"Biz ki İstanbul şehriyiz, Seferberliği görmüşüz: Kafkas, Galiçya, Çanakkale, Filistin, vagon ticareti, tifüs ve İspanyol nezlesi bir de İttihatçılar, bir de uzun konçlu Alman çizmesi 914'ten 918'e kadar yedi bitirdi bizi."
Translation: We are the city of Istanbul, we have seen mobilization: Caucasia, Galicia, Çanakkale, Palestine, wagon trade, typhus and Spanish fever, as well as Unionists, and a long German boot finished us from 914 to 918.
(Nazim Hikmet, Kuvayi Milliye destanı)
The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919. In the United States, it was first identified in military personnel in spring 1918. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.
Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.
Mavi Boncuk |
PANDEMIC INFLUENZA 1918-19: LESSONS FROM 20TH CENTURY TO THE 21ST FROM THE HISTORY OF MEDICINE POINT OF VIEW
Berna Arda[1], Ahmet Acıduman[2]
[1] Prof. Dr. MD (Med. Spec.), PhD. Ankara University, Faculty of Medicine, Department of History of Medicine and Ethics
[2] Assoc. Prof. Dr. MD (Med. Spec.), PhD. Ankara University, Faculty of Medicine, Department of History of Medicine and Ethics
ABSTRACT
Global influenza pandemics are known for centuries. Starting from the 16th century, there are records of three pandemics per each century. The pandemics of the 20th century which are accurately recorded in detail are; “Spanish flu” where the factor was H1N1A, “Asian flu” which was caused by H3N2A and “Hong Kong flu” which originated from H3N2A. The heaviest panorama among these was observed in the “Spanish flu” of 1918 in which more than 40 million people were
dead. The goals of this article are to investigate the literature in detail and to achieve some results to the 21st century’s epidemics.
Keywords: Spanish flu; Influenza pandemics; History of infectious diseases.
INTRODUCTION
The influenza pandemic 1918-19 was one of the most catastrophic events in the history. Disease
primarily affected the adults in the contrary with the general expectation to children and older
people. The recent articles emphasized that the real mortality was 50-100 million. At the end of
the First World War, humanity has been realized the presence of a common enemy which named
Spanish Flu that killed more people than all the military forces. Some of the authors argued that, this pandemic led to the ending of the World War I (WWI). Contrary to this argument it is possible to say that under the war circumstances; namely the US’s enormous army mobilization, broken of French lines by Germans and Paris bombardment; who care getting grippe?1,2,3
The onset and closing dates of pandemic seem to be important in the light of Turkey’s history. On one hand this reflects the final days of Ottoman Empire, namely the agony days of “the sick man”, we can see the name of Sultan Mehmed VI among the other statesmen who came down with it, like Japan Prince Yamagata and Queen Alexandrine of Denmark. On the other hand the founder of modern Turkey, Mustafa Kemal, got the cold just before he departed from Istanbul to launch the National Independence War in Samsun in 1919. Similar personal observations have seen in the biography of painter Fikret Mualla lost his mother to this disease when he was a teenage and accused himself to infect her from school. In Turkish language the “Spanish Flu” term starting to use since 1918. We can also find the term in Turkish literature, famous poet Nazım Hikmet had been used the Spanish flu as one of the descriptive element of Istanbul’s atmosphere 1914-18 like the others: typhus, railway car trade, mobilization for war, the German top-boot. According to the general dissemination of the pandemic, a detailed description a of H1N1 pandemic on this country in the years of 1918- 19, has been drawn in the light of archive documents by the authors as another manuscript. This study has been shown that it is possible to argue that the 1918-1919 influenza pandemic had a significant impact on the territory of the Ottoman Empire.4
REFERENCES
1. Collier R. The Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919. London, New York: Mac Millan, 1974; pp 11,139,157,175,200.
2. Johnson NP, Mueller J. Updating the Accounts: Global Mortality of the 1918-1920 “Spanish” Influenza Pandemic. Bull Hist Med 2002; 76:105-115.
3. Davies P. Catching cold: 1918’s forgotten tragedy and scientific hunt for virus. London: Michael Joseph, 1999; pp 47- 48,56-58,63,205,213,219-220
4. Arda B, Acıduman A. Last tango of the “Sick Man of Europe” with Spanish lady. Ankara Üniversitesi Tıp Fakültesi Mecmuası (accepted article 2012).
