Graphic depicting two men wearing medical masks.

Episode 2: Preparing for the Worst

An influenza outbreak seems inevitable and Australia prepares. As vaccination is rolled out, thousands of service men and women begin returning home at the end of the First World War. But how do you reunite with loved ones when death is following you home?

Featuring medical historian Dr Peter Hobbins.

MUSIC: Molène: Eracilon, Seung Gong: Dylan Tinlun Chan, Tour de manège-version piano: Real Rice, Train: Sergey Kovchik, Fuguencelle: Eracilon, Promencelle: Eracilon, Balancelle: Eracilon, Sur le fil: Eracilon, The End in your Eyes: Aufklarung, Anxiety: Shymonmusic, sun s smile: Alexander Klein, Cylinder Five: Chris Zabriskie, Anxiety: Hafizzhais, The Last Post: courtesy of the Band of the Royal Military College. (All tracks amended)

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ELISE EDMONDS: It’s the second week of restrictions under the COVID-19 gatherings and isolation orders in NSW. The Health Minister has announced this year more than ever it’s important for Australians to get their flu shot. My producer Sabrina has cycled into Sydney’s CBD to do just that.

SABRINA ORGANO: The pharmacies close to where I live were all booked out so I thought it would be a good excuse to do some exercise after being at home for a week. It feels like it’s been three weeks. The city’s actually pretty busy. Lots of construction workers hanging out.

ELISE: Today, the death rate in NSW has reached 20, with one more nursing home resident passing away.

SABRINA: There’s a big sign next to the pedestrian crossing saying, “Don’t push the button. Pedestrian crossing now automated.” This lady crossing the road is wearing a face mask and a plastic eye shield.

ELISE: Yesterday, President Trump announced that 100,000 deaths would be a good outcome for the US.

SABRINA: The buses are all still running. There’s a lot of them around. Only got one or two passengers on them.

(SPEAKS TO SOMEONE) Are you a press photographer?

WOMAN: Yes.

SABRINA: How are you going?

WOMAN: Yeah, it’s alright. A lot of people are very angry at me.

SABRINA: What do they suppose we – you know, we don’t document it? Like, it’s so important to take photos.

She’s running out into the middle of the street to take pictures. I don’t know if you just heard that but the photographer I just stopped and talked to said that a lot of people were getting angry with her.

ELISE: The library has now been shut for a week. While everyone is figuring out how to work from home, there’s a feeling that no-one really knows what’s going on. We can’t know how bad things will get or how long they’ll last.

SABRINA: All these shops on Oxford Street are closed. Barber shop is closed. Massage place closed, fashion place closed. Café is open. Ah, and the bike shop is open. Yes! My inner tube is very well puncture-repaired. I just wanted to get a spare one in case everything shuts down.

ELISE: I’m Elise Edmonds, Senior Curator at the State Library of New South Wales. While the country locks down to stop the spread of COVID-19, we continue our exploration of how Australia tried to do the same thing over a century ago, when the Spanish flu appeared.

SABRINA: There’s not a single car on that big stretch of Anzac Parade, which is crazy! It’s like a warped version of Christmas Day.

ELISE: This is The Gatherings Order, a podcast about however far we think we’ve come, the past is much closer than it seems.

SABRINA: I think a lot of people have got the same idea. Come down to Centennial Park to have a walk or a ride. The big digital signs that usually say things like, “Event parking this way,” or “Bikes, keep to your left,” now reads, “Observe social distancing,” which is really weird. The geese are not observing social distancing.

ELISE: In this episode, with the war won, Australia’s servicemen and women returned to find their homeland bracing for an outbreak. After months of containing the disease in quarantine, could the heroes of war be the ones to bring this new threat home?

SABRINA: Oh, my arm is aching. I don’t know if this was a good idea.

ELISE: Just five days after the streets had been filled with Armistice celebrations, a vessel carrying the first attachment of original ANZACs reached Western Australia. The ship was inspected and declared free of pneumonic influenza.

NEWSPAPER REPORT: “Sydney Morning Herald, 18th November, 1918. The first big batch of original ANZACs on furlough, 800 strong, landed at Fremantle on Friday. They marched in procession through the streets and were enthusiastically welcomed in Perth by the Premier and Mayor. They were entertained at lunch at Government House.”

