled suicide as ‘this beautiful act’.115 Two years later, in August 1893, Ernest Clark, a young carpet designer, shot himself at Liverpool Street station after posting a suicide note and poem to the Daily Chronicle in which he declared: ‘I object to life. I

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hate and despise it.’ Clark’s suicide note caused a sensation, one that mass market papers like the Daily Chronicle were only too happy to fuel by inviting their readers to offer their opinions as to why Clark had killed himself.116 The result was that by the late 1890s suicide was seen as increasingly fashionable in literary and aesthetic circles, with both Dorothy Richardson and Virginia Woolf speaking in its favour.117 Of course, it is debatable how far and to what extent such morbid attitudes were shared by the lower middle and working classes. Although the Daily Chronicle claimed that ‘nineteen out of twenty people believed in the propriety of suicide under certain conditions’, Anderson maintains that there was no single outlook on suicide and that the ‘plain man’s notion’ was often at variance with the aesthete’s.118 Having said that, the decline of religious dogmatism in the later Victoran period and the diminishing social importance of death meant that by the end of the century suicide was certainly no longer automatically regarded by Victorians as something to be concealed. On the contrary, Anderson argues that while in the early Victorian period suicide had been considered shameful and sinful, by the end of the century increasing familiarity with quasi-medical explanations of suicide had made the act almost acceptable. Moreover, she argues, these quasi-medical explanations of suicide were ‘continually widening’. The result was that by the 1890s such explanations could include not only insanity but ‘influenza, and “over pressure’’’.119 It is impossible to say to what extent medical theories about the idiosyncratic nature of the nervous sequels of influenza were shared by the general public, and whether the apparent willingness of coroners’ juries to accept such testimony in suicide cases reflected the wide currency of these theories or else jurors’ natural sympathy for the bereaved and a desire to save families from pain. Given the Victorian fascination with sensation and editors’ efforts to come up with new ways of titillating their readers, the press coverage is equally difficult to interpret. A good example of the way the presumed neuropathological role of influenza could be invoked to sell newspapers came at the height of the destructive second wave of the pandemic in Rotherham, when the Sheffield and Rotherham

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Independent carried the ‘sensational’ story of a young surgeon who had jumped from a hotel window, seemingly in the throes of a ‘delirium’ brought on by influenza.120 According to the report, Dr John Kenny had been removed to the Crown Hotel in Rotherham by colleagues concerned about his condition after complaining of ‘neuralgic pains’ and ‘mental aberrations’. Apparently Kenny had worn himself out attending to patients, and the influenza epidemic had ‘added to the pressure’. ‘Being a young man of 28 years of age and sober habits, it was hoped that he would pull through, but his constitution appears to have been affected by his unremitting attention to his patients,’ the paper explained. Worried for his safety, Kenny’s colleagues removed him to the coffee room on the second floor of the hotel. No sooner was Kenny safely inside than he became convinced his colleagues wished to harm him, and bolted the door in order to prevent them from entering. He then climbed out of the window, shouted to the crowd outside, and jumped 15 feet, smashing through a bay glass window. Remarkably, Kenny was uninjured by the fall and was escorted back inside the hotel by his colleagues. ‘His illness is entirely attributed to suffering and excitement of overwork,’ the report concluded. This supposed link between overwork, post-influenzal psychosis and the social and economic pressures to which doctors and other bourgeois professionals were thought to be subject was nowhere made more explicit than in the Strand story. Although Feveral is not suicidal—on the contrary, in the story Halifax makes a point of saying that he does not believe in the ‘suicide idea’121—in other respects his story could have come straight from the pages of a Victorian penny paper or one of Althaus or Dowse’s casebooks.122 Certainly, Feveral appears to be beset by very similar delusions and feelings of doom. From the start, Halifax leaves us in no doubt that the influenza has reduced Feveral’s nerves to an alarming state. Halifax tells us that when he last met Feveral he had been a promising medical student, but ‘now he looked like a man who had undergone a sort of collapse’. Feveral quickly takes Halifax into his confidence, explaining that the ‘awful influenza’ has been raging all around his country practice at

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Westfield. ‘The more I see of that insidious, treacherous complaint, the more I dread it,’ he admits. ‘It is my firm conviction that influenza has caused more deaths and wrecked more lives than the cholera ever did.’123 One of the victims was his 18-month-old daughter. Next his wife’s ‘strength gave way’ and he suffered a ‘short, sharp attack’.124 Feveral made what he thought was a rapid recovery only to be beset a few days later by the ‘dread’ that he was on the point of ‘making a fearful professional mistake, and so ruining my prospects as a medical man’. Pressed by Halifax to explain what he means, Feveral describes how he has been suffering ‘extraordinary lapses of memory’ and cannot remember which medicines he has been dispensing. As a result, he is worried he may have administered a poison to a patient by mistake. Curiously, his memory lapses only occur at work—or, as Feveral puts it, ‘in connection with my profession’. ‘When I am alone with my wife I feel at comparative ease, and almost like my usual self.’125 Halifax attempts to reassure Feveral by telling him that such sequels are not unusual after influenza and that his condition is temporary. However, Feveral confesses that he thinks he is being followed and fears he may be going insane. Eventually, Halifax persuades Feveral that this too is a delusion and to sleep on it, but the following morning he finds a note from Feveral claiming that he has accidentally murdered a patient with strychnine and fears he is about to be arrested by the police. Convinced that he has ruined his prospects, and tormented by the thought that his wife will be left destitute, Feveral withdraws all his money from the bank and flees to Monte Carlo where he is almost ruined at the roulette tables. At this point Feveral’s wife approaches Halifax, and together they hire a private detective to trace the patient Feveral thinks he has murdered. The man turns out to be alive and well and, armed with a telegram from the private detective, Halifax and Feveral’s wife travel to Monte Carlo to break the good news. The story ends happily: presented with the telegram proving his innocence, Feveral is immediately restored to his senses. Feveral’s luck has also turned at the roulette tables, and with his winnings he and his wife embark on a six-month jaunt

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around Europe, later returning to London, where Feveral resumes his medical practice. In many ways the story can be read as a commentary on masculine identity and the social, moral and economic pressures to which Victorian male professionals were thought to be subject. This interpretation is discussed in more detail in the following chapter. For the moment I merely wish to note how in the story Feveral’s delusions and feelings of ‘dread’ seem to be linked to his worries about his professional standing or, as he puts it, to his concern that his memory will fail him ‘in connection with my profession’. These anxieties in turn are linked to the disgrace of being branded a murderer and what that will mean for his wife and for his ability to provide for her in the future. In this respect, Feveral’s concern that he is going insane is secondary. Far more significant is that by pathologising the relationship between the ‘shock’ of influenza and Feveral’s subsequent ‘mad’ behaviour, Halifax is able to provide an explanation that absolves Feveral of blame for his perceived moral failings. Thus, in a passage that could have been drawn straight from Dowse’s book, Halifax explains that Feveral is suffering from ‘a sort of double shock’: The death of his child, followed immediately by an attack of influenza, provided the first bad effect upon his nerves—the second shock was worse than the first, but for that, he would not be losing money as fast as man can at the present moment.126 Interestingly, it was not only middle-class male professionals whose behaviour could be ‘absolved’ by such post-influenzal psychoses. As with neurasthenia, the psychoses could also be invoked to elicit sympathy for men from working-class backgrounds. A good example came a few months before the publication of the Strand story, in March 1895, when readers of the Daily News were greeted by the bold, triple-banked headline: ‘Shocking Tragedy at Tooting. Sevenfold Murder and Suicide. Sad Story of Want, Sickness and Despair.’127 The story, which also appeared in The Times under the

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Figure 3.2 Artist’s impression of Frank Taylor. Lloyd’s Weekly News 17 March 1895, p. 3. Reprinted with the permission of the British Library.

more sober headline, ‘A Family Murdered at Tooting’, described how Frank Taylor (Figure 3.2), an out-of-work plasterer living at Fountain Road, Tooting, had murdered his wife and six children in their sleep by cutting their throats with a razor.128 Taylor had then cut his own throat with the same razor before collapsing by his wife’s side in a pool of blood. Only one of Mr Taylor’s children, a 14-year-old boy, also named Frank, had survived. Despite the shocking nature of Taylor’s crime, The Times described the case as ‘a domestic tragedy’, explaining that Taylor had recently been laid up with influenza and had also been ‘depressed and unhappy’ after losing his job. The result was that when, shortly after finding new work, he had succumbed to influenza and been forced to remain in bed for several days, ‘the fear oppressed him that he would

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lose his employment again’.129 The Daily News, which in common with other regional dailies began referring to the case as the ‘Tooting tragedy’, adopted a similar narrative.130 Indeed, in its news story and accompanying editorial the Daily News went so far as to argue that rather than being regarded as the perpetrator of a horrific crime, Taylor should also be considered a victim. Appropriating the latest medical theories of post-influenzal psychosis and the idiosyncratic nature of the nervous sequels, the paper presented Taylor as a paragon of working-class male virtues who had been brought to the point of crisis by his illness and social conditions. By all accounts, the paper explained, Taylor had been an upstanding and hard-working member of the local community, a teetotaller and regular church-goer who had supplemented his family’s meagre rations by raising vegetables on an allotment. He had also once been decorated for saving a man’s life. However, when he had lost his job his family had fallen into penury, forcing his children to attend the local soup kitchen. Someone in ‘better circumstances’, the paper suggested, might have been able to weather their illness and save the situation, but in Taylor’s case ‘the margin was too narrow’. With no safety net to fall back on, the influenza had tipped him over the edge. ‘He was so ill that he was afraid he would never be able to keep at work,’ the paper explained, before adding that ‘the poor swimmer had to confess himself spent at last’. Although it was presumed that his brain had become ‘unhinged by the worry’, the Daily News argued there was little point in trying to understand the psychopathology of Taylor’s particular brand of ‘insanity’: We shall search in vain for the causes of this man’s misery in his faults. He was a model workman, a model husband and father. He might have been chosen out of all London as a representative of his class.131 In other words, it was no use searching Taylor’s past for evidence of pre-existing character flaws; his behaviour could just as well be explained as an idiosyncratic reaction to flu and changing circumstances.

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The Daily News was a Liberal paper so it could be expected to decry the absence of a safety net for men in Taylor’s position. However, what is striking about the press coverage of the case is the extent to which other papers were also willing to embrace the notion of an influenza-induced crisis to exonerate Taylor of blame for failing to live up to his prescribed role as a breadwinner and patriarch. The Hampshire Telegraph, for instance, reported that Taylor had no criminal record and had never been heard to threaten to kill either himself or a member of his family, while The Times reported that although Taylor’s brain had appeared ‘perfectly healthy and normal’ at postmortem it was true that ‘mental derangement sometimes followed influenza’.132 This quasi-medical explanation appears to have found favour with the jury, which returned a verdict that Taylor had killed his wife and children and committed suicide ‘whilst in a state of unsound mind’. This was despite the fact that in his suicide note Taylor had made no reference to his illness, writing simply that he was unable to ‘bair [sic] the shame that I am accused of,’ and that he loved his wife and children ‘too dearly to allow people to jeer them.’133 (Figure 3.2). Similar reports of suicides and homicides appeared during the Spanish influenza pandemic. In December 1918, for instance, the Manchester Evening News carried a story about a gardener named Williams from Portmadoc, in North Wales, who had attacked his wife and six children with a razor while suffering from the aftereffects of influenza. In the next paragraph the paper reported on a woman named Ellen Booth who had committed suicide after both she and her husband had been attacked by the disease and her husband had died.134 In January 1919, the Hackney Gazette carried similar reports of a series of suicides involving local young women, followed in April 1919 by a report that several doctors had also committed suicide following attacks of flu.135 But perhaps the best example came in a story involving the suicide of a lance corporal from the Royal Engineers. Billed by The Observer as a ‘remarkable story of delusions and despair’, the paper reported that James Ernest Jones had first tried to kill himself in February while awaiting demobilisation (he had apparently become depressed after an attack

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of influenza and, suffering from the delusion that he had a degenerative disease, feared he was about to be placed in a lethal gas chamber). Doctors arranged for him to be admitted to Stoke Hospital, where he was given light duties. However, one night Jones absconded. According to the inquest report, nothing further was heard of him until March, when he turned up at his mother’s house. When two guardsmen arrived to arrest him, he absconded again. Eventually he was taken into custody, but in late May he escaped for a third time and returned to his mother’s house once more. Against her better judgment she allowed him to stay overnight, only to discover him dead in her living room the following morning, his face pressed hard up against the nipple of the gas fire. The jury returned a verdict of ‘suicide whilst of unsound mind’.136 The fact that coroners considered a link between influenza and suicide plausible speaks volumes about the continuing influence of theories of the nervous sequelae of flu into the Edwardian period. In 1918, of course, the nervous sequels associated with the Russian flu were, if not fresh in the memory, then well within the historical memory of most adults, and for those who did not recall influenza’s nervous associations there were plenty of physicians to remind them. Writing in the Practitioner, for instance, the respiratory disease expert Samuel West, now a consulting physician at St Bartholomew’s Hospital, argued that post-febrile depression was ‘perhaps the most remarkable characteristic of influenza’. This depression does not vary necessarily with the severity of the original attack, for it may be extreme after what appeared to be quite a mild attack . . .. I have seen very little reference to this condition in current literature, but it is of great importance.137 Writing in the same edition of the journal George Savage went to similar pains to underscore the connection between influenza and depression. However, Savage warned that the ‘the danger which is most imminent . . . is that of suicide’.

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In earlier epidemics I took the trouble to collect the accounts of suicide during the epidemic periods, and there could not be any doubt that there was a very large increase in suicides after the epidemics. . . patients admitted into asylums after the disease have always to be considered suicidal.138 Just as in the 1890s the psychoses had drawn on the example of neurasthenia, appropriating Victorian notions of ‘wear and tear’ and metaphors of fatigue and entropy, so in 1918 influenza drew on emerging medical models of ‘shell shock’ and the latest theories about the ‘hysterical disorders of warfare’.139 As Peter Lees has shown, approaches to the treatment of shell shock in Britain varied far more widely than post-war literary stereotypes suggest, with some physicians focusing on the physical shock and concussion of the shelling and others favouring psychodynamic and psychoanalytical interpretations that emphasised the role of pre-existing anxieties and neuroses.140 However, whether shell shock was considered analogous to the physical shock experienced in railway accidents or acted as a trigger for deeper emotional and psychological conflicts, like neurasthenia it was still regarded as a species of neurosis traceable to the disruption of nerve function. Indeed, although W. H. R. Rivers incorporated the talking cure and other psychoanalytical methods into his therapeutic regime at Craiglockhardt, officers suffering from shell shock were typically diagnosed as neurasthenics. This was not only true of Rivers’ two most famous patients, Siegfried Sassoon and Wilfred Owen. As Lees has shown the majority of shell shock victims treated at the National Hospital in Queen Square, London—the hospital for which we have the most extensive records—were also diagnosed as neurasthenics.141 Rivers’ treatment of Owen is discussed in more detail in Chapter 6. For the moment, I simply wish to note that given the way that shell shock was thought to be precipitated by neurasthenia it is hardly surprising that Edwardian psychiatrists allowed for a similar pathophysiological relationship between shell shock and influenza. ‘I suppose we shall have to wait until after this epidemic and the war are over before we are able to draw any conclusions as to the effect of

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influenza upon shell-shock cases,’ wrote Savage in 1919. ‘[But] I shall be surprised if we do not meet with a good number of cases in which mental disorder has been precipitated by influenza when occurring in people who have had shell-shock or some wound of the head’.142 In the event, of course, explanations that sought to account for the psychopathology of shell shock in the language of the neuroses were superseded by the progressive mentalisation of the trauma concept, and Freudian and post-Freudian approaches to unconscious ideation. The result was that in the 1920s the investigation of shell-shock moved away from a possible neurological basis toward the abstract world of psychoanalysis. At Shorter has shown, under the influence of Freudian theory and more specific diagnostic categories neurasthenia suffered a similar fate, being rebranded as essentialy a form of ‘anxiety disorder’.143 The result was that by the 1920s cases of neurasthenia had been subsumed within the expanding category of the psychoneuroses, and cases of ‘true’ neurasthenia were considered relatively rare by psychiatrists and practitioners of psychological medicine, with such a diagnosis now being considered synonymous with ‘chronic mental and physical fatigue’.144 The ‘psychoses of influenza’ appear to have suffered a similar fate. As neurasthenia was subsumed within the psychoneuroses, the nervous sequelae of influenza were reconfigured as a type of ‘exhaustion psychosis’.145 Such exhaustion psychoses were considered to encompass both physical and mental fatigue states and could be the result of either internal physiological changes or infection by an exogenous toxin. In 1926 depression, ‘profound mental disturbance’ and suicidal thoughts were still considered common symptoms of flu, but these reactions were now regarded as failures of the individual to adapt to stress rather than evidence of psychoneurosis.146 Interestingly, there was no place for the psychoses of influenza within the burgeoning category of ‘war neuroses’. Indeed, one 1932 textbook went so far as to claim that toxic and infectious factors were not very prominent in the aetiology of war psychoses owing to the ‘comparative freedom from serious infectious illness of troops in the Western theatre’—a somewhat surprising remark given the wide morbidity of Spanish flu in Allied and German battalions.147 The

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result was that by the late 1930s the ‘psychoses of influenza’ had disappeared from dictionaries of psychological medicine, though whether this was due to the waning of the pandemic and a decline in the virulence of the virus or to changing diagnostic fashions, or a combination of both, is impossible to say.148 *** This chapter has examined the psychological constructions of influenza in the 1890s, showing how the nervous sequels of the disease drew on Victorian medical models of neurosis and psychosis and fin-de-sie`cle concerns about fatigue and the dissipation of nervous energy. Male patients were thought to be at particular risk because of the way their occupations exposed them to ‘overwork’ and ‘overworry’—key tropes of modernity. At the same time, these nervous constructions of influenza drew on deeper social and psychological anxieties, hence Dowse’s observation that in the most extreme cases of all the psychoses of influenza manifested in profound feelings of ‘gloom’, ‘dejection’ and ‘dread’. As in the earlier phase of the Russian pandemic, the association between influenza and nervousness was amplified by the press—in particular, by the sensational reports of suicides and homicides linked to prior attacks of influenza. However, the diagnosis that the psychoses of influenza most closely resembled was neurasthenia, and in the same way that neurasthenia became an acceptable medical label for what otherwise might have been construed as evidence of hypochondria or hysteria, so the psychoses of influenza offered patients a similar medical alibi. In particular, I have suggested that by characterising the psychoses as an idiosyncratic reaction to an external infective agent, Victorian nerve doctors removed the diagnosis from the stigma of hereditary causation and notions of ‘insanity’. At the same time, by arguing that influenza’s effects on the nervous system were capricious and unpredictable, and could so exhaust or impair nervous function as to block the automatic process necessary for the maintenance of will, the diagnosis exonerated patients’—particularly male patients’—feelings of anxiety and guilt about their inability to live up to masculine norms and bourgeois measures of performance.

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The power of these nervous discourses to exonerate male professionals of blame is nowhere better illustrated than in the Strand story. However, by drawing attention to Feveral’s anxieties about his mental symptoms the story also highlights the fragility of masculine identities and Victorian conceptions of male subjects. As we shall see in the next and subsequent chapters, these shifting conceptions of masculinity were to become increasingly important in the later fin-de-sie`cle period as influenza was transformed into a celebrity illness, one in which men were no longer cast as malingerers but as ‘sufferers’ who deserved the widest social sympathy.

CHAPTER 4 DEMONS AND DISEMBODIED SPIRITS: INFLUENZA, MASCULINITY AND GOTHIC PRODUCTION AT THE FIN-DE-SIÈCLE

On 25 February 1895, while attending a Liberal Party banquet in Westminster, the British Prime Minister Lord Rosebery suffered a sudden nervous collapse and was rushed to his home in Berkeley Square. Just four days earlier, Rosebery had threatened to resign the premiership in protest at growing ideological discord within his Cabinet. In an attempt to reassure a sceptical press and public that all was well, Rosebery’s physician, Sir William Broadbent, issued a bland statement saying that his patient had suffered a ‘sharp attack of influenza’ and was now ‘somewhat better’.1 The following day, however, Broadbent was forced to admit that the previous night had ‘not been good’ and that it was doubtful whether Rosebery would be able to continue to fulfil his public engagements.2 Realising that Rosebery needed peace and quiet, Broadbent arranged for him to be removed to The Durdans, his country house at Epsom. However, although his initial symptoms of fever and chill soon subsided, Rosebery was unable to sleep, prompting Broadbent to confide to Rosebery’s close friend Reginald Brett (later Lord Esher)

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that he had never come across such a serious case of chronic insomnia and that he feared a ‘fatal termination’.3 Crippled by fatigue and with his writing hand mysteriously paralysed so that he was unable to compose letters to Queen Victoria, Rosebery spent the next six weeks secluded at The Durdans as Broadbent sought to divine the source of his affliction and restore him to health. Rosebery’s prolonged illness—he would not resume his public duties until May 1895—is open to multiple interpretations. In an era when mental disturbances were thought to be due to organic changes to nerve function, the most popular medical explanation for Rosebery’s insomnia was that he was suffering from a ‘nervous sequel’ of influenza. However, Broadbent attributed Rosebery’s insomnia to a ‘long-continued derangement of the digestive organs’.4 Rosebery’s diary entries and those of his close friends, meanwhile, suggest another explanation: namely, that he was worn out by the stress and strain of trying to unite his warring Cabinet colleagues and was still mourning the death five years earlier of his wife, Hannah de Rothschild.5 More recently, historians have advanced other theories, including speculation that Rosebery was unsettled by rumours linking him to a homosexual liaison with the Marquess of Queensberry’s eldest son Lord Drumlanrig (Francis Douglas), the brother of Oscar Wilde’s lover Alfred ‘Bosie’ Douglas, who had committed suicide in mysterious circumstances on an estate in Somersetshire the previous year.6 Blaming his son’s death on Rosebery’s ‘evil influence’, Queensberry had threatened to name him in criminal proceedings brought by the government against Wilde for gross indecency—a circumstance that would almost certainly have spelt the end of his political career. Only when Wilde was convicted and imprisoned in late May 1895, it is claimed, was Rosebery relieved of the daily fear that sexual allegations against him would surface in court protected by judicial privilege, hence the disappearance of his symptoms at around the same time.7 It is easy to see the appeal of such theories for proponents of ‘psycho-history’. According to historian John Davis, that Rosebery retained in adulthood an emotional attachment to young men is supported by the highly charged tone of a note contained in one of his

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jottings books, and by his reclusive holidays, following Hannah’s death, among a colony of homosexual English expatriates around Naples.8 In this chapter, however, I will not be concerned with such retrospective psychoanalytic interpretations. Rather, my aim is to show how Rosebery’s insomnia elides easy categorisation and disrupts post-Freudian models of mind/body. Instead, my approach privileges Victorian medical discourses by seeking to situate Rosebery’s insomnia in the context of then medical theories of nervous dysfunction. At the same time, I will show how his illness drew on Gothic metaphors and the gendered rhetoric of the fin-de-sie`cle. In particular, this chapter aims to show how reports of Rosebery’s nervous breakdown in March 1895 drew on Victorian anxieties about the divided bourgeois male subject and Rosebery’s celebrity as a political aristocrat to create broad public sympathy for his plight, prompting sympathetic portrayals of other celebrity influenza sufferers. One of the most striking aspects of these representations of male influenza patients is the way that they disrupted Victorian notions of agency, drawing attention to the ambivalent and unstable nature of masculine identities at the fin-de-sie`cle. As such, my treatment of Rosebery’s insomnia should be seen as a contribution to recent scholarship that emphasises the range and subtlety of Victorian debates on identity. Close textual analysis of these debates has exploded the myth of ‘repressed’ Victorians by demonstrating the ‘profoundly ambivalent sense of self’ that underpinned discussions of sexual identity in this period.9 Indeed, to the extent that the debate over Rosebery’s illness calls our attention to similar ambivalences, it serves to underscore the dangers of overly psychoanalytic ‘re’-readings of the past.

Morbid Introspection In the previous chapter we saw how the nervous ‘sequels’ of influenza drew on Victorian medical theories about ‘nervousness’ and fin-de-sie`cle discourses about the ‘fatigue’ and ‘exhaustion’ that was thought to flow from modern urban lifestyles. However, as John Tosh has argued, the 1890s also saw men facing new challenges in

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the domestic and public spheres, precipitating what he calls a ‘crisis’ in masculinity.10 With the emergence of the women’s movement and the rise of the ‘New Woman’, traditional male hegemonies could no longer be taken for granted. Instead, fin-de-sie`cle Victorian males increasingly found themselves having to negotiate new identities predicated on models of masculinity constructed outside of narrow domestic spaces.11 These models were shifting and unstable, encompassing Kingsley’s muscular-Christian, Newman’s gentleman-Christian, and the literary dandies and aesthetes associated with Oscar Wilde.12 However, as the decade progressed and concerns about degeneration and national efficiency intensified, masculinity became more and more contested as social critics increasingly sought to define masculinity in opposition to femininity. As a result, the language of degeneration took on ‘strongly imperial overtones’, one in which women were cast as ‘mothers of the race [and] men as the active, assertive element’.13 Cultural discourses around influenza are an example of what Foucault calls a ‘discursive field’.14 As such, I will argue, they can be used to read the gendered assumptions about the male/female ‘difference’ that underpinned discussions of degeneration and national efficiency in the 1890s. As we have seen in the previous chapter, nervous responses to influenza were highly charged because of the way that they could be construed as a form of hysteria and/or hypochondria. This was because, despite the growing recognition of influenza’s respiratory and nervous dangers, flu was still generally regarded as a nuisance rather than a mortal threat to life, hence Morell Mackenzie’s dismissal of the disease as ‘a convenient means of escape from troublesome engagements’.15 In an era when men’s health was thought to be dependent on mental and physical fortitude or ‘pluck’, a bout of flu could therefore raise discomfiting questions about character.16 Although Victorian nerve doctors sought to medicalise the psychoses of influenza and remove the stigma that could attach to male (and, to a lesser extent, female) convalescents, the influenza convalescent’s tendency to dwell on his (or her) illness could also be construed as a form of ‘morbid introspection’—

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evidence, in other words, of a suspect temperament.17 As The Times noted at the height of the second wave of Russian flu: Hypochondriacs and valetudinarians often take a morbid delight in studying their supposed ailments . . . but men in good health wisely leave such topics, for the most part, to those whom they properly concern.18 For Victorian nerve doctors such as Maudsley, Clouston, Savage and Hack-Tuke, such morbid tendencies were an indulgence that, left unchecked, could undermine psychological well-being. As Michael Clark puts it: ‘Introspection and self-absorption, persistent abstention from ordinary social intercourse, and neglect of active pursuits all tended to weaken the will, undermine the “natural” moral affections, and encourage idleness, eccentricity, and the growth of perverse or immoral tendencies.’19 The result was that men who suffered repeated attacks of influenza or who succumbed to the nervous complications of the disease risked being branded hysterical or somehow effeminate—hence the ‘ritualized silences’ that Micale has identified in the medical discourses around hysteria in male patients.20 However, while the marked recrudescences of influenza in 1895, 1898 and 1899 – 1900 coincided with a critical period for masculinity amid mounting concerns about degeneration, national efficiency and the fate of the British Empire, I will argue that influenza was never gendered feminine. On the contrary, what is most striking about the narrative productions of influenza in this period is the way that newspaper representations of Rosebery’s illness negated such genderisation, fostering widespread sympathy for male sufferers. This had not been the case in the early 1890s, when unfamiliarity with the symptoms of nervous exhaustion had resulted in medical scepticism about the hysteria observed in working men. By 1895, however, the symptoms of influenzal prostration and fatigue no longer warranted particular medical comment. Instead, it was the recurrence of attacks and questions of susceptibility and immunity that increasingly preoccupied medical investigators.

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An Illustrious Invalid A high-born aristocrat and millionaire race-horse owner famed for his oratorical skills, Rosebery enjoyed huge celebrity in the 1890s. Thrust to the front rank of politics by Gladstone’s retirement in 1894, Rosebery was regularly portrayed in the Liberal press as the ‘saviour of the nation’, while his biographer, Leo McKinstry, writes that by the turn of the century ‘his stature almost eclipsed that of Royalty’.21 As a Liberal peer, Rosebery was reluctant to accept the highest office, fearing that without a base in the House of Commons he would be unable to command wide support within his party. However, his popularity was cemented in June 1894 when, after winning the Two Thousand Guineas at Newmarket, his horse Ladas II galloped to victory in the Derby, making him the first Prime Minister in history to win the coveted flat race. The news was reportedly greeted by a wave of euphoria and a surge in demand for round-edged ‘Rosebery collars’ at West End tailors.22 For all his successes on the turf, however, Rosebery was ill-prepared for the premiership, and soon found himself at odds with many members of his own Cabinet, including the Leader of the Commons, Sir William Harcourt, who harboured his own ambitions to be Prime Minister, and whose son, Loulou, conspired tirelessly with Henry Labouche`re, the editor of Truth, to undermine Rosebery’s authority. With his administration racked by ideological discord over Home Rule, and with the Queen opposed to his attempts to reform the House of Lords, on 19 Feburary 1895 Rosebery threatened to resign. The threat coincided with the news that influenza had returned to the capital. As during the initial wave of Russian flu in 1890, the first to succumb were employees of the Post Office, followed by railway workers at London’s mainline stations. Wealthy boroughs, such as Chiswick and Kensington in the west of the capital, were affected before central and eastern districts, but by the final week of February influenza had reached the City, and there were reports that St. Bartholomew’s and Guy’s hospitals were once again flooded with patients.23 By the first week of March, Reuters was reporting that influenza was also ‘raging’ in St Petersburg, fuelling fears that

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London was in the grip of another wave of the pandemic.24 By now, the BMJ was reporting that deaths from influenza were running at 296 a week, while deaths from respiratory diseases had risen to the ‘immense total’ of 1,449—945 above the seasonal average.25 Predictably, the news provoked a rush for antipyrins and other dubious medications, prompting the BMJ to issue a warning about the ‘craze for self-physicking’. Admonishing the press for spreading needless hysteria, the BMJ caustically observed that ‘the timorous are so terrified that they become ready victims to the disorder’.26 The first the public knew of Rosebery’s illness was when he collapsed at a Liberal Party banquet in Westminster in late February.27 As in the winter of 1890 when Lord Salisbury had succumbed to flu, the news sparked frenzied speculation in the press, with both Reuters and the Central News Agency dispatching reporters to Rosebery’s home in Berkeley Square. Although Rosebery had withdrawn his threat to resign on 21 February, his administration was poised on a knife edge, so it is little wonder that Broadbent tried to dampen the speculation about the Prime Minister’s condition. By March, however, as Rosebery’s chronic insomnia enforced his withdrawal from public life, his symptoms had become fodder for political speculation and satire. Rosebery’s illness is open to multiple interpretations. While his colleagues and friends tended to see his symptoms as the result of political pressures and stresses in his personal life arising from loneliness and depression, modern-day writers, struck by the coincidence between the timing of Rosebery’s withdrawal from public life and Wilde’s trials, have offered an alternative and, on the surface, far more seductive interpretation. Drawing on modern psychoanalytical theory, these narratives assume that Rosebery was a closet homosexual, and feared the scandal and damage to his reputation should the rumours linking him to Wilde’s circle become more widely known. In 1892, it is pointed out, Rosebery had brought Drumlanrig to the Foreign Office as his assistant private secretary, an appointment that entailed his elevation to the English peerage. The move infuriated his father, the proudly Scots Marquess of Queensberry, who objected not merely to the honour but also to

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Rosebery’s ‘evil influence’ over his son. Queensberry’s enmity for Rosebery deepened in 1894, when Drumlanrig was killed in a mysterious incident during a shooting party on an estate in Somerset. Although the coroner returned a verdict of accidental death, Queensberry suspected ‘suicide’. In 1895, Queensberry threatened to name Rosebery during the Crown proceedings against Wilde for gross indecency that had followed Wilde’s ill-considered libel suit against the Marquess. It was the prospect that Rosebery would be named in the scandalous court proceedings, not influenza, it is suggested, that precipitated Rosebery’s breakdown in the early spring of 1895—hence Rosebery’s miraculous ‘recovery’ once Wilde was convicted and imprisoned at the end of May.28 However, this line of argument is disputed by Rosebery’s most recent biographer, Leo McKinstry. Arguing that such theories rest on unreliable witnesses and ‘misreadings’ of the chronology, he points out that Rosebery’s illness pre-dated Queensberry’s libel of Wilde, and that Rosebery was already well on his way to recovery when Wilde was finally dispatched to Reading gaol on 27 May 1895. ‘The fact is that Rosebery’s lifelong insomnia, dating from childhood, is well documented, and it is clear that his savage bout of insomnia in 1895 was brought on not by Wilde but by the unique pressures of his post as Prime Minister, combined with other worries,’ McKinstry concludes.29 Whether Rosebery was suffering from a nervous breakdown brought on by the stresses and strains of the Wilde trial or from other sources of psychological anxiety is not at issue here. Rather, I wish to explore how Rosebery’s illness was interpreted at the time, and what form the representations of his illness took in the political and popular press. Rosebery writes that his first intimation of illness came on 22 February, the day after the Cabinet meeting at which he had withdrawn his threat to resign, when he woke at three in the morning ‘unspeakably sure that I was suffering from influenza’. On arrival at The Durdans, Broadbent confirmed the diagnosis, reporting that Rosebery was running a temperature of 1018F and that his pulse was ‘scarcely perceptible’. On the first two nights Broadbent gave him bromide to help him sleep, followed by an injection of morphine. To his surprise, this also proved ineffectual, and on 27 February

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Broadbent informed the Queen’s physician, Sir James Reid, that he had been compelled to give Rosebery further doses.30 One of the most embarrassing aspects of Rosebery’s illness was the way that the influenza had induced a peculiar form of neuralgia in his writing hand. Convention required that prime ministers write in person to the monarch to keep them abreast of important diplomatic developments but, ashamed by his illegible handwriting, Rosebery struggled to pen even short letters to Queen Victoria. Instead, he instituted a complex arrangement whereby he would dictate letters to a political confidante who would then forward them to the Queen’s private secretary, Lieutenant-Colonel Bigge (later Lord Stamfordham). Bigge would then lay these letters before the Queen on the understanding that they came directly from her head of government. Nevertheless, Rosebery recognised that in matters of utmost state secrecy it would be necessary for him to write some letters in his own hand.31 None of these details appeared in the press. On the contrary, on 7 March Broadbent briefed newspapermen that his patient was making good progress and ‘continues to improve’.32 In fact, by now Rosebery was getting no more than two to four hours sleep a night and was so weak that, when on 11 March he travelled to Windsor for an audience with the Queen, he records that he ‘nearly toppled over from weakness on rising the second time from my knees’.33 According to George Murray, Rosebery’s private secretary, Broadbent described it as ‘the most obstinate and puzzling case he had ever come across’.34 On visiting Rosebery at The Durdans on 18 March, his close friend Eddie Hamilton was similarly struck by the severity of Rosebery’s insomnia and his ‘depressed’ condition: ‘He said it could not go on; if he did not break down in body, he would certainly break down in mind’.35 Nevertheless, on travelling up to London for a Cabinet meeting the following day—the first since his confinement— Rosebery appears to have been at pains to put on a show of public stoicism. This was hardly surprising given the jockeying for power that was going on behind the scenes, yet even in private Hamilton remarks that Rosebery was often ‘wonderfully uncomplaining and plucky’. Interestingly, Hamilton records that Broadbent thought

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that Rosebery’s insomnia was due to a ‘stomachic derangement’ caused by his habit of reading while eating his meals alone, ‘with the result that the nervous power had gone from the stomach to the brain’.36 Rosebery, however, had little time for Broadbent’s theories or his treatments, telling Hamilton that he attributed his illness to ‘the harassing time he had had in seeing all his colleagues individually and hinting to them that he must be better supported’.37 Hamilton and Brett, meanwhile, blamed Rosebery’s insomnia on his ‘loneliness’ and isolation following the death of his wife.38 Rosebery’s illness was a gift to his political opponents, who used his convalescence to suggest that he was not cut out for the highest political office and was considering resigning. The rumours were dismissed as ‘absurd’ by the Liberal-supporting Daily News, while The Speaker described the speculation as ‘silly gossip’ and ‘ridiculous inventions’.39 However, while Broadbent continued to paint an optimistic picture of his patient’s progress, there was an awkward moment on 9 May when Rosebery made a speech at the National Liberal Club only to lose his train of thought in mid-sentence.40 According to those present, Rosebery had been urging on his colleagues the need for party unity when ‘the thread of his thought seemed to snap’. There then followed an embarrassing 20 second silence during which time he turned to Sir Henry CampbellBannerman, his Secretary of State for War, and confessed he was unable to carry on. Although Rosebery eventually resumed speaking, the correspondent for the Evening News and Post described it as a ‘painful episode’, remarking that the Prime Minister looked ‘pale and wan, as though scarcely convalescent’. His appearance was ‘a revelation of the serious nature of the illness from which the Prime Minister has been suffering’. The St James’s Gazette’s correspondent was similarly shocked, questioning whether in view of the fact that Rosebery was still clearly an ‘invalid’ he was the right person to lead the Liberal Party.41 Nevertheless, while Rosebery’s inability to fulfil his public duties was the source of considerable personal and political embarrassment, even his critics never suggested that he was to blame for his insomnia. As the correspondent for the St James’s Gazette put it: ‘We are very sorry, indeed, politics apart . . . that [Rosebery] is still

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to be regarded as an invalid, suffering badly from that nervous prostration which is one of the most distressing of our modern maladies.’42 The Daily News, as might be expected of a Liberalsupporting paper, was even more sympathetic, arguing that ‘the very same sort of thing would have happened if he had been a butcher, or a baker, or a candlestick maker. Any member of those respectable occupations might have been caught by influenza.’43 Indeed, Rosebery was far from the only prominent casualty of the recrudescence of the Russian flu. As in 1890, Arthur Balfour, the leader of the opposition, also fell victim, prompting The Times to opine that he was ‘one of those unfortunate persons who are exceptionally liable to influenza, and who are marked out in advance at each outbreak as pretty certain to be struck down’.44 Other celebrity casualties included the actor Harry Nicholls, who had been appearing in ‘Fatal Card’ at the Adelphi Theatre; Thomas Huxley, the biologist and supporter of Darwin; and Bram Stoker, the novelist and soon-to-be author of Dracula.45

Susceptibilty and Sympathy One reason for the wide public sympathy was that the insomniac, like the neurasthenic, tended to be viewed as the victim of automatic nervous processes. Just as fatigue could overtax the nervous system and increase nervous exhaustion, so it could also disrupt the brain’s vigilance over the nervous processes that regulated sleep. It was all a matter of entropy. While in ‘normally’ fatigued individuals the body retained sufficient residual nervous power to ensure the smooth functioning of the sleep cycle, in those who through excessive physical or mental strain were ‘overly’ fatigued this residual power was exhausted, depriving such individuals of the ability to ‘will’ themselves into slumber. The result was a paradox in which the usual hierarchy of the will was overturned, ‘rendering the most willfully minded . . . the most frighteningly powerless’.46 Little wonder then that Beard and Dowse identified insomnia as one of the cardinal signs of neurasthenia. In theory, the stress and strain of intellectual labour ought to make it easier for brain workers and other high-performance

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individuals to get to sleep by draining excess energy from the nervous system. In practice, however, the opposite was often the case, making insomnia, like other forms of nervousness, a circumstance beyond even a prime minister’s control. Another key sign of the failure of these automatic nervous processes was indigestion. As the organ responsible for ‘fueling’ the body, the stomach had long-enjoyed a privileged position in pathologies of nervousness, hence its identification as the seat of such diverse historical nervous conditions as dyspepsia, ‘biliousness’ and the ‘English Malady’.47 This sympathy between stomach and brain was conceived as reciprocal. Just as a ‘morbid sensibility’ of the bowels could interfere with the smooth functioning of the nervous system, so ‘morbid thoughts’ and mental anxiety could result in disordered digestion.48 Essentially, however, it was a matter of nervous tension. The result was that while dyspepsia could be viewed with suspicion by physicians as a secondary symptom or a sign of underlying mental troubles, to the extent that digestion, like sleep, was dependent on automatic nervous processes, in principle there was no shame in being labeled dyspeptic. ‘A neurotic person,’ declared Clifford Allbutt, was merely ‘a light fly-wheel and a small furnace’: We are disposed to forget that the silent work of nutrition uses more force perhaps than many people expend in their neuromuscular life; hence, the early failure of digestive resources of neurotics.49 By identifying a ‘stomachical derangement’ as the cause of Rosebery’s troubles, and arguing that his habit of reading while eating had diverted nervous power ‘from the stomach to the brain’, Broadbent was merely adopting the then model of nervous pathology, one that, it is worth adding, had the additional advantage of ensuring that he would not be placed in the embarrassing position of having to censure his patient. A further reason for the widespread sympathy for Rosebery was the ubiquity of influenza and the way that by the mid-1890s the

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medicalisation of the epidemic form of the disease had begun to transform popular notions of what constituted an appropriate masculine response to flu. In his first report on the pandemic, Parsons had noted how ‘vigorous health’ was no protection against influenza, and that patients who returned to work before they were fully recovered often suffered severe relapses.50 This danger was more pronounced in the case of male patients, he thought, because of the way that their vocations put them at greater risk of fatigue and exposure to the germ of the disease.51 Parsons’ observations were reinforced by a growing medical appreciation of the role of ‘susceptibility’ and ‘predisposition’. Following the second wave of Russian influenza, several doctors and MOsH had commented on the small but significant numbers of repeat patients. For instance, Dr H. Turney, the assistant physician to St Thomas’s Hospital, had found that out of 1,324 patients who had attended the casualty department between May and June 1891, nearly 7 per cent had suffered a prior attack the previous winter. There were two possible inferences to be drawn from this observation, he maintained. One was that post-influenzal debility lasted longer than had previously been supposed, meaning that some patients may not have fully recovered by the time the second wave of infection came around. The other was that certain ‘otherwise robust individuals’ were simply more susceptible to attack, or else that a case of previous infection could give rise to an ‘acquired predisposition’ to the disease.52 These observations were reinforced by the recrudescence of influenza in the winter of 1895. ‘The worst of influenza is that, whether the attack in each case is slight or severe, the patient may look for a return of it at each successive outbreak,’ observed The Times. This was not the case with other diseases of a ‘much more formidable character’. Whether it is that the sufferer from it was originally more susceptible than his fellows who escaped; or whether the disease, having once got a foothold, has thereby created a susceptibility which did not previously exist, the result is the same. The man who has had influenza once may expect to have

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it a second time and a third time and as often as it makes it appearance.53 One consequence of the growing medical focus on susceptibility was that male convalescents were no longer automatically viewed as hypochondriacs or ‘malingerers’. Instead, the comic weeklies were just as likely to highlight the threat that influenza presented to those who ignored the risks of relapse. A good example came at the height of the 1898 epidemic, when Moonshine published a cartoon making fun of a stoical businessman named ‘Mr Brown’ who dismisses

Figure 4.1 ‘The Man Who Did Not Believe in Influenza’, Moonshine, 12 March 1898, p. 123. Reprinted with the permission of the British Library.

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influenza as ‘an old-fashioned cold’ only to come round to the view, after a long bout of illness, that influenza is a very serious complaint and one that he is ‘bound to have again!’54 (Figure 4.1).

Divided Subjects Another, more nuanced, example came at the height of the 1895 epidemic, when Fun published a cartoon showing a London police officer lying prone on the ground with a demonic figure perched on his chest. Headed ‘The London Police and the Influenza Fiend’, the caption reads: ‘What chance has the ordinary mortal of keeping the fiend at bay when 1,000 stalwart London policemen have been, according to the papers, bowled over by him’55 (Figure 4.2). On one level the cartoon can be read as a sympathetic commentary on the large numbers of police officers invalided by the flu, but the inclusion of the qualifying phrase, ‘according to the papers’, suggests that the cartoonist may have been somewhat sceptical of the reports of policemen suffering repeated bouts of illness. There is also arguably something homoerotic in the positioning of the fiend,

Figure 4.2 ‘The London Police and the Influenza Fiend’, Fun, 18 March 1895, p. 122. Reprinted with the permission of the British Library.

