Port Elizabeth of Yore: The Effect of Spanish Flu

In the midst of the Coronavirus epidemic ravaging the world, South Africa will have to brace itself for a tsunami of dead bodies. Given crowding in the townships and on the public transport, social distancing is impractical. The last time that South Africa experienced such a pandemic was in 1918 which resulted in at least an estimated 500 000 deaths.

How did this pandemic affect Port Elizabeth? And what lessons can be learnt?

Main picture: Mouth of the Shark River in Humewood with Lazaretto Contagious Diseases Hospital

Previous epidemics

Prior to the outbreak of the Spanish Flu pandemic, Port Elizabeth did experience various outbreaks of infectious diseases. The first recorded outbreak was in the early 1880s when the Cape Colony was infected by smallpox. This was sufficient motivation for the Council to commission the erection of a Lazaretto, the old name for an isolation hospital for people with infectious diseases, especially leprosy or plague. The first consideration was to locate the hospital some distance  from human habitation. The isolated location selected was the south bank of the Shark River where the Road Lodge is currently situated. The building, comprising a simple wood-and-iron structure, was opened on the 9th September 1882.

In 1892 the council began discussing about a site for a Lazaretto to replace the one at Shark River, which was difficult to access as Humewood was undeveloped. The small-pox and typhoid epidemics in the middle of  1893 must have chivvied the Council on as in August 1893 the site was decided upon and the Government agreed to pay half the costs. The new Lazaretto, designed by EJ. Sherwood, was completed on 13th September 1894 on the site of the present Elizabeth Donkin Hospital [on the Victoria Park lands]. There were 4 separate buildings, designed by EJ. Sherwood. Notifiable diseases were small-pox, typhus, cholera, scarlet fever, diphtheria, yellow fever and enteric fever (typhoid). The Public Health Act of 1883 had made vaccination compulsory and the Amendment Act of 1897 made the following diseases notifiable: relapsing and puerperal fevers and leprosy.

On 13 April 1901, Rats infected with bubonic plague were found in mealie stacks on Harbour Board property. A Plague Board with far-reaching powers was formed on 23rd April, and officials, including the Colonial Secretary, came here to discuss the situation with the Council. Free inoculation was made available. The first vic­tim in town. Sergeant Pegg, who had worked on the Military Stores depositing ground, died at the Base Hospital on 20 May. By 1 June there had been 5 fatal cases. Dr David Rees of London, an expert on tropical diseases, was brought out, first to Cape Town and then Port Elizabeth, to organise the fight against the disease.

At a later stage the Elizabeth Donkin Hospital was built on the site of this Lazaretto.

The Misnamed Virus

Like the Coronavirus, the misnamed Spanish Flu also arose due to zoonotic transfer. Unlike the cute pangolin, a delicacy in China, it was the “domesticated” pig which is the presumed culprit. The virus was started encountered in Etaples, France, where more than 100 000 men lived in close proximity to pigs. Somehow this virus was spread to American troops in Kansas who were awaiting shipment to Europe in March 1918. By June of that year, about 43 000 troops had succumbed to the virus. Much like the deflection practiced by current politicians and other leaders, the US Army Officers deliberately misled their nation as to its cause by attributing the origins of the flu to Spain. Forever this contagion would be known as the Spanish Flu.

A Comedy of Errors or how not handle a pandemic

The initial appearance of the virus in South Africa was in September of that year. As Dr Howard Phillips states in a recent article, “South Africa bungled the Spanish flu in 1918 and those lessons are still relevant today”, elementary errors were made in the treatment of this virulent flu. Being a cynic as I am of the belief that humankind does not learn from its mistakes, we are doomed to repeat these errors made in treating Spanish Flu.

“Towards the end of World War I, in September 1918, two troop ships arrived in Cape Town from England carrying over 2,000 black South African Labour Corps soldiers. They were being repatriated after spending over a year behind the lines on the battlefields of France and Belgium where, as non-combatants (the South African government of the day did not allow black people to bear arms), they had provided ancillary support for the white soldiers in the frontline.