ELISE: When Britain declared itself at war with Germany, Australia, as a vassal of the Crown, was automatically drawn in to the conflict, and these were some of the first men and women to volunteer their services for King and Country. Britain initially requested 20,000 Australian soldiers. 50,000 signed up. Ultimately, over 400,000 Australians would join the conflict, a huge offering from a country with a population under 5 million. While those left behind did not endure conflict, the war visited them in other ways. Collapsed international markets brought the economy to its knees, a bitter fight over conscription divided families and communities and a constant stream of death notices saw the nation overwhelmed with grief. Australia and its ANZACs would find each other much changed but while those first returnees had their moment in the sun, the ship that arrived the following day was not so lucky. Three cases of influenza were identified and it went into quarantine in Melbourne. By the time the Armistice was signed in November 1918, 93,000 personnel had already been returned. That still left 135,000 in Europe and nearly 17,000 in the Middle East. It would take ten months and 201 shipments to bring them all home. Nearly everyone had their hand up to be the first out so the Repatriation Department devised a prioritisation system. If you’d been among the first to enlist and serve at Gallipoli, you’d be the first to return. This is likely why Archie Barwick and Anne Donnell, the diarists we met in episode 1, were aboard some of the first ships to be heading back to Australia following the war’s end.

ARCHIE BARWICK: “I’m actually on my way home, yet it seems to be just like a dream. I’m taking it as a matter of course, the same as I’ve taken everything the last four years, and yet underlying all there is an emotion of almost complete happiness, for one can now look the whole world in the face, satisfied in his own heart that he has done all that was expected of him and perhaps a little more. I’m sure that’s what’s kept most of us alive all through this awful war - the very thought that we would one day return to our native land and get among our own people again.”

ANNE DONNELL: “It’s come, just what we hoped and longed for, but at the same time it’s a terrible break parting from our active service friends and the Diggers. I’m in a party of ten going on the Margha. No-one has heard of the boat before so I’m prepared for the worst.

Later. We are on the ship and it’s perfectly beautiful. It’s adorable and divine and I’m so happy, all of the expressions. I have never been on a ship that gives such promise of comfort. The Ulysses sails too, soon. She looks a nice boat but I like ours best.”

ELISE: The Australian Government were acutely aware of the risk these trips posed, coming as they were from a country still riddled with pneumonic influenza. When Archie and Anne boarded their ships home, Britons were still dying in their thousands. If sickness was found aboard, swift action was taken.

ANNE DONNELL: “We had a wireless to say the Ulysses sailed eight hours after us but has influenza on board and has to stop at Gibraltar to take off the worst cases. It’s hard luck. So far we have no sickness.”

ELISE: The same day those first troops marched through the streets of Perth, the NSW Government convened a special meeting of its cabinet to consider what should be done in the event of an outbreak. In his statement following the meeting, the Minister for Public Health, Mr J.D. Fitzgerald, had a warning for the public.

J.D FITZGERALD: Theatres, picture shows and other such places will necessarily have to be closed which will no doubt cause some amount of inconvenience. But it is expected that in view of the virulence of the disease, the public will accept the conditions imposed on them as being absolutely necessary.

ELISE: But for now, while the disease was still contained in quarantine, the state set about planning for the worst. When the Spanish flu had reached Cape Town in late 1918, 15,000 deaths occurred in the first 24 days. This was pointed to as a possible scenario for Sydney. For a city with a population of just over 800,000, this would be a catastrophic loss, so a special committee was formed. Their plan would see the city divided into 13 areas, each with an influenza relief depot to oversee things like distributing food donations and medicine, transporting patients to hospital and arranging for the care of orphan children. Various public buildings were flagged for conversion into hospitals and a call would go out to former nurses to return to service. But the major plan of action, the one thing the health authorities felt could save the population from total disaster, was vaccination.

DR PETER HOBBINS: The problem is how do you deal with preventing a disease when you don’t know what actually causes it?

ELISE: Medical historian Peter Hobbins.

DR PETER HOBBINS: There were scientists around the world looking down their microscopes to try and identify the germ of pneumonic influenza and they couldn’t find it. Now, we worked out later on they couldn’t find it because it was actually caused by a virus that was too small to be seen through the microscopes they had at the time but what they could see was a range of bacteria that were found in the lungs of people who were sick or dying from pneumonic influenza and they had to kind of say, “Well, somewhere in that soup of bacteria is maybe what’s causing this disease.”

ELISE: The bacteria considered the main culprit had been identified during the previous influenza pandemic, which began in 1889 when a far less deadly strain took over one million lives around the world. At that time, German physician Richard Pfeiffer managed to isolate a rod-shaped bacteria from influenza patients. He hypothesised that this, Bacillus influenzae, was the cause of the disease. With little advancement in the field since Pfeiffer, the medical fraternity, now faced with Spanish flu, were stuck with his hypothesis so in 1918, Bacillus influenzae was one of four bacteria mixed together to create the vaccine.

