One hundred years ago this month New Zealand suffered its worst peacetime disaster and its greatest public health crisis. It had taken four years of the First World War to kill 18,000 New Zealand soldiers, but in the space of only two months an estimated 9,000 New Zealanders, mostly civilians, died from the pneumonic complications of pandemic influenza. Pakeha (Europeans) died at the rate of 5.8 per 1000, but the indigenous Maori population died at almost eight times that rate, or 49 per 1000. Doctors at the time estimated that about half the population caught the flu, and most recovered, but some small towns suffered almost 90 per cent morbidity and when there were too few able-bodied adults to organise care for the sick, high death rates resulted.
The so-called ‘Spanish’ influenza pandemic of 1918-19 killed an estimated 60 million people worldwide. That is more than three times the estimated death toll of the First World War. The pandemic came to New Zealand with troops returning from camps in southern England, where many had been exposed to the severe second-wave infection that had spread from the zone of the Western Front in the late summer of 1918. Wartime troop movements ensured rapid world-wide diffusion of the virus. This pandemic was highly unusual, killing mostly young adults between 20 and 45 years old. Seasonal influenza normally kills only the very vulnerable: the very young, the elderly and those with compromised immunity. In New Zealand, also unusually, twice as many males as females died in these most-at-risk age groups.
The latest explanation for excess young adult mortality relates this pandemic to the previous one, the ‘Russian’ or ‘Asiatic’ flu pandemic of 1889-1892. Research on North American cities has revealed a uniform peak of flu deaths at age 28. That cohort was born in 1890. The suggestion is that babies and young children exposed to the flu in the early 1890s suffered damage to their immune systems, and that when as young adults they contracted a different flu virus, the dysregulated T-cells in their immune systems overreacted, causing a ‘cytokine storm’ in which excess production of fluid and antibody flooded their lungs, causing cyanosis and death.
Severe symptoms marked the 1918 flu as something very unusual. Sudden onset often caused complete prostration, with high fever, delirium, epistaxis (nose-bleeds), loss of hair and the distinctive dusky purple pallor of cyanosis. Bodies turned black on death, and rapid decomposition demanded urgent burial. Relief workers often commented on the unusual smell of death from the victims’ bodies.
Medical science in 1918 knew nothing about viruses. Their discovery awaited the invention of the electron microscope in the 1930s. Thanks to Pasteur and Koch, bacteria had been identified as the cause of many infectious diseases, and vaccines had been developed to combat some of them, such as typhoid and diphtheria, but there was no known cure or preventive for influenza in 1918. Assuming that the infection was bacterial, communities responded with disinfection and removal of rubbish. In some countries the wearing of face masks was made compulsory. In New Zealand the only official remedies offered were cough medicine and an atomised zinc sulphate inhalation.
About a third of New Zealand’s doctors and nurses were serving overseas in the war, so medical resources at home were at a low ebb. But the doctors had no miracle cures, apart from aspirin, and the best chance of survival for those with pneumonic complications was careful nursing. However, hospitals were soon overwhelmed with serious pneumonia cases, and many towns set up emergency influenza wards in schools and church halls. Volunteers directed by experienced nurses did heroic work looking after the ill, but some volunteers knew nothing about nursing pneumonia cases, and the temporary influenza wards may have enhanced cross-infection of pneumonia strains.
Towns that organised promptly tended to keep their death rates low. Patrols of volunteers going from house to house found the worst cases and arranged for their removal to hospital, but most flu sufferers were nursed in their own homes. Debilitated by serious illness, those who survived needed care and feeding for several weeks afterwards. Many towns set up soup kitchens, and Boy Scouts helped distribute food as well as medicine. School children and teenagers were largely unaffected, and in many households the children nursed their parents.
Though the whole country seemed to shut down in the middle weeks of November 1918, with shops, offices and factories closed for lack of staff or customers, the long-term economic impact was negligible. The crisis passed relatively quickly, and there was no return of infection in 1919. The best outcome was the 1920 Health Act which gave New Zealand its modern health system and helped the Maori population to recover quickly. However, the impact of the 1918 flu at the micro-level of families and households had been profound, altering the life-chances of thousands of orphans, widows and widowers.
Dr Geoffrey Rice is a retired independent historian who was Head of History (2006-10) at the University of Canterbury, New Zealand, where he remains an Emeritus Professor. He was general editor for the second edition Oxford History of New Zealand (1992) and is the author of several books on local and public history. The second edition of his definitive account of the 1918 influenza pandemic in New Zealand, Black November (2005), was shortlisted in the History section of the 2006 Montana NZ Book Awards. A condensed and updated version of Black November was published by Canterbury University Press in 2017 as Black Flu 1918: the story of New Zealand’s worst public health disaster.