The Last Irish Plague: The Great Flu Epidemic in Ireland 1918–19 (review)

Regional studies of epidemic diseases are especially cogent in understanding the effects on populations, governments, and medical facilities. Foley has given us a nicely balanced account of the 1918/19 influenza epidemic in Ireland, utilizing government and medical reports, secondary sources, and an extensive variety of Irish newspaper accounts. In fact, this latter source is the greatest strength of her work, providing the context for this engaging social history.

With 20,000 influenza deaths in a population just exceeding 4,000,000, the Irish influenza death rate was roughly proportional to that of other European countries. However, Foley’s approach to documentation allows her to present, in impressive detail, the disproportionate burden of disease borne by the urban poor and those in remote rural areas, particularly the western islands. Prostration of entire families by influenza led to lack of food, fluids, and heat in the cold of winter, further worsening morbidity and mortality. She correctly identifies the three waves of the epidemic with different effects on the population, the second being the worst. Foley also vividly documents the disproportionate mortality in young adults and, especially, pregnant women.

In considering the power of the many names for this epidemic, the term plague surpassed all other names used by the populace and the medical and nursing professions. Sadly, in Foley’s estimation, the government and public health authorities and boards, at both the national and local levels, were late in recognizing the force of the influenza epidemic and misdirected and often feeble in their responses to it. The word plague seemed not to be in their lexicon. For example, their efforts at sanitation continued throughout the epidemic while giving little attention to closing schools, churches, and other public gatherings. Of course, the actual viral cause of influenza was not recognized until 1930 but commonsense in 1918 and 1919 made clear to even the uneducated that human contact was the propelling force in the epidemic. On page 156, Foley writes, “One of the epidemic’s clearest effects was to expose the flawed structure of the public health system in Ireland.” By contrast, the Roman Catholic Church, through its priests, nuns, bishops, and institutions, is identified as a consistent effective force in dealing with the epidemic throughout 1918 and 1919.

If epidemics can have heroes then Foley identifies them as the medical and nursing professions with numerous accounts of long hours, selfless devotion to patients, and personal sacrifice. Counterbalancing the ennui of male public servants she recognizes the dedicated work of women volunteers, individually and in groups, and especially nuns and several female religious orders. A variety of newspaper accounts are presented to document concern and aid of neighbors, the solace of religion, and even the occasional escape of attending a motion picture show and seeing life without the ever worsening oppression of sickness and death then seemingly ubiquitous in Ireland.

Foley’s references to the worst medical aspects of the 1918/19 influenza are accurate and well documented. She contrasts the relatively mild manifestations of influenza in most previous seasonal epidemics in Ireland with the rapidly worsening course of some infections in 1918/19 in young adults, leading to death from acute pulmonary edema in as short a time as a day after the initial signs of infection. Thus, Foley displays an understanding of the role of aggressive immune response to the influenza virus causing this form of death in the young. She also describes the role of bacterial pneumonia as the common secondary infection leading to death later in the illness. However, she does not present the other aspect of influenza which, even in the pandemic of 1918/19, caused mild-to-moderate symptoms of illness spread over days to a week or so in most of those infected. And, many citizens of Ireland were either not infected with influenza at all or infected at a subclinical level. She devotes a chapter to fear...