DR PETER HOBBINS: So the vaccines were created against pneumonic influenza in 1918 and 1919 basically by scooping out the gunk found in the lungs of people who’d died of pneumonic influenza at the quarantine station, in the hope that somewhere in there we’d be injecting people with something that would help build their immunity against one or more of these bacteria, so we did have these vaccines, as they were called, but we had no proof that they actually worked.

NEWSPAPER REPORT: "The medical authorities do not guarantee that vaccination will furnish immunity from the disease. The probabilities are, they say, that it will be of great assistance and should minimise complications consequent on influenza.”

ELISE: Not long after the pandemic had swept across Australia, the Director-General of Public Health started work on a report. In it, he acknowledged that while the vaccine helped reduce the severity, it did not provide anything close to immunity.

DIRECTOR-GENERAL OF PUBLIC HEALTH: Investigations during recent years have cast some doubt upon the long-cherished belief that Pfeiffer’s Bacillus influenzae was the essential cause and has raised the question whether some very minute organism not yet identified may not be responsible.

ELISE: It would take just another 13 years for that very minute organism to be found. In 1932, British medical researchers would isolate the influenza virus from humans. But in 1918, physicians still struggled to solve the mystery of the Spanish flu and speculation was plentiful. Was it airborne? Could it be transferred via surfaces? Could wearing masks limit transmission? While debates continued, the first public inoculation depots opened.

NEWSPAPER REPORT: “The Sydney Morning Herald, Friday, 20 December, 1918. Although the pneumonic influenza has now thrown its sinister shadow upon Australia’s two main gateways and thus made immeasurably harder the task of keeping the dread disease within quarantine, the bulk of the community still view with apparent unconcern the advice of the authorities to undergo inoculation. It is in a spirit of procrastination rather than of direct opposition to it that many people are delaying action until a case breaks out. Precisely in this direction danger lies.”

DR PETER HOBBINS: We have to remember that in the 19th century and early 20th century, being immunised was a far more painful and unpleasant process than it is today. The needles were bigger, they hurt a lot more when they went in. You’d often end up with a pus-y wound at the site of the injection and then you’d have a scar. And many people would feel quite off-colour and even be bedridden for a day or two after being immunised against some diseases so it was much more unpleasant then than it is today. So it was not surprising not everybody wanted to be immunised. Having said that, when a disease hit town, suddenly people are very keen. In 1900, when bubonic plague arrived in Sydney, there were scenes of pandemonium at the Board of Health building, where people basically rushed the building when the doors opened because they heard that there were several hundred doses of a plague serum that had been brought out from India. They were hanging out the windows and actually broke the balustrade inside the Board of Health building because of the pressure of people trying to be immunised. So that gives a sense of the panic when the disease was present and that’s understandable. It’s a present threat.

ELISE: The state continued its campaign, urging the public to be vaccinated. Perhaps as an incentive, the numbers were published on an almost daily basis. For a while, things were looking up. The vaccination uptake grew while numbers of influenza cases being held in quarantine fell and then, just a few days into the new year, newspapers triumphantly reported inoculations had passed 100,000 and influenza was beaten.

NEWSPAPER REPORT: “Sydney Morning Herald, Thursday, 4th January, 1919. New South Wales is at the moment free from pneumonic influenza. The disease has been beaten in quarantine and it has not been allowed to slip out, a wonderful record when the public are still reading daily of the way in which it has swept through practically every country other than Australia, a result achieved only after a ceaseless and heroic battle lasting about ten weeks.”

ELISE: Throughout this time, 51 ships were received at North Head and over 6,000 people quarantined. 653 of them were diagnosed with Spanish flu. Of the 43 who died, more than half were nurses or soldiers who didn’t quite make it home.

NEWSPAPER REPORT: “The organisation at North Head, as well as the Health Department’s elaborate plans, will remain intact for some time in order to meet any emergency and on the principle that with a disease such as this there is no knowing what the morrow may bring forth.”

ARCHIE BARWICK: “January 23rd. We are now lying at anchor off Queenscliff. The quarantine staff have come aboard with masks on to have a look at us. We fell in on the boat deck and the doctor came round and took every man’s temperature. After the doctors examined our ship we thought we were set. Everyone was ready, dressed up to go ashore and all were in high spirits but what a shock we got, for a notice was put up on the board to the effect that we were to be quarantined for seven days. The disappointment was too much and a perfect storm of curses broke loose. What made it all the worse was the fact that we have not had a single flu case on board. Everyone is going about the boat as black as thunder and fit for anything. It has been a proper shock to everyone and has knocked all plans on the head. There is a great string of chaps at the orderly room now sending telegrams to their people and swearing like troopers at the same time.”