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which is shown perched on top of the policeman pressing its knee into his chest. The fiend’s bat-like wings and pointy, demon-like tail also appear to draw on Gothic tropes. Unfortunately, I have been unable to identify the cartoonist and shed further light on what may have been in his mind when he drew the cartoon. Nor does the issue of Fun in which the illustration appears make further reference to influenza or the reports of police absentee levels. However, in juxtaposing the fiend with a burly policemen—a symbol of Victorian male rectitude—it could be argued that the cartoonist was unconsciously tapping into fin-de-sie`cle anxieties about the divided male subject that pervade the classic works of Victorian Gothic fiction. Novels such as Stevenson’s Dr Jekyll and Mr Hyde (1886), Wilde’s The Picture of Dorian Gray (1891) and Stoker’s Dracula (1897), it has been argued, confronted Victorian readers with questions about human nature while exploring ‘the unstable, often hybrid, male subject’.56 In Dr Jekyll and Mr Hyde, for instance, Stevenson uses the story of a doctor transformed into a murderer by a potion of his own invention to explore anxieties about how a middle-class male professional could, under certain circumstances, degenerate into an amoral atavistic state. Similarly, in Dracula the lawyer Jonathan Harker is represented as a sexually and physically passive character, associating him with femininity. By contrast, Dracula is possessed of sexual charisma and an elemental strength, associating him with masculinity. According to Andrew Smith, ‘what Harker learns from his encounter with Dracula is that he needs to transform himself . . . into a man of action’. However, the price of this transformation is that Harker is forced to become more like the count, in other words, more like a degenerate. Although the paradox is never fully resolved, Stoker’s novel leaves the reader in little doubt that what is at a stake is ‘the role of a specifically bourgeois masculinity’.57 This notion of the bifurcated bourgeois male is nowhere better illustrated than in Dorian Gray, in which Wilde uses the figure of a decadent and corrupt aristocrat, Dorian, to explore such a ‘double life’ and to suggest that masculinity is a performance. Although Wilde is careful to frame the discussion of Dorian’s double life in aesthetic

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terms, the novel is pervaded by an air of fatigued homosexuality— hence the attempt by Queensberry’s defence counsel, Edward Carson, during Wilde’s unsuccessful prosecution of the Marquess for libel, to suggest that the affection and love shown in the novel by Basil Hallward, the artist who paints Dorian’s portrait, was illustrative of a ‘certain tendency’.58 At the trial, Wilde was easily able to shrug off Carson’s innuendo by countering that the book developed chaste ideas about love and beauty, and had been inspired by Shakespeare’s sonnets. Outside the courtroom, however, social commentators such as Max Nordau had little doubt that Wilde’s work was a thinly veiled account of his own homosexuality, arguing in Degeneration that Wilde and his circle of aesthetes were guilty of propagating an ‘unmanly emotionalism’ that was undermining of national virility and vitality.59 If Wilde’s main contribution to these debates was to frame anxieties about bourgeois male sexual identity in aesthetic terms, in Stevenson’s and Stoker’s novels the same ideas get played out in a biological context. Bourgeois ideals of masculinity are also arguably what is at stake in the Strand story. In the past, Halifax informs us, Feveral had been ‘full of muscle and vigour, with the indomitable Englishman’s pluck written all over him’. But on encountering him again after his attack of influenza, Halifax is shocked at his transformation, describing him in almost Gothic terms. He had contracted a slight stoop between his shoulders, his abundant black hair was slightly streaked with grey, his eyes were sunken and suspiciously bright, there were heavy, black lines under them, and his cheeks were hollow.60 Like Dr Jekyll, Feveral is unable to resist the urge to commit criminal acts, and seems to manifest the traits of a split personality—hence his complaint of ‘memory lapses’ and his ‘inexpressible dread’ that in his disturbed mental state he may have poisoned a patient.61 Just as in Stevenson’s novel Dr Jekyll is driven to suicide by his inability to halt his transformation into Hyde and his fear that the police are closing in on his murderous alter ego, so Feveral is also convinced he is being

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pursued by the police and toys with the idea of suicide. It is only when Halifax presents him with proof of his innocence that Feveral is relieved of his delusions and metamorphoses once again into a mildmannered bourgeois professional.

‘A Disembodied Spirit’ To judge by Rosebery’s account of his illness, influenza had a similarly destabilising effect on his personality. Following his embarrassing public slip at the National Liberal Club in April, Rosebery embarked on a cruise around the south coast of England in the hope that the sea breezes would restore him to health.62 In the event, the weather was terrible and, by Rosebery’s own account, he suffered a ‘very bad night at the close’.63 Following his return on 20 May, however, his insomnia abated and Rosebery was able to make a gradual return to public life. Unfortunately, his long absence had dangerously weakened his grip on power, and on 21 June his government lost a crucial budget vote, giving him little choice but to go to the palace and tender his resignation. Fed up with trying to manage his divided party, Rosebery’s initial reaction was relief. ‘To London —free,’ he recorded in his diary on leaving the palace.64 However, in later years his recollection of his terrible battle with insomnia in the last months of his premiership would return to haunt him. ‘I cannot forget 1895,’ he wrote in 1903: To lie night after night, staring wide awake, hopeless of sleep, tormented in nerves, and to realise all that was going on, at which I was present, so to speak, like a disembodied spirit, to watch one’s own corpse as it were, day after day, is an experience which no sane man with a conscience would repeat.65 Rosebery’s sense of himself as a ‘disembodied spirit’ contains echoes of Dowse’s description of his influenza patients. Just as Rosebery was plagued by insomnia, so Dowse wrote that patients suffering from post-influenzal depression frequently complained of ‘sleeplessness’ and ‘troublesome dreams’. They were also prone to break down in

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tears, and suffered from a sense of ‘gloom’ and ‘dejection’ that was so profound that Dowse considered it a ‘conscious living entity’.66 Intriguingly, this spectrum of emotional and psychological responses to influenza was captured in a cartoon that appeared in Moonshine at the height of Rosebery’s confinement. Headed ‘Influenza Testimonials’, the cartoon featured caricatures of eight well-known male public figures, and imagined their contrasting responses to flu. These included T. P. O’Connor, the Irish Nationalist MP and editor of the Star, who had ‘felt a great inclination to weep’—a reference, presumably to his emotional Celtic origins—and the well-known theatrical dandy Ivan Caryll, who ‘had hardly sufficient energy to curl his moustache’. Other supposed celebrity convalescents whose imagined responses to flu are mocked in the cartoon include Tim Healey, an Irish nationalist politician and radical journalist who is ‘seldom without it’, and the criminal trial judge Justice Hawkins, a no-nonsense judicial figure who had not had influenza and ‘don’t intend to’ (Figure 4.3).67 On one level the cartoon is a straightforward satire on celebrity. However, implicit in it is the notion that masculinity is a performance, and that the spectacle of male celebrity can encompass a wide range of dramaturgical forms.68 In showing some male figures as tearful and depressed, and others as dried-eyed and stoical, the Moonshine cartoon appears to be suggesting that the responses to influenza are performative and may have as much to do with male character ‘types’ as with underlying nervous pathologies. This implicit psychosomaticism is most obvious in the image of Rosebery in the top right-hand corner, where he is shown cowering under the bed covers haunted by the apparitions of his political opponents—the implication being that stress due to his political troubles was the real source of his insomnia. Rosebery’s unhappy recollections of 1895 were not only connected to his illness but to his record in government. It was not just that Rosebery had seen his budget plans thwarted, he had also failed to win the backing of his parliamentary colleagues for reform of the House of Lords, a long-cherished measure he considered essential to ending the dominance of Liberal peers on contentious issues like

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Figure 4.3 ‘Influenza Testimonials’, Moonshine, 30 March 1895, p. 145. Reprinted with the permission of the British Library.

Home Rule. The result was that when his resignation was compounded by a catastrophic defeat for his party at the 1895 general election, Rosebery chose to distance himself from the Gladstonian mainstream of the party, beginning a self-imposed exile that lasted three years. In 1898, however, he re-emerged as a political force during the London County Council elections, and by the outbreak of the South African War in October 1899 he had aligned himself with the Liberal Imperialist wing of the party. The British reverses in South Africa gave Rosebery a cause with which to rally his

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supporters, and in 1900 – 1 he enjoyed renewed political prominence, campaigning on a platform of Britain’s political and social rejuvenation.69 One of the main issues was Britain’s defeat at the hands of the Boers, which had drawn attention to the poor physical condition of volunteers recruited from inner city areas, prompting anti-poverty campaigners such as Seebohm Rowntree to express the fear that up to half Britain’s working population might be unfit for military duty.70 At his much-trailed Chesterfield speech in December 1901, Rosebery made his position on these issues clear by joining with the Webbs in openly calling for reforms aimed at furthering Britain’s ‘national efficiency’. If such calls were not met, Rosebery warned, the result would be ‘a perpetual lowering of the vitality of the Imperial Race [which] no amount of hectic, feverish activity on the confines of the Empire will be able to arrest’.71 By 1902, Rosebery had honed his message further, calling for a three-pronged policy that would ‘restore efficiency to our parliament, our administration and our people’ in order to attain ‘a condition of national fitness equal to the demands of our empire’.72 Rosebery’s more muscular political discourse was arguably matched by a reversion to a more muscular ideal of masculinity in the Edwardian period, one that celebrated traditional manly virtues such as strength, courage, stoicism and reticence. As we shall see in Chapter 6, during World War I this emphasis on physical and mental fortitude was to become increasingly important as hysteria and dread were politicised as emotions that could undermine both the individual’s resistance to microbial threats and civilian resistance to external military threats. *** This chapter has argued that in an era when doctors relied on the functional language of nerves to make sense of symptoms that today might be attributed to psychological causes, Rosebery’s insomnia was open to a range of interpretations. For Broadbent, Rosebery’s insomnia was the result of a simple ‘stomachic derangement’ brought on by his habit of reading while eating his meals alone. By contrast, Rosebery’s close friends and confidantes suspected his symptoms were due to anxiety and depression brought on by his efforts to unite his

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warring Cabinet colleagues and his sense of emotional isolation following the death of his wife. Several modern-day writers, meanwhile, have suggested various psychoanalytical readings, according to which Rosebery’s insomnia can be variously explained by his anxiety about his sexual identity and his fear of being linked to Oscar Wilde’s circle of decadent aesthetes. A further possibility is that Rosebery’s insomnia had a simple physiological cause, albeit one that today scientists would more likely locate in the virus’s invasion of the central nervous system and the expression of viral antigens with an affinity for particular brain regions, than in Broadbent’s ‘stomachic derangement’. Given the diverse symptomatology of influenza and its association with a range of nervous conditions, these are not questions that can be resolved by medical historians one way or the other. Instead, I have outlined a discursive approach, showing how Rosebery’s symptoms drew on and mirrored Gothic literary forms and fin-de-sie`cle anxieties about degeneration and then norms of masculine performance. In particular, I have argued that Rosebery’s insomnia drew on Victorian anxieties about the divided bourgeois male subject. At the same time, Rosebery’s celebrity helped transform the public perception of influenza convalescents as hysterics and malingerers, generating broad public sympathy for male flu sufferers. This approach sidesteps the issue of whether or not Rosebery’s insomnia was a symptom of repressed emotions or unconscious desires (how could we ever know?), highlighting instead the way in which the responses to Rosebery’s illness destabilised Victorian notions of agency and drew attention to the ambivalent and unstable nature of masculine identity at the fin-de-sie`cle. As we shall see in the next chapter, however, celebrity productions of influenza not only destabilised discourses around gender, they also cut across class and social boundaries. A good illustration of this was the community of feeling engendered by the unexpected death of the Duke of Clarence from post-influenzal pneumonia in the winter of 1892.

CHAPTER 5 `

DEATH IS VERY BUSY JUST NOW': INFLUENZA, CELEBRITY AND SUFFERING

On Saturday 9 January 1892 the Prince of Wales sent an ‘urgent’ telegram to Sir William Broadbent, asking him to proceed directly to the royal estate at Sandringham in Norfolk. Five days earlier the Prince of Wales’s son, the Duke of Clarence, had caught a chill while attending the funeral of his cousin, Prince Victor of Hohenlohe, and Clarence was now seriously ill with influenza and what appeared to be the early stages of pneumonia. On arriving the following afternoon, Broadbent found that the indications were not good. There were signs of ‘consolidation’ in Clarence’s left lung and congestion in his right lung, indicating possible ‘double pneumonia’.1 Such pneumonias were by no means always fatal, but the fact that there was influenza in the background gave Broadbent cause for concern as it meant that he could not predict when the consolidation would stop or ‘whether it might not implicate such an extent of lung as to be incompatible with life’. Broadbent was right to be worried. The next morning he found Clarence’s breathing laboured, and that evening Clarence became delirious, imagining an old regimental comrade had entered his room. He died in the presence of his father and mother three days

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later, with the Princess of Wales holding a sheet over his face to conceal his expression at the moment of death.2 The death of Prince ‘Eddy’, as Clarence was fondly known to the Victorian public, stunned the nation, underscoring the threat that influenza posed to every British household. Not only was Clarence a ‘royal’, with access to the best medical care, but he was a young man in the prime of life. Indeed, the Prince of Wales had recently announced his son’s engagement to Princess Victoria Mary of Teck (later Queen Mary) and the public were said to be eagerly anticipating their wedding. Writing to her son, Stanley, the women’s rights campaigner Josephine Butler predicted that Clarence’s death was ‘an event that will call out all the nation’s sympathies’: Poor young prince Edward, how quickly he has been taken. Death is very busy just now; it strikes the great as much as the weak.3 Butler was right to anticipate a sympathetic reaction, but not even she could have forseen the strength of public feeling. More than 5,000 people attended the public memorial service held at Westminster Abbey on 20 January, while the same number again spilled into the adjoining St Margaret’s churchyard. The service at St Paul’s Cathedral was similarly oversubscribed, with ‘immense crowds’ thronging the entrance, resulting in an ‘unseemly scramble for places’ in which several ladies were seen to faint.4 According to the Speaker, the spectacle was ‘unique’. ‘Never before has a display of mourning like that which has been seen over the death of the Duke of Clarence struck the imagination of spectators.’5 This chapter explores how the death of the Duke of Clarence drew on the Victorian fascination with sensation, celebrity and suffering. Contrasting the newspaper reports of Clarence’s illness with the private accounts of his attending physicians, I will show how the Prince of Wales sought to manage the public response to his son’s illness by issuing a series of misleading medical bulletins. The result was that the gravity of Clarence’s illness was kept from the public until the last possible moment. Once the news was out, however, it

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radiated rapidly across the nation and Empire via the electric telegraph, creating a chain of ‘sensation’ that multiplied the public expressions of grief. As we saw in Chapter 2, the public’s identification with Clarence’s plight was exacerbated by the fact that his death came in the midst of the pandemic. It also coincided with a critical shift in influenza’s aetiological identity, from a miasmatic disease associated with atmospheric and meterological disturbances, to an infectious disease associated with a specific bacillus. In particular, I have argued that the announcement by Richard Pfeiffer two days after Clarence’s death that Haemophilus influenzae was the ‘exciting casuse’ of influenza transformed the metaphorical productions of the disease, prompting the personification of the bacillus in the Sunday graphics and comic weeklies as a ‘demon’ and a ‘fiend’. This chapter goes on to show how these metaphorical representations were reinforced by Victorian patent medicine advertising. Indeed, if the public’s preoccupation with celebrity deaths secured influenza a starring role on the editorial pages, it was patent medicine advertising—the industry that underwrote the productions of headline writers—that kept the dread of flu constantly in the minds of Victorian readers, promoting and sustaining the notion that consumers were part of a community of sufferers who shared in each other’s illness experiences through the act of purchasing this or that medical product. This phenomenon is nowhere better illustrated than by the celebrated case of Carlill v. Carbolic Smoke Ball Company, in which a South London woman, Louise Elizabeth Carlill, sued Frederick Roe, the British-based American manufacturer of a putative influenza cure, for non-payment of an advertised reward of £100. Today, Carlill v Carbolic Smoke Ball is best remembered as a milestone in English contract law.6 However, this chapter is not concerned with the legal technicalities of the case so much as with Roe’s exploitation of celebrity endorsements and the use of similar ploys by other patent medicine advertisers in the 1890s—strategies that, I will argue, played on the Victorian dread of infectious disease and kept influenza constantly in the minds of consumers. By purchasing the Carbolic Smoke Ball and dutifully

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applying it in accordance with Roe’s instructions, I will argue, Carlill was not merely entering into a contract with Roe but was joining herself sympathetically to other consumers of the smoke ball. In an era when conventional medicine was powerless to prevent influenza, and the ‘microbe’ could strike down the wealthiest and highest-born individuals in the land, this made the purchase of the smoke ball and similar quack medical cures first and foremost an act of faith in the magical powers of consumption. Roe’s mistake was to make this unspoken contract explicit by offering a reward to any person who contracted the ‘increasing epidemic’ after using the smoke ball, thereby shattering Carlill’s illusion that her purchase of the ball—a product that Roe claimed ‘in no ascertained case’ had permitted contraction of influenza—would guarantee her similar protection from the epidemic.7 Finally, I examine the use of hyperbole, metaphor and symbolism in the production of advertisements for Bovril and other popular flu remedies in the later 1890s. Tracing these productions through the turn of the century and up to 1910, I argue that Bovril advertising provides a particularly fertile source for the cultural historian. In particular, I will show how during the Boer War Bovril exploited influenza’s metaphorical fecundity to draw a parallel between the threat faced by British troops in South Africa and the threat represented by influenza to civilians on the Home Front.

Electric ‘Tidings’ The Duke of Clarence was by no means the first prominent royal death of the nineteenth century, nor was he the first prominent personage to be accorded an elaborate state funeral. As John Wolffe has pointed out, the sudden death of Princess Charlotte in childbirth in 1817 at the age of 21—a tragedy that underlined the risks faced by expectant mothers from all social classes—had prompted similar outpourings of collective grief, with churches throughout the country crowded with mourners on the day of the princess’s funeral at Windsor.8 The death of George III’s estranged wife, Queen Caroline, in 1821 also stirred public sentiment, albeit

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for different reasons.9 By contrast George III’s funeral the year before had been low key. While in 1827 the Duke of Kent was accorded a grander send-off, it was not until the Duke of Wellington’s death in September 1852 that Victorians witnessed a ceremony to compare with the spectacle of the Great Exhibition in 1851.10 Delayed until 18 November to permit the state re-opening of Parliament, Wellington’s funeral saw over 1 million people press onto the streets of London to watch the procession of his funeral car from Chelsea Hospital to St Paul’s Cathedral. The pageantry exceeded that of any recent sovereign. Indeed, so intense was the public interest that extra officers had to be drafted in to police Wellington’s lying-in-state at Chelsea Hospital where the body had been moved on 13 November. The Illustrated London News’s special editions documenting the processional route and Wellington’s internment at St Paul’s sold nearly 2 million copies, a then record.11 Prince Albert’s funeral was less elaborate, with a private funeral service at St George’s, Windsor, but the sense of shock and national loss was arguably more acute. According to Wolffe, the ‘intensity of feeling’ can be traced to a number of factors, including Albert’s relative youth—he was 42—and the sense that he had so much more to contribute to public life; the British public’s identification with the plight of his widow, and the fear that the Queen would be unable to cope on her own, precipitating a national crisis; as well as the sense that, as with the death in childbirth of Princess Charlotte, this was a personal tragedy for the whole royal family. However, Wolffe argues that it was also due to the fact that the gravity of Albert’s condition had been deliberately kept secret until the last possible moment, giving the public little time to prepare for the shock. The other factor was the speed with which news of Albert’s death spread via the electric telegraph, amplifying the sense of national grief. Previously, churches had been the principal means of relaying such news, meaning that the first that many parishioners knew of a royal death was when they arrived at morning service. Now, as a clergyman in Penzance observed, thanks to the telegraph this grief was immediate and universal:

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The sensations we individually experience, on the first tidings of some great sorrow, are doubled and redoubled as we find that every one we meet is occupied by the same sad story, every member of a vast community in contact with the same electric chain, along which the tumultuous excitement is flashing from one end to the other.12 The illness of Albert’s eldest son, Edward, in October 1871 sparked similarly anxious sensations as news that he had contracted typhoid while visiting a friend’s hunting lodge in the country was telegraphed from town to town. In contrast to Albert, the Prince of Wales’s illness was closely monitored by the newspapers, with correspondents filing regular updates on his health. Public anxiety was heightened by the death of a fellow guest, Lord Chesterfield, on 1 December, and the fact that Albert was popularly thought to have died of the same disease. As the royal family gathered at Sandringham, believing death was imminent, the future poet laureate, Alfred Austin, wrote: Flash’d from his bed, the electric tidings came, He is not better; he is much the same.13 What made these electric ‘tidings’ so powerful was both the instantaneous nature of the communications and the collective way in which they were experienced. In the 1860s, novelists such as Wilkie Collins had pioneered a new type of ‘sensation’ fiction that seemed to bypass the intermediary stage of reflection, creating what Alison Winter calls a direct route from page to nerve that ‘thrilled’ and ‘mesmerized’ Victorian readers.14 As Altick and Boyle have argued, this growing fascination with sensation was also fuelled by the broadside press and the exploitation of the growing public appetite for true stories of crime, horror and gore by the mass market dailies and illustrated weeklies.15 In the hands of the pioneers of the New Journalism such as W. T. Stead, the editor of the Pall Mall Gazette, and T. P. O’Connor, the editor of the mass market Star, reports of murders and violent crimes became a form of ‘sensation horror

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news’—a way of shocking and thrilling newly literate working-class Victorian readers.16 One way to achieve this effect was through the adoption of bold subheads and more expansive layouts to make stories stand out from the page. The other was through the publication of ever more lurid and sensational details. The success of ‘sensation novels’ and ‘sensation news’, of course, did not rest merely on their ability to electrify the nerves of individual readers, but also on their ability to produce involuntary responses in a vast community of readers. Sensation novels and mass market newspapers connected readers in new and distinctive ways. As Anderson has observed, a newspaper is a ‘mass ceremony’, joining readers who are for the most part anonymous and invisible to each other in a collective ritual predicated on the ‘almost precisely simultaneous consumption’ of an imagined world.17 In this respect, the consumption of sensational news is analogous to practices such as mesmerism that mass people so as to make them more susceptible to outside stimuli. As Winter puts it, in mesmerism ‘people placed themselves in situations that connected them to the group by a partial suspension of their will or judgment, and by a coordinating stimulus that acted where the will did not’.18 Sensation fiction produces an analagous ‘giant reflex in the social body of readers’.19 The death of the Duke of Clarence, I will argue, prompted a similar involuntary sensation in the Victorian social body—sensations that were amplified by the knowledge that they were shared by an invisible community of like-minded readers. ‘Gravis sed non vera periculosa’ Compared to his father, Clarence was a shadowy and insubstantial figure. Nicknamed ‘Collar-and-Cuffs’ by the Prince of Wales owing to his unnaturally long neck and arms, Clarence was a rather feckless young man who had failed to excel either at university or in the army. Clarence was a regular patron of a homosexual brothel in Cleveland Street, central London, raided by the police in 1889, and there is evidence that long before he contracted influenza his health had been undermined by heavy drinking, gout, and possibly syphilis.20 Prince Albert Victor had been made Duke of Clarence and Avondale and

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Earl of Athlone in May 1890. Just 19 months later, the palace announced his betrothal to Princess Victoria Mary of Teck with a wedding date fixed for 27 February 1892. The announcement was widely covered in the press, raising public expectations about the forthcoming nuptials.21 The first the public knew of Clarence’s illness was on Monday 11 January, when Dighton Probyn, the comptroller of the Royal Household at Sandringham, issued a bulletin saying that the Duke had caught a chill the previous Monday while attending the funeral of his cousin, and that his illness ‘continue[d] to pursue a somewhat severe course’.22 In fact, Probyn had been concerned about Clarence’s health since Wednesday 6 January when, after returning from the funeral, he had joined a shooting party at Sandringham only to retire early complaining of ‘headache and chilliness’.23 On the Thursday he was running a temperature of 101.48F and although the next day, Friday 8 January, was his birthday, he was too ill to join the party that had been arranged in his honour, and once again retired early. On Saturday 9 January, the Prince of Wales’s physician, Dr Francis Laking, who had originally called at Sandringham to check on the health of Clarence’s younger brother, Prince George (later George V), who had recently recovered from an attack of typhoid fever, was asked to examine the Duke. Finding that Clarence was running a temperature of 103.48F and that there were also signs of ‘consolidation’ to his left lung, Laking immediately telegrammed Broadbent, marking the telegram ‘urgent’ and asking him to proceed directly to Sandringham. An exemplary hospital doctor—Broadbent joined St Mary’s Hospital, London, in 1858, as an obstetrics officer and remained an active member of staff until 1896—by 1892 Broadbent had also built a lucrative private practice, counting among his celebrity clients the prime minister, Lord Salisbury, whom he had treated for influenza in 1890.24 That same year he also attended to Lady Rosebery during her protracted illness from typhoid fever, and in 1895 he treated her husband, Lord Rosebery, for chronic insomnia following an attack of influenza.25 More importantly, Broadbent had also nursed the Prince of Wales to health during his attack of typhoid

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in 1871, and had recently visited Sandringham at Laking’s request to check on the health of Prince George. Broadbent thus had the confidence of the royal family and could be counted on to be discreet—an important consideration given the ever-present press interest in the health of the royals and the constitutional implications should Clarence’s illness take a fatal course. The moment he arrived at Sandringham Broadbent realised he was facing ‘a very serious case’.26 The consolidation of Clarence’s left lung had spread as high as the scapula, while the base of the right lung was showing the same signs of consolidation, leading Broadbent to conclude that Clarence had ‘extensive double pneumonia’. Such extensive consolidation was not necessarily a bad sign in the early stages of pneumonia, especially if the temperature, as in the Duke’s case, was not all that high and the patient was otherwise fit and healthy. However, the fact that there was ‘influenza in the background’ and that there was no way of knowing when the symptoms of pneumonia had set in worried Broadbent. It appears that it was at this point that Broadbent, realising the gravity of Clarence’s condition, began keeping a careful record of events in the royal household, later preparing a ten-page handwritten manuscript recording the course of the Duke’s illness and the royal family’s reaction to his death.27 In his account, Broadbent complains that there was ‘a little vagueness’ in the explanation he and Laking had been given about the onset of the Duke’s symptoms. Although Broadbent is careful to be even-handed, reading between the lines it is clear that he suspected this vagueness may have been due to the attempts by the local medical attendant, Dr Manby, to exonerate himself of blame for the decision to allow the Duke to join the shooting party at Sandringham the previous Thursday, despite having complained of a headache and chilliness the day before. As Broadbent knew from his visit to Sandringham shortly after Christmas, and as he makes clear in his narrative, several visitors and officials there had already been attacked by influenza.28 He also records how during his stay he learnt that the Prince of Wales had ‘spoken sharply’ to Manby, placing the blame squarely on his shoulders, and that afterwards Manby could speak of little else, constantly ‘bemoaning’ his situation and saying that he

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was a ‘ruined man and that if the Duke died every body would say that he had killed him’.29 From the beginning, the Prince of Wales made every effort to manage the public reception of the news. This is hardly surprising, given his experience in 1871 when he had contracted typhoid while visiting a friend’s country estate in Yorkshire and had lain mortally ill for weeks. Broadbent writes that the experience, which was the occasion of much public apprehension, had left Edward with ‘a morbid but very natural dread of alarming the public’, fearing the stream of telegrams that would arrive at Sandringham and ‘the swarm of reporters who would beset every part of the Park’ should news of Clarence’s condition leak out. Instead, he suggested Dighton Probyn issue a brief statement saying the Duke was suffering from influenza and a ‘slight attack of inflammation of the lungs’. Mindful of his reputation, Broadbent objected that if the word ‘pneumonia’ or the phrase ‘inflammation of the lungs’ was used it ‘ought not to be called slight’.30 In the event, Probyn struck a compromise and issued a statement on the Sunday saying that Clarence had suffered a ‘severe attack of influenza, accompanied by pneumonia’ but that his strength was ‘well maintained’.31 If the Prince of Wales had hoped the statement would mollify the public, however, he was mistaken. Instead, the announcement brought a flood of telegrams to Sandringham, taxing the powers of the estate’s private telegraph ‘to the utmost’.32 By Tuesday morning, Broadbent’s concerns had deepened as he could ‘quite distinctly’ hear the free passage of air in Clarence’s left lung—a sign that a ‘reversal’ might be under way. Broadbent immediately set about drafting a new statement, conveying his opinion ‘of the gravity of the case’. However, when the Prince read it he considered it ‘much too strong’ and, ‘afraid of the effect it would have on the public mind’, insisted on modifying it.33 The resulting bulletin posted on the gates of Sandringham explained that while Clarence’s inflammation was still ‘pursuing its course’ and no improvement could be reported, ‘the strength is well-maintained’.34 By now Dr Laking was in touch with the Queen, who had remained at Osborne on the Isle of Wight, telephoning her day and

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night with updates on Clarence’s health. On hearing that her grandson’s respirations had increased, she asked Laking to ask Broadbent if the consolidation was ‘periculosa’. On this occasion, Broadbent did not need any prompting to put a favourable spin on Clarence’s symptoms, dispatching a telegram to the Queen that read, ‘gravis sed non vera periculosa’ (‘serious but not truly dangerous’).35 That night, however, Clarence’s condition worsened and he became delirious, imagining an old regimental comrade had entered his room. Broadbent reports he also began talking manically about leading political figures at Westminster ‘showing much more knowledge and original thought than he had been credited with’. On Wednesday morning he was still delirious, and Broadbent and Laking felt they had no choice but to publicly acknowledge the seriousness of his illness. Laking anticipated a protest from the Prince but in the event, Broadbent reports, he made no objection, simply saying that ‘that was my opinion and he had nothing to say’.36 Released at last from the need to obfuscate, Broadbent immediately issued a joint statement with Laking saying that ‘symptoms of great gravity had supervened’ and that the Duke’s condition was ‘critical’.37 At the same time he prepared an outline of the Duke’s illness for the medical journals, enclosing a private note to the editors ‘anticipating only too truly the further course of events’.38 According to The Times, the brief telegram provoked ‘universal sorrow’ and as news of the Duke’s condition spread through the city ‘the greatest eagerness was displayed at the clubs, the exchanges, and in the streets to gain additional information regarding the Duke’s condition’.39 By now Sandringham was thronging with reporters just as the Prince of Wales had feared, and telegraphic updates were being sent to London every couple of hours. With every movement in and around the royal park being monitored, the telegraph had truly become an ‘electric chain’, uniting the reporters with the crowds gathered outside Marlborough House and Mansion House, and amplifying the collective sense of emotion. The sensations felt by the crowds were vividly documented by The Times. As the morning passed and there was no further news, the paper reported that ‘the

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excitement rose to the highest pitch, the pressure of the crowd outside Marlborough House being so great that it was found necessary to place at the gates extra boards bearing copies of the [earlier] bulletin’. This was followed at 1pm by news that Clarence had sent a telegram to his childhood valet, Mr Fuller, requesting that he join him at Sandringham in ‘all haste’—news that the crowd took as an indication that the Duke’s illness had reached a crisis point. Soon after, a correspondent telegraphed from Sandringham that the Duke remained in ‘critical condition’ with a pulse rate of 120 and a temperature of 1078F. This, The Times noted, was ‘considerably higher’ than that of his father during his attack of typhoid fever in 1872—an event that had produced a similar outpouring of public ‘sympathy and condolence’.40 At 1.20pm Broadbent, Laking and Manby posted a third bulletin, stating there had been ‘no change’ in the duke’s condition. After this, there was a three-hour hiatus, with no further news being received until 4.15pm when a correspondent telegraphed that the Duke’s condition was still unchanged, followed at 4.45pm by the information that there had been a ‘slight change for the better’. There was then a delay, during which no further news was forthcoming. It was known that the doctors at Sandringham were due to hold a consultation at 7pm, but ‘as time passed and no news came to hand, hopes of a satisfactory report began to dwindle away’. The general opinion among the crowd, according to The Times, was that ‘no news was bad news’. By now the crowds outside Marlborough House reached across the roadway and anyone emerging from the side entrance was immediately questioned. Finally, at 9.30pm a commissionaire appeared with a fresh bulletin. Signed by all three doctors, it announced that there had been ‘no abatement of the unfavourable symptoms’ and that although the Duke’s strength was still ‘well-maintained’ his condition continued to cause ‘grave anxiety’. According to The Times, ‘anxious inquirers’ immediately crowded the boards outside Marlborough House, eager to read the news. ‘The words “No better” quickly passed from one to another,’ recorded the paper’s correspondent on the spot. Then the crowd ‘melted away’.41

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That evening Clarence’s condition appeared to improve, and Broadbent decided to rest. However, shortly before 2am on Thursday morning Manby came rushing into Broadbent’s room, saying ‘He’s dying’. Broadbent found the Duke ‘ghastly white, cold, pulseless and absolutely unconscious’ in his bed. He immediately revived him with an injection of ether followed by strychnine, but by 6am ‘all remedies ceased to have any effect’, and at 9.15am on 14 January Broadbent pronounced the Duke dead. Clarence died in the presence of his parents, his sister Princess Victoria, and his three physicians. Afterwards, Broadbent records, he overheard Manby muttering that he was a ‘ruined man’.42

‘An Event that Will Call Out All the Nation’s Sympathies’ If the crowds outside Marlborough House and Mansion House the day before had been impressive, they were nothing compared to what was witnessed now. The news of the Duke’s death was first communicated to the Lord Mayor in a private telegram at 9.15am, the telegram being posted outside Mansion House soon after. At the same time, a telegram was received at Marlborough House. ‘Five minutes later,’ The Times reported, ‘there was a crowd outside . . . such as has never been seen there before.’ By 10.30pm, cabs containing ‘anxious callers’ began arriving at Marlborough House, many of them containing ladies ‘moved to tears’. By 11am, all the clubs in the West End had their blinds drawn and nearly all the shops were shuttered, the area seeming to have ‘given itself over entirely to a feeling of gloom’. The posting of Broadbent’s formal announcement of the Duke’s death at noon brought further visitors to Marlborough House, and by 1.30pm the crush was so great that police had to be summoned to control the traffic. ‘Ominous as were the bulletins and telegrams published on Wednesday, the shock which the news gave the public mind was very great,’ The Times concluded. Nor was the shock confined to London. Similar scenes were witnessed in Birmingham, Manchester, and Edinburgh, and by early afternoon the news had radiated out across Europe and the Empire, bringing a flood of return telegrams from as far away as Australia.43 ‘Nothing more

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remarkable in its own kind has ever been recorded than the demonstrations of sympathy and mourning with which our columns overflowed yesterday and are overflowing today,’ observed The Times in a leader the following day.44 The Daily News was similarly struck by the spontaneous and universal expressions of emotion, its Sandringham correspondent reporting that in nearby villages ‘everywhere one could see people in the roads talking with eyes streaming with tears’.45 Searching for an explanation, most commentators agreed that the shock at Clarence’s death was best explained by his youth and the public anticipation of his forthcoming nuptials. As Lord Salisbury acknowledged in a letter to Queen Victoria shortly afterwards, ‘The betrothal was in everybody’s mind; everyone was looking forward to the wedding’.46 Another factor was the brief period that had elapsed between the first announcement of the Duke’s illness on 11 January and his death four days later. ‘The news has therefore been received with more than the feeling which would in any case have been stirred by the death of one who was born to be the Sovereign of this country,’ argued the Saturday Review. But perhaps the most important factor of all was that Clarence was an unknown, a blank slate onto which the public could project its desires and fantasies about royalty. ‘To the vast majority of the inhabitants of Her Majesty’s Kingdoms the Duke of Clarence was necessarily little more than a name . . .. For that reason there is a greater vividness in the sorrow which is felt throughout the country.’47 As the physician at the time of death, Broadbent was a privileged witness to Clarence’s transformation into a symbol of national loss. That transformation began with the consecration of Clarence’s deathbed. The Princess of Wales, Broadbent reported, had covered the wall at the head of the bed with a white sheet, arranging large palm-branches on the pillows that rose almost to the ceiling so as to form a ‘graceful arch’. Within the arch hung a cross of white flowers, and below it a crucifix, with another crucifix lying on the Duke’s chest. ‘All the confusion of the sick room had disappeared.’ Instead, the room had become ‘a beautiful chamber of death’.48 In the days and weeks that followed, the image and memory of the Duke would be further transformed—first through the elaborate

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funeral rites, and subsequently in special souvenir editions of the graphic weeklies that memorialised the event for the masses. Just as in 1852 the Illustrated London News had produced two special editions documenting Wellington’s procession from Chelsea to St Paul’s, now the Graphic produced a ‘double number’ documenting Clarence’s journey from Sandringham on the same gun carriage that had borne Lord Napier of Magda, and via a special 11-carriage train to Windsor Station and on to Windsor Castle where Clarence was laid to rest in the royal chapel.49 Two weeks earlier, on the eve of his fateful attendance at Prince Hohenlohe’s funeral, Clarence had sat for the Graphic’s artist, Professor Herkomer, and the paper now reproduced his sketch showing Clarence looking relaxed in an informal dress suit. Herkomer’s portrait gave flesh to the image of Clarence as a modern young man on the eve of marriage—an image that was accentuated by the paper’s juxtaposition on the next page of a portrait of the prince as a three-year-old dressed, as was the then royal custom, in girls’ clothing. ‘No effort had ever been made to thrust [Clarence] on the attention of the public,’ the paper argued in an accompanying editorial. But Englishmen, rightly interpreting all that was known about him, had arrived at the conclusion to which personal intercourse with him had brought so keen a judge of men as Prince Bismarck—that he was a young man of frank and amiable character, “a perfect type of an English gentleman.” The editorial went on to argue that if anything the emotions that had overtaken the country on the day of his death had intensified since. ‘It was as if every man and woman in the kingdom had been overtaken by a great private sorrow . . . the more the calamity was thought of, the more sad it seemed, and the more tender became the expressions of sympathy for the dead Prince’s family.’50 One reason why this sorrow was so pervasive was that it was a tragedy with which every Briton could empathise. By the winter of 1892 most households had experienced at least one episode of Russian influenza, and quite a few would have known what it meant

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Figure 5.1 Professor Herkomer’s image of the Duke of Clarence from the front cover of the Graphic’s ‘double’ memorial issue. Graphic, 23 January 1892. Reprinted with the permission of the British Library.

to lose a close family member to flu or some other epidemic disease. On 18 January, for instance, Rudyard Kipling married Carrie Balestier in a quiet ceremony at All Souls Church, Marylebone. It was quiet not only because of the proximity of the ceremony to Clarence’s funeral, but because the month before Carrie’s brother, the American writer and publisher Wolcott Balestier, had died of typhoid. He was just 30, two years older than Clarence. On hearing of Balestier’s death, Kipling had immediately proposed to his sister. As he would

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Figure 5.2 Front cover of the Illustrated London Police News, juxtaposing the death of the Duke of Clarence (top left) with that of an unnamed Victorian baby (top right) and Cardinal Manning’s lying-in-state (middle right), as the ‘influenza fiend’ hovers over the three coffins. The other panels show the response to Clarence’s death of his fiance´e, Princess May, and his mother, the Princess of Wales. Illustrated London Police News, 30 January 1892, p. 1. Reprinted with the permission of the British Library.

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later recall in his memoir, the ceremony was a sombre affair, taking place ‘in the thick of an influenza epidemic, when the undertakers had run out of black horses and the dead had to be content with brown ones [and] the living were mostly abed’.51 Kipling’s observation is confirmed by the official returns. As discussed in Chapter 2, statistical analyses confirmed that deaths from influenza in the third week of January 1892 had been the highest on record. Not only that, but ‘excess’ deaths from bronchitis and pneumonia had added considerably to the death toll.52 Although Clarence and the 84-year-old Cardinal Manning were the most prominent casualties, the victims also included a number of young children. To commemorate the wide age ranges of the victims and the democratic nature of the epidemic, the Illustrated London Police News commissioned an illustration for its front cover showing the influenza ‘demon’ hovering over the coffins of the Cardinal, the 28-year-old Duke, and an unnamed one-year-old baby (Figure 5.2). In other panels, the cartoonist showed Clarence’s grieving mother and fiance´e. Pneumonia had long been considered the ‘old man’s friend’, but as the paper pointed out in an accompanying article, the ‘plague of 1892’ had proved ‘devastating . . . to both young and old’.53 When, on hearing of the Duke’s death, Josephine Butler wrote that ‘death is very busy just now’, she was simply reflecting a grim everyday reality.54

The Miraculous Smoke Ball Given how Clarence’s death highlighted the respiratory dangers of influenza, it is hardly surprising that the patent medicine industry seized upon the occasion of his state funeral to market a range of influenza and cold cures to the public. In a full-page advertisement for the Carbolic Smoke Ball that ran in the Graphic a few days after Clarence’s internment at Windsor Castle, for instance, the device was presented as a panacea that would ‘positively cure’ influenza within 24 hours, as well as some 16 other diseases, including ‘coughs’, ‘cold in the head’, ‘catarrh’, ‘asthma’, ‘bronchitis’, ‘loss of voice’, ‘hay fever’ and ‘whooping cough’. Just as today manufacturers employ

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celebrities to endorse their products, so in 1892 Frederick Roe, the manufacturer of the smoke ball, included a series of testimonials from notable users. These included Mrs Gladstone, the wife of the Liberal leader and former prime minister; the Duke of Portland; the Bishop of London; and Sir Morell Mackenzie, the eminent Victorian ear, nose and throat expert. By way of further assurance, the advertisement also stated that the company was willing to pay £100 (the equivalent of £6,000 at current values) to ‘any person who contracts the increasing epidemic, influenza, colds, or any diseases caused by taking cold’ after using the product in accordance with the ‘printed instructions supplied with each ball’. As a surety, the company deposited £1,000 in the Alliance Bank in Regent Street. ‘During the last epidemic of Influenza many thousand Carbolic Smoke Balls were sold as preventatives against this disease and in no ascertained case was the disease contracted by those using the Carbolic Smoke Ball,’ the advertisement claimed (Figure 5.3).55 Today, the smoke ball is best remembered for its role in a precedent-setting legal case.56 In February 1892, Elizabeth Carlill filed suit against Roe, claiming that she was entitled to the reward as she had contracted influenza despite using the ball three times daily for two weeks in accordance with Roe’s instructions. The essence of Carlill’s suit was that the advertisement, which she had originally seen in the Pall Mall Gazette in November 1891, amounted to a contract, and that by failing to pay her the advertised £100 reward Roe was in breach of it. Roe vigorously contested Carlill’s claim, arguing that the advertisement was a ‘mere puff’ and that the company had no way of knowing whether Carlill had used the smoke ball in accordance with the manufacturer’s instructions. However, in December 1892 the High Court found for Carlill and ordered Roe to pay her the advertised reward, thereby setting a precedent in contract law widely regarded as a forerunner of modern trade descriptions regulations.57 The legal technicalities of Carlill v Carbolic Smoke Ball Co. and the case’s contribution to consumer protection laws do not concern us here. Instead, I wish to focus on the way that Roe’s use of celebrity endorsements and the profusion of similar claims by other patent

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Figure 5.3 The advertisement for the Carbolic Smoke Ball that appeared in the Graphic a few days after Clarence’s internment. Graphic, 23 January 1892, p. 129. Reprinted with the permission of the British Library.

medicine advertisers in the 1890s made influenza more visible to Victorian consumers and, in the process, helped transform the narrative productions of the disease. These narrative productions, I will argue, drew on the Victorian dread of infectious disease and the fascination with celebrity, and can be read, in part, as a commercial response to the sensational reports of the illness and deaths of prominent convalescents such as the Duke of Clarence. However, I will also argue that the proliferation of advertisements for influenza medications and quack ‘cure-alls’ constituted what the literary critic

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Thomas Richards calls a ‘new, microscopic form of commodity culture’ in which ordinary objects came to be invested with extraordinary symbolic power.58 Tracing the phenomenon back to the Great Exhibition of 1851 and the Victorian love of spectacle, Richards argues that in the second half of the nineteenth century Victorian advertisers fashioned a new mass consumer ideology founded on representations of English ideals and fantasies of the real world. By the 1890s, this ideology was increasingly finding expression in the ‘crazy material culture of Victorian advertisements’ and the market for quack medical products in publications like the Illustrated London News and its competitor, the Graphic. In the absence of laws to regulate truth in advertising, manufacturers of ‘cure-alls’ were free to ‘canvass every illness imaginable’ and promise consumers ‘anything and everything’, resulting in what Richards calls a ‘proliferation of commodity narratives’ whose site was the body of the Victorian consumer.59

Quacks, ‘Cures’ and Commodity Culture Carbolic acid, also known as phenol, had been discovered in 1834 when it was extracted from coal tar, and although it was valued as an antiseptic in surgical settings it was recognised that if taken internally it could be fatal. Indeed, in 1882 the Pharmaceutical Society had campaigned to have it added to the list of scheduled poisons, and as a form of prophylaxis it carried considerable risks. To obviate such concerns Roe had designed the smoke ball so that the powdered phenol was contained within a sealed rubber ball that when squeezed released a puff of acidic smoke into a tube inserted into the nostrils of the user. The idea was that the acrid smoke would cause the nose to run, thereby expelling the ‘germs’ of influenza and colds. Although no examples of the smoke ball have survived, Roe’s original directions warn that the process of inhalation can cause ‘sneezing’, and Simpson conjectures that the smoke must have produced ‘a numbing and astringent effect and been somewhat disagreeable’.60 Today, the promotion of such a dubious medical product would almost certainly be illegal. In the 1890s, however, quack medical

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cures were big business, with both the London and regional dailies depending on the money generated by the advertising of patent medicines to fund their editorial runs.61 Although it has been argued that better educated readers tended to be sceptical of the claims made for these ‘secret remedies’, a royal commission set up to investigate the impact of the patent medicine industry on public health concluded in 1914 that the middle classes made up a large proportion of the purchasers.62 Although The Lancet and the Pharmaceutical Society had long campaigned for stricter regulations on patent medicine advertising, arguing that the promotion of cure-alls undermined ‘legitimate’ medical cures, the truth was that many of the treatments recommended by recognised members of the medical profession were equally ineffectual. The line between approved and unapproved products was further blurred by the fact that patent medicine manufacturers frequently included testimonials from prominent doctors or such phrases as ‘as prescribed by’ to lend their advertisements the aura of credibility. In some cases, these testimonials were fictitious. In others, they were genuine but the testimonials appeared without the named party’s approval—not surprising, given the ethical prohibition on the advertising of ‘secret remedies’ by doctors.63 The point is that from the consumer’s point of view it was often difficult to tell. Indeed, Loeb notes that in 1892 doctors had written to both The Lancet and the BMJ to recommend carbolic acid in droplet form on handkerchiefs and in commercial vapourising devices. The result was that although doctors purported to disapprove of ‘secret remedies’, patent flu medications ‘were not always all that different from professional prescriptions’.64 Nor was carbolic acid the most outlandish treatment available: in the same period The Lancet and BMJ also carried articles recommending rectal injections of eucalyptus oil for influenza and mixtures containing ammonia, chloroform and belladonna.65 The difference was that manufacturers of patent medicines would frequently adjust their advertising in accordance with whatever disease was likely to boost sales, expanding or contracting the list of ailments according to the season and the prevailing epidemic. By today’s standards such advertisements strain credulity, but to the casual Victorian newspaper

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reader they were no less unbelievable than the sensational ‘true’ stories of suicide and homicide that filled the editorial pages. Judging by the huge sums spent by the advertisers of quack medical products and the growing corpus of specialist agents that grew up in and around Fleet Street to service the industry, it is also safe to assume that such advertisements were a considerable consumer inducement.66 According to Loeb, the period between 1850 and 1880 saw an ‘unparalleled advertising craze’. Spurred by the abolition of advertising duty and the growth of mass market newspapers, she argues that an expansive middle class became the target for a new kind of advertising characterised by ‘visual and verbal exaggeration’.67 According to Loeb, these advertisements tested the credulity of Victorian readers by ‘depict[ing] fantasies, ideals, life as it ought to be’, making such productions ‘both a mirror and instrument of the social ideal’.68 Given the wide prevalence of influenza in the 1890s and the repeated waves of infection in the early Edwardian period, it is hardly surprising that influenza became a prime candidate for incorporation into these narratives, with advertisers seizing on consumer anxieties about influenza and winter chills to ruthlessly promote their products with what Loeb calls ‘unprecedented frequency and flamboyance’.69 Indeed, the smoke ball was just one of a several products that competed for readers’ attention in the winter of 1892. In the same edition of the Graphic that featured the advertisement for the smoke ball, for instance, readers would also have noted a quarter-page advertisement for ‘Brown’s Bronchial Troches’, a pastille said to cure ‘Cough, Cold, Hoarseness, and Influenza’; and ‘Clarke’s “Fairy” Combination Lamp’, a kettle inhaler and food warmer that according to its manufacturer had proved ‘invaluable to sufferers from bronchitis, influenza, etc.’.70 A week earlier, readers purchasing the Graphic to read the lengthy appreciation of the Duke of Clarence’s short life would have found equally extravagant claims being made for a device known as ‘Harness’s Electropathic Belt’, marketed by the Medical Battery Company of Oxford Street. The brainchild of a C. B. Harness, the belt was claimed to act directly on the nervous system through the

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emission of a constant electric current so as to ‘renew vital energy’, thereby preventing ‘chill, bronchitis, congestion of the lungs, rheumatism, debility, and internal weakness’.71 A month later, in a new advertisement for the belt that appeared in the Illustrated London News, the list had been expanded to include influenza ‘and all weak and languid feelings’, as well as ‘gout, sciatica, lumbago, brain fag, sleeplessness, ladies’ ailments, hysteria, indigestion, constipation, loss of appetite, and kidney troubles’.72 This proliferation of ailments was typical, illustrating the quack’s talent for simultaneously engineering new diseases and ‘curing’ them. However, such preposterous claims were by no means the preserve of quacks. Doctors were just as guilty of inventing new diseases, especially nervous diseases—hence the popularity of neurasthenia in the 1890s as a diagnosis for nervous stress and strain. As Richards puts it, the majority of patent medicine advertisements employed ‘scare tactics simultaneously to invent and eliminate the same diseases that occupied the waking energies of the medical profession’, as if the quacks were aware that disease was ‘a socially created reality that can be produced and consumed in a great variety of ways’.73

Distinguished Endorsements While to the modern eye, such advertisements appear amateurish, it must be remembered that in the 1890s mass advertising was a new phenomenon and elaborate display advertisements were considered state-of-the-art. With their exaggerated claims and hyperbolic language, advertisements for patent medicines frequently blurred the line between fact and fiction, making it difficult for both middle class readers and the newly literate working classes—who formed the core audience of the mass market dailies—to resist their blandishments. Characterised by their liberal use of exclamation marks and bold capitals, such advertisements were often written in the style of newspaper hawkers, so as to give the impression of reporting a running news story. ‘Influenza, influenza, influenza’, read a classified advertisement for Kure-Quic, a quinine-based tonic that appeared in the Standard in the first month of the pandemic.