READ MORE FROM SOURCE
Translation: We are the city of Istanbul, we have seen mobilization: Caucasia, Galicia, Çanakkale, Palestine, wagon trade, typhus and Spanish fever, as well as Unionists, and a long German boot finished us from 914 to 918.
(Nazim Hikmet, Kuvayi Milliye destanı)
The 1918 influenza pandemic was the most severe pandemic in recent history. It was caused by an H1N1 virus with genes of avian origin. Although there is not universal consensus regarding where the virus originated, it spread worldwide during 1918-1919. In the United States, it was first identified in military personnel in spring 1918. It is estimated that about 500 million people or one-third of the world’s population became infected with this virus. The number of deaths was estimated to be at least 50 million worldwide with about 675,000 occurring in the United States.
Mortality was high in people younger than 5 years old, 20-40 years old, and 65 years and older. The high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic. While the 1918 H1N1 virus has been synthesized and evaluated, the properties that made it so devastating are not well understood. With no vaccine to protect against influenza infection and no antibiotics to treat secondary bacterial infections that can be associated with influenza infections, control efforts worldwide were limited to non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings, which were applied unevenly.
Mavi Boncuk |
It is clear that people fell victim to the Spanish flu at an appalling rate across the Middle East. Civilian mortality rates in the Greater Syrian region itself were almost certainly high, even if little hard statistical evidence is available. But Lind notes that out of those 500,000 or so people who perished in Greater Syria from starvation or starvation-related diseases in the second-half of the war, a great many were surely victims of the influenza pandemic.
It was 1919 and the British politician, diplomat and all-round swashbuckler was working at the Paris Peace Conference at Versailles when he retired to his hotel room in the French capital and died, on the evening of February 16. He was just 39.
As for Sir Mark[1], a curious interest in his short life reemerged when his lead-lined coffin was dug up in 2008 in order to try to extract more information about the virus which killed him. Sadly, the coffin had split and scientists had to make do with inferior specimens. Yet, a diary entry on the day of Sir Mark’s death, written by a friend of the controversial colonialist, surely sums up the harrowing nature of the pandemic, which, during its reign of terror, killed anybody, anywhere, at anytime. “… [We] go to the Lotey Hotel to visit the remains of our friend. Wilson is prostrated with weeping. Lady Sykes receives us and thanks us. It is a terrible situation for this unfortunate woman, alone, in a hotel room, without relations or friends.”
Indeed, the man who was co-architect of the 1916 Sykes-Picot Agreement, which carved up the Middle East into colonial spheres of influence in a post-Ottoman world, may have been one of the very last victims of the virus.
In the region where Sir Mark’s colonial legacy still stirs great controversy, countless people also perished from the deadly effects of the Spanish flu – so-called because the virus was first widely reported in the Spanish press.
Across the Middle East, the flu took lives as mercilessly as elsewhere. The global pandemic came in three waves, but it was the second, more virulent wave, which secured a deathly grip on the likes of the Ottoman province of Greater Syria (encompassing the modern-day states of Syria, Lebanon, Jordan and Palestine/Israel) around September 1918.[2]
![]()
(pictured) Sykes caricatured by Wallace Hester for Vanity Fair, 1912
(pictured) Sykes caricatured by Wallace Hester for Vanity Fair, 1912[1] Colonel Sir Tatton Benvenuto Mark Sykes, 6th Baronet (16 March 1879 – 16 February 1919) During his life, Sykes succeeded – quite literally – in leaving his mark on the world map. As the British government's lead negotiator in a secret 1916 deal with France to carve up the Ottoman Empire, he laid the groundwork for the boundaries of much of the present-day Middle East and, according to some critics, its current conflicts.
But it was the manner of the death in his room at the Hôtel Le Lotti near the Tuileries Gardenof this Conservative MP, British Army general, and father of six children, that may yet prove the source of his most significant legacy by providing key answers in how medical science can cope with the 21st century's first lethal flu pandemic.
![]()
But there are only five useful samples of the H1N1 virus around the world and none from a well-preserved body in a lead-lined coffin. H1N1 has already been sequenced by scientists using frozen remains found in Alaska but many questions remain about just how the virus killed its victims, and the way it had mutated by the time it killed Sir Mark.