Their voyage included a coaling stopover in Freetown, Sierra Leone, where Spanish flu was already raging. Within days of their departure from there, cases of influenza began to appear aboard both ships. When the first of them docked in Table Bay, 13 of the soldiers were still laid up.

The corps’ medical officer insisted that the influenza on board was similar to ordinary influenza. Nevertheless, as a precautionary measure, the state’s local medical officer had the sick troops placed in isolation at 7 Military Hospital in Woodstock. The rest of the men were put under quarantine at a military camp at Rosebank. There they were all medically examined thrice in 72 hours for signs of influenza before they could be demobilized.

But these examinations were rather cursory. And three days later all were allowed to board trains for their homes across the country. It is clear that the enforcement of the quarantine at the camp was cursory too. A local journalist wrote in the Cape Argus, the Cape Town newspaper, on Oct. 9 1918 about how some of the impatient soldiers were seen on the, “prowl in shoals about the Peninsula, notably in District Six.”

Within a day of the soldiers having left the camp on trains for home, influenza cases began to appear in a host of sites. These ranged from the staff at the camp and 7 Military Hospital and members of the transport unit which had ferried the returned soldiers from the harbour to fishermen and stevedores working in the docks.

But by then the trains were well on their way, carrying the newly discharged soldiers all over South Africa. Even before they disembarked, some had begun to show symptoms of influenza. From as remote a district as Tsolo in the deep rural Transkei, the local magistrate was soon reporting that, since the arrival of a batch of soldiers, “sickness has become rife … in village and country and people are being brought in to local doctor by wagon and sledge loads.”

Spanish flu had arrived, becoming more lethal by the day.

Inexorably infecting the entire country, railway station by railway station, it engulfed the whole of South Africa within weeks, during what contemporaries called ‘Black October’. It had been “allowed to run everywhere at once, like spilt quicksilver,” fulminated one magazine.

Port Elizabeth was not exempt

In an article entitled, “Spanish Flu Epidemic: Responses Reflected Racial Prejudices of the Time”, Lindinxiwa Mahlasela exposes what the response to this disease was in Port Elizabeth.

An extemporised influenza hospital in America during 1918

Thus, in Port Elizabeth the virus came via a train from Cookhouse on 4 October 1918. Within a period of three days 16 cases of the virus were authenticated by the Medical Officer of Health, Dr John Galloway. In his address he stated that “the source of the infection is clear, either they [the infected individuals] are people who have just arrived ill from the infected towns in the Union, or those who have been in contact with others who have travelled through the infected areas, who have themselves been suffering from the disease.” Moreover, he advised people to suspend travelling, avoid visits and public gatherings. Understandably, influenced by the ideology of racial segregation that the Union government advocated, Europeans, who by then had a strong feeling of superiority, put the blame for the transmission of the virus squarely on Natives. Thus, District Surgeon Dr Hobart Kay advised, amongst other things, that Europeans should ensure that their servants do not visit New Brighton. Perhaps this advice was informed by an article in the Eastern Province Herald on 8 October 1918 which stated that “as was only to have been expected, its [Spanish flu] greatest ravages have been at New Brighton.”

Similarly, Dr Galloway’s counterpart in Uitenhage, Dr Diermont, advised citizens to ensure that their servants remained on the premises at night. He went further and advised the Council to disinfect the townships in order to ensure that they were “thoroughly cleaned.” His colleague in the Council, Acting Mayor F.T. Couldridge, agreed by suggesting that attempts must be made to “get the government to fumigate the railway carriages [because] they are the one of the worst places of infection.” There were similar comments elsewhere in the Union and they were a clear indication of “renewed sanitation syndrome fears by white residents that infection was spread by black inhabitants.”

Indeed, restrictions were imposed on trains. Concerns from wool brokers added impetus to calls by Uitenhage’s Municipal Council and other authorities, including Port Elizabeth Municipal Council.

