As we deal with the coronavirus pandemic it is perhaps worth contemplating the 1918 flu pandemic (known as the “Spanish Flu” not because it originated in Spain – the geographical origin is still not known – but because Spain appeared to be more widely hit being the only country that allowed free newspaper reporting at the time).  It is also an opportunity to reflect on Manchester’s role in that pandemic.

It is interesting to look at how the 1918 pandemic differs from the current one.  The 1918 pandemic, which affected a third of the world’s population, killed at least 17 million people, maybe even 50 million and possibly up to 100 million.  It is often stated that the flu pandemic killed more people than World War I and it is inexorably linked with that conflict.  In the United Kingdom around 228,000 people died.

The death rate was thought to be so high because of malnourishment, overcrowded camps and hospitals, and poor hygiene leading to a bacterial superinfection.  Although the main pandemic started in 1918 the same strain of flu was probably apparent in the British hospital camp of Etaples in France in 1916.  The camp saw thousands of soldiers pass through and was also home to a piggery – one theory is that birds passed the virus to pigs and then on to humans.  This is of course a similar situation to the current virus with animals thought to be the source.

The Spanish Flu, unlike coronavirus, also killed many young adults, nearly half of deaths being in the age group 20-40 years.  Soldiers were particularly vulnerable, their immune systems compromised by malnourishment and combat stress.  So were pregnant women with many losing their child.

The pandemic proper began in the spring of 1918 with a second wave in the autumn of that year, lasting until early 1919.

So what of Manchester’s fate and role in the 1918 pandemic?  This can perhaps best be illustrated by looking at articles in The Guardian newspaper of the time (then the The Manchester Guardian). An article on 26th June stated that the disease “is now definitely established in Manchester and Salford.”  At this stage it was felt that the strain was not a new one and that symptoms were mild, although it was seen as highly infectious.  Some schools were forced to close because of the number of pupils off with the disease and works and businesses, Manchester Tramways amongst them, began to suffer from short staffing.

An article on 10th July reported 100 deaths from pneumonia and influenza in the previous week for the city but the paper also reported in articles around this time that the situation seemed to be improving.  When the second wave came in the autumn there was initially a feeling that Manchester would not be badly affected: on 25th October  the headline was “The New Visitation: Influenza still “quiet” in Manchester”.  Yet by 2nd November the paper reported that the Medical Officer of Health (James Niven – see below) had issued a leaflet saying the disease was “again prevalent in Manchester”.   On  4th November the paper acknowledged that the general opinion was now that the illness was of the “severer type” and on 13th November an increase in the death rate  was reported: 149 deaths for the previous week compared to 81 in the week preceeding that. 200 deaths occurred in the week up to 19th November and 387 in the week up to 3rd December.   It wasn’t until 25th March 1919 that the paper reported that figures were decreasing.

Manchester is particularly significant in the 1918 pandemic because of the role of its Medical Officer of Health James Niven (1851-1925) seen here in an image from Manchester Libraries Local Image Collection (ref m81053).   Niven, who was Medical Officer of Health 1894-1922, made many improvements to the city’s sanitation and maternity services as well as being resposible for Monsall Fever Hospital. He also made strenuous efforts to contain the effects of the Spanish Flu pandemic and this was portrayed in the 2009 BBC drama The Spanish Flu – the Forgotten Fallen starring  Bill Paterson as Niven. According to Wikipedia Niven “was probably the first Medical Officer of Health to enforce preventive measures to stop the spread of disease.”

Dr James Niven, born 1851, died 1925.

Again the The Guardian gives us an insight into Niven’s actions.  On 26th June 1918 he was not concerned that this was a new strain of influenza but did advocate prompt treatment and isolating oneself.  On 28th of June Niven was advocating isolating the sick and stated “this is especially important in the case of first attacks in a household, factory or workshop.”  He also said used handkerchiefs should be disposed of, articles and rooms should be disinfected and those infected should not meet in groups for.  On 23rd October (second wave) Niven was acknowledging the more virulent nature of the disease.  He prepared a leaflet emphasising the measures already mentioned in this paragraph.  On 5th December he persuaded the Hospital Committee to ask Doctors to notify them of families suffering hardship because of the disease so they could obtain assistance.

It does seem to be highly likely that Niven’s actions saved many lives. There are a number of resources for those who want to read more about the pandemic and James Niven’s role:

Report on the Epidemic of Influenza in Manchester, 1918-19 by James Niven

Available at

The Medical Officer Of Health Reports for Manchester: done yearly these contain statistics on births, deaths and disease.  Manchester Libraries hold a large printed set of these and the years 1918-20 can be viewed at

Observations on the History of Public Health Effort in Manchester by James Niven himself, published in 1923.  This does not seem to be available digitally but can be viewed in Central Library when it re-opens.

Living with Enza : the forgotten story of Britain and the great flu pandemic of 1918 by Mark Honigsbaum published in 2008: tells the story of the pandemic with much reference to Manchester.  This is not available digitally but can be borrowed/viewed from Central Library on re-opening.

Finally there is another connection with both the current pandemic and with Manchester – it relates to David Lloyd George, the Prime Minister of the time.  He was born at 5 New York Place, Chorlton-upon-Medlock, Manchester in 1863 (although he and his family moved to Wales in 1865).  

David Lloyd George birthplace, 5 New York Place, Manchester (Photo taken 1950)

Like our current Prime Minister he himself contracted the disease himself.  This was in the autumn of 1918 and it was in Manchester, where he was visiting, that he was confined: in a makeshift room in the Town Hall.

David Lloyd George Freedom of City, 12/09/1918