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‘. . .Startling Fact! Doctors State it. Papers Confirm it. It is the weakly who are struck down, the feeble who die.’74 Others, such as the advertisement for the coca-based remedy Mariana Wine, that appeared in the classified pages of the Daily News, deliberately mimicked the telegraphic reports coming out of Russia, going so far as to reproduce a purported telegram from the Empress of Russia in which she appeared to place an order for one dozen bottles of the stimulating drink.75 In many ways, Frederick Roe’s advertisements for the Carbolic Smoke Ball were typical, ruthlessly exploiting celebrities so as to endorse his product and adding or subtracting diseases as the season suited. Thus in the original advertisements for the smoke ball that appeared in the winter of 1888, only three diseases—‘catarrh, bronchitis, and influenza’—are mentioned by name. However, at the same time, the advertisement invites ‘all who are troubled with any disease of the head, throat or lungs’ to visit Roe’s office in Regent Street for a free test.76 By March Roe has secured a testimonial from Wallace Ross, the former champion rower, in which he claims that the smoke ball had also cured him of his ‘lumbago’, enabling him to compete in the World Sculling Championship at Putney.77 Then, in January 1890, following the outbreak of Russian influenza, the list of diseases is extended to include asthma, hay fever, neuralgia and ‘throat deafness’. Interestingly, although influenza is the first disease mentioned in the advertisement, Roe makes no further reference to the epidemic. The following winter Roe sponsors a new series of advertisements in the Illustrated London News, claiming that his invention cures influenza ‘in twenty-four hours’, cold in the head or chest ‘in twelve hours’ and catarrh ‘in three months’. If used before retiring to bed, the advertisement also claims the smoke ball will prevent snoring. By the spring of 1891, with the widely reported outbreak at the Palace of Westminster and with newspapers printing the names of prominent convalescents, Roe begins providing testimonials from distinguished sufferers, such as the Duchess of Sutherland and the Earls of Westmoreland, Cadogan and Leitrim. At the same time, he advances a new claim: that as influenza and other winter ailments all proceed ‘from the same cause—viz. taking cold’,

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they can all be cured by ‘one remedy – viz. the Carbolic Smoke Ball’.78 In May, Roe introduces a testimonial from Sir Morell Mackenzie, as well as other distinguished doctors such as Sir Andrew Clark, the society physician and neurasthenia expert whose clients included Gladstone.79 Then, with the waning of the epidemic in June, Roe deletes the references to influenza and other diseases, concentrating his advertising solely on hay fever.80 It is not until the following November that Roe again begins targeting the influenza market, by placing an advertisement in the Pall Mall Gazette offering £100 reward to anyone who contracts the ‘increasing Epidemic . . . after having used the ball 3 times daily for two weeks according to the printed directions supplied with each ball’.81 By the standards of the elaborate advertisements that Roe had placed earlier in the Illustrated London News and that he would place in the Graphic the following January, the advertisement in the Pall Mall Gazette was relatively innocuous, taking the form of a small box display at the top of page three alongside other classified advertisements. However, it would be this advertisement that Carlill would later cite in her statement of claim as having persuaded her to experiment with the smoke ball, and which she would argue amounted to a contract between her and Roe (Figure 5.4).

Figure 5.4 The advertisement for the Carbolic Smoke Ball that gave rise to Elizabeth Carlill’s claim. Pall Mall Gazette, 13 November 1891, p. 3. Reprinted with the permission of the British Library.

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An ‘Impertinent’ Claimant Little is known about Elizabeth Carlill other than that she was a writer—her counsel described her as a ‘literary lady’—and that she resided in Dulwich with her husband James Carlill.82 On 20 November, seven days after the appearance of Roe’s advertisement in the Pall Mall Gazette, Elizabeth Carlill had gone to a druggist’s shop in Oxford Street and purchased a smoke ball for 10 shillings (about £30 at current values), paying for the ball out of her literary earnings. According to her subsequent account at the trial, she assiduously used the ball in accordance with Roe’s instructions, inhaling the smoke in the morning before breakfast, at 2pm, and again before she went to bed. She persevered with this treatment until 17 January when she was suddenly taken ill with influenza and a doctor was called to her bedside.83 Three days later, her husband wrote to the Carbolic Smoke Ball Company informing them that, despite having followed their instructions, his wife had been ‘attacked by influenza’ and was now under the care of their physician, Dr Robertson, of West Dulwich, who would ‘no doubt be able to certify in the matter’. When his letter was ignored, James Carlill wrote again, eventually receiving a reply in the form of a circular from the company suggesting that it had been inundated by fraudulent claims and that to protect itself from litigation it required that ‘intending claimants’ attend their offices three times daily, where they would administer the smoke ball ‘free of charge’. When Carlill replied that his claim was perfectly honest, Roe responded that the company considered his letter ‘impertinent’ and gave him the name of his solicitors, prompting Carlill to file a claim for the promised £100 on 15 February.84 The defendant’s arguments were ingenious, if somewhat convoluted. The company made no attempt to challenge Mrs Carlill’s evidence about her use of the smoke ball or her account of her illness. Instead, Roe’s lawyers advanced a series of technical objections, claiming variously that advertisement was an offer to the ‘whole world’ and could not be construed as an individual contract; that Mrs Carlill had never communicated her acceptance of

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the contract; and that the promise of £100 was a ‘mere puff’ and more akin to a wager than a contractual offer. The judges rejected each of these arguments in turn, and on 7 December 1892 Roe was ordered to pay Carlill the £100.85 What interests us here, however, is not so much the verdict as what drove Carlill to purchase the smoke ball in the first place; her motivations for bringing the claim; and the way that Roe was able to turn the adverse publicity to his advantage. In November 1891, when Carlill purchased the ball, and through the subsequent winter of 1892, concerns about influenza were at a high. The second wave of Russian influenza that had claimed the lives of the Archbishop of York and some 2,000 Londoners the previous spring was still fresh in memory, and there was every reason to believe that there would be a recrudescence of influenza in the autumn, the traditional time of year for respiratory diseases.86 Moreover, while many doctors and patients continued to subscribe to miasmatic theories to explain influenza’s wide prevalence, there was increasing acceptance that, as Parsons had put it in his report in July 1891, influenza was ‘eminently infectious’ and that the diffusion of flu was the product of a microbe ‘capable of multiplication in the air’ or of being spread from person to person, or a combination of the two.87 Indeed, the wide popularity of inhalants, fumigants, and disinfecting lozenges attested to consumer acceptance of the microbial origins of the disease, as well as to the importance of taking personal hygiene measures seriously. Occasionally, the presumed microbial origins of influenza were made explicit, as in an advertisement for the inhalant Calista that appeared shortly after the death of the Duke of Clarence: Calista, The New Inhalant. Kills the Influenza microbe. No internal remedy will avail as a preventive. The germs are in the air; we inhale them as we breathe; and common sense tells us that we must inhale the preventive agent also.88 Usually, however, advertisers went for cruder appeals that played on more basic fears and that appealed to holistic notions of bodily health. A good example came in a full-page advertisement for the beef extract Caffyn’s Malto-Garnis that appeared in the Chemist and Druggist at the

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height of the epidemic. Illustrated by a mock headline reading ‘250,000 persons attacked in London’, the advertisement reminded readers that during the 1847 influenza epidemic in London ‘5,000 died in six weeks’ and that it was the ‘old and debilitated’ who were most at risk. There then followed a quote from a Dr Parkes advising against the administration of ‘hot beef tea’ which he argued ‘invariably increases the languor’ and instead recommending Caffyn’s raw beef extract, a preparation that, according to the blurb, acted as both a ‘stimulant’ and a ‘nutrient’ and that was ‘rapidly assimilated’ by the body.89 The advertising columns were not the only source of alarm. Throughout November and December the obituary columns of The Times brought daily reminders of the dangers of influenza.90 The victims included Sir William Arthur White, the British Ambassador to Constantinople, who had been on his way to spend Christmas with his family in Berlin when he caught a cold, dying shortly after of a ‘failure of the heart’s action from an attack of influenza’.91 Meanwhile, in Scotland, The Times reported, the number of influenza deaths recorded in the obituary columns were ‘quite unprecedented’. ‘I learn that in Edinburgh nurses are at a premium and undertakers are at their wit’s end,’ reported the paper’s Edinburgh correspondent. ‘The former cannot be had . . . for love or money, and the latter are scouring the provincial towns for hearses.’92 To judge by her testimony, Carlill appears to have shared these concerns. Asked why she had persisted in using the smoke ball every day for nearly three months, Carlill replied: ‘I thought it was keeping me safe from the influenza, so I persevered, and I recommended it to one or two friends.’93 Her choice of words is surely not accidental: not only did she think the smoke ball would keep her ‘safe’ but by recommending it to her friends Carlill sought to diminish the risks to other influenza sufferers. In other words, consumption of the smoke ball was not only a private act, it was also a public act, one in which Carlill joined herself symbolically to a community of fellow sufferers. It is also striking that while her purchase of the smoke ball predated Clarence’s death, her use of the device coincided exactly with his illness and she continued using the ball for three days after his death. At a time of national mourning, when public expressions of

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sympathy for the Queen and the Prince of Wales were commonplace, it is not too far-fetched to suppose that Carlill’s perseverance with the smoke ball may have reflected her growing anxieties about the epidemic and its ability to strike, as Butler had put it, the ‘great as much as the weak’.94 In this respect, the celebrity endorsements that featured prominently in Roe’s advertisements may have been as significant as the reward offer. After all, who could not fail to be reassured by the smoke ball ‘as prescribed by’ Sir Morell Mackenzie, and ‘supplied to’ the Dukes of Edinburgh, Connaught and Argyll?95 While no one who had followed the trial proceedings closely could be under any illusion about Roe’s claims on behalf of the smoke ball, the legal setback did little to dampen his enthusiasm. On the contrary, the case appears to have encouraged Roe to take out even more audacious advertisements. Thus a few months after the Court of Appeal’s verdict Roe reorganised his company and placed a new advertisement in the Illustrated London News increasing the reward to £200 and extending the guarantee to 18 other named diseases, including ‘laryngitis’ and ‘diphtheria’. Although influenza still occupies first place in the list, it is now the smoke ball that is the centrepiece of his campaign, hence Roe’s boast that ‘many thousand Carbolic Smoke Balls were sold on these advertisements, but only three persons claimed the reward of £100, thus proving conclusively that this invaluable remedy will prevent and cure the above mentioned diseases’. If nothing else, Roe’s audacious marketing campaign illustrates how patent medicine manufacturers constantly strove to construct an image and narrative for their brand that was capable of surviving changing disease fashions. The result was that, like a minor character in a soap opera, influenza could be written in or out of the plot at will.

Advertising Flu Advertising, it has been argued, constitutes a privileged ‘discourse through and about objects’. With their ability to ‘appropriate and transform a vast range of symbols and ideas’, advertisements have the power to ‘redescribe reality, by taking the familiar components of everyday life . . . and conjuring up scene after scene of hypothetical

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interactions between these components and a product’.96 This effect is commonly achieved through the manipulation of images and the employment of metaphors to invite comparison between two things that appear dissimilar but which, the advertisement suggests, share a common meaning. At the same time, advertisers seek to exploit insights into consumer psychology by linking the product to consumers’ incipient desires and aspirations, or by playing on negative emotions, such as envy, fear and anxiety, to reinforce the juxtaposition between the ‘real’ world and the fantasy world of commodity culture.97 In the case of influenza, the opportunities that the epidemic provided advertising agents attuned to its narrative possibilities is nowhere better illustrated than in the advertising campaigns for Bovril. A blended meat extract, Bovril’s origins date back to the 1870– 1 Franco-Prussian War, when a Scottish entrepreneur, John Lawson Johnston, won a contract to supply canned meat to French troops during the siege of Paris. Inspired by Bulwer Lytton’s 1871 futuristic novel The Coming Race, featuring a subterranean master race known as the Vrilya, in 1877 Johnston renamed his fluid beef extract Bovril, by combining the Latin word ‘Bo’ for beef with ‘Vril’, the name of the life-giving liquid imbibed by Lytton’s fictitious master race. The earliest advertisements for Bovril date from around 1889, but it was not until S. H. Benson, a former Bovril employee, set up in business as an advertising agent, with Bovril as his first client, that the company embarked on a sustained and coordinated advertising campaign.98 From the start, Benson sought to associate Bovril with ‘strength’, or what its early advertisements called the ‘vital principle of prime ox beef’ [italics inserted]. To underscore the superiority of Bovril over other meat extracts, the advertisements often juxtaposed jars of Bovril with the virile image of a bull. Another common device was to show images of youths wrestling lions or to seek endorsements by celebrities, such as Henry Morton Stanley, the discoverer of Livingstone, who in 1890 lent his name to a campaign announcing that ‘Stanley recruits his strength with Bovril’.99 As a peculiarly fatiguing disease that was thought to deplete nervous energy, influenza lent itself readily to these metaphors. Little wonder then

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that at the height of the first wave of Russian influenza, Bovril launched a campaign promising that ‘liberal use’ of its product would ‘fortify’ consumers against the epidemic as Bovril was the ‘perfect food for blood, brain, bone and muscle’.100 Like other manufacturers, Bovril was also quick to exploit the marketing opportunity presented by Clarence’s death, a good example being the advertisement that appeared on page four of the Pall Mall Gazette on 15 January 1892 opposite a lengthy obituary and account of the royal funeral arrangements. Anticipating consumer anxieties about the exposure to cold that attending the royal procession would entail, the advertisement reads: ‘The Very Thing!! For a Cold Day. Bovril Hot!!! The best preventive and cure for colds, chills, influenza, general low vitality, and the numerous ills peculiar to our variable climate.’101 By the time of the 1895 epidemic, these claims had been extended: now Bovril not only gave ‘strength to resist’ influenza, it also gave patients ‘strength of throw off an attack in its incipient stage; or strength to carry the patient through an attack to speedy recovery’.102 This notion of Bovril as a source of internal energy that could both enable the body to resist attack and aid its powers of recovery was to prove a recurring theme in the company’s advertising. Indeed, in an era when dread was considered an emotion that could undermine an individual’s powers of resistance and it was common to frame subjective mental states such as courage, fortitude and resilience in terms of somatic reserves of ‘nerve force’, it was a short step to seeing Bovril as a panacea for a wide range of environmental and social ills. Thus, in a later advertisement from 1895, it is claimed that Bovril provides protection not only against influenza but against ‘climatic changes’ and the ‘general wear and tear and mental overstrain of life’.103 By now, Bovril, in common with other leading manufacturers, was designing ever more elaborate display and block-style advertisements for placement on the back and inside pages of newspapers and periodicals.104 The epidemics of influenza in the later 1890s provided Benson with a perfect opportunity to experiment with these new formats. Following the unexpected recrudescence of influenza in 1895, annual deaths from the disease fell steadily, raising hopes that Britain

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had finally seen the last of the Russian influenza, but in February 1898 there was a sudden resurgence of infections, with 1,283 flu fatalities recorded in London alone. The following year there was a further severe outbreak, this time coinciding with the early spring. On this occasion the epidemic was accompanied by marked gastric symptoms, leading to the flu’s confusion with diarrhoea and enteric fever.105 The return of influenza saw the birth of Bovril’s most famous advertising slogans: ‘Bovril is Liquid Life’. The first example I have been able to find appeared in Ludgate Magazine at the height of the winter 1898 epidemic. Illustrated by a picture of a young girl sitting in a chair wrapped in a blanket with a book open on her lap, the advertisement occupies a full page and is headlined “Getting Better”, with ‘Bovril is Liquid Life’ picked out at the bottom in large bold type. The text reads: Nearly everyone knows the delightful feeling of ‘getting better’ after a more or less severe attack of illness, when the reviving appetite, too feeble as yet for heavy foods, requires the most nourishing diet in a light and tempting and easily digestible form. Bovril is an ideal food for invalids and convalescents, being strengthening, stimulating, and reinvigorating to a supreme degree. It rapidly renovates wasted tissue, forms blood, brain, bone and muscle and thoroughly fortifies the nervous system after prolonged prostration.106 Here, the phrase ‘liquid life’ neatly encapsulates Bovril’s unique selling point as a nourishing food and stimulant that can repair and renovate damaged tissue, and as a rejuvenating elixir that can ‘fortify’ the body against future attacks. However, as we shall see, it was not until the outbreak of the Boer War in December 1899 - a war that coincided with a new epidemic of influenza - that Benson thought to revive the slogan, and that ‘Bovril is liquid life’ took on dramatic new meaning. Military metaphors are never far from the surface in discussions about epidemics. Epidemics of influenza, plague and cholera are commonly said to ‘attack’ civilian populations, ‘defeating’ the

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elaborate public health measures put in place by the state. To restore the nation to health, campaigns against infectious disease are often portrayed as a form of warfare in which it is necessary to ‘kill’ the pathogens that threaten society by deploying an ‘arsenal’ of drugs and vaccines drawn from the laboratory. As Roger Cooter has argued, this ‘invasion’ of medicine by military metaphors owes much to the historiographical assumption of a ‘fatal partnership’ between wars and epidemic diseases, as well as to the way that the employment of such belligerent language has tended to legitimate the power of civilian doctors and the disciplining of civilian populations for medical purposes. As Cooter goes on to acknowledge, such metaphors may also serve a wider polemical purpose by, for example, giving urgency to public health campaigns and underlining ‘the need for national virility’.107 As an example, Cooter cites the Webbs’ campaign against poverty in the 1910s and D. Stark Murray’s campaign against microbial pathogens in the 1920s. Something very similar appears to have occurred during the Boer War. Indeed, the war in South Africa afforded Benson metaphoric and symbolic opportunities undreamed of in peace. In particular, medical discourses drew on the example of British losses in South Africa to highlight the medical risks that influenza posed to the civilian population and the importance of individuals regulating their behaviour to avoid infection. These parallels were brought home by the ‘Black Week’ of 10– 15 December 1899, when British forces suffered a series of humiliating defeats at the hands of the Boers, culminating in General Sir Redvers Buller’s ill-advised assault on Colenso in which 143 British were killed and 1,002 wounded compared to South Africa’s seven killed and 22 wounded.108 A week later, a new wave of influenza swept across the British Isles, claiming the lives of 3,288 Londoners, and elevating the capital’s death rate in the first week of the new year to 37.1 per 1,000 living—the highest rate since March 1895.109 Observing that influenza had ‘slain as many people in London as have been killed outright by bullets, shells, and bayonets in the South African war’, the Review of Reviews lamented that ‘not even in the black week of December did the Boers kill as many as were mown down by influenza in one week in

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January’. The periodical also noted that as in previous epidemics the casualties were not confined to the poorer classes but included several household names, including the art critic John Ruskin, and Richard Blackmore, the novelist and author of the popular historical romance Lorna Doone. ‘The run upon doctors and nurses was phenomenal, while the number of burials in some of the city cemeteries passed all previous records.’110 The Lancet was similarly alert to the dangers posed by the recurrence of influenza. However, recognising that in a time of national crisis dread was double-edged, it urged readers to keep the threat in perspective. ‘The recurrence of influenza in an epidemic form is a national evil of great importance,’ began a leading article. But at a crisis like the present, when every available man—and woman too—is wanted . . . it is, to say the least, specially inconvenient . . .. It needs to be insisted on, when such heavy demands are being made on the nation at home and abroad, that to neglect proper precautions is unpatriotic as well as foolish.111 Benson was also alert to the parallels but rather than playing down the threat, he seized on the grim telegrams from South Africa to take out advertisements in several London dailies showing a businessman holding a handkerchief to his nose beneath the slogan, ‘Influenza, The Enemy At Home’. To underline the juxtaposition between the war and the dangers posed by influenza on the Home Front, ‘Bovril’ was picked out in spiked capital letters, as if to suggest imminent fright or alarm, while the text explained that Bovril afforded ‘effectual resistance to the enemy’s attack’ [italics inserted], thereby suggesting that Bovril was a source of vitality and resilience for those susceptible to infection (Figure 5.5).112 Benson placed similar advertisements in the woman’s periodical Hearth and Home, except this time the copy line, ‘The Enemy at Home’, was juxtaposed with a picture of fashionable young woman (Figure 5.6). By February, Benson was employing these metaphors to even better effect, taking out half-page advertisements proclaiming

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Figure 5.5 ‘Influenza: The Enemy At Home,’ Penny Illustrated Paper, 13 January 1900, p. 28. Reprinted with the permission of the British Library.

‘Bovril to the Front in Peace and War’. Now the worlds of the solder and the civilian were explicitly contrasted to create a patriotic connection between the consumption of Bovril in the two fields of ‘battle’. In the advertisement, a wounded soldier with his arm in a

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Figure 5.6 ‘Influenza: The Enemy at Home’, Hearth and Home, 18 January 1900, p. 462. Reprinted with the permission of the British Library.

sling is shown at ease drinking a large cup of Bovril, while an accompanying testimonial from Sir William McCormac after the Battle of Tugela extols the benefits of Bovril in assisting recovery from battle wounds. The image of the soldier aided by Bovril ‘On the Field of Battle’ is juxtaposed with the slogan ‘Influenza at Our Doors’ in an attempt to create an identity of feeling between the two types of consumers. Thus, just as Bovril ‘gives life to the soldier faint from the loss of blood’, it also gives ‘vigour to those surrounded by an epidemic of influenza . . . [being both] tonic, food, and stimulant to the convalescent’. The advertisement concludes: ‘Bovril is Liquid Life.’113 A few months later in an advertisement that ran in Sphere in October 1900, Benson revisited the theme, using the image of a cup of hot Bovril to forge a symbolic link between soldiers waiting in line for their discharge papers and civilians who had come to applaud their return from South Africa. For soldiers and civilians alike, the copy read, ‘there is nothing better [than Bovril] to keep out the cold and remove fatigue . . . Bovril gives to the body warmth to resist successfully the attacks of Influenza and other Winter Diseases.’ Here the suggestion seems to be that Bovril is not only a stimulant and a restorative but a prophylactic—hence the claim that unlike other stimulants that merely ‘act on the system as the bellows to the fire’, Bovril is

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analogous to coal, providing a constant source of energy that acts as a ‘safeguard during inclement weather’.114 With the Boer surrender in 1902 and the return of peace, advertisements for Bovril and other cold medications metamorphosed again, drawing this time on anxieties about urban overcrowding. Thus in one advertisement that appeared in the Illustrated London News in 1907 a cup of Bovril is juxtaposed against a crowd of working class men. The caption reads: Three thousand five hundred such crowds as this could have been supplied with a cup of piping hot BOVRIL from the Bovril sold on a single day recently. Bovril repels Influenza and resists Cold and Chills. Crowds know it!115 By 1910, the message had become even more subtle and suggestive. Now, in an advertisement showing a group of respectably dressed Edwardians huddled beneath an umbrella in Trafalgar Square, Bovril was presented as an antidote not only to ‘cold, drenching rain’ and the ‘damp air that chills’, but to what Loeb calls the ‘chilling impersonality of the public sphere’. No longer is the crowd a source of alienation, she suggests. Instead, the advertisement seems to transform the crowd into a ‘metaphor for the expanded parameters of the shared experience of being a consumer’ and the act of consumption into ‘an agent of courage and mastery’.116 *** In this chapter I have argued that the Russian influenza drew on the Victorian dread of infectious disease and the fascination with sensation, celebrity and spectacle. Influenza had long been known to carry the risk of potentially mortal respiratory complications, but it took the death in the winter of 1892 of the Duke of Clarence—the embodiment of Victorian privilege—to underscore the risks to highand low-born casualties of the epidemic alike. As during the first wave of the pandemic, mass market newspapers and telegraphic communications technologies were crucial to this process, greatly accentuating the public shock at Clarence’s death and

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uniting the nation in an electric chain of sensation, which saw Clarence transformed into a symbol of national loss. The result was that Clarence’s death became a public ‘spectacle’, one in which Victorians were invited to identify with the grief of the Prince and Princess of Wales and unite in a community of suffering. This sense of shared suffering and danger was sustained by the promotion by patent medicine manufacturers of quack ‘cure-alls’. Mirroring the narrative productions of influenza in the editorial pages, advertisements for influenza remedies like the Carbolic Smoke Ball traded on consumer anxieties about the epidemic, and the Victorian fascination with celebrity and spectacle. Although the competing claims of patent medicine advertisers strained credulity, in an era when fears of infectious microbes were rife and bacteriology was making it possible to visualise the influenza bacillus in new ways, the smoke ball appeared no more outlandish than many conventional treatments for influenza. At the same time, the purchase of such products was a sympathetic act, one that joined individuals symbolically to other influenza sufferers. The result was that, just as Clarence’s state funeral became the focus of public mourning, engendering a shared sense of national loss, so patent medicine advertisers were able to foster the illusion that consumers would be proteced from flu by sharing in the consumption of the same mass produced product. Frederick Roe’s mistake, I have suggested, was to offer consumers a cast-iron guarantee, thereby shattering these illusions. However, although the failure of the Carbolic Smoke Ball to protect Elizabeth Carlill against influenza was central to her legal claim, it proved incidental to Roe’s marketing campaign, which was able to draw on Victorian fears of a wide range of diseases and the celebrity accorded by the court case to continue promoting the smoke ball to credulous consumers. In this respect, Clarence’s death from post-influenzal pneumonia was just one of a series of marketing opportunities that Roe and other manufacturers of patent medicines exploited in the 1890s. As a protean ailment, influenza has considerable metaphorical flexibility. This is nowhere better illustrated than by Bovril’s

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advertisements during the Boer War, in which Bovril was a symbol for the parallel threats faced by soldiers in South Africa and civilians on the home front. Similarly, in 1910 Bovril advertising was able to draw on Edwardian anxieties about urban overcrowding to present Bovril as a prophylactic that would protect consumers against influenza and other diseases that multiplied in the public sphere. As we shall see, this notion of Bovril as a source of inner strength and resilience would be revived four years later when Britain once again found herself at war.

CHAPTER 6

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A SENSE OF DREAD IS VERY GENERAL': THE FIRST WORLD WAR, THE SPANISH' FLU AND THE NORTHCLIFFE PRESS

On 24 June 1918, the war poet Wilfred Owen crawled into an Army-issue bell tent in a wind-blown field near Scarborough and began composing a letter to his mother, Susan. Then a 20-year-old lieutenant in the Second Manchesters, Owen had just been deemed fit for duty after a lengthy convalescence in Scotland following an attack of neurasthenia, a nervous condition brought on by the stresses and strain of trench warfare, but as Owen waited in North Yorkshire for the orders that would return him to northern France his thoughts were seemingly on another disease entirely. ‘STAND BACK FROM THE PAGE! and disinfect yourself,’ he begins his letter to Susan Owen. ‘Quite 1/3 of the Batt and about 30 officers are smitten with the Spanish Flu. The hospital overflowed on Friday, then the Gymnasium was filled, and now all the place seems carpeted with huddled blanketed forms . . .. The boys are dropping on parade like flies in number.’1 At first glance, Owen’s bold capitals and self-conscious underlinings read like genuine alarm, but as the next passage makes clear Owen is being ironic and, far from taking the disinfectant measures seriously, considers the flu something of a joke.

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‘The thing is much too common for me to take part in. I have quite decided not to! Scottie [a regimental friend], whom I still see sometimes, went under today, & my servant yesterday. Imagine the work that falls on unaffected officers.’2 Owen’s wry remarks, though clearly calculated to amuse, were typical of British attitudes to the ‘Spanish flu’ that summer.3 Although in May the sudden emergence of flu in Madrid had made the front page of the Daily Express, by June it was regarded as little more than a footnote to war and had been relegated to the inside pages.4 As The Times’s medical correspondent put it: The man in the street, having been taught by that plagosus orbilius, war, to take a keener interest in foreign affairs, discussed the news of the epidemic which spread with such surprising rapidity through Spain a few weeks ago, and cheerfully anticipated its arrival here.5 While these casual attitudes to the Spanish flu were understandable during the initial, mild summer wave of the pandemic, by the autumn of 1918 the flu had mutated into a far deadlier infection. Indeed, in Britain it is estimated that 64 per cent of the estimated 228,000 deaths from the pandemic occurred in the last three months of 1918.6 Young adults between the ages of 25 and 40 accounted for nearly half the deaths, a departure from the pattern of previous pandemics and epidemics where the brunt of the mortality was borne by infants and the elderly. Overall, the case mortality rate averaged 2.5 per cent, 25 times higher than in a normal epidemic.7 Yet for all the destruction wrought by the Spanish flu, stoicism seems to have been the characteristic response even during the later waves of the pandemic. ‘Never since the Black Death has such a plague swept over the face of the world,’ commented The Times in December 1918, ‘ [and] never, perhaps, has a plague been more stoically accepted.’8 With hindsight, this disdain for the Spanish flu seems odd. In Britain, as elsewhere, the virus sparked a peculiar autoimmune reaction that caused the lungs of young adults to fill with choking fluids. Such deaths were truly shocking to behold as they resulted in a

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condition known as heliotrope cyanosis, in which the cheeks, lips and ears of patients turned a vivid blue colour as oxygen was leeched from the blood vessels supplying the heart.9 By contrast, the deaths from the Russian flu were not nearly as alarming, being the result for the most part of complications due to pneumonia, a familiar cause of death at the time, particularly for the elderly who accounted for the vast majority of the victims. This supposed stoicism about the Spanish flu puzzled commentators at the time and has continued to puzzle historians since. Reflecting on his experience of the the 1918 – 19 pandemic in 1935, Major Greenwood, then Professor of Epidemiology and Medical Statistics at the London School of Hygiene, observed ‘there is some psychological interest in the fact . . . that actually the emotional impression created [by the pandemic] was fainter than that produced by much less grave epidemiological happenings’.10 The American historian Alfred Crosby is similarly baffled by the paucity of references in contemporary American literature, dubbing the Spanish flu ‘America’s forgotten pandemic’.11 More recently, the British medical historian and historical geographer Niall Johnson has characterised the flu as variously an ‘unregarded’ and ‘overshadowed’ killer in 1918, and a ‘bit player in . . . the larger story of the Great War’.12 However, Johnson does not explore this insight further, regarding the war as merely one of the factors that caused the pandemic to be ‘overshadowed’ in 1918.13 In this chapter I want to move beyond this notion of ‘overshadowing’ by examining the ways in which popular responses to the Spanish flu did, and did not, draw on the narratives of war and then emotional and biopolitical discourses—discourses that, I will argue, were governed both by the wartime propaganda effort and by medical attempts to police the civilian response to influenza. In particular I aim to probe Owen’s expressions of disdain by asking how his stoicism was produced, what wider social and political purposes it may have served, and what emotions it may have masked. At the same time, I wish to examine the role of government, voluntarist organisations, and the mass media in the production not only of stoicism during World War I (WWI) but of emotions, such as dread

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and hatred. In so doing, I do not claim to be able to access Owen’s or other people’s past emotional experiences and ‘know’ their subjective content. Rather, my method seeks to relate emotional expressions and displays to then cultural and political discourses in an attempt to understand the meanings and functions they had for individuals at the time—an approach that has been termed ‘emotionological’.14 Finally I wish to suggest that these emotional scripts may have had an important influence on people’s responses to influenza, a disease whose protean symptomatology and metaphorical fecundity at once masked the Spanish flu’s ‘social’ impacts and gave the flu wide cultural currency. Whereas in peacetime dread had posed little threat to the social order, I will argue that in 1914– 18 it became an important instrument of social and political control.15 In an effort to unite Britons against a common enemy and stifle domestic dissent, the government, with the voluntary cooperation of newspaper proprietors and editors, deliberately fostered dread and hatred of Germany. At the same time, British propaganda efforts aimed to build unity on the Home Front by fostering civilian resilience and ‘staying power’, making the cultivation of stoicism a social and political imperative. However, these discourses did not operate in isolation but drew on and sometimes clashed with one another. For instance, at the same time as British propaganda sought to promote hatred of Germany, it also risked undermining civilian morale by provoking excessive fear of the enemy and its capacity to launch attacks on the civilian population.16 In this respect, propaganda discourses were a means of producing disciplinary power and also operated as what Foucault calls ‘stumbling blocks’ and ‘points of resistance’ to the operation of biopower.17 Medical discourses that sought to employ dread as a selfregulating technology were similarly oppositional.18 To the extent that doctors were keen to persuade patients to take the ‘dangers’ of influenza seriously and adjust their behaviour accordingly by, for instance, convalescing at home when sick, the risk of spreading infection and the dread of the respiratory complications of flu was a key instrument of biopower. However, to the extent that the dread of

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flu was potentially pathological and could tip into hysteria, the amplification of such biopolitical discourses carried considerable risks, frequently clashing with propaganda discourses that urged civilian disdain of foreign threats.

Metaphor, Emotion and Action Although there has been much scholarship in recent years on the media’s role in communicating biopolitical discourses and the metaphorical framing of modern disease epidemics generally, this scholarship has not usually extended to the relationship between emotions and biopolitical discourse.19 This is odd when one considers the role that metaphor plays in cognitive affective processes. According to Lakoff and Johnson, metaphors are not merely rhetorical flourishes but actually ‘create’ or constitute social, cultural and psychological realities for us by inviting us to act upon the world in particular ways. ‘The heart of metaphor,’ they argue, ‘is inference . . . [and] because we reason in terms of metaphor, the metaphors we use determine a great deal about how we live our lives’.20 One way metaphors achieve this is by orienting our emotional responses to people, events and objects within our field of experience. As Bono puts it: ‘The work of metaphor is not so much to represent features of the world, as to invite us to act upon the world as if it were configured in a specific way like that of some already known entity or process’ [italics in original].21 In other words, metaphors are not just representational, but performative. However, while metaphors help shape and direct our cognitive emotional responses, to the extent that emotions are embodied, they also stand outside of language and discourse. As Reddy has argued, departing from strong constructionist models, performing anger, fear or shame is not the same as being angry, fearful or ashamed.22 This is because emotional utterances, or what he terms ‘emotives’, are never merely descriptive or performative but build, hide and intensify emotions by altering what they refer to. It is this ‘inner’ dimension of emotion that, Reddy argues, ‘sets a limit on discursive construction’.23 Furthermore, while at the level of discourse

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metaphors may serve as messengers of meaning between different disciplines and cultural domains, once they become embodied they become hybridised and subject to what Bono calls ‘complex feedback loops’.24 It is this dual aspect of metaphor as both representational and performative, and its complex relationship to emotion and cognition, that underpins my analysis of the Spanish flu pandemic. In particular, I will argue that Edwardian medical constructions of influenza lent themselves readily to somatic metaphors of nervous ‘weakness’, because of the way flu was framed as a fatiguing disease that depleted nervous energy. These metaphors were also central to biopolitical and propaganda discourses that sought to regulate emotional responses to exogenous threats to the body, whether those threats took the form of German Zeppelins or microscopic pathogens of unknown foreign provenance. However, far from these discourses being seamless and consistent, I will show that they contained discontinuities and sites of divergence.

