The influenza pandemic of 1918-20 is recognized as having generally taken place in three waves, starting in the northern spring and summer of 1918. This pattern of three waves, however, was not universal: in some locations influenza seems to have persisted into or returned in 1920. The recorded statistics of influenza morbidity and mortality are likely to be a significant understatement. Limitations of these data can include nonregistration, missing records, misdiagnosis, and nonmedical certification, and may also vary greatly between locations. Further research has seen the consistent upward revision of the estimated global mortality of the pandemic, which a 1920s calculation put in the vicinity of 21.5 million. A 1991 paper revised the mortality as being in the range 24.7-39.3 million. This paper suggests that it was of the order of 50 million. However, it must be acknowledged that even this vast figure may be substantially lower than the real toll, perhaps as much as 100 percent understated.

Updating the Accounts: Global Mortality of the 1918-1920 "Spanish" Influenza Pandemic

The biological existence of human beings has become political in novel ways. The object, target and stake of this new 'vital' politics are human life itself. The contemporary state does not 'nationalize' the corporeality of its subjects into a body politic on which it works en masse, in relation to the body politics of other states competing in similar terms. Biopolitics addresses human existence at the molecular level: it is waged about molecules, amongst molecules, and where the molecules themselves are at stake. Human beings in contemporary Western culture are increasingly coming to understand themselves in somatic terms – corporeality has become of the most important sites for ethical judgements and techniques. Biopolitics was inextricably bound up with the rise of the life sciences, the human sciences, clinical medicine. It has given birth to techniques, technologies, experts and apparatuses for the care and administration of the life of each and all, from town planning to health services.

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The Politics of Life Itself

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(06)69895-4.pdf

Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: a quantitative analysis

1. SUMMARY From the history of influenza epidemics and pandemics, which can be traced back with some accuracy for the past three hundred years, and with less certainty before this time, it is apparent that outbreaks occur somewhere in the world in most years. Annual epidemics are due to antigenic drift; and pandemics, occurring at 10 to 50 years intervals, are due to new virus subtypes resulting from virus reassortment. Nothing has been introduced during the past 100 years to affect the recurrent pattern of epidemics and pandemics; and our future in the new century is clearly indicated by our past. This past experience is reviewed in the present paper.

A history of influenza.

The World Health Organization’s recommended pandemic influenza interventions, based on limited data, vary by transmission pattern, pandemic phase, and illness severity and extent. In the pandemic alert period, recommendations include isolation of patients and quarantine of contacts, accompanied by antiviral therapy. During the pandemic period, the focus shifts to delaying spread and reducing effects through population-based measures. Ill persons should remain home when they first became symptomatic, but forced isolation and quarantine are ineffective and impractical. If the pandemic is severe, social distancing measures such as school closures should be considered. Nonessential domestic travel to affected areas should be deferred. Hand and respiratory hygiene should be routine; mask use should be based on setting and risk, and contaminated household surfaces should be disinfected. Additional research and field assessments during pandemics are essential to update recommendations. Legal authority and procedures for implementing interventions should be understood in advance and should respect cultural differences and human rights.

Nonpharmaceutical interventions for pandemic influenza, national and community measures

The age of light, soap, and water: Moral reform in English Canada, 1885–1925

Yellow fever epidemics and mortality in the United States, 1693-1905.

The Gold Coast (modern Ghana) was severely attacked by the influenza pandemic of 1918–19. The disease was introduced by shipping along the southern coast and overland across the northern frontier. As was true elsewhere on the continent, the spread of influenza was greatly facilitated by the new colonial transportation network. Quarantines and other preventive measures were futile and therapy, African or British, could do no more than alleviate symptoms. Influenza struck the majority of the population, but mortality rates varied regionally and, to some extent, by occupation. Deaths were especially numerous in the far north. The influenza epidemic killed 100,000 or more people in less than six months and was almost certainly the worst short-term demographic disaster in the history of Ghana.

https://www.jstor.org/stable/info/41406618

The influenza epidemic of 1918-1919 in the Gold Coast.

The diffusion of influenza in sub-Saharan Africa during the 1918-1919 pandemic.

A drastic decline of aboriginal populations has been an important by-product of European commercial and imperial expansion in many parts of the world. Europeans have been aware of this phenomenon from the early days of Spanish exploration and conquest when Fray Bartolome de las Casas deplored the rapid collapse of Indian populations in the Caribbean. The problem still seemed acute in the nineteenth century. For example, the young Charles Darwin, describing the decline of the Australian Aborigines, placed most of the blame on alcoholism, introduced diseases, and the loss of hunting grounds. But these factors did not fully explain what appeared to be the impending extinction of a variety of peoples. ‘Besides these several evident causes of destruction,’ he wrote,there appears to be some more mysterious agency at work. Wherever the European has trod, death seems to pursue the aboriginal. We may look to the wide extent of the Americas, Polynesia, the Cape of Good Hope, and Australia, and we find the same result.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0021853700001134

K. David Patterson

Papers

The age of light, soap, and water: Moral reform in English Canada, 1885–1925

Yellow fever epidemics and mortality in the United States, 1693-1905.

The influenza epidemic of 1918-1919 in the Gold Coast.

The diffusion of influenza in sub-Saharan Africa during the 1918-1919 pandemic.

The vanishing Mpongwe: European contact and demographic change in the Gabon River