ELISE: After four years of war, with home just a gangplank away, the soldiers may well have been frustrated but the doctors were right to be cautious for several suspected cases were at that moment under observation in Melbourne hospitals.

DR PETER HOBBINS: When the disease came ashore somewhere in Victoria in early January 1919, there was a problem. We still had seasonal flu, like we see every winter, going through the community and it was present in Victoria in January 1919 so when people started presenting with symptoms of severe influenza and when quarantine seemed to be working and keeping pneumonic influenza out of the country, at first it was just assumed that these were the cases that were doing the rounds every year and it took a while for the Victorian health authorities to realise that, oh, actually maybe this is the pandemic version of the flu that we’re seeing in the community. But because they weren’t sure, because they didn’t really want to be the scapegoats, they didn’t mention that to the other states or to the Commonwealth at first.

ELISE: As vaccination was being rolled out in late 1918, the Commonwealth Government had gathered ministers from each state together in Melbourne. They agreed upon a set of resolutions that would come into effect should an outbreak occur in any part of Australia. Chief among these was a process for notification, a chain of communication that would result in the Commonwealth declaring a state infected. Borders would immediately close to prevent the spread to neighbouring states. In delaying notification, Victoria, it seems, had endangered the rest of the country.

ARCHIE BARWICK: “January 28th. We went through the usual inspections today and the ship was pronounced clean. Everyone is in a great state of excitement tonight, getting cleaned up once more, for I think it’s dinkum this time and soon we shall be home. I can’t realise that we’re now even in Australia yet but once we hit the land, we will understand.”

ELISE: The day Archie writes these final words in his diary, Australia’s first outbreak is reported in Sydney.

DR PETER HOBBINS: You could potentially blame a soldier because, after all, there were so many soldiers coming back from the war, but that would be unfair because we don’t have that evidence but let’s just say there were many soldiers desperate to come home after four years overseas and we know that many of them, once they did come ashore, were trying to break out of quarantine to just get home. You know, they’d had enough and they felt that they were heroes and deserved a hero’s welcome. They didn’t see why they were being locked up for another week when they felt healthy, even though they’d actually seen the impact of the disease itself. And so when a soldier got on a train from Melbourne and spent the night travelling to Sydney in a compartment with a civilian who was coughing all through the night, that poor soldier didn’t know that he was being exposed to pneumonic influenza and when he got sick a couple of days later and reported to Randwick Military Hospital nor did the hospital authorities know that he actually had pneumonic influenza either and so for the first couple of days, his disease was misdiagnosed. And it was only unfortunately when that disease had spread to several other doctors and visitors and therefore out into the community that finally it was diagnosed as pneumonic influenza in late January 1919 - that the NSW health authorities said they had a case. And at that point, Victoria said, “Um, yeah, we might have several hundred cases already.”

NEWSPAPER REPORT: “Sydney Morning Herald, Wednesday 29, January, 1919. We do not wish to cry over spilt milk or to raise any controversies which may interfere with our heartiest cooperation in the endeavour to stamp out the disease but we cannot help wondering at Victoria’s complacent and short-sighted attitude in a matter of such vital importance. The states on either side of her have made influenza a notifiable disease. Victoria failed to do so with the result that for days there were cases of infection and hosts of contacts before the authorities were able to take any action to isolate them effectively or to identify the disease with certainty. Every case, as far as we know, has been traced to Melbourne. Meanwhile, we must make up our minds to face the situation and to do each our utmost to help those who are charged with the work of fighting the plague.

ELISE: As predicted, there was an immediate rush on the inoculation depots. Hundreds gathered at locations across the city and suburbs, with queues spilling out onto the streets. Just three days after the Sydney outbreak was declared the vaccine began to run out. Not only had the number of depots increased, GPs were also overwhelmed and large businesses started making private arrangements to inoculate their staff. For the two weeks in February that stocks were low, quarter and half doses were given in order to service demand.

DR PETER HOBBINS: Of these hurriedly produced vaccines without really any evidence whatsoever and purely based on the assertions or best guesses of the medical authorities at the time, a quarter of the population of NSW agreed to be immunised in the hope that it would help prevent them catching pneumonic influenza. I think that tells us a lot about the confidence of Australians in 1919 about medical authorities and the power of modern medicine and even though it seemed powerless to stop the spread of the disease in Australia in 1919 at least this was a measure people felt they could take as an active preparation against the disease.

ELISE: The inoculation depots continued to operate until May 1919, when the virus was thought to have run its course, but quarantine as a preventative measure was continued as the first line of defence as it had been since 1814.