As was to be expected, restrictions applied only to the natives. This evoked a sharp disapproval from leaders of the Black community, who included the famous Dr Rubusana. He decried the action and asked “why, whenever there is sickness of any kind, a native has to suffer. We suffered during the rinderpest, bubonic plague, East Coast Fever, etc., and now we have to suffer for somebody else’s neglect… when anyone falls into sin or commits an offense, is it right to attribute it to the Prince of Darkness because he is the hated one? I think not”. Another correspondent protested “if railway travelling was to be restricted, it should affect all classes of the population and not natives only.”

Racial bias in mitigating the virus was further evident in Port Elizabeth City Council’s efforts. Mayor Henry Forbes called upon citizens to volunteer their services and save the city’s citizens from the epidemic. Volunteers, some of whom were qualified health professionals, worked in temporary hospitals that catered for European patients. Temporary hospitals included Old Provincial Hospital in Richmond Hill, Lazaretto in South End, the Feather Market Hall, Village Hall in Red House, New Provincial Hospital in Gipson Street, Seaman’s Institute South End, Albany Road Fire Station and North End Library. However, there was a depot in New Brighton that dispensed free medication.

Unfortunately, some volunteers contracted the virus while they were helping the victims and some even died of it. They included the wife of the Dr Kay, who himself got infected; she was the internationally-famous artist Dorothy Kay, who probably caught it from her husband, but fortunately both recovered. In 1923 the Council honoured volunteers by unveiling a plaque that was designed by Mr. Pickford Marriott; the plaque included the names of those who died and is still on display in the Main Library on Vuyusile Mini Square.

Original Provincial Hospital on Richmond Hill

Needless to say, there’s no memorial to remember volunteers in Native communities. A song by R. Caluza whose lines include “in the year of 1918 we were wiped out by a disease which they call influenza. II took friends which we loved, mothers, fathers, sisters and brothers”, served to memorialize the destruction of 1918.

Lastly, the official figure of Spanish flu casualties in Port Elizabeth stands at 2017 [1123 per Margaret Harradine]. Establishing the number of natives who made up the 2017 casualties has been difficult. However, it is safe to assume that, although natives were a minority in the city at the time – 11 000 as opposed to 24000 Europeans (both figures from 1911 statistics) – the majority of casualties were natives. This is due to the fact that there was minimal effort employed in saving Natives compared to the interventions made in European communities.

Lessons for the latest pandemic

Both the Spanish Flu and the COVID-19 viruses cause a respiratory infection. Hence not only are they more infectious than other viruses such as AIDS, but if the condition is serious, a ventilator is required otherwise the patient will die when they are unable to breathe anymore. As the earliest breathing machine, the Drinker Respirator, colloquially known as the “iron lung”, was only invented in 1928, most of the seriously ill patients in1918 would have died a traumatic death. Under pandemic circumstances, this issue will still beset modern hospitals as their modest stocks of this vital piece of equipment will rapidly be overwhelmed as the number of infected people accelerates.

Lessons learned from the 1918 Spanish Flu

In both instances, the medical and other authorities debunked the fact that the disease was fatal. They downplayed its effects as being no worse than the usual seasonal flu. Some politicians today, even claim that coronavirus is a hoax.

Sources

https://qz.com/africa/1818699/south-africa-bungled-spanish-flu-lessons-are-still-relevant/ South Africa bungled the Spanish flu in 1918 and those lessons are still relevant today

Port Elizabeth: A Social Chronicle to the end of 1945 by Margaret Harradine (2004, Historical Society of Port Elizabeth, Port Elizabeth)

https://open.uct.acz. a/handle/11427/7852. 17 August 2018

https://www.health24.com/Medical/Flu/The-1918-epidemic1/918-South-Arficas­ death-toll-20120721, 7 September 2018

https://www.statssa.qov.za/publications/P0302/P03022017.Qd11 S

Looking Back, Vol 58 2019 pages 33-35

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