Camp Funston Flu Ward, 1918
Private Harry Underdown was a brave man who had returned to the Western Front after being injured in action but he did not succumb to a bullet wound or a bomb blast.
In fact there was nothing heroic about the manner of his passing: choking, gasping for air and his skin turning grey.
A century later it is now believed that the 20-year-old, a farmer’s son from Kent, was among the first to die in the flu pandemic that ravaged the world in 1918.
Spanish flu claimed 100million lives and remains the worst medical catastrophe in history, dwarfing the Black Death (1346 to 1353) and making the current outbreak of so-called Australian flu look insignificant.
In the UK a century ago 200,000 people died while in the US – where about a quarter of the population fell ill – the figure was 550,000.
The flu also rampaged through all of Europe. In India as many as 17million people lost their lives and we will probably never know how many were stricken in China.
Worst of all was that fit, healthy men and women were cut down in their prime. Yet because war was raging the scale of the pandemic was downplayed.
It is the subject of a new book by historian Catharine Arnold who became fascinated by the Spanish flu after learning that her grandparents were among the victims.
A typist wears mask while working at her office desk, during the influenza epidemic, 1918
Pandemic 1918: The Story Of The Deadliest Influenza In History traces the origins of the outbreak and examines its impact on ordinary people by relying on letters and other testimony from the time.
And the author also poses the chilling question: could it happen again? “This was devastating,” says Arnold.
“The flu pandemic of 1918 killed many more people than died in combat during the whole of the First World War. Hardly anywhere in the world escaped. It seemed unstoppable.”
Today flu is regarded as an inconvenience requiring a few days off work, plenty of rest, paracetamol and hot lemon drinks.
But it has a long history with records of flu outbreaks dating back to Roman and Greek times.
The name influenza was first used in about 1500 when the Italians introduced the term to describe diseases they believed were “influenced” by the stars.
Virulent outbreaks were not uncommon but the strain that swept the world a century ago was like no other.
Up to 20 per cent of those who became infected died and in the terrible second wave, in the late autumn of 1918, victims collapsed in the street haemorrhaging from their lungs and nose and suffocating.
There were cases of children starving to death while their parents lay helpless. Undertakers ran out of coffins.
Scientists who have studied the pandemic believe they have traced the start of the outbreak to the camp in Etaples, France, where Harry Underdown died.
A nurse demonstrates a facemask on a British soldier during the influenza epidemic
There in late 1917 men were crammed together and one theory is that the flu jumped species from animals or birds that were kept for food.
“The war created a giant global petri dish,” says Arnold.
“There was huge movement of troops dispersing the flu in every direction and resistance was low because men were worn out from fighting.”
A single sneeze or cough would send half a million virus particles flying through the air. The US army suffered terrible losses.
Nurse Shirley Millard wrote in her diary in April 1918: “We are swamped with cases. I thought influenza was a bad cold but this is much worse. These men run a temperature so high we can’t believe it is true.
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“When they die – as about half of them do – they turn a ghastly dark grey and are taken out at once and cremated.”
The authorities were slow to react but were understandably distracted by the war and at the time the nature of flu was misunderstood.
It was wrongly thought influenza was the result of bacteria rather than a virus. In a cruel twist it was the young and healthy who suffered most.
With this strain the harder the body fought against the flu, the worse its symptoms. People began wearing masks but they offered little protection and only added to the eerie, apocalyptic atmosphere.
There was no cure and no one was immune. PM David Lloyd George and Franklin D Roosevelt, who would later become US president, were among the lucky ones to contract flu and survive.
Pandemic 1918: The Story Of The Deadliest Influenza In History
King Alonso of Spain and Mahatma Gandhi also became ill, along with Walt Disney and Groucho Marx. Spain was badly affected and the name Spanish flu stuck.
In one famous cartoon the flu was depicted as a skeletal woman wearing a death mask and flamenco dress.
In Britain Whitehall chiefs were reluctant to impose quarantine regulations on trams and buses or shut public places such as theatres for fear of damaging morale.
“Local authorities just tried to muddle through,” adds Arnold.
This disorganised, stiff-upper-lip approach allowed the flu to spread although some places fared better than others.
In Manchester casualty rates were lower due to the efforts of Dr James Niven, the city’s medical officer, who did impose quarantine rules.
However in Newcastle, mines and docks almost ground to a halt as 70 per cent of the workforce fell ill.
The German army was also decimated by the flu, which was known as Blitzkatarrh and affected almost 150,000 men during the summer of 1918.
If there was one silver lining it was that the Kaiser’s army was brought to a state of exhaustion and some experts claim the flu actually shortened the war.
The flu pandemic lingered on and delivered cruel twists. One of the last fatalities of the year was William Leefe Robinson, 23, who had won a Victoria Cross for becoming the first pilot to shoot down a German Zeppelin.
Armistice Day celebrations, which brought tens of thousands of people together, also caused a spike.
Author Catharine Arnold
But in the aftermath of the war the battle fought on the home front against flu was largely forgotten by most save a handful of scientists.
Experts now know that the strain was H1N1, which is a relative of later outbreaks including avian flu.
Advances in health, improved communications, vaccination programmes and antibiotics for treating secondary conditions all mean that we are better equipped now.
But flu is a cunning enemy always lurking in the background and constantly probing out our weaknesses. And still quite capable of surprising mankind.
To pre-order Pandemic 1918: The Story Of The Deadliest Influenza In History, by Catharine Arnold, published in hardback on January 25 by Michael O’Mara Books at £20, call the Express Bookshop with your card details on 01872 562310. Or send a cheque or PO made payable to The Express Bookshop to: Pandemic Offer, PO Box 200, Cornwall, TR11 4WJ or visit expressbookshop.co.uk UK delivery is free.