DR PETER HOBBINS: So certainly there were many ships arriving, not only in Sydney but also in Melbourne, Adelaide, Albany, Fremantle, Darwin, Brisbane, all of these ports had cases of pneumonic influenza arrive, and it’s worth remembering that those quarantine stations still operated even after the disease came ashore. They were still keeping out cases of pneumonic influenza because we didn’t know how deadly those versions were. They were a major part of protecting the community and stopping the disease escalating even further right through most of 1919.

ELISE: It was near the end of February when Anne’s ship finally neared Australia. By this time, there were 213 reported cases of pneumonic influenza in NSW, it having spread as far as Lismore, Wagga Wagga, Bathurst, Culcairn, Corowa and Millthorpe. Troops from the transport the Argyllshire had recently marched out of the quarantine station in protest for being held, 900 of them overwhelming the 150 strong police guard at the gate. Calls to move the quarantine station to a less populous place like Jervis Bay, calls which had started in November, had now reached a fever pitch. But as Anne neared the west coast of Australia, her thoughts were far from influenza for her ship would soon stop off in Fremantle, where they would receive their first welcome home. The West Australia troops would disembark and she would have a few hours to reunite with her sister who lived in Perth before sailing onward, home to Adelaide.

ANNE DONNELL: “February 22nd. I just can’t sleep for the anticipation of the pleasure of seeing my folk in Perth, at least will have a few hours with them. We have been seeing the Southern Cross for some nights but today – and surely it cannot be my imagination – but there’s a scent being wafted across to us. Some cannot detect it but I can, distinctly. It’s an uncommon scent but we fancy it savours of trees so we just call it the smell of Australia. Only a few hours now.”

(THUNDER RUMBLES)

ANNE DONNELL: “23rd. A thunderstorm passed over last night and somehow it predicted a warning of disappointment. I awakened at 4.30 am and thought I would watch the sun rise over Australia. But there was no sun. The ship had anchored about four miles out and then I heard someone call out, “We can’t get off. They’re just going to take off the WA troops and we’re off again.” I couldn’t believe it. We are a clean ship and surely there was some sort of a welcome in store. We’ll get off after the Medical Officer has done his inspection. A little later, that is completed, a farce really. Then a rumour. “We’re a clean ship so there’s a hope of going into the wharf.” Well, that faint hope is soon dashed, though, for a black, ugly, old tug comes along and off go our WA boys with cheers from their shipmates. Can it really be true? Can one ever realise that not a smile is given, not a sign of welcome? After taking eight hours to get off about 50 boys we sail on our way. I could weep and weep with the ache of disappointment. “C’est la guerre,” said someone, but it isn’t.”

ELISE: Since 1915, Anne had kept a continual record of her service and these were her final words. “’C’est la guerre,’ said someone, but it isn’t.” “C’est la guerre,” meaning, “It’s the war,” was a French expression that had come into popular use around Europe, something you would say when anything and everything that could go wrong did go wrong. But for Anne, the war was supposed to be over. She was ready to celebrate, to be welcomed back to normal life. Instead, she landed in a country under lockdown, businesses shut, schools closed, public gatherings called off and hospitals overflowing. It must’ve felt, in that moment, like everything they had endured would be cast aside and forgotten. Now that the virus is out, what exactly did it do to Australia?

DR PETER HOBBINS: Neighbours avoid neighbours, people barricaded themselves away. It was a period of substantial chaos, really.

ELISE: That’s next time on The Gatherings Order. Many thanks once again to Peter Hobbins for sharing his knowledge with us and thanks to you for listening. If you have a moment and are on a platform where you can rate and review that would be great because it helps other people find the podcast.

(THE LAST POST)

RADIO HOST: Tomorrow will be an Anzac Day like no other, with no public Dawn Services or major sporting events. Even RSL clubs will be closed. Necessary coronavirus restrictions have put paid to all of that but, as Oliver Gordon discovered, there are plans underway to ensure the rituals and traditions associated with the date remain intact.

OLIVER GORDON: This markedly different Anzac Day is sure to go down in history and NSW State Library curator Elise Edmonds is keen to document it.

ELISE: The word, of course, is overused but it is unprecedented. This year’s Anzac Day we will all be staying at home so we really want to make sure that we capture all of those images of Australians commemorating at home this year so that in 50 years’ time, researchers can access the State Library’s collections to actually see how Australians commemorated in 2020, so whether or not they choose to stand at their front gates or their farm gate at dawn or perhaps they might be choosing to play some two-up in the backyard, we’re asking that if you take photographs of those events, you share them on your Instagram feed or on Twitter using the hashtag #AnzacAtHome. The State Library will capture those social media posts from you and we will be displaying them on our own website, the State Library’s website.