![]()
Professor John Oxford, the leading virologist based at Queen Mary's College in London, who led the team investigating Sir Mark's remains, said: "He died very late in the epidemic, when the virus had almost burnt itself out. We want to get a grip on how the virus worked both when it was at its most virulent and when it was coming to the end of its life. It will take several months to study the 17 samples taken from Sir Mark's remains before any new findings are confirmed from the exhumation project, which has been chronicled by BBC1's Inside Out documentary series.
The 'Sledmere Cross' takes the form of an Eleanor Cross and is a true 'folly' that Sir Mark Sykes 'converted' into a war memorial in 1919. He added a series of brass portraits in commemoration of his friends and the local men who fell in the war. He also added a brass portrait himself in crusader armour with the inscription "Laetare Jerusalem (Rejoice, Jerusalem)".
[2] Kjell Jostein Langfeldt Lind’s highly accomplished 2012 thesis, The Impact of the 1918 Spanish Influenza Pandemic on Greater Syria, from London’s School of Oriental and African Studies, tells us that, “this mutated and virulent [second wave] presumably embarked on a ship in France or Britain and disembarked in the Egyptian port of Alexandria [in] September”.
But it was the manner of the death in his room at the Hôtel Le Lotti near the Tuileries Gardenof this Conservative MP, British Army general, and father of six children, that may yet prove the source of his most significant legacy by providing key answers in how medical science can cope with the 21st century's first lethal flu pandemic.
But there are only five useful samples of the H1N1 virus around the world and none from a well-preserved body in a lead-lined coffin. H1N1 has already been sequenced by scientists using frozen remains found in Alaska but many questions remain about just how the virus killed its victims, and the way it had mutated by the time it killed Sir Mark.
Professor John Oxford, the leading virologist based at Queen Mary's College in London, who led the team investigating Sir Mark's remains, said: "He died very late in the epidemic, when the virus had almost burnt itself out. We want to get a grip on how the virus worked both when it was at its most virulent and when it was coming to the end of its life. It will take several months to study the 17 samples taken from Sir Mark's remains before any new findings are confirmed from the exhumation project, which has been chronicled by BBC1's Inside Out documentary series.
The 'Sledmere Cross' takes the form of an Eleanor Cross and is a true 'folly' that Sir Mark Sykes 'converted' into a war memorial in 1919. He added a series of brass portraits in commemoration of his friends and the local men who fell in the war. He also added a brass portrait himself in crusader armour with the inscription "Laetare Jerusalem (Rejoice, Jerusalem)".
[2] Kjell Jostein Langfeldt Lind’s highly accomplished 2012 thesis, The Impact of the 1918 Spanish Influenza Pandemic on Greater Syria, from London’s School of Oriental and African Studies, tells us that, “this mutated and virulent [second wave] presumably embarked on a ship in France or Britain and disembarked in the Egyptian port of Alexandria [in] September”.
The Middle East was a region in conflict, with Britain’s Imperial war machine battling Germany’s Great War allies, the Ottoman Turks. Before the entirety of Egypt succumbed to the second wave in November 1918, Lind says the vast and unyielding troop movements in and out the region hastily spread the pandemic, with “Jaffa… in all likelihood the first point of entry for the virus on the Levantine coast [in September], carried by British ships from Alexandria or Port Said”.
Civilians and military troops alike were struck down by the contagion as it spread across Greater Syria’s sun-beaten lands where British legend T E Lawrence had set the desert on fire with his brave band of Ottoman-rebelling Arab irregulars. Troops from both sides of the war – British, Australian, Indian, Turkish and others – fell victim to the Spanish flu. The British Empire military formation of the Egyptian Expeditionary Force (EEF) experienced simultaneous epidemics of malaria and influenza in Palestine in October 1918 as it defeated the Turkish Army in a great cavalry campaign.
Lind also writes that, “Spanish influenza in Damascus, accompanied by malaria, put nearly half the Desert Mounted Corps of the Australian and New Zealand Army Corps (Anzacs) out of action” in the same month.
