By Patricia Marsh, Public Record Office of Northern Ireland
The 1918-19 influenza pandemic struck in three concurrent waves throughout the world. Ireland was no exception. As many as 23,000 Irish people may have died from influenza and there were approximately 7,500 deaths in Ulster. By 1918, Belfast was Ireland’s most industrial city and, as elsewhere in the world, there were three waves of influenza in the city. The first wave lasted from June to July 1918; the second, most virulent wave, from mid-October to December 1918; and the third and mildest from February to April 1919. The disease caused severe disruption throughout the city to businesses, public services and transportation. With at least 1,830 recorded influenza deaths during the three waves, in 1918, Belfast County Borough suffered the third highest influenza death rate of any county in Ireland. This beggars the question: how did the Belfast authorities react to this public health catastrophe?
The Waves of Influenza
Influenza was first reported in Belfast as early as 11 June 1918. It caused disruption to the working life of the city, forcing James Mackie & Sons munition factory to close for a week. Other businesses were disrupted including the shipyards. During the three waves, the Belfast tramway service suffered operational difficulties due to staff absenteeism. The second wave started in Belfast in late October 1918. It was not official policy for institutions to close to stop the spread of infection. However, during November Queen’s University suspended classes for a month and all Belfast public libraries, including the Linen Hall Library, also closed.. Also during November 1918, Purdysburn Asylum and Whiteabbey Sanatorium both closed to visitors. Influenza would have spread rapidly through these institutions and during this wave there were at least 14 influenza and pneumonia deaths in Pursdyburn Asylum. School closures were a common recommendation during the three waves throughout Ireland. During November 1918, the Commissioners of National Education recommended the closure of national schools in Belfast until after the Christmas holidays. Not all schools agreed to close and unfortunately Methodist College in Belfast remained open during the virulent second wave with tragic results as two teachers and a student who was a boarder, died from the complication of pneumonia. The death toll in Belfast was very high and in the six weeks leading up to 18 December 1918, there were 404 more interments in corporation cemeteries compared to the corresponding period in 1917.
Image: Influenza and Pneumonia Deaths in Belfast during 1918. © Patricia Marsh.
The third wave in Belfast began in February 1919. This wave of influenza was the mildest outbreak but it still caused disruption to the city’s businesses. In February 1919, 90 Belfast police officers were absent with influenza and two police constables from the College Square barracks were among those who died from the disease. Those people who worked with the public were at greater risk from infection with many deaths reported of policemen, nurses and doctors. In Ulster, those people who worked in the crowded conditions of factories, especially the linen and textile factories in large industrial towns such as Belfast, Lurgan and Portadown were especially vulnerable to infection. Also at risk were the age group 20 to 45 as well as the very old and very young. The Irish figures also show that infants under one year were also at particular risk. This was unsurprising as, even without influenza, the urban areas of Ireland such as Dublin and Belfast suffered from one of the highest infant mortality rates in the United Kingdom due to extreme poverty and poor diet.
Belfast Union Hospital
The Poor Law Union Hospital in Belfast was situated on Lisburn Road and many influenza patients were admitted during the three waves of the pandemic. The first wave peaked in the last week of June 1918 and there were 210 influenza cases admitted to the institution during this week. This put a great strain on the staff, who were at particular risk from infection. During this outbreak at least eight nurses and several other officers from the workhouse infirmary contracted influenza and tragically probationer nurse Catherine Fenton, aged 21, died on 26 June 1918 from pneumonia. She had only been working for six weeks prior to her death.
During the second wave, the union infirmary was again under severe pressure. Due to the considerable absenteeism among the nursing and other workhouse staff, a medical officer was appointed to treat only those employed in the Belfast workhouse and infirmary. Nevertheless, during November 1918 four nurses, Catherine Doocey, Mary Griffin, Josephine Neild and Rosanna Ellison died from influenza. From the start of the second wave up to 23 November 1918, 1,100 influenza cases were treated at the workhouse infirmary and at least 150 of these patients died from influenza or pneumonia. On 31 December 1918 the guardians reported that the influenza outbreak in Belfast seemed to be practically over due to the decrease in admissions of ‘flu patients to the infirmary. Although this was the end of the second wave, influenza returned for a third time in February 1919. Again, nursing and other workhouse staff contracted the disease but fortunately they all recovered. The number of influenza patients in the union hospital steadily declined until June 1919 signifying the end of the third and final wave in Belfast.