‘The King of Lies’ In order to appreciate the interaction between military and medical discourses in WWI it is necessary to understand the critical role played by the media, and the Northcliffe Press in particular, in the dissemination of wartime propaganda.25 Unlike in other countries, the British government had little need to direct propaganda on the home front. Instead, the government relied on sympathetic newspaper proprietors and editors to stifle domestic dissent and foster hatred of Germany, hence Lloyd George’s admission in December 1917 to C. P. Scott, the editor of the Manchester Guardian, that if people really knew the truth about the war it would be stopped tomorrow.26 Although the actual impact of propaganda is notoriously difficult to measure, Lloyd George’s admission reflected the widely-held political belief that the British press had immense power to influence public opinion in 1914– 18. Today, cultural and media historians are rather more circumspect about attributing such influence to the press.27 However, if a measure of the effectiveness of

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the press is whether it enabled the support for the war to remain firm, then it was broadly successful.28 Arguably, another measure of the popularity of press propaganda was the huge circulation increase enjoyed by mass market newspapers and weekly journals, such as the ultra patriotic John Bull, which was selling 2 million copies by war’s end. Although all newspapers were complicit to a greater or lesser degree in the propaganda process, the foremost press propagandist was Lord Northcliffe, the owner of the Daily Mail, Evening News and The Times. Regarded as a promotional ‘genius’, Northcliffe had grasped early on in his career that the manipulation of the emotions of the ‘common man’, as he put it, held the key to the circulation growth of his newspapers.29 Indeed, in 1909, Northcliffe—then plain Alfred Harmsworth—had commissioned a series of inflammatory articles in the Daily Mail imagining a German invasion of England.30 While the articles had the desired effect of boosting circulation, they also earned Harmsworth a reputation as an unscrupulous war-monger— one who, it was soon claimed, had done as much as any man alive, save for the Kaiser, to bring about the European conflict.31 It was a reputation that Harmsworth was happy to embrace, and with the outbreak of hostilities he quickly styled the Daily Mail ‘the soldiers’ paper’, using its columns to condemn pacifist sentiments and promote anti-German hatred through images of Germans as ‘Evil Hun’.32 Beaverbrook’s Daily Express was similarly vociferous in its anti-German war-mongering and condemnation of dissenters. The result was that by 1918 the Daily Express’s circulation had nearly doubled to 595,000 while the Daily Mail was selling nearly a million copies.33 These attempts to foster hatred of Germany and stifle domestic dissent were reinforced by government-sponsored recruitment campaigns, posters and other forms of propaganda produced by voluntarist organisations, as well as by the activities of ultra-patriotic organisations, such as the British Empire Union.34 However, with its mass circulations and ability to appeal directly to readers’ emotions, the power of Northcliffe’s papers was unrivalled.35 Amongst its more notorious campaigns was the false claim, promulgated in 1917 in

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both The Times and the Daily Mail, that the Germans were sending the corpses of their war dead back to Germany to be rendered into fat at a factory near Coblenz.36 Little wonder then that, when in February 1918 Northcliffe accepted Lloyd George’s offer to become director of overseas propaganda, the Germans christened his headquarters at Crewe House the ‘Prime Gas Factory’ and Northcliffe the ‘King of Lies’.37

Fear, Hatred, and the ‘Crowd Mind’ Among the more astute observers of the press’s influence over the home front was Caroline Playne. The daughter of a Gloucestershire cloth manufacturer and a Dutch mother, Playne was a committed pacifist who had first become alert to the dangers of a European war in 1904 when she joined Britain’s National Peace Council. In 1908 she had attended the International Peace Congress in London where she was introduced to Bertha von Suttner, the Austrian novelist and radical pacifist. Six years later, when war broke out, Playne joined the Emergency Committee for the Relief of Distressed Enemy Aliens (Germans trapped in Britain); E. D. Morel’s Union for the Democratic Control of Foreign Policy; and worked for the Nailsworth Peace Association and the National Peace Council. At the same time, she began collecting suppressed pacifist pamphlets and keeping press cuttings and a diary, recording the government’s propaganda efforts and her impressions of the darkening civilian mood. Following the war, Playne set about organising this material in an effort to understand what she saw as the ‘collective madness’ that had overtaken Britain and Europe in the years leading up to and during the Great War.38 The result was three pioneering works of cultural history and social psychology analysing the pre-war mentality and what she saw as the media’s role in manipulating popular opinion.39 Drawing on Gustave Le Bon’s notion of the contagious power of crowds and Wilfred Trotter’s notion of the herd instinct, Playne argued that in 1914 individuals had been swept along on a tide of ‘fear, dread and bellicose passion’.40 These ‘mental contagions’, she argued, had overridden rational thought, resulting

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in a ‘paralysing fear’ and collective ‘anaesthesia’ that made it almost impossible for individuals to think for themselves or resist the majority opinion.41 As Playne saw it, the media—and the Northcliffe Press, in particular—was key to this process, both pandering to and helping to excite ‘the hatreds and fears [. . .] of the crowd mind’. It was the media, she believed, that had ‘kept the consuming conflagration of war alight’, making it impossible for people to question the horrendous loss of life or entertain the possibility of a negotiated peace. She also observed that the war left little room for other narratives as it ‘drowned out or made irrelevant other topics of news . . . [taking] away the appetite for everything but war’.42 In Playne’s view, the promulgation of hatred of Germany through emotive language and symbols and the cultivation of stoical attitudes were key factors in this process, both reinforcing civilian resilience in the face of the German threat and helping to stifle domestic dissent. However, as I will show, this hatred and fear could also become attached to other narrative objects, contaminating and destabilising the propaganda efforts. This was nowhere more true than in the case of the Spanish flu. Retrospective accounts of the 1918– 19 pandemic frequently treat the successive waves of Spanish flu as a single epistemic event. However, as Ramussen has argued, at the time it was experienced more as ‘a succession of crises and moments of respite’.43 Similarly, Bresalier points out that initially the relationship between the mild summer wave and lethal follow-on waves in the autumn of 1918 and winter of 1919 baffled the Edwardian medical community. It was only later that epidemiological and military bacteriological experts agreed on the essential identity of the three waves, and that the pandemic came to be seen as a ‘single cataclysmic event’.44 Consequently, in the summer of 1918 when Owen wrote to his mother there was little reason for Britons to fear flu. As in other countries, flu epidemics were seasonal occurrences. Flu visited Britain every autumn and winter, elevating the death rate of infants and the over-65s but leaving the adult mortality rate unchanged. The result was that flu rarely accounted for as many as 1,000 annual deaths in London.45

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The first Britons knew of the flu was in late May when the Daily Express and Daily Mail ran brief reports about a ‘mysterious epidemic’ in Spain.46 Wary of frightening the public, the BMJ dismissed the reports as ‘alarmist’ while The Lancet ignored them entirely.47 In contrast to the Russian flu pandemic, when the LGB had instructed its Medical Department to initiate a nationwide investigation, in 1918 the board made no effort to investigate the epidemiology or bacteriology of the Spanish flu or to canvass doctors as to the symptoms or the incubation period of the disease. Indeed, at a ‘discussion on influenza’ with other experts held at the Royal Society of Medicine on 13 November 1918, Arthur Newsholme, the chief medical officer of the LGB, said that in the summer he had considered issuing a memorandum on flu only to shelve it on the grounds of expediency, reasoning that there were ‘national circumstances in which the major duty is to “carry on”’.48 This was perhaps understandable given that, as Eyler points out, in 1918 the LGB’s authority was much diminished and Newsholme lacked manpower due to the war effort.49 According to Bresalier, confusion over the identity of influenza also meant Newsholme had little confidence in preventive measures, hence his willingness to defer to the medical department of the War Office and the Medical Research Council, who he reasoned were in a better position to conduct detailed bacteriological and pathological investigations into the cause of the epidemic.50 This ‘silence’ on the part of British medical authorities contrasts with the more proactive measures taken in other Allied countries, such as Australia and the United States, and has prompted the claim that British medical professionals suffered a ‘failure of expertise’ in 1918.51 However, to seek to compare the British response with the more vigorous measures taken elsewhere is to overlook the very different conditions prevailing on the Home Front in Britain in 1918, and the extent to which the LGB and the medical press were active participants in the propaganda effort. Like the Northcliffe Press, the British medical profession’s priority in 1918 was to avoid panicking the civilian population, especially as more than half of all medical personnel were occupied with military duties.52 However, as

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the epidemic spread and chemists reported a rush on quinine and other medications, sparking fears of panic-buying, it became clear that this silence could not be sustained.53 Instead, Newsholme turned to the Northcliffe Press, briefing the Daily Mail and, it seems, The Times’s medical correspondent, about the board’s knowledge of the epidemic and using its columns to issue practical and upbeat medical advice to readers. In so doing, Newsholme’s actions can be seen as a form of biopolitics. However, I will argue that in the process Newsholme, like other medical commentators, soon found himself caught between opposing discourses—discourses that, on the one hand, required him to counsel civilians to take the threat of influenza seriously and at the same time valorised the maintenance of a ‘cheerful’ disposition lest fear itself become the ‘mother’ of infection.54

War, Emotion and Metaphor The notion that emotions can act on the imagination so as to make individuals more susceptible to disease can be traced at least as far back as Robert Burton’s Anatomy of Melancholy.55 Although by the Edwardian period emotional susceptibility was more commonly framed in terms of the depletion of somatic reserves of ‘nerve force’, pre-modern notions of the role of the imagination continued to enjoy wide currency. ‘Fear worries the nervous system,’ argued a 1902 medical advice pamphlet.56 ‘One of the best ways of preventing influenza is to keep your mind easy instead of imagining, like so many do, that you are going to fall a victim to the disease.’ The pamphlet also recommended foods and drinks rich in ‘nerve’building nutrients and to avoid ‘depressing’ influences, such as cold weather or ‘overwork’ and ‘overstrain’. The cultivation of positive character traits was also thought to strengthen an individual’s powers of resistance, hence the pamphlet’s claim that ‘there is no better established fact in the whole history of epidemics than . . . that the man or the woman of pluck and energy is the last to take the prevalent disease’.57 Such views were shared by many members of the medical profession, including the pioneering British psychiatrist

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W. H. R. Rivers, who used his appointment in 1916 to Craighlockhart War Hospital in Edinburgh to explore the psychopathology of shell shock and other forms of ‘war’ trauma prevalent among officers and enlisted men.58 It was there that Rivers first encountered Wilfred Owen, who had been sent for recuperation to Craighlockhart in June 1917 after enduring a ‘tornado of shells’ in a dugout in no-man’s land in northern France, and Siegfried Sassoon, the poet and conscientious objector who would become Rivers’ most famous patient. While Rivers does not appear to have had much to do with Owen, considering him an uninteresting product of a grammar school, his theory that the superior education of officers made them better able to withstand the shocks and traumas of war were shared by his colleague, A. J. Brock, to whom it fell to treat Owen, and imbued the therapeutic regime at Craiglockhart.59 As Allan Young has shown, Rivers was convinced that officers were better able to withstand ‘fear and its expression’ because of the way that their minds had been trained to suppress negative emotions through the public school ethos of stoicism and the emphasis on competitive games. However, according to Rivers the trauma of trench warfare and the nervous shocks from the incessant shelling had been too much for even educated men to bear, hence the traumatic neuroses he encountered at Craiglockhart. Rather than repressing the traumatic memories lying behind these neuroses and ‘carrying on’ as if nothing had happened, which was the solution favoured by the military and by Newsholme in relation to the influenza epidemic, Rivers encouraged patients to relive the trauma of war and their disturbing dreams through writing exercises and an early version of the ‘talking cure’. The result was that rather than victims of shell shock being labelled malingerers and hysterics—a diagnosis that carried connotations of womanly emotionality—Rivers’ reconfigured the officer class’s anguish as a form of neurasthenia that was both noble and heroic. The result, as Young puts it, was that Rivers’ neurasthenia became ‘weakness without stigma’.60 In Owen’s case, his neurasthenic diagnosis and treatment at Craiglockhart could be worn as a particular badge of honour, as it put him in the same company, therapeutically speaking, as the

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aristocratic, public-school educated Sassoon, who Rivers had diagnosed as suffering from an ‘anti-war complex’ and whose literary success Owen was eager to emulate. As Shephard and others have argued, when Owen arrived at Craiglockhart there was little to indicate that he had the makings of poetic greatness. However, after editing the hospital paper, the Hydra, and being persuaded by Sassoon that his poetry could embrace a ‘reasoned opposition to the war’, Owen’s writing was transformed. Certainly, by the time he was discharged from Craiglockhart for ‘light duties’ with his regiment at Scarborough, Owen had discovered his voice, and by May 1918 he had polished the collection of poems that would make his name.61 It is against this background of growing self-confidence as a fully paidup member of the ‘neurasthenic’ officer classes that we should read Owen’s dismissal of the Spanish flu in the summer of 1918 as ‘common’ and beneath his social status. However, as Showalter has persuasively argued, the stoicism exhibited by Owen and other male war trauma cases was largely a performance, a way of reasserting manly unemotionalism in the face of the brutality and horrors of war.62 Owen’s dismissal of the Spanish flu as a ‘joke’ can be seen as similarly performative, a way of shaping his emotional response to the flu in a way that valorised the ‘superior’ breeding of officers. Thus rather than succumbing to flu in the manner of enlisted men, Owen makes fun of their hysterical reactions and informs his mother he ‘has quite decided not to [succumb]’. In other words, the emotional utterance—Owen’s verbalisation of his determination not to succumb—is crucial to the production of his stoicism. To use Reddy’s terminology, the emotive reinforces Owen’s cognitive attitude to the object of the emotion, flu. If the activities of Rivers and other military psychiatrists can be seen as an attempt to come to terms with the emotional contradictions inherent in the prosecution of the war while restoring soldiers to psychological health in the interests of the state, similar contradictions bedevilled the advertisements for patent medicines and other commercial products. The war saw a deluge of advertisements for everything from British-made rubber tyres to Macintoshes as manufacturers competed to do their bit for the

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military effort while portraying their products as more patriotic than those of their competitors. Some of the most promiment campaigns were sponsored by Bovril. As during the Boer War, Bovril was adept at drawing parallels between the twin domestic and foreign threats to the health of the British population. To underscore the supposed vitality of its beef tea and its association with patriotic tropes, the company sponsored a series of advertisements showing the Bovril bull standing guard outside an Army recruiting tent above the copy line ‘British to the backbone’ and ‘Bovril recruits its strength through the power of beef’.63 As a peculiarly fatiguing disease that depleted nervous energy, influenza lent itself readily to these somatic metaphors, hence Bovril’s claim that it could ‘prevent influenza and colds by fortifying the system against their attacks’ and that Bovril was ‘liquid life’.64 The problem was that in order to sell Bovril as a preventive the advertisements explicitly traded on consumers’ fears of exogenous pathogens, frequently drawing an analogy between the threat to individual bodies and the threat posed by Germany to the political and social body. In this way they raised the very fears that wartime propaganda was meant to obviate. A good example was a full-page advertisement that appeared in various papers in 1914– 15. Headed ‘Are you on Dangerous Ground?’, the advertisement shows a jar of Bovril coming to the rescue of the ‘threatened corps of the body,’ which is shown being encircled by enemy battalions labelled ‘chills’, ‘colds’ and ‘influenza’. The copy explains that ‘dangerous ground’ is a metaphor for those who are ‘run down’ or ‘who are always “catching something”’, or ‘who do not pick up as they ought after illness’. In each case, the advertisement explains, ‘Bovril is the best Home Defence’.65 Similarly, in another advertisement, dating from the German air raids on the east coast of England in 1915, a Zeppelin becomes a metaphor for the various germs waiting to attack stressed civilians. The copy reads: ‘More insidious than hostile aircraft are the enemies that fill the air in the shape of colds, chills and influenza, which are always “hovering to strike” the man or woman who is run down and out of sorts.’66 Similar contradictions bedevilled wartime advertisements for germicides, tonics and disinfectants. Thus, in an

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advertisement for the disinfectant Santol that appeared in the Salford Reporter in the early autumn of 1918, readers are warned that ‘the Germs of Influenza and other Diseases Attack at your Unguarded Moments, and only when the Grim Spectre of Illness or the Shadow of the Awful Reaper falls on your home do you realise the Danger’.67 These contradictions can be seen as a reflection of the tensions inherent in both biopolitical and propaganda discourses. To the extent that dread of flu and other microbial ‘threats’ could persuade patients to take responsibility for their hygiene and regulate their health accordingly, the emotion was encouraged by the medical profession and the manufacturers of patent medicines. But to the extent that this dread could spill over into panic and hysteria, thereby destabilising propaganda discourses, it was to be deprecated. ‘Alarm is not only needless—it is positively harmful,’ warned an advertisement for the anti-germicidal vaporiser Perolin, that appeared in Vogue at the height of the deadly autumn wave of influenza. ‘Instead of getting panicky people should listen to the advice of medical men, and take a few perfectly simple precautions.’68 The problem was that, because influenza presented as alternately threatening and benign, the line between what was considered an acceptable and unacceptable emotional response was continually shifting. Thus during the autumn wave, when deaths in England and Wales were running at around 5,000 a week, it made sense to ‘fear’ influenza and for individuals to err on the side of caution. By contrast, during the mild summer wave when influenza was a novelty and the risks were not well-understood, dread risked being construed as a suspect emotion, one that could just as easily be read as evidence of hysteria and a lack of ‘nerve’.

Reporting the Flu A good example of the contradictions in these biopolitical discourses came in an article that appeared on the main comment page of the Daily Mail in the first week of June. Headlined ‘Is Influenza Coming?’, and bearing the by-line of the paper’s medical correspondent, the article begins by reminding readers that most

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attacks of influenza are no worse than a cold, and that patients should not have ‘any great dread of [the disease]’. In the very next sentence, however, the writer warns that the complications of flu can be very serious indeed, and it would be wise to ‘prepare our defences now’. There then follows a list of recommendations, such as spending as much time as possible out of doors so as to avoid infection with the presumed ‘bacillus’ of influenza (‘the conscientious allotment holder stands a better chance of escape than his sedentary neighbour’). Readers are also reminded to avoid ‘over-fatigue’ and ‘chills’. However, the key advice is to ‘maintain a cheery outlook on life’ as ‘depressed mental states’ are said to favour the onset of the disease.69 At this stage, it would appear, the flu was not considered sufficiently serious to destabilise the dominant political discourses. However, by the end of June, with ‘sporadic’ outbreaks being reported throughout the capital, the Daily Mail changed tack, advising readers who suspected they had influenza to ‘go to bed immediately and not attempt to “carry on,” which only means carrying infection to others’.70 The following day, with the news that ‘300 girls’ at a leather factory in Bermondsey were ill, Newsholme gave the paper the first in a series of on-the-record briefings, informing its medical correspondent that while the current epidemic is not ‘so severe as the great epidemic of 1889– 92’ outbreaks were being reported from various parts of Britain, as well as from France, Germany and Spain. Describing general isolation measures as ‘impracticable’, the gist of Newsholme’s message is that individuals should monitor their symptoms and act in their own—and the wider population’s—best health interests: hence his advice that patients should go to bed as soon as symptoms appear and remain isolated for at least four to five days afterwards. ‘A relapse may be more dangerous than the original attack,’ he warns, before adding that a ‘good preservative from infection is to use a disinfectant nose spray or mouth wash’.71 In late June and July, there was another subtle shift in the language used to describe the epidemic. The trigger was an outbreak of influenza at a German prisoner-of-war camp in Bramley, Hampshire, that had hospitalised nearly 1,000 men—a third of the camp’s prison population. Several guards, it was reported, had also

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been laid low.72 Suddenly the ‘Hun’ was no longer the only enemy. ‘New Foe in Our Midst’, declared the Salford Reporter. The epidemic of influenza has reached Salford and it is not of the old “sneezing variety,” it is very prostrating. Hundreds of cases have occurred in the borough during the week, and doctors are extraordinarily busy. The article went on to advise that patients should on ‘no account attempt to “carry on”’, but instead should go to bed the moment they were attacked. ‘If you get about and try to shake it off it becomes much worse,’ a doctor was quoted as telling the paper.73 For the most part, however, discourses of resilience and stoicism tended to dominate, and nowhere more so than in the editorial pages of the The Times. A good example was the article in late June claiming that the man in the street was ‘cheerfully’ anticipating the arrival of the Spanish flu. What makes the article so striking in retrospect is not so much its appeal to the stereotype of ‘plucky’ Britons as the writer’s suggestion that the epidemic is the result of a German germ warfare experiment and the activities of the ‘unseen hand’—a reference to the secret German spy networks thought to be operating inside Britain. The writer goes on to agree with Newsholme that the Spanish epidemic does not appear to be nearly as severe as previous epidemics, before suggesting that ‘malnutrition and the general weakening of nerve-power known as war-weariness’ and the ‘contact between national armies’ are sufficient conditions for its spread.74 This notion that the epidemic was a consequence of war was to prove a familiar refrain not only in the columns of The Times, but in the Daily Express, The Lancet, the BMJ, and the official report on the pandemic produced by the Ministry of Health after the war.75 This is hardly surprising. As long as the outcome of the war hung in the balance, the propaganda consensus demanded that flu should not be allowed to usurp the dominant military discourses necessary for the maintenance of civilian morale. In August a new, virulent form of influenza had appeared in the Allied lines, prompting a flurry of confidential correspondence

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between Medical Research Committee (MRC), the War Office and the Army Medical Service calling for the renewal of medical investigations amid fears that it could herald a second wave of flu.76 However, the first public indication that the Spanish flu had returned, and possibly in a more dangerous form, came in September when it was reported that Prime Minister Lloyd George had been taken ill in Manchester. Lloyd George had succumbed to the disease during a morale-boosting trip to Manchester on 12 September, and spent ten days confined to a sick bed in the town hall, many of them hooked up to a ventilator to ease his laboured breathing. Judging by the recollections of the Secretary of State for War, Sir Maurice Hankey, Lloyd George’s illness was very serious indeed and, according to his valet, at one point it had been ‘touch and go’.77 However, with the help of the attending physician, Sir William Milligan, and friendly newspaper barons such as C. P. Scott the true gravity of his illness was kept out of the public prints.78 Instead, the Manchester Guardian joked that Lloyd George had caught a ‘severe chill’ when he had accidentally been soaked in a downpour in Albert Square and that he had since become ‘a prisoner of [Manchester’s] not too kindly climate’.79 In the meantime, The Times censored several of Milligan’s medical bulletins, waiting until the 18th to report that the prime minister was on his way to recovery.80 Growing concern about the impact the flu was having on Army sickness rates also failed to make it past the military censors. The American Expeditionary Force (AEF) first began to note a resurgence of influenza in northern France in early September. The outbreaks were most extensive at Le Mans and Brest, and by the end of the month the AEF had recorded some 11,000 new cases. This time, however, the influenza was frequently accompanied by severe pneumonia and sometimes proved fatal.81 By now, the Americans were also struggling to contain the level of infections. One of the most striking outbreaks occurred at Camp Devens, a US Army barracks near Boston where 50,000 men were crowded into a facility designed for 40,000. By the end of the month some 14,000 men— nearly a third of the camp’s population—had been hospitalised with influenza or pneumonia, and 757 were dead. The sight of rows of

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young men laid out in the hospital infirmary, their lips and cheeks a mahogany colour from cyanosis, shocked medics hardened by battle service. ‘One can stand it to see one, two, or twenty men die,’ recalled a member of the camp’s surgical team, ‘but to see these poor devils dropping like flies sort of gets on your nerves.’82 The conditions on American transporters such as the Leviathan, which arrived at Brest on 8 October, were similarly alarming, with 2,000 cases and 80 deaths.83 Similarly, when the troopship Olympic docked at Southampton on 21 September, so many of the crew were sick that the British military authorities had to requisition beds in a nearby isolation hospital. A total of 119 severe cases were admitted, of which 41 proved fatal.84 Whether by accident or design, however, few of these incidents found their way into the press.85 The first official acknowledgment that the flu was again affecting civilians came in early October, when Glasgow’s MOH reported that there had been 66 deaths from influenza in the city, and 65 from pneumonia.86 By 15 October the figures were even more disturbing: 450 deaths from influenza and pneumonia, or 38 per 1,000 population, the highest mortality rate recorded in Glasgow in 20 years.87 The reports were picked up by both The Times and the Daily Mail, with the Daily Mail heading its article on the 10th ‘Infection in the air’, and reporting that the influenza appeared to be of ‘a more virulent type than in the early part of the year’.88 The following day, it was acknowledged the flu had reached the fringes of London, with some 17 patients reported dead at an ‘outer London institution’.89 If the Northcliffe Press’s coverage of the first wave of Spanish flu had been sporadic, the same could certainly not be said of the second wave. Between June and July, The Times published just 17 articles on influenza. By contrast, in October and November—the peak months of the autumn wave—it ran 93. In terms of individual articles, the Daily Mail’s coverage appears to have been more even—21 articles in June– July versus 29 in October –November. However, many of the articles during the first wave had been no more than one or two paragraphs long, and tended to be buried at the back of the editorial run. By contrast, in the autumn of 1918 the Daily Mail devoted several leaders to the epidemic. By the third week in October, it had

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also promoted the epidemic to the prime news spot at the top of page three, where it received equal billing with the war. As the mortality from flu worsened, both the Daily Mail and The Times also began reproducing statistics from the Registrar General’s weekly mortality returns—data that made the mounting death toll more visible to readers. At the same time, the Daily Mail employed triple-tiered headlines and crossheads to emphasise alarming statistics and to draw readers’ attention to particular phrases and tragic incidents. By the first week in November, it was not unusual for these round-ups to extend the full length of a page and across several columns. In addition, the Daily Mail ran a series of articles by a medical expert questioning official information about the epidemic and criticising the government’s ‘neglect’ of research.90 Even before the Registrar General’s weekly returns confirmed it, the threat that this new wave of flu posed was obvious. Although news from northern France was still heavily censored, news from other parts of the world continued to flow along the worldwide telegraph, confirming that flu was rampant in India and South Africa. Some of the most alarming reports of all came from Cape Town, where on 10 October The Times reported some 14,000 people had been attacked and that the epidemic was ‘assuming the proportions of a national calamity’.91 Three days later the paper’s Cape Town correspondent telegraphed that fatalities in the first two weeks of October were running at 5,000.92 Realising that censorship was pointless, and faced with a medical catastrophe to rival the mortality from the war, the Northcliffe Press found itself in a difficult position. Should it downplay the threat to civilians and hope the epidemic would go away, or should it play up the threat and look for someone to blame? The answer, it would seem, was a bit of both. As in the summer, the Daily Mail’s first instinct was to strike an optimistic tone, quoting Newsholme to the effect that though there was ‘a good deal of influenza in London’, the capital did not have it nearly as severely as other parts of the country and that ‘the hopeful view [was that] the worst might be over’.93 This message chimed with the latest reports from northern France, where the British Fourth Army had broken through the Hindenburg Line at

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Cambrai and was now engaged in a three-pronged assault on the German Army with the support of the French and the Americans. But as reports began to find their way into the papers of people collapsing in the streets, the tone shifted from stoical disdain to emphasising the gravity of the threat. ‘Everything that lowers the vitality should be avoided,’ advised the Mail’s medical correspondent. ‘The cases of collapse in the streets are probably due to people going out after they have had warning symptoms.’94 The key turning point, however, was Newsholme’s decision to issue a public memorandum giving official advice to patients on ‘precautions against infection’. The memorandum amounted to a reaffirmation of the traditional British faith in sanitary science and laissez-faire attitudes, according to which influenza was primarily a disease of the environment and poor hygiene—hence Newsholme’s appeal to individuals to regulate their behaviour in their own and other people’s interests. As The Times put it: ‘Dr Newsholme emphasises the fact that control over the disease can be secured only by the active cooperation of each member of the community.’95 Newsholme’s memo marked a turning point in the reporting of the epidemic. Until October the Northcliffe Press and the leading medical journals had been broadly sympathetic to the LGB. But with the rapid increase in mortality, Newsholme’s memo was seen as a case of too little too late. ‘It would have been better to lock the stable door before the escape of the horse,’ remarked The Times in a caustic editorial the following day.96 The Daily Mail was somewhat slower to join the attack, choosing instead to praise Newsholme’s decision to call a conference of medical and bacteriological experts. Rather than singling out the LGB or Newsholme for criticism, an editorial focused on the lack of bacteriological research, and differences of opinion as to the identity of the disease—a position that reflected the then medical consensus.97 While the tone of the editorial was measured, however, the paper’s news pages conveyed a very different message. ‘Stricken Homes, Girls Dead on Bridal Day’, announced an item recording the simultaneous deaths of two girls who worked in a warehouse at St Paul’s Churchyard and who had been due to be married the following day. Other news items included the report that

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1,400 police and 1,000 telephone operators were on the sick list, and that doctors and undertakers were ‘worked off their feet’.98 By the end of the month, however, both the Daily Mail and The Times were growing more critical of official complacency, and on 26 October The Times published a coruscating editorial headlined ‘A Serious Epidemic’.99 Two days later, The Times returned to the theme, arguing that the ‘real meaning of the present calamity is that steps must be taken to make somebody answerable for the nation’s health. It will then be possible to bring home the neglect and lack of foresight.’100 Although The Times criticised the authorities’ handling of the epidemic, when at the end of the month the Registrar General’s returns showed there had been 4,482 deaths from influenza in England and Wales the previous week and that there was no sign of the death toll declining, the first instinct of its medical correspondent was to seek to reinforce readers’ resolve by equating ‘resistance’ to influenza with ‘resistance’ to Germany. Though the official returns did not show any ‘sensible diminution’, neither did they show ‘any particularly marked increase,’ the correspondent argued: It is important to realize this and to see things in perspective, as a stout heart is a great safeguard in these days. Fear is certainly the mother of infection. To go about expecting influenza is to invite it. Such an attitude lowers one’s natural resistance to external enemies. The alarmists and defeatists are the allies of the epidemic.101 This was not an isolated opinion but appears to have reflected the consensus view of the British medical profession. Just as at the Royal Society of Medicine summit in November Newsholme had invoked the importance of ‘carrying on’, so a succession of doctors and medical experts now came forward to call for a greater show of civilian nerve. ‘Terror is a big ally of influenza, and if the public state of mind can be steered out of the channel of fright a long, long step will have been taken to conquer the epidemic,’ argued a doctor in a letter to the Manchester Guardian.102 Particular ire was directed at the publication of the weekly death returns and other alarming reports of flu

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fatalities. ‘We read in our daily newspapers the enormous fatalities due to the “influenza epidemic”,’ complained a correspondent to the BMJ. When epidemics occur deaths always happen. Would it not be better if a little more prudence were shown in publishing such reports instead of banking up as many dark clouds as possible to upset our breakfasts?103 If a conversation between three Army doctors overheard by a correspondent in the Daily Mail is any guide, such attitudes were also widespread in military medical circles. ‘A lot of cases are due to sheer panic,’ said one. ‘So much publicity has necessarily had to be given to the present epidemic that everyone more or less talks “flu”. The consequence is that people begin to imagine symptoms and frighten themselves and other people into a condition which renders the task of germs more easy. For of course it is an acknowledged fact that the mental state affects the rest of the body.’104 One result of the intensification of the contradictions inherent in the medical and propaganda discourses was to undermine the rhetorical strategy that had served to regulate emotional responses during the early phase of the pandemic. This was especially the case in late October as the death toll from influenza mounted, prompting panicked scenes outside chemists and doctors’ surgeries. As undertakers struggled to cope with the demand for burials, and the victims of influenza and pneumonia began to crowd out the names of the war dead in the obituary columns of The Times, ‘flu’ could no longer be mocked. Instead, the dread that had once been directed at Germany increasingly became attached to the epidemic, destabilising the propaganda discourses and deflecting relief at the news that the Armistice was imminent. As Caroline Playne noted in her diary on 26 October:

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Influenza is very bad in places. In trains and trams the depression shown on travellers’ faces was very noticeable and talk was all about specially sad cases of death from influenza. A sense of dread is very general. Some who, one knows, are anxious for peace, say they dread to think it may come.105 For a pacifist such as Playne this was a depressing turn of events. It had been her hope that the influenza pandemic would serve as a collective wake-up call, ‘a warning that it was high time to end the stress and strain of world belligerency’. Instead, she observed, it appeared to have had the opposite effect. The evil spirit that was abroad seems to have used the influenza epidemic as a means of exciting undefined dread and distracting men from being any way keen on making peace.106 The Manchester Guardian’s London correspondent noted a similar pathology at work, observing that people were ‘fighting shy of theatres and kinemas [sic] and all kinds of meetings’: People generally are scared and the crowds besieging the doctors’ surgeries and chemists’ shops included a good many who think they may be going to have influenza.107 Yet at the same time as Londoners seemed to be panicked by influenza, the correspondent reported that news of the AustroHungarian peace offer had been met by Londoners with characteristic ‘phlegm’. The result was that a foreign visitor to London had heard more about ‘the certainty of influenza than about the prospects of peace’. However, he argued, this stoicism was a mask. ‘People are afraid, even at this half-past eleventh hour, to let their thoughts rest on peace,’ he explained.108 It was only with the declaration of the Armistice on 11 November that, according to Playne, letters from readers concerned about the epidemic began to ‘crowd out letters demanding vengeful, retaliatory punishment of Germany’ and that something like rationality

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returned to public discourse.109 For all its anti-German posturing, even the Daily Mail noted how the Armistice had acted as a ‘wonderful tonic’, coming to the aid of doctors and patients battling influenza. ‘The fear of influenza has vanished from the public mind,’ the paper declared. ‘Patients suffering from it are being cured by the best of all remedial agents, cheerfulness.’110 *** Medical historians have long been baffled by absence of pronounced social and emotional responses to the 1918 – 19 pandemic. Instead of focusing on the social responses, I have taken an emotionological approach, one that puts emotion words, emotives and metaphors at the heart of my analysis. Rather than seeing the pandemic as ‘overshadowed’ by the war, I have sought to understand how the regulation of emotional responses to the pandemic was governed by the political and medical discourses that prevailed at the time and the deployment of words, phrases and metaphors designed to elicit stoicism, hatred and dread. Taking Wilfred Owen’s disdainful response to Spanish flu as emblematic of British attitudes in the summer of 1918, I have argued that Owen’s stoicism was largely performative, an emotional ‘style’ that conformed to official propaganda scripts and then medical theories of psychopathology and male traumatic responses to war. For Owen, deprecating influenza was of a part with his self-image as a member of the officer class and a recovering neurasthenic—a psychiatric diagnosis that allowed him to glorify his experience of war while denigrating enlisted men’s responses to flu as a form of hysteria. Similarly, for British civilians who had endured five years of deprivation punctuated by frightening Zeppelin raids on the Home Front, ‘cheerful’ disdain of flu was a way of maintaining unity in face of the continuing German threat while avoiding deeper political and psychological introspection about the purpose of the belligerency. However, the maintenance of stoicism and civilian ‘staying power’ came at a cost, requiring the amplification by the Northcliffe press of negative emotions in which acceptance of the brutality and trauma of

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war was achieved at the expense of fostering hatred and dread of Germany and other ‘foreign’ threats to the political and social body. As a protean Janus-like disease that manifests as alternately benign and plague-like, influenza has an unusual ability to subvert biopolitical discourses. This can clearly be seen in the statements issued by the LGB and the articles by medical correspondents immediately before and during the worst weeks of the pandemic. Thus, at the same time as some medical commentators sought to downplay the threat of influenza, others sought to impress upon patients the dangers of the respiratory complications of flu. Indeed, in the absence of vaccines and other forms of biomedical prevention, it made sense for young adults to dread the cyanosis and fatal pneumonias associated with the Spanish flu—hence the stress placed by medical officers and medical correspondents on personal hygiene and social distancing measures. Drawing on the diaries and observations of the cultural historian Caroline Playne, I have sought to show how wartime propaganda discourses encouraged the cultivation of stoicism at the expense of other emotional scripts. However, in the final weeks of the war it appears that the emotions of hatred and dread that had been so important to the maintenance of civilian morale and the stifling of domestic dissent were displaced onto a new narrative object, the flu. In this respect, biopolitical discourses around the pandemic can be seen as what Foucault calls a ‘point of resistance’ to the dominant propaganda discourses. These tensions were most apparent in wartime advertisements for products such as Bovril that drew on patriotic tropes and then medical theories of ‘nervous force’ while, at the same time, seeking to exploit consumer fears of exogenous threats to the body. However, they also manifested in the editorial pages of The Times and Daily Mail—papers that, during the early years of the war, had been crucial to the propaganda effort and the maintenance of civilian morale. Initially, Northcliffe’s papers had downplayed the threat of Spanish flu. Instead, echoing Newsholme’s message to ‘carry on’, they had drawn on pre-modern notions of psychopathology according to which the imagination could act on the body so as to make it

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more susceptible to infection, hence the importance of cultivating fortitude and resilience as a way of boosting civilian ‘staying power’. However, by emphasising the role of positive emotions these discourses could not help but draw attention to the assumed pathological role of negative emotions such as hatred, fear and dread, underscoring the extent to which these emotions had now themselves become objects of epidemiological regulation. The result was that as the death toll from influenza mounted and dread of the disease increased, so the ‘resistances’ in these discourses became increasingly apparent, destabilising both the flow of biopower and the wartime propaganda effort. Although historians cannot directly access past emotional experiences and therefore can never ‘know’ what the emotion of dread felt like in 1918, by adopting an emotionological approach we can at least analyse the discourses governing the deployment of dread and other emotional words and phrases, and seek to understand how metaphors and emotional utterances may have served to repress or intensify certain emotional states. Moreover, by recognising that emotives are not merely passive objects of discourse but can also act on and shape the emotional objects to which they refer, my approach brings out the way in which emotives interact with discourse, sometimes reinforcing and at other times highlighting ambivalences and contradictions in and between different discursive regimes. This was nowhere more apparent than in the autumn of 1918, when the tensions between the propaganda discourses and biopolitical discourses reached breaking point.

CHAPTER 7 `

THE FORGOTTEN' PANDEMIC: FLU, TRAUMA AND MODERN MEMORY

In his meditation on World War I (WWI) and ‘modern memory’, Jay Winter draws attention to the way that, by applying to the past a paradigm of ironic action, ‘a rememberer is enabled to locate, draw forth, and finally shape into significance an event or moment which otherwise would merge without meaning into the general undifferentiated stream’.1 In this way, he argues, men who survived the senseless killing on the Somme and other WWI battlefields were able to find a literary register in which to give voice to their loss of innocence and disillusion at the myth of the ‘Great War’. In a leading article that coincided with the publication of the Ministry of Health’s Report on the Pandemic, The Times evoked a similar sense of ironic detachment to make sense of what it saw as people’s failure to register the enormity of the death toll from the Spanish flu. The difference was that here the ironic detachment was provided by the temporal juxtaposition between the flu and the war itself, as well as by the impossibility of imagining death on such an epic scale. ‘So vast was the catastrophe and so ubiquitous its prevalence that our minds, surfeited with the horrors of war, refused to realise it,’ asserted the anonymous leader writer:

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[Influenza] came and went, a hurricane across the green fields of life, sweeping away our youth in hundreds of thousands and leaving behind it a toll of sickness and infirmity which will not be reckoned in this generation.2 In both cases, irony is seen as a psychological response to trauma, a way of protecting the psyche against individual and shared memories that are considered too painful to recall. This notion that the 1918– 19 pandemic was a collective ‘trauma’ that has somehow been ‘forgotten’ or erased from modern memory because of its proximity to WWI is central to the historiography of the Spanish flu—hence Johnson’s characterisation of the flu as an ‘unregarded’ killer and a ‘bit player in . . . the larger story of the Great War’.3 Other factors cited by Johnson include the flu’s rapid onset and equally rapid departure (the three waves of the pandemic were concentrated in an 11-month period from May 1918 to April 1919); and the difficulty of imagining deaths on such a ‘scale’, a point I will return to later.4 This characterisation of the ‘forgotten’ pandemic is hardly surprising when one considers the centrality of trauma to modern thought and psychological conceptions of memory. Writing at the beginning of a century that opened with the ‘collective American trauma’ of the 2001 terrorist attacks on the World Trade Center and Pentagon, and which was preceded by two world wars and the Holocaust, this notion of trauma has become so naturalised, so much a part of everyday cultural discourse, that we have forgotten that trauma also has a genealogy. As Ian Hacking and others have argued, memories have not always been thought of as painful, nor have they always been objects of forgetting and repressing. Trauma, or the notion that that which is painful to recall is central to the formation of personality, is very much a product of the late nineteenth-century sciences of memory.5 In its original medical incarnation, trauma was conceived of as a bodily wound, a type of whiplash that, although invisible to anatomists, could result in a condition known as ‘railway spine’ for which plaintiffs injured in railway accidents could seek redress via the courts. From the spinal column, trauma migrated to the nervous system, becoming an

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explanation for hysteria and other psychogenic symptoms in otherwise physically undamaged individuals. The result was that by the 1880s trauma already encompassed the notion that bad events could leave invisible but indelible traces on the mind—or the ‘soul’ as Hacking prefers to call it—so that ‘instead of the remembering being what affected us, it was the forgotten’.6 In this sense, trauma was already both a theory of mind and a historical methodology-inwaiting. The final, some would say decisive, move came with the emergence of theories of the ‘traumatic neuroses’ in the late nineteenth century that transferred the concept of trauma from the physical to the psychological realm and then, under the influence of Freud, internalised trauma to the psyche itself.7 The result was that trauma was no longer that which had simply been forgotten but that which had also become ‘repressed’ and opaque to consciousness. Although Freudians and other schools of psychiatric and psychoanalytic thought now differ as to the precise source of these psychic traumas, today traumatic metaphors thoroughly colour the way that historians approach the past. In fields as diverse as Holocaust studies and accounts of ‘recovered’ memories of past childhood sexual abuse, repressed or reticent memories are commonly invoked as evidence of the ‘unspeakable’ or the ‘unwitnessable’.8 Violence perpetrated on individuals or groups of individuals may not always enter collective memory, but such memories are always traumatic, runs the theory, and they always leave traces. The task of the historian therefore becomes to rummage in the archive, much as the psychoanalyst rummages in the psyche, in search of these repressed or painful-to-recall memory traces—traces that, once found, will serve to corroborate the originating act of violence. In this way, write Fassin and Rechtman, ‘suffering establishes grounds for a cause; [and] the event demands a reinterpretation of history’.9 However, this approach arguably reveals more about present-day theories of mind than it does about the past, for by adopting psychological metaphors of trauma as a historical methodology we arguably change our relationship to time and to history itself. As Fassin and Rechtman put it, the pervasiveness of trauma narratives means that we ‘live time differently’ today. ‘Our relationship to history has turned tragic.’10

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In this chapter, I probe the consequences of applying these tragic readings of history to the 1918 – 19 pandemic. In so doing, my aim is to show how influenza destabilises both psychological theories about the traumatic basis of memory and historical methodologies in which notions of social amnesia and trauma are routinely deployed to reveal subjective ‘truths’ about the past. My principal witness will be Virginia Woolf, who suffered repeated attacks of influenza throughout her life, including immediately prior to and during the pandemic. These attacks and her responses to them were noted in her diaries and letters to friends and family. Moreover, in 1925, following a particularly vivid episode of influenza, Woolf was inspired to write On Being Ill, one of the most well-known perorations on the nature of illness in the English language. Far from regarding the flu as traumatic, Woolf appears to have drawn literary inspiration from the experience. At the same time, she appears to have paid scant heed to the 1918 –19 pandemic, mentioning it just four times in her diaries, and then only in passing.11 No one who has read Woolf closely can doubt that illness—and mental illness in particular—was central to her literary aesthetic and to her sense of self.12 To the extent that the symptoms of influenza resembled and overlapped with other forms of nervous disorder, a diagnosis of flu could—and frequently was—invoked by Woolf as an acceptable label for diverse physical and mental symptoms that risked being pathologised by her doctors. Throughout her life, Woolf was plagued by disturbing mental symptoms ranging from depression to mania and flights of euphoria. These symptoms were frequently accompanied by nervous breakdowns and a fearful ‘apprehension’ (Woolf’s word) such that on at least four occasions she was driven to attempt suicide, before succeeding on her fifth attempt in 1941.13 However, Woolf’s illness could also take the form of exhaustion or a rapid pulse rate, or could manifest as headaches, backaches, flu, ‘fidgets’ and a high temperature. During these episodes Woolf was often bedbound for weeks, displayed a reluctance to eat, and suffered severe fluctuations in weight. Not surprisingly, Woolf and her husband Leonard canvassed a wide spectrum of medical and psychiatric opinion in search of an explanation for her

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condition, leading to her being diagnosed as variously a ‘neurasthenic’, a ‘manic-depressive’ and a ‘self-destructive masochist’.14 This attempt to ‘read’ Woolf’s mental pathology has continued since her death, with a succession of biographers variously labelling Woolf as a Freudian neurotic with an unhealthy preOedipal attachment to her mother or the victim of incest and childhood sexual abuse, to name but two of the most common explanations.15 However, in life and in her writing Woolf resisted the attempt to reduce her symptoms to convenient psychiatric and psychoanalytic categories. Despite recalling how she had been abused at the age of six or seven by her step-brothers George and Gerald Duckworth, for instance, Woolf never consulted a psychoanalyst, apparently fearing that Freud’s ‘talking-cure’ would destroy the source of her creativity. Her unhappy experience of being treated by George Savage, the leading Victorian exponent of the hereditary theory of the neuroses, who insisted on feeding her copious amounts of milk while banning her from intellectual activity, also instilled a deep distrust of Victorian psychiatry and its tendency to moralise mental illness—hence her thinly veiled attack on Savage in her novel Mrs Dalloway.16 Finally, Woolf is regarded as one of the foremost literary figures of the twentieth century, a writer whose novels marked the end of the realist novel and who inaugurated a new modernist stream-ofconsciousness style. Woolf’s novels are also centrally preoccupied with the problem of memory and the ‘truth’ or otherwise of subjective representations of the past. Furthermore, in her reflections on influenza, Woolf specifically grapples with this problem in relation to the phenomenology of suffering and its resistance to narration. Thus, in both her life and work Woolf can be said to encompass and exemplify the challenges that illness and other types of subjective experience in the past present to narrative and memory.

The ‘Present Moment’ In ‘A Sketch of the Past’, the essay that Woolf wrote just two years before her suicide at the age of 62, Woolf recalls how at the age of six

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or seven her step-brother Gerald Duckworth lifted her onto a ledge and groped her private parts. Woolf tells us that she resented and disliked the experience, and that this feeling was instinctive (elsewhere, she speaks of how the memory of his sexual attentions make her ‘shiver with shame’).17 In other words, it would seem to be an example of what Woolf called a ‘moment of being’—hence her ability to recall the experience many years later.18 Yet, as her biographer Louise DeSalvo points out, in recalling this formative childhood experience Woolf forgets to mention that at the time Duckworth molested her she was recovering from a severe bout of whooping cough. Indeed, according to DeSalvo, the illness, which affected all the Stephens children, was so life-threatening that Woolf, who was sickest of all, did not leave the nursery at St Ives for five or six weeks and suffered up to 24 coughing spasms a day.19 One possible explanation is that, for Woolf, illness was an example of ‘non-being: ‘I had a slight temperature last week; almost the whole day was non-being.’20 However, DeSalvo argues that precisely the reverse is true, and that the real significance of her first memory— lying in bed hearing the waves, being grateful for her continued existence—‘can only be fully comprehended given her near death experience and the abuse which came so soon after’.21 Furthermore, DeSalvo goes on to speculate that the fact that Woolf was molested so soon after a life-threatening illness may have led her to forever associate illness with her repressed memories of childhood sexual abuse. Any illness must have reawakened her panic, her sense of vulnerability, and her feelings of disintegration. I believe that this is why Woolf’s physical illnesses—her bouts of flu, for example—were so often accompanied by panic, depression, and a deeply felt anxiety and why her suicidal feelings were sometimes the sequelae to her physical illnesses’.22 By importing a traumatic explanation to Woolf’s memories of her childhood sexual abuse, DeSalvo thus succeeds in traumatising everything around it, including Woolf’s ‘forgotten’ (because,

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presumably, repressed) memory of whooping cough. The result is that any subsequent illness, such as her frequent bouts of flu, can now be seen as psychological triggers for these formative memories of childhood sexual abuse—memories that, because they are blocked and give rise to psychic conflicts, find expression in symptoms of panic, anxiety and depression. The problem with such a reading is that it is not supported by Woolf’s own account of her many illnesses or by her imaginative engagement with influenza. On the contrary, I will suggest it reverses the actual causality. Although Woolf may have ‘forgotten’ her childhood experience of whooping cough, her diaries and letters show an obsessive preoccupation with illness as an almost quasi-mystical experience.23 In particular, her writings betray a fascination with the nervous symptomatology of influenza. This is not, I suggest, because influenza reminds her of a repressed childhood trauma, but because of the way that Edwardian psychiatric medicine constructed influenza as a somatic nervous complaint, one that drew on other forms of nervous illness and which, in Woolf’s mind at least, offered a plausible biological explanation for her recurrent disturbances. Indeed, far from forgetting influenza, Woolf appears to have gone to great lengths to recall her bouts of flu and to describe their phenomenology. Crucially, Woolf is not interested in flu’s effect on the world but in how it changes her view of reality. In other words, she is not interested in the ‘social life’ of flu so much as her subjective experience of the disease. However, even for an artist of her powers, she recognises there is something about influenza that evades language. ‘English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache,’ she laments in ‘On Being Ill’. ‘It has all grown one way.’24

‘A Mix Up of Influenza with My Own Remarkable Nervous System’ Woolf’s diaries provide ample evidence for how she tended to connect influenza and other forms of physical stress to mental breakdown. ‘How are you?’ she asks Vanessa Bell in January 1918.

