The flu pandemic of 1918-19 claimed at least 50 million lives, yet only recently has its devastation and aftermath been studied. Guy Beiner examines a strange case of worldwide amnesia

In 1918 and 1919, a serial killer prowled the streets and crept into houses. Nobody was safe. Upon boarding a streetcar in Cape Town, an off-duty soldier had to fill in for a conductor who had just dropped dead.

Over the course of his 5km trip, five passengers died before the service was finally brought to a halt by the death of the driver. On the other side of the world, four women in America gathered for a late-night game of bridge; by morning, three of them had passed away. Such stories, ingrained in the memories of horrified witnesses, were commonplace. Around the globe, people were dying in droves and little, if anything, could be done about it. Corpses piled up, undertakers were unable to meet the demand for coffins, and gravediggers could not dig enough graves.

Attacking in three waves from the spring of 1918 into early 1919, the so-called Spanish influenza wreaked unparalleled havoc. A recent calculation cautiously puts worldwide mortality at 50 million, but its authors (geographer Niall Johnson and economist Juergen Mueller) note that this "may be substantially lower than the real toll, perhaps as much as 100 per cent understated". Informed speculation on morbidity rates suggests that a billion people may have suffered influenza-related illnesses (and that is without counting sequelae, such as epidemic outbreaks of encephalitis lethargica, Parkinson's disease and nervous irregularities).

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Moreover, a significant fall in birth rates in the wake of the pandemic implies long-term demographic ramifications.

The pandemic crossed national boundaries, affected soldiers fighting the final campaigns of the First World War and civilians on the home front and also ravaged non-combatant countries. It attacked rich and poor, men and women (but puzzlingly killed more males), old and young, although it showed a preference for normally healthy young and middle-aged adults. It was symptomatically irregular and proved particularly perplexing for epidemiological diagnoses. Modern medicine and public health were impotent in the face of this aggressive pandemic. Panic broke out. In less than a year, influenza caused more devastation than any other disease or calamity of similar duration in world history.

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Despite the magnitude of the pandemic, historiographical interest remained largely dormant for many decades. Only recently, in light of growing concern about a possible avian flu pandemic, is the catastrophe of 80 years ago being increasingly evoked as a cautionary tale of epic proportions and becoming a hot topic. Concurrently, scientific breakthroughs have succeeded in resurrecting the 1918-19 influenza virus from tissue specimens that were exhumed from Eskimo victims buried in permafrost so that we now know that it was a deadly strain of bird flu (H1N1) that mutated and infected humans.

However, it is unclear whether phylogenetic data can shed light on unresolved historical puzzles. For example, it is impossible to determine the place of origin of the pandemic or to map precisely its routes of geographic distribution. In truth, it was not a Spanish influenza. The misleading nickname probably originated from the fact that neutral Spain's press, which was not censored like that of the belligerent countries, reported the epidemic's outbreak. Just as in Spain it was known as the "Naples soldier", each inflicted area cast the blame elsewhere. In Italy it was called the "German disease"; in Germany the "Russian pest"; in Russia the "Chinese disease". The Japanese label of "American influenza" may be closest to the mark, as recent American research insists that it first struck military cantonments in the US and spread from there with the great mobilisation of 1918. On the other hand, virologist John A. Oxford finds more truth in the epithet "Flanders grippe" used by British troops, as epidemic influenza was first spotted in Allied army camps in France in the winter of 1916.

The first conference on the pandemic was convened only as late as 1998. The subsequent publication of a limited selection of its proceedings in a volume edited by historians Howard Phillips and David Killingray and published in 2003 showcases cutting-edge "new perspectives". It also reveals patchiness in the field while exposing huge gaps of knowledge for vast areas (particularly inland China, South-East Asia, Russia, the Middle East and Latin America). Overall, the experience of the US has attracted most attention from historians. It was the focus of Adolph Hoehling's rather rudimentary The Great Epidemic (1961) and Alfred Crosby's seminal Epidemic and Peace , 1918 (1976), which was later reissued to critical acclaim as America's Forgotten Pandemic and has just been updated. More recently, John M. Barry's The Great Influenza: The Epic Story of the Deadliest Plague in History (2004) has presented a riveting narrative of the epidemic in the US and the desperate efforts of the finest medical minds to rescue collapsing public health systems in face of the unresponsiveness of administrators, politicians and military commanders.

The graphic descriptions, illustrated by chilling anecdotes, vividly bring home the terrifying realities. However, the US case is hardly typical of the struggle against the pandemic's rampage in less developed countries or in European countries worn out by four years of war.

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It is commonly assumed that the Great Flu was somehow connected to the Great War or - as phrased by Carol R. Byerly in Fever of War (2005), a study of the epidemic in the US Army - that "influenza collaborated with the war" and "the war created the influenza epidemic by producing an ecological environment in the trenches in which the flu virus could thrive and mutate". Nonetheless, the pandemic struck more or less simultaneously around the world, and most of its victims lived in areas that were not involved in the hostilities. The death of millions in Asia cannot simply be attributed to the war without charting a comprehensive global map of war-related transport, which may well fall short of proving a direct correlation.

The most recent contribution, Niall Johnson's Britain and the 1918-19 Influenza Pandemic: A Dark Epilogue (2006), not only offers a national study in a broad comparative context but also includes a chapter on "cultural dimensions", which features discussions of memory, representations and recollections. The most striking lacuna of scholarship to date has been the neglect of the cultural history of the pandemic. There are no monuments, museums or heritage centres dedicated to the influenza pandemic and (apart from a couple of exceptions) it has not featured prominently in contemporary literature and art, so that this would seem to be a sweeping case of collective amnesia. The lack of official recognition of the universal trauma inflicted by the Great Flu stands out in contrast to the ubiquitous commemoration of the Great War. Although the masses who suffered and died during the pandemic remain unnamed and unacknowledged in the public sphere, there is good reason to believe that bereavement featured prominently in private memories and family circles. An investigation of hidden remembrance would therefore need to probe beyond cultural canons. As the anthropologist Terence Ranger has noted, "an accumulation of such private histories will eventually redeem the neglect of the pandemic in official historiography".

Guy Beiner is a lecturer in history at Ben-Gurion University, Israel. He specialises in the historical study of remembrance and forgetting. This piece is a distilled version of a longer essay published in Cultural and Social History . Details: