What a difference a century makes

Picture courtesy of the State Library of NSW

There’s widespread panic, restrictions and quarantines are in place, medicines are in short supply, false information is spreading, staff are getting sick and people are refusing to wear masks. Welcome to pharmacy in 1919!

Flicking through back issues of the AJP from the year immediately after World War I can be a little startling from the viewpoint of a reader in 2020.

Alright, there is some archaic language, a lot of imperial references and much about the war that had just ended. But then you come across reports of the terrible influenza pandemic and the similarities to our current situation really come to the fore.

The 1918–19 flu pandemic was an unusually deadly one caused by the H1N1 influenza A virus. Lasting from February 1918 to April 1920, it infected 500 million people—about a third of the world’s population at the time—in four successive waves.

The death toll internationally is estimated to have been somewhere over 50 million, making it one of the deadliest pandemics in human history.

In the words of Australian public health researchers Curson and McCracken, “the 1918–1919 influenza pandemic stands as one of the greatest natural disasters of all time. When the disease finally reached Australia in 1919 it caused more than 12,000 deaths.

While the death rate was lower here than in many other countries, the pandemic was a major demographic and social tragedy, affecting the lives of millions of Australians.”

An unusual pandemic

The pandemic is conventionally marked as having begun on 4 March 1918, with the recording of the case of Albert Gitchell, an army cook in Kansas, despite there likely having been cases before him. Within days, 522 men at the camp had reported sick.

To maintain morale, World War I censors in many countries minimised these early reports, according to recent accounts of the epidemic. However, newspapers reported on the epidemic’s effects in neutral Spain—in particular the illness of King Alfonso XIII—and these stories created an impression of Spain as being especially impacted. This gave rise to the name “Spanish” flu.

A 2007 analysis of medical journals from the time of the pandemic found that the viral infection was no more aggressive than previous influenza strains. Instead, malnourishment, overcrowded medical camps and hospitals, and poor hygiene, all exacerbated by the recent war, promoted bacterial superinfection.  

The reviewers said these factors most likely accounted for its most unusual effect—unlike most influenza outbreaks which disproportionately kill the very young and the very old, with a higher survival rate for those in between, the Spanish flu pandemic resulted in a higher than expected mortality rate for young adults.

Dangerous waves

The first wave ran through the first quarter of 1918 and while relatively mild, it did cause significant disruption to the operations of World War I.

The second wave began in the second half of August, and was much more deadly than the first.
October 1918 was, internationally, the month with the highest fatality rate of the whole pandemic.
The third wave had by far the greatest impact in Australia, hitting our shores in January 1919, resulting in around 12,000 deaths. It also spread through Europe and the United States, lingered through to June 1919.

“Despite a vigorous policy of maritime quarantine, the disease reached Australia in early 1919. The first wave occurred between mid March and late May, affecting twice as many males as females and resulting in about 31 per cent of total deaths,” wrote Curson and McCracken.

“The wave peaked in June and July and was more virulent than the first—it produced a higher mortality rate, involved more females and affected far more people over the age of 50 years.”

The pharmacy perspective

In Pharmacy in Australia: The National Experience, Gregory Haines writes: “The impact on community pharmacies of the second and major wave of the epidemic, the winter of 1919, was dramatic, though Tasmania was not seriously affected till September”.

Haines reviewed the prescription books of a Sydney pharmacy located in an upper middle class suburb. His search revealed a “huge surge” in the number of cases in June 1919.

“During this month some 900 new items for influenza were prepared—as distinct from repeat dispensing of influenza remedies. This represented an estimated 287 new cases of influenza. On the peak day (23 June), dispensing for influenza alone would have occupied one person for more than 24 hours”.

The sense of gradual realisation of the scale of the crisis can be felt in the pages of the AJP.

December 1918: Optimism

In the December 2018 edition of the AJP, the mood was cautiously optimistic.

Spanish Influenza
So far the quarantine authorities have been successful in preventing pneumonic influenza from entering Australia—that is, outside of the quarantine areas. The medical officers express themselves as very confident that with the advent of warm weather there is every chance of the pandemic being stopped.
Nevertheless, many persons, including several pharmacists and their staffs, are presenting themselves for inoculation.
There has been quite a flood of literature on the subject, and the public by now must have a very good idea as to the best course to pursue if attacked.
According to South African advices the drags mostly in use there during the epidemic were ammoniated quinine, eucalyptus oil, and formalin throat tablets.
In New Zealand the newspapers refer to the wide use of menthol ointments and sprays. The principal drugs used were bromides, quinine, bicarbonate of potash, salicylate of soda, quinine, and acid acetyl sal. Glycoheroin was greatly sought after as a mouth wash and gargle.

February 1919: A growing crisis

By our second issue of 1919, it was becoming apparent that the situation was worsening in many parts of Australia, with our reporter saying it would be “little short of a miracle” if the situation was contained.

Outbreak Becomes More Widespread.
Dr. J H Cumpston, Director of Federal Quarantine, draws attention to the fact that the present epidemic has been prevalent in Australia for several months past, and that the average death rate towards the end of last year from pneumonic-influenza in some of the States was eight per day, whereas the outbreak in Victoria was responsible for nine deaths per day from the same disease.
He inclines to the belief that it will be some time before the last traces disappear.
In Great Britain and America there were at least two—in some cases, three—distinct outbreaks, with intervals of four or five months between. The second outbreak was generally more virulent than the first.
So far Victoria has suffered the heaviest mortality. It is not surprising that Melbourne became infected, as since the troops have been returning, it has been the clearing centre for all the States.
Careful observers believe that the disease travels on a thirty years’ cycle, that the least fit die, and that those who survive become immunised, such immunity lasting until a new generation grows up. The manner in which the present epidemic lays hold of persons of both sexes up to 30 or 40 years of age seems to give semblance to this theory.
Dr. Wunderlich, who has had an experience of the disease in other countries, supports this contention, and argues that no matter what quarantine precautions are taken the disease sooner or later must run its course throughout Australia.
Recent cables indicate a serious recrudescence in England, and an alarming outbreak in Japan. If Australia escapes with the present number of cases, it will be little short of a miracle.

There was growing concern expressed in this issue over the dangerous implications of people taking suggested remedies that had little evidence, and were in some cases downright dangerous.

Dangerous Inhalants
The harmful effects produced by inhaling creosote and eucalyptus oil were referred to by Dr. R. P. McMeekin, the medical superintendent of the Melbourne Hospital, recently. He said that many people had adopted this practice as a precaution against infection, but instead of being a preventive this habit caused an inflammatory condition of the nose and throat, and lessened the resistance of the mucous membrane. Probably in many cases it predisposed the individual to nose and throat infection. “In this hospital,” added Dr. McMeekin, “we have already had two cases of laryngitis and coryza, which were entirely due to the constant use of eucalyptus and creosote on the masks worn by the persons affected.”

However, much like today, there seems to have been a vocal band of mask refusers in 1919.

Doctor Refuses to Wear Mask,
Dr. George Fox, Balmain, was brought before the Balmain Police Court on February 7, charged with being in a public place without a mask. He said that he would test the legality of the matter, and go before a jury. At the invitation of the magistrate, Dr. Fox stated the grounds for his action. He believed that masks did more harm than good, and in the case of many persons suffering from lung trouble were insufferable.
He considered that the regulation was oppressive to the sick and to the poor who had to earn their living by hard work. People were as liable to get contagion through the eye as through the nose. It was impossible for the workers to wear a mask. It lowered their power of resistance, and rendered them an easier prey to the influenza germ. The magistrate committed Dr. Fox for trial.

Picture courtesy of the State Library of NSW

April 1919: From bad to worse

The situation was worsening as the flu pandemic tightened its grip by April. Reports were now emerging of pharmacists who had paid the ultimate price for their service to the community.

Progress of the Disease
During the month New South Wales has become badly affected with pneumonic influenza, and serious restrictions have been imposed on the community, in the endeavour to combat the spread of the disease.
In Victoria a new “wave” has been operating. Reported cases have greatly increased, but, fortunately, the death rate is comparatively low.
South Australia has been unable to keep the epidemic outside its borders.
In Queensland there have been a few suspicious cases, but no alarming spread of epidemic has so far followed.
Western Australia and Tasmania appear to have escaped infection.

The NSW section of the AJP contained the following notices.

Miss Louisa Wilson, pharmacist, of Lindfield West, died, after two weeks’ illness, on April 4, at her residence. This lady served her apprenticeship with Mr. Parker, of William-street, and was the pioneer lady ‘pharmacist of New South Wales’ to ‘qualify by examination after’ going through the university curriculum.
Several pharmacists have been suffering from the milder form of influenza and some complain of the risk that they run through their shops being crowded with customers, who are, in many cases, contacts, coming for medicine for patients, but who do not wear masks when they come to the pharmacy to make their purchases.
Mr. Norman Spicer, manager of Kiernan’s Pharmacy, died of influenza on April 8. He was a very capable pharmacist. On the reported death of the late Mr. A. A. Kiernan, on active service, abroad, the sole executor under the will… Appointed Mr. Spicer manager of the pharmacy, on behalf of the estate, and Mr. Monty White was the qualified dispenser-assistant. Mr. White died of influenza about a week previous to the decease of Mr. Spicer. Great regret is expressed at the decease of these two young pharmacists, who were most promising men, and greatly esteemed by a large circle of friends.

May 1919: Is the end in sight?

By May, the AJP was hoping for a positive future, but fatalities and serious illnesses among pharmacists were continuing to rise.

As we predicted in January last, the epidemic appears to be running its course throughout the Commonwealth. So far, Western Australia and Tasmania have escaped.
New South Wales and Victoria have suffered considerably during the month, and at the time of writing both South Australia and Queensland are experiencing an outbreak.