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‘Influenza, [Dr] Craig told me, poisons the nervous system, and nourishment is the only way to get rid of it.’25 A few weeks later she returns to the theme, writing to Bell that ‘I wish I could impress on you some of the remarks about influenza and the nervous system which I had to hear every day from [Dr] Fergusson’.26 During her life, Woolf consulted at least 12 doctors—Maurice Craig, a neurologist, and Dr Fergusson, a heart specialist, were only two of them. However, like Savage, who had diagnosed Woolf as a neurasthenic and who, following her suicide attempt in 1913, Leonard Woolf had come to distrust, they shared Edwardian psychiatry’s belief in the somatic basis of insanity. According to this view, mental illness was a nervous complaint resulting from excessive physical or mental strain to a weakened system, whether that strain was due to infection with influenza, pneumonia or some other extraneous biological agent, or to excessive intellectual work or exposure to ‘depressing influences’. Similarly, irregularities in bodily functions, such as an intermittent pulse or high temperature, could also add to the ‘strain’ on an overtaxed nervous system and trigger mental disturbances. The then orthodox ‘cure’ was rest coupled with a fortifying diet. This cure had been popularised by the American neurologist Silas Weir Mitchell in the United States in the 1870s and taken up enthusiastically by Savage—hence his insistence that Woolf disengage from all intellectual activity and submit to a diet rich in milk and protein. Although Woolf came to detest Savage’s regimen, there is good evidence that she and Leonard accepted the somatic basis of her illness and incorporated the notion of emotional and nervous strain into their medical belief system. As Leonard recorded in his memoirs: If Virginia lived a quiet, vegetative life, eating well, going to bed early, and not tiring herself mentally or physically, she remained perfectly well. But if she tired herself in any way, if she was subjected to any severe physical, mental, or emotional strain, symptoms at once appeared which in the ordinary person are negligible and transient, but with her were serious danger signals.27

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These symptoms included a ‘peculiar “headache” low down at the back of the head, insomnia and a tendency for the thoughts to race’.28 As Woolf herself avows, they could also include ‘jumping pulse, aching back, frets, fidgets’.29 Although Woolf liked to satirise Edwardian doctors’ recourse to nervous terminology, Hermione Lee argues that Woolf’s writing was imbued with ‘nerve’ talk, and that it was through the language of nerves that Woolf made sense of her shifting mental states.30 One of the clearest examples of Woolf’s adoption of nervous terminology comes in 1922. No sooner had the new year dawned than Woolf suffered an attack of influenza. The illness kept her confined to bed for a fortnight, and it was the third week of January before she felt well enough to resume her diary and correspondence. As usual, the flu had left Woolf weakened, and with the nagging fear that it could be the prelude to another of her manic-depressive episodes. ‘Writing is like heaving bricks over a wall,’ she confesses in a letter to E. M. Forster on 21 January 1922. ‘. . . I’m shivering on the brink, and waiting to be submerged with a horrid sort of notion that I shall go down and down and down and perhaps never come up again’.31 A few months later she confides in Violet Dickinson about her consultation with a ‘nice . . . but rather severe’ doctor called Salisbury who has advised her against travelling to Italy on the grounds that ‘my old intermittent pulse had rather tired my heart, and the influenza had made this worse’.32 The month of May finds her suffering ‘another attack of influenza, which has again made my heart wrong’.33 But it is in a letter the following September that Woolf makes plain the extent to which nervous terminology now informs her thinking about her recurrent bouts of ill-health. ‘Now I will plunge into my medical history— only it is so long and various that I must curtail,’ she begins her letter to Janet Case. Only one dr says my right lung is wrong: upon which the other says it is perfectly all right: they compromise now upon pneumonia germs in my throat, which are said to cause slight fever. Last week however, getting wet, I had flu again—but a

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slight attack, and I feel none the worse and in my view the whole thing is merely a mix up of influenza with my own remarkable nervous system, which, as everybody tells me, can’t be beaten for extreme eccentricity, but works all right in the long run.34 Note that it is the ‘extreme eccentricity’ and ‘remarkable’ nature of her nervous system that Woolf stresses. Lee suggests that one reason Woolf may have been attracted to somatic explanations of her illness is that it allowed her to evade feelings of guilt and shame about the sources of her mental disturbances. At the same time, the language of nerves can be seen as appealing to her snobbish prejudices, according to which some nervous systems, such as hers, can be constructed as more refined and sensitive than others.35 However, Woolf also attempted to move beyond such nervous terminology and find her own way of describing and explaining her symptoms. Crucial to this project was the way in which she saw illness not so much as a curse as an aesthetic gift. As she put it in her diary: Once or twice I have felt that odd whirr of wings in the head which comes when I am ill so often . . . I believe these illnesses are in my case—how shall I express it?—partly mystical. Something happens in my mind. It refuses to go on registering impressions. It shuts itself up. It becomes chrysalis. I lie quite torpid, often with acute physical pain. . . Then suddenly something springs . . . ideas rush in me; often though this is before I can control my mind or pen.36

‘Novels, One Would Have Thought, Would Have Been Devoted to Influenza’ These lines were written in 1930, her most fruitful literary period when she was in the midst of drafting The Waves and was basking in the literary acclaim that had followed the publication of To the

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Lighthouse (1927) and Orlando (1928). It also came four years after the publication in the New Criterion of ‘On Being Ill’, an essay that she had been moved to write when she fell ill while struggling to complete Mrs Dalloway. Woolf had retired to her sickbed in the first week of October 1925, and had spent the next eight weeks confined to her room with few visitors. When she resumes her diary in late November she makes no reference to her symptoms, other than to tell us that she has lain ‘prostrate half the day’ and has been tormented with thoughts of her inadequacies as a writer.37 However, the essay strongly suggests that once again Woolf had been ill with influenza or, if not influenza, then a disorder that she imaginatively associates with the flu. As she declares halfway through the essay: But to return to the invalid. “I am in bed with influenza”—but what does that convey of the great experience; how the world has changed its shape . . . the whole landscape of life lies remote and fair, like the shore seen from a ship far out at sea.38 The essay presents illness as a mystical and almost sublime experience, one in which the mind has direct access to the phenomenology of the body. ‘Considering how common illness is, how tremendous the spiritual change that it brings,’ Woolf thinks it ‘strange . . . that illness has not taken its place with love and battle and jealousy among the prime themes of literature’. Novels, one would have thought, would have been devoted to influenza, epic poems to typhoid, odes to pneumonia; lyrics to toothache. But no; with a few exceptions . . . literature does its best to maintain that its concern is with the mind.39 These passages may strike those familiar with Woolf’s frequent complaints about the effects of illness on her writing as disingenuous. After all, how can you write anything when you are delirious with fever, or afterwards when you are exhausted and drained? And yet elsewhere in her diaries, as has already been noted, Woolf invokes illness as an inspirational experience, one that reveals sensations and

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imaginings that are inaccessible to her in the world of the healthy, and in which her imagination is released to engage directly with the body and its sensations. In this sense, ‘On Being Ill’ can be seen as that rarest of artefacts—a patient’s account of illness unmediated by medical authority.40 Like John Donne’s famous peroration on illness, Devotions Upon Emergent Occasions, Woolf’s musings on pain and suffering seem to speak directly to readers in the present, demolishing the barriers that time and changing theories of body and mind erect between patients in different historical periods.41 One of the most notable features of Woolf’s essay is the way that it challenges the reader to engage with her illness experience outside of preconceived medical and diagnostic categories. Instead, in long looping sentences, punctuated by diverting sub-clauses and whimsical asides, Woolf tries to invoke in the reader something of her own aesthetic experience. The reason that novels have not been devoted to influenza, she thinks, is that ‘people write always of the doings of the mind’. The result is that, ‘those great wars which the body wages with the mind a slave to it, in the solitude of the bedroom against the assault of the fever or the oncome of melancholia, are neglected’. The challenge for a writer then, is how to convey the experience of ‘this monster, this body, this miracle, its pain’ without slipping into mysticism.42 Prose, she believes, is not up to the task. This is partly down to readers’ expectations of what constitutes an appropriate subject of narrative. ‘The public would say that a novel devoted to influenza lacked plot; they would complain there was no love in it.’ Woolf thinks this is wrong, however. Invoking the image of a delirious invalid lying in bed listening for the creak of her lovers’ footstep on the stairs, she asserts that ‘illness often takes on the disguise of love, and plays the same old tricks’.43 Nevertheless, she acknowledges that poetry is a far better medium with which to capture the phenomenology of illness. In short, she argues, illness imbues words with ‘a mystic quality’ and invests everyday sights and sounds with an extraordinary vividness. Far from shutting down the flow of words, she argues, illness frees the imagination and inspires new forms of artistic expression.

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‘We Are, by the Way, in the Midst of A Plague’ Reading Woolf’s response to illness on her terms and in the language in which she tried to make sense of her symptoms begins to explain what, at first glance, looks like a curious disinterest in the pandemic raging around her. Woolf’s references to the Spanish flu in her diaries are brief and fleeting. The first mention comes on 2 July 1918 in an almost throwaway line at the end of an entry recounting an unwelcome visit by relatives, and her efforts to get Katharine Mansfield’s story Prelude published by Hogarth Press. ‘My hand shakes no longer, but my mind vibrates uncomfortably,’ she begins the entry, before signing off a dozen lines later with the casual information that ‘Influenza, which rages all over the place, has come next door.’44 The same characteristic mix of detachment and dread is evident in the second entry eight days later, where, after recounting a discussion on the prospects of peace, she signs off with the gloomy news: ‘Rain for the first time for weeks today, & a funeral next door; dead of influenza.’45 A few months earlier, of course, Woolf had herself been bedridden with flu, but she seems to draw no parallels between the deaths then occurring around her and her own recurrent bouts of illness. One is tempted to say that flu is so familiar to Woolf, something that she associates so closely with her own ‘eccentric’ nervous system, that for once her imagination fails her. Or perhaps it is that she has no interest in connecting with ordinary people’s experience of the disease? Whatever the case, she does not appear to regard the deaths from the Spanish flu as either notable or particularly traumatic. A similar disregard is apparent in her final reference to the pandemic on 28 October, where after a lengthy discussion of Lytton Strachey’s treatment for a swollen finger she mentions that he is avoiding London because of the influenza. As afterthought, she adds in parentheses: (we are, by the way, in the midst of a plague unmatched since the Black Death, according to the Times, who seem to tremble lest it may seize upon Lord Northcliffe, & thus precipitate us into peace).46

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What is striking about this aside is how disinterested Woolf is in the notion that she is in the midst of a plague that leading commentators are comparing to the Black Death. Rather, in an echo of Caroline Playne’s observation about how the deaths from influenza in October fed into the generalised dread after nearly five years of fighting, her suggestion seems to be that The Times has been deliberately talking up the threat in a bid to forestall the peace negotiations. A few days later she returns to the subject, but only to use it as a device with which to criticise another’s writing: ‘How I dislike writing directly after reading Mrs H Ward!—she is as great a menace to health of mind as influenza to the body.’47 Woolf’s last reference to the Spanish flu in her diaries comes in the middle of December and is similarly dismissive, noting simply that the epidemic ‘seems to be over’.48 Even more striking is the fact that her letters do not contain any references to the pandemic. Nor, with the exception of Mrs Dalloway, does the pandemic feature in her fiction. Woolf began Mrs Dalloway in 1922, shortly after an attack of influenza and nervous depression, marked by the usual symptoms of racing pulse, heart murmurs and racking pains, and completed it in 1924. The novel covers one day in the life of Clarissa Dalloway, an upper-class London housewife, as she prepares for a party that she will host that evening, and intercuts between her point of view and that of a young WWI veteran, Septimus Smith, who is recovering from shell shock. In the novel Woolf experiments with a stream-ofconsciousness style, chronicling the interior thoughts of her characters with little pause or explanation. One of the novel’s central preoccupations is with death and the moments of being when the veil parts and a person sees reality, and their place in it, clearly. Thus in the first pages of the novel, at the start of her day, Clarissa goes out to buy flowers for her party and remembers a moment in her youth when she suspected a terrible event would occur. It is June and the war is over, but as Woolf describes it Clarissa experiences ‘a particular hush, or solemnity; an indescribable pause; a suspense (but that might be her heart, affected, they said, by influenza) before Big Ben strikes’.49 As the clock strikes,

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she seems to have an epiphany—that she loves life and loves London in this moment in June—and as the day goes on she repeats a line from Shakespeare’s Cymbeline over and over: ‘Fear no more the heat o’ the sun/Nor the furious winter’s rages.’ The line is from a funeral song that celebrates death as a comfort after a difficult life, and indicates that death is very much in her thoughts. However, it is not the deaths from influenza that haunt her but the devastation wrought by the war and the effect this has had on her perception of her mortality. The words also foreshadow the death at the end of the novel of Clarissa’s double, the veteran Septimus, who repeats them before he commits suicide, and as Clarissa meditates on the lines throughout the day we come to realise that the war has affected a permanent shift in people’s attitudes to death. Although Woolf’s drafting of the novel coincided with repeated bouts of flu and nervous illness—and mental illness is a major theme of the novel—flu is not. On the contrary, the pandemic appears to be incidental to the novel’s preoccupation with war and death.

Validating Traumatic Memory Woolf was not the only British writer to find the pandemic an uninteresting subject for fiction. Although William Clunie Harvey made the flu a central plot device in his 1938 detective novel, The Influenza Mystery, there are few examples of major post-war British authors taking up the theme.50 Nor does the Spanish flu feature in many post-war memoirs. The principal exceptions are Vera Brittain, Robert Graves and Anthony Burgess. In Testament to Youth, her bestselling autobiography of the war years, Brittain recalls succumbing to a ‘bug’ in January 1918 en route from Boulogne to London to be reunited with her brother, Edward. However, while Brittain informs us that she spent the next ten days in London in bed, she does not say that the ‘bug’ was definitely influenza. Her descriptions of soldiers in the throes of pneumonia at Etaples, the military hospital camp in northern France where she served as a nurse in the winter of 1917, are rather more descriptive. However, even in these cases her focus is on individual cases of suffering and the

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transformative effect of pneumonia on personality rather than on the disease as a social phenomenon.51 Similarly, in his autobiography, Goodbye to All That, Graves mentions the death of his mother-in-law from the Spanish influenza in July 1918, followed by his own illness in February 1919. The flu attack appears to have been serious, as on arrival in Brighton Graves was informed he had double septic pneumonia and had ‘no hope of recovery’.52 However, his flu does not trigger deeper reflections about his own mortality or his part in the pandemic. Rather, Graves collapses his illness into an amusing anecdote describing his evasion of the military authorities in Northern Ireland and his subsequent demobilisation in southern England. ‘Having come through the war, I would not allow myself to succumb to Spanish influenza,’ he writes.53 Only Anthony Burgess connects the pandemic to what could be characterised as a ‘traumatic’ memory. This may be because, unlike Brittain and Graves who were both adults, he was a baby at the time of the pandemic, and associates the flu with the death of both his mother and sister. Thus in his memoir, Little Wilson and Big God, Burgess recalls how in 1919 his father returned on furlough to the family house in Manchester to find his wife and daughter dead: The Spanish influenza pandemic had struck Harpurhey. There was no doubt of the existence of a God: only the supreme being could contrive so brilliant an afterpiece to four years of unprecedented suffering and devastation. I, apparently, was chuckling in my cot while my mother and sister lay dead on a bed in the same room.54 At first glance, Burgess’s memory fits Winter’s paradigm of ironic action: it is the juxtaposition of his mother and sister’s death with the end of the war—a period of ‘unprecedented suffering and devastation’—that lends his childhood memory significance. But could Burgess, who was just one at the time, really have had direct recall of the moment? Even if he did recall the event it is unlikely he remembered ‘chuckling’ in his cot, hence his interjection of the word ‘apparently’. Rather than being what Woolf calls a ‘moment of

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being’, this seems to smack of the reconstruction in adulthood of something that Burgess thinks he ought to have remembered. In other words, it is an event that only took on ‘ironic’ significance in retrospect. This sense of ironic juxtaposition is also commonly evoked by other childhood survivors of the Spanish flu whose memories have been solicited by social historians decades after the event. Often, these survivors will inform the interviewer that the flu is an experience that is seared in memory. But once they have recalled the prosaic details of their illness, it is the war and the generalised sense of suffering that seems to lend their memories vividness. ‘I can remember having a very high temperature and we were all delirious, having terrible nightmares,’ Dorothy Jack, who was ten at the time of the pandemic, informed the British social historian Richard Collier in 1973: There was too the awful feeling of complete prostration. None of us, however, had any real complications and we gradually returned to normal. . . It was an extension of all the sadness of the casualties of war.55 Similarly, writing from Coventry in 1973, Ethel Robson informed Collier how at the age of nine she was suddenly thrust into the role of sole caregiver for her family when her eight siblings contracted flu. Most of Robson’s siblings recovered, but on 3 November 1918 her seven-year-old sister died, followed two days later by Robson’s mother. ‘I would like to tell you I am 64 years of age now but that period of my life I will never forget,’ she tells Collier. In this case, perhaps, Robson can be given the benefit of the doubt. However, it is significant that her clearest childhood memory is not of her mother and sister’s deaths but of the double funeral held six days later on Armistice Day. The funeral, she recalls, ‘caused quite a sensation’: I can remember very well when the corte`ge was on its way to the church. Bells, hooters and all sounds of celebration. It was raining but how silent people stood who realised it was our

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funeral. It really was a terrible time not knowing who we were going to lose next.56 As with the recollections of other childhood survivors, the memory only appears to come alive—to acquire emotional significance—from its ironic juxtaposition with the Armistice. Of itself, the flu does not appear to be associated with a particular sense trace. In Chapter 6, I suggested that there may have been special reasons, particular to the conditions prevailing on the Home Front in Britain during the war, why the Spanish flu was so lacking in emotional colour in 1918. In contrast to the 1890s, when news of the Russian epidemic had been widely broadcast and the flu had become a cause of sensation, in 1918 nervous discourses were deprecated for fear that they might undermine civilian resolve and erode British ‘staying power’. In this account, stoicism overrode the ‘normal’ emotional responses to the flu. However, the pandemic’s resistance to recall can also be seen as a problem of scale. As The Times leader cited at the outset of this chapter put it, the ‘catastrophe’ was simply too ‘vast’. In 1919, of course, The Times was estimating that a total of 6 million people had perished in the pandemic worldwide. Since then the toll has become even more difficult to imagine, with the latest estimate putting the global toll at around 50 million.57 Suffering on such a scale, it has been suggested, is impossible to represent to memory. While the imagination can grasp the meaning of a single human calamity, deaths of such an order of magnitude cannot be imagined and evoke little emotion. As Albert Camus reflects in his novel about an outbreak of plague in a mythical North African town, ‘But what are one hundred million deaths?’ When one has fought a war, one hardly knows any more what a dead person is. And if a dead man has no significance unless one has seen him dead, a hundred million bodies spread through history are just a mist drifting through the imagination.58 In such circumstances, the enormity of the event renders individual experience irrelevant. To recover the individual story it is necessary to

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invest it with meaning and significance. In the case of the Holocaust this only became possible with the emergence of a public literature in the 1960s recalling the Nazis’ crimes and their deliberate destruction of European Jewry.59 These books validated the collective experience of Holocaust survivors, creating a social and political space in which it was not only possible for individuals to tell their personal stories but in which it was important that they do so. In the case of the 1918– 19 pandemic, there has been no equivalent moral imperative. Having said that, the renewed interest in the pandemic shown by environmental and social historians beginning in the 1970s did create a similar collective social space for remembering, one that validated the ‘traumatic’ memories of individual survivors.60 Such accounts tend to associate the pandemic with casual acts of forgetting—hence Crosby’s observation that ‘Americans took little notice of the pandemic, and then quickly forgot whatever they did notice’.61 For Crosby, as for Johnson, this absence of individual narratives was a function of the pandemic’s proximity to war, and the way in which it was overshadowed by the military losses. This phenomenon was exacerbated by the proliferation of public memorials to the fallen after the war, and the inauguration of public acts of remembering, such as the annual procession to the Cenotaph every Remembrance Sunday. In Britain in particular, these memorials to the war dead exacerbated the tendency, already apparent in 1918, to conflate the pandemic with the war and the Armistice. ‘This was “only flu” and, as such, may have been masked by the deep scars caused by the war and subsumed into the whole war experience,’ writes Johnson.62 The renewed historiographical interest and focus on the pandemic, however, has gone some way to off-setting this process, at last creating a public space where the trauma of the Spanish flu can be commemorated and remembered. The problem with this approach, of course, is that it is circular. It is the assumption of suffering that establishes the grounds for a cause, validating the reinterpretation of history. But what if for most people the Spanish flu was not particularly traumatic? What if, instead of it being forgotten, it was simply not sufficiently striking to be remembered in the first place? After all, although the pandemic

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affected 25 per cent of the population and the case fatality rate was unusually high, less than 1 per cent of the population actually died from flu. This is the paradox presented by a close reading of Woolf’s letters and diaries. For Woolf, the flu only seems to have been significant insofar as it drew on medical models of nervous illness and inspired her to flights of artistic expression. Certainly, nowhere in her writings does she connect her personal experience of flu with the collective experience and deaths of other influenza sufferers. At the same time, however, we cannot read Woolf’s accounts of her illness without recognising that they are also open to other readings. As Woolf herself avows, the things we do not remember because they do not strike us as exceptional at the time may be no less important than those things that do strike us as exceptional. In other words, we cannot discount the possibility that DeSalvo may be right to read Woolf’s obsession with disease in the light of the proximity of her sexual abuse to her illness from whooping cough. In this sense, Woolf’s memory of abuse and her non-memory of a life-threatening childhood infection stands in the same relation to her memory as the non-remembering of the Spanish flu does to the historiography of the pandemic and the war. In the end, it all comes down to what sort of history historians wish to write and what sort of metaphors they wish to employ.

CHAPTER 8 APOCALYPSE REDUX

On 1 April 2009, while much of the world was focused on avian influenza in South East Asia, HealthMap, an online information service that scans the internet for reports of unusual disease outbreaks, began tracking a ‘mysterious’ influenza-like illness in a village in central Mexico.1 According to a report in the Mexican press monitored by HealthMap, some 60 per cent of the villagers in La Gloria, in Veracruz, had been infected with the acute respiratory disease since March and two had died.2 Five days later, Veratect, a Seattle-based service that employs similar web-crawling algorithms to trawl the web for ‘chatter’ about emerging infectious diseases, also posted an item about the Veracruz outbreak.3 However, it was only on 10 April, when Canada’s Global Public Health Intelligence Network, which tracks reports of disease outbreaks on news wires and websites in seven languages, also picked up the report that the story went global. Within hours the report had been forwarded to the World Health Organization’s (WHO’s) Global Outbreak Alert and Response Network, resulting in alerts being sent to the WHO headquarters in Geneva and the Centers for Disease Control (CDC) in Atlanta.4 Those reports were the first indication that a new flu-like disease was circulating and it was not long before print and television news media were also pursuing the story. By the end of April, with the CDC affirming that a swab from a four-year-old boy in La Gloria had

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confirmed the presence of a new swine influenza A virus and that the same virus had also been isolated in two Californian schoolchildren, the 2009 swine flu panic was in full flight.5 As journalists descended on La Gloria to photograph the four-year-old—dubbed Mexico’s ‘patient zero’— and as authorities in Mexico City announced they were closing the city’s schools as a precaution, the WHO began issuing regular ‘alerts’ about the spreading morbidity.6 This process culminated on 11 June 2009 with the declaration by WHO DirectorGeneral Margaret Chan of a ‘phase six’ alert—the formal signal that a pandemic was underway.7 Speaking directly to a global television audience via a live satellite link from Geneva, she explained: No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness. According to Chan, the WHO’s epidemiological surveillance systems had given it ‘a head start’. However, while that put the WHO in a strong position, she also warned that it created ‘a demand for advice and reassurance in the midst of limited data and considerable scientific uncertainty’: Thanks to close monitoring, thorough investigations, and frank reporting from countries, we have some early snapshots depicting spread of the virus and the range of illness it can cause. We know, too, that this early, patchy picture can change very quickly. The virus writes the rules and this one, like all influenza viruses, can change the rules, without rhyme or reason, at any time.8 Chan’s characterisation of flu is striking, reflecting both the possibilities and limits of present-day scientific ‘knowledge’ of the virus. Unlike in the nineteenth century, when there were no diagnostic tests for influenza and many medical practitioners considered ‘flu’ a suspect diagnosis, in 2009 the WHO’s scientific

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advisors had no doubt that the Mexican outbreak was flu and that it was the harbinger of a pandemic. Not only had specimens tested positive for swine influenza A (H1N1) antigens, but using the latest molecular technology scientists at the CDC had been able to drill down into the virus’s genome and confirm that it was also a new subtype, comprising genetic segments from human, avian, and Eurasian and North American strains of swine flu. The appearance of such a ‘triple reassortant’ virus in the northern hemisphere during spring was highly unusual—as was the fact that the virus had emerged from an animal host in North America rather than in South East Asia, which was where most flu experts had been expecting the next pandemic to come from. A few years earlier, analysis of preserved autopsy materials from 1918 had enabled researchers to recreate the Spanish flu virus and establish that it was a highly pathogenic H1N1 virus containing largely avian-derived genes.9 The fact that the 2009 swine virus shared the same basic genetic code as the Spanish flu served to underline the parallels with 1918, when flu had also emerged in the northern hemisphere in the spring and early summer. If the 2009 swine flu followed the same pattern, the experts reasoned, the consequences could be catastrophic. One British scientist even raised the spectre of swine flu combining with the H5N1 bird flu virus to create an ‘Armageddon’ strain.10 Although most commentators drew parallels with 1918, a better model might have been 1890. Although the Russian flu emerged in Central Asia rather than North America, in 1890 there was no war raging as there would be in 1918, and no censorship to interfere with the transmission of news that might be considered unsettling to civilian populations. So, just as in 2009 the internet enabled subscribers of HealthMap and other disease-tracking sites to monitor the outbreak in La Gloria in something like real time, in 1890 the worldwide telegraph had ensured that Victorian newspaper subscribers knew about the outbreak in St Petersburg within 24 hours of it occurring. And just as in 1890 journalists were accused of fostering ‘an epidemic by telegraph’, so in 2009 the lurid press reports provoked similar accusations of media-induced panic. ‘Swine flu has already infected my brain and the brains of 20 million of my

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neighbours,’ complained a Mexico City blogger, writing in the Guardian shortly before Chan’s declaration, ‘. . . not with influenza but with a terrifying and incredibly resistant strain of fear.’ This fear was ‘toxic’, he warned, and appeared to have ‘no known cure’.11 Joe Collier, emeritus professor of medicines policy at St George’s, University of London, concurred, writing on a medical blogsite that: ‘One thing about the current swine flu pandemic is that it has brought with it a universal sense of fear.’12 In 1890 The Lancet had tried to strike a balance between what it termed ‘morbid dread’ of flu and ‘recklessness of unconcern’. In 2009 the journal found itself caught between similar discourses, hence its advice that ‘vigilance, and not alarm, is needed, with readiness to self-isolate oneself at home if an influenza-like illness develops’.13 Indeed, it is striking that although the UK Department of Health, in common with other European health ministries, had taken the precaution of stockpiling hundreds of thousands of doses of antiviral drugs precisely because of the fear that a pandemic might be imminent, in the event England’s chief medical officer resorted to many of the same measures that had proven effective during previous epidemics: namely, social distancing and isolation of the sick. And just as in the 1890s patients had been told to seek medical advice if in doubt about their symptoms, so in 2009 the Department of Health urged those who suspected they were infected with swine flu to stay at home and call a dedicated government hotline for diagnostic advice. Unfortunately, these attempts to reassure the public were not wholly successful, as was witnessed on 23 July when the website maintained by the National Pandemic Flu Service was overwhelmed with anxious callers and had to be shut down.14 Although health officials and scientists blamed the media for the panic, journalists claimed they were merely the messengers, and that the real culprits were the WHO and the Department of Health. After all, it was Margaret Chan who had declared a phase six alert and announced that further spread of swine flu was ‘inevitable’, and it was the Department of Health that had warned that the country should prepare for as many as 65,000 deaths.15 For the Guardian columnist, Simon Jenkins, this was ‘scaremongering’ plain and simple. ‘Lord Haw-Haw could not have

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calibrated a more demoralising panic than the government’s health establishment,’ he commented witheringly.16 In fact, this was by no means the worst outcome envisaged by pandemic planners. Just two years earlier, in response to concerns about the possibility of a pandemic triggered by the H5N1 bird flu virus, the Department of Health and the Cabinet Office had envisaged an even more alarming ‘what if’ scenario. In 1918, the pandemic modellers noted, the case fatality rate from the flu had been 2.5 per cent. Assuming that a quarter of the British population were infected with bird flu, that could result in as many as 375,000 deaths. However, in some population groups in 1918, the report noted, the cumulative attack rate had been as high as 50 per cent. Assuming a 2.5 per cent case fatality rate, this produced ‘possible excess deaths’ of 750,000.17 In the event, of course, the 2009 swine flu resulted in just 18,000 deaths worldwide, about the same number who die in Britain in a bad seasonal flu year.18 Bird flu and swine flu are outside the remit of this book. By mentioning some of the more outlandish predictions about their possible harm I merely wish to draw attention to the long historical shadow cast by the 1918 – 19 pandemic and the way that the statistical discourses described in this book are now routinely invoked by pandemic planners. As the cultural historian Mike Davis noted in 2005 in the context of the then ‘pandemic scare’ about bird flu: The Apocalyptic pandemic of 1918 – 19—according to the WHO, “the most deadly disease event in the history of humanity”—is the template for the public health community’s worst fears about the imminent threat of avian influenza.19 As we have seen in previous chapters, these discourses can be traced all the way back to the mid-nineteenth century and the project by Victorian sanitary reformers to ‘banish panic’ by revealing the underlying conditions governing the prevalence of epidemic diseases. Such discourses are largely a product of historical epidemiology and the nineteenth century’s ‘avalanche of printed numbers’. It was these

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statistical discourses that first made the epidemic and pandemic forms of influenza visible to medical science by retrospectively revealing patterns of excess mortality that had previously been invisible to medical practitioners and the general public. At the same time, these discourses were also employed prognosticatively to make predictions about future epidemic and pandemic events—predictions that could not help but draw attention to the elevated risk of illness and death faced by certain social groups and age ranges. In the early 1890s, the amplification of these discourses by the medical profession and the media fuelled widespread dread of influenza. In particular, in the early phases of the pandemic, concern about influenza drew on cultural anxieties about the rapid pace of social change and bourgeois measures of male performance— anxieties that, as with neurasthenia, could be linked to Victorian notions of ‘overwork’ and fatigue. By the later 1890s, however, influenza was increasingly drawing on the tropes of degeneration and fin-de-sie`cle artistic and emotional styles. The result was that, just as a diagnosis of neurasthenia became a badge of honour for a certain type of sensitive fin-de-sie`cle male, so the fatigue and psychosis that could follow primary attacks of influenza could invoke similar sympathy for male intellectual labour. However, although influenza became a subject of growing psychiatric interest in the 1890s, flu tended to escape sanitary regulation. The result was that except where influenza threatened the key functions of government (by sickening leading politicians and civil servants) or threatened to stall the wheels of commerce and finance (by sickening railway workers and employees of the Bank of England), it never became a site for state medicine or coercive hygienic regimes. Instead, flu was a disease that, to paraphrase Virginia Woolf, each individual narrated for him- or herself. In the late nineteenth century, flu tended to be regarded as a protean, sphinx-link infection. These palimpsest-like qualities gave it considerable metaphorical flexibility. To get at these qualities I have employed a narratological and emotionological approach. Drawing on official publications, newspaper reports, medical journals and the accounts of prominent doctors and celebrity patients, I have

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argued that the ‘modern’ notion of flu is a product of new medical and scientific ways of ‘knowing’ the disease that first emerged in the 1890s. This scientific ordering of flu did not take place in a vacuum, however, but was subject to continual amplification by medical commentators and popular news media. Indeed, one of the central arguments of this book is that while epidemics have always been sites for knowledge production, the mediatisation of epidemics is a ‘modern’ phenomenon, a process that dates from the expansion of the worldwide telegraph and the growth of a mass newspaper market in the latter half of the nineteenth century. It was the combination of these new communication technologies and new ways of consuming news that, in the 1890s, transformed the Russian flu from a scientific curiosity with transitory health and social impacts into a mass media phenomenon and a cause of sensation and dread. This dread of influenza was partly a product of medical statistics and bacteriology, and partly of the latest theories of nervous pathology, and can best be understood through an examination of biopolitical discourses aimed at regulating the emotional and social responses to infectious diseases. Tracing these discourses through the interpandemic period, I have argued that while Britain was at peace, dread of influenza became an object of psychiatric epidemiology and a tool of biopolitics and biopower. By contrast, during WWI the politicisation of dread and the stricter policing of negative emotions served to de-emphasise the risks associated with the Spanish flu, destabilising medical attempts to regulate civilian responses to the pandemic. However, while scientific knowledge drives biopolitical discourses about epidemics and pandemics, influenza also has an unusual ability to mirror other forms of discourse. This discursive flexibility, I have suggested, is a result of flu’s protean symptomatology and its metaphorical fluidity. Just as the virus is continually changing its genetic identity, so influenza is continually shifting its cultural identity. Tracing these cultural productions of influenza through the fin-de-sie`cle and early Edwardian periods, I have argued that during the initial phase of the Russian pandemic, influenza drew on anxieties about globalisation and new transportation and communications

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technologies. By the second and third waves of the pandemic, with the recognition that influenza was an infectious disease that spread more rapidly in closed institutions and confined spaces, these anxieties increasingly focused on the workplace, drawing on social concerns about fatigue, degeneration and the stress and strain of modern urban lifestyles. By the mid-1890s, as physicians became more familiar with the nervous sequelae of influenza, and as psychiatrists observed the depths of depression and despair to which victims of the psychoses could sink, flu was regarded as primarily a nervous disease. By the turn of the century, however, the cultural identity of influenza had morphed yet again, drawing this time on growing concerns about urbanisation and national efficiency. These concerns were thrown into sharp relief by the Boer War, hence the proliferation of advertisements for Bovril and other patent medicines that drew on influenza’s metaphorical fecundity to draw a parallel between the simultaneous threats confronting the nation at home and abroad. However, it was during WWI that these militaristic metaphors reached their apogee. The result was that rather than the Spanish flu being regarded as a matter of biological chance and historical accident, the 1918– 19 pandemic came to be seen as a product of wartime conditions and the unusual pressures to which war had subjected the civilian population. At the same time, wartime propaganda served to suppress the emotional responses that had been such a striking feature of the 1889– 93 pandemic. However, if in the 1920s the Spanish flu struck observers as incidental to the larger story of the Great War, by the 1980s the 1918– 19 pandemic was acquiring fresh historical significance. This historical revisionism is most apparent in the steady upward revision of the estimates of the global mortality due to the pandemic. In 1920, for instance, the Ministry of Health estimated that some 150,000 Britons had perished in the pandemic and that 6 million deaths had been recorded in British India alone.20 Seven years later, the Chicago University bacteriologist, E. O. Jordan, in an epidemiological review undertaken for the American Medical

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Association, was estimating the worldwide death toll at no less than 21.6 million.21 In 1991, Patterson and Pyle called for a further upward revision, estimating the worldwide mortality at a ‘conservative’ 30 million.22 Then, in 2002, using new data and revised methods for calculating the ‘excess mortality’, Johnson and Mueller put the global death toll at 50 million. However, they acknowledged that even this might not be the final word, and that owing to lack of data from many countries and the difficulty of distinguishing deaths ascribed to influenza from those ascribed to pneumonia and other complications, the true figure might be of the order of 100 million.23 The result is that today the 1918– 19 pandemic is regarded as the Ur-pandemic of modern times and the template for all our apocalyptic futures. But what if 1918– 19 was a unique, never-to-be repeated event? What if the influenza virus does not conform to any set biological pattern or epidemiological cycle? What if instead of the past behaviour of influenza providing a guide to the future, it destabilises the present, showing the past to be a set of contingent events? That is the ‘enigma’ and challenge that influenza continues to present to medical historians and pandemic planners. These are not questions that I have sought to address, nor do I believe they are likely to be resolved by modern science any time soon: influenza is too much of a changeling for that. As Jeffery Taubenberger and David Morens, two of the world’s leading experts on, influenza virology and epidemiology, respectively, put it, despite the tremendous progress made in microbiology, immunology, vaccinology and preventive medicine over the last century, influenza researchers are still no closer to being able to predict when new pandemic strains will emerge or how they will impact on human populations when they do, hence their claim that: As our understanding of influenza viruses has increased dramatically in recent decades, we have moved ever further from certainty about the determinants of, and possibilities for, pandemic emergence.24

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Indeed, despite Chan’s boast that the 2009 pandemic was the first to have been observed ‘right from the beginning’, Taubenberger and Morens argue that, in fact, ‘No one predicted the emergence of the 2009 H1N1 swine-origin pandemic virus; [and that] with current knowledge, we doubt anyone will be able to accurately predict any future pandemic either.’25 While we may be no closer to being able to predict pandemics, however, we are surely far better equipped to track their progress and marshall an effective public health response. In 1890 the world had no way of monitoring obscure outbreaks in the Yucatan, Mongolia or other ‘silent spaces’ on the map. Today, for all its faults, the WHO has an unparalleled ability to keep tabs on novel pathogens via electronic disease-reporting systems. Moreover, in 1890, as in 1918, there were no influenza vaccines or stockpiles of antiviral medications. Nor were antibiotics available to treat pneumococcal infections and other bacterial fellow-travellers of flu. Instead, all that doctors could offer patients was palliative nursing care accompanied by well-tried medical nostrums, such as quinine for relief of fever, morphine for relief of pain, and digitalis to slow the heart. No viral autopsy material from the 1890s has been preserved, and so modern-day scientists have not been able to study the genome of the Russian flu, but it is likely that the high mortality was not due to any special lethality of the virus but rather to the wide morbidity of the infection. As Churchill observered, the flu fell on rich and poor alike, and when between a third to half the population are affected even a low mortality rate produces a significant number of deaths. As an editorial writer in Outlook observed in 1900, at the end of a decade marked by recurrent epidemics of flu: ‘Influenza is still the same blustering, back-breaking, terrifying, but comparatively harmless calamity as ever. A pair of blankets and a pillow, properly applied, still form a complete protection against ninety-nine attacks out of a hundred.’26 That is a verdict that in an era of faster global communications and a world made smaller and more nervous by the expansion of information technologies we would do well to remember. Flu should still warrant our respect, to be sure, but at the end of the day it is ‘only flu’.

ACKNOWLEDGEMENTS

This book is the culmination of five years of research on influenza— more if you count the time I spent researching my previous book, Living With Enza, which in some respects can be seen as a companion to the present work. During that time I incurred a number of debts. First and foremost, I would like to thank Rhodri Hayward, who supervised the PhD dissertation on which this book is based and who first encouraged me to engage with the burgeoning historiography of the emotions. Rhodri believed in this project from the beginning and helped me avoid several intellectual ‘wrong turns’ (he also rescued me from an institutional cul-de-sac). Supportive when he needed to be, harsh when he needed to be, I couldn’t have asked for a more conscientous intellectual guide. This thesis was originally conceived as a work of social and economic history and although I went on to take a very different path I am grateful to Anne Hardy for having welcomed me into the academic fold at the Wellcome Trust Centre for the History of Medicine at UCL, now sadly defunct, and for her perceptive comments on some of the early chapter drafts. My thanks also to Michael Neve, to whom I owe the ‘mad’ suggestion one lunch time (when else?), that I should look more deeply into the history of influenza in the 1890s. Little did we realise then that the Russian flu pandemic would prove both hors d’oeuvre and entre´e to 1918’s dessert.

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This book also benefited greatly from the feedback that I received at the annual conferences of the American Association for the History of Medicine (AAHM) in Cleveland in April 2009—a conference that coincided with the first reports of the emergence of a new strain of pandemic flu—and the European Association for the History of Medicine and Health in Heidelberg in September of the same year. It was at the latter conference that the Society for the Social History of Medicine awarded me the Roy Porter Student Essay Prize for a paper drawing on the research that now forms Chapters 2 and 3 and which was originally published in the Social History of Medicine under the title, ‘“The Great Dread”: Cultural and Psychological Impacts and Responses to the “Russian” Influenza in the United Kingdom, 1889– 1893’. I would also like to thank Sanjoy Bhattacharya, the editor of Medical History, and the anonymous reviewers of that journal for their comments on my article, ‘Regulating the 1918 –19 Pandemic: Flu, Stoicism and the Northcliffe Press’, which appears here with minor ammendments as Chapter 6. Ditto the reviewers who read my article ‘“Russian” influenza: Lessons Learned, Opportunities Missed’ for Vaccine. Though we were only colleagues briefly, I would also like to thank Thomas Dixon at Queen Mary’s Centre for the Emotions, for encouraging me to think more deeply about the concept of ‘dread’; Miri Rubrin, for doing such a stellar job as graduate tutor; and Tilli Tansey for her detailed comments on the first draft of my PhD. I am also grateful to my PhD examiners, Virginia Berridge and Mark Harrison, for their perceptive criticisms and suggestions of how to develop this monograph. Although much of the hard intellectual labour was done at the Wellcome Trust Centre at UCL and at Queen Mary’s Centre for the Emotions, I would not have been able to complete this work without the support of Flurin Condrau, the director of the Institute and Museum of the History of Medicine in Zurich. By inviting me to join the institute as a research associate in 2011, and giving me the time and space to refine my thoughts—not to mention access to Zurich’s world-class research facilities—Flurin has contributed to this work in more ways than he can know. In a short period of time, he has also

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assembled an excellent team and I am grateful to my colleagues, Niklaus Ingold, Janina Kehr and Sandra Eder, for their many perceptive comments and suggestions. Earlier versions of Chapter 6 were also presented at the conference on ‘Mastering the Emotions’ held at the Centre for the Emotions, Queen Mary University of London, in July 2011, and at the annual meeting of the AAHM in Baltimore in April 2012. Finally, I would like to thank the Wellcome Trust for funding my transfer to Queen Mary and my wife, Jeanette, for her love, forbearance and unfailing support.

NOTES

Introduction 1. The Oxford English Dictionary dates the first use of ‘flu’ to 1839. For ease of

reading, I will use influenza and flu interchangeably.

2. Virginia Woolf, ‘On Being Ill’ in The Moment and Other Essays (London: The

Hogarth Press, 1981, first publ. 1925), pp. 14 –24 (p. 15).

3. Susan Sontag, Illness as Metaphor and Aids and Its Metaphors (London:

Penguin, 1991), pp. 59–60.

4. Ibid, p. 126. 5. See, for example, Arthur W. Crosby, America’s Forgotten Pandemic: The

6. 7. 8. 9. 10.

Influenza of 1918 (Cambridge; New York: Cambridge University Press, 1989); Pete Davies, Catching Cold: 1918’s Forgotten Tragedy and the Scientific Hunt for the Virus That Caused It (London: Michael Joseph, 1999); Mark Honigsbaum, Living With Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918 (Basingstoke; New York, NY: Palgrave Macmillan, 2008). Heliotrope cyanosis was a notable symptom of the ‘Spanish’ influenza in 1918. Honigsbaum, Enza, pp. 80 –1. Morell Mackenzie, ‘Influenza’, Fortnightly Review, 49, 394 ( June 1891): 877–86, p. 881. The Times, 18 December 1918, p. 5; Arthur W. Crosby, Epidemic and Peace, 1918 (Westport, CT: Greenwood Press, 1976), p. 207. H. Franklin Parsons, Further Report and Papers on Epidemic Influenza 1889– 92 (London: HMSO, 1893), p. 15; Nature, 19 December 1889, p. 145. I will use biopolitics and Foucault’s closely related term biopower to refer both to the collective attempts to rationalise the problems posed by the physical existence of populations, such as health, hygiene, longevity and race, and also to more subtle, self-governing practices operating at the individualising pole of discipline. Michel Foucault, The Will To Knowledge,

NOTES TO PAGES 3 – 4

11.

12.

13.

14.

15.

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The History of Sexuality, volume I (London: Penguin, 1998), pp. 139–43; Michel Foucault, The Birth of Biopolitics: Lectures at the College de France 1978–1979 (Basingstoke: Palgrave Macmillan, 2008); Thomas Lemke, Biopolitics: An Advanced Introduction (New York; London: New York University Press, 2011). See, for instance, Richard Collier, The Plague of the Spanish Lady: The Influenza Pandemic of 1918 –1919 (London: Macmillan, 1974); Crosby, Epidemic and Peace; W. I. B. Beveridge, Influenza: The Last Great Plague, An Unfinished Story of Discovery (London: Heinemann, 1977). Amy C. Norrington, ‘The Greatest Disease Holocaust in History’: The British Medical Response to the Influenza Pandemic of 1918– 19 (Unpublished BSC dissertation, Wellcome Institute for the History of Medicine, 2000). Davies, Catching Cold; L. Iezzoni and D. G. McCullough, Influenza 1918: The Worst Epidemic in American history (New York, NY: TV Books, 1999); Gina B. Kolata, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It (London: Macmillan, 2000); Howard Phillips and David Killingray, The Spanish Influenza Pandemic of 1918–19: New Perspectives (London; New York: Routledge, 2003); Carole. R. Byerly, Fever Of War: The Influenza Epidemic in the U.S. Army During World War I (New York; London: New York University Press, 2005); John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York, NY: Viking, 2004); Geoffrey W. Rice and Linda Bryder, Black November: The 1918 Influenza Pandemic in New Zealand (Christchurch, New Zealand: Canterbury University Press, 2005); Niall Johnson, Britain and the 1918–19 Influenza Pandemic: A Dark Epilogue (London; New York: Routledge, 2006); Esyllt Wynne Jones, Influenza 1918: Disease, Death, and Struggle in Winnipeg (Toronto; London: University of Toronto Press, 2007); Honigsbaum, Enza; Nancy K. Bristow, American Pandemic: The Lost Words of the 1918 Influenza Pandemic (Oxford; New York: Oxford University Press, 2012). The exceptions are F. B. Smith, ‘The Russian influenza in the United Kingdom, 1889–1894’, Social History of Medicine, 8 (1995): 55 –73; James Mussell, ‘Pandemic in Print: The Spread of Influenza in the fin-de-sie`cle’, Endeavour, 31, 1 (2007): 12– 17; Mark Honigsbaum,‘The Great Dread: Cultural and Psychological Impacts and Responses to the “Russian” Influenza in the United Kingdom, 1889– 1893’, Social History of Medicine, 23, 2 (2010): 299–319; Kevin D. Patterson, Pandemic Influenza, 1700– 1900: A Study in Historical Epidemiology (Totowa, NJ: Rowan and Littlefield, 1986), pp. 49–82. Ludmilla Jordanova, ‘The Social Construction of Medical Knowledge’, in Frank Huisman and John Harley Warner (eds), Locating Medical History: The

242

16. 17. 18.