Greater Syria’s civilian population fared little better. In a November 6, 1918, diary entry, the Spanish consul of Jerusalem wrote: “There are so many cases of pneumonia lately. The sadly famous flu transforms into pneumonia, and in three days one is making the trip to the next world… A girl only 20 years old… got a temperature of 43°C. She died, so to say, all burned up”.
Indeed, the untimely death of this woman was another curious aspect of this killer virus. The young and fit perished at an astonishing rate due to their strong immune systems which, scientists say, went into overdrive and turned against them. The influenza bug also moved inland toward the Gulf, appearing in Arabia by late autumn 1918. Ibn Saud, the first monarch and founder of Saudi Arabia, called for the services of American doctor, Paul Harrison. He arrived in Riyadh and found that one-10th of the city’s 10,000 population had expired.
Berna Arda[1], Ahmet Acıduman[2]
[1] Prof. Dr. MD (Med. Spec.), PhD. Ankara University, Faculty of Medicine, Department of History of Medicine and Ethics
[2] Assoc. Prof. Dr. MD (Med. Spec.), PhD. Ankara University, Faculty of Medicine, Department of History of Medicine and Ethics
ABSTRACT
Global influenza pandemics are known for centuries. Starting from the 16th century, there are records of three pandemics per each century. The pandemics of the 20th century which are accurately recorded in detail are; “Spanish flu” where the factor was H1N1A, “Asian flu” which was caused by H3N2A and “Hong Kong flu” which originated from H3N2A. The heaviest panorama among these was observed in the “Spanish flu” of 1918 in which more than 40 million people were
dead. The goals of this article are to investigate the literature in detail and to achieve some results to the 21st century’s epidemics.
Keywords: Spanish flu; Influenza pandemics; History of infectious diseases.
INTRODUCTION
The influenza pandemic 1918-19 was one of the most catastrophic events in the history. Disease
primarily affected the adults in the contrary with the general expectation to children and older
people. The recent articles emphasized that the real mortality was 50-100 million. At the end of
the First World War, humanity has been realized the presence of a common enemy which named
Spanish Flu that killed more people than all the military forces. Some of the authors argued that, this pandemic led to the ending of the World War I (WWI). Contrary to this argument it is possible to say that under the war circumstances; namely the US’s enormous army mobilization, broken of French lines by Germans and Paris bombardment; who care getting grippe?1,2,3
The onset and closing dates of pandemic seem to be important in the light of Turkey’s history. On one hand this reflects the final days of Ottoman Empire, namely the agony days of “the sick man”, we can see the name of Sultan Mehmed VI among the other statesmen who came down with it, like Japan Prince Yamagata and Queen Alexandrine of Denmark. On the other hand the founder of modern Turkey, Mustafa Kemal, got the cold just before he departed from Istanbul to launch the National Independence War in Samsun in 1919. Similar personal observations have seen in the biography of painter Fikret Mualla lost his mother to this disease when he was a teenage and accused himself to infect her from school. In Turkish language the “Spanish Flu” term starting to use since 1918. We can also find the term in Turkish literature, famous poet Nazım Hikmet had been used the Spanish flu as one of the descriptive element of Istanbul’s atmosphere 1914-18 like the others: typhus, railway car trade, mobilization for war, the German top-boot. According to the general dissemination of the pandemic, a detailed description a of H1N1 pandemic on this country in the years of 1918- 19, has been drawn in the light of archive documents by the authors as another manuscript. This study has been shown that it is possible to argue that the 1918-1919 influenza pandemic had a significant impact on the territory of the Ottoman Empire.4
REFERENCES
1. Collier R. The Plague of the Spanish Lady: The Influenza Pandemic of 1918-1919. London, New York: Mac Millan, 1974; pp 11,139,157,175,200.
2. Johnson NP, Mueller J. Updating the Accounts: Global Mortality of the 1918-1920 “Spanish” Influenza Pandemic. Bull Hist Med 2002; 76:105-115.
3. Davies P. Catching cold: 1918’s forgotten tragedy and scientific hunt for virus. London: Michael Joseph, 1999; pp 47- 48,56-58,63,205,213,219-220
4. Arda B, Acıduman A. Last tango of the “Sick Man of Europe” with Spanish lady. Ankara Üniversitesi Tıp Fakültesi Mecmuası (accepted article 2012).
READ MORE FROM SOURCE