Image: Miss G. Gault and other Nurses on a Ward in the Union Infirmary (now Belfast City Hospital) c.1917. © National Museums NI.
The Corporation’s Response
The combined forces of Belfast Corporation’s public health committee, public health department, and Medical Superintendent Officer of Health for Belfast (MSOH), Dr H.W. Bailie, were responsible for the production of an influenza policy for management of the pandemic in the city. Although this first outbreak of influenza in June 1918 was milder than the second, it was still reasonably serious. Nevertheless, the public health response was very rudimentary. During this wave, Dr Bailie ordered school closures and recommended the disinfection of cinemas. He did not produce any public notices but advised that if a person contracted influenza that they should go to bed as soon as they observe any symptoms and visit a doctor immediately. This response from the public health officials was lacklustre maybe because this outbreak was thought to be a seasonal ‘flu.
Coinciding with the second influenza outbreak in the city was a strike by the labourers of the Belfast house cleansing and street cleansing departments which commenced on 2 October 1918 and lasted until 12 November 1918. There were concerns raised in parliament about the health of Belfast citizens due to the unsanitary state of the streets. The Irish News criticised the corporation for not resolving the strike with ‘matters are assuming a grave aspect, from the point of view of public health’. The Belfast Telegraph agreed that ‘the state of the streets could hardly be worse.’ The death from influenza on 9 November of Alice Boswell aged 3 from the Holywood Arches, brought matters to a head. At her inquest, the jury linked her death to the strike and urged ‘an immediate settlement of the dispute before the city is plague-ridden’. This indicated that the sanitary situation in Belfast had reached a very serious level for the strike to be linked in the cause of a death in an inquest in the city.
It was incorrectly thought in 1918 that influenza was caused by the bacteria, Pfeiffer’s bacillus, and that cleanliness and disinfection were the main preventative measures against the infection. Therefore, as the strike was allowed to continue and the streets remained in such a dirty and unhygienic state, the corporation showed little regard for the health of its citizens. Dr Bailie recommended cleanliness, free ventilation and the burning of all organic matter to prevent influenza. However, as the Irish News commented on 31 October 1918, ‘unfortunately these nuisances never existed to a greater degree in the city that at present.’
During the second and third waves, Dr Bailie produced a public notice which was published in the press and displayed in tramcar windows. This notice recommended avoiding crowded gatherings, the disinfection of factories and workshops, and discouraged spitting on the streets as sputum contained infection. It advised that influenza sufferers should go to bed early and remain there until completely recovered. Influenza was not a notifiable disease but in December 1918 Belfast corporation made septic pneumonia notifiable for a period of six months under the Infectious Disease (Notification) Act 1889. Although it was not the first local authority in Ulster to do so, it was still one of the few in Ireland that did.
Several councillors suggested that cinemas should be closed but the public health committee had no compulsory powers to close these venues. Cinemas were instead closed between performances for disinfection and ventilation. In Ulster, several councils singled out places of entertainment for closure and ventilation under the pretext that people gathered there. Mass gathering of people in trams, cinemas and theatres was a cause for concern and it was feared that the gathering of huge masses of people on the streets at the armistice celebrations would facilitate the spread of influenza. This was a valid fear. The armistice celebration occurred during the peak of the second influenza wave in Belfast and, unsurprisingly, the city’s influenza and pneumonia mortality peaked on 23 November 1918 not long after these celebrations took place.
During the third wave, Dr Bailie reacted promptly and organised the disinfection of tramcars twice daily and ordered the closure of all schools. Children under 14 years of age were prohibited from entering amusement houses. The military authorities put all Belfast cinemas and theatres out of bounds to military personnel. The Belfast Newsletter reported on 4 March 1919 that as the health committee had taken prompt action, adding that Belfast would probably suffer much less than in the previous outbreaks. Belfast did suffer fewer fatalities during this wave than in the previous waves in 1918 and had the lowest influenza mortality rate in Ulster. However, it was doubtful that this low mortality was due to the Belfast public health committee’s actions but rather to immunity gained from the previous waves of the disease.