19. 20.

21.

22.

NOTES TO PAGES 4 –15 Stories and their Meanings (Baltimore: Johns Hopkins University Press, 2004) pp. 338–63 (p. 346). Of course, to the extent that all diseases can be said to be social constructions this is also true of other diseases. However, I will argue that it is particularly true of influenza because of the way that flu encompasses such a wide range of clinical forms and diverse symptoms and signs. Fifty-fifth Annual Report of the Registrar General for England and Wales, 1892, p. xiv. See note 10 above. Paul Rabinow and Nikolas Rose, The Essential Foucault: Selections from the Essential Works of Foucault, 1954 –1984 (New York; London: The New Press, 2003), pp. xxviii-xxxi. David Armstrong, A New History of Identity: A Sociology of Medical Knowledge (Basingstoke: Palgrave, 2002), pp. 72 –73. For further discussion see Philip Alcabes, Dread: How Fear and Fantasy have Fueled Epidemics from the Black Death to Avian Flu (New York: Perseus Books Group, 2010), pp. 1–6, p. 95. August Hirsch, Handbook of Geographical and Historical Pathology, trans. by Charles Creighton, 3 vols., volume I (London: The New Sydenham Society, 1883), pp. 7–54. Outlook, 4 March 1899, p. 153.

Chapter 1

Pre-Modern Influenza

1. Theophilus Thompson, Annals of Influenza or Epidemic Catarrhal Fever in

2. 3. 4. 5.

6. 7. 8. 9.

Great Britain from 1510 to 1837 (London: Sydenham Society, 1852), pp. 36 –7. Ibid, p. 32. Ibid, pp. 33–4. Ibid, pp. 37–8. See note 1 op. cit. for full reference. The German disease geographer August Hirsch was similarly confident of his ability to retrospectively ‘read’ influenza epidemics. Indeed, arguing that ‘the disease may be followed into the remotest period from which we have any epidemiological record at all,’ Hirsch claimed to have identified influenza epidemics dating back as far as 1173—in other words, 300 years before the earliest epidemic mentioned by Thompson. Hirsch, Handbook, p. 7. Thompson, Annals, pp. ix-x. Ibid, pp. v, xii. Ibid, p. x. Ibid, p. xi.

NOTES TO PAGES 15 –18

243

10. Thomas Kuhn, The Structure of Scientific Revolutions (Chicago: University of

Chicago Press, 1962).

11. Bruno Latour and Steven Woolgar, Laboratory Life: The Construction of

12. 13.

14.

15. 16.

17.

18. 19.

20. 21.

22.

23.

Scientific Facts, 2nd ed. (Princeton, NJ: Princeton University Press, 1986); Ian Hacking, The Social Construction of What? (Cambridge, MA: Harvard University Press, 1999); Roger Cooter, ‘The Life of A Disease?’, The Lancet, 375, 9709 ( January 2009): 111–12. Letters of Charles Lamb to Bernard Barton, 1822– 1831. British Library, Add. MS 35256. John Donne, Devotions Upon Emergent Occasions, edited with a commentary by Anthony Raspa, first publ. 1623 (Montreal: McGill Queen’s University Press, 1975). David Thomson and Robert Thomson, Annals of the Pickett-Thomson Research Laboratory, IX (London: Baillie`re, Tindall and Cox, 1934), p. 47. No doubt they owed that confidence in part to the close resemblance between Lamb’s symptoms and the classic features of influenza—namely a chill and dry cough accompanied by neuralgia and fatigue. However, Lamb’s description also fits half-a-dozen other diseases, not least the ‘bad cold’ he mentions. Letters of Charles Lamb to Bernard Barton, 1822– 1831. British Library, Add. MS 35256. Thompson, Annals, pp. 371–2. See also, Charles Creighton, A History of Epidemics in Britain, 2 vols., volume II (Cambridge: Cambridge University Press, 1894), pp. 306–433. Oxford English Dictionary, Second Edition, volume VII (Oxford: Clarendon Press, 1989), p. 941. Italian writers also speak of ‘influenza di freddo’ (‘influence of the cold’), and some authorities argue that the English usage may possibly derive from the Latinate ‘influxio’, meaning humour or flux. Beveridge, Influenza, pp. 24–5; Lancet 11 (April 1896), pp.1007–8. The Lancet 11 (April 1896), pp. 1007–8. See also David M. Morens, Jeffery K. Taubenberger, Gregory K. Folkers, and Anthony S. Fauci, ‘Pandemic Influenza’s 500th Anniversary’, Clinical Infectious Diseases, 51, 12 (December 2010): 1442–4. Beveridge, Influenza, pp. 27 –30. John Huxham, An Essay On Fevers, repr. of 1757 edition (Canton, MA: Science History Publications, c.1988), p.11. The first edition of Huxham’s book was published in 1750. Margaret DeLacy, ‘The Conceptualization of Influenza in EighteenthCentury Britain: Specificity and Contagion’, Bulletin of the History of Medicine, 67, 1 (Spring 1993): 74– 114, pp. 79 –92. Richard Quain, A Dictionary of Medicine (London: Longmans Green, 1890), pp. 705–6.

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NOTES TO PAGES 18 –21

24. Thompson, Annals, pp. 9–10. 25. Ibid, pp. 17–18. 26. Sydenham’s notion of an ‘epidemic constitution’ encompasses the belief

27.

28.

29. 30. 31. 32. 33. 34. 35. 36.

that epidemic fevers are the result of ‘invisible emanations’ from within the bowels of the earth that pollute the upper atmosphere. See Kenneth Dewhurst (ed.), Dr Thomas Sydenham (1624–1689), His Life and Original Writings (London: Wellcome Historical Medical Library, 1966), pp. 60–1; Donald Bates, ‘Thomas Sydenham: the Development of his Thought, 1666–1676’ (unpublished doctoral thesis, Johns Hopkins University, 1975), pp. 146–52. For a more recent interpretation of Sydenham’s theories and his influence on British epidemiologists in the early twentieth century, see J. Andrew Mendelsohn, ‘From Eradication to Equilibrium: How Epidemics Became Complex after World War I’, in Christopher Lawrence and G. Weisz (eds.), Greater than the Parts: Holism in Biomedicine, 1921 – 1950 (New York; Oxford: Oxford University Press, 1988), pp. 303–31. Although the reports were signed by George Graham, contemporary commentators attributed the words to Farr. See The Times, 10 February 1848, p. 4. Langmuir also argues that ‘the often flowery prose [and] the rigorous marshalling of statistical data [. . .] are unmistakably Farr.’ Alexander D. Langmuir, ‘William Farr: Founder of Modern Concepts of Surveillance’, International Journal of Epidemiology, 5, 1 (1976): 13 –18, p. 15. Hereafter I will refer to the report as Farr’s. John M. Eyler, ‘Farr, William (1807– 1883)’, Oxford Dictionary of National Biography, (Oxford University Press, 2004). , http://0www.oxforddnb. com.catalogue.ulrls.lon.ac.uk/view/article/9185. [accessed 24 Feb 2011]. See also, John M. Eyler, William Farr (1807–1883): An Intellectual Biography of a Social Pathologist (unpublished thesis, University of Wisconsin, 1971), pp. 125–30. John M. Eyler, Sir Arthur Newsholme and State Medicine, 1885 –1935 (Cambridge; New York: Cambridge University Press, 1997) p. 32 –3. Anne Hardy, Health and Medicine in Britain since 1860 (Basingstoke: Macmillan, 2000), p. 8. Ian Hacking, ‘Biopower and the Avalanche of Printed Numbers’, Humanities in Society, 5 (1982): 279–95, p. 287. Robert J. Graves, A System of Clinical Medicine (Dublin: Fannin, 1843), pp. 544–5. Ibid, pp. 545–6. Thompson, Annals, pp. 37–8. Ibid, p. 159. Tenth Annual Report of the Registrar General for England and Wales, 1852, pp. xxviii –xxix.

NOTES TO PAGES 21 – 26

245

37. The new system of registration came into force in 1837. Cholera epidemics

38. 39. 40.

41.

42.

43.

44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55.

occurred in Britain in 1831 –2, 1848 –9, 1853 and 1866; smallpox in 1837–0, 1862 –3, 1871 and 1881; and influenza in 1803, 1831, 1833, 1836–7, 1847–8, 1857–8 and 1889–93. Typhus and typhoid were epidemic throughout the 1830s and 1840s. Anne Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventive Medicine, 1856 –1900 (Oxford: Clarendon Press, 1993), p. 152; Flurin Condrau and Michael Worboys, ‘Second Opinions: Epidemics and Infections in NineteenthCentury Britain’, Social History of Medicine, 20, 1 (April 2007): 147–58, p. 149. The General Registry Office was established in 1838 and the new system of registration began in 1839. Tenth Annual Report of the Registrar General for England and Wales, 1852, p. xxviii. The Times, 10 February 1848, p. 4. Christopher Hamlin, Cholera: The Biography (Oxford: Oxford University Press, 2009), pp. 2–3; Pamela K. Gilbert, Cholera and Nation: Doctoring the Social Body in Victorian England (Albany, NY: State University of New York Press, 2008), p. 2. For further discussion, see John M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (Baltimore: Johns Hopkins University Press, 1979) and Langmuir, ‘William Farr’. Michael. J. Cullen, The Statistical Movement in Early Victorian Britain: The Foundations of Empirical Social Research (New York, NY: Harvester Press, 1975), p. 37. Second Annual Report of the Registrar General, 1840, cited in William Farr, Vital Statistics: A Memorial Volume of Selections from the Reports and Writings of William Farr (Metuchen, NJ: Scarecrow Press, 1975), p. 170. The Times, 10 February 1848, p. 4. Worboys, Spreading Germs, pp. 34–5. Ibid, pp. 40–1. Thompson, Annals of Influenza, p. x. Ibid, pp. ix–x. Ibid, p. 375. Tenth Annual Report of the Registrar General for England and Wales, 1852, pp. xxvi –xxix. Ibid, pp. xxxiii–xxxv. The Times, 10 February 1848, p. 4. Daily News, 10 February 1848, p. 3; Gentleman’s Magazine January 1848, p. 74. The Times, 8 December 1847, p. 4. See, for instance, ‘Sanitary Reform,’ Daily News, 13 December 1847, p. 3; ‘Express from Paris,’ Daily News, 1 February 1848, p. 5.

246

NOTES TO PAGES 27 –31

56. See, for instance, ‘Foreign Intelligence’, Lloyd’s Weekly Newspaper,

23 January 1848, p. 1.

57. Patterson, Pandemic Influenza, pp. 43 –7. According to Patterson, unlike the

58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70.

71. 72.

73.

previous 1836–7 pandemic and the later 1889–93 pandemic, the Americas and Asia were unaffected. He concludes that while the outbreaks were widespread and severe enough to attract attention, the promotion of the 1847–8 epidemic to ‘pandemic status’ was probably the result of its occurrence in ‘the centre of medical writing, western Europe’. Martin Walker, Powers of the Press, The World’s Great Newspapers (London: Quartet, 1982), pp. 34 –7. Dennis Griffiths, Fleet Street, Five Hundred Years of the Press (London: British Library, 2006), pp. 111–12. Thomson and Thomson, Annals, p. 7. Thomas B. Peacock, On the Influenza, or, Epidemic Catarrhal Fever of 1847–48 (London: J. Churchill, 1848), pp. 19–79. Peacock, Influenza, p. 22. Ibid, pp. 24–40. Ibid, pp. 58–79. Ibid, p. 99. Ibid, pp. 104–5. Ibid, pp. 110–13. Richard Quain, A Dictionary of Medicine (London: Longmans Green, 1894), pp. 708–11 and pp. 954–64. Ibid, p. 709. For further discussion, see Eyler, Victorian Social Medicine; Margaret Pelling, Cholera, Fever and English Medicine, 1825 –1865 (Oxford: Oxford University Press, 1978). Eyler, Victorian Social Medicine, p. 280. Infectious diseases are estimated to have accounted for between a third and 55 per cent of all deaths in England and Wales in the period 1850–1870. The difference depends on whether or not infectious respiratory diseases are also included in the total. Flurin Condrau and Michael Worboys, ‘Second Opinions: Epidemics and Infections in Nineteenth-Century Britain’, Social History of Medicine, 20, 1 (April 2007):147–58, p. 150; Graham Mooney, ‘Infectious Diseases and Epidemiological Transition in Victorian Britain? Definitely,’ Social History of Medicine, 20, 3 (October 2007): 595–606, p. 600. According to official returns, influenza accounted for 16,686 deaths in 1891 and a further 57,890 excess deaths from respiratory disease, far surpassing the death toll from the 1849 cholera. Fifty-Fourth Annual Report of the Registrar General for England and Wales, 1891, p. xx.

NOTES TO PAGES 32 –35

247

Chapter 2 ‘An Epidemic Started By Telegraph’: News, Sensation and Science 1. ‘The Influenza,’ Winston Churchill, Harrovian School Newsletter, 10

December 1940.

2. Ibid. 3. According to Celia Sandys, Churchill wrote the poem at a time when he

4. 5.

6.

7.

8.

9. 10.

was under pressure from his parents to improve his academic performance. She writes that the verses came to him in a ‘flash of brilliance’ in November 1890, shortly before his sixteenth birthday, and won him a House prize. Celia Sandys, The Young Churchill: The Early Years of Winston Churchill (New York, NY: Dutton, 1995), pp. 142–3. The Lancet, 11 January 1890, Vol. 135, p. 88. Parsons, Further Report on Epidemic, pp. viii, 2– 3; Richard Sisley, Epidemic Influenza: Notes on its Origin and Method of Spread (London; New York: Longmans Green, 1891), pp. 67 –8; Samuel West, ‘The Influenza Epidemic of 1890 as Experienced at St Bartholomew’s Hospital and the Royal Free Hospital’, St Bartholomew’s Hospital Reports, 26 (1890): 193– 258, p. 200; The Lancet, 11 January 1890, Vol. 135, pp. 104–5. The economic slowdown had begun in the 1870s and was sparked by falls in the price of British grain due to competition from North American farmers. The resulting collapse in agricultural rents forced many landowners into bankruptcy, spurring the emigration of labourers to the city in search of work. A. E. Musson, ‘The Great Depression in England, 1873–1896: A Reappraisal’, Journal of Economic History, 19 (1959): 199–228, p.199; Christopher A. Bayly, The Birth of the Modern World, 1780 –1914: Global Connections and Comparisons (Malden, MA; Oxford: Blackwell, 2004), p. 459. Roger E. Kasperson et al., ‘The Social Amplification of Risk: A Conceptual Framework’, Risk Analysis, 8 (1988): 177–87. See also Jeanne X. Kasperson et al., ‘The Social Amplification of Risk: Assessing Fifteen Years of Research and Theory’, in Nick F. Pidgeon, Roger E. Kasperson and Paul Slovic (eds), The Social Amplification of Risk. (Cambridge: Cambridge University Press, 2003), pp. 13 –46. William J. Burns et al., ‘Incorporating Structural Models into Research on the Social Amplification of Risk: Implications for Theory Construction and Decision Making’, Risk Analysis, 13 (1993): 611–23, p. 621. Sontag, Illness as Metaphor, pp. 173–6. The image of the social body was invoked repeatedly by pioneers of the sanitary movement, such as Edwin Chadwick and Thomas Southwood Smith, as well as by radicals such as Robert Owen and Frederick Engels. For further discussion see Mary Poovey, Making a Social Body: British

248

11. 12.

13. 14.

15. 16. 17. 18. 19. 20. 21. 22.

23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33.

34. 35. 36.

NOTES TO PAGES 35 – 43 Cultural Transformation, 1830 –1864 (Chicago and London: University of Chicago Press, 1995), pp. 40 –1. See Patterson, Pandemic Influenza, pp. 49 –82; Lucy Brown, Victorian News and Newspapers (Oxford: Clarendon Press, 1985), p. 32. Virginia Berridge, Popular Journalism And Working Class Attitudes 1854– 1886: A Study of Reynolds’s Newspaper, Lloyd’s Weekly Newspaper and the Weekly Times (unpublished doctoral thesis, University of London, 1976), pp. 9 –10, 24 –6. Brown, Victorian News, p. 33. Mark Hampton, Visions of the Press in Britain, 1850–1950 (Urbana, IL: University of Illinois, 2004), p.28; Dennis Griffiths, Fleet Street: Five Hundred Years of the Press (London: British Library, 2006), p.107; Curtis, Jack The Ripper, p. 59. The Times, 3 December 1889, p. 9. Daily News, 11 December 1889, p. 5. The Times, 12 December, 1889, p. 5; Standard, 12 December 1889, p. 5. Standard, 12 December 1889, p. 5. ‘Tout le Monde l’a Terre l’Influenza,’ Le Grelot, 12 January 1890, p. 1. Standard, 11 December 1889, p. 3. The Lancet, 4 January 1890, p.13; Sisley, Epidemic Influenza, pp. 65– 6. Salisbury’s illness coincided with Portuguese efforts to oust British settlers from the gold-rich Mashonalands along the Zambezi River in South Africa. The Times, 1 January 1890, p. 3. Liverpool Mercury, 2 January 1890. Fun, 15 January 1890, p. 24. The Times, 7 January 1890, p. 5; 9 January 1890, p. 7. Review of Reviews, February 1890, p. 87. Liverpool Mercury, 2 January 1890, p. 3. The Times, 10 January 1890, p. 10. Liverpool Mercury, 2 January 1890, p. 3. Curtis, Jack the Ripper, p. 62. Ibid, pp. 63–4. Liverpool Mercury, 6 January 1890, p. 5; Manchester Times, 18 January 1890, p. 2. On closer inspection Tatham concluded that most of the cases had been ‘ordinary colds’ and that the Russian influenza was responsible for only a ‘fraction’ of the morbidity attributed to it; hence he told Manchester’s health committee ‘there was no need for “special provision”’. Cf. James Niven, Manchester’s Medical Officer of Health in 1918. Honigsbaum, Enza, pp. 98– 9, 132–3. The Lancet, 4 January 1890, pp. 12 –13. The Lancet, 21 November, p. 1311. The Lancet, 18 January 1890, p. 167. Globus hystericus was the medical term for a hysterical fit in which a patient had the sensation of a lump in the

NOTES TO PAGES 43 –50

37. 38. 39. 40. 41. 42. 43.

44. 45. 46. 47.

48.

49. 50. 51. 52. 53. 54.

55.

56. 57.

249

throat or, as Feuchtersleben put in in his pioneering textbook of psychiatry, ‘the feeling as of a ball rising from the stomach into the throat’. Ernst Von Feuchtersleben, The Principles of Medical Psychology, trans. by H. Evans Lloyd from the 1845 German edition (London: Sydenham Society, 1847), p. 227. West, ‘Influenza Epidemic’, pp. 194– 5. Ibid, pp. 194–5. Ibid, p. 227. The Lancet, 11 January 1890, p. 88. Ibid. See, for instance, BMJ, 9 March 1895, Vol. 1, p. 550. For further discussion of medical constructions of hysteria and hypochondria in the nineteenth century see, Mark S. Micale, Hysterical Men: The Hidden History of Male Nervous Illness (London; Cambridge, MA: Harvard University Press, 2008), especially pp. 117–61. ‘Answers to Correspondents,’ Punch, 4 January 1890, p. 9. ‘Some Cures for the Influenza,’ Fun, 20 January 1890, p. 6. Women’s Penny Paper, 11 January 1890, p. 139. Anne Hardy, ‘On the Cusp: Epidemiology and Bacteriology at the Local Government Board, 1890–1905’, Medical History, 42 (1998): 328–46, p. 330. Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865– 1900. (Cambridge: Cambridge University Press, 2000), BMJ, 8 November 1913, Vol. 2, pp. 211–16; Hardy, On the Cusp, pp. 328– 9. ‘Henry Franklin Parsons,’ BMJ, 8 November 1913, Vol. 2, pp. 1263–4; ‘Henry Franklin Parsons,’ The Lancet, 18 November 1913, pp. 135–56. ‘The Influenza Epidemic: Requests for Information,’ BMJ, 11 January 1890, Vol. 2, pp. 102–3. H. Franklin Parsons, Report on the Influenza Epidemic of 1889–90 (London: HMSO, 1891), p. 1. Parsons, Report, p. x. Parsons, Further Report, pp. viii, 12 –13. Patterson, Pandemic Influenza, p. 52. Patterson argues that the lack of pronounced respiratory symptoms, coupled with the high fatality rate, summer prevalence and the long duration of the epidemic, make it more likely that this was an outbreak of early seasonal malaria, or possibly dengue fever. Edmund Symes Thompson, Influenza, or Epidemic Catarrhal Fever: An Historical Survey of Past Epidemics in Great Britain from 1510 –1890 (London: Percival and Co., 1890), p. 416. See also, The Times, 23 January 1890, p. 14. Thompson, Influenza, pp. 412, 414–19. Public Health, 2 (1890): 358–67, pp. 362–3; Parsons, Report, p. 52.

250

NOTES TO PAGES 51 – 61

58. Frank Clemow, ‘The Recent Pandemic of Influenza: Its Place of Origin and 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71.

72. 73. 74. 75.

76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88.

89.

Mode of Spread,’ The Lancet, 1 (20 January 1894): 139–43, pp. 142–3. The Times, 12 April 1890, p. 14; Clemow, Recent Pandemic, pp. 140–2. Parsons, Report, p. 13. Ibid, pp. 105–11. Ibid, pp. 10–12. Public Health, 2, (April 1890), p. 366. Parsons, Report, pp. 10 –11. Ibid, p. 52. Ibid, p. 181. Ibid, pp. 87–92. Ibid, p. 52. Ibid, pp. 113–14. Parsons, Report, pp. 3, 67. Parsons, Further Report, p. 2. According to Parsons, this excess of male to female deaths held for every age group except the over 65s, and was a ‘reversal’ of the pattern of previous years. In 1891 the Registrar General recorded a similar excess of male to female deaths. However, in 1892 women accounted for a little over half the recorded influenza deaths, suggesting that the higher male mortality observed in the first phases of the pandemic may have reflected men’s increased exposure to the virus due to their occupations and their greater social mobility. The Times, 25 April 1890, p. 9. The Times, 25 April 1890, p. 13. Parsons, Report, pp. 318– 22. Parsons, Further Report, p. 28; T. Thomson, ‘Influenza in Sheffield’ Public Health, 3 (1891), p. 420; H. Littlejohn, Report of the Medical Officer of Health for Sheffield, 2 November 1891. Yorkshire Telegraph, 6 May 1891, p. 2. John Stokes, The History of the Cholera Epidemic of 1832 in Sheffield, (Sheffield: North End, 1921), p. 98. Littlejohn, Report, pp. 16 –17. Parsons, Further Report, pp. 10 –11. The Times, 1 May 1891, p. 10; 2 May 1891, p. 11; 4 May 1891, p. 6. The Times, 5 May 1891, p. 10. The Times, 6 May 1891, p. 5. Manchester Guardian, 6 May 1891, p. 5; Parsons, Report, pp. 322–5. The Times, 7 May 1891, p. 9. The Times, 12 May 1891, p. 9; Manchester Guardian, 12 May 1891, p. 7. The Times, 15 May 1891, p. 9. Manchester Guardian, 12 May 1891, p. 7. Manchester Guardian, 18 May 1891, p. 5. Salisbury seems to have escaped the second wave, suggesting he may have enjoyed immunity thanks to his earlier exposure in the winter of 1890. The Times, 18 May 1891, p. 9.

NOTES TO PAGES 61 – 67 90. 91. 92. 93. 94. 95. 96.

97. 98. 99. 100. 101. 102. 103.

104.

105. 106. 107.

108. 109. 110. 111. 112. 113.

251

Yorkshire Telegraph, 13 May 1891, p. 5. The Times, 22 May 1891, p. 6. Manchester Guardian, 25 May 1891, p. 5. Parsons, Report, p. 322. The Times, 8 May 1891, p. 6. BMJ, 16 May 1891, Vol. 1, p. 1085. The diseases covered by the act were smallpox, cholera, diphtheria, erysipelas, scarlet fever, typhus, and typhoid and enteric and puerperal fever. Sisley, Epidemic Influenza, p. 131. The Times, 27 May 1891, p. 6. Parsons, Report, p. x. The Lancet, 11 July 1891, Vol. 138, p. 80. The Times, 4 July 1891, p. 11. Medical Press, 15 January 1890, p. 39. Medical Press, 17 June 1891, p. 624. Richard Sisley, ‘Influenza and the Laws of England Concerning Infectious Diseases: Proceedings of Society of Medical Officers of Health’, Public Health, 4 (1892): 136–42. See also The Times, 20 January 1892, p. 14. Clarence had caught a chill on 4 January 1892 while attending the funeral of his cousin, Prince Victor of Hohenlohe. As was the custom, he had removed his top hat while standing at the graveside and received a soaking in the rain. By the time he returned to Sandringham two days later he was ill, and by 7 January he was running a high temperature. To reassure the press and public that all was well his doctors issued daily bulletins, but for all their ministrations the infection spread to his left lung, and by 11 January both lungs were compromised with a progressive ‘influenzal pneumonia’. He died four days later in the throes of an ‘acute delirium’. BMJ (16 January 1892), p. 137. For further discussion see Chapter 5. BMJ (23 January 1892), p. 183. Ibid. F. A. Dixey, ‘On the Influenza Epidemic of 1892 in London’, BMJ, 13 August 1892, pp. 353–6. See also, F. A. Dixey, Epidemic Influenza: A Study in Comparative Statistics (Oxford: The Clarendon Press, 1892). Parsons, Further Report, p. 60. Fifty-fifth Annual Report of the Registrar General for England and Wales, 1892, p. xiv. Fifty-sixth Annual Report of the Registrar General for England and Wales, 1893, p. xiv. Parsons, Report, pp. 81 –2. William J. Croft, Under the Microscope: A Brief History of Microscopy (London: World Scientific, 2006). The Times, 22 January 1890, p. 5; The Lancet, (25 January 1890), Vol. 135, p. 211.

252

NOTES TO PAGES 67 – 71

114. Ibid; Parsons, Report, p. 68. Other researchers made similar claims. In February

115. 116. 117. 118. 119. 120. 121. 122. 123. 124. 125. 126. 127. 128. 129.

130.

131.

132. 133. 134. 135. 136. 137. 138.

1890, for instance, Dr E. Levy of the University of Strasbourg reported finding the diplococcus in the sputum of 17 out of 18 influenza patients examined during the epidemic. See The Lancet, (22 February 1890), Vol. 135, p. 431. The Times, 4 February 1890, p. 5. ‘Bacteriology of Influenza’, BMJ, (25 January 1890), Vol. 135, pp. 194–5; (1 February 1890), Vol. 135, p. 249. Richard Sisley, ‘The Influenza’, Universal Review, 6, 21 ( January 1890): 20–39, p. 26. Parsons, Report, p. 69. BMJ, (16 January 1892), Vol. 139, p. 128. Ibid. Ibid. Hardy, ‘On the Cusp’, p. 330, 340; P. Mortimer, ‘The Bacteria Craze of the 1890s’, The Lancet, (13 February 1999), Vol. 353, pp. 581–4. Edward Klein, ‘Some Remarks on the Influenza Bacillus,’ BMJ, (23 January 1892), Vol. 1, pp. 170–1. Emanuel Klein, ‘Report on Influenza, in its Clinical and Pathological Aspects’, in Parsons, Further Report, pp. 85 –155. Ibid, p. 118. Ibid, p. 119. Ibid, p. 116. Ibid, p. 121. For example, Crosby described Pfeiffer’s bacillus as ‘an authoritative road sign pointing in the wrong direction’. Crosby, America’s Forgotten Pandemic, p. 269. Pfeiffer’s bacillus was most likely Haemophilus influenzae. A common bacteria of the nose and throat, type b (Hib) strains of H. influenzae are associated with serious invasive disease in young children, most commonly meningitis. Although the bacillus is spread through coughs and sneezes, it is no longer considered the causative agent of flu. http://www.patient.co.uk/doctor/Haemophilus-Influenzae.htm [accessed 20 June 2012]. Michael Bresalier, ‘Transforming Flu: Medical Science and the Making of a Virus Disease in London, 1890 –1939’ (unpublished PhD dissertation, University of Cambridge, 2010), p. 68. Ibid, pp. 67–91. Klein, ‘Report’, p. 120. Ibid, p. 121. Ibid, p. 125. Ibid, pp. 141–55. Bresalier, ‘Transforming Flu’, pp. 77 –8. Klein, ‘Report’, p. 140.

NOTES TO PAGES 72 –80

253

139. Koch’s fourth postulate requires that microorganisms grown and isolated

140. 141. 142. 143.

144. 145. 146.

147.

148.

149. 150. 151. 152. 153. 154. 155. 156. 157. 158.

in culture must be able to reproduce the same disease when inoculated into healthy test animals. ‘The Bacillus of Influenza’, The Lancet, (20 May 1899), Vol. 153, pp. 1378 –9. ‘Gradual Transformation Scene—Flight of the Demon Influenza at the Approach of Spring,’ Punch, 25 January 1890, p. 38. ‘Influenza at the “Zoo”,’ Moonshine, 18 January 1890, p. 36. ‘More Influenza—John Bull Attacked by Wild Microbes,’ Fun, 5 February 1890, p. 56. The caption reads: “‘It has recently been discovered that the Influenza microbe strongly resembles parasitic bishops and other fearful and wonderful creatures of a parasitic nature.’ – Daily Paper.” ‘The Influenza Fiend; Or, The Old Man and the Sneeze’, Fun, 27 January 1892, p. 36. Ibid, p. 37. Michel Foucault, ‘Technologies of the Self,’ in L. H. Martin, H. Gutman and P. H. Hutton (eds), Technologies of the Self: A Seminar with Michel Foucault (London: Tavistock, 1988) pp. 16 –49. For further discussion, see Michael Bresalier, ‘Uses of a Pandemic: Forging the Identities of Influenza and Virus Research in Interwar Britain’, Social History of Medicine, 25, 2 (2012): 400–24. Parsons, Further Report, p. 119. Obtained from the bark of the cinchona tree, quinine had long been observed to interrupt the cycle of fevers and chills in malaria, and thus, it was reasoned, might also prove efficacious against the fevers and chills of influenza. Mark Honigsbaum, The Fever Trail: In Search of the Cure for Malaria (New York, NY: Farrar, Straus and Giroux, 2001), pp. 19 –38. Parsons, Further Report, p. 45. Parsons, Further Report, p. ix. Richard Sisley, ‘Influenza and the Laws of England Concerning Infectious Diseases,’ Public Health, 4 (October 1891—September 1892): 136–42. Ibid. BMJ, (23 January 1892), Vol. 1, p. 183. Ibid, p. 184. Parsons, Further Report, pp. 82 –3; The Times, 25 January 1892, p. 4. Parsons, Further Report, pp. 82 –3. Ibid. The Times, 25 January 1892, p. 7.

254

NOTES TO PAGES 82 –83

Chapter 3 ‘An Inexpressible Dread’: Influenza, Nervousness and Psychosis 1. The Lancet, (21 December 1889), Vol. 134, p. 1311; Julius Althaus,

2.

3.

4. 5. 6. 7. 8. 9. 10.

11.

Influenza: Its Pathology, Symptoms, Complications, and Sequels, its Origin and Mode of Spreading and its Diagnosis, Prognosis, and Treatment, 2nd ed. (London: Longmans, 1892), pp. 15 –16. Charles K. Mills, ‘The Nervous and Mental Phenomena and Sequelae of Influenza’, Journal of the American Medical Association, 18, 5 (30 January 1892): 121–7. Besides the neuralgias and depression noted by Huxham, Arthbunot observed that the epidemic had seen ‘a great run of hysterical, hypochondriacal, and nervous distempers,’ adding that in some cases these distempers had been so severe as to induce ‘fatality or madness’. Thompson, Annals, pp. 37–8. Julius Althaus, ‘On Psychoses after Influenza’, Journal of Mental Science, 69, 165 (April 1893): 163–76. Althaus, Influenza, pp. 15 –16, 87. Daniel H. Tuke, A Dictionary of Psychological Medicine (London: J. & A. Churchill, 1892), p. 688. Smith, ‘Russian Influenza’, p. 55. Morell MacKenzie, ‘Influenza’, Fortnightly Review, 49, 394 ( June 1891): 877–86, p. 882. T. S. Clouston, ‘Asylum Reports for 1890’, Journal of Mental Science, 37 (1891): 590–606, pp. 598–9. G. H. Savage, ‘The Psychoses of Influenza’, Practitioner, 52 (January –June 1919), pp. 36 –46; Karl A. Menninger, ‘Influenza and Schizophrenia: An Analysis of Post-Influenzal “Dementia Precox,” as of 1918, and five years later’, American Journal of Psychiatry, 82 (April 1926): 469–529. See also Hackney Gazette, 20–23 January 1919, 16 April 1919; The Times, 1 June 1919; Krister Kristensson, ‘Avian Influenza and the Brain—Comments on the Occasion of the Resurrection of the Spanish Flu Virus’, Brain Research Bulletin, 68 (2006): 406–13, p. 407; Steinberg et al., ‘Influenza Causing Manic Psychosis’, British Journal of Psychiatry (1972), 120: 531–5; R. M. Still, ‘Psychosis Following Asian Influenza in Barbados’, The Lancet, 5, 2 (5 July 1958): 20–1; ‘Neurologic Complications Associated with Novel Influenza A (H1N1) Virus Infection in Children—Dallas, Texas, May 2009’, Journal of the American Medical Association, 302, 16 (28 October 2009): 1746 –8. DSM-IV (Arlington, Virginia: American Psychological Association, 2000), pp. 329–48; The last reference I have been able to find is in Maurice Craig and Thomas Beaton, Psychological Medicine (London: J. &

NOTES TO PAGES 83 –85

12. 13.

14. 15.

16.

17.

255

A. Churchill, 1926), pp. 297–9. Although Craig and Beaton do not refer explicity to the ‘psychoses of influenza’ but talk instead of ‘post-febrile mental disturbance’ and the ‘insanity’ that may follow attacks of influenza, it is clear from their discussion that they considered such disturbances a type of ‘exhaustion psychosis’. See, for example, Punch, 4 January 1890, p. 9; Strand Magazine, 10 July 1895, p. 81. For further discussion see Marijke Gijiswijt-Hoffstra and Roy Porter (eds), Cultures of Neurasthenia: From Beard to the First World War, (New York: Rodopi, 2001); Mark S. Micale, ‘Jean-Michel Charcot and Les Nevroses Traumatiques’, in Mark S. Micale and Paul Lerner (eds), Traumatic Pasts: Human Psychiatry and Trauma in the Modern Age, 1870 –1930 (Cambridge: Cambridge University Press, 2001), pp.115–39.; Edward Shorter, From Parlaysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (New York, NY; Toronto: Free Press, 1992), pp. 220–32.; Eric Caplan, Mind Games: American Culture and the Birth of Psychotherapy (Berkeley and Los Angeles, CA; London: University of California Press, 1998), pp. 37 –42; Janet Oppenheim, ‘Shattered Nerves’: Doctors, Patients, and Depression in Victorian England (New York, NY: Oxford University Press, 1991), pp. 79 –109. Kristensson, ‘Avian Influenza and the Brain’, p. 410. M. Takahashi and T. Yamada, ‘A Possible Role of Influenza: A Virus Infection for Parkinson’s Disease’, Advances in Neurology, 86 (2001): 91–104; M. Takahashi and T. Yamada, ‘Influenza: A Virus Infection of Primary Cultured Cells from Rat Fetal Brain’, Parkinsonism and Related Disorders, 3 (1997): 97– 102. J. Stowe et al., ‘Investigation of the Temporal Association of GuillainBarre´ Syndrome with Influenza Vaccine and Influenza-like Illness using the United Kingdom General Practice Research Database’, American Journal of Epidemiology, 169, 3 (2009): 382–8; S. Toovey, ‘InfluenzaAssociated Central Nervous System Dysfunction: A Literature Review,’ Travel Medicine and Infectious Disease, 6, 3 (2008): 114–24; D. Steinberg et al., ‘Influenza Infection Causing Manic Psychosis’, British Journal of Psychiatry, 120 (1972): 531–5; T. H. Flewett and J. G. Hoult, ‘Influenza Encephalopathy and Post-Influenzal Encephalitis’, The Lancet, (5 July 1958), Vol. 272: 11–15; ‘Psychosis following Asian Influenza in Barbados’, The Lancet (5 July 1958), pp. 20–1. O. Okusaga, R. H. Yolken, P. Langenberg, et al., ‘Association of Seropositivity for Influenza and Coronaviruses with History of Mood Disorders and Suicide Attempts’, Journal of Affective Disorders (April 2011), 130 (1-2): 220–5.

256

NOTES TO PAGES 85 –88

18. A. S. Brown et al., ‘Serologic Evidence of Prenatal Influenza in the

19.

20. 21.

22. 23.

24.

25. 26. 27. 28. 29. 30.

Etiology of Schizophrenia’, Archives of General Psychiatry, 61 (2004): 774– 80; S. C. Yudofsky, ‘Contracting Schizophrenia: Lessons from the Influenza Epidemic of 1918 –1919’, Journal of the American Medical Association, 301 (2009): 324–6. Sherman McCall, Joel A Vilensky, Sid Gilman ‘The Relationship between Encephalitis Lethargica and Influenza: A Critical Analysis’, Journal for Neurovirology, 14 (2008): 177–85; P. P. Mortimer, ‘Was Encephalitis Lethargica a Post-Influenzal or Some Other Phenomenon? Time to ReExamine the Problem’, Epidemiology and Infection, 137 (2009): 449–55; R. Tamaki, T. Kamigaki, and H. Oshitani, ‘Encephalitis and Encephalopathy Associated with Pandemic Flu’, Brain and Nerve, 61 (2009): 153–60. See, for example, Sisley: The Influenza, p. 36; Local Government Board memo, May 1895. Oppenheim, Shattered Nerves, pp. 79 –109, 154–5; Christopher E. Forth, ‘Neurasthenia and Manhood in fin-de-sie`cle France’, in Gijiswijt-Hoffstra and Porter, Cultures of Neurasthenia, Rodopi, pp. 329– 63; Tom Lutz, ‘Varieties of Medical Experience: Doctors and Patients, Psyche and Soma in America’, in Gijiswijt-Hoffstra and Porter: Cultures of Neurasthenia, pp. 51 –77 (p. 54); Shorter, Paralysis, pp. 230–2; Caplan, Mind Games, pp. 37 –42. See, for example, The Lancet, (11 January 1890), Vol. 135, p. 88. Thomas Stretch Dowse, On Brain and Nerve Exhaustion (Neurasthenia) and on the Exhaustions of Influenza (London: Baillie`re, Tindall and Cox, 1892), pp. 132– 3. Although neurasthenia fell out of vogue in the 1930s, it was not removed from the Diagnostic and Statistical Manual of Mental Disorders until 1980. See DSM-III (Arlington, VA: American Psychological Association, 1980). See also, Shorter, Paralysis, p. 231. George Cheyne, The English Malady: or, A Treatise of Nervous Disease of all Kinds (London: G. Straham and J. Leake, 1733). Oppenheim, Shattered Nerves. William F. Bynum, ‘Cullen, William (1710 –1790)’, Oxford Dictionary of National Biography, (Oxford: Oxford University, 2004). Oppenheim, Shattered Nerves, p. 8; Shorter, Paralysis, p. 215. Oppenheim, Shattered Nerves, p. 9. Chandak Sengoopta, ‘A Mob of Incoherent Symptoms? Neurasthenia in British Medical Discourse, 1860 –1920’, in Gijiswijt-Hoffstra and Porter: Cultures of Neurasthenia, pp. 97 –115 (p. 97).

NOTES TO PAGES 88 – 92

257

31. Lee A. W. Scrivener, Modern Insomnia: Vicious Circles and Paradoxes of

32. 33.

34. 35.

36. 37. 38. 39.

40. 41. 42. 43. 44.

45. 46.

Attention and Will, 1860–1910 (unpublished thesis, University of London, 2011), p. 59. Ibid, p. 60. Tom Lutz, ‘Varieties of Medical Experience: Doctors and Patients, Psyche and Soma in America’, In Gijiswijt-Hoffstra and Porter: Cultures of Neurasthenia, p. 52–4. For further discussion of the connection between nervousness and modernity see Laura Salisbury and Andrew Shail (eds), Neurology and Modernity: A Cultural History of Nervous Systems, 1800 –1950 (Basingstoke: Palgrave Macmillan, 2010). Iwan R. Morus, ‘The Measure of Man: Technologizing the Victorian Body’, History of Science, 33 (1999): 249–82. Iwan R. Morus, ‘“The Nervous System of Britain”: Space, Time and the Electric Telegraph in the Victorian Age’, British Journal for the History of Science, 33 (2000): 455–75, p. 456. As Morus points out, this metaphor also worked the other way, since Victorians commonly described the electric telegraph as a sort of electrical nervous system. Anson Rabinbach, The Human Motor: Energy, Fatigue, and the Origins of Modernity (Berkeley: University of California Press, 1992), p. 6, 23. Rabinbach, Human Motor, pp. 40–3. See Shorter, Dictionary of Psychiatry, p. 29. A good example was Thomas Glover Lyon, assistant physician to Victoria Park Hospital—hence his shock at cases of ‘globus hystericus’ and his remark that the epidemic should be known as ‘influenza nervosa’. The Lancet, (18 January 1890), Vol. 135, p. 167. L.T. Mead and Clifford Halifax, M.D., ‘Stories from the Diary of a Doctor’, Strand, 10 ( July 1895): 80 –95. Ibid, pp. 80–1. Ibid, p. 82. Ibid, p. 91. Ibid, p. 80. Feveral’s story was co-authored by Elizabeth Thomasina Meade and ‘Clifford Halifax MD’ and was headlined ‘Stories from the Diary of a Doctor’. In fact Halifax was the pseudonym for Dr Edgar Beaumont, a distinguished Harley Street physician. Between 1896 and 1900 he and Meade produced three collections of medico-detective stories, with Beaumont providing many of the plot lines. ‘Stories from the Diary of a Doctor’, which ran to two series and was twice re-printed, was by far the most successful. BMJ, (12 November 1921), Vol. 2, p. 815. West, ‘Influenza Epidemic’, p. 227. Samuel West, ‘An Address on Influenza’, The Lancet, (28 April 1894), Vol. 143, pp. 1047 –52 (p. 1047).

258

NOTES TO PAGES 92 –96

47. The Lancet, (18 January 1890), Vol. 135, p. 167. See also The Lancet,

48.

49. 50. 51. 52. 53. 54. 55. 56. 57.

58. 59. 60. 61.

62.

63. 64. 65. 66.

67.

(21 December 1889), Vol. 134, p. 1311. For newspaper accounts of postinfluenzal psychosis and suicide see ‘A Family Murdered at Tooting’, The Times, 8 March 1895, p. 11; ‘Suicides Owing to Influenza’, Daily News, 9 March 1895, p. 3; ‘Doctor’s Strange Conduct’, Lloyd’s Weekly Newspaper, 5 May 1895, p. 3. Otto Leichtenstern, ‘Influenza and Dengue,’ in Julius Mannaberg et al., Malaria, Influenza and Dengue (Philadelphia, PA; London: W. B. Saunders, 1905), pp. 521–716 (p. 658). Althaus, Influenza, p. 18. Tuke, Dictionary, p. 687–8. Ibid. Thomas S. Clouston, ‘Asylum Reports for 1890’, Journal of Mental Science, 37 (1891): 590–606, p. 598. Ibid, p. 599. Thomas S. Clouston, Clinical Lectures on Mental Disease (London: J. & A. Churchill, 1896), p. 661. George Savage, ‘Influenza and Neurosis’, Journal of Mental Science, 38 (1892): 360–4, p. 360. Ibid, p. 368. Ibid. Savage was still insisting on the primacy of a pre-existing neuropathic condition in 1907. See George Savage, Insanity and the Allied Neuroses (London: Cassell, 1907), p. 80 –1. Wilhelm Griesinger, Mental Pathology and Therapeutics, first publ. 1867 (New York, NY: New York Academy of Medicine, 1965), p. 175. Savage, ‘Influenza and Neurosis’, p. 360. Tuke, Dictionary, p. 688. Ross Diefendorf, and Emil Kraepelin, Clinical Psychiatry: A Text-Book for Students and Physicians (New York, NY; London: Macmillan, 1902), p. 84 –7. This may have reflected the fact that staff and attendants were more likely to have been exposed to the disease and therefore would have been the first to introduce it to the asylum. Claye T. Shaw, ‘The Psychoses of Influenza’, Practitioner, 78 ( January– June 1907): 86–117, p. 87. Ibid, p. 89. Clifford T. Allbutt, ‘Influenza’, The Practitioner, 78 ( January –June 1907): 1–25, pp. 1– 9. Julius Althaus, A Treatise on Medical Electricity, Theoretical and Practical: and its uses in the Treatment of Paralysis, Neuralgia and Other Diseases (London: Traubner, 1859). Julius Althaus, On the Failure of Brain Power (London: Longmans, 1882); The Functions of the Brain: A Popular Essay (London: Longmans, 1880),

NOTES TO PAGES 96 – 99

68.

