Spanish flu: What Mexico learned from the 1918 pandemic

The 1918 Spanish flu pandemic was one of the deadliest pandemics ever

Spanish flu: What Mexico learned from the 1918 pandemic
Influenza victims crowd into an emergency hospital - Photo: National Museum of Health/AP
English 25/07/2020 14:12 Mexico City Elisa Villa Román Actualizada 19:32
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On October 27, 1918, Dr. Guillermo Cergueda sent a letter from Tamaulipas to the Oaxaca governor with precise instructions to combat a disease that began with symptoms like a cold, sore throat, coughing, headaches, and joint pain.

“Mr. State Governor Juan Jiménez Méndez: In the El Regional newspaper, that is published in that city (Tamaulipas), I’ve seen they’ve had some difficulties to gather the medical body and take defensive measures, both important and timely, against the Spanish flu, in the unfortunate event it would reach you,” he wrote.
 

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Doctor Cergueda’s letter to Oaxaca’s governor Juan Jiménez in October 1918 –Photo:  Oaxaca’s General Archive.

As a doctor, Cergueda was one of the people in charge of implementing the first health caravan in the world in 1912, which consisted of hospital trains, an idea that was adopted during World War I by other countries’ armies, according to Antonio Moreno-Guzmán’s article “Military Medicine in Mexico.”

By 1918, Cergueda worked as a Health delegate of the Republic’s General Health Department (equivalent to the current Health Ministry) and worked from Nuevo Laredo, Tamaulipas, one of the first cities hit by the epidemic that spread from the north of Mexico.

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The letters sent by Dr. Cergueda detail the first symptoms of the epidemic when it had just arrived in Mexico. The Spanish flu took place between 1918 and 1919 in different countries. It was called like that because Spain, as a neutral country during WWI, decided to report the disease and its consequences, according to Sandra Pulido in The Spanish Flu: The 1918 Pandemic that Did Not Begin in Spain.
 

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“Wash your hands before eating and every time you handle dirty objects, especially those that are suspected of being in touch with a sick person,” said the information bulletins of the time. – Photo: Oaxaca’s General Archive.

It is estimated that between 20 and 50 million people died worldwide due to this disease that had three waves: the first by mid-May 1918; the second outbreak went from September 1918 to February 1919; the third wave took place by late May 1919.

The second wave had the toughest impact in Mexico. It hit the country in October 1918 amid political and social instability caused by the Mexican Revolution. In the case of Oaxaca, it was registered that there were 21,000 deaths due to the Spanish flu that year.
 

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Warning about the Spanish flu from Dr. Cergueda to the population in 1918 – Photo: Oaxaca’s General Archive.

“You might not imagine the horrible effects caused by the Spanish flu and the fear sowed by its presence wherever it arrives. I’m glad to send you, if you deem them useful, some of the provisions implemented by my suggestion during the sudden development of influenza in this city,” as read the letter sent by Dr. Cergueda.
 

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Six out of every 10 people who died of the Spanish flu in Oaxaca were indigenous people – Photo: Taken from the book Brief Historical review of Oaxaca state (Smithsonian Libraries).

Hence, the population followed the health measures, including washing their mouths with hydrogen peroxide, took Bromo Quinine, and applied sudorifics, which are measures that have been improved nowadays but that were quite popular back then.

Isolation was also recommended, as well as not shaking hands, using menthol oil in the nostrils, putting creoline in spittoons used by infected patients, boiling cloths or napkins used to blow people’s noses, burning sulfur in rooms, and not taking aspirins in excess since they had secondary effects in sick people.

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On November 5, 1918, 5,000 posters were printed to inform the Oaxaca population about the new health measures. An ad of the time says “Important: The Spanish flu that is currently developing in an alarming way in this population, even though it might not seem serious, can become extremely serious and cause death (…) when it is not treated on time.”
 

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“Citizen chief of the State Printing Workshops. URGENT: Order to print 5,000 units of the attached instructions”. Photo: Oaxaca’s General Archive.

Ads for the population warned that although some of the early symptoms did not necessarily leave people bedridden, it was necessary for them to isolate so as not to worsen their condition. The government even warned about complications such as pneumonia and cerebral accidents, in which case people needed to go to the hospital.

People were also requested to stop spitting for it caused more contagions. The recommendation was to cover house floors with lime to prevent the spread of the virus.
 

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Fatalities registry during three days of November 1918 – Oaxaca’s General Archive.