During this public health crisis Belfast’s official response, especially during the second and third outbreaks, was one of prevention. Dr Bailie’s recommendations shifted the responsibility for influenza prevention from the medical and local authorities and placed it instead on to the individual. Belfast’s response to influenza seemed poor but was within the guidelines provided by central government. The United Kingdom as a whole did not respond effectively to the pandemic, as central government was pre-occupied by the war. It was left to individual local authorities to deal with influenza at a local level. Manchester was a similar industrial city to Belfast. However, the public health committee—aware of the gravity of the situation—supplied additional help to those in need in the city. They provided nurses, domestic assistance as well as food and coal to those who required this help. Closer to home, the local authorities in Ulster towns such as Newry and Cookstown encouraged their middle-class citizens to provide extra aid for the poor in those towns through relief schemes, but there was no evidence that any organisation in Belfast, whether official or charitable, took similar steps. Belfast had one of the highest death rates in the country during 1918, so maybe if steps had been taken to help the poor in a philanthropic way the death toll may not have been so high.
Image: Comparison of the Age-Specific Influenza Death Rates for Ireland for 1918 and 1919. © Patricia Marsh
© The Author(s) 2021. Published by the Epidemic Belfast team on behalf of Ulster University.
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 Patricia Marsh, ‘The Effect of the 1918-19 Influenza Pandemic on Belfast’. Unpublished M.A. thesis, Queen’s University Belfast, 2006), p. 42; Ida Milne, Stacking the Coffins: Influenza, War and Revolution in Ireland, 1918-19 (Manchester: University of Manchester Press, 2018), pp. 58-59
 Belfast Evening Telegraph (12 June 1918);Northern Whig (12 June 1918).
 Irish News (2 July 1918); Belfast News-Letter (27 November 1918); Northern Whig (27 February 1919).
 Irish News (9 November 1918).
 Belfast Evening Telegraph (1 November 1918); Belfast Evening Telegraph (8 November 1918).
 Irish News (8 November 1918); Irish News (16 November 1918); Irish News (22 November 1918); Irish News (29 November 1918).
 John Watson Henderson, Methodist College, Belfast, 1868-1938: A Survey and Retrospect Vol. 1 (Belfast: Methodist College, 1939), p. 271.
 Public Record Office Northern Ireland [Hereafter PRONI], LA/7/11/AB/8, ‘Belfast Corporation: Minutes of Cemetery and Parks Committee’, 4 December 1918, 18December 1918, 1 January 1919.
 Northern Whig (26 February 1919); Northern Whig (1 March 1919).
 Ruth Barrington, Health, Medicine and Politics in Ireland 1900-1970 (Dublin: Institute of Public Administration, 1987), p. 75.
 Belfast Evening Telegraph (4 July 1918).
 PRONI, BG/7/A/99, ‘Belfast Board of Guardians Minutes’, 25 June 1918; PRONI, BG/7/A/100, ‘Belfast Board of Guardians Minutes’, 2 July 1918; Irish News (26 June 1918); Belfast Newsletter (17 July 1918).
 PRONI, BG/7/A/100, Belfast Board of Guardians Minutes, 5 November; 19 November; 26 November 1918; 3 December; 10 December; 31 December 1918.
 PRONI, BG/7/A/101, Belfast Board of Guardians Meeting, 18 February 1919; Irish News (19 February 1919).
 Irish News (18 October 1918).
 Hansard (Commons), cx [etc], col. 2509.
 Irish News (31 October 1918); Belfast Evening Telegraph (30 October 1918).
 Belfast Evening Telegraph (11 November 1918); Irish News (12 November 1918).
 Irish News (31 October 1918); Belfast Newsletter (31 October 1918).
 PRONI, LA/7/2/EA/25, ‘Belfast Corporation City Council Minutes Book’, Meeting, 14 December 1918.
 Irish News (3 December 1918).
 Irish News (13 November 1918).
 Weekly Returns of Births and Deaths in the Dublin Registration Area and in Eighteen of the Principal Towns in Ireland 1918, (Dublin: HMSO, 1919).
 Irish News (3 March 1919); Irish News (4 March 1919); Belfast Newsletter (1 March 1919); Belfast Newsletter (4 March 1919).
 Fifty-Sixth Detailed Annual Report of the Registrar–General (Ireland), SP 1920 [Cmd.997], xi, 629, p. v, p. xxv.
 James Niven, ‘Report on the Epidemic of Influenza in Manchester, 1918-19’ in Ministry of Health, Report on the Pandemic of Influenza, 1918–19. (London: H.M.S.O., 1920), p. 483.
 Patricia Marsh, The Spanish Flu in Ireland: A Socio-Economic Shock to Ireland, 1918–1919: (London: Palgrave Macmillan, 2021), p. 253.