69.

70. 71. 72. 73. 74. 75. 76.

77.

78. 79. 80. 81. 82. 83. 84. 85. 86.

259

p. 15. As Oppenheim points out, this notion has a long lineage dating back as far as the late eighteenth century and animal experiments with electricity. However, the key reason for the growing popularity of electrical metaphors to describe the functioning of the nervous system was the discovery in 1847 of the second law of themodynamics, or entropy, which posited a gradually decreasing amount of energy in the universe. Oppenheim, Shattered Nerves, p. 82. See also Rabinbach, Human Motor, pp. 3 –4. D’A. Power, rev. Caroline Overy, ‘Althaus, Julius (1833–1900)’, rev. Caroline Overy, Oxford Dictionary of National Biography, (Oxford: Oxford University Press, 2004). Julius Althaus, ‘An Address on the Pathology of Influenza, with Special Reference to its Neurotic Character’, The Lancet, (14 November 1891), Vol. 138, pp. 1091 –3, and The Lancet, (21 November 1891), pp. 1156–8; See also The Lancet, (5 March 1892), Vol. 139, p. 556; (19 March 1892), Vol. 139, p. 664; (29 July 1893), Vol. 142, p. 279. Althaus, ‘On Psychoses’. Althaus, Influenza. Ibid, pp. 1–2. Ibid, pp. 15–16, 87. Ibid, p. 9, 18. The Lancet, (14 November 1891), Vol. 138, pp. 1091 – 3, and (21 November 1891), Vol. 138, pp. 1156–8. The Lancet, (14 November 1891), Vol. 138, 1091–3, p. 1092. By ‘predisposition’ Althaus included not only hereditary factors but a previous history of neurosis or psychosis in the patient, previous brain injury, alcoholism, syphilis and ‘grief or shock after the feverish attack’. Althaus, ‘On Psychoses’, p. 168. Althaus, Influenza, p.118–19. For further discussion of Victorian theories of idiosyncrasy in disease, see Humphrey Rolleston, Idiosyncrasies (London: Kegan Paul, 1927). Althaus, Influenza, p. 98. Ibid, pp. 90–3. Ibid, p. 90. Ibid, p. 98. Ibid, pp. 88–9. Ibid, p. 84. Ibid, p. 93. Ibid, p. 101. Ibid, p. 123. Unfortunately, Althaus does not say which cases were seen in hospital and which at his Harley Street practice, so it may be that the proportions reflected the bias of his private practice towards men.

260

NOTES TO PAGES 100 –105

87. Thomas Stretch Dowse, On Brain and Nerve Exhaustion (Neurasthenia) and

88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110.

111. 112. 113. 114.

115.

on the Nervous Sequelae of Influenza (London: Baillie`re, Tindall and Cox, 1894), p. 109. Ibid, p. 12 Thomas Stretch Dowse, On Neurasthenia, or Brain and Nerve Exhaustion (London: Baillie`re, Tindall and Cox, 1890), p. 40 Ibid, p. 42. Ibid, pp. 65–7. Dowse, On Brain and Nerve Exhaustion (Neurasthenia) and on the Nervous Exhaustions of Influenza (London: Baillie`re, Tindall and Cox, 1892). Ibid, pp. 72–3. Ibid, pp. 74–5. Ibid, pp. 86–7. Dowse, On Brain (1894), pp. 84 –5. Ibid, pp. 131–2. Ibid, p. 133. Ibid, p. 133. John Erich Erichsen, On Railway Travel and Other Injuries of the Nervous System (London: Walton and Maberly, 1866). Wolfgang Schivelbusch, The Railway Journey (Leamington Spa: Berg, 1977), pp. 143–56; Caplan, Mind Games, pp. 17 –19. Schivelbusch, The Railway Journey, p. 145. Dowse, On Brain (1894), p. 29. Hampshire Telegraph and Sussex Chronicle, 8 February 1890, p. 3. Liverpool Mercury, 15 April 1891, p. 5. The Times, 4 June 1891, p. 7. Ibid. Olive Anderson, Suicide in Victorian and Edwardian England (Oxford; New York, NY: Clarendon Press, 1987), p. 244. Smith, ‘Russian Influenza’, p. 71. Searches of The Times Gale database and the British Library’s database of nineteenth-century newspapers between 1890 and 1895 using the terms ‘suicide’ and ‘influenza’ turned up a dozen more cases. There is good reason to believe that a more systematic manual search of regional papers would produce several more. Smith, ‘Russian Influenza’, p. 70. Shaw, ‘Psychoses’, p. 87. Parsons, Report, p. 21; Althaus, Influenza, pp. 100–1. Mills, ‘Nervous and Mental Phenomena’, p. 126; ‘Grip Makes Old Man a Murderer’, New York Tribune, 15 April 1891, p. 1; ‘Driven to Suicide by Grip’, New York Tribune, 17 April 1891, p. 3. The phrase was used in Ibsen’s Hedda Gabler, which was first performed in London on 20 April 1891 at the height of the second wave of the pandemic. Anderson writes that the play was staged repeatedly, and

NOTES TO PAGES 105 –115

116. 117. 118. 119. 120. 121. 122.

123. 124. 125. 126. 127. 128. 129. 130. 131. 132. 133. 134. 135. 136. 137. 138. 139. 140.

141. 142. 143. 144.

145.

261

subsequently ‘this beautiful act’ became something of a catchphrase. Anderson, Suicide, p. 242. Anderson, Suicide, pp. 246–7. Ibid, p. 243. Ibid, p. 4, 250. Ibid, pp. 255–6. Sheffield and Rotherham Independent, 12 May 1891, p. 7. Mead and Halifax, ‘Stories’, p. 87. This is not beyond the realms of possibility given that Halifax was a pseudonym for Dr Edgar Beaumont, a Harley Street doctor who most likely was familiar with many of Dowse and Althaus’s writings. See note 44 above. Mead and Halifax, ‘Stories’, p. 81. Ibid. Ibid, p. 82. Ibid, p. 91. Daily News, 8 March 1895, p. 3. The Times, 8 March 1895, p. 11. Ibid. Daily News, 8 March 1895, p. 3. See also Northern Echo, Birmingham Daily Post, Liverpool Echo, 8 March 1895. Daily News, 8 March 1895, p. 3, 5. Hampshire Telegraph, 9 March 1895, p. 3; The Times, 11 March 1895, p. 12. Lloyd’s Weekly News, 17 March 1895, p. 3. Manchester Evening News, 9 December 1918. Hackney Gazette, 20–23 January 1919; 16 April 1919. The Observer, 1 June 1919, p. 15. Practitioner, 52 ( January –June 1919), p. 46. Savage, ‘Psychoses’, p. 40. Lewis R. Yealland, The Hysterical Disorders of Warfare (London: Macmillan, 1918). Peter Leese, ‘“Why are They not Cured?” British Shellshock Treatment During the Great War’, in Micale and Lerner, Traumatic Pasts, pp. 205– 21. Ibid, p. 217. Savage, ‘Psychoses of Influenza’, p. 40. Shorter, Paralysis, p. 231. William H. B. Stoddart, Mind and its Disorders: A Textbook for Students and Practitioners of Medicine (London: H. K. Lewis, 1921), pp. 216–58; D. K. Henderson and R. D. Gillespie, A Textbook of Psychiatry for Students and Practitioners, 3rd ed (London; New York, NY: Oxford University Press, 1932), pp. 417–23. Maurice Craig and Thomas Beaton, Psychological Medicine: A Manual on Mental Disease for Practitioners and Students (London: J. & A. Churchill, 1926), pp. 72– 84.

NOTES TO PAGES 115 –121

262

146. Ibid, pp. 297–9. 147. Henderson and Gillespie, Textbook of Psychiatry, p. 481. 148. A further possibility is that shell-shock proved a more interesting object

for post-war psychiatrists. To this extent, the psychoses of influenza, like the often remarked absence of memorials to the victims of the Spanish flu, can be seen as one more casualty of the war.

Chapter 4 Demons and Disembodied Spirits: Influenza, Masculinity and Gothic Production at fin-de-sie`cle 1. Daily News, 24 February 1895, p. 3. 2. Birmingham Daily Post, 25 February 1895, p. 8. 3. Richard Rhodes James, Rosebery: A Biography of Archibald Philip, Fifth Earl

of Rosebery. (London: Weidenfeld and Nicolson, 1963) p. 370.

4. Robert O. A. Crewe-Milnes, Lord Rosebery, 2 vols. (London: John Murray,

1931), p. 501.

5. The only child of Baron and Baroness Mayer de Rothschild, Hannah had

6.

7.

8. 9. 10. 11. 12. 13. 14.

married Rosebery in 1878, bringing with her an independent fortune and her unfailing support, but in November 1890, at the age of 39, she contracted a fatal case of typhoid fever. According to James, Hannah’s death was the ‘greatest personal tragedy’ of Rosebery’s life and plunged him into a ‘dark depression’ from which he never fully recovered. James, Rosebery, p. 229. The most detailed exegesis of this theory can be found in Michael Foldy, The Trials of Oscar Wilde: Deviance, Morality, and Late-Victorian Society (Yale University Press, New Haven, CT; London, 1997), pp. 21–8. See also, Brian Roberts, The Mad Bad Line: The Family of Lord Alfred Douglas (London: Hamish Hamilton, 1981). John Davis, ‘Primrose, Archibald Philip, Fifth Earl of Rosebery and First Earl of Midlothian (1847 –1929)’, Oxford Dictionary of National Biography, (Oxford: Oxford University Press, 2004); online edn, January 2011. http:// www.oxforddnb.com/view/article/35,612 [accessed 14 Jan 2011]. Ibid. Jenny Bourne Taylor and Sally Shuttleworth, Embodied Selves: An Anthology of Psychological Texts, 1830– 1890 (Oxford: Clarendon Press, 1998), p. xvi. John Tosh, Manliness and Masculinities in Nineteenth-Century Britain: Essays on Gender, Family, and Empire (Harlow: Pearson Longman, 2005), p. 119. Ibid, pp. 116–19, 204–5. James E. Adams, Dandies and Desert Saints: Styles of Victorian Masculinity (Ithaca, NY: Cornell University Press, 1995). Tosh, Manliness, p. 195. Michel Foucault, ‘Politics and the Study of Discourse’, in Graham Burchell, Colin Gordon and Peter Miller (eds), The Foucault Effect (Chicago, IL;

NOTES TO PAGES 121 –127

15.

16.

17.

18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28.

29. 30. 31. 32. 33. 34. 35.

36.

263

London: University of Chicago Press, 1991), pp. 53 –72, (p. 58). See also Michel Foucault, The Will To Knowledge, The History of Sexuality, volume I (London: Penguin, 1998), pp. 100–2. MacKenzie, ‘Influenza’, p. 878; For other examples of the popular disparagement of influenza see ‘A Curious Cure’, Punch, 14 January 1890, p. 29; ‘Our Paris Letter’, Ladies’ Monthly Magazine, 1 February 1890, p. 18; ‘Leader’, Times, 25 April 1890, p. 9. In his study of the Victorian cultures of health, Bruce Haley argues that the doctrine of mens sana in corpore sano venerated ‘manliness or pluck, a quality similar to physical strength or courage and dependent on them’. Bruce Haley, The Healthy Body and Victorian Culture (Cambridge, MA; London: Harvard University Press, 1987), pp. 21 –2. Michael J. Clark, ‘“Morbid Introspection”: Unsoundness of Mind and British Psychological Medicine’, in William F. Bynum, Roy Porter and Michael Shepherd (eds) The Anatomy of Madness, III: The Asylum and its Psychiatry (London: Routledge, 1988). pp. 71–101. The Times, 25 April 1891, p. 9 Clark, ‘Morbid Introspection’, p. 80. Micale, Hysterical Men, p. 281. Leo McKinstry, Rosebery: Statesman in Turmoil (London: John Murray, 2005), p. 1. Ibid, p. 323. The Times, 25 February 1895, p. 9; The Times, 26 February 1895, p. 5. Daily News, 7 March 1895, p. 2. BMJ, (9 March 1895), Vol. 1, p. 550. Ibid. Speaker, 2 March 1895, p. 235. John Davis, ‘Primrose, Archibald Philip, Fifth Earl of Rosebery and First Earl of Midlothian (1847 –1929)’, Oxford Dictionary of National Biography, (Oxford: Oxford University Press, 2004); online edn, January 2011 ,http://www.oxforddnb.com/view/article/35612. [accessed 14 Jan 2011]. McKinstry, Rosebery, pp. 343–68. Ibid, p. 343. Queen Victoria, Letters of Queen Victoria, 3rd series, volume II (London: John Murray, 1930), p. 494. Daily News, 7 March 1895, p. 3. Crewe-Milnes, Rosebery, p. 501. Ibid, p. 501. Edward Hamilton and David Brooks, The Destruction of Lord Rosebery: From the Diary of Sir Edward Hamilton, 1894–1895 (Historians’ Press: London, 1986), p. 228. Ibid, pp. 228–9.

264 37. 38. 39. 40. 41. 42. 43. 44. 45.

46.

47. 48. 49.

50. 51. 52. 53. 54. 55. 56. 57. 58. 59.

60. 61. 62. 63. 64. 65. 66. 67.

NOTES TO PAGES 127 –136

Ibid, p. 224. McKinstry, Rosebery, p. 344. Daily News, 21 March 1895, p. 4; Speaker, 23 March 1895, p. 319. McKinstry, Rosebery, p. 346. Western Mail, 10 May 1895, p. 5. Ibid. Daily News, 8 May 1895, p. 4. The Times, 25 February 1895, p. 9. Birmingham Daily Post, 25 February 1895, p. 8. Both Nicholls and Stoker survived. However, after contracting influenza Huxley suffered lung and heart complications, dying at the end of June. The Times, 1 July 1895, p. 7. Lee A. W. Scrivener, Modern Insomnia: Vicious Circles and Paradoxes of Attention and Will, 1860–1910 (unpublished thesis: University of London, 2011), pp. 49–52. Ian Miller, A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800 –1950 (London: Pickering & Chatto, 2011). James Johnson, An Essay On Morbid Sensibility of the Stomach and Bowels (London: Thomas and George Underwood, 1827), pp. 60 –5. Clifford T. Allbutt, On Visceral Neuroses: Being the Gulstonian Lectures on Neuralgia of the Stomach and Allied Disorders (Philadelphia: P. Blakiston, 1884), p. 95. Parsons, Report, p. 67. Parsons, Further Report, p. 2. The Lancet, 5 February 1898, pp. 363–5. The Times, 25 February 1895, p. 9. Moonshine, 12 March 1898, p. 123. Fun, 18 March 1895, p. 122. Andrew Smith, Victorian Demons: Medicine, Masculinity and the Gothic at the fin-de-sie`cle, (Manchester: Manchester University Press, 2004), p. 28. Ibid, pp. 34–7. Smith, Victorian Demons, p. 151. Max Nordau, Degeneration (Lincoln, NE: University of Nebraska Press, 1993), p. 2. Nordau’s book was first published in German in 1892 as Entartung. The first English language edition appeared in 1895 under the title Degeneration. Mead and Halifax, ‘Stories’, p. 80. Ibid, p. 82. Speaker, 11 May 1895, p. 506. Victoria, Letters, p. 518. James, Rosebery, p. 384. Ibid, p. 373. Dowse, On Brain and Nerve Exhaustion, pp. 131–3. Moonshine, 30 March 1895, p. 145. Hawkins was also the trial judge in Carlill v. Carbolic Smoke Ball Company, a celebrated 1892 legal case in which a South London woman, Elizabeth Carlill, sued the manufacturer of a quack

NOTES TO PAGES 136 –145

265

medical device that was said to be an infallible prophylactic against influenza. See Chapter 5 for further discussion. For further discussion, see James Eli Adams, Dandies and Desert Saints: Styles of Victorian Manhood (Ithaca, NY; and London: Cornell University Press, 1995), pp. 1–19. Davis, Rosebery. Richard Soloway, ‘Counting the Degenerates: The Statistics of Race Deterioration in Edwardian England’, Journal of Contemporary History, 17, 137 (1982): 137– 94, pp. 140–2. McKinstry, Rosebery, p. 438. Davis, Rosebery.

68.

69. 70.

71. 72.

Chapter 5

‘Death Is Very Busy Just Now’: Influenza, Celebrity and Suffering

1. Consolidation refers to the process whereby the lungs become firm and

2. 3. 4. 5. 6.

7. 8.

9.

10. 11. 12.

solid rather than elastic and air-filled because the alveoli are clogged with exudate. Sir William Broadbent, ‘Account of the Illness and Death of the Duke of Clarence, 9–15 January 1892’, Sir William Broadbent papers and letters, Royal College of Physicians. MS-BROAW/801/A. Hereafter citations will follow page numbers of typescript manuscript. Ibid. Josephine Butler to Stanley Butler, 15 January 1892. 3JBL/31/01. Standard, 21 January 1892, p. 3. Speaker, 23 January 1892, p. 94. For a detailed account of the case and its aftermath see A. W. B. Simpson, ‘Quackery and Contract Law: The Case of the Carbolic Smoke Ball’, The Journal of Legal Studies 14, 2 (1985): 345–89. ‘Carbolic Smoke Ball,’ Graphic, 23 January 1892, p. 129. John Wolffe, Great Deaths: Grieving, Religion, and Nationhood in Victorian and Edwardian Britain (Oxford: Oxford University Press, 2000), p. 17. Wolffe argues that the expressions of grief may have been due in part to the royal family’s cultivation of an image of ‘ordinary and accessible family life’. Her ‘trial’ before the House of Commons for alleged marital infidelities had made her a focus for Whig and radical protest, and her funeral procession through London attracted large crowds, leading to scuffles with the police. Wolffe, Great Deaths, pp. 20–2. Ibid, pp. 23–4. Ibid, pp. 28–55. Phillip Hedgeland, National Grief and Some of Its Uses (Penzance, 1861). Quoted in Wolffe, Great Deaths, p. 197.

266

NOTES TO PAGES 145 –148

13. H. C. G. Matthew, ‘Edward VII (1841 –1910)’, Oxford Dictionary of

14.

15.

16. 17. 18. 19. 20.

21.

22. 23. 24.

25. 26. 27. 28.

National Biography, (Oxford: Oxford University Press, 2004); online edn, May 2009 , http://www.oxforddnb.com/view/article/32975. [accessed 11 Jan 2011]. In the event, Edward survived but it had been a close run thing, and Gladstone immediately capitalised on his recovery to hold a public celebration, thereby pricking the bubble of Republican sentiment that had grown up around the prince following the rumours of his extramarital affairs and the questions about his character. Alison Winter, Mesmerized: Powers of Mind in Victorian Britain (Chicago, IL; London: University of Chicago Press, 1998), pp. 320–31. Winter’s discussion focuses on Collins’ The Woman in White, which was first serialised in 1859–60. Similar techniques were also employed by later Victorian novelists, notably Ellen Wood, Mary Elizabeth Braddon and Charles Reade. Richard D. Altick, Victorian Studies in Scarlet (London: Dent, 1972); Thomas Boyle, Black Swine in the Sewers of Hampstead: Beneath the Surface of Victorian Sensationalism (London: Hodder & Stoughton, 1990). Lewis P. Curtis, Jack the Ripper and the London Press (New Haven, CT: Yale University Press, 2001), p. 14. Benedict Anderson, Imagined Communities: Reflections on the Origins and Spread of Nationalism (London: Verso, 2006), p. 35. Winter, Mesmerized, p. 342. Ibid, pp. 328–9. John Van der Kiste, ‘Albert Victor, Prince, Duke of Clarence and Avondale (1864–1892)’, Oxford Dictionary of National Biography, (Oxford: Oxford University Press, 2004); online edn, Jan 2008 ,http://www.oxforddnb. com/view/article/275. [accessed 11 Jan 2011]. He was also briefly suspected of being Jack the Ripper. See, for instance, Morning Post, 7 December 1891, p. 4; Manchester Times, 11 December 1891, p. 8; Penny Illustrated Paper and Illustrated Times, 19 December, p. 392. The Times, 12 January 1892, p. 10. Broadbent, ‘Account’. Kevin Brown, ‘Broadbent, Sir William Henry, First Baronet (1835– 1907)’, Oxford Dictionary of National Biography, (Oxford: Oxford University Press, 2004). ,http://0-www.oxforddnb.com.catalogue. ulrls.lon.ac.uk/view/article/32077. [accessed 11 Jan 2011]. Ibid. Broadbent, ‘Account’, p. 1. Ibid, p. 2. Ibid, p. 1.

NOTES TO PAGES 149 –158

267

29. ‘It was a terrible aggravation of our troubles and anxieties to have him

30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50.

51. 52. 53. 54. 55. 56.

57.

continually dwelling on his selfish fears for his own prospects,’ Broadbent continues. ‘Nothing Dr Laking & I could say gave him comfort.’ Ibid, p. 6. Ibid, p. 4. The Times, 11 January 1892, p. 9. The Times, 12 January 1892, p. 9. Broadbent, ‘Account’, pp. 5 –6. The Times, 13 January 1892, p. 9. Broadbent, ‘Account’, pp. 5 –6. Broadbent, ‘Account’, pp. 7 –8. The Times, 14 January 1892, p. 9. Broadbent, ‘Account’, p. 8. The Times, 14 January 1892, p. 9. Ibid, p. 9. Ibid, p. 9. Broadbent, ‘Account’, pp. 9 –11. The Times, 15 January 1892, p. 9. The Times, 16 January 1892, p. 9. Daily News, 15 January 1892, p. 5 Queen Victoria, Letters of Queen Victoria, 3rd series, volume II, 1891– 95 (London: John Murray, 1930), pp. 93 –4. Saturday Review, 16 January 1892, p. 65. Broadbent, ‘Account’, p. 12. Graphic, 23 January 1892. Ibid, p. 102. In this respect, the reaction to Clarence’s death resembled the response to Princess Diana’s death in a car crash in the Pont de l’Alma tunnel in Paris in 1997. For further discussion, see Adrian Kear and Deborah Lynn Steinberg, Mourning Diana: Nation, Culture, and the Performance of Grief (London; New York, NY: Routledge, 1999). Rudyard Kipling, Something Of Myself: For My Friends Known and Unknown (Edinburgh: R & R Clark, 1935), p. 105. Dixey, ‘Influenza Epidemic’; Dixey, Epidemic Influenza. Illustrated London Police News, 30 January 1892, p. 2. Josephine Butler to Stanley Butler, 15 January 1892. 3JBL/31/01. ‘Carbolic Smoke Ball’, Graphic, 23 January 1892, p. 129. For a modern interpretation of the legal implications of the case and its aftermath see A. W. B. Simpson, ‘Quackery and Contract Law: The Case of the Carbolic Smoke Ball’, The Journal of Legal Studies, 14, 2 (1985): 345– 89; Janice Dickin McGinnis, ‘Carlill v Carbolic Smoke Ball Co.: Influence, Quackery and the Unilateral Contract’, Canadian Bulletin of the History of Medicine, 5 (1988): 121–41. Ibid, pp. 356–68.

268

NOTES TO PAGES 160 –163

58. Thomas Richards, The Commodity Culture of Victorian England: Advertising

59. 60. 61.

62.

63.

64.

65. 66.

67. 68. 69. 70. 71. 72.

and Spectacle, 1851 –1914 (Stanford, CA: Stanford University Press, 1990), p. 169. Ibid, pp. 3–9. Simpson, ‘Quackery’, pp. 351–2. Wilkinson estimates that by 1902 patent medicine advertising generated an astonishing £200,000 for the Daily Telegraph. Glen R. Wilkinson, ‘“To The Front”: British Newspaper Advertising and the Boer War’, in John Gooch (ed), The Boer War: Direction, Experience and Image (London: Frank Cass, 2000), p. 205. Lori Anne Loeb, Consuming Angels: Advertising and Victorian Women (Oxford: Oxford University Press, 1994), p. 105. In its 1907 investigation into the composition of ‘secret remedies’ and patent medicine advertising, the British Medical Association reached a similar conclusion, arguing that the ‘well-to-do’ took a ‘mysterious pleasure in experimenting with mysterious compounds’. Secret Remedies: What They Cost and What They Contain (London: British Medical Association, 1909), p. viii. This was followed by a second report, More Secret Remedies ((London: British Medical Association, 1912) and the Report from the Select Committee on Patent Medicines in 1914. Thomas Percival’s Medical Ethics had stipulated that no doctor could prescribe or recommend a medicine whose composition and, by implication, effects were unknown. Thomas Percival, Medical Ethics (Manchester: S Russell, 1803), pp. 44 –5. Lori Anne Loeb, ‘Beating the Flu: Orthodox and Commercial Responses to Influenza in Britain, 1889 –1919’, Social History of Medicine, 18, 2: 203– 24, pp. 213–14. Simpson, ‘Quackery’, pp. 367–8. Besides the advertisements in the Graphic and The Pall Mall Gazette, Roe also placed a series of advertisements in the Illustrated London News, paying up to £100 for a full-page display. By 1908 it is estimated that the patent medicine industry was spending 2 million pounds a year on advertising. Simpson, ‘Quackery’, p. 352; Richards, Commodity Culture, p. 172. For an account of the rise of advertising agents see Eric Field, Advertising: The Forgotten Years (London: Ernest Benn, 1959). Loeb, Consuming Angels, pp. 5–7. Ibid, pp. viii, 10. Loeb, ‘Beating the Flu’, p. 213. Graphic, 23 January 1892, p. 127, 130, 131. Graphic, 16 January 1892, p. 85. Illustrated London News, 20 February 1892. Quoted in Simpson, ‘Quackery’, p. 382.

NOTES TO PAGES 163 –171 73. 74. 75. 76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96.

97. 98. 99. 100. 101. 102.

103. 104.

269

Richards, Commodity Culture, pp. 187–8. Standard, 9 January 1890, p. 4. Daily News, 12 March 1895, p. 9. Era, 14 January 1888, p. 10. Era, 28 March 1888, p. 10. Simpson, ‘Quackery’, p. 352–3. Graphic, 23 May 1891, p. 590. Graphic, 20 June 1891, p. 712. Pall Mall Gazette, 13 November 1891, p. 3. Ibid, p. 356–8. Chemist and Druggist, 18 June 1892, p. 875–6. Chemist and Druggist, 9 July 1892, pp. 39 –41; Simpson, ‘Quackery’, pp. 359– 60. Carlill v. Carbolic Smoke Ball Co. ,http://www.bailii.org/ew/cases/ EWCA/Civ/1892/1.html. [accessed 6 Jan 2011] Parsons, Further Report, p. 12. Parsons, Report, p. 81. Graphic, 23 January 1892, p. 130. Chemist and Druggist, 13 February 1892, p. 37. See, for example, The Times, 13 November 1891, p. 1; 20 November 1891, p. 1; 2 December 1891, p. 1. The Times, 29 December 1891, p. 4. The Times, 2 December 1891, p. 2. Chemist and Druggist, 18 June 1892, p. 876. Josephine Butler to Stanley Butler, 15 January 1892. 3JBL/31/01. Graphic, 23 January 1892, p. 129. William Leiss, Stephen Kline, and Sut Jhally, Social Communication in Advertising: Persons, Products and Images of Well Being (London: Routledge, 1997), pp. 1–5, 287–9. Ibid, pp. 287–9. Peter Hadley, The History of Bovril Advertising (London: Ambassador Publishing Services Ltd, 1971), pp. 3–6. Ibid, pp. 7–9. Standard, 8 January 1890, p. 4. Pall Mall Gazette, 14 January 1892, p. 4. Standard, 25 March 1895, p. 6. A later advertisement that appeared at the height of the 1898 epidemic was even more explicit. Headlined ‘Influenza’, it declared that ‘Bovril is strength and strength is precisely what is wanted to fortify the system against infection, or to pilot a patient through an attack to a speedy convalescence and recovery.’ Speaker, 12 February 1898, p. 217. Hadley, Bovril Advertising, p. 10. The London dailies began accepting display and block ads in around 1895. However, while papers like the Daily News were quick to embrace the new formats, the Daily Mail, launched in 1896, was rather slower, while the

270

105. 106. 107.

108. 109.

110. 111. 112. 113. 114. 115. 116.

NOTES TO PAGES 171 –181 Morning Post did not accept advertisements over single columns until 1910. Eric Field, Advertising: The Forgotten Years (London: Ernest Benn, 1959) p. 62. Report of the Public Health Committee of the London County Council for 1903, pp. 38 –39. Ludgate, 7 December 1898, p. 8. Roger Cooter, ‘Of War and Epidemics: Unnatural Couplings, Problematic Conceptions’, Social History of Medicine, 16 (2003): 283–302, pp. 283, 294–5. Dennis Judd and Keith Surridge, The Boer War (London: John Murray, 2002), p. 126. Daily News, 6 January 1900, p. 8. In all, the Registrar General for England and Wales recorded 16,245 deaths from influenza in 1900, the highest number since 1891. The epidemic also saw a marked elevation in the death rate to 504 per million, which was the highest rate since the mortal secondary wave of the pandemic in 1892. Annual Report of the Registrar General, 1919, p. 11. Review of Reviews, February 1900, p. 110. The Lancet, 13 January 1900, p. 107. Penny Illustrated Paper, 13 January 1900, p. 28. Illustrated London News, 24 February 1900, p. 275. Hadley, Bovril Advertising, p. 15. Loeb, Consuming Angels, p. 145. Ibid, p. 146.

Chapter 6 ‘A Sense of Dread is Very General’: the First World War, the ‘Spanish’ Flu and the Northcliffe Press 1. Letter to Susan Owen, June 24 1918, in H. Owen and J. Bell (eds), Wilfred

Owen Collected Letters (London: Oxford University Press, 1967), p. 560.

2. Ibid, p. 560. 3. The flu’s nomenclature was due to the fact that Spain was a neutral country

4. 5. 6. 7.

8.

in World War I and foreign correspondents based in Madrid were not subject to the censorship rules that applied in other parts of Europe, meaning they could freely report the depredations of the epidemic. Johnson, Dark Epilogue, p. 37. Daily Express, 23 May 1918, p. 1; Daily Express, 29 May 1918, p. 1. The Times, 25 June 1918, p. 9. Johnson, Dark Epilogue, pp. 45–46, 73. Jeffery K. Taubenberger and David M. Morens, ‘Influenza: The Once and Future Pandemic’, Public Health Reports, 125, 3 (April 2010); 16 –27, p. 20. The Times, 18 December 1918, p. 5.

NOTES TO PAGES 182 –183

271

9. Honigsbaum, Enza, pp. 24– 5, 71–2, 80–1. 10. Major Greenwood, Epidemics and Crowd Diseases: An Introduction to the Study

of Epidemiology (London: Williams and Norgate, 1935), p. 326.

11. Crosby, America’s Forgotten Pandemic. Bresalier has recently challenged this

12.

13.

14.

15.

16.

17. 18.

notion of historical forgetting, arguing that it rests on ‘a restricted time scale’ and ignores the ‘crucial role of virus research in shaping the medical and social legacies of the pandemic’. Michael Bresalier, ‘Transforming Flu: the Making of a Virus Disease in London, 1890–1939’ (unpublished doctoral dissertation, Trinity College, Cambridge, 2010), pp. 18 –20. Niall Johnson, ‘The Overshadowed Killer: Influenza in Britain in 1918– 19’, in Howard Phillips and David Killingray (eds), The Spanish Influenza Pandemic of 1918 –19: New Perspectives (London; New York, NY: Routledge, 2003), p. 155; Johnson, Dark Epilogue, p. 180. Other factors cited by Johnson include the ‘mild’ nature of the initial wave of infections and the fact that the summer wave went largely unreported in Britain. He also argues that while the second wave of the pandemic was associated with high levels of mortality and would have ‘terrified’ Britons, ‘the lesser magnitude of the third wave [. . .] undermined the committing of the pandemic to memory’. Johnson, Dark Epilogue, p. 165. For further discussion see Peter N. Stearns and Carol Z. Stearns, ‘Emotionology: Clarifying the History of Emotions and Emotional Standards’, American Historical Review, 90, 4 (October 1985): 813–36; Joanna Bourke, ‘Fear and Anxiety: Writing about Emotion in Modern History’, History Workshop Journal, 55 (Spring 2003): 111–22. Joanna Bourke argues that the authorities made a similar effort to manage fear responses in World War II, virtually dissolving the distinction between the home and military fronts. Joanna Bourke, ‘Disciplining the Emotions: Fear, Psychiatry and the Second World War’, in Roger Cooter, Mark Harrison, Steve Sturdy (eds), War, Medicine And Modernity (Stroud: Sutton Publishing, 1998), pp. 225–38. A good example was the panic engendered by the Zeppelin raids on the south and east coasts of England in 1915. Cate Haste, Keep the Home Fires Burning, Propaganda in the First World War (London: Allen Lane, 1977), pp. 95 –6. Foucault, History of Sexuality, pp. 100–1. I use self-regulation in the Foucauldian sense to refer to the way that biopolitical discourses encourage individuals to act as ‘doctors to oneself’ thereby rendering them subjects of neoliberal forms of governance. Michel Foucault, ‘Technologies of the Self,’ in L. H. Martin, H. Gutman and P. H. Hutton (eds), Technologies of the Self: A Seminar with Michel Foucault (London: Tavistock, 1988), pp. 16– 49.

272

NOTES TO PAGES 184 –186

19. See, for instance, Charles L. Briggs and Daniel C. Hallin, ‘Biocommunic-

20. 21.

22. 23. 24. 25.

26. 27.

28. 29.

ability: The Neoliberal Subject and its Contradictions in News Coverage of Health Issues’, Social Text, 93, 25, 4 (Winter 2007): 43 –66; Brigitte Nerlich and Christopher Halliday, ‘Avian Flu: the Creation of Expectations in the Interplay between Science and the Media’, Sociology of Health and Illness, 29, 1 (2007): 46 –65; Patrick Wallis and Brigitte Nerlich, ‘Disease Metaphors in New Epidemics: The UK Media Framing of the 2003 SARS Epidemic’, Social Science and Medicine, 60 (2005), 2629– 39; Patrick Wallis, Brigitte Nerlich, and Brendon M. H. Larson, ‘Metaphors and Biorisks: The War on Infectious Diseases and Invasive Species’, Science Communication, 26, 3 (2005): 243–68. George Lakoff and Mark Johnson, Metaphors We Live By (Chicago, IL; London: University of Chicago Press, 2003), pp. 3– 6, 244. James J. Bono, ‘Why Metaphor? Toward a Metaphorics of Scientific Practice’, in S. Maasen and M. Winterhager (eds), Science Studies: Probing the Dynamics of Scientific Knowledge (Bielefeld: Transcript Verlag, 2001), pp. 215– 35, 225. William M. Reddy, ‘Against Constructionism: The Historical Ethnography of Emotions’, Current Anthropology, 38, 3 ( June 1997): 327–51. Ibid, p. 332. Bono, ‘Why metaphor?’, p. 222. The Oxford English Dictionary defines propaganda as ‘the systematic dissemination of information, especially in a biased or misleading way, in order to promote a political cause or point of view.’ However, I will also refer to propaganda in the broader sense of ‘mass suggestion or influence through the manipulation of symbols and the psychology of the individual’. Anthony R. Pratkanis and Elliot Aronson, Age of Propaganda: The Everyday Use and Abuse of Persuasion (New York, NY: W.H. Freeman, 2001), p. 11. C. P. Scott, The Political Diaries of C. P. Scott, ed. Trevor Wilson, Trevor Wilson (ed.) (London: Collins, 1970), p. 321. See, for instance, Michael L. Sanders and Peter M. Taylor, British Propaganda during the First World War, 1914–18 (London: Macmillan, 1982); G. S. Messinger, British Propaganda and the State in the First World War (Manchester: Manchester University Press, 1992); Brock Millman, Managing Domestic Dissent in First World War Britain (London: Frank Cass, 2000). For further discussion see Mark Hampton, Visions of the Press in Britain, 1850–1950 (Urbana, IL: University of Illinois Press, 2004), pp. 130–72. D. George Boyce, ‘Harmsworth, Alfred Charles William, Viscount Northcliffe (1865 – 1922)’, Oxford Dictionary of National Biography,

NOTES TO PAGES 186 –188

30. 31. 32.

33.

34. 35.

36.

37.

38.

39.

40.

41. 42.

273

(Oxford: Oxford University Press, 2004); online edn, Jan 2011 ,http:// www.oxforddnb.com/view/article/33,717. [accessed 25 Jan 2011]. Haste, Home Fires, p. 18. Hampton, Visions, p. 149. Haste, Home Fires, pp. 79–107. The term ‘Hun’ was coined by the Daily Mail’s senior reporter Lovat Fraser. S. J. Taylor, The Great Outsiders: Northcliffe, Rothermere and the Daily Mail (London: Orion, 1998), p. 143. John M. McEwen, ‘The National Press during the First World War: Ownership and Circulation’, Journal of Contemporary History, 17, 3 (July 1982): 459–86. Gerald DeGroot, Blighty: British Society in the Era of the Great War (London; New York, NY: Longman, 1966), pp. 174–95. It is estimated that through his ownership of the Daily Mail, The Times, Evening News and Sunday Evening Dispatch, Northcliffe controlled approximately 40 per cent of the then English newspaper market. Northcliffe’s brother, Harold (Lord Rothermere), also owned the Daily Mirror, the largest daily paper for women. J. Lee Thompson, Politicians, The Press, And Propaganda: Lord Northcliffe and the Great War, 1914 –1919 (Ohio, OH; London: Kent State University Press, 1999), p. 2. Haste, Home Fires, pp. 90–1. The story resulted from a misunderstanding over the German word ‘Kadaver’, which was incorrectly presumed to mean ‘human body’ rather than the more accurate ‘animal corpse’. Dennis Griffiths, Fleet Street: Five Hundred Years of the Press (London: British Library, 2006), p. 203. Although Northcliffe made it clear that his role was to be non-ministerial, his appointment, which followed Cabinet posts for his brother Harold (Lord Rothermere) and Beaverbrook, signalled that all three major press barons were now united behind the government’s war aims. Sybil Oldfield, ‘Playne, Caroline Elizabeth (1857 – 1948)’, Oxford Dictionary of National Biography, (Oxford: Oxford University Press, 2004). ,http://www.oxforddnb.com/view/article/38,530. [accessed 27 Jan 2011]. Caroline E. Playne, The Neuroses of the Nations (London: Allen and Unwin, 1925); Caroline E. Playne, Society at War, 1914–1916. (London: Allen and Unwin, 1931); Caroline E. Playne, Britain Holds On, 1917, 1918 (London: Allen and Unwin, 1933). Playne, Society at War, p. 7; Gustave Le Bon, The Crowd: A Study of the Popular Mind, repr. of 1896 edition (London: Ernest Benn, 1930); W. Trotter, Instincts of the Herd in Peace and War, first publ. 1910 (London: T. Fisher Unwin, 1916). Playne, Society at War, pp. 7, 16–17, 25, 31. Ibid, pp. 286–8.

274

NOTES TO PAGES 188 –190

43. Anne Ramussen, ‘Prevent or Heal, Laissez-faire or Coerce? The Public

44.

45. 46. 47.

48. 49. 50. 51.

52. 53. 54.

55.

56. 57.

Health Politics of Influenza in France, 1918 –19,’ in Tamara GilesVernick and Susan Craddock, Influenza and Public Health: Learning from Past Pandemics (Earthscan: London, 2010), pp. 69–83. Michael Bresalier, ‘Fighting Flu: Military Pathology, Vaccines, and the Conflicted Identity of the 1918 –19 Pandemic in Britain’, Journal of the History of Medicine and Allied Sciences, 68, 1 (2013): 87 –128. Dixey, ‘On the Influenza Epidemic’. Daily Express, 23 May 1918, p. 1; 29 May 1918, p. 1; Daily Mail, 28 May 1918, p. 3; 29 May 1918, p. 3; 30 May 1918, p. 3. ‘The Reported Epidemic in Spain,’ BMJ, (1 June 1918), Vol. 1, p. 627. The first reference to the epidemic in The Lancet came in a short article in August in which the journal belatedly acknowledged the elevation of mortality that had occurred in July. The Lancet, (3 August 1918), Vol. 192, p. 162. Arthur Newsholme, ‘Discussion on Influenza,’ Proceedings of the Royal Society of Medicine, 12 (1919): 1–18, p. 13. John Eyler, Sir Arthur Newsholme and State Medicine, 1835 –1935 (Cambridge: Cambridge University Press, 1997), p. 226. Bresalier, ‘Fighting Flu’, pp. 3–4. Sandra M. Tomkins, ‘The Failure of Expertise: Public Health Policy in Britain during the 1918–19 Influenza Epidemic,’ Social History of Medicine, 5, 3 (December 1992): 435–54, p. 445. For a detailed discussion of the responses in other countries, see Phillips and Killingray, Spanish Influenza. Jay M. Winter, The Great War and the British People (London: Macmillan, 1985), p. 186. See, for instance, Chemist and Druggist, 6 July 1918, p. 35; 26 October 1918, p. 34. The Times, 31 October 1918, p. 7. Not all commentators shared Newsholme’s opinion that preventive measures were pointless. Indeed, George Newman, the then Chief Medical Officer of the Board of Education, was highly critical of the position adopted by Newsholme at the Royal Society of Medicine meeting, describing him afterwards in his diary as ‘vacillating’ and ‘incompetent’. Honigsbaum, Enza, p. 93. ‘Men, if they see another man tremble, giddy, or sick of some fearful disease, their apprehension and fear is so strong in this kind that they will have the same disease.’ Robert Burton, The Anatomy of Melancholy, I (Philadelphia, PA: J. W. Moore, 1857, first publ. 1638), p. 160. Anonymous, Influenza, its Cause, Cure and Prevention, The Penny Medical Library (Manchester: Abel and Heywood, 1902), p. 237. Ibid.

NOTES TO PAGES 191 –198

275

58. For a recent discussion of the methodological problems involved in

59. 60. 61. 62.

63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75.

76. 77. 78. 79. 80. 81.

82.

popular and historical treatments of trauma and shell shock, see Tracey Loughran, ‘Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and Its Histories’, Journal of the History of Medicine and Allied Sciences, 67, 1 (2012): 94 –119. Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (London: Jonathan Cape, 2000), pp. 91–3. Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton, NJ: Princeton University Press, 1995), pp. 63–7. Shephard, pp. 90– 3. Elaine Showalter, The Female Malady: Women, Madness and English Culture, 1830–1980 (London: Virago, 1998), pp. 167–94. Showalter argues that it was only after the war that female novelists such as Virginia Woolf and Rebecca Mead would re-interpret shell-shock in gendered terms as a male hysterical response to the trauma of war and the repressive patriarchal system that underpinned the exercise of Edwardian psychiatric power and Britain’s wartime society. Bovril Co., Bovril Book of War Facts (London: Bovril, 1915). Hadley, Bovril Advertising, p. 224. Ibid, pp. 31–3. Ibid. Salford Reporter, 23 November 1918, p. 2. Vogue, 6 November 1918, p. 2. Daily Mail, 6 June 1918, p. 2. Daily Mail, 24 June 1918, p. 4. Daily Mail, 25 June 1918, p. 4. See also Chemist and Druggist, 29 June 1918, p. 44. Glasgow Herald, 23 July 1918, p. 6. Salford Reporter, 29 June 1918, p. 2. The Times, 25 June 1918, p. 5. Daily Express, 29 May 1918, p. 1; ‘The Influenza Epidemic’, The Lancet, (2 November 1918), Vol. 192, pp. 595– 6; Ministry of Health, Report on the Pandemic of Influenza 1918 –19 (London: HMSO, 1920), pp. xviii-xix. Bresalier, ‘Fighting Flu’, pp. 25 –8. John Grigg, Lloyd George: War Leader, 1916–1918 (London: Allen Lane, 2003), p. 594. For further discussion see Honigsbaum, Enza, pp. 65 –9. Manchester Guardian, 13 September, p. 6; 14 September, p. 6. The Times, 18 September 1918, p. 8. Carole R. Byerly, Fever of War: The Influenza Epidemic in the U.S. Army during World War I (New York, NY; London: New York University Press, 2005), pp. 97 –8. R. N. Grist, ‘Pandemic Influenza 1918’, BMJ, (22 December 1979), Vol. 2, pp. 1632–3.

276

NOTES TO PAGES 198 –204

83. Byerly, Fever of War, p. 103. 84. R.E. Lauder, Annual Report on the Health of the County Borough of

Southampton and the Port of Southampton for the year 1918, p. 8.

85. An exception is an article that appeared in The Lancet in October referring

86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96. 97. 98. 99. 100. 101. 102. 103. 104. 105.