The lesson is repeated
Recently, anthropologist Jorge González Galdamez, from Oaxaca’s General Archive, performed extensive research that showed new information about the effects of the Spanish flu in that community. His report is based on the death certificates from the state courts issued in October, November, and December 1918, the toughest months of the pandemic in Oaxaca.
 

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Different aspects of Oaxacan traditions and culture by the beginning of the 1920s – Photo: EL UNIVERSAL ILUSTRADO.

The archives related to the Spanish flu epidemic in Oaxaca reveal the kind of measures implemented by the government at an administrative level to handle the health emergency.

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One of the documents is a list of people who died from November 11 to 13, 1918. The sheet shows 33 fatalities, including those of Alfonso Cortés (2 months old), Plácido Blanco (86 years old), María Rodríguez (7 months old), Eduviges García (93 years old), and Felipa Castro (30 years old).
 

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Request for drugs to fight the epidemic – Photo: Oaxaca’s General Archive.

In the report “The Spanish flu figures in Oaxaca de Juárez and Huajapan de León,” González highlights the challenges of the time to count the number of active cases and fatalities caused by the epidemic.

“The handling of the number of fatalities and infections in an epidemic, in different chapters of history, has always depended on decisions made by authorities, many of whom have prioritized a balance between containing and fighting the epidemic and not alarming the population,” reads the text.
 

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“I’ve already decided on the provisions aimed to fight the epidemic.” Telegram sent on December 10, 1918 – Photo: Oaxaca’s General Archive.

One of the documents states that the first recommendation is to avoid public places such as theaters, movie theaters, or churches, “for it is quite easy to be in touch with people that carry the microbe and, on the other hand, leaving these places might involve a drastic temperature change.”

Those who were sick were asked to leave their room as few as possible and to cover their nose and mouth with a napkin whenever they coughed or sneezed. “Avoid being in front of people who sneeze or cough without turning away. After using them, napkins must be washed and boiled; it is best to use small clothes that can be destroyed by fire; you can also use paper tissues which must be burnt once used.”
 

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EL UNIVERSAL published on February 23, 1920, that it was Spanish flu, indeed, the disease that was hitting the Mexican population; a secondary article said it had already been scientifically proven.

Among other measures similar to the ones implemented nowadays, authorities recommended people to wash their hands and disinfect common use objects: “People who look after sick person must wear masks the Health Department will provide for free. Do not leave your bed until you are completely healthy. Remain in isolation up to a week after the disease has gone away or until a doctor says you can go out,” says a 1918 bulletin.

One of the main challenges was the registry of fatalities since there were no standardized criteria to determine if someone had died of Spanish flu. Therefore, every region kept a record according to its possibilities.

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For instance, from October to November 1918, downtown Oaxaca did not have Spanish flu as a cause of death. Instead, there were other criteria like common influenza,  flu, pneumonia, pertussis, intermittent fever, flu pneumonia, and bronchitis. These causes were not always determined by medical personnel, as shown by the registries.
 

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Oaxacan dancer at the beginning of the 20th century – Photo: Taken from the book Brief Historical and Geographical Review of Oaxaca (Smithsonian Libraries).

Nevertheless, in Huajuapan de León, Spanish flu was a cause of death in death certificates. “As happens today, statistics that reflect the impact of an epidemic are not free of bias. However, it’s what we have to get closer to what really happened in 1918,” says González.

The anthropologist explains that the largest outbreak took place between October and November 1918, but there were other important surges, such as the one from January to March 1919 that caused more fatalities, and there was another one in September. He even adds that there were new cases in 1923.
 

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Health personnel in front of the COVID-19 pandemic – Photo: Alfredo Estrella/AFP

“Nowadays, we are all worried about when the pandemic will be over or when its curve will flatten, but the registries tell us they last for years. We must not think we can go through this as nothing had happened. The advantage here is that now, we have the opportunity of a vaccine, which was not available a century ago,” he says.

We can obtain useful information from previous epidemics. Archivists say in an interview that their research intends to call the public’s attention to perform their own research and contribute with new information.
 

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Personal protective equipment for healthcare workers – Photo: Alfredo Estrella/AFP.

For Jorge Álvarez Fuentes, the director of Oaxaca’s General Archive, the objective of this collaborative search was to find valuable information in Oaxaca’s past regarding the pandemic that took place 100 years ago.

“What’s interesting is that every epidemic, especially in a pandemic, you need to measure. When you measure something, you can act over that reality. I think this report can be attractive to see, with a historical perspective, that there are things we must learn from that experience. It’s just one exercise, but it helps stimulate curiosity,” he said.

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