This piece is part of HWO’s feature on ‘Apocalypse Then and Now’. The feature brings together radical reflections and historic perspectives on catastrophe and calamity. How have crises (both real and imagined), and responses to them, shaped our world?

Lincoln’s online community newspaper, The Lincolnite, is a relatively small-scale local media enterprise. This publication takes its place in the great history of the British provincial press, and, more specifically, in the tradition of the popular free press. Against the backdrop of the current pandemic, it has stepped up worthily in offering much-sought-after information and advice; capturing personal tragedies and local curiosities; and providing a voice and sounding board for the community. A century ago, the Lincolnshire press conducted itself correspondingly in relation to the Spanish Flu epidemic of 1918. The content from that time is a compelling and instructive record of how local communities responded to the outbreak.

From late March 2020 up to today, The Lincolnite has observed, speculated and questioned, in much the same way as the Lincolnshire Echo did through the second half of 1918. In my own series of pieces since March, I have been lucky enough to contribute to this reflective and expansive coverage of the COVID–19 outbreak in The Lincolnite. My columns included remarks on the effective return of rationing and on the new lockdown measures that echo the various orders and recommendations issued by the district Medical Officers of Health in response to the Spanish Flu. Discussion of how long infection might last became a critical concern as it did one hundred years ago. Consumers in the present, and in 1918, both faced supply issues and personal health anxieties. Coverage in the The Lincolnite and Echo carried affecting human stories – such as the ‘whole street’ who suffered with influenza during the 1918 pandemic. In addition, some have recalled other epidemics in the past such as the 1950s polio outbreak, and, with them, superstitious fears of hospitalisation and isolation.

Ministry of Health, Reports on Public Health and Medical Subjects, No. 4: The Report on the Pandemic of Influenza, 1918-19 (London: HMSO, 1920), Public Domain Mark 1.0 via archive.org

What of the future, though, lockdown lifted and pandemic analysed and assessed? The Lincolnshire Echo offers insights. In mid-December 1918, local officials could report with confidence that the peak of infections had passed. During 1919, however, newspaper reports continued to reflect the ways in which the pandemic lingered as a concern among members of the community, the local authorities, professional bodies and certain commercial businesses. The themes and issues that recur are ones that will be very familiar to historians of health policy in the modern period, and indeed are conspicuous in critical debate and media comment currently. The list of challenges and concerns here does not aim to be exhaustive, but seven are certainly of prominence:

  1. To what extent should health and social care be directed and resourced by central government?
  2. How far should the management and development of services be devolved to regions and localities?
  3. What are the most appropriate and effective ways of sharing responsibilities across public, commercial and charitable sectors, organisations and representatives?
  4. What level of expectation ought to be placed on individuals and families regarding their own personal care and self-help in the home?
  5. How best can health and social care strategies meet the needs of the population in general, and without discrimination, while also targeting and prioritising the most vulnerable in our society?
  6. Is there a requirement for a more radical transformation of the training and supply of professionals, and greater investment in specialist facilities and equipment?
  7. Finally, is a more enhanced form of pandemic response strategy necessary in anticipation of similar outbreaks in the future?

A selection of reports in the Lincolnshire Echo demonstrate how three particular bodies attempted to respond in different ways to this set of questions and challenges in 1919, and take on board the lessons of an epidemic for the communities that they represented and served. At the same time, they were also looking forward to the emergence of a stronger strategic direction for national health policy. Through the previous year, the Medical Officers of Health were essential figures in local districts, issuing directions on personal health, and advising on the continuation or easing of restrictions. Centrally, however, the Spanish Flu epidemic had drawn attention to the urgent need for reform of higher-level structures. In the midst of the Autumn 1918 wave, Echo readers had been informed of debates in Parliament on the influenza outbreak and the merits of extracting the administration of health from the remit of the Local Government Board.

Reform at a national level was welcomed in a report of the Lincoln Rural Workers’ Insurance Society, which suggested that influenza had given rise to an increase in claims. The body had responsibilities to discharge in meeting the needs of its members, alongside remaining financially viable as an organisation. It expressed hopes for the new Ministry of Health. As the Society put it in 1919, greater centralisation might bring clearer communication at the very least. It ‘would mean the unification of the various departments now dabbling in a vital subject, and would save them being sent from pillar to post on various occasions.’

For the Lincoln Branch of the St John’s Ambulance, there were local changes required and opportunities to be grasped. It announced an ‘important extension of effort’, through taking its training out to ‘workplaces, offices and other establishments.’ ‘But’, the Society added, ‘the scheme goes materially further, and contemplates such highly important subjects as home nursing and advice on healthy home surroundings and administration’. Its new agenda referred to the recent influenza epidemic: ‘how deeply it has been felt that there was something more one could do for the dear ones lying ill’– a sentiment that cuts sharply through to the present.

The Lincolnshire Nursing Association, meanwhile, was also in campaigning mood. It lamented the state of confusion over the funding and supply of district nurses, with responsibilities split between the local authorities and voluntary bodies, and conflicting views on the purpose of public health provision: was it a general service or a charitable function? At the same time, the powers of the new Ministry had yet to reveal themselves. For now, ‘a nurse in every village’ was the ambition of the Association’s new appeal: ‘if only they had been able to get nurses during the influenza epidemic the mortality would not have been so great’.

The context, character and impact of the 1918 and 2020 pandemics remind us of key national and local issues that have faced and still face public health and social care policy makers today. The list is, alas, a long one, and in the long view, historians might also ask how it will be possible to overcome them today?

 

Dr Andrew Jackson is Head of Research and Knowledge Exchange at Bishop Grosseteste University in Lincoln. Projects in recent years have included home-front dialect poetry, women’s suffrage, munitionette worker football teams, the co-operative movement, and early council houses. Andrew has a long-established interest in the history of the provincial, regional and local press, and in the role of public and community history.

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