When the Spanish Lady came to Visit

Florence Amelia Knibb was born in 1886, the eldest of five children born to the village Milkman, William Knibb and his wife Elizabeth.

Like most places in England during 1918, Castle Bromwich was visited by the Spanish Lady, as the flu pandemic was known. For one local family, that of Florence Amelia,  it was to have tragic consequences to which the local grave yard bears testimony showing that she along with her parents died as a consequence of influenza.

Nationwide the pandemic caused 240,000 deaths, in Warwickshire alone 2,400 people died as a result. Worldwide it is estimated that between 40 and 100 million people died.

Official advice was given out via the newspapers which suggested that everyone should:

  • Breathe through the nose
  • Wash inside the nose morning and night drawing the liquid through the back of the nose and spitting it out through the mouth
  • Sneeze night and morning
  • Gargle with a weak solution of potash and common salt
  • Avoid indiscriminate expectoration as dirtiness favours infection
  • School closures were left to local authorities
  • Keep in bed till the infection is gone
  • Keep children away from patients
  • Boil handkerchiefs
  • Disinfect all areas

Doctors and pathologists of the period had seen flu before, but they knew they were dealing with something unique in 1918. On initial infection, the symptoms were much the same as any other flu, but a proportion of people who succumbed to the virus didn’t improve as expected on the fifth or sixth day, and in fact they got worse. Doctors noted an unusual feature of the disease that spelt grave danger. Those patients who developed a lavender-grey hue over their face and ears, or heliotrope cyanosis as it is called, were facing imminent death. Pathology reports from 1918 describe very distinctive changes in lung tissue that were the likely cause of death in many victims and probably contributed to the heliotrope cyanosis. Healthy lung tissue is like a sponge filled with air, but in flu victims the lungs were filled with fluid containing red blood cells and immune cells – causing death by asphyxiation.

One newspaper report suggested that one doctor tried to treat this lack of oxygen circulating around the body by inserting tubes into a man’s chest to enable him to pump in oxygen from a cylinder. The report states that he left a nurse supervising the procedure who unfortunately fell asleep. When she awoke, the report claimed that the man had swollen up like a balloon, but with no lasting ill effects, the treatment apparently worked and he survived.

Another unique feature of the 1918 flu pandemic was the age profile that it attacked. The first wave of flu, at the start of 1918, was largely only fatal in the very young and the elderly. In the middle of 1918 there was a sudden change and the virus began killing healthy adults between the ages of 25-40. And then by 1919 the virus had reverted back to its old ways, targeting the very young and the elderly. This strange pattern of virulence is one of the mysteries of the great flu pandemic of the First World War.

Unlike today, when reports of bird flu infections are broadcast round the world in minutes, in 1918 there was no early warning system, no vaccine and no way of telling who might be next.

No one knows precisely where, when or how the 1918 pandemic began. The first recorded case came on March 8 1918 at Camp Fuston, in Kansas. However, British army medical reports suggest the virus could have been circulating in hospital camps in northern France as early as the winter of 1917, infecting soldiers weakened by three years of fighting and exposure to mustard gas. The first wave coincided with the arrival in Britain of American soldiers and spread outwards from the ports following the transport lines, particularly those of the railway. But it was the second wave, between September and December 1918, and the third wave, between February and April 1919, which were to prove devastating.

The flu pandemic left barely a family untouched. It is reported that it drove many a woman to suicide following the death of their husbands. Why it occurred and why it ended is still something of a mystery, although there are many theories. “The disease simply had its way. It came like a thief in the night and stole treasure.”