Pharmacists in Sydney, Melbourne and Adelaide have had an anxious time. If they have not caught the disease themselves, it has been the exception for their staffs or families not to be affected.
In Victoria several pharmacies; had to be closed owing to the illness of the proprietor, and his inability to secure assistants. Mr. C.G. Imes, of South Melbourne, had to close two of his branches. He and his sister, Miss A. M. Imes, were both laid up, and his assistant (Mr. W. F. Ready) succumbed after a. very short illness.
Mr. G. S. Prout, dispenser at the Exhibition Hospital, and Mr. C. E. Keays, pharmacist, of Newmarket, both had illnesses which terminated fatally. Mr. P. T. Williams, Box Hill, had a most severe attack, and is only now recovering.
Miss Rose Franklin, Trafalgar, died on May 5. Mr. J. A. Walker, of North cote, on his return from a visit to Adelaide, found all his staff laid up, and it was only by the courtesy of a brother pharmacist that he was enabled to carry on.
Quite a large number of New South Wales chemists have been down with influenza and some have had a narrow escape for their life.
Among these are Mr. Manning, North Sydney, Mr. J. H. R. Mackey, Balmain; Mr. Bayley, Drummoyne; Mr. Davis, Camperdown; Mr. Cunninghame, Enmore; and Mr. Brown, Double Bay. Dr. Grovenor Williams, of Williams’ Pharmacy, had a very bad time of it.

Pharmacists were coming under criticism in some sections of the press for supposed “profiteering”, prompting a stern Letter to the Editor of the Melbourne Age from CA Butchers, secretary of the Pharmaceutical Society of Australasia.

The ‘Age’ early in the epidemic made several references to “profiteering” by pharmacists. It stated that it was a “shocking thing that a public menace of the present kind should be ruthlessly used as a means for extorting extravagant fees and profits out of the people.”

June 1919: Struggling to keep up

By June, the wider impacts of the pandemic were becoming obvious, with the wholesalers struggling to keep up with demand, essential items sold out or in low supply, and staff illness rates skyrocketing.

Influenza and the Wholesale Trade

Owing to the large number of employees that are absent from work from influenza, Elliott Brothers Limited have issued a circular to the trade asking them to send their orders in as early as possible to facilitate their prompt execution and despatch. The warehouse will be closed daily at 4 p.m. so as to allow the employees to cope with accumulated orders. No orders received later than noon can be executed the same day.
All day long crowds of customers are waiting at the counter for goods, and it has been found impossible to cope with the rush during working hours without some special arrangement for the execution of orders. Waiting orders are executed strictly in the rotation in which they are received.

Shortage of Clinical Thermometers.
The demand for clinical thermometers has been very great throughout New South Wales, and Sydney wholesale houses have quite exhausted their stocks.
The Minister for Health has been appealed to. and cables have been despatched to other parts of the world for larger supplies by post. There is little prospect, however, of receiving fresh supplies until 1920. as the very large stocks received were deemed sufficient for at least a twelve month in this State. In December last Sydney importers held in ail about 500 gross of these instruments.
The whole of this enormous supply has been disposed of. and now there is not a clinical thermometer to be bought in Sydney.
Doctors have been advising families to keep a clinical thermometer in the house, so as to take the temperature of any member of the family who should be taken ill with influenza, and if the temperature rises to 104 or thereabout, to send for the doctor without delay. Hence, there has been a large sale for these instruments by retail pharmacists.

A 1919 NSW public health notice. Courtesy State Library of NSW

July 1919: Counting the toll

Our July issue reported that NSW had recorded 2360 deaths from influenza in June alone. Victoria had reported 2628 deaths from influenza for the year to date, reaching a peak of 265 deaths in the week ending 2 May. Queensland had 186 influenza deaths for the year to the end of June.

Chemists have suffered more than most business men from influenza. This arises from the fact that customers not infrequently come into the shop suffering from the disease in order to obtain advice or medicine.
At the same time, the demands for drugs have been phenomenal.

The legacy

Pharmacy historian Gregory Haines wrote in 1988 that the epidemic had led to a “strengthening of the bonds between many pharmacists and their local communities”.

He says people were in more regular, and longer, contact with the pharmacies at a time when pharmacy designs were becoming less austere and welcoming, and communities gained a respect for the dedication and service pharmacies provided.

“As the study of the Sydney pharmacy suggests, pharmacists worked long hours at the time of the crisis, far exceeding normal expectations,” Haines wrote.

“It was an exception for pharmacy staff and their families to escape the disease and the dedication and work most displayed was genuinely appreciated in the community. •

For references, and more on this topic, see the full article in our November 2020 magazine. Thank you to the State Library of NSW for the use of their images in this article.

The Library’s new PANDEMIC! display (free, until 24 January 2021) and podcast delves into the year 1919 to uncover the parallels between the Spanish Flu and COVID-19.

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1 Comment

  1. Peter Allen

    Remarkable story from some exceptional work. Congratulations.

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