106. 107. 108. 109. 110.

to ‘alarming accounts’ of the deaths on an American troopship, S.S. Otranto. Addressing the issue of ‘confusion’ as to case fatality rate, The Lancet reported there had been 50 cases of influenza and four deaths, with other deaths from pneumonia being due to the crewmen’s ‘exposure during rescue’. The Lancet, (19 October 1918), Vol. 192, p. 535. Glasgow Herald, 3 October 1918, p. 6. Glasgow Herald, 15 October 1918, p. 4. The Times, 3 October 1918, 5; Daily Mail, 10 October 1918, p. 4. Daily Mail, 11 October 1918, p. 4. Daily Mail, 29 October 1918, p. 2. The Times, 10 October 1918, p. 5. The Times, 21 October 1918, p. 7. Daily Mail, 11 October 1918, p. 4. Daily Mail, 21 October 1918, p. 4. The Times, 22 October 1918, p. 3. The Times, 23 October 1918, p. 7. Daily Mail, 28 October 1918, p. 2. Ibid, p. 3. The Times, 26 October 1918, p. 7. The Times, 28 October 1918, p. 6. The Times, 31 October 1918, p. 7. Manchester Guardian, 21 December 1918, p. 4. BMJ, (9 November 1918), Vol. 2, p. 534. Daily Mail, 15 November 1918, p. 2. Playne, Britain Holds On, p. 380. See also ‘Playne Diary’, 26 October 1918, Caroline Playne Collection, Senate House Library, University of London. MS1112. The entry in Playne’s diary is slightly different from the edited version, and reads: ‘Influenza very bad in places. People did not seem cheered by the prospect of peace [. . .] People full of very sad cases of influenza. A great sense of dread about everything.’ Playne, Britain Holds On, p. 380. Manchester Guardian, 30 October 1918, p. 4. Ibid, p. 4. Playne, Britain Holds On, p. 377. Daily Mail, 13 November 1918, p. 4.

NOTES TO PAGES 207 –212

277

Chapter 7 The ‘Forgotten’ Pandemic: Flu, Trauma and Modern Memory 1. Jay Winter, The Great War and Modern Memory (Oxford: Oxford University 2. 3. 4. 5.

6. 7. 8. 9.

10. 11.

12. 13. 14.

15.

16.

17. 18.

19. 20. 21.

Press, 2000), p. 30. ‘The Great Death’, The Times, 2 February 1921, p. 11. Johnson, Dark Epilogue, p. 180. Ibid. Ian Hacking, ‘Memory Sciences, Memory Politics’ in Paul Antze and Michael Lambek (eds), Tense Past: Cultural Essays in Trauma and Memory (New York, NY; London: Routledge, 1996), pp. 67–87; Allan Young, Harmony of Illusions. Ibid, p. 76. Ruth Leys, Trauma: A Genealogy (Chicago, IL; London: University of Chicago Press, 2000). Katharine Hodgkin and Susannah Radstone (eds), Regimes of Memory (London: Routledge, 2002), p. 11. Didier Fassin and Richard Rechtman, The Empire of Trauma: An Inquiry into the Condition of Victimhood (Princeton, PA: Princeton University Press, 2009), p. 16. Ibid, p. 275. The Diary of Virginia Woolf, vol. I, 1915–19, Anne Oliver Bell (ed) (Harmondsworth: Penguin Books, 1982), 2 July 1918, p. 163; 28 October 1918, p. 209. Hermione Lee, Virginia Woolf (London: Vintage, 1997), pp. 195–220. Lee, Woolf, pp. 198–9, 201–2, 803–5. Thomas C. Caramango, The Flight of the Mind: Virginia Woolf’s Art and Manic-Depressive Illness (Berkeley, CA: University of California Press, 1992), pp. 6– 32. See, for example, Louise DeSalvo, Virginia Woolf: The Impact of Sexual Abuse on her Life and Work (Boston, MA: Beacon Press, 1989); Shirley Panken, Virginia Woolf and the ‘Lust of Creation’: A Psychoanalytic Exploration (Albany, NY: State University of New York Press, 1987). Savage was the model for Sir William Bradshaw, the Harley Street nerve specialist who is portrayed in the novel as exercising a repressive patriachal authority over his patients. Lee, Woolf, p. 146. Virginia Woolf, ‘A Sketch of the Past’ in Jeanne Schulkind (ed), Virginia Woolf: Moments of Being, 2nd edn. (London: The Hogarth Press, 1985), pp. 64 –159. DeSalvo, Woolf, p. 107–8. Woolf, ‘Sketch’, p. 70. DeSalvo, Woolf, pp. 107–8.

278

NOTES TO PAGES 212 –222

22. Ibid, p. 111. Curiously, given her psychoanalytic reading of Woolf, DeSalvo

23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40.

41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53.

does not mention that the death in 1895 of Woolf’s mother, Julia Stephen, to whom she argues Woolf had an unhealthy pre-Oedipal attachment, also appears to have been precipitated by influenza. The flu appears to have put a strain on Stephen’s heart, resulting in her premature death at the age of 48. Soon after Woolf had her first major breakdown, writing that her pulse raced so quickly she could ‘hardly bear it’. Lee, Woolf, p. 197. See the diary entry for 16 February 1930, quoted in Lee, Woolf, p. 212. Woolf, ‘On Being Ill’, p. 15. Woolf, The Letters of Virginia Woolf, II, 1882–1912, Nigel Nicolson (ed) (London: Hogarth Press, 1975), 29 January 1918, pp. 213–6. Woolf, Letters II, 23 February 1918, p. 218. Quoted in Caramango, Flight, p. 12. Ibid. Woolf, Diary I, 10 June 1921, p. 125. Lee, Woolf, p. 209. Woolf, Letters II, 21 January 1922, p. 498. Ibid, 1 March 1922, pp. 510–11. Ibid, 16 May 1922, p. 526. Ibid, 23 September 1922, p. 559. Lee points out that elsewhere Woolf refers to the ‘the celebrated sensibility of my nervous system’. Lee, Woolf, p. 209. Virginia Woolf, The Diary of Virginia Woolf, III, 1925 –30, ed. Anne Oliver Bell (London: Hogarth Press, 1983), 16 February 1930, p. 287. Ibid, 27 November 1925, p. 46. Woolf, ‘On Being Ill’, p. 16. Ibid, p. 14. For further discussion, see Roy Porter, ‘Doing History from Below’, Theory and Society, 14 (March 1985): 175–98; Flurin Condrau, ‘The Patient’s View Meets the Clinical Gaze’, Social History of Medicine, 20, 3 (2007): 525–40. Donne, Devotions. Woolf, ‘On Being Ill’, p. 15. Ibid, p. 15. Woolf, Diary I, 2 July 1918, p. 163. Ibid, 10 July 1918, p. 165. Ibid, 28 October 1918, p. 209. Ibid, 30 October 1918, p. 211. Ibid, 17 December 1918, p. 229. Virginia Woolf, Mrs Dalloway (London: Penguin Classics, 1992), p. 4. Sutherland Scott [William Clunie Howie], ‘The Influenza Mystery’ (1938). Vera Brittain, Testament of Youth: An Autobiographical Study of the Years 1900–1925 (London: Virago, 1978). Robert Graves, Goodbye to All That. An Autobiography (London: Penguin, 1998), p. 297. Ibid.

NOTES TO PAGES 222 –228

279

54. Anthony Burgess, Little Wilson and Big God (London: Heinemann, 1987),

p. 17– 18.

55. Dorothy E. Jack, Letter 5 May 1973, Collier Collection, IWM. 56. Ethel Robson, Letter 16 May 1973, Collier Collection, IWM. 57. Niall Johnson and Ju¨rgen Mueller, ‘Updating the Accounts: Global

58. 59.

60.

61. 62.

Mortality of the 1918 –1920 “Spanish” Influenza Pandemic’, Bulletin of the History of Medicine, 76, 1 (2002): 105–15, p. 115. Albert Camus, The Plague (London: Penguin Classics, 2002) p. 31. I am thinking of Raul Hilberg’s 1961 history The Destruction of the European Jews, and Primo Levi’s 1959 Auschwitz survival memoir, If This is a Man. This process began with the publication of Richard Collier’s The Plague of the Spanish Lady in 1974 and continued with the publication of Albert Crosby’s Epidemic and Peace in 1976. The latest iteration of this phenomenon was the 2008 publication by the Centers for Disease Control of a collection of American survivors’ accounts of the pandemic. Using ‘scant editing, so the unique voice of the storyteller is heard’, the CDC’s Pandemic Influenza Storybook purports to be both an oral history record and a ‘training module’ for pandemic planners involved in crisis and emergency risk communication. Centers for Disease Control, Pandemic Influenza Storybook. http://www.cdc.gov/about/panflu/ [accessed 15 May 2012]. Crosby, Epidemic and Peace, p. 322. Johnson, Dark Epilogue, p. 180.

Chapter 8 Apocalypse Redux 1. ‘Influenza A (H1N1) Virus, 2009—Online Monitoring’, New England

Journal of Medicine, 360, 21 (21 May 2009): 2156–7. Ibid. ,http://digitaljournal.com/article/27,1720. [accessed 12 Oct 2012]. Note 1 op. cit. ‘Swine influenza A (H1N1) Infection in Two Children – Southern California, March-April 2009,’ Morbidity and Mortality Weekly Report, 24 April 2009, 58, 15: 400–2. 6. Jo Tuckman, ‘“My head hurt a lot” – child who could reveal origin of swine flu outbreak’, Guardian, 29 April 2009. ,http://www.who.int/medi acentre/news/statements/2009/h1n1_20,090427/en/index.html. [accessed 22 Dec 2009]. 7. , http://www.who.int/mediacentre/news/statements/2009/ h1n1_pandemic_phase6_20,090611/en/index.html. [accessed 22 Dec 2009]. 8. Ibid.

2. 3. 4. 5.

280

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9. Jeffery K. Taubenberger, A. H. Reid and T. G. Fanning, ‘Capturing a Killer

Flu Virus’, Scientific American, 292, 1 (Jan 2005): 48 –57.

10. The prediction was made by John Oxford, a virologist at St Barthlomew’s

11. 12.

13. 14. 15. 16. 17.

18. 19. 20. 21. 22.

23.

24. 25. 26.

Hospital and London School of Medicine, in an interview with the BBC in April 2009. ‘UK homes to get swine flu advice,’ BBC News 29 April 2009. ,http://news.bbc.co.uk/1/hi/80,23977.stm. [accessed 28 February 2011]. Daniel Hernandez, ‘In Mexico City, the infection is fear’, Guardian, G2, 5 May 2009, pp. 10–11. ‘Joe Collier on Swine Flu and the Ministries of Fear’, BMJ Group Blogs, 4 November 2009. ,http://blogs.bmj.com/bmj/2009/11/04/joe-colliers-onswine-flu-and-ministries-of-fear/. [accessed 12/10/2012]. Editorial, ‘Swine Influenza: How Much of a Global Threat?’, The Lancet, (2 May 2009), Vol. 373, p. 1495. ‘Swine flu website overwhelmed by demand as new cases double in a week’, Guardian, 24 July 2009, p. 1. ‘Swine Flu: 65,000 Deaths is UK’s Worst Case Scenario,’ Guardian, 16 July 2009. Simon Jenkins, ‘Just Two months of Swine Flu Sniffles and Madness Reigns’, Guardian, 21 July 2009. Cabinet Office and Department of Health, ‘Pandemic Flu: A National Framework for Responding to an Influenza Pandemic’, 22 November 2007, pp. 26 – 7. http://www.dh.gov.uk/en/Publicationsandstatistics/Publicati ons/PublicationsPolicyAndGuidance/DH_080,734 [accessed 4 Mar 2011]. Pandemic (H1N1) 2009—update 112. ,http://www.who.int/csr/don/ 2010_08_06/en/index.html. [accessed 15 Oct 2012]. Mike Davis, The Monster at Our Door, The Global Threat of Avian Flu (New York, NY: New Press, 2005), p. 24. Ministry of Health, Report on Pandemic (London: HMSO, 1920), p.iv, 383. Edwin O. Jordan, Epidemic Influenza, A Survey (Chicago, IL: American Medical Association, 1927), p. 3. Kevin D. Patterson and G. F. Pyle, ‘The Geography and Mortality of the 1918 Influenza Pandemic’, Bulletin of the History of Medicine, 65, 1 (1991): 4–21, p. 13. Niall Johnson and Ju¨rgen Mueller, ‘Updating the Accounts: Global Mortality of the 1918 –1920 “Spanish” Influenza Pandemic’, Bulletin of the History of Medicine, 76, 1 (2002): 105–15, p. 115. Jeffery Taubenberger and David Morens, ‘Influenza: The Once and Future Pandemic’, Public Health Reports, 125, 3 (April 2010): 16 –26, p. 24. Ibid. p. 23 ‘The Influenza’, Outlook, 6 January 1900, p. 738.

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Steinberg, D., Hirsch, S. R., Marston, S. D. 1972. ‘Influenza Infection Causing Manic Psychosis’, British Journal of Psychiatry 120: 531– 5. Stigler, Stephen M. 1986. The History of Statistics: The Measurement of Uncertainty before 1900. Cambridge, MA: Belkam Press of Harvard University Press. Stokes, J. 1921. The History of the Cholera Epidemic of 1832 in Sheffield. Sheffield: North End. Stowe, Julia, Andrews, Nick, Wise, Lesley. 2009. ‘Investigation of the Temporal Association of Guillain-Barre´ Syndrome with Influenza Vaccine and Influenzalike Illness using the United Kingdom General Practice Research Database’, American Journal of Epidemiology 169, 3: 382– 8. Sturdy, Steve, and Cooter, Roger. 1998. ‘Science, Scientific Management, and the Transformation of Medicine in Britain’, c. 1870– 1950, History of Science 36: 421– 66. Takahashi, M., and Yamada, T. 1997. ‘Influenza: A Virus Infection of Primary Cultured Cells from Rat Fetal Brain’, Parkinsonism and Related Disorders, 3: 97 –102. ———2001. ‘A Possible Role of Influenza: A Virus Infection for Parkinson’s Disease’, Advances in Neurology 86: 91 – 104. Tamaki, R., Kamigaki, T. and Oshitani, H. 2009. ‘Encephalitis and Encephalopathy Associated with Pandemic Flu’, Brain and Nerve 61: 153– 60. Tanner, Andrea. 2002. ‘The Spanish Lady Comes to London’, London Journal 2, 27 –8: 51– 76. Taubenberger, Jeffery K., A. H. Reid and T. G. Fanning. 2000. ‘The 1918 Influenza Virus: A Killer Comes into View’, Virology 274: 241– 5. ———Morens, David M. and Fauci, A. S. 2007. ‘The Next Influenza Pandemic: Can it be Predicted?’, Journal of the American Medical Association 297: 2025– 7. ———and Morens, David. 2010. ‘Influenza: The Once and Future Pandemic’, Public Health Reports 125, 3: 16 – 26. ———A. H. Reid and Fanning, T. G. 2005. ‘Capturing a Killer Flu Virus’, Scientific American 292, 1: 48 – 57. Taylor, S. J. 1998. The Great Outsiders: Northcliffe, Rothermere and the Daily Mail. London: Orion. Thompson, J. L. 1999. Politicians, the Press, and Propaganda: Lord Northcliffe and the Great War, 1914 –1919. Ohio, IL; London: Kent State University Press. Thomson, Mathew. 1998. The Problem of Mental Deficiency: Eugenics, Democracy, and Social Policy in Britain c.1870– 1959. Oxford: Clarendon Press. ———2001. ‘Neurasthenia in Britain: An Overview’, in Gijswijt-Hofstra, Marijke and Porter, Roy (eds). Cultures Of Neurasthenia from Beard to the First World War. Amsterdam; New York, NY: Rodopi, pp. 77 – 97. Tognotti, E. 2003. ‘Scientific Triumphalism and Learning from Facts: Bacteriology and the “Spanish Flu” Challenge of 1918’, Social History of Medicine 16: 97 – 110. Tomes, Nancy. 1998. The Gospel of Germs: Men, Women, and the Microbe in American Life. Cambridge, MA: Harvard University Press. ———2010. ‘“Destroyer and Teacher”: Managing the Masses during the 1918 –19 Influenza Pandemic’, Public Health Reports 125, 3: 48 – 62. Tomkins, Sandra M. 1989. ‘Britain and the Influenza Epidemic’. Unpublished doctoral thesis, Department of History, University of Cambridge.

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INDEX

‘n’ after a page reference indicates the number of a note on that page (e.g. 252n129 refers to note 129 on page 252). Page references which relate exclusively to illustrations are given in italics. abdominal symptoms 28, 29 advertising: patent medicines 142, 157– 79, 192–4, 205, 267nn61, 62, 268n66, 269nn102, 104 Albert, Prince: funeral 144 Alcabes, Philip 6 Allbutt, Clifford 95–6, 129 Althaus, Julius 82–3, 92, 96 –100, 103, 259nn76, 86 American Expeditionary Force (AEF) 197 Anatomy of Melancholy (Burton) 190, 274n55 Anderson, Benedict 146 Anderson, Olive 105, 106 Andrewes, F. W. 69, 72 Annals of Influenza (Thompson) 14–15 Arbuthnot, John 14, 20 –1, 82 Armistice (1918) 202, 203–4, 223– 4, 225

Armstrong, David 6 asthma and influenza 25–6 Austin, Alfred 145 autobiography 221–3 bacilli 4, 77, 93, 142, 195, 252nn129, 130 public image 74 –5, 142, 178 research 66–72, 75– 6, 97 bacillus, Pfeiffer’s see Pfeiffer, Richard bacteriology 3, 47, 66 –72, 75, 80, 189, 200, 233 Baker, George 21 Balestier, Wolcott 155–6 Balfour, Arthur 39–40, 128 Beard, George M. 84, 88, 89, 100, 128 Beaumont, Edgar 257n44 Beaverbrook, Lord 186, 273n37 behaviour, regulation of 5–6 Benson, S. H. 170, 172–3, 174–5 Bethlem Royal Hospital 93, 94

INDEX biopolitics 3–4, 179, 233, 240n10, 271n18 1889–93 pandemic 23, 49, 80 1918–19 pandemic 182, 183–4, 185, 190, 194, 204–5, 206 biopower 3–4, 183, 206, 233, 240n10 bird flu 229, 231 Boer War 138, 143, 172– 7, 179, 234 Bokhara: 1889–93 pandemic 49–50 Bono, James J. 184–5 bourgeois masculinity 133–4 Bourke, Joanna 271n15 Bovril advertising 143, 170–8, 179, 193, 205, 234, 269n102 Bresalier, Michael 69, 70, 188, 189, 270n11 Brett, Reginald 118–19, 127 British Medical Journal (BMJ) 1889–93 pandemic 47, 51 –2, 64–5, 67, 68, 78, 124, 161 1918–19 pandemic 189, 196, 202 Brittain, Vera 221 Broadbent, William Duke of Clarence’s illness 140, 147– 50, 151, 152, 153, 265n1 Lord Rosebery’s illness 118–20, 125– 6, 127, 129, 138 Brock, A. J. 191 bronchitis and influenza 25 –6, 28 –9, 49, 53, 80 Buchanan, George 8, 47, 48, 49, 63 Burgess, Anthony 222–3 Burns, William J. 34 Burton, Robert 190, 274n55 Butler, Josephine 141, 157 Caffyn’s Malto-Garnis 168 Calista 167 Camus, Albert 224 Cape Town: 1918– 19 pandemic 199 Carbolic Smoke Ball 142–3, 157–9, 164– 9, 178, 179

303

Carlill, Elizabeth 142– 3, 159, 165–7, 168–9, 179 Carlyle, Thomas 28 Caroline, Queen: funeral 143–4 Carson, Edward 134 cartoons see Fun; Moonshine; Punch catarrh 4, 16, 17, 29, 53, 82, 157, 164 ‘catarrhal fever’ 17, 18, 28 Cecil, Robert (Lord Salisbury) 5, 39, 40, 41, 153, 250n88 celebrity endorsement: patent medicines 158–9, 159–60, 164, 165, 169, 170–1 census data 19 Centers for Disease Control (CDC) 227–8, 229, 278n60 central nervous system (CNS) 84, 139 Central News Agency 36, 124 Chan, Margaret 228–9, 230, 236 Charcot, Jean-Michel 83, 84, 96 Charlotte, Princess: funeral 143 Chemist and Druggist 168 Chesterfield, Lord 145 Cheyne, George 87, 88 China: 1889 –93 pandemic 50 cholera 1832 epidemic 57 1848/1849 epidemic 30–1 influenza and 21, 22, 23, 25, 50 Churchill, Winston 32, 35 Clarence, Duke of 5, 64–5, 78, 79 –80, 140–2, 146–57, 251n104, 265n1 advertising and 157, 168–9, 171, 178, 179 Clark, Andrew 59, 88, 165 Clark, Ernest 105– 6 Clemow, Frank 50 –1, 79– 80 Clouston, T. S. 83, 93, 122 Collier, Richard 223 Collins, Wilkie 145 commodity culture 159–60

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contagion: influenza transmission 4, 15, 30, 33, 51, 52 –3, 54, 61 contagious diseases 24 convalescence 59, 61, 85– 6, 91, 92, 98–9, 172, 183 Cooter, Roger 173 coqueluche 17 Craig, Maurice 214 Craiglockhardt Hospital 114, 190– 2 Crosby, Alfred W. 182, 225, 252n129, 270n11, 278n60 crowd metaphor 177–8 Cullen, William 87 Daily Chronicle 36, 105–6 Daily Express 181, 186, 189, 196 Daily Mail 272n35 1918–19 pandemic 189, 190, 194– 5, 198–201, 202, 205 First World War propaganda 186– 7, 204, 205, 272n32 patent medicine advertising 269n104 Daily Mirror 272n35 Daily News 36 1847–8 epidemic 26 1889–93 pandemic 33 Clarence’s death 153 patent medicine advertising 164, 269n104 Rosebery’s illness 127, 128 Taylor, Frank, case 109, 110–12 Daily Telegraph 36, 267n61 Davis, Mike 231 death rates 1847–8 epidemic 25–6, 31 1849 cholera epidemic 31 1850–70 period 246n72 1889–93 pandemic 4, 35, 54 –5, 64–6, 80, 246n73, 250n71, 269n109 London 49, 53, 54, 65–6, 156– 7 Sheffield 55 –6

1895 epidemic 124 1899– 1900 epidemic 174 1918– 19 pandemic 181, 194, 198, 201, 224, 231, 234–5 excess 19 –20, 24 –5, 231–2 see also specific epidemics, pandemics influenza’s influence on other diseases 24 –5, 25 –6 degeneration 5, 121–2, 133, 135, 139, 232, 234, 264n59 DeLacy, Margaret 17–18 Department of Health (UK) 230, 231 depression 2, 20–1, 115 period of 1889 –93 pandemic 82, 83, 93, 94, 98, 99–100, 101–2, 234 Lord Rosebery 135–6, 138–9, 262n5 period of 1918 –19 pandemic 113, 195, 203 Virginia Woolf 210–11, 212, 213, 214, 215, 220 DeSalvo, Louise 212–13, 215, 226, 277n22 Deutsche Medicinische Wochenschrift 68 diagnosis: 1732 epidemic 14 –15 Diagnostic and Statistical Manual of Mental Disorders (DSM) 83, 256n24 Dictionary of Psychological Medicine (Tuke) 92–3 diet: 1732 epidemic 14 digitalis 76, 236 Dixey, F. A. 65 Dowse, Thomas Stretch 100–3, 116, 128, 135–6 Dr Jekyll and Mr Hyde (Stevenson) 133, 134–5 Dracula (Stoker) 133, 134 dread 171 First World War 183, 187, 203, 205–6

INDEX of influenza 190 1889–93 pandemic 44–5, 79–80, 80 –1, 84, 86, 232, 233 1899–1900 epidemic 174 1918–19 pandemic 183–4, 201– 3, 204, 233 2009 pandemic 229–30 First World War 194–5, 205– 6, 219–20 nature of 3–4, 5, 6, 83 –4 symptom of influenza 86, 91, 102, 116 see also fear Driffield: 1889–93 pandemic 55, 56, 58–9, 62 Drumlanrig, Lord 119, 124, 125 Dublin: 1836 –7 epidemic 20 –1 Duckworth, Gerald 211–12 dyspepsia 87, 129 economy: impact of 1889–93 pandemic 33 Edinburgh: 1889–93 pandemic 168 Education Act (1870) 35 Edward, Prince of Wales 145, 146, 147– 8, 148–9, 150, 265n13 electrical metaphors 84, 88 –9, 96, 101, 257n35 emotional pathology 3 emotions biopolitical discourse and 184, 206 disease and 190, 274n55 emotives and 184, 192, 204, 206 encephalitis lethargica and influenza 85 ‘English Malady’ 87, 88, 129 ‘epidemic constitution’ 18, 23, 24, 25, 244n26 epidemics (1732) 13 –15 (1836–7) 20 (1847–8) 21, 25 –6, 246n57

305

(1895) 122, 130, 132, 171 see also Rosebery, Lord (1898) 122, 131–2, 172 (1899–1900) 122, 174 equine influenza 51–2 Erichsen, John Eric 102 Essays on Fevers (Huxham) 17 Europe: spread of epidemics 26–7 Evening News and Post 127, 272n35 exhaustion psychoses 115 Farr, William 19–20, 21 –3, 25– 6, 30 –1, 47 Fassin, Didier 209 fatigue 2, 22, 28 1920s period 115 Charles Lamb 243n14 patent medicine advertising 175, 193 period of 1889 –93 pandemic 79, 89, 90, 116, 122, 232, 234 Dowse, Thomas Stretch 100–1, 103 gendered 54 Rosebery’s illness 119, 128, 130 period of 1918 –19 pandemic 195 fear morbid 89 preventive measure 79–80, 80– 1 see also dread fear management: Second World War 271n15 fiction masculine subjectivity 133–5 sensationalism 145, 146 Virginia Woolf 211, 216–17, 220–1 see also specific novels; Strand Magazine First World War see World War, First fomites: zyme theory 24 Foucault, Michel 5–6, 75, 121, 183, 205, 240n10, 271n18

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Freudianism 115, 209 Fun 36, 40, 45, 72, 73–5, 132–3 Functions of the Brain, The (Althaus) 96 funerals, state 143– 4, 153–4, 157, 171 general paralysis of the insane (GPI) 86, 87, 93, 94 General Registry Office (GRO) 7, 19, 47, 245n37 Gentleman’s Magazine 26 germ theory 47, 66 germ warfare 196 Germany, propagation of hatred and dread of 183, 185, 186, 188 Gladstone, William 59, 60, 165, 265n13 Glasgow: 1918 –19 pandemic 198 globus hystericus 43, 45, 248n36, 257n39 Goodbye to All That (Graves) 222 Gothic metaphors 132–3, 134, 139, 142 governmentality 5–6 Graphic, The 154, 155, 157, 158, 160, 162, 165 Graves, Robert J. 20 –1, 222 Great Exhibition (1851) 159–60 Greenwood, Major 182 Grelot, Le 37, 38 Griesinger, Wilhelm 94, 95 ‘grip’ 96 grippe 17 Guardian, The 229–30, 230–1 Hacking, Ian 20, 208, 209 Hackney Gazette 112 Haemophilus influenzae 142, 252n130 Hall, Walter 69 –70 Hamilton, Eddie 126–7 Hampshire Telegraph 112 Harcourt, William 123 Harness’s Electropathic Belt 162– 3

hatred: First World War and 1918 – 19 pandemic 183, 185, 186, 188, 203–4, 205–6 headache 2, 13, 22, 28, 97, 98, 100, 215 HealthMap 227, 229 Hearth and Home 175 heliotrope cyanosis 2, 181–2, 198, 204 heredity: psychoses 94 –6, 98 insanity 86, 87–8 Heyfelder, Johann 50 Hippocratic theories 23, 24 Hirsch, August 242n5 historical analysis and trauma 209–10 Holocaust 225 homicidal impulses 82, 90, 92, 99, 134–5 homicide 109– 12 homoeroticism 132 homosexuality 134 Houghton, Lord 58 Hull: 1889 –93 pandemic 55, 58 –9, 61 –2 Huxham, John 13 –14, 17, 82 Huxley, Thomas 128, 263n45 Hydra 192 hypochondria 90, 99, 116, 121, 122, 254n3 gendered 45, 131 hysteria 21, 121, 208–9, 254n3 gendered 45, 91, 122, 163, 191, 274n62 period of 1889 –93 pandemic 44 –5, 81, 87, 88 –90, 116, 121, 139, 254n3 globus hystericus 43, 45, 248n36, 257n39 period of First World War and 1918– 19 pandemic 114, 183–4, 194 Wilfred Owen 192, 204

INDEX illness and literature: Virginia Woolf 210– 21, 226 Illustrated London News 144, 160, 163, 164– 5, 169, 177, 268n66 Illustrated London Police News 156, 157 indigestion 129 infection see contagion Infectious Disease (Notification) Act (1889) 77, 251n96 influenza origins of name 17–18, 243n17 reclassification 92 –3 insanity 86, 87 –8, 92, 94–5, 99, 108, 111, 116, 214 temporary 104 insomnia 90, 92, 97, 99, 100, 135– 6 Lord Rosebery 118–19, 120, 125, 126– 7, 135–6, 138–9 Virginia Woolf 215 introspection 121–2 irony: response to trauma 207–8, 222– 3 isolation of patients 54, 76, 78, 79, 80, 195, 230 Jack, Dorothy 223 Jenkins, Simon 231–2 John Bull 73 –5 John Bull 186 Johnson, Niall 182, 184, 208, 225, 235, 270nn3, 13 Johnston, John Lawson 170 Jolles, A. 67 Jones, James Ernest 112– 13 Joyce, Charles 70 Kasperson, Roger E. 34 Kazakhstan: 1889– 93 pandemic 51 Kenny, John 106–7 Kensington Infirmary 69 Kipling, Rudyard 155–6 Kitasato, Shibashuro 68, 69 Klein, Edward 68 –72, 77, 78 knowledge production 15, 233

307

Koch, Robert 66, 252n139 Kraepelin, Emil 95 Kure-Quic 163–4 laboratory-based medicine: LGB scepticism 47 Labouche`re, Henri 123 Laking, Francis 147, 148, 149–50, 151 Lamb, Charles 16, 243n14 Lancet, The 1889– 93 epidemic 33, 42–3, 44, 63, 67, 92, 96, 230 1918– 19 pandemic 189, 196, 273n47, 275n85 Boer War 174 patent medicine advertising 161 Lee, Hermione 215, 216 Leichtenstern, Otto 92 Leviathan (ship) 198 liberty, personal, and preventive measures 77–8 life tables 19 –20 literature and illness: Virginia Woolf 210–21, 226 Little Wilson and Big God (Burgess) 222–3 Liverpool Echo 36 Lloyd George, David 185, 197 Lloyd’s Weekly Newspaper 33 Local Government Board (LGB) 47 –9, 62– 3, 68, 78, 189, 200, 205 Loeb, Lori Anne 161, 162, 177, 267n62 London 1847– 8 epidemic 21, 25–6, 27, 30 –1 1889– 93 pandemic 38 –9, 40 –1, 48 –9, 52, 59–61 death rates 49, 53, 54, 65–6, 156–7 1895 epidemic 123–4, 132 1899– 1900 epidemic 173– 4

308

A HISTORY OF THE GREAT INFLUENZA PANDEMICS

1918–19 epidemic 198, 199, 203, 219 London County Council Asylum, Banstead 95 London Sick Asylum, Highgate 100 Low, Bruce 61–2 Ludgate Magazine 172 Lyon, Thomas Glover 43 Lytton, Bulwer 170 machine metaphor 89 Mackenzie, Morell 2, 83, 121, 157– 8, 165, 169 Magee, William Connor 58– 9 Maida Vale Hospital for Nervous Diseases 92, 96 Manby, Alan 148–9, 151, 152 Manchester: 1889 –93 pandemic 42, 52, 248n33 Manchester Evening News 112 Manchester Guardian 36, 60, 61, 185, 197, 201–2, 203 mania 83, 87, 90, 93, 210 Manning, Cardinal Henry 157 mapping 46– 54 Mariana Wine 164 masculine subjectivity 120–1, 132– 6, 138, 139 see also men McKinstry, Leo 123, 125 Meade, Elizabeth Thomasina 257n44 media risk amplification 34 see also newspapers; specific newspapers and journals mediatisation of epidemics 233 Medical Ethics (Percival) 268n63 Medical Officers of Health (MOsH) 47, 52, 53, 130 Medical Press 63 –4 Medical Research Council 189, 196–7 melancholia 87, 90, 93, 94, 99, 218 memorials, war 225 memory and trauma 208–10, 225

men celebrity patients 120, 136 death rates 53–4 exonerated for psychoses 109, 112, 116–17, 232 manliness 262n16 prone to psychoses 99, 109, 116 risk 85–6 stigma of influenza 121–2 mental illness: nervous complaint 214 metaphor 170, 184–5, 226, 232 flu as 1, 2 see also crowd metaphor; electrical metaphors; Gothic metaphors; machine metaphor; military metaphors; political metaphors; traumatic metaphors miasmic theory cholera transmission 24, 30–1 influenza transmission 24, 48, 50 –1, 52– 3, 61, 63, 66, 167 microbes 61, 66 –7, 73– 5, 80, 167, 173, 178, 253n143 military metaphors 173, 174– 7, 179, 193, 234 Milligan William 197 Mitchell, Silas Weir 214 modernity, nervousness and 84, 88, 116 Moonshine 36, 72 –3, 131–2, 136, 137 moral judgement: flu diagnosis 3 Morningside Asylum, Edinburgh 83, 93 morphine 76, 99, 125, 236 Mrs Dalloway (Woolf) 211, 217, 220–1 Murray, George 126 National Peace Council 187 nervous symptoms 2, 20–1, 43, 45, 82 –117, 120–2, 128–9, 234 Lord Rosebery 119, 120, 125, 128, 129, 135–6

INDEX Virginia Woolf 213, 215–16, 219, 226 neuralgia 82, 92, 97, 98, 104, 107 Lord Rosebery 126 neurasthenia 256n24 Lord Rosebery 128 period of 1889–93 pandemic 84, 85, 86, 88–9, 99–100, 103, 116, 163 period of First World War 114– 15, 180, 191–2, 204 Wilfred Owen 180, 191–2, 204 Virginia Woolf 210–11, 214 New Journalism 42, 145–6 Newman, George 274n54 Newsholme, Arthur 189, 190, 191, 195, 199–200, 201–2, 205, 274n54 newspapers 3, 7, 8– 9, 31 1847–8 epidemic 23, 26 –7 1889–93 pandemic 33, 35 –42, 80, 106–7, 178 circulation 36 Lord Rosebery 124, 126, 127–8 sensationalism see sensationalism see also specific titles; Beaverbrook, Lord; Northcliffe, Lord; Rothermere, Lord Nicholls, Harry 128 non-contagious diseases 24 Nordau, Max 134, 264n59 Northcliffe, Lord 185, 186, 187, 219, 272n35, 273n37 see also Daily Mail; Daily News; Evening News and Post; Times, The nosology lack of agreed 16 statistical 19 notifiable diseases 62– 4, 77, 78, 80 novels see fiction; specific novels Observer, The 112–13 O’Connor, T. P. 42, 136, 145–6

309

Olympus (ship) 198 On Being Ill (Woolf) 210, 213, 217 On Brain and Nerve Exhaustion (Neurasthenia) (Dowse) 100–1 On Failure of Brain Power (Althaus) 96 Outlook 236 overwork and influenza 59, 84, 107, 116, 232 Owen, Wilfred 114, 180–1, 188, 191–2, 204 pacifism 186, 187, 203 Page, Herbert 102–3 Pall Mall Gazette 42, 145–6, 159, 165–6, 171 pandemics (1510) 17 (1889–93) 3, 4, 5, 32 –86, 90 –109, 229–30, 233–4, 236 see also advertising: patent medicines; carbolic smoke ball; Clarence, Duke of; Salisbury, Lord (1918–19) 4, 180–4, 188–208, 219–26, 231, 234–5, 270n13, 273n47 (2009) 227–31, 236 nature of 2 panic 1889– 93 pandemic 44, 45, 81 2009 pandemic 229 Paris: 1889–93 pandemic 33, 37, 51, 54, 105 Parkinson’s disease and influenza 84 Parliament: 1889–93 pandemic 57 –61 Parsons, Henry Franklin 47 –9, 56, 61, 66, 76, 130, 250n71 views on transmission of influenza 49, 51–4, 63, 67, 78– 9, 167 Pasteur, Louis 66 patent medicine advertising 142, 157–79, 192–4, 205,

310

A HISTORY OF THE GREAT INFLUENZA PANDEMICS

267nn61, 62, 268n66, 269nn102, 104 pathology, emotional 3 Peacock, Thomas 28– 30, 53 –4 Percival, Thomas 268n63 periodicals, Victorian 6 Perolin 194 Pfeiffer, Richard 68 –72, 74, 76, 93, 142, 252nn129, 130 Pharmaceutical Society 160, 161 phthisis and influenza 5, 53 Picture of Dorian Gray, The (Wilde) 133– 4 pink-eye 51–2 plague and influenza 25 Playfair, Lyon 60–1 Playne, Caroline 187–8, 202–3, 203– 4, 220, 276n105 pneumonia 221–2 influenza and 2 1847–8 epidemic 25–6, 28, 29 1889–93 pandemic 35, 41, 67, 182 death rates 49, 53, 55–6, 57, 64, 65 –6, 80 Duke of Clarence 140, 148, 149, 156–7, 179 1918–19 pandemic 197–8 police and influenza 132–3 political metaphors 73 –4 Practitioner 95–6, 113 press see newspapers Press Association 36 preventive measures 47, 75 –80 Probyn, Dighton 147, 149 propaganda 183–4, 185–8, 194, 196, 202, 205–6, 234, 272n25 Bovril advertising 193 medical press 189 psychoanalysis 86, 114, 115, 209, 211 pitfalls 120 psychoneuroses 115

psychoses 82– 6, 87–8, 90–117, 121–2, 232, 234, 254n11, 261n148 Public Health Act (1875) 77 Punch 36, 45, 46, 71, 72 Quain’s Dictionary of Medicine 30 quarantine 54, 76, 78 Queensbury, Marquess of 119, 124–5 quinine 37, 76, 163, 189–90, 236, 253n148 Rabinbach, Anson 89 Rabinow, Paul 6 railway: transmission of influenza 5, 7–8, 27, 33, 50, 51 railway accidents: trauma 85, 101, 102–3, 114, 208 Rechtman, Richard 209 registration data 19, 245n37 regulation, state, lack of 75–6, 80 remedies, popular 76 repressed memory 209, 212–13 respiratory complications 3, 5, 11, 54, 57–8, 59, 60 respiratory diseases and influenza 246n72 1847– 8 epidemic 21, 22, 25 –6 1889– 93 pandemic 35, 41, 54, 59, 60, 72 death rates 49, 55, 64, 65–6, 80, 105, 157, 246n73 Duke of Clarence 157, 178 Reuters 27, 33, 37, 123–4 Review of Reviews 36, 41, 174 Richards, Thomas 159–60, 163 Richmond, Duke of 58 risk signals 34, 35 risks, visibility of 5 Ritchie, Charles 62 –3 Rivers, W. H. R. 114, 190–1, 191–2 Robson, Ethel 223 Roe, Frederick 142–3, 157, 159, 160, 164–7, 169, 179, 268n66

INDEX Rose, Nikolas 6 Rosebery, Lord 118–20, 122, 123– 30, 135–6, 136–9 Ross, Wallace 164 Rothermere, Lord 272n35, 273n37 Rothschild, Hannah de 119, 262n5 Royal College of Physicians 18, 21 Royal Free Hospital 28 –30 Russian influenza see pandemics (1889–93) Salford Reporter 196 Salisbury, Lord 5, 39, 40, 41, 153, 250n88 sanitary reform, Victorian 18 –23, 26, 30, 232 Sassoon, Siegfried 191–2 Saturday Review 153 Savage, George 94, 95, 113–14, 114– 15, 122, 211, 214, 258n57 schizophrenia and influenza 82, 85 science: epistological and social frameworks 15–16 Scott, C. P. 185, 197 seasons and influenza 30, 53 self-regulation 80, 271n18 sensationalism 145–6, 159 1889–93 pandemic 3, 7–8, 41–6, 80, 84, 106–7, 233 homicides and suicides 105–6, 109– 13, 116 Lord Rosebery 124 sexual abuse: Virginia Woolf 211–12 Shaw, Thomas Claye 95 Sheffield: 1889–93 pandemic 55– 7, 58, 62 Sheffield and Rotherham Independent 106– 7 shell shock 190– 1, 274n62 influenza and 114– 15, 261n148 Short, Thomas 18 Showalter, Elaine 192, 274n62 Simon, John 68 Sisley, Richard 42 –3, 64, 67, 77 –8

311

smallpox and influenza 25 Smith, Andrew 133 Smith, F. B. 105 social amplification of risk 34 –5 social body 35, 74, 146, 193, 247n10 social impact of 1889–93 pandemic 33 –4, 35 Society of Medical Officers of Health 63, 64, 77, 78 Sontag, Susan 1–2, 34 –5 Spanish influenza 270n3 see also pandemics (1918 –19) Speaker, The 127, 141, 269n102 spectacle 136, 141, 144, 159– 60, 178 Spectator 36 Sphere 175 St Bartholomew’s Hospital, London 43 –4, 68, 69, 91 –2, 123 St George’s Hospital, London 42–3, 230 St James’s Gazette 127–8 St Petersburg 1889– 93 pandemic 32, 33, 37, 49, 50, 51, 229 1895 epidemic 123–4 Stamp Act: abolition 35 Standard 33, 36, 37, 38, 163–4 Stanley, Henry Morton 170–1 Star 36, 42, 136, 145– 6 state regulation, lack of 75– 6, 80, 232 statistics medical 3, 231–2, 233 LGB 47 –54 risk amplification 34 –5, 232 Victorian sanitary reform 18–23, 26 Stead, W. T. 42, 145–6 Stevenson, Robert Louis 133, 134–5 stoicism 44, 131–2, 136, 138 First World War and 1918–19 pandemic 181–3, 188, 191, 196, 200, 203, 204, 224

312

A HISTORY OF THE GREAT INFLUENZA PANDEMICS

Wilfred Owen 191, 192, 196, 200, 203, 204, 205, 224 Lord Rosebery 126 Stoker, Bram 128, 133, 134 stomach 127, 129, 138, 139, 172, 248n36 Strand Magazine 90– 1, 98, 107– 9, 116– 17, 134 suicidal impulses 82 –3, 84 –5, 90, 98, 99, 106–7, 116, 134–5 suicide 99, 102, 103–6, 109–14, 260nn110, 115 Virginia Woolf 210, 212, 214, 221 susceptibility: relapse 129–31 sweating-sickness and influenza 25 swine flu 227–31, 236 Sydenham, Thomas 18, 24, 244n26 symptomatology, diversity of 2 –3, 29–30 symptoms 1732 epidemic 13 –14 1889–93 pandemic 39, 42 –3 typical 22 variability 27 –8, 97 –8, 233 Taylor, Frank 109–12 telegraph 3, 27, 233 1889–93 pandemic 33, 37, 42, 44, 80, 88, 178 1918–19 pandemic 199 royal illnesses and deaths 144–5 Duke of Clarence 149, 150 Testament to Youth (Brittain) 221 testimonials, doctors’: patent medicines 161 Thompson, E. Symes 50 Thompson, Theophilus 14 –15, 18, 24–5 Thorne, Richard 77, 78 –9 Times, The 272n35 1847–8 epidemic 22, 23, 26, 27 1889–93 pandemic 33, 54 –5, 63, 67, 79 –80, 122, 260n110

celebrity patients 39, 58, 59, 150–1, 152–3, 168 telegraph 37 1895 epidemic 128, 130–1 1918– 19 pandemic 196, 197, 198–9, 200, 201, 207– 8, 219–20, 224 upbeat approach 181, 190, 196 First World War propaganda 186–7, 205, 219– 220 Frank Taylor case 109–10, 112 towns health problems 22–3 spread of influenza 48, 53 ‘toxin, grippal’ 97, 98, 99 trauma 1918– 19 pandemic 207–8, 225 Virginia Woolf 212–13 war 190–2 trauma theory 102, 115, 208– 9 traumatic metaphors 209 Truth 123 tuberculosis and influenza 49 Tuke, Daniel H. 92–3, 95, 122 Turney, H. 130 typhus and influenza 21, 25, 28 urban areas health problems 22–3 spread of influenza 48, 53 vaccines 76 ‘vascular bulb’ 97 Victoria Park Hospital 43 Vienna: 1889–93 pandemic 27, 37, 51 violence and memory 209 viruses: zyme theory 24 Vogue 194 War Office 52, 76, 189, 196–7 war psychoses 115 war trauma 190–2 weather and influenza 30, 53

INDEX Weichselbaum, Anton 67 Wellington, Duke of: funeral 144 West, Samuel 43 Westminster, Palace of: 1889–93 pandemic 57 –61 White, William Arthur 168 whooping-cough influenza and 26 Virginia Woolf 212, 226 Wilde, Oscar 119, 121, 124, 125, 133– 4, 139 Williams, Dawson 30 Winter, Alison 145, 146, 265n14 Winter, Jay M. 207, 222 Wolffe, John 143, 144, 265nn8, 9 women: death rates: 53–4 Women’s Penny Paper 45–6 Woolf, Leonard 210–11, 214

313

Woolf, Virginia 1, 106, 210, 211–21, 226, 274n62, 277nn22, 35 World Health Organization 227, 228–9, 236 World War, First 6–7, 180–3, 185–208, 221, 222–5, 226, 233, 234 worry and influenza 84, 85, 111, 116 York, Archbishop of (Magee) 58 –9 Yorkshire Telegraph 36, 57, 61 Young, Allan 191 zyme theory 23 –4 zymotic diseases 15, 19, 21, 23– 4, 26

(Index by Nick James)